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The Fat Cell Killer Genius

The Fat Cell killer is an at-home collection of simple routines that trigger the self-destruction of fat cells. It is a creation of Liss, a mother who fought with esteem issues for a while as she tried to regain a good body shape without success for a while. The Fat Cell Killer is a home collection of simple routines that trigger the self-destruction of fat cells. The program uses nature to find healthy and simple ways to lose weight and prevent rebound weight gain. The program was designed by Liss who once suffered from low self-esteem and no confidence because she gained weight rapidly after giving birth. In this program, she offers solutions and easy ways to regain youthful gorgeous bodies. She offers experience, knowledge, and tested procedures from an experienced and results-oriented researcher and author, Mr Brad. This program is beneficial as it not only restores the users' good body shape but also helps them restore their confidence and boost their overall health. Continue reading...

The Fat Cell Killer Genius Summary

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The Fat Cell Killer Genius

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Risk Factors The Epidemiology Of Obesity And Hyperinsulinemia In Children

It is well accepted that overweight as a child is a risk factor for obesity in adulthood. Using data from the Fels Longitudinal Study, Guo et al. (76) correlated girls' percent ideal body weight aged 10-18 with their percent ideal weight at age 35 all coefficients exceeded 0.6. We know that obesity, impaired glucose tolerance and insulin resistance are important metabolic risk factors for Type 2 diabetes mellitus (77, 78), and they are also suspected to be important etiologic components of youth-onset disease. Defining obesity in growing children and adolescents is more problematic than in adults, and various investigators have relied on skinfolds, body mass index (BMI defined as weight height2), ponderosity (weight height3), and other methods (79). Irrespective of which of these measures is used, most secular analyses indicate that adiposity has increased among US youth since 1960. Comparing data from four US national surveys collected between 1963 and 1980, Gortmaker et al. (80)...

Why has the genetics of obesity been difficult to study Defining the phenotype

One of the first problems faced in attempting to define a genetic basis for obesity is deciding what kind of effect (phenotype) we seek to examine. Obesity is a heterogeneous clinical disorder. Whilst it can be conveniently defined and clinically measured in terms of elevated body mass index (BMI), this is a definition chosen to define people or populations thought to be most at risk from its complications. It is a composite measure of body mass in relation to height, and Obesity and Diabetes. Edited by Anthony H. Barnett and Sudhesh Kumar 2004 John Wiley & Sons, Ltd ISBN 0-470-84898-7 For this reason, some studies have investigated genetic influence on more specific measures of body composition such as percentage body fat, total fat mass, visceral fat mass, subcutaneous fat mass or waist-hip ratio. These variables can be measured by bioelectrical impedance, computed tomography, magnetic resonance imaging, dual-energy X-ray absorbimetry scanning or underwater weighing. Whilst there is...

Dietary iron intake absorption and metabolism

Although there is no physiological means of iron excretion, a well-balanced diet containing sufficient iron is needed. Only about 10 per cent of ingested iron is absorbed in the gut. Therefore, around 10-20 mg of dietary iron intake is needed to balance the 1 or 2mg of daily losses. The normal amount of total body iron is about 40-50 mg kg body weight. In the body, iron is mainly needed to form the porphyrin complex of haemoglobin (30 mg kg), myoglobin in muscle cells (48 mg kg) and also iron-containing enzymes, such as cytochromes, oxidases and peroxidases. Up to 30 per cent of body iron (12mg kg) may be stored as ferritin and hemosiderin in the bone marrow, spleen and liver. The efficiency of iron absorption is mainly regulated by body requirements to maintain iron homeostasis. Iron deficiency causes an increase in iron absorption, while iron overload reduces but does not eliminate absorption. Fertile women, for example, need to absorb up to 2-5 mg of iron each day to compensate for...

Dietary prevention of chronic heart failure CHF the role of micronutrients dietary fatty acids and reduced sodium intake

The vital importance of micronutrients for health and the fact that several micronutrients have antioxidant properties are now fully recognised. These may be as direct antioxidants, such as vitamins C and E, or as components of antioxidant enzymes superoxide dismutase or glutathione peroxidase.56 It is now widely believed (but still not causally demonstrated) that diet-derived antioxidants may play a role in the development (and thus in the prevention) of CHF. For instance, clinical and experimental studies have suggested that CHF may be associated with increased free radical formation57 and reduced antioxidant defences58 and that vitamin C may improve endothelial function in patients with CHF.59 In the secondary prevention of CHD, in dietary trials in which the tested diet included high intakes of natural antioxidants, the incidence of new episodes of CHF was reduced in the experimental groups.18,60 Taken altogether, these data suggest (but do not demonstrate) that antioxidant...

Obesity and type diabetes

Obesity is a powerful risk factor for the development of type 2 diabetes and more than two-thirds of patients with type 2 diabetes are obese. The risk of type 2 diabetes correlates positively with increasing obesity (Larsson et al., 1981 Harris, 1989). In the Nurses Health Study, the risk of developing diabetes increased five-fold in women with BMI of 25 kg m2 compared with those with BMI of 22 kg m2 The risk becomes higher reaching 28-fold with BMI of 30 kg m2 and 93-fold with BMI 35 kg m2 (Colditz et al., 1996). The risk of obesity and type 2 diabetes was better defined by a high WHR and waist circumference (Larsson et al., 1984). Additionally, the duration of obesity was directly related to the risk of diabetes (Everhart et al., 1992). The risk of type 2 diabetes from obesity is more prevalent across certain ethnic groups such as South Asians and Afro-Caribbeans (Bhopal, 2002). The increasing prevalence of type 2 diabetes is paralleled by the rise in the level of obesity in the...

Why We Gain Weight The Arithmetic of Obesity

With more than 60 percent of the population either overweight or obese, weight gain is a problem that apparently affects most of us. The usual explanations for those extra few or more pounds range from, The holidays killed my diet, to, I couldn't get to the gym this week, to, My scale must be broken. However, there is a simple (yet somewhat painful) reason for weight gain it's the calories We take in fuel in the form of food. The energy we extract from food fires our basic biological functions and provides the energy we need to work, play, think, and survive. But what happens when we take in more fuel than we use In your car, unused gasoline sits in the tank until it's needed. In your body, unused fuel gets stored for future use as fat. Any imbalance between energy in and energy out results in weight gain or loss. This simple equation explains virtually all we need to understand about why we gain or lose weight.

Use of other drugs that may cause weight gain

There is a long list of drugs, mainly centrally acting, that can cause weight gain (Table 10.1), and these are often prescribed to patients with diabetes. Of particular note are tricyclic antidepressants and anticonvulsants such as carbamazepine and gabapentin used for symptom control in painful neuropathy. Other drugs include antipsychotic drugs, notably the newer atypical antipsychotic agents, such as clozapine and olanzapine, that can cause substantial weight gain, and have been suggested to independently worsen insulin resistance and perhaps increase diabetes risk in non-diabetic subjects (Hedenmalm et al., 2002). Pizo-tifen, a serotonin antagonist used in the management of migraine, may cause increased appetite and therefore weight gain (Galanopoulou et al., 1990). Cor-ticosteroids and some progesterone preparations, such as medroxyprogesterone acetate may also cause substantial weight gain, and in the case of corticosteroids, worsen insulin resistance and impair f-cell function....

Promotion of Weight Gain

In the UKPDS, weight gain was significantly greater in the intensively treated group (mean of 2.9 kg) compared with the conventional group. Patients treated with insulin had greater weight gain (mean of 4 kg) compared with those receiving chlorpropamide (2.6 kg) or glibenclamide (1.7 kg) (UKPDS 1998). Changes in bodyweight may be inversely related to change in HbA1c and directly related to the change in free insulin levels (Yki-Jarvinen et al 1992). Initially weight gain after a long period of poor glycaemic control may be associated with a reduction in basal metabolic rate and rehydration resulting from the amelioration of the osmotic diuresis associated with glycosuria (Makimattola, Nikkila and Yki-Jarvinen 1999). However, about two-thirds of subsequent long-term weight gain is associated with an increase in adipose tissue (Groop et al 1989), with the remaining weight gain due to an increase in lean muscle mass. Since excessive weight gain is undesirable for elderly patients with...

Weight gain and improved glycaemic control

Weight gain is associated with improved glycaemic control, and is a complication of therapy with both insulin and oral insulin secretagogues, such as the sulphonylureas. This is a major problem when considered in terms of the poor compliance with medication that is known to be prevalent in patients with diabetes (Morris etal., 1997). Often weight gain following improved glycaemic control is a reflection of the previous poor glycaemic control and associated weight loss, secondary to the catabolism of adipose tissue and protein, however this is seen by many patients as a major disadvantage of the treatment of diabetes, particularly in the young. In the main DCCT study, intensified therapy was associated with an increase in the risk of becoming overweight, and at 5 years the mean weight gain was 4.6 kg greater in those receiving intensified than conventional therapy. In an ancillary study of the DCCT, it was observed that patients who gained most weight on the intensified treatment arm...

Dieting Body Image Problem

There is a culture of body image in our society, thus it is important to pay close attention to the behavioral and mental health concerns for children and adolescents. The American Academy of Pediatrics Diagnostic and Statistical Manual for Primary Care (DSM-PC) distinguishes dieting body image behaviors that were, in the past, difficult to categorize as eating disorders. Children and adolescents may exhibit behaviors that do not meet full DSM-IV criteria, yet still deserve attention. The two specific complexes in the DSM-PC-related diagnostic categories include dieting body image behaviors and purging binge-eating behaviors (125). There are two levels of pathology for both of these behavior patterns in children that do not fulfill DSM-IV criteria for an eating disorder. In DSM-PC, variations constitute minor deviations from normal that still might be of concern for a parent or clinician (125). An adolescent with a dieting body image problem will be one who exhibits voluntary food...

Diabetes Obesity and the Brain

Hypothalamus Energy Homeostasis Mc4r

Recent evidence suggests a key role for the brain in the control of both body fat content and glucose metabolism. Neuronal systems that regulate energy intake, energy expenditure, and endogenous glucose production sense and respond to input from hormonal and nutrient-related signals that convey information regarding both body energy stores and current energy availability. In response to this input, adaptive changes occur that promote energy homeostasis and the maintenance of blood glucose levels in the normal range. Defects in this control system are implicated in the link between obesity and type 2 diabetes. the brain in glucose homeostasis, its importance was largely neglected after the discovery of insulin in 1923. However, new findings have revived interest in the role played by the brain in both glucose homeosta-sis and the mechanism linking obesity to type Conversely, a decrease in neuronal input from one or more of these afferent signals is proposed to alert the brain to a...

Physical activity and obesity

Exercise is the most variable component of energy expenditure it is therefore clear to see why exercise has been adopted as a component to treat overweight and obesity. Indeed, exercise or physical activity is promoted within a range of guidelines for the prevention and treatment of overweight and obesity (WHO, 1997 NIH, 1998). Understanding the impact of physical activity and exercise on obesity and associated variables is important, as an increase in physical activity not only has significant positive effects on body mass and body fat mass, but also on a range of other variables associated with health (Blair and Brodney, 1999). Physical activity has been suggested to have favourable effects on weight loss, decreased fat percentage, decreased skinfold thickness, android disease, decreased risk of coronary heart disease (CHD), improved glucose metabolism, increased basal metabolic rate (BMR), prevention of loss of fat free mass (FFM), increased dietary thermogenesis, reduced blood...

Obesity and Type Diabetes in Children

The epidemic of obesity, which has spread to children in the United States in the past few decades, has led to a much higher prevalence of type 2 diabetes in children than was ever seen before. Overweight or obesity is present in as many as 25 percent of all children. Only a fraction of these children go on to develop diabetes. There are a number of conditions that can cause obesity in children but they represent probably 1 percent of the causes. Most of them can be diagnosed during the course of a good physical examination by your child's pediatrician. By far the major reason for obesity in children is too many calories in and too few burned up by exercise. Even without diabetes, obesity is a burden for children. The obese child faces severe psychological and social consequences Defining obesity in children The definition of obesity in children age 2 to 19 is based on the body mass index, BMI (see Chapter 7). A child is obese or overweight if his BMI is at the 95th percentile or...

Exercise tolerance and cardiorespiratory fitness in overweight and obese adults and children

There is very little data published on the exercise tolerance of obese adults. We tested 19 obese adults (4 males and 15 females aged 40.3 13.5 years) for exercise tolerance (Gately et al., 1997). Mean body mass and BMI of the group was 112.6 18.9 and 37.9 10.6 kg m, respectively. Exercise tolerance was assessed using the treadmill walking test protocol developed for the Allied Dunbar National Fitness Survey (ADNFS Activity and Health Research, 1992). Exercise tolerance was low as identified by a symptom limited mean peak VO2 of 2.05 0.51 l-min-1 or 19.62 5.45 ml-kg-1 -min-1 for the females and 2.15 1.06l min or 16.28 8.56 ml-kg-1-min-1 for males, respectively. Average values for the ADNFS for females and males aged 35 to 44 years were 34.8 and 45.5 ml-kg-1 -min-1 respectively. Even comparing the values with the 5th percentile from the ADNFS (24.5 ml-kg-1-min-1 for the females and 34.2 ml-kg-1-min-1 for the males respectively) the values for the obese are significantly lower (20 and...

Obesity and the Abdominal Phenotype in PCOS

This could be due to a depot-specific inhibition of the expression of hormone-sensitive lipase (HSL) by testosterone and or to a decrease in the amount of b2 adrenergic receptors. This could also be an important pathophysiological factor behind the insulin-resistant phenotype of the upper-body obesity in men and of the hyperandrogenic PCOS (104). Obesity has profound effects on the clinical and hormonal and metabolic features of PCOS, which largely depend on the degree of excess body fat and on the pattern of fat distribution. The recognition of the impact of obesity on PCOS may have some relevance in the pathophysiology of the disorder. In addition, obesity intuitively represents a target for therapeutic strategies, as weight loss produces several benefits on major complaints of women with PCOS, including hormonal and metabolic abnormalities, menses and ovulation, and therefore, fertility (107). Finally, the definition of the obesity phenotype is of...

Ectopic fat storage fat content in obesity

Positive energy balance produces an excess of triglyceride with storage in the liver (Ryysy et al., 2000) and skeletal muscle (Goodpaster and Kelley, 1998 Goodpaster et al., 1997, 2000 Shulman, 2000) which is subsequently followed by insulin resistance, glucose, intolerance and diabetes. This similar effect is also observed in patients with lipodystrophy characterized by a severe reduction in adipose tissue with increased triglyceride storage in the liver and skeletal muscle (Robbins et al., 1979, 1982) and subsequent type 2 diabetes disease. These observations suggest that in either the obese or lipodystrophic state, adipose tissue mass is unable to sequester dietary lipid away from the liver, skeletal muscle or the pancreas. As a result, too much or too little adipose tissue mass leads to ectopic fat storage and may further predispose individuals to insulin resistance and finally type 2 diabetes (Figure 4.3). of fat is insufficient to cope with the accumulation of dietary fat being...

Carbohydrate And Dietary Fibre

The suggestion that refined carbohydrates, and sugars in particular, might be involved in the aetiology of Type 2 diabetes dates back to the writings of early Indian physicians. However, in the 1960s, Yudkin resurrected the suggestion that high intakes of sucrose may be particularly important in the aetiology of Type 2 diabetes when he drew attention to the positive correlation between intakes of sucrose and diabetes prevalence in 22 countries (11). But it has subsequently become clear that the correlations were heavily dependent upon which countries were selected for inclusion and that such geographic correlations do no more than provide clues for further research, they certainly do not imply causality. Over 40 studies have examined the role of sugars in the aetiology of Type 2 diabetes, with about half suggesting a positive association and a comparable number suggesting no association. Some have even suggested an inverse association between diabetes incidence and sucrose intake...

The epidemiological link between obesity and diabetes

The link between obesity prevalence and rates of diabetes in different populations was demonstrated by West with an increase in the prevalence of type 2 Figure 1.1 Prevalence of obesity in the UK from 1980 to 1997 from Joint Health Surveys Unit on behalf of the Department of Health 1999. Within populations there is clear evidence of a strongly positive relationship between obesity and the risk of diabetes. Data in the United States from the Health Professionals' Follow-up Study in men (Chan et al., 1994) and the Nurses' Health Study in women (Colditz et al., 1995) graphically illustrates the increasing risk of diabetes that obesity brings (Figure 1.3). Compared with those of a BMI less than 21, women with a BMI greater than 35 had a 93-fold excess risk of developing diabetes. The risk of developing type 2 diabetes rises progressively with increasing adiposity (whether assessed by BMI, or percentage of ideal body weight). Data from NHANES shows that for each kilogram increase in weight...

Maternal obesity and inflammation

Studies of inflammation and insulin resistance in pregnancy were performed in non-obese women.1317 Since obesity precipitates inflammatory responses, excessive free fatty acid release, and subsequent insulin-resistant states in non-pregnant individuals, it is reasonable to assume that inflammatory responses and insulin resistance would be enhanced in obese compared to lean pregnant women. Comparisons of metabolic adjustments in lean and obese pregnant women are limited, but the few studies done show that obese women rely more on fat oxidation as a source of energy in late pregnancy than do lean women.18,19 The increase in fat oxidation among the obese women was significantly correlated with serum leptin concentrations (r 0.76, p

The Epidemic of Type Diabetes Mellitus Its Links to Obesity Insulin Resistance and Lipotoxicity

The Epidemic of Type 2 Diabetes Mellitus Metabolic Consequences of Obesity Why Does it Predispose to T2DM Role of Lipotoxicity in the Development of Skeletal Muscle Insulin Resistance FFA and the Liver The epidemic of type 2 diabetes (T2DM) is a public health problem that threatens to spiral out of control in the twenty-first century. Early intervention can greatly mitigate the serious socioeconomic impact of the disease, driven largely by disabling microvascular complications and cardiovascular disease. Obesity is at the core of the epidemic of T2DM, affecting 2 3 of adults and reaching alarming rates in children in modern society. Our understanding of adipose tissue has evolved drastically in the past decade being now viewed as a dynamic endocrine organ responsible for the development or worsening of insulin resistance and lipotoxicity in obese individuals. Lipotoxicity describes the damage that occurs when chronic energy supply exceeds metabolic needs and lipid accumulates in...

Obesity and inflammation

The above data explain why an insulin-resistant state may be pro-inflammatory. They do not, however, explain the origin of insulin resistance. Mutations of the genes involved in insulin signal transduction provide one approach to the study of this issue in humans and in mice with specific gene knockouts. Such lesions are of interest but are too infrequent to provide a basis for the understanding of the pathogenesis of insulin resistance at large in humans. Thus, some recent observations on the interference of insulin signal transduction by inflammatory mechanisms are of great interest because obesity is a pro-inflammatory state (Figure 2.2). Even if we accept that inflammatory mechanisms are involved in the patho-genesis of interference with insulin signal transduction and of insulin resistance itself, how does inflammation arise Over the past decade, obesity has been associated with inflammation. This association was first proposed in a landmark paper by Hotamisligil et al. in which...

Hunt P. 1995 Dietary Counselling Theory Into Practice. J Inst Health Educ 33 4-8

Counselling strategies for dietary management expanded possibilities for effecting behaviour change. J Am Diet Assoc 1986 86 924-928. 9. Glanz K, Eriksen MP. Individual and community models for dietary behaviour change. J Nutr Educ 1993 25 (2) 80-85. 10. Hunt P. Dietary counselling theory into practice. J Inst Health Educ 1995 33 (1) 4-8. 28. Travis T. Patient perceptions of factors that affect adherence to dietary regimens for diabetes mellitus. Diabetes Educ 1997 23 (2) 152-156. 29. Delamater AM, Smith JA, Kurtz SM, White NH. Dietary skills and adherence in children with Type I diabetes mellitus. Diabetes Educ 1997 14 (1) 33-36. 31. Thomas D. Dietary care - negotiation or prescription Diabetes Care 1994 3 (3) 8-9. 39. Health Behaviour Change in Managed Care. A Status Report on Selected Evidence for Behavioural Risk Reduction in Clinical Settings Dietary Practices. Florida Centre for the Advancement of Health, 2000, http www.cfah.org

How Obesity Causes Diabetes Not a Tall Tale

The epidemic of obesity-associated diabetes is a major crisis in modern societies, in which food is plentiful and exercise is optional. The biological basis of this problem has been explored from evolutionary and mechanistic perspectives. Evolutionary theories, focusing on the potential survival advantages of thrifty genes that are now maladaptive, are of great interest but are inherently speculative and difficult to prove. Mechanistic studies have revealed numerous fat-derived molecules and a link to inflammation that, together, are hypothesized to underlie the obesity-diabetes connection and thereby represent prospective targets for therapeutic intervention. Type 2 diabetes stems from the failure of the body to respond normally to insulin, called insulin resistance, coupled with the inability to produce enough insulin to overcome this resistant state. This common form of diabetes is often associated with obesity, and the current epidemics of these two conditions are seemingly...

The approach to dietary prescription

The initial approach to the patient and the initial emphasis on diet and dietary alterations are of extreme importance. This may be the only advice the patient remembers, and first approaches to dietary intervention are liable to provide the best outcomes relative to both improved control and weight loss in the overweight obese diabetic. The restriction of single nutrients such as sugar, is not advised but dietary habits in general should be discussed, as well as the modification and reduction or increase in specific food groups, e.g. reduction in overall fat and increase in complex carbohydrate. Simple guidelines for dietary manipulation, suitable for the primary care health team to provide at the time of diagnosis, are preferable until, and if, fuller advice is given by the community and hospital dietitian. It is well recognized, however, that weight loss and maintenance in the overweight obese diabetic is more difficult than in the non-diabetic, generally speaking about half that...

Pathological causes of obesity

Genetic and endocrine abnormalities are rare causes of obesity in childhood. However, they are important to mention as many parents of obese children are convinced that their child has an underlying 'hormonal' problem and this belief can be a significant barrier to the lifestyle changes that need to be made when tackling childhood obesity. The clinical features of these genetic and endocrine disorders are highlighted in Table 12.2. Children with simple obesity tend to be tall for their age as excess nutrition supplements the growth hormone drive to growth. They are also more likely to develop early puberty. Obese children with short stature, poor growth or delayed puberty should raise concern as they are more likely to have an underlying disorder for which they should be screened. Single gene defects, including leptin deficiency, leptin receptor deficiency, melanocortin-4 receptor deficiency and pro-opiomelanocortin deficiency, have been described in children but are extremely rare...

How to identify obesity genes

The ultimate goal of obesity genetics is to identify a gene defect found exclusively in obese patients producing a functional variant (for example with altered or absent protein function, the so-called 'smoking gun'). The approaches that may be used in the attempt to identify such mutations depend to a large extent on what is known a priori about the function of the normal protein product. If there is knowledge that an abnormal protein product is capable of causing obesity (or counteracting it), evidence for the presence of mutations in the responsible 'candidate gene' may be sought in the population at large and related to measures of adiposity. In general, a gene may be considered a candidate gene for obesity based either on knowledge of its physiological role or because it becomes implicated in one or more forms of experimental or naturally occurring animal or human obesity. effects. Furthermore, the presence of a polymorphism may not necessarily lead to alterations in protein...

Obesity inflammation and insulin resistance

Obesity in non-pregnant adults is associated with subclinical inflammation and insulin resistance.7 The inflammatory and insulin-resistant states arise from changes in cellular and molecular functions and metabolism when adipocytes become enlarged in obese individuals. Perlipin, a phosphoprotein on the surfaces of triglyceride droplets that acts as a gatekeeper preventing lipases from

Dietary Prescription and Monitoring

The goal of dietary management for the type 1 diabetic woman is to maintain nor-moglycemia (54). Moreover, in the type 1 diabetic woman, the food and the insulin must match. The diet shown in Table 5 demonstrates a frequent small-feedings schedule designed to avoid postprandial hyperglycemia and preprandial starvation ketosis, as well as to promote an average weight gain of 12.5 kg in accord with the Committee on Maternal Nutrition (55). In the obese type 1 diabetic woman ( 120 of ideal body weight), fewer calories per kilogram of total pregnant weight are needed to prevent ketosis yet provide sufficient nutrition for the fetus and mother (about 24 kcal kg 24 h). Recently, it has been reported that when overfeeding of the pregnant woman completely suppresses ketone production, there is an increased risk of macrosomia (56).

Dietary prevention of sudden cardiac death SCD the role of dietary fatty acids alcohol and antioxidants

We now examine whether diet (and more precisely, certain dietary factors) may prevent (or help prevent) SCD in patients with established CHD. We focus our analyses on the effects of the different families of fatty acids, antioxidants and alcohol.2 The hypothesis that eating fish may protect against SCD is derived from the results of a secondary prevention trial, the Diet And Reinfarction Trial (DART), which showed a significant reduction in total and cardiovascular mortality (both by about 30 per cent) in patients who had at least two servings of fatty fish per week.3 The authors suggested that the protective effect of fish might be explained by a preventive action on ventricular fibrillation (VF), since no benefit was observed on the incidence of nonfatal acute myocardial infarction (AMI). This hypothesis was consistent with experimental evidence suggesting that n-3 polyunsaturated fatty acids (PUFA), the dominant fatty acids in fish oil and fatty fish, have an important effect on...

Dietary Modifications

Alterations in neuroendocrine-immune balance and movement toward intracellular fermentative metabolism create intracellular acidity and heightened risk for other chronic disease, including cancer. Dietary changes can reduce the progression to these shifts and are imperative in controlling inflammatory signaling and its complex milieu of comorbid symptoms, conditions, and pathologies. The focus of treating a patient with type 2 diabetes, obesity, cancer, or any other condition should be on the impact of multiple nutritional imbalances (both excess and deficiency) in the individual. Various nutrients specific for an individual's biochemistry may help to modulate factors associated with disease. Using dietary changes and nutritional supplements to help bring homeostasis back to the individual's biochemical makeup is of upmost importance. Dietary factors have effects on inflammatory signaling, independent of smoking, hypercholesterolemia, and hypertension. The dietary sources of high...

Obesity and the risk of type diabetes

Several prospective studies have documented that obesity is probably the most powerful predictor of the development type 2 diabetes (Knowler et al., 1981 Colditz et al., 1990 Manson et al., 1992). However, not every obese subject develops diabetes, i.e. obesity alone is not sufficient to cause type 2 diabetes there are other factors that considerably modify the effect of obesity on diabetes risk. For instance, it is likely that genetic susceptibility to diabetes is a necessary prerequisite for diabetes. This was demonstrated in the Pima Indians in whom the incidence increases more steeply with body mass index (BMI) in those whose parents have diabetes than in those who do not (Knowler et al., 1981). Vice versa, in non-obese people the incidence of type 2 diabetes is low in the middle-aged even in populations such as the Pima Indians where the overall risk of the disease is very high. However, a large proportion of the human populations possess genes that permit type 2 diabetes to...

Using the food guide pyramid

The federal government, with the assistance of many experts, has come up with a simple way for you to eat a good, balanced diet the food guide pyramid. This pyramid was recently completely revised so that you can be more specific about food choices and portions depending on your specific needs. For complete information about the new pyramid and how you can use it to your best advantage, be sure to check out www.mypyramid.gov. After you enter some basic information about yourself, using the site's interactive tool, you can get specific portion sizes for each food group. This Web site is full of great nutritional information and tips on how to adapt the pyramid's recommendations to your lifestyle. The food guide pyramid is probably a good tool for a person with type 2 diabetes who doesn't tend to gain weight, but the person with type 1 diabetes or the person who is obese with type 2 diabetes needs to know the specific number of calories and particularly the carbohydrate calories that he...

Genetic basis of obesity in PCOS

Several studies have shown that PCOS is a familial disorder and various features of the syndrome may be differentially inherited (Franks et al., 1997). However, the genetic basis of the syndrome remains controversial. Since then, many studies have revealed that most women with PCOS, both obese and lean, have a degree of insulin resistance and compensatory hyperinsulinaemia, and genes involved in the secretion and action of insulin have been investigated. Molecular studies of the insulin receptor gene in women with PCOS have shown a large number of polymorphisms, which are common in normal subjects and do not lead to any disturbance of receptor function (Talbot et al., 1996). The observation that although insulin resistance is largely reversible by weight reduction in obese women with PCOS, an abnormality of first-phase insulin secretion from i-cells of pancreas still exists, led to investigation of the insulin gene in the pathogenesis of PCOS. Waterworth et al. reported an association...

Losing Weight Rapidly at Kilocalories

If you're a moderately active male, 5 feet, 6 inches tall, you need 1,680 or approximately 1,700 kilocalories daily to maintain your weight. (Refer to Table 3-2.) If you eat only 1,200 kilocalories daily, you'll have a daily deficit of approximately 500 kilocalories. By dividing the kilocalories in a pound of fat (3,500) by 500, you can see that you'll lose 1 pound per week (3,500 divided by 500 is 7, so the loss will take 7 days). You can create your diet using recipes where you know the grams of carbohydrate, such as the ones in this book. Table 3-2 shows you such a diet. The portions on all food labels are based on a 2,000-kilocalorie diet. Not one of the diets in this chapter allows you to eat that many calories. Such a portion may be much too large for a person on a 1,200-kilocalorie diet.

Clinical Efficacy of Metformin HbAlc Lowering But No Weight Gain

In placebo-controlled trials, metformin lowered HbAlc concentrations by about 1.0-2.0 8,9 . The efficacy of metformin monotherapy was equivalent to the monotherapy of sulfonylurea or thiazoliden-diones 10,11 . The greatest advantage of metformin compared with other anti-diabetic agents (insulin, sulfonylureas or thiazolidendiones) has been the fact that it is associated with weight loss but not with weight gain 1,9-14 . This has been shown for drug-nai've patients as well as for patients already receiving other oral anti-diabetic drugs. In the UKPDS, weight gain was modest with met-formin and very similar to the diet group, whereas treatment with insulin and sulfonylureas was associated with a significant weight gain of 4-8 kg over 10 years 14 . The effect of metformin to pioglitazone or gliclazide in monotherapy or combination therapy was recently studied in large randomized head-to-head studies (QUARTET Recently, the data of the ADOPT (A Diabetes Outcome Progression Trial) study...

Longterm Dietary Advice For The Mother And Her Child

As most women with GDM are obese and all have at least one child at increased risk of adolescent obesity and diabetes, providing dietary education and advice that extends beyond the pregnancy is extremely important. Lifestyle changes encompassing diet and exercise have been shown to reduce the risk of GDM in subsequent pregnancies as well as delaying the progression to Type 2 diabetes (59,95,96). Women with a history of GDM are an ideal group to target, not only because of their own heightened risk of future diabetes (97,98) but to ensure a healthy lifestyle within the family unit, hence reducing the risk of obesity and future diabetes in the children also.

Diabetes And Minerals Vitamins And Dietary Supplements

At present, megadoses of dietary antioxidants, such as selenium, P-carotene, vitamin E, and vitamin C, have not demonstrated cardioprotection in diabetic patients in some clinical trials, such as the Heart Outcomes Prevention Evaluation (HOPE) trial, they have actually been shown to be inferior to certain medications, particularly angiotensin-converting enzyme (ACE) inhibitors (16). Medical nutrition therapy should be individualized according to the metabolic profile, desired goals, and clinical outcomes, in accordance with the usual dietary habits of the patient. Family members of individuals with type 2 diabetes should be encouraged to engage in regular physical activity and dietary management to decrease their risk of developing the disease. 2. The Rotterdam Study (20). This study evaluated the relationship between dietary intake of P-carotene, vitamin C, and vitamin E in 4800 people aged 55-95 years with no history of myocardial infarction. This study demonstrated that P-carotene...

Why do Obesity TDM and Nafld Cluster The Liver as the Metabolic Sensor of Lipotoxicity

As with obesity and T2DM, there is also considerable concern that NAFLD and NASH are reaching epidemic proportions (287) . However, the true magnitude of the disease is not appreciated by many clinicians because the majority ( 70 ) of patients affected have normal liver enzymes (279, 288-290). It has been recently estimated that fatty liver disease affects 1 3 of the adult population or 80 million Americans, and as many as 2 3 of obese subjects in the United States (278, 279, 288). In a large population-based study (n 2,287 subjects) performed in Dallas, Texas, in which liver fat was evaluated by means of the gold-standard MRS technique, 34 of the population had a fatty liver, being much more common in Hispanics (45 ) compared to whites (33 ) and African-Americans (22 ) (288). That adult Hispanic are affected more than Caucasians and African-Americans has been confirmed by others even after adjusting for major confounding variables (94, 96, 99, 101, 291-294). Recent studies indicate...

Pathogenesis of Obesity Related Type Diabetes

The profound changes in eating habits, agricultural capabilities and pattern of physical activity has fuelled today's epidemic of obesity, bringing with it a host of long-term complications. However, obesity has not always been regarded as a disadvantage. Statues dating from the Stone Age period appear to provide the earliest depictions of obesity. These Stone Age sculptures demonstrate not only the social importance attached to it, but also the survival advantage conferred by the ability to store energy (Bray, 1990). The most famous of these, the Venus of Willendorf, a 12-cm limestone figurine, demonstrates a woman with excessive body fat stores (Figure 4.1) whose habitus has been ascribed to a diet rich in fat and marrow and a sedentary lifestyle secondary to confinement in caves during the glacial period. These early depictions, however, not only highlight obesity as a phenomenon but also draw attention to the importance of body fat distribution. Whilst the lower body fat...

How Common Are Overweight and Obesity

The prevalence of obesity and overweight have, without exaggeration, skyrocketed in recent years. In 2001 David Satcher, M.D., then surgeon general of the United States, described it as an epidemic. He predicted that the health consequences of overweight and obesity would soon overtake the effects of tobacco. Thirty-one percent, or almost one-third, of North Americans are now obese. They are part of the 65 percent two-thirds of North Americans who are now overweight. The number of overweight children also is disturbing. Estimates of overweight children range from 13 to 20 percent. These increases in weight result largely from the increased consumption of junk foods consisting chiefly of refined sugars, carbohydrates, and fats. A major source of dietary sugar is soft drinks, which the consumer-oriented Center for Science in the Public Interest has described as liquid candy. A 64-ounce bottle of any calorically sweetened (in contrast to artificially sweetened) soft drink contains...

What are the recommendations concerning the intake of dietary fibre vitamins salt and alcohol

The intake of an adequate amount of dietary fibre is considered very important. Soluble dietary fibre (pectins, comea, etc.) found in fruits and vegetables is more beneficial than insoluble fibre (cellulose, hemicellu-loses) found in cereals, because it decreases the post-prandial glycaemia and acts favourably on blood lipids. It is recommended that the diet of a diabetic person contains at least 20-30g of dietary fibre daily. The recommendation for salt restriction in the diet concerns all individuals today, since foods contain a much bigger quantity of sodium than humans need. For diabetics this recommendation is even more imperative, since as a whole they constitute a group of people generally considered to be 'salt sensitive', particularly if hypertension coexists (as it frequently does) or, even more crucially, nephropathy. It is recommended that salt intake does not exceed 6 g (i.e., one teaspoon) daily. A frequent question regarding the diet of diabetic individuals concerns the...

Therapeutic targets for reducing oxidant stress in overweight and obese patients

The findings of Block,9 Davi,10 and Keaney11 are not only important with respect to the study of basic mechanisms underlying oxidant stress associated with obesity, but they also have important public health implications in regard to the treatment of obesity-associated disease. The incidence of overweight and obesity is becoming more prevalent in the United States and weight loss programs are often ineffective.2 Thus, the number of persons with diseases associated with obesity is going to be a continuing burden to the medical community42 and novel strategies to prevent and treat these disorders based on the physiological perturbations associated with obesity need to be developed and tested. The findings of the studies discussed herein implicate decreasing in vivo levels of oxidant stress as one potential therapeutic target for obesity-associated disesase. Emerging evidence has implicated increased dietary intake of fish oil containing large amounts of polyunsaturated fatty...

Role of metabolic programming in etiology of obesity epidemic

Population-based evidence and studies of early nutritional experiences in animals suggest that different nutritional insults during fetal or neonatal life may result in increased risks of developing metabolic diseases such as obesity and metabolic syndrome later in life.10 Metabolic programming is a phenomenon in which a stimulus or insult that occurs during a critical period of organogenesis in early life results in permanent alterations in the structures and functions of affected organs and increased susceptibility to adult disease (Figure 4.1).17,18

Correlation of altered nutritional experience in early life to subsequent high incidence of obesity and metabolic

Studies of the long-term consequences of an altered nutritional experience in early post-natal life indicate the importance of this phase of life for metabolic programming effects. Dietary habits for all ages have undergone tremendous changes over the past several decades. The present obesity epidemic, to a large measure, may be the result of such changes. Extrapolation of data obtained from HC rat models suggests that post-natal increased consumption of carbohydrates by infants (formula feeding with early introduction of carbohydrate-rich supplements such as cereals, fruits juices, etc.) in Western societies may be partly responsible for the increase in the incidence of obesity. This effect is exacerbated by the mode of feeding (bottle, spoon, etc., resulting in overfeeding). Supplementation of milk (breast or formula) with early introduction of carbohydrate-enriched baby foods and overfeeding may result in malprogramming effects in these babies, leading to adult onset obesity and...

Excessive Weight Gain

Patients who are overweight often have peripheral in-sensitivity to insulin. They may, therefore, develop symptomatic hyperglycaemia and be diagnosed with diabetes at an earlier stage of their decline in beta-cell function than someone who has normal insulin sensitivity. Insulin may exacerbate weight problems for patients who are morbidly overweight and may also increase or aggravate existing insulin resistance. Very often these patients gain more weight than the expected 4 kg when started on insulin because of poor glycaemic control. This is a reflection that the original cause of the patient's hyperglycaemia may have a significant dietary component and is an indication for further strict dietetic advice, concentrating on avoidance of refined carbohydrates and reduced fat intake. Some patients

Dietary Needs of Diabetic Residents

Residents are likely to have several reasons for being nutritionally at risk. These include a lack of nutritional knowledge and outdated ideas about diabetic diets held by some staff. It is vital that up-to-date information about diabetes and healthy eating be given to care home staff, especially those who have responsibility for menu planning, food purchasing and cooking. The local community dietitian (where available) will usually be a good source of help and advice in implementing healthy eating policies. They may often be able to help in staff training on the dietary aspects of diabetes care.

Central Visceral Obesity

Central obesity (obesity localized to central visceral fat depots) is the most prevalent precursor of Type 2 diabetes mellitus (Ohlsson et al 1985). Insulin resistance, which is more prominent in visceral obesity than generalized obesity or that localized to peripheral gluteofemoral depots, is considered to be related to this pattern of obesity (Peiris et al 1986). Free fatty acids have been implicated in the pathogenesis of insulin resistance in muscle through their interface with critical steps in glycolysis. Muscle tissue is the main regulator of systemic insulin sensitivity (Bjorntrop and Rosmond 1999). Compared with subcutaneous fat, visceral fat has increased sensitivity to lipolytic stimuli and has decreased antilipolytic effects to insulin. This means that the potential per unit mass of visceral adipose tissue to mobilize free fatty acid is much larger than that of subcutaneous fat (Bjorntrop 1994). Acute reductions in caloric intake has been shown to improve insulin...

The Role Of The Dietitian In Diabetes Care

Ideally, it is the role of the dietitian to provide the dietetic intervention. A vital part of the dietetic consultation is the assessment of readiness to change eating behaviour (19). Exploration of barriers to change and awareness of psychosocial issues form part of the dietary consultation process. In the short term, food intake needs to be regulated and balanced against medication, in order to optimise blood glucose control. This also includes assessment of whether current medication matches the meal pattern and therefore whether it is appropriate, as well as the management and prevention of hypoglycaemia and hyperglycaemia. Long-term dietary control can offer protection against cardiovascular disease with weight management and modification of other lifestyle factors being essential. Dietary counselling should be innovative and specific to the requirements of the individual, rather than being rigid, prescriptive and restricted to a particular system of teaching, as may be the case...

The Optimal Mix Of Dietary Carbohydrate And Fat For

The diet for the diabetic mother needs to limit excess maternal-foetal transfer of glucose. As post-prandial hyperglycaemia is the time of maximal maternal-foetal glucose transfer, treatment interventions need to target this period (6). Controversy exists on how best to achieve this. Some authorities recommend limiting carbohydrate at the expense of increasing dietary fat, while others The American Diabetic Association (62) recommend limiting carbohydrate to 40 of the total energy content by increasing dietary fat to 40 . This advice is based on clinical studies showing women with GDM have better glycaemic control when consuming less than 45 , rather than more than 45 , of their calorie intake as carbohydrate (72,73). The American approach gives no acknowledgement to the fact that different ingested carbohydrates have different glycaemic responses as measured by their glycaemic index (74). British advice on the diabetic diet in pregnancy does not recommend limiting carbohydrate to 40...

The Need And Feasibility Of Future Dietary Studies In Pregnancy

There remains a lack of good randomised studies on the dietary management of diabetic pregnancies. Such studies are required for both short-term pregnancy outcomes and long-term outcomes for the mother and her child. One of the main difficulties in conducting such studies is the control arm even when no dietary advice is given, women once diagnosed with GDM make lifestyle changes based on family beliefs or information gathered from a variety of sources. Also if the health care providers are aware of the diagnosis they too unintentionally are likely to influence lifestyle factors. The need to blind both the women and the health care staff to the diagnosis is difficult and often considered unethical, as GDM if ignored can carry a risk to the pregnancy (99). It is hoped that the HAPO Study (Hyperglycaemia Adverse Pregnancy Outcome Study) currently underway, looking at pregnancy outcomes in 25 000 pregnant women in whom lesser degrees of glucose intolerance will go untreated, will help to...

Macronutrient Composition Of The Diet

The main dietary components of the diet for an individual with diabetes should be carbohydrate-containing foods with a low glycaemic index and cis-monounsaturated fat. Although it is important to give people with diabetes advice to modify their dietary intakes so that they shift the balance of their nutritional intake in the direction of the recommendations, the relative proportions of macronutrients may vary depending on the markers of diabetes control for the individual.

General Dietary Recommendations For

A dogmatic approach to the dietary advice for GDM should be avoided as only four randomised trials of primary dietary management of GDM against no treatment were considered to be of sufficient standard to include in a recent Cochrane systematic review (57). This pooled data analysis of 612 women failed to show any benefit of dietary intervention on final birthweight, risk of LGA infants and or Caesarean deliveries (57). However, ignoring all clinical and observational nutritional studies that have no non-intervention arm is probably unwise, and until definitively controlled studies are done each available study should be considered on its own merit. The objectives in the dietary management of GDM include glycaemic control, balancing adequate nourishment for the mother and foetus, while limiting excessive weight gain, and establishing healthy eating habits that will continue beyond the pregnancy. Lifestyle changes encompassing diet and exercise should be started during the pregnancy...

Diets For Weight Control Is The Amount And Type Of Carbohydrate Important

Weight loss is usually a major treatment goal in Type 2 diabetes, but the ideal dietary composition for weight control is still the subject of debate. Many health professionals are concerned that high-fat diets, irrespective of the type of fat, might promote weight gain. The prevalence of obesity is often lower in people with high carbohydrate consumption (expressed as a percentage of energy) than in those with high fat intakes (but this is not always true). In animal studies, high-fat diets induce faster weight gain and greater insulin resistance compared with high-carbohydrate diets, whether fed ad libitum or isocalorically (50). In humans, several studies have shown that ad libitum

Approaches To Weight Management

In theory, the management of the obese diabetic patient should not differ from that of the obese non-diabetic patient. However, it has been reported that weight loss is much more difficult for Type 2 diabetic subjects than obese non-diabetic subjects. For example, 12 overweight diabetic patients treated in a behavioural weight loss programme for 20 weeks lost significantly less weight than their non-diabetic spouses on the same programme (29). Although it appears that dietary adherence alone may account for the difference, a small sample size and family dynamics may be confounding factors in these results. Indeed a more recent study using larger numbers and unrelated subjects showed that, on the contrary, Type 2 diabetic subjects can lose as much weight as their non-diabetic peers during active treatment but that the diabetic subjects regain significantly more weight at 1 year follow-up (37). This suggests that weight loss maintenance rather than initial weight loss is the main...

Dietary Treatment For Type Diabetes Mellitus

An integral component of diabetes management by both the health-care professional and the patient with diabetes is the need to know the principles of dietary management of the condition. Nutrition is complex and a registered dietician is best placed to offer advice on recommended diets, although all team members need to be knowledgeable about nutrition therapy. The dietary recommendations for patients with type 1 diabetes mellitus (DM) do not differ greatly from those recommended for the general population. Dietary advice must be tailored to the given patient and certain population groups require special consideration, for example, particular ethnic minorities or children. The total fat intake should not exceed 30 of total energy intake, and 10 should come from saturated fats. Dietary cholesterol intake should be less than 300mg day. Intake of trans unsaturated fatty acids should be kept to a minimum. Carbohydrates, predominantly complex carbohydrates, should comprise 50 of the total...

Weight Gain in Pregnancy

Very similar mean increases in body weight of around 12 kg have been observed by a number of groups (9, 23, 28). Prentice and Goldberg (5) observed that women from poorer countries have a lower percentage weight gain and have a wide variation in absolute weight gain (0-23 kg in women of moderate nutritional status). Women who gain weight prior to 20 weeks gestation were more likely to retain this weight postpartum than women who gained weight after 20 weeks when fetal growth rate is higher (29).

The Impact of Maternal Obesity on the Energy Cost of Pregnancy

The total energy cost of pregnancy is positively associated with prepregnancy fat mass, body fat, and pregnancy weight gain (6), but maintenance costs are only associated with prepregnancy fatness. This might be explained by the fact that prepregnancy fatness is a marker of overall nutritional status or that prepregnancy fatness may indicate a positive energy balance before conception, and this energy balance might be maintained throughout pregnancy. Either mechanism would explain the wide variability in metabolic response to pregnancy and serve to match energy requirements to energy availability, hence optimizing fetal growth. Leptin has been suggested to be the signal that may link prepregnancy fatness with the maternal metabolic response to pregnancy (5). Butte et al. (13) compared energy metabolism in women with a low, normal, and high body mass index (BMI). The increase in BMR during pregnancy was highest in a high BMI ( 26 kg m2) group at 16.3 (5.4) kcal week compared with a...

Lipid Changes in Obesity

Obese women demonstrated similar increases in fat oxidation, in the absence of changes to carbohydrate metabolism, to those observed in lean individuals (11). In obese NGT and GDM women there was an inverse correlation between endogenous glucose production and fat oxidation from prepregnancy to early gestation (11). Triglyceride oxidation, as assessed by recovery of exogenous 13C Hiolein (a biosynthetic triglyceride) as exhaled 13CO2 (19), was significantly lower in GDM independent of obesity. The authors proposed that this could be due to decreased plasma triglyceride lipolysis, reduced nonesterified free fatty acid uptake and oxidation, or increased hepatic oxidation and esterification of nonesterified fatty acids to provide for increased gluconeogenesis and VLDL synthesis. Maternal obesity is associated with increased total and VLDL triglycerides (59, 71). Reduced levels of plasma HDL but similar levels of LDL were also observed (59). A correlation between maternal BMI and...

Shortterm Renal Effects Of Dietary Protein Intake Healthy subjects

For more than half a century it has been recognised that short-term changes in dietary protein intake is followed by significant alterations in GFR and renal plasma flow (RPF) in healthy subjects. Originally, Nielsen et al. 18 in 1948 demonstrated a decline in GFR of 7 in 8 healthy women during a low-protein, low caloric diet of two weeks. Subsequently, Pullman et al. 19 in 1954 extended this observation and documented a decline in GFR of 9 and RPF of 6 in 20 healthy subjects after two weeks treatment with a low protein diet (average 0.3 g kg day), compared to a usual-protein diet (average 1.0 g kg day). It was further demonstrated that a short-term high-protein diet (average 2.6 g kg day) increased GFR and RPF, 13 and 12 , respectively, compared to a usual protein diet. Several investigators have since verified these findings 20-25 .

Dietary Salt Intake And Diabetic Nephropathy

Systemic blood pressure elevation accelerates the progression of diabetic nephropathy in both type 1 and type 2 diabetic patients 93 , and effective antihypertensive treatment reduces albuminuria and the rate of decline in GFR in these patients. Extracellular fluid volume expansion due to impaired renal sodium excretion is the most clinically important mechanism that leads to the development of secondary hypertension in diabetic and non-diabetic patients with chronic renal disease 94 95 . Regardless of which specific antihypertensive agent is used, sodium restriction and treatment with loop diuretics is of major importance for the management of hypertension in these patients 95 . Recent short-term studies have demonstrated that the antiproteinuric effect of blockers of the renin-angiotensin-system RAS and nondihydropyridine calcium channel blockers is enhanced during dietary salt restriction independently of the blood pressure reduction in both diabetic and non-diabetic renal diseases...

Obesity and Nutritional Intake

Obesity, in general, is associated with decreased adiponectin expression in adipose tissue and plasma levels (7,13). In both men and women, overall obesity, assessed by parameters such as body mass index (BMI) and fat mass, is negatively correlated to adiponectin, although prolonged weight reduction leads to increased adiponectin levels (7,14-17). Nutritional intake does not seem to explain this relationship. Although fasting decreases adiponectin messenger ribonucleic acid (mRNA) levels in mice, serum levels remain unchanged (18). In humans, short-term fasting also does not change plasma levels of adiponectin, although prolonged caloric restriction does result in weight loss and increased adiponectin levels (14,19). Additionally, daily caloric intake, macronutrient intake, or a high-fat meal is not related to any immediate change in circulating adiponectin levels in humans except possibly in obese individuals (20-22).

Pathophysiology of Adipose Tissues Obesity and Insulin Resistance

Lipid storage in adipose tissue represents excess energy consumption relative to energy expenditure, which in its pathological form has been coined 'obesity'. In recent years, overnutrition has reached epidemic proportions in developed as well as developing countries. This reflects recent lifestyle changes, however there is also a strong genetic component as well. While the biochemical mechanism(s) for this genetic predisposition are still under investigation, the genes that control appetite and regulate energy homeostasis are now better known. For example, adipocytes produce leptin (see above) that suppresses appetite and was initially considered a promising target for drug therapy. However, most overweight individuals overproduce leptin, and no more than 2-4 of the overweight population has defects in the leptin appetite suppression pathway 14 . In contrast, genetic predisposition to obesity and or T2D when excess calories are consumed is common in the population for instance,...

Inflammation A Process Associated with Obesity Induced Insulin Resistance

Adipose tissue modulates metabolism by releasing NEFAs and glycerol, hormones -including leptin and adiponectin - and proinflammatory cytokines 19 . There is now clear evidence that obesity associated with or without T2D is an inflammatory state, consistent with the production of TNF-a and other cytokines by adipose tissue. Chronic inflammation of white adipose tissue characterized by macrophage infiltration is thought to contribute to insulin resistance associated with obesity, and in obesity, the production of many of these adipokines is increased. RBP4 induces insulin resistance through reduced phosphatidylinositol-3-OH kinase (PI3K) signaling in muscle and enhanced expression of the gluconeogenic enzyme phosphoenolpyruvate carboxykinase in the liver through a retinol-dependent mechanism. By contrast,

The role of antiobesity drugs in diabetic management

Given the overwhelming evidence that obesity is of fundamental importance in the aetiology of type 2 diabetes, as well as many of its co-morbid conditions such as hypertension, dyslipidaemia and other aspects of the metabolic syndrome, it is surprising how little attention has been given to weight management, compared to the extensive studies that have been conducted with drugs to control hyperglycaemia, hypertension and dyslipidaemia. There is little doubt that reduction of excess body weight can be very effective treatment. Dietary intervention studies suggest that a weight loss of approximately 10 per cent is required to significantly improve HbA1c in subjects with established type 2 diabetes, although some subjects may respond dramatically to lesser degrees of weight loss (Wing et al., 1987). Modest weight loss early in the course of the disease, combined with other changes to diet and lifestyle can also be extremely effective, as was shown during the first 3 months of dietary...

Physical activity and the behavioural treatment of obesity

The behavioural treatment of obesity refers to a set of principles and techniques designed to help overweight and obese individuals reverse their maladaptive eating, activity and thinking habits (Wadden and Foster, 2000). Safety and the environment Sallis and Owen (1997) have suggested that time spent outdoors was the single best correlate of physical activity for children. However, many parents keep their children indoors because of concern about safety and lack of space and facilities near homes. A consideration for children is not only their physical safety, but their psychological safety is also of paramount importance. The evidence on the psychological co-morbidities associated with obesity is high (Gortmaker et al., 1993 Sullivan et al., 1993). For a thorough consideration of the role of behavioural approaches in the treatment of obesity the reader is referred to the preceding chapter and a number of reviews of this subject (Wadden et al., 1999 Faith et al., 2000 Wadden and...

Obesity and hypertension

A rise in blood pressure is associated with increased body weight. Epidemi-ological studies indicate that obesity is a strong independent risk factor for hypertension (Modan et al., 1985 Stamler et al., 1993). In the Framingham Study, for example, the prevalence of hypertension among obese individuals was twice that of those individuals with normal weight irrespective of sex and age (Hubert et al, 1983). The INTERSALT Study involving 10000 men and women showed that a 10-kg increase in weight was associated with 3-mmHg rise in systolic and 2.3-mmHg rise in diastolic blood pressure (Dyer and Elliott, 1989). This level of blood pressure elevation is associated with a 12 per cent increase risk for CHD and 24 per cent increase for stroke. In the Nurses' Health Study, the relative risk of hypertension in those women who gained 5.0 to 9.9 kg and greater than 25.0 kg was 1.7 and 5.2, respectively (Huang et al., 1998). The risk of hypertension was even higher with abdominal obesity (WHR 0.9 in...

Integrating obesity management with diabetes

Within primary care there has been a lot of interest in developing distinctive practice-based obesity clinics, often led by one or two enthusiastic members of the practice team and some achieving excellent results. Many others, however, find the prospects of developing such a stand-alone clinic daunting, citing the lack of time, staff, resources or skill-base as their main concerns. When considering the management of diabetes in primary care, however, the need for medical management of overweight is inescapably integral to any serious diabetes treatment plan. It must therefore be within the scope and remit of primary care diabetic clinics to provide for the management of overweight. To do otherwise is to fail to recognize and address the root cause of the disease we are trying to control, and thereby miss the perfect opportunity to develop life-long lifestyle change with all the medical benefits that would confer. This approach does however require an informed and motivated practice...

Implications of obesityassociated diabetes

The consequences of obesity are serious. Obese individuals are predisposed to a cluster of metabolic disturbances known as 'syndrome X' or the metabolic syndrome, which comprises glucose intolerance (the inability to metabolize glucose adequately), type 2 diabetes mellitus, hypertension, dyslipidaemia (high triglyceride levels accompanied by a raised concentration of low-density lipopro-teins and diminished high-density lipoproteins), leading to an increased risk of stroke and cardiovascular disease (Ramirez, 1997 Reaven 1988, 1995 Walker 2001). In addition, obesity is also a risk factor for some malignancies such as endometrial cancer (Iemura et al., 2000). The more life-threatening, chronic health problems have been categorized into four main areas by WHO. These include cardiovascular problems including hypertension, stroke and coronary heart disease conditions associated with insulin resistance, namely type 2 diabetes certain types of cancer as well as gall bladder disease.

How much of obesity is genetic

Given that the explosion in obesity prevalence over the past 20 years is likely to have taken place against a background of relatively constant population genetic structure, the question of to what extent obesity is subject to genetic influence is one that merits careful consideration. Many studies have attempted to resolve the population variance of a specific obesity phenotype into genetic, environmental and unknown (or residual) effects. In principle, the total observed phenotypic variance, Vp may be considered to be due to the sum of genetic variance (Vg), shared environmental variance (Vc) and an unknown residual (unshared environmental) variance (Ve) such that Vp Vg + Vc + Ve. The percentage genetic inheritability of the trait in question is represented by the term Vg Vp. Modifications of this simple model to attempt detection of gene-gene and gene-environment interactions and the application of complex multivariate computational modelling in different study populations are...

Factors modifying the relationship between obesity and diabetes

A large number of factors influence the relationship between obesity and diabetes and many of them are closely inter-related. That obesity on its own is not sufficient to cause diabetes is apparent from the observation that 20 per cent of patients with type 2 diabetes are not obese and even in the highest risk group with high BMI and high waist-hip ratio over 80 per cent will escape type 2 diabetes (Colditz et al., 1995). Other factors include body fat distribution, duration of obesity, weight gain, age, physical activity, diet, the in utero environment, childhood stunting and genetic factors. Methodological issues are also important in examining the relationship between obesity and diabetes. Some of the observed increase in diabetes prevalence attributed to obesity could be related to more awareness and detection of type 2 diabetes, rather than a true increase in numbers (previous Diabetes UK estimates are that 50 per cent of patients do not know they have type 2 diabetes). The...

Evaluating obesityrelated hypotheses for progression of type diabetes

Although the portal hypothesis is associated with obesity, insulin resistance and the pathogenesis of type 2 diabetes associations between subcutaneous fat on the trunk and insulin resistance have been shown in obese non-diabetic men (Abate et al., 1995 Goodpaster et al., 1997) and in men with type 2 diabetes Abate et al., 1996 Kelley and Mandarino, 2000 Smith et al., 2001. As the present data suggests that subcutaneous fat, which accounts for 80 per cent of total adipose tissue, is a cause of insulin resistance this must occur via a non-portal mechanism as this fat depot does not drain into the portal vein. Furthermore, insulin resistance appears independently by an increased truncal subcutaneous adipose tissue and an increased visceral fat store (Albu et al., 2000 Marcus et al., 1999 Bavenholm et al., 2003). Because of growing evidence that subcutaneous fat may play an important role in obesity-related type 2 diabetes with conflicting evidence for the role of the portal fat, changes...

Tips for Avoiding Dieting Pitfalls

The first tip for avoiding pitfalls is to not think about being on a diet, because being on a diet implies that someday you will be off the diet. It is better to convey to yourself and others that you are working on trying to change your lifestyle to eat healthily and be more active. Some of the best advice on how to avoid dieting pitfalls, or in other more positive words how to change your lifestyle to lose weight and keep it off, comes from Helen McGrane, one of the DPP participants. She called her piece (written in diary form), To Tell the Truth (How to Lose Weight and Keep It Off). October 1998 No pain, no loss. The Tufts Letter described research on people who had been successful with permanent weight loss. It found 60 percent had been stricter about their dietary approach, and 80 percent exercised more vigorously. The DPP gave me the guidelines about daily and weekly goals for diet and exercise. . . . I keep a food diary

Self Monitoring Recording Your Weight Loss Progress

The first step to self-monitoring is to put your weight loss goals on paper. Identify your current weight and 5 percent, 7 percent, and 10 percent weight loss targets and record them on your weight loss graph. Weigh yourself on a reliable scale at the same time of day and in the same clothing (either naked or in your underwear, if you're self-conscious) because your weight can fluctuate by several pounds over the course of the day. Ideally, you should weigh yourself in the morning before eating to minimize fluctuations in your measurements. How often should you weigh yourself You may start by weighing yourself daily to keep focused and get into a habit of monitoring your weight. However, if you find this discouraging and counterproductive, weigh yourself a little less often, either every other day or twice a week. Research shows that people who weigh themselves regularly do best at keeping weight off over the long term, so it is critical that you establish a habit of weighing yourself...

How to Change Your Eating Behavior

Chances are you've tried to change your diet in the past and have found it difficult. It is difficult, and we don't mean to suggest anything otherwise. But our experience with the DPP lifestyle-change program has been that lots of people can be successful. The diet and exercise program was developed by a lifestyleintervention committee, a multidisciplinary team of professionals including dietitians, behavioral psychologists, diabetes experts, and exercise physiologists who reviewed the evidence in nutrition, exercise, and behavioral research literature to identify the best ways to help people lose weight and keep it off. The DPP lifestyle program was then implemented in more than one thousand people from all over the country. The DPP volunteers represented a broad swath of the U.S. population, including women and men from all walks of life, and older and younger people from diverse racial and ethnic backgrounds. People can lose weight and keep it off. The National Weight Control...

Obesity And Glycemic Control

For this reason, there is now agreement that prevention of weight gain is an important target when drug treatment is initiated in obese subjects with type 2 diabetes (29). This aspect is particularly significant in insulin-treated patients independent of the type of diabetes. Management of Obesity in Subjects with Type 2 Diabetes The management of obesity represents a central component in the treatment strategy for type 2 diabetes, as obesity is not only a major predisposing factor of the disease and its accompanying disorders, but also aggravates the achievement of a good metabolic control. Moreover, it was repeatedly shown that reducing excessive body weight in individuals with type 2 diabetes improves metabolic control and prolongs life (30-33). However, currently available weight reduction programs for patients suffering from diabetes turned out to have only limited success, particularly in the long run. An essential prerequisite for successful...

Dietary strategies for preventing the onset of diabetes

The different natures of the two types of diabetes requires diverse dietary strategies in order to prevent their onset. For type 1 diabetes, while the exact causes are still being investigated, it is acknowledged that various environmental factors increase the risk of diabetes in genetically susceptible subjects. If these factors can be identified, there could be a good chance of decreasing the incidence of the disease. Other dietary factors being investigated include the active form of vitamin D,5 which is thought to help prevent the development of autoimmune diabetes and gluten since studies have shown that islet cell antibodies may disappear after a gluten-free diet in celiac patients.6'7 However, time is needed before an answer on the efficacy of these dietary intervention trials is known. There are various risk factors for developing type 2 diabetes. One of the primary ones being obesity as defined by a body mass index of over 30 (Table 7.1). Other risk factors include increased...

Dietary control of conventional risk factors cholesterol blood pressure type diabetes and obesity

Cholesterol is a determinant of CHD mortality, and its blood level is at least partly regulated by diet. However, few epidemiological studies have prospec-tively included analyses of the dietary habits of the studied populations in the evaluation of their risk.119 In the Seven Countries Study, marked differences in CHD mortality, dietary habits and cholesterol distribution were observed in the different cohorts.119 Cholesterol levels were high in Northern Europe and in the USA (an average level of 7mmol L), and low in rural Japan (an average of 4mmol L), and population cholesterol levels were positively associated with CHD mortality. Secondary prevention trials with statins in Northern Europe120 and Australia121 confirmed the importance of cholesterol by demonstrating a A major (and often underestimated) finding of the Seven Countries Study was the large difference in absolute risk of CHD death at the same level of serum cholesterol in the different cohorts. At a cholesterol level of...

Economic Impact Of Obesity

The increasing prevalence of obesity is associated with rising health care costs. The cost of treating obesity-related illnesses to the economy of the U.S. business sector has escalated in recent years. It has been estimated that over 9.0 of annual medical expenditures are related to obesity (142). Health insurance expenditures for treating obesity-related illnesses such as hypertension, Type 2 diabetes, and coronary artery disease amounted to 43 of the total amount. Additional costs include increased sick leave, and life and disability insurance payments. In 2003, annual U.S. obesity-attributable medical expenditures were estimated at 75 billion in 2003 dollars, and approximately one-half of these expenditures were financed by Medicare and Medicaid (143). Other countries have seen similar obesity-related increases in health care costs (144), and spend a considerable amount of available health care dollars for treating obesity-related comorbidities. Most obesity-related expenditures...

What Is Dietary Fiber

Dietary fiber comes from the portion of plants that is not digested by enzymes in the intestinal tract. Bacteria in the lower gut, however, may metabolize part of it. (Dietary fiber is only found in plants, Meat and other animal products do not contain fiber.) In contrast, fibers in cell walls are water insoluble. These include cellulose, hemicellulose and lignin. Such fibers increase fecal bulk and speed up the passage of food through the digestive tract. Wheat bran and whole grains contain the most insoluble fiber, but vegetables and beans also are good sources. Recently psyllium has become a popular high fiber source. Psyllium is higher in dietary fiber than most other sources. Sometimes there is confusion as to the difference between crude fiber and dietary fiber. Both are determined by a laboratory analysis, but crude fiber is only one-seventh to one-half of total dietary fiber.

Improve Your Diet And Increase Exercise If you improve your diet and increase your level of exercise you may be able to

After 2.8 years in the study, the incidence of diabetes in the placebo group was 11 per 100 people. In the metformin group, the incidence was only 7.8 per 100 people. But the diet lifestyle group had the best results of all only 4.8 of every 100 developed diabetes. In other words, diet and exercise were 38 more effective than metformin in preventing diabetes in high-risk people.

Losing Weight More Slowly at Kilocalories

The smaller the deficit of calories between what you need and what you eat, the more slowly you'll lose weight. If your daily needs are 1,700 kilocalories and you eat 1,500, you'll be missing 200 kilocalories each day. Because a pound of fat is 3,500 kilocalories, you'll lose a pound in about 17 days (3,500 divided by 200). You'll lose almost 2 pounds a month, or 24 pounds in a year. You can accomplish this loss by reducing your daily intake by only the equivalent of a piece of bread and two teaspoons of margarine. Put that way, losing the weight doesn't seem difficult at all. As you create your meals, you'll be amazed at how small the portions really are. Four ounces of lean meat isn't much compared to what most people are used to eating at home or in restaurants. Eating proper portions is very important because it will ultimately make the difference between weight gain and weight maintenance or loss. Portion size may also be the difference between controlling your blood glucose and...

Letting Legumes into Your Diet

It's tough to find a more perfect all-round food than legumes. They're rich in protein, low in fat (what fat they do have is the good fat), high in dietary fiber, and rich in complex carbohydrates and vitamins. Besides being healthy, they're inexpensive, very versatile, and easy to use. They store well when dried, and have a shelf life of a full year.

Healthy eating and weight control

Recommendations for healthy eating and weight control Eat smaller portions and never skip meals Studies suggest that approximately 80 of people with type 2 diabetes are overweight or obese 14 . Experts agree that people with type 2 diabetes should be encouraged to achieve and maintain a desirable body weight. A majority of these experts agree with the following recommendations a body mass index (BMI) of

Age Obesity And Glucose Counterregulation

Both the autonomic nervous system and the hypothalamic-pituitary-adrenal axis are activated in excess in the morbidly obese. Before and after bariatric surgery (average weight loss 40 kg over 12 months), severely obese non-diabetic subjects, underwent a hyperinsulinaemic hypoglycaemic clamp (blood glucose 3.4 mmol l). Before weight reduction, patients demonstrated brisk peak responses in glucagon, epinephrine, pancreatic polypeptide, and norepinephrine. After surgery and during hypoglycaemia, all these responses were attenuated and most markedly so for glucagon, which was totally abolished in association with a marked improvement in insulin sensitivity. In contrast, the growth hormone response was increased after weight reduction (Guldstrand et al., 2003).

The Anti Inflammation Syndrome Food Pyramid

Because of the widespread use of the U.S. Department of Agriculture's food pyramid, this drawing might help some people visualize the Anti-Inflammation Syndrome Food Pyramid. Foods toward the top are those you would eat the least of, whereas those toward the bottom are those you would eat the most of.

Assessing Motivation To Lose Weight

When conducting an assessment of obesity, it is important to establish the ability and motivation of the individual to make lifestyle changes at that time. The style of the therapist can be crucial in facilitating behaviour change (48) and enhancing the confidence of the individual to be able to sustain changes. Key skills include the core counselling skills of listening and reflecting,

Obesity and dyslipidaemia

Obesity is associated with alteration in lipoprotein metabolism resulting in increase in total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDLc), very-low-density lipoprotein cholesterol (VLDL) and reduced level of high-density cholesterol (HDLc) (Hubert et al., 1983 Grundy and Barnett, 1990). Epidemiological studies such as the Framingham Heart

Ending the Diet Mentality

As we have discussed, successful lifestyle change that leads to weight loss involves more than just changing your diet. In fact, diets alone don't work for permanent weight loss. But you will need to learn to manage and plan your eating how you eat, where you eat, why you eat, what you eat, and when you eat. It's a long-term commitment to your health, not a short-term test of your willpower. That means getting rid of the diet mentality. A diet does not sound permanent. It suggests an element inserted 134, into your life rather than the consistent long-term change in Are you really ready and willing to change your eating habits and become more active Are you ready to self-monitor your weight, activity, and food intake Are you willing to get rid of the diet mentality and begin to shop, cook, and eat for health

Dietary sources and intake levels of flavonoids

Only a few of the thousands of different flavonoids identified in plants are present in considerable amounts in the human diet, and the intake of these dietary flavonoids varies among countries and cultures (Table 9.1) The dihydrochalcone phloretin and its glycoside phloridzin are found in large amounts in apple, but no estimates of intake levels have been reported. The flavanones are present mainly in citrus fruits, predominated by naringin (the glycoside of naringenin), responsible for the bitter taste of grapefruit, and hesperidin (the glycoside of hesperetin) found in oranges. Since the intake of orange juice is extensive in many Western countries, e.g. Denmark and Finland, the intake of in particular the citrus flavanone hesperetin is very high (Kumpulainen et al., 1999 Justesen et al., 2000). Table 9.1 Dietary sources and intake of flavonoids Major dietary

Fisoprostanes and overweight and obesity

Quantification of F2-IsoPs has been used to implicate a role for oxidative stress in the pathophysiology of a number of human conditions and diseases. Notably, F2-IsoP levels were shown to be increased in neurodegenerative conditions such as Alzheimer's disease, Huntington's disease, aging, certain types of cancers, and, of notable importance to consequences of overweight and obesity, atherosclerotic cardiovascular disease.1422-26 In the first of these studies, Block and colleagues at the University of California at Berkeley and Kaiser Permanente in Oakland sought for the first time to gather large-scale epidemiological data describing oxidative damage that occurs in normal, healthy populations and the demographic, physical, and nutritional factors associated with it.9 More than 300 volunteers (55 women, 45 men) between the ages of 19 and 80 were recruited, and their complete dietary information and medical histories were known. Plasma F2-IsoPs were measured in all volunteers and...

Your Diet for Type Diabetes

People with type 2 diabetes are frequently overweight, so advice about nutrition is directed not only at controlling carbohydrate intake, but also at limiting calories. (I discuss caloric restriction and weight loss in Chapter 10.) If you have type 2 diabetes, there are several reasons why you still need to estimate the carbohydrate content of your food

Counting Alcohol as Part of Your Diet

Because alcohol has calories, if you drink some, you must account for it in your diet. The proof of the alcohol is the percentage of alcohol in an ounce of the drink multiplied by 2. Wine that is 12.5 percent alcohol is 25 proof. Beer is 12 proof most of the time. Liquor is often 80 proof. To determine the calories, use the following formula

Risk Factors For Obesity

The patient's age is important in determining risk from obesity and generally there is greater risk from obesity in those under 40 years of age. Taking a weight history can ascertain the onset and duration of obesity as well as the pattern of weight gain and weight loss throughout the individual's life. Longitudinal studies have shown that weight gain confers a greater risk of cardiovascular disease than an unchanging level of obesity (40). In addition, the longer the duration of obesity the more difficult treatment may be. Gender is another variable that impacts on the development of obesity, with women generally having a higher prevalence of obesity compared to men, especially in middle age (41). Reproductive function can be affected in younger women, with menstrual disorders including irregular bleeding and amenorrhea being more common among obese females. Various medical genetic causes of obesity must also be considered. Endocrine conditions associated with weight gain include...

Behavioural modification strategies in obesity treatment

There are multiple published articles describing the commonly employed behavioural modification strategies for dietary change, exercise adoption, and relapse prevention (Brownell, 2000 Foreyt and Poston, 1998 Poston and Foreyt 2000 Wing, 1998). Establishing reasonable, specific short-and long-term goals, daily self-monitoring of dietary intake and exercise behaviours, using stimulus control techniques to modify environmental and intrapersonal factors that precede and cue food intake, cognitive restructuring to address maladaptive thoughts impacting behaviour change, problem-solving environmental, emotional, or motivational challenges to change efforts, enlisting social support resources, and relapse prevention training are useful techniques in modifying behaviours associated with weight loss. Several examples of how the primary behavioural modification strategies might be incorporated throughout the weight loss process are provided in Table 7.1.

What Are Overweight and Obesity

By clinical definition, a person is obese when he or she is thirty or more pounds over his or her ideal weight. Simply being overweight is characterized by being a few pounds to up to thirty pounds over his or her ideal weight. Of course, a well-trained muscular person might be incorrectly considered overweight because muscle tissue is more dense and heavy than fat tissue. Therefore, accurate assessments should calculate fat-to-muscle or hip-to-waist ratios. From a practical standpoint, a look in the mirror can make much of the testing unnecessary. Most people who are overweight or obese know that they are, though they might want to deny the obvious. Overweight and obesity usually are diseases of overeating, although metabolic factors affect some people. The traditional view is that people gain weight when they consume more calories than they burn. This is partly true because many people are not as physically active as their ancestors, but it fails to explain everything. Several...

Prevention Of Obesity

Studies that aim to reduce obesity or prevent it from developing are relevant to the prevention of type 2 diabetes, since obesity is one of the major modifiable risk factors. Like diabetes, overweight and obesity have been the outcomes for a large number of clinical trials and observational studies exploring risk factors for their development and reduction. Comprehensive reviews of obesity prevention issues and approaches have been published13,163,262-264 and it is not possible to review them here. The interventions studied have been similar to those for type 2 diabetes, and have focused on lifestyle modification as well the use of selected pharmacological agents that may reduce weight. No large RCTs have investigated the prevention of obesity (in contrast to obesity reduction) as it relates to type 2 diabetes. Several community-based cardiovascular prevention studies have included obesity as one of several outcomes, often with limited success265-267. However, hypertension prevention...

Does obesity in childhood matter

Obese children appear to be at risk of the same complications of obesity as are obese adults (Table 12.3). However, no data exist which correlate definitions of childhood obesity based on BMI cut-offs with the risk of adverse health outcomes in childhood. Instead BMI criteria are used to highlight those who may be at greater risk and who would benefit from assessment and intervention. Currently the greatest concern is the development of type 2 diabetes, the emergence of which has changed the face of paediatric diabetes practice over the last 5-10 years.

Physical activity and the prevention of weight gain

With the use of doubly labelled water researchers have been able to determine the relationship between physical activity and typical patterns of unhealthy weight gain in adults. Schulz and Schoeller (1994) examined the relationship between percentage body fat and non-basal energy expenditure and proposed that a PAL of 1.75 to 1.80 should be a threshold target for the population as a whole. Black et al. (1996) using data on 574 free-living individuals stated that their modal physical activity level (PAL) was between 1.55 to 1.65 for both men and women. Thus, to raise the PALs of these individuals to a value that would prevent unhealthy weight gain would require an increase of 0.3 PAL, which relates to moderate exercise lasting between 30-60 min four to five times per week. Although such guidelines are useful for quantifying levels of physical activity for the population, studies using such levels of physical activity prescription have been limited in their ability to achieve weight...

Modification of dietary intake

Bariatric surgery results in a substantial reduction in nutrient intake which may account for the normalization of plasma glucose reported. In a recent study, a sham operated individual who followed the same strict postoperative diet recommended to Roux-en-Y gastric bypass patients showed similar improvements in insulin and glucose levels. This suggests that calorific restriction is a major factor in promoting glycaemic control after weight loss surgery (Pories et al., 1995). Furthermore, there are some indications that gastric bypass may alter the type of food patients ingest. Induction of the 'dumping syndrome' or postoperative changes in taste and food preference result in a preferential reduction in carbohydrate ingestion (Sugarman et al., 1992). This may enhance diabetic control because it is known that obese individuals with a high carbohydrate intake (especially simple sugars), have increased insulin secretion. Hyperinsulinaemia favours anabolic metabolism (Woods et al., 1974...

Dietary treatment of diabetes

Dietary advice will form the backbone of a diabetic's future management and it is therefore crucial to get the right message across from the outset. Poor information delivered early in management can have adverse short, and long-term effects, and should be avoided. The aims of dietary advice should be to minimize symptoms of hyperglycaemia, minimize the risk of hypoglycaemia, and to promote weight loss, while ensuring that any proposed changes are tolerable and sustainable (Frost et al., 1991). Remember that in encouraging the patient to make (possibly) substantial changes to their dietary intake you will be asking them to change life-long habits, to stop doing things they enjoy (and perhaps replace with less-well-received alternatives) and will at first appear to be asking them to make changes that will diminish their ability to socialize with family and friends at the dinner table and on special occasions. For most new diabetics, but depending on the severity of their glycaemia, it...

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4 Steps To Permanent Weight Loss

4 Steps To Permanent Weight Loss

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