Obesity and Diabetes Articles

Obesity and Diabetes Articles

• Clinical Gems in Diabetes in Control: International Textbook of Diabetes Mellitus
• NIH(2016). Diabetes in America, 3rd Edition, Diabetes in America, 2nd Edition
• Corkey (2016).What Causes Type 2 Diabetes?
• BMJ: Diabetes
• Bibliographic resource: Diabetes and the environment.
• International Society for Prediatric and Adolescent Diabetes (2009): The Clinical Practice Consensus Guidelines
• Pathogenesis of type 2 diabetes: tracing the reverse route from cure to cause (2008)
• IDF - Diabetes Atlas
• Diagnosis of Diabetes and prediabetes
• Diagnosis and Classification of Diabetes Mellitus (ADA, 2013)
• Definition and diagnosis of diabetes mellitus and intermediate hyperglycaemia (History of criteria) (WHO, 2006)
• Use of HbA1c in the diagnosis of diabetes (BMJ, 2012)
• Values for diagnosis of diabetes mellitus (Venous, capillary of whole blood (1998)
• Added (A1c, prediabetes): Categories of increased risk for diabetes (2011)
• Added (A1c): Diagnosis and Classification of Diabetes Mellitus (2010)
• Revised (FPG, prediabetes): Categories of increased risk for diabetes (2004)
• Revised (schemes): Diagnosis and Classification of Diabetes Mellitus (2003)
• Revised (FPG): Diagnosis and Classification of Diabetes Mellitus (1997)
• Diagnosis and Classification of Diabetes Mellitus (1979)
• Homeostatic model assessment
• Wikipedia. Homeostatic model assessment
• Matthews (1985). Homeostatic model assessment
• Wallace (2004). Use and abuse of HOMA modeling
• Caumo (2006). New insights on the simultaneous assessment of insulin sensitivity and beta-cell function with the HOMA2 method
• Diabetes Care (2007). HOMA Point and Counterpoint
• Tabak (2009). Trajectories of glycaemia, insulin sensitivity, and insulin secretion
• Predicting type 2 diabetes
• German Institute of Human Nutrition (GIFE) provides a on-going systematic review and calculators of predicting model of type 2 diabetes.
• Obesity
• ConscienHealth (2018).The Counterintuitive Physiology of Obesity
• Levis (2016).Are All Calories Equal?
• Waist Circumference and Waist–Hip Ratio (WHO, 2008)
• R!: Body weight in the U.S. (2012)
• Damaged Hearts NEED Fat and Top 10 Super Foods To Control Diabetes fat (2011)
• Short sleep duration as a cause of obesity: myth or reality? (2011)
• Energy expenditure during sleep, sleep deprivation and sleep following sleep deprivation in adult humans (2010) This article support that sleep conserves energy and that sleep deprivation increases total daily EE in humans.
• Exercise and diet in weight management: updating what works (2010)
• Extra Calories Cause Weight Gain—But How Much? (2010)
• Triglycerides and Cardiovascular Disease: A Scientific Statement From the American Heart Association (2011): "...A long-standing association exists between elevated triglyceride levels and cardiovascular disease* (CVD).  However, the extent to which triglycerides directly promote CVD or represent a biomarker of risk has been debated for 3 decades..."
• The Endocrine Function of Adipose Tissue: An Update (2006) - Medscape
• Lifestyle or medicine (2006)
• High-fructose corn syrup and obesity and diabetes (2009)
• Is Sugar Toxic? (2011) - NYTimes.com
• Brown Adipose Tissue: Function and Physiological Significance (2004) - Physilogical Reviews
• Upper and Lower Body Adipose Tissue Function (2004) - Obesity
• Obesity: BAI as a new measure of adiposity—throw away your scale? I will not use this index.
• An integrative view of obesity (2010) by David Heber another An Integrative View of Obesity (2007) by Brent E. Wisse et al.
• How Obesity Causes Diabetes: Not a Tall Tale (2005)
• Diabetes, Obesity, and the Brain (2005)
• Obesity in Biocultural Perspective (2006)
• Nature Insight: Obesity and Diabetes (2006)
• Science Special Issue: Obesity--What Is To Be Done? (2003)
• Measured Smoking-Related Chemicals in NHANES
• Global Burden of Disease and Risk Factors
• Video Clips: Obesity, Diabetes, and Heart Diseases
  • Jamie Oliver's TED Prize wish: Teach every child about food
  • Sugar: The Bitter Truth, an interesting talk.
  • Why We Get Fat: Adiposity 101 and the Alternative Hypothesis of Obesity, another interesting talk but quite long.
  • What is the single best thing we can do for our health?

Int. J. Epidemiol. Table of Contents for October 2010; Vol. 39, No. 5
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Editor's Choice
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George Davey Smith
John Snow or Raymond Pearl: who would you rather have dinner
with?
Int. J. Epidemiol. 2010 39: 1129-1132; doi:10.1093/ije/dyq216.
http://ije.oxfordjournals.org/cgi/content/full/39/5/1129?etoc
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Editorial
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Debbie A Lawlor and Nish Chaturvedi
Methods of measurements in epidemiology--call for a new type of
paper in
the IJE
Int. J. Epidemiol. 2010 39: 1133-1136; doi:10.1093/ije/dyq178.
http://ije.oxfordjournals.org/cgi/content/full/39/5/1133?etoc
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Reprints and Reflections
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C Spearman
The proof and measurement of association between two things
Int. J. Epidemiol. 2010 39: 1137-1150; doi:10.1093/ije/dyq191.
http://ije.oxfordjournals.org/cgi/content/full/39/5/1137?etoc
Sandy Lovie and Pat Lovie
Commentary: Charles Spearman and correlation: a commentary on
'The proof
and measurement of association between two things'
Int. J. Epidemiol. 2010 39: 1151-1153; doi:10.1093/ije/dyq183.
http://ije.oxfordjournals.org/cgi/content/full/39/5/1151?etoc
Julie Perks
Commentary: 'The next trick is impossible.'
Int. J. Epidemiol. 2010 39: 1153-1155; doi:10.1093/ije/dyq182.
http://ije.oxfordjournals.org/cgi/content/full/39/5/1153?etoc
Donna Spiegelman
Commentary: Some remarks on the seminal 1904 paper of Charles
Spearman
'The Proof and Measurement of Association between Two Things'
Int. J. Epidemiol. 2010 39: 1156-1159; doi:10.1093/ije/dyq201.
http://ije.oxfordjournals.org/cgi/content/full/39/5/1156?etoc
Nick de Klerk
Commentary: Spearman's 'The proof and measurement of association
between
two things'
Int. J. Epidemiol. 2010 39: 1159-1161; doi:10.1093/ije/dyq200.
http://ije.oxfordjournals.org/cgi/content/full/39/5/1159?etoc

Glucosamine Causes The Death Of Pancreatic Cells

Glucosamine Causes The Death Of Pancreatic Cells

High doses or prolonged use of glucosamine causes the death of pancreatic cells and could increase the risk of developing diabetes, according to a team of researchers at Université Laval's Faculty of Pharmacy. Details of this discovery were recently published on the website of the Journal of Endocrinology.

In vitro tests conducted by Professor Frédéric Picard and his team revealed that glucosamine exposure causes a significant increase in mortality in insulin-producing pancreatic cells, a phenomenon tied to the development of diabetes. Cell death rate increases with glucosamine dose and exposure time. "In our experiments, we used doses five to ten times higher than that recommended by most manufacturers, or 1,500 mg/day," stressed Professor Picard. "Previous studies showed that a significant proportion of glucosamine users up the dose hoping to increase the effects," he explained.

Picard and his team have shown that glucosamine triggers a mechanism intended to lower very high blood sugar levels. However, this reaction negatively affects SIRT1, a protein critical to cell survival. A high concentration of glucosamine diminishes the level of SIRT1, leading to cell death in the tissues where this protein is abundant, such as the pancreas.

Individuals who use large amounts of glucosamine, those who consume it for long periods, and those with little SIRT1 in their cells are therefore believed to be at greater risk of developing diabetes. In a number of mammal species, SIRT1 level diminishes with age. This phenomenon has not been shown in humans but if it were the case, the elderly - who constitute the target market for glucosamine - would be even more vulnerable.

"The key point of our work is that glucosamine can have effects that are far from harmless and should be used with great caution," concluded Professor Picard.

The results obtained by Picard and his team coincide with recent studies that cast serious doubt on the effectiveness of glucosamine in treating joint problems.

This study was co-authored by Mathieu Lafontaine-Lacasse and Geneviève Doré.

Source: Université Laval

Copyright: Medical News Today

ACARAJÉ DE FEIJÃO BRANCO OU FRADINHO

Recipe - ACARAJÉ  DE FEIJÃO BRANCO OU FRADINHO

By Paloma Jorge Amado Costa (Brazilian) 

Acarajé with white beans or black eyed pea 

Ingredients

• 1 kg white beans (or black eyed peas)
• 1kg onions
• 1 onion (for frying)
• Salt
• Palm oil (for frying; you may use other oil if you prefer)

Instructions

• Beat the beans quickly in a blender or food processor to break the skin and then let them rest in water overnight. 
• Discard the water and remove the skins (if you wish, keep them). Pass the beans through a meat grinder or mix in a blender or food processor. 
• Grind the onions and mix with the beans and salt and mix well. Make the balls with two spoons.
• Heat he oil (add sufficient amount to cover about half the height of the balls) and add the entire onion.
• Fry the balls in both sides, turning them when one side is brown.

You may serve them by themselves or cut in halves and accompanied by dried shrimp with spicy sauce and vatapá.

MOLHO DE CAMARÃO SECO (dried shrimp sauce)

Ingredients

• 200 g dried shrimp
• 1 onion
• 1 cup palm oil (you may use other oil if you prefer)
• 5 cashew nuts
• Salt
• 1 cup dried red malagueta pepper (you may adjust quantity to your taste!)

Instructions

• Chop the onion
• Mix the pepper in a blender or crush with mortar and pestle.
• Beat cashew and dried shrimp
• Fry the onion and add the cashew/shrimp
• Add the rest of the shrimp and cook for about 5 minutes.
• Serve cold

VATAPÁ

Ingredients

• 1kg white bread
• ½ kg onions
• 300 g dried shrimp
• 250 g cashew nuts
• 250 g peanuts
• 3 cups unsweetened coconut milk
• 50 g ginger
• 2 cups palm oil

Fish or chicken broth (if made at home, use salt, garlic, tomatoes, onions, peppers, cilantro and lime juice or rind)

Instructions

• Chop the bread and let it soak with 1/3 of the coconut milk and then blend in the mixer.
• Chop the onions
• Blend the dry shimp
• Beat the peanuts and the cashew with 1/3 of the coconut milk
• Grind the ginger
• Fry onions and dry shrimp
• Add the bread, mixing always
• Add peanuts, cashew and ginger and continue mixing
• Add the broth mixing well
• Add the rest of the coconut milk
• Mix until the mixture frees itself from the pan.

Tent Tube Repair and Replacement

This is site I found for tent tube replacement or repair. Do you know
any better places for tent tube replacement? Thanks.

http://www.polesforyou.com/index.htm

Access 20 years of survey methodology for public health researchers

Access 20 years of survey methodology for public health researchers

Read our free virtual issue, Survey Methodology for Public Health
Researchers: Selected Readings from 20 years of Public Opinion
Quarterly. The virtual issue's 18 articles illustrate the range of
survey methods material that can be found in POQ and include conclusions
that are still valid today. Specially chosen by guest editor Floyd J.
Fowler, the articles will be of interest to those who work and research
in public health and health services more broadly.

http://www.oxfordjournals.org/our_journals/poq/collectionspage.html

The Lack of Utility of Circulating Biomarkers of Inflammation and Endothelial Dysfunction for Type 2 Diabetes Risk Prediction Among Postmenopausal Women

Arch Intern Med -- The Lack of Utility of Circulating Biomarkers of
Inflammation and Endothelial Dysfunction for Type 2 Diabetes Risk
Prediction Among Postmenopausal Women: The Women's Health Initiative
Observational Study, September 27, 2010, Chao et al.

A study from WHI:
http://archinte.ama-assn.org/cgi/content/full/170/17/1557

In the spotlight: Margins of predicted outcomes

In the spotlight: Margins of predicted outcomes
http://www.stata.com/news/statanews.25.3.pdf

Hierarchical and Covariance Models for Public Health Data

Hierarchical and Covariance Models for Public Health Data
By Prof. Sudipto Banerjee

http://www.biostat.umn.edu/~sudiptob/CDC/CDC_2010.html

ADDITION: No significant benefit of intensive therapy in diabetes

September 22, 2010 | Lisa Nainggolan

Stockholm, Sweden - Intensive multifactorial treatment was not significantly better than routine care in a study of 3000 patients with newly diagnosed type 2 diabetes treated by general practitioners, at least in terms of the primary outcome, a composite of first cardiovascular events. Results of the Anglo-Danish-Dutch Study in General Practice of Intensive Treatment and Complication Prevention in Type 2 Diabetic Patients Identified by Screening (ADDITION) trial were reported today at the European Association for the Study of Diabetes (EASD) 2010 Meeting by Dr Simon J Griffin (University of Cambridge, UK).

 

Griffin said the study "was pragmatic and relevant to everyday general practice" and shows that "intensive treatment in people with screen-detected diabetes is feasible" in primary care. The lack of a significant effect of the intensive intervention on the primary end point was likely the result of the great improvements in the routine care of diabetes over the course of the study in the three countries involved, Denmark, the Netherlands, and the UK, he commented.

 

"Even in the routine-care group that did not receive significant additional support, cardiovascular risk factors improved in the five years following detection by screening. Our intervention to promote more intensive treatment was associated with statistically significant but relatively modest differences in prescribed treatment, in levels of risk factors, and in the proportion of patients for whom treatment targets were achieved. These relatively small differences were in turn associated with a nonsignificant 17% relative reduction in the incidence of a composite CV end point over five years," he told meeting attendees.

Important to note also, said Griffin, was the fact that maintaining average glycated hemoglobin (HbA_1c) levels of 6.5% in the intensive-treatment arm of the study was not associated with any increased mortality risk. This is seen as particularly important in the wake of the ACCORD results, a trial in which intensive glucose lowering appeared to increase mortality.

Commentators applauded the ADDITION trial, which they noted must have been very difficult to carry out. The invited discussant, Dr William H Herman (University of Michigan, Ann Arbor), explained that all prior studies of this nature have been observational, and this was research that "I personally believed would never be performed." ADDITION demonstrates that primary-care-based stepwise screening for type 2 diabetes "is feasible and identifies patients with substantial levels of cardiovascular risk that is potentially modifiable," said Herman.

Common Errors in English Usage

http://www.wsu.edu/~brians/errors/errors.html#errors

Changes in Terminology for Childhood Overweight and Obesity

Changes in Terminology for Childhood Overweight and Obesity

http://www.cdc.gov/nchs/data/nhsr/nhsr025.pdf

Statistic software, books etc. websites

Statistic software, books etc. websites

This website listed here comprise a powerful, conveniently-accessible,
multi-platform statistical software package. There are also links to
online statistics books, tutorials, downloadable software, and related
resources.

http://statpages.org/

Russ Lenth's power and sample-size page

Russ Lenth's power and sample-size

A nice website for power and sample size calculation.

http://www.stat.uiowa.edu/~rlenth/Power/#Download_to_run_locally

JAMA -- Beyond Hemoglobin A1c--Need for Additional Markers of Risk for Diabetic Microvascular Complications, June 9, 2010, Hirsch and Brownlee 303 (22): 2291

Beyond Hemoglobin A1c--Need for Additional Markers of Risk for Diabetic
Microvascular Complications

http://jama.ama-assn.org/cgi/content/full/303/22/2291

Recent population changes in A1c and insulin among adults with preserved glucose homeostasis

Recent population changes in A1c and insulin among adults with preserved
glucose homeostasis

Attached please find our distribution paper published on Diabetologia
last week (http://www.springerlink.com/content/c5137gn6gh426115/). The
homeostasis concept at a individual level is not new, but this is a new
insight (thanks Henry teaching me this word in English) from a
population perspective. To me, this is an most important study/a
milestone of my diabetic study career so far; it changes my ways of
thinking and ordering all pieces of puzzle of diabetes significantly.

I enjoy the process of this study and very appreciate all the
contributions from the authors, Yiling

Medical News: CODHy: Debate Rages on HbA1c for Diabetes Diagnosis - in Meeting Coverage, CODHy from MedPage Today

Debate Rages on HbA1c for Diabetes Diagnosis

http://www.medpagetoday.com/MeetingCoverage/CODHy/20132

Quotes

“To accomplish great things, we must not only act, but also dream; not only plan, but also believe.” ~ Anatole

“Only as high as I reach can I grow, only as far as I seek can I go, only as deep as I look can I see, only as much as I dream can I be.” ~ Karen Ravn

“Be who you are and say what you feel because those who mind don't matter and those who matter don't mind.” ~ Dr. Seuss

“Success is not final, failure is not fatal: it is the courage to continue that counts.” ~ Winston Churchill

“If your actions inspire others to dream more, learn more, do more and become more, you are a leader.” ~ John Quincy Adams

“Being deeply loved by someone gives you strength, while loving someone deeply gives you courage.” ~ Lao Tzu

Word and Phrase search in PDF Files

Word and Phrase search in PDF files - a feature of PDFXChange
http://www.techsupportalert.com/content/word-and-phrase-search-pdf-files
.htm

Don't Be Loopy: Re-Sampling and Simulation the SASR Way

Don't Be Loopy: Re-Sampling (bootstrapping) and Simulation the SAS(r)
Way

http://www.lexjansen.com/wuss/2009/anl/ANL-Cassell.pdf

A French view on obesity as a social construction, with mention of CDC.

A French view on obesity as a social construction, with mention of CDC.

 

http://www.slideshare.net/Poulain/obesit-version-anglaise-1845333

 

Meditation | The Buddha | PBS Video

Meditation | The Buddha | PBS Video

http://video.pbs.org/video/1438055848/

HowStuffWorks - How Force, Power, Torque and Energy Work

If you've read many http://howstuffworks.com/ articles, you've seen a lot of terminology thrown around -- words such as mass, force, torque, work, power and energy. What do the-se words really mean, and are they interchangeable? Go to http://howstuffworks.com/ and find the answer.

Why Dichotomizing Variables is a Bad Idea

This is a nice review from the research perspective, but may be not so practicable without using dichotomized variable of a continuous variable. For example, the criteria of diabetes and hypertension diagnosis are based on dichotomized variables from continuous blood glucose level and blood pressure level.

_From Bob

        It is well recognized in the methodological literature that dichotomization of continuous variables introduces major problems in the analysis and interpretation of models derived in a data-dependent fashion. Nevertheless, dichotomization of continuous variables is widespread in clinical research. Problems include loss of information, reduction in power, uncertainty in defining the cutpoint, arriving at a biologically implausible step function as the estimate of a dose–response function, and the impossibility of detecting a non-monotonic dose–response relation. Uncertainty in how to select a ‘sensible’ cutpoint to group a continuous variable into two classes has led researchers to use either the median or an ‘optimal’ cutpoint. The latter approach gives a highly inflated type 1 error probability, together with biased parameter estimates and variances that are too small [9, 11]. Although some remedies for these diffculties have been developed [9, 21–23], none of the authors of these papers actually recommends the use of ‘optimal’ cutpoints with their proposed corrections. In general, the situation seems hardly to have improved since the advice in 1993 of Maxwell and Delaney [1] to avoid dichotomization, quoted at the beginning of this paper.

Instead of dichotomizing a continuous variable, we prefer to obtain a prognostic index by methodology which combines selection of variables with selection of functions for continuous variables [4, 26]. As stated in an editorial [2] in an epidemiological journal a decade ago, ‘these elegant approaches [fractional polynomials and splines] merit a larger role in epidemiology.’ Clinical researchers should in general avoid dichotomization at the model-building stage and adopt more powerful methods.

Royston, Patrick (2006) Statistics in Medicine 25:127-141

Please share this with your son.

Gentlemen,

Yes gentlemen, you are no longer the little Tiger Cubs we started out with 5 years ago.  Each of you have grown up into nice young men during that time. It has been my pleasure being first a Den Leader and then the Cubmaster for your years in the Pack.  Over these 5 years  have seen you boys grow not only in size but as a human beings.  I hope that Cub Scouts has been a positive experience for you.  For those that have decided to take a break from the Scouting program I hope that you will find your way back to it at some point.  Either in a few years as a Boy Scout or later as an adult with your son in Scouting.  The mission of the Boy Scouts is to instill values in young people and to help prepare them to make ethical choices during your lifetime.  These values can be found in the Scout Oath and Law.  Please remember the 12 point of the Scout Law and try to live your life based upon these 12 points, not only as a youth but also as an Adult.

It has been a pleasure working with you young gentlemen.

YIS

Mr. Alan  

In memory of Dr. John Denis McGarry

In memory of Dr. John Denis McGarry

Dr. Denis McGarry was a great teacher and sage. His lecture affects my way of thinking on diabetes. Unforgettable.

“In 1992, he published a famous paper in Science entitled “What if Minkowski Had Been Ageusic?” (1). In this paper he suggested that scientific concentration on abnormal glucose metabolism had masked the critical importance of abnormal fat metabolism, especially in type 2 diabetes. Subsequent to this paper there was a huge swing by investigators toward the key role of abnormal lipid metabolism in insulin resistance and lipotoxic damage to tissues as diverse as the heart and the β-cell of the pancreas.”

Please find the full article here.

K M Venkat Narayan: A case of well-intentioned public health reductionism?

K M Venkat Narayan: A case of well-intentioned public health
reductionism?

Very good comments.

http://blogs.bmj.com/bmj/2010/03/04/k-m-venkat-narayan-a-case-of-well-in
tentioned-public-health-reductionism/

Findings - When It Comes to Salt, No Rights or Wrongs. Yet. - NYTimes.com

 

This article may not  be scientifically proved, but I like the title and Effect E. By the way, I don’t like the comparison of smoking and salt, it makes salt such a evil substance like cigarette. We cannot abstain from salt. The question is how much and the answer is it depends…

FDA internal reports unhappy about rosiglitazone (Avandia)

Research Ties Diabetes Drug to Heart Woes

 

http://www.nytimes.com/2010/02/20/health/policy/20avandia.html

 

Does anyone know why Avandia increases the risk of CHD? Is because of efficiently lowing the glucose level (too low)? Or any other side-effects.

 

A Lasting Gift to Medicine That Wasn't Really a Gift

A Lasting Gift to Medicine That Wasn’t Really a Gift

 

 

http://www.nytimes.com/2010/02/02/health/02seco.html?th&emc=th

 

A cell line called HeLa (for Henrietta Lacks) was born. Those immortal cells soon became the workhorse of laboratories everywhere. HeLa cells were used to develop the first polio vaccine, they were launched into space for experiments in zero gravity and they helped produce drugs for numerous diseases, including Parkinson’s, leukemia and the flu. By now, literally tons of them have been produced.

Dr. Gey did not make money from the cells, but they were commercialized. Now they are bought and sold every day the world over, and they have generated millions in profits.

Ukrainian registry of type 2 dm shows U-shaped relation of BMI to mortality

Ukrainian registry of type 2 dm shows U-shaped relation of BMI to mortality
(Heart 2009;95:454-460. doi:10.1136/hrt.2008.150524)

Not too surprising, a common sense is that extreme, fundamental, or radical ends are not good. But one of the interesting figures (finding) is even obese population (≥45) had lower risk of death than low BMI population (<20 for all-cause death, and <21 for CVD death).

Manifest Destiny is an funny video related to the report of recent stable obesity rate.

This is a good omen. This means that we will see the diabetes prevalence going to reach the platform soon.
_____________________________________________
Obesity rate appears to be stabilizing.

ABC World News (1/13, story 8, 0:20, Stephanopoulos) reported, "New numbers today from the CDC show the rate of obesity stabilizing."
The New York Times (1/14, A20, Belluck) reports that "Americans, at least as a group, may have reached their peak of obesity." The good news is that "the numbers indicate that obesity rates have remained constant for at least five years among men and for closer to 10 years among women and children -- long enough for experts to say the percentage of very overweight people has leveled off." The bad news is that "nearly 34 percent of adults are obese, more than double the percentage 30 years ago," while "the share of obese children tripled during that time, to 17 percent," according to studies published online Jan. 13 in the Journal of the American Medical Association.
The first study "examined height and weight data in a nationally representative sample of 5,555 adult Americans collected in 2007 and 2008," the Los Angeles Times (1/14, Stein) reports. "In the sample, 33.8% of the subjects" were "obese." After comparing "those numbers...to ones collected from 1999 to 2006 in a similar sample," researchers found that "among women, obesity statistics remained fairly flat throughout the period encompassed by the two studies," while "obesity rates among men rose slightly during the decade, but leveled off in the later years."
In the second study of nearly 4,000 children ranging in age from two to 19, the Wall Street Journal (1/14, Dooren) reports, researchers found that 17% of the youngsters met the threshold for obesity and 32% could be deemed to be overweight, a pattern similar to what was seen a decade ago. For both studies, the Journal notes that the CDC researchers based their estimates on data derived from the most recent National Health and Nutrition Examination Surveys.
USA Today (1/14, Hellmich) reports that "William Dietz, director of the CDC's Division of Nutrition, Physical Activity and Obesity, says this may reflect that people are becoming aware of 'the adverse health consequences of obesity' and are adopting healthier habits." Still, when it comes to the impact of obesity on children, Cynthia L. Ogden, PhD, the author of both studies, is concerned, because "obese kids are at a greater risk of weight-related health problems such as high cholesterol, blood pressure, and diabetes, plus they are at a greater risk of becoming obese adults, she says."
Bloomberg News (1/14, Ostrow), the AP (1/14, Tanner), Reuters (1/14, Steenhuysen), Time (1/13, Kluger), HealthDay (1/13, Gordon), &&&WebMD (1/13, DeNoon), and &&&HeartWire (1/13, O'Riordan) also covered the story.

Why Genes Aren't Destiny
 An article from Time

A nice article for understanding the relation of disease and DNA and epigenetic markers

... Biologists offer this analogy as an explanation: if the genome is the hardware, then the epigenome is the software. "I can load Windows, if I want, on my Mac," says Joseph Ecker, a Salk Institute biologist and leading epigenetic scientist. "You're going to have the same chip in there, the same genome, but different software. And the outcome is a different cell type."...

High-Fructose Corn Syrup Linked to Obesity, Diabetes


High-fructose corn syrup (HFCS) is also known as corn syrup, isoglucose and fructose on package labels and has been undergoing scrutiny for the last several years. Back in the '80s, when the low-fat craze started, HFCS began to be added to everything as a relatively easy way to add flavor and moisture to lower-fat products. Seemed like a great idea at the time. Corn is in abundance in the United States, and corn syrup is cheap and easy to add to commercially prepared foods. Little did we know that this type of sugar is digested very differently, and unlike glucose, actually prevents you from feeling full even when you have eaten a lot. Here's how it works: You eat something with HFCS and the sugar goes to your liver for processing. There it gets broken down into smaller components and eventually gets broken down completely. This is how all sugars are managed by the body. The problem is HFCS uses a lot more of the cell's energy to breakdown and leaves the cell with less energy to properly metabolize other foods. In addition, the breakdown products of the process cause an increase in lipid levels and triglycerides in the blood and within the cell itself, causing the fat to fill the cell. HFCS metabolism increases circulating insulin levels significantly and results in insulin resistance (the precursor of adult onset diabetes and metabolic syndrome). Lastly, unlike glucose, HFCS byproducts in the blood send a message to the brain that you are still hungry and need to eat. The more you eat, the more you crave! Most other sugars get stored in the cell, not as fat but as a substance called glycogen that can be easily mobilized for energy when needed, unlike the lipid that is formed from HFCS that is hard to mobilize when needed. HFCS leads to fatty liver, high blood lipids and triglycerides, high blood insulin levels and a continued craving to eat even when the body doesn't need any more calories. This is a recipe for central body obesity, heart disease, diabetes and liver failure from fatty deposits. Interestingly, this is the exact outcome when alcohol is consumed (minus the buzz or drunken feeling). If you drink alcohol too much, you get a "beer belly" (central obesity), fatty liver, heart disease from high triglycerides and lipids, and type 2 diabetes. We wouldn't dream of giving our kids alcohol, but as it turns out, HFCS is metabolized in the exact same way with the same damage done, calorie for calorie. For most adults, some alcohol drinking is OK, but excessive use or abuse can lead to serious long-term physical consequences. The same is true for HFCS. By the way, even though fresh fruit contains fructose, because it is "packaged" with natural fiber, it is digested very differently and doesn't cause these changes. Whole, fresh fruit is healthy, but fruit juices, fruit roll-ups and fruit snacks are devoid of the fiber and therefore no better than candy. I encourage families to spend time reading labels and becoming aware of how ubiquitous this additive is. It is in store-bought bread, crackers, pop, cookies, some lunch meats, fruit juices, packaged chocolate milk, candy, all-natural fruit snacks and many other packaged foods. I am not suggesting you need to completely eliminate it from your life, but I encourage you to decrease the amount your family eats every day.

Dr. Molly O'Shea is a Troy pediatrician. Read Dr. Molly's blog, get answers to your questions and discuss children's health issues at detnews.com/drmolly.

Health News Review - Objective Ratings of Health and Medical Journalism
http://www.healthnewsreview.org/

NHS 2009 Annual Evidence Update on Diabetes and Complication

http://www.library.nhs.uk/Diabetes/ViewResource.aspx?resID=328114

This is the third year of review on diabetes issues.

Colorbrewer: Color Advice for Maps

Colorbrewer: Color Advice for Maps

http://colorbrewer2.org/

Pathogenesis of type 2 diabetes: tracing the reverse route from cure to cause

The metabolic abnormalities of type 2 diabetes can be reversed reproducibly by bariatric surgery. By quantifying the major pathophysiological abnormalities in insulin secretion and insulin action after surgery, the sequence of events leading to restoration of normal metabolism can be defined. Liver fat levels fall within days and normal hepatic insulin sensitivity is restored. Simultaneously, plasma glucose levels return towards normal. Insulin sensitivity of muscle remains abnormal, at least over the weeks and months after bariatric surgery. The effect of the surgery is explicable solely in terms of energy restriction. By combining this information with prospective observation of the changes immediately preceding the onset of type 2 diabetes, a clear picture emerges. Insulin resistance in muscle, caused by inherited and environmental factors, facilitates the development of fatty liver during positive energy balance. Once established, the increased insulin secretion required to maintain plasma glucose levels will further increase liver fat deposition. Fatty liver causes resistance to insulin suppression of hepatic glucose output as well as raised plasma triacylglycerol. Exposure of beta cells to increased levels of fatty acids, derived from circulating and locally deposited triacylglycerol, suppresses glucose-mediated insulin secretion. This is reversible initially, but eventually becomes permanent. The essential time sequence of the pathogenesis of type 2 diabetes is now evident. Muscle insulin resistance determines the rate at which fatty liver progresses, and ectopic fat deposition in liver and islet underlies the related dynamic defects of hepatic insulin resistance and beta cell dysfunction. These defects are capable of dramatic reversal under hypoenergetic feeding conditions, completely in early diabetes and to a worthwhile extent in more established disease.

Qian Xuesen, Tsien Hsue-shen

http://zh.wikipedia.org/wiki/%E9%92%B1%E5%AD%A6%E6%A3%AE
http://en.wikipedia.org/wiki/Tsien_Hsue-shen

Association of A1C and Fasting Plasma Glucose Levels With Diabetic Retinopathy Prevalence in the U.S. Population


... CONCLUSIONS The steepest increase in retinopathy prevalence occurs among individuals with A1C ≥5.5% and FPG ≥5.8 mmol/l. A1C discriminates prevalence of retinopathy better than FPG...

Diagnosis of diabetes using the oral glucose tolerance test

The prevalence of type 2 diabetes varies greatly by ethnic group within and across countries. The most reliable data on the prevalence of diabetes are based on two hour plasma glucose values after an oral glucose tolerance test,¹ which is currently the gold standard epidemiological and clinical diagnostic test for diabetes and impaired glucose tolerance. In Newcastle, England, on the basis of clinical evidence and oral glucose tolerance test results, about 20% of British South Asians had diabetes, compared with only 4% of white Europeans, after age adjustment in a sample of 25-74 year olds.² Might such observed differences in prevalence, at least in part, be artefacts of the diagnostic method?

In 1965, the World Health Organization expert committee drew attention to the "lack of suitable epidemiological information about glucose tolerance in various populations of various races and cultures in different countries"³ and highlighted the need for research in different populations. The call was repeated in 1980,¹ with special reference to the oral glucose tolerance test and the dose of glucose, with 75 g being recommended pending further investigations. The International Diabetes Federation in consultation with WHO and the American Diabetes Association (ADA) have raised similar concerns, particularly about the oral glucose tolerance test.^{4 5} With a 75 g dose, a venous plasma glucose value of 11.1 mmol/l or more is indicative of diabetes, as indicated by its association with complications such as retinopathy. A value of 7.8-11.0 mmol/l is indicative of impaired glucose tolerance. Yet these concerns have not been dealt with.
The prevalence of diabetes is increasing worldwide, and accurate testing is more important than ever. The best way to make a diagnosis has been debated for decades,^{1 3 4 5} and more guidance is imminent. In some ethnic groups, comparatively low fasting plasma glucose concentrations are seen in people who have two hour postload glucose values that are diagnostic for diabetes.⁶
In the light of these concerns it is vital to know whether the 75 g carbohydrate load is appropriate for all adults, regardless of ethnicity. Glucose tolerance is influenced by several factors—from genetics, to body build (height and weight), to diet and lifestyle. Differences in body composition and skeletal muscle mass are important determinants of postprandial glucose metabolism, and height measurement partly reflects such differences.
An independent inverse association with two hour plasma glucose after the oral glucose tolerance test has been repeatedly shown for height in diverse populations.^{7 8} In a study of the prevalence of type 2 diabetes in white Europeans, African-Caribbeans, and Pakistanis, height almost completely accounted for ethnic differences in two hour plasma glucose in multiple regression models. Pakistanis, in whom the prevalence was the greatest, were markedly shorter (by 2-5 cm) than people in other ethnic groups.⁷ The implications of these findings are that a uniform oral glucose load may not accurately assess glucose tolerance across populations,¹ and a high two hour plasma glucose after the oral glucose tolerance test may overdiagnose impaired glucose tolerance in some ethnic groups compared with white populations.
Other factors related to body composition that vary by ethnicity may also be important. Varying the glucose load, as is done in children, or adjusting the results according to ethnicity or height (or both), may improve measures of glucose tolerance. These general observations could have wider implications in explaining inequalities. Impaired fasting glucose is more prevalent in men, whereas impaired glucose tolerance is more prevalent in women.⁹ Women are generally shorter than men, so this difference could simply reflect height differences by sex.
Whereas height has been shown to have a marked association with two hour plasma glucose after the oral glucose tolerance test, fasting plasma glucose and glycated haemoglobin measurements vary very little with height or sex.^{8 10} We should consider whether the oral glucose tolerance test can be replaced with other measures, such as glycated haemoglobin, in everyday clinical practice. This was a topic of debate at this year’s ADA annual conference in New Orleans, and work is already under way to standardise the measurement of glycated haemoglobin. However, as with the oral glucose tolerance test, the validity of glycated haemoglobin needs to be shown across ethnic groups before it is accepted and implemented.
WHO’s warnings in 1965 about the validity of the oral glucose tolerance test across various populations were prescient and deserve continuing attention. The uniform size of the oral glucose load used in this test, even though body size and composition vary, may account for some of the variation in the prevalence of diabetes between men and women and different ethnic groups. Nonetheless, the excess of diabetes in South Asians is marked using other criteria, such as those based on fasting glucose used by the ADA.¹¹ The complications of diabetes, such as retinopathy and nephropathy, are also greater in South Asians.¹²
Clinicians must be confident that the key tests for diabetes or impaired glucose tolerance are accurate, because the consequences of these diagnoses are considerable and lifelong. Although a false positive result might lead to good advice about diet and exercise, it could also provoke anxiety and adoption of the sick role. A false negative result is potentially dangerous in view of the high levels of cardiovascular diseases and renal dysfunction in South Asians. We must always establish the validity of diagnostic tests across sexes, age groups, and ethnic groups. This still applies to the oral glucose tolerance test and its likely successor, the measurement of glycated haemoglobin.
Cite this as: BMJ 2009;339:b4354

Open and free courses

Open and free courses
http://oli.web.cmu.edu/openlearning/forstudents/freecourses
Carnegie Mellon’s Open Learning Initiative (OLI) Meets with Bill Gates
Bill Gates, chairman of Microsoft Corp. and co-chair and trustee of the Bill & Melinda Gates Foundation came to Carnegie Mellon University on Tuesday, September 22, for the dedication of the Gates and Hillman Centers at the Pittsburgh campus. As part of his campus visit, Gates, accompanied by Foundation Senior Program Officer Josh Jarrett and Microsoft Corporate Vice President Anoop Gupta, met for nearly 90 minutes with the Open Learning Initiative (OLI) team to discuss the past, present, and future of the project as it moves forward under support from the Bill and Melinda Gates Foundation. CMU personnel in attendance were Provost Mark Kamlet, Vice Provost and CIO Joel Smith, Director of OLI Candace Thille, Director of the Pittsburgh Science of Learning Center Kenneth Koedinger and OLI Senior Software Engineers John Rinderle and Bill Jerome.
A brief presentation by Thille highlighted OLI’s unique approach of applying learning science research results and methods to open course design and then collecting data to continuously improve the learning experience--a combination that has been drawing increasingly positive attention from a variety of sources. Discussion then centered around the possibilities and challenges inherent in the potential for rapid growth of the initiative, with a particular emphasis on possible ways to overcome technical, organizational, and cultural barriers to scale.
“The opportunity to discuss with Bill Gates what we’ve accomplished and get his advice first-hand is truly a privilege and an honor,” said Thille. Later that day, in his keynote address celebrating the opening of the Gates Center for Computer Science and the Hillman Center for Future Generation Technologies, Gates referred to OLI as “an amazing and critical piece of work. . . . The idea of these virtual labs and intelligent tutoring systems, I think, can really revolutionize education. And we need to revolutionize education.”

Online - Diabetes in America, 2nd Edition

Diabetes in America, 2nd Edition, is a 733-page compilation and assessment of epidemiologic, public health, and clinical data on diabetes and its complications in the United States. It was published by the National Diabetes Data Group of the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD. The book contains 36 chapters organized in five areas:
1) the descriptive epidemiology of diabetes in the United States based on national surveys and community-based studies, including prevalence, incidence, sociodemographic and metabolic characteristics, risk factors for developing diabetes, and mortality.
2) the myriad complications that affect patients with diabetes.
3) characteristics of therapy and medical care for diabetes.
4) economic aspects, including health insurance and health care costs.
5) diabetes in special populations, including African Americans, Hispanics, Asian and Pacific Islanders, Native Americans, and pregnant women.
Diabetes in America, 2nd Edition, has been designed to serve as a reliable scientific resource for assessing the scope and impact of diabetes and its complications, determining health policy and priorities in diabetes, and identifying areas of need in research. The intended audience includes health policy makers at the local and Federal levels who need a sound quantitative base of knowledge to use in decision making; clinicians who need to know the probability that their patients will develop diabetes and the prognosis of the disease for complications and premature mortality; persons with diabetes and their families who need sound information on which to make decisions about their life with diabetes; and the research community which needs to identify areas where important scientific knowledge is lacking.

Education Matters for Health

 

Education Matters for Health

Robert Wood Johnson Fdn, September 9, 2009

Education can influence health in many ways. This issue brief, prepared by the Robert Wood Johnson Foundation Commission to Build a Healthier America, examines three major interrelated pathways through which educational attainment is linked with health­health knowledge and behaviors; employment and income; and social and psychological factors, including sense of control, social standing and social support. In addition, this brief explores how educational attainment affects health across generations, examining the links between parents’ education­and the social and economic advantages it represents­and their children’s health and social advantages, including opportunities for educational attainment.

http://www.rwjf.org/pr/product.jsp?id=48252

Report: S, Braveman P, Sadegh-Nobari T, Grossman-Kahn R and Dekker M. Education Matters for Health. Issue Brief 6: Education and Health. Commission to Build a Healthier America. Robert Wood Johnson Foundation. Sep 2009.

http://www.rwjf.org/files/research/commission2009eduhealth.pdf To leave, manage or join list: https://listserv.yorku.ca/cgi-bin/wa?SUBED1=sdoh&A=1