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| English: > 30% 25% to 20% to 15% to 10% to No Data Percent of people per state with a BMI greater than 30 from 1986. Date from: Obesity and Overweight for Professionals: Data and Statistics: U.S. Obesity Trends. Centers for Disease Control and Prevention (). Retrieved on . (Photo credit: Wikipedia) |
by Tyrone M. Reyes, M.D.
The terms may differ some experts call it diabesity, while others prefer to call it cardiometabolic disease or metabolic syndrome. But the same problems underlie it all: insulin resistance and obesity, specifically abdominal obesity. According to research presented at the annual meeting of the American Diabetes Association (ADA) last June, half of all American adults are now at risk for developing type 2 diabetes (and heart disease) because of the connection between excess abdominal fat and insulin resistance, the precursor to full-blown diabetes. A new study from Canada found that having type 2 diabetes confers a risk of having a heart attack equivalent to prematurely aging 15 years.
Big Belly, Bigger Risk
The culprit is fat cells, particularly those accumulating around your belly. “Fat cells, especially abdominal fat, produce excess hormones that affect insulin uptake by cells and tissues, causing insulin resistance, raising blood pressure, and increasing inflammation throughout the body,” explains Dr. Louis J. Aronne, director of the Comprehensive Weight Management Program at New York Presbyterian-Weill Cornell Medical Center. “Abdominal obesity leads to increased fat in the liver, which also drives insulin resistance. Increased fat in muscle tissue leads to resistance to insulin in these tissues.” (See figure.)
Women who gain weight around their abdomen at menopause are at particular risk. “They often develop insulin resistance and other risk factors such as high triglycerides and low levels of ‘good’ HDL, factors that are shown to be incrementally additive when it comes to predicting heart attack risk,” says Dr. Aronne.
Age plays a role. “As people get older, the pancreas’ ability to produce insulin diminishes,” says Dr. Carol J. Levy, assistant professor of medicine at the Weill Medical College of Cornell University. “The pancreas may not be able to keep up with increased stresses, like obesity. This may tip a person over the edge into type 2 diabetes. Your risk of developing diabetes is elevated if you have an impaired fasting glucose between 100 and 125 mg/dL, indicating insulin resistance.
Body mass index (BMI) can function as a crystal ball for predicting diabetes risk. Compared to a normal-weight 18-year-old person, whose lifetime risk of diabetes is just 17 percent, an overweight individual’s risk is more than doubled (to 35 percent). An obese person’s risk of type 2 diabetes is more than tripled (to 54 percent) that of a normal-weight person, and a morbidly obese individual is more than quadrupled (to over 74 percent), according to a study of adults aged 18-84 by the Centers for Disease Control and Prevention reported at the June 2006 meeting of the American Diabetes Association (ADA).
The Heart Disease Connection
When blood sugar rises out of control, it damages blood vessels and can trigger heart attacks and strokes. Even before you develop full-blown diabetes, your risk of heart disease increases once you have impaired fasting glucose — a condition now called prediabetes. Prediabetes is defined as having blood glucose levels between 100 and 125 mg/dL; diabetes is diagnosed when glucose levels exceed 126 mg/dL. Once a person is definitely diagnosed with type 2 diabetes, the risk of suffering a heart attack is not only greater but also increases earlier. A Canadian study, reported in the July 1, 2006 issue of Lancet, followed 379,003 people with diabetes and 9,018,082 people without the disease living in Ontario for 16 years. Those with diabetes entered a high-risk category for suffering a heart attack at an average age of 54, almost 15 years earlier than they would have due to normal aging. Another large population study, reported in the May 3, 2006 issue of the Journal of the American College of Cardiology, found that having diabetes put people at greater risk of dying of heart disease than having a prior heart attack.
How large the risk?
Your risk of diabesity depends in large part on factors such as waist circumference, according to the January 2006 Journal of Women’s Health. In the study of 7,000 women, aged 18-93 years old with no known heart disease or diabetes, women with a waist circumference greater than 35 inches were more apt to have insulin resistance and metabolic syndrome. Another study presented at the ADA conference, conducted among 3,000 men and women, aged 20-75 with impaired fasting glucose but without a diagnosis of diabetes, found that 28 percent had prediabetes and more heart disease risk factors compared to adults whose glucose levels were normal. Those factors include obesity (particularly a wide waist circumference), high blood pressure, elevated total cholesterol, high LDL, the “bad” cholesterol, high triglycerides, and low HDL, the “good” cholesterol — all part of the cardiometabolic syndrome.
The constellation of risk factors that makes up the cardiometabolic syndrome is additive — the more you have, the greater the risk for a heart attack, say experts like Dr. Aronne. Insulin resistance poses other health threats as well — such as an increased risk of stroke, endometrial cancer (cancer of the uterus), and Alzheimer’s disease.
Breaking The Cycle
The best way to reduce your risk of developing type 2 diabetes (and cardiovascular disease) is to lose weight and to keep it off, according to a study in the February 7, 2006 New England Journal of Medicine. The study randomly assigned 3,200 nondiabetics with elevated blood glucose to a placebo metformin (a drug given to lower blood glucose in type 2 diabetics), or a lifestyle modification program of diet and exercise (at least 150 minutes weekly) designed to lose at least seven percent of body weight. The lifestyle intervention reduced the incidence of diabetes in high risk individuals by 58 percent and was more effective than metformin. Low-fat dairy products may also help. Data from the Women’s Health Study, which followed more than 37,000 women for over a decade, showed those women with the highest intake of low-fat dairy foods were 21 percent less likely to develop type 2 diabetes than those with the lowest intake. Researchers from the University of California Los Angeles School of Public Health reported in the July 2006 issue of Diabetes Care that for every extra daily serving of dairy foods, people had a four percent lower risk of type 2 diabetes.
“The most important step you can take to reduce your risk of developing diabesity and heart disease is to avoid gaining weight in the first place,” says Dr. Aronne. “When obese people lose even small amounts of weight, they have a tremendous improvement in their blood sugar and in many of the other complications we see in obesity. The reason seems to be that fat in the liver, which is a key factor in insulin resistance, is the first fat mobilized. Losing weight mobilizes fat in the liver and leads to an improvement in insulin resistance.”
What You Can Do
To reduce diabesity and your risk of type 2 diabetes, here is what you can do:
• Try the Mediterranean diet. A systematic review of 43 studies on the Mediterranean diet, published in the February 2006 Nutrition Review, found that the diet favorably influenced diabetes, cardiovascular disease, and body composition in obese people who had a previous heart attack. The diet includes monounsaturated fats such as olive oil, lean protein, low or nonfat dairy foods, and high-fiber foods like lentils and beans, as well as fruits and vegetables.
• Limit refined carbohydrates and increase fiber. Refined carbs are processed by the body more quickly than complex carbohydrates, such as whole grains, leading to higher blood glucose levels. Some studies show high intake of refined carbs may be involved in insulin resistance.
• Boost your metabolism and calorie burn with weight training and aerobic exercise. Performing moderate to vigorous aerobic and resistance exercise at least four hours per week is associated with improved blood glucose and cardiovascular disease risk reduction, according to new guidelines from the ADA. Seven hours per week of exercise is recommended to maintain weight loss.
Thus, weight loss, a healthful diet, and exercise are the three cornerstones of diabesity prevention. So follow the advice of experts and practice a healthy lifestyle if you want to live longer.
Source: Philippine Star
[...] Diabesity: Are you at risk? By Von Your risk of diabesity depends in large part on factors such as waist circumference, according to the January 2006 Journal of Women?s Health. In the study of 7000 women, aged 18-93 years old with no known heart disease or diabetes, … Health News Update - http://enervon.com/ [...]
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The findings dovetail with trends seen in obesity and lack of exercise - two health measures where Southern states also rank at the bottom.
"It isnt surprising the problem is heaviest in the South - no pun intended," agreed Matt Petersen, who oversees data and statistics for the American Diabetes Association.
The study, led by Karen Kirtland of the Centers for Disease Control and Prevention, provides an up-to-date picture of where the disease is exploding.
Sonographer - Weill Medical College of Cornell University - Career ...: Founded in 1898, and affiliated with wha...
ReplyDelete[...] body weight is never impossible if one has the determination and patience needed to stabilize the metabolism level, which plays an important role in weight loss. A person needs to realize that eating right and [...]
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