Exercise In A Pill

July 31, 2008 (Press Release) - Trying to reap the health benefits of exercise? Forget treadmills and spin classes, researchers at the Salk Institute for Biological Studies may have found a way around the sweat and pain. They identified two signaling pathways that are activated in response to exercise and converge to dramatically increase endurance.

The team of scientists, led by Howard Hughes Medical Investigator Ronald M. Evans, Ph.D., a professor in the Salk Institute's Gene Expression Laboratory report in the July 31 advance online edition of the journal Cell that simultaneously triggering both pathways with oral drugs turned laboratory mice into long-distance runners and conferred many of exercise's other benefits.

In addition to their allure for endurance athletes, drugs that mimic the effects of exercise have therapeutic potential in treating certain muscle diseases, such as wasting and frailty, as well as obesity and a slew of associated metabolic disorders where exercise is known to be beneficial.

Previous work with genetically engineered mice in the Evans lab had revealed that permanently activating a genetic switch known as PPAR delta turned mice into indefatigable marathon runners. In addition to their super-endurance, the altered mice were resistant to weight gain, even when fed a high-fat diet that caused obesity in ordinary mice. On top of their lean and mean physique, their response to insulin improved, lowering levels of circulating glucose.

"We wanted to know whether a drug specific for PPAR delta would have the same beneficial effects," says Evans. "Genetic engineering in humans, commonly known as gene doping when mentioned in connection with athletic performance, is certainly feasible but very impractical."

An investigational drug, identified only as GW1516 (and not commercially available), fit the bill. When postdoctoral researcher and lead author Vihang A. Narkar, Ph.D., fed the substance to laboratory mice over a period of four weeks, the researchers were in for a surprise.

"We got the expected benefits in lowering fatty acids and blood glucose levels but no effect, absolutely none, on exercise performance," says Narkar. Undeterred, he put mice treated with GW1516 on a regular exercise regimen and every day had them run up to 50 minutes on a treadmill.

Now the exact same drug that had shown no effect in sedentary animals improved endurance by 77 percent over exercise alone and increased the portion of "non-fatiguing" or "slow twitch" muscle fibers by 38 percent. The result, while very dramatic, gave rise to a vexing question: Why is exercise so important?

First and foremost, exercise depletes muscles' energy store, a chemical known as ATP. In times of high demand, ATP releases all its energy and forms AMP. Rising AMP levels alert AMPK, a metabolic master regulator, which acts like a gas gauge that the cell is running on empty and revs up the production of ATP. "That led us to consider whether AMPK activation was the critical trigger that allowed PPAR delta to work," recalls Narkar.

Usually, AMPK can be found in the cytoplasm, the compartment that surrounds the nucleus, but the Salk researchers' experiment revealed that some exercise-activated AMPK molecules slip into the nucleus. There they physically interact with PPAR delta and increase its ability to turn on the genetic network that increases endurance.

"It essentially puts a turbo charge on PPAR delta, which explains why exercise is so important," says Evans.

Then came the ultimate couch potato experiment. The researchers fed untrained mice AICAR, a synthetic AMP analog that directly activates AMPK. After only four weeks and without any prior training, these mice got up and ran 44 percent longer than untreated, untrained mice. "That's as much improvement as we get with regular exercise," says Narkar.

"Exercise in a pill" might sound tempting to couch potatoes and Olympic contenders alike, but the dreams of the latter might be cut short. Evans developed a test that can readily detect GW1516 and its metabolites as well as AICAR in blood and urine and is already working with officials at the World Anti-Doping Association, who are racing to have a test in place in time for this year's Summer Olympics.

The study was supported by the Howard Hughes Medical Institute, the Hillblom Foundation and the National Institute of Health.

Researchers who contributed to the work include postdoctoral researchers Michael Downes, Ph.D., Ruth T. Yu, Ph.D., doctoral candidate Emi Embler, B.S., research associates Michael C. Nelson, B.S., Yuhua Zou, M.S., Ester Banayo, and Henry Juguilon, in the Gene Expression Laboratory, doctoral candidate M. Mihaylova, and assistant professor Reuben Shaw, Ph.D., in the Molecular and Cell Biology Laboratory, assistant professor Yong-Xu Wang, Ph.D., at the University of Massachusetts Medical School, Massachusetts, and professor Heonjoon Kang, Ph.D., at the School of Earth and Environmental Sciences, Seoul National University, South Korea.

The Salk Institute for Biological Studies in La Jolla, California, is an independent nonprofit organization dedicated to fundamental discoveries in the life sciences, the improvement of human health and the training of future generations of researchers. Jonas Salk, M.D., whose polio vaccine all but eradicated the crippling disease poliomyelitis in 1955, opened the Institute in 1965 with a gift of land from the City of San Diego and the financial support of the March of Dimes.

Posted by dlife at 07:01 PM | Comments (2)

Drinking in Excess Associated with Increased Risk for Metabolic Syndrome

July 31, 2008 (Newswise) - Those who drink in excess of the U.S. Dietary Guidelines (i.e., men who usually drink more than two drinks per day or women who usually drink more than one drink per day) or those who binge drink are at increased risk for the metabolic syndrome, according to a new study accepted for publication in The Endocrine Society’s Journal of Clinical Endocrinology & Metabolism (JCEM).

The metabolic syndrome consists of a series of risk factors and conditions that are strongly related to cardiovascular disease, the leading cause of death in the United States. These conditions include obesity, high blood pressure, and diabetes.

“These findings are significant because the National Health and Nutrition Examination Survey shows 58 percent of all current drinkers in the United States reported usual alcohol consumption that exceeded the Dietary Guidelines, and 52 percent of all current drinkers reported at least one episode of binge drinking in the past year," said Amy Fan, M.D., Ph.D., of the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), in Atlanta, Ga., and lead author of the study. “Most people who consume alcohol in the United States drink in ways that may increase their risk of the metabolic syndrome and related conditions.”

For this study, Dr. Fan and other researchers evaluated data from 1,529 participants of the 1999-2002 National Health and Nutrition Examination Survey. They restricted their analysis to current drinkers (participants who consumed at least 12 alcoholic drinks in 12 months) aged 20 to 84 years. The survey included both an interview and a physical examination that included a blood test. Measures of alcohol consumption included usual quantity consumed, drinking frequency, and frequency of binge drinking.

“Since more than half of current drinkers in our study drank in excess of the Dietary Guidelines limits and reported binge drinking, prevention efforts should focus on reducing alcohol consumption to safer levels,” said Dr. Fan. “Unfortunately, few physicians screen their patients about alcohol use or are knowledgeable about guidelines that define low-risk or moderate drinking.”

Dr. Fan went on to say that public health messages should emphasize the potential cardiometabolic risk associated with drinking in excess of national guidelines and binge drinking.

Other researchers working on the study include Timothy Naimi, Yan Li, Youlian Liao, Ruth Jiles, and Ali Mokdad of the National Center for Chronic Disease Prevention and Health Promotion, CDC, in Atlanta, Ga., and Marcia Russell of the Pacific Institute for Research and Evaluation in Berkeley, Calif.

The article “Patterns of Alcohol Consumption and the Metabolic Syndrome,” will appear in the October issue of JCEM, a publication of The Endocrine Society.

Posted by dlife at 04:14 PM | Comments (0)

New Uses For Old-Line Diabetes Monitoring Test: Screening And Diagnosis

July 31, 2008 (EurekAlert) - A blood test currently used as the gold standard for monitoring people already under care for diabetes may have far wider use in identifying millions with undetected diabetes, a team led by a Johns Hopkins physician suggests.

The hemoglobin A1c test (HbA1c), based on a blood sample, is widely used to keep tabs on how well confirmed diabetics keep their blood sugar, or glucose, in check by showing how much glucose red blood cells have been exposed to for the past 120 days, the average lifespan of these cells.

"The test is a measure of long-term glucose control, but doctors don't typically use it to screen for or diagnose the disease, " says Christopher Saudek, M.D., professor of endocrinology and metabolism at the Johns Hopkins University School of Medicine and director of the Johns Hopkins Comprehensive Diabetes Center. "There's reason to believe it could help identify many of the estimated six million people in the U.S. who have diabetes but don't know it," he adds. The current screening and diagnostic tests measure only the amount of sugar present at the moment that blood sample is taken. Consequently, Saudek says, these tests are accurate only if patients fast for at least 10 hours before the test because glucose concentrations can vary greatly depending on a person's recent meals.

Even then, explains Saudek, the tests miss a significant portion of people who have diabetes or are at high risk to develop the disease since glucose also varies depending on a person's diet and exercise regimen for several days leading up to the blood draw.

"If a patient is scheduled for a physical, he or she may 'tune up' by changing their regimen for a few days and throw off their test results, causing doctors to miss the patient's usual pattern of high blood sugar," he says.

In a consensus statement published in the July Journal of Clinical Endocrinology and Metabolism, Saudek and his colleagues conclude that the HbA1c test should be used as a front-line method for identifying patients with diabetes, especially for those at high risk for the disease. Since the test does not require fasting and isn't affected by short-term changes in diet and exercise, the HbA1c test has significant advantages to current testing methods.

The consensus was reached by a group of diabetologists, pathologists and internists seeking to improve detection methods because of the serious consequences of untreated diabetes for patients and public health. They met recently in Chicago with financial support from Metrika Inc., a major manufacturer of diabetes testing equipment. The panel deliberations and manuscript preparation were made independently of the sponsor, according to its members.

After reviewing relevant published studies and available tests, the national panel recommended that individuals who score at least 6 percent on an HbA1c test may have or be at risk for diabetes and should be tracked with additional glucose or HbA1c tests. Those who score between 6.5 percent or above, if confirmed, should be considered to have diabetes.

"This is a first step towards changing medical practice," notes Saudek, and "could greatly enhance how well we're able to identify people with diabetes."

Posted by dlife at 10:20 AM | Comments (1)

National Birth Defects Prevention Study Finds Pre-pregnancy Diabetes Increases Risk for Multiple Types of Birth Defects

July 30, 2008 (CDC Press Release) - Women who receive a diagnosis of diabetes before they become pregnant are three to four times more likely to have a child with one or even multiple birth defects than a mother who is not diabetic, according to a study by the Centers for Disease Control and Prevention (CDC), released in the American Journal of Obstetrics and Gynecology.

The article from the National Birth Defects Prevention Study (NBDPS), “Diabetes Mellitus and Birth Defects,” shows that pregnant women with pre-gestational diabetes mellitus (pre-pregnancy diagnosis of diabetes, such as type 1 or type 2 diabetes) are more likely than a mother with no diabetes or a mother with gestational diabetes mellitus (pregnancy-induced diabetes) to have a child with various types of individual or multiple birth defects. This includes heart defects, defects of the brain and spine, oral clefts, defects of the kidneys and gastrointestinal tract and limb deficiencies. This study is the first to show the broad range and severity of birth defects associated with type 1 and type 2 diabetes.

“The continued association of diabetes with a number of birth defects highlights the importance of increasing the number of women who receive the best possible preconception care, especially for those women diagnosed with diabetes,” says Adolfo Correa, M.D., M.P.H., Ph.D., lead author and epidemiologist at CDC’s National Center on Birth Defects and Developmental Disabilities. “Early and effective management of diabetes for pregnant women is critical in helping to not only prevent birth defects, but also to reduce the risk for other health complications for them and their children.”

Researchers also found that some of the pregnant women with gestational diabetes were more likely to have a child with birth defects. Because birth defects associated with diabetes are more likely to occur during the first trimester of pregnancy and before a diagnosis of gestational diabetes is made, the observed associations suggest that some of the mothers with it probably had undiagnosed diabetes before they became pregnant. However symptoms went unnoticed until pregnancy.

Further, the associations of gestational diabetes with various birth defects were noted primarily among women who had pre-pregnancy obesity, which is a known risk factor for both diabetes and birth defects. Preconception care also should be considered and promoted for women with pre-pregnancy obesity to prevent birth defects and reduce the risk for health complications.

The NBDPS is a population-based, case-control study that incorporates data from nine birth defect centers in the United States—Arkansas, California, Georgia, Iowa, Massachusetts, New York, North Carolina, Texas and Utah. These centers have been working on the largest study of birth defects causes ever undertaken in the United States. Researchers have gathered information from more than 30,000 participants and are using this information to look at key questions on potential causes of birth defects.

Birth defects affect one in 33 infants and are a leading cause of infant mortality. For some birth defects, some risk factors or causes have been identified; however, for the majority of birth defects the causes remain unknown.

In the United States, the prevalence of gestational diabetes has been increasing in recent years and currently affects about seven percent of all pregnancies, resulting in more than 200,000 cases annually. While it is usually resolved shortly after delivery, women who have had gestational diabetes are at increased risk of developing type 2 diabetes in the future.

For more information about birth defects, please visit http://www.cdc.gov/ncbddd/bd/facts.htm. For more information on diabetes, please visit http://www.cdc.gov/diabetes/, or call toll-free 1-800-CDC-INFO.

Posted by dlife at 02:22 PM | Comments (1)

Women With Gestational Diabetes At Risk Of Type 2 Diabetes

July 29, 2008 (Science Daily) - Women with gestational diabetes are at greater risk of developing type 2 diabetes, with almost 20% of women developing the condition within 9 years of pregnancy, found a large, population-based study of 659,000 women published in the Canadian Medical Association Journal.

The study, conducted by a group of researchers from the University of Toronto, Mount Sinai Hospital and the Institute for Clinical and Evaluative Sciences, looked at 21,823 women diagnosed with gestational diabetes and examined follow up records up to 9 years. They found the rate of diabetes increased rapidly in the first 9 months after delivery, peaking at 9 years.

"In this large, population-based study, we found that diabetes developed within 9 years after the index pregnancy in 18.9% of women with previous gestational diabetes; this rate was much higher than the rate among women without gestational diabetes (2%)," state Dr. Denice Feig and coauthors.

As well, they note that the rate of gestational diabetes in Ontario, the study province, seems to be increasing and is linked to older mothers. Living in low-income neighbourhoods and in urban areas were also risk factors for gestational diabetes. Higher urban statistics "may reflect the large numbers of South and East Asian and black populations living in urban areas, who have a higher risk of type 2 diabetes," postulate Dr. Feig and colleagues.

"The main strength of our study lies in the fact that it was a large population-based study involving more than 21,000 women with gestational diabetes, with up to 9 years of follow-up," state the researchers. "Unlike other studies, it covered a large, well-defined geographic region with a population of 13 million, which allowed us to make a more robust assessment of the risk of type 2 diabetes after gestational diabetes than has been possible in previous studies."

However, the study could not "assess the effect of ethnicity, obesity and level of fasting glucose during pregnancy, risk factors that are clearly associated with the development of diabetes."

"These women may benefit from both preventative interventions and regular screening," conclude the researchers who point out that physicians and policy makers need to counsel and screen these women accordingly.

In a related commentary, Dr. David Simmons of Cambridge University Hospitals NHS Foundation in the UK comments that many women with gestational diabetes become pregnant again, leading to potential risks for the fetus. "Type 2 diabetes in pregnancy, particularly if previously undiagnosed, is associated with poor outcomes, including an increased incidence of fetal loss, malformation and perinatal death." He argues for more investment in prevention and screening programs for at-risk women to protect women and their future children.

Posted by dlife at 10:38 AM | Comments (0)

Study Links Soft Drinks And Fruit Drinks With Risk For Diabetes In African-American Women

July 28, 2008 (EurekAlert) - Researchers from Boston University's Slone Epidemiology Center have found that regular consumption of sugar-sweetened soft drinks and fruit drinks is associated with an increased risk for type 2 diabetes in African-American women. These findings appear in the July 28 issue of Archives of Internal Medicine.

Type 2 diabetes, a leading cause of morbidity and mortality in the United States, has increased in incidence in recent years, while the age of diagnosis has dropped. Type 2 diabetes is a particular problem among U.S. black women, as their incidence rate is twice that of U.S. white women.

In questionnaires mailed to participants of the Black Women's Health Study (an ongoing prospective study of 59,000 African-American women from all parts of the U.S.) the researchers obtained information on height, weight, demographic characteristics, medical history, usual diet and other factors. Follow-up questionnaires that requested updated information on lifestyle factors, occurrences of diabetes and other serious illnesses were mailed to participants every two years.

The researchers found 2,713 participants developed diabetes during the first ten years of follow-up in the study. The incidence of type 2 diabetes rose with increasing intake of both sugar-sweetened soft drinks and fruit drinks. Women who consumed two or more soft drinks a day had a 24 percent increase in incidence of relative to women who drank less than one soft drink per month. A similar association was observed for sweetened fruit drinks, with a 31 percent increase observed for two or more servings per day relative to less than one per month.

The researchers note that while there has been increasing public awareness of the adverse health effects of soft drinks, little attention has been given to fruit drinks, which often are marketed as a healthier alternative to soft drinks.

"Fruit drinks were consumed more frequently than soft drinks in our study, and the proportion of total energy intake from fruit drinks in the U.S. population doubled from 1977 to 2001," said lead author Julie Palmer, ScD, a professor of epidemiology at Boston University School of Public Health. "The public should be made aware that these drinks are not a healthy alternative to soft drinks with regard to risk of type 2 diabetes," she added.

Posted by dlife at 09:14 AM | Comments (4)

Compound That Helps Rice Grow Reduces Nerve, Vascular Damage From Diabetes

July 28, 2008 (EurekAlert) - You may want to soak your brown rice.

Researchers have found that a compound that helps rice seed grow, springs back into action when brown rice is placed in water overnight before cooking, significantly reducing the nerve and vascular damage that often result from diabetes.

"You have to let it grow, germinate a little bit," says Dr. Robert K. Yu, director of the Institute of Molecular Medicine and Genetics and Institute of Neuroscience at the Medical College of Georgia. "Some of the active ingredients generated as a result of the germination process are beneficial to you."

Germinated brown rice's ability to help diabetics lower their blood sugar has been shown but how it works remained unknown. New research, published online in the Journal of Lipid Research, shows the growth factor acylated steryl glucosides or ASG, helps normalize blood sugar and enzymes that are out-of-whack in diabetes.

"The advantage of knowing this key ingredient and its structure is we can now make a ton of it; you don't have to rely on rice to produce it or eating rice to get this beneficial effect," says Dr. Yu, the paper's corresponding author.

Studies were done in animal models of type 1 diabetes with two different blood sugar levels that reflect patients' varying blood sugars. They were fed diets of white, brown or pre-germinated brown rice. Unlike white rice, less-processed brown rice still has some of the germ or growth structure that, after about 24 hours in water, resumes activity. Scientists watched as the resurrected ASG, a growth factor and lipid, helped normalize metabolism.

"When blood sugar levels increase, the metabolic balance changes," says Dr. Seigo Usuki, neurobiologist in the MCG School of Medicine and the paper's first author. "Part of the way we know this growth factor works is by increasing levels of good enzymes that are decreased in diabetes."

Dr. Usuki is talking about enzymes such as ATPase, which help maintain nerve membranes so they can conduct electricity and communicate. Decrease of ATPase is a hallmark of the nerve damage that accompanies diabetes. Also reduced in diabetes is homocysteine-thiolactonase, or HTase, an enzyme that decreases levels of homocysteine, a known risk factor for vascular disease. The liver produces a low level of homocysteine but that level is elevated in diabetes while the enzyme that controls it decreases. Unchecked, homocysteine makes oxidative stress compounds that injure and kill cells. HTase is one way HDL, the so-called "good cholesterol," helps protect blood vessels from disease. A regular diet of pre-germinated brown rice diet helps get both back to a healthier level.

Fancl Hatsuga Genmai Co., Ltd., in Yokohama, Japan, which funded the studies and supplied the pre-germinated rice, already is working with Dr. Usuki on a supplement that can provide consumers who prefer not to soak – or eat – rice with the benefits of ASG.

The MCG research team reported in December 2007 in Nutrition & Metabolism that pre-germinated brown rice was better at protecting nerves from diabetes than un-soaked brown or white rice. They showed a then-unidentified lipid helped protect the nerve membrane and increase activity of HTase and the good cholesterol. Germination also is known to increase levels of the neurotransmitter GABA, which is believed to have many beneficial health effects such as lowering blood pressure, improving cognition and lowering blood glucose levels. However the MCG scientists have shown the lipid has a more powerful impact on HTase activity.

The germ layer activated by soaking brown rice contains many vitamins and minerals in addition to the bioactive ingredient that would be beneficial to everyone, Dr. Yu says. The roughage of the rice grain also is helpful.

Posted by dlife at 09:10 AM | Comments (2)

Study Clarifies Amount of Exercise Needed to Keep Weight Off

July 25, 2008 (Newswise) - In addition to limiting calories, overweight and obese women may need to exercise 55 minutes a day for five days per week to sustain a weight loss of 10 percent over two years, according to a report in the July 28 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

More than 65 percent of U.S. adults are overweight, a public health concern, according to background information in the article. “Among obese adults, long-term weight loss and prevention of weight regain have been less than desired,” the authors write. “Therefore, there is a need for more effective interventions.” Current recommendations prescribe 30 minutes of moderate physical activity on most days of the week, for a total of 150 minutes per week. However, a growing consensus suggests that more exercise may be needed to enhance long-term weight loss.

To calculate the amount of exercise needed, John M. Jakicic, Ph.D., of the University of Pittsburgh, and colleagues enrolled 201 overweight and obese women in a weight loss intervention between 1999 and 2003. All the women were told to eat between 1,200 and 1,500 calories per day. They were then assigned to one of four groups based on physical activity amount (burning 1,000 calories vs. 2,000 calories per week) and intensity (moderate vs. vigorous). Group meetings focusing on strategies for modifying eating and exercise habits, as well telephone calls with the intervention team, also were conducted over the two-year period.

After six months, women in all four groups had lost an average of 8 percent to 10 percent of their initial body weight. However, most were not able to sustain this weight loss. After two years the women’s weight was an average of 5 percent lower than their initial weight, with no difference between groups.

The 24.6 percent of individuals who did maintain a loss of 10 percent or more over two years reported performing more physical activity (an average of 1,835 calories per week, or 275 minutes per week over the baseline level of activity) than those who lost less weight. They also completed more telephone calls with the intervention team, engaged in more eating behaviors recommended for weight control and had a lower intake of dietary fat.

“This clarifies the amount of physical activity that should be targeted for achieving and sustaining this magnitude of weight loss, but also demonstrates the difficulty of sustaining this level of physical activity,” the authors write. “Research is needed to improve long-term compliance with this targeted level of physical activity. Moreover, continued contact with the intervention staff and the ability to sustain recommended eating behaviors also may be important contributing factors to maintaining a significant weight loss that exceeds 10 percent of initial body weight, which suggests that physical activity does not function independently of these other behaviors.”
(Arch Intern Med. 2008;168[14]:1550-1559. Available pre-embargo to the media at http://www.jamamedia.org.)

Editor’s Note: Dr. Jakicic is on the Scientific Advisory Board for BodyMedia Inc. and the Calorie Control Council (www.caloriescount.com). This study was supported by a grant from the National Institutes of Health and the National Heart, Lung, and Blood Institute. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Posted by dlife at 05:39 PM | Comments (3)

Dietary Factors Appear to Be Associated With Diabetes Risk

July 25, 2008 (Newswise) - Drinking more sugar-sweetened beverages or eating fewer fruits and vegetables both may be associated with an increased risk of type 2 diabetes, whereas eating a low-fat diet does not appear to be associated with any change in diabetes risk, according to three reports in the July 28 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

Diabetes rates continue to increase, particularly in developed countries, according to background information in the articles. By the year 2030, 11.2 percent of U.S. adults are expected to have the condition. Obesity is the strongest modifiable risk factor for the development of type 2 diabetes.

In one study, Julie R. Palmer, Sc.D., of the Slone Epidemiology Center, Boston University, and colleagues examined the association between type 2 diabetes, weight gain and the consumption of sugar-sweetened soft drinks and fruit drinks in 43,960 African American women. In 1995 and again in 2001, the women completed a questionnaire about the types of foods and beverages they typically consumed. A total of 17 percent reported drinking one sugar-sweetened soft drink each day, 32 percent drank one sweetened fruit drink each day and 22 percent had at least one glass of orange juice or grapefruit juice.

Over 10 years of follow-up, 2,713 of the women developed type 2 diabetes. Those who drank more regular soft drinks and fruit drinks—including regular soda, other fruit juices, fortified fruit drinks and Kool-Aid but not diet soda, orange juice or grapefruit juice—were more likely to develop diabetes than those who drank less of those beverages.

Women who drank two or more soft drinks per day had a 24 percent increase in diabetes risk compared with women who drank less than one soft drink per month, and those who drank two or more fruit drinks per day had a 31 percent increased risk compared with women who drank less than one per month. Diet soft drinks, grapefruit juice and orange juice were not associated with diabetes risk.

When the researchers adjusted for body mass index (BMI), the association between soft drinks and diabetes risk decreased. However, the association between fruit drinks and diabetes risk did not appear dependent on BMI. “Our study suggests that the mechanism for the increase in diabetes risk associated with soft drink consumption is primarily through increased weight. Reducing consumption of soft drinks or switching from sugar-sweetened soft drinks to diet soft drinks is a concrete step that women may find easier to achieve than other approaches to weight loss,” the authors write.

“Finally, it should be noted that consumption of fruit drinks conveyed as high an increase in risk as did consumption of soft drinks. Fruit drinks typically contain as many or more calories compared with soft drinks and, like soft drinks, may not decrease satiety to the same extent as solid food,” they conclude. “The public should be made aware that these drinks are not a healthy alternative to soft drinks with regard to risk of type 2 diabetes.”

In another study, Anne-Helen Harding, Ph.D., of Addenbrooke’s Hospital, Cambridge, England, and colleagues analyzed blood vitamin C levels and fruit and vegetable intake in 21,831 individuals (average age 58) who did not have diabetes at the beginning of the study (1993 to 1997). Vitamin C level is a good indicator of fruit and vegetable consumption, the authors note, because these foods are the main source of vitamin C in the Western diet. Participants provided blood samples and reported how often they ate fruits and vegetables on a food frequency questionnaire.

Over 12 years of follow-up, 735 participants developed diabetes. Those with higher blood levels of vitamin C were substantially less likely to develop diabetes. “Compared with men and women in the bottom quintile [one-fifth] of plasma vitamin C, the odds of developing diabetes was 62 percent lower for those in the top quintile of plasma vitamin C,” the authors write. “A weaker inverse association between fruit and vegetable consumption and diabetes risk was observed.”

Fruits and vegetables may reduce diabetes risk by preventing obesity or by providing nutrients that protect against diabetes, including antioxidants, the authors note. “Because fruits and vegetables are the main sources of vitamin C, the findings suggest that eating even a small quantity of fruits and vegetables may be beneficial and that the protection against diabetes increases progressively with the quantity of fruit and vegetables consumed,” they conclude.

In a third article, Lesley F. Tinker, Ph.D., of the Women’s Health Initiative, Fred Hutchison Cancer Research Center, Seattle, and colleagues studied the effects of eating a low-fat diet on diabetes risk in 48,835 post-menopausal women. From 1993 to 2005, 29,294 of the women were randomly assigned to continue eating their usual diet while 19,541 were given a low-fat (20 percent of calories from fat) diet with increased levels of fruits, vegetables and whole grains. The diet was not intended to help participants lose weight.

A total of 1,303 of the women eating the low-fat diet (7.1 percent) and 2,039 women eating their usual diet (7.4 percent) developed diabetes over the 8.1 years of the study. There was no significant reduction in the risk of developing diabetes among women on the low-fat diet. However, “trends toward reduced incidence were greater with greater decreases in total fat intake and weight loss,” the authors write.

Women in the low-fat diet group lost about 1.9 kilograms or 4.2 pounds more weight over the course of the study than women in the regular diet group. “Weight loss, rather than macronutrient composition, may be the dominant predictor of reduced risk of diabetes,” the authors conclude.
(Arch Intern Med. 2008;168[14]:1487-1492, 1493-1499, 1500-1511. Available pre-embargo to the media at http://www.jamamedia.org.)

Editorial: Calories May Count the Most in Reducing Diabetes Risk

“The relationship between food and the development of type 2 diabetes mellitus has been debated for many years,” write Mark N. Feinglos, M.D., C.M., and Susan E. Totten, R.D., of Duke University Medical Center, Durham, N.C., in an accompanying editorial.

“So, what do we now know about the impact of diet on the development of type 2 diabetes mellitus, and what remains unknown?” they write. “We know that, as a population, we eat too much for our level of activity, and we are growing fatter as a result. In association with this increasing weight, we are in the midst of a dramatic increase in the number of cases of type 2 diabetes mellitus, not only in the United States, but in countries like India and China, where the caloric intake has also increased.”

“We do not know whether specific macronutrients put genetically predisposed people at increased risk of developing diabetes mellitus, or whether adding lots of fat or refined carbohydrate to the diet just makes it easier to take in excess calories,” Drs. Feinglos and Totten conclude. “Studies to isolate these effects will be difficult to perform, but, until we have more information, we have to assume that calories trump everything else, and that our number one goal for the reduction of new cases of type 2 diabetes mellitus should be to reduce the intake of high-energy, low-benefit foods, particularly in young members of the most vulnerable populations.”
(Arch Intern Med. 2008;168[14]:1485-1486. Available pre-embargo to the media at http://www.jamamedia.org.)

Posted by dlife at 04:37 PM | Comments (1)

Research Says Fat Friends and Poor Education Helps People Think Thin

July 24, 2008 (EurekAlert) - Research by economists at the University of Warwick, Dartmouth College, and the University of Leuven, finds that people are powerfully but subconsciously influenced by the weight of those around them. Without being aware of it, the researchers believe, human beings keep up with the weight of the Joneses. For a whole society, this can lead to a spiral of imitative obesity. The researchers will present their results on Friday July 25th at a National Bureau of Economic Research conference in Cambridge Massachusetts in a paper entitled Imitative Obesity and Relative Utility at the NBER Summer Institute on Health Economics.

Using data on 27,000 Europeans from 29 countries, the researchers find that nearly half of European women feel overweight. Less than a third of males feel overweight.

The authors suggest that whether for reasons of job promotions or finding a mate it is someone's weight relative to others that matters. They show that overweight perceptions and dieting decisions are influenced by people's comparisons with others of the same age and gender.

Highly educated Europeans hold themselves to a particularly tough standard, the research shows. For any given level of Body Mass Index (BMI), somebody with a university degree feels much fatter than someone with low educational qualifications.

Overall, the researchers believe that a person's "utility" (an economic term roughly meaning satisfaction levels) depends on their own weight relative to the weight of those around them. They suggest that it is easier to be fat in a society that is fat.

However, the authors also found a significant gender split. Females were much more prone, for any given BMI value, to feel overweight. For European women, weight dissatisfaction and overweight perceptions depended crucially upon not just their own absolute BMI, but also upon their BMI relative to other women of exactly the same age in their country. Conversely, being overweight tended not to be a significant issue for men if many of those around them were as overweight as they were.

Professor Andrew Oswald at the University of Warwick, one of the researchers, said "Consumption of calories has gone up but that does not tell us why people are eating more. Some have argued that obesity has been produced by cheaper food, but if fatness is a response to greater purchasing power, why do we routinely observe that rich people are thinner than poor people?"

He said: "A lot of research into obesity, which has emphasized sedentary lifestyles or human biology or fast-food, has missed the key point. Rising obesity needs to be thought of as a sociological phenomenon not a physiological one. People are influenced by relative comparisons, and norms have changed and are still changing."

However, the authors found a significant gender split. Females were much more prone, for any given BMI value, to feel overweight. For European women, weight dissatisfaction and overweight perceptions depended crucially upon not just their own absolute BMI, but also upon their BMI relative to other women of exactly the same age in their country.

Posted by dlifenews at 01:43 PM | Comments (0)

Limiting Fructose May Boost Weight Loss

July 24, 2008 (Newswise) — One of the reasons people on low-carbohydrate diets may lose weight is that they reduce their intake of fructose, a type of sugar that can be made into body fat quickly, according to a researcher at UT Southwestern Medical Center.

Dr. Elizabeth Parks, associate professor of clinical nutrition and lead author of a study appearing in a current issue of the Journal of Nutrition, said her team’s findings suggest that the right type of carbohydrates a person eats may be just as important in weight control as the number of calories a person eats.

Current health guidelines suggest that limiting processed carbohydrates, many of which contain high-fructose corn syrup, may help prevent weight gain, and the new data on fructose clearly support this recommendation.

“Our study shows for the first time the surprising speed with which humans make body fat from fructose,” Dr. Parks said. Fructose, glucose and sucrose, which is a mixture of fructose and glucose, are all forms of sugar but are metabolized differently.

“All three can be made into triglycerides, a form of body fat; however, once you start the process of fat synthesis from fructose, it’s hard to slow it down,” she said.

In humans, triglycerides are predominantly formed in the liver, which acts like a traffic cop to coordinate the use of dietary sugars. It is the liver’s job, when it encounters glucose, to decide whether the body needs to store the glucose as glycogen, burn it for energy or turn the glucose into triglycerides. When there’s a lot of glucose to process, it is put aside to process later.

Fructose, on the other hand, enters this metabolic pathway downstream, bypassing the traffic cop and flooding the metabolic pathway.

“It’s basically sneaking into the rock concert through the fence,” Dr. Parks said. “It’s a less-controlled movement of fructose through these pathways that causes it to contribute to greater triglyceride synthesis. The bottom line of this study is that fructose very quickly gets made into fat in the body.”

Though fructose, a monosaccharide, or simple sugar, is naturally found in high levels in fruit, it is also added to many processed foods. Fructose is perhaps best known for its presence in the sweetener called high-fructose corn syrup or HFCS, which is typically 55 percent fructose and 45 percent glucose, similar to the mix that can be found in fruits. It has become the preferred sweetener for many food manufacturers because it is generally cheaper, sweeter and easier to blend into beverages than table sugar.

For the study, six healthy individuals performed three different tests in which they had to consume a fruit drink formulation. In one test, the breakfast drink was 100 percent glucose, similar to the liquid doctors give patients to test for diabetes – the oral glucose tolerance test. In the second test, they drank half glucose and half fructose, and in the third, they drank 25 percent glucose and 75 percent fructose. The tests were random and blinded, and the subjects ate a regular lunch about four hours later.

The researchers found that lipogenesis, the process by which sugars are turned into body fat, increased significantly when as little as half the glucose was replaced with fructose. Fructose given at breakfast also changed the way the body handled the food eaten at lunch. After fructose consumption, the liver increased the storage of lunch fats that might have been used for other purposes.

“The message from this study is powerful because body fat synthesis was measured immediately after the sweet drinks were consumed,” Dr. Parks said. “The carbohydrates came into the body as sugars, the liver took the molecules apart like tinker toys, and put them back together to build fats. All this happened within four hours after the fructose drink. As a result, when the next meal was eaten, the lunch fat was more likely to be stored than burned.

“This is an underestimate of the effect of fructose because these individuals consumed the drinks while fasting and because the subjects were healthy, lean and could presumably process the fructose pretty quickly. Fat synthesis from sugars may be worse in people who are overweight or obese because this process may be already revved up.”

Dr. Parks said that people trying to lose weight shouldn’t eliminate fruit from their diets but that limiting processed foods containing the sugar may help.

“There are lots of people out there who want to demonize fructose as the cause of the obesity epidemic,” she said. “I think it may be a contributor, but it’s not the only problem. Americans are eating too many calories for their activity level. We’re overeating fat, we’re overeating protein; and we’re overeating all sugars.”

Some data were collected at the University of Minnesota, where Dr. Parks worked before joining the UT Southwestern faculty in 2006.

The work was supported by the National Institutes of Health, the Cargill Higher Education Fund and the Sugar Association.

Visit http://www.utsouthwestern.org/nutrition to learn more about clinical services in nutrition at UT Southwestern.

Dr. Elizabeth Parks -- http://www.utsouthwestern.edu/findfac/professional/0,2356,78859,00.html

Posted by dlifenews at 10:54 AM | Comments (23)

Diabetes Experts Recommend One-Two Punch for Treating Patients with Pre-Diabetes

July 23, 2008 (American Association of Clinical Endocrinologist) – For the first time, a consensus of diabetes and metabolic disorder experts have recommended a comprehensive treatment regimen for patients with pre-diabetes. The recommendations call for specific guidelines on both lifestyle, and pharmaceutical intervention where appropriate. The recommendations are made in a Consensus Statement released this morning by the American Association of Clinical Endocrinologists (AACE).

Pre-diabetes is a condition defined by elevated fasting glucose levels or impaired glucose tolerance. According to the Centers for Disease Control (CDC), more than 56 million Americans currently have the condition, which leaves patients at risk, not only for developing type 2 diabetes, but also for cardiovascular complications. This is an extension of the effort to recognize and treat type 2 diabetes earlier and more aggressively.

However, at this time, there are no pharmacologic therapies that have been approved by the FDA for prevention of the conversion of pre-diabetes to diabetes. That’s why the expert panel has recommended a two-pronged approach to treating pre-diabetes. The first is intensive lifestyle management to prevent the progression to type 2 diabetes.

“As individuals and as a society, we need to address those forces which are creating the epidemic of obesity, diabetes, and pre-diabetes,” said Yehuda Handlesman MD, FACP, FACE, Treasurer of AACE and Medical Director of the Metabolic Institute of America. “We understand the difficulties in implementing solutions, but as an association of endocrinologists we are committed to supporting community and national efforts in every way we can.”

The recommendation calls for patients to adhere to the guidelines set forth in the Diabetes Prevention Program, established by the United States government.

“Although lifestyle can clearly modify the progression of patients towards overt diabetes, it may not be sufficient,” said Alan J. Garber, MD, PhD, FACE, Professor of Medicine, Baylor College of Medicine, Houston, and Chairman of the Consensus Conference. “Medications may well be required, particularly in high risk groups.”

The second approach is to prevent the development of cardiovascular complications, and to help those patients where lifestyle modifications have been insufficient to modify cardiovascular risk factors. This requires cardiovascular risk reduction medications for abnormal blood pressure and cholesterol independent of glucose control medications.

“The data show that there is a spectrum of severity, with the most severely affected approaching the risks of people with diagnosed type 2 diabetes,” said Daniel Einhorn, MD, FACP, FACE, Vice President of AACE and Medical Director of the Scripps Whittier Institute for Diabetes in La Jolla, CA. “In these highest risk individuals, who represent a minority, pharmacologic strategies may be appropriate if intensive lifestyle therapies fail. Regardless, all individuals at risk for diabetes should be aware of the level of their risk factors and be prepared to take action.”

While the number of people with pre-diabetes in the United States exceeds 56 million, most patients with the condition have not been diagnosed. People are considered high risk if they have near diabetic levels of blood glucose, hypertension, or abnormal lipid profiles. These patients should consider working with their doctor to monitor their status.

The preliminary publication of the Consensus Statement is available at media.aace.com. The final document will be published later this year in Endocrine Practice, the Journal of the American Association of Clinical Endocrinologists.

The AACE pre-diabetes consensus conference executive summary will be available shortly.

About AACE
AACE is a professional medical organization with more than 6,000 members in the United States and 84 other countries. Founded in 1991, AACE is dedicated to the optimal care of patients with endocrine problems. AACE initiatives inform the public about endocrine disorders. AACE also conducts continuing education programs for clinical endocrinologists, physicians whose advanced, specialized training enables them to be experts in the care of endocrine diseases, such as diabetes, thyroid disorders, growth hormone deficiency, osteoporosis, cholesterol disorders, hypertension and obesity.

For more information, contact Bryan Campbell of the American Association of Clinical Endocrinologists at 904-353-7878, or bcampbell@aace.com.

Posted by dlifenews at 02:23 PM | Comments (1)

Newly Published Study Results Showed That Two Mealtime Insulin Dosing Algorithms Were Effective for Patients with Type 2 Diabetes

Two Regimens Including Lantus® and Apidra® Resulted in Significant Reductions in A1C in Patients with Type 2 Diabetes, Whatever the Algorithm Used

July 22, 2008 (Sanofi–Aventis Press Release) - Results from the “Adjust to Target in Type 2 Diabetes: Comparison of a Simple Algorithm to Carbohydrate Counting for Adjustment of Mealtime Insulin Glulisine” study, were published in the American Diabetes Association’s (ADA) medical journal, Diabetes Care. This study, using a basal-bolus insulin regimen with Lantus® (insulin glargine [rDNA origin] injection) once daily (basal insulin) and rapid-acting Apidra® (insulin glulisine [rDNA origin] injection) at mealtime (bolus insulin) demonstrated significant reductions in postprandial blood glucose and A1C using two different dosing algorithms.

The 24-week, multicenter, randomized, controlled study compared two algorithms for adjusting mealtime insulin (Apidra®) in 273 intent-to-treat patients with type 2 diabetes. Apidra® and Lantus® were adjusted weekly in both groups based on the previous week’s self-monitored blood glucose (SMBG) results. One group, the “Simplified Algorithm” group, was provided set doses of Apidra® to take before each meal. The second group, the “Carbohydrate Counting” group, was provided an insulin-to-carbohydrate ratio to use for each meal and adjusted their Apidra® dose based on amount of carbohydrate consumed. After 24 weeks, the percentage of patients who achieved A1C<7 percent – the ADA’s recommended target for blood sugar control – while following these two treatment algorithms were 73% and 69% (P=0.70), respectively.

Average A1C levels at week 24 were 6.70 percent in the Simplified Algorithm group and 6.54 percent in the Carb Counting group. The respective mean A1C changes from baseline to 24 weeks were –1.46 percent and –1.59 percent (P=.24). A1C <7.0 percent was achieved by 73 percent (Simplified Algorithm) and 69 percent (Carb Counting) (P=.70); respective values for A1C <6.5 percent were 44.3 percent and 49.5 percent (P=.28). The Simplified Algorithm group had 53 episodes of severe hypoglycemia in 19 patients, and the Carb Counting group had 37 episodes in 19 patients, leading to estimates of 0.89 and 0.67 event/patient-year for the two groups (P=0.58). SMBG < 50 mg/dL with symptoms was slightly but statistically significantly more common in the Carb Counting group than in the Simplified Algorithm group (8.0 vs. 4.9 events/patient-year, P=0.02). 2

“A combination of basal and bolus insulin may be needed to achieve optimal glucose control in type 2 diabetes patients,” explained study author Richard M. Bergenstal, MD, executive director, International Diabetes Center, Park Nicollet Health Services, Minneapolis, MN. “The simplified algorithm investigated in this study allowed patients to start with a fixed dose of Apidra® and then effectively adjust to target based on premeal glucose patterns, or to use carbohydrate counting, which involves a mathematical formula that helps patients match the size of their mealtime insulin dose with the amount of carbohydrates they eat. Having two effective options for managing mealtime insulin doses may increase patients’ and clinicians’ willingness to initiate basal-bolus therapy.”

Throughout the study, SMBG levels were recorded before meals and at bedtime each day, as well as a 7-point blood glucose profile at weeks 2, 6, 12, 18, and 24 (endpoint). Blood glucose values at each visit declined in both arms, and the within-group change from baseline was statistically significant over all daily time points and study visits. By the study’s conclusion, both arms significantly improved fasting plasma glucose (FPG) levels as well, with averages of 112.0 mg/dl in the Simplified Algorithm group and 101.8 mg/dl in the Carb Counting group (P<0.0001 for both groups).

“Type 2 diabetes is a progressive disease that requires treatment adjustments to help manage the potential risks that come with prolonged hyperglycemia,” said Dr. Bergenstal. “The Adjust to Target trial demonstrated that basal-bolus insulin therapy may be an effective option for the many people with type 2 diabetes who are not achieving glycemic targets with their current insulin regimen.”

About the Trial
Study participants were 28-71 years old, had type 2 diabetes for ≥6 months and mean ± SD A1C values of 8.1 ± 0.9% (Simplified Algorithm) and 8.3 ± 0.9% (Carb Counting Algorithm) at screening. They had taken ≥2 insulin injections/day (36 percent on 2 injections, 64 percent on more than 2 injections) ± metformin (one-third were on metformin), for ≥3 months before study entry. Upon entry into the study, 37 percent were using Lantus® and at least one injection of a rapid-acting insulin analog, 36 percent were using a pre-mixed insulin and the remainder were on a combination of various other diabetes treatment regimens.

About Diabetes
Diabetes is a chronic, widespread condition in which the body does not produce or properly use insulin – the hormone needed to transport glucose (sugar) from the blood into the cells of the body for energy. More than 230 million people worldwide are living with the disease and this number is expected to rise to a staggering 350 million within 20 years. It is estimated more than 20 million Americans have diabetes, including an estimated 6.2 million who remain undiagnosed. At the same time, more than 40 percent of those diagnosed are not achieving the blood sugar control target of A1C <7 percent recommended by the American Diabetes Association (ADA). The A1C test measures average blood glucose levels over a two- to three-month period.

About sanofi-aventis
Sanofi-aventis, a leading global pharmaceutical company, discovers, develops and distributes therapeutic solutions to improve the lives of everyone. Sanofi-aventis is listed in Paris (EURONEXT : SAN) and in New York (NYSE : SNY).3

Forward Looking Statements
This press release contains forward-looking statements as defined in the Private Securities Litigation Reform Act of 1995, as amended. Forward-looking statements are statements that are not historical facts. These statements include financial projections and estimates and their underlying assumptions, statements regarding plans, objectives, intentions and expectations with respect to future events, operations, products and services, and statements regarding future performance. Forward-looking statements are generally identified by the words “expects,” “anticipates,” “believes,” “intends,” “estimates,” “plans” and similar expressions. Although sanofi-aventis’ management believes that the expectations reflected in such forwardlooking statements are reasonable, investors are cautioned that forward-looking information and statements are subject to various risks and uncertainties, many of which are difficult to predict and generally beyond the control of sanofi-aventis, that could cause actual results and developments to differ materially from those expressed in, or implied or projected by, the forward-looking information and statements. These risks and uncertainties include those discussed or identified in the public filings with the SEC and the AMF made by sanofi-aventis, including those listed under “Risk Factors” and “Cautionary Statement Regarding Forward- Looking Statements” in sanofi-aventis’ annual report on Form 20-F for the year ended December 31,
2007. Other than as required by applicable law, sanofi-aventis does not undertake any obligation to update or revise any forward-looking information or statements.

U.S. Media Contacts:
Carrie Melia
Carrie.Melia@sanofi-aventis.com
908-981-6486
US.GLA.08.06.085

Posted by dlifenews at 01:42 PM | Comments (0)

Can Diet Alone Control Type 2 Diabetes? No Evidence Yet

July 16, 2008 (Science Daily) - Despite strong evidence that type 2 diabetes can be prevented or at least delayed by a combination of lifestyle changes and good dietary advice, a team of Cochrane Researchers found that there is no indication whether dietary advice alone can prevent the disease.

Type 2 diabetes is very common and the number of people affected is increasing. The disease is linked to obesity, with 80% of individuals who develop the disease being obese. Therefore as the incidence of obesity rises around the world, so too does the incidence of type 2 diabetes. The World Health Organization (WHO) estimates that more than 180 million people worldwide have diabetes. It claims that this number is likely to more than double by 2030.*

When a team of Cochrane Researchers set out to see if dietary advice alone could help a person with type 2 diabetes, they were only able to identify two trials that together involved just 358 people.

"Considering the importance of this disorder, we were disappointed to find such a small amount of relevant data," says lead researcher Lucie Nield, who works in Centre for Food, Physical Activity & Obesity, University of Teesside, Middlesbrough.

The two studies did, however, indicate that dietary advice alone could play an important role. One study randomly assigned people to either a control group or a dietary advice group. After six years 67.7% of people in the control group had diabetes, compared with only 43.8% in the advice group. This was a 33% reduction. In another study 12 months of dietary advice led to significant reductions in many diabetes related factors, such as insulin resistance, fasting C-peptide, fasting proinsulin, fasting blood glucose, fasting triglycerides, and fasting cholesterol and PAI-1.

"These two studies give grounds for believing that dietary advice alone could play an important role in reducing type 2 diabetes, but we do need more well-designed, long-term studies before we can work out the best advice to give," says Nield.

Posted by dlife at 03:01 PM | Comments (5)

Diabetes Increases Risk Of Tuberculosis, Studies Show

July 15, 2008 (Science Daily) - People with diabetes mellitus are at increased risk of developing active tuberculosis (TB), according to an analysis published in PLoS Medicine.

Searching for research over the past four decades containing data on the relationship between diabetes and TB, Christie Jeon and Megan Murray of the Harvard School of Public Health identified 13 studies involving more than 1.7 million participants, including 17,698 cases of TB.

Combining the data from cohort studies in particular, the researchers calculated that diabetes increases the risk of active TB by about a factor of three.

A three-fold increased risk suggests that diabetes may already be responsible for more than 10% of TB cases in India and China. If these findings are replicated in other countries, global TB control might benefit from special attention to people with diabetes when identifying and treating latent TB.

Increased efforts to diagnose and treat diabetes might also decrease the global burden of TB, which kills about 1.6 million people each year.

Posted by dlife at 03:03 PM | Comments (3)

Type 2 Diabetes: Culturally-Tailored Education Can Improve Blood Sugar Control

July 15, 2008 (EurekAlert) - Using community-based health advocates, delivering information within same-gender groups or adapting dietary and lifestyle advice to fit a particular community's likely diet can help people with type 2 diabetes control their blood sugar levels, certainly for up to six months, following health education. This conclusion was reached by a team of Cochrane Researchers after they considered the data in 11 trials that involved 1,603 people.

Type 2 diabetes is a particular problem for minority ethnic groups who originate from developing countries, but live in upper-middle income or high income countries. These people tend to have low socio-economic status and find that they are faced with many physical, communication and cultural barriers that make it difficult to access healthcare effectively.

The Cochrane Researchers found 11 trials where people had deliberately tried to overcome cultural barriers. In short-term studies, culturally appropriate health education programs led to improved blood-sugar control within 3 months. This benefit was still seen when the 6-month trial periods ended. Knowledge about diabetes and healthy lifestyles also improved over this time period. One-year later, however, the benefits had not been sustained.

"These are important and encouraging results. They show that providing culturally tailored information can help people control their diabetes." says Kamila Hawthorne, who works at the Department of Primary Care and Public Health at the University of Cardiff, UK.

"Diabetes is a chronic condition and complications can develop over many years. We now need to carry out longer term studies with larger groups, all measuring the same results, to discover which type of assistance is most useful and see how to keep the benefits running for longer," says Hawthorne.

Posted by dlife at 02:58 PM | Comments (0)

All Sweeteners Not The Same For Managing Type 2 Diabetes

July 15 , 2008 (Newswise) - Recent research by Kalidas Shetty of the University of Massachusetts Amherst and Lena Galvez Ranilla of the University of San Paolo, Brazil, shows that when it comes to managing Type 2 diabetes, all sweeteners may not be the same. Some sweeteners, including date sugar and less refined, dark brown sugars, showed potential for managing Type 2 diabetes and related complications − information that could help Type 2 diabetics make better dietary choices.

“Depending on their origin and grade of refining, many sweeteners contained significant amounts of antioxidants, which have the potential to control diabetes-linked high blood pressure and heart disease,” says Shetty, who adds that these were in vitro laboratory studies performed outside of living organisms. “Several types of sweeteners also showed an interesting potential to inhibit the action of a key enzyme related to Type 2 diabetes, which is also the target of drugs used to treat this condition.”

Additional members of the research team include food scientist Young-In Kwon of UMass Amherst and Maria Ines Genovese and Franco Maria Lajolo of the University of San Paulo, Brazil. Results were published in the most recent issue of the Journal of Medicinal Food.”

The team started by collecting an exhaustive array of sweeteners, everything from the complete line offered by Domino, to unprocessed, dark brown sugars from Mauritius and Peru. Pure maple syrup, corn syrup-based sweeteners, “natural” sugar products like sucanat and sugars from Asia, India, South America and China rounded out the list.

Extracts of the sweeteners were first analyzed to determine their total content of a group of antioxidants known as phenolic compounds, the same plant chemicals that give red wine and tea their heart-healthy benefits. Testing showed that when it comes to sugar, darker is definitely better. Dark brown sugars contained up to 4,741 micrograms of phenolic compounds per gram, compared to 18 micrograms per gram for white sugar. The highest antioxidant levels were found in the darkest sugars.

Further testing showed that these phenolic compounds had significant antioxidant properties, scavenging harmful free radicals that can damage the delicate machinery of cells. According to Shetty, high blood sugar levels in diabetics can cause the overproduction of these free radicals, contributing to high blood pressure and accelerating the development of heart disease.

Date sugar produced in the United States and dark brown sugars from Peru and Mauritius packed the biggest punch, racking up the highest antioxidant levels and scavenging an impressive 82 to 88 percent of free radicals in laboratory in vitro tests.

Sweeteners were then tested for their ability to inhibit the activity of alpha-glucosidase, an enzyme that moderates blood glucose levels by controlling the passage of sugars from the small intestine. “Diabetes is characterized by a rapid rise in blood glucose levels after meals,” says Shetty. “Inhibiting alpha-glucosidase, which is the target of several drugs used to treat diabetes, can help prevent this spike.”

Most sweeteners derived from sugar cane inhibited alpha-glucosidase action by 26 to 50 percent, including the dark brown sugars and natural sugar products from evaporated cane juice. Date sugar inhibited the enzyme by 75 percent.

Surprisingly, several sweeteners based on corn syrup inhibited alpha-glucosidase levels by 77 to 81 percent, although they contained low levels of phenolic compounds. “This level of inhibition could be due to sugar polymers known as oligosaccharides that are not completely broken down, mimicking the action of certain drugs that inhibit alpha-glucosidase,” says Shetty. “This investigation is continuing.”

Date sugar and sweeteners based on corn syrup also inhibited an enzyme that plays a role in high blood pressure, a common complication of diabetes. According to Shetty, the reason for this is not clear based on current studies.

“Replacing sugars in processed foods and beverages with low calorie and noncaloric sweeteners is one long term strategy for Type 2 diabetics,” says Shetty. “But these results indicate that a strategic choice of dietary sweeteners, especially less refined sugars close to the original nature of the ingredients found in whole plants, also has potential in managing Type 2 diabetes and related complications. This provides a strong rationale for further animal and clinical studies for better diet design.”

Posted by dlife at 10:34 AM | Comments (3)

Long-Acting Insulin: Safer, Slightly Tighter Glucose Control in Type 1 Diabetes

July 15, 2008 (Newswise) - Introduced this decade, the long-acting insulin medications glargine and detemir have largely replaced the older intermediate-acting insulin NPH in the treatment of type 1 diabetes. However, a review of studies reveals that the newer drugs offer only a slight benefit over NPH in terms of blood glucose control.

The researchers did see a clear benefit of long-acting insulin in the risk for hypoglycemia — dangerously low blood glucose that can result from insulin injections — particularly at night.

The review comprised 23 studies of more than 6,500 people.

“Long-acting insulin preparations have gained much popularity in recent years for the treatment of type 1 diabetes mellitus,” said review author Moshe Vardi, M.D. “Our objective was to assess whether there is a significant clinical advantage for these drugs.”

Vardi, a physician in the internal medicine department at Carmel Medical Center in Haifa, Israel, said pharmaceutical companies have waged a tremendous marketing campaign to promote these newer insulin medications.

The review appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Type 1 diabetes — formerly called juvenile diabetes because of its early onset in children, teenagers and young adults — accounts for only about 5 percent of all cases of diabetes. Patients with type 1 diabetes have a defect in the pancreas that prevents them from making enough insulin. All patients with type 1 diabetes require insulin treatment to control blood glucose.

The newer therapies allow for insulin replacement that more closely mimics how the body releases insulin. To do this, injected insulin needs to replace basal or “background” insulin secretion that occurs at a continuous level in the body, as well as to replace the spike in insulin that occurs after eating a meal.

Most people with type 1 diabetes inject basal (long- or intermediate-acting) insulin once or twice a day under the skin, with additional boluses of short- or rapid-acting insulin at meals. Insulin pumps are an alternative option.

The intermediate-acting insulin NPH has served to help replace basal insulin secretion since the 1950s; however, some physicians consider the newer long-acting insulin analogues glargine and detemir to be clinically superior to NPH. Most of the review studies compared glargine or detemir with NPH.

To determine effectiveness, the researchers looked at the results for hemoglobin A1c, a widely used measure of long-term blood glucose control. They also looked at fasting glucose levels in the blood.

To assess safety, they evaluated rates of hypoglycemia and adverse events. In severe cases, hypoglycemia can lead to seizures or coma if left untreated. Because type 1 patients often need large amounts of insulin, the risk of hypoglycemia is much greater in type 1 patients than in insulin-treated type 2 patients.

The researchers found that long-acting insulin medications offered only a slight improvement in A1c and blood glucose levels over intermediate-acting options.

“We were surprised to find such a minor advantage in the overall glucose-lowering abilities of the long-acting drugs compared to the older, intermediate-acting drugs,” Vardi said.

However, when compared with intermediate-acting insulin, long-acting insulin medicines decreased the risk for severe nighttime hypoglycemia by 30 percent. The review noted no additional differences between the two types of insulin for other adverse events.

Irl Hirsch, M.D., an expert in type 1 diabetes from the University of Washington School of Medicine’s Diabetes Center in Seattle, said that currently there is very little use of NPH in the treatment of type 1 diabetes in the United States, primarily because the newer insulin medications are much less likely to cause severe hypoglycemia.

“The reduction in the frequency of hypoglycemia has been profound,” Hirsch said. “Insulin analogues have totally revolutionized our ability to reduce hypoglycemia in adults with diabetes in the U.S.”

Despite the review findings, Hirsch said, “NPH is not a good basal insulin,” because it has an unnatural peak in its action that the long-acting medications glargine and detemir do not have. This difference becomes more important in patients aggressively trying to reduce their A1c levels to a target normal level, which many diabetic patients do not try to achieve. This could explain why many studies do not find differences in blood glucose control between intermediate- and long-acting insulin choices, he said.

However, the review authors concluded, “When compared to intermediate-acting insulin, their effect on glucose control appears to be subtle, if at all.” Vardi cautioned that none of the studies examined risks for development of long-term diabetes-related complications, such as heart disease, blindness or kidney disease.

Vardi M, et al. Intermediate acting versus long acting insulin for type 1 diabetes (Review). Cochrane Database of Systematic Reviews 2008, Issue 3.

The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit http://www.cochrane.org for more information.

Posted by dlife at 10:07 AM | Comments (0)

Potential To Prevent Loss Of Insulin In Type 2 Diabetes

July 14, 2008 (Science Daily) - There are two completely different diseases known as diabetes. Type 1 is an autoimmune condition that often starts in childhood or adolescence. Type 2 is a metabolic disorder sometimes associated with lifestyle. In both cases, the insulin-secreting beta cells in the pancreas die, albeit at different rates.

Until now, it was thought that the processes leading to beta cell death were similar in both diseases. Scientists at the Garvan Institute of Medical Research in Sydney have now shown that the causes of cell death are quite different.

In April 2007, Garvan's Associate Professor Trevor Biden and Dr Ross Laybutt published a landmark paper establishing the existence of ER (Endoplasmic Reticulum) stress in people with Type 2 diabetes. The ER is the part of a cell where simple strings of amino acids are structured into three-dimensional proteins which then go on to perform specific tasks in the body. Insulin is one such protein. When the correct re-structuring of proteins is disrupted, beta cells suffer ER stress, and eventually die.

The new study, undertaken by PhD student Mia Akerfeldt, expands our knowledge about ER stress in Type 2 diabetes, while ruling out its importance in Type 1 diabetes. The paper is now online in the international journal Diabetes.

Mia is hopeful that the findings will translate quickly into treatments. "Garvan was first to show that ER stress was present in people with Type 2 diabetes, and that reducing it could slow down beta cell death," she said. "We've not only shown the same thing again, we've identified a potentially useful therapeutic agent."

Project leader Ross Laybutt echoes Mia's optimism. "One interesting aspect of the new study is that we used a "chemical chaperone", an agent that helps the secretory protein, in this case insulin, to form properly. This compound relieved cell death and ER stress in laboratory experiments."

"The compound, known as PBA, is already FDA approved for use in another clinical application. That suggests it could be fast tracked for use in humans to prevent or delay beta cell dysfunction."

"Naturally, we would want to test it on animals before conducting clinical trials on people."

Posted by dlife at 04:10 PM | Comments (1)

UT Southwestern Launches Study Of Surgical Option For Treating Diabetic And Other Neuropathies

July 10, 2008 (EurekAlert) - UT Southwestern Medical Center plastic surgeons and specialists in diabetes, neurology, pain management and rehabilitation are launching a cutting-edge study of peripheral nerve surgery to alleviate long-standing pain and numbness in patients with diabetic neuropathy.

Neuropathy is nerve-related pain, often associated with diabetes. The risk of developing neuropathy increases the longer a person has diabetes, and it is estimated that up to 40 percent of diabetics have some form of neuropathy. UT Southwestern is one of a few U.S. medical centers, and the only facility in North Texas, to offer surgery on peripheral nerves, which originate from the spine.

"Patients with neuropathy are often told that the problem is irreversible and that they cannot be helped," says Dr. Shai Rozen, assistant professor of plastic surgery. "Diabetic neuropathy is a complex problem caused by multiple factors. We think pressure on nerves may be one component responsible for the symptoms in certain patients. This is very important to emphasize: Surgery may be helpful only in patients we suspect have pressure on their nerves in addition to their neuropathy and is not for all neuropathy patients."

About one-third of patients with diabetic neuropathy have overlying compression of certain nerves in the leg that may worsen the pain and cause loss of sensation at the bottom of the foot. Several studies have demonstrated that the nerves may increase in diameter in diabetic patients. In this study, UT Southwestern investigators are hoping to show that by releasing pressure from the specific nerves of these patients, pain may be decreased and sensation improved.

"The concept of nerve compression in diabetics is not new," Dr. Rozen said. "Carpal tunnel syndrome is a medical term used to describe compression of the median nerve at the wrist. It appears in approximately 2 percent of the general population, but in 15 percent to 30 percent of patients with diabetes. The treatment of choice in these patients, if conservative treatment has failed, is surgical nerve release."

In addition to pain, patients suffering from diabetic neuropathy have decreased sensation on the bottoms of their feet. Because they can injure their feet without noticing it, many develop ulcerations. About one out of every six patients with ulcers require amputations – accounting for the nearly 100,000 amputations per year in the U.S. because of diabetes.

"If we are able to restore at least protective sensation – that means patients will feel it if they hit something with their foot – it may decrease the amount of ulcers and eventual amputations in this high-risk population," Dr. Rozen said.

Peripheral nerves supply sensation and are responsible for activating different muscles in the body. If these nerves are injured or compressed, they may be responsible for pain, loss of sensation, or even loss of function. Some of these problems may be helped by nerve surgery.

"Pain problems like these are not uncommon. The main problem is education and awareness among patients and physicians alike that there may be surgical solutions to some of these problems," Dr. Rozen said. "We all know patients who had surgery for a 'pinched' nerve in the back. The concepts are very similar – relieve a nerve from pressure, repair it or even cut it in certain cases, and the pain may be relieved."

Posted by dlife at 02:49 PM | Comments (2)

Elevated Level of Certain Protein Linked With Risk for Diabetes

July 8, 2008 (Newswise) - Having a higher than normal level of fetuin-A, a protein produced in the liver and secreted into the blood stream, is associated with an increased risk of the development of diabetes, according to a study in the July 9 issue of JAMA.

“Type 2 diabetes mellitus has become a global epidemic and the increased prevalence of obesity is a major contributing factor. However, diabetes does not develop in all obese individuals and there is a strong genetic contribution to risk. Despite significant recent advances, mechanisms responsible for individual differences in clinical phenotype remain largely unknown,” the authors write. Previous studies have found an association between higher fetuin-A levels and insulin resistance, but the association with incident type 2 diabetes mellitus is unknown.

Joachim H. Ix, M.D., M.A.S., of the University of California, San Diego, and San Diego Veterans Affairs Healthcare System, and colleagues conducted a study to examine whether higher fetuin-A levels are associated with the occurrence of diabetes in older persons. The study included 406 persons (age 70 to 79 years) without diabetes at the start of the study, and who had fetuin-A levels measured at baseline, and had six years of follow-up. Diabetes developed in 135 participants (10.1 cases/1,000 person-years [the number of individuals in the study times the number of years of follow-up per person]).

Analysis indicated a graded increase in the incidence of diabetes with increased fetuin-A levels. The third of the group with the highest levels had more than twice the incidence rate compared with the lowest third (13.3 vs. 6.5 cases/1,000 person-years). The association was independent of physical activity, inflammatory biomarkers, and other commonly available measures of insulin resistance and was irrespective of sex, race, and obesity status. The association was moderately weakened by adjustment for visceral adiposity (fat accumulation around the abdomen).

“Future studies should evaluate whether the results may generalize to middle-aged individuals in whom the [diabetes] incidence rate is highest. If confirmed in future studies, fetuin-A may ultimately prove useful as a target for therapeutics, and its study may provide novel insights to glucose metabolism in humans,” the authors conclude.

Posted by dlife at 11:29 AM | Comments (0)

Diabetes Linked To Male Infertility; Excess Sugars In The Body Have Direct Effect On Sperm Quality

July 9, 2008 (EurekAlert) - Diabetes in men has a direct effect on fertility, a scientist told the 24th annual conference of the European Society of Human Reproduction and Embryology today (Wednesday 9 July). Dr. Con Mallidis from Queen's University, Belfast, UK, said that, despite the prevailing view that it had little effect on male reproductive function, the Belfast group had shown that diabetes caused DNA damage in sperm.

The increase in the numbers of diabetics diagnosed at a young age has coincided with worldwide concerns over male fertility, he told the conference. "But this is not simply a coincidence," he said. "We have shown for the first time that diabetes adversely influences male fertility at a molecular level."

The scientists studied semen samples from men with diabetes who were receiving insulin therapy. On initial routine microscopic examination the semen samples appeared normal, apart from a slight decrease in volume.

"But when we looked for DNA damage, we saw a very different picture," said Dr. Mallidis, adding that this is not part of a routine semen analysis. "Sperm RNA was significantly altered, and many of the changes we observed are in RNA transcripts involved in DNA repair. And comparison with a database of men of proven fertility confirmed our findings. Diabetics have a significant decrease in their ability to repair sperm DNA, and once this is damaged it cannot be restored."

Transcription is the synthesis of RNA under the direction of DNA, and is the first step towards gene expression, where the information from the gene becomes a product such as a protein translating the genetic information into a cellular function. If there are errors in transcription, there will also be errors in the function of the gene. "We were particularly interested to see a fourteen-fold decrease in the expression of a protein called ornithine decarboxylase, which is responsible for the production of spermine and spermidine, compounds responsible for cell growth that help stabilise the structure of DNA. We also found that spermatogenesis 20, a factor unique to the testis and whose function remains unknown, was greatly increased. Taken together, these factors indicate clearly that having diabetes has a direct influence on the health of semen."

Sperm DNA quality is known to be associated with decreased embryo quality, low embryo implantation rates, higher miscarriage rates, and some serious childhood diseases, in particular some childhood cancers. Over the years possible causes for sperm DNA fragmentation have been suggested but to date the exact mechanism for the damage remains unknown, say the scientists.

"We found a class of compounds known as advanced glycation end products (AGEs) in the male reproductive tract. These are formed as the result of glycation (the addition of sugar)," said Dr. Mallidis, "and accumulate during normal ageing. They are dependent on life style – diet, smoking etc – and in many diabetic complications are centrally implicated in DNA damage. We believe that they play a similar role in the male reproductive system."

The scientists intend to follow up their work by trying to determine how AGEs cause and contribute to DNA damage. They believe that they may have uncovered a new role for AGEs, and that their influence goes far beyond diabetes and its complications.

"We must now try to develop strategies to protect sperm, and to diminish the accumulation of AGEs," said Dr. Mallidis. Such strategies could involve changes in diet, disrupting a step in the formation of AGEs, or increasing the body's protection against AGEs, possibly through the use of dietary supplements.

"Finally, there is spermatogenesis 20. What does it do, how does it do it, under what circumstances and why? Why is it so greatly increased in diabetics? We need to find answers to all these questions," said Dr. Mallidis.

Posted by dlife at 11:27 AM | Comments (0)

Fish Oil and Red Yeast Rice Studied for Lowering Blood Cholesterol

July 8, 2008 (Newswise) - A great deal of scientific evidence shows that cholesterol-reducing medications known as statins can help prevent coronary artery disease. Although the safety of these medications has been well documented, as many as 40 percent of patients who receive a prescription for statins take the drug for less than one year. Doctors believe that several factors -- including cost, adverse effects, poor understanding of statin benefits and patients’ reluctance to take prescription medications long term -- may explain why some patients stop taking these medicines. In the July issue of Mayo Clinic Proceedings, a group of researchers from Pennsylvania examine whether an alternative approach to treating high blood cholesterol may provide an effective treatment option for patients who are unable or unwilling to take statins.

Study design
Researchers followed 74 patients with high blood cholesterol who met standard criteria for using statin therapy. Patients were randomly assigned to either the alternative treatment group or the statin group and followed for three months.

The alternative treatment group participants received daily fish oil and red yeast rice supplements, and they were enrolled in a 12-week multidisciplinary lifestyle program that involved weekly 3.5-hour educational meetings led by a cardiologist, dietitian, exercise physiologist and several alternative or relaxation practitioners. Red yeast rice is the product of yeast grown on rice. A dietary staple in some Asian countries, it contains several compounds known to inhibit cholesterol production.

The statin group participants received 40 milligrams (mg) of Zocor (simvastatin) daily, as well as printed materials about diet and exercise recommendations. At the end of the three-month period, participants from both groups underwent blood cholesterol testing to determine the percentage change in LDL cholesterol.

Results
The researchers noted that there was a reduction in LDL cholesterol levels in both groups. The alternative treatment group experienced a 42.4 percent reduction, and the statin group experienced a 39.6 percent reduction. Members of the alternative therapy group also had a substantial reduction in triglycerides, another form of fat found in the blood, and lost more weight.

“Our study was designed to test a comprehensive and holistic approach to lipid lowering,” notes the study’s lead author, David Becker, M.D., a Chestnut Hill Hospital and University of Pennsylvania Health System cardiologist. “These results are intriguing and show a potential benefit of an alternative, or naturopathic, approach to a common medical condition.”

Dr. Becker acknowledges that a larger, multicenter trial with longer follow-up is necessary to determine long-term compliance with the alternative regimen, because previous studies involving diet and exercise have found a high rate of patients unable or unwilling to follow lifestyle recommendations.

“The excellent adherence in the alternative group was undoubtedly related to the intensive follow-up, education and support provided for this group,” says Dr. Becker.

Other authors of this article include: Ram Gordon, M.D., Patti Morris, and Jacqueline Yorko, M.Ed., from Chestnut Hill Hospital and the University of Pennsylvania Health System; Y. Jerold Gordon, M.D., from the University of Pittsburgh School of Medicine; Mingyao Li, Ph.D., from the University of Pennsylvania School of Medicine; and Nayyar Iqbal, M.D., from the Philadelphia VA Medical Center/University of Pennsylvania.

Posted by dlife at 11:18 AM | Comments (10)

Researchers Say Popular Fish Contains Potentially Dangerous Fatty Acid Combination

July 8, 2008 (Newswise) - Farm-raised tilapia, one of the most highly consumed fish in America, has very low levels of beneficial omega-3 fatty acids and, perhaps worse, very high levels of omega-6 fatty acids, according to new research from Wake Forest University School of Medicine.

The researchers say the combination could be a potentially dangerous food source for some patients with heart disease, arthritis, asthma and other allergic and auto-immune diseases that are particularly vulnerable to an “exaggerated inflammatory response.” Inflammation is known to cause damage to blood vessels, the heart, lung and joint tissues, skin, and the digestive tract.

“In the United States, tilapia has shown the biggest gains in popularity among seafood, and this trend is expected to continue as consumption is projected to increase from 1.5 million tons in 2003 to 2.5 million tons by 2010,” write the Wake Forest researchers in an article published this month in the Journal of the American Dietetic Association.

They say their research revealed that farm-raised tilapia, as well as farmed catfish, “have several fatty acid characteristics that would generally be considered by the scientific community as detrimental.” Tilapia has higher levels of potentially detrimental long-chain omega-6 fatty acids than 80-percent-lean hamburger, doughnuts and even pork bacon, the article says.

“For individuals who are eating fish as a method to control inflammatory diseases such as heart disease, it is clear from these numbers that tilapia is not a good choice,” the article says. “All other nutritional content aside, the inflammatory potential of hamburger and pork bacon is lower than the average serving of farmed tilapia.”

The article notes that the health benefits of omega-3 fatty acids, known scientifically as “long-chain n-3 polyunsaturated fatty acids” (PUFAs), have been well documented. The American Heart Association now recommends that everyone eat at least two servings of fish per week, and that heart patients consume at least 1 gram a day of the two most critical omega-3 fatty acids, known as EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid).

But, the article says, the recommendation by the medical community for people to eat more fish has resulted in consumption of increasing quantities of fish such as tilapia that may do more harm than good, because they contain high levels of omega-6 fatty acids, also called n-6 PUFAs, such as arachidonic acid.

“The ratio of arachidonic acid (AA) to very long-chain n-3 PUFAs (EPA and DHA) in diets of human beings appears to be an important factor that dictates the anti-inflammatory effects of fish oils,” the researchers write. They cite numerous studies, including a recent one that predicts “that changes in arachidonic acid to EPA or DHA ratios shift the balance from pro-inflammatory [agents] to protective chemical mediators … which are proposed to play a pivotal role in resolving inflammatory response” in the body.

For their study, the authors obtained a variety of fish from several sources, including seafood distributors that supply restaurants and supermarkets, two South American companies, fish farms in several countries, and supermarkets in four states. All samples were snap-frozen for preservation pending analysis, which was performed with gas chromatography.

The researchers found that farmed tilapia contained only modest amounts of omega-3 fatty acids – less than half a gram per 100 grams of fish, similar to flounder and swordfish. Farmed salmon and trout, by contrast, had nearly 3 and 4 grams, respectively.

At the same time, the tilapia had much higher amounts of omega-6 acids generally and AA specifically than both salmon and trout. Ratios of long-chain omega-6 to long-chain omega-3, AA to EPA respectively, in tilapia averaged about 11:1, compared to much less than 1:1 (indicating more EPA than AA) in both salmon and trout.

The article notes that “there is a controversy among scientists in this field as to the importance of arachidonic acid or omega-6:omega-3 ratios vs. the concentration of long-chain omega-3 alone with regard to their effects in human biology.” Those issues are raised in an editorial in the same issue of the Journal.

The Wake Forest article anticipates that criticism and notes that one human study involving AA showed a probable gene-nutrient connection to coronary heart disease in a specific group of heart disease patients. In another study, four subjects were removed after consumption of high amounts of AA due to concerns about the effect of the acid on their blood platelets.

Floyd H. “Ski” Chilton, Ph.D., professor of physiology and pharmacology and director of the Wake Forest Center for Botanical Lipids, is the senior author of the Journal article. He said that in next month’s Journal, he will publish a rebuttal to this month’s editorial.

“We have known for three decades that arachidonic acid is the substrate for all pro-inflammatory lipid mediators,” Chilton said in an interview. “The animal studies say unequivocally that if you feed arachidonic acid, the animals show signs of inflammation and get sick.

“A New England Journal of Medicine article three years ago said if you had heart disease and had a certain genetic makeup, and you ate arachidonic acid, the diameter of your coronary artery was smaller, a major risk factor for a heart attack,” said Chilton. “My point is that it’s likely not worth the risk in this or other vulnerable populations.”

Chilton said tilapia is easily farmed using inexpensive corn-based feeds, which contain short chain omega-6s that the fish very efficiently convert to AA and place in their tissues. This ability to feed the fish inexpensive foods, together with their capacity to grow under almost any condition, keeps the market price for the fish so low that it is rapidly becoming a staple in low-income diets.

“We are all familiar with the classical Hippocratic admonition, Primum no nocere, ‘First, do no harm.’ I think it behooves us to consider this critical directive when making dietary prescriptions for the sake of health,” Chilton said.

“Cardiologists are telling their patients to go home and eat fish, and if the patients are poor, they’re eating tilapia. And that could translate into a dangerous situation.”

Posted by dlife at 02:54 PM | Comments (1)

Liver Protein Associated With Type 2 Diabetes In Older Adults

July 8, 2008 (EurekAlert) - The presence of a protein expressed by the liver which inhibits insulin action may identify individuals more likely to develop type 2 diabetes, according to a new study led by a researcher from the UCSD School of Medicine, to be published July 9 in the Journal of the American Medical Association (JAMA.)

Researchers led by Joachim H. Ix, M.D., M.A.S., assistant professor in the Division of Nephrology and Hypertension and the Division of Preventive Medicine at UC San Diego and at the San Diego Veterans Affairs Healthcare System, found that higher serum levels of a protein called fetuin-A, produced by liver cells, was associated with type 2 diabetes in humans, independent of other risk factors.

"Higher fetuin-A was associated with a 1.7-fold increased risk of diabetes, when adjusted for other factors," said Ix. Despite compelling laboratory and animal data of the protein's role in insulin resistance, until now the association of fetuin-A with new development of type 2 diabetes had not been evaluated in humans, according to Ix. "On the basis of this study, fetuin-A might be considered as a novel therapeutic target for prevention or treatment of insulin resistance,' he said.

Type 2 diabetes is a metabolic disorder characterized by insulin resistance that has become a global epidemic. The increased prevalence of obesity is a major contributing factor; however diabetes does not develop in all obese individuals, and reasons why one individual develops type 2 diabetes while another dose not are largely unknown.

Recent research shows that proteins from fat tissue called adipocytokines regulate the metabolism of blood sugar or glucose, and may ultimately prove to be a target for new diabetes therapies. In contrast, fetuin-A is produced in liver cells, and is secreted into blood. In laboratory studies, fetuin-A binds to the insulin receptor found in muscle and fat, resulting in insulin resistance – the hallmark of diabetes. Preliminary data from a separate study of participants without diabetes had shown an association between fetuin-A and insulin resistance.

In this study, the researchers measured levels of fetuin-A in 519 diabetes-free individuals aged 70 to 79 years, and followed them for development of diabetes for