September 22, 2009 (EurekAlert) - Physical therapist-directed exercise counseling combined with fitness center-based exercise training can improve muscular strength and exercise capacity in people with type 2 diabetes, with outcomes similar to those of supervised exercise, according to a randomized clinical trial published in the September issue of Physical Therapy, the scientific journal of the American Physical Therapy Association (APTA).Type 2 diabetes is associated with numerous health complications, including a decline in muscular strength and exercise capacity. Studies show that a decline in muscular strength increases the risk of loss of physical function and that a decline in exercise capacity increases the risk of cardiovascular and all-cause mortality. "Improving muscular strength and exercise capacity in people with type 2 diabetes is crucial to preventing loss of physical function and decreasing comorbidity and mortality in these patients," said lead researcher J. David Taylor, PT, PhD, CSCS, assistant professor in the Department of Physical Therapy at the University of Central Arkansas.

Supervised exercise programs improve both muscular strength and exercise capacity in people with type 2 diabetes; however, Medicare and other health insurance programs do not currently reimburse physical therapists and other clinicians for these exercise programs.

In this study, 24 people with type 2 diabetes were randomly allocated to either an experimental group that received two months of physical therapist-directed exercise counseling and fitness center-based exercise training or a comparison group that received two months of laboratory-based, supervised exercise. Exercise training for all participants consisted of resistance training (chest press, row, and leg press exercises) and aerobic training (walking or jogging on a treadmill) as recommended for people with type 2 diabetes by the American Diabetes Association and the American College of Sports Medicine. Participants in the experimental group received a face-to-face counseling session at baseline and one month after baseline, weekly 10-minute telephone calls, and seven-day-per-week access to a local fitness center. Each participant in the comparison group received the same prescribed exercise program as the experimental group, but in a supervised environment.

Although both groups had significant improvements in muscular strength and exercise capacity following exercise training, the results showed no significant differences in improvements between these two groups. "The fact that there were no significant differences in improvements between patients who received exercise counseling and those in a supervised program suggests that physical therapists may make an evidence-based choice of prescribing either exercise counseling combined with fitness center-based training or supervised exercise training for patients with type 2 diabetes," said Taylor.

September 22, 2009 (Newswise) - Childbearing is associated directly with future development of the metabolic syndrome - abdominal obesity, high triglycerides, insulin resistance and other cardiovascular disease risk factors - and for women who have had gestational diabetes, the risk is more than twice greater, according to a study co-authored by University of Alabama at Birmingham (UAB) researchers published in the American Journal of Obstetrics and Gynecology.UAB Professor of Preventive Medicine Cora E. Lewis, M.D., M.S.P.H., and colleagues used data collected in the CARDIA (Coronary Artery Risk Development in Young Adults) study to determine the correlation between a higher incidence of the metabolic syndrome among women ages 18-30 at the start of the study who bore at least one child during the 20-year period following.

"Pregnancy can have lasting, adverse physiological effects and may result in behavioral changes," Lewis said. "Some previous studies have shown an association between childbearing and the metabolic syndrome, and some have shown that a history of gestational diabetes is a strong predictor of Type 2 diabetes.

"However, these studies lacked the preconception measurements to establish a baseline with which to measure the changes brought on by pregnancy," she said. "Many have not had control groups of women who had not had pregnancies, and thus they have rarely provided conclusive evidence linking pregnancy-related risk factor changes to disease onset. CARDIA began following participants ages 18-30 years in 1985-1986 and continues today, and we had the necessary information to track women both before and after pregnancy and to compare women with pregnancies to those without."

Of the 2,787 women in the CARDIA study, 1,451 were included in this study analysis. Of those, 706 had no births and 745 had at least one birth during the 20 years following. Of the 745, 88 had at least one birth complicated by gestational diabetes.

After controlling for preconception measurements of body mass index (BMI), all metabolic syndrome components and physical activity, Lewis and her colleagues found that women who had given birth to one child or more than one child were independently associated with a higher incidence of the metabolic syndrome (33 percent and 62 percent higher, respectively) than women who had not had children. Among women with gestational diabetes, once baseline adjustments were made, the researchers found that they were nearly two-and-a-half times more likely to develop the metabolic syndrome than those women who had not had gestational diabetes-complicated pregnancies.

"Our findings suggest that childbearing can contribute to the development of the metabolic syndrome and that part of the association may be through weight gain and lack of physical activity," Lewis said. "And, although women with gestational diabetes had the highest relative risk of developing the metabolic syndrome, those with non-gestational diabetes pregnancies made up the larger at-risk group."

Lewis and her colleagues suggested that future studies may determine whether reductions in weight retention and central obesity, and reductions through treatment of cholesterol and triglycerides, after pregnancy may prevent disease later in life. They also suggested postpartum screening of cardio-metabolic risk factors, especially among women with gestational diabetes, may offer an important opportunity for disease prevention among women of reproductive and older ages.

Until then, Lewis said, the best way for everyone to prevent disease, including women of childbearing age, is to make the necessary lifestyle changes: exercise regularly and eat a healthy diet.

July 23, 2009 (EurekAlert) - People with potentially 'stigmatizing' medical conditions are just as likely as those with less stigmatizing illnesses to allow their personal information to be used for health research. A new study, published in the open access journal BMC Medical Ethics, found that the purpose of the research and the type of information to be collected were more important in determining patients' consent choices. In particular, they were very wary of allowing their personal information to be put to commercial use.Donald Willison, Senior Scientist with the Ontario Agency for Health Protection and Promotion, Canada, led a team of researchers who surveyed 1137 people who either had potentially stigmatizing conditions (HIV, alcoholism, chronic depression or lung cancer) or lower-stigma conditions (hypertension, breast cancer or diabetes), as well as a reference group of healthy people. They presented the subjects with a series of situations and asked them to indicate how much control they would want over the use of their personal information in each case.

According to Willison, "Across scenarios, consent choice profiles were very similar for all health conditions. They were also very similar to the profile of the reference group. These findings surprised us. It may be that, across health conditions, those who were more privacy-sensitive were less inclined to participate in the study, or it may just be that, where people believe that their information will be put to constructive use, people are equally willing to allow their information to be used, regardless of their health condition."

The researchers found people wanted more control in research scenarios involving profit or those that linked health information with income, education, or occupation. Focus groups were held with some of the respondents where they were asked to explain their choices. One participant form the HIV group said,

"I think the simple answer is that physical tissue sample is just a piece of what you are, what you might be…where the rest of the information [education, income, and employment] is more of who you are. People are more afraid of the revelation of who you are than what you are."

Speaking about the results, Willison said, "Individuals should be offered some choice in use of their information for different types of health research. In some cases, like population health research, that may be limited to selectively opting-out of research projects. In other cases, like linkage of biological samples with one's health information, the process would likely continue to require an opting in, perhaps through a broad consent for a range of uses. Just what choices would be offered would have to be determined through further engagement with the public and other stakeholders. Many questions remain, including how best to capture the opinions of those who are more privacy sensitive."

July 21, 2009 (EurekAlert) - Mothers' health in the days and weeks prior to becoming pregnant may determine the health of offspring much later in life, according to results of studies reported at the annual meeting of the Society for the Study of Reproduction, which takes place July 18 to 22 at the David L. Lawrence Convention Center in Pittsburgh. These studies demonstrate that maternal nutrition, protein intake and level of fat in the diet may cause epigenetic changes in the developing fetus that can have long-term health consequences.Summaries of their findings are as follows:

Too Much of a Sweet Thing? Maternal Diabetes and Embryo Development

The time between ovulation and conception may be a critical one for maternal and fetal health, according to Kelle Moley, M.D., Washington University School of Medicine. In mouse studies, she found that subtle differences in maternal metabolism had long-lasting effects. Indeed, when Dr. Moley transferred embryos from a diabetic mouse into a non-diabetic mouse shortly after egg implantation, she noted neural tube defects, heart defects, limb deformities and growth defects in offspring. These findings indicate that we may need to re-direct our ideas about maternal health to the time prior to pregnancy, she says.

Take Your Vitamins Before Becoming Pregnant

Are we encouraging pregnant women to take vitamins when it may be too late to impact the health of a growing fetus? According to Kevin Sinclair, Ph.D., University of Nottingham, maternal nutrition even at the time of conception can alter fetal development. In studies with sheep and rodents, he found that offspring of mothers with vitamin B12 and folic acid deficiencies were fatter, became insulin resistant and had higher blood pressure by the time they reached middle-age, demonstrating that early molecular changes may not manifest themselves for many years.

Low Protein Diet May Lead to "Jumpy" Offspring

Low protein levels in female mice during the first few moments of conception, when the egg is still dividing, caused abnormal growth, cardiovascular disease, high blood pressure and jumpy behavior in their offspring. According to Tom Fleming, Ph.D., University of Southampton, mice born to mothers with low protein grew bigger - extracting as much nutrients as they could to compensate for poor nutrition while in the womb.

Beyond Genetics: How Dormant Memories Can Impact Later-Life Events

According to epigenetic theory, changes in the genome can happen at any time through the impact of environmental factors on the expression of genes over time. One of the most critical periods is early life when epigenetic memories are created that may impact a person's susceptibility to disease later in life, says Shuk-mei Ho, Ph.D., University of Cincinnati Medical Center. According to her research, these "memories" may remain dormant until an environmental trigger brings them to the surface, modifying risk for disease.

May 26, 2009 (EurekAlert) - The new project is an interdisciplinary research project covering the neurobiological and socio-psychological causes of obesity. It has been awarded EUR 6 million from the EU, corresponding to just over SEK 60 million. The project will gather scientists from seven countries, and will be co-ordinated from the Sahlgrenska Academy, University of Gothenburg, Sweden.Those working on the project include scientists active within psychology, epidemiology, genetics, nutrition and endocrinology. All are internationally renowned experts in their field.

"There are many factors that contribute to cause obesity. The purely biological factors are, of course, very important, but the cultural, sociological and psychological aspects are just as important. This is why we want to create a comprehensive picture of the problem," says Professor Suzanne Dickson at the Sahlgrenska Academy, who is co-ordinating the EU project.

The new research project has been given the name NeuroFAST (The Integrated Neurobiology of Food Intake, Addiction and Stress), and involves 12 research groups from seven countries. Participants are located in the Netherlands, Italy, Great Britain, Germany, Hungary and Spain, in addition to Sweden. The broad research collaboration within the project will ensure that it has access to a large group of patients on which to base the research. The research project is to last for five years.

The work of Suzanne Dickson and her colleagues at the Sahlgrenska Academy will focus on how the central nervous system controls the composition of the body. The Swedish research team is particularly interested in the signalling system in the hypothalamus, which is the part of the brain that controls hunger and thirst, among other things.

"There is a neurological reward system for food, which has many similarities to the reward system for alcohol. This reward system makes eating a pleasure, and it can also lead to addiction. We are investigating the detailed way in which various hormones and other substances interact within the reward system", says Suzanne Dickson.

May 20, 2009 (EurekAlert) - Gestational diabetes happens in more than three per cent of pregnancies in Ontario. Usually the condition resolves itself after delivery, but many studies have shown that these women are at a very high risk for developing "regular" type 2 diabetes later in life. New research out of the Institute for Clinical Evaluative Sciences (ICES) has found that even women with mild abnormalities in their blood sugar during pregnancy, previously thought not to have any clinical significance, are 2.5 times more likely to develop type 2 diabetes compared to those who had completely normal glucose testing.To test for gestational diabetes, women receive a glucose challenge test (GCT) in the late second trimester of pregnancy. If the result of this test is abnormal, they go on to have a diagnostic test, called the oral glucose tolerance test (OGTT). If this test does not show gestational diabetes, women are reassured their glucose levels are normal and that no further testing is needed.

However, recent studies have suggested that women who have even mild abnormalities on either the GCT or the OGTT do actually have subtle differences in their metabolism after pregnancy.

The study examined 15,000 pregnant women aged 20-49 in Ontario who had a mild abnormality on their GCT but did not ultimately get diagnosed with gestational diabetes. They were compared to about 60,000 pregnant women who did not have abnormalities on their GCT. The women were followed for 6.4 years after delivery, and those who had had an abnormal GCT were 2.5 times more likely to develop type 2 diabetes compared to those who had not had an abnormal GCT.

"These results show that even a mild abnormality in glucose testing during pregnancy is associated with an increased risk of diabetes later in life. Although we already know that women who've had gestational diabetes need to be monitored, the study suggests that even women with mild glucose abnormalities might benefit from diabetes prevention and detection strategies," says Baiju Shah, ICES researcher.

May 19, 2009 (EurekAlert) - Babies born to obese mothers may have an increased risk of asthma, according to data from a new study to be presented on May 19 at the 105th International Conference of the American Thoracic Society in San Diego."Obesity is not a neutral state; adipose tissue is an active producer of pro-inflammatory cytokines, while it also suppresses the action of anti-inflammatory cytokines," said Jet Smit, Ph.D., of the National Institute of Public Health and the Environment in the Netherlands. "Therefore, when you have an obese person, you are not just looking at a problem of excess fat, but a problem of systemic inflammation. This may affect the immunological and pulmonary development in the fetus and possibly result in a higher risk of asthma symptoms after birth."

To determine whether the presence of these pro-inflammatory factors in overweight mothers did, in fact, put their children at a greater risk of developing asthma, Dr. Smit and colleagues analyzed data from nearly 4,000 children of the Prevention and Incidence of Asthma and Mite Allergy (PIAMA) birth cohort for evidence of asthma. The children were included prenatally and followed up yearly until the age of eight years.

Asthma was defined as at least one episode of wheeze and/or dyspnea and/or a prescription for inhaled corticosteroids in the last year. Maternal body mass index (BMI) of greater than 25 kg/m2 was considered overweight.

More than one in five mothers (20.9 percent) were overweight. In children who had at least one asthmatic parent, maternal obesity increased their risk of having asthma at age eight by 65 percent over children of asthmatic parents whose mothers were not overweight. This was true irrespective of confounding factors, such as birth weight and the child's BMI.

"This suggests that children of overweight mothers are exposed to increased levels of pro-inflammatory factors during fetal life, and may have a much greater risk for developing asthma than similar children whose mothers were not overweight," said Dr. Smit.

"These findings suggest that there are multiple benefits to maintaining-or in some cases attaining-a healthy body weight. In women of child-bearing age, it may not just be a benefit to their health, but to their offspring as well," said Dr. Smit.

May 18, 2009 (EurekAlert) - Being overweight or obese is a leading contributor to cardiovascular disease (CVD) and associated risk factors; however, in patients with established CVD, obesity appears to play a protective role. In fact, data suggest obese patients with heart disease do better and tend to live longer than leaner patients with the same severity of disease, according to a review article published in the May 26, 2009, issue of the Journal of the American College of Cardiology.
"Obese patients with heart disease respond well to treatment and have paradoxically better outcomes and survival than thinner patients," said Carl Lavie, M.D., F.A.C.C., medical director of Cardiac Rehabilitation and Prevention, Ochsner Medical Center, New Orleans, LA and lead author of the article. "Although these patients have a more favorable short- and long-term prognosis, we don't yet understand the mechanisms for why this might be the case."

The obesity paradox in patients with CVD, which was first noticed earlier this decade, is complex. It is likely due to a combination of obesity's impact on fat cells and other metabolic processes (e.g., insulin resistance, glucose metabolism, metabolic syndrome), as well as other consequences of being obese. Dr. Lavie speculates that excess weight may be somewhat protective because these patients have more reserves to fight disease than thinner patients. Another explanation might be that obese patients present with problems earlier due to physical deconditioning (being out of shape) and other non-cardiovascular symptoms and, therefore, have the opportunity to be diagnosed with milder disease.

Although obese patients appear to experience fewer cardiovascular events and have better survival rates, Dr. Lavie is quick to caution that patients with heart disease shouldn't incorrectly assume that gaining weight is the answer.

"Obesity is often what's causing high blood pressure, blockages in arteries, and increased risk of sudden death in the first place. Such excess weight has adverse effects on all of the major cardiovascular risk factors and has increased the prevalence of heart disease," he said. "Taken together, most studies are supportive of purposeful weight loss for preventing and treating cardiovascular disease."

Health-promoting behaviors to stay active and lose weight can also confer benefits beyond initial heart disease. For example, patients who are overweight or obese are at heightened risk of diabetes, which can further complicate treatment and outcomes. Patients who make sustained lifestyle changes, including regular exercise and some weight reduction through a reduction in calories, cut their risk of developing diabetes by roughly 60 percent.

"Obesity is skyrocketing in America and if this continues, we may see an unfortunate reversal to what has been a steady increase in life expectancy," says Dr. Lavie. "We need more research: first to prevent obesity in the first place; second, to intervene early enough so that patients who are overweight or obese won't develop heart disease; and then to better understand why these patients have a better prognosis once they have heart disease. Perhaps this information could lead to benefits for all patients, including patients with heart disease who aren't overweight or obese."

According to authors, obesity may soon overtake tobacco use as the leading cause of preventable death in the United States if current trends continue. Nearly 7 out of 10 adults are classified as overweight or obese. In adults, overweight is defined as a body mass index (BMI) 25 to 29.9 kg/m2 and obesity as BMI =30 kg/m2. Other indices that have been used less commonly, but possibly with more predictive power include body fatness, waist circumference (WC), waist-to-hip ratio (WHR), and weight-to-height ratio.

"Clinicians should emphasize to patients the importance of achieving and maintaining a healthy weight, as well as benefits that can be obtained from restricting their intake of calories and getting regular exercise of 30 to 40 minutes on most, if not all, days," said Dr. Lavie.

April 29, 2009 (EurekAlert) - Scientists believe they may have found a preventative therapy for Type 1 diabetes, by making the body's killer immune cells tolerate the insulin-producing cells they would normally attack and destroy, prior to disease onset.Type 1 diabetes is an autoimmune condition, where the body attacks its own insulin producing cells. It is very serious, with a sudden and dramatic onset, usually in youth. People with Type 1 diabetes must maintain an insulin-monitoring and insulin-injecting regimen for the rest of their lives.

PhD student Eliana Mariño and Dr Shane Grey, from the Garvan Institute of Medical Research in Sydney, have demonstrated how a particular molecule may be used in future as a preventative therapy. Their findings are published online in the international journal Diabetes.

The body's immune cells, or white blood cells, include B cells and T cells. B cells make antibodies and present 'antigens' to T cells, allowing them to recognise, and kill, invaders.

In previously published studies about Type 1 diabetes, Mariño and Grey showed that groups of B cells migrate to the pancreas and pancreatic lymph nodes, presenting specific insulin antigen to T cells. In other words, B cells go to the disease site and tell T cells to kill the cells that produce insulin.

"Taking that work further, our current study looks at different ways of subduing B cells, and how that affects development of the disease," said Grey.

Working with mice that spontaneously develop Type 1 diabetes, Eliana Mariño found that if she blocked BAFF (a hormone that controls survival of B cells) prior to onset, none of the mice developed diabetes.

"This is a remarkable finding, as other B cell depletion methods tested elsewhere have just delayed or reduced disease incidence," said Eliana.

When B cells were depleted, the regulators of the immune system (a subclass of T cells known as T regulatory cells) rose in numbers.

By removing B cells from the picture for a while, it appears you allow T regulatory cells to function as they should, subduing killer T cells and somehow making them tolerant of the insulin producing cells.

The Juvenile Diabetes Research Foundation supported this research. Garvan's Diabetes Vaccine Development Centre (DVDC), the mandate of which is to develop a vaccine for Type 1 Diabetes, is funding further research with the compound.

The molecule used by Grey and colleagues to inhibit BAFF is known as BCMA, and is already being used in clinical trials for other autoimmune diseases, such as Sjogren's Syndrome and Lupus.

April 28, 2009 (EurekAlert) - Diet and nutrition counseling for virtually all overweight and obese women of childbearing age can reduce health risks associated with excess weight for mothers and children alike, according to a newly released position paper from the American Dietetic Association and the American Society of Nutrition.The position, published in the May issue of the Journal of the American Dietetic Association, represents the associations' official stance on obesity, reproduction and pregnancy outcomes:

Given the detrimental influence of maternal overweight and obesity on reproductive and pregnancy outcomes for the mother and child, it is the position of the American Dietetic Association and the American Society for Nutrition that all overweight and obese women of reproductive age should receive counseling prior to pregnancy, during pregnancy and in the interconceptional period on the roles of diet and physical activity in reproductive health, in order to ameliorate these adverse outcomes.

The joint ADA/ASN position and accompanying paper were written by Anna Maria Siega-Riz, PhD, RD, LDN, assistant professor of maternal and child health at the University of North Carolina; and Janet C. King, PhD, senior scientist at Children's Hospital and Research Center, Oakland, Calif.

An estimated 33 percent of U.S. women are obese, according to the authors, who write that a long-term goal of health professionals must be to reduce the number of women who become pregnant while obese. They add that the effect of a woman's nutritional status prior to pregnancy is an issue of great public health importance.

"Among obese women, who already have aberrations in glucose and lipid metabolism, the further adjustments induced by hormonal changes in pregnancy create a metabolic milieu that enhances the risk for metabolic disorders such as gestational diabetes mellitus and preeclampsia," according to the position paper.

Infants born to obese mothers have "a higher prevalence of congenital anomalies than do offspring of normal-weight women, suggesting that maternal (obesity) alters development in the sensitive embryonic period." The authors note neural tube defects such as spina bifida and anencephaly are about twice as common among children of obese women. "Other birth defects more frequent in offspring of obese women include oral clefts, heart anomalies, hydrocephaly and abdominal wall abnormalities."

Objectives of the new ADA/ASN position are to provide guidance to nutrition professionals in becoming aware of risks and possible complications of excess weight and obesity for fertility, course of pregnancy, birth outcomes and short and long-term maternal and child health; and to commit ADA and ASN to identifying gaps in scientific research needed to improve knowledge of risks and complications and develop effective strategies "that can be implemented before and during pregnancy as well as during the interconceptional period," the authors write.