Diabetes risk in children increases risk for weak bones

Diabetes Risk in Children Increases Risk for Weak Bones


ScienceDaily (Aug. 16, 2010) — Children at risk for diabetes before they reach puberty also appear to be at risk for weak bones, Medical College of Georgia researchers report.



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A study of 140 overweight children age 7-11 who got little regular exercise found that the 30 percent with signs of poor blood sugar regulation had 4-5 percent less bone mass, a measure of bone strength, said Dr. Norman Pollock, bone biologist at MCG's Georgia Prevention Institute.
The study is the first to suggest the association between weaker bones and type 2 diabetes risk in children. Type 2, which is becoming more common in children, is often associated with obesity and inactivity; type 1 diabetes, believed to result from genes and environmental triggers, is known to be associated with poor bone health.
"This finding provides the first clue linking childhood obesity to skeletal fractures," said Pollock, first author on the study published in the Journal of Bone and Mineral Research. "While overweight children may have more bone mass than normal-weight kids, it may not be big or strong enough to compensate for their larger size."
It's not as simple as saying that everyone who is overweight has weak bones, he notes. It may have more to do with how fat is distributed throughout the body. For instance pre-diabetics tend to have more fat around their abdominal area, specifically visceral fat, a type of fat deep in the belly that is linked to diabetes and cardiovascular disease.
In this study, higher amounts of visceral fat were associated with lower bone mass while more body fat overall was associated with higher bone mass. "Taken together, it seems that excessive abdominal fat may play a key role linking pre-diabetes to lower bone mass," Pollock said.
The findings appear to be another wakeup call for parents about the potential lifelong consequences of an overweight childhood. And increased physical activity might be a relatively simple fix.
"Our greatest window of opportunity to enhance bone strength and ultimately reduce the risk of osteoporosis is during childhood, before the capacity to build bone diminishes," Pollock said. "One of the best things you can do for bone development and general health is exercise."
"Children have a lot of potential and a whole lot of time to make positive changes," echoed Dr. Catherine Davis, clinical health psychologist at the Georgia Prevention Institute and study co-author whose research has shown that regular physical activity reduces children's body fat and diabetes risk and even improves learning. "If you could patent exercise as a drug, somebody would be really, really rich."
Next steps include learning more about how abdominal fat impairs bone mass, including looking at the activity of cells that make and destroy bone -- the bone makers should be more active in children -- as well as vitamin D and vitamin K metabolism.

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Building muscle doesn't require lifting heavy weights, study shows

Building Muscle Doesn't Require Lifting Heavy Weights, Study Shows


ScienceDaily (Aug. 12, 2010) — Current gym dogma holds that to build muscle size you need to lift heavy weights. However, a new study conducted at McMaster University has shown that a similar degree of muscle building can be achieved by using lighter weights. The secret is to pump iron until you reach muscle fatigue.



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The findings are published in PLoS ONE.
"Rather than grunting and straining to lift heavy weights, you can grab something much lighter but you have to lift it until you can't lift it anymore," says Stuart Phillips, associate professor of kinesiology at McMaster University. "We're convinced that growing muscle means stimulating your muscle to make new muscle proteins, a process in the body that over time accumulates into bigger muscles."
Phillips praised lead author and senior Ph.D. student Nicholas Burd for masterminding the project that showed it's really not the weight that you lift but the fact that you get muscular fatigue that's the critical point in building muscle. The study used light weights that represented a percentage of what the subjects could lift. The heavier weights were set to 90% of a person's best lift and the light weights at a mere 30% of what people could lift. "It's a very light weight," says Phillips noting that the 90-80% range is usually something people can lift from 5-10 times before fatigue sets in. At 30%, Burd reported that subjects could lift that weight at least 24 times before they felt fatigue.
"We're excited to see where this new paradigm will lead," says Phillips, adding that these new data have practical significance for gym enthusiasts but more importantly for people with compromised skeletal muscle mass, such as the elderly, patients with cancer, or those who are recovering from trauma, surgery or even stroke.

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The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by McMaster University, via EurekAlert!, a service of AAAS.




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Burd et al. Low-Load High Volume Resistance Exercise Stimulates Muscle Protein Synthesis More Than High-Load Low Volume Resistance Exercise in Young Men. PLoS ONE, 2010; 5 (8): e12033 DOI: 10.1371/journal.pone.0012033

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Free statins with fast food could neutralize heart risk, scientists say

Free Statins With Fast Food Could Neutralize Heart Risk, Scientists Say


ScienceDaily (Aug. 12, 2010) — Fast food outlets could provide statin drugs free of charge so that customers can neutralise the heart disease dangers of fatty food, researchers at Imperial College London suggest in a new study.



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Statins reduce the amount of unhealthy "LDL" cholesterol in the blood. A wealth of trial data has proven them to be highly effective at lowering a person's heart attack risk.
In a paper published in the American Journal of Cardiology, Dr Darrel Francis and colleagues calculate that the reduction in cardiovascular risk offered by a statin is enough to offset the increase in heart attack risk from eating a cheeseburger and a milkshake.
Dr Francis, from the National Heart and Lung Institute at Imperial College London, who is the senior author of the study, said: "Statins don't cut out all of the unhealthy effects of burgers and fries. It's better to avoid fatty food altogether. But we've worked out that in terms of your likelihood of having a heart attack, taking a statin can reduce your risk to more or less the same degree as a fast food meal increases it."
One statin, simvastatin, is already available in low doses (10mg) over the counter at pharmacies without a prescription. Other statins are so far only prescribed by doctors, and limited by cost to patients at particular risk of heart attack or stroke. However, the cost of the tablets has fallen sharply in recent years (from ~£40/month to ~£1.50/month), such that the cost to the NHS of seeing a doctor is much greater than the cost of the tablet.
"It's ironic that people are free to take as many unhealthy condiments in fast food outlets as they like, but statins, which are beneficial to heart health, have to be prescribed," Dr Francis said.
Statins have among the best safety profiles of any medication. A very small proportion of regular statin users experience significant side effects, with problems in the liver and kidneys reported in between 1 in 1,000 and 1 in 10,000 people.
"Everybody knows that fast food is bad for you, but people continue to eat it because it tastes good. We're genetically programmed to prefer high-calorie foods, and sadly fast food chains will continue to sell unhealthy foods because it earns them a living.
"It makes sense to make risk-reducing supplements available just as easily as the unhealthy condiments that are provided free of charge. It would cost less than 5p per customer -- not much different to a sachet of ketchup.
"When people engage in risky behaviours like driving or smoking, they're encouraged to take measures that minimise their risk, like wearing a seatbelt or choosing cigarettes with filters. Taking a statin is a rational way of lowering some of the risks of eating a fatty meal."
Studies have shown a clear link between total fat intake and blood cholesterol, which is strongly linked to heart disease. Recent evidence suggests that trans fats, which are found in high levels in fast food, are the component of the Western diet that is most dangerous in terms of heart disease risk.
Dr Francis and his colleagues used data from a previous large cohort study to quantify how a person's heart attack risk increases with their daily intake of total fat and trans fat. He compared this with the decrease in risk from various statins, based on a meta-analysis of seven randomised controlled trials.
The results showed that most statin regimes are able to compensate for the relative risk increase from eating a cheeseburger and a small milkshake.
The researchers note that studies should be conducted to assess the potential risks of allowing people to take statins freely, without medical supervision. They suggest that a warning on the packet should emphasise that no tablet can substitute for a healthy diet, and advise people to consult their doctor for more advice.

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Journal Reference:

Emily A. Ferenczi, Perviz Asaria, Alun D. Hughes, Nishi Chaturvedi, Darrel P. Francis. Can a Statin Neutralize the Cardiovascular Risk of Unhealthy Dietary Choices? The American Journal of Cardiology, 2010; 106 (4): 587 DOI: 10.1016/j.amjcard.2010.03.077

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Focusing on immediate health effects may improve weight loss success

Focusing on Immediate Health Effects May Improve Weight Loss Success


ScienceDaily (Aug. 11, 2010) — Most weight loss programs try to motivate individuals with warnings of the long-term health consequences of obesity: increased risk for cancer, diabetes, hypertension, heart disease and asthma. New research suggests the immediate health benefits -- such as reduced pain -- may be the most effective motivator for helping obese individuals shed extra weight and commit to keeping it off.



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In a pilot research study, University of Cincinnati (UC) researchers found that 21 percent of participants in a local dietary weight loss program reported significantly less pain in the lower extremities and back after losing an average of 10 pounds. Additionally, study participants reported a 20 to 30 percent reduction in overall bodily pain after weight loss.
Researchers say their results indicate that even small weight loss can relieve pain and reduce the burden excessive weight puts on the musculoskeletal system.
"By focusing on an immediate benefit that can be felt -- like pain reduction -- instead of the future health impact of obesity, weight loss programs may be able to inspire overweight individuals to lose weight," says Susan Kotowski, PhD, study collaborator and director of the Gait and Movement Analysis Laboratory in the UC College of Allied Health Sciences.
Kotowski and colleague Kermit Davis, PhD, report their findings in the August 2010 issue of the journal Work.
According to the Centers for Disease Control and Prevention (CDC), 44 million Americans are considered clinically obese. Since 1975, the number of obese Americans has risen from 47 percent to 66.3 percent. Previous studies have estimated obesity-attributable medical expenditures in the United States at $75 billion, with half of these costs financed by Medicare or Medicaid.
"Obesity has become a national health crisis, but compliance for weight loss programs is notoriously poor. One potential reason for this is that current programs target long-term diseases, with little direct relevance to the person's current health status," adds Davis, senior author of the study and director of the Low Back Biomechanics and Workplace Stress Laboratory at the UC College of Medicine's environmental health department. "Our study results challenge people to rethink the way they structure weight loss programs."
For this pilot study, UC researchers partnered with a Cincinnati-based weight loss clinic to recruit study volunteers. Thirty two women between the ages of 22 and 76 participated in the study and data was collected over the course of a 12-week dietary weight loss regimen.
Researchers collected baseline individual weight and musculoskeletal pain data related to nine body regions: neck, shoulders, elbows, hands and wrists, upper back, lower back, hips, knees and lower legs and feet. Participants were then tracked each week to record any weight loss and asked to rate their pain on a scale of zero to 10 every other week.
Significant associations were found between weight loss and overall pain reduction, as well as pain reduction in the elbow, hip region and upper and lower back.
Researchers say these preliminary results could have ramifications for companies with a high prevalence of overweight workers with musculoskeletal problems -- particularly in industries that require manual or repetitive weight-bearing labor.
"From an ergonomics perspective, we can only do so much to alter the work environment to remove body stressors," explains Kotowski. "Excess weight adds additional stress to the musculoskeletal system and that can only be relieved through weight loss."

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Bariatric surgery in diabetic adults improves insulin sensitivity better than diet, study finds

Bariatric Surgery in Diabetic Adults Improves Insulin Sensitivity Better Than Diet, Study Finds


ScienceDaily (Aug. 9, 2010) — Gastric bypass surgery improves Type 2 diabetes by other mechanisms in addition to weight loss and does so better than a low-calorie diet despite achieving equal weight loss, a new study finds.



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The results are being presented at The Endocrine Society's 92nd Annual Meeting in San Diego.
"Our study shows that in the short term, weight loss by diet alone does not achieve the same improvements in diabetes as gastric bypass surgery," said the presenting author, Judith Korner, MD, PhD, assistant professor of medicine at Columbia University College of Physicians and Surgeons, New York.
Korner and her colleagues found that gastric bypass surgery better improved insulin sensitivity, the body's ability to successfully clear glucose sugar from the bloodstream into the cells. Insulin sensitivity is impaired in people with Type 2 diabetes, and obesity adds to this problem. The result is a buildup of sugar in the blood.
The study compared the effects on diabetic adults of a low-calorie diet versus Roux-en-Y gastric bypass, the most common gastric bypass procedure. Roux-en-Y gastric bypass decreases the size of the stomach and reroutes the digestive tract to bypass most of the stomach and part of the small intestine. After gastric bypass, many diabetic patients achieve normal blood glucose control or vastly improved control, and some may no longer require diabetes medications.
In the study, seven obese patients with Type 2 diabetes received a daily 800-calorie liquid diet and no surgery, while seven other obese diabetic adults underwent gastric bypass surgery. The study ended when both groups lost the same amount of weight: an average of 8 percent of body weight. However, the surgery-treated patients lost the weight faster: in about 3.5 weeks compared with 8 weeks for the dieters.
Surgical patients were able to discontinue all of their diabetes medications by the study's end, but the dieters reduced their medication use by 55 percent, Korner reported.
The researchers found significant improvements in the surgery group in measures of insulin sensitivity and function of beta cells, the insulin-producing cells in the pancreas. Improvements in insulin sensitivity in the low-calorie diet group was not statistically significant and beta cell function improved to a lesser extent.
Korner speculated that hormonal changes may be responsible for the improvements resulting from Roux-en-Y surgery in individuals with Type 2 diabetes.
"It will be important to understand how surgery works to produce these results so that we can develop medical therapies of equivalent efficacy," she said.
The National Institute of Diabetes and Digestive and Kidney Diseases funded this study.

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Larger waist associated with greater risk of death

Larger Waist Associated With Greater Risk of Death


ScienceDaily (Aug. 9, 2010) — Individuals with a large waist circumference appear to have a greater risk of dying from any cause over a nine-year period, according to a report in the August 9/23 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.



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Having a large waist circumference has previously been associated with inflammation, insulin resistance, type 2 diabetes, abnormal cholesterol levels and heart disease, according to background information in the article. This may be because waist circumference is strongly correlated with fat tissue in the viscera -- surrounding the organs in the abdomen -- which is thought to be more dangerous than fat tissue under the skin.
Eric J. Jacobs, Ph.D., and colleagues at the American Cancer Society, Atlanta, examined the association between waist circumference and risk of death among 48,500 men and 56,343 women age 50 and older (median or midpoint age, 69 years in men and 67 years in women). All had participated in the Cancer Prevention Study II Nutrition Cohort, for which they completed a mailed questionnaire about demographic, medical and behavioral factors in 1992 or 1993 and provided information about weight and waist circumference in 1997. Deaths and their causes were tracked through the National Death Index until Dec. 31, 2006; a total of 9,315 men and 5,332 women died during this timeframe.
After adjusting for body mass index (BMI) and other risk factors, very large waists (120 centimeters or 47 inches or larger in men, and 110 centimeters or 42 inches or larger in women) were associated with approximately twice the risk of death during the study period. A larger waist was associated with higher risk of death across all categories of BMI, including normal weight, overweight and obese; however, among women, the association was strongest for those at a normal weight.
"The reason for the stronger association between waist circumference and mortality among women with low BMI in our study is unclear," the authors write. "Future detailed analyses of the relationship between waist circumference and visceral adipose tissue or measures of insulin resistance within categories of BMI could identify biological reasons for potential differences in the strength of the association between waist circumference and mortality."
The results may affect the development of future guidelines for obesity, the authors suggest. "Currently available clinical guidelines from the National Institutes of Health are based on evidence from the 1990s," they write. "These guidelines recommend that waist circumference be used to identify increased disease risk only among individuals in the overweight and obese categories of BMI. In addition, the NIH guidelines recommend weight loss goals for all patients in the obese category of BMI (30 or greater), but they do not specifically recommend weight loss goals for abdominally obese patients (waist circumference of 88 centimeters or larger in women or 102 centimeters or larger in men) who are in the normal or overweight BMI category unless they also have two or more cardiovascular risk factors or a desire to lose weight."

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Journal Reference:

Jacobs et al. Waist Circumference and All-Cause Mortality in a Large US Cohort. Archives of Internal Medicine, 2010; 170 (15): 1293 DOI: 10.1001/archinternmed.2010.201

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'Lap-band' weight loss surgery in very obese adults improves mental health, study finds

'Lap-Band' Weight Loss Surgery in Very Obese Adults Improves Mental Health, Study Finds


ScienceDaily (Aug. 10, 2010) — One year after weight loss surgery with laparoscopic gastric banding, extremely obese adults demonstrate not only better physical health but also improved psychological health, a new study shows.



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The results are being presented at The Endocrine Society's 92nd Annual Meeting in San Diego.
"Surgical treatment, such as laparoscopic gastric banding, is increasingly recognized as the most effective means of achieving weight loss and improving blood sugar control in morbidly obese patients with Type 2 diabetes," said study co-author Andrew Johnson, MD, of Southmead Hospital in Bristol, U.K.
"However, until now, the long-term psychological status of morbidly obese individuals undergoing gastric banding has been unclear despite its increasing use," said Johnson, a consultant physician specializing in diabetes and endocrinology.
Laparoscopic gastric banding, also called the "Lap-Band" procedure, is a minimally invasive weight loss surgery. It involves repeated adjustment of a band to gradually make the stomach smaller and limit food consumption.
Four men and 21 women (ranging in age from 30 to 58 years) participated in the study and had the weight loss surgery. Of these 25 patients, 16 had Type 2 diabetes and nine did not. All had a body mass index (BMI, a measure of body fat) that classified them as morbidly obese.
Participants completed psychological testing before surgery and six and 12 months after surgery. These tests measured general anxiety and depression, quality of life, and social anxiety, that is, anxiety related to what others might think of one's appearance.
Compared with before surgery, patients' psychological test scores improved significantly at both six and 12 months after surgery. They had better psychological and physical quality of life, reductions in levels of general anxiety and depression, and reductions in their levels of social anxiety.
As shown in other studies, gastric banding significantly reduced BMI and hemoglobin A1c, a measure of blood sugar control over time.
"These results provide evidence one year after gastric banding that psychological health improves in parallel with physiological health," Johnson said.
Researchers at the University of the West of England in Bristol also contributed to this study.

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