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Nutrition (13 ) over nutrition - Diabetes

Terms in this set (39)

Diabetes mellitus
A group of disorders comprising abnormalties of metabolism (fat protein carb), characterized by hyperglycemia, resulting from insulin deficiency or resistence


Lead to serious complications such as
blindness
kidney damage
cardiovascular disease
lower limb amputations
possibly dementia

But people with diabetes can lower the occurence of theese and other complications by controlling blood glucose and blood pressure and blood lipids
Type 1 Insulin Dependent
weight loss, polyuria, polydyspia
Ketosis, (keto-acidotic coma)
10 percent of all cases in adults
can develop at any age, usually before 40 years old and especially in childhood
- The most common type of diabetes found in childhood
Type 2 - Non - insulin dependent DM
Often asymptomatic
overweight - usually, not always
infections - urinary tract, vulva
thirst
rarely coma


Usually appears >40 year in caucasians , or at younger age >20 years in those ethnic groups at greater risk

Becoming more common in children, adolescents, and young people of all ethnicities

Accounts for between 85 to 95 percent of all people with diabetes
Gestational diabetes
May be assymptomatic - apat from hyperglycemia but sxns if present like TYPE 2

Affects 2 to 10 percent pregnancies in previously non - diabetic pregnant women

Usually second or third trimester

uSUALLay goes away after giving birth but type 2 may develop
- immediately in 5 to 10 percent women with GDM
- In 35 to 60 percent in next 10 to 20 years

Mother s at risk if
overweight or obese
have had gestational diabetes before
have had a large baby in previous pregnancies
have a family history of diabetes
Black, hispanic, latino, american india, south asian, or middle eastern background
Maternal Obesity and gestational diabetes
50 percent of women of childbearing age are overweight in developed societies

GDM risen from 10 to 20 pecrecnt of pregnancies in asia (HK, singapore, urban china)

rISK OF sustained diabetes in mother ---> altered genes ----> regulation of metabolic genes, obesity in offspring


Diabetes begets diabesity
The majority of people with diabetes are affected by which type
type 2

used to occur in adults, now in children too
China ranks 1st and then _____ranks 2nd ________3rd
2nd india
3rd usa
Proportion of disease prevalence attributable to obesity in usa
61 percent is TYPE 2 diabetes
Fast facts on diabetes
29.1 million people or 9.3 percent of the us population have diabetes

Diagnosed 21 million people

Undiagnosed 8.1 million people
Pre diabetes predicted from fasting glucose or hemoglobin A1C levels
>20 years, 86 million, 37 percent
Incidence of diabetes varies marketedly between ethnic/minority groups
piMA Indians (40 to 50 years) at 50 years old
Non-hispanic black
asian indian (13 percent)
Hispanic (12.8 percent)
Type 1 is mainly
t-cell mediated autoimmune disease

Genetic HLA Linked - 40 percent risk , low penetrance

Enviornmental factors 60 perent risk - including
viruses - rubella, enterovirus, coxsackie, CMV

Dietry factors
- Drinking cow milk proteins esp bovine serum albumin
- Early introduction of gluten before 3 months
- breast feeding protects


-Vit D protects?



Hygience hypothesis: too much cleaning leading to defciciency in immuno regulation

low level of expression of gene in heterzygote
Type 1 incidence -
highest in finland>sweden>UK=NZ> Netherlands

High consumption of milk (association)
Theories for cow milk relationship
immature gut mucosa allows antigenic proteins to cross (beta casein, beta lactoglobulin and albumin) --- mimicary of pancreatic beta cell (beta cells have similar antigens to these proteins) --- therefore developing the antibodies to these proteins -- will eventually lead to developing antibodies to the beta cells


- bovine insulin in milk triggers antibodies to insulin

Breast feeding is protective
Women with GDM (Can reduce risk by ____)
could have their risk of type 2 diabetes after delivery by breastfeeding for atleast 2 months
Type 2 and GDM have strong enviornmental eitology ? Pathogensis:
defective insulin secretion ad action
Insulin secretory defect (genetic transmission)
low or high birth weight (fetal origin theory)

Chronic hyperglycemia - high GI/GL foods (glycemic load)
Peripheral insulin resitance (impaired insulin -mediated glucose uptake in muslce)
nothing wrong with beta cellls ---

GLUT 4 transporters are Not placed on the cell membrane

genetic - 50 percent
environment factors : (weight gain 25 percent, physical activity 25 percent)
obesogenic environment is a major causal factor? True or False
True
Risk factors for Type 2 diabetes
Age
family history ethnic group
social class
fetal nutrition and early growth patters

Diet (SFA)
inadequate Physical activity
Central obesity
Metabolic syndrome
Diabetes: Prevalence and nutritional etiology
Type 2 and GDM: Strong environmental etilogy

Type 1 : Autoimmune induced by viruses, cow milk, gluten, lack of vit D, and or external immune stimulation (Hygiene hypothesis)
Body weight and Type 2 diabetes risk:
70 to 80 percent of type 2 diabetics are either overweight or obese

continous relationship between weight and risk of type 2

each 1 kg increase in weight in the population - risk goes up by 4.5 percent

overweight and fat distribution are important

Patients with central adiposity (waist>1.02m IN MEN, > .88m in women) have higher insulin levels are more insulin resistant than patient with similar weight but peripheral obesity
Central obesity leads to insulin resitance and metabolic syndrome - a precursor of
type 2 DM

Artherosclerotic vascular disease

increased risk of death
Metabolic syndrome
a clustering of disorders , atleast 3 that result from the failure of the normal actions of insulin

1. Glucose intolerance
2. central adiposity (insulin resistence, hyperinsuliemnia)
3. HTN
4, Dyslipidiea (Tag increase)
5. Dyslipdiea (reduce HDL)


Central adiposity leads to -- insulin resistance --> Metabolic syndrome leads to NIDDM, and Also CVD


Metabolic syndrome = clinically identifiable
Metabolic syndrome disorders increaes the risk of
CHD Death
Non fatal MI risk
Central adiposity is key determinant of
CHD risk in mean and women
The main cause of metabolic syndrome
intra-abdominal visceral obesity
Central obesity and insulin resistance
-Drains directly to liver via portal system (first one into blood- very fast mobilization)

- More NEFA produced than from Gluteal- femoral fat: NEFA delivery to muscle causes IR

- More inflammatory cytokines (Causes IR) than from gluteal femoral fat

- Adipocytes located centrally are larger and more resistant to insulin than peripherally

- hyperinsulemina directly related to waist circumference
Keypoints for metabolic syndrome:
Clustering of clinically identifable disorders result from insulin resistence

The metabolic syndrome is a major predisposing factor for TYPE DM and CHD

Central obesity is major cause of MS

There are clear benefits from loss of central fat
Treatment for Type 1 Diabetes
change diet, lifestle and you need insulin
Treatment Type 2 and GDM
Diet / lifestyle
+ orgal hypoglycemic drugs (metformin) - several others

+ insulin if needed
Current US statistics for Treatment of DM
23 percent no insulin or oral medication
49 percent take oral medical only
16 percent take insulin only
12 percent take both insulin and oral medication
Metformin
improved glycemic control, and reduces diabetic complications by reduction of hepatic gluconeogensis

Decreased absorption of glucose from the GI Tract

Increased insulin sensitivity
Lifestyle changes/dietary principles for diabetes treatment and prevention
weight control, or lose weight or increase excercise


Modest energy deficit within healthy diet
- add fruit and vegetables
- healthy fats (low sats, high mufa/pufa ratio)
-regular meals (snacks in type 1)
- maintain adequate vit D
-Avoid excess salt
- Moderate alcohol consumption

- Complicated diets dont work
Avoid Trans-fats, reduce saturated fat
SFA is casual factor in insulin resistance (experimental and cross sectional studies)


Substitution with either pufa/mufa reduces insulin resistance and changes abdominal fat distribution
Fish oil has overall benefits in diabetes? True or False?
True
omega 3 fatty acids activate
macrophage reception in intraperitoneal macrophages , result in antiflammatory effects and improved systemic insulin sensitivity
healthy Diets
diretry approaches to stop hypertension (DASH)
- HIGH fruit intake, vegetables, nuts, legumes, low fat dairy product, whole grains
- Low intake of sodum, sweetened beverages, red, processed meats

Alternative healthy eating (aHEI)
- High intake of fruits, veg, nuts, soy,
- high pufa, to SFA, high white meat vs red meat
- use of dietry supplements and moderate alcohol consumption
-low intakes of trans fat
Higher dietary quality (DASH, aHEI)
associated with lower risk of type 2 DM
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