Besides Diabetes and CVD, Obese Children Will Have 50% Higher Risk of Colon Cancer

The newest reason for doing everything possible to reduce childhood obesity names certain cancers as risks associated with a high BMI....



Obesity in childhood has a direct link with bladder and urinary tract (urothelial), and colorectal cancers in adulthood, warn Israeli researchers.

Childhood obesity is associated with all sorts of immediate health problems, including high blood pressure, high cholesterol, breathing and joint problems, along with an increased risk of developing diabetes and heart disease. This study set out to examine the relationship between childhood obesity and future diagnoses of urothelial, or bladder, and colorectal cancers.

Researchers at Tel Aviv University gathered the health information of 1.1 million males collected by the Israeli Defense Forces and then linked this medical data to the National Cancer Registry. They looked specifically at the rates of urothelial and colorectal cancer over a follow-up period of 18 years in those who were obese, meaning that they had a body mass index (BMI) in the 85thpercentile and above, at age 17. Adjustments were made for year of birth, level of education, and religiosity.

Those whose BMI placed them in the range of obesity in adolescence had a 1.42% greater chance of developing urothelial or colorectal cancers in adulthood.

While these results only tell us about the incidences of two specific types of cancer, Ari Shamiss, one of the doctors involved in the study, has indicated that he is currently researching connections between childhood obesity and other cancers in the hopes of uncovering other connections. "We still need to learn whether obesity is directly causing the high risk of cancer, and, perhaps most essentially, whether losing weight is effective -- and if so, how much and when -- in lowering it.

In conclusion, childhood obesity is associated with a 50% higher risk of urothelial or colorectal cancers.

"Overweight in Adolescence is Related to Increased Risk of Future Urothelial Cancer," published in the journal Obesity.

Staying Safe During (and After) Vigorous Exercise

Q: My husband has type 1 diabetes and is training to ride in a 65-mile bicycle race. How can he best control his blood sugar levels during and after this race? His levels sometimes crash a few hours after training.

A:First, I would like to congratulate your husband on having the remarkable discipline such an activity requires. This is long and strenuous exercise. I am assuming that he has been evaluated and cleared by his doctor to participate in such physical activity, so I will focus on glucose control. When engaging in arduous exercise, people who have diabetes should be vigilant about preventing both high and low glucose levels.

The risk of low sugar levels is more intuitive to understand than high sugar levels because the body uses so much energy from glucose during exercise. In addition, after exercising, the body tries to replenish the energy stores of the muscles and the liver, which can also lead to abnormally low blood sugar levels.

High sugar levels can develop because the body considers long and strenuous exercise a form of stress. Any type of stress triggers the production of adrenaline and other hormones that inhibit insulin and increase the production of glucose. Here are some general guidelines.

Before training begins, your husband should have his diabetes controlled very well with intense insulin therapy, either with three or more injections a day or with an insulin pump. This allows for better flexibility during his training and race.
During his training weeks or months, your husband should monitor his glucose levels both before and after meals. He should also track the amount of insulin he injects, his dietary intake, and the duration of each exercise or training session. He should also check his glucose levels at 2 a.m.

Before he starts his training sessions, he should determine his glucose level. The ideal glucose level is 100 to 250 mg/dl. If it is below 100 mg/dl, then he must eat a snack containing carbohydrates. If it's above 250 mg/dl, he should also check for the presence of ketones in his urine. Ketones are the by-product of fat energy metabolism. The body reverts to this process when it lacks sufficient amounts of insulin. If he has urine ketones, he should refrain from exercising until the insulin deficiency is corrected. If his sugar is above 300 mg/dl, he must postpone his training session until his levels are corrected.

While he's training, your husband should check his glucose level frequently. He should also carry drinks that contain carbohydrates, or sugar tablets, to compensate for low levels. Having a "map" of his sugar levels (see step 2) will provide him a reference to base his insulin requirement on as well.

After exercising, your husband's body will try to restore the glucose in his muscles and liver, so it will continue to remove glucose from the bloodstream. This leads to low sugar levels even hours after he's through exercising. Your husband must check his glucose level immediately after exercising and several times later, for up to 12 hours afterwards.

Based on the records he has kept on his glucose levels, he may need to reduce his insulin dose by more than 50 percent.

It is best to exercise at least 30 minutes after injecting insulin to limit the effect of exercise on insulin absorption. If your husband exercises in the afternoon or evening, he might find his glucose level to be abnormally low in the middle of the night — his bedtime or evening insulin doses would have to be adjusted accordingly. If your husband is on NPH, the evening dose should be given at 10 or 11 p.m. Your husband will probably need to increase his carbohydrate intake in the evening to prevent low blood sugar levels in the middle of the night.

It is also generally recommended that diabetic athletes have a meal two to six hours before exercising. It should contain 83 to 200 grams of carbohydrate, a small amount of protein, and fat.

Get Pumped: For Better Blood Sugar Control in Diabetes, It's Weights First

In people with type 1 diabetes, weight training before cardio exercise was linked with less severe drops in blood sugar.

MONDAY, Mar. 12, 2012 — It’s a question many workout devotees struggle with: weights before cardio, or vice versa? Now a new report says that for those with type 1 diabetes, it may be better to pump iron before getting on the elliptical or jogging around the block.

The study, published in the journal Diabetes Care, followed 12 active, young (average age 32) people with type 1 diabetes who were already running and doing strength training at least three times a week. In the first of two exercise sessions, the participants ran on a treadmill for 45 minutes, then lifted weights for 45 minutes. For the second session, the order was reversed (weights first, then running). Blood sugar levels were monitored before, during, and after each session.

The researchers found that when cardio was done first, glucose levels tended to drop and remain at low levels throughout the workout. By comparison, doing resistance exercise first was linked to less severe decreases in blood sugar, even hours after working out.

The study was small, and other factors that could have affected blood sugar were not considered. But according to Reuters Health, the findings agree with previous reports showing that aerobic workouts produce a quicker drop in blood sugar than strength training.

Balancing the health benefits of exercise with the risk of hypoglycemia (low blood sugar) can be tricky. During exercise, the body draws on blood glucose for energy — which can lead to those dangerous lows. Signs of hypoglycemia include dizziness, sweating, grumpiness, weakness, or hunger.

If you have type 1 diabetes and workout regularly, what else can you do to prevent low blood sugar besides switching around your exercise routine? The National Diabetes Information Clearinghouse recommends checking blood sugar first before exercising and having a snack if the level is below 100 milligrams per deciliter, as well as testing blood sugar at regular intervals both during an extended workout and after the session is completed. Wearing a medical identification bracelet and carrying food or glucose tablets during your workout are also smart ideas.

Fat Disrupts Sugar Sensors Causing Type 2 Diabetes

US researchers say they have identified how a high-fat diet interferes with the body's sugar sensors and triggers type 2 diabetes....

The authors argue that a deeper understanding of the processes involved could help them develop a cure. One of the main risk factors for type 2 diabetes is being overweight -- rising obesity levels have contributed to a doubling of diabetes cases in the last 30 years.

Sugar in the blood is monitored by pancreatic beta cells. If sugar levels are too high then the cells release the hormone insulin, which tells the body to bring the levels back down. Key to this is the enzyme GnT-4a. It allows the cells to absorb glucose and therefore know how much is in the blood.

Researchers at the University of California and the Sanford-Burnham Medical Research Institute say they have shown how fat disrupts the enzyme's production. Experiments on mice showed that those on a high-fat diet had elevated levels of free fatty acids in the blood. These fatty acids interfered with two proteins - FOXA2 and HNF1A - involved in the production of GnT-4a. The result: fat effectively blinded cells to sugar levels in the blood and the mice showed several symptoms of type 2 diabetes. The same process also took place in samples of human pancreatic cells.

Lead researcher Dr. Jamey Marth said, "The observation that beta cell malfunction significantly contributes to multiple disease signs, including insulin resistance, was unexpected."

He suggested that boosting GnT-4a levels could prevent the onset of type 2 diabetes: "The identification of the molecular players in this pathway to diabetes suggests new therapeutic targets and approaches towards developing an effective preventative or perhaps curative treatment." "This may be accomplished by beta cell gene therapy or by drugs that interfere with this pathway in order to maintain normal beta cell function."

Dr. Iain Frame, Director of Research at Diabetes UK, said, "The researchers have linked their results in mice to the same pathways in humans and although they did not show they could prevent or cure type 2 diabetes, they have shown it is a theory worth investigating further."

"We will watch this with great interest and hope this early work will eventually lead to some benefit to people with type 2 diabetes."

Hemoglobin A1c as a Diagnostic Tool for Diabetes Screening and New-Onset Diabetes Prediction

A 6-year community-based prospective study

OBJECTIVE Various cutoff levels of hemoglobin A1c (A1C) have been suggested to screen for diabetes, although more consensus about the best level, especially for different ethnicities, is required. We evaluated the usefulness of A1C levels when screening for undiagnosed diabetes and as a predictor of 6-year incident diabetes in a prospective, population-based cohort study.

RESEARCH DESIGN AND METHODS A total 10,038 participants were recruited from the Ansung-Ansan cohort study. All subjects underwent a 75-g oral glucose tolerance test at baseline and at each biennial follow-up. Excluding subjects with a previous history of diabetes (n = 572), the receiver operating characteristic curve was used to evaluate the diagnostic accuracy of the A1C cutoff. The Cox proportional hazards model was used to predict diabetes at 6 years.

RESULTS At baseline, 635 participants (6.8%) had previously undiagnosed diabetes. An A1C cutoff of 5.9% produced the highest sum of sensitivity (68%) and specificity (91%). At 6 years, 895 (10.2%) subjects had developed incident diabetes. An A1C cutoff of 5.6% had the highest sum of sensitivity (59%) and specificity (77%) for the identification of subsequent 6-year incident diabetes. After multivariate adjustment, men with baseline A1C ≥5.6% had a 2.4-fold increased risk and women had a 3.1-fold increased risk of new-onset diabetes.

CONCLUSIONS A1C is an effective and convenient method for diabetes screening. An A1C cutoff of 5.9% may identify subjects with undiagnosed diabetes. Individuals with A1C ≥5.6% have an increased risk for future diabetes.
Footnotes

This article contains Supplementary Data online at http://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc10-0644/-/DC1.

Received April 6, 2010.
Accepted January 23, 2011.

© 2011 by the American Diabetes Association.

American Diabetes Association's New Clinical Practice Recommendations Promote A1c as Diagnostic Test for Diabetes and Pre-Diabetes

Faster, easier test could help reduce number of undiagnosed with diabetes and pre-diabetes.

The American Diabetes Association's (ADA) new Clinical Practice Recommendations being published as a supplement to the January issue of Diabetes Care call for the addition of the A1c test as a means of diagnosing diabetes and identifying pre-diabetes. The test has been recommended for years as a measure of how well people are doing to keep their blood glucose levels under control.

"We believe that use of the A1c, because it doesn't require fasting, will encourage more people to get tested for Type 2 diabetes and help further reduce the number of people who are undiagnosed but living with this chronic and potentially life-threatening disease. Additionally, early detection can make an enormous difference in a person's quality of life," said Richard M. Bergenstal, MD, President-Elect, Medicine & Science, ADA.

"Unlike many chronic diseases, Type 2 diabetes actually can be prevented, as long as lifestyle changes are made while blood glucose levels are still in the pre-diabetes range."

A1c is measured in terms of percentages. The test measures a person's average blood glucose levels over a period of up to three months and previously had been used only to determine how well people were maintaining control of their diabetes over time. A person without diabetes would have an A1c of about 5 percent.

Under the new recommendations, which are revised every year to reflect the most current available scientific research, an A1c of 5.7 -- 6.4 percent would indicate that blood glucose levels were in the pre-diabetic range, meaning higher than normal but not yet high enough for a diagnosis of diabetes. That diagnosis would occur once levels rose to an A1c of 6.5 percent or higher.

The ADA recommends that most people with diabetes maintain a goal of keeping A1c levels at or below 7 percent in order to properly manage their disease. Research shows that controlling blood glucose levels helps to prevent serious diabetes-related complications, such as kidney disease, nerve damage and problems with the eyes and gums.

The A1c would join two previous diagnostic tests for diabetes, Fasting Plasma Glucose (FPG) and the Oral Glucose Tolerance Test (OGTT), both of which require overnight fasting. Because the A1c is a simple blood test and does not require fasting, allowing patients this option could increase willingness to get tested, thereby reducing the number of people who have Type 2 diabetes but don't yet know it.

According to the Centers for Disease Control and Prevention, one-fourth of all Americans with diabetes, or 5.7 million people, don't realize they have it. Another 57 million have pre-diabetes and 1.6 million new diagnoses are made every year.