Autism Linked to Mom's Diabetes

Mothers who are obese or who have diabetes appear to be more likely to have children with neurodevelopmental disorders, including autism.... According to Paula Krakowiak, MS, a PhD candidate at the MIND Institute at the University of California Davis, and colleagues, maternal obesity was associated with greater odds of the offspring receiving a diagnosis of an autism spectrum disorder (OR 1.67, 95% CI 1.10 to 2.56) or a developmental delay (OR 2.08, 95% CI 1.20 to 3.61) by age 5. A combination of maternal metabolic conditions was associated with a range of impairments in the children's development, the researchers reported. Susan Hyman, MD, of the University of Rochester in Rochester, N.Y., who is the chair of the American Academy of Pediatrics' autism subcommittee, called the findings provocative. Although the observational study could not prove causal relationships, Hyman said the findings suggest that maternal metabolic disorders are contributing causes to autism and other developmental disorders. Roughly one in every 88 children has an autism spectrum disorder (ASD), according to a recent estimate from the CDC, and one in every 83 has another developmental delay. Hyman also said that if maternal metabolic conditions are adding to the burden of autism, it is likely a small contribution. She noted that other factors related to obesity that were not captured in the database could be involved in the relationships. She added that mothers of children with disabilities often scrutinize everything they did, ate, and were exposed to during their pregnancy to try to find an explanation. But, she said, "At the time of your child's diagnosis, that's all ancient history. What you have to concentrate on is what you can do, what are effective interventions ... being proactive and changing what you can change is really what research is all about. It's not about pointing fingers." Krakowiak agreed, noting that the study is preliminary and cannot prove cause and effect; it is possible there are other factors involved that independently affect obesity and autism. "So I would definitely not want moms to feel guilty for having any one of these conditions, and that being a cause of their child's disorder," she said. The exact cause of autism has not been identified, but both genetics and environmental factors are believed to be involved. Previous studies have identified an association between diabetes during pregnancy and general developmental impairments in the offspring, although research examining the relationship with autism has yielded mixed results. To further explore issue, Krakowiak and colleagues turned to the CHARGE (Childhood Autism Risks from Genetics and the Environment) study, an ongoing case-control study of children born in California. The current analysis included 1,004 children ages 2 to 5 -- 517 with an autism spectrum disorder, 172 with other developmental delays, and 315 with typical development. All of the children were evaluated using the Mullen Scales of Early Learning (MSEL) and the Vineland Adaptive Behavior Scales (VABS), which assessed cognitive and adaptive development, respectively. The specific metabolic conditions assessed among the mothers were obesity, hypertension, and diabetes (either gestational diabetes or type 2 diabetes) during pregnancy. All three of the metabolic conditions were more frequent among the mothers of children with an ASD or other developmental delay. Combined, the rates were 28.6% for mothers of children with an ASD, 34.9% for mothers of children with a developmental delay, and 19.4% for mothers of typically developing children. After adjustment for sociodemographics and other factors, mothers who had one of the three conditions were more likely to have a child diagnosed with an ASD (OR 1.61) or developmental delay (OR 2.35). Maternal hypertension alone was not related to either outcome, and maternal diabetes was associated with greater odds of having a child with a developmental delay (OR 2.33), but not autism. Maternal obesity was associated both with ASD and developmental delay among the children. Among the children with an ASD, maternal diabetes was associated with "relatively small" impairments in expressive language. Among the children without an ASD, the combination of maternal conditions was associated with a wide range of deficits in cognition and adaptive development. Although a case-control study cannot prove cause and effect, there are some possible mechanisms to explain a relationship between maternal metabolic conditions and a child's neurodevelopment, according to Hyman. Maternal glucose, but not insulin, can cross the placenta. If the mother has elevated levels of glucose, the fetus will have to produce more insulin. The increased oxygen demand that results can induce intrauterine tissue hypoxia. Poorly regulated maternal glucose could also result in iron deficiency in the fetus. Both hypoxia and iron deficiency can harm the developing brain. An alternate explanation is that the proinflammatory cytokines present in mothers with metabolic conditions may impair fetal neurodevelopment. Hyman said all of these explanations are hypothetical and need to be studied further. "I think that we have to look at this as a call to our society that there are multiple implications of the obesity epidemic that we need to consider, and that we need to be proactive in what we can do," she said. "What we can do is we can eat healthy and exercise, and this is a positive suggestion for change. There are so many things we can't change. We can change this."

'Fat Chefs' and Diabetes: An Occupational Hazard?

Paula Deen's not alone. The new show 'Fat Chef' follows a dozen kitchen pros as they try to drop the pounds and reclaim their health.

FRIDAY, Jan. 27, 2012 — Have you ever heard the expression "Never trust a skinny chef?" Paula Deen isn't the only kitchen pro who's struggled with obesity — or with diabetes. Many men and women who make their living in the food industry, whether they're professional chefs, restauranteurs, caterers, or bakers, have issues with weight and compulsive eating. A new show, Fat Chef, which premiered on the Food Network this week, focuses on 12 of them as they embark on a 16-week plan to lose weight and get in shape.

One of the Fat Chef participants, 36-year-old Michael Mignano, is a bakery owner and pastry chef who was diagnosed with type 2 diabetes in 2009 after his weight reached 500 pounds. He told ABC News Nightline, "I allowed the stresses of work and life to just compound and just literally eat me alive," adding that when his blood sugar was finally checked by a doctor, it was "to the roof." But after four months eating lean protein and fiber and working out, Mignano has lost 100 pounds — going from a size 6X chef jacket down to a 2X. He also says he's "cured his diabetes" and hasn't taken any medication in three months.

Another Fat Chef participant, 41-year-old Ally Vitella, didn't know she had type 2 diabetes until she underwent a check-up for the show. Vitella, who weighed 345 pounds, says that her excess pounds affected her catering business, leaving her physically unable to carry equipment to her clients' locations. She told the Associated Press, "I was eating hors d'oeuvres for lunch and dinner. I would scoop up half a tray of food and eat it.…We cook things you're supposed to eat once in a while, but I was eating them every day." After doing the show, she's lost nearly 60 pounds and dropped from a size 28 to a size 16.

Another chef interviewed by the AP, Art Smith, was diagnosed with diabetes three years ago and says he reached 325 pounds on a diet of refined sugar and caffeine. Although he isn't one of the show participants, Smith, who was a former chef for Oprah Winfrey, has now lost 118 pounds and now runs marathons.

Mignano acknowledges the dangers of his chosen profession, telling the AP, "You have this abundance of food all around you…You're constantly tasting, working late hours, eating late." But the chef whose signature recipe is a "candy bar" loaded with caramel, nuts, and chocolate has no plans to find another line of work. "I love what I do, so for me to get another job and replace my profession is unfathomable," he told Nightline.

What can you do if you're surrounded by tempting, rich food all day long and need to watch your weight? One thing that may help is practicing mindful eating, which focuses on quieting the mind and tuning in to the body's hunger and fullness signals — both of which can stop that automatic hand-to-mouth motion. A recent study in the Journal of Nutrition and Education Behavior found that using mindful eating techniques when eating out helped women lose weight, even when they weren't trying to.

Weight Loss Is Not The Answer for Preventing Diabetes

Richard Kahn, PhD, who was the chief scientific and medical officer of the ADA for nearly 25 years stated at a conference that, "Community-based weight-loss programs have not been shown to be effective at reducing the incidence of diabetes, so implementing a national program would likely be money down the drain."...

He stated that, "Community programs are ineffective at achieving weight loss."

Kahn -- who now teaches medicine at the University of North Carolina at Chapel Hill -- said that just sustaining significant weight loss, even with intensive dieting, exercise, and coaching, "requires near-heroic measures" in the face of a "very hostile food environment."

He outlined his views in a published paper, in which he wrote that there are two ways to dramatically reduce the toll of diabetes: One is to detect diabetes early and then treat it so effectively that complications from the disease are practically zero. The other is to prevent diabetes before it even happens.

Thousands of public health campaigns are aimed at prevention, and for diabetes, that generally means losing weight. But people have the "fundamental problem" of not being able to maintain weight loss, so preventing diabetes in a person at high risk for the disease is extremely difficult, Kahn said.

His paper looked at diabetes prevention studies, including the large Diabetes Prevention Program, in which patients lost an average of between 4% and 6% of their body weight (but gained about 40% back by the end of the nearly three-year trial). It also looked at the government-funded Look AHEAD trial, which found that intensive lifestyle changes resulted in a major reduction in cardiovascular risk factors, but the effects greatly diminished after four years when many participants gained weight and lost their improved fitness.

Kahn said those studies, along with the Finnish Diabetes Prevention Study -- in which the greatest diabetes prevention benefit occurred in people who lost at least 5% of their body weight -- suggest that "without substantial, sustained weight loss, progression to diabetes will probably resume." Progression to diabetes may be delayed for a few years, but the long-term effects are uncertain, he said.

(However, a preliminary study presented at the American Diabetes Association meeting last year found that a short-term lifestyle modification program for overweight diabetic patients showed long-term benefits for many of the participants.)

"In sum, to date, we have not seen a demonstration of any program that results in a clinically meaningful weight loss that can be maintained for more than two to three years in the great majority of participants and at a low cost," Kahn wrote.

Kahn's remarks preceded those of Kenneth Thorpe, of Emory University, who outlined how the healthcare reform law laid the groundwork for a national, community-based diabetes prevention strategy modeled on the Diabetes Prevention Program.

Kahn said that would be a waste of money. "The main argument is that implementing a nationwide community intervention program is not going to do anything, I believe, except waste resources." He also stated that there are too many unanswered questions about how weight loss works that must be answered before a national program would ever succeed in preventing diabetes in the long term.

"We really need to know what is going on with this complex system we have," he said. "What is going on in our physiology that precludes us from losing weight and keeping it off?" Another issue that prevents people from keeping weight off is the ubiquity of the "cheap, widely available, delicious food that we eat again and again."

He suggested "painful policies" as the solution -- such as raising the price of all food except for fruits and vegetables, and offering financial incentives to people who can keep weight off, while penalizing overweight people with higher insurance premiums.

He acknowledged those aggressive policies likely would be unpopular among members of Congress and doctors. "While we wait for the time when lifestyle modification becomes practical, we might be better served by focusing more attention on improving our understanding of the processes that affect energy intake and expenditure and improving the medical management of diabetes," Kahn wrote.

Those medical management strategies include making an early diagnosis and administering "proven treatments that have been shown to reduce complications of diabetes and extend life," he said.

He added that the best doctors can offer right now is to suggest to overweight patients that losing 4% body weight and keeping it off can reduce the risk for serious complications of diabetes by 15% to 20%.
Health Affairs, Jan. 2012

Paula Deen Announces She Has Diabetes

TV chef Paula Deen—the queen of deep-fried Southern cooking—joins Halle Berry, Randy Jackson, Dick Clark and 28.5 million other Americans in battling diabetes.

The Daily reported last week that the Food Network star--famed for artery-clogging fare as deep-fried macaroni and cheese—wrapped in bacon—would soon come clean about a “big fat secret," her type 2 diabetes diagnosis. Deen just announced the diabetes news with Today’s Al Roker.

Rumors about Deen’s diabetes first surfaced in April when both the National Enquirer and The Daily Mail reported that the bestselling cookbook author was keeping her disorder hidden due to concerns that it would harm her career. However, learning that she has a disease strongly linked to obesity and unhealthy eating would hardly shock fans who have watched her prepare such belly-busters as egg-and-bacon-topped burgers served between two glazed donuts.

Deen, who has described butter as “a little stick of smiles and happiness,” has already come under fire for the lavish amounts of fat and sugar in her cooking. Now that the diva of the deep fryer has confirmed a diabetes diagnosis, what might be ahead for her? Here’s a look at a disease that’s predicted to affect in one in three Americans in coming years if current trends continue.

Use these 7 diabetes tips to manage your condition

What triggers type 2 diabetes?

While the cause isn’t fully understood, type 2 diabetes starts when the body becomes insensitive to insulin, a hormone that acts like a key to let sugar—the body’s main source of fuel—into cells. This forces the pancreas to pump out higher and higher amounts of insulin, to try to keep up with demand. Ultimately, the pancreas becomes exhausted and blood sugar rises, leading to diabetes. A diet that’s high in saturated fats—such as the deep-fried dishes that figure prominently in Deen’s cooking—also increase insulin resistance.

Who’s at risk?

Like Paula Deen, about 90 percent of people who develop type 2 diabetes are overweight. And the more belly fat you have, the more likely you are to develop insulin resistance. A particular danger zone is a waist circumference of more than 35 inches for a woman and 40 inches for a man.

Other risk factors include family history, a couch potato lifestyle, age (risk rises significantly after age 45), and ethnicity, with African-Americans and Hispanics, Native Americans and Asian Americans facing a greater threat of the disease. Women who have had gestational diabetes during pregnancy or who have given birth to babies weighing over 9 pounds are also at higher risk.

Learn which foods can help diabetes patients manage their blood sugar

What are the symptoms?

One-third of the 28.5 million Americans with diabetes and the 87 million with pre-diabetes (an earlier stage) don’t know it because the disease may not cause symptoms until serious complications set in.

Warning signs include increased thirst, frequent urination, extreme hunger, blurred vision, slow-healing wounds, and frequent infections, such as gum infections, bladder infections, or yeast infections.

How dangerous is diabetes?

The disease triples the danger of heart attacks and strokes. Other complications, particularly if diabetes goes undiagnosed and untreated, include kidney damage, nerve damage, blindness, foot infections and lower leg amputation.

Recent research suggests that high blood sugar may also boost for Alzheimer’s disease in diabetes with a certain gene. A 2011 study linked high blood sugar to increased risk for colon cancer.

Read about how diet affects your children's risk of diabetes

What’s the best test to check for diabetes?

The American Diabetes Association (ADA) considers the oral glucose tolerance test the “gold standard” for diabetes detection. After an overnight fast, you’ll drink a sugary liquid, with blood samples taken at timed intervals to measure sugar levels. The ADA also recommends the A1C blood test, which measures your average blood sugar level for the past two to three months. Have your blood sugar checked every three years, starting at age 45, or at a younger age if you are overweight with at least one other risk factor.

Is there a diabetes diet?

There’s no specific diet advised for everyone with the disease. However, large studies show that focusing on low-fat, high-fiber foods—such as fruits, vegetables and whole grains—is the healthiest plan for diabetes.

Figuring out the what to eat can be complex for people who are newly diagnosed, so doctors advise working with a registered dietician to develop a meal plan that takes health goals, food preferences and lifestyle into account.

Find out about the top 5 diabetes-healing supplements

What’s the treatment?

Along with a healthy diet, therapies for type 2 typically include medication—which can include both diabetes drugs and statins to reduce heart disease risk--exercising at least 150 minutes per week, and weight loss. Deen may want to take cooking lessons from such chefs as Art Smith, who shed a whopping 85 pounds after getting a diabetes diagnosis.

And if you have pre-diabetes, a review of 28 previous studies, published in Health Affairs this month, finds losing 5 to 7 percent of your body weight (10 to 12 pounds if you weight 200), coupled with stepping up exercise and improving your eating habits, cuts the risk of progressing to full-blown diabetes by 50 percent.

Will Deen now revamp her famously fatty recipes to trim down calories? And if so, will her fans be willing to give up deep-fried Twinkies and eat more veggies? Stay tuned to see what the TV chef dishes up next.