Modifiable Risk Factor For Development Research Articles

THU0504 The Relationship Between Weight Loss and Reduced Cartilage Loss in the Medial Knee Joint is Non-Linear in Obese People

BackgroundObesity is the strongest modifiable risk factor for development and progression of knee osteoarthritis (OA). There is emerging evidence for a beneficial effect of weight loss on knee structure. The...

Integrating substance abuse care with community diabetes care: implications for research and clinical practice.

Cigarette smoking and alcohol use are prevalent among individuals with diabetes in the US, but little is known about screening and treatment for substance use disorders in the diabetic population. This commentary discusses the scope and clinical implications of the public health problem of coexisting substance use and diabetes, including suggestions for future research. Diabetes is the seventh leading cause of death in the US, and is associated with many severe health complications like cardiovascular disease, stroke, kidney damage, and limb amputations. There are an estimated 24 million adults in the US with type 2 diabetes. Approximately 20% of adults aged 18 years or older with diabetes report current cigarette smoking. The prevalence of current alcohol use in the diabetic population is estimated to be around 50%–60% in epidemiological surveys and treatment-seeking populations. Cigarette smoking is associated with an increased risk of type 2 diabetes in a dose-dependent manner and is an independent modifiable risk factor for development of type 2 diabetes. Diabetic patients with an alcohol or other drug use disorder show a higher rate of adverse health outcomes. For example, these patients experience more frequent and severe health complications as well as an increased risk of hospitalization, and require longer hospital stays. They are also less likely to seek routine care for diabetes or adhere to diabetes treatment than those without an alcohol or other drug use disorder. The Affordable Care Act of 2010 and the Mental Health Parity Act and Addiction Equity Act of 2008 provide opportunities for facilitating integration of preventive services and evidence-based treatments for substance use disorders with diabetes care in community-based medical settings. These laws also offer emerging areas for research.

Nutritional risk factors of early development of postpartum prediabetes and diabetes in women with gestational diabetes mellitus

Objective Early detection of prediabetes and diabetes after delivery helps prevent and delay the development of overt type 2 diabetes in women with gestational diabetes mellitus (GDM). We sought to identify modifiable risk factors for the early development of postpartum type 2 diabetes in women with GDM that may help establish interventions for preventing or delaying the subsequent onset of type 2 diabetes. Methods Three hundred eighty-one women who developed GDM during pregnancy were tested for 1) antepartum anthropometric and biochemical measurements, 2) pregnancy outcome, 3) oral glucose tolerance test at 6 to 12 wk after delivery, and 4) postpartum anthropometric, biochemical, and nutritional measurements. The subjects were divided into three groups on the basis of the postpartum oral glucose tolerance test results: normal glucose tolerance group ( n = 193), prediabetes ( n = 161), and diabetes ( n = 27). Results The incidences of postpartum prediabetes and diabetes at 6 to 12 wk follow-up in Korean women with GDM were 44.8% and 5.2%, respectively. Antepartum modifiable risk factors for developing type 2 diabetes at early postpartum included higher body mass index, lower β-cell function, insulin dosage during late pregnancy, and the non-modifiable risk factor of family history of diabetes ( R 2 = 0.14). Postpartum risk factors included higher body mass index, serum triacylglycerols, hemoglobin A 1c, and energy intake and lower insulin secretion capacity ( R 2 = 0.43). Animal fat intake was higher in the prediabetes and diabetes groups than in the normal glucose tolerance group, whereas breast-feeding did not alter the risk for the development of postpartum diabetes. Conclusion This study strongly suggests that the development of postpartum type 2 diabetes in women with GDM can be prevented and/or delayed by lifestyle and nutritional intervention during antepartum and postpartum.

B-Vitamins and Fatty Acids in the Prevention and Treatment of Alzheimer's Disease and Dementia: A Systematic Review

The increasing worldwide prevalence of dementia is a major public health concern. Findings from some epidemiological studies suggest that diet and nutrition may be important modifiable risk factors for development of dementia. In order to evaluate the strength of the available evidence of an association of dietary factors with dementia including Alzheimer's disease (AD), we systematically searched relevant publication databases and hand-searched bibliographies up to end July 2007. We included prospective cohort studies which evaluated the association of nutrient levels with the risk of developing dementia and randomized intervention studies examining the treatment effect of nutrient supplementation on cognitive function. One hundred and sixty studies, comprising ninety one prospective cohort studies and sixty nine intervention studies, met the pre-specified inclusion criteria. Of these, thirty-three studies (19 cohort and 14 randomized controlled trials) investigated the effects of folate, B-vitamins, and levels of homocysteine (a biomarker modifiable through B-vitamin supplementation) or fish/fatty acids and are the focus of the present report. Some observational cohort studies indicated that higher dietary intake or elevated serum levels of folate and fish/fatty acids and low serum levels of homocysteine were associated with a reduced risk of incident AD and dementia, while other studies reported no association. The results of intervention studies examining the effects of folic acid or fatty acid supplementation on cognitive function are inconsistent. In summary, the available evidence is insufficient to draw definitive conclusions on the association of B vitamins and fatty acids with cognitive decline or dementia, and further long-term trials are required.

The Effect of Abdominal Support on Functional Outcomes in Patients Following Major Abdominal Surgery: A Randomized Controlled Trial

Immobility and pain are modifiable risk factors for development of venous thromboembolism and pulmonary morbidity after major abdominal surgery (MAS). The purpose of this study was to investigate the effect of abdominal incision support with an elasticized abdominal binder on postoperative walk performance (mobility), perceived distress, pain, and pulmonary function in patients following MAS. Seventy-five patients scheduled to undergo MAS via laparotomy were randomized to experimental (binder) or control (no binder) groups. Sixty (33 male, 27 female; mean age 58±14.9 years) completed the study. Preoperative measurements of 6-minute walk test (6MWT) distance, perceived distress, pain, and pulmonary function were repeated 1, 3, and 5 days after surgery. Surgery was associated with marked postoperative reductions (p<0.001) in walk distance (∼75-78%, day 3) and forced vital capacity (35%, all days) for both groups. Improved 6MWT distance by day 5 was greater (p<0.05) for patients wearing a binder (80%) than for the control group (48%). Pain and symptom-associated distress remained unchanged following surgery with binder usage, increasing significantly (p<0.05) only in the no binder group. Elasticized abdominal binders provide a non-invasive intervention for enhancing recovery of walk performance, controlling pain and distress, and improving patients' experience following MAS.

Sustained postprandial decrease in plasma levels of LDL cholesterol in patients with type‐2 diabetes mellitus

Objective. Low density lipoprotein cholesterol (LDL‐C) is an independent and modifiable risk factor for development of cardiovascular disease (CVD). Postprandial lipid metabolism has been linked to CVD, but little is known about the postprandial LDL‐C profile in patients with type‐2 diabetes (T2DM). We aimed to study the postprandial levels of LDL‐C in T2DM patients. Material and methods. After an overnight fast, 74 T2DM patients, mean age approximately 60 years, were served a standard fat‐rich meal of 3,515 kJ containing 54 % fat, 13 % protein and 33 % carbohydrates. Only drinking water was allowed postprandially. Blood samples were drawn at times 0 (fasting), 1.5, 3.0, 4.5 and 6.0 h (postprandial). In all samples, LDL‐C was measured with modified beta quantification (separation by ultracentrifugation followed by measurement of infranate high density lipoprotein cholesterol (HLD‐C) using a homogeneous assay). Results. At all postprandial times, levels of LDL‐C showed highly significant (p<0.005) decreases compared to time 0 (mean [95 % CI] maximum change in LDL‐C levels at 3.0 h: −0.16 mmol/L [−0.12; −0.20]; p<0.001). Independently of fasting LDL‐C levels and ongoing statin therapy, LDL‐C decreased significantly more in female compared to male patients postprandially (mean [95 % CI] maximum unadjusted change versus time 0 in LDL‐C for men [n = 56] at 3.0 h: −0.14 mmol/L [−0.19; −0.10], p<0.001; for women [n = 18] at 4.5 h: −0.26 mmol/L [−0.35; −0.18], p<0.001; −0.14 mmol/L [−0.24; −0.05], p = 0.005 between genders for the mean [95 % CI] fasting adjusted difference at 4.5 h in the change versus time 0 in LDL‐C; gender by time interaction: p = 0.007 (repeated measures mixed model)). Conclusions. In T2DM patients served a fat‐rich meal, levels of LDL‐C decreased significantly more in women compared to men postprandially, irrespective of fasting levels or ongoing statin therapy. This might have implications in the atherosclerotic process and on any difference in the risk of CVD between genders.

Risk Factors for the Metabolic Syndrome

The aim of this study was to describe the association of the metabolic syndrome with demographic characteristics and to identify modifiable risk factors for development of the metabolic syndrome. Men and women (55%) aged 18-30 years from the Coronary Artery Risk Development in Young Adults (CARDIA) study without the metabolic syndrome at baseline (n = 4,192, 49% black) were followed-up from 1985 to 2001. Incident metabolic syndrome, defined according to the National Cholesterol Education Program Adult Treatment Panel III criteria, was ascertained 7, 10, and 15 years after baseline. Risk factors were measured via clinical examination and standardized questionnaires. The age-adjusted rate of metabolic syndrome was 10 per 1,000 person-years (n = 575). Metabolic syndrome risk increased with age and was higher among black participants and those with less than a high school education. Higher baseline BMI, no alcohol intake (versus one to three drinks per day), higher intake of dietary carbohydrates, and lower intake of crude fiber were each associated with an increased risk for the metabolic syndrome (relative risk [RR] ranging from 1.3 to 1.9), and physical activity was protective (RR 0.84 [95% CI 0.76-0.92]). In models adjusting simultaneously for all factors, black participants and women were less likely to develop metabolic syndrome. Risk for metabolic syndrome increased 23% (20-27%) per 4.5 kg (10 lb) of weight gained, whereas regular physical activity over time versus low activity was protective (RR 0.49 [0.34-0.70]). BMI and weight gain are important risk factors for the metabolic syndrome. Regular physical activity may counter this risk.