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CMR Short Reviews The Concept of CMR Historical background on global cardiometabolic risk, epidemiological aspects of obesity and type 2 diabetes, ABCs of cardiovascular disease risk factors, intra-abdominal adiposity, metabolic syndrome and contribution to cardiometabolic risk.
The fast, simultaneous growth of obesity and type 2 diabetes has led to the coining of the term ?diabesity? to illustrate the close relationship between these two diseases. As a health hazard, obesity has been linked to numerous metabolic complications such as dyslipidemia, type 2 diabetes, and cardiovascular disease (CVD) (1). The strong relationship between obesity and type 2 diabetes does not mean that being overweight or obese will inevitably cause type 2 diabetes. The possibility of a relationship between body fat distribution and type 2 diabetes was first raised in the mid-forties by French physician Jean Vague (13). Several prospective studies have shown that abdominal obesity increases the risk of type 2 diabetes (16, 17).
Although the mechanism linking abdominal obesity and type 2 diabetes is not fully understood, several studies using anthropometric measurements have reported that upper body obesity?also known as ?android obesity??was more common in diabetic patients than in non-diabetic patients (25, 26). Evidence is mounting in support of the notion that it is not excess body fat but rather high intra-abdominal adiposity that increases the risk of type 2 diabetes and CVD (30). In summary, measuring waist circumference makes it easier to identify patients with intra-abdominal obesity, insulin resistance, and metabolic complications leading to type 2 diabetes. The content of this website is provided for educational and informational purposes only and is not to be used for medical advice, diagnosis or treatment. God hasn’t been randomly changing childhood diabetes melitus form throughout history. Diabetes Supplies Store for Blood Glucose Testing Diabetes is diabetes a virus or bacteria Nutrition Skin Prep Carrying Cases & more. Preventive Services Task Force (USPSTF) recommends using the 50-g oral glucose challenge test to screen pregnant women for gestational diabetes after 24 weeks of gestation. It took me longer to empty the vacuum than to vacuum and then the dirt fuzz sticks to the filter so you have to brush it off somehow with your hand. Syndrome and Insulin Resistance If you’re an adult in America million people in the United States you may not have heard of this syndrome much less understand it.
Gimme yer damn loot!” I don’t know an diabetes uk recipe books exact study you should look one up and send it to me! The World Health Organization predicts there will be 2.3 billion overweight adults in the world by 2015 and more than 700 million of them will be obese. The increase of convenience foods, labour-saving devices, motorised transport and more sedentary jobs means people are getting fatter. The body mass index (BMI) is the most commonly-used way of classifying overweight and obesity in adult populations and individuals. Each BMI figure is classified within a range, eg 18-25 is ideal and over 30 is reckoned to be obese.
According to a survey of bodyshapes conducted in the UK in 1951, a woman's average waist size was 70cm (27.5in).
There was no comparative data for men in 1951, but the SizeUK survey showed the average man in 2004 had a waist of 94cm (37in) and a BMI of 25.2, technically just outside the ideal range.
But obesity is not just a problem for adults - the spread of obesity among children is also alarming experts. At least 20 million children under the age of 5 years were overweight globally in 2005, according to the WHO. Measuring children, aged 5 to 14 years, who are overweight or obese is challenging because there is not a standard definition of childhood obesity applied worldwide. Experts are worried that the increase in obesity will lead to more health problems as people who are overweight have a higher risk of heart disease, Type II diabetes and other diseases including some cancers. As most data sources do not distinguish between Type I and II diabetes in adults, it is not possible to present the data separately. Even if the prevalence of obesity remains stable until 2030, the American Diabetes Association, says that the number of people with diabetes will more than double.
It says the increase may be "considerably higher" than this if, as expected, the prevalence of obesity continues to rise around the world. The number of overweight or obese individuals is fast increasing worldwide, and this increase has meant a concomitant rise in the prevalence of type 2 diabetes (2). For example, some normal weight individuals may be at high risk of developing type 2 diabetes, whereas many very obese individuals are not insulin resistant (11) and may never develop the disease. He reported that the complications generally found in obese patients depended more on the location of the excess fat rather than obesity per se (13).
This is due largely to the fact that large amounts of abdominal fat can cause metabolic complications such as glucose intolerance, hyperinsulinemia, and insulin resistance, all of which increase the risk of type 2 diabetes (18, 19). For a given amount of total body fat, individuals with more intra-abdominal?or visceral? adipose tissue are at substantially greater risk of being insulin resistant and developing atherogenic and diabetogenic complications (30, 31).


Unlike overall obesity per se?which can cause moderate metabolic complications?excess intra-abdominal adipose tissue has a significant negative effect on indices of plasma glucose-insulin homeostasis that predict an increased risk of type 2 diabetes. Development and consequences of insulin resistance: lessons from animals with hyperinsulinaemia. Pathogenesis of type 2 diabetes: metabolic and molecular implications for identifying diabetes genes. Contributions of regional adipose tissue depots tp plasma lipoprotein concentrations in overweight men and women: possible protective effects of thigh fat.
Associations between regional body fat distribution, fasting plasma free fatty acid levels and glucose tolerance in premenopausal women. Biology of regional body fat distribution: relationship to non-insulin-dependent diabetes mellitus. Adiposity and adipose tissue distribution in relation to incidence of diabetes in women: results from a prospective population study in Gothenburg, Sweden. Comparison of abdominal adiposity and overall obesity in predicting risk of type 2 diabetes among men.
Contribution of intra-abdominal fat accumulation to the impairment of glucose and lipid metabolism in human obesity.
Visceral adiposity and risk of type 2 diabetes: a prospective study among Japanese Americans. Scientifically proven principles that will have your body producing more insulin naturally. I love this product it’s a bigger bottle than I have purchased in the store for LESS $. A 3-D survey carried out by SizeUK in 2004 found the average woman had a waist measurement of 86cm (34in) and a BMI of 24.4, just inside the ideal range. With type 2 diabetes reaching epidemic proportions, the International Diabetes Federation (IDF) has predicted that the number of individuals with diabetes may rise to almost 333 million by 2025 (3).
Some etiological factors linking excess body fat and type 2 diabetes could explain this phenomenon. Following this observation, he described the high-risk form of obesity as ?android obesity,? a condition commonly found in men and in which adipose tissue accumulates in the trunk. The study involved 792 men selected by year of birth (54 years old) and followed for 13.5 years. The study compared the predictive power of waist circumference, WHR, and BMI in diagnosing type 2 diabetes.
It has been shown that intra-abdominal adipose tissue is more metabolically active and more closely tied to metabolic abnormalities than subcutaneous adipose tissue (32, 33). They found that excess intra-abdominal adiposity preceded the disease?s development in Japanese Americans. Measuring intra-abdominal adipose tissue using simple tools such as waist circumference should therefore be a crucial step in assessing type 2 diabetes risk among patients.
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Treatment for gestational diabetes includes special diabetic meal plan and scheduled physical activity. Polyuria or frequent and large volumes of urination is a common sign of diabetes along with other complications such as suppressed immune response weakened eye sight and others. For this reason, the World Health Organization (WHO) has called obesity and diabetes the ?21st century epidemic? (4). Obesity and type 2 diabetes share a number of causative lifestyle factors such as excessive energy intake, a diet high in saturated fat, and a sedentary lifestyle. Excess abdominal adipose tissue has been linked to hyperinsulinemia during the fasting state as well as following an oral glucose load (18, 19).
Another study of some 15,000 women (25) showed that obese women who accumulated body fat in the abdominal area had a tenfold increase in their risk of diabetes compared to non-obese women who accumulated body fat in the gluteo-femoral region.
The population sample was divided into tertiles according to body mass index (BMI) and waist-to-hip ratio (WHR) as a marker of relative abdominal fat accumulation (Figure). Intra-abdominal adipose tissue was predictive of type 2 diabetes independent of fasting insulin, insulin secretion, glycemia, total and regional adiposity, and family history of diabetes.
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The term ?diabesity? has been coined (5, 6) to emphasize the close relationship between these two diseases. However, the risk of developing type 2 diabetes may also depend on genetic susceptibility and the distribution of adipose tissue (12). Since these pioneering observations, many cross-sectional and prospective studies have linked type 2 diabetes to body fat distribution.
The increased insulin secretion, insulin resistance, and decreased hepatic insulin extraction that are common metabolic complications of abdominal obesity could explain the hyperinsulinemia also found in abdominally obese individuals. The authors found that the risk of type 2 diabetes rose in step with WHR within each BMI tertile. Study findings showed that type 2 diabetes risk increased with waist circumference and WHR within each category of baseline BMI, revealing that both overall and abdominal adiposity independently predict type 2 diabetes risk. This study confirms that intra-abdominal adipose tissue plays a key role in the development of type 2 diabetes.
Indeed, obesity and type 2 diabetes frequently occur together, and the vast majority of type 2 diabetic individuals are or have been obese (7, 8).
Moreover, obese patients with abdominal adipose tissue accumulation are often glucose intolerant despite their hyperinsulinemia, which suggests these subjects are insulin resistant (18, 19). Even among non-obese men, being in the third WHR tertile was associated with an increased incidence of type 2 diabetes.
The study also found that measuring abdominal adiposity using waist circumference and WHR provides a strong indication of type 2 diabetes risk, independent of overall obesity. They found that subjects with large amounts of intra-abdominal adipose tissue had higher fasting plasma triglyceride levels and higher plasma glucose responses following an oral glucose challenge than subjects who had the same total body fat mass (as measured by BMI) but a preferential accumulation of abdominal subcutaneous adipose tissue. Along with genetic susceptibility, obesity is the most important risk factor for type 2 diabetes (9, 10). It has been suggested that the relationship between excess abdominal adipose tissue and diabetogenic abnormalities is in part related to the direct release of free fatty acids into the portal vein (22). Moreover, in the lowest WHR tertile, the risk of developing the disease did not increase with BMI.
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The term ?diabesity? singles out excess body weight as the major cause of type 2 diabetes (5).
These free fatty acids could decrease hepatic clearance of insulin and worsen systemic hyperinsulinemia (23), a precursor to type 2 diabetes. Furthermore, elevated BMI and WHR increased the risk of type 2 diabetes thirtyfold compared to elevated BMI alone.
Two groups of obese patients were carefully matched for the same amount of total body fat but had either low or high amounts of  intra-abdominal adipose tissue. These observations indicate that abdominal adipose tissue measured by WHR is an important marker of diabetes risk even when the degree of overall obesity is taken into account. The authors found that obese individuals with low levels of intra-abdominal adipose tissue had normal glucose tolerance when compared to lean controls.
However, obese subjects with high levels of intra-abdominal adipose tissue showed an increase in their glycemic and insulinemic responses to an oral glucose challenge.
In 1989, a prospective study of 1,492 women followed for 12 years reported that WHR independently predicted type 2 diabetes (27). In the Nurses? Health Study?a prospective study conducted on a cohort of over 43,000 women free of diabetes and other major chronic diseases at baseline?Carey et al. When individuals who were matched for similar abdominal subcutaneous adipose tissue but had different levels of intra-abdominal adipose tissue were compared, it was revealed that subjects with high intra-abdominal adipose tissue had higher glucose values following an OGTT and lower glucose disposal values compared to subjects with low intra-abdominal adipose tissue. These results lend weight to the idea that obese individuals with excess intra-abdominal adipose tissue display alterations in indices of plasma glucose-insulin homeostasis and are therefore at increased risk of developing type 2 diabetes. They found a consistent increase in type 2 diabetes risk as waist circumference increased within each BMI category. They also found that a high BMI value predicted type 2 diabetes, even among women with a low WHR or low waist circumference values. The Nurses? Health Study therefore yielded solid evidence that using waist circumference to measure abdominal obesity can enhance our ability to predict type 2 diabetes risk beyond what can be provided by BMI.



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