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Science, Technology and Medicine open access publisher.Publish, read and share novel research. Data snapshotIn the March 2010 quarter the unemployment rate for Pacific peoples was 14.4 percent, higher than for all ethnicities. Inadequate housing affects children more than adults, particularly children in low-income families, in larger families, rental dwellings, and more deprived neighbourhoods (Centre for Housing Research, 2010). Social cohesion means cohesive community relationships with levels of participation in communal activities and public affairs, and a high number of community groups.
A healthy diet is a key determinant of health outcomes and is particularly important for the growth and development of children and young people.Food choices are influenced by affordability as well as personal, family, and cultural preferences.
Data snapshotThe National Children’s Nutrition Survey conducted in 2002 found that Pacific children were the least likely to bring their food from home to school, and most likely to buy it from a canteen, shop, or takeaway.Pacific children had a lower mean energy intake than Maori children (but higher than European children), and derived a higher portion of their energy intake from fat. Physical activity is known to protect against obesity and cardiovascular disease, particularly in combination with a healthy diet (National Institute for Health and Clinical Excellence, 2010). Life at Faith City‘Life-changing’ is how participants have described the Life 12 Week Weight Loss Challenge run by Manukau’s Faith City Church.The first Life challenge was held late in 2010. New Zealand has one of the highest obesity rates among OECD countries (Ministry of Social Development, 2009).
Smoking is the biggest single cause of preventable morbidity (the non-death impacts of disease) and mortality in OECD countries, including New Zealand, and is well recognised as the leading risk factor for many forms of cancer, respiratory disease, and cardiovascular disease in adults.
More Maori and Pacific peoples smoke (45 percent and 31 percent, respectively) compared with the total New Zealand population (20.7 percent) (Ministry of Health, 2008k). Potentially hazardous drinking carries a high risk of damage to physical and mental health; including death and injury due to traffic accidents, drowning, suicide, and violence. Problem gambling can result in a range of negative effects for the gambler, their families, and the wider community.
People’s beliefs and practices in relation to health and illness influence the ways they engage in health-promoting behaviours and access health services.
Pacific peoples’ beliefs and practices may be different from mainstream understandings about health and illness. Access to timely and effective health care is an important determinant of health outcomes, for both death rates and the impact that chronic conditions have on Pacific peoples. Data snapshotImmunisation provides protection against a range of communicable diseases, and is considered to be one of the most cost-effective public health interventions. For the 12 months to October 2010, 89 percent of Pacific two-year-olds were fully immunised, compared with 87 percent of European two-year-olds.
Screening identifies potential health problems at an early stage in people who do not show any symptoms.
Breast and cervical cancer screening programmes have been effective in reducing mortality in the general population. The Primary Health Care Strategy (Ministry of Health, 2001b) established primary health organisations (PHOs) to provide structures for the local delivery of primary health-care services.
The benefits of health care are dependent upon the quality of care received as well as accessibility of care. The average time spent annually with GPs during visits is a key indicator of access and use of primary care.
Secondary care includes services provided by specialists, as well as in-patient and out-patient care in public and private hospitals.
Health is strongly influenced by a broad range of cultural, social, economic, and environmental factors. La raison de l’accumulation de ces graisses est multiple, mais c’est principalement du a votre hygiene alimentaire, votre sexe, le facteur genetique et egalement la sedentarite. La graisse sous cutanee est tout simplement celle qui se trouve entre votre peau et vos abdominaux. Toutefois, meme si vous avez l’estomac ressortit, il n’est pas certain que vous ayez beaucoup de graisse viscerale.
Ceci est d’autant plus amplifie si vous avez une forte cambrure qui a tendance a faire ressortir l’estomac. Avoir un taux de graisse viscerale bas est important pour votre sante, pour votre perte de graisse sous cutanee, libido etc… Je vous recommande de consulter une etude juste ICI.
Avoir un mauvais sommeil, des nuits courtes ou sans cesse perturbe va favoriser la prise de graisse viscerale. Un exces d’apport en sucre va obliger votre corps a stocker ceci sous forme d’energie ou sous forme de graisse. Les sucres sont presents dans les pates, le riz, les confiseries, barre chocolatees, pain, semoule etc…vous en trouverez presque partout. Comme la liste d’aliments a limiter est tres longue, lorsque vous croisez des produits et aliments dont les 3 premiers ingredients sont : dextrose, maltodextrine, sirop de glucose, sirop de fructose, sirop de mais, sucre… et a moindre mesure la farine de ble et farine blanche. Tout ces ingredients primaires ont de fortes chances de vous faire prendre du gras lorsqu’ils sont consommes en exces durant un repas par exemple. Lorsque vous consommez de l’alcool en quantite, les fonctions de votre corps vont le traiter en priorite. Donc, evitez d’en abuser et faites attention aux alcool comprenant des glucides comme la biere. Que cette activite soit cible au niveau du travail des abdominaux ou non, une perte de gras aura lieu si votre alimentation reste bonne. Vous n’etes pas oblige de vous tenir a un regime particulier ou de courir tous les jours pour perdre du gras. Unhealthy foods and habits have been identified to actually sap away human intelligence and make cognitive tasks and problem solving more difficult. One recent study determined that children who eat fast food diets—those high in fat, processed food, and sugar—had lower IQs in later childhood than children who consume nutrient-rich homemade food[1].
If you have ever tried one you’ll know immediately that stripping your body of carbohydrates is one of the fastest ways to become irritable and susceptible to mood swings. Academic research substantiates the idea that lack of carbohydrates in a diet cause mood problems. Removing carbohydrates in the short run can definitely help you lose weight but you shouldn’t live the rest of your life without this important macronutrient.
Some researchers argue that gum actually improves mental function, so this one is still up for debate.
Their argument goes in the face of current studies that contend chewing gum improves short-term memory. While the research is unique and goes in the face of what many other scientists have said, it is enough to consider avoiding gum if you have short-term memory problems. Results from the 1999-2002 National Health and Nutrition Examination Survey (NHANES), using measured heights and weights, indicate that an estimated 16 percent of children and adolescents ages 6-19 years are overweight.
To assess changes in overweight that have occurred, prevalence estimates for participants in the 1999-2002 NHANES were compared with estimates for those who participated in earlier surveys.
When the overweight definition (greater than or equal to 95th percentile of the age- and sex-specific BMI) is applied to data from earlier national health examination surveys, it is apparent that overweight in children and adolescents was relatively stable from the 1960s to 1980 (table 1). 2 Data for 1963-65 are for children 6-11 years of age; data for 1966-70 are for adolescents 12-17 years of age, not 12-19 years. Even in some cases, blood sugar levels in diabetics declined significantly after consuming mangosteen fruit.
Number of patients with disease caused by excessive sugar intake can be increased significantly if left alone. For patients with type 2 diabetes, mangosteen shown to be very effective in controlling glucose levels.
For patients with type 1 diabetes, the effect of decreasing glucose levels may be slightly lower, but you still get the benefits of antioxidants in this fruit. Last for the record, although the mangosteen fruit proved to be very effective and good for diabetics, for those of you who use insulin injections are not advised to reduce the dose without consulting your physician first.
Treat diarrhea How to treat diarrhea naturally.  Diarrhea is a disease which is prevalent in almost every person.
Projected Elderly Population of the United States: 2000-2050, Data obtained from the US Census Bureau from the year 2000. Muscle Mass Changes with Aging.Peak muscle mass occurs between the ages of 20 and 30 years, and naturally declines as one ages.
Obesity in the United States, 1960-2008.Trends in the obesity epidemic in the United States in both males and females over the age of 60 years. Relative Risks of Mortality by Body Mass Index Category by Epidemiological Survey Data, Caption: BMI indicates body mass index, measured as weight in kilograms divided by the square of height in meters.
Walking Limitations, C-reactive Protein and Handgrip Strength.Age- and sex-adjusted prevalence of walking limitations according to body fat percentage levels according to C-reactive protein (CRP) and handgrip strength. Possible Mechanisms linking Ageing, Obesity, Sarcopenia and Insulin resistance (Zamboni et al.
The quality of housing and household crowding are closely related to the risk of developing ARF, meningococcal disease, respiratory disease, and other infectious diseases.Due to their low income, many Pacific families live in less affluent communities. Healthier food options are often more expensive than those with high concentrations of fat and sugar, and those that are nutritionally limited.
Thirty-three mostly Pacific women completed the three-month course, which is designed for those who are very overweight and are keen to eat more healthily and be more active.Life involves training four times a week, sessions with a nutritionist and three weekend retreats to help address the psychological reasons behind obesity and unhealthy lifestyles. Obesity is associated with many adult health conditions such as cardiovascular disease, type 2 diabetes, cancer, and psychological and social problems (Ministry of Health, 2008e). Exposure to cigarette smoke (during a mother’s pregnancy and in childhood) is recognised as a major risk factor for sudden unexplained death in infancy syndrome and respiratory illness (Ministry of Health, 2005).Smoking is an important contributor to inequalities in life expectancy between ethnic groups. Alcohol problems are also associated with high-risk sexual behaviour and consequent problems.Fewer Pacific peoples drink alcohol than the general population. Pacific peoples’ understandings tend to be characterised by a holistic perspective, where healthy and strong families are the basis for the well-being of individuals and communities. Suicide, for example, can be seen as the “ultimate rejection of one’s family” and a bereaved family can experience a “sense of failure to adequately care for and support the individual who is ill” (Beautrais et al, 2005). In 2006, just over 90 percent of New Zealand infants were enrolled with Plunket, which provides clinical assessment, health promotion and parent education services.
Screening improves health outcomes by offering effective interventions before diseases become advanced. An increase in the uptake of cervical screening and the introduction of the HPV vaccination programme in 2008 (which has reported high coverage among Pacific girls (Minister of Pacific Island Affairs, 2010) should contribute to lower incidence of, and deaths from, cervical cancer in the future.
The levels of coverage are below the target of 70 percent of all eligible women, but there has been a sustained increase in coverage for Pacific women. Each PHO has an enrolled population, and is responsible for providing services to this population.In October 2007, nearly 100 percent of Pacific peoples were enrolled with a PHO6. The quality of health care is in part determined by interpersonal care; the interaction between health-care professionals and health-care users or their caregivers.
The National Primary Medical Care Survey found that Pacific, Maori, and Asian people spent significantly less time with GPs, after controlling for a range of other variables. Secondary care services are normally accessed by referral from primary care or hospital emergency departments.
In general, people with fewer socio-economic resources tend to have poorer health outcomes due to a combination of reduced material resources, greater exposure to health risks and behaviours, greater psychosocial stress, and reduced access to health services.Many Pacific peoples have not experienced success in the education system, and therefore tend to have lower incomes and live in communities with the fewest economic resources.
The estimate of the socio -economic contribution is based on analysis undertaken in relation to the impact of socio-economic inequality on the difference between the Maori and the European or other ethnic group in the NZ Census-Mortality Study. That is, they were physically active for at least 30 minutes a day, for at least five days in the previous week. The survey uses AUDIT, which is a ten-item questionnaire covering alcohol consumption, abnormal drinking behaviour, and alcohol-related problems. This data is from the Enriched CBF Register produced by HealthPac at the Ministry of Health. Livre electronique bien detaille pour tous ceux ou celles qui ne peuvent pas s’entrainer dans une salle de sport ou qui n’ont pas envie d’investir. C’est elle qui cache malheureusement votre ceinture abdominale et qui vous empeche d’avoir une belle definition musculaire. Lorsque vous avez un tour de taille eleve et un estomac en avant, il y a des chances que vous ayez de la graisse viscerale.
Il existe de nombreuses moyens et activites comme le yoga, le the, la meditation, la lecture ou l’activite physique qui permettent d’evacuer le stress. De meme, manger des quantites regulieres de legumes (en debut de repas est une solution interessante).
Tout ce qui est Omega 6, graisses saturees, graisse trans, huiles hydrogenees ou partiellement hydrogenees vous feront egalement stocker du gras notamment au niveau de la graisse viscerale et sous cutanee. C’est l’exces qui peut provoquer une prise de gras au niveau du ventre et de la graisse viscerale. One report published by researchers determined that excessive dietary sugar alters the way dopamine works in the brain[2].
Dopamine also plays an important role in happiness and preventing depression—two factors that can alter your ability to learn. However, researchers in a recent article published in the Quarterly Journal of Experimental Psychology argue that chewing gum can negatively impact short-term memory recall.
The research effectively qualified and proved the brain-impairing abilities of gum with three separate experiments[4]. As shown in Table 1, this represents a 45 percent increase from the overweight estimates of 11 percent obtained from NHANES III (1988-94). The NHANES 1999-2002 and earlier surveys used a stratified, multistage, probability sample of the civilian noninstitutionalized U.S.
However, from NHANES II (1976-80) to NHANES III, the prevalence of overweight nearly doubled among children and adolescents.
Healthy diet program and standardization of sugar intake should be socialized from an early age in schools. Improvement in the control of glucose levels is known because the fruit’s ability to reduce insulin resistance in tissues in the body.
As it is known that the devastating impact of the disease is aggravated by free radicals that are absorbed in the body. Proportion of People >65 years old in a sample of Organisation for Economic Co-operation and Development (OECD) countries from 1960 to projects at 2050.
The Sarcopenia taskforce did conclude the importance of identifying such mechanisms to better understand the underlying pathophysiology, and to allow the identifications of interventions these targets.
Models were adjusted for age, race, field center, education, smoking status, alcohol consumption, and physical activity at study baseline.
Low, medium and high levels of body fat percentage, CRP and handgrip strength were defined by recoding quartiles of each variable in to three categories by combining quartiles II and III. More recently, the incorporation of muscle quality into these definitions has been proposed (Cruz-Jentoft et al. For example, the proportion of Pacific households (with at least one Pacific adult) spending more than 30 percent of their income on housing was 33 percent in 2009, reflecting a steady increase from 23 percent in 2004 (Ministry of Social Development, 2010, p69).Students attending schools in communities with fewer economic resources tend to experience less education success than those in more affluent communities (Ministry of Social Development, 2009, p138). The prevalence of factors associated with lower levels of well-being, such as widespread smoking, obesity, hazardous drinking, and non-casino gaming machines, is greater in these communities. Societies with diminished social cohesion have higher mortality rates and worse social outcomes than those with high levels of social cohesion (Stansfeld, 2006).Most Pacific communities have strong social connections, often centred on church and community activities. Affordability of food is a significant issue for Pacific households, who were the least likely to report that they could always eat properly.
The training sessions include gym workouts, weights, running, boxing, aquarobics, and hill running.
Obesity is primarily caused by poor nutrition and sedentary lifestyles (Ministry of Health, 2008e). Pacific peoples who drink alcohol are more likely to be New Zealand-born and young (Alcohol Advisory Council of New Zealand, 2009). Similarly, 7.6 percent of the Pacific population reported experiencing problems as the result of someone else’s gambling, double the number of adults in the total population who reported being affected by someone else’s gambling. Suicide prevention, support, and other interventions must therefore be tailored to work with and within existing beliefs and attitudes.Similarly, culturally-based attitudes towards sex mean that Pacific youth often have reduced access to information regarding sexual health.
It includes the provision of health education and prevention services, coordination and treatment of less serious illnesses, and referral to secondary care.Other than emergency departments, primary care services are the first step into the health system. Pacific infants (87.2 percent) were less likely than European, but more likely than Maori infants to be enrolled (Craig et al, 2007, p121).
Effective screening is dependent on well-structured and organised processes and the monitoring of indicators of process quality. One of the providers, BreastScreen South, has reached the 70 percent target for both Maori women and Pacific women (National Screening Unit, nd, a). For the overall population, the target coverage is 75 percent (Massey University, Centre for Public Health Research, 2008). Craig et al (2007) reported that Pacific children and young people had higher enrolment rates compared with non-Pacific people. Underlying good interpersonal skill are communication skills, the building of trust, understanding and empathy, the discussion and explanation of the patients’ symptoms, and involvement in decisions regarding management or treatment of a patient’s condition (Campbell, Roland, & Buetow, 2000). Overall, Pacific patients spent an average of 18.8 minutes less time annually with GPs than European patients.
Despite this, Pacific peoples are actively involved in their communities and have strong social and cultural resources with strong family ties, church affiliation, and community support. L’entrainement avec poids de corps ou avec des charges, il vous indique l’importance de l’alimentation pour avoir des abdominaux. Ainsi, vous serez tres certainement plus rapidement rassasie et vous eviterez les fringales et la consommation en exces de sucre et de graisses. What you might not know is that eating fast food actually results in lower intelligence levels. Based on current recommendations of expert committees, children with BMI values at or above the 95th percentile of the sex-specific BMI growth charts are categorized as overweight. In the time interval between NHANES II and III, the prevalence of overweight among children ages 6-11 years increased from an estimated 7 percent to 11 percent (figure 1), and among adolescents ages 12-19 years, increased from 5 percent to 11 percent.
Need to know that maintaining a healthy weight is a very important factor in controlling the severity of the disease. Proved that there is a decrease in blood sugar levels are very significant, even in just a few days early consumption of mangosteen juice. And the mangosteen fruit has many powerful antioxidants to fight free radicals in the body. Pacific students tend to have poorer education outcomes than other students from the same communities.


An individual’s identity and well-being are traditionally dependent on family heritage, connections, roles, and responsibilities. They were also more likely (at nearly 50 percent) than Maori and Europeans to report sometimes running out of food due to lack of money (Ministry of Health, 2003). Social interaction is one of the factors that promote participation in physical activity (De Bourdeauhuiji, 1998), which in turn encourages social cohesion and social well-being.Pacific children have relatively high levels of incidental physical activity (such as walking to school), although they participate less than other groups in organised leisure and sport. Day one of the challenge requires participants to push four-wheel drive vehicles around a carpark.Faith City project manager Essendon Tuitupou says women in last year’s challenge called it “life-changing”.
Smoking accounted for 37 percent of this loss for men and 13 percent of the loss for women (Ministry of Health, 2001a).
However, the Youth 2007 Survey found that twice as many Pacific students are regular smokers compared with European students.Living in a house with a smoker influences children and young people to take up smoking, and contributes to respiratory and other childhood illnesses.
Overall, those aged 35–44 years had the highest prevalence of problem gambling (Ministry of Health, 2008a). Parents are less available to provide advice, as it is considered culturally inappropriate for children to discuss sexual health with their parents. They are crucially important in identifying serious illnesses that are then managed in conjunction with secondary and tertiary services.
The results demonstrate that effective means are available to engage with Pacific peoples and deliver care services. BreastScreen South used a communications campaign where Maori and Pacific women were the priority audience, as it was apparent they were groups who were less familiar with the service (National Screening Unit, nd, b). From 2011, the coverage target will be 80 percent (National Screening Unit nd, e).Since 2007, National Cervical Screening Programme communications campaigns have been particularly focused on encouraging more Maori and Pacific women to have regular smears (National Screening Unit nd, c). Fifteen percent of Pacific peoples were enrolled with a Pacific PHO and the remainder with a mainstream PHO (Ministry of Health, 2010c). Improvements in the annual consultation rate coincide with the implementation of the Primary Health Care Strategy (Ministry of Health, 2001b) and the reduction in fees to access primary care.To access services, people must first be aware that the services are available and that they are needed. Only 21.2 percent of Pacific adults compared with 31 percent of non-Pacific adults used medical specialists in the previous 12 months. These community ties provide protection from some of the worst consequences of illness, and health services can be promoted to Pacific peoples through community organisations.Lower incomes mean that many of the conditions or factors that support good health, such as good nutrition and quality housing, are less accessible.
From this low base about 85 percent of Pacific peoples are sending remittances overseas (Money Pacific, 2010). A household interview and a physical examination were conducted for each survey participant. One of the national health objectives for 2010 is to reduce the prevalence of overweight from the NHANES III baseline of 11 percent. This syndrome has a number of risk factors, a number that are modifiable over the course of one’s life span, but can have profound impact on one’s overall state of health and quality of life. This is a result of a combination of factors, including lower levels of participation in early childhood education and teaching and learning practices throughout schooling that are less effective for Pacific students(Statistics NZ and Ministry of Pacific Island Affairs, 2010).Poor education reduces peoples’ employment opportunities.
This reduces access to employment or education opportunities, community activities, and health care. Having a strong sense of belonging seems to reduce the likelihood that an individual will consider or attempt suicide (Beautrais et al, 2005).In the 2006 Census, 83 percent of Pacific peoples stated they had at least one religion, compared with 61 percent of New Zealand overall.
The 2002 National Children’s Nutrition Survey found that Pacific children were more likely than European children to be the most active, and the least likely to be the least active. In 2006, 48.1 percent of Pacific children under the age of 15 years lived in a household with a smoker (Craig et al, 2007, p165).
Primary care services have historically been centred around GP and practice nurse services, but more recently these have been expanded to involve multi-disciplinary teams and a broader range of services. It was considered that this may reflect the difficulties of working through caregivers during the consultation, or generational or cultural differences (Davis et al, 2005).
These findings are concerning given the documented high health needs of Pacific peoples, particularly the prevalence of chronic health conditions.Cultural competence is the ability of individuals and systems to understand and appreciate the differences and similarities within and among groups. Pacific peoples were even less likely to visit medical specialists when the specialist was located at a private facility. Pacific peoples experience greater exposure to risk factors such as smoking, alcohol, and poor nutrition, with Pacific youth being particularly at risk.
During the physical examination, conducted in mobile examination centers, height and weight were measured as part of a more comprehensive set of body measurements. However, the NHANES 1999-2002 overweight estimates suggest that since 1994, overweight in youths has not leveled off or decreased, and is increasing to even higher levels. The content of the mangosteen fruit can slow down or even stop the insulin resistance, which in turn will make your blood sugar more stable. Balestat (2007), "Trends in Severe Disability Among Elderly People: Assessing the Evidence in 12 OECD Countries and the Future Implications", OECD Health Working Papers, No.
A number of studies have outlined the differences between those with and without sarcopenia or obesity.
Wang, 2008Obesity and central obesity as risk factors for incident dementia and its subtypes: a systematic review and meta-analysis. 4 percent).For the 12-month period to October 2010, 89 percent of Pacific 2-year-olds were fully immunised, compared with 87 percent of European 2-year-olds.
The 2006 Census of Population and Dwellings showed that 35 percent of Pacific peoples had no qualifications, compared with 25 percent of all New Zealanders. Improvements in health can be achieved by improving educational performance and other social and economic circumstances. Pacific students express the importance of spiritual beliefs (57 percent) much more frequently than European students (20 percent) (Helu et al, 2009). The biggest thrill for me is when those ladies go away and continue with physical activity themselves.”Members of the group forged strong friendships and have continued to train together. Interestingly, the rate of parents ‘smoking at home’ was much lower than overall parental smoking rates, indicating that approximately half of Pacific families with smokers do not support smoking inside the house.Youth smoking rates are a key predictor of adult smoking behaviour, as taking up smoking early increases the risk of smoking-related diseases. Overall, Pacific adults experienced greater levels of harmful consequences subsequent to drinking and those who drank reported greater alcohol consumption (Huakau et al, 2005).According to the results of a 2003 Alcohol Advisory Council (ALAC) survey that looked at youth access to alcohol, Pacific young people are more likely to be non-drinkers compared with other ethnicities. Pacific young people are less likely to access sexual health services as they are concerned that others may find out (Ministry of Health, 2008i). Programmes with a strong community-support focus, including provision of transport to attend appointments, have also had a positive effect on cervical screening participation rates.Cost is recognised as a continued barrier and the Ministry of Health supports subsidised cervical screening for groups where the uptake of screening services is lower (H Lewis, personal communication, October 2010).
Similarly, medical insurance, which can allow more timely access to health care, is held by half as many Pacific (19 percent) as non-Pacific adults (38.
Exposure to these risk factors contributes to a greater incidence of chronic diseases (such as diabetes, stroke, and ischaemic heart disease) among Pacific peoples.
These measurements were taken by trained health technicians, using standardized measuring procedures and equipment.
The data for adolescents are of notable concern because overweight adolescents are at increased risk to become overweight adults.
Muscle mass develops up to the age of 20 and 30 years, and is relatively maintained throughout adult life. In one of the pivotal studies, 52 subjects matched obese elderly, non-obese frail, and non-obese, non-frail were evaluated on objective measures of functional status and health-related quality of life and differences in body composition (Villareal et al.
Wu, 2010Sarcopenia, cardiopulmonary fitness, and physical disability in community-dwelling elderly people.
The unemployment rate is higher for Pacific peoples (14.4 percent in the March 2010 quarter) than for any other ethnic group (Statistics NZ, 2010). This has been discussed in Education and Pacific peoples in New Zealand (Statistics NZ and Ministry of Pacific Island Affairs, 2010) and will be explored in a future report on economic development.
Voluntary work underpins a wide range of groups and organisations whose activities contribute to social well-being. The survey found that about two-thirds of Pacific young people (compared with just under half of young people overall) are non-drinkers (McMillen, Kalafatelis & De Bonnaire, 2004).
Appropriate sexual and reproductive health information needs to be made available by alternative means.The relatively low success rate of smoking cessation programmes among Pacific peoples may be related to the belief, held by a relatively large number of Pacific smokers (24.
Cultural competence training of professionals improves patient satisfaction and the number of patients continuing with agreed medical care plans. 6 percent) (Ministry of Health, 2008a).‘Did-not-attend’ rates for out-patient appointments appear to be consistently higher among Pacific peoples. Alcohol consumption is associated with a greater risk of injury through accidents and violence. Observations for persons missing a valid height or weight measurement were not included in the data analysis. The 1999-2002 findings for children and adolescents suggest the likelihood of another generation of overweight adults who may be at risk for subsequent overweight and obesity related health conditions. As one ages, muscle mass decreases and one reaches a threshold whereby low muscle mass will inevitably lead to disability and future complications (Sayer et al. Since the March 2008 quarter, the rise in Pacific unemployment has been greater than the total rise in unemployment.
The General Social Survey 2008 showed that 42 percent of Pacific peoples had done voluntary work in the previous four weeks, significantly more than the mainly European ethnic group (Ministry of Social Development, 2010).The General Social Survey showed that 85 percent of Pacific peoples had at least weekly face to face contact with friends compared to 79 percent of the total population. This may be because Pacific children have higher rates of incidental activity, but lower rates of participation in organised leisure and sport, which is what SPARC measured.Research findings about adult levels of activity are mixed. However, among young people who do drink, Pacific youth consumed, on average, 6.9 standard drinks.
Those Pacific people who used face-to-face counselling services were experiencing more severe harm5 than those from other ethnic groups (Francis Group, 2009). Pacific primary care providers deliver integrated services that include health promotion, primary care, secondary care, and social services.
4 percent), followed by lack of time, lack of availability of a suitable appointment, and not wanting to make a fuss. It impacts on the ability of an individual to communicate with health professionals, to discern what good advice is, and to translate this into action.
The New Zealand Health Practitioners Competence Assurance Act 2004 requires professional bodies to ensure that set levels of cultural competence are met by practitioners (Tiatia, 2008). Addressing these risk factors will improve Pacific peoples’ health outcomes.People’s beliefs and practices in relation to health and illness influence their behaviour and how they access health services. They discovered that obese and non-obese frail groups had lower and similar scores in physical function, functional status and impairments in strength and walking speed. Lustman, 2001The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Pacific peoples are over-represented in non-skilled and lower-skilled occupations (Ministry of Pacific Island Affairs, 2010).
The Youth 2007 Survey found that 17 percent of Pacific youth had helped others in their community in the last 12 months, (Helu et al, 2009) compared with 14 percent of youth overall (Adolescent Health Research Group, 2008).
The New Zealand Health Survey (Ministry of Health, nd, f) found that only about half of New Zealand’s total population, and slightly fewer Pacific peoples (46.1 percent), were sufficiently active to gain any health benefits3. Fonua Mo’ui grants are designed to improve Pacific peoples’ health by supporting initiatives that promote healthy eating and physical activity. Since 1999, the number of smokers in the total New Zealand population has been trending down for all groups including Pacific boys and girls (Paynter, 2010).
Pacific smokers are also most likely to believe that smokers should be able to quit without the assistance of a programme (Ministry of Health, 2009a). They aim to provide services that incorporate Pacific cultural care and language components to ensure the services are more appropriate for, and responsive to, Pacific peoples. Pacific peoples were significantly more likely than non-Pacific people to cite cost as a reason for an unmet GP need. Those with limited health literacy have worse health status than those with adequate health literacy.
This applies to both nurses (Nursing Council of New Zealand, nd) and doctors (Medical Council of New Zealand, 2006).
The higher rate among Pacific peoples may reflect the barriers Pacific peoples face in accessing services, including getting time off work, transport difficulties, cultural beliefs, and a lack of cultural responsiveness (Ministry of Health, 2008f).Surgical admissions (which tend to be elective rather than emergency) are lower for Pacific peoples.
For example, attitudes to sexual health act as a barrier to Pacific peoples accessing sexual health services and protecting their sexual health. There are a number of definitions that have been proposed, yet they have been developed on different populations and ethnicities, factors which are known to affect body composition. Continued debate in the literature with regard to associations of mortality with BMIs between 25 and 35 continue and will not be reviewed here. They concluded that physical frailty in obese elders was associated with lower fat free mass (lean mass), poor muscle quality and worsening quality of life.One of the more pivotal studies by Baumgartner’s group demonstrated the combined effect of obesity and muscle mass or strength on physical functioning or disability (Baumgartner 2000). Garry, 1995Cross-sectional age differences in body composition in persons 60+ years of age. Evidence from previous recessions also suggests that unskilled workers are hit hardest in times of recession, when unemployment rates for unskilled workers increase more than those for skilled workers (Department of Labour, 2009).Figure 1 shows that approximately half of all Pacific children and young people live in a crowded house, a higher proportion than other ethnic groups. Pacific peoples were the most sedentary group (undertaking less than 30 minutes of physical activity in the previous week) – 19.
The Youth 2007 Survey found that Pacific students regularly smoked at twice the rate of European students, and that rates were highest among Samoan and Cook Island students (Helu et al, 2009).The 2006 Census showed that there are sub-group differences within the Pacific population. The proportion of Pacific young people (32 percent) who reported ‘binge drinking’ at least once in the previous four weeks was slightly lower than European young people (Helu et al, 2009).Drinking alcohol at an early age is associated with greater adverse health outcomes (Odgers et al, 2008). These findings show that beliefs regarding the nature of nicotine addiction and cessation options need to be changed in order to increase the number of Pacific people who give up smoking. Access to care has been improved through lowering fees, providing local facilities, and giving nurses a greater role in primary care. Cost is also a factor in the collection of prescribed medications (Jatrana, Crampton, & Norris, 2010).
Older people, those with more limited education, lower socio-economic groups, and those whose primary language is not local tend to have more limited levels of health literacy (Adams et al, 2009).
Access to coronary artery bypass grafts (CABG) operations, angioplasties, and major joint-replacement operations has improved (Ministry of Health, 2006b). Lack of knowledge of tobacco addiction and smoking cessation interventions may prevent Pacific peoples accessing cessation services and traditional respect for authority may prevent Pacific peoples demanding the best care within the health system.
Additionally, muscle quality and strength have yet to be incorporated into such definitions. Obesity has also been demonstrated to be associated with disability, lower quality of life, and increased resource utilization, particularly in elderly subjects (Guralnik, Fried, and Salive 1996). Baumgartner’s group examined the impact of sarcopenic obesity and incident instrumental ADL disability in the New Mexico elder health survey and New Mexico aging process study (Baumgartner et al.
A child growing up in an over-crowded house will be more susceptible to communicable diseases (Hawker, 2005) and over-crowding can have a detrimental effect on successful learning.
It is estimated that three-quarters of Pacific peoples in New Zealand send money to family members in the Pacific region (Money Pacific, 2010).As well as building resilient and supportive communities, social connections also provide useful foundations for community health interventions. 4 percent – and were 40 percent more likely to be sedentary than the total New Zealand population.
Drinking socially at an early age can cause increased short-term harm such as motor vehicle injuries and deaths, suicide, as well as longer-term harm from alcohol dependence, abuse, and related medical conditions (Alcohol Advisory Council of New Zealand, 2002). Nicotine replacement therapies are considered ineffective by a large number of Pacific peoples, and a relatively low proportion of Pacific peoples in south Auckland made claims for subsidised nicotine replacement therapies. Pacific providers have shown better results for the management of patients with long-term conditions than other providers (Ministry of Health, 2010c).
The Adult Literacy and Life Skills Survey 2006 showed that, overall, the literacy of Pacific peoples was lower than other ethnic groups (Statistics NZ and Ministry of Pacific Island Affairs, 2010). Ambulatory-sensitive hospitalisations (ASH) are admissions that are potentially avoidable through primary care interventions. While the number of admissions for coronary operations is low compared with the need experienced by Pacific peoples (Tukuitonga & Bindman, 2002), the inequalities in angioplasty operations are narrowing. Recently, there was a European consensus on the definition and diagnosis on Sarcopenia (Cruz-Jentoft et al. Obesity is associated with nursing home admissions and increasing one’s risk to be homebound (Jensen et al. Sarcopenic obesity predicts instrumental activities of daily living disability in the elderly.
Projects that “create and reinforce strong social connections across Pacific communities” (Tait, 2008) provide useful foundations for effective public health action.
SPARC’s 2008 Active NZ Survey used the same criteria as the New Zealand Health Survey, and had similar findings.
Tokelauans are the most likely to be regular smokers, followed by Cook Islanders (38 percent), Niueans (33 percent), Tongans (29 percent), and Samoans (28 percent). Among young people, Cook Islanders are the heaviest drinkers with the most harmful drinking patterns, while Samoan men and women, and Tongan women are the least likely to drink (Ministry of Health, 2008i). Although more Pacific people are likely to smoke, 60 percent fewer Pacific people used nicotine replacement therapies compared with Europeans (Thornley, Jackson, Mcrobbie, Sinclair, & Smith, 2010). This may be due to a combination of factors, including poor communication of services by providers and difficulties managing the required application processes. Pacific peoples experience other factors that contribute to limited health literacy, such as lower socio-economic status and language difficulties.
Between 1999 and 2005, there was a larger growth in the number of Pacific peoples receiving angioplasties than in the number of non-Maori, non-Pacific peoples receiving angioplasties (Ministry of Health, 2006b). This study ascertained ADLs in patients longitudinally and assigned points (0-2) depending on whether someone could not perform an instrumental activities of daily living, could do it with difficulty, or could do it independently. For example, the success of initiatives such as the MeNZB and HPV vaccination campaigns in Pacific communities has been attributed to these strengths (F Tupu, personal communication, 2009; CBG Health Research Ltd, 2006).
An ALAC study also found that Pacific young people, born and raised in New Zealand, consumed alcohol more frequently, pointing to the influence of acculturation factors (Alcohol Advisory Council of New Zealand, 2009). A Counties Manukau study of Pacific and Maori parents showed that these groups had a low awareness of other available cessation options (Glover & Cowie, 2010).
For example, in education, difficulty with application processes was one of the main reasons identified for poor access to supplementary support (particularly when language is a barrier) (Clark et al, 2007; Rivers, 2005). The incidence of ischaemic heart disease among Pacific peoples suggests that this group would have a greater need for angioplasties. This taskforce suggested the use of both low muscle mass and low muscle function (strength or performance) for the diagnosis of sarcopenia. Smoking is particularly common for young Samoans and Cook Islanders, older men, Pacific-born men – particularly Tongan men, and younger New Zealand-born women, particularly Tokelauan and Cook Island women.Traditionally, Pacific men were more likely to be smokers than Pacific women.


This clearly indicates that these groups of smokers need to be better informed.The traditional respect for authority figures in Pacific communities can make it more difficult for Pacific people to question their health professionals and demand more effective services (Statistics NZ and Ministry of Pacific Island Affairs, 2010). The rationale for using these criteria include that muscle mass and muscle strength are not directly correlated to each other (Goodpaster et al. As can be seen in the Figure #9 below, only those with sarcopenic obesity had a markedly shorter time to drop in ADLs. Hoffman, 2005Clinical implications of the reduced activity of the GH-IGF-I axis in older men. This can lead to Pacific peoples being disempowered in the health system, not receiving services as needed, and therefore experiencing poorer outcomes.
However, rates did decline for Pacific children aged 0-4 years (Ministry of Health, 2008c).There is some evidence that the delivery of effective health care to Pacific peoples is improving. These issues all create a worrisome public health concern in that, in one study, 9% of all total excess healthcare costs may be attributable to overweight or obesity (Finkelstein, Fiebelkorn, and Wang 2003). The other three groups were no different from each other (sarcopenic non-obese, obese non-sarcopenic, and non-obese non-sarcopenic).
Between 2001 and 2007, the proportion of people with diabetes receiving an annual check through the Get Checked Programme has increased, including for Pacific peoples, who have higher coverage than other ethnic groups. Prescription of statin medication also increased markedly for all ethnic groups, including Pacific peoples (Ministry of Health, 2008b). DEXA scanning is unique in that it not only allows ascertainment of muscle mass but can be used concurrently to assess bone density as well.
Pahor, 2005Sarcopenia, obesity, and inflammation--results from the Trial of Angiotensin Converting Enzyme Inhibition and Novel Cardiovascular Risk Factors study. This may be due to the fact that smoking was traditionally a male activity in the Pacific Islands.
In a study of people with both type 1 and type 2 diabetes in Counties Manukau, access to tests and appropriate medication was consistent across ethnic groups (Smith et al, 2010).
Bioelectrical impedance on the other hand is inexpensive, and easily reproducible with prediction equations available to calculate various measures of body composition (Chumlea et al. It appears Pacific women born in New Zealand have been influenced by local smoking behaviour. A study of patients with type 2 diabetes in south and west Auckland showed Pacific peoples, who visited a regular GP, had a higher average number of consultations, equivalent frequency of testing, but worse glucose control. Other cross-sectional studies have demonstrated conflicting results based on NHANES III (Davison et al.
They were less likely to be on a statin, despite higher serum lipids compared with the total population (Robinson et al, 2006).Overall, Pacific peoples receive less effective care.
Body water can affect these results, though, and elders’ changes in body composition, both in health and disease, may affect such estimates. Access to care and the quality of care is improving but outcomes are not equivalent to other ethnic groups.
Unfortunately, the relative availability and cost of DEXA in particular can be prohibitively expensive, not portable, and would be impractical to use for routine use in an office setting (Chien, Kuo, and Wu 2010). The reasons for this are complicated, and seem to include a combination of late presentation, receiving appropriate medication and treatment less often, and less effective ongoing management.
Other measures, including grip strength, knee strength, or gait speed have been proposed but no studies have validated such measures.
This is influenced by the cultural attitudes and expectations of both Pacific peoples and those in the health system, and by levels of financial resources.
These authors observed that women in the highest quintile for percent body fat were twice as likely to report functional limitations than in the other comparison groups, and weaker but similar relationships were observed in men. Improved cultural competence of services will improve the quality of consultations and services, promote improved health-care delivery, and improve health outcomes.
Sarcopenic obesity – A subset of sarcopenia and obesityOften times, we consider sarcopenia in the context of weight loss and cachexia; but sarcopenia can occur with obesity.
Low muscle mass and sarcopenia with obesity, in this study were not associated with additional limitations.
These vary over one’s lifespan and are impacted by each other, with interactions that are poorly understood.
The impact of obesity on sarcopenia continues to be a subject of investigation and emerging as a public health problem.
In Zoico’s cross-sectional study of 167 females, aged 67-78, those in the highest quintile of body fat demonstrated a significantly higher prevalence of functional limitation, but 40% of sarcopenic elderly women and 50% of elderly women with high body fat and normal muscle mass were functionally limited (Figure #10).
In subjects who gain weight, there is proportionally an increase in fat mass as compared to lean mass. Aging and obesityAlong with the rise in the number of elderly patients, the number of patients diagnosed with overweight and obesity are increasing.
As described above, both entities lead to disability and the synergistic effects lead to worsening disability. They demonstrated that isometric leg strength was significantly lower in subjects with sarcopenia and sarcopenic obesity.
These subjects can also be considered ‘fat frail’ who suffer from increased weakness from sarcopenia and the requirement to carry additional weight from obesity (Launer et al.
Little attention has been given to the obese elder, largely due to a paucity of studies including elderly (>65 years old) patients. Yet, current estimates, specifically in the United States population, indicate that the prevalence of obesity continues to rise, and exceeds 35% of the general population, a trend that is also observed in elderly subjects.
Common inflammatory pathways have linked sarcopenia and obesity yet the interplay between these two entities is poorly understood. 2004).There are other studies that have demonstrated the relationship between sarcopenic obesity and higher degrees of functional limitations. The prevalence of obesity has increased almost three-fold from 1960-2008, and continues to rise at a frightening rate (Flegal et al. One author hypothesized that both sarcopenia and obesity are similar behaviorally and biologically (Roubenoff 2000). One of the most trophic effects on muscle is physical activity, which normally falls as people age.
2008) examined the association between different obesity indicators and walking limitations in examining the role of C-reactive protein and handgrip strength. Concurrently, there is a positive energy balance and weight gain, predominantly fat in nature. This cross-sectional study of a Finnish population looked at subjects >55 years, and demonstrated that the highest two quartiles of body fat percent and C-reactive protein and the lowest two quartiles of handgrip strength were significantly associated with greater risk of walking limitations after adjusting for chronic diseases and other pertinent co-variates. Additionally, this loss of fat-free mass (muscle) lowers the amount of tissues that can respond to insulin targeting, thereby promoting insulin resistance, metabolic syndrome and obesity (Reaven 1988).
The prevalence of walking limitations were higher in persons who had high fat and low handgrip (61%) than in those with low fat and high handgrip (7%). These numbers are remarkably higher than estimates in 1999 whereby 31.8% of males were obese, yet prevalence estimates seem to be similar in females. Muscle and fat are both metabolically active, the latter producing TNF-a, IL-6 and adipokines all of which have a direct catabolic effect on the former, and promote insulin resistance.
Leptin and low adiponectin concentrations have been found to negatively impact muscle mass and lead to a decline in muscle quality (Hamrick et al. On a biological level, macrophages in adipocytes or in adipose tissue, produce such proinflammatory cytokines (Fantuzzi 2005) which can upregulate the inflammatory response. Obesity is associated with an increased number of medical conditions and complications, and is a recognized independent cardiovascular risk factor. 2009), using the InCHIANTI study, analyzed data from 934 participants aged 65 years and older with at least 6 years of follow-up. Obesity is associated with an increased risk of both physical and cognitive disability (Beydoun, Beydoun, and Wang 2008; Jensen 2005). The authors identified mobility limitations as difficulty walking ? mile or climbing 10 steps over a 7-year of follow-up. Using data from the INChianti study, global and central obesity directly affect inflammation, negatively affects muscle strength and can contribute to the development and progression of sarcopenic obesity (Schrager et al. Earlier onset of obesity in life contributed to increased mobility limitations of old age (Houston et al.
Furthermore, compounding the decline in neuronal and hormonal signals that occur with aging, malnutrition, and loss of a-motor units and changes in gene expression, further increase the risk of this entity in occurring (Doherty et al. Those who were overweight in the lowest grip strength tertile had 1.4 times higher mortality risk compared to normal weight persons in the highest grip strength. This pro-inflammatory state leads to a perpetuating cycle of reduced muscle strength among obese subjects inevitably further contributing to functional decline.
While a number of chronic medical conditions prevalent in elders, including cancer, COPD and heart failure are associated with elevated pro-inflammatory levels and can lead to loss of muscle mass, the process of age-related sarcopenia is a natural phenomenon and differs from such.
Aging, sarcopenia, insulin and insulin resistanceThere are hormonal changes linking age-related decline in muscle strength and mass, which include insulin, growth hormone, and catecholamines as a few examples.
On a cellular level, animal studies have demonstrated a relationship between obesity-related insulin resistance and insulin receptor signaling pathway.
A low grade inflammation often is present in most obese patients which is a result of chronic activation of the innate immune system, leading to insulin resistance, impaired fasting glucose and diabetes. The involvement of cytokines and inflammation in obesity in relation to glucose metabolism continues to be controversial. Both IL-6 and TNF- alter insulin sensitivity by impacting given steps in the insulin signaling pathway. In animal models, resistin induces insulin resistance, but whether this occurs in humans is unclear. Subjects with obesity-related insulin resistance, type 2 diabetes and coronary heart disease have low levels of adiponectin. This hormone is known to inhibit liver gluconeogenesis and can promote fatty acid oxidation in skeletal muscle. With aging, muscle can be infiltrated with fat, and this may eventually perpetuate insulin resistance. As expected higher rates of intermuscular fat and visceral abdominal fat were associated with higher fasting insulin levels.
This study concluded that elderly men and women with normal body weight may be at risk for metabolic abnormalities, including type 2 diabetes if they possess an inordinate amount of muscle fat or visceral abdominal fat. A smaller study by the same group elucidated whether thigh fat was a determinant of insulin resistance.
They compared a small number of subjects and confirmed that muscle composition reflected increased fat content was associated with insulin resistance (Goodpaster, Thaete, and Kelley 2000).Furthermore, insulin is well known to be an anabolic hormone which may have a pleiotrophic effect on muscle tissue and protein metabolism.
Lower protein synthesis and higher insulin levels occur in elderly subjects compared to younger subjects after food intake. Previous studies have shown that subjects with insulin resistance can negatively predict muscle strength, often seen in elderly subjects with diabetes. The correlation between insulin resistance and muscle strength is quite poor and accelerates the loss of leg muscle strength and quality. In a pilot study examining this relationship examined the homeostasis model assessment (HOMA-IR) in type 2 diabetes, demonstrated that knee extension, adjusted for body weight was significantly correlated with HOMA-IR in both sexes and that this relationship persisted as an independent determinant in a stepwise regression model (Nomura et al. In another study, the degree of insulin resistance was evaluated using HOMA-IR and muscle strength using handgrip strength.
BMI-adjusted handgrip strength correlated positively with physical activity, muscle area, and muscle density (Abbatecola et al. Physical activity has a positive effect on muscle mass and quality specifically with resistance training (Goodpaster and Brown 2005). Figure 12.Possible Mechanisms linking Ageing, Obesity, Sarcopenia and Insulin resistance (Zamboni et al. Growth hormone and insulin-like growth factor 1Additional contributors to sarcopenia include insulin-like growth factor-1 (IGF-1) and growth hormone (GH), both of which decline with age. Growth hormone is associated with low fat mass, increased lean body mass and ideal metabolic profile, while IGF-1 can increase protein synthesis in existing muscles.
One study partially described the relationship of the hypothalamic pituitary axis in subjects with sarcopenia and sarcopenic obesity.
Using DEXA, they ascertained 45 subjects with varying degrees of adiposity and lean mass and measured pituitary function (Waters et al. They demonstrated that appendicular skeletal muscle mass was independently and negatively correlated with leptin in all groups, even after adjusting for body fat, and that subjects with sarcopenic obesity had lowered and blunted GH responses. Low levels of this anabolic hormone has been proposed to be positively associated with low muscle strength (Ceda et al. Using data from the Longitudinal Ageing Study Amsterdam (LASA), among subjects aged 65-88 years, serum testosterone levels were positively associated with muscle strength and physical performance (Schaap et al. With respect to IGF-1 levels, physiologically one would expect that the age-associated decline in IGF-1 levels would be associated with poorer muscle strength and mobility. It is hypothesized that the aging muscle loses the capability of secreting GH and the responsiveness to IGF-1 is also likely attenuated. These may be molecular targets in the future to promote muscle building and prevent sarcopenia. Diabetes and geriatric syndromesDiabetes is associated with an increased incidence of many geriatric syndromes. Many studies have demonstrated the impact of diabetes on functional impairment, including inability to ambulate and perform instrumental ADLs (Volpato et al. Diabetes itself, on a microvascular level can lead to functional impairment, but notably, complications of diabetes have also been implicated. It is known that persons with diabetes have an accelerated aging process leading to disability and frailty. Diabetes is known to lead to each of the components of the operationalized definition of frailty and insulin resistance appears to be a core factor in this pathophysiology (Morley 2008). In the Health, Aging and Body Composition study, type 2 diabetes was associated with lower skeletal muscle strength and quality, as well as excessive skeletal muscle mass loss (Park et al. It is believed that hyperglycemia directly impairs skeletal muscle contractility and force (Sayer et al. 2005) ; whether this is due to excessive toxicity of sugar alcohols on muscles remains elusive at this time.
Other hypotheses include the accumulation of lipids which may affect insulin signaling (Janssen and Ross 2005; Furler et al. There are a number of similarities between metabolic syndrome and insulin resistance and one study by Sayer examined the relationship between these entities and sarcopenia (Sayer et al. Their findings suggested that impaired grip strength was associated, not only with individual constructs of the metabolic syndrome but also the composite definition itself. Although the authors acknowledge that further investigation is required to understand the underlying mechanisms, the potential for using grip strength and interventions tested thereof to improve muscle strength, could also potentially improve insulin resistance.
The following figure (Figure #13) demonstrates some of the potentiating cellular mechanisms observed in diabetes.There are a number of emerging studies observing the relationship between sarcopenia, obesity, sarcopenic obesity and diabetes.
The Korean Sarcopenic Obesity Study examined the prevalence of sarcopenia in Korean subjects with and without type 2 diabetes (Kim et al. Skeletal muscle index (muscle mass adjusted for height squared), as a measure of sarcopenia, was significantly lower in patients with diabetes compared to subjects without diabetes. Quite interestingly, though, the prevalence of type 2 diabetes was highest in Mexican Americans using NHANES III data with the lowest prevalence of obesity and sarcopenia, while Whites had the highest prevalence of sarcopenic obesity (Castaneda and Janssen 2005). This study challenges whether there indeed is a relationship between sarcopenia and obesity.
Whether ethnicities need to be accounted for due to differences in body composition is a matter of further investigation.
In other population, specifically, dialysis subjects, diabetes is thought to be a risk factor for losing lean mass (Pupim et al.
Muscle mass, particularly in dialysis patients, are known to decline continuously and hence this study suggested that controlling a risk factor for incipient sarcopenia (diabetes), would reduce this declining process. Many of the changes suggested, in one editorial, were due to systemic inflammatory cytokines previously described, often which are implicated in diabetes and insulin resistance (Kaysen 2005).
This was echoed in another small study looking at changes in inflammatory cytokines implicated in losing lean mass (Pedersen et al. 2003).Subjects with diabetes are at higher risk of developing peripheral neuropathy, which leads to a decrease in one’s motor end plates. This entity is important in maintaining muscle homeostasis and coordination of muscle contraction, therefore their loss can perpetuate and accelerate age-related decline in muscle mass.
Additionally, the microvascular damage from hypoxia not only affects nerves, renal glomeruli and optic nerves, but also can lead to muscle hypoxia.
Macrovascularly, atherosclerosis can lead to diminished peripheral blood flow to leg muscles leading to impaired strength. Other cellular entities are implicated, as well as other endocrine changes as illustrated in the figure below. Undoubtedly there is a relationship between the underlying pathophysiology of sarcopenia, insulin resistance and diabetes.10. ConclusionA number of studies are increasingly confirming the relationship between sarcopenia and reduced functional activities and disability.
Sarcopenia and obesity are often thought as a preludes to frailty, known to adversely predict hospitalizations, morbidity, institutionalization and mortality (Figure #14). Reduced physical activity and a sedentary lifestyle are important risk factors for developing sarcopenia, which subsequently leads to physical disability and reduced physical performance (Figure #15).
The relationship between sarcopenia, sarcopenic obesity and insulin resistance requires further investigation. The clinical implications are not insignificance in that globally, sedentary lifestyles are becoming the norm and the potential implications on utilization are not significant. 2008)Figure 15.Body Composition Changes Leading to Sarcopenic Obesity (Jarosz and Bellar 2009)11.



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