With Obesity, Diabetes, And Cardiovascular Disease On The Rise, Physicians Need More Comprehensive Guidelines

According to survey results released, when 2007 Cardiometabolic Health Congress participants were asked what guidelines they follow for treating patients with multiple cardiovascular and metabolic risk factors, the largest group of respondents indicated that they didn't follow any particular set of guidelines and that better guidelines are needed.

The survey queried more than 750 cardiology, endocrinology, nephrology, and primary care clinicians who attended the 2007 Cardiometabolic Health Congress here in September.

The survey results indicate a clear lack of consensus among clinicians on how to screen, diagnose, and manage patients at increased risk. For example, when congress participants were asked, "When treating patients with multiple cardiometabolic risk factors, what is your highest priority?" the survey results were as follows:

-- Blood pressure (40%)

-- Hyperglycemia (23.3%)

-- LDL cholesterol (22.8%)

-- Obesity (11.6%)

-- HDL cholesterol (1.6%)

"While comprehensive national guidelines exist for hypertension, diabetes, hypercholesterolemia, obesity, and other risk factors for diabetes and cardiovascular disease, our survey results indicate that more specific guidelines are needed to clearly convey the interrelationship between the constellation of risk factors and how clinicians can best diagnose and manage these underlying conditions to improve patient outcomes," said Robert H. Eckel, M.D., of the University of Colorado Denver and co-chairperson of the Cardiometabolic Health Congress.

The 2007 Cardiometabolic Health Congress convened an unprecedented group of world-renowned physician experts and prestigious medical societies, including the American Diabetes Association, American Heart Association, and National Kidney Foundation. "The 2007 Cardiometabolic Health Congress provided the medical community with the broadest program possible covering those risk factors responsible for cardiovascular disease. The meeting focused on the recently recognized importance of cardiovascular risk factors related to obesity and type 2 diabetes, two conditions epidemic in proportion. The newest options to treat cardiovascular risk were presented," said Richard W. Nesto, M.D., of Lahey Clinic Medical Center and co-chairperson of the Cardiometabolic Health Congress.

Cardiometabolic Health Congress http://www.cardiometabolichealth.org

For the full survey results, highlights from the 2007 congress, testimonials, or to learn more about the upcoming 2008 Cardiometabolic Health Congress, visit http://www.cardiometabolichealth.org.

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Obesity, Diabetes Linked to Cancers

Studies find effects on breast, prostate and colorectal tumors

By Ed Edelson

FRIDAY, Dec. 7 (HealthDay News) -- Obesity and diabetes -- risk factors so often linked to heart disease -- can also affect the incidence and severity of cancer, a collection of four new studies suggests.

The findings, presented Friday at the American Association for Cancer Research's Sixth Annual International Conference on the Frontiers of Cancer Prevention Research in Philadelphia, link weight gain and diabetes to a number of malignancies, including breast, prostate and colorectal cancer.

"All of these are consistent with what we would expect with the occurrence of each of these cancers or cancer survival," said Elizabeth Platz, associate professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health. "Metabolic perturbations enhance certain cancers. Insulin and other hormonal factors influence cell growth and make cells multiply."

Women with diabetes have a 50 percent increased risk of developing colorectal cancer, according to the first study, by researchers at the University of Minnesota. The group, led by Andrew Flood, assistant professor of epidemiology and public health, followed more than 45,000 women enrolled originally in a breast cancer detection program for more than eight years.

The increased incidence of colorectal cancer remained significant after all possibly confounding factors were taken into account. While the reason for the increased risk is not known, Flood said it could be due to the elevated levels of insulin seen with diabetes.

High levels of insulin in diabetic women could explain a threefold higher risk of death from breast cancer, said the second study, by researchers at Yale University. They measured blood levels of C-peptide, a marker of insulin secretion, in women in a long-term study of breast cancer. Over an eight-year period, the women in the highest third of C-peptide levels had twice the risk of dying from breast cancer, compared to women in the bottom third, the researchers said.

Another study, by researchers at the Johns Hopkins Bloomberg School of Public Health, found that weight gain after a diagnosis of invasive breast cancer could significantly increase a women's risk of death from the cancer.

The study of more than 4,000 women with breast cancer classified them by body mass index, a ratio of weight to height. For obese women, the risk of dying of breast cancer was 2.4 times greater than for women with a normal body weight, a relationship that persisted when age, menopausal status and smoking were taken into account.

Another Johns Hopkins study provided a possible explanation for the lower risk of prostate cancer seen in men with diabetes. The researchers matched 264 men diagnosed with the cancer with a group of 264 cancer-free men, measuring C-peptide levels in both groups.

Men with elevated blood levels of C-peptide when the study started were one-third less likely to develop prostate cancer than those with lower levels. Men with higher C-peptide levels had half the risk of developing prostate cancer confined to the prostate.

The protective effect of those high levels could be due to the activity of insulin in relation to the male hormone testosterone, Plantz said. C-peptide derives from the same parent molecule as insulin, and insulin is known to reduce the activity of testosterone, which stimulates the growth of prostate cancer, she said.

The possible protective effect of insulin against prostate cancer could offer a mirror image of the negative effect of estrogen -- the female sex hormone -- in breast cancer, said Dr. Rexford Ahima, professor of medicine at the University of Pennsylvania.

"We have known for years that women who are obese are at high risk of breast cancer," Ahima said. "Fat tissue makes estrogen, which promotes breast cancer. The frightening thing is that the more obese you are, the greater the risk you have of dying of cancer. For every increase of 10 kilograms, 14 pounds, there is a 14 percent increased risk of breast cancer death."

So, instead of thinking of obesity just as a risk factor for heart disease, its effects on cancer must also be taken into account, Platz said. "In general, it is a good thing to do to avoid obesity," she said. "That is a message consistent with what we know about good health."

More information

To learn more about obesity and the associated health risks, visit the U.S. National Library of Medicine.


SOURCES: Elizabeth Platz, Sc.D., associate professor of epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore; Rexford Ahima, M.D., professor of medicine, University of Pennsylvania, Philadelphia; Dec. 7, 2007, presentations, American Association for Cancer Research, Sixth Annual International Conference on the Frontiers of Cancer Prevention Research, Philadelphia

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Aerobic, Weight Training Combo Best Against Diabetes

Exercise is always good, but combining two approaches brings better results, study finds

By Kathleen Doheny
HealthDay Reporter

MONDAY, Sept. 17 (HealthDay News) -- Most people know that exercise can help beat type 2 diabetes, but one type of fitness regimen might work best, a new study shows.

Specifically, workouts that combine aerobic and resistance training exercises appear better at controlling blood sugar than either type of activity alone, researchers say.

The finding is new, because "most other studies have looked at just one kind of exercise, either aerobic or resistance," noted lead researcher Dr. Ronald J. Sigal, an associate professor of medicine and cardiac sciences at the University of Calgary, in Alberta, Canada.

The study is published in the Sept. 18 issue of the Annals of Internal Medicine.

As part of their research, Sigal's team evaluated 251 adults, ages 39 to 70, all with type 2 diabetes and not regular exercisers at the start of the study.

The participants were assigned to one of four groups: those who did 45 minutes of aerobic training three times a week, those who did 45 minutes of resistance (i.e., weight) training three times a week, those who did 45 minutes each of both forms of exercise three times a week, and those who did no exercise at all.

The aerobic group worked out on a treadmill or a bike at the gym; memberships were provided. The resistance group also worked out at the gym, with memberships provided, doing seven different exercises on weight machines.

Sigal's team evaluated changes in A1c values -- a measurement reflecting blood sugar concentrations -- over the previous two to three months. A1c is expressed as a percentage. A decline of 1.0 percent in A1c value would be linked to a 15 percent to 20 percent decrease in risk of heart attack or stroke, the researchers explained, and a 25 percent to 40 percent decline in risk of complications linked to diabetes, such as eye disease or kidney disease.

As expected, blood sugar control improved in all the exercise groups. In those who did either aerobic or resistance, the A1c value declined by about 0.5 percent compared to the non-exercisers. Those who did both kinds of exercise had double that level of success, with their A1c value dropping by 0.97 percent compared to the non-exercising group. Non-exercisers experienced no change in their A1c values over the 26-week study.

The bottom line: "There is additional value to doing both resistance and aerobic exercise," according to Sigal.

He said the decrease of nearly one percent of A1c seen in the study "translates to a 15 to 20 percent reduction in risk of heart attack or stroke and a 25 to 40 percent reduced risk of other complications, such as retinopathy," an eye problem related to diabetes.

How does physical activity fight type 2 diabetes, the most common and obesity-linked form of the disease? According to Sigal, "exercise decreases insulin resistance. It makes the transport of glucose [blood sugar] more efficient."

Another expert said the study adds gives new information for people hoping to beat back diabetes.

"Basically, aerobic and resistance training both do very well, and the combination does even better," said Cathy Nonas, director of physical activity and nutrition for the New York City Department of Health and Mental Hygiene and a registered dietitian and certified diabetes educator.

But she said couch potatoes often need to ease into exercise to maintain a fitness regimen over time.

The study participants built up to their 45-minute fitness sessions, Nonas noted, and the combination group ended up doing about 4.5 hours of exercise a week -- an amount some might find daunting.

"I would never talk about 4.5 hours a week to someone who doesn't exercise at all," Nonas said. Rather, she encourages physical activity in any amount to start. "Anything you do is good," she said. Then, she encourages people to slowly build up their time.

"I think this is a very uplifting study," she added. "It says whatever you do will have an effect, and the more you do, the better the effect."

More information

To learn more about the benefits of exercise for diabetes, visit the American Diabetes Association.

SOURCES: Ronald J. Sigal, M.D., associate professor, medicine and cardiac sciences, University of Calgary, Alberta, Canada; Cathy Nonas, R.D., director, physical activity and nutrition, New York City Department of Health and Mental Hygiene, and certified diabetes educator; Sept. 18, 2007, Annals of Internal Medicine

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Women's midlife weight key to future diabetes risk

NEW YORK (Reuters Health) - People carrying excess weight who aim to ward off diabetes should try to lose the pounds before they reach middle age, Australian researchers suggest.

A woman's body mass index (BMI) in her late 40s was the strongest predictor of her risk of developing diabetes over the next eight years, Dr. Gita D. Mishra of the University of Queensland and her colleagues found.

On the other hand, there was no link between weight change in subsequent years and the likelihood of becoming diabetic.

While excess weight is understood to boost the risk of developing type 2 diabetes, the effects of shorter-term weight gain or loss are not as clear, Mishra and her team note in the journal Diabetes Care. To investigate, the researchers followed 7,239 women for 8 years. Study participants were 45 to 50 years old when the study began, and they completed surveys on their health at the study's outset in 1996 and in 1998, 2001 and 2004.

Those with BMIs of 25 or greater, indicating they were overweight or obese, in 1996 were at the highest risk of developing type 2 diabetes by 2004, the researchers found. Very obese women with BMIs of 35 or above were 12 times more likely than their normal-weight peers to become diabetic.

Weight gain or loss during the course of the study had no influence on a woman's risk of developing diabetes, while physical activity only reduced risk for the most active women.

"Because women's risk of developing type 2 diabetes in midlife is more closely related to their initial BMI (when aged 45-50 years) than to subsequent short-term weight-change, public health initiatives should target the prevention of weight gain before and during early adulthood," the researchers conclude.

They note that only small changes in physical activity and calorie intake are needed to stop from becoming overweight or obese, and that it is particularly important to "inspire people" to make those changes while they are young adults.

SOURCE: Diabetes Care, June 2007.

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Study: Most diabetics don't exercise

By CHASE SQUIRES,

DENVER - Bad news when it comes to diabetics and exercise: Most people with Type 2 diabetes or at risk for it apparently ignore their doctors' advice to be active.

Fewer than 40 percent get exercise, a new study found, and the more in danger the patients are, the less likely they are to be active.

That's despite an earlier study that found nearly three-quarters of diabetics said their doctors had advised them to exercise. The patients who got the strongest warnings to get moving were the least likely to listen, according to research being released Friday.

"People should exercise more, that story is out," said Dr. Elaine Morrato, who led both studies.

"What we're saying is, 'Here's a high-risk population that can benefit from exercise, and they're even less likely to exercise.'"

Without exercise, Type 2 diabetics face complications ranging from nerve damage to high blood pressure.

Morrato, an assistant professor at the University of Colorado Denver with a doctorate in public health and epidemiology, said researchers surveyed more than 22,000 patients for the new survey. Results of the study appear in the February edition of the American Diabetes Association's journal Diabetes Care.

The federal Centers for Disease Control and Prevention estimates more than 20 million Americans have diabetes, about 90 percent of them Type 2, which is linked with obesity.

Dr. Larry Deeb, president of medicine and science at the American Diabetes Association, said by the time patients have Type 2 diabetes or are at risk of getting it, the deck is stacked against them. They may already have problems with mobility as a result of obesity or foot and circulatory disorders that make exercise difficult.

"We have to be careful not to blame the victims," he said. "There's a difference between being unable and being unwilling."

Even for the most disabled, there's hope, said author and fitness expert Charlotte Hayes, but health professionals must do more.

Hayes, who wrote "The I Hate to Exercise Book For People With Diabetes," said telling patients to exercise is different from telling them how.

Every step of exercise is important, she said. For those who can walk, a few steps a day helps. For those who can't, there are alternatives.

"We take a small-steps approach," she said.

The American Diabetes Association recommends people get at least 30 minutes of aerobic exercise, such as brisk walking, five times a week. But the association says for those who can't, there are benefits from even five minutes a day, along with everyday activities such as gardening or walking to work.

Morrato said she doesn't know the answer, only that the results of her study are disappointing.
"It is difficult to be optimistic about addressing the twin epidemics of obesity and diabetes without success in increasing physical activity in the population," her study concludes. "The results of this study provide very pessimistic data."

Deeb, who specializes in pediatrics, said the next generation is off to a better start. Children, he said, are taught nutrition and the benefits of physical activity. Now, families, local governments and school boards need to take action, while doctors need to follow up and find out if at-risk patients know where to get help.

"When you ask a family what they're doing, the answer is all about time. They know what's good for their families, but both parents are working, and sometimes the only time they have is to pick up fast food," he said. "They have to understand, your health depends on it.
"We will not give up," he said. "We can't give up."

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