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Item
#4
Weight
Control- Most Important Factor in the Prevention of Type 2
Diabetes
Even
BMIs at the high end of normal conferred a substantially increased
risk of diabetes
A
16-year follow-up of 84,941 women (97% of whom were white) in the
Nurses' Health Study determined that 91% of cases of type 2
diabetes can be prevented by adhering to five lifestyle
criteria: weight loss, regular exercise, diet modification,
abstinence from smoking, and consumption of limited amounts of
alcohol.
Of
these, weight control is the most effective.
Study
subjects were free of diabetes, cardiovascular disease, and cancer
at baseline. Sixteen years later, 3,300 new cases of type 2
diabetes were documented.
To
assess the risk of diabetes, the investigators compiled a set of
low-risk variables: 1) a body mass index (BMI) within the normal
range (<25 kg/m2); 2) a diet high in cereal fiber
and polyunsaturated fat and low in trans fat (formed during the
partial hydrogenation of vegetable oils) and glycemic load (an
indication of the effect of diet on the blood glucose level); 3)
moderate-to-vigorous physical activity for at least 30 minutes a
day; 4) no current smoking; and 5) the consumption, on average, of
5 g of alcohol a day (about half a drink).
The relative risk of diabetes was
0.09 in the 3.4% of women who adhered to the low-risk criteria
throughout the study.
BMI was the most important predictor
of diabetes. The relative risk was 38.8 in women with a BMI of >
35, 20.1 in those with a BMI of 30 to 34, 7.59 in women with a BMI
of 25 to 29.9, 2.67 in women with a BMI of 23 to 24.9, and 1.0 in
those with a BMI of <23.
Even BMIs at the high end of normal
conferred a substantially increased risk of diabetes. In the group
of women who were overweight (BMI, >25), 61% of diabetes
cases were attributed to weight status.
When data on the other four
behavioral variables were stratified according to BMI, the risk of
diabetes associated with diet, physical activity, smoking status,
and alcohol consumption were generally similar among
normal-weight, overweight, and obese women. Nevertheless, each of
the four factors was associated with a significantly increased
risk of diabetes, even after adjustment for BMI. For example, the
relative risk of diabetes was 1.34 for women who smoked 15 or more
cigarettes a day. The other three risk ratios were expressed as
inverse associations: for example, the relative risk of diabetes
was 0.59 for women who drank more than 10 g of alcohol a day, 0.49
for women who most strictly adhered to the defined diet, and 0.71
for women who exercise more than 7 hours a week.
Stratification of data according to
BMI also showed that almost 50% of the cases of diabetes among
overweight and normal women might have been prevented had they
adhered to the other four low-risk criteria. Among obese women,
adherence to a healthy diet and regular exercise was associated
with a 24% reduction in the risk of diabetes. It should be noted
that the definition of diabetes used in this study was a fasting
glucose of 140 mg/dL. Using current diagnostic criteria of a
fasting glucose of 126 mg/dL, the number of identified cases is
expected to be higher. Finally, this study demonstrates an
association between weight, lifestyle, and development of
diabetes. However, an intervention study is needed to prove
causation between these risk factors and the ability to prevent
diabetes.
Hu
FB et al. Diet, lifestyle, and the risk of type 2 diabetes
mellitus in women. N Engl J Med. 2001;345:790-797.
================================
News
Flash:
ADA
Releases New Dietary Guidelines
The
new guidelines support the view that the total amount of
carbohydrates consumed in meals and snacks is important in
diabetes control, not the source of the carbohydrates. The
guidelines emphasize weight loss and physical activity and focus
on individualized dietary plans based on lifestyle, diabetes
management goals and other lifestyle factors.
Reference:
American Diabetes Association. Evidence-based nutrition principles
and recommendations for the treatment and prevention of diabetes
and related complications. Diabetes Care 2002; 25: 202-12.
================================
To
see how you can provide individualized dietary plans based on
lifestyle for your patients,
Click
Here For More Information!
================================
Did
you know
that diabetes advocates in Ohio are working hard to pass
legislation that is similar to the bills already passed in 46
other states? and that our opposition is also working hard,
and passage of Ohio's Diabetes Cost Reduction Act (HB 100/SB 45) is
not yet assured?
If
passed, HB 100/SB 45 would require private insurance to cover
diabetes education and supplies. This is not a new idea at
all, but Ohio's legislators have not yet understood the importance
of this bill, and the widespread support it has among their
constituents.
If
you are from Ohio please write to your state legislators about
their support for this bills.
For
more detailed information on Ohio's Diabetes Cost Reduction Act,
and for sample letters to Ohio legislators, you can go to www.ohfdc.org.
Ann
S. Williams, MSN, RN, CDE
Ohio
State Legislative Coordinator for AADE
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