From a Diabetologia online study release (April 15, 2020):
“Having normal body weight is crucial in the prevention of type 2 diabetes, regardless of genetic predisposition.”
“The results suggest that type 2 diabetes prevention by weight management and healthy lifestyle is critical across all genetic risk groups.”
“Overall, the results indicate that a favorable lifestyle should be universally recommended in the prevention of type 2 diabetes, regardless of genetic predisposition, thus supporting current public health guidelines,”
We examined the joint association of genetic predisposition, obesity and unfavourable lifestyle with incident type 2 diabetes using a case-cohort study nested within the Diet, Cancer and Health cohort in Denmark. The study sample included 4729 individuals who developed type 2 diabetes during a median 14.7 years of follow-up, and a randomly selected cohort sample of 5402 individuals.
Obesity (BMI ≥ 30 kg/m2) and unfavourable lifestyle were associated with higher risk for incident type 2 diabetes regardless of genetic predisposition (p > 0.05 for GRS–obesity and GRS–lifestyle interaction). The effect of obesity on type 2 diabetes risk (HR 5.81 [95% CI 5.16, 6.55]) was high, whereas the effects of high genetic risk (HR 2.00 [95% CI 1.76, 2.27]) and unfavourable lifestyle (HR 1.18 [95% CI 1.06, 1.30]) were relatively modest.
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Patients with osteoarthritis of the knee who underwent physical therapy had less pain and functional disability at 1 year than patients who received an intraarticular glucocorticoid injection.
Osteoarthritis of the knee is a leading cause of disability.1 Current management is typically limited to the treatment of symptoms until late stages of arthritis lead to knee replacement.2 Intraarticular glucocorticoid injections are commonly used as a primary treatment for osteoarthritis of the knee,3 but there are conflicting reports regarding the extent and duration of the relief of symptoms with this therapy.4-6 Complications from these injections occur infrequently but include joint infection,7 accelerated degradation of articular cartilage,8 and subchondral insufficiency fractures.9
The physical therapy intervention, which is described in the protocol,26 included instructions and images for exercises, joint mobilizations, and the clinical reasoning underlying the priorities, dosing, and progression of treatment. During a typical clinical session, the physical therapist would implement hands-on, manual techniques immediately before the patient performed reinforcing exercises to help the patient perform the movements with little or no pain. For example, if a patient could not fully extend or flex the knee, or those movements were painful, the physical therapist would use a hands-on, passive mobilizing technique to repeatedly move the knee to reduce stiffness while altering the mechanics of the technique to avoid pain. The patient would then perform repeated active knee movements in the same direction.
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Conclusion: The study was inconclusive with respect to potential differences in progression of individual radiographic features after surgical and non-surgical treatment for degenerative meniscal tear. Further, we found no strong evidence in support of differences in development of incident radiographic knee osteoarthritis or patient-reported outcomes between exercise therapy and arthroscopic partial meniscectomy.
Objective: To evaluate progression of individual radiographic features 5 years following exercise therapy or arthroscopic partial meniscectomy as treatment for degenerative meniscal tear.
Design: Randomized controlled trial including 140 adults, aged 35-60 years, with a magnetic resonance image verified degenerative meniscal tear, and 96% without definite radiographic knee osteoarthritis. Participants were randomized to either 12-weeks of supervised exercise therapy or arthroscopic partial meniscectomy. The primary outcome was between-group difference in progression of tibiofemoral joint space narrowing and marginal osteophytes at 5 years, assessed semi-quantitatively by the OARSI atlas. Secondary outcomes included incidence of radiographic knee osteoarthritis and symptomatic knee osteoarthritis, medial tibiofemoral fixed joint space width (quantitatively assessed), and patient-reported outcome measures. Statistical analyses were performed using a full analysis set. Per protocol and as treated analysis were also performed.
Results: The risk ratios (95% CI) for progression of semi-quantitatively assessed joint space narrowing and medial and lateral osteophytes for the surgery group were 0.89 (0.55-1.44), 1.15 (0.79-1.68) and 0.77 (0.42-1.42), respectively, compared to the exercise therapy group. In secondary outcomes (full-set analysis) no statistically significant between-group differences were found.
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From a MedPage Today online article (April 2, 2020):
This relationship between higher glucose levels and poorer cognitive functioning extended beyond just CASI z-score, as well, Cukierman-Yaffe noted. Higher HbA1c levels were also tied to significantly poorer performance in other psychological tests, including the clock making test of executive functioning, test of discriminative ability, and for the test of verbal fluency.
Poorer glycemic control was tied to cognitive decline following a lacunar stroke in a prospective cohort study.
Among 942 individuals with type 2 diabetes who had a lacunar stroke, every 1% higher HbA1c was tied to a 0.06 drop in cognitive function at baseline measured by Cognitive Assessment Screening Instrument (CASI) z-score (95% CI -0.101 to -0.018), reported Tali Cukierman-Yaffe, MD, MSc, of Sheba Medical Center and the Sackler School of Medicine of Tel Aviv University in Israel.
From a New York Times online article (March 16, 2020):
“Maintaining weight loss can get easier over time. Over time, less intentional effort, though not no effort, is needed to be successful. After about two years, healthy eating habits become part of the routine. Healthy choices become more automatic the longer people continue to make them. They feel weird when they don’t.”
Among the useful strategies identified in the new study is to keep lower calorie foods like fruits and vegetables more accessible. “We eat what we see,” Dr. Phelan noted. The corollary is equally important: keep high-calorie, less nourishing foods relatively inaccessible and out of sight if not out of the house entirely.
The new study led by Dr. Phelan, professor of kinesiology and public health at California Polytechnic State University, identified habits and strategies that can be keys to success for millions. Yes, like most sensible weight-loss plans, they involve healthful eating and regular physical activity. But they also include important self-monitoring practices and nonpunitive coping measures that can be the crucial to long-term weight management.
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From a BMJ Open Heart online study (March 8, 2020):
Overall, the evidence in the literature suggests that spirulina improves several well-established CVD risk factors including hyperlipidaemia and seems to provide benefits around weight loss.
Although caloric restriction and exercise are the mainstay treatments for obesity, spirulina has shown significant benefits in aiding weight loss. The phycocyanin in spirulina contains a light-harvesting chromophore called phycocyanobilin, which is capable of inhibiting nicotinamide adenine dinucleotide phosphate hydrogen (NADPH) oxidase, a significant source of oxidative stress in adipocytes playing a key role in inducing insulin resistance and shifting adipokine and cytokine production in hypertrophied adipocytes. Thus, by suppressing adipocyte oxidative stress, spirulina may lead to systemic anti-inflammatory and insulin-sensitising effects.
Spirulina is both a salt and fresh water blue-green algae, which is being increasingly studied recently. Spirulina was initially classified under the plant kingdom due to its rich plant pigments and its ability to photosynthesize, but was later placed into bacterial kingdom (cyanobacteria) due to its genetic, physiological and biochemical makeup. Spirulina grows naturally in high salt alkaline water reservoirs in subtropical and tropical areas of America, Mexico, Asia and Central Africa.
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From a The Guardian online article (Feb 12, 2020):
What characterizes ultra-processed foods is that they are so altered that it can be hard to recognize the underlying ingredients. These are concoctions of concoctions, engineered from ingredients that are already highly refined, such as cheap vegetable oils, flours, whey proteins and sugars, which are then whipped up into something more appetizing with the help of industrial additives such as emulsifiers.
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From a MedPage Today online article (March 7, 2020):
The top ultra-processed foods by calorie intake were breads, beverages, cakes, cookies and pies, salty snacks, frozen and shelf-stable dishes, pizza, and breakfast cereals.
Altogether, ultra-processed foods accounted for 58% of all calories in the U.S. diet and nearly 90% of all added sugars.
They divided foods into four categories:
- Unprocessed or minimally processed foods: Fresh, dry, or frozen fruits or vegetables, grains, legumes, meat, fish, and milk
- Processed culinary ingredients: Table sugar, oils, fats, salt, and other substances extracted from foods or from nature and used in kitchens to make culinary preparations
- Processed foods: Foods manufactured with the addition of salt, sugar, or other substances of culinary use to unprocessed or minimally-processed foods, such as canned food, simple breads, and cheese
- Ultra-processed foods: Formulations of several ingredients that — besides salt, sugar, oils, and fats — include food substances not used in culinary preparations, in particular, flavors, colors, sweeteners, emulsifiers, and other additives used to imitate sensory qualities of unprocessed or minimally-processed foods and their culinary preparations or to disguise undesirable qualities of the final product
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From a BMJ Research study (March 4, 2020):
Habitual fish oil supplementation is associated with a 13% lower risk of all cause mortality, a 16% lower risk of CVD mortality, and a 7% lower risk of CVD events among the general population
Fish oil is a rich source of long chain omega 3 fatty acids, a group of polyunsaturated fats that primarily include eicosapentaenoic acid and docosahexaenoic acid. Initially, these compounds were recommended for daily omega 3 fatty acid supplementation for the prevention of cardiovascular disease (CVD). Consequently, the use of fish oil supplements is widespread in the United Kingdom and other developed countries.
Several mechanisms could explain the benefits for clinical outcome derived from fish oil supplementation. Firstly, the results of several studies have indicated that supplementation with omega 3 fatty acids has beneficial effects on blood pressure, plasma triglycerides, and heart rate, all of which would exert a protective effect against the development of CVD. Secondly, several trials have shown that omega 3 fatty acids can improve flow mediated arterial dilatation, which is a measure of endothelial function and health. Thirdly, omega 3 fatty acids have been shown to possess antiarrhythmic properties that could be clinically beneficial. Finally, studies have reported that fish oil can reduce thrombosis. Additionally, studies have reported that the anti-inflammatory properties of fish oil could have a preventive role in the pathophysiology of CVD outcomes. Other mechanisms could also be involved to explain the effect of fish oil on CVD outcomes.
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From a BMJ Research online study (March 4, 2020):
We found no association between egg consumption and risk of cardiovascular disease in three large US cohorts. Results from the updated meta-analysis lend further support to the overall lack of an association between moderate egg consumption (up to one egg per day) and cardiovascular disease risk.
Eggs are a major source of dietary cholesterol, but they are also an affordable source of high quality protein, iron, unsaturated fatty acids, phospholipids, and carotenoids.
Introduction: In the United States, cardiovascular disease is the leading cause of death in men and women. Diet and lifestyle undisputedly play a major part in the development of cardiovascular disease. In the past, limiting dietary cholesterol intake to 300 mg per day was widely recommended to prevent cardiovascular disease. However, because of the weak association between dietary cholesterol and blood cholesterol, and considering that dietary cholesterol is no longer a nutrient of concern for overconsumption, the most recent 2015 dietary guidelines for Americans did not carry forward this recommendation.
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The National Diabetes Statistics Report is a periodic publication of the Centers for Disease Control and Prevention (CDC) that provides updated statistics about diabetes in the United States for a scientific audience. It includes information on prevalence and incidence of diabetes, prediabetes, risk factors for complications, acute and long-term complications, deaths, and costs. These data can help focus efforts to prevent and control diabetes across the United States.