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Study highlights the importance of heart health for preventing diabetes

While genetics do contribute to the probability of developing type 2 diabetes, the findings indicate that maintaining healthy lifestyle habits, and especially having a healthy body weight, can help lower the lifetime risk of the condition.

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Heart healthy middle-aged adults are less likely to develop type 2 diabetes during their lifetime, according to a study published on World Heart Day in the European Journal of Preventive Cardiology, a journal of the European Society of Cardiology (ESC).

The research found that the importance of favorable cardiovascular health was apparent regardless of an individual’s genetic likelihood of developing type 2 diabetes. Favorable cardiovascular health was defined as having a healthy body weight, blood pressure, and cholesterol, not smoking, eating a balanced diet, and being physically active.

It is estimated that 463 million adults have diabetes and that 10% of global health expenditure is spent on the condition (USD 760 billion).

Study author Dr. Fariba Ahmadizar of Erasmus University Medical Centre, Rotterdam, the Netherlands, said: “While genetics do contribute to the probability of developing type 2 diabetes, the findings indicate that maintaining healthy lifestyle habits, and especially having a healthy body weight, can help lower the lifetime risk of the condition.”

The study included 5,993 participants of the population-based Rotterdam Study who were free of type 2 diabetes at baseline. The average age was 69 years and 58% were women. Participants received a cardiovascular health score of 0 to 12 according to body mass index, blood pressure, blood cholesterol, smoking status, diet and physical activity at baseline, with higher scores corresponding to better cardiovascular health. Participants were then divided into three categories of cardiovascular health according to their score: poor (0-5), intermediate (6-7) and ideal (8-12).

To assess genetic predisposition to type 2 diabetes, the researchers used 403 independent genetic variants related to the condition to calculate a genetic risk score. Participants were then categorised as low, intermediate or high genetic risk according to their score.

A total of 869 individuals developed type 2 diabetes during 69,208 person-years of follow-up. The researchers estimated and compared the lifetime risk for type 2 diabetes within the cardiovascular health and genetic risk categories.

Looking at cardiovascular health alone, the researchers found that the remaining lifetime risk of type 2 diabetes was lower in those with better heart health. For example, at age 55, participants with ideal cardiovascular health had a 22.6% risk of developing type 2 diabetes in their lifetime, compared to 28.3% and 32.6% risks for those with intermediate and poor cardiovascular health, respectively.

When genetic risk was taken into account, the lifetime risk for type 2 diabetes was still lower in those with better cardiovascular health. At age 55, for example, the remaining lifetime risk of diabetes in the high genetic risk group was 23.5% for those with ideal cardiovascular health, compared to 33.7% and 38.7% for those with intermediate and poor cardiovascular health, respectively. The same relationships were seen within the low and intermediate genetic risk groups.

Dr. Ahmadizar said: “Our results highlight the importance of favorable heart health in preventing type 2 diabetes among middle-aged adults regardless of whether they are genetically at high or low risk of the condition. In other words, a healthy lifestyle is associated with a significantly lower risk of type 2 diabetes within any genetic risk category. The findings applied equally to men and women and indicate that healthy habits in midlife are an effective strategy for avoiding diabetes later on.”

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Major weight loss may reverse heart disease risks associated with obesity – study

Adults who previously had obesity were on average older than those who never, or currently had obesity, and more likely to smoke cigarettes (36% vs 24% vs 19%). After adjusting for age, gender, smoking and ethnicity, researchers found that the risk of high blood pressure and dyslipidemia were similar in those who used to have obesity and those who had always maintained a healthy weight.

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Major weight loss appears to reverse most of the cardiovascular risks linked with obesity, according to a cross-sectional analysis of the US adult population being presented at the Annual Meeting of the European Association for the Study of Diabetes (EASD).

The findings indicate that the risk of high blood pressure and dyslipidemia (unhealthy levels of cholesterol or other fats in the blood) were similar in people who used to have obesity (but were now a healthy weight) and those who had always maintained a healthy weight. However, although the risk of current type 2 diabetes lessened with weight loss, it remained elevated in people who formerly had obesity compared to those who had never had obesity.

More than 40% of adults have obesity (BMI of more than 30kg/m²) and close to one in 10 is classed as having severe obesity. Body weight is directly associated with almost all the cardiovascular risk factors. As BMI increases, so does blood pressure, low-density lipoprotein (LDL, or bad) cholesterol, other abnormal blood fats, blood sugar, and inflammation. These changes increase the risk for heart disease, stroke, and death from cardiovascular disease. However, little is known about whether the effects of obesity persist in those who subsequently achieve and maintain healthy weight.

To find out more, researchers analysed cardiovascular risk factors in 20,271-non-elderly US adults (aged 20-69 years), comparing those who used to have obesity but had been healthy weight for at least the past year (326) to both those who were always a healthy weight (6,235) and those who currently had obesity (13,710). They used data from a series of cross sections, collected biennially from the 1999-2013 National Health and Nutrition Examination Survey (NHANES; a study conducted by the Centers for Disease Control and Prevention) to compare the prevalence of high blood pressure, dyslipidemia, and type 2 diabetes between the groups.

Adults who previously had obesity were on average older than those who never, or currently had obesity, and more likely to smoke cigarettes (36% vs 24% vs 19%). After adjusting for age, gender, smoking and ethnicity, researchers found that the risk of high blood pressure and dyslipidemia were similar in those who used to have obesity and those who had always maintained a healthy weight.

Compared to those who were always healthy weight, people who used to have obesity had three-fold higher odds of diabetes than those who never had obesity; whilst people with current obesity were seven times as likely to experience diabetes. Those who currently had obesity were also at three times greater odds of current high blood pressure and dyslipidemia.

“The key take away of this study is that weight loss is hard, but important, for cardiovascular health”, says lead author Professor Maia Smith from St George’s University in Grenada. “First of all, it’s no surprise that losing weight and keeping it off is hard. Almost everyone in our original sample who had ever had obesity, stayed that way. But don’t despair: if you do manage to lose weight, it can not only prevent but reverse significant health problems. The best time to get healthy is 20 years ago; the second best time is now.”

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Children who eat more fruit and veg have better mental health

“Public health strategies and school policies should be developed to ensure that good quality nutrition is available to all children both before and during school in order to optimize mental wellbeing and empower children to fulfill their full potential.”

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Children who eat a better diet, packed with fruit and vegetables, have better mental wellbeing – according to new research from the University of East Anglia.

This study is the first to investigate the association between fruit and vegetable intakes, breakfast and lunch choices, and mental wellbeing in UK school children. It shows how eating more fruit and veg is linked with better wellbeing among secondary school pupils in particular. And children who consumed five or more portions of fruit and veg a day had the highest scores for mental wellbeing. The study was led by UEA Health and Social Care Partners in collaboration with Norfolk County Council.

The research team stated that public health strategies and school policies should be developed to ensure that good quality nutrition is available to all children before and during school to optimise mental wellbeing and empower children to fulfil their full potential.

Lead researcher Prof Ailsa Welch, from UEA’s Norwich Medical School, said: “We know that poor mental wellbeing is a major issue for young people and is likely to have long-term negative consequences. The pressures of social media and modern school culture have been touted as potential reasons for a rising prevalence of low mental wellbeing in children and young people.

“And there is a growing recognition of the importance of mental health and wellbeing in early life – not least because adolescent mental health problems often persist into adulthood, leading to poorer life outcomes and achievement.

“While the links between nutrition and physical health are well understood, until now, not much has been known about whether nutrition plays a part in children’s emotional wellbeing. So, we set out to investigate the association between dietary choices and mental wellbeing among schoolchildren.”

The research team studied data from almost 9,000 children in 50 schools across Norfolk (7,570 secondary and 1,253 primary school children) taken from the Norfolk children and Young People’s Health and wellbeing Survey.

This survey was commissioned by the Public Health department of Norfolk County Council and the Norfolk Safeguarding Children Board. It was open to all Norfolk schools during October 2017.

Children involved in the study self-reported their dietary choices and took part in age-appropriate tests of mental wellbeing that covered cheerfulness, relaxation, and having good interpersonal relationships.

Prof Welch said: “In terms of nutrition, we found that only around a quarter of secondary-school children and 28 per cent of primary-school children reported eating the recommended five-a-day fruits and vegetables. And just under one in ten children were not eating any fruits or vegetables.

“More than one in five secondary school children and one in 10 primary children didn’t eat breakfast. And more than one in 10 secondary school children didn’t eat lunch.

The team looked at the association between nutritional factors and mental wellbeing and took into account other factors that might have an impact – such as adverse childhood experiences and home situations.

Dr Richard Hayhoe, also from UEA’s Norwich Medical School, said: “We found that eating well was associated with better mental wellbeing in children. And that among secondary school children in particular, there was a really strong link between eating a nutritious diet, packed with fruit and vegetables, and having better mental wellbeing.

“We also found that the types of breakfast and lunch eaten by both primary and secondary school pupils were also significantly associated with wellbeing.

“Children who ate a traditional breakfast experienced better wellbeing than those who only had a snack or drink. But secondary school children who drank energy drinks for breakfast had particularly low mental wellbeing scores, even lower than for those children consuming no breakfast at all.

“According to our data, in a class of 30 secondary school pupils, around 21 will have consumed a conventional-type breakfast, and at least four will have had nothing to eat or drink before starting classes in the morning.

“Similarly, at least three pupils will go into afternoon classes without eating any lunch. This is of concern, and likely to affect not only academic performance at school but also physical growth and development.

“Another interesting thing that we found was that nutrition had as much or more of an impact on wellbeing as factors such as witnessing regular arguing or violence at home.

Prof Welch said: “As a potentially modifiable factor at an individual and societal level, nutrition represents an important public health target for strategies to address childhood mental wellbeing.

“Public health strategies and school policies should be developed to ensure that good quality nutrition is available to all children both before and during school in order to optimize mental wellbeing and empower children to fulfill their full potential.”

‘Cross-sectional associations of schoolchildren’s fruit and vegetable consumption, and meal choices, with their mental wellbeing: a cross-sectional study’ is published in the journal BMJ Nutrition, Prevention & Health.

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People over 40 with type 1 diabetes and COVID-19 are more likely to be hospitalized

People with diabetes are at higher risk for COVID-19-related complications, especially if they are over the age of 40.

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Adults with type 1 diabetes need to be extra cautious of COVID-19 as they are more likely to be hospitalized and die, according to a new study published in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism.

People with diabetes are at higher risk for COVID-19-related complications, especially if they are over the age of 40. Children with COVID-19 rarely develop severe respiratory symptoms and often remain asymptomatic. In contrast, adults experience respiratory symptoms of varying severity, with older adults and those with diabetes at higher risk of acute respiratory distress syndrome and death.

“Our study shows people over 40 with type 1 diabetes have worse outcomes from COVID-19 than children and young adults. Children and young adults experienced milder disease and a better prognosis,” said Carla Demeterco-Berggren, M.D., Ph.D., of the University of California San Diego in San Diego, Calif. “These findings indicate the need for age-tailored treatments, immunization and clinical management of individuals affected by type 1 diabetes and COVID-19. Public health recommendations, including wearing masks and getting vaccinated, need to be followed by all to reduce the risk of contracting COVID-19.”

The researchers studied data from 767 patients with COVID-19 and type 1 diabetes from 56 diabetes clinics across the U.S. Fifty-four percent were 18 or younger, 32% were 19-40 years old and 14% were over 40. The study found patients over 40 were seven times more likely to be hospitalized with COVID-19 compared to the younger group. No patients from the 18 and under group died, while three died from the over 40 age group and two died from the 19-40 age group.

People with diabetes and COVID-19 who were 40 and older were more likely to experience adverse outcomes such as death, diabetic ketoacidosis or severe hypoglycemia. This group also had a significantly higher prevalence of obesity, hypertension or cardiovascular disease and chronic kidney disease when compared to the younger groups.

“The goal of our study is to prevent poor COVID-19 outcomes for adults with type 1 diabetes and to highlight the need to base health care decisions on data as the COVID-19 pandemic evolves,” said Demeterco-Berggren.

Other authors of the study include: Osagie Ebekozien of the T1D Exchange in Boston, Mass. and the University of Mississippi School Medical Center in Jackson, Miss.; Saketh Rompicherla of the T1D Exchange; Laura Jacobsen of the University of Florida in Gainesville, Fla.; Siham Accacha and Mary Pat Gallagher of NYU Langone in New York, N.Y.; Todd Alonso of the University of Colorado in Aurora, Colo.; Berhane Seyoum of Wayne State University in Detroit, Mich.; Francesco Vendrame of the University of Miami in Miami, Fla.; Sonya Haw of Grady Hospital in Atlanta, Ga.; Marina Basina and David M. Maahs of Stanford University in Stanford, Calif.; and Carol J. Levy of the Icahn School of Medicine at Mount Sinai in New York, N.Y.

The manuscript, “Age and Hospitalization Risk in People with Type 1 Diabetes and COVID-19: Data from the T1D Exchange Surveillance Study,” was published online, ahead of print.

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