ADA 2009: Expert Committee Recommends Use of Hemoglobin A1C for Diagnosis of Diabetes
Martha Kerr
From Medscape Medical News
June 7, 2009 (New Orleans, Louisiana) — The American Diabetes Association (ADA), the International Diabetes Federation (IDF), and the European Association for the Study of Diabetes (EASD) have joined forces to recommend the use of the hemoglobin A1C assay for the diagnosis of diabetes.
"This is the first major departure in 30 years in diabetes diagnosis," committee chairman David M. Nathan, MD, director of the Diabetes Center at Massachusetts General Hospital and professor of medicine at Harvard Medical School in Boston, declared in presenting the committee's findings.
"A1C values vary less than FPG [fasting plasma glucose] values and the assay for A1C has technical advantages compared with the glucose assay," Dr. Nathan said.
A1C gives a picture of the average blood glucose level over the preceding 2 to 3 months, he added.
"A1C has numerous advantages over plasma glucose measurement, It's a more stable chemical moiety.... It's more convenient. The patient doesn't need to fast, and measuring A1C is more convenient and easier for patients who will no longer be required to perform a fasting or oral glucose tolerance test.... And it is correlated tightly with the risk of developing retinopathy."
The committee has determined that an A1C value of 6.5% or greater should be used for the diagnosis of diabetes.
This cut-point, Dr. Nathan said, "is where risk of retinopathy really starts to go up."
He cautioned that there is no hard line between diabetes and normoglycemia, however, "...an A1C level of 6.5% is sufficiently sensitive and specific to identify people who have diabetes."
"We support the conclusion of the committee, that this is an appropriate way to diagnose diabetes," stated Paul Robertson, MD, president of medicine and science at the ADA and professor of medicine at the University of Washington in Seattle.
"We purposely avoided using estimated average glucose, or EAG, as this is just a way to convert the A1C into glucose levels.... And one thing we want to try to get away from is the term prediabetes," Dr. Nathan said. "It suggests that people with it will go on to get diabetes, but that is not the case."
"We don't know if we will be diagnosing more patients with diabetes or less, with AIC," Dr. Nathan commented. Cut-off values or practice guidelines have not been established. More study needs to be done first, but "physicians should not mix and match A1C and blood glucose levels. They should stick with one in reviewing a patient's history," Dr. Nathan asserted.
"There is no gold standard assay," said session moderator Richard Kahn, PhD, chief medical and scientific officer of the ADA, which is headquartered in Alexandria, Virginia. "All of these tests measure different things. They all have value. But A1C is the best test to assess risk of retinopathy."
"Some parts of the world are not going to be able to use this," Dr. Robertson added. "It may be too expensive to use in the developing world. Some of these countries have severe chronic anemia, hemolytic anemia, and so on, where we will have to fall back on traditional tests. We are being very cognizant of the international implications." A1C assays are inaccurate in cases of severely low hemoglobin levels.
"We don't think physicians will have a hard time adopting the test...a lot of them are doing it already. We think it will only take a couple of years to be adopted widely into clinical practice," Dr. Kahn told Medscape Diabetes & Endocrinology. "Physicians won't be shocked by this report, but patients — and insurance companies — might be. There are wider social issues that haven't been looked at yet."
American Diabetes Association (ADA) 69th Scientific Sessions. Presented June 5, 2009.
Diabetes Care. Published online June 5, 2009.
Monday, July 27, 2009
Friday, July 17, 2009
Visceral Reaction: Abdominal Fat Trumps BMI
From Heartwire
by Steve Stiles
July 14, 2009 (Quebec, Quebec City) — Two years ago, a group reported an inverse relationship between cardiorespiratory fitness and intra-abdominal adiposity that was independent of body-mass index (BMI) in patients with asymptomatic diabetes enrolled in the Quebec Family Study.
Now that research team, studying nondiabetics from the same observational study, has observed that poor fitness in overweight and obese people, compared with those with good cardiorespiratory fitness, is associated with low-grade inflammation. That's not necessarily a new finding, but another was more novel: "Our results show for the first time that the relation between obesity and inflammation is attributable to a very large extent to visceral adipose-tissue accumulation rather than to excess body weight per se," write Benoit J Arsenault (Université Laval, Quebec, QC) and colleagues in the July 15, 2009 issue of the American Journal of Cardiology.
A cohort of 272 asymptomatic men and women were scored for inflammation based on plasma biomarker levels. Visceral adipose tissue, measured by computed tomography (CT), was positively associated with levels of C-reactive protein (CRP) and interleukin-6 (p<0.0001) but inversely associated with adiponectin levels (p<0.0003) after adjustment for fitness levels (as measured by bicycle ergometry).
Inflammation scores went up (p<0.05) with greater insulin resistance, and they were reduced (p<0.05) in subjects with low vs high levels of visceral adiposity (low defined as <130 cm2 for men and <100 cm2 for women). Within both subgroups with low and high levels of visceral adiposity, subjects with high and low fitness had similar inflammation scores.
Visceral adiposity levels varied widely at any given BMI value.
"The state of insulin resistance associated with visceral adiposity appeared to represent a potential link between low [cardiorespiratory fitness] levels and low-grade inflammation. Hence, we propose that unfit subjects are characterized by an inflammatory state because of their increased visceral [adipose-tissue] accumulation and associated insulin-resistance state."
by Steve Stiles
July 14, 2009 (Quebec, Quebec City) — Two years ago, a group reported an inverse relationship between cardiorespiratory fitness and intra-abdominal adiposity that was independent of body-mass index (BMI) in patients with asymptomatic diabetes enrolled in the Quebec Family Study.
Now that research team, studying nondiabetics from the same observational study, has observed that poor fitness in overweight and obese people, compared with those with good cardiorespiratory fitness, is associated with low-grade inflammation. That's not necessarily a new finding, but another was more novel: "Our results show for the first time that the relation between obesity and inflammation is attributable to a very large extent to visceral adipose-tissue accumulation rather than to excess body weight per se," write Benoit J Arsenault (Université Laval, Quebec, QC) and colleagues in the July 15, 2009 issue of the American Journal of Cardiology.
A cohort of 272 asymptomatic men and women were scored for inflammation based on plasma biomarker levels. Visceral adipose tissue, measured by computed tomography (CT), was positively associated with levels of C-reactive protein (CRP) and interleukin-6 (p<0.0001) but inversely associated with adiponectin levels (p<0.0003) after adjustment for fitness levels (as measured by bicycle ergometry).
Inflammation scores went up (p<0.05) with greater insulin resistance, and they were reduced (p<0.05) in subjects with low vs high levels of visceral adiposity (low defined as <130 cm2 for men and <100 cm2 for women). Within both subgroups with low and high levels of visceral adiposity, subjects with high and low fitness had similar inflammation scores.
Visceral adiposity levels varied widely at any given BMI value.
"The state of insulin resistance associated with visceral adiposity appeared to represent a potential link between low [cardiorespiratory fitness] levels and low-grade inflammation. Hence, we propose that unfit subjects are characterized by an inflammatory state because of their increased visceral [adipose-tissue] accumulation and associated insulin-resistance state."
Tuesday, July 14, 2009
Reject the Victim Mentality
By: Ken Keis
"We live in a society of victimization, where people are much more comfortable being victimized than actually standing up for themselves."
Marilyn Manson, Musician 1969 -
"The price of greatness is taking responsibility."
Sir Winston Churchill, British Politician 1874 - 1965
Reject the Victim Mentality. Take Personal Responsibility!
Victim: One who is acted on and usually adversely affected by a force or agent; one who is injured, destroyed, or sacrificed under any of various conditions; one who is subjected to oppression, hardship, or mistreatment; one who is tricked or duped.
Responsibility: The quality or state of being responsible; moral, legal, or mental accountability; reliable; trustworthy; something for which one is responsible.
Are you taking responsibility for your life and circumstances or are you playing the role of a victim?
Do you know individuals who are constantly playing the victim card -- blaming others and the world for their unfortunate circumstances?
Several activist groups would have you believe their entire group is oppressed and that they are ALL victims! Yes, some have a legitimate story that supports their situation -- but does that justify the victim mentality?
Absolutely not -- and here’s why!
When the victim card is played, the victim is trying to shift the onus for the condition of the person or group onto outside influences. That suggests the victim has played no role in creating the situation and that he or she has no power to change it.
That attitude plays perfectly into the victim mentality: After all, it’s not the victim’s fault, so he or she can’t do anything about it.
In his book The Road Less Traveled, author Scott Peck identified that one of the most difficult character disorders to treat is where it is everyone else’s fault. The reason successful treatment is so challenging is that the individuals do not take personal responsibility for the contribution they are making to their own situation.
The motto of the victim-mentality mindset? It’s not my fault!
Although most of us are guilty of feeling that way at some level or another, we don’t make it a way of life. Here are examples of victim mentality.
Watch who these individuals are blaming for their external conditions.
- My son felt he could not get good grades in math because of the teaching style of the teacher. We reframed the situation to show that no matter what, he is responsible for his marks. His math grade is now the highest in 2 years.
- Previous board members at our school said we could never grow the school, given the condition of the community and that most individuals could not afford private education. Obviously, the school was a victim of circumstances.
Now, that the victim-mentality individuals have left the board, we are on our way to 60% growth in just the past 12 months. I guess all the individuals who could not invest in private education moved out of the area in the past year.
- A local poverty-action group said that unless the government and the community put several initiatives in place, individuals could never get out of the cycle of poverty. So far, they have fulfilled their expectations and their poverty group continues to grow.
Note: This does not suggest new programs are not needed but this group is implying no one can get out of poverty without new programs.
- A very successful colleague in Chicago tells me that many of his friends still struggle and blame their race for their poor conditions. That did not stop him.
- It has been proven in research that your posture and the way you carry yourself reveal whether or not you are an easy target (victim). If you act like a victim, it’s more probable that you will become one -- even just walking down the street.
- When confronted by a teenage mother-to-be who wanted support because she could no longer work, Minnesota Governor Jesse Ventura suggested she should have thought about that before she got herself into that condition. He asked why the state should pay for other people’s choices/mistakes.
- Over the past 5 years, my company has contracted three different marketing copywriters, all of whom did not work out for us. We started to play into the victim mindset, feeling sorry for ourselves and blaming everyone for this failure except ourselves. In the end, it was us that had to be held accountable. After all, we signed the contracts.
I’m sure you can think of examples where similar victim mindsets were evident.
Nothing positive or productive comes out of that attitude.
You are also a product of your environment and the company you keep.
Who are you are hanging out with? They are influencing your behaviors and mindset.
Be aware of your primary peer group(s). If you are spending most of your time interacting with individuals who like to blame others for their circumstances, guess which path you will be heading down.
Even if they are family members or long-term friends, don’t play victim to the victim. Take personal responsibility and upgrade your circle of friends and peers.
Action Steps to Reject the Victim Mentality
1. When someone around you is constantly playing the victim card, how does that make you feel?
2. Think and make a list of the negative consequences of the victim mindset.
3. Is there any part of your life where you are currently playing the victim card? If Yes, list them now.
4. What has playing a victim cost you or others around you?
5. List what has to change for you to take personal responsibility for your current condition. What attitudes do you have to give up?
6. Are there people in your life who frequently play the victim card? How is that affecting you? What can you do to limit, reduce, or eliminate these individuals from your life?
7. List the benefits that individuals enjoy when they take personal responsibility for their circumstances.
8. To improve their circumstances, victims believe they must wait for others to act -- which might never happen. Alternatively, taking personal responsibility can happen this very instant, providing you the opportunity to improve and more forward.
Until next time, keep Living On Purpose,
Ken Keis, MBA, CPC, is an internationally known author, speaker, and consultant. He is President and CEO of CRG Consulting Resource Group International, Inc., Many professionals herald CRG as the Number One global resource center for Personal and Professional Development.
For information on CRG Resources, please visit crgleader.com
Smart Articles @ http://www.articlebrain.com
"We live in a society of victimization, where people are much more comfortable being victimized than actually standing up for themselves."
Marilyn Manson, Musician 1969 -
"The price of greatness is taking responsibility."
Sir Winston Churchill, British Politician 1874 - 1965
Reject the Victim Mentality. Take Personal Responsibility!
Victim: One who is acted on and usually adversely affected by a force or agent; one who is injured, destroyed, or sacrificed under any of various conditions; one who is subjected to oppression, hardship, or mistreatment; one who is tricked or duped.
Responsibility: The quality or state of being responsible; moral, legal, or mental accountability; reliable; trustworthy; something for which one is responsible.
Are you taking responsibility for your life and circumstances or are you playing the role of a victim?
Do you know individuals who are constantly playing the victim card -- blaming others and the world for their unfortunate circumstances?
Several activist groups would have you believe their entire group is oppressed and that they are ALL victims! Yes, some have a legitimate story that supports their situation -- but does that justify the victim mentality?
Absolutely not -- and here’s why!
When the victim card is played, the victim is trying to shift the onus for the condition of the person or group onto outside influences. That suggests the victim has played no role in creating the situation and that he or she has no power to change it.
That attitude plays perfectly into the victim mentality: After all, it’s not the victim’s fault, so he or she can’t do anything about it.
In his book The Road Less Traveled, author Scott Peck identified that one of the most difficult character disorders to treat is where it is everyone else’s fault. The reason successful treatment is so challenging is that the individuals do not take personal responsibility for the contribution they are making to their own situation.
The motto of the victim-mentality mindset? It’s not my fault!
Although most of us are guilty of feeling that way at some level or another, we don’t make it a way of life. Here are examples of victim mentality.
Watch who these individuals are blaming for their external conditions.
- My son felt he could not get good grades in math because of the teaching style of the teacher. We reframed the situation to show that no matter what, he is responsible for his marks. His math grade is now the highest in 2 years.
- Previous board members at our school said we could never grow the school, given the condition of the community and that most individuals could not afford private education. Obviously, the school was a victim of circumstances.
Now, that the victim-mentality individuals have left the board, we are on our way to 60% growth in just the past 12 months. I guess all the individuals who could not invest in private education moved out of the area in the past year.
- A local poverty-action group said that unless the government and the community put several initiatives in place, individuals could never get out of the cycle of poverty. So far, they have fulfilled their expectations and their poverty group continues to grow.
Note: This does not suggest new programs are not needed but this group is implying no one can get out of poverty without new programs.
- A very successful colleague in Chicago tells me that many of his friends still struggle and blame their race for their poor conditions. That did not stop him.
- It has been proven in research that your posture and the way you carry yourself reveal whether or not you are an easy target (victim). If you act like a victim, it’s more probable that you will become one -- even just walking down the street.
- When confronted by a teenage mother-to-be who wanted support because she could no longer work, Minnesota Governor Jesse Ventura suggested she should have thought about that before she got herself into that condition. He asked why the state should pay for other people’s choices/mistakes.
- Over the past 5 years, my company has contracted three different marketing copywriters, all of whom did not work out for us. We started to play into the victim mindset, feeling sorry for ourselves and blaming everyone for this failure except ourselves. In the end, it was us that had to be held accountable. After all, we signed the contracts.
I’m sure you can think of examples where similar victim mindsets were evident.
Nothing positive or productive comes out of that attitude.
You are also a product of your environment and the company you keep.
Who are you are hanging out with? They are influencing your behaviors and mindset.
Be aware of your primary peer group(s). If you are spending most of your time interacting with individuals who like to blame others for their circumstances, guess which path you will be heading down.
Even if they are family members or long-term friends, don’t play victim to the victim. Take personal responsibility and upgrade your circle of friends and peers.
Action Steps to Reject the Victim Mentality
1. When someone around you is constantly playing the victim card, how does that make you feel?
2. Think and make a list of the negative consequences of the victim mindset.
3. Is there any part of your life where you are currently playing the victim card? If Yes, list them now.
4. What has playing a victim cost you or others around you?
5. List what has to change for you to take personal responsibility for your current condition. What attitudes do you have to give up?
6. Are there people in your life who frequently play the victim card? How is that affecting you? What can you do to limit, reduce, or eliminate these individuals from your life?
7. List the benefits that individuals enjoy when they take personal responsibility for their circumstances.
8. To improve their circumstances, victims believe they must wait for others to act -- which might never happen. Alternatively, taking personal responsibility can happen this very instant, providing you the opportunity to improve and more forward.
Until next time, keep Living On Purpose,
Ken Keis, MBA, CPC, is an internationally known author, speaker, and consultant. He is President and CEO of CRG Consulting Resource Group International, Inc., Many professionals herald CRG as the Number One global resource center for Personal and Professional Development.
For information on CRG Resources, please visit crgleader.com
Smart Articles @ http://www.articlebrain.com
Tuesday, July 7, 2009
Vegetarian Diet
American Dietetic Association Endorses Vegetarian Diets
by Laurie Barclay
July 6, 2009 — Vegetarian diets, if well-planned, are healthful and nutritious for all age groups and can help prevent and treat chronic diseases, according to an updated position paper released by the American Dietetic Association. The revised recommendations are published in the July issue of the Journal of the American Dietetic Association. The position was adopted by the House of Delegates Leadership Team in 1987 and was reaffirmed in 1992, 1996, 2000, and 2006; the updated position paper is to remain in effect until December 31, 2013.
"Common reasons for choosing a vegetarian diet include health considerations, concern for the environment, and animal welfare factors," write Winston J. Craig, PhD, MPH, RD, from Andrews University in Berrien Springs, Michigan, and Ann Reed Mangels, PhD, RD, LDN, FADA, from the Vegetarian Resource Group in Baltimore, Maryland. "Vegetarians also cite economic reasons, ethical considerations, world hunger issues, and religious beliefs as their reasons for following their chosen eating pattern.... Individual assessment is required to accurately evaluate the nutritional quality of the diet of a vegetarian or a self-described vegetarian."
Defining and Planning a Vegetarian Diet
The American Dietetic Association defines a vegetarian diet, or lacto-ovo vegetarian diet, as one that does not include meat, fowl, seafood, or products containing those foods. The lacto-vegetarian diet also excludes eggs and primarily consists of grains, vegetables, fruits, legumes, seeds, nuts, and dairy products. The vegan, or total vegetarian, eating pattern excludes eggs, dairy, and other animal products. Within these broad definitions, there is still variation in the degree to which animal products are excluded.
A well-planned vegetarian diet can meet current recommendations for all vital nutrients, including protein, omega-3 fatty acids, iron, zinc, iodine, calcium, and vitamins D and B-12. However, use of supplements or fortified foods may be helpful to boost intake of important nutrients in certain cases.
The American Dietetic Association contends that carefully planned vegetarian diets, including vegan diets, are healthful and nutritionally sufficient for individuals of all ages, including pregnant or lactating women, infants, children, adolescents, and athletes. During pregnancy, adherence to a nutritionally adequate vegetarian diet can lead to positive health outcomes for both the mother and infant.
Furthermore, well-constructed vegetarian diets may offer health benefits in terms of preventing and treating certain chronic diseases, including heart disease, cancer, obesity, and diabetes. Vegetarian diets are linked to lower risk for death from ischemic heart disease, according to findings of an evidence-based review. In addition, low-density lipoprotein cholesterol levels, blood pressure, and body mass index appear to be lower in vegetarians than in nonvegetarians, as do rates of hypertension, type 2 diabetes, and cancer.
The position paper also reviews available evidence concerning the effects of vegetarian diets on cardiovascular disease, obesity, osteoporosis, renal disease, dementia, diverticulitis, and rheumatoid arthritis.
Specific vegetarian considerations regarding specific nutritional programs are also reviewed, including the Special Supplemental Nutrition Program for Women, Infants, and Children; child nutrition programs; feeding programs for elderly adults; corrections facilities programs; military and armed forces programs; and other institutions and quantity food service organizations.
During the next decade, the number of vegetarians in the United States is expected to increase. Vegetarian diets are typically characterized by certain healthful features that may lower the risk for chronic disease — notably, reduced consumption of saturated fat and cholesterol and increased consumption of fruits, vegetables, whole grains, nuts, soy products, fiber, and phytochemicals with potent antioxidant, antiproliferative, and cancer-protective activity.
However, individual diets should be evaluated to ensure that they are nutritionally adequate, given the variability of dietary habits among vegetarians. Other important roles for food and nutrition professionals are to educate vegetarians regarding sources of key nutrients, food purchase and preparation, and individual dietary modifications to meet their specific requirements.
Recommendations for a Healthy Diet
Specific recommendations to help ensure that vegetarians have healthful diets with sufficient nutrients are as follow:
•The diet should contain a wide variety of healthful foods, including whole grains, vegetables, fruits, legumes, nuts, and seeds, as well as dairy and eggs if desired.
•Consumption of foods that are high in sugar, sodium, and fat, particularly saturated fat and trans-fatty acids, should be minimized.
•The diet should contain a wide range of healthful fruits and vegetables.
•For vegetarians who consume dairy products and eggs, moderation is recommended, as well as use of lower-fat dairy products.
•A regular source of vitamin B-12 is recommended, as well as of vitamin D if sunlight exposure is limited.
•Nutritionists should be able to recommend local, reliable sources for purchase of vegetarian foods, or mail order sources in some communities where suitable local sources are unavailable.
•To facilitate meeting nutrient needs on a vegetarian diet, clinicians should collaborate with family members, especially the parents of children following vegetarian diets.
•Practitioners unfamiliar with the principles of vegetarian nutrition should help their vegetarian patients find a nutritionist or other qualified provider to advise them regarding their diet.
"It is the position of the American Dietetic Association that appropriately planned vegetarian diets, including total vegetarian or vegan diets, are healthful, nutritionally adequate, and may provide health benefits in the prevention and treatment of certain diseases," the position paper authors write. "Well-planned vegetarian diets are appropriate for individuals during all stages of the lifecycle, including pregnancy, lactation, infancy, childhood, and adolescence, and for athletes.... Food and nutrition professionals can assist vegetarian clients by providing current, accurate information about vegetarian nutrition, foods, and resources."
J Am Diet Assoc. 2009;109:1266–1282.
by Laurie Barclay
July 6, 2009 — Vegetarian diets, if well-planned, are healthful and nutritious for all age groups and can help prevent and treat chronic diseases, according to an updated position paper released by the American Dietetic Association. The revised recommendations are published in the July issue of the Journal of the American Dietetic Association. The position was adopted by the House of Delegates Leadership Team in 1987 and was reaffirmed in 1992, 1996, 2000, and 2006; the updated position paper is to remain in effect until December 31, 2013.
"Common reasons for choosing a vegetarian diet include health considerations, concern for the environment, and animal welfare factors," write Winston J. Craig, PhD, MPH, RD, from Andrews University in Berrien Springs, Michigan, and Ann Reed Mangels, PhD, RD, LDN, FADA, from the Vegetarian Resource Group in Baltimore, Maryland. "Vegetarians also cite economic reasons, ethical considerations, world hunger issues, and religious beliefs as their reasons for following their chosen eating pattern.... Individual assessment is required to accurately evaluate the nutritional quality of the diet of a vegetarian or a self-described vegetarian."
Defining and Planning a Vegetarian Diet
The American Dietetic Association defines a vegetarian diet, or lacto-ovo vegetarian diet, as one that does not include meat, fowl, seafood, or products containing those foods. The lacto-vegetarian diet also excludes eggs and primarily consists of grains, vegetables, fruits, legumes, seeds, nuts, and dairy products. The vegan, or total vegetarian, eating pattern excludes eggs, dairy, and other animal products. Within these broad definitions, there is still variation in the degree to which animal products are excluded.
A well-planned vegetarian diet can meet current recommendations for all vital nutrients, including protein, omega-3 fatty acids, iron, zinc, iodine, calcium, and vitamins D and B-12. However, use of supplements or fortified foods may be helpful to boost intake of important nutrients in certain cases.
The American Dietetic Association contends that carefully planned vegetarian diets, including vegan diets, are healthful and nutritionally sufficient for individuals of all ages, including pregnant or lactating women, infants, children, adolescents, and athletes. During pregnancy, adherence to a nutritionally adequate vegetarian diet can lead to positive health outcomes for both the mother and infant.
Furthermore, well-constructed vegetarian diets may offer health benefits in terms of preventing and treating certain chronic diseases, including heart disease, cancer, obesity, and diabetes. Vegetarian diets are linked to lower risk for death from ischemic heart disease, according to findings of an evidence-based review. In addition, low-density lipoprotein cholesterol levels, blood pressure, and body mass index appear to be lower in vegetarians than in nonvegetarians, as do rates of hypertension, type 2 diabetes, and cancer.
The position paper also reviews available evidence concerning the effects of vegetarian diets on cardiovascular disease, obesity, osteoporosis, renal disease, dementia, diverticulitis, and rheumatoid arthritis.
Specific vegetarian considerations regarding specific nutritional programs are also reviewed, including the Special Supplemental Nutrition Program for Women, Infants, and Children; child nutrition programs; feeding programs for elderly adults; corrections facilities programs; military and armed forces programs; and other institutions and quantity food service organizations.
During the next decade, the number of vegetarians in the United States is expected to increase. Vegetarian diets are typically characterized by certain healthful features that may lower the risk for chronic disease — notably, reduced consumption of saturated fat and cholesterol and increased consumption of fruits, vegetables, whole grains, nuts, soy products, fiber, and phytochemicals with potent antioxidant, antiproliferative, and cancer-protective activity.
However, individual diets should be evaluated to ensure that they are nutritionally adequate, given the variability of dietary habits among vegetarians. Other important roles for food and nutrition professionals are to educate vegetarians regarding sources of key nutrients, food purchase and preparation, and individual dietary modifications to meet their specific requirements.
Recommendations for a Healthy Diet
Specific recommendations to help ensure that vegetarians have healthful diets with sufficient nutrients are as follow:
•The diet should contain a wide variety of healthful foods, including whole grains, vegetables, fruits, legumes, nuts, and seeds, as well as dairy and eggs if desired.
•Consumption of foods that are high in sugar, sodium, and fat, particularly saturated fat and trans-fatty acids, should be minimized.
•The diet should contain a wide range of healthful fruits and vegetables.
•For vegetarians who consume dairy products and eggs, moderation is recommended, as well as use of lower-fat dairy products.
•A regular source of vitamin B-12 is recommended, as well as of vitamin D if sunlight exposure is limited.
•Nutritionists should be able to recommend local, reliable sources for purchase of vegetarian foods, or mail order sources in some communities where suitable local sources are unavailable.
•To facilitate meeting nutrient needs on a vegetarian diet, clinicians should collaborate with family members, especially the parents of children following vegetarian diets.
•Practitioners unfamiliar with the principles of vegetarian nutrition should help their vegetarian patients find a nutritionist or other qualified provider to advise them regarding their diet.
"It is the position of the American Dietetic Association that appropriately planned vegetarian diets, including total vegetarian or vegan diets, are healthful, nutritionally adequate, and may provide health benefits in the prevention and treatment of certain diseases," the position paper authors write. "Well-planned vegetarian diets are appropriate for individuals during all stages of the lifecycle, including pregnancy, lactation, infancy, childhood, and adolescence, and for athletes.... Food and nutrition professionals can assist vegetarian clients by providing current, accurate information about vegetarian nutrition, foods, and resources."
J Am Diet Assoc. 2009;109:1266–1282.
Friday, June 26, 2009
H1N1 Flu - vaccine or antiviral?
What is the difference between a vaccine and an antiviral?
--------------------------------------------------------------------------------
Vaccines are usually given to prevent infections. Influenza vaccines are made from either pieces of the killed influenza virus or weakened versions of the live virus that will not lead to disease. When vaccinated, the body’s immune system makes antibodies which will fight off infection if exposure to the virus occurs.
Antivirals are drugs that can treat people who have already been infected by a virus. They also can be used to prevent infection when given before or shortly after exposure and before illness occurs. A key difference between a vaccine and antiviral drug is that the antiviral drug will prevent infection only when administered within a certain time frame before or after exposure and is effective during the time that the drug is being taken while a vaccine can be given long before exposure to the virus and can provide protection over a long period of time.
Why won't the annual flu vaccine protect people against pandemic influenza?Influenza vaccines provide the best protection against viruses closely related to the vaccine strains. Current annual influenza vaccines include influenza A subtype H3N2 and H1N1 viruses. A vaccine made from these viruses would not provide protection from other influenza A viruses (such as H5N1) that are not closely related to them.
source: http://www.pandemicflu.gov/faq/vaccines/1090.html
My comment: do not use anti viral against flu indiscriminately or without medical prescription (to avoid wrong dosing or wrong diagnosis) - this may allow the virus to develop resistant strains to the antiviral making future treatment options very hard indeed.
--------------------------------------------------------------------------------
Vaccines are usually given to prevent infections. Influenza vaccines are made from either pieces of the killed influenza virus or weakened versions of the live virus that will not lead to disease. When vaccinated, the body’s immune system makes antibodies which will fight off infection if exposure to the virus occurs.
Antivirals are drugs that can treat people who have already been infected by a virus. They also can be used to prevent infection when given before or shortly after exposure and before illness occurs. A key difference between a vaccine and antiviral drug is that the antiviral drug will prevent infection only when administered within a certain time frame before or after exposure and is effective during the time that the drug is being taken while a vaccine can be given long before exposure to the virus and can provide protection over a long period of time.
Why won't the annual flu vaccine protect people against pandemic influenza?Influenza vaccines provide the best protection against viruses closely related to the vaccine strains. Current annual influenza vaccines include influenza A subtype H3N2 and H1N1 viruses. A vaccine made from these viruses would not provide protection from other influenza A viruses (such as H5N1) that are not closely related to them.
source: http://www.pandemicflu.gov/faq/vaccines/1090.html
My comment: do not use anti viral against flu indiscriminately or without medical prescription (to avoid wrong dosing or wrong diagnosis) - this may allow the virus to develop resistant strains to the antiviral making future treatment options very hard indeed.
Friday, June 19, 2009
QDScore Helps Estimate 10-Year Risk for Diabetes
by Laurie Barclay & Charles Vega
Medscape News
March 19, 2009 — The QDScore, which includes both social deprivation and ethnicity, is the first risk prediction algorithm to estimate the 10-year risk for diabetes, according to the results of a prospective open cohort study reported in the March 18 Online First issue of the BMJ.
"Although several algorithms for predicting the risk of type 2 diabetes have been developed, no widely accepted diabetes risk prediction score has been developed and validated for use in routine clinical practice," write Julia Hippisley-Cox, from University Park, Nottingham, United Kingdom, and colleagues. "Previous studies have been limited by size, and some have performed inadequately when tested in ethnically diverse populations. A new diabetes risk prediction tool with appropriate weightings for both social deprivation and ethnicity is needed given the prevalence of type 2 diabetes, particularly among minority ethnic communities, appreciable numbers of whom remain without a diagnosis for long periods of time."
The goal of this study was to develop and validate the QDScore for estimating 10-year risk of acquiring diagnosed type 2 diabetes during a 10-year period, with use of routinely collected data from an ethnically and socioeconomically diverse population
Obesity has been a growing problem in Western countries for decades, and a study by Christakis and Fowler suggests that social networks play a prominent role in the risk for obesity. Their research, which was published in the July 26, 2007, issue of the New England Journal of Medicine, demonstrated that an individual's risk of becoming obese increased by 57% if he or she had a friend who became obese in a given interval. Moreover, incident obesity among siblings and spouses also increased subjects' risk for obesity. However, the development of obesity in a neighbor had no significant effect on the personal risk for obesity.
The epidemic of obesity has led to a sharp increase in the prevalence of type 2 diabetes. The current study examines a tool to predict the risk for incident type 2 diabetes without the use of laboratory data
The risk tool, the QDScore, (www.qdscore.org) was calculated from the following variables, all of which were found to independently affect the risk for incident type 2 diabetes:
◦Age
◦Body mass index
◦Family history of diabetes
◦Smoking status
◦Treated hypertension
◦Use of corticosteroids
◦Diagnosed cardiovascular disease
◦Social deprivation, as measured by the Townsend deprivation scale
◦Ethnicity
Medscape News
March 19, 2009 — The QDScore, which includes both social deprivation and ethnicity, is the first risk prediction algorithm to estimate the 10-year risk for diabetes, according to the results of a prospective open cohort study reported in the March 18 Online First issue of the BMJ.
"Although several algorithms for predicting the risk of type 2 diabetes have been developed, no widely accepted diabetes risk prediction score has been developed and validated for use in routine clinical practice," write Julia Hippisley-Cox, from University Park, Nottingham, United Kingdom, and colleagues. "Previous studies have been limited by size, and some have performed inadequately when tested in ethnically diverse populations. A new diabetes risk prediction tool with appropriate weightings for both social deprivation and ethnicity is needed given the prevalence of type 2 diabetes, particularly among minority ethnic communities, appreciable numbers of whom remain without a diagnosis for long periods of time."
The goal of this study was to develop and validate the QDScore for estimating 10-year risk of acquiring diagnosed type 2 diabetes during a 10-year period, with use of routinely collected data from an ethnically and socioeconomically diverse population
Obesity has been a growing problem in Western countries for decades, and a study by Christakis and Fowler suggests that social networks play a prominent role in the risk for obesity. Their research, which was published in the July 26, 2007, issue of the New England Journal of Medicine, demonstrated that an individual's risk of becoming obese increased by 57% if he or she had a friend who became obese in a given interval. Moreover, incident obesity among siblings and spouses also increased subjects' risk for obesity. However, the development of obesity in a neighbor had no significant effect on the personal risk for obesity.
The epidemic of obesity has led to a sharp increase in the prevalence of type 2 diabetes. The current study examines a tool to predict the risk for incident type 2 diabetes without the use of laboratory data
The risk tool, the QDScore, (www.qdscore.org) was calculated from the following variables, all of which were found to independently affect the risk for incident type 2 diabetes:
◦Age
◦Body mass index
◦Family history of diabetes
◦Smoking status
◦Treated hypertension
◦Use of corticosteroids
◦Diagnosed cardiovascular disease
◦Social deprivation, as measured by the Townsend deprivation scale
◦Ethnicity
Thursday, June 11, 2009
AHA Urges Exercise to Cut CV Risk in Diabetics
by Steve Stiles
June 10, 2009 (Dallas, Texas) — At least two and half hours per week, spread out over at least three sessions--that's the amount of moderate-intensity exercise recommended by the American Heart Association for reducing cardiovascular risk in people with type 2 diabetes, according to a scientific statement published online June 8, 2009 in Circulation [1].
Ninety minutes per week of "vigorous-intensity cardiorespiratory exercise" can be an alternative for some patients, but both options are considered minimums, according to the document, from a writing group chaired by Dr Thomas H Marwick (University of Queensland School of Medicine, Brisbane, Australia). In addition, "moderate- to high-intensity" resistance training three times per week is highly recommended.
The document is rich with evidence from the literature to support the recommendations, but "unfortunately, only a few large-scale, randomized, controlled trials are available."
Still, it reviews likely physiologic mechanisms by which exercise improves CV risk factors, such as improvements in insulin sensitivity and vascular function, as well as potential CV risks of exercise training. Recommendations on counseling and other strategies for promoting adherence are included. And it describes how some patients, especially the many who may start out deconditioned or are limited by comorbidities, can begin lightly and work their way up to the training goals.
http://www.medscape.com/viewarticle/704205?sssdmh=dm1.483760&src=nldne
June 10, 2009 (Dallas, Texas) — At least two and half hours per week, spread out over at least three sessions--that's the amount of moderate-intensity exercise recommended by the American Heart Association for reducing cardiovascular risk in people with type 2 diabetes, according to a scientific statement published online June 8, 2009 in Circulation [1].
Ninety minutes per week of "vigorous-intensity cardiorespiratory exercise" can be an alternative for some patients, but both options are considered minimums, according to the document, from a writing group chaired by Dr Thomas H Marwick (University of Queensland School of Medicine, Brisbane, Australia). In addition, "moderate- to high-intensity" resistance training three times per week is highly recommended.
The document is rich with evidence from the literature to support the recommendations, but "unfortunately, only a few large-scale, randomized, controlled trials are available."
Still, it reviews likely physiologic mechanisms by which exercise improves CV risk factors, such as improvements in insulin sensitivity and vascular function, as well as potential CV risks of exercise training. Recommendations on counseling and other strategies for promoting adherence are included. And it describes how some patients, especially the many who may start out deconditioned or are limited by comorbidities, can begin lightly and work their way up to the training goals.
http://www.medscape.com/viewarticle/704205?sssdmh=dm1.483760&src=nldne
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