(Press-News.org) CHICAGO – Participants in a study who were normal weight at the time of a diagnosis of diabetes experienced higher rates of total and noncardiovascular death compared with those who were overweight or obese at diabetes diagnosis, according to a study in the August 8 issue of JAMA.
"Type 2 diabetes in normal-weight adults is an understudied representation of the metabolically obese normal-weight phenotype that has become increasingly common over time. It is not known whether the 'obesity paradox' that has been observed in chronic diseases such as heart failure, chronic kidney disease, and hypertension extends to adults who are normal weight at the time of incident diabetes," according to background information in the article
Mercedes R. Carnethon, Ph.D., of the Feinberg School of Medicine, Northwestern University, Chicago, and colleagues conducted a study to compare mortality between participants who were normal weight and overweight/obese at the time of new adult-onset diabetes. The study consisted of a pooled analysis of 5 longitudinal studies with a total of 2,625 participants with new diabetes. Included were men and women (older than 40 years of age) who developed incident diabetes based on fasting glucose 126 mg/dL or greater or newly initiated diabetes medication and who had concurrent measurements of body mass index (BMI). Participants were classified as normal weight if their BMI was 18.5 to 24.99 or overweight/obese if BMI was 25 or greater. Half (50 percent) of the participants were women, 36 percent were non-white.
The proportion of adults who were normal weight at the time of incident diabetes ranged from 9 percent to 21 percent (overall 12 percent). During follow-up, 449 participants died: 178 (6.8 percent) from cardiovascular causes and 253 (10.4 percent) from noncardiovascular causes; 18 causes of death were unidentified. In the pooled sample, total mortality and cardiovascular and noncardiovascular mortality were higher in normal-weight participants as compared with rates among overweight or obese participants. Following adjustment for certain variables, the researchers found that participants with normal-weight diabetes experienced a significantly elevated total mortality and noncardiovascular mortality. While cardiovascular mortality was elevated, the association was not statistically significant.
"These findings are relevant to segments of the U.S. population, including older adults and nonwhite persons (e.g., Asian, black), who are more likely to experience normal-weight diabetes."
The researchers write that mechanisms to explain their findings are unknown. "However, previous research suggests that normal-weight persons with diabetes have a different genetic profile than overweight or obese persons with diabetes. If those same genetic variants that predispose to diabetes are associated with other illnesses, these individuals may be 'genetically loaded' toward experiencing higher mortality. Future research in normal-weight persons with diabetes should test these genetic hypotheses, along with other plausible mechanisms to account for higher mortality, including inflammation, the distribution and action of adipose tissue, atherosclerosis burden and the composition of fatty plaques, and pancreatic beta-cell function."
(JAMA. 2012;308[6]:581-590. Available pre-embargo to the media at http://media.jamanetwork.com)
Editor's Note: This research is funded by a National Institute of Diabetes and Digestive and Kidney Disease grant. All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
Editorial: Beyond the Obesity Paradox in Diabetes - Fitness, Fatness, and Mortality
In an accompanying editorial, Hermes Florez, M.D., M.P.H., Ph.D., and Sumaya Castillo-Florez, M.D., M.P.H., of the University of Miami Miller School of Medicine, and Miami Veterans Affairs Healthcare System, write that "the article by Carnethon et al addresses an emerging challenge regarding diabetes and weight status."
"This could be a wake-up call for timely prevention and management to reduce adverse outcomes in all patients with type 2 diabetes, particularly in those metabolically obese normal-weight at diagnosis, who may have a false sense of protection because they are not overweight or obese. Standards of diabetes care recommend weight loss for all overweight or obese individuals who have diabetes. Low carbohydrate, low-fat, calorie-restricted, or Mediterranean diets may be effective weight-loss strategies in these individuals. The additional benefits of increased physical activity and behavior modification strategies may lead to the successful implementation of weight management and healthy living programs for all patients with diabetes. It is important to understand how diabetes duration relates to the benefits of intentional weight loss, as well as the clinical consequence associated with sarcopenic obesity and bone loss in older adults with or at high risk for diabetes."
(JAMA. 2012;308[6]:619-620. Available pre-embargo to the media at http://media.jamanetwork.com)
Editor's Note: Support was provided by the Department of Veterans Affairs Geriatrics Research, Education, and Clinical Center program and a grant from the National Institutes of Health and Department of Health and Human Services. Both authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
INFORMATION:
To contact Mercedes R. Carnethon, Ph.D., call Marla Paul at 312-503-8928 or email marla-paul@northwestern.edu. To contact Hermes Florez, M.D., M.P.H., Ph.D., call Lisa Worley at 305-243-5184 or email lworley2@med.miami.edu.
A glass a day of grapefruit juice lets patients derive the same benefits from an anti-cancer drug as they would get from more than three times as much of the drug by itself, according to a new clinical trial. The combination could help patients avoid side effects associated with high doses of the drug and reduce the cost of the medication.
Researchers at the University of Chicago Medicine study the effects that foods can have on the uptake and elimination of drugs used for cancer treatment. In a study published in August in Clinical Cancer Research, they show that eight ...
A new disinfectant, Akwaton, that works at extremely low concentrations could be used in healthcare settings to help control persistent hospital-acquired infections such as Clostridium difficile. The study is reported online in the Journal of Medical Microbiology.
Researchers from the Université de Saint-Boniface in Winnipeg, Canada tested the new compound, Akwaton, against bacterial spores that attach to surfaces and are difficult to destroy. Previous work by the group has shown Akwaton is also effective at low concentrations against strains of Meticillin-resistant Staphylococcus ...
They say the real crisis stems from current incentives that reward companies for developing large numbers of new drugs with few clinical advantages over existing ones.
Since the early 2000s, numerous articles and reports have claimed that the pipeline for new drugs will soon run dry, write Donald Light from the University of Medicine and Dentistry of New Jersey and Joel Lexchin from York University in Toronto. Yet data indicate that the number of new drugs licensed remains at the long term average range of 15-25 a year.
The authors argue that telling "innovation crisis" ...
It has recently been suggested that patients should be kept alive using elective ventilation to facilitate the harvesting of organs for donation. But David Shaw, Honorary Lecturer at the University of Aberdeen believes there is a much simpler way to increase the number of donated organs – by ensuring that doctors respect the wishes of the deceased and over-rule any veto.
Veto by the family is the main impediment to an increase in organ donation, with at least 10% of families refusing to donate. Yet Shaw points out that families have no legal grounds for over-riding the ...
Balance and strength training is known to reduce falls in older adults. However, less than 10% of older people routinely engage in strength training and it is likely that this is much lower for activities that challenge balance.
It has been suggested that integrating exercise into everyday activities may help people stick to it, but this approach has never been investigated in frail older people at risk of falls.
So a team of researchers at the University of Sydney designed and tested the Lifestyle integrated Functional Exercise (LiFE) programme, which involves embedding ...
CORVALLIS, Ore. – A survey of teachers from the United States and Canada found that one out of four educators who used live animals as part of their science curriculum released the organisms into the wild after they were done using them in the classroom.
Yet only 10 percent of those teachers participated in a planned release program, increasing the likelihood that the well-intentioned practice of using live organisms as a teaching tool may be contributing to invasive species problems.
The study was presented today (Aug. 7) in Portland at the national meeting of the ...
New research published online in the scientific journal Addiction shows that plain packaging (requiring cigarettes to be packaged in standard packages without attractive designs and imagery) may help to draw the attention of some adolescent smokers to the health warnings on the package. If so, this may in turn deter young smokers from continuing to smoke.
Researchers asked eighty-seven teenage secondary school (high school) students from the city of Bristol, UK, to look at twenty images of cigarette packs on a computer screen for ten seconds each while a device tracked ...
CHICAGO --- American adults of a normal weight with new-onset diabetes die at a higher rate than overweight/obese adults with the same disease, according to a new Northwestern Medicine study.
The study, to be published in the Aug. 7 issue of JAMA, found that normal-weight participants experienced both significantly higher total and non-cardiovascular mortality than overweight/obese participants.
Normal-weight adults with type 2 diabetes have been understudied because those who typically develop the disease are overweight or obese. In this study about 10 percent of those ...
WINSTON-SALEM, N.C. – August 6, 2012 – When a stroke patient is discharged from the hospital, they often must cope with a new disability or lack of function, so changes in their medications or a new dosing prescription can be particularly confusing. This can lead the patient to overmedicate, take the wrong medication or skip medications entirely and can result in being readmitted to the hospital.
But a pilot study that is looking at a new discharge strategy and being led by researchers at Wake Forest Baptist Medical Center, indicates that phone calls and conversations ...
As the medical community continues to make positive strides in personalized cancer therapy, scientists know some dead ends are unavoidable. Drugs that target specific genes in cancerous cells are effective, but not all proteins are targetable. In fact, it has been estimated that as few as 10 to 15 percent of human proteins are potentially targetable by drugs. For this reason, Georgia Tech researchers are focusing on ways to fight cancer by attacking defective genes before they are able to make proteins.
Professor John McDonald is studying micro RNAs (miRNAs), a class ...
