Diabesity: A Multidisciplinary Approach

Débora Villaño, Javier Marhuenda, Cristina García Viguera

• Verlag: Bentham Science Publishers
• Jahr: 2001
• ISBN:
  9789815039801
• Thema: Medicine
• Thema: Endocrinology & Metabolism

Diabesity: A Multidisciplinary Approach Diabesity refers to the linkageof both diabetes and obesity that results in the coexistence of these 2conditions. Research has identified pathophysiological mechanisms revolvingaround insulin resistance and hyperinsulinemia. Diabesity has importantdiagnostic and therapeutic implications. This book is a multidisciplinaryreview of diabesity. It highlights the various pharmacological methods ofmanaging the condition. The book presents 10 chapterscontributed by more than 40 experts from around the world. The review startswith an overview of diabesity and progressively describes the relationships ofdiabesity with the choice of diets and psychological factors. The chapters thencover the role of adipokines as therapeutic biomarkers before presentingresearch on medicinal and nutritional approaches to treat the condition.Modern approaches to diabesitytreatment such as the use of new bioactive phytochemicals, mitigatingmeta-inflammation and laboratory techniques are also reviewed in the book. Diabesity: A MultidisciplinaryApproach is a timelyreference for clinicians (in endocrinology and family medicine subspecialties)and students of pharmacology and medicinal chemistry on the intricaterelationship between diabetes and obesity.

Dietary Recommendations And Prevention Of Diabesity- Are The Current Guidelines Enough?

Masoodi Hedyeh¹, Barbour-Tuck Erin¹, Hassan Vatanparast^{1, *}

¹ University of Saskatchewan, Department of Pharmacy and Nutrition, Saskatchewan, Canada

Abstract

Obesity is a chronic non-communicable condition. Rates of obesity have risen globally over the last few decades, like the rates of comorbidities of obesity, such as the clustering of metabolic risk factors, as seen in the condition diabesity. Given the high prevalence and widespread nature of these chronic conditions, much effort has been put towards lifestyle interventions, many of which target weight loss or prevention of weight gain. Reducing weight and body fat remains a highly effective treatment for mitigating the adverse health effects of obesity and reducing the risk of related chronic diseases. There is a burgeoning cache of evidence suggesting that certain macro and micronutrient intake, and diet composition and patterns may be more or less effective at preventing diabesity. Several dietary interventions, such as the Mediterranean diet and DASH diet, have proven to reduce obesity and the risk or severity of obesity-related conditions such as insulin resistance, diabetes, and metabolic syndrome. While these dietary patterns have similar elements to those of the recommendations for general healthy eating, minor adjustments could be made to the current guidelines to optimize the prevention of diabesity. Alternatively, a secondary set of dietary information could be developed, specifically addressing dietary requirements for people living with obesity and diabetes. This chapter will discuss current dietary and nutritional guidelines, highlight similarities and differences between countries and resources, and identify discrepancies and agreements between current guidelines in nutritional epidemiology literature.

Keywords: AI, CDRR, Diabesity, Dietary Guidelines, Dietary Recommendations, DRI, EAR, EFSA, FAO, FBDG, Food, Food Pyramid, IDF, Insulin Resistance, Macronutrients, Metabolic Syndrome, Micronutrients, Obesity, Over-Weight, Planetary Diet, RDA, Sustainable Diet, UL, WHO.

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^* Corresponding author Hassan Vatanparast: University of Saskatchewan, College of Pharmacy and Nutrition, Vatanparast Nutritional Epidemiology Lab (VNEL), Canada; Email: [email protected]

INTRODUCTION

Obesity is a worldwide public health problem. Over the past two decades, there has been a consistent upward global trend of obesity and, consequently, diabetes mellitus and cardiovascular diseases [1]. Non-communicable chronic diseases

(NCDs), including obesity, diabetes mellitus and cardiovascular disease, often cluster together in a condition known as diabesity [1] and are collectively responsible for 70% of all global deaths annually. As such, efforts to end obesity and ameliorate its consequences remain at the forefront of public health efforts. Lifestyle interventions are one of the most effective methods for mitigating the risk of diabesity and often include the modifications of dietary habits [1].

Dietary habits are modifiable lifestyle behaviors that are foundational to health. They are likely to be maintained into adulthood [2] and as such, poor dietary habits can compromise health across the life course, and are a key factor and contributor to the global burden of disease and death as a primary driver of NCD’s [3]. The recent widespread transition of dietary habit in the form of a shift towards increasing consumption of refined carbohydrates, added sweeteners, edible oils, animal source foods and reduced intake of legumes, vegetables, and fruits, has worsened the global burden [4]. Bourgoning evidence on diet and nutrition-related risk factors emphasizes the need to explore how nutrients and dietary habits contribute to chronic disease. Furthermore, there is a lack of information on whether or not recommendations for disease-specific levels of nutrients and vitamins can be determined and are needed to ameliorate the risk of chronic disease.

DIET AND DISEASE

The oldest description of food and nutrients, and their effect on health was recorded by the ancient Egyptians in 3200 BC, while the idea of healing through nutrition was conceived in 400 BC by Hippocrates, (the Greek physician and the father of Medicine) [5]; however, it wasn’t until the early 20^th century that most vitamins were discovered and synthesized, which addressed the ubiquitous epidemic of vitamin deficiencies [5]. In 1938 and 1941, respectively, Canada and the USA developed and issued their first public nutrient intake recommendation during World war II, which was a time of fear of the food shortage. The first RDA was generated as the direct but separate result of scientists’ work for the league of nations, British medical association and the U.S government [6]. To be prepared for the war (to mitigate some of the risk of low food avialability), they generated a new minimum dietary requirements [6]. The RDA was presented at the national nutrition conference on defence in 1941 [7], and included guidelines for total calorie, and selected nutrients, including vitamins, protein, calcium, phosphorus, and iron [8]. These RDA’s remained in use until 1997, when the Institute of Medicine issued Dietary Reference Intake (DRI) as a series of nutrient reference values, which encompassed RDA [9] and provided appropriate quantitative information for diet planning. These DRI’s remain the most current guidelines for nutrient intake. Unlike the initial focus of recommendations on preventing nutrient deficiency disorders, the current recommendations focus on nutrient requirements for optimal health and prevention of chronic diseases [10].

Dietary patterns are important predictors of nutritional status and health. Dietary patterns are developed when repeated food choices are made. A person’s macro and micro nutrient intake, and to some extent the quantity of calories consumed, are indicated by a person’s food choices and resulting habitual eating patterns [11].

The food choices we make are in-turn, influenced by our food environment. The food environment can include the food options available at home, school and work, availability and access to healthy food stores or retail food outlets and restaurants, and healthy food information, education and resources and exposure to food marketing for less healthy food choices [2]. The importance of the food environment is particularly evident for newly immigrated and indigenous peoples. The limited availability of traditional foods, or foods prepared in traditional ways (e.g. trapping, fishing, hunting) are added barriers to healthy eating in these populations that can constrain and limit healthy food choices [11]. The consequences of a negative food environment often include a higher prevalence of obesity and obesity-related diseases [11]. Many of the non-communicable diseases such as diabesity are largely preventable [12], and while food choices at the individual level can be effective at preventing disease onset, most people will make their choices based on what they can access and afford.

DIETARY GUIDELINES AND HEALTHY EATING RESOURCES

In an effort to support healthy individual food choices while recognizing upstream levels of intervention required, the World Health Organization (WHO) developed the Global Strategy on Diet, Physical Activity and Health. This strategy ...