The relationship between body fat distribution, insulin sensitivity and postprandial lipids in Europeans and South Asians : a cross-sectional study.

Metabolic disturbances associated with central obesity and insulin resistance might underlie the higher rates of diabetes and coronary heart disease in South Asians compared with Europeans. A cross sectional study of 135 healthy South Asians and Europeans, aged 40-55 years, was performed to test whether lower insulin sensitivity in South Asians is explained by ethnic differences in body fat pattern and to establish if there are ethnic differences in postprandial triglyceride and intramyocellular lipid (IMCL) content that are associated with insulin sensitivity. Visceral fat area (VFA), measured by CT scan, was higher in South Asians than in Europeans in analyses adjusted for age, sex and body mass index (p=0.001). VFA was strongly associated with insulin sensitivity index (ISI), measured by the short insulin tolerance test, in both groups independently of total % body fat (measured by DEXA scan). In age and sex adjusted analyses ISI was 0.71 % min-1 lower in South Asians (95% CI -1.18 to -0.25, p=0.003). Adjustment for body fat pattern and triglyceride (fasting and 8 hour postprandial) reduced the ethnic difference in ISI to - 0.41 % min-1 (95% Cl -0.86 to 0.03, p=0.066). In both groups 8 hour postprandial triglyceride was highly correlated with ISI and VFA and the relationship of ISI to VFA was eliminated by adjusting for triglyceride. In a sub- study, mean IMCL content (measured by magnetic resonance spectroscopy) was higher in South Asians (p=0.046). In Europeans IMCL was correlated positively with % body fat, waist/hip ratio, VFA and negatively with ISI. In South Asians IMCL was not significantly related to ISI or obesity. We conclude that body fat pattern and IMCL cannot account for ethnic difference in insulin sensitivity. Alterations of lipid metabolism, possibly in the postprandial period, are likely to underlie the association of central obesity with insulin resistance

Epidemiology of diabetes.

The disease burden related to diabetes is high and rising in every country, fuelled by the global rise in the prevalence of obesity and unhealthy lifestyles. The latest estimates show a global prevalence of 382 million people with diabetes in 2013, expected to rise to 592 million by 2035. The aetiological classification of diabetes has now been widely accepted. Type 1 and type 2 diabetes are the two main types, with type 2 diabetes accounting for the majority (>85%) of total diabetes prevalence. Both forms of diabetes can lead to multisystem complications of microvascular endpoints, including retinopathy, nephropathy and neuropathy, and macrovascular endpoints including ischaemic heart disease, stroke and peripheral vascular disease. The premature morbidity, mortality, reduced life expectancy and financial and other costs of diabetes make it an important public health condition.NGF and NJW acknowledge support from the core Medical Research Council Epidemiology Unit Programmes ( MC_UU_12015/5 and MC_UU_12015/1 ).This is the author accepted manuscript. The final version is available from Elsevier via http://dx.doi.org/10.1016/j.mpmed.2014.09.00

Early outcomes of referrals to the English National Health Service Digital Weight Management Programme

Objective The study objective was to assess participant weight change for the English National Health Service (NHS) Digital Weight Management Programme, the first such digital intervention to achieve population coverage. Methods A service evaluation was used to assess intervention effectiveness for adults with obesity and a diagnosis of hypertension and/or diabetes, between April 2021 and March 2022, using prospectively collected, national service–level data in England. Results Of the 63,937 referrals made from general practices, within the time period, 31,861 (50%) chose to take up the 12-week Programme. There were 31,718 participants who had time to finish the Programme; of those, 14,268 completed the Programme (defined as attending ≥60%), a 45% completion rate. The mean weight change for those who had time to finish the Programme was −2.2 kg (95% CI: −2.25 to −2.16), for those who completed it was −3.9 kg (95% CI: −3.99 to −3.84), and for those who had time to finish the Programme but did not complete it was −0.74 kg (95% CI: −0.79 to −0.70). Conclusions The NHS Digital Weight Management Programme is effective at achieving clinically meaningful weight loss. The outcomes compare favorably to web-based weight management interventions tested in randomized trials and those delivered as face-to-face interventions, and results suggest that the approach may, with increased participation, bring population-level benefits

Genetic study of the Arctic <i>CPT1A</i> variant suggests that its effect on fatty acid levels is modulated by traditional Inuit diet

Several recent studies have found signs of recent selection on the carnitine palmitoyl-transferase 1A (CPT1A) gene in the ancestors of Arctic populations likely as a result of their traditional diet. CPT1A is involved in fatty acid transportation and is known to affect circulating fatty acid profiles in Inuit as does the unique traditional diet rich in marine animals. We aimed to assess which fatty acids may have driven the selection of rs80356779, a c.1436C>T (p.(Pro479Leu)) variant in CPT1A, by analyzing a potential interaction between the variant and traditional Inuit diet. We included 3005 genome-wide genotyped individuals living in Greenland, who had blood cell membrane fatty acid levels measured. Consumption of 25 traditional food items was expressed as percentage of total energy intake. We tested for CPT1A × traditional diet interaction while taking relatedness and admixture into account. Increasing intakes of traditional diet was estimated to attenuate the effect of 479L on 20:3 omega-6 levels (p = 0.000399), but increase the effect of the variant on 22:5 omega-3 levels (p = 0.000963). The 479L effect on 22:5 omega-3 more than doubled in individuals with a high intake of traditional diet (90% percentile) compared with individuals with a low intake (10% percentile). Similar results were found when assessing interactions with marine foods. Our results suggest that the association between traditional diet and blood cell fatty acid composition is affected by the CPT1A genotype, or other variants in linkage disequilibrium, and support the hypothesis that omega-3 fatty acids may have been important for adaptation to the Arctic diet

Epidemiology of diabetes

This is the author accepted manuscript. The final version is available from Elsevier via http://dx.doi.org/10.1016/j.mpmed.2014.09.007The disease burden related to diabetes is high and rising in every country, fuelled by the global rise in the prevalence of obesity and unhealthy lifestyles. The latest estimates show a global prevalence of 382 million people with diabetes in 2013, expected to rise to 592 million by 2035. The aetiological classification of diabetes has now been widely accepted. Type 1 and type 2 diabetes are the two main types, with type 2 diabetes accounting for the majority (>85%) of total diabetes prevalence. Both forms of diabetes can lead to multisystem complications of microvascular endpoints, including retinopathy, nephropathy and neuropathy, and macrovascular endpoints including ischaemic heart disease, stroke and peripheral vascular disease. The premature morbidity, mortality, reduced life expectancy and financial and other costs of diabetes make it an important public health condition.NGF and NJW acknowledge support from the core Medical Research Council Epidemiology Unit Programmes ( MC_UU_12015/5 and MC_UU_12015/1 )

Early outcomes of referrals to the English National Health Service Digital Weight Management Programme

Publication status: PublishedAbstractObjectiveThe study objective was to assess participant weight change for the English National Health Service (NHS) Digital Weight Management Programme, the first such digital intervention to achieve population coverage.MethodsA service evaluation was used to assess intervention effectiveness for adults with obesity and a diagnosis of hypertension and/or diabetes, between April 2021 and March 2022, using prospectively collected, national service–level data in England.ResultsOf the 63,937 referrals made from general practices, within the time period, 31,861 (50%) chose to take up the 12‐week Programme. There were 31,718 participants who had time to finish the Programme; of those, 14,268 completed the Programme (defined as attending ≥60%), a 45% completion rate. The mean weight change for those who had time to finish the Programme was −2.2 kg (95% CI: −2.25 to −2.16), for those who completed it was −3.9 kg (95% CI: −3.99 to −3.84), and for those who had time to finish the Programme but did not complete it was −0.74 kg (95% CI: −0.79 to −0.70).ConclusionsThe NHS Digital Weight Management Programme is effective at achieving clinically meaningful weight loss. The outcomes compare favorably to web‐based weight management interventions tested in randomized trials and those delivered as face‐to‐face interventions, and results suggest that the approach may, with increased participation, bring population‐level benefits.</jats:sec