The State of Evaluation Research on Food Policies to Reduce Obesity and Diabetes Among Adults in the United States, 2000–2011

Introduction Improvements in diet can prevent obesity and type 2 diabetes. Although policy changes provide a foundation for improvement at the population level, evidence for the effectiveness of such changes is slim. This study summarizes the literature on recent efforts in the United States to change food-related policies to prevent obesity and diabetes among adults. Methods We conducted a systematic review of evidence of the impact of food policies. Websites of government, academic, and nonprofit organizations were scanned to generate a typology of food-related policies, which we classified into 18 categories. A key-word search and a search of policy reports identified empirical evaluation studies of these categories. Analyses were limited to strategies with 10 or more reports. Of 422 articles identified, 94 met these criteria. Using publication date, study design, study quality, and dietary outcomes assessed, we evaluated the strength of evidence for each strategy in 3 assessment categories: time period, quality, and study design. Results Five strategies yielded 10 or more reports. Only 2 of the 5 strategies, menu labeling and taxes on unhealthy foods, had 50% or more studies with positive findings in at least 2 of 3 assessment categories. Most studies used methods that were rated medium quality. Although the number of published studies increased over 11 years, study quality did not show any clear trend nor did it vary by strategy. Conclusion Researchers and policy makers can improve the quality and rigor of policy evaluations to synthesize existing evidence and develop better methods for gleaning policy guidance from the ample but imperfect data available

Expansion of Electronic Health Record-Based Screening, Prevention, and Management of Diabetes in New York City

To address the increasing burden of diabetes in New York City, we designed 2 electronic health records (EHRs)-facilitated diabetes management systems to be implemented in 6 primary care practices on the West Side of Manhattan, a standard system and an enhanced system. The standard system includes screening for diabetes. The enhanced system includes screening and ensures close patient follow-up; it applies principles of the chronic care model, including community–clinic linkages, to the management of patients newly diagnosed with diabetes and prediabetes through screening. We will stagger implementation of the enhanced system across the 6 clinics allowing comparison, through a quasi-experimental design (pre–post difference with a control group), of patients treated in the enhanced system with similar patients treated in the standard system. The findings could inform health system practices at multiple levels and influence the integration of community resources into routine diabetes care

Effect of angiotensin receptor blockade on insulin sensitivity and endothelial function in abdominally obese hypertensive patients with impaired fasting glucose

AngII (angiotensin II) may contribute to cardiovascular risk in obesity via adverse effects on insulin sensitivity and endothelial function. In the present study, we examined the effects of ARB (angiotensin receptor blocker) therapy (losartan, 100 mg/day) on insulin sensitivity and endothelial function in 53 subjects with stage I hypertension, abdominal obesity and impaired fasting glucose. The study design was a randomized double-blinded parallel design placebo-controlled multi-centre trial of 8 weeks duration. We used the hyperinsulinaemic-euglycaemic clamp technique to measure insulin sensitivity (expressed as the 'M/I' value) and RH-PAT (reactive hyperaemia-peripheral arterial tonometry) to measure endothelial function. Additional measures included HOMA (homoeostasis model assessment)-B, an index of pancreatic β-cell function, and markers of inflammation [e.g. CRP (C-reactive protein)] and oxidative stress (e.g. F2-isoprostanes). ARB therapy did not alter insulin sensitivity [5.2 (2.7) pre-treatment and 4.6 (1.6) post-treatment] compared with placebo therapy [6.1 (2.9) pre-treatment and 5.3 (2.7) post-treatment; P value not significant], but did improve the HOMA-B compared with placebo therapy (P=0.05). ARB therapy also did not change endothelial function [RH-PAT, 2.15 (0.7) pre-treatment and 2.11 (0.7) post-treatment] compared with placebo therapy [RH-PAT, 1.81 (0.5) pre-treatment and 1.76 (0.7) post-treatment; P value not significant]. Markers of inflammation and oxidative stress were not significantly changed by ARB therapy. In conclusion, ARB therapy did not alter peripheral insulin sensitivity or endothelial function in this cohort of patients with essential hypertension, abdominal obesity and impaired fasting glucose, but did improve pancreatic β-cell function

Metabolic changes following a 1-year diet and exercise intervention in patients with type 2 diabetes

WSTĘP. Celem pracy było określenie związku między długotrwałą poprawą wskaźników obwodowej wrażliwości na insulinę [wskaźnik zużycia glukozy (GDR, glucose disposal rate)], stężenia glukozy na czczo i wolnych kwasów tłuszczowych (FFA, free fatty acids) a towarzyszącymi zmianami wagi, masy i dystrybucji tkanki tłuszczowej w wyniku wprowadzenia modyfikacji stylu życia u otyłych chorych na cukrzycę typu 2. MATERIAŁ I METODY. Zmierzono GDR, stężenie glukozy na czczo i FFA metodą klamry normoglikemicznej, a także masę i dystrybucję tkanki tłuszczowej, tłuszcz narządowy, rozmiar adipocytów za pomocą absorpcjometrii podwójnej energii promieniowania rentgenowskiego, tomografii komputerowej i biopsji tkanki tłuszczowej u 26 mężczyzn i 32 kobiet w próbie Look-AHEAD przed stosowaniem rocznej diety i ćwiczeń fizycznych, ukierunkowanych na utratę masy ciała, oraz po ich stosowaniu. WYNIKI. Masa ciała i stężenie glukozy na czczo znacznie się zmniejszyły (p < 0,0001), bardziej znamiennie u mężczyzn niż u kobiet (odpowiednio: -12% do -8% i -16% do -7%; p < 0,05), podczas gdy FFA zredukowano w czasie hiperinsulinemii, a GDR znamiennie wzrósł (p < 0,00001) u osób obojga płci (odpowiednio: -53% do -41% i 63% do 43%; p = NS). U mężczyzn stwierdzono korzystniejszą zmianę rozkładu tkanki tłuszczowej poprzez redukcję w większym stopniu górnych niż dolnych i głębszych niż płytszych magazynów tkanki tłuszczowej (p < 0,01). Spadki masy ciała i masy tkanki tłuszczowej poprzedzały poprawę GDR, ale nie stężenia glukozy na czczo lub FFA na czczo; jednak zmniejszenie FFA podczas hiperinsulinemii znacząco wpłynęło na polepszenie GDR. Tłuszcz wątrobowy był jedyną lokalizacją narządową, której zmiana wpływała niezależnie na zmianę wskaźników metabolicznych. WNIOSKI. U chorych na cukrzycę typu 2 poddanych rocznej zmianie stylu życia stwierdzono znaczącą poprawę GDR, stężenia glukozy na czczo, FFA i dystrybucji tkanki tłuszczowej. Natomiast najważniejszymi determinantami poprawy metabolizmu były ogólne zmiany masy ciała (masy tkanki tłuszczowej) i tłuszczu wątrobowego. (Diabet. Prakt. 2011; 11, 4: 142-152)OBJECTIVE. To characterize the relationships among long-term improvements in peripheral insulin sensitivity (glucose disposal rate, GDR), fasting glucose, and free fatty acids (FFA) and concomitant changes in weight and adipose tissue mass and distribution induced by lifestyle intervention in obese individuals with type 2 diabetes. RESEARCH DESIGN AND METHODS. We measured GDR, fasting glucose, and FFAs during a euglycemic clamp and adipose tissue mass and distribution, organ fat, and adipocyte size by dual-energy X-ray absorptiometry, CT scan, and adipose tissue biopsy in 26 men and 32 women in the Look-AHEAD trial before and after 1 year of diet and exercise aimed at weight loss. RESULTS. Weight and fasting glucose decreased significantly (p < 0.0001) and significantly more in men than in women (-12 vs. -8% and -16 vs. -7%, respectively; p < 0.05), while FFAs during hyperinsulinemia decreased and GDR increased significantly (p < 0.00001) and similarly in both sexes (-53 vs. -41% and 63 vs. 43%; p = NS). Men achieved a more favorable fat distribution by losing more from upper compared with lower and from deeper compared with superficial adipose tissue depots (p < 0.01). Decreases in weight and adipose tissue mass predicted improvements in GDR but not in fasting glucose or fasting FFAs; however, decreases in FFAs during hyperinsulinemia significantly determined GDR improvements. Hepatic fat was the only regional fat measure whose change contributed independently to changes in metabolic variables. CONCLUSIONS. Patients with type 2 diabetes undergoing a 1-year lifestyle intervention had significant improvements in GDR, fasting glucose, FFAs and adipose tissue distribution. However, changes in overall weight (adipose tissue mass) and hepatic fat were the most important determinants of metabolic improvements. (Diabet. Prakt. 2011; 11, 4: 142-152

Recombinant Human Growth Hormone and Rosiglitazone for Abdominal Fat Accumulation in HIV- Infected Patients with Insulin Resistance: A Randomized, Double-Blind, Placebo-Controlled, Factorial Trial

Background: Recombinant human growth hormone (rhGH) reduces visceral adipose tissue (VAT) volume in HIV-infected patients but can worsen glucose homeostasis and lipoatrophy. We aimed to determine if adding rosiglitazone to rhGH would abrogate the adverse effects of rhGH on insulin sensitivity (SI) and subcutaneous adipose tissue (SAT) volume. Methodology/Principal Findings: Randomized, double-blind, placebo-controlled, multicenter trial using a 262 factorial design in which HIV-infected subjects with abdominal obesity and insulin resistance were randomized to rhGH 3 mg daily, rosiglitazone 4 mg twice daily, combination rhGH + rosiglitazone, or double placebo (control) for 12 weeks. The primary endpoint was change in SI by frequently sampled intravenous glucose tolerance test from entry to week 12. Body composition was assessed by whole body magnetic resonance imaging (MRI) and dual Xray absorptiometry (DEXA). Seventy-seven subjects were randomized of whom 72 initiated study drugs. Change in SI from entry to week 12 differed across the 4 arms by 1-way ANCOVA (P = 0.02); by pair-wise comparisons, only rhGH (decreasing SI; P = 0.03) differed significantly from control. Changes from entry to week 12 in fasting glucose and glucose area under the curve on 2- hour oral glucose tolerance test differed across arms (1-way ANCOVA P = 0.004), increasing in the rhGH arm relative to control. VAT decreased significantly in the rhGH arms (217.5% in rhGH/rosiglitazone and 222.7% in rhGH) but not in the rosiglitazone alone (22.5%) or control arms (21.9%). SAT did not change significantly in any arm. DEXA results were consistent with the MRI data. There was no significant rhGH x rosiglitazone interaction for any body composition parameter. Conclusions/Significance: The addition of rosiglitazone abrogated the adverse effects of rhGH on insulin sensitivity and glucose tolerance while not significantly modifying the lowering effect of rhGH on VAT

Dual Paraneoplastic Endocrine Syndromes Heralding Onset of Extrapulmonary Small Cell Carcinoma: A Case Report and Narrative Review

ObjectiveExtrapulmonary small cell carcinoma (EPSCC) is rare and frequent metastases at presentation can complicate efforts to identify a site of origin. In particular, SCC comprises &lt;1% of prostate cancers and has been implicated in castration resistance.MethodsClinical, laboratory, imaging, and pathology data are presented.ResultsA 56-year-old man with locally advanced prostate adenocarcinoma on androgen deprivation therapy presented with a clogged nephrostomy tube. Laboratory results included calcium 13.8 mg/dL (8.5–10.5 mg/dL), albumin 3.6 g/dL (3.5–5 mg/dL), and potassium 2.8 mmol/L (3.5–5.2 mmol/L). Hypercalcemia investigation revealed intact PTH 19 pg/mL (16–87 pg/mL), 25-OH vitamin D 15.7 ng/mL (&gt;30 ng/mL), and PTH-related peptide (PTHrP) 63.4 pmol/L (&lt;2.3 pmol/L). Workup for hypokalemia yielded aldosterone 5.3 ng/dL (&lt;31 ng/dL), renin 0.6 ng/mL/h (0.5–4 ng/mL/h), and 6:00 a.m. cortisol 82 µg/dL (6.7–22.6 µg/dL) with ACTH 147 pg/mL (no ref. range). High-dose Dexamethasone suppression testing suggested ACTH-dependent ectopic hypercortisolism. Contrast-enhanced CT findings included masses in the liver and right renal pelvis, a heterogeneous enlarged mass in the region of the prostate invading the bladder, bilateral adrenal thickening, and lytic lesions in the pelvis and spine. Liver biopsy identified epithelioid malignancy with Ki proliferation index 98% and immunohistochemical staining positive for synaptophysin and neuron-specific enolase, compatible with high-grade small cell carcinoma. Staining for ACTH was negative; no stain for CRH was available. Two weeks after chemotherapy, 6:00 a.m. cortisol normalized and CT scans showed universal improvement.ConclusionExtensive literature details paraneoplastic syndromes associated with SCC, but we report the first case of EPSCC diagnosed due to onset of dual paraneoplastic syndromes

No Influence of Overweight/Obesity on Exercise Lipid Oxidation: A Systematic Review

Compared to lean counterparts, overweight/obese individuals rely less on lipid during fasting. This deficiency has been implicated in the association between overweight/obesity and blunted insulin signaling via elevated intramuscular triglycerides. However, the capacity for overweight/obese individuals to use lipid during exercise is unclear. This review was conducted to formulate a consensus regarding the influence of overweight/obesity on exercise lipid use. PubMed, ProQuest, ISI Web of Science, and Cochrane Library databases were searched. Articles were included if they presented original research on the influence of overweight/obesity on exercise fuel use in generally healthy sedentary adults. Articles were excluded if they assessed older adults, individuals with chronic disease, and/or exercise limitations or physically-active individuals. The search identified 1205 articles with 729 considered for inclusion after duplicate removal. Once titles, abstracts, and/or manuscripts were assessed, 24 articles were included. The preponderance of evidence from these articles indicates that overweight/obese individuals rely on lipid to a similar extent during exercise. However, conflicting findings were found in eight articles due to the outcome measure cited, participant characteristics other than overweight/obesity and characteristics of the exercise bout(s). We also identified factors other than body fatness which can influence exercise lipid oxidation that should be controlled in future research

Severe-intensity constant-work-rate cycling indicates that ramp incremental cycling underestimates ⩒o2max in a heterogeneous cohort of sedentary individuals.

In the absence of a ⩒o2-work-rate plateau, debate continues regarding the best way to verify that the peak ⩒o2 achieved during incremental exercise (⩒o2peak) is the "true ⩒o2max." Oft-used "secondary criteria" have been questioned in conjunction with the contention that a severe-intensity constant-work-rate "verification bout" should be considered the "gold standard." The purpose of this study was to compare the ⩒o2peak during ramp incremental cycling (RAMP-INC) by a heterogeneous (with respect to body composition and sex) cohort of sedentary individuals with the ⩒o2peak during severe-intensity constant-work-rate cycling (CWR) performed after RAMP-INC at the highest work rate achieved. A secondary purpose was to determine the degree to which traditional and newly-proposed age-dependent secondary criteria (RER, HR) identified RAMP-INC which CWR confirmed were characterized by a submaximal ⩒o2peak. Thirty-five healthy male (n = 19: 33.4 ± 6.3 yrs) and female (26.8 ± 3.6 yrs) sedentary participants performed RAMP-INC followed by CWR. The ⩒o2peak values from the two tests were correlated (r = 0.96; p < 0.01; mean CV = 24%); however, ⩒o2peak for CWR was significantly greater (29.6 ± 7.2 v. 28.6 ± 6.8 mL∙min-1∙kg-1; p < 0.01) with a mean bias of 0.98 mL∙min-1∙kg-1 (z = -2.9, p < 0.01). Both traditional and newly-proposed criterion values for RER were achieved during RAMP-INC by 33 of 35 participants (including 21 of 23 who registered a higher ⩒o2peak on CWR). The traditional HR criterion value was achieved on only seven tests (three of which were confirmed to be characterized by a submaximal ⩒o2peak) while use of less stringent newly-proposed criteria resulted in acceptance of an additional seven tests of which five were confirmed to be submaximal. Severe-intensity CWR to limit of tolerance indicates that RAMP-INC underestimates ⩒o2max in sedentary individuals and both traditional and newly-proposed secondary criteria are ineffective for identifying such tests