Treatment of Diabetes with Lifestyle Changes: Diet

The present chapter critically reviews scientific evidence on the impact of the diet and its components on the metabolic control, cardiovascular risk factors, and morbidity/mortality in diabetic patients. Three main topics are included in this chapter: (1) the effects of dietary treatment on body weight control in diabetic patients; (2) the optimal dietary composition in order to achieve blood glucose control and reduce other cardiovascular risk factors associated with type 2 diabetes; (3) the effects of lifestyle modifications and dietary changes on the risk to develop type 2 diabetes. The overall body of evidence seems to confirm the efficacy of current recommendations for diabetes management. However, although dietary strategies based on structured interventions are often successful, particularly in relation to body weight control, they are not easily applicable in clinical practice and, therefore, more feasible strategies should be identified. In addition, further intervention studies focused on the effects of lifestyle on hard endpoints in diabetic subjects are needed to definitively prove the role of diet in the prevention of both cardiovascular and microvascular complications in these patients over and above their impact on weight reduction

Body mass index and age at natural menopause: an international pooled analysis of 11 prospective studies

Current evidence on the association between body mass index (BMI) and age at menopause remains unclear. We investigated the relationship between BMI and age at menopause using data from 11 prospective studies. A total of 24,196 women who experienced menopause after recruitment was included. Baseline BMI was categorised according to the WHO criteria. Age at menopause, confirmed by natural cessation of menses for ≥ 12 months, was categorised as < 45 years (early menopause), 45–49, 50–51 (reference category), 52–53, 54–55, and ≥ 56 years (late age at menopause). We used multinomial logistic regression models to estimate multivariable relative risk ratios (RRRs) and 95% confidence intervals (CI) for the associations between BMI and age at menopause. The mean (standard deviation) age at menopause was 51.4 (3.3) years, with 2.5% of the women having early and 8.1% late menopause. Compared with those with normal BMI (18.5–24.9 kg/m2), underweight women were at a higher risk of early menopause (RRR 2.15, 95% CI 1.50–3.06), while overweight (1.52, 1.31–1.77) and obese women (1.54, 1.18–2.01) were at increased risk of late menopause. Overweight and obesity were also significantly associated with around 20% increased risk of menopause at ages 52–53 and 54–55 years. We observed no association between underweight and late menopause. The risk of early menopause was higher among obese women albeit not significant (1.23, 0.89–1.71). Underweight women had over twice the risk of experiencing early menopause, while overweight and obese women had over 50% higher risk of experiencing late menopause

A wake-up call for preconception health: a clinical review

Preparing for a healthy pregnancy, preconception care, should be the norm and a more actively managed step in primary care. Decades of improvement in the quality of maternity care have greatly reduced the risks associated with pregnancy and childbirth, but improvements in preconception care have lagged behind. The health of women as they enter pregnancy remains a major challenge to maternity services, and two-thirds of maternal deaths in the UK are now in women with pre-existing medical conditions.1 Animal and human research show clear links between preconception influences and offspring health extending across two or more generations.2 In the UK and most other countries, preconception health is frequently compromised by maternal and paternal obesity, dietary deficiencies, smoking, excessive alcohol consumption, mental health issues, and recreational drug use, all of which are associated with poorer pregnancy outcomes and frequently rooted in social and economic deprivation. The rise in obesity among women of reproductive age has been the most pressing ‘wake-up call’ to improve preconception health. Obesity (body mass index [BMI] ≥30 kg/m2), which affects over one in five (21.6%) pregnant women in the UK,3 is strongly linked to almost all adverse pregnancy and birth outcomes, notably pre-eclampsia, gestational diabetes, and stillbirth, and has lasting consequences for the health of the offspring.4 Unfortunately, attempts to tackle the problem through diet and physical activity interventions starting in pregnancy have had negligible effect on immediate and later outcomes.5,6 Together, these findings call for a new focus on improving health before conception