The document discusses evidence from studies on the effect of lifestyle modifications such as caloric restriction, physical activity, and weight loss on health outcomes. It summarizes key findings from several studies:
1) The Diabetes Prevention Program clinical trial found that intensive lifestyle intervention reduced the risk of developing type 2 diabetes by 58% compared to 31% for treatment with metformin.
2) Studies on caloric restriction in primates showed decreased fasting glucose and insulin levels as well as reduced risk of age-related diseases like diabetes and cardiovascular disease.
3) Physical activity has been shown to increase lifespan in animal models, and a study of over 1300 male rats found a 10% reduction in body weight led to a 13.5
Understanding the problems of having Lifestyle Disorders / Diseases and how to prevent these deadly Diseases. These are simple slides for creating awareness for Common men / Women
Understanding the problems of having Lifestyle Disorders / Diseases and how to prevent these deadly Diseases. These are simple slides for creating awareness for Common men / Women
Intermittent Fasting is the new kid on the block in terms of weight loss. But is it just a fad or are the proclaimed benefits backed by science?
http://blackbeltwhitehat.com/mma/nutrition/intermittent-fasting-diet-plan/
Medical Nutrition Therapy for Cardiovascular Diseases, Krause Book 14th editionBatoul Ghosn
Prepared from the chapter of MNT of CVD from Krause's book 14 the edition 2017 as well as some part from " Modern Nutrition in health and disease" 11th edition.
Exercise is any bodily activity that enhances or maintain physical fitness and overall health, Exercise with its Countless Benefits is the logical salvage for a group of diseases related to inactivity . In view of the prevalence, global reach and health effect of these physical inactivity related diseases, the issue should be appropriately described as pandemic, with far-reaching health, economic, social and Environmental consequences.These diseases include, Obesity, Coronary artery disease, Diabetes, Hypertension, Cancer, Depression and anxiety, Arthritis, Osteoporosis, Etc, etc, etc… I think we have no option except doing regular exercises if we seriously searching for a salvage to escape the bad and serious consequences of these new life style diseases.
http://www.our-diabetic-life.com Intake of large amount of carbohydrates can spike your blood glucose level. Right amount of carbohydrate can make your glucose level under control.
Are you Struggling to Control of your Diabetes and Weight?
People who are overweight or obese are more prone to developing Type 2 diabetes. Those who have Type 1 and Type 2 diabetes with weight problems struggle to control their blood sugar levels. Research shows that people with diabetes find it more difficult to lose weight than those without diabetes.
Weight loss significantly improves blood sugar control and also reduces the risk of getting complications from diabetes. However, whilst attempting to lose weight, people with diabetes find it hard to restrict their intake of food since eating less may trigger hypoglycaemia (low blood sugar). All these facts explain the need for specialist input in management of weight in people with diabetes.
This Slideshow gives you insight to Diabesity
For more information please visit
http://www.simplyweight.co.uk
Articles
http://www.simplyweight.co.uk/articles/
Videos
http://www.simplyweight.co.uk/video/
Blogs
http://simplyweight.co.uk/blogs/
Forum
http://www.simplyweight.co.uk/forum/forum.php
Contact Us
http://www.simplyweight.co.uk/how-to-contact-us/
By Juliana C N Chan, MBChB, MD, FRCP Professor of Medicine & Therapeutics, Director, Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong, China
The Best Dietetic Principles To Life Extensionswissestetix
Das ist ein Vortrag, den Dr. Clarence P. Davis im Jahre 2007 im Rahmen eines Anti-Aging Kongresses in Paris gehalten hat.
Er beinhaltet theoretisches Basis- und Hintergrundswissen zu den verschiedenen Diaettypen, sowie einige praktische Beispiele aus dem aerztlichen Alltag.
Der Vortrag ist auf Englisch und einem hohen Niveau. Er richtet sich ausschliesslich an professionelle Leser mit fundierten Vorkenntnissen.
Overview of the Health Benefits of Vitamin C by Prof Margreet VissersKiwifruit Symposium
Prof Margreet Vissers, Research Professor at University of Otago, New Zealand: http://www.kiwifruitsymposium.org/presentations/overview-of-the-many-health-benefits-of-vitamin-c/
Presented at 1st International Symposium on Kiwifruit and Health.
Vitamin C is essential for life, and humans obtain this nutrient exclusively through the diet. It functions inside the cells in our bodies, where it plays an important role in supporting many essential processes. One kiwifruit a day gives the daily requirement of vitamin C.
Intermittent Fasting is the new kid on the block in terms of weight loss. But is it just a fad or are the proclaimed benefits backed by science?
http://blackbeltwhitehat.com/mma/nutrition/intermittent-fasting-diet-plan/
Medical Nutrition Therapy for Cardiovascular Diseases, Krause Book 14th editionBatoul Ghosn
Prepared from the chapter of MNT of CVD from Krause's book 14 the edition 2017 as well as some part from " Modern Nutrition in health and disease" 11th edition.
Exercise is any bodily activity that enhances or maintain physical fitness and overall health, Exercise with its Countless Benefits is the logical salvage for a group of diseases related to inactivity . In view of the prevalence, global reach and health effect of these physical inactivity related diseases, the issue should be appropriately described as pandemic, with far-reaching health, economic, social and Environmental consequences.These diseases include, Obesity, Coronary artery disease, Diabetes, Hypertension, Cancer, Depression and anxiety, Arthritis, Osteoporosis, Etc, etc, etc… I think we have no option except doing regular exercises if we seriously searching for a salvage to escape the bad and serious consequences of these new life style diseases.
http://www.our-diabetic-life.com Intake of large amount of carbohydrates can spike your blood glucose level. Right amount of carbohydrate can make your glucose level under control.
Are you Struggling to Control of your Diabetes and Weight?
People who are overweight or obese are more prone to developing Type 2 diabetes. Those who have Type 1 and Type 2 diabetes with weight problems struggle to control their blood sugar levels. Research shows that people with diabetes find it more difficult to lose weight than those without diabetes.
Weight loss significantly improves blood sugar control and also reduces the risk of getting complications from diabetes. However, whilst attempting to lose weight, people with diabetes find it hard to restrict their intake of food since eating less may trigger hypoglycaemia (low blood sugar). All these facts explain the need for specialist input in management of weight in people with diabetes.
This Slideshow gives you insight to Diabesity
For more information please visit
http://www.simplyweight.co.uk
Articles
http://www.simplyweight.co.uk/articles/
Videos
http://www.simplyweight.co.uk/video/
Blogs
http://simplyweight.co.uk/blogs/
Forum
http://www.simplyweight.co.uk/forum/forum.php
Contact Us
http://www.simplyweight.co.uk/how-to-contact-us/
By Juliana C N Chan, MBChB, MD, FRCP Professor of Medicine & Therapeutics, Director, Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong, China
The Best Dietetic Principles To Life Extensionswissestetix
Das ist ein Vortrag, den Dr. Clarence P. Davis im Jahre 2007 im Rahmen eines Anti-Aging Kongresses in Paris gehalten hat.
Er beinhaltet theoretisches Basis- und Hintergrundswissen zu den verschiedenen Diaettypen, sowie einige praktische Beispiele aus dem aerztlichen Alltag.
Der Vortrag ist auf Englisch und einem hohen Niveau. Er richtet sich ausschliesslich an professionelle Leser mit fundierten Vorkenntnissen.
Overview of the Health Benefits of Vitamin C by Prof Margreet VissersKiwifruit Symposium
Prof Margreet Vissers, Research Professor at University of Otago, New Zealand: http://www.kiwifruitsymposium.org/presentations/overview-of-the-many-health-benefits-of-vitamin-c/
Presented at 1st International Symposium on Kiwifruit and Health.
Vitamin C is essential for life, and humans obtain this nutrient exclusively through the diet. It functions inside the cells in our bodies, where it plays an important role in supporting many essential processes. One kiwifruit a day gives the daily requirement of vitamin C.
'Lo último en obesidad'. Este es el título del Simposio Internacional que organizamos en la Fundación Ramón Areces los días 1 y 2 de diciembre de 2015. En colaboración con la Fundación General CSIC, reunió a algunos de los mayores expertos en la materia para analizar cómo reducir este grave problema de salud pública.
Cancer is not all about what we inherit-- it's also about what we eat, how much we move and even how we stay connected. This is good news! This talk reviews the evidence for how we can reduce our risk of cancer through simple lifestyle changes.
What happens as athletes age? The physiological changes are important to note, so that training, recovery and overal healthcare can adapt to maximize the athlete's performance year after year. Dr. David Carfagno offers a unique insider's perspective, as a practitioner of sports medicine, internal medicine and a competitive athlete.
Dietary Lifestyle, Way of Life Practices and Corpulence: Towards Present Day Science by Alok Raghav, Aditi, Sneha Gupta, Pratibha Singh, Aman Nikhil, Saba Noor and Jamal Ahmad in Examines in Physical Medicine & Rehabilitation
THERAPEUTIC EFFECT OF SOYA BEAN CHUNKS SUPPLEMENTION DURING HEMODIALYSISNeeleshkumar Maurya
The present study was conducted during the year 2016-17 on 30 ckd-5 patients on hemodialysis admitted in various medical wards of the MLB, Medical College, Jhansi (U.P.) India. The primary data were obtained from all CKD patients 30 days intervals and three times first time proper medication with hemodialysis therapy and second time same condition patients with additional dietary counseling. The data was collected in all the patients, thorough anthropometric measurement, dietary history and blood are collected for analysis of Hb, serum albumin, blood urea, cholesterol and cretonne. The Proper dietary counseling along with high biological protein (20 gm) given during hemodialysis superior the nutritional value of undernourished chronic kidney disease patient. About proper diet counseling of the patients showed significant statistical positive (<0.005) response in a various nutritional factor like BMI, MUAC, Serum Albumin, hemoglobin, total calorie intake while the only medication and dialysis therapy showed an undergoing undernourished in their nutritional value. The patients undergoing hemodialysis often develop protein-energy malnutrition which is related to mortality and morbidity rate increases. Special nutritional care is required for the dialysis patient to improve the net protein anabolism. The nutritional value of soya bean chunks in patients on HD requirements more attention providing one-to-one nutrition psychotherapy could be improvements in the patients. Key words : Dialysis, malnutrition, soybean chunks, high biological protein.
Future opportunities for food tech product innovation from a research perspec...MIT Startup Exchange
"Future opportunities for food tech product innovation from a research perspective," Omer Yilmaz, Ph.D., Assistant Professor of Biology, MIT and gastrointestinal pathologist, Massachusetts General Hospital and Harvard Medical School. Presented at MIT Startup Exchange (STEX) cluster workshop on Food Tech Innovation, 22 April 2015, MIT. Twitter" #STEXfood
Cereal fibre and hypertension: could it be the new salt?MichelleBroom
The results from my systematic review indicate emerging evidence that a 10g/d increased intake of soluble cereal fibre can reduce blood pressure in older (>50yrs) and hypertensive adults by between 5 and 7mmHg. This reduction is clinically comparable to the expected effects of a salt reduced diet.
Join Doc Andrew to see the research that supports plant based diet recommendations. Address common misconceptions. Ask questions @DenverWWAD or join current discussions at #PlantBased, #PlantBasedRx, or #CulinaryRx.
Also, enjoy bonus learning with these topic-related, 2-minute podcasts by Dr. Andrew:
"The Plant Based Diet and How to Get Started"
https://soundcloud.com/denverwwad/healthcast-23
"Eat Your Way to the Finish Line"
https://soundcloud.com/denverwwad/healthcast-4
Andrew Freeman, MD, FACC, FACP is a cardiologist and Assistant Professor of Medicine at National Jewish Health, Denver, Colorado. He is part of the leadership of both the local and national American College of Cardiology.
Dr. Freeman founded the Denver chapter of the Walk with a Doc program and is the leader of Walk with a Doc-Colorado.
Walk with a Doc-Denver is a free health improvement and community empowerment initiative. Local doctors and a team of healthcare professionals--all volunteers--host Saturday walks that include expert talks, health screenings, refreshments, and motivational giveaways. For more info visit: Denver.WalkWithADoc.org
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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1. Effect of lifestyle modification
: search for evidence
Nayanjeet Chaudhury, MD,MPH
Director M&E and Health Services Delivery
Population Services International, India
Certified Personal Trainer (ACSM)
Certified Aerobics Trainer (Reebok)
2. Aging, Disease & Free Radicals,
• Aging is the accumulation of diverse deleterious
changes in the cells and tissues with advancing
age that increase the risk of disease and death.
(Harman, D. (2001) Aging: Overview. Annals of New York Academy of Sciences , 928, 1-21. )
• Our expected lifespan at birth and/or the rate of
aging are influenced by
– Individual genetic backgrounds and/or
– environmental factors influence.
(Gerstenblith G. Cardiovascular Aging: What We Can Learn From Caloric Restriction⁎. J Am Coll
Cardiol. 2006;47(2):403-404)
3. Ageing and lifespan
The inherent aging process limits
• Average life expectancy at birth to about 85 years
• and the Maximum life span to around 122 years.
Harman 2001
Improved nutrition
Economic and social uplift
Better living conditions
Improved sanitation
Housing
Environmental protection
Conventional methods of increasing life span
Although in developing countries, these are primary concerns, they
are progressively unsuccessful in prolonging life in developed countries
beyond a certain age limit.
4. Who’s the culprit?
• A possible determinant
– Overproducation of the Free Oxygen Radicals
or Reactive Oxygen Species)
• An important mediator of cell damage and
consequently many disease states :
– Cancer & Diabetes (mitochondrial Oxidative stress)
– Atherosclerosis and chronic inflammation
(inflammatory oxidative conditions )
– Ischemia (xanthine oxidase-induced damage)
Valko et al. Free radicals and antioxidants in normal physiological functions and human
disease. Int J Biochem Cell Biol. 2007;39(1):44-84. Epub 2006 Aug 4.
5. Caloric Restriction
• CR can greatly increase the longevity of
rodents and invertebrate model systems
(Frankel S and Rogina B (2006) Sir2, caloric restriction and aging.Pathol Biol (Paris) 54(2):55-7)
• precise biological mechanisms and
applicability to humans remain unknown.
[Roth, G. S., Ingram, D. K. and Lane, M. A.(2001) Caloric Restriction in Primates and Relevance
to Humans.Annals of the New York Academy of Sciences 928:305-315 (2001).]
6. Rodent studies
• Purified diet with 22% casein
was offered to rats from the
21st day of life in ad libitum or
in restricted amounts.
• These regimens were either
maintained throughout life or
changed at 70, 300, or 365
days of age.
21 days old rats
Restricted diet
from 21 to 70 days
Followed by
Ad libitum feed
Ad libitum
feed
Normal lifespan
Increased lifespan
400 + days
•Dietary experiences early in life influence Length of life in rats
Ross, M. H.( August, 1972).Length of life and caloric intake. The American Journal of Clinical Nutrition 25, 834-838
7. Primate studies on caloric
restriction and aging
• Conclusive evidence yet to come
• Results similar to rodent studies
• Promising outcomes shown in age related
diseases e.g.Diabetes, CVD, osteoporosis
• Monkeys on CR show
– Decreased Fasting glucose and insulin
– Increased insulin sensitivity
– Change in body fat to favor less risk for CVD
Lane, M.A., Black, A., Handy, A., Tilmont, E. M., Ingram, D.K., Roth, G.S.( 2001, April). Caloric
Restriction in Primates. Annals of the New York Academy of Sciences 928(1), 287-295.
8. Early life, CR and diseases
• Diseases that have origins in events of early life:
– Atherosclerosis, coronary heart disease, hypertension,
breast and prostate cancer, Alzheimer disease, Parkinson
disease, essential hypertension, cataracts, amyloidosis,
diabetes mellitus, and amyotrophic lateral sclerosis
(Many of these are diseases of adulthood that shorten life).
(Harman, D. (2001) Aging: Overview. Annals of New York Academy of Sciences , 928, 1-21. )
• CR primates will be less likely to incur these age-
related diseases and may in fact be aging more
slowly than fully fed counterparts.
[Roth, G. S., Ingram, D. K. and Lane, M. A.(2001) Caloric Restriction in Primates and Relevance to
Humans.Annals of the New York Academy of Sciences 928:305-315 (2001).]
9. • Caloric Restriction(CR) and CR-like effects can
significantly reduce mortality in primates by
inducing a physiological state that protects
against age-related disease in various tissues,
including the liver, heart, and the brain.
Mattison JA, Roth GS, Beasley TM, Tilmont EM, Handy AM, et al. (2012) Impact of caloric restriction on
health and survival in rhesus monkeys from the NIA study. Nature 489: 318–321
10. Fructose controversy
Multivariate relative risk of incident gout in 46393 men from
health professionals follow-up study, according to fifths of free
fructose intake in subgroups. Reference group for comparisons
was men in lowest fifth of fructose intake and (top) with body
mass index <25 kg/m2, (middle) no alcohol use, and (bottom)
total daily dairy intake ≤1.6 servings. Relative risks were
adjusted for age, total energy intake, bodymass index, diuretic
use, history of hypertension, history of renal failure, intake of
alcohol, intake of total vitamin C,and percentage of energy from
total carbohydrate and protein
Choi and Curhan. Soft drinks, fructose
consumption, and the risk of gout in men:
prospective cohort study. BMJ. 2008; 336
Nayanjeet/Surat/16Dec2012
11. Intake of added sugars correlates closely with the
rise in obesity, metabolic syndrome, and diabetes
Johnson et al. ,Sugar, Uric Acid, and the Etiology of Diabetes and Obesity. Diabetes 62:3307–3315, 2013
13. Physical Activity and Health
• Like Caloric Restriction, regular physical
activity has been shown to increase
lifespan in animal models
J Gerontol (1983) 38 (1): 36-45. doi: 10.1093/geronj/38.1.36
Philadelphia interdisciplinary longevity study of more than
1300 male rats showed:
• For every 10% reduction of Body weight there was a
13.5% gain in life expectancy
• For every 10% gain in body weight there was a 13.5%
reduction in life expectancy
Ross, M. H.( August, 1972).Length of life and caloric intake. The American Journal of Clinical Nutrition 25, 834-838
14. Lifestyle modification – evidence for prevention
Variable Evidence for
Inverse
Dose-Response
Relationship
Category of
Evidence
All-cause mortality Yes C
Cardiovascular and coronary heart disease Yes C
Blood pressure and hypertension Noa B
Blood lipids and lipoproteins Insufficient
data
Coagulation and hemostatic factors Insufficient
data
Overweight, obesity, and fat
distribution
Yes C
Type 2 diabetes mellitus Yesb C
Colon cancer Yes C
Low back pain, osteoarthritis, and
osteoporosis
Insufficient data
Quality of life and independent living
in older persons
Yes C
Depression and anxiety Noa B
15. Lifestyle modification – evidence for prevention
Variable Evidence for
Inverse
Dose-Response
Relationship
Category of
Evidence
All-cause mortality Yes C
Cardiovascular and coronary heart disease Yes C
Blood pressure and hypertension Noa B
Blood lipids and lipoproteins Insufficient
data
Coagulation and hemostatic factors Insufficient
data
Overweight, obesity, and fat
distribution
Yes C
Type 2 diabetes mellitus Yesb C
Colon cancer Yes C
Low back pain, osteoarthritis, and
osteoporosis
Insufficient data
Quality of life and independent living
in older persons
Yes C
Depression and anxiety Noa B
Category A: Evidence is from endpoints of well-designed randomized clinical trials (RCTs)
Category B: Evidence is from endpoints of intervention studies that include only a limited number of RCTs,
post hoc or subgroup analysis of RCT, or meta-analysis of RCTs.
Category C: Evidence is from outcomes of uncontrolled or nonrandomized trials or observational studies.
Category D: Expert judgment is based on the panel's synthesis of evidence from experimental research
described in the literature and/or derived from the consensus of panel members based on clinical
experience or knowledge that does not meet the listed criteria.
a No indicates a lack of evidence for a “dose response” for the relationship between the health outcome
and physical activity; it does not indicate the absence of a favourable relationship.
b Inverse dose response for primary prevention, but not for improvement in blood glucose control among
diabetics
AmericanCollegeofSportsMedicine;
16. Fatty Acid
Complement
administered in the
body
Diacyl Glycerol and
Ceramide
Highly Bioactive and
Activates pro
inflammatory
pathway
Inhibits Insulin
signaling and
promotes fatty acid
mediated Insulin
Resistance
Intra Muscular
Tri Glyceride
(IMTG)
Innocuous Fatty
acid metabolite
Increases
Insulin
sensitivity
Recent Studies in Immunology and Bio-signaling
(Acute exercise increases triglyceride synthesis in skeletal muscle and prevents fatty acid–induced insulin resistance S. Schenk and
J.F. Horowitz; Acute exercise increases triglyceride synthesis in skeletal muscle and prevents fatty acid–induced insulin resistance;
The Journal of Clinical Investigation, Volume 117 Number 6 June 2007)
Sedentary group Exercise group
17. Fatty Acid
Complement
administered in the
body
Diacyl Glycerol and
Ceramide
Highly Bioactive and
Activates pro
inflammatory
pathway
Inhibits Insulin
signaling and
promotes fatty acid
mediated Insulin
Resistance
Intra Muscular
Tri Glyceride
(IMTG)
Innocuous Fatty
acid metabolite
Increases
Insulin
sensitivity
Recent Studies in Immunology and Bio-signaling
Acute exercise increases triglyceride synthesis in skeletal
muscle and prevents fatty acid–induced insulin resistance
(S. Schenk and J.F. Horowitz; 2007)
Sedentary
group
Exercise group
18. REDUCTION IN THE INCIDENCE
OF TYPE 2 DIABETES WITH
LIFESTYLE INTERVENTION OR
METFORMIN
The New England Journal of Medicine.
Volume 346, Number 6, 2002
pp 393-403
Evidence of lifestyle modification
19. Objectives
Does a lifestyle intervention or treatment
with Metformin, prevent or delay the onset
of Diabetes?
Do these two interventions differ in
effectiveness ?
Does their effectiveness differ according
to age, sex, race or ethnic group?
21. Exclusion Criteria
Taking medicines known to alter glucose
tolerance.
Had illness which could seriously reduce
life expectancy or their ability to
participate in the trial.
22. The Four Step Screening and
Recruitment Process ( Ref. 6)
23. Interventions
Random allocation of participants in three
groups :
SLR plus Metformin
SLR plus placebo
Intensive lifestyle modification program
24. Randomized Clinical Trial: 27 centers
Four Step Screening & Recruitment
Process
Eligible Participants
Random Allocation in three groups
Standard lifestyle
& Metformin
N=1073
Standard lifestyle
& Placebo
N=1082
Intensive
Program of
lifestyle modifin
N=1079
Diabetes Prevention Programme Study
25. Goals for the Intensive lifestyle
intervention
A weight reduction of 7 % of the initial
body weight.
To engage in physical activity of moderate
intensity for at least 150 mins. per week.
26. Session No. Activity
1 Getting started being active
2 Move your muscles
3 Being active – a way of life
4 Be a fat detective
5 Three ways to eat less fat
6 Healthy eating
7 Take charge of what’s around you
8 Tip the calorie balance
9 Problem solving
10 Four keys to healthy eating out
11 Talk back to negative thoughts
12 The slippery slop of lifestyle change
13 Jump start your activity plan
14 Make social cues work for you
15 You can manage stress
16 Ways to stay motivated
27. Outcome Measures
Diagnosis of Diabetes : FBS ≥ 126 mg%
or Post load test value of ≥ 200 mg%
The values were also confirmed within six
weeks by same tests, done second time.
The diagnosed participants would be
monitored with FBS.
28. Outcome Measures.. (contd.)
Levels of leisure physical activity were assessed
with Modifiable Activity Questionnaire.
The calculations were done by multiplying
duration with frequency as well as MET.
Daily calorie intakes from various sources were
also assessed.
29. MET
Physical Activity MET
Light Intensity Activities < 3
sleeping 0.9
watching television 1.0
sexual activity 1.3
writing, desk work, typing 1.8
walking, less than 2.0 mph (3.2 km/h), level ground, strolling, very slow 2.0
Moderate Intensity Activities 3 to 6
bicycling, stationary, 50 watts, very light effort 3.0
calisthenics, home exercise, light or moderate effort, general 3.5
bicycling, <10 mph (16 km/h), leisure, to work or for pleasure 4.0
bicycling, stationary, 100 watts, light effort 5.5
Vigorous Intensity Activities > 6
jogging 7.0
General calisthenics (e.g. pushups, situps, pullups,jumping jacks), heavy,
vigorous effort
8.0
Running, jogging in place 8.0
37. Discussion
The incidence of Diabetes was reduced by 58% and
31% in lifestyle intervention group & metformin
group, respectively.
The results were similar for all age, sex, race &
ethnic groups.
The incidence of DM was higher in placebo groups,
than anticipated.
Role of metformin as well as lifestyle intervention, in
prevention of T2DM was established.
38. DPP as the forerunner for the Look AHEAD trial
aDPPDiabetes Prevention Program.
bAHEADAction for Health in Diabetes.
cMean follow-up of 3.0 years (3,17).
dMean follow-up 1 year (4,7).
eHbA1chemoglobin A1c.
fNAspecific results not available;
g0.001 compared with control group.
hTo convert mg/dL glucose to mmol/L,
multiply mg/dL by 0.0555. To convert
mmol/L
glucose to mg/dL, multiply mmol/L by 18.
Glucose of 108 mg/dL6.00 mmol/L.
iLDLlow-density lipoprotein.
jTo convert mg/dL cholesterol to mmol/L,
multiply mg/dL by 0.0259. To convert
mmol/L
cholesterol to mg/dL, multiply mmol/L by
38.7. Cholesterol of 193 mg/dL5.00
mmol/L.
kNSnot significant.
lHDLhigh-density lipoprotein.
mTo convert mg/dL triglycerides to
mmol/L, multiply mg/dL by 0.0113. To
convert
mmol/L triglycerides to mg/dL, multiply
mmol/L by 88.6.
(Linda M., et al, Implications of the Diabetes Prevention Program and Look AHEAD Clinical Trials
for Lifestyle InterventionsJ. A. D. A, 2008, pp 66,72)
39. .
Mean percentage
reduction in initial
weight over 1 year
for participants
assigned to
sibutramine alone,
lifestyle modification
alone, combined
therapy, or
sibutramine plus
brief therapy.
Wadden et al 2005. Randomized Trial of Lifestyle Modification and Pharmacotherapy
for Obesity. N Engl J Med 2005; 353:2111-2120
Lifestyle modification vs pharmacotherapy
40. CHALLENGES WITH LIFESTYLE
MODIFICATION
• Lack of trained manpower
– Principally in research and hospital settings
• Needs multidisciplinary approach.
• Translating findings from clinical trials
into primary care and community
practice – greater challenge.