Most Older Adults with ‘Prediabetes’ Don’t Develop Diabetes

Lisa Rapaport wrote . . . . . . . . .

Older adults with slightly elevated blood sugar, sometimes called “prediabetes,” usually don’t develop full-blown diabetes, a Swedish study suggests.

Researchers followed 2,575 men and women aged 60 and older without diabetes for up to 12 years. At the start of the study, 918 people, or 36% of the group, did have higher-than-normal blood sugar levels that were still below the threshold for diabetes.

Only 119 people, 13% of those who started out with elevated blood sugar, went on to develop diabetes. Another 204, or 22%, had blood sugar levels drop enough to no longer be considered prediabetic.

“Progressing to diabetes is not the only destination,” said lead study author Ying Shang of the Aging Research Center at the Karolinska Institute in Stockholm.

“In fact, the chance to stay prediabetic or even revert back to (normal blood sugar) is actually pretty high (64%), without taking medication,” Shang said by email. “Lifestyle changes such as weight management or blood pressure control may help stop prediabetes from progressing.”

Average blood sugar levels over the course of about three months can be estimated by measuring a form of hemoglobin that binds to glucose in blood, known as A1c. Hemoglobin A1c levels of 6.5% or above signal diabetes.

Levels between 5.7% and 6.4% are considered elevated, though not yet diabetic, while 5.7% or less is considered normal.

Worldwide, about 352 million adults have elevated blood sugar that’s not high enough to warrant a diabetes diagnosis, the study team notes in the Journal of Internal Medicine. By 2045, that’s projected to rise to 587 million, or 8.3% of adults worldwide.

People in the study with prediabetes were more likely to return to healthy blood sugar levels if they lost weight, were free of heart disease and had low blood pressure.

Obese adults with prediabetes were more likely to progress to full-blown diabetes.

The study wasn’t designed to determine why people with prediabetes might progress to full-blown disease or return to healthy blood sugar levels.

One limitation of the study is that it had too few people with prediabetes to draw broad conclusions about how the condition might progress for millions of people worldwide. Researchers also lacked data on what lifestyle changes, such as shifts in eating or exercise habits, people might have used to try to reverse prediabetes.

“Larger studies will be needed to confirm these findings, and more treatment and lifestyle information would be needed to better understand why less people became diabetic than anticipated,” said Dr. R. Brandon Stacey of Wake Forest University School of Medicine in Winston-Salem, North Carolina.

“By having more lifestyle and treatment information, it may be possible to better identify patterns that enabled patients to successfully lose weight or lower their blood pressure to potentially reduce the risk of diabetes,” Stacey, who wasn’t involved in the study, said by email.

Even so, the results suggest that a diagnosis of prediabetes should motivate patients to make lifestyle changes, said Dr. Ron Ruby, co-director of the cardiometabolic center at Providence Little Company of Mary Medical Center in Torrance, California.

“Optimize the things you can control; weight loss, diet, exercise, and sleep,” Ruby, who wasn’t involved in the study, said by email. “This approach, though challenging to maintain for the long term, may be sufficient to prevent the progression to diabetes.”

Source: Reuters


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Food Neophobia May Lead to Poorer Dietary Quality and Increase the Risk of Lifestyle Diseases

Food neophobia, or fear of new foods, may lead to poorer dietary quality, increase the risk factors associated with chronic diseases, and thus increase the risk of developing lifestyle diseases, including cardiovascular diseases and type 2 diabetes. These are some of the findings of a study conducted by the National Institute for Health and Welfare, the University of Helsinki, and the University of Tartu in Estonia.

Food neophobia is an eating behaviour trait in which a person refuses to taste and eat food items or foods they are not familiar with.

The study examined the independent impact of eating behaviour, and especially food neophobia, on dietary quality as well as lifestyle diseases and their risk factors. So far, little research has been carried out on this area.

The study monitored individuals aged between 25 and 74 years in the Finnish FINRISK and DILGOM cohorts and an Estonian biobank cohort during a seven-year follow-up.

Food neophobia is hereditary

Food neophobia has been observed to be a strongly hereditary trait: twin studies have found that up to 78% of it may be hereditary. The trait can be easily measured using the FNS questionnaire (Food Neophobia Scale), which contains ten questions charting the respondent’s eating behaviour. The FNS questionnaire was also used to measure and quantify the fear of new foods in this study.

Food neophobia is common in children and older persons, in particular. Few studies have so far been carried out on food neophobia in the adult population. Traits similar to food neophobia, including picky and fussy eating, also occur in different age groups in the population. These eating behaviours may also have a significant impact on dietary quality and subsequently health. As different traits associated with eating behaviours have overlapping characteristics – making a clear-cut distinction between them is challenging.

Food neophobia has independent health impacts

The study found that food neophobia is linked to poorer dietary quality: for example, the intake of fibre, protein and monounsaturated fatty acids may be lower and the intake of saturated fat and salt greater in food neophobic individuals.

Additionally, a significant association was found between food neophobia and adverse fatty acid profile and increased level of inflammatory markers in blood. Subsequently, food neophobia also increases the risk of developing cardiovascular diseases or type 2 diabetes.

It is often thought that the impacts of eating behaviour and diet on health are mainly mediated through weight changes alone. In this study, however, the impacts of food neophobia emerged independently regardless of weight, age, socioeconomic status, gender or living area.

Your parents were right: you should always try all foods!

“The findings reinforce the idea that a versatile and healthy diet plays a key role, and even has an independent role in health. If we can intervene in deviant eating behaviours, such as food neophobia, already in childhood or youth, this will help to prevent potential future health problems early on”, says Research Professor Markus Perola from the National Institute for Health and Welfare.

”Hereditary factors and our genotype only determine our predisposition to food neophobia. Early childhood education and care and lifestyle guidance in adulthood can provide support in the development of a diverse diet”, Perola continues.

The study was published in the American Journal of Clinical Nutrition.

Source: National Institute for Health and Welfare


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What and How You Eat Affects Your Odds for Type 2 Diabetes

Serena Gordon wrote . . . . . . . . .

The kind of foods you eat, and even the order in which you eat them can affect your odds of developing type 2 diabetes, three new studies suggest.

The studies — being presented to the American Society for Nutrition — found:

  • Switching to a mostly plant-based diet (but one that could still include meat and dairy) could reduce the risk of type 2 diabetes by as much as 60%.
  • Eating greater amounts of vitamins B2 and B6 was linked to a lower risk of type 2 diabetes, while getting more B12 in the diet seemed to be associated with a higher risk of type 2 diabetes.
  • The order that you eat your foods appears to matter. People who ate vegetables before having meat or rice had lower blood sugar levels, along with positive changes in their hunger hormones.

Dr. Rekha Kumar, an endocrinologist at NewYork-Presbyterian and Weill Cornell Medical Center in New York City, reviewed the findings.

“Emphasizing fruits and vegetables and whole foods is a very practical and easy way to manage type 2 diabetes,” she said. “Half your plate should be green, even at breakfast, when you could have an egg white omelet with spinach for example.”

As for the sequence of eating, Kumar said vegetables, high-fiber foods and even protein take longer to leave the stomach, which slows down the rise in blood sugar levels.

“Theoretically, changing the order you eat foods could have implications on weight and appetite control,” she said.

Prioritize plants

The first study included more than 2,700 people recruited at an average age of 25. Forty percent were black and nearly 60% were women. Their health and diets were followed over 30 years.

People who made the greatest improvement in dietary quality from early to middle adulthood cut their odds of diabetes by almost two-thirds compared to those whose diet quality declined slightly, the study found.

What constitutes a quality diet? Researchers said it’s one that contains more “nutritionally rich, plant-centered” foods.

The study’s lead author, Yuni Choi, a doctoral candidate at the University of Minnesota-Twin Cities in St. Paul, said a plant-centered diet is high “in natural plant foods, low in highly processed plant foods and generally low in animal-based foods.”

So, vegetables, fruits and whole grains get a thumbs-up, but white bread and white rice get low-quality scores. Choi said this type of diet can include some lean meat and low-fat dairy.

On average, those who improved their diets the most ate four or more servings of vegetables daily, two servings of fruit, 1-1/2 servings of nuts or seeds, nearly two servings of whole grains, less than one serving of processed meat and about one serving of red meat, Choi said.

Choi and her advisor and co-author, David Jacobs, think the diverse nutrients found in plant foods help to prevent diabetes.

‘B’ gets an A for health

The second study looked at dietary data from about 200,000 American adults over 15 years.

People who had the most vitamin B2 and B6 had a roughly 10% reduction in their diabetes risk. B2 is found in eggs, lean meat, green vegetables and fortified grain products such as cereals and bread, according to the U.S. Department of Agriculture. B6 is found in fish, lean meat, fruits (other than citrus), and potatoes and other non-starchy veggies.

Though total vitamin B12 intake wasn’t linked to a higher risk of type 2 diabetes, the odds rose 11% when researchers looked solely at B12 from food sources. They found no similar increase in diabetes risk from B12 in diet supplements. They said this may be because B12 in foods often comes from animal products.

The third study found that the order in which you eat can affect your blood sugar levels. Researchers asked 16 Chinese adults, mostly men, to eat five experimental meals in a set order. The meals contained a vegetable, meat and rice, and portion sizes stayed the same.

Overall, the smallest spike in blood sugar levels resulted when vegetables or meat were eaten first. The meal with vegetables, meat and rice eaten separately, in that order, led to a lower increase in blood sugar and a favorable response in appetite hormones.

“The way we eat and present food to our mouth may have significant physiological effects,” said study author Christiani Henry, director of the Clinical Nutrition Research Center at Singapore Institute for Clinical Sciences.

Henry said fiber and other nutrients in vegetables appear to slow the transit time of food, which may also slow the rise in blood sugar levels after eating.

Eating vegetables first is “a simple, practical way to reduce blood glucose rise when eating rice,” he said. Henry added that more research is necessary to see if similar changes would help control blood sugar spikes for foods eaten in places like the United States.

The three studies were scheduled to be presented between Saturday and Tuesday at the American Society for Nutrition meeting in Baltimore. Research presented at meetings is typically seen as preliminary until published in a peer-reviewed journal.

Source: HealthDay


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Acetaminophen Safe For Most Older Adults—But May Increase Stroke Risk For Those With Diabetes

Acetaminophen (otherwise known by brand names such as Tylenol) is one of the most widely used pain relievers. Almost 60 years of widespread use have made acetaminophen a household product. It’s distributed over the counter (OTC) in most countries and judged safe by the scientific community. However, acetaminophen is also one of the most common medications involved in overdoses (the medical term for taking more of a medicine than you should) and is the most common cause of drug-induced liver failure.

Surprisingly, we are only now coming to understand how acetaminophen works—and recent research shows that we may need to develop a better understanding of the need for caution when using acetaminophen, especially when it comes to avoiding some of the risks associated with its use. Past research suggests these can range from increased asthma to interactions with other medications or the risk for developing other health concerns (such as kidney toxicity, bone fractures, or blood cancers).

Another important reason to look more carefully at all medications is that our bodies may react to these treatments differently as we age. Older adults experience physical changes as they age including, for example, reduced muscle mass, more fat tissue, changes in body composition, and less fluid in the body systems. Older people may also have multiple chronic conditions and take several different medications. These issues affect many different body functions, and that can raise your risk of having an unwanted reaction to a medication.

For all these reasons, a team of researchers decided to study the safety of acetaminophen in a nursing home setting. Their study was published in the Journal of the American Geriatrics Society.

The researchers’ aim was to explore any connection between acetaminophen use, death, and major heart events such as strokes and heart attacks in a large group of older adults living in nursing homes in southwestern France.

The researchers used information from the IQUARE study, which relied on two different questionnaires completed online by nursing home staffers. The researchers looked at deaths, heart attacks, and strokes that took place during the 18 months of the study period.

Of the 5,429 participants in the study, 3,190 were not taking acetaminophen and 2,239 were taking acetaminophen. Participants were around 86 years old and 74 percent were women.

The researchers reported that acetaminophen did not affect the number of heart attacks the participants experienced. There also was no increase in overall deaths.

The researchers found that the number of strokes was about the same in both groups—about 5 percent of the people who took acetaminophen had strokes, while about 4 percent of those who did not take acetaminophen had strokes. However, in participants who had diabetes, there was a slightly higher risk for stroke among people who took acetaminophen.

The researchers concluded that acetaminophen is a safe first choice in pain management for most older adults but should be considered with a bit more caution for older adults with diabetes.

As the population gets older and frailer, studies need to focus on the safety of the drugs these frail older adults commonly use to better our practice, said the researchers.

“My personal message to the people in my everyday practice is that any drug they take may have some form of harmful side effect unknown to them, even those they can buy over the counter. It is always best to check with your health care provider before you take any new medication, and make sure you’re taking the dose that’s right for you,” said study author Philippe Gerard, MD.

Source: Health In Aging


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No ‘One-Size-Fits-All’ Diet for Diabetics, Expert Panel Says

There is no one right diet for people with diabetes, and patients should instead have personalized nutrition plans, a new American Diabetes Association (ADA) report says.

There simply is no ideal percentage of calories from carbohydrates, proteins and fats. And combinations of different foods or food groups are acceptable for the management of diabetes and pre-diabetes, the report added.

“‘What can I eat?’ is the number one question asked by people with diabetes and pre-diabetes when diagnosed,” said Dr. William Cefalu, chief scientific, medical and mission officer at the ADA. “This new consensus report reflects the ADA’s continued commitment to evidence-based guidelines that are achievable and meet people where they are.”

As with type 2 diabetes, being obese with type 1 diabetes can worsen insulin resistance, blood sugar levels, microvascular disease complications and heart disease risk factors. Therefore, weight management should be an essential component of care for people with type 1 diabetes who are overweight or obese, as it is for those with type 2 diabetes, the report said.

General recommendations on nutrition plans include: emphasis on non-starchy vegetables; minimizing added sugars and refined grains; eating whole, unprocessed foods as much as possible; replacing sugary beverages with water as often as possible; and replacing saturated fats with unsaturated fats.

Research suggests that medical nutrition therapy for adults with type 2 diabetes can achieve hemoglobin A1c reductions similar to or greater than what could be expected with medications, according to the report.

Hemoglobin A1c is a test used to check blood sugar levels over a period of time.

The report was prepared by a panel of 14 experts, and published online in the journal Diabetes Care.

The panel reviewed more than 600 studies published between 2014 and 2018 to produce the new nutrition guidelines.

“The importance of this consensus also lies in the fact it was authored by a group of experts who are extremely knowledgeable about numerous eating patterns, including vegan, vegetarian and low-carb,” Cefalu added.

“As detailed by the latest evidence, there is no one single nutrition plan to be recommended for every person with diabetes due to the broad variability of diabetes for each individual, as well as other life factors such as cultural backgrounds, personal preferences, other health conditions, access to healthy foods and socioeconomic status,” Cefalu said.

“The ADA strongly encourages an individualized approach that includes regular review of nutrition status for all people living with diabetes,” he said. “Reassessment of an individual’s nutritional plan is particularly important during significant life and health status changes,” Cefalu concluded.

Source: HealthDay


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