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The care of children and adolescents with type 2 diabetes.

The prevalence of Type 2 diabetes has dramatically increased in children and adolescents over the past 10 years. Type 2 diabetes is characterized by insulin resistance and high insulin levels. Reasons cited for the rise of this condition in children and adolescents are speculated to stem from obesity because of a rise in sedentary behavior, nonnutritious food choices, and genetic predisposition. A high recurrence rate in families shows that therapy for children and adolescents must involve the entire family to be successful. Treatment recommendations vary depending on severity but include nutrition, exercise, and medication. Assessment of the patient's and family's willingness to change their current lifestyle behaviors is an integral part of treatment. Nutrition and exercise goals should be made on an individual basis to meet the needs of the patient. Success of therapy is difficult to measure because this is a chronic condition being diagnosed in young people. As in any chronic condition, success of therapy is difficult to measure.

Acanthosis Nigricans↗

On the road to obesity: Television viewing increases intake of high-density foods.

Television viewing (TVV) has been linked with obesity, possibly through increased sedentary behavior and/or through increased ingestion during TVV. The proposition that TVV causes increased feeding, however, has not been subjected to experimental verification until recently. Our objective was to determine if the amount eaten of two familiar, palatable, high-density foods (pizza and macaroni and cheese) was increased during a 30-min meal when watching TV. In a within-subjects design, one group of undergraduates (n = 10) ate pizza while watching a TV show of their choice for one session and when listening to a symphony during the other session. A second group of undergraduates (n = 10) ate macaroni and cheese (M&C). TVV increased caloric intake by 36% (one slice on average) for pizza and by 71% for M&C. Eating patterns also differed between conditions. Although the length of time to eat a slice of pizza remained stable between viewing conditions, the amount of time before starting another slice was shorter during TVV. In contrast, M&C was eaten at a faster rate and for a longer period of time during TVV. Thus, watching television increases the amount eaten of high-density, palatable, familiar foods and may constitute one vector contributing to the current obesity crisis.

Adult↗

The mutually reinforcing triad of depressive symptoms, cardiovascular disease, and erectile dysfunction.

The conditions of depression, erectile dysfunction (ED), and cardiovascular disease may seem at a superficial level as independent medical problems managed by 3 separate and unrelated healthcare disciplines. Various studies, however, have revealed significant associations between depression and cardiovascular disease, ED and cardiovascular disease, and depression and ED. The purpose of this research was to identify whether the 3 medical conditions share mutually reinforcing associations and predictors. Population-based epidemiologic studies were utilized where possible. Variables including age, heart disease, hypertension, sedentary behavior, related medications, cigarette smoking, and abnormal lipids have been found to be highly associated with depressive symptoms, cardiovascular disease, and ED. It was concluded that all 3 medical conditions share many of the same risk factors and etiologic associations and may be best modeled in a 3-way holistic, mutually reinforcing relation. Of particular relevance, patients with sexual dysfunction have a likely comorbidity of cardiovascular disease and depression, as well as the potential increased risk for cardiac morbidity and mortality.

Causality↗

[Physical activity as a therapeutic tool in type 2 diabetes: practical aspects].

Physical activity is an integral part of the therapeutic management of type 2 diabetic patients. Its beneficial effects on patients' metabolic control and quality of life are well recognized. The clinical intervention is based on two complementary approaches: to promote physical activity and/or to decrease sedentary behavior, with the aim of long term maintainance. Careful examination of the patient, and assessment of his/her physical capacity and potential risks associated with activity represent the first steps. Assessment of the patient's motivation and stage of change regarding physical activity appears to be a key element for the success of the physical activity project. Main objectives should be clearly defined, as well as the means to reach them (changes in every day-life activities, progressive structured physical exercise), and should be reevaluated and adapted on a regular basis, together with the patient, and whenever possible, with his/her familial/social environment.

Diabetes Mellitus, Type 2↗

Active living for assisted living: promoting partnerships within a systems framework.

In response to a growing need for assistance among our aging population, assisted-living facilities have been designed to fill the widening chasm between community living and nursing care. Although sedentary behavior has been linked to functional limitations and disability, no comprehensive information exists about the social and physical environments and the programming available to promote physical activity in assisted living. Accordingly, this article includes data from an exploratory study that underscores the issues clearly related to physical activity for older adults in assisted living. The intent of this exploratory study was to partner with executive directors in order to conduct an analysis of the social and physical characteristics of assisted living. Interviews were conducted with executive directors (N=21) to discuss methods for assessing and promoting positive lifestyle behaviors with distinct emphasis on the targeted behavior of physical activity. Potential ways in which the social and physical environments could be modified to promote and support physically active living were identified. Clearly, promoting physical activity in assisted living is a challenge and will require a partnership with assisted living communities to develop effective and feasible systems-based interventions designed to make environments more engaging and, thereby, promote active living.

Aged↗

Acceptability and feasibility of physician-based activity counseling. The PAL project.

BACKGROUND: The continued prevalence of sedentary behavior in older adults underscores the need for physical activity promotion. Physician-delivered activity counseling may be an important avenue of promoting physical activity for these individuals. The Physically Active for Life (PAL) project was a randomized study of the effects of brief physician counseling plus follow-up on physical activity behaviors in older adults. METHOD: Twelve practices were randomized to the intervention group and 12 to standard care. Physicians in the intervention group participated in a 1-hour training session and received support materials for exercise counseling. Pre-assessment and post-assessment of self-reported exercise counseling behaviors and confidence in providing exercise counseling were obtained from physicians in the study. Patient evaluations of the exercise counseling and support materials were also obtained. RESULTS: Results showed that physicians favorably endorsed the training and the support materials, and reported adherence to delivery of the intervention protocol. Comparisons between the two groups showed significant improvements in confidence for intervention-group physicians, but no significant changes in physician reports of exercise counseling provided to all patients. Patients reported satisfaction with the exercise counseling and support materials. CONCLUSIONS: Physicians and patients indicated the PAL project offered an acceptable and feasible approach to promote physical activity in older adults.

Adult↗

Can brain dysfunction be a predisposing factor for metabolic syndrome?

The various mechanisms that may explain the association between brain dysfunction and the pathogenesis of metabolic syndrome (MS) leading to cardiovascular disease and type 2 diabetes have been reviewed. A Medline search was conducted until September 2003, and articles published in various national and international journals were reviewed. Experts working in the field were also consulted. Compelling evidence was found that saturated and total fat and low dietary n-3 fatty acids and other long-chain polyunsaturated fatty acids (PUFAs) in conjunction with sedentary behavior and mental stress combined with various personality traits can enhance sympathetic activity and increase the secretion of catecholamine, cortisol and serotonin, all of which appear to be underlying mechanisms involved in MS. Excess secretion of these neurotransmitters in conjunction with underlying long-chain PUFA deficiency may damage the neurons in the ventromedial hypothalamus and insulin receptors in the brain, in particular during fetal life, infancy and childhood, and lead to their dysfunction. Since 30-50% of the fatty acids in the brain are long-chain PUFAs, especially omega-3 fatty acids which are incorporated in the cell membrane phospholipids, it is possible that their supplementation may have a protective effect. Omega-3 fatty acids are also known to enhance parasympathetic activity and to increase the secretion of anti-inflammatory cytokines as well as acetylecholine in the hippocampus. It is possible that a marginal deficiency of long-chain PUFAs, especially n-3 fatty acids, due to poor dietary intake during the critical period of brain growth and development in the fetus, and later in the infant and also possibly in the child, adolescent and adult may enhance the release of tumor necrosis factor-alpha (TNF-alpha) interleukin (IL)-1, 2 and 6 and cause neuronal dysfunction. Experimental studies indicate that ventromedial hypothalamic lesions in rats induce hyperphagia, resulting in glucose intolerance and insulin resistance. Treatment with neuropeptide Y abolished hyperphagia and ob mRNA (leptin mRNA) in this animal model. Long-term infusion of norepinephrine and serotonin into the ventromedial hypothalamus impaired pancreatic islet function inasmuch as ventromedial hypothalamic norepinephrine and serotonin levels were elevated in hyperinsulinemic and insulin-resistant animals. Treatment with insulin was associated with restoration of hypothalamic neurotransmitter abnormalities, indicating that ventromedial hypothalamus dysfunction can impair pancreatic beta cells resulting in metabolic abnormalities consistent with MS. Treatment with omega-3 fatty acids, beta blockers, ACE inhibitors, estrogen, and meditation may have a beneficial effect on insulin receptors and ventromedial hypothalamic dysfunction. However, no definite or precise insight into the pathophysiological link between MS, brain function and nutrition is available. Despite this, epidemiological studies and intervention trials indicate that treatment with n-3 fatty acids may be adopted in clinical practice and used to direct therapy for prevention of type 2 diabetes, hypertension, coronary artery disease (CAD), and atherosclerosis, thereby indicating that MS may also respond to this treatment.

Animals↗

Spontaneous sigh rates during sedentary activity: watching television vs reading.

BACKGROUND: Spontaneous sighs are thought to play an important role in preventing atelectasis and in regulating airway tone. Recent studies have provided a mechanism by which expansion of the lungs could cause relaxation of smooth muscle. OBJECTIVE: To investigate breathing patterns during 2 forms of sedentary behavior: reading and watching television. METHODS: Breathing patterns were monitored for 1 to 2 hours to document respiratory rates and sigh rates. Each participant was monitored while reading and while watching a movie on videotape. During the first experiment (17 controls), metabolic rates were also measured. In the second experiment (18 controls and 9 patients with mild-to-moderate asthma), only breathing patterns were monitored. RESULTS: There were no significant differences in respiratory or metabolic rates between the 2 activities. In contrast, in the first experiment, 13 of 17 controls had lower sigh rates while watching a videotape than while reading (P < .01). In the second experiment, the sigh rate was significantly lower overall while watching a videotape (mean, 13.7 sighs per hour; range, 1.8-26.0 sighs per hour) than while reading (mean, 19.3 sighs per hour; range, 7.7-30.0 sighs per hour) (P < .001). A similar decrease was observed in patients with asthma (P < .01). CONCLUSIONS: Given that many children and adults watch television for 5 or more hours per day, breathing patterns during this time may be relevant to lung function. Our results demonstrate that prolonged periods of watching a videotape are associated with lower sigh rates than while reading. Further research is needed to determine whether these changes are relevant to increased bronchial reactivity.

Adolescent↗

Type 2 diabetes and diabetes risk factors in children and adolescents.

Long considered a disease of older adults, type 2 diabetes mellitus (DM) is now affecting children. While the prevalence and incidence of type 2 DM are not yet established in children, the number of affected individuals continues to climb. At the same time, obesity, the primary risk factor for type 2 DM, has become epidemic, affecting all ethnic and demographic groups across the United States. The lifestyle trends contributing to both of these phenomena include changes in dietary patterns and habits, declining levels of physical activity, and increasing sedentary behaviors. In response to these problems, the medical profession must become proactive with its patients and in the community.

Adolescent↗

Influences of preschool policies and practices on children's physical activity.

The objective of this study was to determine if moderate to vigorous physical activity (MVPA) of 3-5 year old preschool children varied with differences in policies/practices, and overall quality of preschools. A total of 266 children (47% males, 60% African American) from 9 preschools were observed for 1 hour on 3 different days. PA of children was observed twice per minute and scored as 1-5, with 1 for stationary/motionless and 5 for fast movement. Summary MVPA was calculated over the 3 days as percent of times observed at levels of 4 or 5, and percent of time at levels 1 or 2 as sedentary activity. A structured interview about PA policies was conducted with an administrator at each preschool and overall quality of the preschool was assessed using Early Childhood Environment Rating Scale-Revised Edition (ECERS-R). Preschools were divided into groups according to whether a specific policy/practice that would be logically hypothesized to promote PA was in place at the school. MVPA differences between groups of children was assessed using mixed ANOVA controlling for preschool. When preschools offered more field trips, and more college educated teachers, the children participated in more MVPA. Children who attended preschools with lower quality spent more time in sedentary activity. In conclusion, children in preschools which may have more resources and better quality appear to show both more sedentary behavior and more MVPA.

Black or African American↗

Prevalence of overweight among inner city Hispanic-American children and adolescents.

OBJECTIVE: National surveys have pointed to a particularly high risk of pediatric overweight among U.S. Hispanics. However, the data have been primarily from the Mexican-American community. We studied the prevalence of overweight and clinical comorbidities in children and youth of predominantly El Salvadoran ancestry. RESEARCH METHODS AND PROCEDURES: A sample of 309 Hispanic youth, 6-18 years was surveyed from two inner city Washington, DC, clinics. BMI; triceps skinfold (TSF) and subscapular skinfold thickness (SSSF); bioelectrical impedance analysis (BIA); and blood pressure measures were obtained, along with information regarding physical activity, sedentary behavior, dietary history, family, and personal medical history. RESULTS: Thirty-eight percent were overweight (BMI > or = 95th percentile) and 22% at risk for overweight (BMI 85-94th percentile). Thirty-four percent had TSF > or = 90th percentile and 29% had SSSF > or = 90th percentile. Fifty-one percent of males and 70% of females had body fat > 30%. Compared to their nonoverweight counterparts, overweight youth had significantly higher systolic blood pressure (111.4 +/- 1.3 vs. 104.5 +/- 0.9 mm Hg, p < 0.0001). Among children younger than 11 years, overweight was associated with onset of adrenarche (23% vs. 10%, p = 0.01). Participation in one or more sports teams was negatively correlated with overweight) p = 0.04). DISCUSSION: The prevalence of overweight and at risk for overweight in this sample was twice the national average for U.S. children and 1.7 times greater than that of Mexican-American children in national surveys. Overweight was associated with advanced pubertal development, high body fat, elevated blood pressure, and decreased sports participation.

Adipose Tissue↗

Relationship between temperament, nonresting energy expenditure, body composition, and physical activity in girls.

OBJECTIVES: To assess the extent that predilection for movement, as measured by a temperament questionnaire (activity temperament), contributes to nonresting energy expenditure and body composition in girls. DESIGN, SETTING, AND PARTICIPANTS: Baseline data for 196 premenarcheal non-obese girls aged 8-12 y were obtained from a longitudinal study of growth and development. The association of activity temperament with nonresting energy expenditure in girls with low and high levels of physical activity was evaluated, as was the association of activity temperament with body composition. MEASURES: Maternal reports of child activity temperament were obtained by questionnaire. Nonresting energy expenditure was calculated as total energy expenditure (measured by doubly labeled water) minus resting energy expenditure (obtained by indirect calorimetry). Body composition was estimated by total body water. Questionnaires and activity diaries were used to assess physical activity and sedentary behavior. RESULTS: Higher activity temperament was associated with higher nonresting energy expenditure after multivariate control for weight, vigorous activity, walking and light activity, and television viewing, although activity temperament did not account for a large percentage of the variability in nonresting energy expenditure (partial squared correlation coefficient=0.03). In girls with physical activity levels below the median, high activity temperament was associated with a mean+/-s.d., nonresting energy expenditure of 310+/-138 kJ (74+/-33 kcal) above that of girls with a low activity temperament. Girls with a high activity temperament had less body fat than did girls with a low activity temperament (21.6 vs 24.5%, a difference of 2.9 percentage points; 95% confidence interval, 1.3-4.4 percentage points). CONCLUSION: Predilection for movement, as measured by a temperament questionnaire, contributes to nonresting energy expenditure and may be useful in capturing an aspect of energy expenditure in population studies. The cross-sectional observation that girls with a high activity temperament were leaner than girls with a low activity temperament suggests that a constitutional predilection for movement may play a role in the development of obesity.

Anthropometry↗

African American women's experiences with physical activity in their daily lives.

Sedentary behavior is a major public health problem for African American women. A qualitative study used focus groups to explore African American women's experiences with physical activity in their daily lives. Women aged 35-50 were recruited to participate in the focus groups. Transcripts from the focus groups were coded and analyzed. African American women's facilitators of physical activity were daily routine, practical and convenient activities, personal safety, child care, weight loss, stress reduction, knowledge and commitment, enjoyment, pets, family and peer support, home and work facilities, and daylight and climate conditions. Barriers to physical activity were lack of child care, no person to exercise with, competing responsibilities, lack of space in the home, inability to use exercise facilities at work, lack of motivation, fatigue, and unsafe neighborhood. This information will provide the basis for generating new strategies to increase physical activity for African American women in the community.

Activities of Daily Living↗

[The energetics of obesity].

Although there is little argument about the state of energy imbalance that produces weight gain, there is considerable argument about the respective role of genetics, diet and physical activity in achieving obesity. In the USA, obesity has increased in the last decades despite a concomitant decrease in total energy and fat intake suggesting that there has been a dramatic drop in total energy expenditure. In this review, we investigated the respective role of resting metabolic rate, post-prandial thermogenesis, and activity energy expenditure in this lower energy output, and provided evidence that physical inactivity is the major contributor. Based on Jean Mayer original observation (Mayer et al., 1954), we hypothesize that there is a level of physical activity below which mechanisms of body mass regulation are impaired. The increasing prevalence of obesity may reflect the fact the majority of the population has fallen below such a level of physical activity. However, a causal relation between physical inactivity and obesity is still difficult to prove, probably because of the lack of longitudinal models to investigate the physiological consequences of inactivity and because the deleterious consequences of sedentary behaviors are essentially deduced from the benefits of exercise training. By using long term strict bed rest as a unique model of inactivity, we provide evidence that inactivity per se indeed disrupts fuel homeostasis and partitions post-absorptive and post-prandial fat use towards storage, thus promoting weight gain in the long term. More research is needed to investigate mechanisms and to determine the minimal physical activity our body has been engineered for by evolution.

Basal Metabolism↗

Peridomestic structure, farming activity and triatomine infestation.

The role of peridomestic structure and farming activity on triatomine infestation was studied on two vector species of Chagas disease (Triatoma pseudomaculata and T. brasiliensis) in Bahia State, northeastern Brazil. A randomly selected population issued from 136 farms was divided into four categories according to the householder activity. At regional scale, the dwellings of farmers working on degraded land of irrigated farms are less exposed to T. pseudomaculata infestation. At premises scale, the farmers and casual workers, who have smaller peridomiciles and less cattle, are also less exposed to T. pseudomaculata. The association of T. brosiliensis with the most mobile populations (casual workers and young breeders) suggests a passive transport of this competitive species. Finally, the retired farmers that own large premises and cattle, but have more sedentary behavior, are the most exposed to T. pseudomaculata infestation.

Agriculture↗

Habitual physical activity in children: the role of genes and the environment.

BACKGROUND: Understanding the factors that contribute to physical inactivity in children is important because sedentary behavior strongly relates to metabolic disorders such as obesity and diabetes. OBJECTIVE: We aimed to quantify the genetic and environmental influences on physical activity energy expenditure (PAEE) in 100 sex-concordant dizygotic (n = 38) and monozygotic (n = 62) twin pairs aged 4-10 y. DESIGN: Resting metabolic rate (RMR) was assessed by using respiratory gas exchange, total energy expenditure (TEE) by using doubly labeled water, and body composition by using dual-energy X-ray absorptiometry. Structural equation modeling was used to partition the phenotypic variance into additive genetic (a2) and common (c2) and unshared (e2) environmental components. RESULTS: Because PAEE [TEE - (RMR + 0.1 x TEE)] depends on body weight, which is highly heritable, we tested several models: 1) after adjustment for age, sex, ethnicity, study date, season, and weight, a2 explained none of the phenotypic variance in PAEE (95% CI: 0%, 38%), whereas c2 and e2 accounted for 69% (33%, 77%; P = 0.001) and 31% (23%, 39%; P < 0.001) of the variance, respectively; 2) after adjustment for the cofactors in model 1, a2 explained 19% of the phenotypic variance in TEE (0%, 60%; P = 0.13), whereas c2 and e2 accounted for 59% (16%, 79%; P = 0.007) and 23% (17%, 31%; P < 0.0001) of the variance, respectively; 3) in models adjusted as above (excluding weight), a2 explained no variance in physical activity level (TEE/RMR) (0%, 32%; P = 0.50), whereas c2 and e2 explained 65% (34%, 60%; P = 0.001) and 35% (28%, 45%; P < 0.0001) of the variance, respectively. CONCLUSIONS: Our data suggest that the familial resemblance in physical activity in these children is explained predominantly by shared environmental factors and not by genetic variability.

Absorptiometry, Photon↗

Physical activity in aging: changes in patterns and their relationship to health and function.

Sedentary behavior is an important risk factor for chronic disease morbidity and mortality in aging. However, there is a limited amount of information on the type and amount of activity needed to promote optimal health and function in older people. The purpose of this review is to describe the change in patterns of habitual physical activity in aging and the relationship of these changes to physical function and selected chronic diseases. We undertook a literature review of large population-based studies of physical activity in older people, and there is encouraging evidence that moderate levels of physical activity may provide protection from certain chronic diseases. Additionally, substantial health effects can be accrued independent of the fitness effects achieved through sustained vigorous activity. Thus, regular participation (i.e., 30 minutes/day on most days of the week) in activities of moderate intensity (such as walking, climbing stairs, biking, or yardwork/gardening), which increase accumulated daily energy expenditure and maintain muscular strength, but may not be of sufficient intensity for improving fitness, should be encouraged in older adults. Public policy should focus on ways of increasing volitional and lifestyle activity in older people, as well as on increasing the availability and accessibility of senior and community center programs for promoting physical activity throughout the life span.

Aged↗

Distribution and correlates of waist-to-hip ratio in black adults: the Pitt County Study.

A 1988 community-based survey of 1,784 black adults aged 25-50 years in Pitt County, North Carolina, found mean waist-to-hip ratios of 0.890 for men and 0.852 for women. Based on guidelines from the US Department of Agriculture, 20% of the men and 76% of the women had an elevated waist-to-hip ratio. Sedentary behavior was associated with elevated waist-to-hip ratio in men, while a similar excess was associated with alcohol consumption in women. Weak, nonsignificant associations with waist-to-hip ratio were observed for smoking. Socioeconomic status was unrelated to waist-to-hip ratio in men, but it had a strong inverse relation for women.

Adipose Tissue↗