Increases in Waist Circumference and Weight May Predict Incident Diabetes CME

News Author: Laurie Barclay, MD
CME Author: Charles P. Vega, MD

Medscape, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

 

May 28, 2010 — Increases in waist circumference and weight may predict incident diabetes, according to the results of a study reported online May 18 in Diabetes Care.

"Individuals with impaired fasting glucose (IFG) are at high risk for type 2 diabetes," write Alain Gautier, MD, from Center Hospitalier Universitaire de Rennes in France, and colleagues from the Data from an Epidemiological Study on the Insulin Resistance syndrome (D.E.S.I.R.) Study Group. "Although visceral adiposity and waist circumference are strong risk factors for type 2 diabetes, the consequence of an increase in waist circumference among individuals with IFG at baseline has not been fully investigated, in particular in those who are not overweight or obese at baseline. This report investigates the relative importance of increases in waist circumference and weight on progression to diabetes, in individuals with baseline IFG, according to baseline BMI [body mass index] strata."

Using the D.E.S.I.R. cohort, the investigators studied the 9-year incidence of diabetes in 979 men and women with baseline IFG. After adjustment for risk factors at baseline, increases in both waist circumference and weight were significantly associated with diabetes incidence. Standardized odds ratios (ORs) were 1.79 for waist circumference (95% confidence interval [CI], 1.45 - 2.21) and 1.86 for weight (95% CI, 1.51 - 2.30).

For patients with a BMI of less than 25 kg/m² at baseline, the effect of increase in waist circumference was greater (OR, 2.40; 95% CI, 1.63 - 3.52) vs patients with a BMI of 25 kg/m² or more at baseline (OR, 1.66; 95% CI, 1.28 - 2.16). Adjustment for concurrent changes in either insulinemia or the updated version of the homeostasis model assessment of insulin resistance (HOMA2-IR) index did not abolish the difference in effect based on initial BMI. The effect of weight change was similar in both BMI groups.

"In IFG individuals, it is important to monitor and prevent increases in waist circumference, in particular for those with BMI<25 kg/m²," the study authors write.

Limitations of this study include absence of gold-standard measures of insulin sensitivity, such as the euglycemic-hyperinsulinemic clamp.

"Impaired β-cell function is considered an important characteristic in individuals with IFG and reduced insulin secretion has been shown to be a prominent mechanism leading to diabetes in lean individuals," the study authors write. "We speculate that an increase in waist circumference may induce further alterations in insulin secretion beyond that inherent in a worsening insulin resistance. Potential mechanisms may involve β-cell lipotoxicity through enhanced free fatty acid release from adipose tissue."

The D.E.S.I.R. study has been supported by INSERM contracts with CNAMTS, Lilly, Novartis Pharma, and Sanofi-Aventis; by INSERM (Réseaux en Santé Publique, Interactions entre les déterminants de la santé, Cohortes Santé TGIR 2008), the Association Diabète Risque Vasculaire, the Fédération Française de Cardiologie, La Fondation de France, ALFEDIAM, ONIVINS, Ardix Medical, Bayer Diagnostics, Becton Dickinson, Cardionics, Merck Santé, Novo Nordisk, Pierre Fabre, Roche, and Topcon. The study authors have disclosed no relevant financial relationships.

Diabetes Care. Published online May 18, 2010. Abstract

Clinical Context

Dysglycemia is a risk factor for the development of type 2 diabetes mellitus, and a previous meta-analysis by Gerstein and colleagues, which was published in the December 2007 issue of Diabetes Research and Clinical Practice, quantified this risk. Compared with normoglycemic individuals, the risk for incident diabetes was increased from 4.6 to 7.5 times among patients with IFG or impaired glucose tolerance. However, the presence of both forms of dysglycemia in the same individual increased the risk for diabetes more than 12-fold.

The current study examines how weight change and waist circumference can affect the risk for incident type 2 diabetes among patients with IFG.

Study Highlights

• Study participants were drawn from the D.E.S.I.R. Study Group. All participants were between the ages of 30 to 64 years and had a fasting plasma glucose level between 5.6 and 6.9 mmol/L.
• Participants underwent screening examinations for diabetes 3 times annually. The planned follow-up period was 9 years.
• The main study outcome was the incidence of type 2 diabetes mellitus, which was defined as a fasting plasma glucose level of at least 7 mmol/L, or treated diabetes.
• In the current study, researchers focused on how weight change and waist circumference affected the risk for incident diabetes, particularly with regard to baseline BMI. This result was adjusted to account for demographic, disease, and lifestyle factors.
• 674 men and 305 women participated in the study.
• There were 142 cases of incident diabetes during follow-up.
• In adjusted models, each 1-SD increase in body weight and waist circumference was associated with ORs of 1.86 and 1.79 for diabetes, respectively. Both of these higher risks were statistically significant.
• When examining only participants with a baseline BMI of less than 25 kg/m², an increase in body weight did not significantly elevate the risk for diabetes when accounting for baseline hyperinsulinemia and insulin resistance.
• However, the adjusted OR for diabetes associated with at least a 1-SD increase in waist circumference was 2.40 vs those with a baseline BMI of 25 kg/m² or more (OR, 1.66). This risk remained significant in analyses adjusted for hyperinsulinemia and insulin resistance.
• In contrast, among participants with a baseline BMI of less than 25 kg/m², increases in both body weight and waist circumference significantly increased the risk for diabetes.
• The effect of waist circumference in increasing the risk for diabetes appeared more profound among participants at normal weight.
• Age did not significantly interact with body weight and waist circumference increases in promoting higher rates of incident diabetes.

Clinical Implications

• A previous meta-analysis found that both IFG and impaired glucose tolerance increase the risk for incident diabetes by a similar degree, but the presence of both forms of dysglycemia was synergistic in promoting an even higher risk for diabetes.
• The current study demonstrates that although both body weight gain and increases in waist circumference can increase the risk for incident type 2 diabetes among overweight or obese adults with IFG, increase in waist circumference may be a more significant risk factor for diabetes among adults at normal weight with IFG.

--
~ida~

nukilanida.blogspot.com

Forget crunches. If you want to get faster, fitter, and stronger, you need to train your core like a runner.

Strength Training for Runners

FAST ABS

Forget crunches. If you want to get faster, fitter, and stronger, you need to train your core like a runner.

By Alyssa Shaffer From the February 2009 issue of Runner's World

A generation ago, you'd be hard-pressed to find elite runners paying attention to their abs. Today, it's practically mandatory. "Our coaches drill the importance of core conditioning into our heads," says world champion hurdler Lolo Jones. "We're at it all the time." That's because scientists and coaches now know that you can't run your best without a strong core, the muscles in your abdominals, lower back, and glutes. They provide the stability, power, and endurance that runners need for powering up hills, sprinting to the finish, and maintaining efficient form mile after mile. "When your core is strong, everything else will follow," says Greg McMillan, a running coach in Flagstaff, Arizona, who has worked with scores of elite and recreational runners. "It's the foundation for all of your movement, no matter what level of running you're doing."

The key is to train your core like a specialist. Experts have mapped out precisely how the movements of running draw on the strength and stability of the glutes, obliques, and ab muscles that lie deep beneath the six-pack. They've learned how essential it is for runners to engage these muscles to finish fast, reduce pain, and hang tough on long runs. Best of all, they've tailored workouts to help them do that.

All runners-from those rehabbing injuries to elites gunning for PRs-can benefit from this detailed approach. "When all the muscles involved in running are supported, and the muscles in the hips and trunk work together, you don't get as many injuries and can enjoy running more," says Phil Wharton, a musculoskeletal therapist and co-owner of Wharton Performance Group in New York and the Wharton Health Experience in Flagstaff.

Quality core work isn't easy. But it doesn't require more than 15 minutes a few times a week-an investment that will pay dividends on the road. Just ask Lolo Jones. Even in the off-season, she's working her core three times a week so that when she races, she'll have the stamina to retain her status as America's top hurdler. "When my core strength is at its peak," says Jones, "I can run more efficiently and maintain that extra edge.

Strength Training Can Help Stave Off Type 2 Diabetes

Fit Fact: Strength Training Can Help Stave Off Type 2 Diabetes

Thursday June 3, 2010

I talk quite a bit about the importance of strength training, which might explain why my friends run away whenever I get near them. The truth is, there are still too many people out there who don't lift weights despite my endless nagging.
The problem some people have with strength training is that the benefits can be abstract and hard to measure. Cardio comes with some built-in instant gratification. You sweat, your heart rate rises and can almost feel the calories disintegrating from your body. With strength training, you may feel the exertion while you're lifting, but the benefits take a while to see and feel. It may take weeks before you see more definition in your body and, even then, the changes aren't always as mind-blowing as you'd like.
Physical changes are important, but it really is those hard-to-measure health benefits that matter the most. Not only can strength training help you avoid losing muscle mass as you age, keep your metabolism up and make you strong, it may help you stave off type 2 diabetes.
In a recent research article, researchers analyzed data on 14,258 people from the National Health and Nutrition Examination Survey III and found that loss of muscle was associated with insulin resistance (a precursor to type 2 diabetes) in both obese and non-obese people.
This type of study is just the impetus I need to keep nagging. Lucky you.
What about you? Has strength training, or any other type of exercise, helped you prevent diabetes or other health problems? If you're not lifting weights, does information like this motivate you to try? Leave a comment and tell us what you think.

SP Ecp Challenge- Ambil Bib

Pada 29 Mac 2010 pas training kat tasik shah alam p berjalan tok amik bib kat Setia Alam.. n org berkata sambil menyelam minum la air...

Gerai2 br nak bukak

Registration

Dah dapat bib, vest n dpt beg skali!

42..42..42

Ada NB bukak gerai.. Sale! N got t socks for 1/2 the price! Rembat dua la!

Macam2 gadget2 ada.. Vest siap ngam tubing skali waduh!!! Mcm tak caya jerk..

Antiblister socks.... Mahainya! Rm65!

masa lapang saya, ni la yg saya suka buat skrg.. huahuahua
Sebelum lari kita main piano dulu!

Tinggal pakai jerk..Yes!

The latest research on how to prevent dehydration—and boost your running performance.

Hydration Tips for Runners

SIPPING POINTS

The latest research on how to prevent dehydration—and boost your running performance.

By Karen Asp

Image by Todd Huffman

From the July 2010 issue of Runner's World

RUNNERS KNOW it's important to stay hydrated to run their best, especially in the summer. "Being more than two percent dehydrated in warm environments causes a decline in performance," says Robert W. Kenefick, Ph.D., a physiologist with the U.S. Army Research Institute of Environmental Medicine. To keep fluids handy, you probably stash a water bottle in a gym bag or leave sports drink in your car. But to really improve performance, you need to be more than a casual sipper. A number of recent studies offer runners smarter ways to stay hydrated while also giving their running a boost. Here's how you can apply some of these strategies to your own hydration plan and run your best all summer long.


PRE-HYDRATE TO RUN FAST
WHY In a study in the April 2010 Journal of Athletic Training, runners who started a 12-K race dehydrated on an 80?F day finished about two and a half minutes slower compared to when they ran it hydrated. Dehydration causes your blood volume to drop, which lowers your body's ability to transfer heat and forces your heart to beat faster, making it difficult for your body to meet aerobic demands.
DRINK UP Drink eight to 16 ounces one to two hours before a run. Sports drinks and water are good choices, says running coach Cassie Dimmick, R.D. Iced coffee and tea are fine, too. Didn't plan ahead? Fifteen to 30 minutes before going out, drink at least four to eight ounces of fluid.


GO COLD FOR LONGER RUNS
WHY In a study published in 2008 in Medicine & Science in Sports & Exercise, cyclists who drank cold beverages before and during their workout exercised nearly 12 minutes longer than those who drank warm beverages. And in a study published this year, runners who had an ice slushy ran about 10 minutes longer than when they had a cold drink. In both cases, the drink that was colder lowered body temperature and perceived effort, allowing participants to exercise longer.
DRINK UP Before going for a hot run, have a slushy made with crushed ice and your favorite sports drink. To keep drinks chilled while you run, fill a bottle halfway, freeze it, and top it off with fluid before starting. Running a loop? Stash bottles in a cooler along your route, says Dimmick.


STAY ON SCHEDULE
WHY According to a study in the July 2009 Journal of Sports Sciences, when cyclists recorded their plan for hydrating during workouts—including exact times and amounts—they drank more frequently and consumed more fluid midworkout than their nonplanning peers. "Planning helps people remember how much and when they need to drink," says lead author Martin Hagger, Ph.D., of the University of Nottingham in the United Kingdom.
DRINK UP Note your thirst during your runs, and write down how offen and how much you drink. Review your notes to help you plan when to drink. Set your watch to beep every 15 minutes as a reminder to consider your thirst. "Drinking smaller amounts at regular intervals can help you absorb fluid more effectively," says Dimmick, "and avoid stomach sloshing."

PARTNER WORKOUTS

Workouts to keep you and your partner on pace

By Jeff Galloway

 Running with a partner is one of the best ways to ensure that you get out the door for every workout. But your workout may unravel if you (A) talk so much that your pace slows to a crawl or (B) race each other until someone bonks. Here are two workouts: one to help maintain a good effort and one to keep the run from becoming a race. Warm up and cool down with five to 10 easy minutes before and after each run.

Keep up the pace:
Break a 30- to 40-minute run into five-minute segments, with one- to three-minute walk breaks in between. During each segment, one person leads without speaking and with the sole focus of setting a strong, even pace. The other person runs behind and serves as coach, offering advice to help sustain the good effort: take shorter and lighter steps, keep feet low to the ground, maintain an upright body posture. After each walk break, runners should switch roles.

Rein in the pace:
To ensure you're not speeding up as you go along, you have to be able to accurately account for distance covered throughout the run. That means either one runner wears a distance-monitoring system like a GPS unit or shoe pod, or you do the run on well-marked trails or on a track. After the warmup, one person keeps tabs on the distance, announcing the passing of each quarter mile or so. The other runner is responsible for taking this information and adjusting the pace up or down according to the agreed-upon pace for the day. You can take walk breaks as needed to talk over pace adjustments. Once the pace is established, the person monitoring distance can keep tabs by announcing every half-mile completed.
PUBLISHED 06/19/2007

A Better Warm-up for Runners

Scott Quill
10/2009

 

Have you ever thought of running as jumping and landing hundreds or thousands of times in a single workout, oftentimes while moving at top speed? When you think of it this way, touching your toes and just starting out slow hardly seems like a sufficient warm-up for this dynamic activity.

"You'll increase your core body temperature, elongate muscles, and activate key areas for running," says Craig Friedman, director of methodology for Athletes' Performance.

This series of movements also benefits your body on a neurological level, Friedman says. It opens the pathways your brain uses to send messages to your muscles and also helps ingrain proper movement patterns.

Simply put, this makes you a more efficient runner. Not convinced? Here are four more ways movement prep will make you a better runner:

1. It helps balance your body

Every time your foot hits the ground, your body has to rebalance itself. Training your balance dynamically with movement prep will prepare you to do this.

2. It improves flexibility

You'll develop new ranges of motion by actively elongating and contracting muscles. Initially, this gets rid of stiffness. Stay consistent with your movement prep routine and you'll maintain your newfound flexibility better.

3. It creates symmetry in your stride

Either a lack of mobility or stability in your body can lead to an asymmetrical stride length where one limb is compensating for another. This typically leads to decreased performance, pain or injury. Movement prep helps clear up these asymmetries.

4. It boosts power, strength and endurance

You'll move more efficiently, which means you'll cover more distance with the same amount of effort and energy, and you can push off the ground with more power in every stride.

Sample warm-up (seven minutes)

You can loosen and prepare your full body for activity in under 10 minutes. Key areas for runners include the hip flexors, calves, glutes and hamstrings. Try this sample 7-minute routine to get started. Perform 4-6 repetitions for each of the movements below. (To see animated examples, check out the Library.)

1. Standing Pec Stretch

Directions: Stand in a doorway or next to a fixed object. Raise one arm and bend it 90 degrees so your upper arm is parallel with the floor and your forearm is pointing straight up to the ceiling. Place your forearm on the doorframe or object, then lean forward until you feel a stretch in your chest. Hold for 1-2 seconds, relax, and repeat for the prescribed number of repetitions.

2. Leg Cradle

Directions: Start standing, then squat back and down a few inches. Lift your right knee to your chest, placing your right hand under the knee and your left hand under your ankle. Gently pull your right leg toward your chest while extending your left leg and contracting the left glute. Alternate with the other leg and repeat for the prescribed number of repetitions.

3. Inverted Hamstring Stretch

Directions: Stand on your right leg with your knee slightly bent and your arms out to the sides with your shoulder blades together. Hinge forward at your right hip with your left leg straight back behind you and your right knee remaining slightly bent. Keep your back in a neutral position throughout the movement and try to keep your left hip from rotating to the sky. When you feel a stretch in your hamstrings and glutes on your right side, return to the starting position and repeat for the prescribed number of reps with each leg.

4. Forward Lunge, Elbow to Instep (crawling)

Directions: From a standing position, step forward into a lunge with your right leg forward. Place your left hand on the floor and your right elbow to the inside of your right foot. Your back leg should be straight. Hold the stretch for two seconds, then place your right hand outside of your right foot and push your hips to the sky. Hold again for two seconds. Drop your hips and crawl into the next repetition with the other leg. Continue for the prescribed number of repetitions.

5. Knee Hug (in place)

Directions: From a standing position, squat down a few inches and grab below your right knee with your hands. Keeping your chest up, pull your right knee toward your chest while contracting your left glute. Repeat with your other leg. Continue the movement for the prescribed number of repetitions.