Type 2 Diabetes, Obesity, and Risk for Dementia: Recent Insights into Brain Insulin Resistance and Hypometabolism

Legacy of a 10-Year Multidomain Lifestyle Intervention on the Cognitive Trajectories of Individuals with Overweight/Obesity and Type 2 Diabetes Mellitus

INTRODUCTION

Weight loss and increased physical activity interventions are commonly recommended for individuals with type 2 diabetes (T2D) and overweight or obesity. We examined the impact of randomization to an intensive lifestyle intervention (ILI) on trajectories of cognitive function over 10 years in a cohort of participants in a randomized clinical trial who had T2D and overweight/obesity at baseline.

METHODS

Participants aged 45-76 years were enrolled in 2001-2004 and were randomized to the ILI or a diabetes support and education (DSE) condition. Cognitive function was assessed in 3,938 participants at up to 4 time points 8-18 years after randomization. General linear mixed effects models examined cognitive trajectories over time. Subgroup analyses focused on sex, individuals with baseline body mass index >30, those carrying the APOE ε4 allele, and those with a baseline history of cardiovascular disease (CVD).

RESULTS

Overall, there were no differences in the rate of cognitive decline by intervention arm. Subgroup analyses showed that participants who had a baseline history of CVD and were randomized to the ILI arm of the study performed significantly worse on the Stroop Color Word Test than those in the DSE arm.

DISCUSSION/CONCLUSIONS

The ILI did not result in preserved cognitive function or slower rates of cognitive decline in this cohort of individuals who had T2D and were overweight or obese at baseline.

Response-to-Failure Analysis of Global Food System Initiatives: A Resilience Perspective

International food system initiatives have led the efforts to combat the threats to global food security resulting from the failure of the current food systems. This study set out to investigate and assess the contributions of global food system initiatives in tackling the food system challenges. In assessing the food system initiatives, we develop a three-step methodology for Food System Initiative (FSI) selection and then conduct a qualitative evaluation using relevant indicators based on food system failure narratives. Furthermore, the authors synthesize present literature in the context of the extent to which coronavirus disease 2019 (COVID-19) pandemic has compounded food system challenges and, together with the response-to-failure analysis, recreate a resilient transformational framework, which will be an invaluable tool to FSI during and after the COVID-19 era, and guarantee we build back better. The findings show that while considerable effort is being made in addressing food system failures, the current COVID-19 pandemic has exacerbated the challenges and would require a paradigm shift not only in the implementation of conventional food system initiatives but also in the role of food system actors. The food system resilience framework presented provides useful pathway in expanding the understanding of the role of all key stakeholders and in identifying tipping points for building the desired resilience moving forward.

Using scenario analyses to address the future of food

The food system was developed around a set of policy drivers to make food cheaper and more available, these included promoting agricultural productivity and global trade to increase the availability of food. However, as has been recognised by a plethora of recent papers and reports, these factors have also led to a food system that is unsustainable through its impacts on human health (particularly the growing obesity epidemic) and the environment (e.g. as a major driver of climate change). The world is changing at an unprecedented rate, and the food system is becoming increasingly 'just in time', spatially extended, and dependent on more facilitating sectors (water, land, transport, finance, cyber, etc.). This produces a degree of systemic fragility that drivers (like demand) can interact with events (e.g. a climate impact) to create the opportunity for large-scale shifts in the way the world works. Given the unsustainability of the food system, and the uncertainty of how it may evolve, scenario analysis can be a useful tool for imagining plausible futures as an aid to unlocking 'business as unusual' thinking. Summarising a number of recent processes, I describe scenarios of countries' food systems shaped by changing patterns of trade and changing dietary patterns.