Physical Activity and Abnormal Blood Glucose Among Healthy Weight Adults

The effect of a low renal acid load diet on blood pressure, lipid profile, and blood glucose indices in patients with type 2 diabetes: a randomized clinical trial

BACKGROUND

Observational studies have reported that dietary renal acid load has an important role in insulin resistance and metabolic factors. The aim of the present study was to assess the effect of a low renal acid load diet (LRALD) on blood pressure, lipid profile, and blood glucose indices in patients with type 2 diabetes.

METHODS

In this parallel randomized clinical trial, 80 patients with type 2 diabetes were randomly assigned to the LRALD (n = 40) or control (n = 40) groups, for 12 weeks. Both groups received a balanced diet and a list of nutritional recommendations based on healthy eating behaviors. In the LRALD group, food items with low renal acid load were prescribed. Primary outcomes including: fasting blood glucose (FBG), hemoglobin A1c (HbA1c), fasting serum insulin, quantitative insulin sensitivity check index (QUICKI), homeostatic model assessment for insulin resistance (HOMA) and secondary outcomes including: weight, systolic blood pressure (SBP), diastolic blood pressure (DBP), triglyceride (TG), total cholesterol (TC), low-density lipoprotein (LDL), and high-density lipoprotein (HDL). were measured at baseline and end of the study. The present trial was registered at IRCT.ir (IRCT20130903014551N5).

RESULTS

Seventy subjects completed the study (n = 35 in control group and n = 36 in LRALD). Weight (P < 0.001), body mass index (P < 0.001), FBG (P < 0.001), HbA1c (P < 0.001), SBP (P = 0.004), and TG (P = 0.049) were reduced and HDL (P = 0.002) was increased in both groups, compared with baseline. After adjusting for baseline values, DBP (P = 0.047) was reduced in the LRALD group compared with control group. Results had no changes after using intention to treat analysis.

CONCLUSION

A LRALD may decrease DBP in type 2 diabetic patients. However, it elicited no significant effect on lipid profile compared with a healthy diet.

TRIAL REGISTRATION

This randomized clinical trial was registered at IRCT.ir (IRCT20130903014551N5).

Association between Physical Activity, Body Composition, and Metabolic Disorders in Middle-Aged Women of Ksar el Kebir (Morocco)

This study aimed to examine the association between physical activity (PA), body composition, and metabolic disorders in a population of Moroccan women classified by menopausal status. This cross-sectional study comprised 373 peri- and postmenopausal women aged 45-64 years old. PA levels were assessed using the short version of the International Physical Activity Questionnaire (IPAQ-SF). Body composition and metabolic disorders were assessed by measurements of anthropometric and biological parameters: weight, body mass index (BMI), waist circumference (WC), hip circumference (HC), WC/HC ratio, percent body fat, systolic and diastolic blood pressure, fasting blood glucose, and serum lipids (total cholesterol (TC), triglycerides (TG), HDL-C, and LDL-C). Metabolic syndrome (MetS) was diagnosed according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) criteria. Pearson correlations were used to test for associations. The mean total PA score of perimenopausal women was 1683.51 ± 805.36 MET-min/week, and of postmenopausal women was 1450.81 ± 780.67 MET-min/week. In all participants, peri- and postmenopausal women, PA was significantly and inversely associated with BMI, weight, percent body fat, HC, WC, and number of MetS components (p < 0.01), and with fasting blood glucose, TC, TG, and LDL-C (p < 0.05). The frequencies of metabolic disorders, obesity, abdominal obesity, type 2 diabetes, dyslipidemia, and MetS were significantly lower at moderate and intense levels of PA (p < 0.05), in also all participants. In middle-aged women, particularly those who are peri-menopausal, PA at moderate and intense levels is associated with more favorable body composition and less frequent metabolic disorders. However, in this particular study, PA does not appear to be associated with blood pressure and HDL-C concentrations. Future studies may be needed to further clarify these findings.

Associations between physical activity levels with nutritional status, physical fitness and biochemical indicators in older adults

BACKGROUND & AIMS

A sedentary lifestyle is one of the major health concerns of all societies that is associated by an increased risk of cardiovascular diseases. In this regard, we compared the anthropometric parameters, physical fitness (PF), lipid profile, and nutritional status of older adults with different levels of physical activity (PA).

METHODS

In this cross sectional study, 220 older people (age: 67.39 ± 2.08 yrs) according to their PA levels had been categorized at high (n = 72), moderate (78) and low (n = 70) PA groups. The International Physical Activity Questionnaires and food frequency questionnaire has been used to determine the PA and nutritional status, respectively. Waist and hip circumference, height, weight, and body mass index of subjects were measured and calculated. Both lower and upper body strength, flexibility, static and dynamic balance, and endurance performance factors were used to determine the level of PF. To assess blood biochemical factors, subjects were asked to visit the laboratory after 12 h of fasting.

RESULTS

The results showed waist circumference, hip circumference, and body fat percent were significantly lower in the high PA group compared to the low PA group in both males and females (P ≤ 0.05). Upper body strength, lower body strength, static balance, dynamic balance flexibility and endurance were significantly better in the high PA group compared to the low PA group in both males and females (P ≤ 0.05). Moreover, triglyceride was significantly lower in the high PA group compared to the low PA group in both males and females (P ≤ 0.05). According to the post hoc results, high-density lipoprotein, low-density lipoprotein and fasting glucose were significantly better in the high PA group compared to the low PA group in both males and females (P ≤ 0.05). All participants regardless PA levels showed insufficient consumption of zinc, calcium, vitamin E, and vitamin D (P ≤ 0.05). On the other hand, carbohydrate, sodium, iron, vitamin C and niacin intake significantly above recommended dietary allowance (P ≤ 0.05).

CONCLUSIONS

The results of the current work showed that a higher level of PA improved anthropometric indicators, PF, and lipid profile in Iranian older adults. Moreover, older nutrition should be monitor to maintain their physical health and to prevent them from developing chronic diseases and their malnutrition complications.

Food insecurity and glycemic control in individuals with diagnosed and undiagnosed diabetes in the United States

AIMS

Investigate the relationship between food insecurity and glycemic control in adults with diagnosed and undiagnosed diabetes.

METHODS

Using National Health and Nutrition Examination Survey (NHANES) between 2003-2016, food insecurity was measured using the household food insecurity scale. Glycemic control was measured using glycated hemoglobin (HbA1c) collected during the NHANES examination. Individuals were categorized into undiagnosed diabetes or diagnosed diabetes based on their measured HbA1c and response to whether they were told by a doctor or other health professional they have diabetes or were taking medications for diabetes. Sampling weights and survey procedures were used when conducting univariate and multivariable models using SAS version 9.4.

RESULTS

Approximately 13.7% of the population sample (35,216 adults representing 207,271,917 US adults) reported food insecurity. Reporting food insecurity was associated with 0.37 higher HbA1c for diagnosed (95% CI 0.15-0.60) and 0.45 higher HbA1c for undiagnosed diabetes (95% CI 0.05-0.85). In the undiagnosed diabetes population, those reporting food insecurity had 80% higher likelihood of HbA1c above 7% (OR = 1.80, 95% CI 1.06-3.06).

CONCLUSIONS

Food insecurity had a stronger relationship with HbA1c for those with undiagnosed diabetes. Results suggest the importance of screening for individuals with food insecurity that may be at high risk for having undiagnosed diabetes.

A predictive model incorporating the change detection and Winsorization methods for alerting hypoglycemia and hyperglycemia

This paper focuses on establishing an effective predictive model to quickly and accurately alert hypoglycemia and hyperglycemia for helping control blood glucose levels of people with diabetes. In general, a good predictive model is established on the features of data. Inspired by this, we first analyze the characteristics of continuous glucose monitoring (CGM) data by the equality of variances test and outlier detection, which show time-varying fluctuations and jump points in CGM data. Therefore, we incorporate the change detection method and the Winsorization method into the predictive model based on the autoregressive moving average (ARMA) model and the recursive least squares (RLS) method to fit the above characteristics. To the best of our knowledge, the proposed method is the first attempt to give a solution for matching the time-varying fluctuations and jump points of CGM data simultaneously. A case study using CGM data is given to validate the effectiveness of the proposed method under 30-min-ahead prediction. The results show that the proposed method can improve the true alarm ratio of hypoglycemia and hyperglycemia from 0.7983 to 0.8783, and lengthen the average advance detection time of hypoglycemia and hyperglycemia from 19.77 to 22.64 min.

Residential Street Block Disorder and Biological Markers of Aging in Older Adults: The National Health and Aging Trends Study

BACKGROUND

Residential environments are associated with older adult health, but underlying physiologic causal mechanisms are not well understood. As adults age, street blocks are likely more relevant to their health than the larger neighborhood environment. This study examined the effects of adverse street block conditions on aging biomarkers among older adults.

METHODS

We included community-dwelling Medicare beneficiaries aged 67 and older with 2017 biomarker data from the nationally representative National Health and Aging Trends Study (n=4,357). Street block disorder in 2016 was measured using interviewer report of any trash/glass/litter, graffiti, or vacant buildings on participants' blocks. Propensity score models were used to create balanced groups with regard to multiple 2015 participant characteristics, including demographic, socioeconomic, residence, and early life characteristics. Linear regressions modeled street block disorder as a predictor of four aging biomarkers, hemoglobin A1C, high-sensitivity C-reactive protein, interleukin-6, and cytomegalovirus antibodies, before and after applying propensity score weighting.

RESULTS

Adjusting for participant sociodemographic characteristics and applying propensity score weights, living on a block with any disorder was associated with 2% higher mean hemoglobin A1C levels (95% CI: 0.002-0.03), 13% higher C-reactive protein (95% CI: 0.03-0.23), 10% higher interleukin-6 (95% CI: 0.02-0.19), and 19% more cytomegalovirus antibodies (95% CI: 0.09-0.29) compared to living on a block with no disorder.

CONCLUSIONS

Street block disorder predicted subsequent aging biomarkers after applying a propensity score approach to account for confounding among a national sample of older adults. Targeting street-level residential contexts for intervention may reduce risk for poor health in older adults.

Demographic, Anthropometric and Food Behavior Data towards Healthy Eating in Romania

Background: Each country has specific social, cultural, and economic characteristics regarding the motivations for improving health. The aim of this study was to evaluate demographic characteristics, anthropometric data, and elements related to food behavior and health, as well as Romanians’ motivations towards healthy eating. Methods: This is a descriptive cross-sectional questionnaire based study enrolling 751 Romanian participants, which was carried out in in 2017–2018. Results: We obtained a positive correlation between age and Body Mass Index, and this was maintained also when we analyzed the two genders separately, being, however, even stronger for women. The number of hours/day spent watching TV or in front of the computer was positively correlated with both age and BMI. In general, with aging, there is an increasing concern regarding the practice of a healthy diet. The higher education level was significantly associated with healthier choices. Conclusions: The study of the three dietary dimensions, food properties, health attitudes, and dietary behavior, vis-à-vis various disorders revealed that the group most concerned of their diet was those who suffered from cardiovascular disorders.

Associations of early-life exposure to famine with abdominal fat accumulation are independent of family history of diabetes and physical activity

The present study aimed to investigate the association of early-life exposure to famine with abdominal fat accumulation and function and further evaluate the influence of first-degree family history of diabetes and physical activity on this association. The present work analysed parts of the REACTION study. A total of 3033 women were enrolled. Central obesity was defined as waist circumferences (W) ≥ 85 cm. Chinese visceral adiposity index (CVAI) was used to evaluate visceral adipose distribution and function. Partial correlation analysis showed BMI, W, glycated Hb and CVAI were associated with early-life exposure to famine (both P < 0·05). Logistic regression showed that the risks of overall overweight/obesity and central obesity in fetal, early-childhood, mid-childhood and late-childhood exposed subgroups were increased significantly (all P < 0·05). Compared with the non-exposed group, the BMI, W and CVAI of fetal, early- to late-childhood exposed subgroups were significantly increased both in those with or without first-degree family history of diabetes and in those classified as physically active or inactive, respectively (all P < 0·05). The associations of BMI, W and CVAI with early-life exposure to famine were independent of their associations with first-degree family history of diabetes (all P < 0·01) or physical activity status (all P < 0·001). Early-life exposure to famine contributed to abdominal fat accumulation and dysfunction, which was independent of the influence of genetic background and exercise habits. Physical activity could serve as a supplementary intervention for women with high risk of central obesity.

Inverse association between physical activity and blood glucose is independent of sex, menopause status and first-degree family history of diabetes

AIMS/INTRODUCTION

Exercise training is a recognized strategy central to the prevention, treatment, and management of diabetes and prediabetes. The aim of the present study was to investigate the association between physical activity and blood glucose, as well as the influence of sex, menopause status and family history of diabetes.

MATERIALS AND METHODS

Participants with normal weight were selected from Risk Evaluation of Cancers in Chinese Diabetic Individuals: A Longitudinal Study, and divided into inactive (moderate-to-vigorous-intensity physical activity [MVPA] <30 min/week), low-degree (MVPA ≥30 and ≤420 min/week) and high-degree (MVPA >420 min/week) activity groups.

RESULTS

A total of 2,601 individuals with an average age of 57.85 ± 8.39 years were enrolled. Multivariate anova uncovered that after adjustment for sex and menopause status, and family history of diabetes, respectively, fasting plasma glucose, 2-h plasma glucose and glycated hemoglobin A1c decreased through inactive, low-degree and high-degree activity groups (all P for trend <0.05). The association of blood glucose indexes with physical activity was independent of this association with sex and menopause status, and first-degree family history of diabetes, respectively. Multivariate linear regression analyses showed that MVPA was an independent factor associated negatively with fasting plasma glucose, 2-h plasma glucose and glycated hemoglobin A1c, respectively (all P < 0.01).

CONCLUSIONS

A higher degree of physical activity was associated with lower blood glucose regardless of sex, menopause status and first-degree family history of diabetes. MVPA is a negative factor associated with blood glucose independently. Physical activity of adequate duration and intensity is strongly recommended to individuals with susceptibility to diabetes as a result of sex and family history, but without overweight/obesity.

Commitment Lotteries Promote Physical Activity Among Overweight Adults-A Cluster Randomized Trial

Background

The World Health Organization has identified physical inactivity as the fourth leading risk factor for global mortality. People often intend to engage in physical activity on a regular basis, but have trouble doing so. To realize their health goals, people can voluntarily accept deadlines with consequences that restrict undesired future behaviors (i.e., commitment devices).

Purpose

We examined if lottery-based deadlines that leverage regret aversion would help overweight individuals in attaining their goal of attending their gym twice per week. At each deadline a lottery winner was drawn from all participants. The winners were only eligible for their prize if they attained their gym-attendance goals. Importantly, nonattending lottery winners were informed about their forgone prize. The promise of this counterfactual feedback was designed to evoke anticipated regret and emphasize the deadlines.

Methods

Six corporate gyms with a total of 163 overweight participants were randomized to one of three arms. We compared (i) weekly short-term lotteries for 13 weeks; (ii) the same short-term lotteries in combination with an additional long-term lottery after 26 weeks; and (iii) a control arm without lotteries.

Results

After 13 weeks, participants in the lottery arms attained their attendance goals more often than participants in the control arm. After 26 weeks, we observe a decline in goal attainment in the short-term lottery arm and the highest goal attainment in the long-term lottery arm.

Conclusions

With novel applications, the current research adds to a growing body of research that demonstrates the effectiveness of commitment devices in closing the gap between health goals and behavior.

Clinical Trial information

This trial is registered in the Dutch Trial Register. Identifier: NTR5559

Effect of Sedentary Lifestyle on Cardiovascular Disease Risk Among Healthy Adults With Body Mass Indexes 18.5 to 29.9 kg/m2

A substantial proportion of adults at healthy body mass index (BMI) are potentially at high risk for cardiovascular disease (CVD). The objective of this study is to determine if sedentary lifestyle characteristics in healthy weight adults increase their likelihood of being at high CVD risk to that of individuals who are overweight. Adults aged 40 to 79 years in the 2011 to 2016 National Health and Nutrition Examination Survey at a healthy BMI (18.5 to 24.9) and overweight BMI (25 to 29.9; unweighted n = 4,572; weighted n = 43,919,354) were analyzed. The American College of Cardiology/American Heart Association atherosclerotic CVD risk score was used to assess CVD risk. For individuals with a BMI 18.5 to 24.9, 29.6% had increased risk of a CVD event. In logistic regressions adjusted for age, race, gender, education, poverty/income ratio, insurance status, and number of visits to a healthcare provider in the past year, individuals with unhealthy sagittal abdominal diameter (odds ratio [OR] 2.44; 95% confidence interval [CI], 0.97 to 6.14), shortness of breath upon exertion (OR 1.35; 95% CI, 0.65 to 2.79), unhealthy waist circumference (OR 0.99; 95% CI, 0.60 to 1.61), and less than recommended levels of physical activity (OR 0.73; 95% CI, 0.43 to 1.23) were not significantly different than overweight adults in being at high risk for CVD events. Individuals with healthy characteristics and a BMI 18.5 to 24.9 were significantly less likely than overweight adults to be at high risk for CVD. In conclusion, the findings suggest that in individuals at a BMI 18.5 to 24.9, characteristics of a sedentary lifestyle increase the likelihood of being at high risk for CVD to that of overweight individuals.

An Exploration of Sensation Seeking in Persons With Disabilities in Rehabilitation

PURPOSE

This study reports the findings of a study about sensation-seeking or high-risk/challenging sports in persons who have disabilities.

DESIGN

Exploratory, cross-sectional, and descriptive.

METHODS

Two hundred and twenty-three recruitment e-mails were sent to potential participants. Data were collected through Qualtrics.

FINDINGS

Mean score for Contextual Sensation Seeking Questionnaire for Skiing and Snowboarding (M = 30.21, SD = 8.18) was significantly lower than a sample of able-bodied skiers and snowboarders, t(239) = 2.75, p = .006. Mean for impulsive sensation seeking was lower than the same sample of able-bodied athletes cited in a previous study, t(240) = 4.56, p = .001. Means for the Zuckerman Kuhlman Personality Questionnaire subscales were impulsivity (M = 1.98, SD = 4.05) and sensation seeking (M = 6.75, SD = 2.68).

CONCLUSIONS

This group scored lower in sensation seeking compared to able-bodied high-risk/challenging sports activities participants. Sensation seeking is not a motivating factor in this sample.

CLINICAL RELEVANCE

Nurses could encourage rehabilitation patients to engage in challenging activities for personal and group mastery.

Informational value of percent body fat with body mass index for the risk of abnormal blood glucose: a nationally representative cross-sectional study

OBJECTIVE

To examine the value of percent body fat (%BF) with body mass index (BMI) to assess the risk of abnormal blood glucose (ABG) among US adults who are normal weight or overweight. We hypothesised that normal-weight population with higher %BF is more likely to have ABG.

DESIGN

A cross-sectional study.

SETTING

National Health and Nutrition Examination Survey, 1999-2006, conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention.

PARTICIPANTS

Participants were US adults aged 40 and older who have never been diagnosed with type 2 diabetes by a doctor (unweighted n=6335, weighted n=65 705 694). The study population was classified into four groups: (1) normal weight with normal %BF, (2) normal weight with high %BF, (3) overweight with normal %BF and (4) overweight with high %BF.

MAIN OUTCOME MEASURES

ORs for ABG including pre-diabetes and undiagnosed diabetes (HbA1c ≥5.7%, ≥39 mmol/mol).

RESULTS

64% of population with normal BMI classification had a high %BF. Prevalence of ABG in normal-weight group with high %BF (13.5%) is significantly higher than the overweight group with low %BF (10.5%, P<0.001). In an unadjusted model, the OR of ABG was significantly greater in adults at normal BMI with high %BF compared with individuals at normal weight with low %BF. In an adjusted model controlling for age, sex, race/ethnicity, first-degree-relative diabetes, vigorous-intensity activities and muscle strengthening activities, risks of ABG were greater in population with normal weight and high %BF (OR 1.55, 95% CI 1.01 to 2.38) and with overweight and low %BF (OR 1.17, 95% CI 0.69 to 1.98, P<0.05).

CONCLUSIONS

Integrating BMI with %BF can improve in classification to direct screening and prevention efforts to a group currently considered healthy and avoid penalties and stigmatisation of other groups that are classified as high risk of ABG.