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iConcept Journal of Emerging Issues in Medical Diagnosis and Treatment
Title
iConcept Journal of Emerging Issues in Medical Diagnosis and Treatment
Editor
Eugenia Giannopoulou
ISSN
2309-3528
Publisher
iConcept Press

iConcept Journal of Emerging Issues in Medical Diagnosis and Treatment

Behavioral Risk Factors and Effects of Lifestyle Modification on Adults with Diabetes: A Brazilian Community-based Study

by Roberto Carlos Burini, Gabriel Augusto Torezan and Kátia Cristina Portero McLellan

Volume: 2 (2013); Issue: 4

Abstract

Lifestyle is directly related to the incidence of type 2 diabetes mellitus (DM-2), a risk dramatically elevated by obesity and inactivity. Several studies have verified that educational interventions can delay the onset of DM-2. Some of the interventions strategies utilized medication and diet, diet and/or physical exercise or the combination of diet and exercise, generally referred to a change in lifestyle. Despite the evidence that DM-2 can be preventive, there is still limited availability of effective prevention programs. DM-2 is considered an emerging public health problem as it is estimated that by the year of 2030 there will be about 366 million people with diabetes worldwide. In the concept of thrifty genotype the diabetic is exceptionally efficient in the intake or utilization of food with basic difference of a quick insulin trigger in response to hyperglycemia. The survival benefit of this phenotype was to minimize urinary glucose loss when fasting was replaced by feasting, leading to the more efficient utilization of food and storage of energy. A quick insulin trigger that helped primitive man survive famine by storing energy more efficiently, now leads to obesity, and eventually to DM-2. Besides this theory (Neel 1962) focusing on energy storage thus allowing primitive man to survive a fast longer, there is another theory (Cahill & Wen 1967) focusing on maintaining muscle mass. According to the latter the more efficient one in conserving muscle protein the better chances to withstand prolonged periods of deprivation, to be able to hunt successfully and to escape it preyed upon. The quick insulin trigger and ensuring hyperinsulinemia, when fasting, decreases urinary loss of glucose, and leads to enhanced energy storage. The consequences for a modern man, faced with a longer life-span, high-dense food intake and decreased physical activity are obesity and acquired insulin resistance, followed by beta-cell failure and onset DM-2. Skeletal muscle takes 80% of insulin-dependent glucose uptake. Hence muscle insulin resistance conserves glucose for utilization by the central nervous system decreasing the amount of muscle protein needed to be converted to glucose (neoglucogenesis). It is postulated that the more insulin resistance an individual, the more efficient will be their ability to decrease proteolysis (and preserve lean body mass) when faced with caloric deprivation. Although a useful survival advantage or primitive man this phenotype predicts an inability to maintain normal glucose homeostasis in modern human. However available evidence strongly supports the view that muscle insulin resistance is, at least to some extent, a genetically determined characteristic. The Botucatu Longitudinal Study (BLS) on Healthy Lifestyle Promotion as a primary care for non-communicable chronic diseases (Move for Health – Mexa-se Pró-saúde) is an ongoing epidemiological study in Botucatu - SP, Brazil. Patients are screened for chronic diseases and are submitted to assessments of physical activity readiness (PAR-Q), clinical, anthropometric, dietary, physical activity, blood analysis, fitness (aerobic, strength and flexibility), and postural at baseline and after intervention (daily sessions of supervised exercises and dietary counseling). A recent study conducted with 1003 individuals clinically selected to participate on our lifestyle changing program “Move for Health” aimed to identify biochemical and anthropometric factors associated with impaired fasting glucose (IFG) and type 2 diabetes (DM-2). The results showed that abdominal obesity, high blood pressure, elevated plasma concentrations of triglycerides, uric acid, and low density lipoprotein cholesterol, and decreased plasma concentration of high density lipoprotein cholesterol are associated with an increased risk for IFG and DM-2. Another study or our group found positive associations of insulin resistance (HOMA-IR) with waist circumference, dietary fat intake, low dietary fiber intake, low muscle mass, elevated plasma concentration of uric acid, and presence of metabolic syndrome on adults. The determinants of insulin resistance among these individuals were related with modifiable factors that could be preventable with an effective lifestyle intervention program. According to our BLS data, eight weeks of physical exercise and food energy adequacy increased insulin sensitivity in high-insulinemic obese women. Moreover, lifestyle modification associated with physical conditioning is able to reduce efficiently the prevalence of IFG on hyperglycemic-overweight adults after 6 months of intervention. DM2 remains a leading cause of cardiovascular disorders and many other complications. Our intent with this chapter is to present researches and strategies (diet and physical activity interventions) that successfully improved plasma glucose control as a result of an effective lifestyle intervention program.

Author Details

Roberto Carlos Burini
Department of Public Health, School of Medicine, Sao Paulo State University, Brazil, Brazil
Gabriel Augusto Torezan
Department of Public Health, School of Medicine, Sao Paulo State University, Brazil, Brazil
Kátia Cristina Portero McLellan
Department of Public Health, School of Medicine, Sao Paulo State University, Brazil, Brazil

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