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Endocrine > Diet and lifestyle > Flashcards

Diet and lifestyle Flashcards

1
Q

what is lifestyle medicine?

A

Lifestyle medicine is an
evidence based medical
specialty that uses lifestyle
therapeutic approaches to
prevent, treat, or modify
non-communicable chronic
diseases.

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2
Q

what is the difference between public health, lifestyle and conventional medicine?

A
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3
Q

what are non communicable diseases?

A

Noncommunicable diseases (NCDs), also known as chronic
diseases, tend to be of long duration and are the result of a
combination of genetic, physiological, environmental and
behaviours factors (WHO 2020)

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4
Q

what are the main types of non communicable diseases?

A
  • Cardiovascular diseases
  • Cancer
  • Chronic respiratory disease
  • Diabetes
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5
Q

how many people die due to non communicable diseases annually?

A

Annually, 41 million people die due
to NCDs
- that’s more than 70% of all
deaths worldwide

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6
Q

does CVD and diabetes cause a higher mortality rate in women or men?

A

women

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7
Q

what are contributions of behavioural, metabolic, and
environmental risk factors to death and disability?

A
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8
Q

what types of food have a high dietary risk?

A

Fast-foods
Sweetened beverages
Processed meat
Red meat
Sweets

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9
Q

what types of food have a low dietary risk?

A

Whole grains
Fruit
Vegetables
Legumes
Dairy (Ca)
Fish

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10
Q

how are dietary risks identified?

A

Dietary risks are identified as number one group of factors
contributing to death and DALY (disability adjusted life years)

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11
Q

what are the most protective dietary patterns?

A

The evidence suggests that the most protective dietary patterns
are those similar to Mediterranean, DASH and Plant-based
patterns, while the Western dietary pattern has been shown to
have unfavorable effect on most health outcomes

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12
Q

what type of diet has an unfavourable effect on most health outcomes?

A

western diet?

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13
Q

what is the relationship between BMI and risk of developing type 2 diabetes?

A
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14
Q

what was one of the first studies to investigate diabetes as a risk factor for CHD?

A

The role of diabetes in the pathogenesis of
cardiovascular disease (CVD) was unclear
until 1976 when Kannel et al used data from
the Framingham Heart Study (FHS) to
identify diabetes as a major cardiovascular
risk factor.

It was also one of the first studies to demonstrate the higher risk of CVD in women with diabetes compared to
men with diabetes.

Since then, multiple studies have been done to recognize and curtail cardiovascular risk factors such as
smoking, obesity, hypertension, hyperlipidemia, and insulin resistance

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15
Q

The mechanisms by which obesity increases the risk of CVD are not yet fully understood… what is understood?

A

It is understood that people with diabetes are at increased risk of CVD and
the presence of obesity increases that risk.

Obesity is a complex condition and patients are often ill-served by simplistic
“eat less move more” messages

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16
Q

what is crucial to the management of diabetes?

A

Dietary intervention is crucial to the management of obesity and it is
becoming better understood how nutrition can be manipulated, for example
with the addition of MUFAs and PUFAs or manipulations of macronutrients
to address some of the factors exacerbating obesity and CV risk.

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17
Q

what is the rapid rise in obesity liekely due to?

A

The rapid rise in obesity is likely not due to a major genetic defect, rather,
lifestyle choices/changes

A plentiful supply of energy dense food and a sedentary lifestyle
predisposes people to weight gain (and makes it difficult to lose weight)

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18
Q

what strain does diabetes place on the nhs?

A

Consequences of diabetes - Type 2 diabetes places a huge strain
on the NHS accounting for just under 9% of the annual NHS budget
at around £8.8 billion a year

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19
Q

Diabetes prevention (or rather a delay in onset ?)

A
  • Much debate centred on whether any of the so-called diabetes
    prevention trials are actually reporting disease prevention or simply
    a delay in the time of disease onset.
  • The term ‘prevention’ is often interpreted as meaning stopping
    diabetes from ever happening…
  • Major public health impact (but need to consider impact at an
    individual level…?)
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20
Q

what lifestule changes have promoted the rise in diabetes?

A

Physical activity has decreased and more time is spent on screen-based and sedentary leisure activities

The unhealthy lifestyle choices we have increasingly been defaulting to all give rise to modifiable risk factors for Type 2 diabetes, which are primarily overweight and obesity (BMI of 25 or more) and a large waist circumference
(abdominal obesity)

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21
Q

what risk factors cannot be controlled or prevented with type 2 diabetes?

A
  • a family history of Type 2 diabetes
  • age – being older than 40 or older than 25 for some black and minority
    ethnic (BME) groups
  • certain ethnicities
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22
Q

what is the eatwell guide?

A

The Eatwell Guide
highlights the different
types of food that make
up our diet, and shows
the proportions we should
eat them in to have a
healthy, balanced diet.

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23
Q

How do diet recommendations differ for healthy eating and Type 2 diabetes ?

A
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24
Q

is there such a thing as a diabetic diet?

A

Healthy eating approach

‘Enjoy Food is our healthy eating resource for everyone – whether you have Type
1, Type 2 or another type of diabetes. It’s also relevant if you a are newlydiagnosed or have been told you are at risk of diabetes.’

healthy, balanced diet.

25
Q

what is the link between dietary factors and health?

A
26
Q

what dietary recommendations have been made for red meat, fat, tran fatty acids, total carbs in the uk?

A
27
Q

what issues does scotland have with physical inactivity?

A
28
Q

what is the physical activity guidelines for adults?

A
29
Q

what are active / sit less guidelines for adults ages 19-64?

A

BE ACTIVE/SIT LESS
At least 150 minutes of moderate
aerobic activity such as cycling or fast
walking every week,
AND
Strength exercises on two or more
days a week that work all the major
muscles (legs, hips, back, abdomen,
chest, shoulders and arms)

30
Q

what are build stregnth/improve balance guidelines for adults ages 19-64?

A

75 minutes of vigorous aerobic activity,
such as running or a game of singles
tennis every week,
AND
Strength exercises on two or more
days a week that work all the major
muscles (legs, hips, back, abdomen,
chest, shoulders and arms).

31
Q

what are other guidelines for adults ages 19-64 on excersize?

A

A mix of moderate and
vigorous aerobic activity every
week. For example, two 30-
minute runs plus 30 minutes of
fast walking equates to 150
minutes of moderate aerobic
activity,
AND
strength exercises on two or
more days a week that work all
the major muscles (legs, hips,
back, abdomen, chest,
shoulders and arms).

32
Q

People who are at least moderately active have a —– lower risk of developing type 2?

A

30-40%

33
Q

how many people in the uk are meeting physical activity guidelines?

A

Proportion of UK adults (16+) meeting physical activity guidelines, 2008-2015

  • In 2015, 63% of adults aged 16 and over met the current moderate/vigorous
    physical activity (MVPA) guideline
  • There has been no significant change to this proportion since 2012. Men were
    more likely than women to meet the guideline (67% compared to 59%).
  • The gap was widest within the oldest age group: 42% of men aged 75+ met the
    guideline, compared with 23% of women of the same age
34
Q

Interaction between PA and glucose metabolism to influence health
- Effect of an acute bout of exercise

A

A bout of endurance-type exercise increases glucose transport into muscle

  • Insulin-stimulated glucose uptake is also elevated for at least 16 hours with
    higher whole-body insulin sensitivity detectable for 3 days post-exercise
  • Although exercise timing should be considered, the window over which
    exercise exerts a glucoregulatory effect spans many meals (~3 days), and thus
    its effect on the first or even second eating occasion (~6 hours) must be
    interpreted accordingly
  • Exercise is widely acknowledged as a potent and non-pharmacological
    strategy for increasing muscle insulin sensitivity and improving postprandial
    glucose contro
35
Q

People who are at least moderately active have a 30% to 40% lower
risk of type 2 diabetes, what mechanism is behind this?

A

Mechanisms - The influence of exercise on postprandial glucose and triacylglycerol
metabolism
* Skeletal muscle plays an important role in regulating the storage and/or oxidation
of glucose and TAG during the postprandial period
* Insulin plays a central role in this regulation
* Reductions in peripheral insulin sensitivity leads to abnormalities in glucose and
TAG metabolism and is the first detectable defect in the pathogenesis of metabolic
diseases, such as type 2 diabetes
* Acutely, exercise is a potent stimulus of muscle glucose and TAG uptake due to the
increased energy demands of the activity, and adaptations to regular training also
benefit postprandial metabolism

36
Q

what is the interaction between PA and metabolism to influence health
–Effect of regular exercise training?

A
  • In healthy humans, endurance-type exercise training increases insulin sensitivity
    allowing postprandial blood glucose to be regulated with lower insulin levels
  • In humans with impaired glucose tolerance, similar training can also improve oral
    glucose tolerance although this may be dependent on the extent of glucose
    intolerance at baseline and the exercise
  • Enhancing the efficacy of exercise?
  • Many individuals fail to meet physical activity recommendations, with a lack of
    time often cited as a barrier
  • Therefore, whilst exercise volume (exercise duration - exercise intensity - exercise
    frequency) is likely the main determinant of the magnitude of improved glycaemic
    responses,
  • strategies to maximise the benefits of ANY exercise performed are of interest
37
Q

how can you enhance the efficacy of exercise?

A
  • Many individuals fail to meet physical activity recommendations, with a lack of
    time often cited as a barrier
  • Therefore, whilst exercise volume (exercise duration - exercise intensity - exercise
    frequency) is likely the main determinant of the magnitude of improved glycaemic
    responses,
  • strategies to maximise the benefits of ANY exercise performed are of interest
38
Q

what different areas should be explored for diet and lifestyle treatment for type 2 diabetes?

A
  • Weight management is a key strategy for those with type 2 diabetes
  • A variety of weight management strategies are effective
  • The ideal amount of macronutrients is unknown
  • Carbohydrate management can improve glycaemic control
  • A variety of dietary patterns are associated with improved outcomes and
    individualised advice is recommended
39
Q

Dietary advice from your doctor or diabetes team about your diet, they will
often make suggestions in order to:

A
  • Provide a knowledge of healthy eating
  • Encourage lifestyle changes in order to reduce obesity and ensure
    optimal weight
  • Maintain blood glucose and lipids as near normal as possible
  • Reduce the acute (short term) complications of diabetes such as
    hypoglycaemia and hyperglycaemia
  • Reduce body weight, if appropriate
40
Q

why is the idea that eating too much sugar will give you type 2 diabetes a myth?

A

Despite some suggestions that a diet with a large proportion of high GI carbohydrates,
typically monosaccharides (i.e. simple sugars), may increase type 2 diabetes risk relative to a
diet containing more complex carbohydrates, this association is not always apparent in the
literature (need to consider whole diet and lifestyle factors)

41
Q

the idea that it doesnt matter what i ea?

A

Diets with high-fibre content have been associated with reduced risk of cardiovascular and
metabolic diseases

Humans ingesting 26 g of dietary fibre/day have been reported to have a 22% lower risk of
type 2 diabetes vs. those consuming 13 g/day

42
Q

what is the best dietary intervention is best for optimisinf glycaemic control?

A

Unclear which dietary intervention is best for optimising glycaemic control, or whether weight loss
itself is the main reason behind observed improvements.

43
Q

what is a systematic reveiw of randomised control trials?

A

Only four RCT indicated the benefit of a particular dietary intervention over another in
improving HbA1c levels, including the Mediterranean, vegan and low glycaemic index (GI)
diets.

44
Q

is there any evidence to suggest any particular diet is superior in treating overweight and obese patients?

A

no

45
Q

does weight loss help obese people?

A

Weight loss will help - the majority of published guidelines emphasise the importance of weight
loss for the 90% of those with type 2 diabetes who are overweight or obese, and of the three
macronutrients (carbohydrate, fat and protein)

  • Carbohydrate management has also been identified as a key strategy for blood glucose control
46
Q

There is strong evidence that improvements in glycaemic control in people with Type 2 diabetes are
associated with significant reductions in risk from both microvascular and macrovascular disease.

A

Unsurprisingly, the total mass (g) of carbohydrate ingested can predict the magnitude of the blood glucose response AND the
type (GI and GL) - a lower GI due to, in part, a slow digestion and release of glucose into the bloodstream.
* Carbohydrate management has also been identified as a key strategy for blood glucose control- carbohydrate consumption &
glycaemic control (carb counting)
* The United Kingdom Prospective Diabetes Study (UKPDS) reported that a reduction in HbA1c of 10 mmol/mol (0.9%) over
median 10 years was associated with a 12% reduction in risk from any diabetes-related end-point, a 25% reduction in risk from
microvascular disease and a 16% trend to reduced risk from myocardial infarction, and that these benefits were sustained
long-term.

47
Q

what does 24 hour blood glucose control do in type 2 diabetes?

A

trying to
reduce the time spent with elevated blood glucose

Even in populations defined as healthy individuals with higher postprandial glucose
levels relative to fasting have a ~10–20% increased risk of heart disease or stroke

48
Q

Concordant and divergent strategies to improve postprandial
glucose metabolism ; basics of nutrition (1)

A

Healthy humans in a fasted
resting state, blood glucose is
tightly regulated at around 4.6 g
or 4–5 mmol/l - with glucose
constantly entering and exiting
the bloodstream for use by
tissues such as brain, muscle and
adipose tissue

49
Q

Concordant and divergent strategies to improve postprandial
glucose metabolism ; basics of nutrition (1)

A
50
Q

Concordant and divergent strategies to improve postprandial
glucose metabolism ; basics of nutrition (1)

A
51
Q
A
52
Q

what is commonly seen newly diagnosed diabetes?

A
  • Larger reductions in HbA1c are commonly seen in those newly diagnosed
    with type 2 diabetes
  • In newly diagnosed people in the United Kingdom Prospective Diabetes
    Study (UKPDS) study, where the only intervention in the first three
    months was dietary therapy, mean weight losses of 4.5 kg were associated
    with a reduction in HbA1c of 2.0%
  • A Mediterranean- style diet study showed similar, sustained reductions in
    both HbA1c and weight at one year’s follow-up after diagnosis
53
Q

what is a mediterranean diet?

A

The Mediterranean diet (MedDiet) has been held up
over the last decade as an example of a good diet that
reduces the risk of CVD

54
Q

what is the PREDIMED?

A

The PREDIMED study made headlines in 2013 for having caused a substantial
reduction in cardiovascular disease.
This was a large study, with a total of 7447 individuals who were at a high
risk of cardiovascular disease. They were randomized to three different
diets:
*A Mediterranean Diet with added extra virgin olive oil (Med + Olive Oil)
*A Mediterranean Diet with added nuts (Med + Nuts)
*A low-fat control group
No one was instructed to reduce calories or increase physical activity. This
study went on for almost 5 years and many papers have been written about
it, some of them looking at different risk factors and end points.

55
Q

Dietary components of MedDiet

A

High consumption of vegetables
* High intake of fruit and nuts
* High consumption of legumes
* High intake of cereals
* High consumption of fish and seafood
* Low intake of meat and meat products
* Low intake of dairy products
* High ratio of monounsaturated fatty acids to saturated fats
* Moderate alcohol intake

56
Q
  • Key learning points
A
  • People with type 2 diabetes are at increased risk of CVD.
  • Obesity is a well-established risk factor and is associated with
    insulin resistance, hypertension, dyslipidaemia, inflammation and
    cardiac dysrhythmia.
  • There is little evidence for the most effective diet for weight loss
    and reducing CV risk, although there is now emerging evidence
    for the Mediterranean-style diet.
  • Weight loss can improve (reduce) CV risk.
57
Q

weigght loss nutritional therapy?

A

-Even a moderate weight loss of 5–10% has been shown to be
beneficial (clinically significant)

58
Q

how can weight loss be acheived?

A

To achieve weight loss, an energy deficit must occur, 500–
1000 kcal/day less than is required for weight maintenance
is recommended

59
Q

Dietary approaches in type 2 diabetes
Key learning poin

A
  • For the majority of people with type 2 diabetes, weight management is a key
    priority and this can be achieved by a variety of strategies with little evidence of
    superiority of any particular approach.
  • Weight loss is more effective in improving glycaemic control in those newly
    diagnosed with type 2 diabetes.
  • There is no evidence supporting specific amounts of fat, protein or carbohydrate in
    the diet for improving glycaemic control and an individualised approach is key.
  • Healthful eating patterns have been shown to improve both glycaemic and
    cardiovascular outcomes and these can be combined with carbohydrate
    monitoring and control to maximise benefit.

Endocrine (35 decks)

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