Irene Strychar

Barriers to physical activity among patients with type 1 diabetes

OBJECTIVE—To determine, in an adult population with type 1 diabetes, barriers to regular physical activity using a diabetes-specific barriers measure (the Barriers to Physical Activity in Diabetes [type 1] [BAPAD1] scale) and factors associated with these barriers. RESEARCH DESIGN AND METHODS—One hundred adults with type 1 diabetes answered a questionnaire assessing perceived barriers to physical activity and related factors. A1C was obtained from the medical chart of each individual. RESULTS—Fear of hypoglycemia was identified as being the strongest barrier to physical activity. Greater knowledge about insulin pharmacokinetics and using appropriate approaches to minimize exercise-induced hypoglycemia were factors associated with fewer perceived barriers. Greater barriers were positively correlated with A1C levels (r = 0.203; P = 0.042) and negatively with well-being (r = −0.45; P < 0.001). CONCLUSIONS—Fear of hypoglycemia is the strongest barrier to regular physical activity in adults with type 1 diabetes, who should therefore be informed and supported in hypoglycemia management.

Resistance Training Does Not Contribute to Improving the Metabolic Profile after a 6-Month Weight Loss Program in Overweight and Obese Postmenopausal Women

CONTEXT Limited data are available regarding the impact of caloric restriction (CR) in combination with resistance training (RT) on the metabolic profile of postmenopausal women. OBJECTIVE The objective of the study was to determine whether RT adds to CR in improving body composition and the metabolic profile. DESIGN AND SETTING This was a 6-month, randomized, clinical trial. PATIENTS Patients included 107 postmenopausal women (body mass index >27 kg/m(2)). INTERVENTION The intervention was a 6-month CR alone or in combination with a RT program. MAIN OUTCOME MEASURES Fat mass (FM), lean body mass (LBM), abdominal sc fat and visceral fat, fasting lipids, insulin sensitivity, resting blood pressure, and inflammation markers were measured. RESULTS Both groups were similar at baseline and significantly decreased body weight, body mass index, FM, percent FM, abdominal sc fat, and visceral fat after the study (P < 0.001), with greater losses of percent FM and trunk FM in the CR + RT group (P < 0.05). LMB significantly decreased in the CR (-0.9 +/- 2.4 kg) and the CR+RT (-0.4 +/- 2.2 kg) groups (P < 0.005), with no difference between them. Both groups significantly improved plasma triglycerides, fasting insulin level, glucose disposal, and markers of the inflammation profile after weight loss (P < 0.05), with no difference between groups. No improvements were observed for the other variables of interest in both groups. CONCLUSIONS CR+RT was associated with greater losses in percent FM and trunk FM compared with CR alone. However, CR+RT was not associated with additional improvements in the metabolic profile compared with CR alone.

The effect of the menopausal transition on body composition and cardiometabolic risk factors: a Montreal-Ottawa New Emerging Team group study

Objective Cardiovascular disease is the first cause of mortality in women in North America. The risk of cardiovascular disease increases sharply after middle age in women, especially after menopause. The aim was to investigate changes in body composition and cardiometabolic profile throughout the menopausal transition. Methods This was a 5-year observational, longitudinal study on the menopausal transition. The study included 102 premenopausal women at baseline (age, 49.9 ± 1.9 y; body mass index, 23.3 ± 2.2 kg/m2). Outcome measures include menopause status, body composition by dual-energy x-ray absorptiometry (total fat mass [FM], trunk FM, and total fat-free mass), waist circumference, visceral and abdominal subcutaneous fat, fasting glucose and insulin levels, homeostasis model assessment of insulin resistance, plasma lipid levels (triglycerides, total cholesterol, and high- and low-density lipoprotein cholesterol), and resting blood pressure. Results Repeated-measure analyses revealed significant increases for FM, percentage FM, trunk FM, visceral fat, plasma fasting glucose, and high-density lipoprotein cholesterol (0.05 > P < 0.01) and a significant decrease for plasma glucose levels after follow-up. Those who were in perimenopause or postmenopause by year 3 of the study showed a significant increase in visceral fat (P < 0.01) compared with baseline. Despite some significant changes in the metabolic profile among the menopause statuses, the women did not show any cardiometabolic deterioration by the end of the study. Conclusions Our results suggest that changes in body composition and fat distribution can occur in nonobese women as they go through the menopausal transition. However, these changes were not accompanied by cardiometabolic deteriorations in the present study.

Total peptide YY is a correlate of postprandial energy expenditure but not of appetite or energy intake in healthy women

Peptide YY (PYY) and ghrelin have been associated with the regulation of energy balance. The objectives of this study were to determine whether total ghrelin and PYY after a standardized meal predict appetite scores and ad libitum energy intake (EI) and to examine the relationship between total ghrelin and PYY and postprandial energy expenditure (PEE). Twenty-five premenopausal women (age, 50.4 +/- 2.0 years; body mass index, 23.5 +/- 2.2 kg/m(2)) were studied. Total PYY, total ghrelin (enzyme-linked immunosorbent assay), EE (indirect calorimetry), and appetite scores (visual analogue scales) were measured fasting and every 30 minute for 3 hours after the ingestion of a standardized breakfast. Ad libitum EI was measured at lunch with a buffet-type meal. Peptide YY increased (P < .001) and total ghrelin decreased (P < .001) after breakfast. Significant changes in EE (P < .001) and appetite scores (P < .001) were noted postprandially. Appetite scores were consistently associated with ad libitum EI at lunch (r = -0.51 to 0.40, P < .05), whereas no association between EI and prelunch total ghrelin and PYY was observed. Finally, partial correlation analyses revealed that total PYY was a significant independent correlate of PEE at 60, 90, 120, and 150 minutes (r = 0.37-0.51, P </= .05). These findings provide evidence that appetite scores are better correlates of EI than are circulating levels of total PYY or ghrelin and that total PYY could be involved in the regulation of PEE.

Association between neighborhood-level deprivation and disability in a community sample of people with diabetes.

OBJECTIVE The objective of the present study was to analyze the association between neighborhood deprivation and self-reported disability in a community sample of people with type 2 diabetes. RESEARCH DESIGN AND METHODS Random digit dialing was used to select a sample of adults with self-reported diabetes aged 18–80 years in Quebec, Canada. Health status was assessed by the World Health Organization Disability Assessment Schedule II. Material and social deprivation was measured using the Pampalon index, which is based on the Canadian Census. Potential risk factors for disability included sociodemographic characteristics, socioeconomic status, social support, lifestyle-related factors (smoking, physical activity, and BMI), health care–related problems, duration of diabetes, insulin use, and diabetes-specific complications. RESULTS There was a strong association between disability and material and social deprivation in our sample (n = 1,439): participants living in advantaged neighborhoods had lower levels of disability than participants living in disadvantaged neighborhoods. The means ± SD disability scores for men were 7.8 ± 11.8, 12.0 ± 11.8, and 18.1 ± 19.4 for low, medium, and high deprivation areas, respectively (P < 0.001). The disability scores for women were 13.4 ± 12.4, 14.8 ± 15.9, and 18.9 ± 16.2 for low, medium, and high deprivation areas, respectively (P < 0.01). Neighborhood deprivation was associated with disability even after controlling for education, household income, sociodemographic characteristics, race, lifestyle-related behaviors, social support, diabetes-related variables, and health care access problems. CONCLUSIONS The inclusion of neighborhood characteristics might be an important step in the identification and interpretation of risk factors for disability in diabetes.

Anthropometric, metabolic, dietary and psychosocial profiles of underreporters of energy intake: a doubly labeled water study among overweight/obese postmenopausal women--a Montreal Ottawa New Emerging Team study.

Background/Objectives:To analyze the anthropometric, metabolic, psychosocial and dietary profiles of underreporters, identified by the doubly labeled water technique, in a well-characterized population of overweight and obese postmenopausal women.Subjects/Methods:The study population consisted of 87 overweight and obese sedentary postmenopausal women (age: 57.7±4.8 years, body mass index: 32.4±4.6 kg/m2). Subjects were identified as underreporters based on the energy intake to energy expenditure ratio of <0.80. We measured (1) body composition (by dual-energy X-ray absorptiometry), (2) visceral fat (by computed tomography), (3) blood profile, (4) resting blood pressure, (5) peak oxygen consumption (VO2 peak), (6) total energy expenditure, (7) muscle strength and (8) psychosocial and dietary profiles.Results:Out of 87 subjects, 50 (57.5%) were identified as underreporting subjects in our cohort. Underreporters showed higher levels of body mass index, fat mass, visceral fat, hsC-reactive protein, perceived stress and percentage of energy from protein, as well as lower levels of VO2 peak, dietary intake of calcium, fiber, iron, vitamin B-1 and 6, as well as servings of fruit and vegetables. Logistic regression analysis showed that fat mass, odd ratio 1.068 (95% confidence interval 1.009–1.130) and perceived stress, odd ratio 1.084 (95% confidence interval 1.011–1.162) were independent characteristics of underreporters.Conclusions:Results from this study show significant differences in anthropometric, metabolic, psychosocial and dietary profiles between underreporters and non-underreporters in our cohort of overweight and obese postmenopausal women.

Recurrent Subthreshold Depression in Type 2 Diabetes: An Important Risk Factor for Poor Health Outcomes

OBJECTIVE To evaluate the association between recurrent subthreshold depressive episodes and functioning in a prospective community sample of people with type 2 diabetes. RESEARCH DESIGN AND METHODS A prospective community study in Quebec, Canada, was carried out between 2008 and 2013 (n = 1,064). Five yearly follow-up assessments (telephone interviews) were conducted. Baseline and the first three follow-up assessments were used to identify recurrent subthreshold depressive episodes (Patient Health Questionnaire [PHQ]-9). Functioning (World Health Organization Disability Assessment Schedule II [WHODAS-II]) and health-related quality of life (Centers for Disease Control and Prevention [CDC] unhealthy days) at 4- and 5-year follow-up assessments were the outcome measures. RESULTS Nearly half of the participants suffered from at least one episode of subthreshold depressive symptoms. After adjusting for potentially confounding factors, the risk of poor functioning/impaired health–related quality of life was nearly three times higher (relative risk = 2.86) for participants with four subthreshold depressive episodes compared with participants with no/minimal depression. Results suggest a dose-response relationship: the risk of poor functioning/impaired health–related quality of life increased with the number of recurrent subthreshold depressive episodes even after controlling for potentially confounding variables (significant linear trend, P < 0.001). CONCLUSIONS Recurrent subthreshold depressive symptoms might be an important risk factor for poor health outcomes in type 2 diabetes. Early identification, monitoring, and treatment of recurrent subthreshold depressive symptoms might improve functioning and quality of life in people with type 2 diabetes.

Impact of receiving blood cholesterol test results on dietary change.

INTRODUCTION The study objective was to determine the impact of receiving results of a blood cholesterol test on changes in dietary behaviors among individuals participating in a Health Risk Appraisal Program. METHODS This randomized trial of maintenance employees at six hospitals included two groups: Group 1 received their blood cholesterol test results at the pretest; Group 2 received results only at the posttest (16-20 weeks later). The pretest interview included (1) a 24-hour dietary recall; (2) an evaluation of dietary behaviors and suggestions on how to change; (3) height, weight, and blood cholesterol measurement. Five hundred employees participated, and 429 eligible employees completed both pretest and posttest interviews. RESULTS Blood cholesterol levels decreased by 4.8% (P < .001) and saturated fat intake decreased by 7.4% (P < .05). Regression analyses indicated that individuals more likely to have lowered saturated fat intake had higher pretest saturated fat intakes, had a family history of high blood cholesterol, and were light-maintenance employees (P < .05); no other variables were associated (receiving blood cholesterol test results, previous blood cholesterol test, pretest blood cholesterol levels, personal history of heart disease, BMI, age, gender, tobacco/alcohol use). Among subjects with normal cholesterol levels, those not receiving blood test results reduced saturated fat intake more than those receiving test results; both groups had similar saturated fat intakes (> 12%) greater than recommended intake (< 10%). CONCLUSIONS Screening programs should include an assessment of saturated fat intake as screening for blood cholesterol may provide normocholesterolemic subjects with a false sense of security.

Effects of a Diet Higher in Carbohydrate/ Lower in Fat Versus Lower in Carbohydrate/Higher in Monounsaturated Fat on Postmeal Triglyceride Concentrations and Other Cardiovascular Risk Factors in Type 1 Diabetes

OBJECTIVE To compare the effects of a eucaloric diet higher in carbohydrate/lower in fat versus lower in carbohydrate/higher in monounsaturated fat on postmeal triglyceride (TG) concentrations and other cardiovascular disease risk factors in nonobese subjects with type 1 diabetes and in good glycemic control. RESEARCH DESIGN AND METHODS In a parallel group design study, 30 subjects were randomly assigned and completed one of the two eucaloric diets. Assessments included: BMI, blood pressure, A1C, plasma lipids, and markers of oxidation, thrombosis, and inflammation. At 6 months, subjects were hospitalized for 24 h to measure plasma TG excursions. RESULTS There were no significant differences between groups other than decreased plasminogen activator inhibitor 1 (PAI-1) levels and weight gain in the lower-carbohydrate/higher–monounsaturated fat group. During the 24-h testing, the lower-carbohydrate/higher–monounsaturated fat group had a lower plasma TG profile. CONCLUSIONS A diet lower in carbohydrate/higher in monounsaturated fat could offer an appropriate choice for nonobese type 1 diabetic individuals with good metabolic and weight control.

Lifestyle and Cardiometabolic Risk in Adults with Type 1 Diabetes: A Review

Over the past decades, there has been a major upward shift in the prevalence of cardiometabolic risk (CMR) factors (central obesity, insulin resistance, hypertension and dyslipidemia) in patients with type 1 diabetes, which could have either an additive or a synergistic effect on risk for cardiovascular disease. These metabolic changes are occurring in parallel to the worldwide obesity epidemic and the widespread use of intensive insulin therapy. Poor lifestyle habits (poor diet quality, sedentary behaviours and smoking) are known to be driving factors for increased CMR factors in the general population. The objective of this review is to explore the lifestyle habits of adults with type 1 diabetes and its potential association with CMR factors. Evidence suggests that adherence to dietary guidelines is low in subjects with type 1 diabetes with a high prevalence of patients consuming an atherogenic diet. Sedentary habits are also more prevalent than in the general population, possibly because of the additional contribution of exercise-induced hypoglycemic fear. Moreover, the prevalence of smokers is still significant in the population with type 1 diabetes. All of these behaviours could trigger a cascade of metabolic anomalies that may contribute to increased CMR factors in patients with type 1 diabetes. The intensification of insulin treatment leading to new daily challenges (e.g. carbohydrates counting, increase of hypoglycemia) could contribute to the adoption of poor lifestyle habits. Preventive measures, such as identification of patients at high risk and promotion of lifestyle changes, should be encouraged. The most appropriate therapeutic measures remain to be established.