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Student presentations 22 October
and 19 November- no lectures on
those days
Coxsackievirus B (CVB) but also rotavirus mumps
virus and cytomegalovirus . Rubella virus has been
suggested to cause type 1 diabetes, but so far only
congenital rubella syndrome has conclusively been
associated with the disease . The prime viral
candidates for causing type 1 diabetes in humans are
enteroviruses. Flu virus also implicated.
A note-taker has been requested for NUTR
2101.
The note-taker is a student the Nutrition 2101
class who simply photocopies (a photocopier is
available here at the centre) their notes or
emails them to the Centre if they are typed,
from the beginning of the term and continues
to do so for the remainder of the fall term
2013. They will be paid $100 at the end of the
term for hand written notes or $150 for typed
notes.
The
Lecture 4- 1 October 2013
Type 2 Diabetes
Outline of today’s talk
I.
Pathology
2.
Socioeconomic factors contributing to the diseases
2I.
Elementary nutritional approaches to be taken to
avoid and treat type 2 diabetes including foods
available to those at risk
IV.
First Nations and other Cape Breton individuals at
risk
V.
How is nutritional assessment made for type 2
diabetes?
VI.
How would one assess from a nutritional perspective
the socioeconomics, pathology and success of
nutritional interventions relative to type 2 diabetes?
Type 2 diabetes
I. Pathology
Obesity leads to dyslipidemia (elevated
triglycerides, decreased HDLc, increased
sd-LDL-c, increased lipid oxidation),
increased blood pressure, decreased
insulin sensitivity = metabolic syndrome
(increased platelet reactivity considered by
some to be part of metabolic syndrome)
metabolic syndrome may lead to T2D
Food and hence nutritional choices depend on:
Personal preference
acceptance of certain foods-implications
versus type I?
Habit
-caregiver should be careful here- why?
how different from type I?
Food and hence nutritional choices depend on:
Ethnic heritage or tradition
which groups would be more
susceptible to type 2 diabetes?
Social interaction
impact of social interaction on obesity?
Food and hence nutritional choices depend on:
Availability of food
if only offending foods available this can
be concern-fast foods, ready prep foods
that are calorie including fat laden
Convenience of food
fast foods-hamburgers,chips,pizza,
donuts, ice cream
ready prep foods-those that are calorie
including fat laden
Food and hence nutritional choices depend on:
Economy of food
-this may discourage type 2 diabetes
can eat well on a low budget-how?
Positive and negative association
-positive –obesity
-negative- examples of implications for
avoidance of weight gain or
inducing weight loss
Food and hence nutritional choices depend on:
Emotional conflict
-comfort food-suggestions for this?
risk of obesity
Values
-implications for obesity?
-implications for weight loss?
Food and hence nutritional choices depend on:
Body image
may encourage slimness-emphasis on
thin is beautiful in our society
Advertising
food companies and fast food companies
always promoting larger servings
supersizing type 2 diabetes
More on socioeconomic factors
Prestige
-occupational
-decisions on healthy foods- obesity is the
central issue here
-societal perceptions
-who is to be listened to about various
diets, nutraceuticals and functional foods
-education
-informed choices about foods that will
prevent or reduce obesity
More on socioeconomic factors
Power
influence on government policy-what is
considered to be fair advertising-this applies
to major food companies including fast food
companies
Income
sometimes poorer people tend to buy junk
food that is rich in empty kcal-however
richer people can also do the same
More on socioeconomic factors
Wealth
comment about power fits in here regarding
type 2 diabetes
Education
usually, but not always, better educated
persons make healthier choices about foods
that increase or reduce obesity
More on socioeconomic factors
Social stratification
-ancestry
-gender
-race-aboriginals and convenience stores
-ethnicity
-mobility-ability to get to quality food
-ability to exercise
-mental and physical illness
mental illness-comfort food issue
physical illness- lack of exercise inducing
obesity
More on socioeconomic factors
Class
-uppers
-lower uppers
-upper middles
-average middles
-working class
-lower class
type 2 diabetes tends to affect all
classes-money or lack thereof
is not an issue
More on socioeconomic factors
Global economy
no real impact given that type 2 diabetes
is rampant all over the world
Government
-anti-obesity campaigns- physical activity
guide and Canada’s food guide
More on socioeconomic factors
Business
advertising
supersizing type 2 diabetes
Psychology
eating simply for something to do-obesity
-group dynamics- eating more in social
settings
History
-history of development of fast foods and easy
prep high fat foods has played a huge role in
the development of type 2 diabetes
Elementary nutritional biochemistry of
nutritional approaches that use foods
available to those at risk
Planning a healthy diet
To do this bear in mind
Adequacy
Balance
Energy control
Nutrient density
Moderation
Variety
Elementary nutritional biochemistry of
nutritional approaches that use foods
available to those at risk
Prevention-obesity
Post-onset-obesity
-carbohydrate-simple sugars
-sweeteners if in fats an issue
-fibre-may inhibit glucose uptake
but effect is not significant
Elementary nutritional biochemistry of nutritional
approaches that use foods available to those at risk
Post-onset-obesity
-protein-conversion to carbohydrate
depends on insulin resistance
-fat- an issue- dyslipidemia compared to nondiabetics
-alcohol-blocks gluconeogenesis-not an
issue
-sodium-hypertension-an issue
-vitamins and minerals-not indicated as
supplements except chromium and
magnesium which boost insulin
sensitivity-perhaps also antioxidants
IV. First nations and other Cape Breton
individuals at risk.
Aboriginals-thrifty genes and a
move away from traditional dietary
habits-cause obesity
Genetics-some individuals
predisposed to weight gain- eg low
leptin
Others?
How is nutritional assessment made for type
2 diabetes?
Nutrient intake analysis
caloric intake and particularly the
fat intake is an issue- why?
vitamins and minerals relative to
low antioxidant chemicals in blood
How is nutritional assessment made for type
2 diabetes?
Daily food record/Diary
-same measures of interest
as per nutrient intake
analysis
How is nutritional assessment made for type
2 diabetes ?
Retrospective data
food frequency questionaire
24-hour recall
do both to act as cross check
against each other
How is nutritional assessment made for type
2 diabetes ?
Anthropometry
waist measurement-central obesity
weight and height giving BMI
How is nutritional assessment made for type
2 diabetes ?
Nutrition focussed physical exam
obesity is the focus here particularly
central obesity
blood pressure
How is nutritional assessment made for type
2 diabetes ?
Skin testing
irrelevant in type 2 diabetes
How is nutritional assessment made for type
2 diabetes ?
Biochemical analysis
Blood concentrations of:
HDLc down
more small dense LDL
more oxidised LDL
triglycerides (VLDL and CM) up
free fatty acids
c-reactive protein?
leptin ?
lipoprotein (a)?
How is nutritional assessment made for type
2 diabetes ?
Biochemical analysis
Blood concentrations of:
glycated protein
fasting insulin is higher
fasting blood glucose is higher
post-prandial insulin and blood
glucose are higher
post-prandial lipemia is higher
How is nutritional assessment made for type
2 diabetes?
CLASSIFYING MALNUTRITION
-obesity is the central issue here
-obesity is considered to be a form of
malnutrition
VI. GROUP DISCUSSION-HOW WOULD
ONE ASSESS FROM NUTRITIONAL
PERSPECTIVE THE SOCIOECONOMICS,
PATHOLOGY AND SUCCESS OF
NUTRITIONAL INTERVENTIONS
RELATIVE TO TYPE 2 DIABETES ?