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10 March 2011

Diabetics in the US, Six Other Countries Ineffectively Treated for Diabetes and Related Risk Factors

Millions of people worldwide may be at risk of early death from diabetes and related cardiovascular illnesses because of poor diagnosis and ineffective treatment, a new study by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington shows. The study examines diabetes diagnosis, treatment, and management in Colombia, England, Iran, Mexico, Scotland, Thailand, and the United States.

In the United States alone, nearly 90% of adult diabetics -- more than 16 million adults aged 35 and older -- have blood sugar, blood pressure, and cholesterol that are not treated effectively, meaning they do not meet widely accepted targets for healthy levels of blood sugar, blood pressure, and cholesterol. In Mexico, 99% of adult diabetics are not meeting those targets. The study, "Management of diabetes and associated cardiovascular risk factors in seven countries: a comparison of data from national health examination surveys," is published in the Bulletin of the World Health Organization's March edition.

"Too many people are not being properly diagnosed with diabetes and related cardiovascular risk factors. Those who are diagnosed aren't being effectively treated," said Dr. Stephen Lim, one of the study's co-authors and an Associate Professor of Global Health at IHME. "This is a huge missed opportunity to lower the burden of disease in both rich and poor countries."

The researchers found that up to 62% of diabetic men in Thailand are undiagnosed or untreated for diabetes. This translates to more than 663,000 people in that country. Within countries, the diagnosis rates were higher for women than men, with the largest difference seen in Colombia, where 15% more women than men with diabetes are diagnosed. Of those diabetics who are diagnosed, most are not being treated for other cardiovascular risks that could be just as dangerous to their health as uncontrolled blood sugar. The percentage of diabetics in the seven countries studied who are reaching International Diabetes Federation treatment goals for blood glucose, blood pressure, and serum cholesterol is very low, ranging from 1% to 12%. In Scotland, researchers had difficulty finding women with diabetes who had met the targets for managing these risks.

In an attempt to determine the cause of the low rates of diagnosis and effective treatment, researchers examined a range of factors and found that there were no inequalities in diagnosis and treatment of diabetes related to socioeconomic status.

"We were very surprised to see that wealth did not have a big impact on diagnosis and treatment," said Dr. Emmanuela Gakidou, the paper's lead author and an Associate Professor of Global Health at IHME. "And in the three countries where we had health insurance data, we thought it was noteworthy that health insurance actually played a much bigger role than wealth, especially in the US."

In the US, people who had insurance were twice as likely to be diagnosed and effectively treated for diabetes as those who did not have insurance.

The researchers said the findings underscore the need for countries to tackle the growing problem of noncommunicable diseases (NCDs), in part by gathering better data.

"We don't have enough data from actual physical exams to accurately document the trend in most countries," said Dr. Rafael Lozano, a co-author on the paper and a Professor of Global Health at IHME. "We looked at surveys from nearly 200 countries and only could find data on blood glucose, cholesterol, or blood pressure in seven. We hope that in the build-up to the UN Summit on NCDs this September, countries will make a commitment to more surveys that take blood samples from a representative percentage of the population."

IHME researchers gathered data and performed their analysis in collaboration with researchers at the University of California, San Francisco, School of Medicine; the Harvard Global Equity Initiative; the National Institute of Public Health in Mexico; and Ramathibodi Hospital in Thailand.

Health-Washing: Is 'Healthy' Fast Food for Real?

New York Times food columnist Mark Bittman recently examined the nutritional merits of McDonald's Fruit & Maple Oatmeal, an apparently "healthy" breakfast item that actually contains more sugar than a Snickers bar and only 10 fewer calories than an Egg McMuffin. Yikes. But while it's easy to supersize our scorn for McDonald's, it's worth noting that Mickey D's isn't playing the only shell game in town.

Many other fast-food joints offer healthy-sounding options that aren't exactly health food. What follows are a few examples of health-washing: items that appear wholesome but don't quite deliver on the nutrition front. The problems with the meals may vary, but the takeaway is the same: always scope out the nutrition information on a fast-food restaurant's website before you show up and order. You may be surprised by what you learn.

Sugary soft drinks linked to high blood pressure

Drinking too many sugary beverages appears to raise the risk of high blood pressure, experts are warning.

Findings suggest blood pressure goes up incrementally for every extra can of sugary drink consumed per day.

Drinking more than 355ml a day of sugar-sweetened fruit juice or carbonated drink can be enough to upset the balance, data on over 2,500 people reveals.

The study by UK and US researchers appears in the journal Hypertension.

The precise mechanism behind the link is unclear, but scientists believe too much sugar in the blood disrupts blood vessel tone and salt levels in the body. Non-sugar sweetened diet drinks did not carry the same risk.

The soft drink industry maintains that the beverages are safe to drink "in moderation".

The American Heart Association says people should drink no more than three 355ml cans of soda a week.

Continue reading the main story

Start Quote
This is another nail in the coffin for soft drinks”
End Quote
Professor Graham MacGregor

Chairman of the Blood Pressure Association
For the study, the participants who were aged 40-59 from the UK and the US were asked to record what they had eaten in the preceding 24 hours on four separate occasions. They also provided a urine sample and had their blood pressure measured.

The researchers found that sugar intake was highest in those consuming more than one sugar-sweetened beverage daily.

They also found that individuals consuming more than one serving per day of sugar-sweetened beverages consumed more calories than those who didn't consume sugary drinks - around 397 extra calories a day.

For every extra can of sugary drink consumed per day, participants on average had a higher systolic blood pressure by 1.6mmHg and a higher diastolic blood pressure by 0.8mmHg.

Overall, the people who consumed a lot of sugar-sweetened beverages appeared to also have less healthy diets and were more likely to be overweight.

But regardless of this, the link with blood pressure was still significant even after adjusting for factors such as weight and height.

Stroke risk

Professor Paul Elliott, senior author of the study, from the School of Public Health at Imperial College London, said: "It's widely known that if you have too much salt in your diet, you're more likely to develop high blood pressure.

"The results of this study suggest that people should be careful about how much sugar they consume as well."

High blood pressure is a major risk factor for cardiovascular disease.

Someone with a blood pressure level of 135mmHg over 85mmHg is twice as likely to have a heart attack or stroke as someone with a reading of 115mmHg over 75mmHg.

In the study, the link between sugary drinks and higher blood pressure was especially strong in people who consumed a lot of salt as well as sugar. Excess salt in the diet is already a known to contribute to high blood pressure.

The British Heart Foundation said more research was now needed to better understand the relationship between sugar and blood pressure.

Victoria Taylor, Senior Dietician at the BHF, said it was best to avoid too many sugary drinks because they add extra calories to our diets that can lead to obesity, a major risk factor for heart disease.

Professor Graham MacGregor, chairman of the Blood Pressure Association said: "This is another nail in the coffin for soft drinks.

"Not only do they make you obese but they may also put up your blood pressure. Drinking sweet soft drinks is not good news."

A spokesman for the British Soft Drinks Association said the study did not establish that drinking sugar-sweetened beverages in any way causes hypertension.

"Soft drinks are safe to drink but, like all food and drink, should be consumed in moderation as part of a balanced diet," he said.

Fish oil builds muscle mass in cancer patients

For cancer patients, taking fish oil supplements could help maintain and even regain lost muscle mass, according to a new study.

Most patients who took a daily supplement of fish oil for 10 weeks either maintained or gained muscle mass, whereas patients who didn't take anything either maintained or lost muscle mass, the study said.

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"Muscle loss in cancer is partly due to the presence of inflammation," which causes a breakdown in muscle mass, said study researcher Vera Mazurak, of the University of Alberta in Canada.

But fish oils interfere with inflammation, thereby reducing its effect on muscle, Mazurak said. Loss of muscle mass and fat is bad for cancer patients because it hampers their ability to respond to cancer treatments, she said.

Fish oil findings
Mazurak and her colleagues asked 16 patients with non-small cell lung cancer to take a 2.2-gram supplement of eicosapentaenoic acid, a compound in fish oil, once a day during their 10-week chemotherapy treatments. The researchers did not give the supplements to 24 other cancer patients also in the study.

The researchers measured the patients' weight, blood levels of eicosapentaenoic acid, and checked their muscle and fat composition using computed tomography images throughout the study period.
Patients who didn't take any fish oil lost an average of 5.1 pounds (2.3 kilograms) over the 10 weeks, but patients who took the fish oil maintained their weight throughout the study, researchers said.

And the patients who had the highest concentration of eicosapentaenoic acid in their blood during the study period gained the most muscle mass, the study said.

Sixty-nine percent of patients who took fish oil either gained or maintained muscle mass, but 29 percent of people who didn't take the supplement gained or maintained muscle mass, the study said.

There were no differences between the groups in terms of the amount of fat tissue in their bodies over the study, researchers said.

Weight loss and survival
Maintaining a healthy body weight is integral to cancer patients' survival, Mazurak said. Wasting syndrome is common in end-stage cancer patients and results in loss of weight, muscle mass and appetite.