Replacing white rice with brown rice and wholemeal bread could cut the risk of diabetes by a third, US experts say.

White rice poses a diabetes threat because it causes steep rises in blood sugar, say Harvard researchers in Archives of Internal Medicine.

Brown rice and other wholegrain foods are a healthier option as they release glucose more gradually, they say.

The study is based on questionnaires; some say the data is not robust enough to base firm conclusions on.

It may be that people who eat less white rice tend to live healthier lifestyles, for example.

'Brown is better'

In the study of nearly 200,000 US people, white rice consumption was linked to type 2 diabetes.

After adjusting for age and other diabetes risk factors, those who ate five or more 150g servings of white rice per week had a 17% increased risk of diabetes compared with people who consumed less than one serving - about a cup of rice - per month.

Although few people - only 2% - in the study ate this much white rice, the finding was significant.

Yet eating brown rice appeared to have the opposite effect, cutting the risk of type 2 diabetes.

People who ate two or more servings of brown rice per week had an 11% reduced risk of developing the condition compared with those who ate less than one serving a month.

Based on the results, the researchers estimate that replacing 50g or one-third of a typical serving of white rice with the same amount of brown rice would lead to a 16% lower risk of type 2 diabetes.

And replacing the white rice with wholegrains, including brown rice and pasta, wholemeal bread and rolled oats, could cut the risk by more than a third.

Food composition

Dr Qi Sun and other researchers say the explanation lies in the composition of the food.

Like other wholegrain foods, brown rice is high in fibre and releases its energy slowly.

In contrast, white rice has had all the bran and some of the germ removed during milling.

This gives white rice a higher glycaemic index (GI) - a measure of how much a food raises blood sugar levels compared with the same amount of glucose or white bread.

"From a public health point of view, replacing refined grains such as white rice by whole grains, including brown rice, should be recommended to facilitate the prevention of type 2 diabetes," according to the researchers.

Experts generally recommend that at least half of carbohydrate intake should come from whole grains like brown rice.

More than 70% of the rice consumed in developed countries such as the US and UK is white.

Dr Victoria King of Diabetes UK said that, since the results were from self-reported food diaries and questionnaires, it was not possible to make conclusive recommendations on how much of certain foods, such as brown rice, might protect against type 2 diabetes at this stage.

"The best way to prevent type 2 diabetes is by keeping active and eating a healthy balanced diet that is low in fat, salt and sugar with plenty of fruit and vegetables," she said.

Researchers have challenged the assumption that a lack of exercise causes children to put on weight.

An 11-year study of more than 200 children in Plymouth suggests the effect is the other way around - that getting fatter makes them inactive.

The paper, published in the Archives of Disease in Childhood, concludes that programmes to tackle obesity may need to focus more on food than exercise.

However, some other experts have questioned the findings.

The paper says there is no disputing the association between physical activity and body fat. And there is no suggestion that exercise is not good for children. But it does question its value as a way of tackling obesity.

The researchers at the EarlyBird Diabetes Study, based at the Peninsula Medical School in Plymouth, has been following a group of more than 200 city school children for the past 11 years.

As part of the long-term study, they monitored body fat and exercise at regular intervals over three years.

They found no indication that doing more physical activity had any effect on weight, but they did find that children who put on weight did relatively less exercise.

The findings indicate that 10% more body fat in a seven-year-old leads to four minutes less moderate or vigorous exercise each day. The lead author, Professor Terry Wilkin, says this may not sound a lot, but it adds up over time.

"Moderate and physical activity only occupies in boys a little less than an hour a day and in girls about 45 minutes.

"So it's a not insubstantial amount of activity that is gained by having the lower body mass.

"And that of course is energy expenditure day in day out, week in week out, month in month out so the balance is changed substantially."

The paper suggests that overweight children may perceive their body image negatively, and as a result choose not to join in sports and exercise. It also argues that children who put on too much weight may suffer discomfort and pain during exercise more quickly.

Professor Wilkin says the policy implications are far-reaching, indicating that nutrition, rather than ever-increasing doses of physical activity, is the key to tackling childhood obesity.

However many experts believe that exercise does have a role to play in helping children to lose weight. Professor Andy Ness from Bristol University, who has also examined activity and obesity in children, says the EarlyBird findings are "partly right".

Academic debate

"In our study we can see evidence that physical activity is predictive of a change in fatness," he said. "But that doesn't mean there's not something going on the other way. We think it's a combination."

Dr David Haslam from the National Obesity Forum says the wider health benefits of exercise for children must not be overlooked.

"The EarlyBird team really force us to question our comfortable assumptions regarding childhood obesity.

"What we, as clinicians must do, is nod reverently at their work, learn lessons from it, and re-appraise our own practices accordingly.

"What we shouldn't do is take the paper at face value and allow lean children to be as lazy as they please, as that would be a catastrophic mistake!"

In a statement the Department of Health in England said the EarlyBird study provided some "useful messages".

A spokesperson said: "We will consider this evidence alongside other research which has different findings on the link between physical activity and weight when we are developing our policy to produce better public health outcomes."

The value of regular health examinations.

Has this ever happened to you? You take a bite out of a fresh, juicy apple only to find that the apple is rotten inside.

Just like the apple, you may be a picture of health, but are you really healthy? Many diseases such as high blood pressure, diabetes, and cancer often go undetected years before symptoms appear. To prevent these illnesses, early detection of risk factors is vital.

Health screens enable you to screen for early signs of disease. For example, a person with diabetes will have a raised blood sugar level long before the onset of symptoms such as thirst, weight loss, or non-healing wounds. Elevated blood cholesterol and triglycerides levels can be present years before the onset of heart disease and stroke.

Early detection of diseases via health screening will enable early treatment and a better control of the condition. Early treatment prevents the risk of serious complications if the condition is managed properly.

Do I need a health screen?

Health screening is highly recommended for people in the following categories:

•Have a family history of chronic diseases or conditions, e.g. if you have an immediate family member with a particular medical condition.
•If you lead a busy lifestyle or you’re 40 years or older.

A health screen will be able to provide you with the following useful information:

Baseline values

Health screening provides a set of baseline values at that point in time, and this can be compared with future tests. Baseline values represent a normal background level or an initial level of a measurable quantity and can be used for comparison with values representing response to an environmental stimulus or intervention.

Prevention of disease

Health screening can detect abnormalities or diseases which the person is not aware of and allow for further investigations, treatment, or preventive measures. For example, in women, a pap smear can be used to detect potentially precancerous lesions and prevent cervical cancer, and mammography can be used to detect breast cancer.

Lifestyle changes

With the information derived from health screening, you can respond accordingly to make the appropriate lifestyle changes. Lifestyle changes are a very effective way to substantially reduce health risks, but to make those changes, you first need to know if you are at risk. Knowledge gives you the power to take charge of your health.

Emotional and psychological factors

Despite the benefits of health screening, some people shun or delay health screenings due to fear of what they might discover. They will try to delay going for health screenings as long as possible because they do not want to face the stress and anxiety that comes with the knowledge of an illness.

For example, according to a study published in a US health and psychology journal, researchers found that some women who were in the category of higher risk of breast cancer may not attend regular screenings because they feared finding out they have the disease. The effect was pronounced in women who were less conscientious in their day to day affairs. Their rationale is that what they do not know cannot hurt them – true, but a health screen that detects early disease can help save a life.

Screening health

Apart from the routine physical examination that includes taking vital signs such as recording the body’s temperature, pulse rate (or heart rate), blood pressure and respiratory rate, the following are recommended to be undertaken in the annual health screening:

Blood test

Blood tests are undertaken through a laboratory analysis performed on a blood sample that is usually extracted from a vein in the arm using a needle, or via finger prick. It is used to determine physiological and biochemical states in the body and to check if there is any damage to any of the organs in the body, such as the kidneys and liver.

Some of the important information that can be obtained via a blood test are whether we have a complete or normal blood count, whether our thyroid hormone levels are normal, and how our LDL cholesterol compares to our HDL cholesterol level.

In addition, blood tests can also tell us about our glucose levels, which is vital for detection of diabetes. Early detection of diabetes can help prevent or delay damage to the heart, kidney, nerves, blood vessels, or eyes.

Urine examination

A urine examination can yield a great deal of useful information about a person’s metabolic functions and the functional integrity of some organs. It can also help to detect cancer and inflammatory diseases of the urinary tract. The examination should also be carried out for individuals who are at high risk of developing bladder cancer.

For those above 40

Women

•Pap smear – for early detection of cervical cancer
•Mammography – for early detection of breast cancer
•Bone density test – a simple and painless procedure to check on bone loss.

Men

•Digital rectal exam – to check for the possibility of prostate cancer
•Prostate specific antigen (PSA) test

Other tests that should be undertaken for both men and women in this age group include chest x-rays and electrocardiography (ECG). Chest x-rays are used to help diagnose conditions affecting the chest, its contents, and nearby structures. Pneumonia and congestive heart failure are very commonly diagnosed by chest x-rays. ECG, on the other hand, is used to detect whether a person has heart disease. This is recommended especially if the person has chest pains or palpitations.

Preparing for health screening

A fasting sample is required for a complete blood test profile and those that involve the following tests:

•Fasting blood glucose
•Fasting lipid profile (cholesterol and triglycerides)

Abstain from all food and drinks for at least 10-12 hours prior to the test. However, plain water is allowed.

No preparation is usually needed for other routine health screenings. The volume of blood taken is minimal, ranging from 2ml to 10ml depending on the type and number of tests.

Health screening plays an important role in preventive healthcare for a wide range of common, and not so common diseases. Frequently, data from health screenings also help to provide scientists with a way of measuring disease trends and the success of early treatment.

If you are unsure about which screening tests are best for you and how often you may need them, check with your healthcare provider.

For those who are just starting out on brown rice, cooking it may be a bit of a hassle.

MUSHY. Too healthy. Food for the old folks. Not tasty. Less starchy. Those who have opted for brown rice over the more popular white version would have heard these comments often enough.

It’s the rice that everyone would pass over unless he is on some sort of diet and/or suffering from diabetes. For many, it doesn’t have the same “oomph factor” as white rice after you eat it.

Think about it. Can you imagine people lining up to get their fix of Banana Leaf Brown Rice? How about Brown Nasi Kandar? Or Brown Rice Pudding? Doesn’t sound too appealing, does it?

However, it would be fair to say that unless you started taking it from young, it is a taste that needs to be acquired. For most Malaysians, the choice all the while has been white, whether it’s locally produced, imported or organic.

But attitudes towards brown rice seem to be changing in line with the drive for a healthier lifestyle. And the evidence is there for all to see: not only are shelves of supermarkets and specialist food stores stocked with brown rice, but there is also a wide range available, including the locally produced ecoBrown brand.

So what is the difference between white rice and brown rice, besides the colour? A whole grain of rice has several layers. Only the outermost layer, the hull, is removed to produce what we call brown rice.

When brown rice is further milled to remove the bran and most of the germ layer, the result is a whiter rice. It takes further polishing to produce white rice.

Polishing removes the aleurone layer of the grain – a layer filled with health-supportive, essential fats. Once exposed to air by the refining process, these fats are highly susceptible to oxidation. Therefore this layer is removed to extend the shelf life of the product. In the end, white rice is simply a refined starch that has been stripped of its original nutrients.

On the other hand, brown rice has only had the hull removed, and as such still has the bran and germ intact. From tests conducted by the United States Food and Drugs Administration, it has been show that the bran and germ store abundant nutrients, such as proteins, natural fibres, calcium, vitamin B complex, plant-based fat and other vitamins and minerals.

As a result, brown rice is considered more nutritional.

However, brown rice tends to become rancid more easily due to the natural oils it contains. But it can last for six months if stored fresh in an airtight container.

When it comes to the eating part, many still associate brown rice with being gross and crunchy. But this is only the case if you don’t cook it properly.

Most brands of brown rice come with specific cooking instructions, yet there is always room to improvise through trial and error if you want to achieve a fluffier consistency.

Despite taking a longer time to cook, brown rice has actually more texture and a refreshing nutty flavour with plenty of fibre.

Here are some tips which will help you achieve a tastier and more pleasant serving of brown rice.

> Make sure to wash the rice thoroughly – to remove any powdered starchy residue – with cold water before cooking. Rinse the rice through a strainer a few times.

> Toasting the damp rice in an oven for 20 to 30 minutes will reduce cooking time and result in a fluffier texture.

> Try boiling and then straining the rice (like pasta), followed by steaming it in a pot. This will prevent it from being too mushy and sticky.

> For short grain brown rice, the ratio should be one cup of rice to three cups of water.

> For brown Basmati rice, use two cups of water per half cup of rice.

> To add more flavour to the rice, use stock (chicken or vegetable) instead of water when cooking.

Try sprucing up leftover brown rice with these ideas:

> Heat cooked rice with milk or soy milk and add in cinnamon, raisins, honey and nuts to make rice pudding.

> Use the rice to make cold rice salad by adding your favourite vegetables, seasonings and dressings. This can be a complete meal.

> Try your favourite fried rice recipe with brown rice. Toss in garlic, ginger and onion to sauté, followed by carrots, peas and your favourite meat to make a delicious Chinese style fried rice.

There are many sites on the Internet offering tips on cooking brown rice, includinghttp://lancaster.unl.edu/food/ciq-brown-rice.shtml which also offers a number of recipes, and a board discussion on http://chowhound.chow.com/topics/366044

Pre-diabetes is a problem where a person’s blood glucose levels are higher than normal, but not high enough to be diagnosed as diabetes. It can be reversed.

MOST people have heard about diabetes and know what it is about, but not many are aware that there is a condition called pre-diabetes. Pre-diabetes is a problem where a person’s blood glucose levels are higher than normal but not high enough to be diagnosed as diabetes.

Pre-diabetes is also known as borderline diabetes, impaired glucose tolerance (IGT), or impaired fasting glucose (IFG). People with this condition are in a “gray zone” between normal and diabetes, but are at risk of developing full-blown type 2 diabetes, with all its complications.

Tell-tale signs

It is normally hard to tell whether a person has pre-diabetes as there are almost no symptoms or signs. Some symptoms appear so slowly that most people do not realise they are affected by the condition until it is too late.

It is recommended that people watch for symptoms that are similar to that to type 2 diabetes:

·Constant hunger

·Unexplained weight loss

·Flu-like symptoms, including weakness and fatigue

·Blurred vision

·Slow healing of cuts or bruises

·Tingling or loss of feeling in hands or feet

·Recurring gum or skin infections

·Recurring vaginal or bladder infections

Screening

One of the ways to determine whether a person has pre-diabetes is through the fasting plasma glucose (FPG) test. During the FPG blood test, the glucose level in the body is measured after an eight hour fast. This test is to help determine if the body metabolises glucose correctly.

Fasting plasma glucose screening is recommended for people aged 30 to 45 and should be repeated at least every three years. Earlier and more frequent screening is recommended for people with high risk factors. The risk factors are listed below:

·Family history (parent or sibling)

·Dyslipidemia (triglycerides > 200 or HDL < 35)

·Overweight or obese (body mass index > 25)

·History of gestational diabetes or infant born with birth weight greater than 4kg

·High risk ethnic group

·Hypertension (systolic blood pressure >140 mmHg or diastolic blood pressure > 90 mmHg)

·Known vascular disease

·Markers of insulin resistance (PCOS – polycystic ovarian syndrome, acanthosis nigricans)

Early detection

If no preventive measures are taken to arrest pre-diabetes, the pancreas would gradually be unable to produce enough insulin to overcome insulin resistance, resulting in glucose levels rising to abnormally high levels.

Prolonged high levels of glucose in the blood would eventually lead to type 2 diabetes and bring about serious complications like blindness, kidney diseases, gangrene, which may require amputation, heart attack, stroke and hypertension.

Since diabetes is one of the major causes of premature illness and death worldwide, it is important for the disease to be detected early. In developing countries, less than half of people with diabetes are diagnosed. Taking action early on pre-diabetes can help prevent type 2 diabetes and more serious health problems.

For some people with pre-diabetes, early intervention can actually return elevated blood sugar levels to the normal, healthy range.

Prevent diabetes by making the right choices

Although pre-diabetes is a serious condition, it is reversible through changes made in daily life routines such as increasing the level of physical activity, achieving a healthy weight, and following a healthy balanced diet.

Studies have shown that lifestyle changes could help to prevent or delay the onset of type 2 diabetes, especially among people at high risk.

·For people with pre-diabetes, lifestyle changes, including a 5% to 7% weight loss and at least 150 minutes of physical activity per week, can reduce the rate of onset of type 2 diabetes by 58%.

·Blood glucose control reduces the risk for eye, kidney, and nerve diseases among people with diabetes by about 40%.

·Blood pressure control reduces the risk for heart disease and stroke among people with diabetes by 33% to 50%. It reduces the risk for eye, kidney, and nerve diseases by about 33%.

·Detecting and treating diabetic eye disease with laser therapy can reduce the risk for loss of eyesight by 50% to 60%.

·Comprehensive foot care programmes can reduce amputation rates by 45% to 85%.

Dietary and lifestyle recommendations

Many studies have shown that a low-carbohydrate diet and regular exercise is a very valuable prevention and treatment tool in diabetes and pre-diabetes. The following are some recommended dietary and lifestyle recommendations for people with pre-diabetes or diabetes:

1. Eat a high fibre and low fat diet, and control your total calorie intake

The total calorie intake is more important than the amount of carbohydrate intake alone. Different people have different calorie requirements, depending on their activities, type of work, hours of sleep, and other factors.

As a guide, the following calories are recommended:

a. Overweight: 1000 to 1500 kcal per day.

b. Elderly, mild, normal weight: 1500 to 2000 kcal per day.

c. Young, active: 1500 to 3000 kcal per day.

2. Eat small regular meals

Meals must be regular and the day-to-day intake as consistent as possible. It is better to eat small meals at short intervals than to eat large meals at long intervals.

3. Protein intake

Protein sources such as lean meat, egg white, skimmed milk and fish can be taken freely provided you are aware of their high calorie value and it does not exceed your daily calories requirement for the day.

4. Avoid alcohol

Alcohol does not need insulin for metabolism but if taken on an empty stomach, can induce hypoglycaemia.

5. Limit amount of fried foods

Fat will increase the risk of vascular damage and therefore intake of fat should be minimised. Food rich in saturated fat include animal fat, coconut oil, milk cream, lard, butter and egg yolk. Overall, fat should not account for more than 30% of your total calorie intake.

6. Check your blood glucose regularly even when under medication, and especially when you feel unwell.

7. Exercise regularly at least 45 minutes per day, five days a week

Foods to take and avoid

Glucose (except for instances of low blood sugar level), sugar, honey, gula melaka, jam, kaya, sweets, chocolates, soft drinks, packet drinks, cakes, pies, pudding, moon cakes, canned fruits in syrup, sweet biscuits, condensed milk, ice-cream, icing, packet snack food should be avoid or taken infrequently.

Eat all kinds of leafy vegetables, beans, bean sprouts, cucumber, celery, peas, mushrooms, onion, garlic, ginger.

Apart from regular exercise, reducing weight by as little as 5% to 10% can also have a significant impact on overall health. The Diabetes Prevention Program (DPP) was a major multicentre clinical research study done in the United States aimed at discovering whether modest weight loss through dietary changes and increased physical activity or treatment with the oral diabetes drug metformin could prevent or delay the onset of type 2 diabetes in study participants. The study found a 16% reduction in diabetes risk for every kilogram of weight loss.

Pre-diabetes is reversible, but diabetes is incurable. By making the right choices and taking the right actions, people with pre-diabetes can prevent it from progressing to full blown diabetes.

The growing popularity of Western junk food is fuelling a diabetes boom across Southeast Asia, Australian researchers warned on Wednesday.

Studies found about 11 percent of men and 12 percent of women in Vietnam’s Ho Chi Minh City had type 2 diabetes without knowing it, on top of the four percent of people who are diagnosed sufferers.
“Dietary patterns have been changing dramatically in Vietnam in recent years, particularly in the cities as they become more Westernised,” said Tuan Nguyen of Sydney’s Garvan Institute of Medical Research.

“There are fast food outlets everywhere.”

He said the findings, based on testing a random sample of 721 men and 1,421 women, mirrored the results of a similar study carried out in Thailand.
“Because of that, we feel very confident that we can extrapolate our findings to other parts of Southeast Asia including Malaysia, Singapore, Cambodia and Laos,” he said.

Type 2, the most common form of diabetes, is caused by high levels of fat and sugar in the diet and a lack of exercise, and can lead to heart disease, vision loss, limb amputation and kidney failure.

Co-author Lesley Campbell said developing countries were facing a “sad story” where they are affected by Western lifestyle diseases alongside hunger and poverty, but without the health resources to treat them.
“Unfortunately, we are watching, in just over a generation, a very rapid increase in diabetes” in developing nations, she said.

The researchers have developed a simple risk assessment for diabetes, using only blood pressure and waist-to-hip ratio, which they hope will help doctors detect those most likely to have the disease.

BET all you teens out there would have asked this question at least once or twice right? Obesity has, to a certain extent, become something that is feared by people of all ages.

Why is this so? Well, for one, it affects health by increasing the risks of high blood pressure, cancer, diabetes and kidney failure.

But aside from this, obesity lowers one’s confidence. How? Being obese may cause one to be clumsy. Those who are overweight also run the risk of hearing hurtful comments from peers and even some insensitive adults. They may be ostracised and looked down on just because of their size. The fault also lies with the media. Photos of celebrities and models plastered on the pages, equate slim with beautiful. No one talks of big as beautiful. So should you just sit there and let obesity affect your confidence as well as your life? Of course not. If you are comfortable with who you are and how you look, hold your head high and show the world how beautiful you are.

If you’re not happy in your own skin, then exercise regularly, eat lots of fruit and vegetables and drink plenty of water. You’ll lose that excess fat in no time, and before you know it, you’ll regain your confidence too.

A full clinical examination at only RM50? ANNIE FREEDA CRUEZ has the details
WITH a basic health check costing as much as RM150 nowadays, it’s a bonus when KL Heartcare Medical Centre is offering to do this and much more for just RM50.

This is thanks to several corporate organisations that are subsidising the cost so as to get as many Malaysians to go for health checks as possible.

KL Heartcare Sdn Bhd medical director, Dr Mohamed Rafiq Ibrahim Marican, said it will distribute 500,000 bookmarks to the public at KL Sentral, KLCC and MidValley Megamall in Kuala Lumpur to encourage health checks.

“Every day the first 50 people who respond will be offered a highly subsidised package, starting next month,” says the consultant cardiologist and physician.

The RM50 payment will encompass a full clinical examination by a team of doctors.

The Body Mass Index will be calculated and examinations include full blood count with complete kidney and liver function tests, sugar levels and a complete lipid profile at the centre, which has Multimedia Super Corridor status. “We want people to detect heart disease, high blood pressure, high cholesterol and kidney disease early so that they can be counselled and, if need be, advised on medication. All these diseases are silent killers and can only be detected through screening,” says Dr Mohamed Rafiq.

Many people suffer from heart attacks and kidney problems because they do not go for early screening. Early detection of a disease is more cost-effective than treating the disease itself. In other words, prevention IS better than cure. All adults should go for health screening. It is particularly recommended for those with a family history of serious illnesses, those above 40 years of age and those with a high risk of developing significant diseases due to diet, lifestyle, nature of work, environment or other circumstances.

Deputy Health Minister Datuk Rosnah Abdul Rashid Shirlin is expected to kick start the health check campaign next month.

Dr Mohamed Rafiq says many people have heart diseases which can be prevented by losing weight, stopping smoking, exercising regularly and controlling their high blood pressure, diabetes and cholesterol.

“People must learn to eat healthy food especially with four per cent of Malaysians being obese and 16.6 per cent overweight. Obesity increases blood pressure and workload on the heart. Obesity is related to increase in stroke (11x), heart attack (15x) and diabetes (30x),” he adds.

A five per cent reduction of body weight will lead to lower blood pressure while a 10 per cent reduction lowers cholesterol.

Dr Mohamed Rafiq also advises people to stop smoking as chronic exposure to nicotine may cause an acceleration of coronary artery and peptic ulcer diseases, reproductive disturbances, oesophageal reflux, hypertension, fetal illnesses and death, and delayed wound healing.

Tobacco, the vehicle of nicotine delivery, contains tar and some 2,000 chemicals. Tobacco and its various components have been associated with an increased risk of cancers of various body organs. Dr Rafiq welcomes corporate organisations to participate in the health check campaign as part of their corporate social responsibility programmes. For details about the campaign, call 03-2785 1957.

“Scientists claim a cup of tea may help cure diabetes,” according to the Daily Mirror. The newspaper and other news sources report on research that found that some chemicals in black tea (theaflavins and thearubigins) mimic the action of insulin in the body. Green tea has long been marketed as having beneficial health properties and this new research suggests some possibilities for black tea.

As it was conducted in a laboratory setting and only on cells in culture, the research behind these stories can be considered preliminary. This research has not investigated whether giving black tea to a living person has any effect on glucose regulation in a way that is similar to insulin or diabetic medications. As one of the researchers noted: “People shouldn’t be rushing to drink masses of black tea thinking it will cure them of diabetes”.

Where did the story come from?

Amy Cameron and colleagues from the University of Dundee and University of Edinburgh carried out the research. The study was funded by the Caledonian Research Foundation, the Chief

Scientist's Office of the Scottish Executive, the Medical Research Council, and scholarships from the Carnegie Trust for the University of Scotland. The study was published in the peer-reviewed medical journal: Aging Cell.

What kind of scientific study was this?

In this controlled laboratory experiment, the researchers looked at whether or not dietary factors played a role in the chemical pathways in the body that are involved in regulating aging and glucose formation and breakdown.

Llittle is known about the actions of polyphenols (the antioxidants that are believed to protect against cell damage) in black tea. The researchers hoped that further research would reveal how age-related metabolic diseases (such as diabetes) can be delayed or prevented.

The rate of ageing in the body is believed to be regulated by a group of molecules known as FOXO transcription factors. Both insulin and insulin-like growth factor-1 (IGF-1) have been found to inhibit FOXOs. The researchers were particularly interested in one type of FOXO molecule – FOXO1a – which is known to prevent glucose production in the liver by suppressing certain genes.

To investigate if certain dietary factors can mimic the effects of insulin and IGF-1 on FOXOs, the researchers carried out laboratory experiments using human kidney cells called “293 cells” and rat liver cells.

Recognised laboratory procedures were used in which selected black tea compounds (theaflavins and thearubigins) were incubated with the cells in order to examine their effects. These effects were compared to those observed when a chemical, dimethyl sulfoxide (DMSO), was used as a control.

The researchers then compared the differences between the effects of tea and the control on the activity of FOXO1a and certain genes using statistical methods.

What were the results of the study?

The researchers found that three different theaflavins induced similar chemical changes in FOXO1a to those made by insulin and IGF-1.

They also found that the theaflavins suppressed the PEPCK genes involved in glucose processing in the liver. The effects were greater with increased dosage of the tea compound.

What interpretations did the researchers draw from these results?

The authors say that their experiments have identified a group of tea compounds that have similar insulin-like effects on FOXO1a and PEPCK that are “key downstream effectors of cellular insulin/longevity signalling.”

They say that “it remains to be established whether black tea polyphenols are sufficiently bioavailable to act in vivo [in the body]”, but suggest that developments may lead to the production of drugs or certain dietary interventions which can treat or delay the onset of age-related diseases.

What does the NHS Knowledge Service make of this study?

This early experimental research was conducted in the laboratory.

The study has not investigated whether giving black tea to an individual has a similar effect on glucose regulation in the body as insulin or diabetic medications, and makes no conclusions or assumptions about any beneficial properties of black tea compounds on diabetes.

The results will be of interest to researchers investigating why some studies have found drinking black tea is linked to a lower incidence of heart disease and cancer. However, while the study forms a basis for further research, it has little practical application now.
It is worth repeating: people shouldn’t drink black tea thinking it will cure them of diabetes.

Like most teenagers, Nurul Rahimah Abu Bakar, 14, loves ice-cream, cakes and chocolates.

Once, she would have these desserts after dinner with her family.

However, such times are no more and the family now has more salad and vegetables on their dinner table, said her mother, Zalilah Selamat, 49.

The family had to change their eating habits after Nurul Rahimah, the youngest among four siblings, was diagnosed with Type 2 diabetes (T2D).

The condition normally hits those in their 50s.

When Nurul Rahimah was 11, it dawned on Zalilah that her daughter could be a diabetic as she was constantly feeling thirsty and going to the washroom to ease herself at least twice every night.

Zalilah, a diabetic since she was 35, said her daughter was going through the same symptoms that she had previously gone through.

Zalilah, whose late father also had diabetes, said Nurul Rahimah’s blood sample was sent to a laboratory in Australia for a detailed diagnosis.

The tests confirmed the teenager as a T2D.

“Since then, we have reduced the intake of processed food as Nurul Rahimah had to lose some weight,” her mother said.

Zalilah said it was difficult initially for her daughter to follow the new diet “because my family just love and enjoy all types of food”.

“However, she is now inspired to be more disciplined in controlling her diet after seeing good results in her blood sugar.

“As advised by her doctors, she has a more balanced meal made up of rice (25%), protein (25%) and vegetables (50%).

“She no longer takes sweet drinks and tries to avoid fast food,” said Zalilah.

Another young patient, Muhammad Ridzwan Rodzi, 13, was overweight by 15kg when he was diagnosed with T2D in March last year.

“He was very much into playing video games and hardly spent time playing with his friends outside of the house,” said his father Rodzi Mashor, 53.

“When he was diagnosed with the disease, his blood sugar level was very high.

“However, with oral medication and the injection of insulin three times a day, his condition has stabilised,” Rodzi said, adding that his son also controlled his diet by eating less to lose weight.

Health Minister Datuk Seri Liow Tiong Lai advised parents not to let their children eat unhealthy food round the clock as it could lead to T2D.

Parents should prepare nutritious food instead, he said.

He was commenting on The Star’s front-page report on the increasing number of young T2D patients.

“Children enjoy fast food, so parents should educate them on cutting down burgers, nuggets, fries and carbonated drinks.

“Parents should inculcate a healthy diet from young,” he told reporters after opening the Malaysian Dietitians’ Association Scientific Conference here yesterday.

He said the National Health and Morbidity Survey conducted in 2006 showed that Malaysian adults with diabetes had increased from 8.3% in 1996 to 14.9% in 2006, while hypertension cases had increased from 29.9% to 43% and obesity from 4.4% to 14%.

Researchers have discovered that this ancient soft martial art form helps promote overall good health and lower blood sugar levels

The ANCIENT art of tai chi may help in controlling or lowering the risk of type 2 diabetes, two small studies suggest.

In one study, Taiwanese researchers found that tai chi helped lower long-term blood sugar levels in 30 middle-aged adults with type 2 diabetes.

In the second, an Australian team found that a combination of tai chi and qigong benefited 11 adults at risk of type 2 diabetes.

Both tai chi and qigong are ancient Chinese practices designed to promote good health. Qigong combines gentle movements, meditation and breathing techniques; tai chi involves slow, fluid movements combined with mental imagery and deep breathing.

Both are moderate, low-impact activities, and recent studies suggest that older adults could reap a number of health benefits from tai chi, such as lower blood pressure, a reduced fall risk and improved arthritis symptoms.

The new studies, both published online by the British Journal of Sports Medicine, suggest that tai chi might aid in managing type 2 diabetes or metabolic syndrome which is a collection of risk factors for diabetes, heart disease and stroke.

For the first study, Dr Kuender Yang and colleagues at Chang Gung Memorial Hospital followed 30 middle-aged and older adults with type 2 diabetes, each of whom was matched with a diabetes-free "control" of the same age and sex.

For 12 weeks, participants attended an hour-long tai chi class three times per week.

At the end of the study, Yang’s team found that the diabetic patients showed a reduction in their average HbA1c level – a measure of long-term blood sugar control.

In the second study, Dr Xin Liu and colleagues at the University of Queensland looked at the effects of a specially designed tai chi/qigong programme among 11 middle-aged to older adults with elevated blood sugar.

Seven of them also had metabolic syndrome, including high blood pressure, abdominal obesity, unhealthy cholesterol and triglyceride levels, and impaired blood sugar control.

The researchers found that, after 12 weeks, participants showed a dip in both their average blood pressure level and waist size. There was also a small improvement in blood sugar control.

The findings are "very promising", Liu told Reuters Health, but added, however, that this was only a small pilot study.

What’s needed, Liu explained, are randomised controlled clinical trials, where participants are randomly assigned to either perform tai chi/qigong or serve as a comparison group.

Liu’s team has just completed such a study, but the results are not available yet.

Overweight and obesity increases the risk of many chronic diseases.

THE bad news is: overweight and obesity increases your risk to coronary heart disease, stroke, diabetes, and high blood pressure. It also aggravates arthritis and breathing problems. More bad news is that overweight and obesity causes certain cancers.

The good news is: overweight and obesity is largely preventable. There is therefore no option – measures must be taken to prevent overweight or obesity. It is particularly important to prevent our children from excessive weight gain. An overweight child is more likely to become an overweight or obese adult. Prevention must therefore start from childhood.

The solution is: maintain body weight in a healthy range. This is the second key message of the Malaysian Dietary Guidelines (MDG) 2010 and is the focus of this instalment of NutriScene.

The MDG 2010 is a set of advisory statements that aim to promote appropriate food habits, physical activity, and wiser food choices.

Overweight and obesity in Malaysia

Available data show that overweight and obesity rates in Malaysia has been on the rise. The nationwide Third National Health and Morbidity Survey (NHMS III) conducted in 2006 showed that 29.1% of the adult population studied was found to be overweight (BMI 25.0 to 29.9). The prevalence of obesity (BMI >30) was reported to be 14.0%.

The proportion of the adult population that are overweight and obese is therefore 43.1%. This means that almost half of the adult population in the country could be overweight or obese.

This rate of occurrence of overweight and obesity is much higher than the rates found in the Second National Health and Morbidity Survey (NHMS II) carried out in 1996. Overweight in NHMS II was 16.6% while obesity was 4.4%. The percentage of adults that were overweight and obese in 1996 was 21.0%.

Comparing the data for 2006 and 1996, it is clear that the current prevalence of overweight is at least 1.8 times higher than that 10 years ago. Furthermore, the rate of obesity is now 3.2 times higher than that a decade ago. The combined problem of overweight and obesity is now two times higher than in 1996.

NHMS III also included children below 18 years in the survey. The prevalence of overweight among children was 5.4%. There was a slightly higher prevalence of overweight among boys (6.0%) compared to girls (4.7%). The proportion of overweight children in urban areas (6.3%) was higher than that observed for rural areas (4.0%). NHMS II in 1996 did not include children in that survey. Recent studies among primary school children have reported high prevalences of overweight and obesity of over 20%.

Causes of overweight and obesity

We take in energy from food and drinks, which is used to carry out a variety of body functions and physical activity. If we take in more energy than we use, we are said to be in a positive energy balance, and we gain weight. Excess energy is stored mostly as body fat laid down at various sites around the body. This excess energy can come from carbohydrates, fats, or proteins contained in the food we eat. Yes, it can also come from ethanol in the alcoholic drinks.

Positive energy balance can also be caused by a sedentary lifestyle or lack of physical activity. I do believe that in the case of Malaysians, the problem of overweight and obesity is largely due to overeating and eating too much energy-dense foods, combined with lack of physical activity.

We need to achieve energy balance by adopting an appropriate dietary pattern and an active lifestyle. We will then be able to maintain our body weight in the healthy range.

What is a healthy weight range?

One of the easiest ways to check if you’re in the healthy weight range is by calculating your Body Mass Index (BMI). This indicator calculates the range of healthy weights for different heights and is a useful guide for most adults. Follow the simple procedures below:

1. Weigh yourself in kilograms (kg) and measure your height in metres (m).

2. Divide your weight by your height squared. This figure is your BMI.

For example, if a person is 1.6 m tall and weighs 65 kg, your BMI would be 25.4.

If your BMI is less than 18.5, you are underweight and your risk of weight-related illness is low.

If your BMI is from 18.5 to 24.9, you are in the normal range and your risk of weight-related illness is average.

If your BMI is From 25.0 to 29.9, you are overweight and your risk of weight-related illness is increased.

If your BMI is 30 or above, you are obese and your risk of weight-related illness is moderate to severe.

Hence, for the example above, the person is said to be overweight and is not in the healthy weight range. His risk to various weight-related problems is increased.

It must be noted that the above guide to interpretating BMI is only for those 18 years and above. For children and adolescents, a different BMI cut-off value must be used for each age group. Furthermore, it should be noted that BMI may not be a suitable indicator for athletes, elderly people, and pregnant women.

The emphasis on overweight and obesity and its related health hazards should not overshadow the fact that the other extreme of weight problems can also occur and should not be ignored. When a person uses up more energy than he takes in, he is said to be in negative energy balance and loses weight.

A low body weight is also unhealthy because it increases the risk of other clinical conditions. Severely underweight persons often have poor nutritional status and are prone to infections, low immune status, anaemia, low bone mass, and difficulty recovering from illnesses.

Hence, it is important for all Malaysians to maintain a healthy body weight range throughout life.

Take action

Key message two of the MDG provides guidelines for maintaining a healthy weight range. It has five key recommendations, and within each of these, the MDG has provided several tips on how to achieve these recommendations.

1. Maintain body weight in the healthy range by balancing calorie intake with physical activity.

● Eat according to calorie recommendation by age, sex and physical activity level.

● Be physically active everyday

● Reduce sedentary activities.

2. Weigh yourself regularly, at least once a week.

● Use a suitable weighing scale.

● Weigh in light clothing and without shoes.

● Weigh yourself at the same time of the day, preferably before breakfast.

3. If you are an adult, prevent gradual weight gain over time.

● Reduce intake of high calorie foods.

● Eat smaller portions of high calorie foods.

● Increase physical activity to increase daily energy expenditure.

4. If overweight, aim for a slow and steady weight loss.

● Set a realistic weight loss goal of ½ to 1 kg per week.

● Decrease calorie intake without sacrificing other nutrients.

● Increase daily physical activity to 90 minutes gradually.

5. If underweight, increase energy intake as recommended.

● Eat three main meals and one to three snacks in a day.

● Choose foods with higher calorie content.

● Eat larger portions of food.

Take charge today

Maintaining a healthy weight range must become the goal of all Malaysians at all stages of life. It is important to minimise the risk of chronic diseases in adults. Maintaining a healthy weight throughout childhood may reduce the risk of becoming an overweight or obese adult.

It is not about looking good. It is about being healthy.

I do believe that the recommendations above are achievable – we just have to tune our mind towards believing in them and actually doing them. Every Malaysian should know his body weight. He should monitor this weight regularly and take steps to maintain it within a desirable range.

For those who are overweight or obese, use these guidelines to help you reduce body weight and maintain it at the healthy range. Losing excess body weight is notoriously difficult. It is nevertheless possible; what is required is determination and discipline. There are no short cuts or quick ways to losing the extra kilos. Do be wary of the various programmes that promise quick weight-loss, that do not require any diet control or exercise.

More young people, some as young as seven, are suffering from Type 2 diabetes (T2D), a disease that generally hits those in their 50s.

Doctors say more primary school students have been diagnosed with T2D in the last decade, a fact that is alarming since the disease is usually linked to those much older.

The doctors found that the young diabetics were usually obese, and their condition could be traced to eating too much unhealthy food and having a sedentary lifestyle.

They said the disease was not just about having excessive sugar in the blood system but could also affect the patient’s vital organs like the heart, kidneys, nerves and eyes.

“The children’s bad dietary habits of eating burgers, nuggets, fried chicken, fries and carbonated drinks are also contributing factors,” Universiti Kebangsaan Malaysia Medical Centre senior consultant paediatrician and paediatric endocrinologist Prof Dr Wu Loo Ling said, adding that long hours of homework, watching television and playing computer games added to the problem.

“Cases of children and teenagers with diabetes are increasing at a faster rate,” said Dr Wu. “Between 30% and 40% of children in Western countries are overweight and the problem of overweight Malaysian children is also on the rise.”

Endocrinologist Dr Lim Soo San said T2D was more apparent in people aged between 18 and 29.

“We even came across children who are below 10 years old and have T2D ,” Dr Lim said.

The Registry on Diabetes in Children and Adolescents (2006-2007) showed that 56% of the 42 T2D cases involved obese individuals.

Dr Lim said parents continued to feed their children with “junk food” due to their lack of awareness of the disease.

Dietician Mary Easaw-John said apart from bad eating habits, irregular eating hours had also contributed to the rising trend of T2D among younger people.

“People tend to eat out instead of packing food from home nowadays. And fried food is common in eateries,” said Easaw, who is Dietetics Food Services of the National Heart Institute senior manager.

The Third National Health and Morbidity Survey, conducted in 2006, showed that there was a high prevalence of overweight primary school children, and over 20% of them were obese.

Statistics pointed that Malaysia had the fourth highest number of diabetes cases in Asia, with 800,000 in 2007. The number is expected to jump to 1.3 million cases this year.

The recent survey also revealed that more than 43% of Malaysian adults were overweight or obese, twice the figure a decade ago.

An expanding waistline translates to an increased risk of degenerative lifestyle diseases such as diabetes and heart disease. IN my younger days, jeans were meant to look rugged, and fitted snugly. In the past decade, the fashion vogue was the hipster, with the waistline very much below the waist. That was the voice of the Y generation, boldly depicting the “y” cleft at the posterior. Some of us young-at-heart baby boomers wore these droopy pants with unflattering results. These pants created the “muffin top” as flabby tummies overflowed its edges.

A century ago, the human population was too busy battling infectious diseases. Heart diseases, hypertension, diabetes, stroke and obesity received scant attention.

Besides, life expectancy only hovered around 50, so these conditions were considered rare as people did not live long enough to get them.

However, today, the cause of mortality has shifted from bugs to degenerative lifestyle diseases. Just like a machine which rusts with time, these degenerative diseases typically accompany the process of ageing. What went wrong?

We certainly missed something here. In our medical curriculum, we are taught to compartmentalise diseases, hence many health professionals, including myself, have been conditioned to relate the different conditions as separate entities, not realising that there is a common link.

In 1988, Dr Gerald Reavens pieced the mystery together and coined the term “Syndrome X”. This is one of the most important discoveries in preventive medicine. The subsequent tussle over definitions by the various authoritative bodies created substantial confusion. Currently, Syndrome X is known as the Metabolic Syndrome, which encompasses the following criteria:

> A waistline more than 40 inches in men, 35 inches in women.

> Elevated triglycerides.

> Reduced HDL-cholesterol.

> Borderline blood pressure.

> Borderline blood sugar reading.

Having any three of the above qualifies for the diagnosis. In the United States, it is estimated that 25% of the population are afflicted with the Metabolic Syndrome and another 25% are going there.

Malaysian obesity rates are approaching those of the West and therefore we do not need to be Einsteins to realise that we are also facing a huge problem.

Why the big concern? The natural progression of this condition can lead to full-blown diabetes, prompting the understanding that it is indeed a pre-diabetic condition.

The Metabolic Syndrome offers us the insight that chronic diseases do not “just happen” overnight. Although there is certainly a genetic predisposition to these diseases, it is not all the parent’s fault. It is mainly the road that we choose to travel on.

Very often, the route becomes slippery and hazardous, but we have the choice to re-chart the course or remain on the road to chronic ill health.

The genesis of metabolic upheaval

The root of the problem is none other than one’s choice of food, in particular, carbohydrate intake, especially if they are highly processed. Fragrant rice, white rice, frosted cereals, white bread, noodles and potatoes are typical components of our meals and these carbohydrates are readily converted into glucose in the body. They are known as high glycaemic foods. Sugar is the ultimate source of the body’s fuel and is channelled to cells, particularly muscle cells, for energy production.

However, trouble brews when the blood sugar spikes repeatedly in a day. I personally know of some who have roti canai and teh tarik for breakfast, char kueh teow for lunch, and nasi kandar for dinner, with calory-dense snacks in between.

After a typical high glycaemic meal, the blood sugar goes through a roller-coaster ride. As it rises rapidly, the pancreas secretes too much of the hormone insulin due to hyperstimulation. This stage is known as “insulin abuse”. Insulin lowers the blood sugar by acting like a key that opens the locks on the muscle cells, thereby allowing the sugar to get into the cells to be burned as energy.

After this, the blood sugar crashes down, dipping below its baseline, leading to low blood sugar and hunger, feeding the craving for carbohydrate. The cycle repeats itself a few times a day, year after year.

Full-blown Metabolic Syndrome

Just like any lock which has been overused, there comes a stage when the cells refuse to open the door despite plenty of insulin, rendering the “keys” ineffective. This state is called insulin resistance and is synonymous with the onset of the Metabolic Syndrome, when the blood sugar now stays elevated,

As the blood sugar cannot get into cells to be used as energy, it switches to a different route to be stored as fat, which is concentrated around the middle. This fat is known as visceral fat, or aptly called, “killer fat”, as it is associated with fatty liver, heart disease, stroke, sleep apnoea and diabetes.

The Metabolic Syndrome is a stubborn guest and a silent harbinger of many maladies.

As time goes on, the pancreas finally wears itself out and this paves the way for type 2 diabetes.

As the pancreas throws in the towel, the insulin level drops. Now, as the blood sugar escalates out of control, there is further starvation of the cells as less and less glucose gain entry. The body’s fats and proteins start to break down, much like the body “eating itself”, leading to extreme fatigue, loss of weight due to wasting muscles, thirst and frequent urination. Diabetes has announced its arrival.

Much like a tug boat collecting junk, the Metabolic Syndrome pulls along a host of related chronic diseases, waiting in the wings to rear its ugly head. We now realise that diabetes, obesity, heart disease and stroke are rival siblings in the same family, with the same root cause, each trying to outdo the other.

Take action

The good news is there is a recipe for avoidance or reversal of the Metabolic Syndrome. The bad news is there is not a single drug that can do the trick. The worst news is that the action required is a triad of unpopular measures that include exercise, taking low glycaemic meals, and following a programme of optimal cellular nutrition.

These are the recommendations of Dr Ray Strand who wrote the book Healthy For Life, which stresses the target of developing a healthy lifestyle with the permanent side effect of weight loss. The key here is to reverse insulin resistance. In a 12-week study of patients with the Metabolic Syndrome who followed the programme, parameters like blood pressure, blood sugar, lipids and insulin resistance were reduced.

Exercise for at least 30 minutes a day, combining stretching, muscle toning and light aerobics. The rationale behind exercise in reducing insulin resistance is the benefit provided by improved muscle capillary blood flow, which delivers insulin to the target tissues.

Concomitant with this is the increase in lean mass, thereby increasing metabolic rate and more efficient glucose utilisation.

Understanding the glycaemic index is paramount in the successful reversal of the Metabolic Syndrome. High rating carbohydrates are, needless to say, our usual favourites. Examples of low glycaemic index carbohydrates include the uninspiring rolled oats, whole bran, broccoli, vegetables and most fruits (except for bananas).

Just like there are good carbs and bad carbs, there are also good proteins and good fat. It makes no sense to practise healthy carbohydrate intake and yet gulp down pots of red meat curries and fatty foods.

The manner of eating is also important as small frequent meals cause less sugar spikes than hearty meals. An ideal concept is “graze”, not “gorge”.

Last but not least is the concept of optimal cellular nutrition, which means providing the cells with the ideal amount of micronutrients (essential cellular food) which meets the shortfall in our unbalanced modern diets.

With specific reference to insulin resistance, supplementation with a mineral called chromium has the promising effect of lowering blood sugar. Animal studies also suggest that chromium supplementation increases lean mass, thereby aiding the burning of fat.

Other minerals like vanadium and manganese may also play a pivotal role in improving blood sugar control.

In caramelising banana, the sugar coats on the fruit and browns with heat. In the body, the glucose also bonds to the red blood cells through a process known as “glycation” (measured by a blood test known as HBA1c). A similar process occurs with fats and proteins, leading to oxidation and inflammation of various tissues, yielding a bewildering array of complications.

A marker for blood vessel inflammation called C–reactive protein gives an indication of the state of the arteries. A broad spectrum antioxidant supplement together with potent doses of vitamin B complexes can offer some protection.

The threat of the Metabolic Syndrome often goes unnoticed by those afflicted as there are hardly any symptoms. However, it is a very real threat, and one in which we should eliminate before it irreversibly robs us of our well-being.

Holding high positions in the public and private sectors comes with a price - diabetes.

The National Health and Morbidity Survey 2006 revealed that the national prevalence of diabetes among senior officers and managers was 15.9 per cent, the second highest after the unemployed (16.1 per cent).

Housewives ranked third with 14.2 per cent followed by those under the technical and associates category (12.1 per cent), machine operators and assemblers (11.7 per cent), services and shop workers (10.7 per cent) and professionals (10 per cent).

Universiti Kebangsaan Malaysia's Emeritus Professor Datuk Dr Khalid Abdul Kadir said there was a "diabetic explosion" in Malaysia and wondered whether enough was being done to stop it.

He said an example could be seen among the Malays in Tanjung Karang, Selangor.

The prevalence was four per cent in 1984 and 6.5 per cent in 1990. Two years ago, it shot up to 20 per cent.

In Malaysia, the prevalence of the disease was one to two per cent in 1960, 6.3 per cent in 1985, 8.3 per cent in 1996 and 14.9 per cent in 2006. In just 20 years, it has increased to 250 per cent.

Dr Khalid said one in seven adults in Malaysia was a diabetic.

The NHMS 2006 revealed that 14.9 per cent of Malaysians were diabetic, 42.6 per cent were hypertensive, 29.1 per cent were overweight and 14.4 per cent were obese.

"The worrying trend is that more people below the age of 45 are getting diabetes," said Dr Khalid, who is also a professor of medicine at Monash University.

He said with modernisation and economic progress, there would be an explosion of "metabolic catastrophe" in Asia, including Malaysia, due to obesity, hypertension and diabetes.

In 1990, he said the prevalence of obesity and diabetes among the Orang Asli, the hunter-gatherers in the jungle fringes of Pahang or in settlements at Carey Islands and Ulu Langat outside Kuala Lumpur was zero. But over the years, the Institute for Medical Research found that five per cent of the resettled Orang Asli had diabetes.

Dr Khalid attributed the growing number of diabetic cases to the lack of physical activity and excess calories accumulation as one ages.

"As the population ages, we are going to see more people with diabetes," he said, adding that diabetes, hypertension and obesity seldom killed a person but they contributed to heart diseases.

He said the problem could only be overcome through lifestyle modifications, such as weight loss, regular physical activity and dietary changes. He added that the time had come to create awareness of the disease among Malaysians.

AGE should not stop anyone from being fit and active. In fact, older people can benefit the most from regular exercise, compared to people from any other age group.

There are two types of exercises that are important for preventing chronic diseases and staying strong: aerobic and strength-training.

Aerobic exercise

● Aerobic exercise can help to prevent and treat many chronic conditions typically associated with age, including diabetes, hypertension, heart disease and osteoporosis.

● Recommendation: At least 30 minutes of aerobic exercise on most, if not all, days. Good aerobic exercises include walking, swimming, aqua gym and stationary cycling.

Strength-training exercise

● Strength-training with weights or resistance-training is necessary to stop or reverse loss of muscle mass, and to increase bone density and muscle strength.

● Recommendation: Two to three days a week of strength-training workouts, with a day of rest in between. When doing exercises at home, do two to three sets of eight to 12 repetitions using six to eight different exercises. When 12 repetitions can be made in good form with ease, the weight can be increased.

Being active also helps to improve appetite, and you will find yourself enjoying your food and looking forward to a healthy, balanced diet.

The international scientific community meets to find solutions to the global epidemic of overweight and obesity.

WITH the increased significance of obesity worldwide, channels for sharing of research findings as well as experiences in obesity prevention and control programmes have become very important. At the 11th International Congress of Obesity (ICO), held in Stockholm in mid July 2010, more than 3,000 participants met in Stockholm to discuss this serious global health problem.

The main scientific programme was made up of five tracks, each focused on rather distinct topics, namely: basic science; experimental medicine and physiology; treatment and co-morbidities; diet, activity, and behaviour; and public health and policy.

I followed the fifth track on public health and policy and would like to share with readers some of the interesting and useful highlights. We can certainly learn from experiences elsewhere as we struggle to combat this growing problem here.

Prevalence and trends of obesity

The increase in the worldwide prevalence of obesity in children has been widely documented. However, a number of recent studies from countries including England, France, Greece, Russia, Switzerland, and the US reported that the rates of increase in overweight and obesity among children may be levelling off, or even reversing. A few presentations discussed if this is indeed so.

Nick Townsend, from the University of Oxford, UK, examined available evidence to determine if obesity prevalence has stopped rising in the United Kingdom and internationally. The authors did find some evidence of levelling off of overweight and obesity prevalence among children internationally. It was, however, pointed out that due to limitations of these studies, it is not possible to conclude confidently that a levelling off is currently occurring.

Also in relation to this question, Kristian Midthjell of the HUNT Research Centre, Norwegian University of Science and Technology, reported findings from the HUNT Study. This comprises three surveys of adult populations in Nord-Trondelag County, Norway, between 1984 and 2008. Obesity and diabetes were reported to have increased for both men and women, especially those below 40 years.

An increase in obesity incidence was also reported for a rural population in Pakistan by Syed Shah, United Arab Emirates University. Data was obtained from two independent cross-sectional adult population surveys conducted in 1995 and 2007.

On the other hand, Melanie Nichols of the WHO Collaborating Centre for Obesity Prevention, Deakin University, Australia, reported that the prevalence of overweight and obesity among Victorian preschool children decreased significantly between 1999 and 2007. Decreases occurred in both genders and all quartiles of socio-economic status, with no concurrent increase in the prevalence of thinness.

New approaches to improve public health

As a result of the increase in obesity rates, there has been increased use of economic tools to reverse this trend, e.g. taxes, subsidies, and regulation. Prof Roland Sturm of RAND Corporation presented an overview of such approaches in the United States.

There are a variety of approaches underway, mostly regulation (e.g. the Fast Food Ban in Los Angeles, menu labeling laws) and some taxes (caloric soft drinks, “junk food”). The Department of Agriculture is also conducting a randomized price experiment to test the effects of a 30% discount on fruits and vegetables.

Alison Hardy of the Department of Health, UK, described a new social marketing approach to obesity prevention launched in England in January 2009. Called “Change4Life”, it sets out to create a societal movement that would engage families, communities, grass roots organisations, teachers, healthcare professionals, NGOs, and businesses, so that everyone could play their part in combating obesity. I was rather impressed to hear that over 400,000 families have joined Change4Life.

Bruce Silverglade of the International Association of Consumer Food Organizations summarised efforts by consumer advocacy organisations that work with the scientific community to influence public health policies related to the reduction of obesity. These include removing soft drinks from schools; and conducting a trans-Atlantic project persuading restaurant chains in Europe to provide calorie content and other nutrition information for standardised food items at the point-of-sale.

Community-based interventions

Community-based interventions are an essential part of comprehensive approaches to obesity prevention. A number of interesting interventions were presented, several of them reporting encouraging results in obesity reduction.

Prof Boyd Swinburn, of the WHO Collaborating Centre for Obesity Prevention, Deakin University, Australia, discussed some lessons learnt from these intervention programmes. The Barwon region around Geelong, Australia, was established as a “Sentinel Site for Obesity Prevention” to develop and evaluate the effectiveness of three demonstration programmes. The “Romp & Chomp” achieved substantial reductions in overweight/obesity prevalence. The “Be Active Eat Well” programme for primary school children achieved significant reductions in unhealthy weight gain. The “It’s Your Move!” adolescent programme had virtually no impact on weight gain.

In another presentation, Andrea de Silva-Sanigorski from the same centre provided more information on the Romp & Chomp (R&C) programme. This intervention (2004-2008) programme aimed to prevent childhood obesity and promote healthy eating and active play in children up to five years old through environmental intervention in family day cares (FDC). The FDC created more opportunities for children to be more active physically and eat more nutritious foods during their time in care.

Lauren Prosser, University of Melbourne, presented yet another intervention programme in Australia, the “KIDS - Go for your life” (KGFYL) for elementary schools. It was found that compared to member schools, significantly more health promotion activities related to healthy eating and physical activity were being implemented in awarded schools and a higher proportion of awarded schools implemented policies promoting these behaviours.

Closer to home, Handy Amin of the Health Promotion Board Singapore reported on a national workplace weight management programme entitled “Lose to Win”. It was organised to educate and motivate the workforce towards achieving healthier weight.

Participants underwent an intensive, 12-week programme comprising fitness assessments, interactive nutrition workshops, and twice weekly Boot Camp exercise sessions. Almost all participants reported weight loss, and all of them reported improved fitness scores.

Gemma Gao Yang of the Chinese University of Hong Kong reported a systematic review of community-based interventions to reduce overweight and obesity in mainland China. All non-drug-controlled interventions (≥3 months), which used anthropometric outcome measures, were selected from three Chinese and nine international electronic databases. Seventeen studies (85%) reported significant effects in anthropometric measurement outcomes.

Food environments

It is generally accepted that the food environment plays a critical role in the prevalence of overweight and obesity. Several presentations discussed various aspects of the food environment and how it could help in the control and prevention of obesity. I noted that there was greater focus on marketing of food to children in this and other nutrition conferences.

In recent years, supermarkets have emerged as a new locus of power in food retailing.

Corinna Hawkes, from the School of Public Health at the University of Sao Paulo, Brazil. examined the implications of supermarket growth and obesity. Leading supermarket operators have developed clear competitive strategies that can influence the decisions consumers make about food. A detailed understanding of such strategies enables the identification of the most critical actions needed to encourage a healthier retail environment.

During the last 12 months, the global dimensions and future impact of obesity have become major areas of focus and activity by governments, corporations, and non-governmental agencies. Dr Derek Yach is director of global health policy at PepsiCo. He spoke of the plans and actions of leading food and retail companies based upon very recent corporate pledges at the global and some national levels. He emphasised on the need for deeper and more effective partnerships between the key players to implement these.

According to Tim Lobstein, International Association for the Study of Obesity, UK, several European Union member states now regulate the marketing of energy-dense foods to children through statutory and co-regulatory initiatives. Some food producing companies have also made “pledges” to reduce their marketing to children. Most states rely on voluntary action by the food industry to limit marketing to children whilst company pledges are limited in their scope and application.

Television food advertising has been shown to impact on children’s food and brand preferences, purchase requests, and consumption. This topic was discussed in at least two presentations.

Lesley King, Sydney University, reported a study to evaluate the impact of the Australian Food and Grocery Council self-regulatory initiative to limit food marketing to children. The impact of a regulatory code is limited by the extent of uptake by food companies. The continued advertising of unhealthy foods indicates that this self-regulatory code does not adequately protect children.

Discussing the same topic, Emma Boyland, University of Liverpool, UK, revealed that food was the third most advertised category, behind channel promotions and toys on UK television during 2008. The most frequently broadcast were supermarket advertisements, fast food, and high sugar breakfast cereals. It was concluded that children are exposed to greater TV food advertising for unhealthy than healthy items.

Fabio Gomes, National Cancer Institute of Brazil, reported that in 2006, the Brazilian government launched a proposal to regulate advertising and marketing of food products with high content of sugar, saturated fat, trans fat and sodium, and also sugary soft drinks.

Several multinational F&B companies have also developed self-rules and/or have signed pledges to regulate their marketing practices. However, these have not been effective and the self-regulations have not been honoured.

Cost-effectiveness analyses are important tools in the effort to prioritise interventions for obesity prevention. Using a models approach, Gary Sacks, Deakin University, Melbourne, compared the cost-effectiveness of conservative scenarios for two commonly proposed interventions: front-of-pack “traffic-light” nutrition labelling and a tax on unhealthy foods (“junk-food” tax).

Based on estimated reduced mean energy intake, reduced mean weight, and disability adjusted life years (DALYs), the cost-effectiveness analysis showed both interventions were effective and cost-saving.

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Syndrome X patients face an increased risk of diabetes and cardiovascular disease due to an abnormal response to insulin. The key to treatment lies in diet and exercise

SYNDROME X, sometimes known as “metabolic syndrome”, is a group of cardiac risk factors that results from insulin resistance — when the body’s tissues do not respond normally to insulin.

The body’s receptors are “deaf” to insulin and one needs to produce more insulin to get the same effects.


A person with metabolic syndrome has a greatly increased risk of diabetes, cardiovascular disease and premature death.

The risk factors of metabolic syndrome include:

• insulin resistance

• obesity (especially abdominal obesity)

• high blood pressure

• abnormalities in blood clotting (the blood is more likely to colt leading to strokes and heart attacks)

• lipid abnormalities

Specifically, metabolic syndrome is diagnosed if any three of the following are present:

1. Elevated waist circumference: 102cm or more for men and 89cm or more for women

2. Elevated triglycerides (150 mg/dL or higher )

3. Reduced HDL (“good”) cholesterol (less than 40 mg/dL in men and less than 50 mg/dL in women)

4. Elevated blood pressure (130/85 mm Hg or higher)

5. Elevated fasting glucose (100 mg/dL or higher)

In the body’s attempt to compensate for insulin resistance, extra insulin is produced, leading to elevated levels. The latter can lead, directly or indirectly, to the characteristic metabolic abnormalities seen in these patients. Frequently, insulin resistance will progress to overt type 2 diabetes, which further increases the risk of cardiovascular complications. In fact, another name for metabolic syndrome is “pre-diabetes”.

Genetic

Syndrome X tends to run in families. Members of the family are more prone to type 2 diabetes. Syndrome X will occur in susceptible people who become overweight and sedentary. It can be prevented with exercise and maintaining a healthy body weight.

Treatment of Metabolic Syndrome

Insulin Resistance: To date, there is no drug that directly treats the underlying insulin resistance.

However, diet and exercise can reverse the syndrome. Those with metabolic syndrome should make every attempt to reduce their body weight to within 20 per cent of their “ideal” body weight (calculated for age and height) and incorporate aerobic exercise (at least 20 minutes) into their daily lifestyle.

With vigorous efforts to reduce weight and increase exercise, metabolic syndrome can be reversed and the risk for cardiovascular complications can be substantially improved.

Lipid Abnormalities: While high LDL (bad cholesterol) and high triglycerides respond nicely to weight loss and exercise, drug therapy is often required.

Treatment should be aimed primarily at reducing LDL levels. Once reduced, LDL targets are reached and efforts at lowering triglyceride and raising HDL levels should be made.

Successful drug treatment usually requires a statin, a fibrate drug or a combination of a statin with either niacin or a fibrate.

Clotting Disorder

Patients with Syndrome X can have several disorders of coagulation that make it easier for blood clots to form within blood vessels. These blood clots are often a precipitating factor in developing heart attacks.

Patients are generally placed on daily aspirin therapy to prevent clotting. You should speak to a doctor, of course, before starting any new medication regimen. Fish oil has been shown to be useful and safe for this condition.

Hypertension: High blood pressure is present in more than half the people with metabolic syndrome and, in the setting of insulin resistance, hypertension is especially important as a risk factor. Adequate blood pressure treatment in these individuals can substantially improve their outcome.

The key to preventing metabolic syndrome, however, remains in the diet (especially one that is low in carbohydrates) and exercise. Anyone with a strong family history of metabolic syndrome or type 2 diabetes should be especially careful to maintain a healthy lifestyle.

The discovery of a new class of compounds in garlic seems to be effective in managing the lipid disturbance linked to Syndrome X. Using supercritical processes, extractions from certain species of garlic have revealed new and unique compounds, identified by Belgian scientists as vinyldithiins and sulfides. They can powerfully reverse and stall the effects of Syndrome X without known short- or long-term side effects. We shall discuss this in more detail next week.

Nutrition experts at Oregon State University have essentially "cured" laboratory mice of mild, diet-induced diabetes by stimulating the production of a particular enzyme.

The findings could offer a new approach to diabetes therapy, experts say, especially if a drug could be identified that would do the same thing, which in this case was accomplished with genetic manipulation.

Increased levels of this enzyme, called fatty acid elongase-5, restored normal function to diseased livers in mice, restored normal levels of blood glucose and insulin, and effectively corrected the risk factors incurred with diet-induced diabetes.

"This effect was fairly remarkable and not anticipated," said Donald Jump, a professor of nutrition and exercise sciences at Oregon State, where he is an expert on lipid metabolism and principal investigator with OSU's Linus Pauling Institute.

"It doesn't provide a therapy yet, but could be fairly important if we can find a drug to raise levels of this enzyme," Jump said. "There are already some drugs on the market that do this to a point, and further research in the field would be merited."

The studies were done on a family of enzymes called "fatty acid elongases," which have been known of for decades. Humans get essential fatty acids that they cannot naturally make from certain foods in their diet. These essential fatty acids are converted to longer and more unsaturated fatty acids. The fatty acid end products of these reactions are important for managing metabolism, inflammation, cognitive function, cardiovascular health, reproduction, vision and other metabolic roles.

The enzymes that do this are called fatty acid elongases, and much has been learned in recent years about them. In research on diet-induced obesity and diabetes, OSU studied enzyme conversion pathways, and found that elongase-5 was often impaired in mice with elevated insulin levels and diet-induced obesity.

The scientists used an established system, based on a recombinant adenovirus, to import the gene responsible for production of elongase-5 into the livers of obese, diabetic mice. When this "delivery system" began to function and the mice produced higher levels of the enzyme, their diet-induced liver defects and elevated blood sugar disappeared.

"The use of a genetic delivery system such as this was functional, but it may not be a permanent solution," Jump said. "For human therapy, it would be better to find a drug that could accomplish the same thing, and that may be possible. There are already drugs on the market, such as some fibrate drugs, that induce higher levels of elongase-5 to some extent."

There are also drugs used with diabetic patients that can lower blood sugar levels, Jump said, but some have side effects and undesired complications. The potential for raising levels of elongase-5 would be a new, specific and targeted approach to diabetes therapy, he said. While lowering blood sugar, the elevated levels of elongase-5 also reduced triglycerides in the liver, another desirable goal. Elevated triglycerides are associated with "fatty liver," also known as non-alcoholic fatty liver disease. This can progress to more severe liver diseases such as fibrosis, cirrhosis and cancer.

Further research is needed to define the exact biological mechanisms at work in this process, and determine what the fatty acids do that affects carbohydrate and triglyceride metabolism, he said. It appears that high fat diets suppress elongase-5 activity.

"These studies establish a link between fatty acid elongation and hepatic glucose and triglyceride metabolism," the researchers wrote in their report, "and suggest a role for regulators of elongase-5 activity in the treatment of diet-induced hyperglycemia and fatty liver."

The study was published in the Journal of Lipid Research. The research was supported by the National Institutes of Health and the National Institute for Food and Agriculture of the U.S. Department of Agriculture.

People must control the intake of 3-in-1 beverages as over-consumption may have a negative impact on their health, according to a nutrition expert.

Dr Roslee Rajikan, a lecturer in the Department of Nutrition and Dietetics, Universiti Kebangsaan Malaysia, said this was because consumers would not be able to control their sugar intake when they consumed 3-in-1 beverages, compared with other beverages prepared the traditional way.

"If they consume the product once in a while, it is all right.

"However, if they come this 3-in-1 beverage five to six times a day, there will be a problem," he said during an interview with Zulkifli Bujang in the Kerusi Panas programme aired on Bernama Radio 24.

Roslee said educating the public on sugar intake remained a difficult task despite various public awareness campaigns mounted by the government and private sector.

"Nevertheless, those who are already aware of the need to reduce sugar intake have switched to a better consumption pattern. Previously, ordering a teh tarik with less sugar, or drinking plain tea, was unheard of, but now it is a normal thing."

Roslee also advised those whose parents or other family members had a history of diabetes, to control their sugar intake and adopt a healthy diet. This would help them to reduce the risk of developing the disease.

"Diabetes is mainly genetic but we cannot blame it on our parents, if they are diabetic, as we all have the ability to change our lifestyle, by choosing a healthy diet and exercising more."