Health care professionals should prescribe better sleep to prevent and treat metabolic disorders
Evidence increasingly suggests that insufficient or disturbed sleep is associated with metabolic disorders such as type 2 diabetes and obesity, and addressing poor quality sleep should be a target for the prevention – and even treatment – of these disorders, say the authors  of a Review, published in The Lancet Diabetes & Endocrinology journal.
“Metabolic health, in addition to genetic predisposition, is largely dependent on behavioural factors such as dietary habits and physical activity. In the past few years, sleep loss as a disorder characterising the 24-hour lifestyle of modern societies has increasingly been shown to represent an additional behavioural factor adversely affecting metabolic health,” write the authors.
Addressing some types of sleep disturbance – such as sleep apnoea – may have a directly beneficial effect on patients’ metabolic health, say the authors. But a far more common problem is people simply not getting enough sleep, particularly due to the increased use of devices such as tablets and portable gaming devices.
Furthermore, disruption of the body’s natural sleeping and waking cycle (circadian desynchrony) often experienced by shift workers and others who work outside daylight hours, also appears to have a clear association with poor metabolic health, accompanied by increased rates of chronic illness and early mortality.
Although a number of epidemiological studies point to a clear association between poor quality sleep and metabolic disorders, until recently, the reason for this association was not clear. However, experimental studies are starting to provide evidence that there is a direct causal link between loss of sleep and the body’s ability to metabolise glucose, control food intake, and maintain its energy balance.
According to the study authors, “These findings open up new strategies for targeted interventions aimed at the present epidemic of the metabolic syndrome and related diseases. Ongoing and future studies will show whether interventions to improve sleep duration and quality can prevent or even reverse adverse metabolic traits. Meanwhile, on the basis of existing evidence, health care professionals can be safely recommended to motivate their patients to enjoy sufficient sleep at the right time of day.”
 The authors of the Review are Dr. Sebastian Schmid, University of Lübeck, Germany; Dr Manfred Hallschmid, University of Tübingen, Germany; and Professor Bernd Schultes, eSwiss Medical and Surgical Centre, St Gallen, Switzerland.
We’ve often been told that breakfast is the most important meal of the day. Now it appears that there’s some data to back that up. A Swedish study following up on 16 year olds after 27 years supports that claim. A study conducted by Umeå University in Sweden, published in Public Health Nutrition supports this claim.
The findings are from the Northern Swedish Cohort, which is a 27-year prospective study of more than 1,000 subjects – the breakfast study included 889 of these. All were in the ninth grade when they enrolled. Since then, they’ve had interviews and full medical exams at ages 18, 21, 30, and 43 years. The study revealed that adolescents who ate poor breakfasts displayed a higher incidence of metabolic syndrome 27 years later, compared with those who ate more substantial breakfasts.
Compared with the breakfast-eaters, the skippers and sweets-eaters had significantly higher alcohol and tobacco intake and exercised significantly less.
Metabolic syndrome is a collective term for factors that are linked to an increased risk of suffering from cardiovascular disorders. Metabolic syndrome encompasses abdominal obesity, high levels of harmful triglycerides, low levels of protective HDL (High Density Lipoprotein), high blood pressure and high fasting blood glucose levels.
The study shows that the young people who neglected to eat breakfast or ate a poor breakfast had a 68 per cent higher incidence of metabolic syndrome as adults, compared with those who had eaten more substantial breakfasts in their youth. This conclusion was drawn after taking into account socioeconomic factors and other lifestyle habits of the adolescents in question. Abdominal obesity and high levels of fasting blood glucose levels were the subcomponents which, at adult age, could be most clearly linked with poor breakfast in youth.
“Further studies are required for us to be able to understand the mechanisms involved in the connection between poor breakfast and metabolic syndrome, but our results and those of several previous studies suggest that a poor breakfast can have a negative effect on blood sugar regulation,” says Maria Wennberg, the study’s main author.
Better habits in adulthood, like exercising and eating lots of fruits and veggies, eliminated the increased risk. So the good news – in this study at least – is that bad-breakfasters are not always irredeemable.
The study has been conducted by researchers at the Family Medicine Unit within Umeå University’s Department of Public Health and Clinical Medicine and has been published in the journal Public Health Nutrition.
How to stick to those good intentions
“I’m going to do more sport in the new year.“ Hardly any resolution is made more frequently than this one after the calorie-filled Christmas holidays – and hardly one that is broken as frequently. A team headed by Prof. Wolfgang Schlicht from the Institute for Sport and Movement Science at the University of Stuttgart are investigating behaviour techniques in the framework of the project “PREVIEW“ with which the physical activity behaviour can be changed in the long term.
The objective of the consortium with 15 partners from eleven nations is to identify those contents of nutrition and physical activity that could prevent the illness breaking out at an early stage in people in danger of becoming diabetic. The recommendations not only help potential diabetic patients but all those intending to live a healthier lifestyle in the new year.
If your trousers feel tight after too many portions of roast goose and too many biscuits, it is not only an aesthetic problem: people who are overweight and have body fat around the abdominal area bear a particularly high risk of becoming ill with type 2 diabetes. As well as massive discomfort, the consequences include serious concomitant diseases of the heart, the kidneys, the eyes, venous occlusions in the extremities up to disabilities or premature death. In Germany almost half of the adult population are overweight, including an increasing number of children. 15 to 20 percent are even considered to be clinically overweight or obese.
Along with a healthy diet, it is physical activity above all that contributes towards reducing the risk of diabetes.
Since intensive training not only sees the pounds drop off but even increases the insulin sensitivity of the muscle cells. These then react to even a low dosage of insulin so that the pancreas is spared and remains functional for a longer period. Yet many people find it hard to vanquish their inner temptation and to change their physical activity behaviour in the long term after an initial burst of motivation. In order to counter obstacles, techniques to change behaviour based on evidence (i.e. based on empirical evidence) were compiled and recorded in a manual.
Making a contract with yourself
Those who want to stay the course with their good intentions in the long term, according to the advice of the scientists, should first make a contract with themselves that records in writing the intentions and objectives but also the necessary resources and the period.
The next step should test which activity opportunities exist in front of their own front doors and which ones match their natures and preferences. “When-then” sentences help to put the good intentions into practice, such as, for example “When I get home on Monday evening, then I’ll go for a walk for half an hour”, preferably also recorded in writing. The same procedure can also be used with predictable barriers such as “If it rains on Monday evening, I’ll do half an hour of keep fit in the living room instead“.
Documenting what you have already achieved is motivating and also serves as feedback for the targets previously set. And last but not least it is recommendable to look for support in the form of a buddy with whom you can do physical and sporting activities together.
The manual in which the above techniques on changing behaviour are also recorded is initially geared to the consultants in the study centres who accompany 2,500 participants at eight locations worldwide over a period of three years and who are trained for this in two workshops. Moreover, the Stuttgart scientists analyse the personal, social, cultural and environmental factors that could favour or obstruct the success of the study. Examples of such factors are faith in yourself, individually dealing with difficult or negative situations or dealing with temptations, such as sweets.
 PREVIEW – Prevention of diabetes In Europe and around the World
Apparently consumers are beginning to wise up about their beverages of choice. Added chemicals, artificial sweeteners, empty calories and rampant diabetes are beginning to impact diet soda sales. Mayor Michael Bloomberg tried to limit the size of sodas that could be sold. He got a lot of flack for that, but his heart and the health of his constituents was firmly in mind.
Now diet soda is the industry’s weightiest problem. Store sales of zero- and low-calorie soda plunged 6.8% in dollar terms in the 52 weeks through Nov. 23, while sales of regular sodas dropped 2.2%, according to Wells Fargo, citing Nielsen scanner data. As a category, diet soda has contracted more than regular soda for three straight years. Read more from the Wall Street Journal.
The Center for Disease Control has a campaign to rethink your drink. Schools across the country are using it to educated students about the impacts of drinking sodas.
From the Harvard Gazette:
Research Also Shows People Who Eat Nuts Weigh Less
According to the largest study of its kind, people who ate a daily handful of nuts were 20 percent less likely to die from any cause over a 30-year period than those who didn’t consume nuts, say scientists from the Harvard-affiliated Dana-Farber Cancer Institute and Brigham and Women’s Hospital, and the Harvard School of Public Health.
Their report, published in the New England Journal of Medicine,contains further good news: The regular nut-eaters were found to be more slender than those who didn’t eat nuts, a finding that should alleviate fears that eating a lot of nuts will lead to overweight.
The report also looked at the protective effect on specific causes of death.
“The most obvious benefit was a reduction of 29 percent in deaths from heart disease — the major killer of people in America,” said Charles S. Fuchs, director of the Gastrointestinal Cancer Treatment Center at Dana-Farber, who is the senior author of the report and a professor of medicine at Harvard Medical School.
“But we also saw a significant reduction — 11 percent — in the risk of dying from cancer,” added Fuchs, who is also affiliated with the Channing Division of Network Medicine at Brigham and Women’s.
Whether any specific type or types of nuts were crucial to the protective effect could not be determined. However, the reduction in mortality was similar both for peanuts (a legume, or ground nut) and for tree nuts — walnuts, hazelnuts, almonds, Brazil nuts, cashews, macadamias, pecans, pistachios, and pine nuts.
Several previous studies had found an association between increasing nut consumption and a lower risk of diseases such as heart disease, type 2 diabetes, colon cancer, gallstones, and diverticulitis. Higher nut consumption also has been linked to reductions in cholesterol levels, oxidative stress, inflammation, adiposity, and insulin resistance. Some small studies have linked an increase of nuts in the diet to lower total mortality in specific populations. But no previous research studies had looked in such detail at various levels of nut consumption and their effects on overall mortality in a large population that was followed for more than 30 years.
For the new research, the scientists were able to tap databases from two well-known, ongoing observational studies that collect data on diet and other lifestyle factors and various health outcomes. The Nurses’ Health Study provided data on 76,464 women between 1980 and 2010, and the Health Professionals’ Follow-Up Study yielded data on 42,498 men from 1986 to 2010. Participants in the studies filled out detailed food questionnaires every two to four years. With each questionnaire, participants were asked to estimate how often they consumed nuts in a serving size of one ounce. A typical small packet of peanuts from a vending machine contains one ounce.
Sophisticated data analysis methods were used to rule out other factors that might have accounted for the mortality benefits. For example, the researchers found that individuals who ate more nuts were leaner, less likely to smoke, and more likely to exercise, use multivitamin supplements, consume more fruits and vegetables, and drink more alcohol. However, analysis was able to isolate the association between nuts and mortality independently of these other factors.
“In all these analyses, the more nuts people ate, the less likely they were to die over the 30-year follow-up period,” explained Ying Bao of Brigham and Women’s Hospital, first author of the report. Those who ate nuts less than once a week had a 7 percent reduction in mortality; once a week, 11 percent reduction; two to four times per week, 13 percent reduction; five to six times per week, 15 percent reduction; and seven or more times a week, a 20 percent reduction in death rate.
The authors noted that this large study cannot definitively prove cause and effect; nonetheless, the findings are strongly consistent with “a wealth of existing observational and clinical trial data to support health benefits of nut consumption on many chronic diseases.” In fact, based on previous studies, the U.S. Food and Drug Administration concluded in 2003 that eating 1½ ounces per day of most nuts “may reduce the risk of heart disease.”
The study was supported by National Institutes of Health and a research grant from the International Tree Nut Council Nutrition Research & Education Foundation.
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