Obesity Surgeon Website: External News Articles relating to Obesity
Hunter gatherer clue to obesity PDF Print E-mail
The idea that exercise is more important than diet in the fight against obesity has been contradicted by new research.
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Obese Kids May Be at Higher Risk for Heart Disease PDF Print E-mail
Title: Obese Kids May Be at Higher Risk for Heart Disease
Category: Health News
Created: 7/24/2012 10:05:00 AM
Last Editorial Review: 7/24/2012 12:00:00 AM
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Reducing salt in your food can cut cancer risk - Times of India PDF Print E-mail

Daily Mail

Reducing salt in your food can cut cancer risk
Times of India
LONDON: Cutting down on salty foods such as bread and breakfast cereals may reduce the risk of developing stomach cancer, a study has found. Eating too much salt is not all about sprinkling it over fish and chips or Sunday lunch, the vast majority is ...
Reducing salt 'would cut cancer'BBC News
Traffic light labelling on foods 'could help cut stomach cancers linked to salt'Daily Mail
Salty food link to stomach cancerNHS Choices
The Press Association -Pulse -Private Healthcare UK
all 64 news articles »
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Can a diet of cheese 'beat diabetes'? PDF Print E-mail

Just two slices [of cheese] a day could reduce risk of diabetes, claims the Daily Mail.

The news is based on the results of a Europe-wide study that aimed to determine whether eating a diet high in dairy products is associated with a change in your risk of developing type 2 diabetes.

Overall, there was no association between total dairy product intake and diabetes risk. However, the results suggested that people who did eat a lot of  cheese and other fermented dairy products (such as yoghurt and buttermilk) may have a lower risk of developing diabetes. This is despite no significant connection between eating more of one particular dairy product and reduced risk of diabetes.

However, the difference in risk varied widely from country to country – people in France who ate more cheese had a reduced risk, while those in the UK who ate more cheese were at increased risk. While the researchers did not examine the types of cheese eaten, it would be interesting and delicious to examine whether this could play a role. When the results were pooled, the possible preventative effects could well be due to chance, not cheese.

So the Mail’s claims that ‘eating lots of cheese’ can ‘beat diabetes’ is full of holes. There are currently far more established methods of reducing your risk of diabetes, such as:

  • losing weight if you are overweight
  • taking regular exercise
  • eating a healthy balanced diet

 

Where did the story come from?

The study was carried out by researchers from European research centres and universities, including the MRC Epidemiology Unit in Cambridge, Oxford University and Imperial College London. The EPIC-InterAct study was funded by the European Union, although the individual researchers were also supported by other organisations. The study was published in the peer-reviewed The American Journal of Clinical Nutrition.

This story was covered in the Daily Mail, Daily Express and The Daily Telegraph. The Mail’s headline focused on the ‘two slices’ of cheese without giving useful information such as weight or cheese type. The Express states that “research shows that regularly snacking on cheese can slash the chances of getting type 2 diabetes by 12 per cent”, while the Telegraph also runs with this figure. This result of the study is based on a comparison of people who ate the most (more than 56g per day) versus the least (less than 11g per day) cheese. So, the idea of ‘snacking’ on cheese or just ‘two extra slices’ may give a misleading impression of the extremely large amounts of cheese that would need to be eaten every day. As the study’s results for cheese were not significant, it renders this advice redundant.

 

What kind of research was this?

This was a nested case-cohort study. Participants were selected from the European Prospective Investigation into Cancer and Nutrition study, a large prospective cohort study that followed up 340,234 people for 3.99 million person-years, during which time 12,403 people developed type 2 diabetes. They compared the dairy intake of these people (cases) with a random selection of people in the study (16,835 people) to see whether dairy product intake was associated with risk of developing diabetes. This is an appropriate study design to address this question, although this study type cannot show causation, only association.

 

What did the research involve?

The researchers collected dietary information at the start of the study using a quantitative dietary questionnaire, with individual portion sizes or validated semi-quantitative food-frequency questionnaires. A random sample of people were also asked to recall what they had eaten and drunk in the previous 24 hours. The researchers collected data on the intake of milk, yoghurt and thick fermented milk (products such as soured cream and crème fraîche), and cheese. The researchers also collected data on the participants’ lifestyle and medical history.

The researchers then divided intake of total dairy products (defined in this study as the total intake of milk, yoghurt and thick fermented milk, and cheese) and the individual subtypes of dairy into fifths, and compared the risk of developing type 2 diabetes in each fifth. The researchers adjusted dairy product intake for total calorie intake. The researchers also looked to see if there was a trend, for example if risk decreased with increasing intake. The researchers also adjusted for potential factors that could be responsible for any association seen (confounder) including:

  • age
  • sex
  • body mass index (BMI)
  • education
  • physical activity index
  • smoking status
  • alcohol consumption
  • other dietary factors

The researchers also looked to see whether any observed association was due to the fact that dairy products are good sources of calcium, magnesium and vitamin D. 

 

What were the basic results?

Total dairy product intake was not associated with the risk of type 2 diabetes (hazard ratio for the comparison of highest intake compared to lowest intake 1.01, 95% confidence interval 0.89 to 1.23 in the fully adjusted model).

Yoghurt and thick fermented milk intake, and cheese intake, were associated with a reduced risk of type 2 diabetes, but this was not significant. The hazard ratio for the comparison of highest intake of yoghurt and thick fermented milk compared to lowest intake was 0.91 (95% confidence interval 0.81 to 1.02 in the fully adjusted model). The hazard ratio for the comparison of highest intake of cheese compared to lowest intake 0.88 (95% confidence interval 0.76 to 1.02).

Cheese did have an inverse association with diabetes (ie eating more cheese appeared to lower the risk of diabetes), but this was not significant when all confounding factors were adjusted for. When fermented dairy products were combined (yoghurt, thick fermented milk and cheese) higher intake was associated with significantly reduced risk of diabetes. The hazard ratio for the comparison of highest intake compared to lowest intake 0.88, 95% confidence interval 0.78 to 0.99.

 

How did the researchers interpret the results?

The researchers conclude that “this large prospective study found no association between total dairy product intake and diabetes risk. An inverse association of cheese intake and combined fermented dairy product intake with diabetes is suggested, which merits further study”.

 

Conclusion

This well-designed study found that overall, total dairy product intake was not associated with either increased or reduced risk of developing type 2 diabetes. Sub-analyses according to type of dairy product did find that people with the highest intake of fermented dairy products (total of yoghurt, thick fermented milk and cheese) were at reduced risk of developing diabetes. However, analyses according to the individual products did not find significant associations, so any advice based on particular foods is likely to be misleading.

There was a trend for increasing cheese intake to be associated with reduced risk of diabetes, although the difference in risk in people eating the most and the least cheese was not statistically significant. Similarly, though there was a trend for intake of yoghurt and thick fermented milk to be associated with reduced risk of diabetes, this trend was not statistically significant.

These findings merit further study. This study had many strengths (including its design, the number of participants, the length of follow-up, range in dairy intake and adjustment for confounders), but it did have some limitations. Limitations of this research included the facts that dairy intake was self-reported and that data on low- and high-fat dairy product intake wasn’t collected. It would also be interesting to determine how these products might influence this reduction in risk. The authors suggest that it could be due to the types of fats contained in these products, or due to the presence of probiotic bacteria. However, these things have not been further examined by this study.

While it is not known for definite whether or how intake of dairy products may affect your risk of diabetes, the best ways to reduce risk are to aim to lose weight if you are overweight or obese, take regular exercise, and eat a healthy, balanced diet.

Read more about preventing type 2 diabetes.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on twitter.

Links To The Headlines

‘Cheese 'beats diabetes': Just two slices a day could reduce risk of developing the disease, study claims’. Daily Mail, July 24 2012

‘Cheese 'could reduce diabetes risk'’. The Daily Telegraph, July 24 2012

Cheese slashes risk of diabetes. Daily Express, July 24 2012

Links To Science

Sluijs I, Forouhi NG, Beulens JWJ, et al. The amount and type of dairy product intake and incident type 2 diabetes: results from the EPIC-InterAct Study. American Journal of Clinical Nutrition. Published online, July 3 2012

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Obese children show early signs of heart disease PDF Print E-mail

“Two thirds of obese children show early signs of heart disease”, the Daily Telegraph has reported.

The news is based on a study that examined how common risk factors for diseases that can affect the heart and the blood vessels (cardiovascular disease or ‘CVD’) are in severely obese children. There is no internationally agreed consensus on what constitutes severe obesity in children.

The researchers found that a majority of children identified had risk factors for CVD that you would normally only expect to see in older adults, such as:

  • over half (56%) had high blood pressure
  • around one in seven had high blood glucose levels

Worryingly, researchers found that when specifically looking at those younger than 12 years, 62% already had more than one CVD risk factor.

These types of risk factors do not usually cause any noticeable symptoms in children but they significantly increase the chance of a child developing a serious disease, such as coronary heart disease in later life.

There are still some limitations to this type of study, including the fact that some obese children might not have been referred to, or seen by, a paediatrician, and a lack of internationally recognised criteria for severe obesity in children.

Also, the study did not have a comparison group and so could not compare findings to children in healthy weight ranges. The findings do reinforce the well-known messages that are common to all age groups:

  • eat healthy
  • exercise regularly
  • aim to maintain a healthy weight

 

Where did the story come from?

The study was carried out by researchers from VU University Medical Centre, Amsterdam, and other institutions in The Netherlands. Sources of funding were not reported. The study was published in the peer-reviewed journal Archives of Disease in Childhood.

The study was reported appropriately by the BBC and Telegraph though arguably the headlines were slightly misleading as the children had a range of risk factors and not just those that might affect the heart.

 

What kind of research was this?

This was a prospective observational surveillance study aiming to determine cardiovascular risk factors in children and adolescents with severe obesity in The Netherlands. In an observational study, researchers typically simply observe groups of people, without changing their exposures or circumstances.

Results from prospective studies are usually considered as more robust then retrospective studies which either use data that was collected in the past for another purpose, or ask participants to remember what happened to them in the past.

 

What did the research involve?

Researchers used information collected from 2005 to 2007 from the Dutch Paediatric Surveillance Unit which Dutch paediatricians report specific diseases to each month. Paediatricians were given protocol describing how to diagnose severe obesity. The researchers specifically looked at reported new cases of severe obesity in those aged from 2 to 18 years. Paediatricians were then asked to complete a questionnaire for each severely obese child including information on:

  • socio-demographic factors
  • cardiovascular risk factors such as blood pressure, fasting blood glucose, and cholesterol
  • BMI

As there were no internationally accepted criteria for defining severe obesity in children, researchers defined severe obesity using gender and age-dependant cut-off points for BMI based on adult BMI cut-off points for severe obesity (considered as 35kg/m2 or above).

The researchers then compared the reported cardiovascular risk factors values at the BMI cut-off points they set. Results were analysed using statistical methods that compared young children (considered as younger than 12 years) to adolescents (considered as older than 12 years). Differences in age groups, sex, socio-demographic characteristics and the co-morbidities (other diseases) of children were also compared.

Body mass index (BMI) is used as a measure to estimate healthy and unhealthy weight ranges. For most adults a healthy BMI is in the range of 18.5 to 24.9.

 

What were the basic results?

From 2005 to 2007, paediatricians newly reported 500 children as severely obese. Questionnaires were provided by the paediatricians for 363 of these children (a 72.6% response rate). After accounting for misclassification and missing data, 307 children were included in the analysis with the following results:

  • Boys younger than 12 years were more often severely obese, compared to boys older than 12 years.
  • Girls older than 12 years were more often severely obese, compared to girls younger than 12 years.
  • 40% of severely obese children were of Turkish, Moroccan or Surinamese origin.
  • Only one child was obese due to a medical cause.

Of the 307 severely obese children, cardiovascular risk factor information was available for 255 children (83%). The findings for these children were:

  • At least one cardiovascular risk factor was identified in 67% of children aged 2 to 18 years
  • Two risk factors were found in 17% of children, three risk factors in 8% of children and more than three risk factors in 2.5% of children
  • High blood pressure (hypertension) was reported in 53% of overall children, and 53% of children younger than 12 years
  • Of overall children, high blood glucose was reported in 14%
  • 62% of children younger than 12 years had one or more cardiovascular risk factor

 

How did the researchers interpret the results?

The researchers conclude that a high number of severely obese children have cardiovascular risk factors. They add that internationally accepted criteria for defining severe obesity, as well as guidelines used for early detection and treatments of severe obesity, are urgently needed.

In discussing the study’s findings, Dr Joana Kist-van Holthe from the university where the research took place said: “The prevalence of impaired fasting glucose in [these children] is worrying, considering the increasing prevalence worldwide of type 2 diabetes in children and adolescents”. She added: “the high prevalence of hypertension and abnormal lipids may lead to cardiovascular disease in young adulthood.”

Doireann Maddock from the British Heart Foundation said of the research: “Although it was a small study, the findings leave a bad taste in the mouth”. She went on to add: “this is a problem that can be addressed by stopping young people becoming overweight and obese in the first place”.

 

Conclusion

Overall, this study provides evidence that cardiovascular risk factors are common in severely obese children aged 2 to 18. Reporting of severe obesity was high among paediatricians in The Netherlands and was recorded accurately (which is a strength of the study). There are still some limitations to this study, some of which the researchers note:

  • Diagnosis of ‘severe obesity’ was reported by paediatricians only. It is likely that children not referred to a paediatrician in the general population were missed and it is not clear how those children differ from ones referred.
  • This was a relatively small study which can limit the results, as it may not be able to be generalised to other populations, for example, severely obese children not referred to paediatricians.
  • Researchers noted there was a lack of internationally accepted criteria for diagnosing severe obesity in children and suggest an urgent need for these criteria to be available.
  • No comparison was made with children in the normal weight range of the same age. This would have added to the strength of the results.
  • 40% of the children were of Turkish, Moroccan or Surinamese ethnic descent (which for historical reasons make up a large part of the Dutch immigrant communities). So there may be other factors associated with these ethnicities that may ‘skew’ the results. 

Considering that the prevalence and severity of obesity is rising, this study provides valuable information about the risks for children with severe obesity. Anyone concerned about their child being severely obese should see their GP.

Analysis by NHS Choices. Follow Behind the Headlines on twitter.

Links To The Headlines

‘Two thirds of obese children show early signs of heart disease: study’. The Daily Telegraph, July 24, 2012

‘Severely obese children's hearts already in danger’. BBC News, July 24, 2012

‘Chubby children risk heart disease signs by age 12’. Metro, July 24, 2012

Heart disease threat to most obese children. Daily Express, July 24, 2012

Links To Science

Van Emmerik NMA, Renders CM, van de Veer M, et al. High cardiovascular risk in severely obese young children and adolescents. Archives of Disease in Childhood. Published online July 23, 2012

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