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Obesity Studies Update

By US Medicine

VA-funded Study: Intervention Improves Diabetes Health

Type 2 diabetes patients can improve their mobility significantly by participating in an intensive lifestyle program to both lower weight and improve fitness.  That is according to a multicenter, randomized, controlled trial funded by the VA and other federal agencies.1

For the study, published in the New England Journal of Medicine, researchers randomly assigned overweight and obese diabetes patients from 45 to 74 years old to an intensive lifestyle intervention or a diabetes support and education program. Data was available for just more than 5,000 patients with at least one follow-up visit, and those subjects demonstrated a 48% reduction in the risk for loss of mobility.

Even after four years, 38.5% of patients in the lifestyle intervention group continued to exhibit good mobility, compared with 31.9% in the support group. They also were more likely to lose weight and have improved overall fitness level.

“An insidious consequence of aging in persons with type 2 diabetes is physical disability, particularly the loss of mobility,” the authors pointed out. “Reduced mobility puts patients at risk for loss of independence, leads to muscle loss and compromises the quality of life.”

They noted that their findings were the first to confirm the longterm efficacy of an intensive lifestyle intervention on weight loss, fitness and risk for cardiovascular disease.

  1. Rejeski WJ, Ip EH, Bertoni AG, Bray GA, Evans G, Gregg EW, Zhang Q; Look AHEAD Research Group. Lifestyle change and mobility in obese adults with type 2 diabetes. N Engl J Med. 2012 Mar 29;366(13):1209-17. PubMed PMID: 22455415.

High Glucose Complicates Colectomy for Cancer

Hyperglycemia creates greater complications for patients undergoing colectomy for treatment of cancer of the digestive system, according to a study from the Department of Surgery at the Washington DC VAMC.1

An unexpected finding of the study was that smoking was negatively associated with hyperglycemia. Authors speculated that could be because smokers tend to be less obese than nonsmokers, and obesity is a strong risk factor for hyperglycemia.

Researchers retrospectively analyzed the 2000-2005 Veterans Affairs Surgical Quality Improvement Program database, linking it with a database on blood glucose (BG) values. They looked at levels on the operative day for 7,576 procedures and the first postoperative day for 5,773 procedures.

Median BG was categorized as hypoglycemic (<80 mg/dL); normoglycemic (BG 80-120 mg/dL); or mildly (BG 121-160 mg/dL), moderately (BG 161-200 mg/dL) or severely (BG >200 mg/dL) hyperglycemic.

Researchers found that moderate hyperglycemia on the day of the surgery was associated with a greater likelihood of surgical site infection (odds ratio = 1.44; 95% CI, 1.10-1.87).

On the first day after surgery, severe hyperglycemia was associated with cardiac arrest (odds ratio = 2.31; 95% CI, 1.08-4.98) and death (odds ratio = 1.97; 95% CI, 1.23-3.15). On that day, variations in blood sugar — mild, moderate and severe hyperglycemia and hypoglycemia — all indicated some increased risk for myocardial infarction, regardless of whether the patient had been diagnosed with diabetes.

“Even mild hyperglycemia was associated with adverse outcomes after colectomy, suggesting that a perioperative BG target of 80 to 120 mg/dL, although avoiding hypoglycemia, might be appropriate,” according to the authors, who called for randomized clinical trials to confirm their findings.

  1. Jackson RS, Amdur RL, White JC, Macsata RA. Hyperglycemia is associated with increased risk of morbidity and mortality after colectomy for cancer. J Am Coll Surg. 2012 Jan;214(1):68-80. Epub 2011 Nov 12. PubMed PMID: 22079879.

Excess Weight Reaches All-Time High for Active-Duty Troops

More than 60% of military personnel were either overweight or obese in 2005 — an all-time high — according to a study from the Army’s Military Nutrition Division in Natick, MA.1

In the study, published in the research journal Obesity, the authors reported that the rate of obesity rose from 8.7% in 2002 to 12.9% in 2005. The rate of overweight and obesity combined was 60.5%.

The study was important because, while nationally representative civilian studies have shown that BMI is associated with select sociodemographic characteristics, active-duty personnel are not included in these surveys, making that information hard to find for the military population.

Researchers used data from the 2002 and 2005 DoD Surveys of Health-Related Behaviors Among Active-Duty Military Personnel to assess the prevalence of overweight and obesity and the association of BMI with sociodemographic characteristics.

Looking at responses from 12,756 servicemembers in 2002 and 16,146 servicemembers in 2005, the researchers found that some of the trends were different from civilian data. For example, women were significantly less likely than men to be overweight or obese in both survey years. On the other hand, the prevalence of obesity was associated significantly with increased age, black or Hispanic/Latino race/ethnicity and being married, which was in line with civilian data.

The authors urged that demographic characteristics associated with being overweight be considered in development of military-sponsored weight-management programs.

  1. Smith TJ, Marriott BP, Dotson L, Bathalon GP, Funderburk L, White A, Hadden L, Young AJ. Overweight and Obesity in Military Personnel: Sociodemographic Predictors. Obesity (Silver Spring). 2012 Feb 8. doi: 10.1038/oby.2012.25. [Epubahead of print] PubMed PMID: 22314620.

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