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1.
Artigo em Inglês | MEDLINE | ID: mdl-34360135

RESUMO

Diet management or caloric restriction for diabetes mellitus patients is essential in order to reduce the disease's burden. Mathematical programming problems can help in this regard; they have a central role in optimal diet management and in the nutritional balance of food recipes. The present study employed linear optimization models such as linear, pre-emptive, and non-pre-emptive goal programming problems (LPP, PGP and NPGP) to minimize the deviations of over and under achievements of specific nutrients for optimal selection of food menus with various energy (calories) levels. Sixty-two food recipes are considered, all selected because of being commonly available for the Indian population and developed dietary intake for meal planning through optimization models. The results suggest that a variety of Indian food recipes with low glycemic values can be chosen to assist the varying glucose levels (>200 mg/dL) of Indian diabetes patients.


Assuntos
Diabetes Mellitus , Planejamento de Cardápio , Diabetes Mellitus/prevenção & controle , Dieta , Ingestão de Energia , Objetivos , Humanos
2.
Artigo em Inglês | MEDLINE | ID: mdl-34360428

RESUMO

Promoting adequate levels of physical activity in the population is important for diabetes prevention. However, the scale needed to achieve tangible population benefits is unclear. We aimed to estimate the public health impact of increases in walking as a means of diabetes prevention and health care cost savings attributable to diabetes. We applied the validated Diabetes Population Risk Tool (DPoRT) to the 2015/16 Canadian Community Health Survey for adults aged 18-64, living in the Greater Toronto and Hamilton area, Ontario, Canada. DPoRT was used to generate three population-level scenarios involving increases in walking among individuals with low physical activity levels, low daily step counts and high dependency on non-active forms of travel, compared to a baseline scenario (no change in walking rates). We estimated number of diabetes cases prevented and health care costs saved in each scenario compared with the baseline. Each of the three scenarios predicted a considerable reduction in diabetes and related health care cost savings. In order of impact, the largest population benefits were predicted from targeting populations with low physical activity levels, low daily step counts, and non active transport use. Population increases of walking by 25 min each week was predicted to prevent up to 10.4 thousand diabetes cases and generate CAD 74.4 million in health care cost savings in 10 years. Diabetes reductions and cost savings were projected to be higher if increases of 150 min of walking per week could be achieved at the population-level (up to 54.3 thousand diabetes cases prevented and CAD 386.9 million in health care cost savings). Policy, programming, and community designs that achieve modest increases in population walking could translate to meaningful reductions in the diabetes burden and cost savings to the health care system.


Assuntos
Diabetes Mellitus , Caminhada , Adulto , Redução de Custos , Análise Custo-Benefício , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/prevenção & controle , Custos de Cuidados de Saúde , Humanos , Ontário/epidemiologia
3.
Artigo em Inglês | MEDLINE | ID: mdl-34300043

RESUMO

Diabetes is considered an epidemic of the 21st century. On 11 March 2020, two months after the outbreak of COVID-19 (coronavirus disease of 2019) epidemic in China, the World Health Organization announced COVID-19 to be a pandemic. From that time, many hospitals and wards have started to function as both infectious and non-infectious ones; so did the Diabetes Clinic Institute of Rural Health in South-Eastern Poland. Considering the global importance of diabetes and its prevalence worldwide, it seemed important to investigate how the Diabetes Clinic passed through the individual phases of the pandemic, and the possibility of protecting hospitalized patients against future pandemic infection. We present detailed characteristics of the situation in a ward which used to treat non-infectious patients with diabetes only and, nowadays, has been obliged to take into account the risk of spreading SARS-Cov-2 (severe acute respiratory syndrome coronavirus-2) infection also. Moreover, we suggest solutions to avoid cases of infectious diseases in non-infectious wards in the future.


Assuntos
COVID-19 , Diabetes Mellitus , Doenças não Transmissíveis , China , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/prevenção & controle , Hospitais , Humanos , Pandemias/prevenção & controle , Polônia/epidemiologia , Saúde da População Rural , SARS-CoV-2
4.
Obes Rev ; 22(9): e13301, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34060197

RESUMO

In 2016, the South African government proposed a 20% sugar-sweetened beverage (SSB) tax. Protracted consultations with beverage manufacturers and the sugar industry followed. This resulted in a lower sugar-based beverage tax, the Health Promotion Levy (HPL), of approximately 10% coming into effect in April 2018. We provide a synthesis of findings until April 2021. Studies show that despite the lower rate, purchases of unhealthy SSBs and sugar intake consumption from SSBs fell. There were greater reductions in SSB purchases among both lower socioeconomic groups and in subpopulations with higher SSB consumption. These subpopulations bear larger burdens from obesity and related diseases, suggesting that this policy improves health equity. The current COVID-19 pandemic has impacted food and nutritional security. Increased pandemic mortality among people with obesity, diabetes, and hypertension highlight the importance of intersectoral public health disease-prevention policies like the HPL, which should be strengthened.


Assuntos
COVID-19/epidemiologia , Promoção da Saúde/métodos , SARS-CoV-2 , Bebidas Adoçadas com Açúcar/efeitos adversos , Bebidas Adoçadas com Açúcar/economia , Impostos , Comorbidade , Comportamento do Consumidor , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/prevenção & controle , Humanos , Hipertensão/epidemiologia , Hipertensão/prevenção & controle , Obesidade/epidemiologia , Obesidade/prevenção & controle , Fatores Socioeconômicos , África do Sul/epidemiologia
5.
Biochimie ; 187: 94-109, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34082041

RESUMO

Despite the development of a number of vaccines for COVID-19, there remains a need for prevention and treatment of the virus SARS-CoV-2 and the ensuing disease COVID-19. This report discusses the key elements of SARS-CoV-2 and COVID-19 that can be readily treated: viral entry, the immune system and inflammation, and the cytokine storm. It is shown that the essential nutrients zinc, ω-3 polyunsaturated fatty acids (PUFAs), vitamin D and magnesium provide the ideal combination for prevention and treatment of COVID-19: prevention of SARS-CoV-2 entry to host cells, prevention of proliferation of SARS-CoV-2, inhibition of excessive inflammation, improved control of the regulation of the immune system, inhibition of the cytokine storm, and reduction in the effects of acute respiratory distress syndrome (ARDS) and associated non-communicable diseases. It is emphasized that the non-communicable diseases associated with COVID-19 are inherently more prevalent in the elderly than the young, and that the maintenance of sufficiency of zinc, ω-3 PUFAs, vitamin D and magnesium is essential for the elderly to prevent the occurrence of non-communicable diseases such as diabetes, cardiovascular diseases, lung diseases and cancer. Annual checking of levels of these essential nutrients is recommended for those over 65 years of age, together with appropriate adjustments in their intake, with these services and supplies being at government cost. The cost:benefit ratio would be huge as the cost of the nutrients and the testing of their levels would be very small compared with the cost savings of specialists and hospitalization.


Assuntos
COVID-19/prevenção & controle , Ácidos Graxos Ômega-3/uso terapêutico , Magnésio/uso terapêutico , Doenças não Transmissíveis/prevenção & controle , Vitamina D/uso terapêutico , Zinco/uso terapêutico , Idoso , COVID-19/terapia , Doenças Cardiovasculares/prevenção & controle , Doenças Cardiovasculares/terapia , Síndrome da Liberação de Citocina/terapia , Diabetes Mellitus/prevenção & controle , Diabetes Mellitus/terapia , Humanos , Inflamação/terapia , Pneumopatias/prevenção & controle , Pneumopatias/terapia , Neoplasias/prevenção & controle , Neoplasias/terapia , Doenças não Transmissíveis/terapia , Estado Nutricional , SARS-CoV-2 , Vitaminas/uso terapêutico
7.
Geospat Health ; 16(1)2021 05 14.
Artigo em Inglês | MEDLINE | ID: mdl-34000786

RESUMO

To decrease diabetes morbidity and mortality rates, early interventions are needed to change lifestyles that are often cemented early, making school-based interventions important. However, with limited resources and lack of within-county diabetes data, it is difficult to determine which local areas require intervention. To identify at-risk school districts, this study mapped diabetes prevalence and related deaths by school district using geographic information systems (GIS). The 2010-2014 records of diabetes-related deaths were identified for 13 cities in Michigan, USA. Diabetes prevalence was estimated using the weighted average of population by school district from the '500 Cities Project' of the Centres of Disease Control and prevention (CDC). Prevalence and mortality rates were mapped by school district and the correlation between diabetes prevalence and mortality rate analysed using the Spearman's rank correlation. Years of potential life lost (YPLL) were calculated using a 75-year endpoint. The result indicated there were geographic variations in diabetes prevalence, mortality and YPLL across Michigan. Most census tracts in the cities of Detroit, Flint and downtown Grand Rapids had higher diabetes prevalence and mortality rate with rs (628)=0.52, P<0.005. School districts with high mortality rates also had high prevalence with rs (13)=0.72, P=0.002. Flint City School District showed a higher rate of diabetes prevalence, death and YPLL than others and should thus be considered a priority for diabetes prevention interventions. Using school districts as the geographic spatial unit of analysis, we identified local variation in diabetes burden for targeting school-based diabetes prevention interventions.


Assuntos
Diabetes Mellitus , Instituições Acadêmicas , Cidades , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/prevenção & controle , Humanos , Michigan/epidemiologia , Prevalência
8.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-48177

RESUMO

O pacto foi lançado nesta quarta-feira (14) na Cúpula Global da Diabetes, que é copatrocinada pela OMS e pelo governo do Canadá com o apoio da Universidade de Toronto. Durante o evento, o presidente do Quênia se juntou aos primeiros-ministros de Fiji, Noruega e Cingapura; o embaixador global da OMS para Doenças e Lesões Não Transmissíveis, Michael R. Bloomberg; e ministros da saúde de vários países, bem como especialistas em diabetes e pessoas que vivem com doença para destacar as maneiras pelas quais apoiarão este novo esforço colaborativo.


Assuntos
Diabetes Mellitus/prevenção & controle , Organização Mundial da Saúde , Cooperação Internacional , Prevenção de Doenças
9.
J Nat Med ; 75(3): 449-466, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33900535

RESUMO

During our studies characterizing functional substances from food resources for the prevention and treatment of lifestyle-related diseases, we isolated the active constituents, salacinol (1) and neokotalanol (4), and related thiosugar sulfoniums, from the roots and stems of the genus Salacia plants [Celastraceae (Hippocrateaceae)] such as Salacia reticulata Wight, S. oblonga Wall., and S. chinensis L., and observed their antidiabetic effects. These plant materials have been used traditionally in Ayurvedic medicine as a specific remedy at the early stage of diabetes, and have been extensively consumed in Japan, the United States, and other countries as a food supplement for the prevention of obesity and diabetes. Here, we review our studies on the antidiabetic effects of plants from the genus Salacia, from basic chemical and pharmacological research to their application and development as new functional food ingredients.


Assuntos
Hipoglicemiantes/farmacologia , Salacia/química , Álcoois Açúcares/farmacologia , Sulfatos/farmacologia , Tioaçúcares/farmacologia , Animais , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/prevenção & controle , Humanos , Japão , Medicina Ayurvédica , Estrutura Molecular , Obesidade/prevenção & controle , Raízes de Plantas/química , Caules de Planta/química , Ensaios Clínicos Controlados Aleatórios como Assunto
10.
Epidemiol Health ; 43: e2021028, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33872481

RESUMO

OBJECTIVES: We aimed to explore trends in the prevalence and management of obesity, hypertension, diabetes, and hypercholesterolemia in Korean adults from 1998 to 2018 using data from the Korea National Health and Nutrition Examination Survey (KNHANES). METHODS: The study participants included 79,753 individuals aged ≥ 30 years who had participated in the health examination and health interview of the first (1998) to the seventh (2016-2018) KNHANES. The prevalence and management as well as annual percent change (APC) in chronic diseases were analyzed using SAS and the Joinpoint software program. RESULTS: The prevalence of obesity in men significantly increased from 26.8% in 1998 to 44.7% in 2018 (APC= 1.9, p< 0.001), whereas that in women decreased slightly from 30.5% in 1998 to 28.3% in 2018 (APC= -0.5, p< 0.001). The prevalence of hypertension in men was 33.2% in 2018, with no significant change, whereas that in women slightly decreased to 23.1% in 2018 (APC= -0.9, p< 0.001). The prevalence of diabetes in men increased slightly from 10.5% in 2005 to 12.9% in 2018 (APC= 1.6, p< 0.001), whereas that in women remained at approximately 8%, with no significant change. The prevalence of hypercholesterolemia in both men and women increased 3-fold in 2018 (20.9% in men [APC = 8.2, p < 0.001] and 21.4% in women [APC= 7.1, p< 0.001]) compared to that in 2005. The awareness rate, treatment rate, and control rate of hypertension and hypercholesterolemia increased 2-3 fold. Regarding diabetes, the treatment rate increased, but the control rate did not change. CONCLUSIONS: Over the past 20 years, the prevalence of obesity (in men), diabetes, and hypercholesterolemia has increased and management indicators, such as the awareness rate, treatment rate, and control rate of chronic diseases, have improved continuously.


Assuntos
Diabetes Mellitus/epidemiologia , Diabetes Mellitus/prevenção & controle , Hipercolesterolemia/epidemiologia , Hipercolesterolemia/prevenção & controle , Hipertensão/epidemiologia , Hipertensão/prevenção & controle , Obesidade/epidemiologia , Obesidade/prevenção & controle , Adulto , Idoso , Doença Crônica/epidemiologia , Doença Crônica/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Prevalência , República da Coreia/epidemiologia , Fatores de Risco
11.
Ann Med ; 53(1): 581-586, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-33825598

RESUMO

Although coronavirus disease 2019 (COVID-19) is a pandemic, it has several specificities influencing its outcomes due to the entwinement of several factors, which anthropologists have called "syndemics". Drawing upon Singer and Clair's syndemics model, I focus on synergistic interaction among chronic kidney disease (CKD), diabetes, and COVID-19 in Pakistan. I argue that over 36 million people in Pakistan are standing at a higher risk of contracting COVID-19, developing severe complications, and losing their lives. These two diseases, but several other socio-cultural, economic, and political factors contributing to structured vulnerabilities, would function as confounders. To deal with the critical effects of these syndemics the government needs appropriate policies and their implementation during the pandemic and post-pandemic. To eliminate or at least minimize various vulnerabilities, Pakistan needs drastic changes, especially to overcome (formal) illiteracy, unemployment, poverty, gender difference, and rural and urban difference.


Assuntos
COVID-19/epidemiologia , Diabetes Mellitus/epidemiologia , Pandemias/prevenção & controle , Insuficiência Renal Crônica/epidemiologia , Sindemia , COVID-19/prevenção & controle , Mudança Climática/economia , Mudança Climática/estatística & dados numéricos , Fatores de Confusão Epidemiológicos , Países em Desenvolvimento/economia , Países em Desenvolvimento/estatística & dados numéricos , Diabetes Mellitus/economia , Diabetes Mellitus/prevenção & controle , Abastecimento de Alimentos/economia , Abastecimento de Alimentos/estatística & dados numéricos , Letramento em Saúde/economia , Letramento em Saúde/estatística & dados numéricos , Humanos , Paquistão/epidemiologia , Pandemias/economia , Política , Pobreza/economia , Pobreza/estatística & dados numéricos , Insuficiência Renal Crônica/economia , Insuficiência Renal Crônica/prevenção & controle , Desemprego/estatística & dados numéricos
12.
Nutrients ; 13(4)2021 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-33920052

RESUMO

Food parenting practices (FPPs) have an important role in shaping children's dietary behaviors. This study aimed to investigate cross-sectional and longitudinal associations over a two-year follow-up between FPP and dietary intake and compliance with current recommendations in 6- to 11-year-old European children. A total of 2967 parent-child dyads from the Feel4Diabetes study, a randomized controlled trial of a school and community-based intervention, (50.4% girls and 93.5% mothers) were included. FPPs assessed were: (1) home food availability; (2) parental role modeling of fruit intake; (3) permissiveness; (4) using food as a reward. Children's dietary intake was assessed through a parent-reported food frequency questionnaire. In regression analyses, the strongest cross-sectional associations were observed between home availability of 100% fruit juice and corresponding intake (ß = 0.492 in girls and ß = 0.506 in boys, p < 0.001), and between parental role modeling of fruit intake and children's fruit intake (ß = 0.431 in girls and ß = 0.448 in boys, p < 0.001). In multilevel logistic regression models, results indicated that improvements in positive FPPs over time were mainly associated with higher odds of compliance with healthy food recommendations, whereas a decrease in negative FPP over time was associated with higher odds of complying with energy-dense/nutrient-poor food recommendations. Improving FPPs could be an effective way to improve children's dietary intake.


Assuntos
Diabetes Mellitus/prevenção & controle , Dieta Saudável/psicologia , Comportamento Alimentar/psicologia , Relações Pais-Filho , Poder Familiar , Adulto , Índice de Massa Corporal , Criança , Estudos Transversais , Inquéritos sobre Dietas/estatística & dados numéricos , Dieta Saudável/estatística & dados numéricos , Escolaridade , Ingestão de Energia , Europa (Continente) , Pai/educação , Pai/psicologia , Pai/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Mães/educação , Mães/psicologia , Mães/estatística & dados numéricos , Recomendações Nutricionais
13.
Transl Behav Med ; 11(5): 1066-1077, 2021 05 25.
Artigo em Inglês | MEDLINE | ID: mdl-33677529

RESUMO

Population health management (PHM) strategies to address diabetes prevention have the potential to engage large numbers of at-risk individuals in a short duration. We examined a PHM approach to recruit participants to a diabetes prevention clinical trial in a metropolitan health system. We examined reach and representativeness and assessed differences from active and passive respondents to recruitment outreach, and participants enrolled through two clinical screening protocols. The PHM approach included an electronic health record (EHR) query, physician review of identified patients, letter invitation, and telephone follow-up. Data describe the reach and representativeness of potential participants at multiple stages during the recruitment process. Subgroup analyses examined proportional reach, participant differences based on passive versus active recruitment response, and clinical screening method used to determine diabetes risk status. The PHM approach identified 10,177 potential participants to receive a physician letter invitation, 60% were contacted by telephone, 2,796 (46%) completed telephone screening, 1,961 were eligible from telephone screen, and 599 were enrolled in 15 months. Accrual was unaffected by shifting clinical screening protocols despite the increase in participant burden. Relative to census data, study participants were more likely to be obese, female, older, and Caucasian. Relative to the patient population, enrolled participants were less likely to be Black and were older. Active respondents were more likely to have a higher income than passive responders. PHM strategies have the potential to reach a large number of participants in a relatively short period, though concerted efforts are needed to increase participant diversity.


Assuntos
Diabetes Mellitus , Gestão da Saúde da População , Diabetes Mellitus/prevenção & controle , Feminino , Humanos , Seleção de Pacientes , Projetos de Pesquisa , Telefone
14.
Biomed Pharmacother ; 138: 111464, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33725590

RESUMO

Encapsulation systems promote targeted delivery to the gastrointestinal tract. An oil-in-water (O/W) nanoemulsion was covered using new delivery system composition based on zein and sodium alginate. The impact of aqueous phase (distilled water and cooked pumpkin puree), pH (2-4), and zein-alginate concentration solution (0.05-0.20% w/v) was investigated on particle size, zeta potential, incorporation efficiency (IE), stability, viscosity, and glucose release from single-layer (SLN) and double-layer nanoemulsion (DLN). DLNs showed a larger droplet size and zeta potential. The slow gradual release of glucose proved effective application of zein/alginate as delivery system for nanoemulsion. Moreover, cooked pumpkin and 0.12% of zein exhibited more delayed release of glucose than distilled water as an aqueous phase of DLN and as a delivery system respectively. Up-to-49% IE, up-to-50% stability in a period of 7-day storage, and controlled-release glucose for 240 min under in vitro gastrointestinal conditions were obtained in DLN. The results of the current study revealed that SLN covered by zein at 0.12% of concentration can be an ideal delivery system composition for patients with hypoglycemia and clinical problems.


Assuntos
Cucurbita , Diabetes Mellitus/metabolismo , Emulsões/metabolismo , Glucose/metabolismo , Hipoglicemia/metabolismo , Nanopartículas/metabolismo , Animais , Cucurbita/química , Cucurbita/metabolismo , Preparações de Ação Retardada/administração & dosagem , Preparações de Ação Retardada/síntese química , Preparações de Ação Retardada/metabolismo , Diabetes Mellitus/prevenção & controle , Sistemas de Liberação de Medicamentos/métodos , Emulsões/administração & dosagem , Emulsões/síntese química , Trato Gastrointestinal/efeitos dos fármacos , Trato Gastrointestinal/metabolismo , Glucose/antagonistas & inibidores , Humanos , Hipoglicemia/prevenção & controle , Nanopartículas/administração & dosagem , Nanopartículas/química , Suínos
15.
Surg Clin North Am ; 101(2): 255-267, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33743968

RESUMO

Type 2 diabetes mellitus (T2D) and associated comorbid medical conditions are leading causes of strain on the American health care system. There has been a synchronous rise of obesity to epidemic proportions. If poorly treated, T2D is a scourge for patients, leading to end-organ damage and early mortality. Although T2D is considered best managed with lifestyle modification, medical management, and pharmacotherapy, recent studies have confirmed the superiority of metabolic surgery to conventional treatment algorithms as a path to remission. Increasing access to metabolic surgery will continue to yield benefits to patient health and improve the macroeconomic health of the world.


Assuntos
Cirurgia Bariátrica/métodos , Diabetes Mellitus/prevenção & controle , Obesidade Mórbida/cirurgia , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/etiologia , Saúde Global , Humanos , Incidência , Obesidade Mórbida/complicações
16.
Diabetes Res Clin Pract ; 174: 108727, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33662491

RESUMO

AIMS: The Diabetes Community Lifestyle Improvement Program (D-CLIP) was a lifestyle education program to prevent diabetes in South Asians with prediabetes. This paper examines the impact of the D-CLIP intervention on moderate-to-vigorous intensity physical activity (MVPA). METHODS: This randomized controlled trial to prevent diabetes included 573 individuals with prediabetes from Chennai, India. The intervention was designed to increase MVPA to ≥150 minutes per week. MVPA was measured by questionnaire at baseline, six, 12, 18, 24, 30 and 36 months of follow-up. Random effects models were used to examine the relationship between treatment group and odds of reporting ≥150 weekly minutes of MVPA and to examine the impact of the intervention on weekly MVPA. RESULTS: With the exception of the proportion of respondents at baseline with a high waist circumference, selected sample characteristics did not differ at baseline between the intervention and control groups. The intervention significantly (p < 0.05) increased the proportion of respondents who reported ≥150 weekly minutes of MVPA by 28.5%, 13.6% and 14.0% at six, 12 and 18 months respectively. Mean minutes of weekly MVPA significantly (p < 0.05) increased by an additional 56.7, 34.3, 23.6 and 24.3 minutes/week at six, 12, 18, and 24 months, respectively. CONCLUSION: The D-CLIP intervention significantly increased MVPA at six, 12 and 18 months of follow-up. Interventions to prevent diabetes in South Asians with prediabetes can significantly increase MVPA in this population.


Assuntos
Diabetes Mellitus/prevenção & controle , Exercício Físico/fisiologia , Promoção da Saúde/métodos , Estado Pré-Diabético/epidemiologia , Adulto , Grupo com Ancestrais do Continente Asiático , Feminino , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Adulto Jovem
17.
Kidney int ; 99(3): 559-569, Mar. 1, 2021. tab
Artigo em Inglês | BIGG - guias GRADE | ID: biblio-1281918

RESUMO

The Kidney Disease: Improving Global Outcomes (KDIGO) 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease for patients not receiving dialysis represents an update to the KDIGO 2012 guideline on this topic. Development of this guideline update followed a rigorous process of evidence review and appraisal. Guideline recommendations are based on systematic reviews of relevant studies and appraisal of the quality of the evidence. The strength of recommendations is based on the "Grading of Recommendations Assessment, Development and Evaluation" (GRADE) approach. The scope includes topics covered in the original guideline, such as optimal blood pressure targets, lifestyle interventions, antihypertensive medications, and specific management in kidney transplant recipients and children. Some aspects of general and cardiovascular health, such as lipid and smoking management, are excluded. This guideline also introduces a chapter dedicated to proper blood pressure measurement since all large randomized trials targeting blood pressure with pivotal outcomes used standardized preparation and measurement protocols adhered to by patients and clinicians. Based on previous and new evidence, in particular the Systolic Blood Pressure Intervention Trial (SPRINT) results, we propose a systolic blood pressure target of less than 120 mm Hg using standardized office reading for most people with chronic kidney disease (CKD) not receiving dialysis, the exception being children and kidney transplant recipients. The goal of this guideline is to provide clinicians and patients a useful resource with actionable recommendations supplemented with practice points. The burden of the recommendations on patients and resources, public policy implications, and limitations of the evidence are taken into consideration. Lastly, knowledge gaps and recommendations for future research are provided.


Assuntos
Humanos , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Pressão Sanguínea/efeitos dos fármacos , Monitorização Ambulatorial da Pressão Arterial/normas , Insuficiência Renal Crônica/prevenção & controle , Exercício Físico , Diabetes Mellitus/prevenção & controle , Transplantados , Estilo de Vida Saudável , Anti-Hipertensivos/uso terapêutico
18.
Nutrients ; 13(2)2021 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-33546262

RESUMO

African Americans have higher incidence of, and mortality from, many health-related problems than European Americans. They also have a 15 to 20-fold higher prevalence of severe vitamin D deficiency. Here we summarize evidence that: (i) this health disparity is partly due to insufficient vitamin D production, caused by melanin in the skin blocking the UVB solar radiation necessary for its synthesis; (ii) the vitamin D insufficiency is exacerbated at high latitudes because of the combination of dark skin color with lower UVB radiation levels; and (iii) the health of individuals with dark skin can be markedly improved by correcting deficiency and achieving an optimal vitamin D status, as could be obtained by supplementation and/or fortification. Moderate-to-strong evidence exists that high 25-hydroxyvitamin D levels and/or vitamin D supplementation reduces risk for many adverse health outcomes including all-cause mortality rate, adverse pregnancy and birth outcomes, cancer, diabetes mellitus, Alzheimer's disease and dementia, multiple sclerosis, acute respiratory tract infections, COVID-19, asthma exacerbations, rickets, and osteomalacia. We suggest that people with low vitamin D status, which would include most people with dark skin living at high latitudes, along with their health care provider, consider taking vitamin D3 supplements to raise serum 25-hydroxyvitamin D levels to 30 ng/mL (75 nmol/L) or possibly higher.


Assuntos
COVID-19/etiologia , COVID-19/prevenção & controle , Colecalciferol/administração & dosagem , Suplementos Nutricionais , Disparidades nos Níveis de Saúde , Deficiência de Vitamina D/etnologia , Deficiência de Vitamina D/epidemiologia , Afro-Americanos , Doença de Alzheimer/etiologia , Doença de Alzheimer/prevenção & controle , Antígenos de Neoplasias , Demência/etiologia , Demência/prevenção & controle , Diabetes Mellitus/etiologia , Diabetes Mellitus/prevenção & controle , Feminino , Humanos , Masculino , Prevalência , Estado Asmático/etiologia , Estado Asmático/prevenção & controle , Vitamina D/análogos & derivados , Vitamina D/sangue , Deficiência de Vitamina D/complicações
20.
Sci Rep ; 11(1): 716, 2021 01 12.
Artigo em Inglês | MEDLINE | ID: mdl-33436978

RESUMO

Based on questionnaires from 197,825 non-diabetic participants in a large Japanese cohort, we determined impact of (1) habit of exercise, (2) habit of active physical activity (PA) and (3) walking pace on new-onset of type 2 diabetes mellitus. Unadjusted and multivariable-adjusted logistic regression models were used to determine the odds ratio of new-onset diabetes mellitus incidence in a 3-year follow-up. There were two major findings. First, habits of exercise and active PA were positively associated with incidence of diabetes mellitus. Second, fast walking, even after adjusting for multiple covariates, was associated with low incidence of diabetes mellitus. In the subgroup analysis, the association was also observed in participants aged ≥ 65 years, in men, and in those with a body mass index ≥ 25. Results suggest that fast walking is a simple and independent preventive factor for new-onset of diabetes mellitus in the health check-up and guidance system in Japan. Future studies may be warranted to verify whether interventions involving walking pace can reduce the onset of diabetes in a nation-wide scale.


Assuntos
Índice de Massa Corporal , Diabetes Mellitus/prevenção & controle , Caminhada , Idade de Início , Idoso , Estudos de Coortes , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Incidência , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Inquéritos e Questionários
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