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Chronic Disease Institute Diabetes: The Link to Obesity, CVD, Stroke and Cancer
Presented by: Roberta M. Troy, PhDHealth Disparities Institute for Research &
EducationJune 26, 2014
Heart DiseaseCancerStrokeLung DiseaseAccidentsDiabetesAlzheimersInfluenzaKidney DiseaseBlood PoisoningSuicide Liver DiseaseHypertension
Top Leading Causes of Death in Alabama
African American Health
• Ten Leading Causes of Death for African Americans• Heart Disease • Cancer• Stroke• Diabetes• Unintentional Injuries• Nephritis, Nephrotic Syndrome, & Nephrosis• Chronic Lower Respiratory Diseases• Homicide• Septicemia• Alzheimer’s Disease
Source: CDC, NCHS, National Vital Statistics System (NVSS), Mortality Data http://www.cdc.gov/nchs/deaths.htm Deaths, Final Data for 2010
Link between Obesity, Diabetes, Heart Disease and Stroke
• High blood pressure leading cause of stroke
• Diabetes is an individual risk factor for stroke
• Obesity increases risk for stroke by having excess body fat leading to difficulty in blood flow and risk of blockage
Source: American Heart Association
Global Burden of Diabetes
• In 2011, 366 million had diabetes
• 183 million with diabetes are undiagnosed
• Greatest number of those affected in the 40-59 yr. age group
• Caused 4.6 million deaths in 2011
• Diabetes cost $465 billion in healthcare expenditures in 2011
• 80% of people live in low- and middle-income countries
Burden of Disease in Alabama
• In United States, 8.3% of population diabetes
• 7th leading cause of death in U.S.
• In Alabama, 11.8% of population had diabetes
• 6th leading cause of death in Alabama
• In Macon and Bullock Counties, 16% of residents with diabetes
Source: http://www.countyhealthrankings.org/app/alabama/2013/
Prevalence of Diabetes in Alabama-2009
What is Diabetes, Really?
• Diabetes is a global disease• Causes can be:
• Genetic• Environmental
• Diabetes is a metabolic disorder that occurs because of poor utilization of insulin and thus an inability to utilize sugar (glucose) to produce energy.• Insulin production good but insulin receptors defective• Insulin production poor
• Beta cell defect in pancreas• Glucose transport defects• Insulin utilization poor, i.e. insulin resistance• Fat increases• Low Vitamin D • Changes in human microflora (over- or under-abundance) in the gut
Glucose Production and Uptake
Diabetes Health Effects• Leading cause of kidney failure
• Lower limb amputations
• Blindness
• Hypertension
• Nerve Damage
• Periodontal disease
• Major cause of heart disease and stroke
Obesity and Diabetes
• AMA recently designated obesity as a disease• Defined in individuals with BMIs ≥30• Obesity is a major risk factor for diabetes, heart disease,
and certain cancers• In 2012, Alabama ranked 47 with respect to obesity and
46 with respect to diabetes• In Macon County, 41% of adult population obese
compared to 33% of population for Alabama• In Bullock County, 39% of adult population obese
Source: http://www.americashealthrankings.org/al, 2012
Obesity and Diabetes
Insulin Resistance Promotes Several Disease States
Diabetes and Intestinal Bacteria (Methanobrevibacter smithii)
In a study conducted by Mathur and colleagues(2013), people who tested positive for methaneand hydrogen gases by breath analysis were observed to have higher body mass indexes and higher percentages of body fat.
High levels of methane and hydrogen attributedto increased levels of the bacterium, M. smithii.
This bacterium aids in conversion of food to energy in conjunction with other bacteria.
Suggested that increases in the bacterium slowsabsorption of food and causes weight gain.
Researchers also observed that individuals withhigher levels of methane have higher levels of glucose in the blood.
DIABETES AND HEART DISEASE
Diabetic Heart Disease
• Diabetic heart disease --develops in people with diabetes• Coronary artery disease• Hypertension• Congestive heart failure• Arrythmia• Heart attack
Diabetes, Heart Disease and Intestinal Microflora
• Recent investigations by Hazan and others (2013) show a microbial by-product contributes to heart disease and can serve as a predictor for heart attacks
• The compound is trimethylamine N-oxide (TMAO)• It is produced after consuming foods containing lecithin such
as eggs• Antibiotic therapy reduced levels of TMAO with no further
TMAO formed even after injesting lecithin-containing foods• Increased levels of TMAO proposed to contribute to heart
disease and even death
Cleveland Clinic (2013, April 24). Gut bacteria byproduct predicts heart attack and stroke. ScienceDaily. Retrieved July 26, 2013, from http://www.sciencedaily.com /releases/2013/04/130424185211.htm
Diabetes and Cancer• Certain cancers occur more frequently in individuals with
type II diabetes:• Pancreatic• colorectal• breast• hepatobiliary • bladder• endometrial cancers
• Common risk factors• Hyperinsulinemia• Insulin resistance• obesity
Mechanisms Linking Diabetes and Cancer
Reference: http://www.mayoclinic.org/medicalprofs/diabetes-and-cancer.html
High Sugar Levels Induce Expression of Cancer-Causing Genes
• Under normal conditions, sugars in the intestine induce the release of the GIP hormone which induces the release of insulin from the pancreas
• The release of GIP is controlled by a protein called β-catenin• β-catenin activity dependent upon sugar levels• High levels of sugar promote accumulation of β-catenin in the
cell nuclei• Nuclear β-catenin causes increased cell growth or proliferation• Increased cell proliferation causes cancer
madrimasd (2013, February 1). Excess sugar linked to cancer. ScienceDaily. Retrieved July 25, 2013, from http://www.sciencedaily.com /releases/2013/02/130201100149.htm
Cancer and Intestinal Microflora
• Studies in obese and lean mice revealed changes in intestinal bacteria composition
• Increase in bacteria that produce deoxycholic acid (DCA)• DCA damages DNA• Investigators observed liver cancer development in the mice• When mice were treated with an antibiotic, DCA levels were
reduced, thereby reducing cancer risk• This investigation shows a clear link between obesity and cancer development
Stroke• Blood vessel blocked or ruptured preventing blood
flow and oxygen to the brain• Brain cells can die resulting in disability or death• Occurs more in older women and African Americans• Family history of stroke is a risk factor• Act FAST to respond to stroke• Face• Arms• Speech• Time• Contributing risk factors could be diet
Summary
• Intestinal microflora changes can result in increases of harmful bacteria
• These bacteria can produce by-products that alter the metabolism of individuals
• These alterations may give rise to obesity, diabetes, heart disease, stroke and cancer
• Since there is a high prevalence of obesity, diabetes, heart disease and certain cancers in racial/ethnic minorities, perhaps the high risk could be due to changes in the intestinal microflora
• Contributing factors could be diet
Management and Prevention
• Nutritional Management
• Physical Activity
• Smoking Cessation
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