The Obesity Epidemic

Obesity and Diabetes

Obesity is often associated with the high risk of having chronic diseases, such as, diabetes mellitus, and cardiovascular diseases. And then, thin people or vegetarians may have a lower risk of diabetes? No. Obesity may not be the main factor.

A healthy lifestyle will determine the quality of human health. Even in a vegetarian, who is also doing regular exercises, may not lower the risk of diabetes, if the main cause is genetic. It is a fact that, human genes, and family history of diabetes, are associate with the risk of diabetes.

Clinical controlled trials had shown solid evidence that type 2 diabetes is a disease of fatness. A five % of weight loss is sufficient to prevent most obese subjects with impaired glucose tolerance, in developing type 2 diabetes. Type 2 diabetes is obesity dependent, and obesity is well understood aetiology (study of causation), as the main cause of type 2 diabetes. (Astrup A, et al. 2000)

However, ask yourself!
How many times you met with an obese Indian, or Chinese?

An update 2012 data, from International Diabetes Federation showed that, there were 33.4 million men, and 29.6 million women with diabetes, in India. Also, there were 51.5 million men, and 40.8 million women with diabetes, in China.

While in my country of Indonesia, from about 300 million population, there were 3.2 million men, and 4.4 million women with diabetes, aged 20 to 79 years. In the US, there were 12.2 million men, and 11.9 million women with diabetes. (IDF)

According to the article published in 2009, by the Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Colorado Denver, the US generations might have a shorter life expectancy than their parents, if the obesity epidemic is not controlled.

Because, 35.1% of adults in the US, were classified as obese. In children, obesity will continue to increase steadily. The study showed that obesity may become the most difficult public health issues in the US. (Catenacci VA, et al. 2009)

Link Between Obesity and Prostate Cancer

The US Health Professionals Followup Study reported an inverse association between obesity, and the risk of developing prostate cancer, in men under 60 years of age, or in those with a family history of prostate cancer. The study found that body mass does not appear to affect the performance of prostate specific antigen as a diagnostic test. But, a lower body mass is associated with a higher cancer detection rate, on a prostate biopsy.

Although, several mechanisms have been proposed to explain the link between obesity and prostate cancer, including, hormonal alterations, hyperinsulinemia (high levels of insulin in the blood), glucose intolerance (inability to metabolize glucose), elevated IGF (insulin-like growth factor, hormone which exert an effect on bone cell metabolism), and leptin (hormone made by fat tissue, that acts on brain to regulate food intake, and body weight) levels, but, the mechanism which explains the association between obesity, and prostate cancer remains unclear. (Amling CL. 2005)

However, an article which published two months earlier, supported the hypothesis, that obesity is inversely associated with prostate cancer risk, in middle aged men. The study used the interviews from 753 men, aged 40 to 64 years, that were diagnosed with prostate cancer between 1993 and 1996. (Porter MP, et al. 2005)

Obesity and Coronary Heart Disease

We cannot control from where we get our genes, and healthy lifestyle may not prevent us from getting diabetes. But, a healthy lifestyle may prevent us from getting coronary heart disease (CHD). High blood cholesterol, high blood pressure, overweight and obesity, are controllable risk factors of CHD.

A healthy diet and having regular exercise, can help maintaining a healthy weight, in which helps to control CHD risk factors. Five to ten % loss of body weight can lower the risk of CHD. Overweight children and teens are associated with the high risk of CHD, and may also have a shorter life expectancy than their parents, if their weight gain rates are not reduced. However, personally reducing calorie diets are not advised, unless approved by a physician. (NHLBI)

Image credit: Shakespeare's Monkey

Link Between Cancer and Family History

Image credit: Tracie Taylor

Cancer, an abnormal and uncontrolled growth of the cells that make up living things, is associated with family medical history. Even in an healthy body, cells could grow into sporadic cancer cells. So, in this case, inside every living things's cells could grow into cancer cells.

Cancer cells may lie dormant for years, or even decades before they grow sporadic and produce the symptoms of disease. Some cancers develop extremly slowly and often escape detection during the life of the patient. Different types of cancer may be caused by many factors, and different combinations of conditions. Also, there is a possibility that the human body immune system might subdue the tumor, or cancer cells without any treatments.

From 6,773.281 million of world population, in 2008, there were 12.6626 million new cancer cases, and 7.5648 million cancer deaths. The risk of getting cancer before the age of 75 years, was 18.6% worldwide. While the risk of dying from cancer before age the 75 years, was 11.1% worldwide.

Denmark was become #1 country with the highest cancer rate, in both men and women. Followed by Ireland in the second, and Australia in the third. The worldwide estimate mortality rate in women was ASR (Age standardised rates) 99.1 people, in 210.8 estimate cancer incidences, per 100,000 people. While in men, the worldwide estimate mortality rate was ASR 139.1 people, in 303.7 estimate cancer incidences, per 100,000 people. (Globocan 2008)

The Worldwide Most Common Cancer

Lung cancer is the most common cancer in the world. Lung cancer contributed 12.7%, or 1,608,055 new cases, in 2008. The death rate was 18,2%, or 1,376,579 cases of cancer death worldwide.

A cohort study involving 71,392 non smokers women, in Shanghai, China, indicated a moderate association of lung cancer risk with a family cancer history in general, and not specifically to a family history of lung cancer. (Zhang Y, et al. 2007)

The data from recent cohort study, such as, clinicopathologic data, tumor genotype, family history of cancer, and specifically family history of lung cancer, from 230 cases of never smokers lung cancer patients, was also supported the earlier study. 57% of the cases had a family history of any common cancers, and only 42 out of 230 cases (18%), was presented a specific family history of lung cancer. (Gaughan EM, et al. 2013)

Inherited Breast Cancer

The second most common cancer worldwide, in which also the world most common cancer in women is breast cancer. Breast cancer in women contributed 10.9%, or 1,384,155 new cases, in 2008. The mortality rate was 6.1%, or 458,503 cases of death worldwide.

The following are breast cancer risk factors:

• Age and Gender
  Advanced breast cancer cases are found mostly in women aged over 50 years. Although, men are 100 times less likely than women to get breast cancer, there is a chance for men in getting breast cancer.
• Family History
  A major risk factor for breast cancer, is the family cancer history, in first degree relatives of the disease. The first degree relatives are parents, brothers, sisters, sons and daughters. About 20% to 30% women with breast cancer, have a family history of the disease.
  Benign breast disease (BBD), a common condition marked by benign (non cancerous) changes in breast tissue, especially hyperplasia (an increased cell production in a normal tissue or organ), is also associated with an increased risk of breast cancer.
  In women with a family history of breast cancer, appear to be at increased risk of being diagnosed with BBD, in which is associated with a greatly increased risk of breast cancer. (Webb PM, et al. 2002)
• Genes
  Human genes play a key role in the development of breast cancers. At least four types of breast cancers have been shown to be inherited, among them, Luminal A, Luminal B, Triple negative/basal-like, and HER2 type.
  Breast cancer may also effect several genes, either by the activation of oncogenes (genes carried by tumor viruses), or the inactivation of tumor suppressor genes (anti-oncogenes). So, genes are involved specifically as causative factors of breast cancer. (Anderson DE. 1992)
• Menstrual Cycle
  In women who got an early menstrual period, or before the age of 12 years, will have a high risk of breast cancer. Also, in women who went through a late menopause, or above the age of 55 years, will have an increased risk of breast cancer.

Family History and Colorectal Cancer

Colorectal cancer became the third most common cancer worldwide with 9.8%, or 1,235,108 new cases, in 2008. There were 609,051 cases of death have been reported, or 8,1% of the mortality rate worldwide.

Family history is well established to be a risk factor for developing colorectal cancer (CRC). Recent study was aimed to observe the link between family history and survival from colorectal cancer. The study was using the data from 10,937 patients of the National Study of Colorectal Cancer Genetics (NSCCG), to compare with the data from 10,782 patients of the National Cancer Data Repository (NCDR).

Although the study found no differences between those with and without a family history of CRC, age, sex, tumour stage, and the presence of multiple cancers. But, the study managed to provide the evidence that a family history of CRC, is associated with better survival after a diagnosis of CRC. (Morris EJ, et al. 2013)

Family History and Cancer in Children

A study presented five families of paediatric patients suffering from choroid plexus carcinoma, a rare cancer in the ventricles (small cavities or chambers within a body or organ) of the brain. Choroid plexus carcinoma is often found in infants below two years of age.

The study had found that three families met the criteria for germline TP53 (tumor protein p53, a tumor suppressor protein) mutation testing. From those three family, only one familiy conformed to the criteria of Li-Fraumeni syndrome, an inherited cancer syndrome associated with the mutations in TP53 genes.

In the remaining two families, there were no family history of cancers, and the parents were not shown to carry the TP53 genes mutation. (Krutilkova V, et al. 2005)

Although we cannot control from where we get our genes, but, we could control our lifestyle habits to reduce the risk. By keeping a healthy living, and diet will surely minimize the risk of cancer. Just like a quote, What you eat is what you are, being healthy is a choice in life.

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Dietary Intake of Vitamin D Against Diabetes and Cancer

NOW Foods Vitamin D-3

What is Vitamin D?

Vitamin D, or widely known as sunshine vitamin, is technically not a vitamin. Because cholecalciferol, or vitamin D3, can be made naturally by the body when the skin is exposed to sunlight. Vitamin D can also be obtained from foods and supplements.

Nowadays, some fortified foods have added with vitamin D, such as, milk, cereal, yogurt, orange juice, cheese, and margarine. Natural vitamin D is also found in cod liver oil, meat, egg yolk, and several fatty fishes, such as tuna, swordfish, salmon, mackerel, and sardines.

Tolerable Upper Daily Intake Levels of Vitamin D

The following are dietary reference intakes (DRIs), tolerable upper daily intake levels of vitamin D, by the US Food and Nutrition Board, Institute of Medicine, National Academies :

• Infants (0 to 6 months) => 25 μg (1000 IU)
• Infants (7 to 12 months) => 38 μg (1520 IU)
• Children (1 to 3 years) => 63 μg (2520 IU)
• Children (4 to 8 years) => 75 μg (3000 IU)
• As for people aged above 8 years, pregnant women, and breastfeeding mom => 100 μg (4000 IU)

μg = microgram; 1 μg = 40 International Units (IU) ([PDF] ULs for Vitamins and Elements)

Benefits of Vitamin D?

Unlike the safety of vitamin D that we obtained from the Sun exposure, having excessive intake of vitamin D from dietary supplements, may cause toxicity. The following are several benefits of vitamin D:

• To promote calcium absorption in the small intestine.
• To maintain adequate serum calcium and phosphate concentrations for bone formation, mineralization, growth, and repair.
• To improve muscle strength.
• To prevent rickets (a disease characterized by a failure of bone tissue to properly mineralize, resulting in soft bones and skeletal deformities) in children, and osteomalacia (a condition which can cause bone pain and muscle weakness), and osteoporosis in adults.
• To reduce inflammation and improve immune function.
• To prevent cancers, diabetes, osteoarthritis progression, multiple sclerosis, hypertension, and secondary hyperparathyroidism (a disorder in which the parathyroid glands in your neck produce too much parathyroid hormone).

Vitamin D Deficiency

Vitamin D deficiency can occur when the usual intake is lower than recommended levels, for example, the limited of sunlight exposure, especially in the subtropical climate area. Milk allergy, lactose intolerance, ovo-vegetarianism, and veganism, are also associated with vitamin D deficiency.

People with dark skin may also at high risk in developing vitamin D deficiency, due to pigment melanin in dark skin people, will reduce the skin's ability to produce vitamin D from sunlight. The elder people might also experience the same thing as the dark skin people. Due to aging, the skin of elder people cannot synthesize vitamin D as efficiently as when they were young.

Vitamin D deficiency is very common in children with cancer. Recent clinical study had shown that the incidence of hypovitaminosis in pediatric cancer patients was 72%. Early detection and supplementation could benefit to high risk patients. (Helou M, et al. 2013)

Vitamin D and Diabetes

Dietary intake of vitamin D supplementation is associated with reducing the risk of type 1 diabetes in animals. A study aimed to demonstrate whether vitamin D supplementation, or vitamin D deficiency in infancy, could affect the development of type 1 diabetes.

The data of 12,055 pregnant women who gave birth, in 1966, in Oulu and Lapland, northern Finland, were collected and diagnosed the development of type 1 diabetes, in December, 1997. From 10,366 children who were analysed, 81 were diagnosed with diabetes during the study. The study ensured that vitamin D supplementation for infants could help to reduce the incidence of type 1 diabetes. (Hyppönen E, et al. 2001)

Another study aimed to investigate calcidiol, or 25-hydroxyvitamin D [25(OH)D], associated with insulin sensitivity and beta cell function. The study among 126 healthy people living in California, had shown a positive correlation of calcidiol with insulin sensitivity and a negative effect of hypovitaminosis D on beta cell function. Hypovitaminosis D subjects may have higher risk of insulin resistance and the metabolic syndrome. (Chiu KC, et al.2004)

83,779 women without history of diabetes, cardiovascular disease, or cancer, were studied for the development of type 2 diabetes. Vitamin D and calcium intake from diet and supplements was assessed every two to four years. During 20 years of follow up, there were 4,843 incident cases of type 2 diabetes.

The collected data had shown that daily intake combination of >1,200 mg calcium and >800 IU vitamin D was associated with a 33% lower risk of type 2 diabetes. The study suggested that vitamin D and calcium intake will potentially benefit in reducing the risk of type 2 diabetes. (Pittas AG, et al. 2006)

Vitamin D and Cancer

A phase II study was demonstrated to determine the pain associated with prostate cancer bone metastasis, and muscle strength parameters, in respond to vitamin D supplementation. The patients were given 2,000 IU oral vitamin D, daily for 12 weeks. The study concluded that vitamin D supplementation may be a useful adjunct for improving pain, muscle strength and quality of life. (Van Veldhuizen PJ, et al. 2000)

A trial using calcium and vitamin D supplementation was demonstrated among 36,282 postmenopausal women. 18,176 women received daily 1000 mg calcium, and 400 IU vitamin D3 supplementation. The other 18,106 women received a placebo for an average of seven years.

The trial resulted that the incidence of invasive colorectal cancer did not differ significantly between women assigned to calcium plus vitamin D supplementation and those assigned to placebo. (Wactawski-Wende J, et al. 2006)

Another randomized placebo controlled trial was demonstrated the efficacy of calcium supplement, and calcium plus vitamin D, in reducing cancers risk. The trial was conducted among 1,179 healthy postmenopausal women aged 55 years or older.

The participants were randomly assigned to receive either, only 1500 mg calcium supplement, a 1500 mg calcium plus 1100 IU vitamin D3 supplement, or a placebo, everyday for four years. The trial, which was also registered at clinicaltrials.gov (NCT00352170), had concluded that the improvement of calcium and vitamin D nutritional status, was related substantially in reducing all types of cancer risk in postmenopausal women. (Lappe JM, et al. 2007)

Several Clinical Trials of Vitamin D

Vitamin D and Fracture Incidence

A randomised double blind controlled trial was conducted to measure fracture incidence and total mortality by cause. The trial was involving 2,037 men and 649 women, aged between 65 to 85 years.

The participants received either 100,000 IU oral cholecalciferol (vitamin D3), or a placebo every four months for five years. The trial resulted that four monthly supplementation, with 100,000 IU oral vitamin D, may prevent fractures without adverse effects in men and women. (Trivedi DP, et al. 2003)

However, another trial among 5,292 people aged 70 years or older, were were randomly received daily 800 IU vitamin D3, or a 1000 mg calcium, or 800 IU vitamin D3 plus 1000 mg calcium, or a placebo. Two years later, 2,886 participants were still taking tablets, 451 had died, 58 had withdrawn, and 1,897 had stopped taking tablets.

But, the collected data from all participants did not support the calcium and vitamin D supplementation, either alone or in combination, for the prevention of fractures in elderly people. (Grant AM, et al. 2005)

Vitamin D to Prevent Weight Gain

Obesity in the U.S. has increased significantly during the past several decades. Also, the promotion that obesity is considered as a disease, and no longer as the linked source of the death triangle of diabetes, heart disease and cancer. A randomized, double-blinded, placebo-controlled trial was performed to observe the role of calcium in the maintenance of a healthy body weight.

36,282 postmenopausal women, aged 50 to 79 years, were randomized at their first, or second annual visit to receive a dose of 1000 mg elemental calcium plus 400 IU of cholecalciferol, or placebo daily. The trial resulted that calcium plus cholecalciferol supplementation has a small effect to prevent weight gain. (Caan B, et al. 2007)

Metabolic Effects of Vitamin D in Pregnant Women

Recently randomized, double blind, placebo controlled clinical trial was conducted in 48 pregnant women aged between 18 to 40 years old at 25 weeks of pregnancy. All participants randomly received either 400 IU cholecalciferol supplements, or placebo, everyday, for nine weeks.

Nine weeks later, the study had concluded that vitamin D supplementation among pregnant women has beneficial effects on metabolic status. (Asemi Z, et al. 2013)