Relationship of Early Obesity & Adult Health

1. Relationship of Early Obesity & Adult Health Mike F. Weaver, Dr.P.H. Guest Lecturer

2. Children, Adolescents& Diabetes Mellitus • Diabetes Mellitus (derived from the Greek words meaning “sweet urine”) is a disease characterized by high levels of blood glucose, resulting in defects in insulin secretion, insulin inaction, or both. • In young people it is generally caused by a lack of insulin production.

3. Types of Diabetes • Type 1 (Juvenile diabetes or early-onset diabetes)- believed to be caused by damage to insulin-producing (beta) cells of the pancreas.

4. Types of Diabetes • Type 2 (non-insulin dependent DM or late-onset diabetes)- insulin-producing (beta) cells produce normal or above-normal levels of insulin, but because of the decline in the number of insulin receptors in target cells, cells are unresponsive to insulin.

5. Prevalence of DM by Age • Total of 25.7 million people—5.9% of the US population—have DM.* • Age 65+- 6.3 million (18.4%) • Age 20-64- 15.6 million (8.2%) • Age <20- 123,000 (.16%) • Cases include both diagnosed and undiagnosed people

6. Risk factors for Type 1 • Genetic • Diet • Viral infection • Environmental pollutant

7. Risk factors for Type 2 • Genetics • Obesity (Visceral fat) • Impaired glucose tolerance • Hyperinsulinemia • Physical inactvity

8. Early symptons of DM • Excessive urination • Thirst • Feeling tired and weak • Weight loss • Blurred vision • Urinary tract infections • Bacterial infections of the bladder

9. Characteristics of DM

10. DM in Children and Adolescents • The Bogalusa Heart Study (selected)

11. DM in Children and Adolescents • The Bogalusa Heart Study (results)

12. DM in Children and Adolescents • University of Cincinnati Department of Pediatrics Study (results)

13. DM in Children and Adolescents • Yale University School of Medicine • Results: Impaired glucose tolerance was detectd in 25% of the 55 obese children (4-10 years of age) and 21% of the 112 obese adolescents (11-18 years of age); silent Type 2 DM was identified in 4% of obese adolescents. • Conclusions: Impaired glucose tolerance is highly prevalent among children and adolescents with severe obesity, irrespective of ethnicity. • Overt Type 2 DM was linked to beta-cell failure.

14. DM in Children and Adolescents • Italian Children’s Study in Verona, Italy • Results: 215 obese children were followed for 14 (+5) years to observe insulin resistance and obesity. 103 were assessed at follow-up. • Conclusions: obesity tracks into adulthood for many obese Caucasian children. In obese girls, however, insulin resistance during childhood appears to oppose the risk of obesity in adulthood.

15. Living with DM • Prescriptions

16. Living with DM • Monitoring

17. Living with DM • Medication Adherence

18. Living with DM • Medications

19. DM Points of Intervention

20. Health Outcomes of DM • Retinopathy- the deterioration of the blood vessels in the eye caused by high blood glucose. • Nephropathy- renal disease associated with glumerulosclerosis due to DM. Dialysis is required for End-Stage Renal Disease. • Diabetic coma- unconsciousness due to insufficient amounts of insulin for a prolonged period. • Insulin shock- an overdose of insulin produces hypoglycemia (reduced blood glucose levels) and causes tremor, fatigue, sleepiness and the inability to concentrate. • Neuropathy- nerve fiber damage to the circulatory system which could result in amputations.

21. Health Outcomes of DM • Amputations- especially lower extremities in DM, result from inevitable elevations in blood glucose levels that occur periodically over the years. Gangrene, the local demise of soft tissue due to loss of blood supply, causes amputations.

22. What could be done forOverweight and Obese Children and their possible predisposition to develop Diabetes Mellitus?