Tajalli 1 Shereen Tajalli Mrs.

Wolcott ENC 1102 14 March 2014 Food and Exercise Affectivity on Type 2 Diabetes The importance of proper nutritional intake for type 2 diabetics is crucial for doctors to be aware of, in order to better educate his or her patients. Insulin resistance is a huge concern regarding type 2 diabetes and with adequate quality of food and exercise, the patient can remain in control of their blood sugar level. Many studies have been held in the past 13 years that test both medicinal and non-medicinal methods of preventing type 2 diabetes during the ages of infancy through puberty; however this paper discusses methods of proper intake and adequate exercise as a means of maintenance. Since blood sugar level must be moderated, low cholesterol consumption is advised. Many examinations around the world have been held as a means of experimenting with insulin resistance of diabetics through means of cholesterol intake. Greater cholesterol intake and less exercise allows for greater resistance of insulin whereas diabetics who consume a more balanced quantity of cholesterol and regularly exercise are much healthier. Belenchia, A. Tosh, A. Hillman, L. and Peterson C. Correcting vitamin D insufficiency improves insulin sensitivity in obese adolescents: a randomized controlled trial. The American Journal of Clinical Nutrition. Vol 97. No. 4. April 2013. Pages 774-781. Biological & Agricultural Index Plus (H.W. Wilson). Web. 8 March 2014. This article summarizes that obese adolescents are at a greater risk of vitamin D deficiency because vitamin D is thought to be sequestered by excess adipose tissue. Poor vitamin D status has been associated with a higher prevalence of the metabolic syndrome,

Tajalli 2 type 2 diabetes, both in adults and adolescents. The objective was to determine in obese adolescents the efficacy and safety of vitamin D and whether subsequent increased circulating concentrations of 25-hydroxyvitamin D are associated with improved markers of insulin sensitivity and resistance and reduced inflammation. Obese adolescent patients were recruited from the University of Missouri Adolescent Diabetes and Obesity Clinic and were randomly assigned to receive either vitamin D3 or placebo as part of their standard care. After 6 months, there were no significant differences in BMI (body mass index), serum inflammatory markers, or plasma glucose concentrations between groups. Participants supplemented with vitamin D3 had increases in serum 25D concentrations fasting insulin, HOMA-IR, and leptin-to-adiponectin ratio. Inflammatory markers remained unchanged. The correction of poor vitamin D status through dietary supplementation may be an effective addition to the standard treatment of obesity and its associated insulin resistance. Biro, FM. and Wien, M. Childhood obesity and adult morbidities. The American Journal of Clinical Nutrition. Vol 91. No. 5. May 2010. Pages 1499-1505. CINAHL Plus. Web. 8 March 2014. This article discusses the prevalence and severity of obesity that has increased in recent years, likely the result of complex interactions between genes, dietary intake, physical activity, and the environment. The expression of genes favoring the storage of excess calories as fat, which have been selected for over many millennia and are relatively static, has become maladaptive in a rapidly changing environment that minimizes opportunities for energy expenditure and maximizes opportunities for energy intake. The consequences of childhood and adolescent obesity include earlier puberty and menarche in girls, type 2

Tajalli 3 diabetes and increased incidence of the metabolic syndrome in youth and adults, and obesity in adulthood. These changes are associated with cardiovascular disease as well as with several cancers in adults, likely through insulin resistance and production of inflammatory cytokines. Although concerns have arisen regarding environmental exposures, there have been no formal expert recommendations. Currently, the most important factors underlying the obesity epidemic are the current opportunities for energy intake coupled with limited energy expenditure. Burrowes, J. Nutrition for a Lifetime: Childhood Nutrition. Nutrition Today. Vol 42. Issue 4. July 2007. Pages 160-167. General Science. Web. 8 March 2014. Obesity rates among children have increased significantly in the past 3 decades, according to Burrowes, an associate professor in the Department of Nutrition at Long Island University. Childhood obesity is an early risk factor for adult morbidity and mortality, contributing to long-term health problems such as type 2 diabetes, coronary heart disease, and osteoporosis. Diet and lifestyle strategies taught at an early age may impact future obesity rates in children. This column reviews childhood nutrition issues that relate to overweight and obesity and provides ways in which the family and the school can work toward healthier eating and lifestyle habits in children. Dabelea, D. and Harrod, C. S. Role of Developmental Nutrition in Pediatric Obesity and Type 2 Diabetes. Nutrition Reviews. Vol 71. Issue S1. 21 Oct 2013. Pages 562567. SPORTdiscus. Web. 1 March 2014. Reviewed in this article is the evidence supporting a transgenerational cycle that increases obesity and diabetes in offspring and contributes substantially to the increases

Tajalli 4 in obesity and type 2 diabetes observed over the past several decades. The public health impact of these findings is discussed and future research opportunities are outlined. Childhood obesity continues to be a significant public health burden. Empirical evidence has begun to identify intrauterine and postnatal pathways that increase the likelihood of excess adiposity and increased risk of type 2 diabetes among offspring. Deboer, M, et al. Early childhood growth failure and the developmental origins of adult disease: do enteric infections and malnutrition increase risk for the metabolic syndrome? Nutrition Reviews. Vol 70. Issue 11. November 2012. Pages 642-653. Wiley Online Library. Web. 8 March 2014. Hypotheses regarding the developmental origins of health and disease postulate that developing fetuses undergo adaptive epigenetic changes that have longstanding effects on metabolism and other processes. Ongoing research explores whether these adaptations occur during early life following early childhood malnutrition. In the developing world, there remains a high degree of nutritional stunting, defined as linear growth failure caused by inadequate caloric intake, which may be exacerbated by inflammation from ongoing infections. In areas with poor sanitation, children experience vicious cycles of enteric infections and malnutrition, resulting in poor nutrient absorption as a result of changes in the intestinal mucosa, now termed 'environmental enteropathy.' Emerging evidence links early childhood diarrhea and/or growth failure with an increased occurrence of risk factors for cardiovascular disease in later life, including dyslipidemia, hypertension, and glucose intolerance. The mechanisms for these associations remain poorly understood and may relate to epigenetic responses to poor nutrition, increased inflammation, or both. Given the increased incidence of cardiovascular disease in

Tajalli 5 developing areas of the world, associations between childhood malnutrition, early-life infections, and the increased occurrence of risk factors for cardiovascular disease underscore further reasons to improve nutrition and infection-related outcomes for young children worldwide. Donin, S. Nightingale, CM. and Owen, CG. Nutritional composition of the diets of South Asian, black African-Caribbean and white European children in the United Kingdom: The Child Heart and Health Study in England (CHASE). British Journal of Nutrition. Vol 104. Issue 02. July 2010. Pages 153-159. Cambridge University Press. Web. 8 March 2014. In the UK, South Asian adults have increased risks of type 2 diabetes and central obesity. Black African-Caribbeans, in contrast, have increased risks of type 2 diabetes and general obesity. This article suggests the growing evidence that these risk differences emerge in early life and that nutritional factors may be important. Scientists have therefore examined the variations in nutritional composition of the diets of South Asian, black African-Caribbean and white European children, using 24 hour recalls of dietary intake collected during a cross-sectional survey of cardiovascular health in eighty-five primary schools in London, Birmingham and Leicester. Compared with white Europeans, South Asian children reported higher mean total energy intake; their intakes of total fat, polyunsaturated fat and protein were higher and their intakes of carbohydrate as a proportion of energy, vitamin C and D. These differences were especially marked for Bangladeshi children. Black African-Caribbean children had lower intakes of total and saturated fat. The lower total and saturated fat intakes were particularly marked among black African children. Appreciable ethnic differences exist in the nutritional

Tajalli 6 composition of children's diets, which may contribute to future differences in chronic disease risk. Edwards, S. et al. Changes in the diet of a South Asian transmigratory population may be associated with an increase in incidence of childhood diabetes. Nutrition Research. Vol 26. Issue 6. June 2006. Pages 249-254. Elsevier. Web. 8 March 2014. The authors discuss how the emigrants from Pakistan to Bradford, UK, have moved from an area of low to one of higher incidence of type 1 diabetes. South Asian children in this population have shown a marked rise in diabetes incidence. Changes in diet over the last 40 years were investigated as a potential explanatory factor. Dietary information were collected on South Asian children aged 9 to 11. For groups 1 and 3, participants were asked to recall all items of food and drink consumed during the previous 24 hours. Nutrient intakes were generated from the raw food data using a computer algorithm. Broad food group consumption and median nutrient intakes were compared between groups. Food intake differed significantly in the Bradford children compared with their counterparts in Pakistan. The childhood diet recalled by adults was similar to that of children currently in Pakistan. Bradford children consumed higher quantities of food that contained more fat, protein, carbohydrate, and sugar than the other two groups. Bradford children were more likely to consume meat, fish, and fast food, although fewer vegetables and dairy products than the other groups. The diets of Pakistani children in Bradford differed significantly from their counterparts in Pakistan, both in broad content and nutrient composition. These dietary changes could be responsible for the increase in diabetes.

Tajalli 7 Goletzke, J, et al. Habitually Higher Dietary Glycemic Index During Puberty Is Prospectively Related to Increased Risk Markers of Type 2 Diabetes in Younger Adulthood. American Diabetes Association. Vol 36. Isse 7. July 2013. Page 1870. Medline. Web. 8 March 2014. Its observed that carbohydrate nutrition during periods of physiological insulin resistance such as puberty may affect future risk of type 2 diabetes. This study examined whether the amount or the quality of carbohydrates during puberty is associated with risk markers of type 2 diabetes in younger adulthood. The analysis was based on 226 participants (121 girls and 105 boys) from the Dortmund Nutritional and Anthropometric Longitudinally Designed Study (DONALD) with an average of five 3-day weighed dietary records (range 2-6) during puberty (girls, age 9-14 years; boys, age 10-15 years) and fasting blood samples in younger adulthood (age 18-36 years). Multivariable linear regression was used to analyze the associations between carbohydrate nutrition and homeostasis model assessment-insulin resistance (HOMA-IR) as well as the liver enzymes alanine ami-notransferase (ALT) and -glutamyltransferase (GGT). The amount of carbohydrates, GL, and added sugar, fiber, and whole-grain intake were not related to the analyzed markers. The data indicate that a habitually higher dietary GI during puberty may adversely affect risk markers of type 2 diabetes in younger adulthood. Marlett, J. McBurney, M. Slavin, J. Position of the American Dietetic Association: Health Implications of Dietary Fiber. Journal of the American Dietetic Association. Vol 102. Issue 7. July 2002. Pages 993-1000. Gale Cengage Learning. Web. 8 March 2014.

Tajalli 8 Discussed in this article is how dietary fiber consists of the structural and storage polysaccharides and lignin in plants that are not digested in the human stomach and small intestine. A wealth of information supports the American Dietetic Association position that the public should consume adequate amounts of dietary fiber from a variety of plant foods. Recommended intakes, 20-35 g/day for healthy adults and 5 g/day for children, are not being met, because intakes of good sources of dietary fiber, fruits, vegetables, whole and high-fiber grain products, and legumes are low. Consumption of dietary fibers that are viscous lowers blood cholesterol levels and helps to normalize blood glucose and insulin levels, making these kinds of fibers part of the dietary plans to treat cardiovascular disease and type 2 diabetes. Fibers that are incompletely or slowly fermented by microflora in the large intestine promote normal laxation and are integral components of diet plans to treat constipation and prevent the development of diverticulosis and diverticulitis. A diet adequate in fiber-containing foods is also usually rich in micronutrients and nonnutritive ingredients that have additional health benefits. It is unclear why several recently published clinical trials with dietary fiber intervention failed to show a reduction in colon polyps. Nonetheless, a fiber-rich diet is associated with a lower risk of colon cancer. A fiber-rich meal is processed more slowly, which promotes earlier satiety, and is frequently less calorically dense and lower in fat and added sugars. All of these characteristics are features of a dietary pattern to treat and prevent obesity. Norton, D. Samani-Radia, D. Van Tonder, A. Evaluation of activ8: the effectiveness of a joint dietetic and physiotherapy weight management group intervention in children and

Tajalli 9 adolescents. Journal of Human Nutrition and Dietetics. Vol 24. Issue 3. June 2011. Page 297. Web. 8 March 2014. This article discusses Activ8, a 6-week community based group intervention targeting overweight and obese children aged between 5 and 18 years. The course consists of weekly 1 hour sessions that combine game based physical activities and nutritional education sessions. The aim of this study was to evaluate the effect of the Activ8 intervention on anthropometry and body composition. Routinely collected data was pooled from all children attending Activ8 during 2009. Information recorded included gender, date of birth and measurements for weight, height and body fat percentage, measured using bioelectrical impedance analysis. Statistical analysis was carried out, comparing anthropometric and body compositional variables before and after attendance and examining the effect of age and gender on outcomes. In 2009, 15 courses were organized. Of the 133 children starting, 70 completed the course. All but two of the participants were clinically obese at the start of the course. No significant differences were observed according to age group or gender in the reduction of body fat percentage. Pereira, M, et al. Breakfast frequency and quality may affect glycemia and appetite in adults and children. The Journal of Nutrition. Vol 141. No 1. 1 January 2011. Page 163-168. American Society of Nutrition. Web. 8 March 2014. Observational studies of breakfast frequency in children and adults suggest an inverse association between the frequency of eating breakfast and the risk for obesity and chronic diseases such as type 2 diabetes. More prospective studies with stronger designs are needed, as are experimental studies on this topic. In addition, above and beyond breakfast

Tajalli 10 frequency, the roles of dietary quality and composition need to be studied in the context of eating or skipping breakfast. Experimental studies are also necessary to rigorously test causality and biological mechanisms. Therefore, scientists conducted 2 pilot experimental studies to examine some of the effects of breakfast skipping and breakfast composition on blood glucose and appetite in children and adults. The results suggest that breakfast frequency and quality may be related in causal ways to appetite controls and blood sugar control, supporting the hypothesis that the breakfast meal and its quality may have important causal implications for the risk of obesity and type 2 diabetes. Rabbitt, A. Coyne, I. Child obesity: nurses role in addressing the epidemic. British Journal of Nursing. Vol 21. No 12. 2012. 28 June 2012. Pages 731-735. CINAHL. Web. 8 March 2014. This article discusses how obesity is a significant long-term health problem that is common among children and adolescents in Western countries. Being overweight or obese can contribute to type 2 diabetes in childhood and increase the risk of cardiovascular disease in adulthood. Primary prevention of obesity prevents the development of serious secondary complications in adulthood. Nurses can help parents and children by providing nutritional advice and, through weight management programs, offer strategies for decreasing caloric intake and increasing physical activity. Nurses' actions should always take a whole-family approach because it is challenging for obese children to alter their dietary or physical habits if not supported by their families. Nurses should work with all members of the multidisciplinary team in addressing childhood obesity as it is a major health issue with long-term morbidities.

Tajalli 11 Stroehla, B. Malcoe, L. Velie, E. Dietary Sources of Nutrients among Rural Native American and White Children. Journal of the American Dietetic Association. Vol 105. Issue 12. December 2005. Pages 1908-1916. Biological and Agricultural Index. Web. 8 March 2014. Important food sources of energy, fiber, and major macro- and micronutrients among rural Native American and white children were investigated and documented in this article. In a cross-sectional study, food frequency questionnaire data were collected during in-person interviews with caregivers of 329 rural Native American and nonHispanic white children aged 1-6 years living in northeastern Oklahoma. There was poor food variety. The principal energy sources were milk, cheese, white breads, salty snacks, non-diet soft drinks, hot dogs, candy, and sweetened fruit drinks. With few exceptions, top sources of most dietary constituents were low-nutrient-dense high-fat foods and refined carbohydrates; solid fruits and vegetables contributed minimally. Age or race and ethnicity did not affect food sources significantly. The nutrient sources identified increase children's risk for childhood obesity, type 2 diabetes, and adult chronic disease. Taylor, J. Timmons, V. Larsen, R. Nutritional Concerns in Aboriginal Children Are Similar to Those in Non-Aboriginal Children in Prince Edward Island, Canada. Journal of the American Diabetic Association. Vol 107. Issue 6. June 2007. Biological and Agricultural Index Plus. Web. 8 March 2014. This article discusses the assessment of food consumption among children in Prince Edward Island, Canada. Unhealthy dietary behaviors among Aboriginal children in Canada have been observed since the 1970s and are believed to be partly responsible for

Tajalli 12 the elevated levels of obesity and type 2 diabetes in this group. A total of 55 children ages 9 to 18 years, living on a Mi'kmaq reserve, completed a self-administered food frequency questionnaire during an in-home interview. Only one child consumed the recommended minimum daily amount of fruit and vegetables; significant numbers consumed 3 or more servings daily of milk products or snack foods and beverages. Although the results are consistent with past reports for Aboriginal children, they are generally similar to recent surveys of other children in Prince Edward Island, suggesting a province-wide rather than cultural health issue. Thane, C. Jones, A. Stephen, A. Whole-grain intake of British young people aged 4-18 years. British Journal of Nutrition. Volume 94. Issue 5. November 2005. Pages 825-831. Cambridge Journals. Web. 8 March 2014. Inverse associations between whole-grain food consumption and risk of CVD, some cancers and type 2 diabetes are discussed in this article. The objective of the present study was to estimate whole-grain intake in a nationally representative sample of young people ages 4-18 years living in Great Britain. Whole-grain intake was quantified from the consumption of all foods containing whole-grain content. Intake was significantly lower among young people whose head of household had a manual occupation, but did not differ significantly by sex, age, region or season. There was no whole-grain intake for 27% of participants. The main sources of whole-grain intake were breakfast cereals and bread. The present study provides the first quantification of absolute whole-grain intake from all significant food sources in any representative age group in the UK.

Tajalli 13 Timpson, A. Morales, E. and Abrams, E. Practical Aspects of Implementing an Intensive Lifestyle Program for Children and Adolescents with Type 2 Diabetes: TODAY Interventionist Perspective. Journal of the American Dietetic Association. Vol 111. Issue 9. September 2011. Pages 69. Medline. Web. 8 March 2014. This study assessed the extent to which the food environment on/near the campus of a major university facilitated healthful eating. The Nutrition Environment Measures Survey-Restaurants was used to evaluate 20% of restaurants on/near campus and adapted to assess 4 dining halls. Assessment of healthy food choice indicators, (evaluators of vegetarian, and salad entrees; healthy accompaniments (whole grain breads, baked chips, reduced-fat salad dressing, non-fried vegetables, fruit without added sugar), and healthy beverages (100% juice, reduced-fat milk, diet drinks)) revealed that dining halls scored significantly higher than sit-down and fast-food, but not fast-casual restaurants. Facilitators to healthy eating (for example menu notations: stating calorie/nutrient content, identifying healthy choices, indicating reduced portion size availability, and encouraging healthy requests) did not differ among the restaurants. Barriers to healthy eating were noted only in sit-down and fast-food restaurants and dining halls. Signs and banners encouraging/discouraging healthy eating were observed infrequently. None of the establishments used pricing practices to encourage healthy eating, but fast-food restaurants were significantly more likely than to price menu items in a manner that discouraged healthy eating. Overall, on-campus dining halls facilitated healthful eating to a greater extent than restaurants. Weigensberg, MJ. Type 2 diabetes in children and adolescents. The Lancet. Vol 373. Issue 9677. May 2009. Pages 17431744. Medline. Web. 8 March 2014.

Tajalli 14 This article summarizes the relationship between adolescent type 2 diabetes in ethnic populations that are more insulin resistant, such as Hispanics, African Americans, and Native Americans. Excessive insulin resistance leads to progressive beta-cell dysfunction ultimately leading to diabetes. Studies are being held to track at-risk children of many ethnic differences. Drug therapies are also being tested to reduce insulin resistance, ultimately reducing beta-cell demand, thus preventing diabetes.