Health for life

Its such a no-brainer, right?  If persons at risk for diabetes would only eat right and exercise more, theyd avoid the disease.  And for those who develop diabetes, diet and exercise will reduce death rates and complications.

Yes and no, say Elizabeth Sumamo Schellenberg and colleagues at the University of Alberta.  Their review of the mixed published scientific evidence on the topic appears in the October 15 issue of the Annals of Internal Medicine.  The purpose of their study was to ascertain the impact of diet and exercise on the prevention of "Type 2 diabetes," as well as lowering complications among persons with who had established Type 2 diabetes. 

To be included, studies had to be prospective and compare the outcomes from an intervention versus a randomly selected control group. The study could only be included if it examined the impact of exercise plus diet and "one other component," such as "counseling, smoking cessation and behavior modification."  The outcomes had to include the development of Type 2 diabetes (in the prevention trials) or complications (in the treatment trials).

1289 candidate studies were found but only 20 made the grade. Nine were prevention trials and 11 were treatment trials.

For the prevention trials:

The interventions lasted from 6 to 72 months, with follow-up going for 3 to 20 years for between 39 to 3234 participants.  The counseling varied and included group and/or individual with or without tobacco cessation, telephony, goal setting, cooking classes or pills involving a range of physician and non-physician professionals.

Results?

Seven of the nine studies showed that diabetes can be delayed. When the results were pooled, compared to the control patients, the risk of developing diabetes over 10 years was only a third and the difference was statistically significant.

But, there was no detectable impact on cardiovascular disease events or on eye, kidney or nerve damage. That may have been due to not all the studies including these outcomes as well as the time it takes for these complications to occur once diabetes develops.  With more patients or more time, a difference could have become apparent.
 
For the treatment trials:

The interventions lasted from 6 to 48 months with follow-up for 6 to 93 months. The counseling was as varied as the prevention trials but included glucose and blood pressure monitoring as well as stress management and, in one instance, a three day residential retreat. There was likewise the range of professionals who provided the interventions.

Results? 

Compared to the control patients, there was no statistically significant difference in all-cause mortality.  Some individual studies had beneficial outcomes involving cardiovascular events or diabetes complications, but they included the aggressive use of medications.  There were no sustained impacts on weight or dietary intake.  And if pills were not included, there was also no real improvement in measures of blood glucose control.

The Disease Management Care Blogs take?

The good news is that there is good evidence that exercise and diet can prevent diabetes.  The bad news is that it takes years for that "return on investment" to declare itself and typically involves interventions that fall outside the traditional health care delivery system.  Its unlikely, thinks the DMCB, that current iterations of payment orm (value based purchasing, bundled payments or upside risk) can be marshaled to make this a reality.  That being said, population health management (PHM) companies like Omada Health are making their evidence-based services available to, for example, employers who have a longer term commitment to the well being of their "human capital" outside of the traditional insurance market.

The bad news is that once diabetes declares itself, diet and exercise dont result in life extension, and control of complications as well as overall blood sugar levels is more a function of pills than lifestyle. Accordingly, expectations need to be realisitically shared with patients and PHM should emphasize taking the pills as prescribed.

Image from Wikipedia

Change in Weight More Important Than Where You Start

Some overweight older adults don’t need to lose weight to extend their lives, but they could risk an earlier death if they pack on more pounds.

In fact, the nationwide study found that people who were slightly overweight in their 50s but kept their weight relatively stable were the most likely to survive over the next 16 years.

They had better survival rates than even normal-weight individuals whose weight increased slightly, but stayed within the normal range.

On the other hand, those who started out as very obese in their 50s and whose weight continued to increase were the most likely to die during that period.

Overall, the results suggest that about 7.2 percent of deaths after the age of 51 are due to weight gain among obese people, at least among the generation in this study, said Hui Zheng, lead author of the study and assistant professor of sociology at The Ohio State University.

“You can learn more about older people’s mortality risk by looking at how their weight is changing than you can by just looking at how much they weigh at any one time,” Zheng said.

While some extra weight seemed protective in this study, Zheng cautioned that these results applied only to people over 50. His previous research, published in Social Science & Medicine, suggests that being overweight may not be helpful for younger people.

“Our other research suggests that the negative effect of obesity on health is greater for young people than it is for older people, so young people especially shouldn’t think that being overweight is harmless,” he said.

This new study was published online this month in the American Journal of Epidemiology. Co-authors are Dmitry Tumin, doctoral student, and Zhenchao Qian, professor, both in sociology at Ohio State.

The researchers used data from the Health and Retirement Study, a nationally representative survey of Americans born between 1931 and 1941. This study analyzed 9,538 respondents who were aged 51 to 61 when the survey began in 1992. They were re-interviewed every two years until 2008, and the researchers had information on how their body mass index (BMI) changed at each interview and whether they died at any point before December 2009.

Body mass index measures weight relative to height and is often used to evaluate obesity.

Zheng and his colleagues classified respondents into six groups, depending on their BMI at the beginning of the study and how it changed over the 16-year period they were surveyed.

While slightly overweight people (BMI of 25 to 29.9) whose weight was steady had the highest survival rate, those who moved from overweight to obese (BMI 30 to 34.9) were close behind.

“This suggests that among overweight people at age 51, small weight gains do not significantly lower the probability of survival,” Zheng said.

The third highest survival rate among the six groups was normal weight individuals (BMI of 18.5 to 24.9) whose weight increased slightly, but stayed within normal range.

Next came the Class I obese (BMI of 30 to 34.9) whose weight was moving upward.

“You can learn more about older people’s mortality risk by looking at how their weight is changing than you can by just looking at how much they weigh at any one time.”

Next to last were normal weight individuals who lost weight. Although the study attempted to control for illnesses among those studied, it may be that many of these individuals dropped weight because of illness.

The most obese individuals (BMI of 35 and over) who continued to add weight had the lowest survival rate of the six groups.

There weren’t enough people who started out as overweight and obese and lost weight to include in this analysis, Zheng said.

“We can’t really evaluate the effectiveness of planned weight loss on mortality. Even in the normal-weight people in this study, there was no way to tell whether weight loss was planned,” he said.

Zheng noted that the study took into account a wide variety of demographic and socioeconomic factors that may play a role in both weight and mortality among Americans. The researchers also controlled for whether the respondents smoked, whether they had a variety of chronic illnesses and even how they rated their own health. The results stood even after all of these factors were taken into account.

Why is being slightly overweight protective for older people?

“It is probably because the older population is more likely to get illnesses and disease, especially cancer, that cause dangerous weight loss,” he said. “In that case, a small amount of extra weight may provide protection against nutritional and energy deficiencies, metabolic stresses, the development of wasting and frailty, and loss of muscle and bone density caused by chronic diseases.”

Younger people are less likely to get many of the diseases that afflict older adults, which is one reason extra weight is not good for them, he said.

But Zheng said the main message for everyone, including older adults, is that packing on the pounds, especially if you’re obese, can be hazardous to your health.

“Continuing to put on weight can lower your life expectancy,” he said.

You may be shocked by the title of this post.  Have I changed my tune?  Am I finally giving up meat and going vegan??  Fear not, my friends, its simply a catchy title I used to draw you in. But it is the topic of an article I read today entitled "Vegetarians have longer life expectancy than meat eaters, study finds".  The study theyre erring to is one that followed 96,000 Canadian citizens, thousands of which were Seventh-day Adventists, who are vegetarians (supposedly).  The study isnt yet complete, but the preliminary results were reported at last weekends Food and Nutrition Conference and Exposition (FNCE) in Philadelphia.  Although I was in attendance at the conference, I did not see the presentation on this Seventh-day Adventist study.  I would have loved to be there, but instead I chose to see a lecture on food blogging, which, incidentally, I am doing right now.  Unfortunately I couldnt be everywhere at once... and Im fresh out of time travel crystals.


So I was happy to come across this article today and find out what I missed.  Heres the lowdown... Seventh-day Adventist men lived on average 9.5 years longer than other men, and women lived on average 6.1 years longer than other women.  Thats a pretty significant chunk of extra life.  But is it the vegetarian diet?  Or is is something else that keeps them truckin?  Maybe we should learn a little more about these Adventists...


What is a Seventh-day Adventist?
According to Wikipedia, the Seventh-day Adventist church is a Protestant Christian denomination that really loves Saturday, among other things.  Adventists abstain from secular work on Saturdays, and spend their day resting, hanging with the family, going on hikes, doing charitable work, and just generally taking it easy.  Many Adventists will meet after sundown on Friday night for worship to begin their Sabbath (Saturday). 


Interestingly, though, according to Wikipedias sources, only about 35% of Seventh-day Adventists actually eat a vegetarian diet... what gives?? 


Okay, so check this out.  There are several reasons for these long lifespans that have nothing to do with vegetarianism.

1.  The church strongly discourages smoking.
Smokers die.  And they die younger than everyone else.  The life expectancy for a smoker in the United States is about 64 years... 14 years younger than the national average (1).  Even former smokers who quit experience significant life extension.  One study found the following:  "Life expectancy among smokers who quit at age 35 exceeded that of continuing smokers by 6.9 to 8.5 years for men and 6.1 to 7.7 years for women."  Even quitting at age 65 adds years back onto your life (2).  But we dont have to stop there...

2.  The church discourages alcohol consumption.
To be fair, moderate alcohol consumption is associated with longevity (3).  But excessive alcohol consumption clearly is not.  In fact, according to this article, alcoholism takes 10-12 years off of ones life (4).  And in Canada, where this Adventist study is being conducted, about 7.7% of ALL deaths from ages 0-64 are due to alcohol (5).  No these Adventists arent your typical Canadian folk.  I find it highly unlikely that any of these people were binge-drinking on Sabbath.

3.  They take Saturday off.
Stress is bad.  We all know it.  If youre spreading yourself too thin, theres never enough time to get things done, you go home feeling like all you have time to do is sleep and get up for the next day and do it all over again... that stuff will kill ya (6).  But not our Seventh-day Adventists.  Because on their seventh day, they relax.  They rest their mind and their body, and they do it because God said so... and God was right.  A day of de-stressing is no doubt beneficial for longevity, regardless of why you do it.

4.  A sense of community.
Seventh-day Adventists are typically active in their local church.  They may spend Friday night and part of their Saturday at church, where they worship, sing, and hang with their buddies.  They typically have strong family structure as well.  In short, they have strong ties to those around them, and thats an important factor in health and longevity.

Is the picture starting to look a little different at this point??


Soooo conclusion.  Despite that articles willingness to use the terms "Adventist" and "vegetarian" interchangeably as if theyre the same thing, theyre clearly not.  There is a lot more going on here than just a propensity to be vegetarian.  There are a whole host of other reasons why these people live long lives, and they have nothing to do with abstaining from meat.  No smoking, no drinking, rest on the weekends, and a strong sense of community.  Thats more of a key to a long, healthy life than a vegetarian diet will ever be.

But I want to hear from you.  What are your thoughts on this article?  Agree or disagree?