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Improving the Diet of Men, Reducing the Risk of Disease – MD Magazine

Posted: July 16, 2022 at 2:02 am

Food deserts and food inequality problems were issues that existed before COVID-19 that have only been made worse by the ongoing pandemic. With obesity rates climbing, there is plenty of concern that the pandemic has resulted in poor dietary decisions and habits that could exacerbate this growing issue.

And obesity is a well-known risk factor for plenty of negative outcomes, including cardiovascular disease, type 2 diabetes, and several other diseases and disorders.

In an interview with HCPLive, Colleen Ereditario, MPH, RD, LDN, Program Manager, Healthy Food Centers, Allegheny Health Network, Megan Klucinek, Manager, Ambulatory Nutrition, Allegheny Health Network, and Tori Vallana, RD, LDN, Project Coordinator, Healthy Food Centers,Allegheny Health Network, spoke about how obesity is connected to different diseases and why diet is so important for men in avoiding some of these outcomes.

HCPLive: What are some of the diseases that can possibly be prevented with better diet decisions from men?

Ereditario: The main ones are obesity, heart disease and stroke, type 2 diabetes and some cancers. So eating a healthy diet, along with getting enough physical activity and sleep can help prevent overweight and obesity, which can then put people at risk.

HCPLive: Specifically in gastroenterology, diet is used both as a preventative measure and a treatment when someone develops a disease like IBD. How important is it to continue to promote gut health diets with gastrointestinal diseases in mind?

Ereditario: So when you have some gastrointestinal diseases, it's really important that you seek help from your doctor and also a registered dietitian, because everybody's plan is going to be individualized and different.

So you want to make sure you have a plan as far as your nutrition goes. And also make sure you're taking your medications as prescribed. But what you are eating can have a huge effect on your stomach with these type of issues.

A lot of times, dietitians will put you on a low residue diet. That limits foods that are higher in fiber. So those are suggested when someone has Crohn's or colitis flares.

But it is important to make sure you're getting foods that include probiotics like yogurt, and also prebiotics like bananas. And this is where you know working with a dietitian, they can help you come up with a meal plan and different ideas of what you can eat.

Some foods that you want to avoid with IBD symptoms could be and again, everyone's different, but some of these foods that can irritate your stomach can be milk and other dairy products, caffeinated drinks, carbonated drinks, alcohol, fruit and fruit juices, spicy foods, fried or high fat foods.

Normally you tell people you need to eat a high fiber diet like whole grains. But when you're having a flare up, you want to decrease the foods that are higher in fiber, like whole grain breads, raw vegetables, beans, anything thing with nuts or seeds that can irritate the stomach.

HCPLive: What are some of the common mistakes men often make in regard to their diet?

Klucinek: Oftentimes men are known for skipping meals, possibly just working through the day and waiting to have one meal. Of course they're hungry, and they'll just eat anything and not be really mindful of perhaps what they're eating and might overeat at one meal.

Also what's in that meal. So oftentimes, they're highly processed foods, eating out, foods that are high in salt, high in fat, and cholesterol and calories. That can be an issue that we often hear with men.

Also something that is different from the CDC is taking a look at alcohol intake. And men are two times more likely to binge drink than women are. 59% of men say in the past 30 days that they might have engaged in that behavior compared to 47% of women.

So not only do you have issues with calories and not eating because you're replacing liquid and maybe not the best judgment with what you might be eating. But also it can increase your risk for obesity and for different cancers and for liver disease.

And something kind of unique, maybe not to men only, is they might have been former athletes and used to training and working out and eating a certain diet and a certain portion size of food when they work out to make up the caloric needs that they would have.

They kind of keep up with that intake, but don't keep up with the exercise at that same time. So that can predispose us to diabetes and some of the chronic illnesses that Colleen had mentioned.

HCPLive: How concerning are the obesity rates among men, which obviously is related to cardiovascular disease, diabetes, and some other diseases? And are we actually seeing those rates come down a little?

Vallana: I always like to be positive. And this one, it's a little tough because we do see the obesity rates rising among men and women, particularly in the US. The Trust for America's Health, they took a look at those rates. And overall, we're at a 42.4% obesity rate in this country, for the last reported years of 2017 to 2018.

In 2008, just doesn't seem that long ago, but we were at 26%. If we keep going at this rate, this is not good for the whole country. And when we take a look at men, in particular, the latest CDC figures, one in three men are classified as being obese or overweight.

When we look at the age classes, the men who are ages 22 to 39, are coming in at 40.3%, obesity and overweight risk. To me looking at that, we have younger people that are experiencing obesity for a greater portion of their lives. And where might that lead them more, it's a little different than in previous generations.

And then for men 40 to 59, that rate is 46.4%. And men 60 and over is 42.2%. So we look at that perfect storm of increase of age and increase of weight that might leave us at greater risk.

And I think one positive thing though, is people have used the pandemic for different reasons.

During the pandemic, we saw folks that maybe took more time for eating and exercising.

But we also have more data to show that patients who were more obese had more difficulty recovering from COVID-19 and increased severity of COVID-19. So hopefully these things will make all men and women but particularly men take a look at their health and go to the doctors more and really start to address these things so we see the rates go down.

HCPLive: Are you afraid during the pandemic that many people developed poor dietary habits and poor routines that some of these habits may stay with people?

Vallana: Working at the healthy food centers, we focused on patients experiencing food insecurity. So coming out it from that angle, just seeing the amount of job loss or hours cut, you know, people are struggling with their budget, that's less money to spend on food.

If you're on that limited budget, you're probably not buying the fresh fruits and vegetables or things that are going to expire really quickly.

So I think it definitely did lead to poor diet quality among the existing food insecure population. And then we saw a lot of people that became food insecure throughout the pandemic.

I'm sure that it negatively impacted their diet quality as well. But beyond just that, a lot of people move to remote work through the pandemic. So just staying at home a lot more not getting out as much.

But hopefully, now that things are opening up, more people are getting back outside the weather's nicer. They're starting to get back into those healthy habits. And that's something that as dieticians, we're always trying to encourage.

HCPLive: How does food access impact the risk of disease in patients? And what can be done to improve these access problems across the country?

Vallana: There's definitely an association between lack of food access and poor diet quality and poor health outcomes, which is partially why the healthy food centers exist is to try and overcome that gap.

As dietitians, we're always telling people specifically how to eat or your doctor wants you to eat in a certain way. But if you can't afford those foods, or can't even get access to those foods, how are you supposed to be successful?

So we want to make sure we're getting people access to not just food but nutritious foods and foods that are appropriate for them and for their diet. So how do we fix that problem is a little bit of I don't know if I can solve that in this interview.

But on a smaller scale, doing things like the healthy food centers, giving people, just directly getting people the food, whether it's a produce distribution of food pantry, different forms of food distributions, but also the education that goes with it.

So just teaching people how to shop on a budget, what foods are low cost, but still going to be good for you how to stretch their food budget a little bit.

I think that's how we bridge it on a smaller scale. And then on a larger scale, looking at inequities and food access, looking for food deserts, how can we make sure that people have grocery stores in their area and have grocery stores that are affordable and that they can get you there on a bus line.

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Improving the Diet of Men, Reducing the Risk of Disease - MD Magazine

Opinion | Discipline and hard work – The Citizen

Posted: July 16, 2022 at 2:02 am

Wouldnt it be nice if there was a magic weight loss pill or perhaps some concoction that you could consume that will melt away all your unwanted fat?

Lets assume there was, would you have to take it for the rest of your life for the results to last forever?

And if you do take it in the long term, what would the side effects be?

Wouldnt it also be nice if those exercise routines promising a six pack in six days work, or if you could get your dream body in six weeks.

I once bought a fat burning cream that you apply on areas you want to lose fat, in the hope that I would not have to exercise or eat clean.

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I even bought an electric vibrating belt and several ab machines promising to give you a sixpack. But thats nothing compared to what my biggest buy was- a fat melting machine- salon style- which I imported from the United States.

With that baby in my life, I thought that if I ate healthy and used the fat buster I would never have to exercise again in my life if I didnt want to.

While I may have seen some difference in everything I bought- call it the placebo effect if you like- nothing really worked.

That aside, the problem with everything I bought is that it all had to used/applied regularly.

I didnt have the patience, time or discipline to follow the instructions and use as required. Weight loss is hard work, and maintaining your weight after weight loss is just as hard.

I have been on numerous diets or eating plans from the low-carb, whole-food diet to a high protein diet to the quick fix cabbage soup diet.

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The protein diet I recall all too well. I had met a prosecutor in court who I hadnt seen in months. She looked as if she had shrunk.

The second I had a free moment, I immediately went to her and started complimenting her weight loss.

She bragged that it was the protein diet she had been on for three months that had led to her weight loss.

She even detailed how it worked.

That night I went home and researched it and most of the comments or reviews of the diet were favourable.

So, before I knew it, I was on the protein diet and in a week or two I lost 1 kilogram. However, it wasnt long afterwards that I got sick and tired of only eating protein and that was the end of the diet.

These days I do intermittent fasting when it suits me, which is an eating plan that switches between fasting and eating on a regular schedule.

However, the downside is that you can end up eating less calories which is actually bad for the body.

What I can say about majority of the diets out there is that a lot of them actually do work, however, it may not be sustainable in the long term, because you just get sick of them.

The key to staying at a particular weight is exercising and cutting out junk or unhealthy foods. But this is difficult to stick to because there are those days, where you crave a donut or chocolates or anything sweet. But thats okay, you are human after all.

However, its important to stick on the healthy side of food more than on the unhealthy side. Its even okay to have a cheat day, or even a cheat weekend, but dont overdo it.

I have always admired celebrities and have held a lot of them in high esteem, always wondering how on earth they manage to stay looking so beautiful and in shape at red carpets events.

But then when you look at unposed photos of them, snapped by paparazzi you realise they are not as perfect as you thought they were.

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For the movie Monster, South African born actor Charlize Theron put on 80 pounds or rather 13.6 kilograms.

It reportedly took her six weeks to lose the weight. Can you or me lose so much weight in that timeframe?

Maybe we can if we had a personal dietician, chef and personal trainer. But many of us are not that lucky.

These personal trainers are like alarm clocks that just wont stop going off. I mean they arrive at your home as scheduled and your training gets started. No time for procrastination.

As a working-class person, with no personal dietician, chef and personal trainer, its difficult to be disciplined especially when it comes to exercising and eating healthily.

In addition, for a lot of people not in the public limelight, they dont get paid for looking good, or having a Size 6 figure.

They do it for themselves.

The bottom line is that if you want to lose weight, or stay in shape there are no quick fixes, you have to put in the work, exercise and eat healthy.

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Opinion | Discipline and hard work - The Citizen

Larsa Pippen in Bathing Suit Enjoys the "Sun" Celebwell – Celebwell

Posted: July 16, 2022 at 2:02 am

Larsa Pippen is soaking up the sun. The Real Housewives of Miami star flaunts her curves in a swimsuit via her latest social media post, while sunbathing on a boat. The only caption needed? A sun emoji. "Gorg," commented Brielle Biermann, while Melissa Gorga simply added three fire emojis. How does the reality star maintain her fit physique? Read on to see 7 of Larsa Pippen's top tips for staying in shape and the photos that prove they workand to get beach-ready yourself, don't miss these essential 30 Best-Ever Celebrity Bathing Suit Photos!

Larsa doesn't believe that cutting carbs is the key to weight loss. "I don't think you can sustain that keto diet or the Atkins Diet," she told HollywoodLife. "Personally, I don't feel like those work. For me it's more about eating healthy and portion control. That's the only thing that lasts forever." "A portion is the amount of food you put on your plate, while a serving is an exact amount of food. To get a better handle on what you're eating, you could carry around measuring cups. Or you could use everyday objects as reminders of appropriate serving sizes, which is what the Mayo Clinic Diet recommends," says the Mayo Clinic.df44d9eab23ea271ddde7545ae2c09ec

"Change your attitude, poor eating habits, and maintain active rather than embarking on a standardized diet that promises a quick fix," she wrote on her blog. "Remember: Slow and steady wins the race."

"If you want to lose a couple of pounds, you have to eat a little bit less," Larsa added to HollywoodLife. "That's the only thing that's gonna work for life, because you can do all these diets, you can start them, but I don't feel like you can live that [way] forever. When you stop doing these diets and you go back to what you normally are used to, you're going to have the same results that you had before. It's a lifestyle of balance eating right, feeling good about yourself, working out for your mind, your body, your soul. It's all connected."

It all boils down to diet, says Larsa. "Being fit is 80 percent diet and 20 percent exercise- you can't outrun your fork," Larsa captioned an Instagram post.

Larsa revealed to HollywoodLife that she works out five times a week, for about 40 minutes. However, she again emphasizes that a balance of the two is key. "What you choose to eat is far more important than the amount of exercise you put in," she added. "The nutrition aspect helps to provide a balanced lifestyle. You have to do both. You cannot win if you just do one or the other."

Larsa suggests meal prepping. "I'm really big on prepping what you eat for the whole week," she told HollywoodLife. "I cook every day for my kids. I have a menu that I draw up [for] all week so I know what we're gonna eat. If you're prepared like that you tend to eat healthier, as opposed to not knowing what you're gonna eat and then you end up eating junk."

Larsa is all about the occasional indulgence "I do love chocolate," she told HollywoodLife "I love dessert and I'm known to make pies. Me and my kids make pies like twice a week apple pie, pumpkin pie. I do cheat, but that's normal. I'll just do 10 extra squats that day. I'll do 20 extra jumping jacks."

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Larsa Pippen in Bathing Suit Enjoys the "Sun" Celebwell - Celebwell

The Scary Link France Just Found Between Cancer And Processed Meat – Mashed

Posted: July 16, 2022 at 2:02 am

Unfortunately, a lot of the work of keeping nitrates and nitrites low in deli meat is out of the consumer's control, according to ANSES. Many of the practices that would curb the level of nitrates and nitrites happen on the farming and manufacturing side of the equation. Since there's nothing the average person can do about that, we have to instead look at how we can change our diets to protect ourselves. Luckily, ANSES has clear, proactive information on how to limit your deli meat intake to lower your personal risk of cancer. They suggest keeping your intake of the kind of meat you'd get from your grocery store's deli counter below 150 grams per week, which is about one serving of deli turkey or chicken breast meat, per Fat Secret.

ANSES also echoes what the NHS says about maintaining a balanced diet: Consume at least five different "portions" of fruit and vegetables per day. Fruits and vegetables not only provide vitamins and minerals like vitamin C and potassium. They also provide fiber, and a diet high in fiber can reduce your risk of colorectal cancers and keep your digestive system healthy. If you're also concerned about losing weight or maintaining a healthy weight, fruit and vegetables are low in both calories and fat. Practice switching out a serving of processed meat every week with a serving of fruits and/or veggies they're delicious, and they could very well help reduce your risk of cancer.

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The Scary Link France Just Found Between Cancer And Processed Meat - Mashed

The Shamanification of the Tech CEO – WIRED

Posted: July 16, 2022 at 2:02 am

Charismatic performance has only grown more important in tech. As a CEO, your job is to sell to all sorts of different people, said a founder-CEO in Boston. First and foremost, you need to convince people to join the company and buy into the mission. You also need to sell to customers.

Especially important are investors. Many tech companies subsist on investment capital for years, making investors perceptions critical. To do the role well, you do have to build a bit of a persona, said a founder-CEO in San Francisco. Investors are often attracted to founders that have some sort of unique charisma or personalityspecial, I think, is the word they would use.

Although neither of them do restrictive diets, these founders understand the social pressures that compel such performances.

Intensifying the need to be special is the uncertainty and gigaton magnitude of potential rewards. Founders have to convince investors that, with time and dollars, their companies will metamorphose into fat, pearly unicorns. But they have little that sets them apart, especially early on. Theres no revenue. There are no profits. Theres an idea, which I dont want to discount, said Khurana. But that leaves you very little to evaluate, other than what school did the person go to, who do they know, where did they work. Like shamans then, founders fall back on personal qualities to convince investors that they can do something near-miraculous.

While CEO of Twitter, Jack Dorsey talked about intermittent fasting on podcasts, in Twitter posts, and during an online Q&A hosted by WIRED. Non-intuitive, he tweeted, but I find I have a lot more energy and focus, feel healthier and happier, and my sleep is much deeper.

Perhaps. But if the scientific literature is any indication, his self-denial isnt all laser-focus and cozy nights. Intermittent fasting seems promising for people with obesity or diabetes, but studies testing the short-term effects of fasting on sleep and cognitive function typically show either no change or deficits.

So are CEO-shamans putting on a show? People everywhere intuit that self-denial and other shamanic practices cultivate power. Being human, tech executives presumably draw the same inferences. At least part of their decision to engage in shamanic practices, then, might stem from a sincere desire to be special.

But humans are also skillful performers. We pay close attention to which identities are esteemed and then craft ourselves to conform. We are guided by automatic, often selfish psychological processes and then delude ourselves with noble justifications. All the world is not, of course, a stage, wrote the sociologist Erving Goffman, but the crucial ways in which it isnt are not easy to specify. If CEOs are anything like the rest of us, their personas (including the shamanic elements) are tweaked for acclaim and then rationalized afterward.

Whatever the motivation, the outcome is the same. Look past buzzwords like biohack and transhumanism and many tech executives look a lot like the trance-dancers and witch doctors of past societies. As long as people search for miracles, others will compete to look like miracle-workers, forever resurrecting ancient and time-tested techniques. Shamanism is neither lost wisdom nor superstition. Rather, its a reflection of human nature, a captivating tradition that develops everywhere as humans turn to each other to produce the extraordinary.

Updated 7/15/2022 9:15 am ET: This story has been updated to correct that Daniel Gross is a former partner at Y Combinator, not a current partner as previously stated.

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The Shamanification of the Tech CEO - WIRED

Zero zinc requires a healthy gut – All About Feed

Posted: July 16, 2022 at 2:02 am

For many years zinc oxide was the most cost effective way to reduce post-weaning diarrhea in piglets. For EU pig producers this era came to an end on June 26 2022. Increasing antibiotics is not an option and another substitute for medicinal zinc isnt found yet, therefore pig producers need to adopt a new production strategy.

We at the Danish Pig Research Centre believe that it is important to share the knowledge that is available so that the phasing out of medicinal zinc does not affect antibiotic consumption, animal welfare and economic profitability.

During the Zero Zinc summit scientists presented latest results and showed practical examples of how to phase out medical zinc, while maintaining productivity. With the aim of increasing our knowledge in this area, we have brought together professors and other leading scientists who have devoted many working hours to finding a solution to weaning diarhoea. We at the Danish Pig Research Centre believe that it is important to share the knowledge that is available so that the phasing out of medicinal zinc does not affect antibiotic consumption, animal welfare and economic profitability, said Christian Fink Hansen https://www.linkedin.com/in/christian-fink-hansen-9a20216/?originalSubdomain=dk, Sector Director, Danish Pig Research Centre, Danish Food and Agriculture Council, when opening the summit.

In 2 days it became clear that the microbiome of the piglets is one of the most, or even most important factor in reducing diarrhoea, and improving animal health and performance. The right development of the microbiome in early life will influence animal health later on. However, there a multiple factors in the current production strategies that could have a negative impact on establishing a healthy gut.

Most attention goes out to the period after weaning, looking at feeding strategies, however there is the lactation period before weaning where some opportunities exist.

It all starts in the very early life of the piglets, before weaning with the colostrum intake, farrowing environment and weaning age. All factors that could influence the occurrence of post weaning diarrhea and performance. John Pulske, CEO and Chief scientist, of the Australasian pork research institute states: Most attention goes out to the period after weaning, looking at feeding strategies, however there is the lactation period before weaning where some opportunities exist.

According to John Pulske, supplementary feeding of the piglet before weaning, with either creep feed or supplemental milk is essential to modulation of the microbiome of the young piglet: Both feeding of the sow in gestation and lactation and supplementary feeding of the piglet, has potential to establish a favorable intestinal environment at weaning, that may reduce antimicrobial use. Feed intake after weaning, is influenced by pre-weaning intake of feed. One of the strategies to increase creep feed intake is to wean piglets at an older age. Pulske: Pre-weaning feed intake will increase as the lactation length increases with the result that diarrhea will be reduced.

This statement was endorsed by Charlotte Amdi of the University of Copenhagen, At the moment piglets are weaned with an immature digestive system. In her study she determined the effect of liquid versus dry creep feeding and weaning age (4 versus 5 weeks). The results of this study showed that pigs weaned in the 5th week were half a kilo heavier than pigs weaned in the 4th week at 9 weeks of age. In addition, pigs given liquid feed weighed nearly 1 kg more than pigs given dry feed at 9 weeks of age.

According to Mike Bailey, of the University of Bristol, one of the problems is that there is a lot unknown on how the microbiome works. He agrees with the fact that piglets are weaned too young, when their mucosal immune system is still poorly developed. These animals dont have the appropriate immune responses yet against pathogens. The active immune systems of young piglets are poorly developed and they seem to have a reduced ability to distinguish between harmless proteins and potential pathogens, mounting strong immune responses to dietary components.

we still dont fully understand the underlying mechanisms, like the impact from the environment or from nutritional interventions in detail.

He adds that the mucosal ecosystem will still develop in the first 8 weeks of life. The early rearing environment has a impact on the development of important components of the immune system. And we still dont fully understand the underlying mechanisms, like the impact from the environment or from nutritional interventions in detail. This all together will contribute to low postweaning performance and the occurrence of diarhoea. Mick Bailey, argues for more detailed studies that show why and how some interventions are successful and why others dont.

WELFARE AS A PREVENTIVE MEDICINETo improve piglet health and performance it is important to look at pig behavior and welfare, said Laura Boyle of Teagasc, Ireland during a symposium of DSM in run-up to the Zinc Summit. It is know that in current systems pigs are close to their biological limit what challenges their health and therewith increased the need for medicinal interventions. You got to get the basics right, treat the cause. The same model is followed for years, but is not working anymore, new systems are needed, stated Laure Boyle. She adds that especially improving welfare of the sows and piglets could work as a preventive medicine. In the farrowing crate there is still a lot of improvement possible. Enrichment in the farrowing crate seems a good tool to increase the welfare of the piglets and also giving the sow more space will benefit not only welfare but also performance, study results show. Inonge Reimert, of Wageningen University studies the effect of loose housing on sows during lactation and results show that the robustness of the piglets will improve in this new farrowing crate design. The transition to weaning is improved what will lead to better postweaning performance.

With so many factors impacting the early life of piglets, it is clear that moving to zero zinc asks for a totally new strategy. Frances Molist of Schothorst Feed Research advocates for a holistic approach: With the restrictions on the use of medical zinc and antibiotics in Europe we need more tailor made diets and apply an integral approach that starts already around farrowing and will continue after the post-weaning period. After the Zero Zinc summit it can be concluded that raising piglets without zinc requires looking at the total picture, evaluating the piglet diets (see box 1) , but also the environment in which the piglets grow up and the associated stress factors (see box 2). That all to ensure that piglets have the chance to develop their microbiome. Zero zinc requires a healthy and well developed gut.

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Zero zinc requires a healthy gut - All About Feed

ViaKeto Gummies Australia (AU & NZ) Reviews: Ingredients, Price and Where To Buy? Does ViaKeto Apple Gummies Work? – Outlook India

Posted: July 16, 2022 at 2:01 am

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Josie Gibson weight loss: TV star ditched the ‘stodgy’ food and lost 10lb – how she did it – Express

Posted: July 16, 2022 at 2:01 am

Josie went on to explain that she "handles stress" by eating, adding: "Ive always done it and I went up to a size 18," she admitted.

You just get to the point where you look in the mirror and dont even recognise who youre looking at anymore.

Speaking more about her weight loss success last year, she told The Sun: "I want to shift quite a lot of weight, but if I were to imagine it as one huge goal, it would put me off."

In order to stick to her goals, she created a clever trick that worked to her advantage.

"Ive turned it into more manageable weekly chunks," she explained.

And sticking to her resolutions saw the TV star lose 10lb thanks to home workouts.

READ MORE:Michael Mosley weight loss: Remove three foods to stay slim

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Josie Gibson weight loss: TV star ditched the 'stodgy' food and lost 10lb - how she did it - Express

Here Is Why Preventing Obesity In Children Is Critical | Femina.in – Femina

Posted: July 16, 2022 at 2:01 am

Image:ShutterStock

Childhood Obesity is a severe health risk for young children with numerous long-term consequences. They are at high risk for a variety of chronic health issues that can negatively impact their mental and physical well-being. Obesity can develop in very young children. Teaching children appropriate dietary and lifestyle habits from a young age is one of the most effective ways for reducing obesity cases. It is also important to recognise that not all overweight children are obese, since some children have larger-than-average body frames at various phases of development, which they may lose and gain depending on their growth. Experts suggest that if one is still unsure whether the child is fat or not, it is better to get the advice and diagnosis of a doctor.

Dr. Asmita Mahajan, Consultant Neonatologist & Pediatrician, SL Raheja Hospital, Mahim, explains the causes of childhood obesity and possible solutions.

What Causes Obesity In Children?Obesity in children can be caused by a variety of factors, some of which are beyond your control. Lifestyle choices, psychological issues, and family history are just a few examples. Children born into an obese family are more likely to be obese themselves. Obesity is caused by a lack of exercise and overeating, including processed foods.

A poor diet that contains high levels of sugar and fat with no nutritional value can cause children to gain weight quickly, and some of the main culprits include fast food, candies & soft drinks.

What Are The Health Risks Associated With Childhood Obesity?Obese children are more likely to acquire numerous health problems than their peers who maintain a healthy weight that is appropriate for their height and age. Diabetes, heart disease, and asthma are among the major conditions they are at risk for.

Nervous System Obesity dramatically increases the risk of stroke that occurs when blood flow to the brain is interrupted. According to research, overweight individuals are at two times higher risk of suffering a Stroke, as excess weight places a lot of stress on your heart and affects the blood flow Respiratory System Fat stored around the neck can cause the airways to become too small, making breathing difficult, especially during the night. If left untreated, it can result in Sleep Apnea, which can even lead to death. Obstructive Sleep Apnea (OSA) is quite common in patients who also suffer from Obesity and can also affect young children Cardiovascular & Endocrine System A healthy heart is essential for the well-being of a person. When a person suffers from Obesity, the heart needs to work extra hard to pump blood to the various organs, which in turn can cause high blood pressure or Hypertension. Additionally, high blood pressure is one of the leading causes of Stroke, so having a healthy weight is essential for all age groups

How To Reduce The Chances Of Obesity In Children?Because young children and teenagers' bodies are not fully matured, weight loss through surgery or drugs is not the best approach. Obese children should not be put on a diet unless a doctor approves it, as a restricted diet may not provide adequate energy and minerals for growth and development. Following are some pointers to help obese youngsters achieve and maintain a healthy weight.

Focus on good health and not on reaching a particular weight. It is essential to teach and model a healthy attitude towards food and physical activity without emphasising body weight. When too much focus is given to weight, it can lead to a negative outlook towards food and diet, which can then result in food-related disorders that can harm a persons mental and physical well-being. It is essential to focus on the family and not isolate overweight children, as it can lead to depression and loneliness. That is why the whole family must work together to improve their physical activity and eating habits. Parents should give healthy snacks to their children at specific times. Combining two food groups, like some fruit wedges and whole-grain crackers, is an excellent idea. Please dont give them packaged items like fruit juices and candies, as they have significantly less nutritional value. Encourage physical activity in children of all ages. A good idea is to set aside time every day with all family members where everyone participates in physical activities like walks, bike rides, hikes, and active games.

Childhood obesity is a severe problem that must be addressed extensively and deliberately because it has long-term consequences. With the right education and assistance, children can learn healthy ways to deal with difficulties, prepare meals, and stay active in order to avoid obesity. Adults who play important roles in the lives of children, such as parents, grandparents, teachers, and other caregivers, must provide this assistance.

Also Read: Expert Tips For Caring for Your Newborn In Summer.

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Here Is Why Preventing Obesity In Children Is Critical | Femina.in - Femina

Diagnosis and Management of Growth Hormone Deficiency in Adults – Consultant360

Posted: July 16, 2022 at 2:00 am

AUTHORS:Alexandra Martirossian, MD1 Julie Silverstein, MD2

AFFILIATIONS:1Fellow, Division of Endocrinology, Metabolism, & Lipid Research, Washington University School of Medicine in St. Louis, St. Louis, Missouri

2Associate Professor of Medicine and Neurological Surgery, Division of Endocrinology, Metabolism, & Lipid Research, Washington University School of Medicine in St. Louis, St. Louis, Missouri

CITATION:Martirossian A, Silverstein J. Diagnosis and management of growth hormone deficiency in adults. Consultant.2022;62(6);e20-e27.doi:10.25270/con.2021.10.00004

Received July 25, 2021. Accepted August 27, 2021.Published online October 14, 2021.

DISCLOSURES:The authors report no relevant financial relationships.

CORRESPONDENCE:Julie Silverstein, MD, Washington University School of Medicine in St. Louis, 660 South Euclid Avenue, St. Louis, MO 63110 (jsilverstein@wustl.edu)

Growth hormone deficiency (GHD) is a clinical syndrome caused by decreased production of or decreased tissue responsiveness to growth hormone. The most common cause of GHD in adults is pituitary tumors and their associated treatments of surgery or radiotherapy. Clinical manifestations of adult-onset GHD are nonspecific and include central obesity, loss of lean muscle mass, decreased bone density, insulin resistance, cardiovascular disease, hyperlipidemia, decreased exercise tolerance, and decreased quality of life. Diagnosis of GHD is confirmed by stimulatory testing or a low insulin-like growth factor 1 (IGF-1) level in the setting of multiple pituitary hormone deficiencies and organic pituitary disease. Treatment involves replacement with recombinant human growth hormone, and goals of therapy include clinical improvement, avoidance of adverse effects, and normalization of IGF-1 levels. Recombinant human growth hormone should only be prescribed for its approved clinical uses by an endocrinologist, and the risks and benefits of therapy should be weighed on a case-by-case basis.1,2

Physiology

Growth hormone (GH) is a polypeptide hormone secreted by somatotroph cells in the anterior pituitary that exerts several anabolic effects throughout the body. The GH receptor is expressed in multiple tissues including the liver, cartilage, muscle, fat, and kidneys.1 Activation of the GH receptor in the liver leads to hepatic production of insulin-like growth factor 1 (IGF-1), a peptide important for mediating many of GHs effects. In children, GH and IGF-1 are required for chondrocyte proliferation and linear growth. In adults, GH promotes several primarily anabolic effects including breakdown of fat, muscle growth, hepatic glucose production, and bone formation.1,3 Growth hormone secretion is regulated by a complex mixture of signals from the hypothalamus, gut, liver, and gonads, with production stimulated by growth hormone-releasing hormone (GHRH) from the hypothalamus and inhibited by somatostatin, which is primarily secreted in the brain and gastrointestinal tract. Factors that stimulate GH secretion include deep sleep, fasting, hypoglycemia, -adrenergic pathways, ghrelin, sex steroids, stress, and amino acids (eg, arginine, leucine).3 Factors that suppress GH secretion include obesity, glucocorticoids, glucose, hypothyroidism, IGF-1 (negative feedback), -adrenergic pathways, and free fatty acids. GH secretion is episodic and exhibits a diurnal rhythm with approximately two-thirds of the total daily GH secretion produced at night triggered by the onset of slow-wave sleep.3 GH levels reach a nadir during the day and may be undetectable, especially in obese or elderly persons. Over the course of a lifetime, GH secretion gradually rises during childhood, peaks during puberty, then gradually declines through adulthood. The phenomenon of age-related decline in GH levels is sometimes referred to as somatopause.4

Causes of Growth Hormone Deficiency

GHD can occur at any age and results from both congenital and acquired disorders (Table 1). Congenital causes include gene mutations and structural defects. Mutations in the genes encoding GH, GH receptor, GHRH receptor, and various transcription factors can cause GHD. Structural defects include empty sella syndrome, septo optic dysplasia, hydrocele, and pituitary hypoplasia.2 Acquired causes include intracranial tumors (eg, pituitary adenoma, craniopharyngioma, Rathke cleft cyst, glioma/astrocytoma, metastasis), head trauma, central nervous system infection, infarction (Sheehan syndrome), and infiltrative/granulomatous disease (eg, sarcoidosis, Langerhans cell histiocytosis, tuberculosis). GHD can also result from treatments for some of the aforementioned conditions, particularly cranial surgery or irradiation. In adults, the most common cause of GHD is a pituitary adenoma or treatment of the adenoma with pituitary surgery and/or radiotherapy, with the risk of deficiency proportional to the size of the tumor and extent of treatment.2

Manifestations of GHD in adults may include central obesity, loss of lean muscle mass, decreased bone mass, insulin resistance, cardiovascular disease, hyperlipidemia, and decreased quality of life.1 Data supporting the benefits of GH replacement are mixed, with much of the data showing benefit coming from retrospective and open-label observational studies. Some, but not all, studies show that GH replacement is associated with an increase in strength and exercise capacity2 and is associated with an increase in bone mineral density5,6 and decreased fracture risk.7 In terms of cardiovascular disease, a metanalysis of randomized, blinded, placebo-controlled trials suggests that GH replacement increases lean body mass and decreases fat mass, has a beneficial effect on low-density lipoprotein cholesterol, and lowers diastolic blood pressure8, but there is no evidence that these changes are associated with measurable changes in cardiovascular function.9

Benefits of Growth Hormone Deficiency

The effect of GH replacement on glucose metabolism is complex. GH antagonizes the action of insulin, and evidence suggests that GH replacement may lead to a transient increase in fasting glucose10 but not necessarily an increased incidence of diabetes.11 Long-term observational studies of patients with adult GHD also suggest that GH replacement is associated with an improvement in quality of life when assessing parameters such as memory and concentration, fatigue, tenseness, socializing, and self-confidence.12,13

Diagnosing Growth Hormone Deficiency

Making the diagnosis of GHD is generally easier in children because the outcome of short stature is readily apparent. The task is more difficult in those with adult-onset deficiency because the symptoms are generally nonspecific, so a higher index of suspicion is required.

Because of the high financial cost of recombinant human growth hormone (rhGH) and possibility of adverse effects, it is crucial that the correct diagnosis is made and that treatment is only pursued in those adults who are truly GH deficient. This shrewdness is important for prevention of inappropriate treatment that is sometimes seen in nonmedical conditions such as aging and sports. In deciding who to screen, a clinical history guides the extent of required testing (Figure).

In adults with a history of organic hypothalamic-pituitary disease (eg, pituitary mass with previous surgery and cranial irradiation) with at least 3 hormone deficiencies (eg, hypothyroidism, adrenal insufficiency, and hypogonadism) and a low serum IGF-1 level (< 2.0 standard deviation score, also reported as a Z-score), no further testing is required, and treatment can be initiated.14 This also applies to adults who have congenital structural defects or genetic mutations affecting the hypothalamic-pituitary axes who have at least 3 other hormone deficiencies and low serum IGF-1 level. In adults who have a history of organic hypothalamic-pituitary disease with 2 or fewer hormone deficiencies, high clinical suspicion, and a low IGF-1 level (< 0 standard deviation score), provocative testing for GHD is indicated.14

In the absence of any of these risk factors, testing is not advised. It should be noted that 30% to 40% of patients with adult-onset GHD may have normal IGF-1 levels, so if clinical suspicion remains high, diagnostic testing should be pursued.15 In adults with idiopathic GHD in childhood, retesting should be performed because a significant proportion of this population may have normal GH secretion as adults.16-19

Figure. Algorithm for Stimulation Testing and Treatment in Adults With Suspected Growth Hormone Deficiency14

Measurement of random GH levels for the purpose of diagnosing GHD is not reliable for multiple reasons. First, GH has a short circulating half-life of only 10 to 20 minutes, and the pulsatility of GH secretion makes interpretation of single measurements difficult.20 Second, GH secretion is suppressed in the postprandial state, so timing of food consumption is important to know. Other factors associated with decreased IGF-1 levels that should be taken into consideration when interpreting laboratory test results include advanced age, obesity, poorly controlled diabetes, liver disease, renal failure, oral estrogen use, hypothyroidism, and critical illness.21 Additionally, assays for GH and IGF-1 have not been rigorously standardized, and normal baseline values for adults are often inadequate. To circumvent these diagnostic issues, GH stimulation tests are used. There are several GH provocative tests available in clinical practice (Table 2), each with its own advantages and disadvantages.

The insulin tolerance test (ITT), although not commonly used in the United States, is considered the gold standard for diagnosis of GHD.4,14,22 Insulin-induced hypoglycemia stimulates the release of GH. The ITT is performed by having the patient fast for at least 8 hours and then intravenous insulin is administered at a dose of 0.05 to 0.15 U/kg. Blood is drawn fasting and then 20, 30, 40, and 60 minutes after adequate hypoglycemia is achieved (blood glucose, < 40 mg/dL).22,23 The diagnostic cutoff for GHD is a GH level 5 g/L or lower after hypoglycemia is achieved. The positive predictive value is 93%, sensitivity is 96%, and specificity is 92%.22 Several drawbacks of the ITTincluding the requirement for close medical supervision by a physician throughout the test, the possibility of inducing severe life-threatening hypoglycemia, and the risk of causing seizures and altered consciousness in certain susceptible populationslimit its use. The ITT is contraindicated in individuals aged older than 65 years, those who are pregnant, and those who have a history of or are at risk for seizures and cardiovascular disease. Moreover, normoglycemic or hyperglycemic patients with obesity and insulin resistance may require higher doses of insulin (0.15-0.2 U/kg) to achieve target hypoglycemia, thus increasing their risk for delayed hypoglycemia.

Finding an alternative to the ITT for the diagnosis of GHD has been challenging. The GHRH-arginine stimulation test showed favor for some time because of its convenience, reproducibility, and discriminatory power. However, in 2008, the recombinant GHRH (ie, injectable sermorelin) was removed from the market, so the test could no longer be performed in the United States.14,22 Since then, the glucagon stimulation test (GST) has become a preferred alternative diagnostic test for GHD in the United States. The exact mechanism for how glucagon stimulates GH secretion is poorly understood, but it has been shown to be a more-potent stimulator of GH secretion than other agents, including arginine and clonidine.24,25 Glucagon is more effective at stimulating GH secretion when administered intramuscularly compared with intravenously.26 The GST is performed by first having the patient fast for 8 to 10 hours, and then intramuscular glucagon is administered (1 mg if weight is 90 kg, 1.5 mg if weight is > 90 kg). Serum GH and blood glucose levels are measured at 0, 30, 60, 90, 120, 150, 180, 210, and 240 minutes after glucagon is administered. A GH cutoff of 3 g/L has been shown to have sensitivity and specificity of up to 100% in lean subjects (body mass index, 25 kg/m2).22 However, because obesity blunts the GH secretion response to glucagon, a lower cutoff of 1 g/L is recommended in individuals who are overweight or obese (body mass index, > 25 kg/m2).22 Advantages of the GST include its availability, reproducibility, safety, lack of influence by gender and hypothalamic cause of GHD, and relatively few contraindications. Disadvantages include its long duration, the need for intramuscular administration and multiple blood draws, and gastrointestinal adverse effects. The test is contraindicated in malnourished individuals or individuals who have not eaten for more than 48 hours, as well as those with severe fasting hyperglycemia (> 180 mg/dL).22,23 Because late hypoglycemia may occur, individuals should be advised to eat small and frequent meals after completion of the test.

In 2017, the US Food and Drug Administration (FDA) granted approval for the use of macimorelin for diagnosing adult GHD.27 Macimorelin acetate is an oral ghrelin receptor agonist with GH secretagogue activity that is readily absorbed and effectively stimulates endogenous GH secretion in healthy volunteers with good tolerability.28 To validate the efficacy and safety of macimorelin in the diagnosis of adult GHD, Garcia and colleagues performed an open-label, randomized, multicenter, 2-way crossover study of the macimorelin test vs the ITT.29 Participants with high (n = 38), intermediate (n = 37), and low (n = 39) likelihood for adult GHD and healthy, matched controls (n = 25) were included in the efficacy analysis. The macimorelin oral solution was prepared at a dose of 0.5 mg/kg of body weight. Blood samples for GH serum levels were collected before and at 30, 45, 60, and 90 minutes after administration of macimorelin. Using a GH cutoff of 2.8 ng/mL for the macimorelin test and 5.1 ng/mL for the ITT, the sensitivity was 87% and specificity was 96%. In post-hoc analyses, increasing the GH cutoff for the macimorelin test to 5.1 ng/mL while maintaining the GH cutoff of 5.1 ng/mL for the ITT resulted in a sensitivity of 92% and specificity of 96%. A greater peak GH level was seen in all groups with the macimorelin test compared with the ITT. Reproducibility for macimorelin was high at 97%. The macimorelin test was well tolerated with no serious or frequent adverse effects reported. The most common adverse effect was mild and transient dysgeusia. Garcia and colleagues later performed post-hoc analyses to determine whether macimorelin performance was affected by age, body mass index, or sex and evaluated its performance vs ITT over a range of GH cutoffs.30 They found that macimorelin performance was not meaningfully affected by age, body mass index, or sex. Caution should be used in generalizing these results in pediatric, elderly, and severely obese patients, since the study population age range was 18 to 66, and the highest recorded baseline body mass index was 36.6 kg/m2, with most participants having a body mass index of less than 30 kg/m2. Of the 4 GH cutoffs evaluated (2.8 ng/mL, 4.0 ng/mL, 5.1 ng/mL, and 6.5 ng/mL), the cutoff of 5.1 ng/mL provided maximal specificity (96%) and high sensitivity (92%) and was in good overall agreement with the ITT at the same cutoff (87%). At present, the approved FDA cutoff is the lower value of 2.8 ng/mL.29 Compared with the ITT and GST, the macimorelin stimulation test has the advantages of being safer, well tolerated, easier to perform, and is less influenced by body weight, so its use in clinical practice may increase in coming years. A major factor currently limiting its widespread use is high financial cost.14

Treatment of Growth Hormone Deficiency

Once the diagnosis of GHD has been made, treatment is initiated with rhGH, which contains the identical sequence of amino acids found in HGH. For many years, the only rhGH product on the US market was somatropin, a once-daily injection. In September 2020, the FDA approved once-weekly somapacitan for the treatment of adult GHD, but it is not yet available on the market.31,32 It is hoped that the decreased frequency of injections should lower the burden of treatment and improve treatment adherence. Multiple brands of somatropin are available, and there is no evidence that one commercial product is different or more advantageous than another, apart from differences in pen devices, electronic autoinjector devices that are user-friendly, dose per milligram adjustments, and whether the product requires refrigeration.14

In adults, the typical dose of somatropin ranges from 0.1 to 0.4 mg/d and is influenced by age, sex, comorbidities, and concomitant medications. Per the 2019 guidelines published by the American Association of Clinical Endocrinologists (AACE), the recommended starting dose for patients aged younger than 30 years is 0.4 to 0.5 mg/d, aged between 30 to 60 years is 0.2 to 0.3 mg/d, and aged older than 60 years is 0.1 to 0.2 mg/d. In patients transitioning from pediatric to adult care, rhGH should be continued at 50% of the dose used in childhood and then gradually adjusted. In patients with concurrent type 2 diabetes, previous gestational diabetes, and obesity, lower doses of 0.1 to 0.2 mg/d are recommended. Women tend to require higher doses than men to achieve the same IGF-1 level, especially if they are taking oral estrogen.33,34 Approximately 85% of circulating IGF-I is liver derived, and oral estrogen, which undergoes first pass metabolism, suppresses hepatic production of IGF-1. rhGH dose reduction is often necessary when oral estrogen is stopped or switched to transdermal. Most adverse effects of treatment are dose related. The most common adverse effects are related to insulin resistance and fluid retention and include hyperglycemia, paresthesias, joint stiffness, peripheral edema, arthralgias, myalgias, and carpal tunnel syndrome.2 Contraindications to treatment include active malignancy and active proliferative or severe nonproliferative diabetic retinopathy.

After GH replacement therapy is initiated, it is recommended that patients follow-up in 1- or 2-month intervals at first, which can later be spaced out to 6- or 12-month intervals once a stable dose has been reached.14 Determination of the appropriate dose is influenced by multiple factors, including clinical improvement in symptoms, avoidance of adverse effects, and IGF-1 level. Assessment of fasting glucose, hemoglobin A1c, fasting lipids, body mass index, waist circumference, waist-to-hip ratio, and quality of life should be performed at least once per year. Assessment of other pituitary hormone deficiencies and structural pituitary lesions with laboratory and imaging studies, respectively, should be performed as clinically indicated. If the initial bone density scan is abnormal, repeat evaluations at 2- to 3-year intervals are recommended. IGF-1 levels are commonly used to guide the adequacy of rhGH dosing, and the general recommendation is to target a level within age-adjusted reference ranges (standard deviation score, 2 and +2). However, studies have shown varying benefits and drawbacks to targeting IGF-1 levels in the upper or lower half of this range. Targeting IGF-1 levels in the upper range of normal (standard deviation score, 1-2) has shown benefits in body fat composition, waist circumference, and microcirculatory function but at the expense of increased insulin resistance and myalgias.35,36 Targeting IGF-1 levels in the lower range of normal (standard deviation score, 2 to 1) is more often associated with fatigue. Women may have a narrower therapeutic dose window than men. In a study by van Bunderen and colleagues, a high-normal IGF-1 target level in female study participants was associated with impaired prefrontal cognitive functioning, whereas a low-normal target IGF-1 level was associated with decreased vigor.37

The question of how long to continue GH replacement therapy is frequently debated. If clinical benefits have resulted from treatment (eg, improved quality of life, body composition, cardiovascular health, bone density), rhGH can be continued indefinitely presuming there are no contraindications. If there are neither subjective nor objective benefits after at least 12 to 18 months of treatment, the option of discontinuing GH replacement should be discussed with the patient.2,14 Since GH promotes cellular proliferation and tissue growth, there has been a longstanding theoretical concern that rhGH leads to increased risk of malignancy. Although studies show no increased risk of malignancy in hypopituitary patients on long-term growth hormone treatment, an abundance of caution should be exercised when deciding whether to start rhGH in patients with GHD and a history of or genetic predisposition to malignancy.38 It has been suggested that in adult patients with a history of cancer, low-dose rhGH should only be initiated 5 years after cancer remission is achieved.14,39 The patients oncologist should be in agreement and closely involved in follow-up care while the patient is taking therapy. In all patients, regardless of cancer risk, cancer screening guidelines should be followed.

A topic that has gained much attention in our culture is the use of GH for antiaging, with some citing it as a fountain of youth.40 Despite the popularity of this idea, no studies have assessed long-term (> 6 months) efficacy or safety of rhGH administration for this purpose in humans.14 Paradoxically, studies performed in mice have shown that mice with isolated GHD caused by GHRH or GHRH receptor mutations, combined deficiency of GH, prolactin, and thyroid-stimulating hormone, or global deletion of GH receptors live longer than their normal siblings and exhibit multiple features of delayed and/or slower aging.41-43 Liu and colleagues performed a meta-analysis of 31 studies describing the use of GH in healthy elderly adults and found that GH use was associated with small changes in body composition but increased rates of adverse events.44 In the United States, off-label distribution or marketing of rhGH to treat aging or aging-related conditions and for the enhancement of athletic performance is illegal. Given the clinical concerns and legal issues involved, it is strongly recommended that rhGH only be prescribed for the well-defined approved uses of the medication, which are GHD and HIV-associated lipodystrophy.14,45,46

Conclusions

Growth hormone replacement therapy in adults with confirmed GHD has been shown to be associated with improvement in multiple aspects of health, including body composition, muscle mass, cardiovascular health, bone density, and quality of life. The clinical manifestations of GHD in adults are often nonspecific, so diligence to confirm an accurate diagnosis is essential for avoiding the costs and ethical dilemmas of inappropriate treatment. There are multiple GH stimulatory tests available, each with its own benefits and caveats. Once the diagnosis of adult GHD is established, rhGH should be initiated at low doses and uptitrated based on IGF-1 levels and symptoms, while avoiding adverse effects. Research into longer-acting rhGH formulations and enhanced diagnostic testing is ongoing and will be essential for guiding the management of adult GHD.

References

1. Melmed S. Pathogenesis and diagnosis of growth hormone deficiency in adults. N Engl J Med. 2019;380(26):2551-2562. https://doi.org/10.1056/nejmra1817346

2. Molitch ME, Clemmons DR, Malozowski S, et al. Evaluation and treatment of adult growth hormone deficiency: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2006;91(5):1621-1634. https://doi.org/10.1210/jc.2005-2227

3. Kaiser U, Ho K. Pituitary physiology and diagnostic evaluation. In: Melmed S, Koenig R, Rosen C, Auchus R, Goldfine A, eds. Williams Textbook of Endocrinology. 14th ed. Elsevier; 2020:184-235.e14.

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5. Barake M, Klibanski A, Tritos NA. Effects of recombinant human growth hormone therapy on bone mineral density in adults with growth hormone deficiency: a meta-analysis. J Clin Endocrinol Metab. 2014;99(3):852-860. https://doi.org/10.1210/jc.2013-3921

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