Type II diabetes I. Pathology Obesity leads to dyslipidemia (elevated triglycerides, decreased HDLc, increased small dense LDL, increased lipid oxidation),

Type II diabetesI. PathologyObesity leads to dyslipidemia (elevated

triglycerides, decreased HDLc, increased small dense LDL, increased lipid oxidation), increasedblood pressure, decreased insulin sensitivity= metabolic syndromeincreased platelet reactivity considered by some to be part of metabolic syndrome

Food and hence nutritional choices depend on:

Personal preference

acceptance of certain foods-implicationsversus type I?

Habit-caregiver should be careful here- why?

how different from type I?

Food and hence nutritional choices depend on:Ethnic heritage or tradition

which groups would be more susceptible to type II?

Social interactionimpact of social interaction on obesity?

Food and hence nutritional choices depend on:Availability of food

if only offending foods available this can be concern-fast foods, ready prep foodsthat are calorie including fat laden

Convenience of food

fast foods-hamburgers,chips,pizza, donuts, ice cream

ready prep foods-those that are calorie including fat laden

Food and hence nutritional choices depend on:

Economy of food-this may discourage type II diabetes

can eat well on a low budget-how?

Positive and negative association-positive –obesity

-negative- examples of implications foravoidance of weight gain or inducing weight loss

Food and hence nutritional choices depend on:

Emotional conflict-comfort food-suggestions for this?

risk of obesity

Values-implications for obesity?

-implications for weight loss

Food and hence nutritional choices depend on:Body image

may encourage slimness-emphasis onthin is beautiful in our society

Advertisingfood companies and fat food companies

always promoting larger servings

supersizing type II diabetes

More on socioeconomic factors

Prestige-occupational

-decisions on healthy foods- obesity is the central issue here

-societal perceptions-who is to be listened to about various diets, nutraceuticals and functional

foods-education

-informed choices about foods that willprevent or reduce obesity

More on socioeconomic factors

Powerinfluence on government policy-what is

considered to be fair advertising-this appliesto major food companies including fast foodcompanies

Incomesometimes poorer people tend to buy junk

food that is rich in empty kcal-however richer people can also do the same

More on socioeconomic factors

Wealthcomment about power fits in here regarding type II diabetes

Educationusually, but not always, better educated

persons make healthier choices about foodsthat increase or reduce obesity

More on socioeconomic factors

Social stratification-ancestry-gender-race-aboriginals and convenience stores-ethnicity-mobility-ability to get to quality food

-ability to exercise-mental and physical illness

mental illness-comfort food issuephysical illness- lack of exercise inducing

obesity

More on socioeconomic factors

Class-uppers-lower uppers-upper middles-average middles-working class-lower class

type II diabetes tends to affect allclasses-money or lack thereof

is not an issue

More on socioeconomic factors

Global economyno real impact given that type II diabetesis increasing- rampant all over the world

Government-anti-obesity campaigns- physical activity

guide and Canada’s food guide

More on socioeconomic factorsBusiness

advertisingsupersizing type II diabetes

Psychologyeating simply for something to do-obesity-group dynamics- eating more in social

settings

History-history of development of fast foods and easy prep high fat foods has played a huge role in the development of type II diabetes

Elementary nutritional biochemistry of nutritional approaches that use foods available to those at risk

Planning a healthy diet 

To do this bear in mindAdequacy

BalanceEnergy controlNutrient densityModerationVariety

Elementary nutritional biochemistry of nutritional approaches that use foods available to those at riskPrevention-obesity

Post-onset-obesity-carbohydrate-simple sugars

-sweeteners if in fats an issue

-fibre-may inhibit glucose uptake but effect is not significant

Elementary nutritional biochemistry of nutritional approaches that use foods available to those at riskPost-onset-obesity

-protein-conversion to carbohydrate depends on insulin resistance

-fat- an issue- dyslipidemia compared to non-diabetics

-alcohol-blocks gluconeogenesis-not an issue

-sodium-hypertension-an issue-vitamins and minerals-not indicated as

supplements except chromium and magnesium which boost insulin sensitivity-perhaps also antioxidants

IV. First nations and other Cape Breton individuals at risk.

Aboriginals-thrifty genes and a move away from traditional dietary habits-cause obesity

Genetics-some individuals predisposed to weight gain- eg low leptin

Others?

How is nutritional assessment made for type II diabetes ?

Nutrient intake analysiscaloric intake and particularly thefat intake is an issue- why?

vitamins, and minerals relative tolow antioxidant chemicals in blood

How is nutritional assessment made for type II diabetes ?

Daily food record/Diary-same measures of interest

as per nutrient intakeanalysis

How is nutritional assessment made for type II diabetes ?

Retrospective data

food frequency questionnaire24-hour recall

do both to act as cross check against each other

How is nutritional assessment made for type II diabetes ?

Anthropometry

waist measurement-central obesityweight and height giving BMI

How is nutritional assessment made for type II diabetes ?

Nutrition focussed physical examobesity is the focus here particularly

central obesity

blood pressure

How is nutritional assessment made for type II diabetes ?

Skin testingirrelevant in type II diabetes

How is nutritional assessment made for type II diabetes ?Biochemical analysis

Blood concentrations of:HDLc downmore small dense LDLmore oxidised LDLtriglycerides (VLDL and CM) upfree fatty acidshigh sensitivity c-reactive protein?leptin ?lipoprotein (a)?

How is nutritional assessment made for type II diabetes ?Biochemical analysis

Blood concentrations of:glycated proteinsfasting insulin is higherfasting blood glucose is higherpost-prandial insulin and blood

glucose is higherpost-prandial lipemia is higher

How is nutritional assessment made for type II diabetes?

CLASSIFYING MALNUTRITION

-obesity is the central issue here-obesity is considered to be a form of

malnutrition