Once foods in the United States were fortified with vitamin D, rickets appeared to have been conquered, and many considered major health problems from vitamin D deficiency resolved. But vitamin D deficiency is common. This review considers the role of vitamin D in skeletal and nonskeletal health and suggests strategies for the prevention and treatment of vitamin D deficiency.

Vitamin D Deficiency

The metabolic syndrome has received increased attention in the past few years. This statement from the American Heart Association (AHA) and the National Heart, Lung, and Blood Institute (NHLBI) is intended to provide up-to-date guidance for professionals on the diagnosis and management of the metabolic syndrome in adults.

The metabolic syndrome is a constellation of interrelated risk factors of metabolic origin— metabolic risk factors —that appear to directly promote the development of atherosclerotic cardiovascular disease (ASCVD).1 Patients with the metabolic syndrome also are at increased risk for developing type 2 diabetes mellitus. Another set of conditions, the underlying risk factors , give rise to the metabolic risk factors. In the past few years, several expert groups have attempted to set forth simple diagnostic criteria to be used in clinical practice to identify patients who manifest the multiple components of the metabolic syndrome. These criteria have varied somewhat in specific elements, but in general they include a combination of both underlying and metabolic risk factors.

The most widely recognized of the metabolic risk factors are atherogenic dyslipidemia, elevated blood pressure, and elevated plasma glucose. Individuals with these characteristics commonly manifest a prothrombotic state and a pro-inflammatory state as well. Atherogenic dyslipidemia consists of an aggregation of lipoprotein abnormalities including elevated serum triglyceride and apolipoprotein B (apoB), increased small LDL particles, and a reduced level of HDL cholesterol (HDL-C). The metabolic syndrome is often referred to as if it were a discrete entity with a single cause. Available data suggest that it truly is a syndrome, ie, a grouping of ASCVD risk factors, but one that probably has more than one cause. Regardless of cause, the syndrome identifies individuals at an elevated risk for ASCVD. The magnitude of the increased risk can vary according to which components of the syndrome are …

https://www.lipidcenter.com/pdf/metabolic.pdf

Diagnosis and Management of the Metabolic Syndrome An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement

The primary purpose of this narrative review was to evaluate the current literature and to provide further insight into the role physical inactivity plays in the development of chronic disease and premature death. We confirm that there is irrefutable evidence of the effectiveness of regular physical activity in the primary and secondary prevention of several chronic diseases (e.g., cardiovascular disease, diabetes, cancer, hypertension, obesity, depression and osteoporosis) and premature death. We also reveal that the current Health Canada physical activity guidelines are sufficient to elicit health benefits, especially in previously sedentary people. There appears to be a linear relation between physical activity and health status, such that a further increase in physical activity and fitness will lead to additional improvements in health status.

/pdf/health-benefits-of-physical-activity-the-evidence-17tsp10zcy.pdf

Health benefits of physical activity: the evidence

Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute scientific statement.

To revise 1998 recommendations on childhood obesity, an Expert Committee, comprised of representatives from 15 professional organizations, appointed experienced scientists and clinicians to 3 writing groups to review the literature and recommend approaches to prevention, assessment, and treatment. Because effective strategies remain poorly defined, the writing groups used both available evidence and expert opinion to develop the recommendations. Primary care providers should universally assess children for obesity risk to improve early identification of elevated BMI, medical risks, and unhealthy eating and physical activity habits. Providers can provide obesity prevention messages for most children and suggest weight control interventions for those with excess weight. The writing groups also recommend changing office systems so that they support efforts to address the problem. BMI should be calculated and plotted at least annually, and the classification should be integrated with other information such as growth pattern, familial obesity, and medical risks to assess the child’s obesity risk. For prevention, the recommendations include both specific eating and physical activity behaviors, which are likely to promote maintenance of healthy weight, but also the use of patient-centered counseling techniques such as motivational interviewing, which helps families identify their own motivation for making change. For assessment, the recommendations include methods to screen for current medical conditions and for future risks, and methods to assess diet and physical activity behaviors. For treatment, the recommendations propose 4 stages of obesity care; the first is brief counseling that can be delivered in a health care office, and subsequent stages require more time and resources. The appropriateness of higher stages is influenced by a patient’s age and degree of excess weight. These recommendations recognize the importance of social and environmental change to reduce the obesity epidemic but also identify ways healthcare providers and health care systems can be part of broader efforts.

/pdf/expert-committee-recommendations-regarding-the-prevention-38kyxmdgpa.pdf

Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity: Summary Report

ContextCurrent public health campaigns to reduce obesity and type 2 diabetes
have largely focused on increasing exercise, but have paid little attention
to the reduction of sedentary behaviors.ObjectiveTo examine the relationship between various sedentary behaviors, especially
prolonged television (TV) watching, and risk of obesity and type 2 diabetes
in women.Design, Setting, and ParticipantsProspective cohort study conducted from 1992 to 1998 among women from
11 states in the Nurses' Health Study. The obesity analysis included 50 277
women who had a body mass index (BMI) of less than 30 and were free from diagnosed
cardiovascular disease, diabetes, or cancer and completed questions on physical
activity and sedentary behaviors at baseline. The diabetes analysis included
68 497 women who at baseline were free from diagnosed diabetes mellitus,
cardiovascular disease, or cancer.Main Outcome MeasuresOnset of obesity and type 2 diabetes mellitus.ResultsDuring 6 years of follow-up, 3757 (7.5%) of 50 277 women who had
a BMI of less than 30 in 1992 became obese (BMI ≥30). Overall, we documented
1515 new cases of type 2 diabetes. Time spent watching TV was positively associated
with risk of obesity and type 2 diabetes. In the multivariate analyses adjusting
for age, smoking, exercise levels, dietary factors, and other covariates,
each 2-h/d increment in TV watching was associated with a 23% (95% confidence
interval [CI], 17%-30%) increase in obesity and a 14% (95% CI, 5%-23%) increase
in risk of diabetes; each 2-h/d increment in sitting at work was associated
with a 5% (95% CI, 0%-10%) increase in obesity and a 7% (95% CI, 0%-16%) increase
in diabetes. In contrast, standing or walking around at home (2 h/d) was associated
with a 9% (95% CI, 6%-12%) reduction in obesity and a 12% (95% CI, 7%-16%)
reduction in diabetes. Each 1 hour per day of brisk walking was associated
with a 24% (95% CI, 19%-29%) reduction in obesity and a 34% (95% CI, 27%-41%)
reduction in diabetes. We estimated that in our cohort, 30% (95% CI, 24%-36%)
of new cases of obesity and 43% (95% CI, 32%-52%) of new cases of diabetes
could be prevented by adopting a relatively active lifestyle (<10 h/wk
of TV watching and ≥30 min/d of brisk walking).ConclusionsIndependent of exercise levels, sedentary behaviors, especially TV watching,
were associated with significantly elevated risk of obesity and type 2 diabetes,
whereas even light to moderate activity was associated with substantially
lower risk. This study emphasizes the importance of reducing prolonged TV
watching and other sedentary behaviors for preventing obesity and diabetes.

https://jamanetwork.com/journals/jama/articlepdf/196345/JOC22407.pdf

Television Watching and Other Sedentary Behaviors in Relation to Risk of Obesity and Type 2 Diabetes Mellitus in Women

OBJECTIVE —The purpose of this study was to prospectively examine the association between vitamin D and calcium intake and risk of type 2 diabetes.

RESEARCH DESIGN AND METHODS —In the Nurses’ Health Study, we followed 83,779 women who had no history of diabetes, cardiovascular disease, or cancer at baseline for the development of type 2 diabetes. Vitamin D and calcium intake from diet and supplements was assessed every 2–4 years. During 20 years of follow-up, we documented 4,843 incident cases of type 2 diabetes.

RESULTS —After adjusting for multiple potential confounders, there was no association between total vitamin D intake and type 2 diabetes. However, the relative risk (RR) of type 2 diabetes was 0.87 (95% CI 0.75–1.00; P for trend = 0.04) comparing the highest with the lowest category of vitamin D intake from supplements. The multivariate RRs of type 2 diabetes were 0.79 (0.70–0.90; P for trend 1,200 mg calcium and >800 IU vitamin D was associated with a 33% lower risk of type 2 diabetes with RR of 0.67 (0.49–0.90) compared with an intake of <600 mg and 400 IU calcium and vitamin D, respectively.

CONCLUSIONS — The results of this large prospective study suggest a potential beneficial role for both vitamin D and calcium intake in reducing the risk of type 2 diabetes.

/pdf/vitamin-d-and-calcium-intake-in-relation-to-type-2-diabetes-3y5mn2dsii.pdf

Vitamin D and Calcium Intake in Relation to Type 2 Diabetes in Women

We conducted a prospective, nested, case-control study of inflammatory markers as predictors of type 2 diabetes among 32,826 women who provided blood samples in 1989 through 1990 in the Nurses' Health Study. Among women free of diabetes, cardiovascular disease, or cancer at baseline, 737 had developed diabetes by 2000. Control women (n = 785) were selected matched on age, fasting status, race, and BMI for cases in the top BMI decile. Baseline levels of tumor necrosis factor (TNF)-alpha receptor 2, interleukin (IL)-6, and C-reactive protein (CRP) were significantly higher among case than control subjects (all P </= 0.001). After adjusting for BMI and other lifestyle factors, all three biomarkers significantly predicted diabetes risk; the odds ratios (ORs) comparing extreme quintiles were 1.64 (95% CI 1.10-2.45) for TNF-alphaR2, 1.91 (1.27-2.86) for IL-6, and 4.36 (2.80-6.80) for CRP (P for trend <0.001 for all biomarkers). In a multivariate model simultaneously including the three biomarkers, only CRP levels were significantly associated with risk of diabetes (OR comparing extreme quintiles of CRP = 3.99, P for trend <0.001). These data support the role of inflammation in the pathogenesis of type 2 diabetes. Elevated CRP levels are a strong independent predictor of type 2 diabetes and may mediate associations of TNF-alphaR2 and IL-6 with type 2 diabetes.

https://diabetes.diabetesjournals.org/content/diabetes/53/3/693.full.pdf

Inflammatory Markers and Risk of Developing Type 2 Diabetes in Women

Background— Accumulating evidence indicates that abdominal adiposity is positively related to cardiovascular disease (CVD) risk and some other diseases independently of overall adiposity. However, the association of premature death resulting from these diseases with abdominal adiposity has not been widely studied, and findings are inconsistent. Methods and Results— In a prospective cohort study of 44 636 women in the Nurses’ Health Study, associations of abdominal adiposity with all-cause and cause-specific mortality were examined. During 16 years of follow-up, 3507 deaths were identified, including 751 cardiovascular deaths and 1748 cancer deaths. After adjustment for body mass index and potential confounders, the relative risks across the lowest to the highest waist circumference quintiles were 1.00, 1.11, 1.17, 1.31, and 1.79 (95% confidence interval [CI], 1.47 to 1.98) for all-cause mortality; 1.00, 1.04, 1.04, 1.28, and 1.99 (95% CI, 1.44 to 2.73) for CVD mortality; and 1.00, 1.18, 1.20, 1.34, and 1....

Abdominal Obesity and the Risk of All-Cause, Cardiovascular, and Cancer Mortality Sixteen Years of Follow-Up in US Women

Background Whether higher levels of physical activity can counteract the elevated risk of death associated with adiposity is controversial. Methods We examined the associations of the body-mass index and physical activity with death among 116,564 women who, in 1976, were 30 to 55 years of age and free of known cardiovascular disease and cancer. Results During 24 years of follow-up, 10,282 deaths occurred — 2370 from cardiovascular disease, 5223 from cancer, and 2689 from other causes. Mortality rates increased monotonically with higher body-mass-index values among women who had never smoked (P for trend <0.001). In combined analyses of all participants, adiposity predicted a higher risk of death regardless of the level of physical activity. Higher levels of physical activity appeared to be beneficial at all levels of adiposity but did not eliminate the higher risk of death associated with obesity. As compared with women who were lean (i.e., they had a body-mass index lower than 25) and active (they spent ...

https://www.nejm.org/doi/pdf/10.1056/NEJMoa042135

Tricia Li

Papers

Television Watching and Other Sedentary Behaviors in Relation to Risk of Obesity and Type 2 Diabetes Mellitus in Women

Vitamin D and Calcium Intake in Relation to Type 2 Diabetes in Women

Inflammatory Markers and Risk of Developing Type 2 Diabetes in Women

Abdominal Obesity and the Risk of All-Cause, Cardiovascular, and Cancer Mortality Sixteen Years of Follow-Up in US Women

Adiposity as Compared with Physical Activity in Predicting Mortality among Women