While it's know that waistline is strongly associated with the risk of Type 2 diabetes the reasons why - the mechanisms - are not well understood.
A recent report on a group of people who were measured and then followed up 34 years later throws some light on the connection, although the study itself sought to establish if there was an association between the waistline and dementia. And that's the interesting thing - there was a strong association.
Somewhere along the line, and we're yet to find out where, there seems to be an association between diabetes and functions of the brain in relation to hormones and endocrines and such, and developing Type 2 diabetes.
In the study the "sagittal abdominal diameter" (SAD), meaning the waistline, of 6,583 subjects was measured, between 1964 and 1973. Then, an average of 36 years later between 1994 and 2006 their medical records were examined and analyzed. The researchers adjusted for other factors such as diabetes, age, sex, education, hypertension and more, and at the end those in the highest one-fifth of belly measurement had three times the risk of dementia compared to those in the lowest one fifth of original belly sizes.
That's quite amazing to consider that original waist measurement was taken when the subjects would have been in their mid-life late twenties to mid-30s.
The study also showed that even if your BMI (Body Mass Index) is in the "normal range" but you have a high waist size then you still have a risk about twice that of those with a low waistline. The waistline was the driver, not BMI. This reinforces that waist size is not a problem limited to those who are overweight or obese; indeed, reports have found that even among those not overweight, more tummy fat is associated with an increased risk of insulin resistance, diabetes, and coronary artery disease.
The study called this the "central obesity" factor. They also state that 50% of adults have what they call central obesity so this is an important medical finding and hopefully will filter into practice notes as soon as possible.
The connection with diabetes is not well understood, but for a start central obesity itself is a more potent risk factor for Type 2 diabetes, insulin resistance, coronary heart disease, stroke (in combination called the Metabolic Syndrome), than total body obesity. Indeed, in this study, obesity elsewhere on the body - peripheral obesity - did not have an association with dementia, and is not thought to have an association with diabetes.
The key, and the connection is the visceral fat. This is the internal fat, also called metabolic fat or intra-abdominal fat, or more medically visceral adiposity. It is slowly becoming know that this metabolic fat is not just dumb fat, sitting as if it were a rubbish dump for useless material which the body doesn't know what to do with for the time being.
What's becoming known is that metabolic fat is very metabolically active - and hence why it is now being dubbed "metabolic" fat, in contrast to the subcutaneous fat (that beneath the skin which you can remove with liposuction).
What's being discovered is that metabolic fat has a strong influence on adipocytokine production and insulin resistance. "Adipocytokines" are a whole bunch of complex things which interact with insulin and how it is used in the body and include adiponectin, interleukin-6, and leptin. There are documented differences in how fats generate (the endocrine secretion) adiponectin, interleukin-6, and leptin and in particular the differences between metabolic fat and subcutaneous fat. Adiponectin and leptin are know to be part of the cast of Type 2 diabetes players, along with the star player insulin.
The connection?
In part dementia is caused by plaque (known as “amyloid plaque”) in the wrong parts of the brain clogging up the function of nerves. Type 2 diabetes is caused and leads to accelerated plaque in the blood system which clogs up the working of the transfer or glucose and energy. Because of these connections and the common role of metabolic fat researchers now believe it possible that insulin resistance (caused by activities of the metabolic fat) could be "a confounder" in the association between midlife central obesity and dementia. That means that insulin is mixed up in all this but we're not sure how yet.
The bottom line is that there certainly seems to be something fundamental about metabolic fat and diabetes and dementia. While it is an amazingly complex medical problem the solution to manage or lower our risk is simple - measure your waistline and do things to reduce it and to maintain it in the recommended range.
According to IDF (International Diabetes Federation) guidelines for "at risk" central obesity:
Female: At or above 32 inches (80 cm);- Male: At or above 38 inches (94cm);
- If you don't have a tape measure you can divide your height in inches by two. Your waistline needs to be that number or smaller in inches;
- There are specific ethnic values here.
For my part, since being diagnosed with Type 2 some 8 years ago, I've managed to reduce my weight by about 10% and my waistline down from a 34" to 30". In fact I now have to check out my jeans in the Boys Wear in some stores because the 30" cuts in Mens can be too big.
Now let's see, according to the guidelines I should be 32" or less. I'm under - that's good. But interestingly my Body Mass Index is 25.0 which is "overweight". I put a lot of that weight down to muscle and that shows up a limitation in BMI, which overestimates body fat in athletes and others who have a muscular build.
I'm hoping I've done a good job, and stave off both further effects of diabetes and perhaps dementia.
What's your story?
Is there a adult diabetes item that you think we should feature? Email tips@diabetorati.com. Thanks!
Visit our customized Amazon shopping mall for diabetic books, food, and fun !
Sponsored Links & Partner Sites: |
We listed Prof. Ben-Jonathan's work as one of the five reasons that we thought that the statistical finding of an association between BPA and diabetes was important.
Resin Codes Poster - click to enlarge
Recent Comments