Obesity, Insulin Resistance and Nutrition Workshop

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Obesity, Insulin Resistance and Nutrition Workshop

• Chairs
• Bernie Zinman
• Jennifer Lovejoy

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General Discussion Points

• Importance of targeting women, pregnant mothers,
  and young children for obesity and diabetes
  prevention efforts
• Political/governmental influences on lifestyle
  factors and lifestyle change are significant
• Variations in macronutrient content of
  traditional diets in indigenous populations
• Impact of culinary culture on energy density
• Role of economics in nutritional choices
• Effects of stress on how people use food

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Questions

• What is the impact of nutrition/exercise during
  pregnancy and early childhood on subsequent
  obesity and insulin resistance?
• How does obesity cause insulin resistance and
  metabolic disease?
• What is the impact of dietary re-culturation on
  obesity, insulin resistance, and metabolic risk?
• What is the impact of changing govt policy on
  obesity in children?

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Q1 What is the impact of nutrition/exercise
during pregnancy and early childhood?

• Rationale
• Intrauterine environment impacts later obesity
  and metabolic risk in offspring
• A short-term intervention (9 mo) could have big
  long-term effects
• Breastfeeding impacts childhood obesity and
  diabetes
• Rapid adiposity rebound in low-birth wt babies
  creates very high risk for later obesity/IR

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Q1 What is the impact of nutrition/exercise
during pregnancy and early childhood?

• Methods/Study Designs
• Comparison of various diet/lifestyle education
  interventions in pregnancy in different popns
• Effect of community-based intervention on
  pregnant women and children
• Compare slow vs. rapid catch-up feeding in
  low-birth weight infants
• Endpoints Anthropometry/body comp, dietary
  intake, IR, BP, glucose, C-peptide, inflammatory
  markers, behavioral measures/stress/cortisol,
  fatty acid profile

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Q1 What is the impact of nutrition/exercise
during pregnancy and early childhood?

• New Knowledge to be Gained
• Comparison of pregnancy/early childhood
  interventions across cultures what works in
  different populations?
• Determine whether a short-term intervention in
  pregnancy/perinatal period can produce long-term
  benefits
• Determine best practices for care of low birth
  weight infants

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Q2 How does obesity cause insulin resistance and
metabolic disease?

• Rationale We dont fully understand the
  relationship between obesity, insulin resistance
  and inflammation (etiology)
• Methods/Study Designs
• What lifestyle interventions reduce inflammation
  in different populations?
• What is the mechanism (basic) of
  obesity-associated insulin resistance?
• What is the best measure of pathologic obesity
  in different ethnic groups?

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Q2 How does obesity cause insulin resistance and
metabolic disease?

• Endpoints
• Anthropometry/body composition
• Inflammatory markers (WBC, CRP, IL-6 etc)
• Insulin sensitivity
• Adipose/muscle biopsies (subset)
• Gut flora
• New Knowledge to be Gained
• Understand the relationship between obesity and
  IR in different ethnic groups and the effect of
  lifestyle modifiers
• Define cut-points and risk factors by ethnicity

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Q3 What is the impact of dietaryre-culturation
on obesity, IR, and DM risk?

• Rationale Acculturation is bad!
• Methods/Study Designs
• Determine traditional diets in various
  geographically isolated populations
• Perform experimental interventions to return
  these populations to an approximation of their
  traditional diet plus/minus traditional
  activity
• Determine effects of traditional lifestyle vs.
  modern lifestyle in comparable populations
  where feasible

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Q3 What is the impact of dietaryre-culturation
on obesity, IR, and DM risk?

• Endpoints
• Anthropometry/body composition, dietary intake,
  IR, Metabolic Syndrome, inflammatory markers,
  health beliefs, cost-effectiveness, behavioral
  measures/stress, endothelial function
• New Knowledge to be Gained
• Feasibility of dietary improvement in different
  cultures
• Effects of health beliefs on feasibility of
  lifestyle modifications
• Mechanism(s) of acculturation effects on
  metabolic risk
• Heterogeneity of healthy diets in different
  cultures

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Q4 What is the impact of changing governmental
policy on obesity in children?

• Rationale
• Examples exist where changing govt policy
  impacted obesity rates (e.g. cooking oil
  subsidies, remove cigarette ads from TV)
• Potentially modifiable targets exist, including
  TV marketing and dietary choices in children
• Methods/Study Designs
• Determine whether changing policy toward TV
  advertising of junk food or counter-advertising
  measures have impact on childhood obesity
• Utilize social marketing and media literacy
  strategies to determine effectiveness of policy
  changes around promotion of unhealthy foods to
  children
• Determine impact of removing trans fats and/or
  restaurant nutrition labeling on obesity
  prevalence

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Q4 What is the impact of changing governmental
policy on obesity in children?

• Endpoints
• Anthropometric/body composition
• Screen time
• Dietary intake
• New Knowledge to be Gained
• How can governments (local and national) make the
  most effective policy changes to produce the
  greatest impact in preventing obesity and diabetes

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Comments from group?Other questions?