VOLUME 9 NUMBER 3 • SEPTEMBER 2012
127
SA JOURNAL OF DIABETES & VASCULAR DISEASE
EVIDENCE IN PRACTICE
C
hildhood obesity-prevention programmes, emphasising improved
nutrition and physical activity levels, are generally effective and
worth the investment, according to a new
Cochrane Review
.
1
This
review of 55 studies updates an earlier
Cochrane
report from 2005 and
includes studies that used a controlled study design, with or without
randomisation, and involved interventions lasting 12 weeks or more.
Success with childhood anti-obesity programmes
Effective childhood obesity strategies
School curricula that place an emphasis on healthy eating,
•
physical activity and body image
Increasing opportunities for physical activity and movement
•
skills during the school week
Improving nutritional quality of school-supplied food
•
Establishing environments and cultural practices within
•
schools that support physical activity, and children eating
healthier foods throughout the day
Offering professional development to support teachers and other
•
staff in implementing health-promotion strategies and activities
Supporting parents and home activities that focus on activ-
•
ity, eating more nutritious foods, and spending less time on
screen-based activities.
SAJDVD recommended action
This large systemic review demonstrates the importance of investing in
childhood obesity-prevention strategies, and in particular those that seek to
change both the surrounding environment and the behaviour of individuals.
Reference
Waters E, de Silva-Sanigorski A, Hall BJ,
1.
et al
.
Interventions for preventing
obesity in children.
Cochrane Database Syst Rev
2011;
12
:
CD001871.
ncbi.nlm.nih.gov/pubmed/22161367.
Armstrong ME, Lambert EV, Lambert MI Physical fitness of South African
2.
primary school children 6-13 years of age: discover vitality health of the
nation study.
Percept Mot Skills
2011;
113
(3): 999–1016.
Harmse B, Kruger HS. Significant differences between serum CRP levels in
3.
children in different categories of physical activity: the PLAY study.
Cardiovasc
J Afr
2010;
21
(6): 316–322.
T
ype 2 diabetes can be reversed by an extremely low-calorie
diet, according to a Diabetes UK study that challenges current
thinking that diabetes is an inevitably progressive disease. The
study in 11 volunteers (aged 49.5 ± 2.5 years, BMI 33.6 ± 1.2 kg/
m
2
)
showed that cutting food intake to only 600 calories a day
for two months reversed their type 2 diabetes and seven of these
patients remained free of diabetes three months after the study
closed.
The participants’ diet consisted of liquid diet drinks and non-
starchy vegetables. They were matched to a control group of
people without diabetes and then monitored over eight weeks.
Can very low-calorie diets reverse diabetes?
SAJDVD recommended action
This small study with close medical supervision suggests that beta-cell func-
tion and hepatic insulin sensitivity can be normalised using intensive calorie
reduction alone. The study offers hope for type 2 diabetes patients, although
patients should not be encouraged to lose weight in this extreme way until
further studies are undertaken.
Reference
Lim E, Hollingsworth K, Aribisala B,
et al.
Reversal of type 2 diabetes: normali-
sation of beta cell function in association with decreased pancreas and liver
triacylglycerol.
Diabetologia
2011;
[
Epub ahead of print]
21656330
KEY IMPROVEMENTS IN TYPE 2 DIABETES
FOLLOWING INTENSIVE DIETARY INTERVENTION
At 1 week
At 8 weeks
Fasting plasma glucose normalised
Hepatic triacylglycerol content
in the diabetic group (from 9.2 ± 0.4
fell from 12.8 ± 2.4% in the
to 5.9 ± 0.4 mmol/l;
p
= 0.003).
diabetic group to 2.9 ± 0.2%
by week 8 (
p
= 0.003).
Pancreatic triacylglycerol
Insulin suppression of hepatic
decreased from 8.0 ± 1.6%
glucose output improved from
to 6.2 ± 1.1% (
p
= 0.03)
43
± 4% to 74 ± 5% (
p
= 0.003
vs baseline; controls 68 ± 5%).
Insulin production from their pancreas and fat content in the
liver and pancreas were studied.
After one week, pre-breakfast blood glucose levels had
returned to normal (from 9.2 ± 0.4 to 5.9 ± 0.4 mmol/l;
p
= 0.003)
in the intervention group. MRI scans revealed that pancreatic
fat had fallen from an elevated level (8%) to normal (6%). The
pancreas also regained its normal ability to make insulin and as a
result, postprandial blood glucose levels steadily improved. After
the study, the participants ate normally but had received advice
on portion size and healthy eating.
Originally from
PCCJ
2011;
4
(4): 142.
Results were assessed according to change in body mass index (BMI)
and showed that, with only a few exceptions, the programmes were
generally effective in reducing adiposity. Children in intervention groups
overall showed a standardised mean difference in adiposity (measured
as BMI or standardised BMI) of –0.15 kg/m². The effects according to
age subgroups were –0.26 kg/m² for ages zero to five years; –0.15 kg/
m² for ages six to 12 years; and –0.09 kg/m² for ages 13 to 18 years.
‘
There is now compelling evidence that strategies can be
implemented to halt the growing rates of obesity in children’, said
lead author Elizabeth Waters from the University of Melbourne,
Australia. ‘We know that doing nothing is likely to result in
increases of overweight and obesity, particularly in countries where
the prevalence continues to rise.’
A recent study in SouthAfrica,
2
of physical fitness inprimary school
children aged six to 13 years, showed the need for encouraging
fitness in school children, and proposed the re-introduction of sport,
particularly in schools in which African children predominate.
An interesting study of C-reactive protein (CRP) levels, undertaken
on African children in a South African township, showed that higher
exercise levels related to lower serum CRP levels and a reduced
likelihood of becoming overweight.
3
