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VOLUME 8 NUMBER 3 • SEPTEMBER 2011
JOURNAL UPDATE
SA JOURNAL OF DIABETES & VASCULAR DISEASE
tomen and non-pregnant womenwho knew
they were born in the south-east of Nigeria
between 1965 and 1973. Data collected
included socio-demographic status, current
smoking, previously diagnosed hypertension
or diabetes mellitus and treatment for these
conditions. Measurements of blood pressure
and plasma glucose were obtained.
Results showed higher blood pressure,
higher plasma glucose and higher weight in
middle-aged people exposed to severe under-
nutrition
in utero
and in infancy. Comparing
unexposed offspring with those of preg-
nant, starving women, foetal–infant under-
nutrition was associated with significant
increases in the prevalence of hypertension
(9.5 vs 24%) and impaired glucose tolerance
or diabetes (8.0 vs 13%). Famine in early
childhood was also associated with increased
hypertension (16%). These results are in line
with previous studies, suggesting that foetal
under-nutrition contributes significantly to
cardiovascular disease risk in adult life.
Accelerated growth in later childhood
and a high BMI in adult life have previously
been found to have a strong adverse effect
on hypertension and diabetes in people who
were small birth-weight babies. The findings
in this study of a higher-than-normal cur-
rent weight, waist circumference and BMI
in adults exposed to foetal–infant famine
imply that accelerated growth in later child-
hood may be on the pathway between early
under-nutrition and the metabolic syndrome
in later life.
Prevention of foetal and infant under-
nutrition could make a significant contribu-
tion to reducing the increased prevalence
of hypertension and glucose intolerance in
sub-Saharan Africa. This should be given
high priority in national health agendas.
Given that the highest risk of hypertension
is in those undernourished in early life and
then becoming overweight, it is important
to consider that preventing excess growth
in later childhood may be equally important
for reducing adult ill health.
Source: Hult M, Tornhammar P, Ueda P, Chima C, Bonamy
AK, Ozumba B, Norman M. Hypertension, diabetes and
overweight: looming legacies of the Biafran famine.
PLoS
One
2010;
5
(10): e13582. PubMed PMID: 21042579;
PubMed Central PMCID: PMC2962634.
The link between alcohol
consumption patterns and
non-communicable disease
There is a strong link between alcohol con-
sumption and non-communicable disease
(NCD), particularly cancer, cardiovascular
disease, liver disease, pancreatitis and dia-
betes. This narrative article summarises the
relationships between different patterns of
alcohol consumption on NCD outcomes,
and estimates the overall impact of alcohol
consumption on global mortality and burden
of disease, with special emphasis on low- to
middle-income countries.
Alcohol is overwhelmingly detrimentally
related to many cardiovascular outcomes
including hypertension, haemorrhagic stroke
and atrial fibrillation. For ischaemic heart dis-
ease and ischaemic stroke, the relationship
is more complex. Chronic, heavy alcohol use
has been uniformly associated with adverse
cardiovascular outcomes, consistent with the
physiological mechanisms of increased clot-
ting and a reduced threshold for ventricu-
lar fibrillations which occur following heavy
drinking. For light to moderate drinking there
is a protective effect on ischaemic diseases,
which disappears when this drinking style
contains irregular heavy drinking occasions.
The relationship between alcohol use and
diabetes is again more complex. There is a
U-shaped relationship between the average
amount of alcohol consumed per day and
the risk of type 2 diabetes. There appears
to be a protective effect of moderate alco-
hol consumption on diabetes, particularly
among women.
Given the overwhelming evidence that
alcohol is a major risk factor for NCDs, atten-
tion should be directed towards addressing
the drivers of alcohol use, particularly those
operating at a social and environmental
level. Special attention should be directed
at reducing the occurrence of episodes of
heavy drinking.
Source: Parry C, Patra J, Rehm J. Alcohol consump-
tion and non-communicable diseases: epidemiology
and policy implications.
Addiction
2011 Aug 5. DOI:
10.1111/j.1360-0443.2011.03605.x. [Epub ahead of
print] PubMed PMID: 21819471.
Delayed complementary food intro-
duction in infants associated with
lower adult adiposity
Studies from high-income settings are sug-
gestive of lower blood pressure and a lower
risk of type 2 diabetes in children and adults
who were breastfed for a longer duration
in infancy. This study tested the hypothesis
that longer duration of breastfeeding and
later introduction of complementary foods
in infancy are associated with reduced adult
cardiovascular risk.
There was no evidence that initial breast-
feeding or longer duration of breastfeeding
was protective against adult hypertension,
diabetes or overweight/adiposity in the low-
or middle-income populations comprising this
study.
Data from 10 912 subjects from five low-
and middle-income country (including South
Africa) birth cohort studies were examined for
associations between infant feeding and adult
blood pressure, plasma glucose concentration
and adiposity. Adjustments were made for
maternal socio-economic status, education,
age, smoking, race, urban/rural residence and
infant birth weight.
No differences in outcomes were found in
adults who had been breastfed opposed to
those that had never been breastfed. Dura-
tion of breastfeeding was not associated with
prevalence of adult diabetes or adiposity. Weak
and inconsistent U-shaped associations were
found between duration of breastfeeding and
systolic blood pressure and hypertension.
Later introduction of complementary foods
was associated with a small reduction in adult
adiposity, displaying lower adult BMI, waist cir-
cumference and percentage body fat; as well
as thinner skin folds.
There are many proven benefits of breast-
feeding, but the evidence that it reduces the
risk of adult chronic disease is not compelling.
Delaying complementary food introduction
until six months of age, as recommended by
the World Health Organisation, may reduce
the risk of adult overweight/adiposity, but the
effect is likely to be small.
Source: Fall CH, Borja JB, Osmond C, Richter L, Bhargava
SK, Martorell R,
et al
; COHORTS group. Infant-feeding
patterns and cardiovascular risk factors in young adult-
hood: data from five cohorts in low- and middle-income
countries.
Int J Epidemiol
2011;
40
(1): 47–62. Epub 2010
Sep 17. PubMed PMID: 20852257; PubMed Central
PMCID: PMC3043278.
Inhibition of DPP4 in pre-diabetic
rats is cardioprotective; results in
improved metabolic control
Cardiovascular risk is closely associated
with insulin resistance and type 2 diabetes.
Therapy based on the actions of GLP-1 is
currently seen as a novel approach to treat-
ing cardiovascular disease. The question of
whether pre-treatment of obese, insulin-re-
sistant, pre-diabetic rats with a DPP4 (dipep-
tidyl peptidase IV) inhibitor could protect the
heart from ischaemia/reperfusion injury, and
the possible mechanisms involved in such
protection are examined in this study.
The secretion of the incretin hormone
GLP-1 is impaired in type 2 diabetes patients.
The enzyme DPP4, situated on the endothe-
