This article presents the conclusions of a WHO Expert Consultation that evaluated the utility of the ‘metabolic syndrome' concept in relation to four key areas: pathophysiology, epidemiology, ...clinical work and public health. The metabolic syndrome is a concept that focuses attention on complex multifactorial health problems. While it may be considered useful as an educational concept, it has limited practical utility as a diagnostic or management tool. Further efforts to redefine it are inappropriate in the light of current knowledge and understanding, and there is limited utility in epidemiological studies in which different definitions of the metabolic syndrome are compared. Metabolic syndrome is a pre-morbid condition rather than a clinical diagnosis, and should thus exclude individuals with established diabetes or known cardiovascular disease (CVD). Future research should focus on: (1) further elucidation of common metabolic pathways underlying the development of diabetes and CVD, including those clustering within the metabolic syndrome; (2) early-life determinants of metabolic risk; (3) developing and evaluating context-specific strategies for identifying and reducing CVD and diabetes risk, based on available resources; and (4) developing and evaluating population-based prevention strategies.
Aims/hypothesis We determined the effects of 6 years of lifestyle intervention in persons with impaired glucose tolerance (IGT) on the development of retinopathy, nephropathy and neuropathy over a 20 ...year period. Methods In 1986, 577 adults with IGT from 33 clinics in Da Qing, China were randomly assigned by clinic to a control group or one of three lifestyle intervention groups (diet, exercise, and diet plus exercise). Active intervention was carried out from 1986 to 1992. In 2006 we conducted a 20 year follow-up study of the original participants to compare the incidence of microvascular complications in the combined intervention group vs the control group. Results Follow-up information was obtained on 542 (94%) of the 577 original participants. The cumulative incidence of severe retinopathy was 9.2% in the combined intervention group and 16.2% in the control group (p = 0.03, log-rank test). After adjusting for clinic and age, the incidence of severe retinopathy was 47% lower in the intervention group than the control group (hazard rate ratio 0.53, 95% CI 0.29-0.99, p = 0.048). No significant differences were found in the incidence of severe nephropathy (hazard rate ratio 1.05, 95% CI 0.16-7.05, intervention vs control, p = 0.96) or in the prevalence of neuropathy (8.6% vs 9.1%, p = 0.89) among the 20 year survivors. Conclusions/interpretation Lifestyle intervention for 6 years in IGT was associated with a 47% reduction in the incidence of severe, vision-threatening retinopathy over a 20 year interval, primarily due to the reduced incidence of diabetes in the intervention group. However, similar benefits were not seen for nephropathy or neuropathy.
Screening for diabetic retinopathy can help to prevent this complication, but evidence regarding frequency of screening is uncertain. This paper systematically reviews the published literature on the ...relationship between screening intervals for diabetic retinopathy and the incidence of visual loss. The PubMed and EMBASE databases were searched until December 2012. Twenty five studies fulfilled the inclusion criteria, as these assessed the incidence/prevalence of sight‐threatening diabetic retinopathy in relation to screening frequency. The included studies comprised 15 evaluations of real‐world screening programmes, three studies modelling the natural history of diabetic retinopathy and seven cost‐effectiveness studies. In evaluations of diabetic retinopathy screening programmes, the appropriate screening interval ranged from one to four years, in people with no retinopathy at baseline. Despite study heterogeneity, the overall tendency observed in these programmes was that 2‐year screening intervals among people with no diabetic retinopathy at diagnosis were not associated with high incidence of sight‐threatening diabetic retinopathy. The modelling studies (non‐economic and economic) assessed a range of screening intervals (1–5 years). The aggregated evidence from both the natural history and cost‐effectiveness models favors a screening interval >1 year, but ≤2 years. Such an interval would be appropriate, safe and cost‐effective for people with no diabetic retinopathy at diagnosis, while screening intervals ≤1 year would be preferable for people with pre‐existing diabetic retinopathy. A 2‐year screening interval for people with no sight threatening diabetic retinopathy at diagnosis may be safely adopted. For patients with pre‐existing diabetic retinopathy, a shorter interval ≤1 year is warranted.
Abstract Objective The study was done to find out the levels of awareness on diabetes in urban adult Indian population and to identify factors that influenced the awareness, including presence of ...diabetes. Research design and methods In population aged ≥20 years ( n = 3681, M = 1769, F = 1912), details regarding awareness about diabetes in relation with physical activity, healthy and unhealthy diet, causes, symptoms, prevention, complications and measures to improve health were collected using a questionnaire. A high total score indicated good knowledge. Influence of age, gender, educational status, occupation and presence of diabetic history was analysed. Results Fifty percent of subjects scored less than15. Maximum scored was 51/65. The median total score was 16. Total score was significantly lower in women than in men (15.0 versus17.0, p < 0.0001). Educational status was low in women. Higher education (16.0 versus12.0, p < 0.0001) and professional or executive jobs (17.0 versus 15.0, p < 0.0001) were significantly associated with better awareness. Age had no influence. Knowledge regarding causes of diabetes, its prevention and the methods to improve health was significantly low among the general population. Diabetic subjects had better knowledge about symptoms of diabetes and the preventive aspects. Conclusions The low median score indicated that the awareness was generally poor. The score was low especially in women and subjects with low education. The study highlights the urgent need for strategies to spread awareness about diabetes in the general population. Diabetic subjects also required better education on many aspects.
Using the microwave-hydrothermal method for the synthesis of composite, high surface density of hydroxyl groups, as an active adsorption sites for arsenic, was obtained. Adsorption mechanisms of ...As(III) and As(V) onto zirconium-doped titanium dioxide (Zr-TiO
2
) were investigated and proposed using macroscopic and microscopic methods. Obtained results are suggesting inner-sphere and outer-sphere adsorption mechanisms for As(III) and As(V), respectively. This allowed us to identify parameters that are critical for the successful removal of arsenic from water, which is essential information for further optimization of the removal process. The composite was further applied for the removal of As(III) and As(V) from water in a dynamic flow through the reactor. Column study proved that the removal of both arsenic species below the value recommended by WHO can be achieved. Elution of As(III) and As(V) from the composite can be done by using small amounts of 0.01 M NaOH solution resulting in preconcentration of arsenic species and possible multiple usage of composite.
Electrochemical degradation procedure for the removal of organic dye Reactive Blue 52 using nano-magnetite-doped carbonaceous electrodes was proposed. The electrode was prepared by calcination of ...graphite grains mixed with phenol–formaldehyde binder modified with iron nitrate. The morphology and phase composition of the electrodes were investigated using scanning electron microscopy and powder X-ray diffraction. Electrochemical degradation was done in Nafion membrane-divided cell where anodic part was filled with color solution and cathodic with supporting electrolyte. Parameters affecting on decolorization rate were investigated. A high increase in the removal efficiency, under optimized parameters, was noticed using carbon electrodes containing 1 mass% of magnetite in the presence of 3 mM hydrogen peroxide and 7 mass% of magnetite in the presence of 10 mM hydrogen peroxide. Almost 100% decolorization was achieved during 30 min with 62–77% of the mineralization. Based on these results, it can be concluded that this approach offered green, cheap and efficient degradation of reactive dyes and could be used as promising candidate for wastewater processing in the textile industry.
To determine the prevalence of diabetes and impaired fasting glycaemia (IFG) and associated conditions such as obesity and hypertension, in the multi-ethnic, adult population of the United Arab ...Emirates in 1999–2000.
A stratified, multistage, random sample was selected. Diagnosis was based on the latest recommendations of a WHO Expert Group.
The overall response rate was 89%. Crude prevalence of diabetes was 20%. It was higher in UAE citizens (25%) than in expatriates (13–19% depending on country of origin). Prevalence of diabetes rose with age to a maximum of 40% after the age of 55 years. Prevalence of impaired fasting glycaemia was 5% in men and 7% in women. Forty-one percent of subjects with diabetes were undiagnosed prior to the survey. Of the previously diagnosed subjects with diabetes, 59% were taking oral hypoglycaemic agents, 8% used insulin and 17% relied on diet alone. Obesity was common in all ethnic groups. Approximately three-quarters of all subjects were either obese (BMI
≥
30) or overweight (BMI 25–29). Presence of diabetes was associated with increasing waist–hip ratio (WHR), age and with systolic blood pressure and ethnicity. Co-morbidity with glucose intolerance occurred with obesity in 8% and with hypertension in 5%. Three-quarters of all subjects had one or more of these conditions.
Diabetes, obesity and hypertension are extremely prevalent in the adult population of the UAE. Prompt action is required to avert a major public health crisis due to the long-term complications of diabetes in the near future.
The goal of this study was to estimate the prevalence of diabetes and the number of people of all ages with diabetes for years 2000 and 2030.
Data on diabetes prevalence by age and sex from a limited ...number of countries were extrapolated to all 191 World Health Organization member states and applied to United Nations' population estimates for 2000 and 2030. Urban and rural populations were considered separately for developing countries.
The prevalence of diabetes for all age-groups worldwide was estimated to be 2.8% in 2000 and 4.4% in 2030. The total number of people with diabetes is projected to rise from 171 million in 2000 to 366 million in 2030. The prevalence of diabetes is higher in men than women, but there are more women with diabetes than men. The urban population in developing countries is projected to double between 2000 and 2030. The most important demographic change to diabetes prevalence across the world appears to be the increase in the proportion of people >65 years of age.
These findings indicate that the "diabetes epidemic" will continue even if levels of obesity remain constant. Given the increasing prevalence of obesity, it is likely that these figures provide an underestimate of future diabetes prevalence.
Efficiency of Fe
2
O
3
and mixture of Fe
2
O
3
and MnO
2
nanoparticles synthesised by mechanical–chemical reaction for inorganic As(III) and As(V) sorption was examined. Sorbents (Fe
2
O
3
and ...mixture Fe
2
O
3
:MnO
2
= 3:1) synthesised by mechanical–chemical treatment in planetary ball mile with different milling times were tested by batch experiments. Experimental data were fitted both to Freundlich and Langmuir adsorption models. Efficiency of sorption was in good correlation with the time of milling in case of pure oxide. There were small differences in sorption between As(III) and As(V). In the case of mixture of oxides results were different. The best results were obtained by 30 min of milling. With prolonged milling, the sorption decreased to 3 h and after that increased again. These results were explained by phase transition. Sorption kinetics, influence of pH and the presence of other anions were examined for mixture of oxides with highest sorption capacity. The bioavailability of sorbed arsen was tested using modified Tessier procedure.
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