Chronic Disease Institute Diabetes: The Link to Obesity, CVD, Stroke and Cancer

Presented by: Roberta M. Troy, PhDHealth Disparities Institute for Research &

EducationJune 26, 2014

Heart DiseaseCancerStrokeLung DiseaseAccidentsDiabetesAlzheimersInfluenzaKidney DiseaseBlood PoisoningSuicide Liver DiseaseHypertension

Top Leading Causes of Death in Alabama

African American Health

• Ten Leading Causes of Death for African Americans• Heart Disease • Cancer• Stroke• Diabetes• Unintentional Injuries• Nephritis, Nephrotic Syndrome, & Nephrosis• Chronic Lower Respiratory Diseases• Homicide• Septicemia• Alzheimer’s Disease

Source: CDC, NCHS, National Vital Statistics System (NVSS), Mortality Data http://www.cdc.gov/nchs/deaths.htm Deaths, Final Data for 2010

Link between Obesity, Diabetes, Heart Disease and Stroke

• High blood pressure leading cause of stroke

• Diabetes is an individual risk factor for stroke

• Obesity increases risk for stroke by having excess body fat leading to difficulty in blood flow and risk of blockage

Source: American Heart Association

Global Burden of Diabetes

• In 2011, 366 million had diabetes

• 183 million with diabetes are undiagnosed

• Greatest number of those affected in the 40-59 yr. age group

• Caused 4.6 million deaths in 2011

• Diabetes cost $465 billion in healthcare expenditures in 2011

• 80% of people live in low- and middle-income countries

Burden of Disease in Alabama

• In United States, 8.3% of population diabetes

• 7th leading cause of death in U.S.

• In Alabama, 11.8% of population had diabetes

• 6th leading cause of death in Alabama

• In Macon and Bullock Counties, 16% of residents with diabetes

Source: http://www.countyhealthrankings.org/app/alabama/2013/

Prevalence of Diabetes in Alabama-2009

What is Diabetes, Really?

• Diabetes is a global disease• Causes can be:

• Genetic• Environmental

• Diabetes is a metabolic disorder that occurs because of poor utilization of insulin and thus an inability to utilize sugar (glucose) to produce energy.• Insulin production good but insulin receptors defective• Insulin production poor

• Beta cell defect in pancreas• Glucose transport defects• Insulin utilization poor, i.e. insulin resistance• Fat increases• Low Vitamin D • Changes in human microflora (over- or under-abundance) in the gut

Glucose Production and Uptake

Diabetes Health Effects• Leading cause of kidney failure

• Lower limb amputations

• Blindness

• Hypertension

• Nerve Damage

• Periodontal disease

• Major cause of heart disease and stroke

Obesity and Diabetes

• AMA recently designated obesity as a disease• Defined in individuals with BMIs ≥30• Obesity is a major risk factor for diabetes, heart disease,

and certain cancers• In 2012, Alabama ranked 47 with respect to obesity and

46 with respect to diabetes• In Macon County, 41% of adult population obese

compared to 33% of population for Alabama• In Bullock County, 39% of adult population obese

Source: http://www.americashealthrankings.org/al, 2012

Obesity and Diabetes

Insulin Resistance Promotes Several Disease States

Diabetes and Intestinal Bacteria (Methanobrevibacter smithii)

In a study conducted by Mathur and colleagues(2013), people who tested positive for methaneand hydrogen gases by breath analysis were observed to have higher body mass indexes and higher percentages of body fat.

High levels of methane and hydrogen attributedto increased levels of the bacterium, M. smithii.

This bacterium aids in conversion of food to energy in conjunction with other bacteria.

Suggested that increases in the bacterium slowsabsorption of food and causes weight gain.

Researchers also observed that individuals withhigher levels of methane have higher levels of glucose in the blood.

DIABETES AND HEART DISEASE

Diabetic Heart Disease

• Diabetic heart disease --develops in people with diabetes• Coronary artery disease• Hypertension• Congestive heart failure• Arrythmia• Heart attack

Diabetes, Heart Disease and Intestinal Microflora

• Recent investigations by Hazan and others (2013) show a microbial by-product contributes to heart disease and can serve as a predictor for heart attacks

• The compound is trimethylamine N-oxide (TMAO)• It is produced after consuming foods containing lecithin such

as eggs• Antibiotic therapy reduced levels of TMAO with no further

TMAO formed even after injesting lecithin-containing foods• Increased levels of TMAO proposed to contribute to heart

disease and even death

Cleveland Clinic (2013, April 24). Gut bacteria byproduct predicts heart attack and stroke. ScienceDaily. Retrieved July 26, 2013, from http://www.sciencedaily.com /releases/2013/04/130424185211.htm

Diabetes and Cancer• Certain cancers occur more frequently in individuals with

type II diabetes:• Pancreatic• colorectal• breast• hepatobiliary • bladder• endometrial cancers

• Common risk factors• Hyperinsulinemia• Insulin resistance• obesity

Mechanisms Linking Diabetes and Cancer

Reference: http://www.mayoclinic.org/medicalprofs/diabetes-and-cancer.html

High Sugar Levels Induce Expression of Cancer-Causing Genes

• Under normal conditions, sugars in the intestine induce the release of the GIP hormone which induces the release of insulin from the pancreas

• The release of GIP is controlled by a protein called β-catenin• β-catenin activity dependent upon sugar levels• High levels of sugar promote accumulation of β-catenin in the

cell nuclei• Nuclear β-catenin causes increased cell growth or proliferation• Increased cell proliferation causes cancer

madrimasd (2013, February 1). Excess sugar linked to cancer. ScienceDaily. Retrieved July 25, 2013, from http://www.sciencedaily.com /releases/2013/02/130201100149.htm

Cancer and Intestinal Microflora

• Studies in obese and lean mice revealed changes in intestinal bacteria composition

• Increase in bacteria that produce deoxycholic acid (DCA)• DCA damages DNA• Investigators observed liver cancer development in the mice• When mice were treated with an antibiotic, DCA levels were

reduced, thereby reducing cancer risk• This investigation shows a clear link between obesity and cancer development

Stroke• Blood vessel blocked or ruptured preventing blood

flow and oxygen to the brain• Brain cells can die resulting in disability or death• Occurs more in older women and African Americans• Family history of stroke is a risk factor• Act FAST to respond to stroke• Face• Arms• Speech• Time• Contributing risk factors could be diet

Summary

• Intestinal microflora changes can result in increases of harmful bacteria

• These bacteria can produce by-products that alter the metabolism of individuals

• These alterations may give rise to obesity, diabetes, heart disease, stroke and cancer

• Since there is a high prevalence of obesity, diabetes, heart disease and certain cancers in racial/ethnic minorities, perhaps the high risk could be due to changes in the intestinal microflora

• Contributing factors could be diet

Management and Prevention

• Nutritional Management

• Physical Activity

• Smoking Cessation