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OBJECTIVE--Little information is available on the impact of abnormal glucose tolerance on mortality in South Asian and African populations in the developing world. We explored this issue in a large, [...]

Decreased insulin sensitivity is associated with diabetes mellitus, ischemic heart disease, and hypertension, both independently and in association as what is called the metabolic syndrome. Although the negative effects of obesity, sedentary lifestyles, and high-fat diets on insulin sensitivity are well established, the influence of type and quantity of dietary carbohydrate is more controversial. This study aimed to assess the acute (24 h) effects of a high-sucrose compared with a high-starch diet on insulin sensitivity and to identify changes in blood metabolites that might lead to altered insulin sensitivity. Eight healthy adults consumed high-sucrose or high-starch diets (50% of dietary energy) in a randomized, crossover trial. Insulin sensitivity was assessed by a short insulin tolerance test the following morning. No differences were detected in insulin sensitivity, either for glucose metabolism [[Kitt.sub.glucose] (the rate constant for the decline in blood glucose concentrations) for sucrose diet = 3.86 %/min, for starch diet = 3.72%/min; pooled SEM = 0.231 or for lipid metabolism [[Kitt.sub.NEFA] (the rate constant for the decline in blood fatty acid concentrations) for sucrose diet = 12.9%/min, for starch diet = 11.4%/min; pooled SEM = 1.18]. Profiles for blood glucose and serum insulin concentrations revealed higher peaks and lower troughs with the high-sucrose diet whereas area under the curve for glucose was higher with the high-starch diet (6780 [+ or -] 245 mmol [multiplied by] L/min) than with the high-sucrose diet (6290 [+ or -] 283 mmol [multiplied by] L/min) (P[is less than] 0.001). Plasma fatty acid concentrations showed a late postprandial rise with the sucrose-rich diet relative to the starch-rich diet, which was mirrored with a fractionally later peak in triacylglycerol concentrations. Am J Clin Nutr 1998;67:1186-96.

Objective-To study changes in the prevalence of risk factors for cardiovascular disease after a five year population-wide intervention programme promoting a healthy lifestyle in a developing country. Design--Cross sectional cluster surveys in 1987 and 1992. Methodology included a two hour 75 g oral glucose tolerance test, measurement of body mass index, waist:hip ratio, basal lipid concentrations, and blood pressure; and a lifestyle questionnaire. Setting-Mauritius, in the Indian Ocean. Subjects-All adults aged 25-74 years residing in geographically defined clusters. Main outcome measures-age standardised prevalence of categorical disease and risk factor conditions and mean levels and frequency distributions of continuous variables. Results-Response rates were 86.2% (5080/5892) in 1987 and 89.5% (5162/5770) in 1992. Significant decreases were found in the prevalence of hypertension 15-0% to 12.1% in men and 12.4*% to 10.9/% in women); cigarette smoking 58-2% to 47.2% and 6-9%. to 3.7% respectively); and heavy alcohol consumption (38-2% to 14.4% and 2.6% to 0.6% respectively). Moderate leisure physical activity increased from 16-9% to 22-1% in men and from 1-3% to 2-7% in women. Mean population serum total cholesterol concentration fen appreciably from 5.5 mmol to 4.7 mmo1/1 (P<0.001). The prevalence of overweight or obesity increased, and the rates of glucose intolerance changed little. The population frequency distributions of blood pressure, serum lipid concentration, and a composite risk factor score shifted advantageously. Conclusions-Lifestyle intervention projects can be implemented and have positive effects in developing countries. A pronounced improvement in the population lipid profile in Mauritius was probably related to a change in the saturated fat content of a widely used cooking oil., Introduction The multiethnic island nation of Mauritius in the Indian Ocean has experienced rapid industrialisation and general improvement in living standards over the past two decades, and its gross national […]

Andrew B Swai, Henry M Kitange, Gabriel Masuki, Peter M Kilima, K George M M Alberti, Donald G McLarty Abstract Objective--To investigate the relation between undernutrition and diabetes. Design--Survey of [...]

Introduction In 1987 the government of Mauritius launched a non-communicable diseases intervention programme to prevent and control diseases caused by unhealthy lifestyles because such diseases were occurring at increasing rates [...]

The International Diabetes Federation (IDF) has embarked on the process of developing consensus on a new global definition due to the confusion created for the best-predicted definitions of those at risk of cardiovascular disease (CVD) and diabetes. The definition recognizes the mounting evidence that visceral adiposity is common to each of the components of the metabolic syndrome.

The crystalloid solutions used to prime cardiopulmonary bypass pumps frequently contain metabolically active substrates. However, there is a lack of controlled studies to investigate the metabolic response to cardiac operations using different pump primes. We have carried out a prospective, randomized study of 24 patients divided into four groups, each group receiving a different crystalloid prime. The primes contained glucose, lactate, glucose and lactate, or neither glucose nor lactate. Using identical anesthetic, surgical, and perfusion techniques, we estimated the metabolic response to cardiac operation in all patients by frequent blood sampling for measurement of hormone (insulin, glucagon, cortisol, and growth hormone) and metabolite concentrations (glucose, lactate, pyruvate, glycerol, alanine, and 3-hydroxybutyrate) from the day before operation to the seventh postoperative day. The results demonstrated that, after 4 hours postoperatively, the endocrine and metabolic response to cardiac operation was unaffected by the nature of the priming fluid. However, major endocrine and metabolic changes occurred before that time, which were related directly to the glucose and lactate contents of the prime. Very high concentrations of both glucose and lactate were observed at the end of bypass if they were included in the prime. Given the known dangers of hyperglycemia in cerebral ischemia and the potential gluconeogenic effects of infused lactate, we suggest that glucose-free and lactate-free primes be employed in the extracorporeal circuit.