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The search for intestinal factors regulating the endocrine secretion of the pancreas started soon after the discovery of secretin, i.e. nearly 100 years ago. Insulinotropic factors of the gut released by nutrients and stimulating insulin secretion in physiological concentrations in the presence of elevated blood glucose levels have been named incretins. Of the known gut hormones only gastric inhibitory polypeptide (GIP) and glucagon-like polypeptide-1 (GLP-1 [7-36] amide) fulfill this definition.--The incretin effect (i.e. the ratio between the integrated insulin response to an oral glucose load and an isoglycaemic intravenous glucose infusion) is markedly diminished in patients with type 2 diabetes mellitus, while the plasma levels of GIP and GLP-1 and their responses to nutrients are in the normal range. Therefore, a reduced responsiveness of the islet B-cells to incretins has been postulated. This insensitivity of the diabetic B-cells towards incretins can be overcome by supraphysiological (pharmacological) concentrations of GLP-1 [7-36], however not of GIP. Accordingly, fasting and postprandial glucose levels can be normalized in patients with type 2 diabetes by infusions of GLP-1 [7-36]. Further studies revealed that this is partially due to the fact that GLP-1 [7-36]--in addition to its insulinotropic effect--also inhibits glucagon secretion and delays gastric emptying. These three antidiabetic effects qualify GLP-1 [7-36] as an interesting therapeutic tool, mainly for type 2 diabetes. However, because of its short plasma half life time natural GLP-1 [7-36] is not suitable for subcutaneous application. At present methods are being developed to improve the pharmacokinetics of GLP-1 by inhibition of the cleaving enzyme dipeptidyl peptidase IV (DPP-IV) or by synthesis of DPP-IV resistant GLP-1 analogues. Also naturally occurring GLP-1 analogues (for instance exendin-4) with a much longer half life time than GLP-1 [7-36] are being tested.--Thus, after 100 years of speculations and experimentations, incretins and their analogues are emerging as new antidiabetic drugs.
Exp Clin Endocrinol Diabetes 2001
PMID:The entero-insular axis in type 2 diabetes--incretins as therapeutic agents. 1146 May 78

PURPOSE OF THE PAPER: To summarize the current health status of Kanaka Maoli (indigenous Hawaiians) with historical background, underlying factors responsible for the Kanaka Maoli health plight and recommendations. METHODS: The author reviewed the available literature and some not readily available, unpublished information. PRINCIPAL FINDINGS: Kanaka Maoli continue to have the worst health and socio­economic indicators of the various ethnic groups in their home islands of Ka Pae'aina (Hawai'i). Cardiovascular disorders, cancer, diabetes, obstructive lung disease, maternal and infant health and mental distress are the prominent maladies. Tobacco smoking, high­fat diet, alcohol drinking, hyperlipidemia and obesity are the major lifestyle risk factors. Societal factors, such as depopulation, foreign transmigration, colonial exploitation, coercive assimilation, cultural conflict and racism persist. Since 1990, Kanaka Maoli communities have established five island­wide Native Hawaiian Health Care Systems to improve availability, accessibility, and acceptability of health services to their people, but with inadequate resources. CONCLUSIONS: Under present conditions, while the future may bring some amelioration of Kanaka Maoli ill health, the price will be progressive acculturation and loss of Kanaka Maoli identity. Accordingly, recommendations include augmented revitalization of the traditional culture, effective recontrol by the Kanaka Maoli of their lives and natural resources and thus, improved total health. KEY WORDS: Pacific Islander Americans, Kanaka Maoli, Hawaiians, Indigenous Health, Culture, Ethnicity, Racism, Colonialism, Sovereignty
Asian Am Pac Isl J Health 1993
PMID:Health Status of Kanaka Maoli (Indigenous Hawaiians). 1156 47

The dietary trends of indigenous Fijians have changed drastically in the past 50 years. Deviating from the traditional food consumption pattern and traditional lifestyle may have increased the incidence and prevalence of non-communicable diseases. The aim of this study is to examine the dietary trends of the indigenous Fijians in relation to the prevalence of diabetes from 1952 to 1994. The data used were obtained from the Naduri Nutrition Survey reports of 1952 to 1994, the Fiji National Nutrition Survey reports of 1983 and 1993, and the two diabetes survey reports of 1965 and 1980. Results indicated an increased consumption of introduced foods, which may be associated with an increased prevalence of diabetes. The total energy derived from cereals and sugar increased dramatically with a reduction in consumption of traditional foods. The prevalence of diabetes among the urban indigenous population in 1965 was very low compared to the 1980 figure, while the National Nutrition Survey of the same ethnic group showed a 433% increase of urban diabetes from 1965 to 1993. The hospital diabetes admission cases of 1952 to 1982 also showed an increased trend.
Asia Pac J Clin Nutr 2001
PMID:Dietary trend and diabetes: its association among indigenous Fijians 1952 to 1994. 1170 5

The dietary patterns of indigenous Fijians are changing rapidly. Dietary relationships in regard to the prevalence of diabetes are poorly studied in Fiji. A survey was conducted to show the relationship of dietary patterns and other lifestyle factors for the development of diabetes among urban indigenous women in Fiji. A sample of 200 Fijian women aged 30-39 who agreed to participate were interviewed by the use of semiquantitative food frequency, 3 day-24 h recall study. Physical activity and ceremonial dietary customs were also taken into consideration. Anthropometry included measurements of height, weight, waist and hip. Total percentage bodyfat measurements and glycosuria tests were also conducted. The results showed high rates of obesity manifested in high percentage bodyfat, high body mass index (BMI) and high waist and hip ratio (WHR). The mean 24 h dietary intake exhibited a moderate intake of protein, high intake of fat and a low intake of carbohydrate. The carbohydrate reduction was a result from the decline in consumption of traditional staples. Consumption of cereals and related products favored the high intake of butter and margarine and also encouraged the use of cooking oil in frying varieties of flour products. The daily intake of anti-oxidant vitamins of beta-carotene and vitamin E were low, however there was a high intake of vitamin C. The food frequency study revealed cassava, bread and sugar were consumed daily as the main carbohydrate foods. Fish and meat were the most frequently consumed protein foods. The main beverage was sweet tea with whole-cream milk. Butter, margarine, coconut cream, cheap lamb flaps and cooking oil provided the main sources of fat. Levels of physical activity included high sedentary lifestyles with a high rate of subjects being overweight and obese. Ceremonial dietary customs showed a high consumption of meat and fish. Fruits were rarely consumed. Glycosuria existed among the age group under study. The impact of dietary transition, coupled with dietary excesses and physical inactivity, seem to be potential risk factors of diabetes among the indigenous women in the urban area.
Asia Pac J Clin Nutr 2001
PMID:Dietary patterns and risk factors of diabetes mellitus among urban indigenous women in Fiji. 1170 6

Iodine is an essential nutrient for human growth and development. The thyroid gland is dependent upon iodine for production of thyroid hormone. It is a common perception that iodine deficiency is not a major public health concern in mainland Australia, with sporadic studies carried out about a decade ago showing average urinary iodine excretion levels of around 200 microg/day. Recent evidence, however, has shown that the consumption of iodine is declining in Australia. A similar situation has occurred in the USA. The present study was designed to evaluate the urinary iodine excretion (UIE), as the indicator of iodine nutrition, in samples obtained from various demographic groups in the Sydney metropolitian area, namely: schoolchildren, healthy adult volunteers. pregnant women and patients with diabetes. Urinary iodine in spot urine sample was measured in a Technicon II autoanalyser using an in-house, semiautomated method. The results in this communication show that all four study groups had the median UIE below 100 microg/L. the criteria set by the World Health Organization for iodine repletion, and confirm what has been described previously, that iodine deficiency has reemerged in Sydney, Australia. One of the major causes of the reduced iodine intake is the reduction of iodine in milk since the dairy industry replaced iodine-rich cleaning solutions with other sanitisers. Secondly, less than 10% of the population are currently using iodised salt. A national survey into the iodine nutrition status in Australia is urgently required as part of the establishment of a systematic surveillance and legislation is required to iodise all edible salt.
Asia Pac J Clin Nutr 2001
PMID:Re-emergence of iodine deficiency in Australia. 1170 9

The rapid shift in the stage of nutrition towards a pattern of degenerative disease is accelerating in the developing world. Data from China, as shown by the China Health and Nutrition Survey, between 1989 and 1993, are illustrative of these shifts. For example, an increase from 22.8 to 66.6% in the proportion of adults consuming a higher-fat diet, rapid shifts in the structure of diet as income changes, and important price relationships are examples that are presented. There appears to reflect a basic shift in eating preferences, induced mainly by shifts in income, prices and food availability, but also by the modern food industry and the mass media. Furthermore, the remarkable shift in the occupations structure in lower-income countries from agricultural labour towards employment in manufacturing and services implies a reduction in energy expenditure. One consequence of the nutrition transition has been a decline in undernutrition accompanied by a rapid increase in obesity. There are marked differences between urban and rural eating patterns, particularly regarding the consumption of food prepared away from home. Other issues considered are the fetal origins hypothesis, whereby the metabolic efficiencies that served well in conditions of fetal undernutrition become maladaptive with overnutrition, leading to the development of abnormal lipid profiles, altered glucose and insulin metabolism and obesity. Furthermore, obesity and activity are closely linked with adult-onset diabetes. The shift towards a diet higher in fat and meat and lower in carbohydrates and fibre, together with the shift towards less onerous physical activity, carries unwanted nutritional and health effects. It is also clear that the causes of obesity must be viewed as environmental rather than personal or genetic.
Asia Pac J Clin Nutr 2001
PMID:Nutrition in transition: the changing global nutrition challenge. 1170 76

The National Nutrition Survey (NNS) in Japan has been undertaken annually since 1946. It was originally intended to provide information on the food and nutrient intake of the Japanese people, with a view to acquiring emergency food supplies from other countries when food shortages caused malnutrition in many Japanese. The food balance sheet (FBS) has been drawn up since 1949 to show the food supply available to the Japanese people. The trends and figures shown by both approaches were similar until the mid-1970s. Since then, however, the disparity between the food supply and the intake of foods and nutrients has been getting larger. National food security means that a country has enough food for everyone. This does not mean, however, that every family has enough food, because the food may not be evenly distributed. In fact, marginal deficiencies in iron and calcium are thought to still exist and there is considerable variation among households in energy intake. In Japan, nutrition and diet are now considered to play important roles in the emerging problems of obesity, diabetes mellitus, hypertension etc., because of excessive energy intake and deficiency or excessive intake of certain nutrients.
Asia Pac J Clin Nutr 2001
PMID:Nutrition trends in Japan. 1170 82

As the world's population ages, cardiovascular health becomes increasing important. The ageing process gradually leads to a decline in the structure and function of the cardiovascular system. Other factors associated with ageing can hasten this decline, for instance, lifestyles that have become more sedentary. Additionally, the prevalence of hypertension, dyslipidaemia and diabetes, major risk factors for cardiovascular disease increase with age. Nutrition throughout the lifecycle can help prevent the development of these conditions and appropriate food habits instigated later in life can improve the management of these conditions and their impact on cardiovascular health.
Asia Pac J Clin Nutr 2001
PMID:Lifecycle nutrition and cardiovascular health: the aged. 1171 Mar 50

The change of lifestyle of Chinese people, along with the development of the national economy, has caused significant changes of the disease pattern in China. This includes the shift from predominantly communicable diseases to non-communicable diseases, such as cancer, cardiovascular disease, diabetes and obesity. This paper summarises epidemiology research results on the relationship between diet, nutrition and cardiovascular diseases (CVD) available in China. Most data used in this paper are from correlation studies. While the information is very useful in generating hypotheses on dietary and nutritional risk factors for CVD, both prospective studies and population-based intervention trials are needed to further verify these hypotheses. The information in this review clearly shows that diet and nutrition play important roles in the occurrence of CVD and hypertension in the Chinese population. Therefore, dietary means should be an important part of the strategies for the control of CVD and hypertension in China.
Asia Pac J Clin Nutr 2001
PMID:Implications from and for food cultures for cardiovascular disease: diet, nutrition and cardiovascular diseases in China. 1171 Mar 56

The level of obesity within the Pacific Islands is extremely high and so is the prevalence of weight-related morbidity and mortality. In contrast, the level of obesity, as defined by the standard WHO classification, remains relatively low in most Asian countries, yet rates of obesity-related disease, such as diabetes and cardiovascular disease are increasing rapidly. Many Asian races appear to be susceptible to the development of excessive abdominal fatness, even at low levels of body mass index (BMI). In addition, the health consequences of weight gain appear to occur at much lower levels of BMI and are more intense than in those of European origin. The exact reasons for these ethnic variations in the development of coronary heart disease (CHD) remain unclear. It is likely that genetic differences contribute to this variation in CHD risk, but different dietary and physical activity patterns may also play a role. The advent of modernisation has resulted in marked changes in the level of physical activity and the food supply available throughout the Asia-Pacific region. There has been a shift towards higher intakes of fats (particularly animal fats and vegetable oils) and sugars. Urbanisation and occupational restructuring have reduced daily physical activity levels. As a result, the population mean BMI and consequent illness is increasing in many countries within the region. Recent studies have shown that infants who were undernourished in utero and then born small have a greater risk of developing abdominal obesity and related morbidity as adults. As undernutrition coexists with overnutrition throughout the Asia-Pacific, focusing efforts to improve nutrition during pregnancy will need to be combined with programs to prevent weight gain in adults if CHD and other chronic diseases are to be effectively tackled in the region.
Asia Pac J Clin Nutr 2001
PMID:Cardiovascular risk in the Asia-Pacific region from a nutrition and metabolic point of view: abdominal obesity. 1171 Mar 63


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