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This symposium addresses the role of exercise testing and training in the diagnosis and/or management of chronic disease in children and youth. Four different diseases or disorders will be addressed including cardiovascular, pulmonary, neuromuscular disease, and obesity. The purpose of this symposium is to enable the exercise professional to recognize the importance of the use of exercise in the diagnosis and/or management of these chronic diseases. The papers give a brief description of the pathophysiology of the disease, and the resultant effects upon the child's response to acute exercise and to training. Each author has summarized as well as contributed original research specific to the understanding and improved care of children with these conditions. Also included are practical suggestions for the implementation of exercise testing and exercise training to enhance the care and well-being of these children. Where applicable, the authors have indicated research questions and similar recommendations for future research efforts. The purpose of this symposium, therefore, is to educate medical and exercise professionals concerning the importance of exercise testing and training in the overall care of children with chronic disease.
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PMID:Introduction: the role of exercise in the diagnosis and management of chronic disease in children and youth. 877 43

Nutrition and food science have each enhanced the development of an abundant, nutritious, safe food supply. A healthy diet should contain all of the required nutrients and sufficient calories to balance energy expenditure and provide for growth and maintenance throughout the life cycle. Importantly, dietary factors are associated with 5 of the 10 leading causes of death, including coronary heart disease, certain types of cancer, stroke, noninsulin dependent diabetes mellitus and atherosclerosis. National health care expenditures for 1990 totaled $666 billion of which 30% are related to inappropriate diet. Identification of external factors that contribute to premature death would aid preventive efforts, improve the quality of life, and reduce health care costs. Even though genetic predisposition increases susceptible people's risk for many of these chronic diseases, these conditions may be diminished or prevented by improvements in the American diet. Each stage of the life cycle has specific nutrient needs. Throughout infancy, childhood and adolescence nutrients are required to meet the growth processes as well as cognitive function. During pregnancy nutrients are required for both mother and developing infant needs. Adult nutrition focuses on tissue maintenance, nutrient and energy needs, and disease prevention. As the population of elderly increase in number and greater age, nutritional needs must be met to minimize certain disease states and assure the quality of life. Nutrition associated health risks have been identified for coronary heart disease, cancer and diabetes mellitus. Recommendations for each includes a decrease in dietary fat, awareness of caloric intake and enhancement of nutrient density including an increase in fruit and vegetables. These recommendations also impact obesity and diminish the compounding of other disease states affected by excessive body weight. Calcium intake at early ages affects development of bone density and manifestation of osteoporosis. Current gaps in knowledge are also identified that could improve health. Numerous nutrients are being examined for their regulation of specific gene expressions and in the processes of transcription and translation. To offer food products with greater nutrient density or improved functional health ingredients, modification of existing foods is needed to assure an improved diet. Policies to improve health require integration of nutrition needs with economic growth and development, agriculture and food production, processing, marketing, health care and education, and includes changing life styles and food choices. Increased research support is required to achieve national health goals with emphasis on nutrition and food sciences. Education methods must be improved to better inform consumers, to encourage food producers and manufactures to produce healthier foods, to assure training of future professionals and to provide legislators with the basis to make informed decisions. Recommendations to CFERR are identified. Improved quality and availability of nutritious foods will result in a healthier, more productive population. A decrease in the occurrence and duration of chronic disease should diminish the cost of health care and allow these resources to further benefit the nation. International concerns about undernutrition include 780 million people who are malnourished, lacking sufficient food to meet their basic nutritional needs for protein and energy, and 2 billion people who subsist on diets lacking essential nutrients needed for growth, development and physiological maintenance. National concerns about undernutrition exist based on incomplete data identified by indices of hunger and characterized by an increased demand for food assistance for women, children and the elderly. Major health problems in the US impacted by diet and nutrition include coronary heart disease, atherosclerosis, some types of cancer, non-insulin dependent diabetes mellitus, hypert
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PMID:Interrelationships of food, nutrition, diet and health: the National Association of State Universities and Land Grant Colleges White Paper. 889 67

The prevalence of obesity increased nearly eight percent over the last decade. In response to the obesity epidemic in the United States. The National Institutes of Health Technology Assessment Conference Panel published "Methods for voluntary weight loss and control" in 1993. Unfortunately, in 1996, the evidence suggests that the prevalence of obesity is still steadily increasing. Current trends predict that most Americans will struggle with weight problems and obesity in the future. There have been no major advances in the treatment of obesity. Interventions produce short-term losses followed by weight regain, and no current treatments appear capable of producing permanent weight loss. Newer treatment approaches assume that obesity is a chronic disorder that requires a continuous care model of treatment. Social and environmental influences on eating and physical activity, along with perceptions of inability to self-control, continually mitigate against maintenance of prudent weight management behaviors. Since the etiology of obesity is multifactorial and can be viewed as an interaction between biology and environmental factors, environmental changes and biological interventions aimed at correcting genetic and metabolic irregularities will be central to any efforts to stem the tide of obesity.
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PMID:Methods for voluntary weight loss and control: update 1996. 893 89

Chronic diseases develop in susceptible individuals following exposure to environmental conditions including high fat diets. Inbred strains of mice differing in susceptibility to atherosclerosis, diabetes, obesity and certain cancers are models for understanding the genetic basis and molecular mechanisms whereby diet influences these polygenic and multifactorial disorders. Expression sequence tags (EST) and disease quantitative trait loci (QTL) are also being identified with these strains. Reported here are comparisons of food intake, growth, nonfasting serum lipids and expression of mRNA for hepatic apolipoprotein E (ApoE), hepatic stearoyl CoA desaturase (Scd1) and heart lipoprotein lipase (Lpl) in a 2 x 2 x 2 design with C57BL/6J and BALB/cByJ mice fed semipurified diets with 4 or 20% saturated (coconut) or unsaturated (corn) oils for 4 mo. Histological studies of aortas and coronary arteries are also reported for these animals. After 4 mo, BALB/cByJ mice were significantly heavier and had significantly higher total serum cholesterol, HDL cholesterol and triglyceride concentrations in the fed state than C57BL/6J mice. Efficiency of utilizing dietary energy did not differ consistently between strains. Oil level affected serum total cholesterol, triglycerides and HDL cholesterol, which were significantly greater in mice fed high fat diets. Lpl and ApoE mRNA expression levels were not significantly affected by mouse strain, oil source or oil level. Scd1 mRNA expression, however, was significantly higher in C57BL/6J than in BALB/cByJ mice and was lower in all mice fed 20% compared with those fed 4% fat diets. Genes regulated differently by diet among strains with distinct susceptibility to diet-influenced disease may be associated with molecular pathways contributing to incidence or severity.
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PMID:Lipid level and type alter stearoyl CoA desaturase mRNA abundance differently in mice with distinct susceptibilities to diet-influenced diseases. 910 6

A majority of African-American women over the age of 50 are obese, have at least one chronic disease, and experience mobility difficulty. Using self-reported data from the 1992 Health and Retirement Study of 1,150 African-American women aged 30-70 years, this report first compares chronic disease prevalence and severity, pain, sensory deficits, and mobility difficulty across four categories of body mass index and, second, investigates whether body mass index affects the association of chronic disease with mobility difficulty. Body mass index was categorized as low, medium, high, and severe, being equal to 19-24 (20%), 25-29 (38%), 30-34 (24%), and 35 or over (18%), respectively. There were few differences when comparing the medium category with either the low or high category. Those in the severe body mass index category, however, reported significantly more frequent and severe hypertension, diabetes, cancer, heart disease, arthritis, pain, sensory deficits, and mobility difficulty than did those in the medium body mass index category. Obesity did not appear to affect the association between chronic disease and mobility difficulty. The relatively high rates of mobility difficulty observed among the severe body mass index group appear to be more likely a result of relatively high chronic disease prevalence and severity than to a disproportionate impact of these on mobility.
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PMID:Distribution and association of chronic disease and mobility difficulty across four body mass index categories of African-American women. 914 58

Morbid obesity is a chronic disease that manifests as a steady, slow, progressive increase in body weight. Because of both emotional and physical reasons, obese people resist pursuing healthcare and may be more difficult to care for. In taking a practical approach to skin and wound care, using an interdisciplinary team is valuable. Difficulty in assessment stems from problems such as equipment that is too small or as patient uncooperativeness. Skin/wound problems which are common, yet more difficult to manage for these patients, include pressure ulcers, tracheostomy care (potentially resulting from ventilatory insufficiency), candidiasis, tape-related skin tears, incontinence and lymphedema. In order to offer care and support to these patients and their families, clinicians must acknowledge and manage any personal prejudice they may have toward this patient population. A comprehensive patient-focused plan of care is the goal. With this article are included four annotated suggested readings introducing topics such as the failure of behavioral and dietary treatments for obesity, theoretical and practical aspects of obesity assessment, current views on obesity (such as a move back to pharmacotherapeutic treatment), and the psychological aspects of severe obesity.
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PMID:Morbid obesity: a chronic disease with an impact on wounds and related problems. 923 36

Non-insulin-dependent diabetes mellitus (NIDDM), or type II diabetes is rapidly becoming one of the most common chronic disease in the United States and worldwide, with more than 7% of the adult population affected. NIDDM is even more common in the elderly and in minority population including Hispanic Americans, African Americans, Asian and Pacific Island Americans, and Native Americans. In these populations, NIDDM may be present in 10% to as much as 50% of the adult population. However diagnosed NIDDM is only the tip of the iceberg of an epidemic of glucose intolerance. Impaired glucose intolerance (IGT) is even more prevalent that NIDDM; and in addition to be a major risk factor for the development of NIDDM, IGT is associated with an increased risk of macrovascular disease. Recent advances in research into the etiology and natural history of diabetes have increased the knowledge to such an extent that primary prevention of NIDDM is becoming a reality. This primary prevention can be implemented a) through a population strategy, i.e. changing the lifestyle and environmental determinants that are known to be risk factors for diabetes, and b) through high-risk strategy, i.e. targeting preventive measures only at those specific individuals or groups that are at high risk for the future development of NIDDM. The latter is the strategy of the Diabetes Prevention Program (DDP), a clinical study sponsored by the National Institute of Diabetes and Digestive and Kidney Disease in USA. Twenty five centers were selected to participate in this program. The purpose of DPP is prevent or delay the development of NIDDM in those persons who are at high risk because they have IGT. DPP will also evaluate if the interventions selected to prevent the development of NIDDM can decrease the frequency of cardiovascular events and the occurrence and magnitude of the cardiovascular risk factors that accompany NIDDM and IGT. Four thousand volunteers will be recruited from populations known to be at particular high risk fo IGT and NIDDM including the following: elderly, overweight individuals, persons with family history of NIDDM, women with history of gestational diabetes, and minority populations. In order to be eligible, persons who are older than 25 years will have to demonstrate IGT with plasma glucose levels 100-139 mg/dl fasting and 140-199 mg/dL two hours after a 75 g OGTT. Three study intervention were selected based on their potential efficacy in ameliorating abnormal glucose metabolism in IGT and on their safety and tolerable profile of side-effects. The interventions include: intensive lifestyle intervention which focuses on a healthy diet to achieve and maintain at least a 7% loss of body weight and an increase in caloric expenditure of at least 700 kcal per week. The drug therapy interventions include the biguanide metformin and the thiazolidinedione troglizatone. Standard life-style recommendations, which include conventional instructions regarding diet and exercise, will be provided to all participants, including a placebo treated group which will serve as the control group for the study. After randomization, participants will have quarterly evaluations and have, in addition, a fasting plasma glucose at semi-annual visits and a 75 g OGTT at annual visits. All participants will be followed for three years after the study-wide closing date for recruitment, resulting in 3 to 6 years of participant follow-up. The primary outcome is the development of NIDDM according to WHO criteria (fasting plasma glucose level 140 mg/dL or 2-hour plasma glucose 200 mg/dL after a 75 g OGTT). Secondary outcome will focus en cardiovascular disease and its risk factors and change of glycemia, insulin secretion and sensitivity, obesity, physical activity and nutrient intake, quality of life, and the occurrence of adverse events.
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PMID:[Steps toward the primary prevention of type II diabetes mellitus. Various epidemiological considerations]. 923 72

Obesity has become an epidemic in the United States and in many other countries of the world. Obesity is a chronic disease, not a failure of willpower. Diet, exercise, and behavioral modification of lifestyle are rarely successful over the long term. Medications have been used sparingly, because of concerns about addiction and ineffectiveness, but used chronically, obesity drugs are effective. The two main categories of obesity drugs are centrally active adrenergic and serotonergic agents. These drugs reduce appetite, enhance satiety, and increase energy expenditure. Use of single agents produces modest weight loss and use of combinations increases loss, but few patients reach their goal weight. Co-morbidities associated with obesity resolve or are reduced in severity with weight loss. Adverse events of major concern are changes in brain biochemistry and primary pulmonary hypertension. Published guidelines for use of obesity medications recommend they be used only for medically significant obesity.
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PMID:Use of drugs in the treatment of obesity. 924 Sep 33

The effect of weight loss with anorectic medications on sleep apnea, non-insulin-dependent diabetes, and steatohepatitis is illustrated in three cases from practice in a clinical nutrition setting. Prevention of obesity, a chronic disorder, is preferable, but when obesity becomes a major obstacle in the care of patients with respiratory, cardiovascular, and metabolic disorders and osteoarthritis, an intense course of weight reduction using anorectic medications under medical and dietetic guidance is essential for patients' survival and reduction of medical cost.
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PMID:Three cases of comprehensive dietary therapy and pharmacotherapy of patients with complex obesity-related diseases. 928 79

Natural whole foods contain fats as structural components, and have a balance of polyunsaturated fat, monounsaturated fat, and saturated fat. Since we are still a Paleolithic species, adapted to eating only wild foods, it is difficult to justify the consumption of anything other than an overall balance of triglyceride/phospholipid types in an evolutionary sense. No natural fats are intrinsically good or bad--it is the proportions that matter. Variety is recommended in dietary lipid structure, degree of saturation, and chain length. Pathological n-3/n-6 polyunsaturated fat imbalance, obesity, and progressive glucose intolerance are consequences of adopting cereal grain based diets by both humans and livestock. Food processing and refining amplify these problems. Excessive concerns regarding polyunsaturated fat peroxidation in vivo are not warranted when trigylcerides are balanced and normal diets are consumed. Numerous phytochemicals present in unrefined oils, fruits, vegetables, and herbs afford significant protection from lipid peroxidation and chronic disease.
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PMID:Balanced intakes of natural triglycerides for optimum nutrition: an evolutionary and phytochemical perspective. 929 70


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