Vegetables and fruit provide a significant part of human nutrition, as they are important sources of nutrients, dietary fibre, and phytochemicals. However, it is uncertain whether the risk of certain chronic diseases can be reduced by increased consumption of vegetables or fruit by the general public, and what strength of evidence has to be allocated to such an association. Therefore, a comprehensive analysis of the studies available in the literature and the respective study results has been performed and evaluated regarding obesity, type 2 diabetes mellitus, hypertension, coronary heart disease (CHD), stroke, cancer, chronic inflammatory bowel disease (IBD), rheumatoid arthritis (RA), chronic obstructive pulmonary disease (COPD), asthma, osteoporosis, eye diseases, and dementia. For judgement, the strength of evidence for a risk association, the level of evidence, and the number of studies were considered, the quality of the studies and their estimated relevance based on study design and size. For hypertension, CHD, and stroke, there is convincing evidence that increasing the consumption of vegetables and fruit reduces the risk of disease. There is probable evidence that the risk of cancer in general is inversely associated with the consumption of vegetables and fruit. In addition, there is possible evidence that an increased consumption of vegetables and fruit may prevent body weight gain. As overweight is the most important risk factor for type 2 diabetes mellitus, an increased consumption of vegetables and fruit therefore might indirectly reduces the incidence of type 2 diabetes mellitus. Independent of overweight, there is probable evidence that there is no influence of increased consumption on the risk of type 2 diabetes mellitus. There is possible evidence that increasing the consumption of vegetables and fruit lowers the risk of certain eye diseases, dementia and the risk of osteoporosis. Likewise, current data on asthma, COPD, and RA indicate that an increase in vegetable and fruit consumption may contribute to the prevention of these diseases. For IBD, glaucoma, and diabetic retinopathy, there was insufficient evidence regarding an association with the consumption of vegetables and fruit. This critical review on the associations between the intake of vegetables and fruit and the risk of several chronic diseases shows that a high daily intake of these foods promotes health. Therefore, from a scientific point of view, national campaigns to increase vegetable and fruit consumption are justified. The promotion of vegetable and fruit consumption by nutrition and health policies is a preferable strategy to decrease the burden of several chronic diseases in Western societies.

/pdf/critical-review-vegetables-and-fruit-in-the-prevention-of-1xwi79ttv4.pdf

Critical review: vegetables and fruit in the prevention of chronic diseases

Guyatt G, Rennie D, editors and The Evidence-Based Medicine Working Group. Users' guides to the medical literature. A manual for evidence-based clinical practice. Chicago: AMA Press, 2002



The JAMA series on how to use the medical literature has been expanded and put into book and CD-ROM format. The Evidence-Based Medicine Working Group along with editors Gordon Guyatt and Drummond Rennie have provided practitioners with a valuable resource for evaluating evidence relevant to their practice. The authors of this “how to” book have made certain that it includes challenges to all levels of users of evidence, from beginners to experts. The material is presented in 3 formats: a 700 page manual for evidence-based practice (EBP) (Manual) that is thorough and comprehensive; a 440 page pocket version of the essentials of EBP (Essentials) that provides an indepth discussion of the basics; and a hyperlinked CD-ROM that contains the contents of the Manual and is included with both hardcopy versions. The Essentials book is small enough to keep in a large pocket, although the print is small and may be difficult for really tired eyes to read. The Manual …

https://ebn.bmj.com/content/ebnurs/5/1/8.full.pdf

Users' Guides to the Medical Literature

In industrialized nations diabetic retinopathy is the most frequent microvascular complication of diabetes mellitus and the most common cause of blindness in the working-age population. In the next 15 years, the number of patients suffering from diabetes mellitus is expected to increase significantly. By the year 2030, about 440 million people in the age-group 20-79 years are estimated to be suffering from diabetes mellitus worldwide (prevalence 7.7%), while in 2010 there were 285 million people with diabetes mellitus (prevalence 6.4%). This accounts for an increase in patients with diabetes in industrialized nations by 20% and in developing countries by 69% until the year 2030. Due to the expected rise in diabetic patients, the need for ophthalmic care of patients (i.e., exams and treatments) will also increase and represents a challenge for eye-care providers. Development of optimized screening programs, which respect available resources of the ophthalmic infrastructure, will become even more important. Main reasons for loss of vision in patients with diabetes mellitus are diabetic macular edema and proliferative diabetic retinopathy. Incidence or progression of these potentially blinding complications can be greatly reduced by adequate control of blood glucose and blood pressure levels. Additionally, regular ophthalmic exams are mandatory for detecting ocular complications and initiating treatments such as laser photocoagulation in case of clinical significant diabetic macular edema or early proliferative diabetic retinopathy. In this way, the risk of blindness can considerably be reduced. In advanced stages of diabetic retinopathy, pars-plana vitrectomy is performed to treat vitreous hemorrhage and tractional retinal detachment. In recent years, the advent of intravitreal medication has improved therapeutic options for patients with advanced diabetic macular edema.

Diabetic retinopathy - ocular complications of diabetes mellitus

Karin Langea, Peter Swiftb, Ewa Pańkowskac and Thomas Danned aDepartment of Medical Psychology, Hannover Medical School, OE 5430, 30625, Hannover, Germany; bChildrens Hospital, Leicester Royal Infirmary, Leicester, LE1 5WW, UK; cThe Institute of Diabetology, ul. Żegańska 46a, 04-736, Warszawa, Poland; and dDiabetes Centre for Children and Adolescents at the Kinderund Jugendkrankenhaus, Auf der Bult, Janusz-Korczak-Allee 12, 30173, Hannover, Germany

ISPAD Clinical Practice Consensus Guidelines 2014. Diabetes education in children and adolescents.

Objective: We sought to validate questionnaires concerning body image perception, body size dissatisfaction and weight-related beliefs in multi-ethnic South African mothers and their daughters. Settings and subjects: Girls attending primary school (ages 9–12 years, n ¼ 333) and their mothers (n ¼ 204) were interviewed regarding their demographics and body image. Weight, height and skinfold thicknesses were measured. Body image questions and body mass index (BMI) were compared with silhouettes adapted from the Pathways Study for girls and Stunkard’s body image figures for mothers. A Feel– Ideal Difference (FID) index score was created by subtracting the score of the silhouette selected by the participants as ‘Ideal’ from the one selected as most closely representing their current appearance or ‘Feel’. We hypothesised that a higher FID index score would be associated with greater body size dissatisfaction. Results: BMI percentiles in girls (r ¼ 0.46, P , 0.05) and BMI in mothers (r ¼ 0.68, P , 0.05) were positively correlated with the selected silhouettes based on size. Participants who reported feelings of being ‘fat’ and those who perceived that their family and friends were more dissatisfied with their body size had significantly higher FID index scores. Scores were lower in black than white girls (all P , 0.05). No differences were found in FID index scores between ethnic groups of mothers. Internal reliability of the ‘thin’ and ‘fat’ belief constructs for girls was demonstrated by standardised Cronbach’s a values $0.7. Conclusion: Silhouettes, FID index, ‘fat’ and ‘thin’ belief constructs (in girls) are ageappropriate, culturally sensitive and can be used in further intervention studies to understand body image.

/pdf/development-and-validation-of-instruments-measuring-body-1hglpr6fb0.pdf

Development and validation of instruments measuring body image and body weight dissatisfaction in South African mothers and their daughters.

Ubergewicht und Adipositas bei Kindern und Jugendlichen sind in Deutschland zahlenmasig bedeutende Gesundheitsstorungen, denen bis vor Kurzem keine ausreichende Aufmerksamkeit gewidmet wurde. Seit den 1980er Jahren hat sich der Lebensstil in Deutschland mehr und mehr verandert. Kinder verbringen immer mehr Zeit vor dem Fernseher oder dem Computer und bewegen sich zu wenig. So genannte Kinderlebensmittel enthalten oft zu viel Fett und Zucker. Aus ubergewichtigen Kindern werden ubergewichtige Erwachsene mit hohem Risiko fur das Auftreten von Typ-2-Diabetes mellitus, von kardiovaskularen, orthopadischen und anderen Erkrankungen. Verhaltenstherapeutische Interventionen sind nur bei einer Minderheit hochmotivierter Familien mittelfristig erfolgreich. Die einzige Losung dieses zunehmenden Problems scheint in der Primarpravention zu liegen. Entsprechende Masnahmen konnen von einzelnen Personen oder Gruppen im Gesundheitssystem allerdings nicht allein erbracht werden. Unterstutzend notwendig ist eine konzertierte Zusammenarbeit verschiedener Akteure aus Politik, Wissenschaft und Gesundheitswesen mit dem Ziel, die Lebensbedingungen zu verandern, die das Ernahrungs- und Bewegungsverhalten der Kinder in unserem Land beeinflussen.

Adipositas bei Kindern und Jugendlichen

Adipositas und Schwangerschaft – Adipositas im Kindes- und Jugendalter

Die folgenden Empfehlungen richten sich an alle Berufsgruppen, die Kinder und Jugendliche mit Diabetes sowie deren Familien betreuen und unterstützen, sowie an übergeordnete Organisationen (z.B. Krankenkassen), die mit der Erkrankung befasst sind. Die Leitlinie konzentriert sich auf die Spezifika für diese Altersgruppe, die nicht oder davon abweichend in den allgemeinen Leitlinien zur Therapie des Typ-1-Diabetes der DDG dargestellt werden [1]. Entsprechend den Vorgaben der Gesundheitsminister der Länder und gängiger Praxis vieler Kliniken wird als Alter, bis zu dem die vorliegenden pädiatrischen Leitlinien gelten sollen, das vollendete 18.Lebensjahr definiert. Im klinischen Einzelfall können diese Leitlinien auch für das junge Erwachsenenalter herangezogen werden.

Diagnostik, Therapie und Verlaufskontrolle des Diabetes mellitus im Kindes- und Jugendalter

Diabetes mellitus im Kindesalter

Patienten mit Diabetes mellitus Typ 1 sind, auch ohne Nahrungszufuhr, lebensnotwendig von der regelmasigen Zufuhr von externem Insulin abhangig. Der Insulinbedarf ist individuell sehr unterschiedlich und kann sich perioperativ stark andern. Da eine katabole Stoffwechselsituation und Hypoglykamien den Patienten stark gefahrden konnen, sollten peri- und intraoperativ engmaschige Blutzuckermessungen sowie eine kurzfristige Anpassung der Insulindosis und der Glukosezufuhr erfolgen. Bei der Narkosevorbereitung sollte ein individuelles Behandlungsregime erstellt werden, das dem gesamten anasthesiologischen Team zur Verfugung steht. Um das anspruchsvolle Management dieser Patienten zu erleichtern, werden im Folgenden die aktuellen Empfehlungen (v. a. der International Society for Pediatric and Adolescent Diabetes, ISPAD) zum perioperativen Management von Kindern und Jugendlichen mit Diabetes mellitus Typ 1 dargestellt.

Diabetes mellitus Typ 1

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