Diabesity, the silent pandemic

It is paradoxical that the expansion of a recent disease such as covid-19 now helps to contextualize in such a graphic way the magnitude of a pathology such as obesity, widespread for so many years. According to data from the World Health Organization (WHO), overweight and obesity have reached epidemic proportions around the world: in 2016, more than 1.9 billion adults over the age of 18 were overweight. And more than 650 million, obesity. Two features mainly characterize obesity: its multifactorial origin and the excessive accumulation of fat that is detrimental to health. It is a fact that bad dietary habits and a sedentary lifestyle encourage it. But we cannot ignore that genetic and epigenetic factors also participate in its development, in addition to the alteration of the intestinal microbiota. In addition, it is considered an important metabolic risk factor for the development of other chronic non-communicable diseases, including cardiovascular diseases, immune system disorders, cancer, non-alcoholic fatty liver or type 2 diabetes mellitus. Researchers have also verified that there is clear evidence that people with obesity and type 2 diabetes have a higher risk of serious complications in SARS-CoV-2 infection. Precisely this duo, obesity and type 2 diabetes mellitus, has increased in parallel in recent years. It has been shown that their relationship is mainly associated with an unbalanced diet accompanied by a sedentary lifestyle. In fact, the relationship between the two is so close that the term “diabesity” has been coined. The main danger of its proliferation is that type 2 diabetes is a relatively silent chronic disease, while high glucose levels can seriously damage many organs and systems in the body, especially nerves and blood vessels. Beyond a certain point it can cause blindness, kidney damage, cardiovascular problems and even limb amputations. Diabetes begins up to six years before its diagnosis As almost always, before reaching these extremes, there are indicators that warn of the danger to the person’s health when it can still be reversed. In this case, prediabetes, a stage prior to diabetes characterized by moderately elevated blood sugar levels, but not high enough to be diagnosed as type 2 diabetes. The main problem, again, is that these levels increase the risk of developing associated complications. Although the strict definition does not consider prediabetes as a disease in itself, there is evidence that the development of type 2 diabetes begins up to 6 years before its diagnosis. In the United States, for example, an estimated 1 in 3 adults have prediabetes, and of those, 9 in 10 don’t know it. And this despite the fact that the indicators that can clear up the mystery are very simple: excess weight, being over 45 years of age, with a history of type 2 diabetes, leading a sedentary lifestyle and, among women, having had gestational diabetes . What to do when the situation is still reversible When the possibility of being in this previous stage is suspected, the most practical thing would be to have an analysis to know the blood glucose levels. Especially if one or more of the risk factors are present. With the result in hand, the usual dilemma: ignore your condition and let yourself go, or promote a real change in your lifestyle, giving priority to weight loss and increased physical activity? For practical purposes, this means 8,000 steps a day or performing physical activity three to six times a week, between 15 and 30 minutes and after which it is difficult to maintain a steady and calm breath. The most effective thing is to bet on the Mediterranean diet, letting ourselves be advised by a nutritionist dietician who will teach us guidelines to have a healthier diet. Regarding the reduction of sedentary lifestyle, it is recommended to reach 150 minutes per week of moderate physical activity. For practical purposes, this means 8,000 steps a day or performing physical activity three to six times a week, between 15 and 30 minutes and after which it is difficult to maintain a steady and calm breath. The microbiota is a key ally In recent years, numerous scientific studies have linked the composition of the intestinal microbiota with the development of obesity and type 2 diabetes. In fact, relevant differences have been described between the microbiota of people with normal weight and obesity . On the other hand, it has been observed that a balanced composition of the intestinal microbiota, with a greater population of healthy microorganisms compared to pathogenic microorganisms, helps to maintain blood sugar within adequate limits. In fact, one of the virtues of having a healthy and balanced intestinal microbiota is the ability to reduce the absorption of sugars from food. One point to keep in mind is that the composition of the microbiota changes with age or the type of diet. It can be modulated by prebiotics, food ingredients that serve as a substrate for the microbiota. But also by probiotics, live microorganisms that, administered in the right amounts, confer a notable benefit to health. Thus, the researchers have come to the conclusion that taking supplements with certain probiotics could be therapeutic strategies for weight control, glycemic control and diabetes prevention. On the other hand, it has been shown in animal models that the administration of zein nanoparticles (the main food protein in corn) can help control blood glucose in prediabetes stages and help slow its progress. These advances may allow the development of a new generation of nutritional supplements aimed at reducing blood sugar levels, thanks to research projects that are already a reality. Authors María Jesús Moreno Aliaga Professor of Physiology, University of Navarra. Santiago Navas Carretero-Associate research scientist. Member of the CIBERobn (Physiopathology of Obesity and Nutrition), University of Navarra. Originally published on The Conversation ES.