1. Type II diabetes I. Pathology Obesity leads to dyslipidemia (elevated triglycerides, decreased HDLc, increased small dense LDL, increased lipid oxidation), increased blood pressure, decreased insulin sensitivity= metabolic syndrome increased platelet reactivity considered by some to be part of metabolic syndrome

2. Food and hence nutritional choices depend on: Personal preference acceptance of certain foods-implications versus type I? Habit -caregiver should be careful here- why? how different from type I?

3. Food and hence nutritional choices depend on: Ethnic heritage or tradition which groups would be more susceptible to type II? Social interaction impact of social interaction on obesity?

4. Food and hence nutritional choices depend on: Availability of food if only offending foods available this can be concern-fast foods, ready prep foods that are calorie including fat laden Convenience of food fast foods-hamburgers,chips,pizza, donuts, ice cream ready prep foods-those that are calorie including fat laden

5. Food and hence nutritional choices depend on: Economy of food -this may discourage type II diabetes can eat well on a low budget-how? Positive and negative association -positive –obesity -negative- examples of implications for avoidance of weight gain or inducing weight loss

6. Food and hence nutritional choices depend on: Emotional conflict -comfort food-suggestions for this? risk of obesity Values -implications for obesity? -implications for weight loss

7. Food and hence nutritional choices depend on: Body image may encourage slimness-emphasis on thin is beautiful in our society Advertising food companies and fat food companies always promoting larger servings supersizing type II diabetes

9. More on socioeconomic factors Prestige -occupational -decisions on healthy foods- obesity is the central issue here -societal perceptions -who is to be listened to about various diets, nutraceuticals and functional foods -education -informed choices about foods that will prevent or reduce obesity

10. More on socioeconomic factors Power influence on government policy-what is considered to be fair advertising-this applies to major food companies including fast food companies Income sometimes poorer people tend to buy junk food that is rich in empty kcal-however richer people can also do the same

11. More on socioeconomic factors Wealth comment about power fits in here regarding type II diabetes Education usually, but not always, better educated persons make healthier choices about foods that increase or reduce obesity

12. More on socioeconomic factors Social stratification -ancestry -gender -race-aboriginals and convenience stores -ethnicity -mobility-ability to get to quality food -ability to exercise -mental and physical illness mental illness-comfort food issue physical illness- lack of exercise inducing obesity

13. More on socioeconomic factors Class -uppers -lower uppers -upper middles -average middles -working class -lower class type II diabetes tends to affect all classes-money or lack thereof is not an issue

14. More on socioeconomic factors Global economy no real impact given that type II diabetes is increasing- rampant all over the world Government -anti-obesity campaigns- physical activity guide and Canada’s food guide

15. More on socioeconomic factors Business advertising supersizing type II diabetes Psychology eating simply for something to do-obesity -group dynamics- eating more in social settings History -history of development of fast foods and easy prep high fat foods has played a huge role in the development of type II diabetes

16. Elementary nutritional biochemistry of nutritional approaches that use foods available to those at risk Planning a healthy diet To do this bear in mind Adequacy Balance Energy control Nutrient density Moderation Variety

17. Elementary nutritional biochemistry of nutritional approaches that use foods available to those at risk Prevention-obesity Post-onset-obesity -carbohydrate-simple sugars -sweeteners if in fats an issue -fibre-may inhibit glucose uptake but effect is not significant

18. Elementary nutritional biochemistry of nutritional approaches that use foods available to those at risk Post-onset-obesity -protein-conversion to carbohydrate depends on insulin resistance -fat- an issue- dyslipidemia compared to non- diabetics -alcohol-blocks gluconeogenesis-not an issue -sodium-hypertension-an issue -vitamins and minerals-not indicated as supplements except chromium and magnesium which boost insulin sensitivity-perhaps also antioxidants

19. IV. First nations and other Cape Breton individuals at risk. Aboriginals-thrifty genes and a move away from traditional dietary habits-cause obesity Genetics-some individuals predisposed to weight gain- eg low leptin Others?

20. How is nutritional assessment made for type II diabetes ? Nutrient intake analysis caloric intake and particularly the fat intake is an issue- why? vitamins, and minerals relative to low antioxidant chemicals in blood

21. How is nutritional assessment made for type II diabetes ? Daily food record/Diary -same measures of interest as per nutrient intake analysis

22. How is nutritional assessment made for type II diabetes ? Retrospective data food frequency questionnaire 24-hour recall do both to act as cross check against each other

23. How is nutritional assessment made for type II diabetes ? Anthropometry waist measurement-central obesity weight and height giving BMI

24. How is nutritional assessment made for type II diabetes ? Nutrition focussed physical exam obesity is the focus here particularly central obesity blood pressure

25. How is nutritional assessment made for type II diabetes ? Skin testing irrelevant in type II diabetes

26. How is nutritional assessment made for type II diabetes ? Biochemical analysis Blood concentrations of: HDLc down more small dense LDL more oxidised LDL triglycerides (VLDL and CM) up free fatty acids high sensitivity c-reactive protein? leptin ? lipoprotein (a)?

27. How is nutritional assessment made for type II diabetes ? Biochemical analysis Blood concentrations of: glycated proteins fasting insulin is higher fasting blood glucose is higher post-prandial insulin and blood glucose is higher post-prandial lipemia is higher

28. How is nutritional assessment made for type II diabetes? CLASSIFYING MALNUTRITION -obesity is the central issue here -obesity is considered to be a form of malnutrition