1. Student presentations 22 October and 19 November- no lectures on those days

2. Coxsackievirus B (CVB) but also rotavirus mumps virus and cytomegalovirus. Rubella virus has been suggested to cause type 1 diabetes, but so far only congenital rubella syndrome has conclusively been associated with the disease. The prime viral candidates for causing type 1 diabetes in humans are enteroviruses. Flu virus also implicated.

3. A note-taker has been requested for NUTR 2101. The note-taker is a student the Nutrition 2101 class who simply photocopies (a photocopier is available here at the centre) their notes or emails them to the Centre if they are typed, from the beginning of the term and continues to do so for the remainder of the fall term 2013. They will be paid $100 at the end of the term for hand written notes or $150 for typed notes. Any interested students to come to the Jennifer Keeping AccessAbility Centre, where Ms. Campbell will further explain the process.

4. The Lecture 4- 1 October 2013 Type 2 Diabetes

5. Outline of today’s talk I.Pathology 2.Socioeconomic factors contributing to the diseases 2I. Elementary nutritional approaches to be taken to avoid and treat type 2 diabetes including foods available to those at risk IV.First Nations and other Cape Breton individuals at risk V.How is nutritional assessment made for type 2 diabetes? VI. How would one assess from a nutritional perspective the socioeconomics, pathology and success of nutritional interventions relative to type 2 diabetes?

6. Type 2 diabetes I. Pathology Obesity leads to dyslipidemia (elevated triglycerides, decreased HDLc, increased sd-LDL-c, increased lipid oxidation), increased blood pressure, decreased insulin sensitivity = metabolic syndrome (increased platelet reactivity considered by some to be part of metabolic syndrome) metabolic syndrome may lead to T2D

7. 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?

8. Food and hence nutritional choices depend on: Ethnic heritage or tradition which groups would be more susceptible to type 2 diabetes? Social interaction impact of social interaction on obesity?

9. 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

10. Food and hence nutritional choices depend on: Economy of food -this may discourage type 2 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

11. 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?

12. Food and hence nutritional choices depend on: Body image may encourage slimness-emphasis on thin is beautiful in our society Advertising food companies and fast food companies always promoting larger servings supersizing type 2 diabetes

14. 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

15. 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

16. More on socioeconomic factors Wealth comment about power fits in here regarding type 2 diabetes Education usually, but not always, better educated persons make healthier choices about foods that increase or reduce obesity

17. 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

18. More on socioeconomic factors Class -uppers -lower uppers -upper middles -average middles -working class -lower class type 2 diabetes tends to affect all classes-money or lack thereof is not an issue

19. More on socioeconomic factors Global economy no real impact given that type 2 diabetes is rampant all over the world Government -anti-obesity campaigns- physical activity guide and Canada’s food guide

20. More on socioeconomic factors Business advertising supersizing type 2 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 2 diabetes

21. 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

22. 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

23. 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

24. 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?

25. How is nutritional assessment made for type 2 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

26. How is nutritional assessment made for type 2 diabetes? Daily food record/Diary -same measures of interest as per nutrient intake analysis

27. How is nutritional assessment made for type 2 diabetes ? Retrospective data food frequency questionaire 24-hour recall do both to act as cross check against each other

28. How is nutritional assessment made for type 2 diabetes ? Anthropometry waist measurement-central obesity weight and height giving BMI

29. How is nutritional assessment made for type 2 diabetes ? Nutrition focussed physical exam obesity is the focus here particularly central obesity blood pressure

30. How is nutritional assessment made for type 2 diabetes ? Skin testing irrelevant in type 2 diabetes

31. How is nutritional assessment made for type 2 diabetes ? Biochemical analysis Blood concentrations of: HDLc down more small dense LDL more oxidised LDL triglycerides (VLDL and CM) up free fatty acids c-reactive protein? leptin ? lipoprotein (a)?

32. How is nutritional assessment made for type 2 diabetes ? Biochemical analysis Blood concentrations of: glycated protein fasting insulin is higher fasting blood glucose is higher post-prandial insulin and blood glucose are higher post-prandial lipemia is higher

33. How is nutritional assessment made for type 2 diabetes? CLASSIFYING MALNUTRITION -obesity is the central issue here -obesity is considered to be a form of malnutrition

34. VI. GROUP DISCUSSION-HOW WOULD ONE ASSESS FROM NUTRITIONAL PERSPECTIVE THE SOCIOECONOMICS, PATHOLOGY AND SUCCESS OF NUTRITIONAL INTERVENTIONS RELATIVE TO TYPE 2 DIABETES ?