title: Inflammatory markers and risk of developing type 2 diabetes in women. Vitamin D, glucose tolerance and insulinaemia in elderly men Diet and risk of clinical diabetes in women. Effects of vitamin D on insulin and glucagon secretion in non-insulin-dependent diabetes mellitus. Effects of calcium and dairy on body composition and weight loss in African-American adults. Vitamin D and calcium intake in relation to type 2 diabetes in women. Effect of energy-reduced diets high in dairy products and fiber on weight loss in obese adults. Oral calcium supplementation reduces intraplatelet free calcium concentration and insulin resistance in essential hypertensive patients. Vitamin D Status and Glucose Homeostasis in the 1958 British Birth Cohort C-reactive protein, interleukin 6, and risk of developing type 2 diabetes mellitus. Dairy consumption and risk of type 2 diabetes mellitus in men: a prospective study. Low vitamin D and high parathyroid hormone levels as determinants of loss of muscle strength and muscle mass (sarcopenia): the Longitudinal Aging Study Amsterdam. No effect of calcitriol on insulin-mediated glucose uptake in healthy subjects. Glucose intolerance is associated with altered calcium homeostasis: a possible link between increased serum calcium concentration and cardiovascular disease mortality. Transition from meeting abstract to full-length journal article for randomized controlled trials. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. Calcium and dairy acceleration of weight and fat loss during energy restriction in obese adults. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. Effects of increased consumption of fluid milk on energy and nutrient intake, body weight, and cardiovascular risk factors in healthy older adults. Circulating MMP9, vitamin D and variation in the TIMP-1 response with VDR genotype: mechanisms for inflammatory damage in chronic disorders? Treatment with one-alpha-hydroxycholecalciferol in middle-aged men with impaired glucose tolerance--a prospective randomized double-blind study.
abstract: We conducted a prospect i ve , nested , case-control study of inflammatory markers as predictors of  type 2 diabetes among 32,826 women who provided blood sample s in 1989 through 1990 in the Nurses ' Health Study . Among women free of diabetes , cardiovascular disease , or cancer at baseline , 737 had developed diabetes by 2000 . Control women ( n = 785 ) were selected matched on age , fasting status , race , and BMI for cases in the top BMI decile . Baseline levels of tumor necrosis factor (TNF)-alpha receptor 2 , interleukin (IL)-6 , and C-reactive protein ( CRP ) were significantly higher among case than control subjects ( all P < /= 0.001 ) . After adjusting for BMI and other lifestyle factors , all three biomarkers significantly predicted diabetes risk ; the odds ratios ( ORs ) comparing extreme quintiles were 1.64 ( 95 % CI 1.10 - 2.45 ) for TNF-alphaR2 , 1.91 ( 1.27 - 2.86 ) for IL-6 , and 4.36 ( 2.80 - 6.80 ) for CRP ( P for trend < 0.001 for all biomarkers ) . In a multivariate model simultaneously including the three biomarkers , only CRP levels were significantly associated with risk of diabetes ( OR comparing extreme quintiles of CRP = 3.99 , P for trend < 0.001 ) . These data support the role of inflammation in the pathogenesis of type 2 diabetes . Elevated CRP levels are a strong independent predictor of type 2 diabetes and may mediate associations of TNF-alphaR2 and IL-6 with type 2 diabetes Summary  Vitamin D status  was assessed in 142 elderly Dutchmen participating in a prospect i ve population -based study of environmental factors in the aetiology of non-insulin-dependent diabetes mellitus . Of the men aged 70–88 years examined between March and May 1990 , 39 % were vitamin D depleted . After adjustment for confounding by age , BMI , physical activity , month of sampling , cigarette smoking and alcohol intake the 1-h glucose and area under the glucose curve during a st and ard 75-g oral glucose tolerance test ( OGTT ) were inversely associated with the serum concentration of 25-OH vitamin D ( r = −0.23 , p < 0.01 ; r = −0.26 , p < 0.01 , respectively ) . After excluding newly diagnosed diabetic patients total insulin concentrations during OGTT were also inversely associated with the concentration of 25-OH vitamin D ( r = −0.18 to −0.23 , p < 0.05 ) . Hypovitaminosis D may be a significant risk factor for glucose intolerance . [ Diabetologia ( 1997 ) 40 : 344–347 To determine the relations of diet with risk of clinical noninsulin-dependent diabetes , we analyzed data from a prospect i ve cohort of 84360 US women . During 6 y of follow-up we identified 702 definite incident cases . Because body mass index ( BMI ) is a powerful risk factor for diabetes , we examined the relations of fat ( including type ) , fiber , sucrose , and other components of diet to risk of diabetes , among women with BMI s ( in kg/m2 ) less than 29 kg/m2 . After controlling for body mass index , previous weight change , and alcohol intake , we observed no associations between intakes of energy  , protein , sucrose ,  carbohydrate  ,  or fiber and risk of diabetes . Compared with women in the lowest quintile of energy-adjusted intake , and relative risks ( and tests for trend ) for those in the highest quintile were 0.61 ( P trend = 0.03 ) for vegetable fat , 0.62 ( P trend = 0.008 ) for potassium , 0.70 ( P trend = 0.005 ) for calcium , and 0.68 ( P trend = 0.02 ) for magnesium . These inverse associations were attenuated among obese women ( BMI s greater than or equal to 29 ) Vitamin D has been shown to increase insulin release from pancreatic islet cells in vitro , and to improve insulin secretion in vitamin D-deficient animals . Few attempts have been made to evaluate this issue directly in humans . We studied 35 otherwise healthy diabetic subjects in the early spring at the seasonal nadir of 25-hydroxyvitamin D [ 25(OH)D ] concentrations ( mean 35 + /- 7 nmol/L ) .  Fasting glucose , insulin , C-peptide , and glucagon concentrations , and their responses to Sustacal stimulation were not related to indexes of mineral metabolism . In 20 subjects , a double-blinded , placebo-controlled , crossover trials of 1,25-dihydroxyvitamin D[1,25](OH)2D ] treatment ( 1 micrograms/d for 4 d ) had no effect on fasting or stimulated glucose , insulin , C-peptide , or glucagon concentrations . However , insulin and C-peptide responses to Sustacal after 1,25(OH)2D treatment were related to duration of diabetes ( r2 = 0.28 , P = 0.052 and r2 = 0.25 , P = 0.002 , respectively ) in that short duration correlated with improvement after 1,25(OH)2D treatment . Hence , vitamin D nutrition , or 1,25(OH)2D therapy , had no major effect on glucose homeostasis in non-insulin-dependent diabetes mellitus OBJECTIVE Our objective was to determine the effects of dairy consumption on adiposity and body composition in obese African Americans . RESEARCH METHODS AND PROCEDURES We performed two r and omized trials in obese African-American adults . In the first ( weight maintenance ) , 34 subjects were maintained on a low calcium ( 500 mg/d)/low dairy ( < 1 serving/d ) or high dairy ( 1200 mg Ca/d diet including 3 servings of dairy ) diet with no change in energy or macronutrient intake for 24 weeks . In the second trial ( weight loss ) , 29 subjects were similarly r and omized to the low or high dairy diets  and placed on a caloric restriction regimen ( -500 kcal/d ) . RESULTS In the first trial , body weight remained stable for both groups throughout the maintenance study . The high dairy diet result ed in decreases in total body fat ( 2.16 kg , p < 0.01 ) , trunk fat ( 1.03 kg , p < 0.01 ) , insulin ( 18.7 pM , p < 0.04 ) , and blood pressure ( 6.8 mm Hg systolic , p < 0.01 ; 4.25 mm Hg diastolic , p < 0.01 ) and an increase in lean mass ( 1.08 kg , p < 0.04 ) , whereas there were no significant changes in the low dairy group . In the second trial , although both diets produced significant weight and fat loss , weight and fat loss on the high dairy diet were approximately 2-fold higher ( p < 0.01 ) , and loss of lean body mass was markedly reduced ( p < 0.001 ) compared with the low dairy diet . DISCUSSION Substitution of calcium-rich foods in isocaloric diets reduced adiposity and improved metabolic profiles in obese African Americans without energy restriction or weight loss and augmented weight and fat loss secondary to energy restriction OBJECTIVE The purpose of this study was to prospect ively examine the association between vitamin D and calcium intake and risk of type 2 diabetes .  RESEARCH DESIGN AND METHODS In the Nurses ' Health Study , we followed 83,779 women who had no history of diabetes , cardiovascular disease , or cancer at baseline for the development of type 2 diabetes .  Vitamin D and calcium intake from diet and supplements was assessed every 2 - 4 years . During 20 years of follow-up , we documented 4,843 incident cases of type 2 diabetes . RESULTS After adjusting for multiple potential confounders , there was no association between total vitamin D intake and type 2 diabetes . However , the relative risk ( RR ) of type 2 diabetes was 0.87 ( 95 % CI 0.75 - 1.00 ; P for trend = 0.04 ) comparing the highest with the lowest category of vitamin D intake from supplements . The multivariate RRs of type 2 diabetes were 0.79 ( 0.70 - 0.90 ; P for trend < 0.001 ) comparing the highest with the lowest category of calcium intake from all sources and 0.82 ( 0.72 - 0.92 ; P for trend < 0.001 ) comparing the highest with the lowest category of calcium intake from supplements . A combined daily intake of > 1,200 mg calcium and > 800 IU vitamin D was associated with a 33 % lower risk of type 2 diabetes with RR of 0.67 ( 0.49 - 0.90 ) compared with an intake of < 600 mg and 400 IU calcium and vitamin D , respectively . CONCLUSIONS The results of this large prospect i ve study suggest a potential beneficial role for both vitamin D and calcium intake in reducing the risk of type 2 diabetes OBJECTIVE Studies suggest that high-dairy and high-fiber/low-glycemic index diets may facilitate weight loss , but data are conflicting . The effects on weight loss and body fat of a high-dairy diet and a diet high in dairy and fiber and low in glycemic index were compared with a st and ard diet . RESEARCH METHODS AND PROCEDURES Ninety obese subjects were recruited into a r and omized trial of three diets design ed to provide a calorie deficit of 500 calories/d over a 48-week period . The study compared a moderate ( not low)-calcium diet with a high-calcium diet . RESULTS Seventy-two subjects completed the study . Significant weight and fat loss occurred with all three diets . A diet with 1400 mg of calcium did not result in greater weight ( 11.8 + /- 6.1 kg ) or fat ( 9.0 + /- 6.0 kg ) loss than a diet with 800 mg of calcium ( 10.0 + /- 6.8 and 7.5 + /- 6.6 kg , respectively ) . A diet with 1400 mg of calcium , increased fiber content , and fewer high-glycemic index foods did not result in greater weight ( 10.6 + /- 6.8 kg ) or fat ( 8.5 + /- 7.8 kg ) loss than the st and ard diet with 800 mg of calcium . Lipid profile , high-sensitivity C-reactive protein , leptin , fasting glucose , and insulin improved significantly , but there were no significant differences between the experimental diets and the control diet . DISCUSSION We found no evidence that diets higher than 800 mg of calcium in dairy products or higher in fiber and lower in glycemic index enhance weight reduction beyond what is seen with calorie restriction alone We evaluated the effect of oral calcium supplementation on blood pressure , calcium metabolism , and insulin resistance in essential hypertension . After receiving a st and ard diet with 500 mg of calcium per day during a 4-week period , 20 nondiabetic , essential hypertensive patients were r and omized in a double-blind fashion to receive oral calcium supplementation ( 1500 mg of calcium per day ) or placebo for 8 weeks . At the end of the 4-week period of low-calcium diet and after the 8-week period of intervention , we measured blood pressure ( by both office and 24-hour ambulatory blood pressure monitoring ) , calcium-regulating hormones [ urinary hydroxyproline and serum osteocalcin , parathormone , and 1,25(OH)2-vitamin D3 ] , intraplatelet free calcium concentration , fasting plasma glucose and insulin levels , and the insulin-sensitivity index ( euglycemic-hyperinsulinemic clamp ) . Compared with patients maintained at low calcium intake , essential hypertensive patients under oral calcium supplementation significantly reduced serum osteocalcin ( from 22.2 + /- 1.9 to 17.9 + /- 2.0 micrograms/L ; P = .0015 ) , parathormone ( from 4.20 + /- 0.38 to 3.30 + /- 0.36 pmol/L ; P = .0003 ) , and 1,25(OH)2-vitamin D3 ( from 98.0 + /- 11.0 to 61.6 + /- 5.7 pmol/L ; P = .0062 ) . Likewise , we found a significant reduction in intraplatelet free calcium concentration ( from 35.9 + /- 1.2 to 26.5 + /- 0.8 nmol/L ; P = .0005 ) and fasting plasma insulin levels ( from 71.8 + /- 5.9 to 64.6 + /- 6.2 pmol/L ; P = .05 ) and a significant increase in the insulin-sensitivity index ( from 2.89 + /- 0.77 to 4.00 + /- 0.95 mg.kg-1.min-1 ; P = .0007 ) . None of these parameters were significantly modified in patients maintained at low calcium intake . Office and 24-hour mean values of systolic and diastolic blood pressure did not change after 8 weeks of oral calcium supplementation or placebo OBJECTIVE —Obesity is a well-known risk factor for vitamin D deficiency . We evaluated the interrelationship between vitamin D status , body size , and glucose homeostasis , measured by HbA1c ( A1C ) . RESEARCH DESIGN AND METHODS — Data are from the survey of the 45-year-old 1958 British birth cohort ( 2002–2004 ) . Information on A1C , 25-hydroxyvitamin D [ 25(OH)D ;  an indicator of  vitamin D status ] , and BMI was collected from 7,198 Caucasian subjects . RESULTS —25(OH)D was < 75 nmol/l in 80 % of the obese subjects ( BMI ≥30 kg/m2 ) versus 68 % of the other subjects ( P < 0.0001 ) . Serum 25(OH)D decreased and A1C increased by increasing BMI ( P < 0.0001 for both comparisons ) . There was a nonlinear association between 25(OH)D and A1C : a steep linear decrease in A1C by 25(OH)D until 65 nmol/l and only smaller decreases with further increases . There was evidence for effect modification by BMI in the association between 25(OH)D and A1C ( P < 0.0001 ) , and differences appeared stronger for participants with higher compared with lower BMI s. After adjustment for sex , season , geographical location , physical activity , and social class , percent change in A1C by 10-nmol/l increase in 25(OH)D was −0.21 ( 95 % CI −0.31 to −0.11 ) for BMI < 25 kg/m2 , −0.25 ( −0.37 to −0.13 ) for BMI 25–29.9 kg/m2 , −0.65 ( −0.95 to −0.34 ) for BMI 30–34.9 kg/m2 , and −1.37 ( −2.09 to −0.64 ) for BMI ≥35 kg/m2 . CONCLUSIONS —Body size was a strong determinant for 25(OH)D , with concentrations being suboptimal in most obese participants . R and omized controlled trials [ using dosages sufficient to improve 25(OH)D also for the obese ] are required to determine whether clinical ly relevant improvements in glucose metabolism can be obtained by vitamin D supplementation CONTEXT Inflammation is hypothesized to play a role in development of type 2 diabetes mellitus ( DM ) ; however , clinical data addressing this issue are limited . OBJECTIVE To determine whether elevated levels of the inflammatory markers interleukin 6 ( IL-6 ) and  C-reactive protein ( CRP ) are associated with development of  type 2 DM in healthy middle-aged women . DESIGN Prospect i ve , nested case-control study . SETTING The Women 's Health Study , an ongoing US primary prevention , r and omized clinical trial initiated in 1992 . PARTICIPANTS From a nationwide cohort of 27 628 women free of diagnosed DM , cardiovascular disease , and cancer at baseline , 188 women who developed diagnosed DM over a 4-year follow-up period were defined as cases and matched by age and fasting status with 362 disease-free controls . MAIN OUTCOME MEASURES Incidence of confirmed clinical ly diagnosed type 2 DM by baseline levels of IL-6 and CRP . RESULTS Baseline levels of IL-6 ( P<.001 ) and CRP ( P<.001 ) were significantly higher among cases than among controls . The relative risks of future DM for women in the highest vs lowest quartile of these inflammatory markers were 7.5 for IL-6 ( 95 % confidence interval [ CI ] , 3.7 - 15.4 ) and 15.7 for CRP ( 95 % CI , 6.5 - 37.9 ) . Positive associations persisted after adjustment for body mass index , family history of diabetes , smoking , exercise , use of alcohol , and hormone replacement therapy ; multivariate relative risks for the highest vs lowest quartiles were 2.3 for IL-6 ( 95 % CI , 0.9 - 5.6 ; P for trend = .07 ) and 4.2 for CRP ( 95 % CI , 1.5 - 12.0 ; P for trend = .001 ) . Similar results were observed in analyses limited to women with a baseline hemoglobin A(1c ) of 6.0 % or less and after adjustment for fasting insulin level . CONCLUSIONS Elevated levels of CRP and IL-6 predict the development of type 2 DM . These data support a possible role for inflammation in diabetogenesis BACKGROUND Diet and lifestyle modifications can substantially reduce the risk of type 2 diabetes . While a strong inverse association has been reported between dairy consumption and the insulin resistance syndrome among young obese adults , the relation between dairy intake and type 2 diabetes is unknown . METHODS We prospect ively examined the relation between  dairy intake and incident cases of  type 2 diabetes in 41,254 male participants with no history of diabetes , cardiovascular disease , and cancer at baseline in the Health Professionals Follow-up Study . RESULTS During 12 years of follow-up , we documented 1243 incident cases of type 2 diabetes . Dairy intake was associated with a modestly lower risk of type 2 diabetes . After adjusting for potential confounders , including body mass index , physical activity , and dietary factors , the relative risk for type 2 diabetes in men in the top quintile of dairy intake was 0.77 ( 95 % confidence interval [ CI ] , 0.62 - 0.95 ; P for trend , .003 ) compared with those in the lowest quintile . Each serving-per-day increase in total dairy intake was associated with a 9 % lower risk for type 2 diabetes ( multivariate relative risk , 0.91 ; 95 % CI , 0.85 - 0.97 ) . The corresponding relative risk was 0.88 ( 95 % CI , 0.81 - 0.94 ) for low-fat dairy intake and 0.99 ( 95 % CI , 0.91 - 1.07 ) for high-fat dairy intake . The association did not vary significantly according to body mass index ( < 25 vs > or = 25 kg/m(2 ) ; P for interaction , .57 ) . CONCLUSION Dietary patterns characterized by higher dairy intake , especially low-fat dairy intake , may lower the risk of type 2 diabetes in men The age-related change in hormone concentrations has been hypothesized to play a role in the loss of muscle mass and muscle strength with aging , also called sarcopenia . The aim of this prospect i ve study was to investigate whether low serum 25-hydroxyvitamin D ( 25-OHD ) and high serum PTH concentration were associated with sarcopenia . In men and women aged 65 yr and older , participants of the Longitudinal Aging Study Amsterdam , grip strength ( n = 1008 ) and appendicular skeletal muscle mass ( n = 331 , using dual-energy x-ray absorptiometry ) were measured in 1995 - 1996 and after a 3-yr follow-up . Sarcopenia was defined as the lowest sex-specific 15th percentile of the cohort , translating into a loss of grip strength greater than 40 % or a loss of muscle mass greater than 3 % . After adjustment for physical activity level , season of data collection , serum creatinine concentration , chronic disease , smoking , and body mass index , persons with low ( < 25 nmol/liter ) baseline 25-OHD levels were 2.57 ( 95 % confidence interval 1.40 - 4.70 , based on grip strength ) and 2.14 ( 0.73 - 6.33 , based on muscle mass ) times more likely to experience sarcopenia , compared with those with high ( > 50 nmol/liter ) levels . High PTH levels ( > or=4.0 pmol/liter ) were associated with an increased risk of sarcopenia , compared with low PTH ( < 3.0 pmol/liter ) : odds ratio = 1.71 ( 1.07 - 2.73 ) based on grip strength , odds ratio = 2.35 ( 1.05 - 5.28 ) based on muscle mass . The associations were similar in men and women . The results of this prospect i ve , population -based study show that lower  25-OHD  and higher  PTH levels increase the risk of sarcopenia in older men and women Administration of active vitamin D ( calcitriol ) improves insulin sensitivity in uraemic patients . These patients have subnormal plasma calcitriol concentrations in parallel with increased intact parathyroid hormone ( PTH ) concentrations . It is therefore unclear whether the improvement in insulin sensitivity results from a direct effect of calcitriol or from amelioration of secondary hyperparathyroidism . So far , no evidence has been presented that insulin sensitivity is specifically affected by calcitriol in healthy subjects . We investigated the effect of (supra)therapeutic doses of calcitriol on insulin sensitivity in healthy volunteers . In a double-blind parallel group design , 18 healthy male subjects received in r and om order either placebo or 1.5 micrograms of calcitriol per day by mouth for 7 days . Insulin-mediated glucose uptake , i.e. insulin sensitivity , was assessed using the euglycaemic clamp technique . Mean glucose disposal rate , i.e. M-value , was not significantly affected by placebo or calcitriol treatment ( placebo : 7.1 + /- 1.3 mg kg-1 min-1 before and 7.2 + /- 1.5 mg kg-1 min-1 after treatment ; calcitriol 7.0 + /- 1.4 mg kg-1 min-1 and 7.2 + /- 1.4 mg kg-1 min-1 ) . There were no significant changes in mean plasma glucose , insulin , phosphate , bicarbonate and ionized calcium concentrations after administration of placebo or calcitriol . Furthermore , platelet intracellular calcium concentration ( assessed by fluorescence spectroscopy ) and mean arterial blood pressure ( 24 h ambulatory measurement ) did not change with placebo and calcitriol treatment . On the other h and , mean intact PTH concentration decreased significantly ( P < 0.01 ) with calcitriol treatment , but not with placebo . In addition , mean 24 h urinary calcium excretion increased significantly ( P < 0.05 ) with calcitriol administration but was unchanged with placebo . Administration of (supra)physiological doses of calcitriol has no effect on insulin sensitivity in healthy subjects , despite a significant decrease in PTH concentrations . These observations are compatible with the notion that the effect of calcitriol on insulin sensitivity is present only in uraemic calcitriol-depleted patients Serum calcium concentration has recently been shown to predict cardiovascular mortality in a large health-screening program . Since impaired glucose tolerance ( IGT ) is an independent cardiovascular risk factor , we examined the association between glucose intolerance and serum calcium in a population -based cohort study . To characterize this association , we measured  total serum calcium , parathyroid hormone ( PTH ) , 25-hydroxyvitamin D ( 25OHD ) , and 1,25-dihydroxyvitamin D ( 1,25-(OH)2D ) levels  in a cohort of 1,071 r and omly selected white individuals aged 40 to 65 years in whom an oral glucose tolerance test had been completed . In multivariate analyses , the  2-hour plasma glucose  was positively associated with increasing total serum calcium and PTH in men and women after adjustment for age , obesity , season , and 25OHD . The adjusted odds ratio ( OR ) between increasing quintiles of total serum calcium and IGT was 1.63 ( 95 % confidence interval [ CI ] , 1.42 to 1.88 ) . The OR comparing the top with the bottom quintile was 8.5 ( 95 % CI , 4.5 to 16.0 ) . The association with quintile of serum PTH was 1.30 ( 95 % CI , 1.14 to 1.49 ) . These data suggest that IGT is associated with an increase in both total serum calcium and PTH that can not be explained by confounding by aging , obesity , or 25OHD . This relationship may explain the previously observed association between serum calcium and cardiovascular mortality . Whether this association is a manifestation of a shared cellular defect or represents a common relationship with an unknown etiologic factor are important questions for further research CONTEXT Not all research presented at scientific meetings is subsequently published and , even when it is , there may be inconsistencies between these results and what is ultimately printed . Although late-breaking trials sessions are now integrated into several major scientific meetings and the results are often promptly and prominently communicated , no studies have examined the publication fate and degree of consistency between meeting abstract s or presentations and subsequent full-length article publications for r and omized controlled trials ( RCTs ) presented at these sessions . OBJECTIVE To compare RCT abstract s presented in the late-breaking trials session vs other sessions at a major scientific meeting and subsequent full-length publications . DESIGN RCTs were identified by h and search ing abstract proceedings booklets and related Web sites for the American College of Cardiology scientific meetings ( 1999 - 2002 ) . Subsequent full-length articles were identified via electronic data bases . MAIN OUTCOME MEASURES Publication fate and degree of consistency between meeting abstract results and subsequent full-length publication results . RESULTS The 86 late-breaking RCTs were significantly larger ( median , 2737 patients vs 896 ; P<.001 ) , were more likely to be preceded by a published design paper ( 27 [ 31 % ] vs 13 [ 13 % ] ; P = .002 ) , had higher quality scores when eventually published ( mean Jadad score 2.69 vs 2.19 ; P = .01 ) , and were less likely to report favorable results for the intervention than the 100 r and omly chosen comparison RCTs presented in other sessions ( 50 [ 58 % ] vs 75 [ 75 % ] ; P = .01 ; odds ratio 0.46 ; 95 % confidence interval , 0.24 - 0.90 ) . RCTs presented at the late-breaking trials sessions were significantly more likely to be published ( 79 [ 92 % ] vs 69 [ 69 % ] ; P<.001 ) and appeared earlier after presentation ( median 11.5 months vs 22.0 months ; P<.001 ) than RCTs presented in other sessions , an association that persisted even after adjusting for sample size , conclusion of study , and RCT design : adjusted hazard ratio , 1.80 ( 95 % confidence interval , 1.24 - 2.61 ) . Sixty ( 41 % ) of the 148 RCTs that were subsequently published exhibited discrepancies between the efficacy estimate reported in the meeting abstract vs the one reported in the full-length article for the primary outcome . The mean change in effect was 0.44 SDs and in 20 cases ( 14 % ) , the point estimate was statistically significant in only 1 member of the pair . The discrepancy rate was the same for late-breaking RCTs as for RCTs presented in other American College of Cardiology sessions ( P = .92 ) . CONCLUSIONS Late-breaking trials were larger , more likely to be preceded by a design paper , and less likely to report positive results than RCTs presented at other sessions , but discrepancies between the meeting abstract results and subsequent full-length publication results were common even for late-breaking trials CONTEXT Obesity and diabetes are increasing in the United States . OBJECTIVE To estimate the prevalence of obesity and diabetes among US adults in 2001 . DESIGN , SETTING , AND PARTICIPANTS R and om-digit telephone survey of 195 005 adults aged 18 years or older residing in all states participating in the Behavioral Risk Factor Surveillance System in 2001 . MAIN OUTCOME MEASURES Body mass index , based on self-reported weight and height and self-reported diabetes . RESULTS In 2001 the prevalence of obesity ( BMI > or = 30 ) was 20.9 % vs 19.8 % in 2000 , an increase of 5.6 % . The prevalence of diabetes increased to 7.9 % vs 7.3 % in 2000 , an increase of 8.2 % . The prevalence of BMI of 40 or higher in 2001 was 2.3 % . Overweight and obesity were significantly associated with diabetes , high blood pressure , high cholesterol , asthma , arthritis , and poor health status . Compared with adults with normal weight , adults with a BMI of 40 or higher had an odds ratio ( OR ) of 7.37 ( 95 % confidence interval [ CI ] , 6.39 - 8.50 ) for diagnosed diabetes , 6.38 ( 95 % CI , 5.67 - 7.17 ) for high blood pressure , 1.88 ( 95 % CI,1.67 - 2.13 ) for high cholesterol levels , 2.72 ( 95 % CI , 2.38 - 3.12 ) for asthma , 4.41 ( 95 % CI , 3.91 - 4.97 ) for arthritis , and 4.19 ( 95 % CI , 3.68 - 4.76 ) for fair or poor health . CONCLUSIONS Increases in obesity and diabetes among US adults continue in both sexes , all ages , all races , all educational levels , and all smoking levels . Obesity is strongly associated with several major health risk factors OBJECTIVE Increasing 1,25-dihydroxyvitamin D in response to low-calcium diets stimulates adipocyte Ca2 + influx and , as a consequence , stimulates lipogenesis , suppresses lipolysis , and increases lipid accumulation , whereas increasing dietary calcium inhibits these effects and markedly accelerates fat loss in mice subjected to caloric restriction . Our objective was to determine the effects of increasing dietary calcium in the face of caloric restriction in humans . RESEARCH METHODS AND PROCEDURES We performed a r and omized , placebo-controlled trial in 32 obese adults . Patients were maintained for 24 weeks on balanced deficit diets ( 500 kcal/d deficit ) and r and omized to a st and ard diet ( 400 to 500 mg of dietary calcium/d supplemented with placebo ) , a high-calcium diet ( st and ard diet supplemented with 800 mg of calcium/d ) , or high-dairy diet ( 1200 to 1300 mg of dietary calcium/d supplemented with placebo ) . RESULTS Patients assigned to the st and ard diet lost 6.4 + /- 2.5 % of their body weight , which was increased by 26 % ( to 8.6 + /- 1.1 % ) on the high-calcium diet and 70 % ( to 10.9 + /- 1.6 % of body weight ) on the high-dairy diet ( p < 0.01 ) . Fat loss was similarly augmented by the high-calcium and high-dairy diets , by 38 % and 64 % , respectively ( p < 0.01 ) . Moreover , fat loss from the trunk region represented 19.0 + /- 7.9 % of total fat loss on the low-calcium diet , and this fraction was increased to 50.1 + /- 6.4 % and 66.2 + /- 3.0 % on the high-calcium and high-dairy diets , respectively ( p < 0.001 ) . DISCUSSION Increasing dietary calcium significantly augmented weight and fat loss secondary to caloric restriction and increased the percentage of fat lost from the trunk region , whereas dairy products exerted a substantially greater effect BACKGROUND Type 2 diabetes affects approximately 8 percent of adults in the United States . Some risk factors -- elevated plasma glucose concentrations in the fasting state and after an oral glucose load , overweight , and a sedentary lifestyle -- are potentially reversible . We hypothesized that modifying these factors with a lifestyle-intervention program or the administration of metformin would prevent or delay the development of diabetes . METHODS We r and omly assigned 3234 nondiabetic persons with elevated fasting and post-load plasma glucose concentrations to placebo , metformin ( 850 mg twice daily ) , or a lifestyle-modification program  with the goals of at least a 7 percent weight loss and at least 150 minutes of physical activity per week . The mean age of the participants was 51 years , and the mean body-mass index ( the weight in kilograms divided by the square of the height in meters ) was 34.0 ; 68 percent were women , and 45 percent were members of minority groups . RESULTS The average follow-up was 2.8 years . The incidence of diabetes was 11.0 , 7.8 , and 4.8 cases per 100 person-years in the placebo , metformin , and lifestyle groups , respectively . The lifestyle intervention reduced the incidence by 58 percent ( 95 percent confidence interval , 48 to 66 percent ) and metformin by 31 percent ( 95 percent confidence interval , 17 to 43 percent ) , as compared with placebo ; the lifestyle intervention was significantly more effective than metformin . To prevent one case of diabetes during a period of three years , 6.9 persons would have to participate in the lifestyle-intervention program , and 13.9 would have to receive metformin . CONCLUSIONS Lifestyle changes and treatment with metformin both reduced the incidence of diabetes in persons at high risk . The lifestyle intervention was more effective than metformin OBJECTIVE To assess the impact of increased consumption of milk , without other dietary advice , on older adults '  energy and nutrient intakes , weight , cardiovascular risk factors ( blood pressure , plasma lipid levels ) , and quality of life . SUBJECTS/ SETTING Two hundred four healthy men and women , aged 55 to 85 years , who consumed fewer than 1.5 dairy servings per day were chosen from six US academic health centers . DESIGN R and omized , controlled open trial . INTERVENTION Advice to increase skim or 1 % milk intake by 3 cups per day ( n = 101 ) or to maintain usual diet ( n = 103 ) for 12 weeks after a 4-week baseline period . MAIN OUTCOME MEASURES Changes in energy and nutrient intake assessed from 3-day food records , body weight , blood pressure , and plasma lipid levels . STATISTICAL ANALYSES PERFORMED Group-by-time analysis of variance with repeated- measures , chi 2 test . RESULTS Compliance with the intervention was good . Compared with controls , participants in the milk-supplemented group significantly increased energy , protein , cholesterol , vitamins A , D , and B-12 , riboflavin , pantothenate , calcium , phosphorus , magnesium , zinc , and potassium intakes . Prevalence of nutrient inadequacy , assessed for nutrients with Estimated Average Requirements , decreased among women in the milk group for magnesium ( 40 % at baseline vs 13 % at 12 weeks , P < .001 ) and vitamin B-12 ( 6 % vs 0 % , P < .05 ) and tended to decrease ( P < .10 ) for protein and thiamin ( women ) and magnesium and vitamin B-6 ( men ) . The milk group gained 0.6 kg more than control group ( P < .01 ) ; however , weight gain was less than predicted , which suggests some compensation for the added energy from milk . Blood pressure decreased similarly over time in both groups . Total and low-density lipoprotein cholesterol levels , and the ratio of total cholesterol to high-density lipoprotein cholesterol , were unchanged . Triglyceride levels increased within the normal range in the milk group ( P = .002 ) . Quality of life scores were high at baseline and remained high throughout . APPLICATIONS/ CONCLUSIONS Older adults can successfully increase milk intake , thereby meaningfully improving their nutrient intakes . Dietitians can play a key role in disseminating this advice BACKGROUND Vitamin-D deficiency and vitamin-D receptor genotype ( VDR ) are risk factors for several disorders with inflammatory components , including coronary heart disease ( CHD ) and diabetes , though the mechanisms involved are unclear . AIM To examine the hypothesis that vitamin D status modulates the matrix metalloproteinase ( MMP ) system in a population with a high prevalence of vitamin D deficiency , a situation affecting susceptibility to CHD and diabetes . DESIGN Prospect i ve cross-sectional , interventional and embedded studies . METHODS Circulating MMP2,9 , the inhibitor TIMP-1 and C-reactive protein ( CRP ) were measured during studies of vitamin-D deficiency as a risk factor for type 2 diabetes and CHD in 171 healthy British Bangladeshi adults , free of known diabetes or major illness .  Vitamin D status , VDR genotype , body-build , blood pressure , lipid and insulin profiles , glucose tolerance , fibrinogen , PAI-1 , folate and homocysteine were measured . Vitamin-D-deficient subjects were re-assessed after 1 years ' supplementation .  MMP , TIMP-1 and CRP levels were measured in 41 subjects halfway through 5-year follow-up . Independent determinants of circulating concentrations of MMP9 , TIMP-1 and CRP were assessed by multiple regression analysis . RESULTS Vitamin D status was the sole determinant of circulating MMP9 ( inversely ) and an independent determinant of CRP ( inversely ) . Determinants of TIMP-1 were MMP9 , systolic blood-pressure ( directly ) and VDR genotype ( TaqI ) . Significant reductions in MMP9 ( -68 % ) , TIMP-1 ( -38 % ) and CRP ( -23 % ) concentrations followed vitamin-D supplementation . DISCUSSION Vitamin-D insufficiency is associated with increased circulating MMP2,9 and CRP , correctable by supplementation . This finding provides a possible mechanism for tissue damage in chronic inflammatory conditions , including CHD and diabetes Experimental evidence suggests a specific role for the active metabolite of vitamin D ( 1,25(OH)2D3 ) in insulin secretion . In order to evaluate the possible clinical significance , 65 middle-aged men with impaired glucose tolerance , and normal serum levels of vitamin D metabolites , were enrolled in a three-month study where they were given either 0.75 micrograms alpha-calcidol ( 1 alpha(OH)D3 ) daily or placebo .  Indices of glucose and lipid metabolism were evaluated before and after treatment . There were no significant changes during the trial neither for fasting blood glucose , hemoglobin A1c or for the intravenous glucose tolerance between the treatment and the placebo groups , nor were there any consistent changes in insulin values during the glucose tolerance test . Subjects treated with alpha-calcidol displayed a significant reduction in body weight with an average of 1.1 kg , while those receiving placebo lost no weight . Treatment did not affect the serum lipoprotein values . Thus , a modest dose of active vitamin D , which did not cause elevation of serum calcium , did not provide general improvement of glucose tolerance or of insulin secretion when given to patients with impaired glucose tolerance , but without vitamin D deficiency , over a three-month period
target: Evidence from trials with vitamin D and /or calcium supplementation suggests that combined vitamin D and calcium supplementation may have a role in the prevention of type 2 DM only in population s at high risk ( i.e. glucose intolerance ) .
  Vitamin D and calcium insufficiency may negatively influence glycemia , whereas combined supplementation with both nutrients may be beneficial in optimizing glucose metabolism
background: CONTEXT Altered vitamin D and calcium homeostasis may play a role in the development of type 2 diabetes mellitus ( type 2 DM ) .