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OBJECTIVE -The International Diabetes Mellitus Practice Study is a 5-year survey documenting changes in diabetes treatment practice in developing regions.RESEARCH DESIGN AND METHODS -Logistic regression analysis was used to identify factors for achieving A1C Ͻ7% in 11,799 patients (1,898 type 1 diabetic and 9,901 type 2 diabetic) recruited by 937 physicians from 17 countries in Eastern Europe (n ϭ 3,519), Asia (n ϭ 5,888), Latin America (n ϭ 2,116), and Africa (n ϭ 276).RESULTS -Twenty-two percent of type 1 diabetic and 36% of type 2 diabetic patients never had A1C measurements. In those with values for A1C, blood pressure, and LDL cholesterol, 7.5% of type 1 diabetic (n ϭ 696) and 3.6% of type 2 diabetic (n ϭ 3,896) patients attained all three recommended targets (blood pressure Ͻ130/80 mmHg, LDL cholesterol Ͻ100 mg/dl, and A1C Ͻ7%). Selfmonitoring of blood glucose was the only predictor for achieving the A1C goal in type 1 diabetes (odds ratios: Asia 2.24, Latin America 3.55, and Eastern Europe 2.42). In type 2 diabetes, short disease duration (Asia 0.97, Latin America 0.97, and Eastern Europe 0.82) and treatment with few oral glucose-lowering drugs (Asia 0.64, Latin America 0.76, and Eastern Europe 0.62) were predictors. Other region-specific factors included lack of microvascular complications and old age in Latin America and Asia; health insurance coverage and specialist care in Latin America; lack of obesity and self-adjustment of insulin dosages in Asia; and training by a diabetes educator, self-monitoring of blood glucose in patients who self-adjusted insulin, and lack of macrovascular complications in Eastern Europe.CONCLUSIONS -In developing countries, factors pertinent to patients, doctors, and health care systems all impact on glycemic control. Diabetes Care 32:227-233, 2009A lthough optimizing diabetes care reduces death and complication rates (1-3), multiple barriers hinder turning evidence into practice (4,5). Most diabetic patients reside in developing countries (6) where standardized data on quality of care is relatively scarce. The International Diabetes Management Practices Study (IDMPS) is an ongoing observational survey to collect, analyze, and disseminate data in a standardized manner. By documenting changes in practices over time in a broad range of health care settings, we aim to raise awareness and identify barriers to quality diabetes care. Other objectives include evaluation of clinical progress, levels of compliance, attainment of treatment targets, and rates of hospitalization and work absenteeism. This analysis of the first-year survey examines factors predictive of glycemic control.RESEARCH DESIGN AND METHODS -There are five waves in this 5-year study, each consisting of a 2-week cross-sectional and a 9-month longitudinal survey. A 3-month interval separates the end of the longitudinal survey and the start of the next wave. Study design and reporting format are in accordance with the recommended STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guideline...

Results: Waist circumference, waist-to-hip ratio (WHR), and US-determined visceral fat values showed the best correlation coefficients with visceral fat determined by CT (r ϭ 0.55, 0.54, and 0.71, respectively; p Ͻ 0.01). Fat mass determined by DXA was inversely correlated with visceralto-subcutaneous-fat ratio (r ϭ Ϫ0.47, p Ͻ 0.01). Bioimpedance-determined fat mass and skinfolds were correlated with only subcutaneous abdominal fat quantified by CT. Linear regression indicated US visceral-fat distance and WHR as the main predictors of CT-determined visceral fat (adjusted r 2 ϭ 0.51, p Ͻ 0.01). A waist measurement of 107 cm (82.7% specificity, 60.6% sensitivity) and WHR of 0.97 (78.8% specificity, 63.8% sensitivity) were chosen as discriminator values corresponding with visceral obesity diagnosed by CT. A value of 6.90 cm for visceral fat USdetermined diagnosed visceral obesity with a specificity of 82.8%, a sensitivity of 69.2%, and a diagnostic concordance of 74% with CT.Discussion: US seemed to be the best alternative method for the assessment of intra-abdominal fat in obese women. Its diagnostic value could be optimized by an anthropometric measurement. Prospective studies are needed to establish CT and US cutoffs for defining visceral-fat levels related to elevated cardiovascular risk.

Cross-talk between the gut microbiota and the host immune system regulates host metabolism, and its dysregulation can cause metabolic disease. Here, we show that the gut microbe Akkermansia muciniphila can mediate negative effects of IFNγ on glucose tolerance. In IFNγ-deficient mice, A. muciniphila is significantly increased and restoration of IFNγ levels reduces A. muciniphila abundance. We further show that IFNγ-knockout mice whose microbiota does not contain A. muciniphila do not show improvement in glucose tolerance and adding back A. muciniphila promoted enhanced glucose tolerance. We go on to identify Irgm1 as an IFNγ-regulated gene in the mouse ileum that controls gut A. muciniphila levels. A. muciniphila is also linked to IFNγ-regulated gene expression in the intestine and glucose parameters in humans, suggesting that this trialogue between IFNγ, A. muciniphila and glucose tolerance might be an evolutionally conserved mechanism regulating metabolic health in mice and humans.

Carotenoid is a group of pigments naturally present in vegetal raw materials that have biological properties. These pigments have been used mainly in food, pharmaceutical, and cosmetic industries. Currently, the industrial production is executed through chemical synthesis, but natural alternatives of carotenoid production/attainment are in development. The carotenoid extraction occurs generally with vegetal oil and organic solvents, but supercritical technology is an alternative technique to the recovery of these compounds, presenting many advantages when compared to conventional process. Brazil has an ample diversity of vegetal sources inadequately investigated and, then, a major development of optimization and validation of carotenoid production/attainment methods is necessary, so that the benefits of these pigments can be delivered to the consumer.

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FOR THE JAPANESE-BRAZILIAN DIABETESSTUDY GROUP* OBJECTIVE -The aim of this study was to examine the association of nutrient intakes with metabolic syndrome in a Japanese descendant population at high risk for metabolic abnormalities. RESEARCH DESIGN AND METHODS-In a population-based study of Japanese Brazilians aged Ն30 years, 412 men and 465 women were studied. The diagnosis of metabolic syndrome was based on the National Cholesterol Education Program criteria modified for Asians. Food intake was assessed by a validated food frequency questionnaire.RESULTS -Men and women showed similar mean ages (55.7 Ϯ 12.7 and 54.4 Ϯ 11.9 years) and 49% (95% CI 44.8 -54.6) and 43% (38.4 -47.6) had metabolic syndrome, respectively. As expected, clinical parameters were less favorable in the subset of subjects with metabolic syndrome. Men with metabolic syndrome showed higher cholesterol (233.2 Ϯ 116.3 vs. 211.7 Ϯ 5.8 g/day, P Ͻ 0.05) and lower carbohydrate (288.5 Ϯ 45.8 vs. 300.1 Ϯ 39.8 g/day, P Ͻ 0.001) intakes than those without metabolic syndrome, but no difference was observed among the women. After adjusting for sex, age, smoking, education level, generation, physical activity, total energy, and dietary fiber intake, a positive association between metabolic syndrome and total fat intake was detected. Comparing people in the highest quintile of total fat consumption with those in the lowest quintile, odds ratio (OR) of metabolic syndrome was 5.0 ([95% CI 1.58 -16.00]; P Ͻ 0.005). In contrast, linoleic acid intake was inversely associated with metabolic syndrome (OR 0.50 [95% CI 0.26 -0.98]; P Ͻ 0.05). Considering food groups, after adjustments only fried food intake was shown to be associated with increased risk of metabolic syndrome.CONCLUSIONS -Despite the limitation of such a study design in investigating causeeffect relationships, our findings favor the hypothesis that dietary total fat may increase whereas linoleic acid intake may reduce the risk of metabolic syndrome in Japanese descendants living in Brazil. Diabetes Care 28:1779 -1785, 2005T he concept of metabolic syndrome includes a number of metabolic disturbances linked by insulin resistance, which increase cardiovascular risk (1). Weight gain (in particular, the abdominal depot of body fat) has a key role for the development of the syndrome.Lack of physical activity and certain dietary patterns, including high saturated fatty acid and low vegetable intake, contribute to weight gain and increase the risk of metabolic disturbances (2,3), whereas such potentially modifiable lifestyle factors may reduce cardiovascular risk.Metabolic syndrome is highly prevalent in the U.S. with an estimated 24% of the adult population affected (4). The National Cholesterol Education Program (5) defined metabolic syndrome based on several parameters including anthropometric measurements. However, anthropometric cutoffs to identify high-risk subjects may be influenced by ethnicity (6,7). Based on the fact that in Asian populations morbidity and mortality are occurring in people with ...

Abstract-Visceral fat accumulation is associated with increased cardiovascular risk. Clinical evaluation of visceral fat is limited because of the lack of reliable and low-cost methods. To assess the correlation between ultrasonography and computed tomography (CT) for the evaluation of visceral fat, 101 obese women, age 50.5Ϯ7.7 years with a body mass index of 39.2Ϯ5.4 kg/m 2 , were submitted to ultrasonograph and CT scans. Visceral fat measured by ultrasonography, 1 cm above the umbilical knot, showed a high correlation with CT-determined visceral fat (rϭ0.67, PϽ0.0001). The ultrasonograph method showed good reproducibility with an intra-observer variation coefficient of Ͻ2%. Both ultrasonograph and CT visceral fat values were correlated with fasting insulin (rϭ0.29 and rϭ0.27, PϽ0.01) and plasma glucose 2 hours after oral glucose load (rϭ0.22 and rϭ0.34, PϽ0.05), indicating that ultrasonography is a useful method to evaluate cardiovascular risk. A significant correlation was also found between visceral fat by CT and serum sodium (rϭ0.18, PϽ0.05). A ultrasonograph-determined visceral-to-subcutaneous fat ratio of 2.50 was established as a cutoff value to define patients with abdominal visceral obesity. This value also identified patients with higher levels of plasma glucose, serum insulin and triglycerides and lower levels of HDL-cholesterol, which are metabolic abnormalities characteristic of the metabolic syndrome. Our data demonstrate that ultrasonography is a precise and reliable method for evaluation of visceral fat and identification of patients with adverse metabolic profile.