Saturday, 31 December 2016

Verging On Obese? Get Ready For Neuropathy!

Today's post from (see link below) is so short, you might wonder why it appears here at all. It may be short but at the end of a festive season for many (if only it were festive for all!) where vast quantities of food have been eaten and waistlines have been irreversibly expanded, you may want to spare a thought for the potential consequences. Have you seen the latest statistics about obesity in the population!!! Of course, over eating and regularly eating the 'wrong' sort of food can lead to diabetes and the commonest cause of neuropathy is diabetes but the message here is much wider than that. This study shows that obese people are prone to nerve damage, irrespective of their glucose and blood sugar levels, so the message is clear - obesity is to be avoided at all costs, for all sorts of health reasons. Unfortunately, neuropathy doesn't frighten people until they have it and then it's too late! We've not even reached New Year's Eve yet, after a crazy year in human history, so before you go on that last food binge before 2017 (it's never the 'last' one), try to make and stick to a New Year's resolution before it sticks to your waistline and brings you nerve damage which you'll regret for ever!

Causes of Polyneuropathy in an Obese Population
JAMA Neurol; ePub 2016 Oct 31; Callaghan, et al November 15, 2016

The prevalence of polyneuropathy is high in obese individuals, even those with normal glucose levels, with diabetes, prediabetes, and obesity being the likely metabolic drivers, a recent study found. This cross-sectional study included 102 obese participants (mean age 52.9 years; 45 [44.1%] with normoglycemia, 31 [30.4%] with prediabetes, and 26 [25.5%] with type 2 diabetes), and 53 lean controls. 

Researchers found:
The prevalence of polyneuropathy was 3.8% in lean controls (n=2), 11.1% in the obese participants with normoglycemia (n=5), 29% in the obese participants with prediabetes (n=9), and 34.6% in obese participants with diabetes (n=9). 

Age (OR, 1.09), diabetes (OR, 4.90), and waist circumferences (OR, 1.24) were significantly associated with neuropathy in multivariable models. 

Prediabetes (OR, 3.82) was not significantly associated with neuropathy.

: Callaghan BC, Xia R, Reynolds E, et al. Association between metabolic syndrome components and polyneuropathy in an obese population. [Published online ahead of print October 31, 2016]. JAMA Neurol. doi:10.1001/jamaneurol.2016.3745.

Commentary: Polyneuropathy can range in severity from bothersome, with intermittent tingling and numbness, to severe and disabling. We are familiar with it as a long-term complication of diabetes as well as occurring sporadically in patients without diabetes. We are beginning to recognize that many of the sporadic cases in patients without diabetes may be due to prediabetes and obesity. A previous paper in Diabetes Care demonstrated that evidence of polyneuropathy was found in 49% of a large cohort of patients with prediabetes and that progression of glucose intolerance over 3 years predicted a higher risk of peripheral neuropathy and nerve dysfunction.1 The lack of relationship to prediabetes reported in the current paper is likely due to the relatively small numbers of patients with prediabetes in the study, since the hazard ratio for polyneuropathy with prediabetes was 3.8. The current paper expands these non-diabetes related risk factors for peripheral neuropathy to include obesity as well as diabetes. —Neil Skolnik, MD
Lee CC, et al. Peripheral neuropathy and nerve dysfunction in individuals at high risk for type 2 diabetes: The PROMISE cohort. Diabetes Care. 2015;38:1-8. doi:10.2337/dc14-2585.

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