Saturday, May 30, 2009

10 Great Reasons to Strength Train For the Rest of Your Life

By: Gen Wright

Are you looking to be strong and fit for life, strong enough to take off for the slopes at a moment's notice, continue playing a sport, or spend holidays tramping in out of the way locations around the world? The simple answer to achieve any of these levels of fitness is two words: Strength Training. When it comes to building and maintaining strength, no other form of exercise offers a better bang for your buck and here's what it can do for you:

1. Avoid Muscle Tissue Loss
Through inactivity adults lose between 2.2 kg and 3.2 kg of lean muscle tissue every decade. Only strength training exercise will stop this happening throughout our lives. Although endurance exercise such as running, swimming etc improves our cardiovascular fitness, it does not prevent the loss of muscle tissue.

2. Avoid Metabolic Rate Reduction
Because muscle tissue is a very active tissue, muscle loss is accompanied by a reduction in our resting metabolism (the rate the body burns fuel) by 2 to 5 percent every decade. Strength training prevents muscle tissue loss preventing the accompanying decrease in resting metabolic rate.

3. Increase Metabolic Rate
Research reveals that simply adding 1.4kg of muscle tissue increases our resting metabolism by 7% and our daily calorie requirements by 15% reducing the likelihood of body fat accumulation.

4. Reduce Body Fat
Muscle tissue is metabolically active, meaning it burns calories. The more of it we have the more calories we burn while we are sleeping, working, and through exercise. For example, think of your metabolism like a car, the more muscle you have, the larger your engine and the more calories (fuel) you burn. If we neglect strength training, our metabolism might be closer to that of a scooter instead of a grunty V8!

5. Increase Bone Mineral Density
Not only does strength training exercise stimulate muscle growth; it also stimulates the growth of bone tissue. Bone mineral density peaks at age 20 then gradually declines for the rest of our lives. This makes us very susceptible to fractures, "shrinking" and diseases such as sarcopenia (muscle loss) and osteoporosis bone loss) as we age.

6. Improve Glucose Metabolism.
Strength training increases the use of blood sugars into the muscles, helping reduce the chance of developing diabetes. Researchers have reported a 23 percent increase in glucose uptake after four months of strength training.

7. Reduce Resting Blood Pressure
Strength training alone has been shown to reduce resting blood pressure significantly reducing risk of heart disease. If our muscles are stronger, less stress is placed on our cardiovascular (heart/lung) system while performing day to day activities.

8. Improve Joint Strength and Stability
Increasing the strength of muscles, also greatly enhances the strength and stability of the our joints. This decreases the stress put on them in day to day activities reducing degeneration of our joints. Arthritis is prevented or symptoms reduced with stronger muscles.

9. Improve Vitality and Quality of Life
The condition of our muscles is responsible for our energy, vigor and our ability to perform everyday activities with ease. Muscles are like an engine of a car, if they are well looked after, you can drive it regularly without fear of it breaking down and strength training is the means to keep them in top condition.

10. Improve Sporting Performance
All forms of power, speed, coordination and explosiveness come from having a good base of strength. Strength training is an effective means of increasing our physical capacity, improving our athletic performance, reducing our injury risk and increasing our enjoyment of our chosen sport.

So as you can see strength training should be performed by everyone. Men, women, children and older people can all benefit from strength training. It prevents our body from deteriorating enabling us to live longer and enjoy more of life as we age.

Strength training really is anti-aging and can match our health span with our life span.


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Coffee Intake not linked to increased deaths

Coffee Intake Not Linked to Increased Mortality in Men or Women

News Author: Laurie Barclay, MD
CME Author: Charles Vega, MD
Ann Intern Med. 2008;148:904-914

June 20, 2008 — Coffee intake does not increase the risk for all-cause mortality in men or women and may decrease risk for cardiovascular mortality, according to the results of a study reported in the June 17 issue of the Annals of Internal Medicine.

"Coffee consumption has been linked to various beneficial and detrimental health effects, but data on its relation with mortality are sparse," write Esther Lopez-Garcia, PhD, from the Harvard School of Public Health, Brigham and Women's Hospital, and Harvard Medical School in Boston, Massachusetts, and colleagues. "Several studies have suggested that coffee might decrease the risk for some types of cancer, such as liver, colon, oral, pharyngeal, and esophageal. The objective of this study was to assess the association of coffee consumption with all-cause, cardiovascular disease (CVD), and cancer mortality."

The investigators used sex-specific Cox proportional hazard models to investigate the association between coffee consumption and the incidence of all-cause and disease-specific mortality in the prospective Health Professionals Follow-up Study and Nurses' Health Study. The study cohort consisted of 41,736 men and 86,214 women with no history of CVD or cancer at baseline.

Coffee consumption was first measured in 1986 for men and in 1980 for women and then every 2 to 4 years through 2004. During an 18-year follow-up, there were 6888 documented deaths (2049 from CVD and 2491 from cancer) in men and 11,095 deaths (2368 from CVD and 5011 from cancer) in women.

Both in men and in women, the relative risks for all-cause mortality across categories of coffee consumption decreased with increasing coffee intake, after adjustment for age, smoking, and other CVD and cancer risk factors. Compared with consumption of less than 1 cup per month, consumption of 6 or more cups per day was associated with a 20% decrease in the risk in men and a 17% decrease in the risk in women.

This inverse association was independent of caffeine intake and was primarily attributed to a moderately reduced risk for CVD mortality.

After adjustment for potential confounders, coffee consumption was not statistically significantly associated with the risk for cancer death.

Intake of decaffeinated coffee was linked to a small decrease in all-cause and CVD mortality rates.

The primary limitation of this study is reliance on self-report for estimated coffee consumption. The cohort was restricted to health care professionals, limiting generalizability.

"Regular coffee consumption was not associated with an increased mortality rate in either men or women," the study authors write. "The possibility of a modest benefit of coffee consumption on all-cause and CVD mortality needs to be further investigated. . . . Our data also suggest that this association was due to components in coffee other than caffeine."

The National Institutes of Health, the Ramón y Cajal Programme, and the American Heart Association supported this study. Two of the study authors are supported by the Ramón y Cajal Programme and the American Heart Association The other 3 study authors have disclosed no relevant financial relationships.

Clinical Context

Coffee is a complex substance with multiple physiologic effects. Previous research has suggested that coffee could lower C-reactive protein levels among women with diabetes. In addition, regular coffee consumption can reduce the susceptibility of low-density lipoprotein (LDL) cholesterol to oxidation, creating more stable arterial plaques. Coffee also contains antioxidants and multiple substances that may improve insulin sensitivity. However, coffee also contains caffeine, which can inhibit insulin activity, stimulate the release of epinephrine, and acutely raise homocysteine levels.

The effect of coffee consumption on the risk for mortality remains unclear, and the current study uses 2 large databases to address this issue.

Pearls for Practice

Although some substances in coffee promote increased insulin sensitivity, caffeine does not. Coffee contains antioxidants and may reduce the rate of oxidation of LDL cholesterol.
The current study finds that coffee consumption is associated with a modest trend toward a reduction in the risk for total mortality among men and women. In particular, coffee consumption reduced the risk for cardiovascular mortality.

Sunday, May 24, 2009

Hospitalized H1N1 Flu Cases in California Show Range of Severity

Emma Hitt, PhD

May 20, 2009 — A report describing 30 novel H1N1 influenza case patients, hospitalized from April 20 to May 17 in California, indicates no deaths as of yet, but describes a range of disease, including severe and prolonged complications.

The report, in the Morbidity and Mortality Weekly Report (MMWR) from the Centers for Disease Control and Prevention (CDC) issued on Monday, also includes a detailed description of 4 of the 30 cases.

Anne Schuchat, MD, the interim deputy director for Science and Public Health Program and director of the CDC's National Center for Immunization and Respiratory Diseases, described the report’s findings at yesterday’s CDC media briefing.

“The detailed descriptions of 4 cases...illustrate the spectrum of illness that we’re seeing with this virus,” Dr. Schuchat said. “Even among hospitalized cases, there seems to be a range of severity from relatively short hospitalizations to longer, much more complicated hospitalizations,” she said.

The most common diagnoses for the patients upon admission were pneumonia and dehydration. Of the patients, 64% had underlying medical conditions, the most common being lung disease (eg, chronic obstructive pulmonary disease and asthma). Patients also had immunosuppressive conditions, chronic heart disease, diabetes, and obesity.

Typical symptoms reported among patients included fever (97%), cough (77%), vomiting (46%), and shortness of breath (43%). Diarrhea was present in only 3 patients (10%).

Of the 30 patients, 25 underwent chest X-ray. Of those, 15 patients (60%) had abnormalities indicative of pneumonia, including 10 with multilobar infiltrates and 5 with unilobar infiltrates; 4 patients required mechanical ven¬tilation.

Five of the patients were pregnant, and 2 of these women developed complications, including spontaneous abortion and premature rupture of the membranes, which resulted in termination of the pregnancies at 13 and 35 weeks of gestation, respectively.

“The role that preceding infection with novel influenza A (H1N1) played in these outcomes is unclear,” according to an editorial note in the MMWR report.

No evidence of secondary bacterial infection was present in any of the patients.

Half of the patients received antiviral treatment with oseltamivir, with one third of those receiving treatment within 48 hours of symptom onset.

As of May 17, according to the report, 7 patients remain hospitalized with a median length of stay of 15 days. The rest of the patients were discharged home with a median length of hospital stay of 4 days (range, 1 – 10 days).

The report also describes 4 of the hospitalized cases in detail. One was a 5-month-old female infant who was in the hospital recovering from neonatal complications and was diagnosed with opacification of both lung fields upon X-ray at day 150 of her hospital stay. The infant remains hospitalized in critical condition.

Another case report describes a previously healthy, 29-year-old woman who was 28 weeks pregnant. Although she was not treated with antiviral medications, the patient gradually improved and was discharged on amoxicillin after 9 days.

During the press conference, Dr. Schuchat noted that pregnancy is a risk factor for worse complications from influenza due to immunosuppression. “We think it’s important to treat with antiviral drugs — sometimes doctors are worried about using medicines during pregnancy,” she told Medscape Infectious Diseases, but she added that “use of one of the antiviral drugs is probably appropriate in treating such women.”

A third case involved a 32-year-old man with a history of obstructive sleep apnea who sought care after a 3-day history of fever, chills, and productive cough. After a course of broad spectrum antibiotics, the man improved and was discharged on hospital day 10.

The fourth patient described was an 87-year-old woman with multiple medical problems, including recently diagnosed breast cancer. The patient was brought in after being found unconscious and remains hospitalized in critical condition under intensive care.

The report, authored by the California Department of Public Health, notes that false-positive and false-negative results may be common for the rapid antigen test and are recommending that clinicians collect respiratory specimens for real-time reverse transcription–polymerase chain reaction "testing, subtyping, and further characterization at public health laboratories from patients who are hospitalized or who die with febrile respiratory illness.”

Morb Mortal Wkly Rep. Published online May 18, 2009.

Friday, May 22, 2009

Efficacy of Pneumococcal Vaccine Questionable in Adults: Meta-Analysis

From Reuters Health Information

NEW YORK (Reuters Health) Jan 05 - Results of a meta-analysis call into question the ability of pneumococcal vaccination to prevent pneumonia in adults, even in populations for whom the vaccine is currently recommended, researchers from Switzerland and the UK conclude in a report released today.

Clinical trials have produced conflicting results on the efficacy of unconjugated pneumococcal polysaccharide vaccine in adults, Dr. Anke Huss from University of Bern and colleagues explain in the January 6 issue of the Canadian Medical Association Journal. Meta-analyses have also produced varied results depending on the trials included.

Dr. Huss and colleagues conducted a meta-analysis of 22 trials (n=101,507) that compared pneumococcal polysaccharide vaccine with a control, taking into account the methodologic quality of the trials -- something past meta-analyses have failed to do, the researchers note.

Eleven of the studies reported on instances of "presumptive pneumococcal pneumonia, 19 on all-cause pneumonia and 12 on all-cause mortality. The current 23-valent vaccine was used in 8 trials," they report.

Dr. Huss and colleagues found "little evidence of vaccine protection in trials of higher methodologic quality." The relative risk was 1.20 for presumptive pneumonia and 1.19 for all-cause pneumonia in double-blind trials.

In addition, there was little evidence of vaccine protection among elderly patients or adults with chronic illness in analyses of all trials. The relative risk was 1.04 for presumptive pneumococcal pneumonia, 0.89 for all-cause pneumonia, and 1.00 for all-cause mortality.

"The prevention of the large burden of disease associated with pneumococcal pneumonia should be a major objective from a public health perspective," Dr. Huss and colleagues note. "This will not be achieved with the use of the currently available pneumococcal polysaccharide vaccine, even allowing for a modest protective effect against invasive pneumococcal disease," they conclude.

However, the authors of an accompanying editorial caution that, "on balance, the study by Huss and colleagues does not justify ceasing pneumococcal polysaccharide vaccination of adults."

Drs. Ross Andrews and Sarah A. Moberley of the Menzies School of Health Research, Casuarina, Northern Territory, Australia, point out that the findings of this meta-analysis were noted in the current World Health Organization position paper on the 23-valent vaccine, but no change in recommendations for the use of the vaccine were made.

"The position of the World Health Organization is that randomized trials, meta-analyses of randomized trials, and most observational studies are consistent with a protective effect against invasive pneumococcal disease among healthy adults and, to a lesser extent, among individuals aged 65 years or more. In the absence of any new data to the contrary, we support that position," they conclude.

CMAJ 2009;180:18-19,48-58.

Smoking increases risk of memory decline

Smoking Appears Linked With Risk for Poor Memory in Middle Age CME/CE

News Author: Marlene Busko
CME Author: Penny Murata, MD

June 12, 2008 — Smoking is linked to an increased risk for memory deficit and cognitive decline in middle age in an analysis based on data from Whitehall II, a large, prospective cohort study.

The findings by Séverine Sabia, MSc, at the Institut National de la Santé et de la Recherche Médicale, in Villejuif, France, and colleagues, are published in the June 9 issue of the Archives of Internal Medicine.

Compared with study participants who had never smoked, after adjustment for other confounding factors, smokers had a 37% increased risk of having scores in the lowest quintile on a memory test (they were more likely to recall less than 5 of 20 words), Ms. Sabia told Medscape Psychiatry.

Cognitive Decline in Middle Age

"This risk is quite important considering that we are only in middle-age when cognitive decline is just starting," she noted. Evidence of this association at this age could support the hypothesis that smoking is involved in the pathogenesis of preclinical cognitive deficit and decline, which is a risk factor for later dementia, she added.

With the aging population and the projected increases in older adults with dementia, it is important to identify modifiable risk factors, she noted. "Our results suggest that smoking had an adverse effect on cognitive function in midlife, [but] 10 years after smoking cessation, there was little adverse effect of smoking on cognition," she added. "Thus, public health messages should target smokers at all ages."

A recent meta-analysis concluded that smoking is a risk factor for dementia, the group writes, adding that it is problematic to study the link between smoking and cognition (thinking, learning, and memory) in older people because many study participants do not return for follow-up visits, or they die from smoking-related diseases.

At the same time, there is increasing evidence that midlife risk factors play a role in later dementia.

A meta-analysis by Anstey and colleagues in the August 15, 2007, issue of the American Journal of Epidemiology found that smoking is a risk factor for dementia. However, as noted by Kukull in the February 1, 2001, issue of Biological Psychiatry, the effects of smoking might be difficult to determine because of attrition and smoking-related mortality before the diagnosis of dementia. However, the effects of smoking on cognitive ability before the onset of dementia could be examined.

In the Whitehall II study described by Marmot and colleagues in the June 8, 1991, issue of The Lancet, civil servants were recruited in 1985 to assess the link between socioeconomic factors and health. This study uses the Whitehall II database to examine whether smoking history is associated with cognitive function in middle-aged adults and to assess the risk for death and participation in cognitive tests in those who smoke.

After adjustment for age, sex, sociodemographics, and health behaviors, middle-aged smokers vs never-smokers are more likely to have cognitive deficits in memory and decline in reasoning skills. Long-term ex-smokers vs never-smokers are less likely to have deficits in memory, vocabulary, and fluency.

Middle-aged adults who smoke have a higher risk for death or nonparticipation in cognitive tests

http://cme.medscape.com/viewarticle/575940?sssdmh=dm1.474949&src=nldne

Wednesday, May 20, 2009

Positive Brainwashing

By:Cornelis Boertjens Creator of Vision Board

Brainwashing is a term perceived in a negative way by most people. But you know what, I think our brains could actually do with a bit of a washing sometimes!

You see, everyone comes into this world with a clear mind, and a belief that everything is possible. All is positive and well. Remember as a child, you could do and become everything, without any boundaries!

As we grow up however, we pick up beliefs, fears and limitations from our surroundings and peers that gradually form the person we are today. A lot of these beliefs unfortunately are negative and as we build our lives they limit us in our actions and being. Very often they therefore contribute to unhappiness or feeling unfulfilled in our lives and business.

It can be the smallest -- seemingly harmless -- remark from a mother like “just let me handle that, you are no good at that” that can convince you that you are not good at a certain task. A teacher who calls a pupil “the clumsy one” can do more harm with this remark than he realizes when repeated often enough. With every remark the belief is harnessed further in the child that it indeed is clumsy. Even though a remark is said with a smile or with the intend to be funny, it still leaves a legacy in the belief system.

This programming of course doesn’t stop at adulthood, it keeps influencing people in all stages of life. We are being influenced by our parents, kids, partner, friends, colleagues, television, newspapers, magazines and so on. Sometimes positive, but very often in a negative way. No wonder we limit ourselves in so many ways! Belief is the key to your success. If you belief you can do something, you can. If you belief you can’t do something, you will be right too.

The good news is: we can “reprogram” our mind and replace our negative, limiting beliefs for positive contributing ones. Positive brainwashing is what I like to call it!

An example is “I easily do 10 sales calls a day”. Or “I am an excellent negotiator”. By stating this positive affirmation regularly during your day, you will achieve the goal you have set for yourself easier. This positive self talk helps your mind to overcome beliefs that you have about yourself, that limit your success and actions. Compare our mind with a computer: when you change the input, the output will change accordingly.

So if you have the limiting belief that you are no good in public speaking (probably because of negative experiences in the past) you can actually reprogram your mind by stating the following affirmation: “ I am an excellent public speaker. I love to speak for huge audiences and people love to hear me talk”. By affirming this belief over and over, you actually start to believe it and your mind will find a way to make this statement a reality. At some stage, you might decide to do a course in public speaking, or someone might ask you to speak at some kind of seminar, which forces you to work on your speaking skills. Somehow, this positive affirmation help you to reach the ‘goal’ you have set for yourself, and open doors for you that would normally would have been kept closed. And this works for virtually everything. Belief, and it will happen.

Imagine standing for a big river, with a heavy stream. You have to cross it, but you don’t think you can actually do it. Your belief is keeping you from crossing, although you physically should be able to do it easily. It just looks too hard! Then someone else comes up from behind you, and without thinking starts crossing the river and gets to the other side. His belief was positive, and he knew he could do it. The interesting thing is that this will probably influence your belief: “if he can do it, I can do it too” and you will then cross the river without any problem at all. Similar things happen when a group of people is introduced to the phenomenon of fire walking. At first a big group of people will say that there is no way they will walk on fire. Until…other people with higher beliefs go first, then all of a sudden everyone else rushes over to do it as well.

So think about YOUR beliefs, and try to discover which belief are actually holding you back from reaching your full potential in your life. Then, one by one, start eliminating these beliefs from your system. Formulate a positive affirmation that counters your negative belief, and re affirm it daily. Write them in your diary, on your bathroom mirror, next to your computer; anywhere you see it often and say the affirmation out loud as often as possible. You will be happily surprised by the results!

Smart Articles @ http://www.articlebrain.com

Thursday, May 14, 2009

Management of H1N1 Influenza

H1N1 INFLUENZA A (SWINE FLU)

source http://images.medscape.com/pi/features/misc/swineflu/swine-flu-chart.pdf?src=mp&spon=9&uac=71630FV

Suspected H1N1 Influenza
Patient with:
• Fever > 100.4ºF (> 38ºC) and
• Respiratory signs and symptoms (cough, sore throat, dyspnea) and
• Onset of acute illness within 7 days of close contact with a person who has a confirmed case of influenza A (H1N1) virus infection, or
• Onset of acute illness within 7 days of travel to a community (in the United
States or internationally) where one or more influenza H1N1 cases have been
confirmed, or
• Residence in a community where at least one influenza H1N1 case has been
confirmed.

Laboratory Testing
Obtain and refrigerate a respiratory specimen for H1N1 influenza testing:
o Preferred—nasopharyngeal swab/aspirate or nasal wash/aspirate
o Acceptable—combined nasal swab with oropharyngeal swab
o Intubated patients—also collect an endotracheal aspirate
• Contact state or local health department to facilitate testing at a state public
health laboratory

Infection Control
Institute:
o Standard precautions (hand hygiene)
o Contact precautions (gown & gloves)
o Droplet precautions (eye protection: goggle or full face shield)
o Airborne precautions (N95 or equivalent respirator)
• Use precautions for all patient care activities
• Maintain precautions for 7 days after illness onset or untilsymptoms have resolved.
• Perform suctioning, bronchoscopy,or intubation in a procedure room with negative-pressure air handling
• Instruct patient in respiratory hygiene/cough etiquette

Transport
• Confine patient to AIIR unless transport is essential
• Notify hospital infection control and receiving departments before transporting patient
• Patient must wear surgical mask when outside AIIRr
Transporter should wear N95
• Avoid populated areas during transport; use secure elevator

Disposition in Hospital
• Notify hospital Infection Control
• Place patient in a single-patient room with the door kept closed.
• If available, an airborne-infection isolation room (AIIR) with negative-pressure air handling can

Environmental Control
Use dedicated noncritical medical equipment (e.g., stethoscope,thermometer) where possible; otherwise, disinfect after use
Follow established guidelines for isolation precautions, including housekeeping practices

Visitors
• Restrict access
• Screen for signs/symptoms of influenza
• Educate in use of infection control

Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings 2007.
http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/Isolation2007.pdf
© 2009 Medscape, LLC

Saturday, May 2, 2009

New-Onset Diabetes in Older Adults Largely Attributable to Lifestyle

News Author: Michael O'Riordan
CME Author: Hien T. Nghiem, MD

April 30, 2009 — Even among older adults, a healthy lifestyle, one that includes physical activity, healthy dietary habits, smoking cessation, and light or moderate alcohol use, is associated with a significantly lower incidence of new-onset diabetes mellitus. Researchers showed that 80% of new cases of diabetes are attributable to these risk factors, a number that increases when obesity is included as a risk factor.

"Our findings suggest that, even later in life, the great majority of cases of diabetes are related to lifestyle factors," write Dariush Mozaffarian (Brigham and Women's Hospital, Boston, MA) and colleagues in the April 28, 2009 issue of the Archives of Internal Medicine. "Our results support the need for emphasizing healthy and achievable physical activity and dietary goals among older adults, including moderate leisure-time activity and walking pace, higher intake of dietary fiber and polyunsaturated fat, and lower intake of trans fat and easily digestible carbohydrates."

Previous studies, including a secondary analysis of the Diabetes Prevention Program trial, have shown that structured dietary advice and physical activity were most effective at reducing the risk of diabetes among the oldest participants. However, as the investigators point out, that trial included mostly high-risk patients participating in a highly structured intervention. Other studies have shown that certain lifestyle behaviors can lower the risk of diabetes, but these often looked at each lifestyle factor individually.

In this analysis of the Cardiovascular Health Study, Mozaffarian and colleagues investigated the relationship between lifestyle risk factors, evaluated in combination, and the incidence of diabetes over a 10-year period in 4883 men and women 65 years of age and older. The group defined optimal lifestyle characteristics and compared these low-risk behaviors with the risk of incident diabetes mellitus.

Low-risk lifestyle behaviors were defined by physical-activity levels above the median and never smoking or smoking ≤5 pack-years or having quit ≥20 years ago. Alcohol use in this cohort was rare, with 94% consuming less than two drinks daily. Individuals were also assigned a dietary score based on their intake of dietary fiber, low glycemic index foods, lower trans fats, and a higher polyunsaturated-to-saturated-fat ratio. Assessments of adiposity were also performed, with a low-risk body-mass index (BMI) defined as not being overweight, or a BMI <25, while a low-risk waist circumference for men was <92 cm and <88 cm for women.

Basic lifestyle risk factors, according to the researchers, strongly predicted diabetes incidence, with individuals cutting their risk in half when they were physically active and had good dietary habits.

Overall, the risk of diabetes was 80% lower among individuals with physical-activity levels above the median, healthy dietary and smoking habits, and moderate alcohol use.

When healthy BMIs and waist circumference were added to the model, the risk of new diabetes was reduced by 89%.

for rest of article refer:

http://cme.medscape.com/viewarticle/702086?sssdmh=dm1.465854&src=nldne