Diabesity: A Multidisciplinary Approach

is a multifactor disease resulting from the interaction of multiple genetic and environmental factors, such as sedentary lifestyle and the diet of the individual. On the other hand, diabetes mellitus is a complex metabolic disease that involves multiple organ systems, and it is characterized by chronic hyperglycemia due to a defect in the glycemic regulation as a result of insulin secretion, its actions or both. Combined, these diseases provide the concept of diabesity, which is defined as the alloy of type II diabetes and obesity, with or without associated risk factors. Obesity encourages diabetes, and both diseases are considered two global epidemics of the modern age that show no signs of decreasing their prevalence and contribute to cardiovascular diseases, the leading cause of death worldwide. This chapter is aimed to characterize both physiopathology and impact on health to understand their management and treatment.

 It is a fact that we eat because we are hungry. If there is an alteration in balance (stimulus), there is a physiological activity (reaction) in a reverse relationship to restore the initial homeostasis hunger/satiety. It is widely recognized that gustatory and olfactory stimuli are transferred from the mother to the fetus through the amniotic fluid. Many of the learnings about food and nutrition In the first two years of life are produced here, which will shape my food preferences and dietary habits that are followed until adulthood, a stage in which some authors have suggested that Obese people show a tendency to salty flavors, as well as greater reactivity to external factors that stimulate pleasure, being less sensitive to internal hunger/satiety signals. On the other hand, the act of eating not only tries to cover a physiological requirement, but other factors also play an essential role in the acquisition of certain eating patterns. The psychological, social, and cultural aspects interrelate with each other and are key to choosing a type of lifestyle. Various authors attribute the confluence of these factors as causal agents of obesity directly, as well as the relevance of personality on food choice. Specifically, neuroticism includes characteristics considered negative emotionality, which influence the eating behaviors of the subjects. In short, sensory stimuli such as smell and taste contribute to the individual choice of food preference, being the choice of diet individually, and therefore, of modulation of appetite, and also, it seems clear that the relationship between personality, emotions and eating pattern, directly affect the tendency to the current obesity conditions.

Obesity is a chronic non-communicable condition. Rates of obesity have risen globally over the last few decades, like the rates of comorbidities of obesity, such as the clustering of metabolic risk factors, as seen in the condition diabesity. Given the high prevalence and widespread nature of these chronic conditions, much effort has been put towards lifestyle interventions, many of which target weight loss or prevention of weight gain. Reducing weight and body fat remains a highly effective treatment for mitigating the adverse health effects of obesity and reducing the risk of related chronic diseases. There is a burgeoning cache of evidence suggesting that certain macro and micronutrient intake, and diet composition and patterns may be more or less effective at preventing diabesity. Several dietary interventions, such as the Mediterranean diet and DASH diet, have proven to reduce obesity and the risk or severity of obesity-related conditions such as insulin resistance, diabetes, and metabolic syndrome. While these dietary patterns have similar elements to those of the recommendations for general healthy eating, minor adjustments could be made to the current guidelines to optimize the prevention of diabesity. Alternatively, a secondary set of dietary information could be developed, specifically addressing dietary requirements for people living with obesity and diabetes. This chapter will discuss current dietary and nutritional guidelines, highlight similarities and differences between countries and resources, and identify discrepancies and agreements between current guidelines in nutritional epidemiology literature.

Obesity has reached epidemic proportions in Western society and is increasing in the developing world. It is considered one of the main contributors to the global burden of disability and chronic diseases, including autoimmune, inflammatory and degenerative diseases. It has notably transformed the obsolete concept that white adipose tissue (WAT) serves simply as an energy deposit. WAT is now recognized as an endocrine organ, active and inflammatory, capable of producing a wide variety of factors known as adipokines. These molecules participate in a wide variety of physiological and physiopathological processes, regulating food intake, insulin sensitivity, immunity and inflammation. Obese patients have chronic inflammation due to the sustained production of pro-inflammatory cytokines in adipose tissue and higher levels of inflammatory cytokines such as IL-6 and C-reactive protein (CRP). Also, within the subsets of adipose tissue pro-inflammatory macrophages (phenotype M1), it has been shown that they replace anti-inflammatory macrophages (phenotype M2). Adipose tissue also produces a large amount of adipokines that act as signaling molecules, with a broad range of effects on many organ systems, including the lungs. Therefore, a possible underlying physiopathological mechanism that explains the effect of obesity on the severity of SARS-CoV-2 infection may be due to anomalies in the production of adipokines by fatty tissue, contributing to the condition called a “cytokine storm”, which characterizes the severe form of COVID 19. Also, expression of the gene (SARS-CoV-2 receptor) is greater in visceral and subcutaneous adipose tissue than in lung tissue, an important target affected by SARS-CoV-2 infection. This suggests a mechanism by which excess adiposity may lead to greater severity of infection in patients with COVID-19. The production of these adipokines and proinflammatory factors of adipose tissue, as well as its importance in the severity of COVID-19, are analyzed in this chapter, proposing these cytokines as possible markers of metabolic and immunological diseases.

The term diabesity indicates the coexistence of both diabetes and obesity. Meta-inflammation has been identified among the mechanisms that link obesity, type 2 diabetes (T2D) and diabesity-associated non-communicable diseases. Metabolic endotoxemia is associated with oxidative stress, whereas Mediterranean diet (Med-diet) and exercise improve antioxidant defence through a hormetic effect. Therefore, a lifestyle intervention, including Med-diet and exercise, could be the better approach for meta-inflammation in diabesity. Although other diets, including low-glycaemic index, Paleolithic diet, high-protein and high-protein vegetarian diet improve glucose control, Med-diet also has a positive impact on microbiota and body mass. However, some concern still exists about the very-low-calorie ketogenic diet and high protein diet in the long-term. It has also been shown that some plant-foods’ bioactive compounds inhibit α-glucosidase or α-amylase, as well as the glucose transporters. Both exercise and some phenolic compounds can increase glucose uptake in skeletal muscle and reduce insulin resistance. Furthermore, the combination of Med-diet and physical activity has a positive effect on body composition and could increase the transition from metabolically unhealthy obesity to metabolically healthy obesity, reducing the obesity-induced T2D.

Towards the end of the last century, the researchshowed that several vegetables and medicinal plants have hypoglycemic potential and therefore may exhibit a positive effect in reducing hyperglycemia in the human body. In vitro and in vivo studies support the antidiabetic effects of polyphenols extracted from berries, black currants, raspberries, and strawberries fruits, out of which the most important are the anthocyanins. Among anthocyanins, the most commonly identified in berries are cyanidin, delfinidine, malvidin, pelargonidine, peonidine and petunidine. Within this chapter, we present the importance of phenolic compounds in the diabetic diet, two plants Helianthus tuberosus and Momordica charantia L. with beneficial effects in the prevention of type 2 diabetes and their mechanisms of action. Also, the market of food supplements currently existing in Romania is presented, along with the products and their form of presentation. 

The change in the lifestyle of the world population towards a westernized style has generated important effects on the metabolism of the population over the years. These metabolic changes trigger negative effects on human health, one of these effects is called Diabesity, a combination of symptoms related to diabetes and obesity. Various ways have been sought to compensate for these negative effects, pharmacologically and in folk medicine, but the focus points are the generation of new habits of foods and/or medicinal plants consumption capable of reversing the negative effects of Diabesity. In this chapter, a series of medicinal and edible plants with reported activity on both weight reduction and consumer glycemic levels are described. The origin of the use of these foods is often based on the ancestral consumption of traditional medicines, which awakened the interest in the scientific community as starting points for the development of new functional foods to reduce the impact of Diabesity worldwide.

Diabesity refers to the co-occurrence of diabetes and obesity. Obesity and type 2 diabetes have been associated with unfavorable changes in the composition and functionality of the intestinal microbiota (dysbiosis), accompanying glucose and lipids metabolic alterations in the host. Moreover, an interrelationship seems to exist between the chronic low-grade inflammation occurring in obesity/diabetes, with mood disorders and early cognitive impairment, frequently associated with these pathologies. Focus on the intestinal microbiota, as a target for developing/evaluating strategies to fight against diabesity, constitutes a novel point of view in the management of this condition. Apart from calorie restricted diets, with proven low efficacy in the long-term, recent studies are focused on particular dietary components such as fatty acids, polyphenols, probiotics and prebiotics and their effect on diabesity, mediated by the intestinal microbiota. Medical treatments include the use of drugs with different mechanisms of action, most of them showing effects on the gut microbiota. The use of bariatric surgery is increasing in recent years for the treatment of severe obesity and favorable changes in microbiota composition and its metabolites have been evidenced linked to weight loss. Further studies are needed to elucidate whether changes in the microbiota are a cause or consequence of diabesity

To tackle diabesity, medical research hopes that treatments will be personalized, and to reach this objective, it will be necessary to develop new equipment and analytic techniques. A proper assessment of diabesity requires blood glucose and body composition monitoring. Although with the ongoing application of new technologies, as in the case of the omics techniques, the possibilities for early diagnosis and personalized treatments of diabesity patients are perhaps even closer than we think. Today, the evaluation of diabesity is more accurate due to discovering novel biomarkers and the rapid advances in gene expression profiling, epigenetics, metabolomics, or microbiome analysis. It is, therefore, essential to keep up with the new technologies used for the study of diabesity and its related pathologies

In this Chapter, new strategies aimed to fight against Diabesity, from a holistic point of view, will be reviewed. A psychological approach to this pathology is needed, aiming to understand the factors behind the food choices of individuals, which will help establish actions that modify the taste preferences of the population. A pharmacological approach is necessary when nutritional or physical activity has failed, or in the case of concomitant pathologies, and efforts are made to better mimic the normal physiological fluctuations of insulin to avoid insulin peaks and the consequent hypoglycemia. The current studies revised training exercise point to the aerobic exercise, maintained over time, to improve glucose uptake and use by muscle cells.