WEDNESDAY, Oct. 28 (HealthDay News) -- Diet and exercise can keep diabetes at bay for a decade, cutting the risk for the disease by more than a third in the most susceptible people, a new study finds.

About 11 percent of U.S. adults (24 million) have diabetes, mostly type 2, which is linked to poor diet and sedentary lifestyle. In addition, 57 million overweight adults have higher-than-normal blood sugar levels, which raise the risk of a heart attack or stroke and the likelihood of developing type 2 diabetes, researchers say.

But new research, published in the Oct. 29 online edition of The Lancet, shows that losing weight and exercising can delay or prevent the onset of diabetes more effectively than the prescription drug metformin or a placebo.

"Interventions that result in weight loss lower the risk of diabetes, and that lower risk appears to persist for a long period of time," said study author Dr. William C. Knowler of the U.S. National Institute of Diabetes and Digestive and Kidney Diseases.

For people who are at high risk of getting diabetes, losing weight "is clearly to be recommended," he said. In addition, using a drug like metformin may also benefit people unable to lose weight through exercise and diet alone, he said.

For the diabetes prevention study, 3,234 overweight or obese adults with elevated blood sugar levels were randomly assigned to either lifestyle changes or metformin to control their blood sugar, or a placebo.

After 10 years, 2,766 remained in the trial, and those taking metformin saw an 18 percent reduction in their rate of developing diabetes, compared with those on placebo.

But those who had made lifestyle changes -- reducing caloric and fat intake and exercising at least 150 minutes a week -- reduced their risk of getting diabetes by 34 percent compared with those on placebo, the researchers found.

In the first year of the trial, people in the lifestyle group lost an average of 15 pounds, regaining all but about five pounds over 10 years. People on metformin maintained a five-pound weight loss, and those on placebo lost less than two pounds over 10 years, the researchers note.

Over 10 years, after all the participants made lifestyle changes, the yearly diabetes incidence rates for the drug and placebo groups had dropped to about 5 to 6 percent, the same rate as the lifestyle group.

"Lifestyle intervention, even when provided later, also seemed to lower diabetes incidence rate," Knowler said.

But losing weight is difficult, and simply telling someone to slim down won't work, he acknowledges.

"To make things like this happen on a large scale, we have to do more than simply tell people to lose weight," he said. People need access to weight loss clinics that can teach them about diet and exercise, he added.

Dr. Anoop Misra, director of the department of diabetes and metabolic diseases at Fortis Hospitals in India, and author of an accompanying journal editorial, said that "prevention of diabetes is important to curb epidemic of diabetes globally. Diet and exercise remain the most important modalities to prevent diabetes, and any drugs are less important."

At-risk groups of diabetes need to be identified, especially certain ethnic groups, and taught proper lifestyle management strategies, Misra said. "Young adults with family history of diabetes should be carefully managed along the same lines," he said.

Diabetes prevention makes economic sense as well, by decreasing costly, lifelong expenditures on management of the disease and its complications, Misra said.

All nations, particularly developing countries, seeing a rapid rise in diabetes should devise or strengthen a national diabetes-control program to help curb the epidemic, he said.

"In particular, regulations should apply for advertisement and sale of energy-dense junk food to children, and regular physical activity should be encouraged starting at a young age. Spreading awareness about proper lifestyle and adverse consequences of obesity and diabetes should be at the top of health agenda of all nations," Misra said.

Regarding the study findings, other experts are optimistic. Dr. Ronald Goldberg, a professor of medicine at the Diabetes Research Institute of the University of Miami Miller School of Medicine, whose institution participated in the study, said that "seeing quite significant effects lasting this long really bodes well for the utility of these interventions for diabetes prevention."

Cutting calories and increasing physical activity clearly slow the progression to diabetes, Goldberg said. "Lifestyle works, and every effort needs to be made to begin and maintain a lifestyle program in the long-term."

More information

For more information on diabetes, visit the U.S. National Institute of Diabetes and Digestive and Kidney Diseases.

MONDAY, Oct. 26 (HealthDay News) -- The location of excess body fat appears to affect the risk of dangerous blood clots in veins, although that location differs in men and women, a new Danish study indicates.

The 10-year study found that bigger hips are associated with an increased risk of venous thromboembolism (VTE) in women but not men, while a wider waistline was associated with increased risk in men, according to a report published online Oct. 26 in the journal Circulation.

Obesity in general is an established risk factor for VTE, which occurs when a blood clot blocks a vein. When VTE happens in a leg, it is known as deep vein thrombosis. In a lung, it is a pulmonary embolism. A particularly deadly form of VTE, thromboembolism, occurs when a clot travels from a leg to a lung.

Researchers at Aarhus University Hospital followed more than 57,000 Danish men and women, aged 50 to 64 when the study started, assessing the relationships between body mass, fat distribution and VTE. The initial analysis showed that waist circumference was associated with VTE risk in both men and women.

"When hip circumference was adjusted for waist circumference, the association between hip circumference and VTE was eliminated for men but was still significant for women," the report said. "In contrast, when waist circumference was adjusted for hip circumference, the association between waist circumference and VTE was eliminated for women but was still significant for men."

"Further studies are needed to explain the associations," they wrote.

The Danish study results echoes those of an American study reported earlier this year, said Lyn Steffen, an associate professor of epidemiology at the University of Minnesota School of Public Health, and a leader of that study.

The Minnesota group followed more than 20,000 people for more than 12 years and found an association between VTE risk and metabolic syndrome, a constellation of risk factors including obesity, high blood pressure, insulin resistance and high blood cholesterol. A heightened risk of VTE was attributed to obesity.

"The message here is that obesity is a risk factor for venous thrombosis," Steffen said. "The effect of obesity in women might be the same as in men, but just is not measured in waist circumference."

It's possible that obesity increases the likelihood of developing blood clots, and it also might have a negative effect on the endothelium, the delicate lining of blood vessels, Steffen said.

"There is information that obesity contributes to inflammation, and it is associated with the metabolic syndrome, which predisposes to stroke," said Dr. Amytis Towfighi, an assistant professor of clinical neurology at the University of Southern California. "There may be similar effects in thrombotic disease, as well as mechanisms that are not well understood at this point."

More information

Learn more about venous thrombosis from the U.S. National Heart, Lung, and Blood Institute.

MONDAY, Oct. 26 (HealthDay News) -- The declines in fitness that accompany growing old typically speed up after the age of 45, new research shows.

But people can slow the inevitable by staying lean, exercising and refraining from smoking.

The findings, appearing in the Oct. 26 issue of the Archives of Internal Medicine, are not so surprising in light of the piles of other research that have drawn similar conclusions.

But the new study has broad implications, given the rising number of older adults in the United States and the explosion in the sedentary, overweight and aging population.

"The Social Security Administration actually has an aerobic capacity threshold. If you're below the threshold, you are considered disabled," said study author Andrew Jackson.

This means more people could qualify for government disability benefits at a younger age, further draining an already strained economy.

This study group included 3,429 women and 16,889 men aged 20 to 96 who had undergone two to 33 health exams with lifestyle counseling between 1974 and 2006.

Reductions in cardiorespiratory fitness (CRF) were not seen as a straight downward line. Instead, after the age of 45, the slope became much steeper, accelerating even further with increases in body-mass index (BMI), smoking and lower levels of physical activity.

"We've known that, as you age, your aerobic capacity goes down, and the exercise physiology literature indicates it's a linear relationship. We found that this is not the case," said Jackson, who is professor emeritus of health and human performance at the University of Houston. "It makes sense to me. When things aren't working right, we tend to go down at faster rates. This was true for both men and women [although the rate of decline was faster for men than for women]."

Taking care of yourself could make you, in a sense, younger than your years.

"If you were overweight, inactive and smoked, your aerobic capacity would be lower at a given age as compared to other people who were healthy weight, active and nonsmokers," Jackson said. "The data showed that if people had that advantage when they were in their 30s and 40s and maintained that lifestyle, their aerobic capacity as they aged was, in fact, higher."

"It could delay the age when these health problems start to spring up," he continued. "If people are very overweight, inactive and smoke, they might see these health problems in their 50s and 60s, whereas people who maintain a healthy lifestyle, it's going to be more like their 70s, 80s and possibly even their 90s."

"You have to exercise. It's now becoming established fact, and if you don't incorporate it, you're going to see the effects. You will get sicker sooner," added Dr. Suzanne Steinbaum, director of women and heart disease for Lenox Hill Hospital in New York City and a spokeswoman for the American Heart Association. "Exercise is the most potent medication around, and the Social Security Administration agrees with me."

A second study in the same issue of the journal provides a measure of good news. Researchers at the University of Pennsylvania School of Medicine in Philadelphia found that blacks who partnered with a family member or friend to lose weight actually did lose pounds -- but only if the partner also lost weight.

More information

The U.S. Centers for Disease Control and Prevention has more on overweight and obesity.

FRIDAY, Oct. 23 (HealthDay News) -- If you're tempted to raid your child's Halloween candy stash at the end of this month, here's one reason you might not have to restrain yourself.

Spanish researchers put 42 men and women on a diet that included 40 grams of unsweetened cocoa powder (about 1.4 ounces) mixed with skim milk daily, or plain skim milk. After one month, those who drank the cocoa-flavored milk had lower levels of inflammatory markers associated with heart disease than those drinking the milk alone.

That result was critical because the participants, whose average age was about 70, were at high risk of cardiovascular disease because they had diabetes and three or more risk factors for heart disease, including smoking, high blood pressure, high levels of LDL "bad" cholesterol (more than 160 milligrams per deciliter), low levels of HDL "good" cholesterol (below 35 milligrams per deciliter), obesity or a family history of early coronary heart disease.

The inflammatory markers, called adhesion molecules, are proteins that cause white blood cells to stick to the walls of the arteries, which can lead to the formation of atherosclerotic plaques, explained Shelley McGuire, an associate professor of food science and nutrition at Washington State University and a spokeswoman for the American Society for Nutrition.

"One of the major strengths of the study was they were measuring adhesion molecules, which we have recently learned are very important in the formation of atherosclerosis," McGuire said. "Another strength is that the study was randomized and controlled. Because of this, we can pretty confidently say there was something in the cocoa powder that had an effect."

The researchers also found that the cocoa powder group had an increase in HDL cholesterol, which can help reduce levels of LDL cholesterol and has been shown to have anti-inflammatory, antioxidant properties.

The study is published in the November issue of the American Journal of Clinical Nutrition.

During the study, participants didn't take additional vitamins or supplements, and the only cocoa-containing products they consumed were those provided by researchers.

Previous research has suggested chocolate may be beneficial for heart health because it contains anti-inflammatory chemicals called polyphenols. Polyphenols are also found in wine, coffee and tea, along with fruits and vegetables such as apples, broccoli, onions, blueberries, blackberries, cherries, strawberries, plums and red grapes, said Connie Diekman, director of university nutrition at Washington University in St. Louis.

"One of the best ways to get plenty of polyphenols is to consume lots of fruits and vegetables," Diekman said.

The researchers noted the anti-inflammatory effects derived from cocoa were modest compared to those observed for other foods rich in polyphenols, such as wine.

And before you start inhaling candy bars, which are high in fat and calories, researchers noted that study participants were given non-fat, sugar-free cocoa powder and skim milk. Even then, they gained a small amount of weight.

In the study, the chocolate milk contained about 136 calories. If adding cocoa to your diet, be sure to reduce calories somewhere else, or get some extra exercise.

"My recommendation, as a registered dietitian, would be for people to look at cocoa -- whether in the form of cocoa or chocolate -- as a part of a healthful eating plan, not a magic bullet for reducing inflammation," Diekman said. "If including cocoa and small amounts of chocolate in an otherwise healthful eating plan helps people enjoy what they eat and stick with that plan, then these things can fit."

In findings that should come as no surprise, researchers noted that "adherence to the dietary protocol was excellent."

More information

The National Confectioners Association  has more on cocoa.