Muhammad Firdaus, MD, FACP, Section of Endocrinology, Department of Medicine, University of Oklahoma Health Sciences Center; Veterans Affairs Medical Center, Oklahoma City, OK, USA.
Timothy J Lyons, MD, FRCP, Section of Endocrinology, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.

The metabolic syndrome, though controversial due to lack of a uniform pathophysiological mechanism, is a useful clinical tool for identifying persons at risk for diabetes and cardiovascular disease. It indicates the cumulative cardiometabolic risk exerted by abdominal obesity, hyperglycemia, high triglyceride, low high density lipoprotein cholesterol (HDL-C), and high blood pressure. Lifestyle factors, high calorie intake, and less physical activity have been implicated in the causation of the metabolic syndrome, and thus older adults are at particular risk for the development of this syndrome. Current evidence indicates that the components of the metabolic syndrome can be targeted with lifestyle interventions to prevent the complications of diabetes and cardiovascular disease. This paper reviews various diagnostic criteria, etiological factors, and lifestyle interventions to combat the metabolic syndrome in order to prevent diabetes and cardiovascular disease in older adults.
Key words: metabolic syndrome, prevention, lifestyle modification, diet, physical activity.

Fatim Ajwani, BSc RD, ARAMARK Canada Ltd at the Toronto Rehabilitation Institute, Toronto, ON.
Maria Ricupero, BA, RD, CDE, ARAMARK Canada Ltd at the Toronto Rehabilitation Institute, Toronto, ON.

Dietary trans fatty acids (TFA) have been implicated in contributing to cardiovascular disease (CVD). Higher intakes of industrial TFA negatively impact cholesterol and inflammation levels, endothelial function, and LDL particle size. Dietary TFA are also associated with myocardial infarction and death. Due to the negative impact of TFA on cardiovascular health, the current recommendation is to keep total TFA intake to less than 2 grams/day. New labeling legislation has made it easier to achieve this goal. However, nutrition claims can be misleading. Despite positive new changes, patient counseling will still be required for accurate and careful interpretation of nutrition information.
Key words: trans fatty acids, diet, cholesterol, cardiovascular disease, conjugated linoleic acid.

The accredited CME learning activity based on this article is offered under the auspices of the CE department of the University of Toronto. Participating physicians are entitled to one (1) MAINPRO-M1 credit by completing this program, found online at www.geriatricsandaging.ca/cme.htm

Diabetes mellitus (DM) is a very common condition in the older population. The disease may interact with other medical conditions that increase the degree of frailty in aging adults. Nonpharmacological and pharmacological interventions are the usual steps in managing of DM. In this article, a stepwise treatment strategy will be suggested after a review of the pertinent literature.

Key words: diabetes mellitus, older adult, diet, exercise, pharmacotherapy.

Daniel Tessier MD, MSc, Head of Geriatric Services, Sherbrooke Geriatric University Institute, Sherbrooke, QC.

D'Arcy Little, MD, CCFP, Lecturer and Academic Fellow, Department of Family and Community Medicine, University of Toronto; Director of Medical Education, York Community Services; 2002 Royal Canadian Legion Scholar in Care of Elderly, Toronto, ON.

Diabetes is a common disease in the elderly. While pharmacological management is important, the need for and benefits of non-phamacological therapy should not be underestimated in this population. Such therapy includes nutrition therapy, physical activity, smoking cessation and diabetic education. This article reviews, in detail, current recommendations for nutrition therapy and physical activity in elderly patients with Type 2 diabetes, including specific recommendations for all types of food groups and specific recommendations for pre-exercise evaluation.
Key words: elderly, diabetes mellitus Type 2, nutrition therapy, diet, physical activity, exercise.

June M. Chan, ScD, Assistant Adjunct Professor, Departments of Epidemiology & Biostatistics and Urology, University of California, San Francisco, CA, USA.

Prostate cancer is the most commonly diagnosed cancer and is second only to lung as the most fatal cancer among men in the United States. It is the ninth most common cancer in the world, with higher rates predominating in North America, Europe and Australia, and lower rates reported in Hong Kong, Japan, India and China. The main non-modifiable risk factors include age, race and family history.

The incidence of prostate cancer increases exponentially with age, with men age 75-79 experiencing an incidence rate more than 100-times greater than that of men age 45-49 (age-specific prostate cancer incidence rate for men age 75-79 = 1400/100,000 person-years; for men age 45-49 = 11/100,000 person-years).¹

African Americans have the highest recorded age-standardized rates in the world, estimated at 137 cases per 100,000 persons in 1997 according to Surveillance, Epidemiology, and End Results (SEER) data.² In contrast, the rate among Caucasians in the U.S. was 101/100,000. Europeans tended to have rates in the range of 20-50 cases/100,000.

Tess Montada-Atin, RN, CDE
Care Leader

Marilyn Mori, RD
Lina Medeiros, MSW
Diabetes Education Centre,
Toronto Western Hospital
University Health Network
Toronto, ON

Diabetes is a chronic illness with significant short and long term complications.¹ The Diabetes Education Centre (DEC) at the Toronto Western Hospital, University Health Network, supports people with diabetes, their family and friends to better understand and manage diabetes. The 1998 Clinical Practice Guidelines (CPG) for the management of diabetes in Canada, recommends initial and ongoing education for the person with diabetes as part of diabetes care and not just as an adjunct to treatment. Diabetes Education should be recognized as a life long commitment.² Comprehensive management of diabetes should be planned around an interdisciplinary diabetes health care team,^1-3 which can be through a DEC. To learn and use the varied complex skills required, people with diabetes need the support of such a team of expert professionals.¹ Interdisciplinary interventions have been shown to improve glycemic control in the elderly. Studies have suggested that a team approach toward older people with diabetes improves blood glucose control, quality of life and adherence to therapy.³

Factors that affect glycemic control are diet, diabetes medications and exercise.