Diabetes and nutrition study group of the European Association for the Study of Diabetes (EASD), Brugge, Belgium, 19-21 June 2003.

This year's symposium focused on diabetes in obesity, postprandial metabolism, alcohol and diabetes, lipids and lifestyle. The recent diabetes prevention trials from Finland (DPS) and the USA (DPP) were of significant interest. Professor Matti Uusitupa introduced his paper with a review on the prevalence of metabolic syndrome in various regions, indicating the main risks were sedentariness and central obesity. Presenting data from the DPS study, he noted that the greater proportion of subjects in the Finnish trial was classified as having metabolic syndrome, and the study population was substantially overweight. Nevertheless, lifestyle intervention (diet and exercise) generated a holistic effect on most factors associated with the metabolic syndrome. These results and those from the DPP show that lifestyle intervention is more effective than current drugs in preventing type 2 diabetes mellitus.

Belgium's Professor Luc Van Gaal noted the benefits of a four kilogram weight loss from the prevention trials, and considered the possible use of pharmacological approaches in achieving that end. His group also reported that impaired glucose tolerance rather than fasting glucose appeared more common in obese subjects, bearing in mind that the former is associated with insulin resistance and the latter, with insulin secretion. In relation to type 1 diabetes, they found that BMI did not appear an independent risk factor for chronic complications associated with microvascular disease, and the impact of BMI on cardiovascular risk appeared to be stronger for men than women.

In his lecture on postprandial metabolism in diabetes Italy's Professor Ceriello outlined a theoretical position linking overconsumption of food and reduced physical activity with fuel overload at the cellular level. Subsequent increased oxidative stress could be linked to a negative cascade of events at the level of [beta] cells, muscle and endothelial cells. Endothelial dysfunction is of increasing interest in the study of the pathology of cardiovascular disease, and here oxidative stress was put forward as a major contributing factor in the context of postprandial hyperglycaemia and hypertriglyceridemia. Additional studies were presented on anti-oxidants, including discussions on foods which may deliver antioxidants such as nuts, fruit and vegetables.

As Brugge is renowned for its beer, the conference was also treated to a detailed presentation on beer production, with the interesting note that little has changed in principle over time. There were various papers on the potential health benefits of alcohol, with a number of epidemiological studies showing reduced risk with moderate intakes. At the clinical level, however, advice would be provided on an individual basis, bearing in mind usual consumption patterns.