Type 2 Diabetes Mellitus (DM2) is a chronic morbidity with worldwide high prevalence. Its treatment includes many therapies such as drugs and lifestyle changes. Bariatric surgery has been widely used for the treatment of severe obesity and has shown improvement in DM2 control. However, it has important nutritional complications such as iron, calcium, vitamin D and vitamin B12 malabsorption. Vitamin B12 is found in animal derived foods and its deficiency is generally manifested by features of megaloblastic anemia with possible neurologic manifestations. Moreover, its deficiency also constitutes an important risk factor for cardiovascular diseases. Metformin is the first line drug in the treatment of DM2 and its main side effects are gastrointestinal, such as nauseas and diarrhea. Besides, its use has been associated with vitamin B12 malabsorption and deficiency. Since it has positive impact on body weight, metformin is commonly used by patients in pre and post-operative of bariatric surgery. This is a cross-sectional study based on medical record information that analyzed B12 serum levels and other variables in Obese patients with impaired glucose tolerance, in use or not of metformin, attended between 2010 and 2012 in a center specialized in clinical and surgical treatment of obesity. Sixty six patients were included in the study. Twenty (30%) of them were in use of metformin and had lower vitamin B12 levels when compared to those who were not in use of this drug. Also, these levels were negatively correlated with metformin time of use and dosage. Thus, patients in use of metformin require special attention in both pre and post-operative of bariatric surgery regarding the deficiency of vitamin B12.

We have reached a limit in our ability to reduce the incidence of Coronary Heart Disease (CHD), Congestive Heart Failure (CHF) and Cardiovascular Disease (CVD) utilizing the traditional evaluation, prevention, and treatment strategies for the top 5 cardiovascular risk factors – hypertension, diabetes mellitus, dyslipidemia, obesity and smoking. Statistics show that approximately 50% of patients continue to have CHD or Myocardial Infarction (MI) despite “normal” levels of these five risk factors as traditionally defined. A more logical and in depth understanding of these top five risk factors is necessary. Advanced testing should include 24 hour ambulatory blood pressure monitoring, advanced lipid profiles, dysglycemic parameters, visceral obesity with effects of adipokines and evaluation of the three finite vascular endothelial responses of inflammation, oxidative stress and immune vascular dysfunction. Congestive heart failure is most commonly due to CHD and presents with both systolic and diastolic heart failure. Understanding translational cardiovascular medicine allows appropriate correlation of the CHD risk factors to the presence or absence of vascular injury and disease utilizing non -invasive vascular testing. This provides for early identification, prevention and treatment of CHD, CHF and CVD.

Most of the cooking oils are vegetable oil. They are very rich in Polyunsaturated Fatty Acids (PUFA), omega-6 (n-3) and omega-3 (n-3) in the ratio of 16-20:1 against the recommended requirement of 1-4:1 and they lack their natural anti-oxidants. Therefore they are very prone to oxidation even at room temperature. Heating and reheating during cooking process enhances the oxidation, hydrolysis and polymerization of lipids and produce varieties of free radicals which creates oxidative stress in the body after consumption. N-6 fatty acids derivatives are pro-inflammatory while n-3 derivatives are anti-inflammatory. Since n-6: n-3 ratio is higher in the oils, there exists a dominance of inflammatory mechanisms over anti-inflammatory mechanisms that results into inflammation. Oxidative stress and inflammation together contribute to the pathogenesis of many diseases like Rheumatoid Arthritis (RA), cancer, Coronary Artery Disease (CAD), diabetes, Non Alcoholic Fatty Liver Disease (NAFLD) etc.Therefore, It has been suggested that fast food and repeated heating of cooking oil at home, must be avoided and n-3 fatty acids must be supplemented in the diet to fight the inflammatory effects of n-6PUFA.

Objective: Health disparities for African-Americans are complex and often interrelated with low socioeconomic status, inequalities in income, education, and overall standard of living. The objective of this study was to assess health knowledge and health behaviors among rural residents at risk for chronic diseases and to provide information that may be used in planning community-based nutrition education intervention.

Methods: Two survey instruments (Fact finding and Health knowledge and behavior) were developed to elicit from rural residents their knowledge, and behavior regarding the prevalence of chronic diseases (cancer, diabetes, obesity)1) The fact finding survey was designed to ascertain information about chronic disease awareness and prevention; willingness to participate and level of commitment; and 2) The health knowledge survey assessed participants’ knowledge, health behavior, and information about their health and demographic information. The completed instruments were coded and entered into SPSS 17.0 Windows version. Descriptive frequencies, t-Test, and correlations were used to analyze the data.

Results: Approximately 95% of respondents agree that community programs can provide answers to nutrition-related chronic diseases prevention. Of those surveyed 87% expressed willingness to participate in nutrition and health education intervention and only 71% expressed willingness to commit for a year-long program, while 69% are desirous of making healthy lifestyle changes. Respondents felt that annual health examination was important (100%) and 75% had scheduled appointments; 24% of respondents had no form of health insurance. In general 77% and 76% agreed that physical inactivity and high salt intake lead to obesity and hypertension, respectively.

Conclusion: Prevention and awareness nutrition education community-based programs are necessary in rural areas for the reduction of risk factors associated with cancer and other chronic diseases. The results provided information that can be used to influence the planning, development and implementation of nutrition based community programs for prevention of obesity, cancer and cardiovascular diseases prevention.