A spare tire can be a sign of diabetes or heart disease

The Rocky

Published December 4, 2007 at 12:05 a.m.

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Adding a few pounds around the midsection during adulthood seems innocuous enough. It has its own moniker - middle-age spread - and was once a sign of prosperity and success.

Today it's a sign of trouble. Abdominal fat, also called visceral fat, contributes more to health problems such as heart disease and diabetes than does fat around the hips and thighs.

A study in the July 2007 Diabetes Care showed that men and women whose waists spread over a nine- year period had corresponding increases in the metabolic syndrome. These risk factors - high blood pressure, resistance to insulin and worrisome cholesterol levels - seriously increases chances of developing heart disease and diabetes.

A six-year study of 73,000 women in China published last spring in the Archives of Internal Medicine shows that those with larger waists were more likely to die prematurely than those with smaller waists.

Measuring your waist offers information you can't get from the scale. Many people lose muscle and add abdominal fat in midlife, and such changes may not affect weight. Expanding waistlines can warn of trouble brewing. National guidelines sound warnings when waist circumference is greater than 40 inches for a man or 35 inches for a woman.

Your waist circumference isn't your belt size. To measure your waist, wrap a flexible measuring tape around your abdomen where the sides of your waist are narrowest, usually even with your navel.

A waistwise expansion over the years should be a wake-up call to re-evaluate your diet and physical activity level.

Giving pneumonia the brush-off

Dental plaque is the white stuff that collects on our teeth, often in the spots the toothbrush doesn't reach. It's a homegrown version of biofilm - mobs of microorganisms that clump up and encase themselves in largish sugar molecules so they are fairly impenetrable.

As a biofilm, dental plaque, which can harden into tartar, may not be all bad. It can create a barrier to some potentially harmful bacteria. But that benefit often is canceled by other bacteria in the plaque that may inflame gum tissue (gingivitis) and the underlying tissues that hold our teeth in place (periodontitis).

A number of studies have linked gum disease to heart disease. Inflammatory factors, or even the bacteria themselves, may get into the bloodstream and make their way to the coronary arteries or the heart.

Dental plaque and gum disease also have been linked to pneumonia, especially in people breathing with a ventilator. Between 10 percent and 25 percent of patients on ventilators come down with pneumonia. When the ventilator pushes air into the patient's lung, the bacteria may get swept along with it. Once in the lungs, the bacteria grow and cause the inflammation that's characteristic of pneumonia.

Heavy use of antibiotics may be a factor: By altering the bacterial environment of the mouth, antibiotics may create an opportunity for bacteria that get into the lungs to colonize dental plaque, as well other areas of the mouth and the throat.

Cleaning patients' mouths with mouthwash or certain kinds of gels looks like it might be a simple way to combat ventilator-associated pneumonia. Not every study has been positive, but results are promising.

A number of studies also have found that nursing home residents with poor oral hygiene are more likely to come down with pneumonia. It's also possible that poor oral hygiene may cause pneumonia among those not living in nursing homes or hospitals, though there's not much evidence of that.

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