Endocrinology, Metabolism & Nutrition

First things first – understanding the basics

Endocrinology is the study of hormones, the endocrine glands that produce them – i.e. the thyroid, pancreas, adrenal glands etc – and the disorders that result when hormones are out of balance. The hormones commonly studied include insulin, cortisol, thyroid hormone, estrogen, testosterone, and so on.

Metabolism refers to all the chemical processes that occur in the human body to maintain life – especially those that convert food into energy and building blocks for cells. Metabolic disorders include things like diabetes, obesity, and high cholesterol.

And nutrition is the science of how food and nutrients affect the body’s growth, maintenance, and health. So this includes what young people eat, how their body uses what they eat, and the impact of diet on disease. Nutritional research often includes things like food allergies and food intolerances.

What is diabetes?

Diabetes is a chronic disease where the body cannot maintain healthy blood glucose (sugar) levels, either because it doesn't produce enough insulin or can't use it effectively.

If you take a disease like diabetes as an example, then these three connected systems might all be examined as follows:

• Endocrine: how insulin (a hormone) is dysregulated.
• Metabolic: how glucose is processed for energy.
• Nutritional: how managing carbohydrates controls blood sugar.

What is obesity?

Driven by an obesogenic environment – i.e. the collective physical, economic, policy, social and cultural factors that promote obesity – obesity is defined as a person having a body mass index (BMI) of 30 or more (or equivalent for those younger than 18 years).

The body mass index (BMI) is a measure that uses a person’s height and weight to work out if their weight is healthy.

Similarly, with obesity, these three connected systems could all be studied as follows:

• Endocrine: how hormonal imbalances can affect hunger and fat storage.
• Metabolic: how energy balances can determine weight gain/loss.
• Nutritional: how diet composition can impact on metabolism and hormones.

Why is obesity a problem in New Zealand?

Excess weight (obesity) is associated with many health conditions including type 2 diabetes, ischaemic heart disease (IHD), stroke, several common cancers, osteoarthritis, sleep apnoea and reproductive abnormalities in adults.

Children affected by obesity are more likely to experience obesity as adults and to have abnormal lipid profiles (increased risk of heart disease), impaired glucose tolerance and high blood pressure at a younger age.

Obesity is also associated with musculoskeletal problems, asthma, and psychological problems including body dissatisfaction, poor self-esteem, depression and other mental health problems caused by bullying due to weight bias.

Children live in families, and families live in communities, and without the environment around them being health promoting, it is very difficult for families to achieve persistent healthy lifestyle change. As a country, we can do more to promote a healthy environment for our children.

Combating childhood obesity with good nutrition and healthy eating habits

Better research is needed to understand the broad societal changes that would help prevent and combat childhood obesity.

Children and their families need access to affordable healthy diets and they also need to be protected from excessive exposure to unhealthy and ultra-processed foods.

Healthy diets are:

• rich in fruit, vegetables and wholegrains products

• low in highly processed foods as they have high contents of sugar, sodium and fat (examples: sugary drinks, processed meats, confectionary, fast-food products).

But there is still work to be done. We need to understand the most efficient and effective ways for a healthy diet to reach those most in need.

WHAT ARE WE DOING TO HELP?

Here are just some of the research projects we are funding to help improve nutrition in New Zealand and reduce our rates of youth obesity.

Automated insulin to improve health outcomes for young Māori and Pasifika with Type 1 diabetes

Associate Professor Martin De Bock, University of Otago

One in four newly diagnosed Type 1 diabetics are non-European, and most of them are Māori and Pasifika. Research has revealed that young Māori and Pasifika people are more likely to have long-term complications from Type 1 diabetes, compared to young New Zealand Europeans. The inequity gap becomes evident just 12 months after diagnosis.

Through earlier work conducted by Dr Mercedes Burnside (Ngāti Toa) with Assoc Prof Martin de Bock’s research team, it was shown that access to an automated insulin delivery system could be the great equaliser.

This new research will utilise gold standard automated insulin delivery from diagnosis, embedded within a culturally-appropriate supportive framework, to see if ethnicity-driven diabetes disparities can be eliminated early in the diabetes journey.

Empowering Māori parents to make healthier food decisions for their children

Distinguished Professor Linda Smith, University of Waikato

This research project, led by Distinguished Professor Linda Smith, seeks to address food inequities and empower young Māori parents with mātauranga (knowledge) around kai and healthy kai practices for the wellbeing of their whānau.

This project will work with a group of parents in the Eastern Bay of Plenty to understand their thinking about kai, their kai aspirations for their pēpi, and their circumstances in which they make decisions.

The team will then use a culturally appropriate, mana-enhancing framework to inspire the parents and whānau to embrace healthier food choices. The research team’s big aim is to drive inter-generational change – from parents to pēpi – that supports kai sovereignty, healthy relationships with kai, and good health.

Using broader ‘systems methods’ and mātauranga Māori to improve nutrition for kids

Professor Boyd Swinburn , University of Auckland

Led by Professor Boyd Swinburn, and based on previous work, this project worked with communities and rangatahi in the Hawke’s Bay to improve children’s nutrition in collaboration with schools, whanau, food providers, and community agencies.

Evaluation of a healthy lifestyle app for screening of weight-related health issues

Dr Yvonne Anderson, University of Auckland

Led by Dr Yvonne Anderson, this project evaluated the implementation of a healthy lifestyle app for children and youth in the multidisciplinary community-based Whānau Pakari programme.

Based in Taranaki, this programme has been successfully running for over a decade, and this research demonstrated that a healthy lifestyle check app can create efficiencies across the patient journey – saving both time and money.