Higher dietary salt intake is associated with microalbuminuria, but not with retinopathy in individuals with type 1 diabetes: the EURODIAB Prospective Complications Study
Engelen, L. ; Soedamah-Muthu, S.S. ; Geleijnse, J.M. ; Toeller, M. ; Chaturvedi, N. ; Fuller, J.H. ; Schalkwijk, C.G. ; Stehouwer, C.D. - \ 2014
Diabetologia 57 (2014)11. - ISSN 0012-186X - p. 2315 - 2323.
urinary albumin excretion - blood-pressure - risk-factors - sodium-excretion - hypertension - mellitus - disease - system - iddm - aldosterone
Aims/hypothesis High dietary salt intake has been associated with elevated BP and may also have a deleterious effect on microvascular complications. We studied the cross-sectional associations between dietary salt intake (estimated from 24 h urinary sodium excretion) and urinary potassium excretion on the one hand, and the prevalence of microvascular complications on the other, in individuals with type 1 diabetes. Methods We measured sodium and potassium concentrations in two 24 h urine samples in 1,212 individuals with type 1 diabetes (40¿±¿10 years old, 51% men) who participated in the EURODIAB Prospective Complications Study. We used multiple logistic regression analyses to investigate associations between dietary salt intake and microvascular complications adjusted for age and sex, and additionally for BMI, smoking, urinary potassium excretion, antihypertensive medication and physical activity, and total energy, protein, alcohol, saturated fat and fibre intake. Results After full adjustment, 1 g/day higher dietary salt intake was positively associated with the presence of microalbuminuria (OR 1.06 [95% CI 1.01, 1.10]), but not macroalbuminuria (OR 0.99 [95% CI 0.94, 1.05]), non-proliferative retinopathy (OR 1.00 (95% CI 0.96, 1.04]) or proliferative retinopathy (OR 1.02 (95% CI 0.95, 1.08]). After excluding individuals with cardiovascular disease and/or antihypertensive medication (n¿=¿418), we found a non-significant association with microalbuminuria (OR 1.04 [95% CI 0.99, 1.10]) and macroalbuminuria (OR 1.05 [95% CI 0.96, 1.16]). The association between dietary salt intake and microalbuminuria was stronger in individuals with a BMI above 25 kg/m2 (OR 1.11 [95% CI 1.04, 1.18]) than in those with BMI below 25 kg/m2 (OR 1.03 [95% CI 0.97, 1.09]). No significant associations were found between urinary potassium excretion and microvascular complications. Conclusions/interpretation In individuals with type 1 diabetes, higher dietary salt intake, as determined by 24 h urinary sodium excretion, may be positively associated with microalbuminuria, particularly in overweight individuals.
Smoking and long-term risk of type 2 Diabetes: The EPIC-InterAct Study in European populations
The InterAct Consortium, A. ; Spijkerman, A.M.W. ; A, D.L. van der; Nilsson, P. ; Balkau, B. ; Beulens, J.W.J. ; Boeing, H. ; Feskens, E.J.M. ; Kaaks, R. - \ 2014
Diabetes Care 37 (2014)12. - ISSN 0149-5992 - p. 3164 - 3171.
kora s4/f4 cohort - middle-aged men - cigarette-smoking - insulin-resistance - physical-activity - fat distribution - active smoking - mellitus - women - glucose
OBJECTIVE The aims of this study were to investigate the association between smoking and incident type 2 diabetes, accounting for a large number of potential confounding factors, and to explore potential effect modifiers and intermediate factors. RESEARCH DESIGN AND METHODS The European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct is a prospective case-cohort study within eight European countries, including 12,403 cases of incident type 2 diabetes and a random subcohort of 16,835 individuals. After exclusion of individuals with missing data, the analyses included 10,327 cases and 13,863 subcohort individuals. Smoking status was used (never, former, current), with never smokers as the reference. Country-specific Prentice-weighted Cox regression models and random-effects meta-analysis were used to estimate hazard ratios (HRs) for type 2 diabetes. RESULTS In men, the HRs (95% CI) of type 2 diabetes were 1.40 (1.26, 1.55) for former smokers and 1.43 (1.27, 1.61) for current smokers, independent of age, education, center, physical activity, and alcohol, coffee, and meat consumption. In women, associations were weaker, with HRs (95% CI) of 1.18 (1.07, 1.30) and 1.13 (1.03, 1.25) for former and current smokers, respectively. There was some evidence of effect modification by BMI. The association tended to be slightly stronger in normal weight men compared with those with overall adiposity. CONCLUSIONS Former and current smoking was associated with a higher risk of incident type 2 diabetes compared with never smoking in men and women, independent of educational level, physical activity, alcohol consumption, and diet. Smoking may be regarded as a modifiable risk factor for type 2 diabetes, and smoking cessation should be encouraged for diabetes prevention.
Different in the prospective association between individual plasma phospholipid saturated fatty acids and incident type 2 diabetes: the EPIC-InterAct case-cohort study
Forouhi, N.G. ; Koulman, A. ; Sharp, S.J. ; Groenendijk-van Woudenbergh, G.J. ; Feskens, E.J.M. - \ 2014
The Lancet Diabetes & Endocrinology 2 (2014)10. - ISSN 2213-8587 - p. 810 - 818.
dairy product intake - de-novo lipogenesis - risk-factors - dietary - humans - cancer - biomarker - mellitus - disease - project
Background Conflicting evidence exists regarding the association between saturated fatty acids (SFAs) and type 2 diabetes. In this longitudinal case-cohort study, we aimed to investigate the prospective associations between objectively measured individual plasma phospholipid SFAs and incident type 2 diabetes in EPIC-InterAct participants. Methods The EPIC-InterAct case-cohort study includes 12¿403 people with incident type 2 diabetes and a representative subcohort of 16¿154 individuals who were selected from a cohort of 340¿234 European participants with 3·99 million person-years of follow-up (the EPIC study). Incident type 2 diabetes was ascertained until Dec 31, 2007, by a review of several sources of evidence. Gas chromatography was used to measure the distribution of fatty acids in plasma phospholipids (mol%); samples from people with type 2 diabetes and subcohort participants were processed in a random order by centre, and laboratory staff were masked to participant characteristics. We estimated country-specific hazard ratios (HRs) for associations per SD of each SFA with incident type 2 diabetes using Prentice-weighted Cox regression, which is weighted for case-cohort sampling, and pooled our findings using random-effects meta-analysis. Findings SFAs accounted for 46% of total plasma phospholipid fatty acids. In adjusted analyses, different individual SFAs were associated with incident type 2 diabetes in opposing directions. Even-chain SFAs that were measured (14:0 [myristic acid], 16:0 [palmitic acid], and 18:0 [stearic acid]) were positively associated with incident type 2 diabetes (HR [95% CI] per SD difference: myristic acid 1·15 [95% CI 1·09–1·22], palmitic acid 1·26 [1·15–1·37], and stearic acid 1·06 [1·00–1·13]). By contrast, measured odd-chain SFAs (15:0 [pentadecanoic acid] and 17:0 [heptadecanoic acid]) were inversely associated with incident type 2 diabetes (HR [95% CI] per 1 SD difference: 0·79 [0·73–0·85] for pentadecanoic acid and 0·67 [0·63–0·71] for heptadecanoic acid), as were measured longer-chain SFAs (20:0 [arachidic acid], 22:0 [behenic acid], 23:0 [tricosanoic acid], and 24:0 [lignoceric acid]), with HRs ranging from 0·72 to 0·81 (95% CIs ranging between 0·61 and 0·92). Our findings were robust to a range of sensitivity analyses. Interpretation Different individual plasma phospholipid SFAs were associated with incident type 2 diabetes in opposite directions, which suggests that SFAs are not homogeneous in their effects. Our findings emphasise the importance of the recognition of subtypes of these fatty acids. An improved understanding of differences in sources of individual SFAs from dietary intake versus endogenous metabolism is needed. Funding EU FP6 programme, Medical Research Council Epidemiology Unit, Medical Research Council Human Nutrition Research, and Cambridge Lipidomics Biomarker Research Initiative.
Liver fat content is linked to inflammatory changes in subcutaneous adipose tissue in type 2 diabetes patients.
Jansen, H.J. ; Vervoort, G.M. ; Graaf, M. van der; Stienstra, R. ; Tack, C.J. - \ 2013
Clinical Endocrinology 79 (2013)5. - ISSN 0300-0664 - p. 661 - 666.
plasminogen-activator inhibitor-1 - insulin-resistance - hepatic steatosis - macrophage infiltration - obese individuals - mellitus - disease - risk - mice - hypoadiponectinemia
Background Patients with type 2 diabetes mellitus (T2DM) are typically overweight and have an increased liver fat content (LFAT). High LFAT may be explained by an increased efflux of free fatty acids from the adipose tissue, which is partly instigated by inflammatory changes. This would imply an association between inflammatory features of the adipose tissue and liver fat content. Objective To analyse associations between inflammatory features of the adipose tissue and liver fat content. Design A cross-sectional study. Patients Twenty-seven obese patients with insulin-treated T2DM were studied. Measurements LFAT content was measured by proton magnetic resonance spectroscopy. A subcutaneous (sc) fat biopsy was obtained to determine morphology and protein levels within adipose tissue. In addition to fat cell size, the percentage of macrophages and the presence of crown-like structures (CLSs) within sc fat were assessed by CD68-immunohistochemical staining. Results Mean LFAT percentage was 11·1 ± 1·7% (range: 0·75–32·9%); 63% of the patients were diagnosed with an elevated LFAT (upper range of normal =5·5%). Whereas adipocyte size did not correlate with LFAT, 3 of 4 subjects with CLSs in sc fat had elevated LFAT and the percentage of macrophages present in sc adipose tissue was positively associated with LFAT. Protein concentrations of adiponectin within adipose tissue negatively correlated with LFAT. Adipose tissue protein levels of the key inflammatory adipokine plasminogen activator inhibitor-1 (PAI-1) were positively associated with LFAT. Conclusions Several pro-inflammatory changes in sc adipose tissue associate with increased LFAT content in obese insulin-treated patients with T2DM. These findings suggest that inflammatory changes at the level of the adipose tissue may drive liver fat accumulation.
Prevalence of Type 2 Diabetes among Newly Detected Pulmonary Tuberculosis Patients in China: A Community Based Cohort Study
Wang, Q.Z. ; Ma, A.G. ; Han, X.X. ; Zhao, S.L. ; Cai, J. ; Ma, Y.B. ; Zhao, J. ; Wang, Y.W. ; Dong, H.F. ; Zhao, Z.L. ; Wei, L. ; Yu, T. ; Chen, P.X. ; Schouten, E.G. ; Kok, F.J. ; Kapur, A. - \ 2013
PLoS ONE 8 (2013)12. - ISSN 1932-6203
double burden - mellitus - risk
Background: Patients with type 2 diabetes (DM) have a higher risk of developing pulmonary tuberculosis (PTB); moreover, DM co-morbidity in PTB is associated with poor PTB treatment outcomes. Community based prevalence data on DM and prediabetes (pre-DM) among TB patients is lacking, particularly from the developing world. Therefore we conducted a prospective study to investigate the prevalence of DM and pre-DM and evaluated the risk factors for the presence of DM among newly detected PTB patients in rural areas of China. Methods and Findings: In a prospective community based study carried out from 2010 to 2012, a representative sample of 6382 newly detected PTB patients from 7 TB clinics in Linyi were tested for DM. A population of 6674 non-TB controls from the same community was similarly tested as well. The prevalence of DM in TB patients (6.3%) was higher than that in non-TB controls (4.7%, p <0.05). PTB patients had a higher odds of DM than non-TB controls (adjusted OR 3.17, 95% CI 1.14-8.84). The prevalence of DM increased with age and was significantly higher in TB patients in the age categories above 30 years (p <0.05). Among TB patients, those with normal weight (BMI 18.5-23.9) had the lowest prevalence of DM (5.8%). Increasing age, family history of DM, positive sputum smear, cavity on chest X-ray and higher yearly income (>= 10000 RMB yuan) were positively associated and frequent outdoor activity was negatively associated with DM in PTB patients. Conclusions: The prevalence of DM in PTB patients was higher than in non-TB controls with a 3 fold higher adjusted odds ratio of having DM. Given the increasing DM prevalence and still high burden of TB in China, this association may represent a new public health challenge concerning the prevention and treatment of both diseases.
The association between dietary energy density and type 2 diabetes in Europe: results form the EPIC-InterAct Study
The InterAct Consortium, A. ; Groenendijk-van Woudenbergh, G.J. ; Feskens, E.J.M. - \ 2013
PLoS ONE 8 (2013)5. - ISSN 1932-6203 - 10 p.
impaired glucose-tolerance - life-style - metabolic syndrome - glycemic load - united-states - weight change - us adults - risk - women - mellitus
Background Observational studies implicate higher dietary energy density (DED) as a potential risk factor for weight gain and obesity. It has been hypothesized that DED may also be associated with risk of type 2 diabetes (T2D), but limited evidence exists. Therefore, we investigated the association between DED and risk of T2D in a large prospective study with heterogeneity of dietary intake. Methodology/Principal Findings A case-cohort study was nested within the European Prospective Investigation into Cancer (EPIC) study of 340,234 participants contributing 3.99 million person years of follow-up, identifying 12,403 incident diabetes cases and a random subcohort of 16,835 individuals from 8 European countries. DED was calculated as energy (kcal) from foods (except beverages) divided by the weight (gram) of foods estimated from dietary questionnaires. Prentice-weighted Cox proportional hazard regression models were fitted by country. Risk estimates were pooled by random effects meta-analysis and heterogeneity was evaluated. Estimated mean (sd) DED was 1.5 (0.3) kcal/g among cases and subcohort members, varying across countries (range 1.4–1.7 kcal/g). After adjustment for age, sex, smoking, physical activity, alcohol intake, energy intake from beverages and misreporting of dietary intake, no association was observed between DED and T2D (HR 1.02 (95% CI: 0.93–1.13), which was consistent across countries (I2 = 2.9%). Conclusions/Significance In this large European case-cohort study no association between DED of solid and semi-solid foods and risk of T2D was observed. However, despite the fact that there currently is no conclusive evidence for an association between DED and T2DM risk, choosing low energy dense foods should be promoted as they support current WHO recommendations to prevent chronic diseases.
Importance of weight loss maintenance and risk prediction in the prevention of type 2 Diabetes: analysis of European Diabetes Prevention Study RCT
Penn, L. ; White, M. ; Lindström, J. ; Boer, A.Th. den; Blaak, E.E. ; Eriksson, J.G. ; Feskens, E.J.M. ; Ilanne-Parikka, P. ; Keinanen-Kiukaanniemi, S.M. ; Walker, M. ; Mathers, J.C. ; Uusitupa, M. ; Tuomilehto, J. - \ 2013
PLoS ONE 8 (2013)2. - ISSN 1932-6203 - 11 p.
life-style intervention - impaired glucose-tolerance - follow-up - program - trial - mellitus - behavior - fin-d2d - obesity - adults
Background Prevalence of type 2 diabetes (T2D) is increasing worldwide. T2D prevention by lifestyle intervention is effective. Pragmatic scalable interventions are needed, with evidence to efficiently target and monitor such interventions. We report pooled analyses of data from three European trial cohorts: to analyse T2D incidence, sustained weight loss and utility of risk predictors. Methods We analysed data on 749 adults with impaired glucose tolerance (278 men and 471 women, mean age 56 years, mean BMI 31 kgm-2) recruited between 1993 and 2003, and randomised to intensive lifestyle intervention (I) or lifestyle advice control (C). The intervention aimed to increase physical activity, modify diet, and promote weight loss=5%. Using Cox-regression survival analysis, we assessed T2D incidence and the impact on T2D incidence of sustained weight loss, and of baseline cut-point values of FINDRISC score, fasting plasma glucose (FPG), and HbA1c. Results Mean follow-up duration was 3.1 years. T2D was diagnosed in 139 participants (I = 45/379, C = 94/370). Cumulative T2D incidence was 57% lower in the intervention compared with the control group (HR 0.42 (95% CI 0.29 to 0.60) P
Dairy product intake in relation to glucose regulation indices and risk of type 2 diabetes
Struijk, E.A. ; Heraclides, A. ; Witte, D.R. ; Soedamah-Muthu, S.S. ; Geleijnse, J.M. ; Toft, U. ; Lau, C.J. - \ 2013
Nutrition, Metabolism & Cardiovascular Diseases 23 (2013)9. - ISSN 0939-4753 - p. 822 - 828.
vitamin-k - consumption - mellitus - women - disease - men - phylloquinone - menaquinones - metaanalysis - association
Background and aim A high intake of dairy has been linked to lower risk of type 2 diabetes (T2D). The relationship between dairy intake and glucose metabolism is still not well understood. The aim of this study was to investigate the relation between the intake of total dairy and dairy subgroups and T2D and measures of glucose metabolism. Methods and results A total of 5953 Danish men and women aged 30–60 years without baseline diabetes or cardiovascular diseases were included in this prospective analysis. The dairy intake at baseline was categorised into low-fat dairy, full-fat dairy, milk and milk products, cheese and fermented dairy. Fasting plasma glucose (FPG), 2-h plasma glucose (2hPG), HbA1c, insulin resistance (HOMA2-IR) and beta-cell function (HOMA2-B) were considered at 5-year follow-up. In the maximally-adjusted model (demographics, lifestyle factors, dietary factors and waist), cheese intake was inversely associated with 2hPG (ß = -0.048, 95% CI -0.095; -0.001). Fermented dairy intake was inversely associated with FPG (ß = -0.028, 95% CI -0.048; -0.008) and HbA1c (ß = -0.016, 95% CI -0.030; -0.001). Total dairy intake and the dairy subgroups were not related to HOMA-IR and HOMA-B in the maximally-adjusted model. Furthermore, there was no significant association between intake of total dairy or any of the dairy subgroups and incidence of T2D. Conclusion Our data suggest a modest beneficial effect of cheese and fermented dairy on glucose regulation measures; however, this did not translate into a significant association with incident T2D.
Dietary glycemic index, glycemic load, and digestible carbohydrate intake are not associated with risk op type 2 diabetes in eight European countries
Sluijs, I. van der; Beulens, J.W.J. ; Schouw, Y.T. van der; Buckland, G. ; Kuijsten, A. ; Schulze, M.B. ; Amiano, P. ; Ardanaz, E. ; Balkau, B. ; Boeing, H. ; Gavrila, D. ; Feskens, E.J.M. - \ 2013
The Journal of Nutrition 143 (2013)1. - ISSN 0022-3166 - p. 93 - 99.
fiber intake - energy-intake - life-style - nutrition - cancer - women - mellitus - cohort - prevention - disease
The association of glycemic index (GI) and glycemic load (GL) with the risk of type 2 diabetes remains unclear. We investigated associations of dietary GI, GL, and digestible carbohydrate with incident type 2 diabetes. We performed a case-cohort study nested within the European Prospective Investigation into Cancer and Nutrition Study, including a random subcohort (n = 16,835) and incident type 2 diabetes cases (n = 12,403). The median follow-up time was 12 y. Baseline dietary intakes were assessed using country-specific dietary questionnaires. Country-specific HR were calculated and pooled using random effects meta-analysis. Dietary GI, GL, and digestible carbohydrate in the subcohort were (mean +/- SD) 56 +/- 4, 127 +/- 23, and 226 +/- 36 g/d, respectively. After adjustment for confounders, GI and GL were not associated with incident diabetes [HR highest vs. lowest quartile (HRQ4) for GI: 1.05 (95% CI = 0.96, 1.16); HRQ4 for GL: 1.07 (95% CI = 0.95, 1.20)]. Digestible carbohydrate intake was not associated with incident diabetes [HRQ4: 0.98(95% CI = 0.86, 1.10)]. In additional analyses, we found that discrepancies in the GI value assignment to foods possibly explain differences in GI associations with diabetes within the same study population. In conclusion, an expansion of the GI tables and systematic GI value assignment to foods may be needed to improve the validity of GI values derived in such studies, after which GI associations may need reevaluation. Our study shows that digestible carbohydrate intake is not associated with diabetes risk and suggests that diabetes risk with high-GI and -GL diets may be more modest than initial studies suggested. J. Nutr. 143: 93-99, 2013.
Association of physical activity with all-cause mortality and incident and prevalent cardiovascular disease among patients with type 1 diabetes: the EURODIAB Prospective Complications Study
Tielemans, S.M.A.J. ; Soedamah-Muthu, S.S. ; Neve, M. De; Toeller, M. ; Chaturvedi, N. ; Fuller, J.H. ; Stamatakis, E. - \ 2013
Diabetologia 56 (2013)1. - ISSN 0012-186X - p. 82 - 91.
density lipoprotein cholesterol - risk-factors - consensus statement - iddm complications - hemoglobin a1c - mellitus - prevention - europe - standardization - retinopathy
AIMS/HYPOTHESIS: The aim of this study was to examine the association of physical activity (PA) with all-cause mortality and incident and prevalent cardiovascular disease (CVD) among patients with type 1 diabetes. METHODS: The EURODIAB Prospective Complications Study is a cohort including 3,250 male and female patients with type 1 diabetes (mean age 32.7¿±¿10.2 years) from 16 European countries, of whom 1,880 participated in follow-up examinations. In analysis 1 (longitudinal), the association of baseline PA (based on the reported number of hours per week spent in mild, moderate and vigorous PA) with all-cause mortality and incident CVD was examined by performing survival analysis. In analysis 2 (cross-sectional), we focused on the association between PA at follow-up (data on sports, walking distance and regular bicycling) and prevalent CVD by performing logistic regression analysis. Adjustments were made for age, sex, BMI, smoking, consumption of alcohol, consumption of certain nutrients and diabetic complications. RESULTS: Analysis 1 (longitudinal): participation in moderate or vigorous PA once a week or more was borderline inversely associated with all-cause mortality (men and women combined) (HR 0.66, 95% CI 0.42, 1.03) and incident CVD (women only) (HR 0.66, 95% CI 0.40, 1.08). No association was found in men. Analysis 2 (cross-sectional): total PA (indexed by sports, walking, bicycling) and distance walked were inversely associated with prevalent CVD (OR(totalPA) 0.66, 95% CI 0.45, 0.97; and OR(walking) 0.61, 95% CI 0.42, 0.89). CONCLUSIONS/INTERPRETATION: PA showed a borderline inverse association with both all-cause mortality (both sexes) and incident CVD (women only) in patients with type 1 diabetes. Since this is an under-researched clinical population, future longitudinal studies with objective PA measurements are needed to expand on these results.
Consumption of dairy products and associations with incident diabetes, CHD and mortality in the Whitehall II study
Soedamah-Muthu, S.S. ; Masset, G. ; Verberne, L.D.M. ; Geleijnse, J.M. ; Brunner, E.J. - \ 2013
The British journal of nutrition 109 (2013)4. - ISSN 0007-1145 - p. 718 - 726.
ischemic-heart-disease - postmenopausal women - metabolic syndrome - vascular-disease - life-style - fat intake - vitamin-d - risk - mellitus - milk
Few prospective studies have examined the effects of different types of dairy food on the risks of type 2 diabetes, CHD and mortality. We examined whether intakes of total dairy, high-fat dairy, low-fat dairy, milk and fermented dairy products were related to these outcomes in the Whitehall II prospective cohort study. At baseline, dairy consumption was assessed by FFQ among 4526 subjects (72 % men) with a mean age 56 (sd 6) years. Death certificates and medical records were used to ascertain CHD mortality and non-fatal myocardial infarction. Incident diabetes was detected by the oral glucose tolerance test or self-report. Incidence data were analysed using Cox proportional hazards models, adjusted for lifestyle and dietary factors. During approximately 10 years of follow-up, 273 diabetes, 323 CHD and 237 all-cause mortality cases occurred. In multivariable models, intakes of total dairy and types of dairy products were not significantly associated with incident diabetes or CHD (all P values for trend >0·1). Fermented dairy products was inversely associated with overall mortality (hazard ratios approximately 0·7 in the middle and highest tertiles; P for trend <0·01) but not with incident CHD or diabetes (P>0·3). In conclusion, intakes of total dairy and types of dairy products showed no consistent relationship with incident diabetes, CHD or all-cause mortality.
Physical activity reduces the risk of incident type 2 diabetes in general and in abdominally lean and obese men and women: the EPIC-InterAct Study
Ekelund, U. ; Feskens, E.J.M. - \ 2012
Diabetologia 55 (2012)7. - ISSN 0012-186X - p. 1944 - 1952.
10 european countries - body-mass index - life-style - insulin sensitivity - fat distribution - heart-rate - mellitus - adiposity - accelerometry - improves
Aims/hypothesis We examined the independent and combined associations of physical activity and obesity with incident type 2 diabetes in men and women. Methods The InterAct case–cohort study consists of 12,403 incident type 2 diabetes cases and a randomly selected subcohort of 16,154 individuals, drawn from a total cohort of 340,234 participants with 3.99 million person-years of follow-up. Physical activity was assessed by a four-category index. Obesity was measured by BMI and waist circumference (WC). Associations between physical activity, obesity and case-ascertained incident type 2 diabetes were analysed by Cox regression after adjusting for educational level, smoking status, alcohol consumption and energy intake. In combined analyses, individuals were stratified according to physical activity level, BMI and WC. Results A one-category difference in physical activity (equivalent to approximately 460 and 365 kJ/day in men and women, respectively) was independently associated with a 13% (HR 0.87, 95% CI 0.80, 0.94) and 7% (HR 0.93, 95% CI 0.89, 0.98) relative reduction in the risk of type 2 diabetes in men and women, respectively. Lower levels of physical activity were associated with an increased risk of diabetes across all strata of BMI. Comparing inactive with active individuals, the HRs were 1.44 (95% CI 1.11, 1.87) and 1.38 (95% CI 1.17, 1.62) in abdominally lean and obese inactive men, respectively, and 1.57 (95% CI 1.19, 2.07) and 1.19 (95% CI 1.01, 1.39) in abdominally lean and obese inactive women, respectively. Conclusions/interpretation Physical activity is associated with a reduction in the risk of developing type 2 diabetes across BMI categories in men and women, as well as in abdominally lean and obese men and women.
Long-term risk of incident type 2 Diabetes and measures of overall and regional obesity: The EPIC-InterAct Case-Cohort Study
Langenberg, C. ; Feskens, E.J.M. - \ 2012
PLOS Medicine 9 (2012)6. - ISSN 1549-1676 - 16 p.
body-mass index - waist circumference - abdominal adiposity - primary-care - nutrition - mellitus - cancer - participants - association - prevention
Background - Waist circumference (WC) is a simple and reliable measure of fat distribution that may add to the prediction of type 2 diabetes (T2D), but previous studies have been too small to reliably quantify the relative and absolute risk of future diabetes by WC at different levels of body mass index (BMI). Methods and Findings - The prospective InterAct case-cohort study was conducted in 26 centres in eight European countries and consists of 12,403 incident T2D cases and a stratified subcohort of 16,154 individuals from a total cohort of 340,234 participants with 3.99 million person-years of follow-up. We used Prentice-weighted Cox regression and random effects meta-analysis methods to estimate hazard ratios for T2D. Kaplan-Meier estimates of the cumulative incidence of T2D were calculated. BMI and WC were each independently associated with T2D, with WC being a stronger risk factor in women than in men. Risk increased across groups defined by BMI and WC; compared to low normal weight individuals (BMI 18.5–22.4 kg/m2) with a low WC (102/88 cm). Among the large group of overweight individuals, WC measurement was highly informative and facilitated the identification of a subgroup of overweight people with high WC whose 10-y T2D cumulative incidence (men, 70 per 1,000 person-years; women, 44 per 1,000 person-years) was comparable to that of the obese group (50–103 per 1,000 person-years in men and 28–74 per 1,000 person-years in women). Conclusions - WC is independently and strongly associated with T2D, particularly in women, and should be more widely measured for risk stratification. If targeted measurement is necessary for reasons of resource scarcity, measuring WC in overweight individuals may be an effective strategy, since it identifies a high-risk subgroup of individuals who could benefit from individualised preventive action.
Meat consumption and its association with C-reactive protein and incident type 2 diabetes : The Rotterdam Study
Woudenbergh, G.J. van; Kuijsten, A. ; Tigcheler, B. ; Sijbrands, E.J.G. ; Rooij, F.J.A. van; Hofman, A. ; Witteman, J.C.M. ; Feskens, E.J.M. - \ 2012
Diabetes Care 35 (2012)7. - ISSN 0149-5992 - p. 1499 - 1505.
glycation end-products - dietary patterns - risk-factor - mellitus - inflammation - women - disease - mice - men - metaanalysis
OBJECTIVE To investigate whether intake of different types of meat is associated with circulating C-reactive protein (CRP) and risk of type 2 diabetes in a prospective cohort study. RESEARCH DESIGN AND METHODS Our analysis included 4,366 Dutch participants who did not have diabetes at baseline. During a median follow-up period of 12.4 years, 456 diabetes cases were confirmed. Intake of red meat, processed meat, and poultry was derived from a food frequency questionnaire, and their association with serum high-sensitivity CRP was examined cross-sectionally using linear regression models. Their association with risk of type 2 diabetes was examined using multivariate Cox proportional hazards model, including age, sex, family history of diabetes, and lifestyle and dietary factors. RESULTS An increment of 50 g of processed meat was associated with increased CRP concentration (ßprocessed meat = 0.12; P = 0.01), whereas intake of red meat and poultry was not. When comparing the highest to the lowest category of meat intake with respect to diabetes incidence, the adjusted relative risks were as follows: for red meat (1.42 [95% CI 1.06–1.91]), for processed meat (1.87 [1.26–2.78]), and for poultry (0.95 [0.74–1.22]). Additional analysis showed that the associations were not affected appreciably after inclusion of CRP into the model. After adjustment for BMI, however, the association for red meat attenuated to 1.18 (0.88–1.59). CONCLUSIONS Intake of processed meat is associated with higher risk of type 2 diabetes. It appears unlikely that CRP mediates this association
The prospective association between total and type of fish intake and type 2 diabetes in 8 European countries: EPIC-InterAct Study
Patel, P.S. ; Forouhi, N.G. ; Kuijsten, A. ; Feskens, E.J.M. ; Woudenbergh, G.J. van - \ 2012
American Journal of Clinical Nutrition 95 (2012)6. - ISSN 0002-9165 - p. 1445 - 1453.
nutrition - cancer - consumption - omega-3-fatty-acids - project - design - risk - calibration - mellitus - validity
Background: Epidemiologic evidence of an association between fish intake and type 2 diabetes (T2D) is inconsistent and unresolved. Objective: The objective was to examine the association between total and type of fish intake and T2D in 8 European countries. Design: This was a case-cohort study, nested within the European Prospective Investigation into Cancer and Nutrition (EPIC) study, with 3.99 million person-years of follow-up, 12,403 incident diabetes cases, and a random subcohort of 16,835 individuals from 8 European countries. Habitual fish intake (lean fish, fatty fish, total fish, shellfish, and combined fish and shellfish) was assessed by country-specific dietary questionnaires. HRs were estimated in each country by using Prentice-weighted Cox regression models and pooled by using a random-effects meta-analysis. Results: No overall association was found between combined fish and shellfish intake and incident T2D per quartile (adjusted HR: 1.00; 95% CI: 0.94, 1.06; P-trend = 0.99). Total fish, lean fish, and shellfish intakes separately were also not associated with T2D, but fatty fish intake was weakly inversely associated with T2D: adjusted HR per quartile 0.97 (0.94, 1.00), with an HR of 0.84 (0.70, 1.01), 0.85 (0.76, 0.95), and 0.87 (0.78, 0.97) for a comparison of the second, third, and fourth quartiles with the lowest quartile of intake, respectively (P-trend = 0.06). Conclusions: These findings suggest that lean fish, total fish, and shellfish intakes are not associated with incident diabetes but that fatty fish intake may be weakly inversely associated. Replication of these findings in other populations and investigation of the mechanisms underlying these associations are warranted. Meanwhile, current public health recommendations on fish intake should remain unchanged
Coronary microvascular dysfunction in a porcine model of early atherosclerosis and diabetes
Heuvel, M. van den; Sorop, O. ; Koopmans, S.J. ; Dekker, R.A. ; Vries, R. de; Beusekom, H.M.M. ; Eringa, E.C. ; Duncker, D.J. ; Danser, A.H.J. ; Giessen, W.J. - \ 2012
American Journal of Physiology : Heart and Circulatory Physiology 302 (2012)1. - ISSN 0363-6135 - p. H85 - H95.
prediabetic metabolic syndrome - arterial resistance vessels - endothelial dysfunction - insulin-resistance - contractile responses - glucose-tolerance - s-nitrosothiols - risk-factors - blood-flow - mellitus
Detailed evaluation of coronary function early in diabetes mellitus (DM)-associated coronary artery disease (CAD) development is difficult in patients. Therefore, we investigated coronary conduit and small artery function in a preatherosclerotic DM porcine model with type 2 characteristics. Streptozotocin-induced DM pigs on a saturated fat/cholesterol (SFC) diet (SFC + DM) were compared with control pigs on SFC and standard (control) diets. SFC + DM pigs showed DM-associated metabolic alterations and early atherosclerosis development in the aorta. Endothelium-dependent vasodilation to bradykinin (BK), with or without blockade of nitric oxide (NO) synthase, endothelium-independent vasodilation to an exogenous NO-donor (S-nitroso-N-acetylpenicillamine), and vasoconstriction to endothelin (ET)-1 with blockade of receptor subtypes, were assessed in vitro. Small coronary arteries, but not conduit vessels, showed functional alterations including impaired BK-induced vasodilatation due to loss of NO (P <0.01 vs. SFC and control) and reduced vasoconstriction to ET-1 (P <0.01 vs. SFC and control), due to a decreased ETA receptor dominance. Other vasomotor responses were unaltered. In conclusion, this model demonstrates specific coronary microvascular alterations with regard to NO and ET-1 systems in the process of early atherosclerosis in DM. In particular, the altered ET-1 system correlated with hyperglycemia in atherogenic conditions, emphasizing the importance of this system in DM-associated CAD development.
Co-occurence of diabetes, myocardial infacttion, stroke, and cancer: quantifying age patterns in the Dutch population using health survey data
Baal, P.H. van; Engelfriet, P.M. ; Boshuizen, H.C. ; Kassteele, J. van de; Schellevis, F.G. ; Hoogenveen, R.T. - \ 2011
Population Health Metrics 9 (2011)1. - ISSN 1478-7954 - 9 p.
coronary-heart-disease - prevalence - comorbidity - risk - mellitus - netherlands - guidelines - mortality - register - trends
Background The high prevalence of chronic diseases in Western countries implies that the presence of multiple chronic diseases within one person is common. Especially at older ages, when the likelihood of having a chronic disease increases, the co-occurrence of distinct diseases will be encountered more frequently. The aim of this study was to estimate the age-specific prevalence of multimorbidity in the general population. In particular, we investigate to what extent specific pairs of diseases cluster within people and how this deviates from what is to be expected under the assumption of the independent occurrence of diseases (i.e., sheer coincidence). Methods We used data from a Dutch health survey to estimate the prevalence of pairs of chronic diseases specified by age. Diseases we focused on were diabetes, myocardial infarction, stroke, and cancer. Multinomial P-splines were fitted to the data to model the relation between age and disease status (single versus two diseases). To assess to what extent co-occurrence cannot be explained by independent occurrence, we estimated observed/expected co-occurrence ratios using predictions of the fitted regression models. Results Prevalence increased with age for all disease pairs. For all disease pairs, prevalence at most ages was much higher than is to be expected on the basis of coincidence. Observed/expected ratios of disease combinations decreased with age. Conclusion Common chronic diseases co-occur in one individual more frequently than is due to chance. In monitoring the occurrence of diseases among the population at large, such multimorbidity is insufficiently taken into account.
The prevention of type 2 diabetes: should we recommend vegetable oils instead of fatty fish?
Feskens, E.J.M. - \ 2011
American Journal of Clinical Nutrition 94 (2011)2. - ISSN 0002-9165 - p. 369 - 370.
risk - mellitus - women - men
The existence of an insulin-stimulated glucose and non-essential but not essential amino acid substrate interaction in diabetic pigs
Koopmans, S.J. ; Meulen, J. van der; Wijdenes, J.W. ; Corbijn, H. ; Dekker, R.A. - \ 2011
BMC Biochemistry 12 (2011). - ISSN 1471-2091 - 11 p.
protein-metabolism - resistance - mellitus - humans - niddm - gluconeogenesis - sensitivity - mechanism - kinetics - alanine
Background The generation of energy from glucose is impaired in diabetes and can be compensated by other substrates like fatty acids (Randle cycle). Little information is available on amino acids (AA) as alternative energy-source in diabetes. To study the interaction between insulin-stimulated glucose and AA utilization in normal and diabetic subjects, intraportal hyperinsulinaemic euglycaemic euaminoacidaemic clamp studies were performed in normal (n = 8) and streptozotocin (120 mg/kg) induced diabetic (n = 7) pigs of ~40-45 kg. Results Diabetic vs normal pigs showed basal hyperglycaemia (19.0 ± 2.0 vs 4.7 ± 0.1 mmol/L, P <.001) and at the level of individual AA, basal concentrations of valine and histidine were increased (P <.05) whereas tyrosine, alanine, asparagine, glutamine, glutamate, glycine and serine were decreased (P <.05). During the clamp, diabetic vs normal pigs showed reduced insulin-stimulated glucose clearance (4.4 ± 1.6 vs 16.0 ± 3.0 mL/kg·min, P <.001) but increased AA clearance (166 ± 22 vs 110 ± 13 mL/kg· min, P <.05) at matched arterial euglycaemia (5-7 mmol/L) and euaminoacidaemia (2.8-3.5 mmol/L). The increase in AA clearance was mainly caused by an increase in non-essential AA clearance (93.6 ± 13.8 vs 46.6 ± 5.4 mL/kg·min, P <.01), in particular alanine (14.2 ± 2.4 vs 3.2 ± 0.4 mL/kg·min, P <.001). Essential AA clearance was largely unchanged (72.9 ± 8.5 vs 63.3 ± 8.5 mL/kg· min), however clearances of threonine (P <.05) and tyrosine (P <.01) were increased in diabetic vs normal pigs (8.1 ± 1.3 vs 5.2 ± 0.5, and 14.3 ± 2.5 vs 6.4 ± 0.7 mL/kg· min, respectively). Conclusions The ratio of insulin-stimulated glucose versus AA clearance was decreased 5.4-fold in diabetic pigs, which was caused by a 3.6-fold decrease in glucose clearance and a 2.0-fold increase in non-essential AA clearance. In parallel with the Randle concept (glucose - fatty acid cycle), the present data suggest the existence of a glucose and non-essential AA substrate interaction in diabetic pigs whereby reduced insulin-stimulated glucose clearance seems to be partly compensated by an increase in non-essential AA clearance whereas essential AA are preferentially spared from an increase in clearance.
Fatty acids measured in plasma and erythrocyte-membrane phospholipids and derived by food-frequency questionnaire and the risk of new-onset type 2 diabetes a pilot study in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Norfolk cohort
Patel, P.S. ; Sharp, S.J. ; Jansen, E.H.J.M. - \ 2010
American Journal of Clinical Nutrition 92 (2010)5. - ISSN 0002-9165 - p. 1214 - 1222.
dietary-fat - epic-norfolk - adipose-tissue - blood-cells - biomarkers - women - men - predicts - mellitus - storage
Background Epidemiologic evidence for the association between types of fatty acid and risk of type 2 diabetes is inconsistent This may in part be due to the limitations of fatty acid measurement methods Objective The objective was to use 3 different measures of fatty acid to estimate the prospective association between fatty acid composition and development of incident diabetes Design We analyzed 199 cases of clinically incident diabetes and 184 noncases aged 40-79 y at baseline in the EPIC (European Prospective Investigation into Cancer and Nutrition)-Norfolk study Fatty acids were derived from a food frequency questionnaire (FFQ) and measured in plasma phospholipid (P FA) and erythrocyte membrane phospholipid (Ery FA) fractions by gas chromatography Results There were stronger associations with diabetes risk with the use of objectively measured tatty acids (P FA and Ery-FA) than with the FFQ in analyses adjusted for age sex and potential confounders Positive associations with diabetes were greater in magnitude with the use of P FA than with Ery FA (highest lowest tertiles) for example the palmitic acid odds ratios (ORs) were 247 (95% CI 1 37 4 46) and 1 96 (95% CI 1 10 3 49) respectively Inverse associations with diabetes were also stronger with the use of P FA than with Ery FA for example the OR for linoleic acid was 050 (95% CI 028 0 91) compared with 0 77 (95% CI 043 1 37) respectively Conclusions The objective measurement of fatty acids with the use of either P-FA or Ery-FA identifies important associations with diabetes Incidence that may be missed when assessed by FFQ Fatty acids measured in P-FA appear to be more strongly associated with diabetes incidence These findings endorse the use of objective measurement of fatty acids for nutritional-epidemiologic studies and the apparently stronger findings for the plasma fraction should be confirmed in larger studies and in different populations Am J Clin Nutr 2010 92 1214-22