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Allaoui G, Rylander C, Fuskevåg OM, Grimnes G, Averina M, Wilsgaard T, Berg V. Longitudinal assessment of classic and 11-oxygenated androgen concentrations and their association with type 2 diabetes mellitus development: the Tromsø study. Acta Diabetol 2024:10.1007/s00592-024-02266-5. [PMID: 38498076 DOI: 10.1007/s00592-024-02266-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 02/27/2024] [Indexed: 03/19/2024]
Abstract
AIM We aimed to investigate changes in pre-diagnostic concentrations of classic and 11-oxygenated androgens in type 2 diabetes (T2DM) cases and healthy controls, associations between androgen concentrations and T2DM, and the potential for androgens to improve the prediction of T2DM when considered in combination with established risk factors. METHODS Androgen concentrations were analysed in serum samples from 116 T2DM cases and 138 controls at 3, pre-diagnostic time-points: 1986/87 (T1), 1994/95 (T2), and 2001 (T3). Generalised estimating equations were used to longitudinally examine androgen concentrations, and logistic regression models were used to estimate the odds ratios (OR) of T2DM at each time-point. Logistic regression models were also used to calculate area under the receiver operating characteristics curve (AROC) from models including established risk factors alone (ERF model) and established risk factors plus each androgen, respectively, which were compared to identify improvements in predictive ability. RESULTS For women, no significant associations were observed between any of the investigated androgens and T2DM after adjusting for confounders. For men, after adjusting for confounders, concentrations of all investigated 11-oxygenated androgens were higher in cases than controls at one or several time-points. We observed associations between T2DM and concentrations of 11-ketoandrostenedione (OR: 1.59) and 11-ketotestosterone (OR: 1.62) at T1; and 11-hydroxyandrostenedione (OR: 2.00), 11-hydroxytestosterone (OR: 1.76), 11-ketoandrostenedione (OR: 1.84), 11-ketotestosterone (OR: 1.78) and testosterone (OR: 0.45) at T3 in men. The addition of these androgens (including 11-hydroxytestosterone at T2) to the ERF model resulted in an improved ability to predict T2DM in men (AROC: 0.79-0.82). We did not observe significant differences in changes in androgen concentrations over time between cases and controls in either sex. CONCLUSION Our results demonstrate that testosterone and 11-oxygenated androgens are associated with T2DM in men before diagnosis and may be potential biomarkers in T2DM risk assessment.
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Affiliation(s)
- Giovanni Allaoui
- Division of Diagnostic Services, Department of Laboratory Medicine, University Hospital of North-Norway, 9038, Tromsø, Norway
- Department of Medical Biology, Faculty of Health Sciences, UiT-The Arctic University of Norway, 9037, Tromsø, Norway
| | - Charlotta Rylander
- Department of Community Medicine, Faculty of Health Sciences, UIT-The Arctic University of Norway, 9037, Tromsø, Norway
| | - Ole-Martin Fuskevåg
- Division of Diagnostic Services, Department of Laboratory Medicine, University Hospital of North-Norway, 9038, Tromsø, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, UIT-The Arctic University of Norway, 9037, Tromsø, Norway
| | - Guri Grimnes
- Department of Clinical Medicine, Faculty of Health Sciences, UIT-The Arctic University of Norway, 9037, Tromsø, Norway
- Division of Medicine, University Hospital of North-Norway, 9038, Tromsø, Norway
| | - Maria Averina
- Division of Diagnostic Services, Department of Laboratory Medicine, University Hospital of North-Norway, 9038, Tromsø, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, UIT-The Arctic University of Norway, 9037, Tromsø, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, Faculty of Health Sciences, UIT-The Arctic University of Norway, 9037, Tromsø, Norway
| | - Vivian Berg
- Division of Diagnostic Services, Department of Laboratory Medicine, University Hospital of North-Norway, 9038, Tromsø, Norway.
- Department of Medical Biology, Faculty of Health Sciences, UiT-The Arctic University of Norway, 9037, Tromsø, Norway.
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Hansen AH, Johansen ML. Personal continuity of GP care and outpatient specialist visits in people with type 2 diabetes: A cross-sectional survey. PLoS One 2022; 17:e0276054. [PMID: 36282805 PMCID: PMC9595526 DOI: 10.1371/journal.pone.0276054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Continuity of care is particularly important for patients with chronic conditions, such as type 2 diabetes (T2D). Continuity is shown to reduce overall health service utilization among people with diabetes, however, evidence about how it relates to the utilization of outpatient specialist services in Norway is lacking. The aim of this study was to investigate continuity of GP care for people with T2D, and its association with the use of outpatient specialist health care services. METHODS We used e-mail questionnaire data obtained from members of The Norwegian Diabetes Association in 2018. Eligible for analyses were 494 respondents with T2D and at least one GP visit during the previous year. By descriptive statistics and logistic regressions, we studied usual provider continuity (UPC) and duration of the patient-GP relationship and associations of these measures with somatic outpatient specialist visits. Analyses were adjusted for gender, age, education, self-rated health, and diabetes duration. RESULTS Mean age was 62.6 years and mean UPC was 0.85 (CI 0.83-0.87). Two thirds of the sample (66.0%) had made all visits to the regular GP during the previous year (full continuity). Among these, 48.1% had made one or more specialist visits during the previous year, compared to 65.2% among those without full continuity. The probability of outpatient specialist visits was significantly lower among participants with full continuity, compared to those without full continuity (Odds Ratio 0.53, Confidence Interval 0.35-0.80). The probability of visiting outpatient specialist services was not associated with duration of the patient-GP relationship. CONCLUSIONS We conclude that continuity of care, as measured by Usual Provider Continuity, is high and associated with reduced use of somatic outpatient specialist services in people with T2D in Norway. Continuity and its benefits will become increasingly important as the number of older people with diabetes and other chronic diseases increases.
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Affiliation(s)
- Anne Helen Hansen
- Faculty of Health Sciences, Department of Community Medicine, UiT The Arctic University of Norway and University Hospital of North Norway, Tromsø, Norway
- * E-mail:
| | - May-Lill Johansen
- Faculty of Health Sciences, Department of Community Medicine, Research Unit for General Practice, UiT The Arctic University of Norway, Tromsø, Norway
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Karpińska M, Czauderna M. Pancreas—Its Functions, Disorders, and Physiological Impact on the Mammals’ Organism. Front Physiol 2022; 13:807632. [PMID: 35431983 PMCID: PMC9005876 DOI: 10.3389/fphys.2022.807632] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/04/2022] [Indexed: 12/15/2022] Open
Abstract
This review aimed to analyze the scientific literature on pancreatic diseases (especially exocrine pancreatic insufficiency). This review also describes the correlation between the physiological fitness of the pancreas and obesity. The influence of the pancreatic exocrine function on the development of the organism of adults and adolescents was also described. The results of piglet studies available in the literature were cited as an established model used to optimize treatments for pancreatic diseases in humans. The pancreas has an exocrine and hormonal function. Consequently, it is one of the key internal organs in animals and humans. Pancreatic diseases are usually severe and particularly troublesome. A properly composed diet and taken dietary supplements significantly improve the patient’s well-being, as well as the course of the disease. Therefore, a diet and a healthy lifestyle positively affect maintaining the optimal physiological efficiency of the pancreas.
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Sluijs T, Lokkers L, Özsezen S, Veldhuis GA, Wortelboer HM. An Innovative Approach for Decision-Making on Designing Lifestyle Programs to Reduce Type 2 Diabetes on Dutch Population Level Using Dynamic Simulations. Front Public Health 2021; 9:652694. [PMID: 33996729 PMCID: PMC8116515 DOI: 10.3389/fpubh.2021.652694] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/22/2021] [Indexed: 12/12/2022] Open
Abstract
The number of individuals suffering from type 2 diabetes is dramatically increasing worldwide, resulting in an increasing burden on society and rising healthcare costs. With increasing evidence supporting lifestyle intervention programs to reduce type 2 diabetes, and the use of scenario simulations for policy support, there is an opportunity to improve population interventions based upon cost–benefit analysis of especially complex lifestyle intervention programs through dynamic simulations. In this article, we used the System Dynamics (SD) modeling methodology aiming to develop a simulation model for policy makers and health professionals to gain a clear understanding of the patient journey of type 2 diabetes mellitus and to assess the impact of lifestyle intervention programs on total cost for society associated with prevention and lifestyle treatment of pre-diabetes and type 2 diabetes in The Netherlands. System dynamics describes underlying structure in the form of causal relationships, stocks, flows, and delays to explore behavior and simulate scenarios, in order to prescribe intervention programs. The methodology has the opportunity to estimate and simulate the consequences of unforeseen interactions in order to prescribe intervention programs based on scenarios tested through “what-if” experiments. First, the extensive knowledge of diabetes, current available data on the type 2 diabetes population, lifestyle intervention programs, and associated cost in The Netherlands were captured in one simulation model. Next, the relationships between leverage points on the growth of type 2 diabetes population were based upon available data. Subsequently, the cost and benefits of future lifestyle intervention programs on reducing diabetes were simulated, identifying the need for an integrated adaptive design of lifestyle programs while collecting the appropriate data over time. The strengths and limitations of scenario simulations of complex lifestyle intervention programs to improve the (cost)effectiveness of these programs to reduce diabetes in a more sustainable way compared to usual care are discussed.
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Affiliation(s)
- Teun Sluijs
- Department of Microbiology and Systems Biology, Netherlands Organisation for Applied Scientific Research (TNO), Zeist, Netherlands
| | - Lotte Lokkers
- Methodology Department, School of Management, Radboud University, Nijmegen, Netherlands
| | - Serdar Özsezen
- Department of Microbiology and Systems Biology, Netherlands Organisation for Applied Scientific Research (TNO), Zeist, Netherlands
| | - Guido A Veldhuis
- Department Military Operations, Netherlands Organisation for Applied Scientific Research (TNO), The Hague, Netherlands
| | - Heleen M Wortelboer
- Department of Microbiology and Systems Biology, Netherlands Organisation for Applied Scientific Research (TNO), Zeist, Netherlands
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Langholz PL, Wilsgaard T, Njølstad I, Jorde R, Hopstock LA. Trends in known and undiagnosed diabetes, HbA1c levels, cardiometabolic risk factors and diabetes treatment target achievement in repeated cross-sectional surveys: the population-based Tromsø Study 1994-2016. BMJ Open 2021; 11:e041846. [PMID: 33757943 PMCID: PMC7993331 DOI: 10.1136/bmjopen-2020-041846] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 02/19/2021] [Accepted: 03/01/2021] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES The aim of this study was to investigate time trends in known and undiagnosed diabetes, glycated haemoglobin (HbA1c) levels and other cardiometabolic risk factors in the general population as well as treatment target achievement among those with diabetes. DESIGN AND SETTING Repeated cross-sectional surveys in the population-based Tromsø Study. METHODS We used age-adjusted generalised estimating equation models to study trends in self-reported and undiagnosed (HbA1c ≥6.5%) diabetes, cardiometabolic risk factors and the metabolic syndrome in 27 281 women and men aged 40-84 years examined in up to four surveys of the Tromsø Study between 1994 and 2016. Further, we analysed trends in diabetes treatment target achievement. RESULTS During 1994-2016, diabetes prevalence increased in women (2.3% to 4.6%) and men (2.4% to 5.8%) and in all age groups, while the proportion of undiagnosed diabetes in women (32% to 17%) and men (37% to 24%) decreased. Blood pressure and total cholesterol decreased, while waist circumference increased in participants with and without diabetes, leading to a relatively stable prevalence of the metabolic syndrome throughout the study period. There was a marginal increase in HbA1c levels among participants without diabetes. Only half of those with diabetes achieved the treatment target of HbA1c ≤7.0%. CONCLUSION In the last two decades, diabetes prevalence increased, while the proportion of undiagnosed diabetes declined. The prevalence of the metabolic syndrome remained stable throughout, driven by opposing trends with an increase in obesity and a decrease in other cardiometabolic risk factors. HbA1c treatment target achievement did not improve.
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Affiliation(s)
- Petja Lyn Langholz
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Inger Njølstad
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Rolf Jorde
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
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Norvik JV, Schirmer H, Ytrehus K, Storhaug HM, Jenssen TG, Eriksen BO, Mathiesen EB, Løchen M, Wilsgaard T, Solbu MD. Uric acid predicts mortality and ischaemic stroke in subjects with diastolic dysfunction: the Tromsø Study 1994-2013. ESC Heart Fail 2017; 4:154-161. [PMID: 28451452 PMCID: PMC5396037 DOI: 10.1002/ehf2.12134] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 12/08/2016] [Indexed: 01/19/2023] Open
Abstract
AIMS To investigate whether serum uric acid predicts adverse outcomes in persons with indices of diastolic dysfunction in a general population. METHODS AND RESULTS We performed a prospective cohort study among 1460 women and 1480 men from 1994 to 2013. Endpoints were all-cause mortality, incident myocardial infarction, and incident ischaemic stroke. We stratified the analyses by echocardiographic markers of diastolic dysfunction, and uric acid was the independent variable of interest. Hazard ratios (HR) were estimated per 59 μmol/L increase in baseline uric acid. Multivariable adjusted Cox proportional hazards models showed that uric acid predicted all-cause mortality in subjects with E/A ratio <0.75 (HR 1.12, 95% confidence interval [CI] 1.00-1.25) or E/A ratio >1.5 (HR 1.51, 95% CI 1.09-2.09, P for interaction between E/A ratio category and uric acid = 0.02). Elevated uric acid increased mortality risk in persons with E-wave deceleration time <140 ms or >220 ms (HR 1.46, 95% CI 1.01-2.12 and HR 1.13, 95% CI 1.02-1.26, respectively; P for interaction = 0.04). Furthermore, in participants with isovolumetric relaxation time ≤60 ms, mortality risk was higher with increasing uric acid (HR 4.98, 95% CI 2.02-12.26, P for interaction = 0.004). Finally, elevated uric acid predicted ischaemic stroke in subjects with severely enlarged left atria (HR 1.62, 95% CI 1.03-2.53, P for interaction = 0.047). CONCLUSIONS Increased uric acid was associated with higher all-cause mortality risk in subjects with echocardiographic indices of diastolic dysfunction, and with higher ischaemic stroke risk in persons with severely enlarged left atria.
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Affiliation(s)
- Jon V. Norvik
- Metabolic and Renal Research GroupUiT The Arctic University of NorwayN‐9037TromsøNorway
- Cardiovascular Research Group IMBUiT The Arctic University of NorwayN‐9037TromsøNorway
| | - Henrik Schirmer
- Department of CardiologyUniversity Hospital of North NorwayN‐9038TromsøNorway
- Cardiovascular Research Group IKMUiT The Arctic University of NorwayN‐9037TromsøNorway
| | - Kirsti Ytrehus
- Metabolic and Renal Research GroupUiT The Arctic University of NorwayN‐9037TromsøNorway
- Cardiovascular Research Group IMBUiT The Arctic University of NorwayN‐9037TromsøNorway
| | - Hilde M. Storhaug
- Metabolic and Renal Research GroupUiT The Arctic University of NorwayN‐9037TromsøNorway
| | - Trond G. Jenssen
- Metabolic and Renal Research GroupUiT The Arctic University of NorwayN‐9037TromsøNorway
- Department of Transplant MedicineOslo University Hospital RikshospitaletN‐0424OsloNorway
| | - Bjørn O. Eriksen
- Metabolic and Renal Research GroupUiT The Arctic University of NorwayN‐9037TromsøNorway
- Section of NephrologyUniversity Hospital of North NorwayN‐9038TromsøNorway
| | - Ellisiv B. Mathiesen
- Department of NeurologyUniversity Hospital of North NorwayN‐9038TromsøNorway
- Brain and Circulation Research GroupUiT The Arctic University of NorwayN‐9037TromsøNorway
| | - Maja‐Lisa Løchen
- Epidemiology of Chronic Diseases Research GroupUiT The Arctic University of NorwayN‐9037TromsøNorway
| | - Tom Wilsgaard
- Epidemiology of Chronic Diseases Research GroupUiT The Arctic University of NorwayN‐9037TromsøNorway
| | - Marit D. Solbu
- Metabolic and Renal Research GroupUiT The Arctic University of NorwayN‐9037TromsøNorway
- Section of NephrologyUniversity Hospital of North NorwayN‐9038TromsøNorway
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7
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Norvik JV, Storhaug HM, Ytrehus K, Jenssen TG, Zykova SN, Eriksen BO, Solbu MD. Overweight modifies the longitudinal association between uric acid and some components of the metabolic syndrome: The Tromsø Study. BMC Cardiovasc Disord 2016; 16:85. [PMID: 27165776 PMCID: PMC4862215 DOI: 10.1186/s12872-016-0265-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 04/29/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Elevated uric acid (UA) is associated with the presence of the metabolic syndrome (MetS). In a prospective cohort study, we assessed whether baseline and longitudinal change in UA were risk factors for development of MetS and its individual components. METHODS We included 3087 women and 2996 men who had UA measured in the population based Tromsø Study 1994-95. The participants were stratified according to body mass index (BMI). Endpoints were MetS and each component of the syndrome after 7 years, according to the revised National Cholesterol Education Program's Adult Treatment Panel III (NCEP-ATP III) definition. RESULTS Multiple logistic regression analyses showed that higher baseline UA was associated with higher odds of developing elevated blood pressure in overweight subjects (BMI ≥ 25 kg/m(2), odds ratio [OR] per 59 μmol/L UA increase 1.44, 95 % confidence interval [CI] = 1.17-1.77, P = 0.001), but not in normal-weight subjects (BMI < 25 kg/m(2), P for interaction = 0.04). Overweight also modified the association between baseline UA and the development of elevated fasting glucose (P for interaction = 0.01). UA was a predictor of MetS in all subjects (OR per 59 μmol/L UA increase 1.29, 95 % CI 1.18-1.41, P < 0.001). Furthermore, longitudinal UA change was independently associated with the development of MetS in all subjects (OR per 59 μmol/L UA increase over 7 years 1.28, 95 % CI 1.16-1.42, P < 0.001). CONCLUSION Increased levels of baseline UA independently predicted development of elevated blood pressure and higher fasting glycemia in the overweight, but not the normal-weight subjects. Baseline UA and longitudinal increase in UA over 7 years was associated with the development of MetS in all subjects. Whether increased UA should be treated differently in normal-weight and overweight persons needs further study.
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Affiliation(s)
- Jon V Norvik
- Metabolic and Renal Research Group, UiT The Arctic University of Norway, N-9037, Tromsø, Norway.
- Department of Medical Biology, UiT The Arctic University of Norway, N-9037, Tromsø, Norway.
- Northern Norway Regional Health Authority, N-8038, Bodø, Norway.
| | - Hilde M Storhaug
- Metabolic and Renal Research Group, UiT The Arctic University of Norway, N-9037, Tromsø, Norway
| | - Kirsti Ytrehus
- Metabolic and Renal Research Group, UiT The Arctic University of Norway, N-9037, Tromsø, Norway
- Department of Medical Biology, UiT The Arctic University of Norway, N-9037, Tromsø, Norway
| | - Trond G Jenssen
- Metabolic and Renal Research Group, UiT The Arctic University of Norway, N-9037, Tromsø, Norway
- Department of Transplant Medicine, Oslo University Hospital Rikshospitalet, N-0424, Oslo, Norway
| | - Svetlana N Zykova
- Metabolic and Renal Research Group, UiT The Arctic University of Norway, N-9037, Tromsø, Norway
- Centre for Clinical Research and Education, University Hospital of North Norway, N-9038, Tromsø, Norway
| | - Bjørn O Eriksen
- Metabolic and Renal Research Group, UiT The Arctic University of Norway, N-9037, Tromsø, Norway
- Section of Nephrology, University Hospital of North Norway, N-9038, Tromsø, Norway
| | - Marit D Solbu
- Metabolic and Renal Research Group, UiT The Arctic University of Norway, N-9037, Tromsø, Norway
- Section of Nephrology, University Hospital of North Norway, N-9038, Tromsø, Norway
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Sung KC, Park HY, Kim MJ, Reaven G. Metabolic markers associated with insulin resistance predict type 2 diabetes in Koreans with normal blood pressure or prehypertension. Cardiovasc Diabetol 2016; 15:47. [PMID: 27001495 PMCID: PMC4802716 DOI: 10.1186/s12933-016-0368-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 03/15/2016] [Indexed: 12/03/2022] Open
Abstract
Background Questions remain as to the association between essential hypertension and increased incidence of type 2 diabetes (T2DM). The premise of this analysis is that insulin resistance/compensatory hyperinsulinemia is a major predictor of T2DM, and the greater the prevalence of insulin resistance within any population, normotensive or hypertensive, the more likely T2DM will develop. The hypothesis to be tested is that surrogate estimates of insulin resistance will predict incident T2DM to a significant degree in persons with normal blood pressure or prehypertension. Methods Analysis of data from a population-based survey of 10, 038 inhabitants of rural and urban areas of Korea, ≥40 years-old, initiated in 2001, with measures of demographic and metabolic characteristics at baseline and 8-years later. Participants were classified as having normal blood pressure or prehypertension, and three simple manifestations of insulin resistance related to the pathophysiology of T2DM used to predict incident T2DM: (1) glycemia (plasma glucose concentration 2-hour after 75 g oral glucose challenge = 2-hour PG); (2) hyperinsulinemia (plasma insulin concentration 2-hour after 75 g oral glucose challenge = 2-hour PI); and (3) dyslipidemia (ratio of fasting plasma triglyceride/high/density lipoprotein cholesterol concentration = TG/HDL-C ratio). Results Fully adjusted hazard ratios (HR, 95 % CI) for incident T2DM were highest (P < 0.001) in the quartile of individuals with the highest 2-hour PG concentrations, ranging from 5.84 (3.37–10.1) in women with prehypertension to 12.2 (7.12–21.00) in men with normal blood pressure. T2DM also developed to a significantly greater degree in subjects within the highest quartile of TG/HDL-C ratios, with HRs varying from 2.91 (1.63–2.58) in women with prehypertension (P < 0.001) to 1.77 (1.12–2.81, P < 0.05) in men with prehypertension. The least predictive index of insulin resistance was the 2-hour PI concentration. Subjects with normal blood pressure in the highest quartile of 2-hour PI concentrations were significantly associated with incident T2DM, with HRs of 1.5 (1.02–2.20, P = 0.25) and 2.02 (1.35–3.02, P < 0.001), in men and women, respectively. Finally, incidence of T2DM in the highest quartile was somewhat greater in patients with prehypertension, irrespective of predictor. Conclusions Metabolic variables associated with insulin resistance (glycemia, insulinemia, and dyslipidemia) predict the development of T2DM in patients with either normal blood pressure or prehypertension. Electronic supplementary material The online version of this article (doi:10.1186/s12933-016-0368-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ki-Chul Sung
- Division of Cardiology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, #108, Pyung Dong, Jongro-Ku, Seoul, 110-746, Republic of Korea.
| | - Hyun-Young Park
- Division of Cardiovascular and Rare Diseases, Center for Biomedical Science, Korea National Institute of Health, 187 Osongsaengmyeng 2-ro, Osong-eup, Heungdeok-gu, Cheongju, Chungbuk, 361-951, Republic of Korea
| | - Min-Ju Kim
- Division of Cardiovascular and Rare Diseases, Center for Biomedical Science, Korea National Institute of Health, 187 Osongsaengmyeng 2-ro, Osong-eup, Heungdeok-gu, Cheongju, Chungbuk, 361-951, Republic of Korea
| | - Gerald Reaven
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
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Lappas M, Mundra PA, Wong G, Huynh K, Jinks D, Georgiou HM, Permezel M, Meikle PJ. The prediction of type 2 diabetes in women with previous gestational diabetes mellitus using lipidomics. Diabetologia 2015; 58:1436-42. [PMID: 25893729 DOI: 10.1007/s00125-015-3587-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 03/23/2015] [Indexed: 01/22/2023]
Abstract
AIMS/HYPOTHESIS The risk of developing diabetes is greater for women with previous gestational diabetes mellitus (GDM). In the general population, plasma lipidomic analysis can identify individuals at risk of developing type 2 diabetes. The aim of this study was to determine whether circulating lipid levels 12 weeks following a GDM pregnancy were associated with an increased risk of developing type 2 diabetes. METHODS Plasma lipid profiles containing >300 lipids were measured in 104 normal glucose-tolerant women 12 weeks following an index GDM pregnancy using electrospray-ionisation tandem mass spectrometry. Women were assessed for 10 years for development of overt type 2 diabetes. RESULTS Among the 104 women with previous GDM, 21 (20%) developed diabetes during the median follow-up period of 8.5 years. Three lipid species, the cholesteryl ester species CE 20:4, the alkenylphosphatidylethanolamine species PE(P-36:2) and the phosphatidylserine species PS 38:4, were independently and positively associated with the development of type 2 diabetes. In a clinical model of prediction of type 2 diabetes that included age, BMI, and levels of pregnancy fasting glucose, postnatal fasting glucose, triacylglycerol and total cholesterol, the addition of these three lipid species resulted in an improvement in the net reclassification index of 22.3%. CONCLUSIONS/INTERPRETATION The lipid species CE 20:4, PE(P-36:2) and PS 38:4 were significant risk factors for the development of type 2 diabetes in women with a previous history of GDM. This report is the first to use plasma lipidomic analysis to identify individual lipids as potential biomarkers for the prediction of type 2 diabetes in women with a history of GDM.
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Affiliation(s)
- Martha Lappas
- Obstetrics, Nutrition and Endocrinology Group, Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Level 4/163 Studley Road, Heidelberg, 3084, VIC, Australia,
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10
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Skogen JC, Stewart R, Knapstad M, Overland S, Mykletun A. Early life factors in relation to cardiovascular risk and cardiovascular disease in old age in Bergen: a Norwegian retrospective cohort study based on the Hordaland Health Study (HUSK). JRSM Open 2014; 5:2054270414527935. [PMID: 25057406 PMCID: PMC4100231 DOI: 10.1177/2054270414527935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives The fetal origins of adult disease hypothesis describes associations found for fetal or early-life exposures with cardiovascular risk and disease in adulthood. The extension or not of these associations into old age has received less attention. We investigated if maternal health and family circumstances were associated with cardiovascular risk factors and cardiovascular disease (CVD) in late life and discuss results in light of possible selection effects and measurement error. Design A retrospective cohort study based on community survey. We examined 224 possible associations between anthropometric measures, maternal health information and family socioeconomic status at birth versus CVD and CVD-related risk factors 72–74 years later. Participants Of 3341 participants in a community survey of people aged 72–74 years, we were able to trace birth records from a historical archive in a broadly representative subsample of 480. Setting Bergen, Norway Main outcome measures Established cardiovascular risk factors and indicators of CVD. Results Only 11 (4.9%) of these associations were found to be statistically significant, and no strong or consistent patterns in the associations between exposures and outcomes were found. Conclusions There was little evidence in this relatively elderly sample for an association between early life factors and CVD outcomes of clinical or public health relevance. Further research is required to confirm the extent to which a diminution of early life influences into old age, if genuine, can be accounted for by selective mortality, systematic bias or by dilution of effects due to competing risk factors.
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Affiliation(s)
- Jens Christoffer Skogen
- Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen 5020, Norway ; Alcohol and Drug Research Western Norway, Stavanger University Hospital, Stavanger 4010, Norway ; Department of Public Mental Health, Division of Mental Health, Norwegian Institute of Public Health, Bergen 5018, Norway
| | - Robert Stewart
- Institute of Psychiatry, King's College London, London WC2R 2LS, UK
| | - Marit Knapstad
- Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen 5020, Norway ; Department of Public Mental Health, Division of Mental Health, Norwegian Institute of Public Health, Bergen 5018, Norway
| | - Simon Overland
- Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen 5020, Norway ; Department of Public Mental Health, Division of Mental Health, Norwegian Institute of Public Health, Bergen 5018, Norway
| | - Arnstein Mykletun
- Department of Public Mental Health, Division of Mental Health, Norwegian Institute of Public Health, Bergen 5018, Norway ; School of Psychiatry, University of New South Wales, Sydney NSW 2052, Australia
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Jorde R, Schirmer H, Wilsgaard T, Joakimsen RM, Mathiesen EB, Njølstad I, Løchen ML, Figenschau Y, Svartberg J, Hutchinson MS, Kjærgaard M, Jørgensen L, Grimnes G. The phosphodiesterase 8B gene rs4704397 is associated with thyroid function, risk of myocardial infarction, and body height: the Tromsø study. Thyroid 2014; 24:215-22. [PMID: 23941514 DOI: 10.1089/thy.2013.0177] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE High serum thyrotropin (TSH) levels predict cardiovascular disease (CVD). Recently several single nucleotide polymorphisms (SNPs) associated with TSH levels have been identified, one of them being the rs4704397 SNP in the phosphodiesterase 8B (PDE8B) gene. If the relation between thyroid function and CVD is causal, one could also expect rs4704397 genotypes to predict CVD and possibly health in general. METHODS DNA was prepared and genotyping performed for rs4704397 in subjects who participated in the fourth survey of the Tromsø Study in 1994-1995 and who were registered with the endpoints myocardial infarction (MI), type 2 diabetes (T2DM), cancer, or death, as well as a randomly selected control group. Similarly, genotyping was performed in subjects who had participated in clinical trials where serum TSH, free T4 (fT4), and free T3 (fT3) were measured. RESULTS From the Tromsø Study, 8938 subjects without thyroid disease or thyroid medication were successfully genotyped for rs4704397. Among these, 2098 were registered with MI, 1025 with T2DM, 2748 with cancer, and 3592 had died. The minor homozygote genotype (A:A) had a median serum TSH level that was 0.29 mIU/L higher than in the major homozygote genotype (G:G). The A:A genotype had a significantly increased risk of MI as compared to the G:G genotype (1.14 [1.00-1.29], hazard ratio [confidence interval], Cox regression with adjustment for age, sex, and body mass index). No significant associations were seen with the other endpoints or CVD risk factors. Furthermore, subjects with the G:G genotype were significantly taller than subjects with the A:A genotype (mean difference 1.5 cm). In 584 subjects with serum TSH, fT4, and fT3 measurements, the subjects with the A:A genotype had significantly higher serum TSH and nonsignificantly lower serum fT3 (mean difference 0.15 pmol/L) levels than subjects with the G:G genotype. CONCLUSION rs4704397 is associated with thyroid function, risk of MI, and body height. However, confirmation in other cohorts is needed before firm conclusions can be drawn.
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Affiliation(s)
- Rolf Jorde
- 1 Tromsø Endocrine Research Group, University of Tromsø , Tromsø, Norway
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Hofman A, Darwish Murad S, van Duijn CM, Franco OH, Goedegebure A, Ikram MA, Klaver CCW, Nijsten TEC, Peeters RP, Stricker BHC, Tiemeier HW, Uitterlinden AG, Vernooij MW. The Rotterdam Study: 2014 objectives and design update. Eur J Epidemiol 2013; 28:889-926. [PMID: 24258680 DOI: 10.1007/s10654-013-9866-z] [Citation(s) in RCA: 259] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 11/08/2013] [Indexed: 02/06/2023]
Abstract
The Rotterdam Study is a prospective cohort study ongoing since 1990 in the city of Rotterdam in The Netherlands. The study targets cardiovascular, endocrine, hepatic, neurological, ophthalmic, psychiatric, dermatological, oncological, and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. The findings of the Rotterdam Study have been presented in over a 1,000 research articles and reports (see www.erasmus-epidemiology.nl/rotterdamstudy ). This article gives the rationale of the study and its design. It also presents a summary of the major findings and an update of the objectives and methods.
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Affiliation(s)
- Albert Hofman
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands,
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13
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Serum calcium and the calcium-sensing receptor polymorphism rs17251221 in relation to coronary heart disease, type 2 diabetes, cancer and mortality: the Tromsø Study. Eur J Epidemiol 2013; 28:569-78. [PMID: 23860708 DOI: 10.1007/s10654-013-9822-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Accepted: 06/27/2013] [Indexed: 12/27/2022]
Abstract
Serum calcium measured in 27,158 subjects in 1994 and the calcium-sensing receptor polymorphism rs17251221 genotyped in 9,404 subjects were related to cardiovascular risk factors, incident myocardial infarction (MI), type 2 diabetes (T2DM), cancer and death during follow-up until 2008-2010. In a Cox regression model with adjustment for age, gender, smoking and body mass index, subjects with serum calcium 2.50-2.60 mmol/L had a significantly increased risk of incident MI [n = 1,802, hazards ratio (HR) 1.40, 95 % confidence interval (CI) 1.18, 1.66] and T2DM (n = 705, HR 1.49, 95 % CI 1.15, 1.94) and a significantly reduced risk of cancer (n = 2,222, HR 0.73, 95 % CI 0.62, 0.86) as compared to subjects with serum calcium 2.20-2.29 mmol/L. For rs17251221 there was a mean difference in serum calcium of 0.05 mmol/L between major and minor homozygote genotypes. No consistent, significant relation between rs17251221 and risk factors or the major hard endpoints were found. The minor homozygote genotype (high serum calcium) had a significant twofold increased risk (HR 2.32, 95 % CI 1.24, 4.36) for prostate cancer, as compared to the major homozygote. This may be clinically important if confirmed in other cohorts.
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Ozery-Flato M, Parush N, El-Hay T, Visockienė Ž, Ryliškytė L, Badarienė J, Solovjova S, Kovaitė M, Navickas R, Laucevičius A. Predictive models for type 2 diabetes onset in middle-aged subjects with the metabolic syndrome. Diabetol Metab Syndr 2013; 5:36. [PMID: 23856414 PMCID: PMC3717122 DOI: 10.1186/1758-5996-5-36] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 07/04/2013] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To investigate the predictive value of different biomarkers for the incidence of type 2 diabetes mellitus (T2DM) in subjects with metabolic syndrome. METHODS A prospective study of 525 non-diabetic, middle-aged Lithuanian men and women with metabolic syndrome but without overt atherosclerotic diseases during a follow-up period of two to four years. We used logistic regression to develop predictive models for incident cases and to investigate the association between various markers and the onset of T2DM. RESULTS Fasting plasma glucose (FPG), body mass index (BMI), and glycosylated haemoglobin can be used to predict diabetes onset with a high level of accuracy and each was shown to have a cumulative predictive value. The estimated area under the receiver-operating characteristic curve (AUC) for this combination was 0.92. The oral glucose tolerance test (OGTT) did not show cumulative predictive value. Additionally, progression to diabetes was associated with high values of aortic pulse-wave velocity (aPWV). CONCLUSION T2DM onset in middle-aged metabolic syndrome subjects can be predicted with remarkable accuracy using the combination of FPG, BMI, and HbA1c, and is related to elevated aPWV measurements.
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Affiliation(s)
- Michal Ozery-Flato
- Machine Learning and Data Mining group, IBM Research - Haifa, Mount Carmel, Haifa 3498825, Israel
| | - Naama Parush
- Machine Learning and Data Mining group, IBM Research - Haifa, Mount Carmel, Haifa 3498825, Israel
| | - Tal El-Hay
- Machine Learning and Data Mining group, IBM Research - Haifa, Mount Carmel, Haifa 3498825, Israel
| | - Žydrūnė Visockienė
- Centre of Endocrinology, Vilnius University Hospital Santariškių Klinikos, Santariskiu g. 2, Vilnius LT-08661, Lithuania
- Vilnius University, Medical Faculty, M. K. Ciurlionio g. 21, Vilnius LT-03101, Lithuania
| | - Ligita Ryliškytė
- Centre of Cardiology and Angiology, Vilnius University Hospital Santariškių Klinikos, Santariskiu g. 2, Vilnius LT-08661, Lithuania
- Vilnius University, Medical Faculty, M. K. Ciurlionio g. 21, Vilnius LT-03101, Lithuania
| | - Jolita Badarienė
- Centre of Cardiology and Angiology, Vilnius University Hospital Santariškių Klinikos, Santariskiu g. 2, Vilnius LT-08661, Lithuania
- Vilnius University, Medical Faculty, M. K. Ciurlionio g. 21, Vilnius LT-03101, Lithuania
| | - Svetlana Solovjova
- Centre of Cardiology and Angiology, Vilnius University Hospital Santariškių Klinikos, Santariskiu g. 2, Vilnius LT-08661, Lithuania
- Vilnius University, Medical Faculty, M. K. Ciurlionio g. 21, Vilnius LT-03101, Lithuania
| | - Milda Kovaitė
- Centre of Cardiology and Angiology, Vilnius University Hospital Santariškių Klinikos, Santariskiu g. 2, Vilnius LT-08661, Lithuania
- Vilnius University, Medical Faculty, M. K. Ciurlionio g. 21, Vilnius LT-03101, Lithuania
| | - Rokas Navickas
- Centre of Cardiology and Angiology, Vilnius University Hospital Santariškių Klinikos, Santariskiu g. 2, Vilnius LT-08661, Lithuania
- Vilnius University, Medical Faculty, M. K. Ciurlionio g. 21, Vilnius LT-03101, Lithuania
| | - Aleksandras Laucevičius
- Centre of Cardiology and Angiology, Vilnius University Hospital Santariškių Klinikos, Santariskiu g. 2, Vilnius LT-08661, Lithuania
- Vilnius University, Medical Faculty, M. K. Ciurlionio g. 21, Vilnius LT-03101, Lithuania
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Albert U, Aguglia A, Chiarle A, Bogetto F, Maina G. Metabolic syndrome and obsessive-compulsive disorder: a naturalistic Italian study. Gen Hosp Psychiatry 2013; 35:154-9. [PMID: 23158675 DOI: 10.1016/j.genhosppsych.2012.10.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 09/30/2012] [Accepted: 10/03/2012] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The increased risk for metabolic syndrome (MetS) in individuals with schizophrenia and bipolar disorder has been documented. No study examined MetS in patients with obsessive-compulsive disorder (OCD), despite the fact that a great proportion of them are treated with antipsychotic addition. The aim of our study was to investigate the prevalence and the sociodemographic and clinical correlates of MetS in an Italian sample of patients with OCD. METHOD Subjects with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, OCD and a Yale-Brown Obsessive-Compulsive Scale score ≥ 16 were included. Sociodemographic and clinical characteristics, current and lifetime pharmacological treatments, lifestyle information, and comorbidity for cardiovascular diseases and diabetes were collected. MetS was diagnosed according to the National Cholesterol Education Program Adult Treatment Panel III modified criteria. RESULTS We enrolled 104 patients with OCD. MetS was present in 21.2% (95% confidence interval: 13.7%-30.3%) of the sample. Abdominal obesity was present in 36.5%, hypertension in 42.3%, high triglycerides in 23.1%, low high-density lipoprotein cholesterol levels in 22.1% and fasting hyperglycemia in 4.8% of the sample. MetS was associated with cigarette smoking (duration of cigarette smoking), absence of physical activity, a higher body mass index and a greater proportion of obesity. Among pharmacological treatments, MetS was associated with the duration of the exposure (lifetime) to antipsychotics. CONCLUSIONS This is the first study that examined the prevalence and correlates of MetS in a sample of patients with OCD. Our cross-sectional evaluation found a prevalence of MetS higher than those reported in the Italian general population, although the confidence interval encompasses the general population estimate reported. Patients with OCD on antipsychotic treatment are particularly at risk for MetS and should be carefully monitored for metabolic abnormalities and cardiovascular complications.
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Affiliation(s)
- Umberto Albert
- Department of Neurosciences, Anxiety and Mood Disorders Unit, University of Turin, Italy, Via Cherasco 11-10126 Torino, Italy.
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XIA Z, WANG Z, CAI Q, YANG J, ZHANG X, YANG T. Prevalence and risk factors of type 2 diabetes in the adults in haikou city, hainan island, china. IRANIAN JOURNAL OF PUBLIC HEALTH 2013; 42:222-30. [PMID: 23641399 PMCID: PMC3633792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 02/12/2013] [Indexed: 11/04/2022]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) occurs around the world with high prevalence and causes serious physical harm and economic burden to the afflicted. Haikou City is China's southernmost tropical island city, which has not been previously studied for its T2DM prevalence. The objective of the study in employing a cross-sectional survey is to discuss the epidemiologic status of T2DM in Haikou City and to analyze the possible determinants. METHODS A total of 12,000 community residents over 18 years old from four districts in Haikou City were stratified-randomly sampled. A questionnaire survey and physical examination were conducted. Data entry and statistical analysis were performed using SPSS17.0 software. RESULTS The prevalence of T2DM in Haikou City was 5.3% (5.15% for males and 5.46% for females). According to the multivariate analysis, the positive factors mainly associated with T2DM in the city included family history, Waist-to-Hip Ratio (WHR), triglycerides, low high-density lipoproteins (HDL), and blood pressure. For both men and women, family history was the highest independent risk factor associated with T2DM (OR= 47.128). The T2DM risk increased with increasing metabolic aggregate. CONCLUSION The prevalence of T2DM for the community population of Haikou City was low. The possible risk factors included age, occupation, BMI, waist circumference, WHR, overweight, systemic obesity, central obesity, systolic blood pressure, diastolic blood pressure, total cholesterol, triglycerides, low-density lipoproteins, family history, and HDL.
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Affiliation(s)
- Zhenfang XIA
- School of Public Health, Central South University, Changsha, Hunan, China
- School of Public Health, Hainan Medical College, Haikou, Hainan, China
| | - Zhuansuo WANG
- Dept. of Endocrinology, affiliated Hospital of Hainan Medical College, Haikou, Hainan, China
| | - Qunfang CAI
- Dept. of Clinical Biochemical, affiliated Hospital of Hainan Medical College, Haikou, Hainan, China
| | - Jianjun YANG
- School of Public Health, Hainan Medical College, Haikou, Hainan, China
| | - Xuan ZHANG
- Dept. of Pathology, affiliated Hospital of Hainan Medical College, Haikou, Hainan, China
| | - Tubao YANG
- School of Public Health, Central South University, Changsha, Hunan, China
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Jaddoe VWV, van Duijn CM, Franco OH, van der Heijden AJ, van Iizendoorn MH, de Jongste JC, van der Lugt A, Mackenbach JP, Moll HA, Raat H, Rivadeneira F, Steegers EAP, Tiemeier H, Uitterlinden AG, Verhulst FC, Hofman A. The Generation R Study: design and cohort update 2012. Eur J Epidemiol 2012. [PMID: 23086283 DOI: 10.1007/s10654‐012‐9735‐1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The Generation R Study is a population-based prospective cohort study from fetal life until adulthood. The study is designed to identify early environmental and genetic causes and causal pathways leading to normal and abnormal growth, development and health during fetal life, childhood and adulthood. The study focuses on six areas of research: (1) maternal health; (2) growth and physical development; (3) behavioural and cognitive development; (4) respiratory health and allergies; (5) diseases in childhood; and (6) health and healthcare for children and their parents. Main exposures of interest include environmental, endocrine, genetic and epigenetic, lifestyle related, nutritional and socio-demographic determinants. In total, n = 9,778 mothers with a delivery date from April 2002 until January 2006 were enrolled in the study. Response at baseline was 61 %, and general follow-up rates until the age of 6 years exceed 80 %. Data collection in mothers, fathers and children include questionnaires, detailed physical and ultrasound examinations, behavioural observations, and biological samples. A genome and epigenome wide association screen is available in the participating children. From the age of 5 years, regular detailed hands-on assessments are performed in a dedicated research center including advanced imaging facilities such as Magnetic Resonance Imaging. Eventually, results forthcoming from the Generation R Study contribute to the development of strategies for optimizing health and healthcare for pregnant women and children.
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Affiliation(s)
- Vincent W V Jaddoe
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands.
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Jaddoe VWV, van Duijn CM, Franco OH, van der Heijden AJ, van IIzendoorn MH, de Jongste JC, van der Lugt A, Mackenbach JP, Moll HA, Raat H, Rivadeneira F, Steegers EAP, Tiemeier H, Uitterlinden AG, Verhulst FC, Hofman A. The Generation R Study: design and cohort update 2012. Eur J Epidemiol 2012; 27:739-56. [DOI: 10.1007/s10654-012-9735-1] [Citation(s) in RCA: 423] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 09/20/2012] [Indexed: 12/11/2022]
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Hjellvik V, Sakshaug S, Strøm H. Body mass index, triglycerides, glucose, and blood pressure as predictors of type 2 diabetes in a middle-aged Norwegian cohort of men and women. Clin Epidemiol 2012; 4:213-24. [PMID: 22936857 PMCID: PMC3429151 DOI: 10.2147/clep.s31830] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Obesity, hypertension, and hypertriglyceridemia are important risk factors for type 2 diabetes (T2D). We wanted to assess the risk associated with these three factors alone and in combination, and the relative importance of these and several other risk factors (eg, nonfasting glucose) as predictors of T2D. METHODS Risk factors in a Norwegian population (n = 109,796) aged 40-45 years were measured in health studies in 1995-1999. Blood glucose-lowering drugs dispensed in 2004-2009 were used to estimate the incidence of T2D. Groups based on combinations of body mass index (BMI), diastolic blood pressure, and triglycerides were defined by using the 50% and 90% quantiles for each variable for men and women. The relative importance of BMI, triglycerides, total cholesterol, high-density lipoprotein cholesterol, glucose, blood pressure, and year of birth for predicting T2D was assessed using deviance from univariate and multivariate logistic regression models. Height, weight, and blood pressure were measured. All biomarkers were measured in nonfasting blood samples. RESULTS In the various groups of BMI, triglycerides, and diastolic blood pressure, the incidence of T2D ranged from 0.5% to 19.7% in men and from 0.15% to 21.8% in women. BMI was the strongest predictor of incident T2D, followed by triglyceride levels in women and glucose levels in men. The inclusion of risk factors other than BMI, glucose, triglycerides, and blood pressure in multivariate models only marginally improved the prediction. CONCLUSION BMI was the strongest predictor of type 2 diabetes. At defined levels of BMI, the incidence of T2D varied substantially with triglyceride levels and blood pressure. Thus, controlling triglycerides and blood pressure in middle-aged individuals should be targeted to prevent later onset of T2D.
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Affiliation(s)
| | | | - Hanne Strøm
- Norwegian Institute of Public Health, Oslo, Norway
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Kim CH, Kim HK, Bae SJ, Kim EH, Park JY. Independent impact of body mass index and metabolic syndrome on the risk of type 2 diabetes in Koreans. Metab Syndr Relat Disord 2012; 10:321-5. [PMID: 22621338 DOI: 10.1089/met.2011.0143] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Although obesity and metabolic syndrome have been associated with the risk of type 2 diabetes mellitus (T2DM), it is unclear whether obese or overweight people without metabolic syndrome are at increased risk for T2DM. METHODS Clinical and laboratory data were assessed in 8,748 subjects without diabetes (5,707 men, 3,041 women; age 20-79 years) who underwent voluntary medical check-ups at a 5-year interval. The subjects were categorized by body mass index (BMI) and metabolic syndrome status at baseline, and the incidence of diabetes over 5 years was assessed. RESULTS Of the 8,748 subjects, 308 (3.5%) developed T2DM over 5 years. Compared with normal weight (BMI <25.0 kg/m(2)) individuals without metabolic syndrome, the adjusted odds ratios (ORs) were 1.61 (1.13-2.29) and 4.93 (1.90-12.79) for overweight (BMI 25.0-29.9 kg/m(2)) and obese (BMI ≥30.0 kg/m(2)) individuals without metabolic syndrome, respectively, and 6.94 (5.08-9.47) and 10.61 (5.59-20.14) for overweight and obese individuals with metabolic syndrome, respectively. Using the lower BMI cutoff points for Asian populations, compared with subjects with BMI <23 kg/m(2) without metabolic syndrome, the adjusted ORs for subjects with BMI 23-27.4 kg/m(2) and BMI ≥27.5 kg/m(2) without metabolic syndrome were 2.64 (1.74-4.00) and 4.31 (2.36-7.86), respectively, and 10.11 (6.53-15.67) and 16.69 (10.40-26.77), respectively, for those with metabolic syndrome. CONCLUSIONS Overweight/obesity and metabolic syndrome both are significant risk factors for development of T2DM in Koreans, and overweight or obesity without metabolic syndrome should not be considered a harmless condition. The lower BMI cutoffs for Asian populations can be useful in predicting risk of T2DM in Koreans.
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Affiliation(s)
- Chul-Hee Kim
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
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Jorde R, Schirmer H, Wilsgaard T, Joakimsen RM, Mathiesen EB, Njølstad I, Løchen ML, Figenschau Y, Berg JP, Svartberg J, Grimnes G. Polymorphisms related to the serum 25-hydroxyvitamin D level and risk of myocardial infarction, diabetes, cancer and mortality. The Tromsø Study. PLoS One 2012; 7:e37295. [PMID: 22649517 PMCID: PMC3359337 DOI: 10.1371/journal.pone.0037295] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 04/17/2012] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Low serum 25(OH)D levels are associated with cardiovascular risk factors, and also predict future myocardial infarction (MI), type 2 diabetes (T2DM), cancer and all-cause mortality. Recently several single nucleotide polymorphisms (SNPs) associated with serum 25-hydroxyvitamin D (25(OH)D) level have been identified. If these relations are causal one would expect a similar association between these SNPs and health. METHODS DNA was prepared from subjects who participated in the fourth survey of the Tromsø Study in 1994-1995 and who were registered with the endpoints MI, T2DM, cancer or death as well as a randomly selected control group. The endpoint registers were complete up to 2007-2010. Genotyping was performed for 17 SNPs related to the serum 25(OH)D level. RESULTS A total of 9528 subjects were selected for genetic analyses which were successfully performed for at least one SNP in 9471 subjects. Among these, 2025 were registered with MI, 1092 with T2DM, 2924 with cancer and 3828 had died. The mean differences in serum 25(OH)D levels between SNP genotypes with the lowest and highest serum 25(OH)D levels varied from 0.1 to 7.8 nmol/L. A genotype score based on weighted risk alleles regarding low serum 25(OH)D levels was established. There was no consistent association between the genotype score or individuals SNPs and MI, T2DM, cancer, mortality or risk factors for disease. However, for rs6013897 genotypes (located at the 24-hydroxylase gene (CYP24A1)) there was a significant association with breast cancer (P<0.05). CONCLUSION Our results do not support nor exclude a causal relationship between serum 25(OH)D levels and MI, T2DM, cancer or mortality, and our observation on breast cancer needs confirmation. Further genetic studies are warranted, particularly in populations with vitamin D deficiency. TRIAL REGISTRATION ClinicalTrials.gov NCT01395303.
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Affiliation(s)
- Rolf Jorde
- Tromsø Endocrine Research Group, Department of Clinical Medicine, University of Tromsø, and Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway.
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Jorde R, Svartberg J, Joakimsen RM, Grimnes G. Associations between Polymorphisms Related to Calcium Metabolism and Human Height: The Tromsø Study. Ann Hum Genet 2012; 76:200-10. [DOI: 10.1111/j.1469-1809.2012.00703.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Nofer JR. Hyperlipidemia and cardiovascular disease: triglycerides - a revival of cardiovascular risk factor? Curr Opin Lipidol 2011; 22:319-21. [PMID: 21743309 DOI: 10.1097/mol.0b013e328348a539] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Schmid R, Vollenweider P, Waeber G, Marques-Vidal P. Estimating the risk of developing type 2 diabetes: a comparison of several risk scores: the Cohorte Lausannoise study. Diabetes Care 2011; 34:1863-8. [PMID: 21636799 PMCID: PMC3142037 DOI: 10.2337/dc11-0206] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare in the Swiss population the results of several scores estimating the risk of developing type 2 diabetes. RESEARCH DESIGN AND METHODS This was a single-center, cross-sectional study conducted between 2003 and 2006 in Lausanne, Switzerland. Overall, 3,251 women and 2,937 men, aged 35-75 years, were assessed, of which 5,760 (93%) were free from diabetes and included in the current study. The risk of developing type 2 diabetes was assessed using seven different risk scores, including clinical data with or without biological data. Participants were considered to be eligible for primary prevention according to the thresholds provided for each score. The results were then extrapolated to the Swiss population of the same sex and age. RESULTS The risk of developing type 2 diabetes increased with age in all scores. The prevalence of participants at high risk ranged between 1.6 and 24.9% in men and between 1.1 and 15.7% in women. Extrapolated to the Swiss population of similar age, the overall number of participants at risk, and thus susceptible to intervention, ranged between 46,708 and 636,841. In addition, scores that included the same clinical variables led to a significantly different prevalence of participants at risk (4.2% [95% CI 3.4-5.0] vs. 12.8% [11.5-14.1] in men and 2.9% [2.4-3.6] vs. 6.0% [5.2-6.9] in women). CONCLUSIONS; The prevalence of participants at risk for developing type 2 diabetes varies considerably according to the scoring system used. To adequately prevent type 2 diabetes, risk-scoring systems must be validated for each population considered.
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Affiliation(s)
- Rémy Schmid
- Institute of Social and Preventive Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Joseph J, Svartberg J, Njølstad I, Schirmer H. Change in cardiovascular risk factors in relation to diabetes status: the Tromso Study. Eur J Prev Cardiol 2011; 19:551-7. [PMID: 21505026 DOI: 10.1177/1741826711408147] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS To investigate changes in cardiovascular risk factors over 14 years in relation to diabetes status. METHODS The study is based on 10,327 subjects who attended the Tromsø Study in 1994 and were screened again in 2007-8. At baseline there were 79 prevalent cases, and 397 incident cases of type 2 diabetes mellitus (DM2) were diagnosed between 1994 and 2008. RESULTS Cases with DM2 had decreasing levels of high-density lipoprotein cholesterol (HDL-C), total cholesterol and blood pressure (BP) and increasing levels of triglycerides, body mass index (BMI), and anti-hypertensive treatment during 14 years of follow-up. Despite decreasing BP, more than 75% of the treated cases had BP above 135/80 at the end of follow-up. Similarly, less than 35% of incident cases using statins had low-density lipoprotein cholesterol (LDL-C) below the recommended threshold value of 2.6 mmol/l. CONCLUSIONS Despite greater relative reduction in cardiovascular risk factors among people with DM2 compared to those without, treatment targets were met in less than 50% of subjects with DM2. Thirteen percent reached the combined targets for glucose, BP and LDL-C control. This indicates a need for more effective strategies to control cardiovascular risk factors especially among individuals with DM2.
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Affiliation(s)
- Josepha Joseph
- Department of Community Medicine, University of Tromsø, Tromsø, Norway.
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