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Dairy product consumption is associated with pre-diabetes and newly diagnosed type 2 diabetes in the Lifelines Cohort Study. Br J Nutr 2019; 119:442-455. [PMID: 29498341 DOI: 10.1017/s0007114517003762] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Previous studies show associations between dairy product consumption and type 2 diabetes, but only a few studies conducted detailed analyses for a variety of dairy subgroups. Therefore, we examined cross-sectional associations of a broad variety of dairy subgroups with pre-diabetes and newly diagnosed type 2 diabetes (ND-T2DM) among Dutch adults. In total, 112 086 adults without diabetes completed a semi-quantitative FFQ and donated blood. Pre-diabetes was defined as fasting plasma glucose (FPG) between 5·6 and 6·9 mmol/l or HbA1c% of 5·7-6·4 %. ND-T2DM was defined as FPG ≥7·0 mmol/l or HbA1c ≥6·5 %. Logistic regression analyses were conducted by 100 g or serving increase and dairy tertiles (T1ref), while adjusting for demographic, lifestyle and dietary covariates. Median dairy product intake was 324 (interquartile range 227) g/d; 25 549 (23 %) participants had pre-diabetes; and 1305 (1 %) had ND-T2DM. After full adjustment, inverse associations were observed of skimmed dairy (OR100 g 0·98; 95 % CI 0·97, 1·00), fermented dairy (OR100 g 0·98; 95 % CI 0·97, 0·99) and buttermilk (OR150 g 0·97; 95 % CI 0·94, 1·00) with pre-diabetes. Positive associations were observed for full-fat dairy (OR100 g 1·003; 95 % CI 1·01, 1·06), non-fermented dairy products (OR100 g 1·01; 95 % CI 1·00, 1·02) and custard (ORserving/150 g 1·13; 95 % CI 1·03, 1·24) with pre-diabetes. Moreover, full-fat dairy products (ORT3 1·16; 95 % CI 0·99, 1·35), non-fermented dairy products (OR100 g 1·05; 95 % CI 1·01, 1·09) and milk (ORserving/150 g 1·08; 95 % CI 1·02, 1·15) were positively associated with ND-T2DM. In conclusion, our data showed inverse associations of skimmed and fermented dairy products with pre-diabetes. Positive associations were observed for full-fat and non-fermented dairy products with pre-diabetes and ND-T2DM.
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Richter B, Hemmingsen B, Metzendorf M, Takwoingi Y. Development of type 2 diabetes mellitus in people with intermediate hyperglycaemia. Cochrane Database Syst Rev 2018; 10:CD012661. [PMID: 30371961 PMCID: PMC6516891 DOI: 10.1002/14651858.cd012661.pub2] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Intermediate hyperglycaemia (IH) is characterised by one or more measurements of elevated blood glucose concentrations, such as impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and elevated glycosylated haemoglobin A1c (HbA1c). These levels are higher than normal but below the diagnostic threshold for type 2 diabetes mellitus (T2DM). The reduced threshold of 5.6 mmol/L (100 mg/dL) fasting plasma glucose (FPG) for defining IFG, introduced by the American Diabetes Association (ADA) in 2003, substantially increased the prevalence of IFG. Likewise, the lowering of the HbA1c threshold from 6.0% to 5.7% by the ADA in 2010 could potentially have significant medical, public health and socioeconomic impacts. OBJECTIVES To assess the overall prognosis of people with IH for developing T2DM, regression from IH to normoglycaemia and the difference in T2DM incidence in people with IH versus people with normoglycaemia. SEARCH METHODS We searched MEDLINE, Embase, ClincialTrials.gov and the International Clinical Trials Registry Platform (ICTRP) Search Portal up to December 2016 and updated the MEDLINE search in February 2018. We used several complementary search methods in addition to a Boolean search based on analytical text mining. SELECTION CRITERIA We included prospective cohort studies investigating the development of T2DM in people with IH. We used standard definitions of IH as described by the ADA or World Health Organization (WHO). We excluded intervention trials and studies on cohorts with additional comorbidities at baseline, studies with missing data on the transition from IH to T2DM, and studies where T2DM incidence was evaluated by documents or self-report only. DATA COLLECTION AND ANALYSIS One review author extracted study characteristics, and a second author checked the extracted data. We used a tailored version of the Quality In Prognosis Studies (QUIPS) tool for assessing risk of bias. We pooled incidence and incidence rate ratios (IRR) using a random-effects model to account for between-study heterogeneity. To meta-analyse incidence data, we used a method for pooling proportions. For hazard ratios (HR) and odds ratios (OR) of IH versus normoglycaemia, reported with 95% confidence intervals (CI), we obtained standard errors from these CIs and performed random-effects meta-analyses using the generic inverse-variance method. We used multivariable HRs and the model with the greatest number of covariates. We evaluated the certainty of the evidence with an adapted version of the GRADE framework. MAIN RESULTS We included 103 prospective cohort studies. The studies mainly defined IH by IFG5.6 (FPG mmol/L 5.6 to 6.9 mmol/L or 100 mg/dL to 125 mg/dL), IFG6.1 (FPG 6.1 mmol/L to 6.9 mmol/L or 110 mg/dL to 125 mg/dL), IGT (plasma glucose 7.8 mmol/L to 11.1 mmol/L or 140 mg/dL to 199 mg/dL two hours after a 75 g glucose load on the oral glucose tolerance test, combined IFG and IGT (IFG/IGT), and elevated HbA1c (HbA1c5.7: HbA1c 5.7% to 6.4% or 39 mmol/mol to 46 mmol/mol; HbA1c6.0: HbA1c 6.0% to 6.4% or 42 mmol/mol to 46 mmol/mol). The follow-up period ranged from 1 to 24 years. Ninety-three studies evaluated the overall prognosis of people with IH measured by cumulative T2DM incidence, and 52 studies evaluated glycaemic status as a prognostic factor for T2DM by comparing a cohort with IH to a cohort with normoglycaemia. Participants were of Australian, European or North American origin in 41 studies; Latin American in 7; Asian or Middle Eastern in 50; and Islanders or American Indians in 5. Six studies included children and/or adolescents.Cumulative incidence of T2DM associated with IFG5.6, IFG6.1, IGT and the combination of IFG/IGT increased with length of follow-up. Cumulative incidence was highest with IFG/IGT, followed by IGT, IFG6.1 and IFG5.6. Limited data showed a higher T2DM incidence associated with HbA1c6.0 compared to HbA1c5.7. We rated the evidence for overall prognosis as of moderate certainty because of imprecision (wide CIs in most studies). In the 47 studies reporting restitution of normoglycaemia, regression ranged from 33% to 59% within one to five years follow-up, and from 17% to 42% for 6 to 11 years of follow-up (moderate-certainty evidence).Studies evaluating the prognostic effect of IH versus normoglycaemia reported different effect measures (HRs, IRRs and ORs). Overall, the effect measures all indicated an elevated risk of T2DM at 1 to 24 years of follow-up. Taking into account the long-term follow-up of cohort studies, estimation of HRs for time-dependent events like T2DM incidence appeared most reliable. The pooled HR and the number of studies and participants for different IH definitions as compared to normoglycaemia were: IFG5.6: HR 4.32 (95% CI 2.61 to 7.12), 8 studies, 9017 participants; IFG6.1: HR 5.47 (95% CI 3.50 to 8.54), 9 studies, 2818 participants; IGT: HR 3.61 (95% CI 2.31 to 5.64), 5 studies, 4010 participants; IFG and IGT: HR 6.90 (95% CI 4.15 to 11.45), 5 studies, 1038 participants; HbA1c5.7: HR 5.55 (95% CI 2.77 to 11.12), 4 studies, 5223 participants; HbA1c6.0: HR 10.10 (95% CI 3.59 to 28.43), 6 studies, 4532 participants. In subgroup analyses, there was no clear pattern of differences between geographic regions. We downgraded the evidence for the prognostic effect of IH versus normoglycaemia to low-certainty evidence due to study limitations because many studies did not adequately adjust for confounders. Imprecision and inconsistency required further downgrading due to wide 95% CIs and wide 95% prediction intervals (sometimes ranging from negative to positive prognostic factor to outcome associations), respectively.This evidence is up to date as of 26 February 2018. AUTHORS' CONCLUSIONS Overall prognosis of people with IH worsened over time. T2DM cumulative incidence generally increased over the course of follow-up but varied with IH definition. Regression from IH to normoglycaemia decreased over time but was observed even after 11 years of follow-up. The risk of developing T2DM when comparing IH with normoglycaemia at baseline varied by IH definition. Taking into consideration the uncertainty of the available evidence, as well as the fluctuating stages of normoglycaemia, IH and T2DM, which may transition from one stage to another in both directions even after years of follow-up, practitioners should be careful about the potential implications of any active intervention for people 'diagnosed' with IH.
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Affiliation(s)
- Bernd Richter
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupPO Box 101007DüsseldorfGermany40001
| | - Bianca Hemmingsen
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupPO Box 101007DüsseldorfGermany40001
| | - Maria‐Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupPO Box 101007DüsseldorfGermany40001
| | - Yemisi Takwoingi
- University of BirminghamInstitute of Applied Health ResearchEdgbastonBirminghamUKB15 2TT
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Paprott R, Scheidt-Nave C, Heidemann C. Determinants of Change in Glycemic Status in Individuals with Prediabetes: Results from a Nationwide Cohort Study in Germany. J Diabetes Res 2018; 2018:5703652. [PMID: 30406150 PMCID: PMC6204174 DOI: 10.1155/2018/5703652] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 07/02/2018] [Accepted: 08/29/2018] [Indexed: 01/19/2023] Open
Abstract
Previous studies investigating determinants of changes in glycemic status among individuals with prediabetes mainly focused on glucose-defined prediabetes. In this study, we examined determinants of a regression to normoglycemia or a progression to diabetes among individuals with HbA1c-defined prediabetes. The study included 817 participants (18-79 years) with prediabetes (HbA1c 5.7-6.4% (39-47 mmol/mol)) at baseline. Glycemic status at follow-up was categorized as diagnosed diabetes (self-reported physician diagnosis or antidiabetic medication), undiagnosed diabetes (HbA1c ≥ 6.5% (≥48 mmol/mol)), prediabetes (as defined at baseline), and normoglycemia (HbA1c < 5.7% (<39 mmol/mol)). Determinants of glycemic changes were identified by multinomial logistic regression (OR (95% CI)), with those remaining in the prediabetic state as reference. During a mean follow-up time of 12.0 years, 33.8% of the participants reverted to normoglycemia, 7.2% progressed to undiagnosed diabetes, 12.8% progressed to diagnosed diabetes, and 46.2% remained prediabetic. Determinants of a regression to normoglycemia were female sex (male vs. female: 0.67 (0.46; 0.98)) and higher HDL cholesterol levels (1.17 (1.02; 1.35) per 10 mg/dl). Determinants of a progression to undiagnosed or diagnosed diabetes were higher values of BMI (1.10 (1.02; 1.18); 1.13 (1.06; 1.21) per kg/m2), waist circumference (1.04 (1.01; 1.07); 1.06 (1.03; 1.09) per cm), alanine aminotransferase (1.06 (1.03; 1.09); 1.07 (1.03; 1.10) per U/l), and gamma-glutamyl transferase (1.02 (1.00; 1.03); 1.03 (1.01; 1.04) per U/l). Higher age (1.04 (1.02; 1.06) per year), female sex (male vs. female: 0.56 (0.33; 0.97)), and parental history of diabetes (yes vs. no: 1.82 (1.05; 3.15)) were further associated with a progression to diagnosed diabetes, whereas higher triglyceride levels (1.03 (1.01; 1.06) per 10 mg/dl) were associated with a progression to undiagnosed diabetes. In conclusion, among the investigated determinants, potentially modifiable anthropometric and metabolic markers were associated with glycemic changes in individuals with HbA1c-defined prediabetes. The findings of this study demonstrate the need for more refined case finding strategies for diabetes prevention.
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Affiliation(s)
- Rebecca Paprott
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, 12101 Berlin, Germany
| | - Christa Scheidt-Nave
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, 12101 Berlin, Germany
| | - Christin Heidemann
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, 12101 Berlin, Germany
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Brouwer-Brolsma EM, van Woudenbergh GJ, Oude Elferink SJWH, Singh-Povel CM, Hofman A, Dehghan A, Franco OH, Feskens EJM. Intake of different types of dairy and its prospective association with risk of type 2 diabetes: The Rotterdam Study. Nutr Metab Cardiovasc Dis 2016; 26:987-995. [PMID: 27692560 DOI: 10.1016/j.numecd.2016.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 07/22/2016] [Accepted: 08/03/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS The prevalence of type 2 diabetes (T2DM) is increasing. Several studies have suggested a beneficial effect of several major dairy nutrients on insulin production and sensitivity. Conversely, harmful effects have been suggested as well. This study aimed to investigate the impact of the full-range of dairy products and its association with incidence T2DM in Dutch adults aged ≥55 years participating in the Rotterdam Study. METHODS AND RESULTS Dairy intake was assessed with a validated FFQ, including total, skimmed, semi-skimmed, full-fat, fermented, and non-fermented dairy, and subclasses of these product groups. Verified prevalent and incident diabetes were documented. Cox proportional hazards regression and spline regression were used to analyse data, adjusting for age, sex, alcohol, smoking, education, physical activity, body mass index, intake of total energy, energy-adjusted meat, and energy-adjusted fish intake. Median total dairy intake was 398 g/day (IQR 259-559 g/day). Through 9.5 ± 4.1 years of follow-up, 393 cases of incident T2DM were reported. Cox and spline regression did not point towards associations of total dairy consumption, dairy consumption based on fat content, non-fermented or fermented dairy consumption, or individual dairy product consumption with incident T2DM. The HR for total dairy intake and T2DM was 0.93 (95% CI: 0.70-1.23) in the upper quartile (P-for trend 0.76). CONCLUSIONS This prospective cohort study did not point towards an association between dairy consumption and T2DM.
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Affiliation(s)
- E M Brouwer-Brolsma
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.
| | - G J van Woudenbergh
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | | | | | - A Hofman
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands; Netherlands Consortium for Healthy Ageing, Netherlands Genomics Initiative, The Hague, The Netherlands
| | - A Dehghan
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands; Netherlands Consortium for Healthy Ageing, Netherlands Genomics Initiative, The Hague, The Netherlands
| | - O H Franco
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands; Netherlands Consortium for Healthy Ageing, Netherlands Genomics Initiative, The Hague, The Netherlands
| | - E J M Feskens
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
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Forouhi NG. Association between consumption of dairy products and incident type 2 diabetes--insights from the European Prospective Investigation into Cancer study. Nutr Rev 2015; 73 Suppl 1:15-22. [PMID: 26175485 PMCID: PMC4502710 DOI: 10.1093/nutrit/nuv018] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The public health burden of type 2 diabetes has risen unabated over the past decades, fueled by obesity and lifestyle influences, including diet quality. Epidemiological evidence is accumulating for an inverse association between dairy product intake and type 2 diabetes risk; this is somewhat counterintuitive to the saturated fat and cardiometabolic disease paradigm. The present report reviews the contribution that the findings of the European Prospective Investigation into Cancer (EPIC) study have made to this debate, noting that types of dairy products, particularly fermented dairy products including yogurt, may be more relevant than overall dairy intake for the prevention of type 2 diabetes. The EPIC study has contributed evidence through complementary approaches of a large prospective study across 8 European countries with heterogeneous dietary intakes assessed using food-frequency questionnaires (EPIC-InterAct study) and through a more detailed examination of diet assessed using a 7-day food diary (EPIC-Norfolk study). The implications of these findings are placed in the wider context, including the use of individual fatty acid blood biomarkers in the EPIC-InterAct study and an appraisal of current research gaps and suggestions for future research directions.
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Affiliation(s)
- Nita G Forouhi
- N.G. Forouhi is with the Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK.
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Physical activity and the risk of type 2 diabetes: a systematic review and dose-response meta-analysis. Eur J Epidemiol 2015; 30:529-42. [PMID: 26092138 DOI: 10.1007/s10654-015-0056-z] [Citation(s) in RCA: 480] [Impact Index Per Article: 53.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 06/09/2015] [Indexed: 02/08/2023]
Abstract
We investigated the association between specific types of physical activity and the risk of type 2 diabetes in a systematic review and meta-analysis of published studies. PubMed, Embase and Ovid databases were searched for prospective studies and randomized trials up to 2nd of March 2015. Summary relative risks (RRs) were calculated using a random effects model. Eighty-one studies were included. The summary RRs for high versus low activity were 0.65 (95 % CI 0.59-0.71, I(2) = 18 %, n = 14) for total physical activity, 0.74 (95 % CI 0.70-0.79, I(2) = 84 %, n = 55) for leisure-time activity, 0.61 (95 % CI 0.51-0.74, I(2) = 73 %, n = 8) for vigorous activity, 0.68 (95 % CI 0.52-0.90, I(2) = 93 %, n = 5) for moderate activity, 0.66 (95 % CI 0.47-0.94, I(2) = 47 %, n = 4) for low intensity activity, and 0.85 (95 % CI 0.79-0.91, I(2) = 0 %, n = 7) for walking. Inverse associations were also observed for increasing activity over time, resistance exercise, occupational activity and for cardiorespiratory fitness. Nonlinear relations were observed for leisure-time activity, vigorous activity, walking and resistance exercise (p nonlinearity < 0.0001 for all), with steeper reductions in type 2 diabetes risk at low activity levels than high activity levels. This meta-analysis provides strong evidence for an inverse association between physical activity and risk of type 2 diabetes, which may partly be mediated by reduced adiposity. All subtypes of physical activity appear to be beneficial. Reductions in risk are observed up to 5-7 h of leisure-time, vigorous or low intensity physical activity per week, but further reductions cannot be excluded beyond this range.
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Chen CM, Lou MF, Gau BS. Prevalence of impaired fasting glucose and analysis of related factors in Taiwanese adolescents. Pediatr Diabetes 2014; 15:220-8. [PMID: 24168425 DOI: 10.1111/pedi.12081] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 08/16/2013] [Accepted: 08/27/2013] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To determine the prevalence of impaired fasting glucose (IFG) in Taiwanese adolescents and important related variables. SUBJECTS AND METHODS This analysis was based on the Nutrition and Health Survey in Taiwan (NAHSIT) data during 2010 and 2011. The original study was a cross-sectional and national representative survey. A total of 1949 subjects (965 males and 984 females) aged 11-20 years participated. Research tools consisted of questionnaires, anthropometry parameters, and blood biochemical indicators. The acquired data were analyzed using descriptive and inferential statistics. RESULTS The prevalence of IFG in Taiwanese adolescents was 22% (a fasting glucose level between 100 and 125 mg/dL is considered abnormal). Factors that significantly affected IFG levels included sex, age, quality of family dietary environment, overweight, obesity, and the number of cardio-metabolic risk factors. CONCLUSION The prevalence of IFG in Taiwanese adolescents is a public health issue that should not be ignored. The prevalence may be reduced by adjusting lifestyles. Healthy family environments should be encouraged and appropriate healthy lifestyle counseling plans offered specifically to male adolescents with overweight, obesity, and cardio-metabolic risk factors.
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Affiliation(s)
- Chen-Mei Chen
- Department of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC; Department of Nursing, Chang Gung University of Science and Technology, Taipei, Taiwan, ROC
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Chen CM, Yeh MC. The prevalence and determinants of impaired fasting glucose in the population of Taiwan. BMC Public Health 2013; 13:1123. [PMID: 24304589 PMCID: PMC3866508 DOI: 10.1186/1471-2458-13-1123] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 11/27/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A current prevalence and relevant risk factors for impaired fasting glucose (IFG) have been reported by various ethnic groups and countries. By contrast, nationwide data for the incidence of IFG in Taiwan have not been presented in the past 15 years. The aim for this manuscript was to estimate the prevalence of IFG and associated risk factors in the population of Taiwan. METHODS For this cross-sectional research, we used a nationally representative sample (N = 2604) obtained from the 2005-2008 Nutrition and Health Survey in Taiwan (NAHSIT), and adopted a stratified multistage sampling design. The tools employed for data collection included questionnaire interviews, anthropometry measurements, and laboratory analysis. RESULTS The prevalence of IFG among adults in Taiwan is 35.8% (a fasting glucose level between 100 and 125 mg/dl is considered abnormal). An estimated number of people with IFG is 6.5 million. A higher prevalence of IFG is observed in men younger than 65 years compared to women. However, this trend is reversed for the elderly population. The factors significantly associated with IFG include the following: sex, age, overweight (27 > BMI ≥ 24), obesity (BMI ≥ 27), waist circumference (men ≥ 90 cm, women ≥ 80 cm), hypertension, and hyperlipidemia. CONCLUSIONS IFG among adults in Taiwan is a health concern that requires attention. We recommend targeting the younger population, especially overweight and obese men between the ages of 19 and 40 years, to provide applicable healthy lifestyle counseling and services. Furthermore, appropriate screening of elderly people is required to detect undiagnosed IFG cases and provide early intervention and treatment.
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Affiliation(s)
| | - Mei Chang Yeh
- Department of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Aune D, Norat T, Romundstad P, Vatten LJ. Whole grain and refined grain consumption and the risk of type 2 diabetes: a systematic review and dose-response meta-analysis of cohort studies. Eur J Epidemiol 2013; 28:845-58. [PMID: 24158434 DOI: 10.1007/s10654-013-9852-5] [Citation(s) in RCA: 336] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 09/16/2013] [Indexed: 12/22/2022]
Abstract
Several studies have suggested a protective effect of intake of whole grains, but not refined grains on type 2 diabetes risk, but the dose-response relationship between different types of grains and type 2 diabetes has not been established. We conducted a systematic review and meta-analysis of prospective studies of grain intake and type 2 diabetes. We searched the PubMed database for studies of grain intake and risk of type 2 diabetes, up to June 5th, 2013. Summary relative risks were calculated using a random effects model. Sixteen cohort studies were included in the analyses. The summary relative risk per 3 servings per day was 0.68 (95% CI 0.58-0.81, I(2) = 82%, n = 10) for whole grains and 0.95 (95% CI 0.88-1.04, I(2) = 53%, n = 6) for refined grains. A nonlinear association was observed for whole grains, p nonlinearity < 0.0001, but not for refined grains, p nonlinearity = 0.10. Inverse associations were observed for subtypes of whole grains including whole grain bread, whole grain cereals, wheat bran and brown rice, but these results were based on few studies, while white rice was associated with increased risk. Our meta-analysis suggests that a high whole grain intake, but not refined grains, is associated with reduced type 2 diabetes risk. However, a positive association with intake of white rice and inverse associations between several specific types of whole grains and type 2 diabetes warrant further investigations. Our results support public health recommendations to replace refined grains with whole grains and suggest that at least two servings of whole grains per day should be consumed to reduce type 2 diabetes risk.
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Affiliation(s)
- Dagfinn Aune
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway,
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Aune D, Norat T, Romundstad P, Vatten LJ. Dairy products and the risk of type 2 diabetes: a systematic review and dose-response meta-analysis of cohort studies. Am J Clin Nutr 2013; 98:1066-83. [PMID: 23945722 DOI: 10.3945/ajcn.113.059030] [Citation(s) in RCA: 287] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The association between intake of dairy products and the risk of type 2 diabetes has been investigated in several studies, but the evidence is not conclusive. OBJECTIVE We conducted an updated systematic review and dose-response meta-analysis of dairy product intake and the risk of type 2 diabetes. DESIGN We searched the PubMed database for prospective cohort and nested case-control studies of dairy product intake and risk of type 2 diabetes up to 5 June 2013. Summary RRs were estimated by use of a random-effects model. RESULTS Seventeen cohort studies were included in the meta-analysis. In the dose-response analysis, the summary RRs (95% CIs) were 0.93 (0.87, 0.99; I(2) = 33%) per 400 g total dairy products/d (n = 12), 0.98 (0.94, 1.03; I(2) = 8%) per 200 g high-fat dairy products/d (n = 9), 0.91 (0.86, 0.96; I(2) = 40%) per 200 g low-fat dairy products/d (n = 9), 0.87 (0.72, 1.04; I(2) = 94%) per 200 g milk/d (n = 7), 0.92 (0.86, 0.99; I(2) = 0%) per 50 g cheese/d (n = 8), and 0.78 (0.60, 1.02; I(2) = 70%) per 200 g yogurt/d (n = 7). Nonlinear inverse associations were observed for total dairy products (P-nonlinearity < 0.0001), low-fat dairy products (P-nonlinearity = 0.06), cheese (P-nonlinearity = 0.05), and yogurt (P-nonlinearity = 0.004), and there was a flattening of the curve at higher intakes. CONCLUSIONS This meta-analysis suggests that there is a significant inverse association between intakes of dairy products, low-fat dairy products, and cheese and risk of type 2 diabetes. Any additional studies should assess the association between other specific types of dairy products and the risk of type 2 diabetes and adjust for more confounding factors.
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Affiliation(s)
- Dagfinn Aune
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway, and the Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
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Kim SY, Lee SJ, Park HK, Yun JE, Lee M, Sung J, Jee SH. Adiponectin is Associated with Impaired Fasting Glucose in the Non-Diabetic Population. Epidemiol Health 2011; 33:e2011007. [PMID: 21909476 PMCID: PMC3163270 DOI: 10.4178/epih/e2011007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Accepted: 07/08/2011] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES Adiponectin is strongly associated with diabetes in the Western population. However, whether adiponectin is independently associated with impaired fasting glucose (IFG) in the non-obese population is unknown. METHODS The serum adiponectin, insulin resistance (IR), and waist circumference (WC) of 27,549 healthy Koreans were measured. Individuals were then classified into tertile groups by gender. IFG was defined as a fasting serum glucose of 100-125 mg/dL without diabetes. IR was calculated using the homeostasis model assessment of insulin resistance (HOMA-IR). The association of adiponectin and IFG was determined using logistic regression analysis. RESULTS WC and adiponectin were associated with IFG in both men and women. However, the association of WC with IFG was attenuated in both men and women after adjustment for the HOMA-IR. Adiponectin was still associated with IFG after adjustment for and stratification by HOMA-IR in men and women. Strong combined associations of IR and adiponectin with IFG were observed in men and women. Multivariate adjusted odds ratios (ORs) (95% confidence interval [CI]) among those in the highest tertile of IR and the lowest tertile of adiponectin were 9.8 (7.96 to 12.07) for men and 24.1 (13.86 to 41.94) for women. CONCLUSION These results suggest that adiponectin is strongly associated with IFG, and point to adiponectin as an additional diagnostic biomarker of IFG in the non-diabetic population.
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Affiliation(s)
- Sang Yeun Kim
- Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Korea
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Baena-Díez JM, Bermúdez-Chillida N, Mundet X, Val-García JLD, Muñoz MA, Schröder H. Glucemia basal alterada y riesgo de diabetes mellitus a los 10 años. Estudio de cohorte. Med Clin (Barc) 2011; 136:382-5. [DOI: 10.1016/j.medcli.2010.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Revised: 05/20/2010] [Accepted: 05/20/2010] [Indexed: 10/18/2022]
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Walker KZ, O'Dea K, Gomez M, Girgis S, Colagiuri R. Diet and exercise in the prevention of diabetes. J Hum Nutr Diet 2010; 23:344-52. [PMID: 20337844 DOI: 10.1111/j.1365-277x.2010.01061.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Individuals with impaired fasting glucose or impaired glucose tolerance are at high risk of progression to type 2 diabetes. Lifestyle modification through change to diet and exercise habit has considerable potential to prevent or delay the onset of this disease. METHODS A systematic literature search was undertaken of Medline, EMBASE, the Cochrane library and the Cumulative Index to Nursing and Allied Health Literature for journal articles relevant to the question of whether type 2 diabetes can be prevented by lifestyle change. RESULTS Four cohort studies in a total of 4864 high risk individuals followed for a period of 2.5-6 years were identified. These showed that lifestyle change may reduce the incidence of type 2 diabetes by 28-59%. Moreover, follow-up studies also indicate that diabetes incidence rates continue to be depressed many years after the discontinuation of a lifestyle intervention. Evidence from a meta-analysis confirms this evidence and suggests that it would be necessary to treat 6.4 (95% confidence interval 5.0-8.4) individuals to prevent or delay one case of diabetes through lifestyle intervention. An examination of weight loss diets (low fat, high protein or Mediterranean) suggests each may be effective but each has limitations requiring care in food selection. Evidence also suggests that the maintenance of weight loss also requires regular exercise with an additional expenditure of approximately 8.4 MJ week(-1) (2000 kcal week(-1)). CONCLUSIONS Diabetes can be prevented by lifestyle change. The challenge is to develop public health approaches to support individuals with respect to incorporating the lifestyle changes needed to reduce the risk of diabetes into their everyday life.
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Affiliation(s)
- K Z Walker
- Preventative Health Unit, Baker IDI Heart and Diabetes Institute and Nutrition & Dietetics Unit, Monash University, Melbourne, Victoria, Australia.
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Balkau B, Lange C, Fezeu L, Tichet J, de Lauzon-Guillain B, Czernichow S, Fumeron F, Froguel P, Vaxillaire M, Cauchi S, Ducimetière P, Eschwège E. Predicting diabetes: clinical, biological, and genetic approaches: data from the Epidemiological Study on the Insulin Resistance Syndrome (DESIR). Diabetes Care 2008; 31:2056-61. [PMID: 18689695 PMCID: PMC2551654 DOI: 10.2337/dc08-0368] [Citation(s) in RCA: 183] [Impact Index Per Article: 11.4] [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 provide a simple clinical diabetes risk score and to identify characteristics that predict later diabetes using variables available in the clinic setting as well as biological variables and polymorphisms. RESEARCH DESIGN AND METHODS Incident diabetes was studied in 1,863 men and 1,954 women, 30-65 years of age at baseline, with diabetes defined by treatment or by fasting plasma glucose >or=7.0 mmol/l at 3-yearly examinations over 9 years. Sex-specific logistic regression equations were used to select variables for prediction. RESULTS A total of 140 men and 63 women developed diabetes. The predictive clinical variables were waist circumference and hypertension in both sexes, smoking in men, and diabetes in the family in women. Discrimination, as measured by the area under the receiver operating curves (AROCs), were 0.713 for men and 0.827 for women, a little higher than for the Finish Diabetes Risk (FINDRISC) score, with fewer variables in the score. Combining clinical and biological variables, the predictive equation included fasting glucose, waist circumference, smoking, and gamma-glutamyltransferase for men and fasting glucose, BMI, triglycerides, and diabetes in family for women. The number of TCF7L2 and IL6 deleterious alleles was predictive in both sexes, but after including the above clinical and biological variables, this variable was only predictive in women (P < 0.03) and the AROC statistics increased only marginally. CONCLUSIONS The best clinical predictor of diabetes is adiposity, and baseline glucose is the best biological predictor. Clinical and biological predictors differed marginally between men and women. The genetic polymorphisms added little to the prediction of diabetes.
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Affiliation(s)
- Beverley Balkau
- INSERM U780-IFR69, Villejuif, France/University Paris-Sud, Orsay, France.
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