Contribution of the Nurses' Health Studies to Uncovering Risk Factors for Type 2 Diabetes: Diet, Lifestyle, Biomarkers, and Genetics

Global burden of Type 2 Diabetes Mellitus attributable to dietary risks in elderly adults: insights from the Global Burden of Disease study 2021

Background

Type 2 Diabetes Mellitus (T2DM) poses a significant global health challenge, particularly among elderly adults. Dietary risk factors, such as high consumption of processed meats and sugar-sweetened beverages and low intake of whole grains and fruits, play a critical role in the burden of T2DM. This study aims to comprehensively quantify the global burden of T2DM attributable to dietary risks among elderly adults, identify significant dietary risk factors driving disease burden, and evaluate temporal, regional, and demographic variations to inform targeted public health strategies and interventions for reducing the impact of T2DM.

Methods

This study utilized data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 to assess T2DM burden attributable to dietary risks among adults aged 65 years and older across 204 countries and territories. Metrics included age-standardized mortality rates (ASMR) and disability-adjusted life-year rates (ASDR). Dietary risk factors analyzed included low intake of whole grains, fruits, vegetables, and fiber, as well as high intake of processed meat, red meat, and sugar-sweetened beverages. Joinpoint regression and decomposition analyses were performed to examine temporal trends and drivers of changes by region, SDI level, sex, and age.

Results

In 2021, dietary risks accounted for 23.61% of T2DM-related deaths and 24.85% of DALYs among elderly adults. ASMR showed a slight decline globally (AAPC: -0.08), while ASDR exhibited a significant upward trend (AAPC: +0.7) from 1990 to 2021. High SDI regions demonstrated decreasing ASMR but persistent DALYs due to prolonged survival with complications. Conversely, low and middle SDI regions exhibited rapid increases in ASMR and ASDR, driven by dietary transitions and limited healthcare resources. Males consistently bore a higher burden than females, with pronounced disparities in low and middle SDI regions. Aging and population growth were the primary drivers of the increasing burden globally.

Conclusion

This study underscores the substantial burden of T2DM attributable to dietary risks among elderly adults and highlights significant regional and demographic disparities. Targeted public health interventions, personalized nutritional strategies, and improved healthcare access are essential to mitigate this burden. Future research should explore the impact of emerging dietary trends and precision nutrition on T2DM prevention and management.

Associations of four obesity indices with diabetes mellitus in Korean middle-aged and older adults using the Korean Genome and Epidemiology Study (KoGES)

BACKGROUND

Obesity is associated with a high risk of diabetes mellitus (DM); therefore, obesity-related indices are strongly associated with DM. This study evaluated the association of obesity indices, including body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and a body shape index (ABSI), with DM in Korean middle-aged and older adults.

METHODS

Data from three population-based cohorts (Ansan and Ansung, Health Examinee, and Cardiovascular Disease Association Study, derived from the Korean Genome and Epidemiology Study) were analyzed. Logistic analysis was used to evaluate the association of BMI, WC, WHR, and ABSI with DM, after adjusting for covariates according to sex and age. The integrated discrimination index (IDI) and category-free net reclassification improvement (cfNRI) and area under the curve (AUC) of the receiver operating characteristic (ROC) curve were analyzed by age group to investigate index-specific model performance.

RESULTS

Among the 160,585 participants, 13,846 had DM (6,837; men [11.86%] and 7,009 women [6.81%]). Age increase was associated with an increased prevalence of DM: 2,339 (4.01%), 5,313 (8.74%), and 6,194 (14.93%) in the 40-49, 50-59, and ≥ 60 years age groups. After adjusting for covariates, the odds ratios (OR) for DM of WHR and WC were higher than those of the other indices in every age group. However, the OR for WHR, WC, and BMI decreased with age in both sexes. ABSI showed steady and slightly increasing ORs with increasing age although the ORs in both sexes were generally low for DM. For IDI and cfNRI, WHR had the highest values among all age groups. The AUC of the ROC curve showed that the WHR had the highest value in all age groups.

CONCLUSION

The WHR had the strongest association with DM, but was not a good DM index in older people. Therefore, age-related index criteria for DM, especially in women, were needed for the effective prevention and management of DM.

Scoring Health Behaviors of Patients with Type 2 Diabetes

Background and Objectives: Millions of people worldwide suffer from diabetes. The ever-increasing number of patients poses a huge challenge to healthcare systems. The purpose of this study was to evaluate the lifestyle and self-monitoring of type 2 diabetes patients using the Healthy Lifestyle and Self-Monitoring Questionnaire. Material and Methods: The analyses conducted were based on data collected using the Polish version of the Healthy Lifestyle and Self-Control Questionnaire among 104 patients diagnosed with type 2 diabetes who were treated at the Diabetes Outpatient Clinic. The in-house study also included an analysis of the relationship between lifestyle habits and disease acceptance and chronic disease functioning. Results: Respondents scored statistically significantly higher for the Healthy Lifestyle and Self-Monitoring Questionnaire than the norms assume, and the largest differences were observed in terms of the healthy dietary choices subscale (t = 8.07; p < 0.05). Only for the subscale of organized exercise were no statistically significant differences found (t = 0.50; p = 0.620). Conclusions: Type 2 diabetes is one of the diseases in which lifestyle not only contributes to its development but is also associated with its course and treatment outcomes. Reinforcing a health-promoting lifestyle is one of the cornerstones of treating patients with type 2 diabetes.

Trait impulsivity is associated with an increased risk of type 2 diabetes incidence in adults over 8 years of follow-up: results from the NutriNet-Santé cohort

BACKGROUND

Type 2 diabetes is one of the most prevalent and preventable diseases worldwide and impulsivity, a psychological trait characterized by making quick decisions without forethought, has been suggested as a key feature for health-related conditions. However, there have been no studies examining the relationships between impulsivity and the incidence of type 2 diabetes and our aim was to assess the prospective association between trait impulsivity and the risk of developing type 2 diabetes.

METHODS

A prospective observational study design was conducted between May 2014 and February 2023 within the NutriNet-Santé cohort. A web-based platform was used to collect data from the French adult population, with voluntary enrollment and participation. Of the 157,591 adults (≥ 18 years old) participating in the NutriNet-Santé study when impulsivity was assessed, 109,214 participants were excluded due to prevalent type 1 or 2 diabetes or missing data for impulsivity or follow-up data for type 2 diabetes. Trait impulsivity, and the attention, motor, and non-planning subfactors, were assessed at baseline using the Barratt Impulsiveness Scale 11. Incident type 2 diabetes was ascertained through follow-up. Medical information was reviewed by NutriNet-Santé physician experts to ascertain incident diabetes cases based on the ICD-10. Cox regression models, using hazard ratios and 95% confidence intervals (HR [95% CI]), were performed to evaluate associations between impulsivity per 1 standard deviation increment and type 2 diabetes risk, adjusting by recognized confounders.

RESULTS

Of the 48,377 individuals studied (women 77.6%; age at baseline = 50.6 year ± 14.5 years), 556 individuals developed type 2 diabetes over a median follow-up of 7.78 (IQR: 3.97-8.49) years. Baseline impulsivity was associated with an increased risk of type 2 diabetes incidence (HR = 1.10 [1.02, 1.20]). The motor impulsivity subfactor was positively associated with type 2 diabetes risk (HR = 1.14 [1.04, 1.24]), whereas no associations were found for attention and non-planning impulsivity subfactors.

CONCLUSIONS

Trait impulsivity was associated with an increased type 2 diabetes risk, mainly driven by the motor impulsivity subfactor. If these results are replicated in other populations and settings, trait impulsivity may become an important psychological risk factor to be considered in the prevention of type 2 diabetes.

COHORT REGISTRATION

Name of registry: The NutriNet-Santé Study. A Web-based Prospective Cohort Study of the Relationship Between Nutrition and Health and of Dietary Patterns and Nutritional Status Predictors. Cohort registration number: NCT03335644. Date of registration: October 11, 2017. URL: https://clinicaltrials.gov/ct2/show/NCT03335644.

Association of diabetes mellitus with dementia- and non-dementia-related mortality amongst women: a secondary competing risks analysis of the California Teachers Study

BACKGROUND AND PURPOSE

The prevalence of dementia is rapidly increasing. Attempts to further understand modifiable risk factors such as diabetes mellitus (DM) are urgently needed to inform public health policies for prevention. Thus, the objective of the current study was to assess the relationship between DM and risk of dementia and non-dementia mortality amongst women in the California Teachers Study prospective cohort.

METHODS

Women (n = 124,509) aged 22-104 years at baseline were included. DM was ascertained from self-reported questionnaires and hospital-linked records. Dementia-related deaths were ascertained from state and national records. Competing risk regression models were used to estimate cause-specific hazard ratios and 95% confidence intervals for the association of DM with dementia- and non-dementia-related mortality.

RESULTS

There were 10,511 total DM cases and 3625 deaths due to dementia over a mean of 21.3 years of follow-up. Fully adjusted cause-specific hazard ratios of the association with DM were 2.26 (2.01, 2.55) for dementia-related and 1.97 (1.89, 2.05) for the competing risk of non-dementia-related mortality. This association was strongest amongst participants with incident DM, younger age at baseline and higher alcohol consumption or who were overweight.

CONCLUSIONS

In the California Teachers Study, women with DM had increased risk of mortality due to both dementia and non-dementia causes; however, the risk of mortality due to dementia was elevated compared to non-dementia causes only amongst participants with incident DM.

Targeting systemic and gut microbial metabolism in ER+ breast cancer

Estrogen receptor-positive (ER+) breast tumors have a better overall prognosis than ER- tumors; however, there is a sustained risk of recurrence. Mounting evidence indicates that genetic and epigenetic changes associated with resistance impact critical signaling pathways governing cell metabolism. This review delves into recent literature concerning the metabolic pathways regulated in ER+ breast tumors by the availability of nutrients and endocrine therapies and summarizes research on how changes in systemic and gut microbial metabolism can affect ER activity and responsiveness to endocrine therapy. As targeting of metabolic pathways using dietary or pharmacological approaches enters the clinic, we provide an overview of the supporting literature and suggest future directions.

Grilling the data: application of specification curve analysis to red meat and all-cause mortality

OBJECTIVES

To present an application of specification curve analysis-a novel analytic method that involves defining and implementing all plausible and valid analytic approaches for addressing a research question-to nutritional epidemiology.

STUDY DESIGN AND SETTING

We reviewed all observational studies addressing the effect of red meat on all-cause mortality, sourced from a published systematic review, and documented variations in analytic methods (eg, choice of model, covariates, etc.). We enumerated all defensible combinations of analytic choices to produce a comprehensive list of all the ways in which the data may reasonably be analyzed. We applied specification curve analysis to data from National Health and Nutrition Examination Survey 2007 to 2014 to investigate the effect of unprocessed red meat on all-cause mortality. The specification curve analysis used a random sample of all reasonable analytic specifications we sourced from primary studies.

RESULTS

Among 15 publications reporting on 24 cohorts included in the systematic review on red meat and all-cause mortality, we identified 70 unique analytic methods, each including different analytic models, covariates, and operationalizations of red meat (eg, continuous vs quantiles). We applied specification curve analysis to National Health and Nutrition Examination Survey, including 10,661 participants. Our specification curve analysis included 1208 unique analytic specifications, of which 435 (36.0%) yielded a hazard ratio equal to or more than 1 for the effect of red meat on all-cause mortality and 773 (64.0%) less than 1. The specification curve analysis yielded a median hazard ratio of 0.94 (interquartile range: 0.83-1.05). Forty-eight specifications (3.97%) were statistically significant, 40 of which indicated unprocessed red meat to reduce all-cause mortality and eight of which indicated red meat to increase mortality.

CONCLUSION

We show that the application of specification curve analysis to nutritional epidemiology is feasible and presents an innovative solution to analytic flexibility.

Can the delivery of behavioural support be improved in the NHS England Low-Calorie Diet Programme? An observational study of behaviour change techniques

BACKGROUND

Previous research has illustrated a drift in the fidelity of behaviour change techniques (BCTs) during the design of the pilot NHS England Low-Calorie Diet (NHS-LCD) Programme. This study evaluated a subsequent domain of fidelity, intervention delivery. Two research questions were addressed: (1) To what extent were BCTs delivered with fidelity to providers programme plans? (2) What were the observed barriers and facilitators to delivery?

METHODS

A mixed-methods sequential explanatory design was employed. Remote delivery of one-to-one and group-based programmes were observed. A BCT checklist was developed using the BCT Taxonomy v1; BCTs were coded as present, partially delivered, or absent during live sessions. Relational content analysis of field notes identified observed barriers and facilitators to fidelity.

RESULTS

Observations of 122 sessions across eight samples and two service providers were completed. Delivery of the complete NHS-LCD was observed for five samples. Fidelity ranged from 33% to 70% across samples and was higher for group-based delivery models (64%) compared with one-to-one models (46%). Barriers and facilitators included alignment with the programme's target behaviours and outcomes, session content, time availability and management, group-based remote delivery, and deviation from the session plan.

CONCLUSIONS

Overall, BCTs were delivered with low-to-moderate fidelity. Findings indicate a dilution in fidelity during the delivery of the NHS-LCD and variation in the fidelity of programmes delivered across England. Staff training could provide opportunities to practice the delivery of BCTs. Programme-level changes such as structured activities supported by participant materials and with sufficient allocated time, might improve the delivery of BCTs targeting self-regulation.

Association of type 2 diabetes mellitus with dementia-related and non-dementia-related mortality among postmenopausal women: A secondary competing risks analysis of the women's health initiative

INTRODUCTION

Alzheimer's disease (AD) and AD-related dementias (ADRD) are leading causes of death among older adults in the United States. Efforts to understand risk factors for prevention are needed.

METHODS

Participants (n = 146,166) enrolled in the Women's Health Initiative without AD at baseline were included. Diabetes status was ascertained from self-reported questionnaires and deaths attributed to AD/ADRD from hospital, autopsy, and death records. Competing risk regression models were used to estimate the cause-specific hazard ratios (HRs) and 95% confidence intervals (CIs) for the prospective association of type 2 diabetes mellitus (T2DM) with AD/ADRD and non-AD/ADRD mortality.

RESULTS

There were 29,393 treated T2DM cases and 8628 AD/ADRD deaths during 21.6 (14.0-23.5) median (IQR) years of follow-up. Fully adjusted HRs (95% CIs) of the association with T2DM were 2.94 (2.76-3.12) for AD/ADRD and 2.65 (2.60-2.71) for the competing risk of non-AD/ADRD mortality.

DISCUSSION

T2DM is associated with AD/ADRD and non-AD/ADRD mortality.

HIGHLIGHTS

Type 2 diabetes mellitus is more strongly associated with Alzheimer's disease (AD)/AD and related dementias (ADRD) mortality compared to the competing risk of non-AD/ADRD mortality among postmenopausal women. This relationship was consistent for AD and ADRD, respectively. This association is strongest among participants without obesity or hypertension and with younger age at baseline, higher diet quality, higher physical activity, higher alcohol consumption, and older age at the time of diagnosis of type 2 diabetes mellitus.

The global prevalence of overweight and obesity among nurses: A systematic review and meta-analyses

BACKGROUND

Several studies have reported the prevalence of overweight and obesity in various countries but the global prevalence of nurses with overweight and obesity remains unclear. A consolidation of figures globally can help stakeholders worldwide improve workforce development and healthcare service delivery.

OBJECTIVE

To investigate the global prevalence of overweight and obesity among nurses.

DESIGN

Systematic review with meta-analysis.

SETTING

29 different countries across the WHO-classified geographical region.

PARTICIPANTS

Nurses.

METHODS

Eight electronic databases were searched for articles published from inception to January 2023. Two independent reviewers performed the article screening, methodological appraisal and data extraction. Methodological appraisal was conducted using Newcastle-Ottawa Scale (NOS). Inter-rater agreement was measured using Cohen's Kappa. Meta-analyses were conducted to pool the effect sizes on overweight, obesity and waist circumference using random effects model and adjusted using generalised linear mixed models and Hartung-Knapp method. Logit transformation was employed to stabilise the prevalence variance. Subgroup analyses were performed based on methodological quality and geographical regions. Heterogeneity was assessed using the I2 statistic.

RESULTS

Among 10,587 studies, 83 studies representing 158,775 nurses across 29 countries were included. Based on BMI, the global prevalence of overweight and obesity were 31.2% (n = 55, 95% CI: 29%-33.5%; p < .01) and 16.3% (n = 76, 95% CI: 13.7%-19.3%, p < .01), respectively. Subgroup analyses indicated that the highest prevalence of overweight was in Eastern Mediterranean (n = 9, 37.2%, 95% CI: 33.1%-41.4%) and that of obesity was in South-East Asia (n = 5, 26.4%, 95% CI: 5.3%-69.9%). NOS classification, NOS scores, sample size and the year of data collected were not significant moderators.

CONCLUSIONS

This review indicated the global prevalence of overweight and obesity among nurses along with the differences between regions. Healthcare organisations and policymakers should appreciate this increased risk and improve working conditions and environments for nurses to better maintain their metabolic health.

PATIENT OR PUBLIC CONTRIBUTION

Not applicable as this is a systematic review.

REGISTRATION

PROSPERO (ref: CRD42023403785) https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=403785.

TWEETABLE ABSTRACT

High prevalence of overweight and obesity among nurses worldwide.

Social isolation, loneliness, and incident type 2 diabetes mellitus: results from two large prospective cohorts in Europe and East Asia and Mendelian randomization

BACKGROUND

Social isolation and loneliness pose significant public health challenges globally. The objective of this study is to investigate the association between social isolation, loneliness, and the risk of type 2 diabetes mellitus (T2DM).

METHODS

423,503 UK adults from the UK Biobank (UKB) and 13,800 Chinese adults from the China Health and Retirement Longitudinal Study (CHARLS) were analyzed. The exposures of interest were social isolation and loneliness. Social isolation was evaluated based on the number of household members, frequency of social activities, contact with others, and marriage status (CHARLS only). Loneliness was evaluated by the subjective feeling of loneliness and the willingness to confide in others (UKB only). The primary endpoint was incident T2DM. The two-sample Mendelian randomization (MR) analysis was based on the genome-wide association studies of UKB (n = 463,010) and the European Bioinformatics Institute (n = 655,666).

FINDINGS

The UKB cohort study documented 15,072 T2DM cases during a mean follow-up of 13.5 years, and the CHARLS cohort study recorded 1,249 T2DM cases during a mean follow-up of 5.8 years. Social isolation and loneliness showed significant associations with an elevated risk of T2DM in both UKB (social isolation [most vs least]: HR 1.17, 95% CI 1.11-1.23; loneliness [yes vs no]: HR 1.21, 95% CI 1.13-1.30) and CHARLS cohorts (social isolation [yes vs no]: HR 1.22, 95% CI 1.06-1.40; loneliness [yes vs no]: HR 1.21, 95% CI 1.07-1.36). These associations remained significant after accounting for baseline glucose status and genetic susceptibility to T2DM. Two-sample MR analyses determined that feeling lonely (OR 1.04, 95% CI 1.02-1.06) and engaging in fewer leisure/social activities (OR 1.03, 95% CI 1.02-1.05) were associated with increased T2DM risk, whereas more contact with friends or family (OR 0.99, 95% CI 0.98-0.99) was associated with reduced T2DM risk.

INTERPRETATION

Social isolation and loneliness are each associated with an elevated risk of T2DM, with MR analyses suggesting potential causal links. These associations remain significant after considering genetic susceptibility to T2DM. The findings highlight the importance of promoting initiatives to address social isolation and loneliness as part of T2DM prevention strategies.

FUNDING

CAMS Innovation Fund for Medical Sciences (No. 2021-I2M-1-008) and National Natural Science Foundation of China (No. 72103187).

Exposure to Noise and Cardiovascular Disease in a Nationwide US Prospective Cohort Study of Women

Background: Long-term noise exposure is associated with cardiovascular disease (CVD), including acute cardiovascular events such as myocardial infarction and stroke. However, longitudinal cohort studies of long-term noise and CVD are almost exclusively from Europe, and few modelled nighttime and daytime noise separately. We aimed to examine the prospective association of outdoor long-term nighttime and daytime noise from anthropogenic sources with incident CVD using a US-based, nationwide cohort of women. Methods: We linked L50 (median) nighttime and L50 daytime modelled anthropogenic noise estimates from a US National Park Service model to geocoded residential addresses of 114,116 participants in the Nurses' Health Study. We used time-varying Cox proportional hazards models to estimate risk of incident CVD, coronary heart disease (CHD), and stroke associated with long-term average noise exposure, adjusted for potential individual- and area-level confounders and CVD risk factors (1988-2018). We assessed effect modification by population density, region, air pollution, vegetation cover, and neighborhood socioeconomic status, and explored mediation by self-reported average nightly sleep duration. Results: Over 2,544,035 person-years, there were 10,331 incident CVD events. In fully-adjusted models, the hazard ratios for each interquartile range increase in L50 nighttime noise (3.67 dBA) and L50 daytime noise (4.35 dBA), respectively, were 1.04 (95% CI 1.02, 1.06) and 1.04 (95% CI 1.02, 1.07). Similar associations were observed for CHD and stroke. Stratified analyses suggested that associations of nighttime and daytime noise with CVD did not differ by prespecified effect modifiers. We found no evidence that inadequate sleep (< 5 hours per night) mediated associations of noise and CVD. Discussion: Outdoor median nighttime and daytime noise at the residential address was associated with a small increase in CVD risk in a cohort of adult female nurses.

History of infertility and risk of breast cancer: a prospective cohort study

PURPOSE

Research on infertility and risk of breast cancer has been conflicting, potentially because many well-established breast cancer risk factors, such as pregnancy history, are strongly correlated with infertility.

METHODS

We followed participants in the Nurses' Health Study II from 1989 to 2015 (n = 103,080) for the development of invasive breast cancer and calculated Hazard Ratios (HR) and 95% confidence intervals (CI) using Cox regression. Participants with a self-reported history of infertility (12 months of trying without conception) were compared to gravid women with no history of infertility. We classified breast cancer by menopausal status and investigated mediation by reproductive factors.

RESULTS

Over 26 years of follow-up, 26,208 (25.4%) women reported a history of infertility, and 3,201 women were newly diagnosed with invasive breast cancer. We observed no association between infertility history and risk of overall breast cancer (HR: 1.05, 95% CI: 0.97-1.14) or premenopausal breast cancer (RR: 0.93, 95% CI: 0.83-1.03). However, we observed a modest association between history of infertility and risk of postmenopausal breast cancer (HR: 1.13, 95% CI: 1.00-1.28), approximately 50% of which could be attributed to lower total parity and later age at first birth (95% CI: 8.2%-91.0%).

CONCLUSIONS

Women with a history of infertility were at increased risk of postmenopausal breast cancer. Older age at first birth and lower total parity explained approximately half of the association between infertility and risk of postmenopausal breast cancer.

Inflammatory and insulinemic dietary patterns and risk of endometrial cancer among US women

BACKGROUND

Although unopposed estrogen exposure is considered a major driver of endometrial carcinogenesis, chronic inflammation and insulin resistance and hyperinsulinemia are also major endometrial cancer risk factors. However, it is unclear whether diets with inflammatory or insulinemic potential are associated with risk of endometrial cancer.

METHODS

We followed 48 330 women from the Nurses' Health Study (1984-2016) and 85 426 women from the Nurses' Health Study II (1989-2017). Using food frequency questionnaires, we calculated repeated measures of empirical dietary inflammatory pattern (EDIP) and empirical dietary index for hyperinsulinemia (EDIH) scores, which characterize the potential of the whole diet to modulate circulating biomarkers of inflammation or C-peptide, respectively. We used multivariable-adjusted Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for type I endometrial cancer risk.

RESULTS

We documented 1462 type I endometrial cancer cases over 2 823 221 person-years of follow-up. In the pooled multivariable-adjusted analyses, women in the highest compared with lowest quintiles were at higher risk of type I endometrial cancer (EDIP HRQ5vsQ1 = 1.46, 95% CI = 1.24 to 1.73; Ptrend < .001; EDIH HRQ5vsQ1 = 1.58, 95% CI = 1.34 to 1.87; Ptrend < .001). Additional adjustment for body mass index attenuated the associations (EDIP HR = 1.03, 95% CI = 0.87 to 1.22; EDIH HR = 1.01, 95% CI = 0.85 to 1.21), and mediation analyses showed that body mass index may explain 60.4% (95% CI = 37.4% to 79.6%; P < .001) and 71.8% (95% CI = 41.0% to 90.4%; P < .001) of the association of endometrial cancer with EDIP and EDIH, respectively.

CONCLUSIONS

In this large cohort study, higher dietary inflammatory and insulinemic potential were each associated with increased endometrial cancer incidence, and this association may be almost entirely mediated by adiposity.

Associations of levels of peripheral blood leukocyte and subtypes with type 2 diabetes: A longitudinal study of Chinese government employees

OBJECTIVES

Available evidence suggests that type 2 diabetes (T2D) may be associated with inflammation and that leukocytes are a topical clinical, biological indicator of inflammation. This study investigates the associations between peripheral blood leukocyte and subtypes levels with T2D.

METHODS

A total of 5,475 individuals were included in the baseline examination from January 2018 to April 2020, with incidence data updated to April 30, 2021, and follow-up to 5,362 individuals. T2D was defined according to the Chinese guidelines for preventing and treating type 2 diabetes. Physiological and biochemical indicators, including leukocyte and subtypes, were obtained from the physical examination results of the tertiary care hospitals relied on at the cohort sites. Covariates such as demographic characteristics and lifestyle were collected by questionnaire. Binary logistic regression and Cox proportional hazard models were used to explore the correlations. Receiver Operating Characteristic (ROC) curves and time-dependent ROC curves were used to estimate the predictive diagnosis of T2D across the subtype of leukocytes.

RESULTS

The mean follow-up time was 12 months, and the cumulative incidence density of T2D was 4.0/1000 person-years. Cross-sectional results at baseline showed that the levels of peripheral blood leukocyte and its subtypes were higher in the T2D group than in the non-T2D group. Total leukocyte count and subtypes levels were grouped by quintile. After adjusting for age, sex, family history of diabetes, lifestyle score, and triglyceride levels, all were compared with the lowest quintile of each group. Logistic regression model results showed that the corrected OR for those with the highest quintile level of leukocyte was 2.01 (95% CI: 1.02-3.98). The longitudinal analysis showed that the adjusted HR was 8.43 (95%CI: 1.06-66.92) for those with the highest quintile level of leukocytes at baseline after controlling for the effects of the above covariates. For those with the highest quintile level of neutrophils at baseline, the adjusted HR was 5.05 (95%CI: 1.01-25.29). The leukocyte and subtypes had predictive values for T2D.

CONCLUSION

Patients with T2D have a higher level of peripheral blood leukocyte and subtypes than those without the disease. Elevated leukocyte and neutrophil counts may link to a higher risk of T2D.

Laparoscopically Confirmed Endometriosis and Risk of Incident Stroke: A Prospective Cohort Study

BACKGROUND

Prior research suggests that women with endometriosis are at greater risk of coronary heart disease. Therefore, our objective was to prospectively investigate the association between laparoscopically confirmed endometriosis and risk of incident stroke during 28 years of follow-up.

METHODS

Participants in the NHSII cohort study (Nurses' Health Study II) were followed from 1989 when they were between the ages of 25 to 42 until 2017 for development of incident stroke (ischemic and hemorrhagic). Cox proportional hazard models were used to calculate hazard ratios and 95% CI, with adjustment for potential confounding variables (alcohol intake, body mass index at age 18, current body mass index, age at menarche, menstrual cycle pattern in adolescence, current menstrual cycle pattern, parity, oral contraceptive use history, smoking history, diet quality, physical activity, NSAID use, aspirin use, race/ethnicity, and income). We estimated the proportion of the total association mediated by history of hypertension, hypercholesterolemia, hysterectomy/oophorectomy, and hormone therapy. We also tested for effect modification by age (<50, ≥50 years), infertility history, body mass index (<25, ≥25 kg/m2), and menopausal status.

RESULTS

We documented 893 incident cases of stroke during 2 770 152 person-years of follow-up. Women with laparoscopically confirmed endometriosis had a 34% greater risk of stroke in multivariable-adjusted models (hazard ratio, 1.34 [95% CI, 1.10-1.62]), compared to those without a history of endometriosis. Of the total association of endometriosis with risk of stroke, the largest proportion was attributed to hysterectomy/oophorectomy (39% mediated [95% CI, 14%-71%]) and hormone therapy (16% mediated [95% CI, 5%-40%]). We observed no differences in the relationship between endometriosis and stroke by age, infertility history, body mass index, or menopausal status.

CONCLUSIONS

We observed that women with endometriosis were at elevated risk of stroke. Women and their health care providers should be aware of endometriosis history, maximize primary cardiovascular prevention, and discuss signs and symptoms of cardiovascular disease.

Endoplasmic reticulum-mitochondria miscommunication is an early and causal trigger of hepatic insulin resistance and steatosis

BACKGROUND & AIMS

Hepatic insulin resistance in obesity and type 2 diabetes was recently associated with endoplasmic reticulum (ER)-mitochondria miscommunication. These contact sites (mitochondria-associated membranes: MAMs) are highly dynamic and involved in many functions; however, whether MAM dysfunction plays a causal role in hepatic insulin resistance and steatosis is not clear. Thus, we aimed to determine whether and how organelle miscommunication plays a role in the onset and progression of hepatic metabolic impairment.

METHODS

We analyzed hepatic ER-mitochondria interactions and calcium exchange in a time-dependent and reversible manner in mice with diet-induced obesity. Additionally, we used recombinant adenovirus to express a specific organelle spacer or linker in mouse livers, to determine the causal impact of MAM dysfunction on hepatic metabolic alterations.

RESULTS

Disruption of ER-mitochondria interactions and calcium exchange is an early event preceding hepatic insulin resistance and steatosis in mice with diet-induced obesity. Interestingly, an 8-week reversal diet concomitantly reversed hepatic organelle miscommunication and insulin resistance in obese mice. Mechanistically, disrupting structural and functional ER-mitochondria interactions through the hepatic overexpression of the organelle spacer FATE1 was sufficient to impair hepatic insulin action and glucose homeostasis. In addition, FATE1-mediated organelle miscommunication disrupted lipid-related mitochondrial oxidative metabolism and induced hepatic steatosis. Conversely, reinforcement of ER-mitochondria interactions through hepatic expression of a synthetic linker prevented diet-induced glucose intolerance after 4 weeks' overnutrition. Importantly, ER-mitochondria miscommunication was confirmed in the liver of obese patients with type 2 diabetes, and correlated with glycemia, HbA1c and HOMA-IR index.

CONCLUSIONS

ER-mitochondria miscommunication is an early causal trigger of hepatic insulin resistance and steatosis, and can be reversed by switching to a healthy diet. Thus, targeting MAMs could help to restore metabolic homeostasis.

LAY SUMMARY

The literature suggests that interactions between the endoplasmic reticulum and mitochondria could play a role in hepatic insulin resistance and steatosis during chronic obesity. In the present study, we reappraised the time-dependent regulation of hepatic endoplasmic reticulum-mitochondria interactions and calcium exchange, investigating reversibility and causality, in mice with diet-induced obesity. We also assessed the relevance of our findings to humans. We show that organelle miscommunication is an early causal trigger of hepatic insulin resistance and steatosis that can be improved by nutritional strategies.

Leveraging Observational Cohorts to Study Diet and Nutrition in Older Adults: Opportunities and Obstacles

By 2060, the number of adults aged ≥65 y is expected to double, and the ≥85 y segment of the population is expected to triple in the United States. US federal nutrition guidance is based on the premise that healthy diets contribute to delaying the onset and progression of many age-related diseases and disability. Yet, little is known about the dietary intakes or nutritional needs across the older adulthood age span. This review aims to identify community-based cohorts that collected information on dietary intake of adults ≥65 y in the United States. Thirty-two cohorts met all inclusion criteria. We summarized information on the cohorts' design, demographics, and diet assessment. We also identified key gaps in the existing databases that, if filled, could enhance their utility to address certain research questions. This review serves as a valuable inventory of cohorts that can be leveraged to answer key questions about the diet and nutritional needs of the oldest old, who represent the fastest growing segment of the population in the United States.

Dietary Acid Load is Associated with Hypertension and Diabetes in the Elderly

BACKGROUND

Diet can affect the body's acid-base balance due to its content of acid or base precursors. There is conflicting evidence for the role of metabolic acidosis in the development of cardiometabolic disorders, hypertension (HT), and insulin resistance (IR).

OBJECTIVE

We hypothesize that dietary acid load (DAL) is associated with adverse metabolic risk factors and we aimed to investigate this in the elderly.

METHODS

A total of 114 elderly participants were included in the study. The participants were divided into four groups such as HT, diabetes (DM), both HT and DM, and healthy controls. Anthropometric, biochemical, and clinical findings were recorded. Potential renal acid load (PRAL) and net endogenous acid production (NEAP) results were obtained from three-day, 24-hour dietary records via a nutrient database program. (BeBiS software program).

RESULTS

The groups were matched for age, gender, and BMI. There was a statistically significant difference between the groups in terms of NEAP (p=0.01) and no significant difference for PRAL (p=0.086). The lowest NEAP and PRAL levels were seen in the control group while the highest in the HT group. Both NEAP and PRAL were correlated with waist circumference (r=0,325, p=0.001; r=0,231, p=0,016, respectively).

CONCLUSION

Our data confirmed that subjects with HT and DM had diets with greater acid-forming potential. High NEAP may be a risk factor for chronic metabolic diseases, particularly HT. PRAL couldn't be shown as a significantly different marker in all participants. Dietary content has a significant contribution to the reduction of cardiovascular risk factors such as HT, DM, and obesity.

Factors Associated With Dietary Behaviour Among Patients With Type 2 Diabetes Mellitus in Rural Indonesia

Background

Type 2 Diabetes Mellitus (T2DM) is one of the fastest-growing diseases and most serious major health problems worldwide. Few studies have focused on the association of social support with diabetes-related dietary behaviour.

Objective

To examine the relationship between social support and dietary behaviour among patients with diabetes in a rural area of Indonesia.

Methodology

This was a descriptive cross-sectional study that included 120 physically healthy patients above 18 years old with T2DM for at least 6 months. Data analysis was done using a stepwise regression model.

Results

The mean age was 61.97 years (SD = 7.85, range = 52-74); 86.7% of the participants were females. Social support (β = 0.272, p = <0.001), diabetes medications (β = 0.169, p = 0.003), duration of diabetes (β = 0.118, p = 0.0047), and presence of diabetes complications (β = 0.197, p = 0.008) were significant predictors of dietary behaviour and accounted for 34.2% of the variance.

Conclusions

Social support, diabetes medications, presence of diabetes complications, and duration of diabetes were associated with improved dietary behaviour. Therefore, social support should be considered when designing dietary interventions for patients with type 2 diabetes mellitus.

Obesity, Lifestyle Behaviors, and Dietary Habits of Saudi Adolescents Living in Riyadh (ATLS-2 Project): Revisited after a Ten-Year Period

Objective: Undesirable lifestyle behaviors are associated with many adverse health outcomes. This study revisited the lifestyle behaviors, dietary habits, and overweight/obesity status of Saudi adolescents from Riyadh during the year 2019/2020. We report on the rationale, design, and methodology of the current study and provide preliminary findings of the changes that occurred between the two cross-sectional studies within the span of a ten-year period. Methods: A comparison was made between two cross-sectional studies, one conducted in 2009/2010 and the other in 2019/2020, using the same design, methods, and instruments. A multistage stratified cluster random sampling technique was used to select adolescents attending public and private secondary schools. Measurements included demographics, weight, height, waist circumference, physical activity (using valid questionnaire and accelerometer), sedentary time, sleep duration, and dietary habits. Results: The total number of participants was 1262 adolescents, of which 52.4% were male, with a mean (SD) age of 16.4 ± 0.95 years. About 41% of paternal and 39.1% of maternal education levels were university degrees. Over 37% of the families earned more than SAR 20,000/month. Body mass index and waist circumference of males was larger than that of females and the overall prevalence of overweight/obesity was 40.5% with significance (p < 0.001) difference between males (47.3%) and females (32.8%). Between 2009/2010 and 2019/2020 datasets, there were significant changes in age (p < 0.001), waist circumference (p < 0.001), screen time (p < 0.001), moderate-intensity physical activity (p < 0.001), vigorous-intensity physical activity (p < 0.001), total physical activity (p < 0.001), and consumption of breakfast (p = 0.015) and fruits (p = 0.002). Conclusion: The most notable change between the two studies was a significant reduction in the prevalence of physical inactivity among Saudi adolescents, which was due to increased levels of moderate-intensity physical activity among Saudi females, as a result of recent positive sociopolitical changes occurring in the country over the past four years. The findings provided rich information that can be used to explore trends in overweight/obesity, lifestyle behaviors, and dietary habits among Saudi adolescents over the past ten-year period.

Poor quality of dietary assessment in randomized controlled trials of nutritional interventions for type 2 diabetes may affect outcome conclusions: A systematic review and meta-analysis

OBJECTIVES

The aim of this study was to evaluate the quality of dietary assessment methods in randomized controlled trials focusing on individuals with type 2 diabetes (T2DM), and its impact on the favorability of conclusions.

METHODS

MEDLINE, EMBASE, CINAHL, and CENTRAL were searched, from inception until September 2019 for RCTs of dietary interventions in individuals with T2DM. Investigators assessed risk of bias and quality of the dietary measurements using the Cochrane Risk of Bias Assessment Tool 2.0 and the redeveloped EURICA tool, respectively. Random-effects meta-analysis assessed mean changes in hemoglobin (Hb)A1c. The study was conducted in accordance with the Preferred Reporting in Systematic Reviews and Meta-analyses. PROSPERO registration number: CRD42019146471.

RESULTS

Of 2552 records retrieved, 23 studies met the inclusion criteria. Two studies were rated as good, 6 as medium, and 15 as poor in the quality assessment of the dietary measurement tool. All eight studies with higher quality of dietary assessment were associated with favorable conclusions. Among the 15 studies with poor quality, 5 failed to draw favorable conclusions. Among studies that sought to produce a reduction in HbA1c, 3 of 6 with better dietary assessment quality produced a significant difference of -0.38% (-0.67% to -0.08%), and 4 of 12 of poorer quality produced a significant difference of -0.26% (-0.37% to -0.14%).

CONCLUSIONS

The poor quality of dietary assessment in clinical trials casts uncertainty on the dietary outcomes and the validity of possible causal mechanisms. Attention to the accuracy and reliability of dietary assessment methods is indicated.

Psychometric Properties and Cultural Adaptation of the Polish Version of the Healthy Lifestyle and Personal Control Questionnaire (HLPCQ)

BACKGROUND

Chronic non-communicable diseases (NCDs), sometimes referred to as lifestyle diseases, are the most common cause of death and disability worldwide. Thus, healthcare professionals should be equipped with tools, knowledge, skills, and competencies in the newly distinguished field of lifestyle medicine. The purpose of this study was to test the psychometric properties of the Polish version of the Healthy Lifestyle and Personal Control Questionnaire (HLPCQ). The Polish version of the HLPCQ would further provide Polish healthcare professionals with a useful and convenient tool for routine lifestyle assessment while giving HLPCQ novel use and potential for further research.

METHODS

Before testing its psychometric properties, the HLPCQ was translated and adapted from the original Greek version into Polish. Subsequently, we tested the instrument's psychometric properties on a sample of 2433 participants. In addition, we tested the factorial validity of the HLPCQ using confirmatory and exploratory factor analysis.

RESULTS

There were more female than male participants (91.78%). Most of them were middle-aged (30.40 ± 7.71), single (39.62%), and living with family (70.65%). In terms of residence, 1122 (46.12%) participants lived in cities with a population of over 500,000. In terms of reliability, the internal consistency of the Polish version and its domains is excellent. Cronbach's alpha for each of the domains of the scale ranged between 0.6 and 0.9.

CONCLUSIONS

The Polish version of the Healthy Lifestyle and Personal Control Questionnaire (HLPCQ) has good characteristics of factorial validity and can be used in clinical practice and research.

Optimizing diabetes screening frequencies for at-risk groups

There is strong evidence that diabetes is underdiagnosed in the US: the Centers for Disease Control and Prevention (CDC) estimates that approximately 25% of diabetic patients are unaware of their condition. To encourage timely diagnosis of at-risk patients, we develop screening guidelines stratified by body mass index (BMI), age, and prior test history by using a Partially Observed Markov Decision Process (POMDP) framework to provide more personalized screening frequency recommendations. We identify structural results that prove the existence of threshold solutions in our problem and allow us to determine the relative timing and frequency of screening given different risk profiles. We then use nationally representative empirical data to identify a policy that provides the optimal action (screen or wait) every six months from age 45 to 90. We find that the current screening guidelines are suboptimal, and the recommended diabetes screening policy should be stratified by age and by finer BMI thresholds than in the status quo. We identify age ranges and BMI categories for which relatively less or more screening is needed compared to the existing guidelines to help physicians target patients most at risk. Compared to the status quo, we estimate that an optimal screening policy would generate higher net monetary benefits by $3,200-$3,570 and save $120-$1,290 in health expenditures per individual in the US above age 45.

Risk Factors for Progression From Gestational Diabetes to Postpartum Type 2 Diabetes: A Review

Gestational diabetes mellitus (GDM) complicates 6% to 8% of pregnancies and up to 50% of women with GDM progress to type 2 diabetes mellitus (DM) within 5 years postpartum. Clinicians have little guidance on which women are most at risk for DM progression or when evidence-based prevention strategies should be implemented in a woman's lifecycle. To help address this gap, the authors review identifiable determinants of progression from GDM to DM across the perinatal period, considering prepregnancy, pregnancy, and postpartum periods. The authors categorize evidence by pathways of risk including genetic, metabolic, and behavioral factors that influence progression to DM among women with GDM.

Recreational and residential sun exposure and risk of endometriosis: a prospective cohort study

STUDY QUESTION

Is recreational and residential sun exposure associated with risk of endometriosis?

SUMMARY ANSWER

Tanning bed use in early adulthood, sunscreen use and history of sunburns were associated with a greater risk of endometriosis; however, higher residential UV exposure was associated with a lower endometriosis risk.

WHAT IS KNOWN ALREADY

Previous research has reported an association between endometriosis and skin cancer, with evidence of shared risk factors between the two diseases. We investigated the potential associations between ultraviolet radiation and endometriosis risk.

STUDY DESIGN, SIZE, DURATION

The Nurses' Health Study II is a prospective cohort of 116 429 female US nurses aged 25-42 years at enrolment in 1989. Participants completed self-administered biennial questionnaires through June 2015.

PARTICIPANTS/MATERIALS, SETTINGS, METHODS

We investigated self-reported measures of recreational sun-exposure and geocoded residential UV exposure in childhood and adulthood in relation to risk of laparoscopically confirmed endometriosis among premenopausal white women. We used Cox proportional hazards models to calculate hazard ratios (HRs) and 95% CIs.

MAIN RESULTS AND THE ROLE OF CHANCE

During follow-up, 4791 incident cases of laparoscopically confirmed endometriosis were reported among 1 252  248 person-years. Tanning bed use during high school/college (≥6 times per year vs. never use: HR = 1.19, 95% CI = 1.01-1.40; Ptrend = 0.04) and at ages 25-35 (HR = 1.24, 95% CI = 1.12-1.39; Ptrend ≤ 0.0001), number of sunburns during adolescence (Ptrend = 0.03) and percentage of time using sunscreen in adulthood (Ptrend = 0.002) were positively associated with risk of endometriosis. In contrast, residential UV level at birth (highest vs. lowest quintile: HR = 0.81, 95% CI = 0.72-0.92; Ptrend = 0.0001), at age 15 (HR = 0.79, 95% CI = 0.70-0.88; Ptrend ≤ 0.0001) and at age 30 (HR = 0.90, 95% CI = 0.82-0.99; Ptrend = 0.21) were associated with a decreased risk of endometriosis.

LIMITATIONS, REASONS FOR CAUTION

Self-reported endometriosis diagnosis may be prone to misclassification; however, we restricted our definition to laparoscopically confirmed endometriosis, which has been shown to have high validity compared to medical records.

WIDER IMPLICATIONS OF THE FINDINGS

Our results suggest that tanning bed use in early adulthood increases endometriosis risk, potentially through a harmful effect of ultraviolet A wavelengths, and that residential UV exposure reduces risk, possibly via optimal vitamin D synthesis. These findings should be investigated further to enhance our understanding of endometriosis aetiology.

STUDY FUNDING/COMPETING INTEREST(S)

This project was supported by NICHD grants HD48544 and HD52473, HD57210, NIH grant CA50385, CA176726. M.K. was supported by a Marie Curie International Outgoing Fellowship within the 7th European Community Framework Programme (#PIOF-GA-2011-302078) and is grateful to the Philippe Foundation and the Bettencourt-Schueller Foundation for their financial support. H.R.H. is supported by the National Cancer Institute, National Institutes of Health (K22 CA193860). The authors have nothing to disclose.

TRIAL REGISTRATION NUMBER

N/A.

Reduced reticulum-mitochondria Ca2+ transfer is an early and reversible trigger of mitochondrial dysfunctions in diabetic cardiomyopathy

Type 2 diabetic cardiomyopathy features Ca²⁺ signaling abnormalities, notably an altered mitochondrial Ca²⁺ handling. We here aimed to study if it might be due to a dysregulation of either the whole Ca²⁺ homeostasis, the reticulum-mitochondrial Ca²⁺ coupling, and/or the mitochondrial Ca²⁺ entry through the uniporter. Following a 16-week high-fat high-sucrose diet (HFHSD), mice developed cardiac insulin resistance, fibrosis, hypertrophy, lipid accumulation, and diastolic dysfunction when compared to standard diet. Ultrastructural and proteomic analyses of cardiac reticulum-mitochondria interface revealed tighter interactions not compatible with Ca²⁺ transport in HFHSD cardiomyocytes. Intramyocardial adenoviral injections of Ca²⁺ sensors were performed to measure Ca²⁺ fluxes in freshly isolated adult cardiomyocytes and to analyze the direct effects of in vivo type 2 diabetes on cardiomyocyte function. HFHSD resulted in a decreased IP3R-VDAC interaction and a reduced IP3-stimulated Ca²⁺ transfer to mitochondria, with no changes in reticular Ca²⁺ level, cytosolic Ca²⁺ transients, and mitochondrial Ca²⁺ uniporter function. Disruption of organelle Ca²⁺ exchange was associated with decreased mitochondrial bioenergetics and reduced cell contraction, which was rescued by an adenovirus-mediated expression of a reticulum-mitochondria linker. An 8-week diet reversal was able to restore cardiac insulin signaling, Ca²⁺ transfer, and cardiac function in HFHSD mice. Therefore, our study demonstrates that the reticulum-mitochondria Ca²⁺ miscoupling may play an early and reversible role in the development of diabetic cardiomyopathy by disrupting primarily the mitochondrial bioenergetics. A diet reversal, by counteracting the MAM-induced mitochondrial Ca²⁺ dysfunction, might contribute to restore normal cardiac function and prevent the exacerbation of diabetic cardiomyopathy.

Utilization of the common functional groups in bioactive molecules: Exploring dual inhibitory potential and computational analysis of keto esters against α-glucosidase and carbonic anhydrase-II enzymes

Diabetes mellitus, a progressive chronic disease, characterized by the abnormal carbohydrate metabolism is associated with severe health complications including long term dysfunction or failure of several organs, cardiovascular and micro-angiopathic problems (neuropathy, nephropathy, retinopathy). Despite the existence of diverse chemical structural libraries of α-glucosidase inhibitors, the limited diabetic treatment due to the adverse side effects such as abdominal distention, flatulence, diarrhoea, and liver damage associated with these inhibitors encourage the medicinal research community to design and develop new and potent inhibitors of α-glucosidase with better pharmacokinetic properties. In this perspective, we demonstrate the successful integration of common functional groups (ketone & ester) in one combined pharmacophore which is favorable for the formation of hydrogen bonds and other weaker interactions with the target proteins. These keto ester derivatives were screened for their α-glucosidase inhibition potential and the in vitro results revealed compound 3c as the highly active inhibitor with an IC₅₀ value of 12.4 ± 0.16 μM compared to acarbose (IC₅₀ = 942 ± 0.74 μM). This inhibition potency was ~76-fold higher than acarbose. Other potent compounds were 3f (IC₅₀ = 28.0 ± 0.28 μM), 3h (IC₅₀ = 33.9 ± 0.09 μM), 3g (IC₅₀ = 34.1 ± 0.04 μM), and 3d (IC₅₀ = 76.5 ± 2.0 μM). In addition, the emerging use of carbonic anhydrase inhibitors for the treatment of diabetic retinopathy (a leading cause of vision loss) prompted us to screen the keto ester derivatives for the inhibition of carbonic anhydrase-II. Compound 3b was found significantly active against carbonic anhydrase-II with an IC₅₀ of 16.5 ± 0.92 μM (acetazolamide; IC₅₀ = 18.2 ± 1.23 μM). Compound 3a also exhibited comparable potency with an IC₅₀ value of 18.9 ± 1.08 μM. Several structure-activity relationship analyses depicted the influence of the substitution pattern on both the aromatic rings. Molecular docking analysis revealed the formation of several H-bonding interactions through the ester carbonyl and the nitro oxygens of 3c with the side chains of His348, Arg212 and His279 in the active pocket of α-glucosidase whereas 3b interacted with His95, -OH of Thr197, Thr198 and WAT462 in the active site of carbonic anhydrase-II. Furthermore, evaluation of ADME properties suggests the safer pharmacological profile of the tested derivatives.

Gestational diabetes mellitus: Prevention, diagnosis and treatment. A fresh look to a busy corner

BACKGROUND

Gestational diabetes mellitus (GDM) is a common pregnancy complication characterized by hyperglycaemia with onset or first recognition during pregnancy. Risk factors include family history of diabetes, previous GDM, genetic predisposition for GDM/type 2 diabetes, insulin resistance conditions such as overweight, obesity and ethnicity. Women with GDM are at high risk for fetal macrosomia, small for gestational age, neonatal hypoglycaemia, operative delivery and caesarean delivery. The aim of this narrative review is to summarize the most recent findings of diagnosis and treatment of GDM in order to underline the importance to promote adequate prevention of this disease, especially through lifestyle interventions such as diet and physical activity.

METHODS

The research was conducted using the following electronic databases, MEDLINE, EMBASE, Web of Science, Scopus, ClinicalTrial.gov, OVID and Cochrane Library, including all published randomized and non-randomized studies as well as narrative and systematic reviews.

RESULTS

The lack of universally accepted criteria makes the definition of diagnosis and prognosis of this condition difficult. Early diagnosis and glucose blood level control may improve maternal and fetal short and long-term outcomes. Treatment strategies include nutritional interventions and exercise. Medical treatment can be necessary if these strategies are not effective. Moreover, novel non-pharmacologic agents such as myo-inositol seem to be effective and safe both in the prevention and the treatment of GDM.

CONCLUSIONS

It is important to promote adequate prevention of GDM. Further studies are needed in order to better define the most appropriate strategies for the clinical management of women affected by GDM.

Dietary Inflammatory and Insulinemic Potential and Risk of Type 2 Diabetes: Results From Three Prospective U.S. Cohort Studies

OBJECTIVE

To examine whether proinflammatory and hyperinsulinemic diets are associated with increased risk of type 2 diabetes.

RESEARCH DESIGN AND METHODS

We prospectively followed 74,767 women from the Nurses' Health Study (1984-2016), 90,786 women from the Nurses' Health Study II (1989-2017), and 39,442 men from the Health Professionals Follow-up Study (1986-2016). Using repeated measures of food-frequency questionnaires, we calculated empirical dietary inflammatory pattern (EDIP) and empirical dietary index for hyperinsulinemia (EDIH) scores, which are food-based indices that characterize dietary inflammatory or insulinemic potential based on circulating biomarkers of inflammation or C-peptide. Diagnoses of type 2 diabetes were confirmed by validated supplementary questionnaires.

RESULTS

We documented 19,666 incident type 2 diabetes cases over 4.9 million person-years of follow-up. In the pooled multivariable-adjusted analyses, individuals in the highest EDIP or EDIH quintile had 3.11 times (95% CI 2.96-3.27) and 3.40 times (95% CI 3.23-3.58) higher type 2 diabetes risk, respectively, compared with those in the lowest quintile. Additional adjustment for BMI attenuated the associations (hazard ratio 1.95 [95% CI 1.85-2.05] for EDIP and hazard ratio 1.87 [95% CI 1.78-1.98] for EDIH), suggesting adiposity partly mediates the observed associations. Moreover, individuals in both highest EDIP and EDIH quintiles had 2.34 times higher type 2 diabetes risk (95% CI 2.17-2.52), compared with those in both lowest quintiles, after adjustment for BMI.

CONCLUSIONS

Higher dietary inflammatory and insulinemic potential were associated with increased type 2 diabetes incidence. Findings suggest that inflammation and hyperinsulinemia are potential mechanisms linking dietary patterns and type 2 diabetes development.

Association between Dietary Habits, Shift Work, and the Metabolic Syndrome: The Korea Nurses' Health Study

Metabolic syndrome (MetS) is an important public health problem, and unhealthy dietary habits and shift work are considered major factors that increase the prevalence of MetS. The purpose of this study was to examine whether dietary habits, alcohol drinking, and shift-working were associated with development of MetS in shift-working female nurses. This study analyzed cross-sectional survey data from the Korea Nurses’ Health Study (KNHS). Of the 1638 nurses, 403 participants were selected based on the propensity score matching method (PSM). These participants had either no or more than three MetS determinant factors. Analysis was conducted by using multivariable logistic regression to confirm the factors influencing MetS. The prevalence of MetS in this group (1638 participants) was 5.6% (92 participants). Consumption of over 50% of daily calorie intake after 7 p.m., consumption of carbonated drinks, family history of diabetes, and non-shift work were significant factors influencing MetS. Nurses are one of the at-risk groups for unhealthy dietary habits due to the nature of their work. Therefore, nurse managers should include regular dietary education for nurses and continue their policy efforts to resolve health problems that may arise in connection with nurses’ work.

Including Social and Behavioral Determinants in Predictive Models: Trends, Challenges, and Opportunities

In an era of accelerated health information technology capability, health care organizations increasingly use digital data to predict outcomes such as emergency department use, hospitalizations, and health care costs. This trend occurs alongside a growing recognition that social and behavioral determinants of health (SBDH) influence health and medical care use. Consequently, health providers and insurers are starting to incorporate new SBDH data sources into a wide range of health care prediction models, although existing models that use SBDH variables have not been shown to improve health care predictions more than models that use exclusively clinical variables. In this viewpoint, we review the rationale behind the push to integrate SBDH data into health care predictive models and explore the technical, strategic, and ethical challenges faced as this process unfolds across the United States. We also offer several recommendations to overcome these challenges to reach the promise of SBDH predictive analytics to improve health and reduce health care disparities.

Factors Facilitating or Hindering Use of Evidence-Based Diabetes Interventions Among Local Health Departments

OBJECTIVE

The objective of this study was to assess facilitators, barriers, and capacities to use of evidence-based programs and policies (EBPPs) in local health departments (LHDs).

DESIGN

A qualitative study design was used to elicit a contextual understanding of factors. One-hour interviews were conducted among directors and diabetes/chronic disease practitioners from LHDs. A consensus coding approach was used to identify themes.

SETTING AND PARTICIPANTS

Twenty-four participants from 14 Missouri LHDs completed interviews.

RESULTS

Themes were identified as facilitators, barriers, or capacities that enhance EBPP use. Facilitators included awareness of EBPPs, leadership and supervisor support of EBPP use, and facilitators to increase capacity to implement EBPPs. Skills development, targeted messaging, and understanding of evidence-based decision-making (EBDM) terminology were needed. Barriers to EBPPs use were described at the individual, organizational, and interorganizational levels and included community buy-in, limited resources, relevance to partners, and time scarcity. Capacities included the ways LHDs learn about EBPPs, methods that influence the use of EBPPs, and resources needed to sustain EBPPs. Top ways to learn about EBPPs were in-person interactions. Staff meetings, meetings with decision makers, and relevant evidence influenced decision making. Resources needed were funding, organizational capacity, and partnerships. Directors' and practitioners' views differed on type of agency culture that promoted EBPP use, preferences for learning about EBPPs, ways to influence decisions, needs, and barriers to EBPPs.

CONCLUSIONS

These findings can inform future strategies to support uptake of EBPPs in diabetes and chronic disease control in LHDs. LHDs have a good understanding of EBPPs, but subtle differences in perception of EBPPs and needs exist between directors and practitioners. Investment in capacity building and fostering an organizational culture supportive of EBDM were key implications for practice. By investing in employee skill development, LHDs may increase agency capacity. Researchers should use preferred channels and targeted messaging to disseminate findings.

Isolation, identification, and inhibitory enzyme activity of phenolic substances present in Spirulina

Spirulina species are edible with high nutritional as well as potential therapeutic values. In this work, we show that phenolic extracts from Spirulina (p-Coumaric acid) possessed inhibitory potential on α-glucosidase (IC₅₀  = 1.67 ± 0.02 mM) and tyrosinase (IC₅₀  = 52.71 ± 3.01 mM). Moreover, p-Coumaric acid inhibited α-glucosidase and tyrosinase in a reversible mixed-type manner. Interestingly, molecular docking demonstrated that p-Coumaric acid penetrated in depth of the active-site of tyrosinase and α-glucosidase by the noncovalent force or interaction. Among them, making polar interactions with Cu²⁺ ions and the amino acid residue capable of forming cation-π significantly contribute to the strong binding of p-Coumaric acid on tyrosinase. p-Coumaric acid was isolated and identified from Spirulina for the first time, which can be used as a lead compound for the design of functional food additives and skin-lightening active ingredient in cosmetics, and pharmaceuticals against type 2 diabetes. PRACTICAL APPLICATIONS: A natural, food-derived compound possessing the potential for the development of an anti-hyperglycaemic and skin-lightening supplement is very promising in cosmetics, functional food, and pharmaceuticals against type 2 diabetes. Herein, the present study is the first to present high levels of p-Coumaric acid from Spirulina, which simultaneously possessed inhibition potential on α-glucosidase and tyrosinase. Importantly, we gained initial information about the polypeptide-inhibitor interactions and underlying mechanisms for Spirulina's therapeutic effects, which will provide the bases for developing new drugs for preventing or treating type 2 diabetes and enzyme inhibitors. Moreover, this work also demonstrates the potential of the extraction of high-value chemicals from Spirulina waste.

Type 2 Diabetes Mellitus in Class II and III Obesity: Prevalence, Associated Factors, and Correlation between Glycemic Parameters and Body Mass Index

Despite the worldwide growth of class II and III obesity, the factors associated with type 2 diabetes mellitus (T2DM) in these obese individuals are not widely understood. Moreover, no study has investigated these associations in South America. Our study aimed to investigate the prevalence of T2DM and its associated factors, with an emphasis on biochemical parameters and eating habits, in class II and III obese individuals. We also aimed to analyze the correlation between glycemic parameters and body mass index (BMI). Baseline data from a randomized clinical trial (DieTBra Trial) of 150 class II and III obese individuals (BMI > 35 kg/m2) was used. An accelerometer, Food Frequency Questionnaire, and bioimpedance analysis were used to assess physical activity levels, eating habits, and body composition, respectively. Blood was collected after 12 h of fasting. Hierarchical multivariate Poisson regression was performed, and prevalence ratios (PRs) were calculated. Correlations between glycemic parameters (fasting blood glucose, glycosylated hemoglobin, homeostasis model assessment of insulin resistance (HOMA-IR), and insulin) and BMI were also analyzed. The prevalence of T2DM was 40.0% (95% CI, 32.1-48.3), high fasting blood glucose level was 19.33% (95% CI, 13.3-26.6), and high glycosylated hemoglobin was 32.67% (95% CI, 25.2-40.8). Age ≥ 50 years (PR = 3.17, 95% CI, 1.26-7.98) was significantly associated with T2DM; there was a positive linear trend between age and T2DM (p = 0.011). Multivariate analysis showed an association with educational level (PR = 1.49, 1.07-2.09, p = 0.018), nonconsumption of whole grains daily (PR = 1.67, 1.00-2.80, p = 0.049), and high HOMA-IR (PR = 1.54, 1.08-2.18, p = 0.016). We found a high prevalence of T2DM and no significant correlations between BMI and glycemic parameters.

Suppression of behavioral activity and hippocampal noradrenaline caused by surgical stress in type 2 diabetes model mice

Background

There has been much discussion recently about the occurrence of neuropsychological complications during the perioperative period. Diabetes is known to be one of the metabolic risk factors. Although the number of patients with diabetes mellitus (DM) has been increasing, the pathophysiology of postoperative neuropsychological dysfunction in DM patients is still unclear. Recently, a deficiency of neurotransmitters, such as monoamines, was reported to be associated with mental disorders. Therefore, we investigated the effects of surgical stress on behavioral activity and hippocampal noradrenaline (NA) level in type 2 diabetes mellitus model (T2DM) mice.

Methods

Eighty-four 6-week-old male C57BL/6J mice were divided into four groups (non-diabetes, non-diabetes with surgery, T2DM, and T2DM with surgery groups). T2DM mice were established by feeding a high-fat diet (HFD) for 8 weeks. At 14 weeks of age, fifteen mice in each group underwent a series of behavioral tests including an open field (OF) test, a novel object recognition (NOR) test and a light–dark (LD) test. In the surgery groups, open abdominal surgery with manipulation of the intestine was performed 24 h before the behavioral tests as a surgical stress. Hippocampal noradrenaline (NA) concentration was examined in six mice in each group by high-performance liquid chromatography. The data were analyzed by the Mann–Whitney U test, and p values less than 0.05 were considered significant.

Results

The T2DM group showed significantly increased explorative activity in the NOR test (P = 0.0016) and significantly increased frequency of transition in the LD test (P = 0.043) compared with those in the non-diabetic group before surgery. In T2DM mice, surgical stress resulted in decreased total distance in the OF test, decreased explorative activity in the NOR test, and decreased frequency of transition in the LD test (OF: P = 0.015, NOR: P = 0.009, LD: P = 0.007) and decreased hippocampal NA (P = 0.015), but such differences were not observed in the non-diabetic mice.

Conclusions

Mice with T2DM induced by feeding an HFD showed increased behavioral activities, and surgical stress in T2DM mice caused postoperative hypoactivity and reduction of the hippocampal NA level.

Evaluation of sex differences in dietary behaviours and their relationship with cardiovascular risk factors: a cross-sectional study of nationally representative surveys in seven low- and middle-income countries

BACKGROUND

Cardiovascular diseases (CVD) are the leading causes of death for men and women in low-and-middle income countries (LMIC). The nutrition transition to diets high in salt, fat and sugar and low in fruit and vegetables, in parallel with increasing prevalence of diet-related CVD risk factors in LMICs, identifies the need for urgent action to reverse this trend. To aid identification of the most effective interventions it is crucial to understand whether there are sex differences in dietary behaviours related to CVD risk.

METHODS

From a dataset of 46 nationally representative surveys, we included data from seven countries that had recorded the same dietary behaviour measurements in adults; Bhutan, Eswatini, Georgia, Guyana, Kenya, Nepal and St Vincent and the Grenadines (2013-2017). Three dietary behaviours were investigated: positive salt use behaviour (SUB), meeting fruit and vegetable (F&V) recommendations and use of vegetable oil rather than animal fats in cooking. Generalized linear models were used to investigate the association between dietary behaviours and waist circumference (WC) and undiagnosed and diagnosed hypertension and diabetes. Interaction terms between sex and dietary behaviour were added to test for sex differences.

RESULTS

Twenty-four thousand three hundred thirty-two participants were included. More females than males reported positive SUB (31.3 vs. 27.2% p-value < 0.001), yet less met F&V recommendations (13.2 vs. 14.8%, p-value< 0.05). The prevalence of reporting all three dietary behaviours in a positive manner was 2.7%, varying by country, but not sex. Poor SUB was associated with a higher prevalence of undiagnosed hypertension for females (13.1% vs. 9.9%, p-value = 0.04), and a higher prevalence of undiagnosed diabetes for males (2.4% vs. 1.5%, p-value = 0.02). Meeting F&V recommendations was associated with a higher prevalence of high WC (24.4% vs 22.6%, p-value = 0.01), but was not associated with undiagnosed or diagnosed hypertension or diabetes.

CONCLUSION

Interventions to increase F&V intake and positive SUBs in the included countries are urgently needed. Dietary behaviours were not notably different between sexes. However, our findings were limited by the small proportion of the population reporting positive dietary behaviours, and further research is required to understand whether associations with CVD risk factors and interactions by sex would change as the prevalence of positive behaviours increases.

Lifestyle Behaviors and Socio-Demographic Factors Associated with Overweight or Obesity Among Saudi Females Attending Fitness Centers

OBJECTIVE

To examine the associations of overweight or obesity with several lifestyle and socio-demographic factors among Saudi women attending fitness centers in Riyadh.

METHODS

Saudi females (n = 460) aged 16 years and older were recruited from 12 randomly selected fitness centers in Riyadh, using a stratified clustered sampling technique. Bodyweight and height were measured. Lifestyle behaviors were assessed using a previously validated instrument, and included physical activity, sedentary behaviors, sleep, and dietary habits.

RESULTS

Over 62% of the participants were either overweight or obese. Mean BMI values for females younger than age 30 years (26.4 ± 5.3) were significantly lower than those 30 years of age or older (29.2±5.6, p >0.001). There was a significant correlation (r = 0.450, p < 0.001) between BMI levels and the participant's reason to engage in exercise for weight loss. Females who were overweight/obese are significantly older, married, have more children, have a lower educational degree, earn less income, have higher numbers of obese in the family, and had attempted to lose weight more frequently than non-overweight/non-obese females. No significant differences were detected between females who were overweight/obese and those who were not overweight/obese in the majority of the lifestyle-related variables, except that females who were not overweight or obese showed lower weekly consumption of milk and dairy products (p =0.029) and higher intakes of fast foods per week (p =0.049).

CONCLUSION

Weight loss attempts, age, number of obese in the family, and females' education level emerged as the most important contributory factors to obesity status, explaining nearly 23% of the common variances. A better understanding of the relationships between obesity and lifestyle behaviors is necessary for effective prevention and management of obesity in Saudi females.

Eating Competence Is Associated with Lower Prevalence of Obesity and Better Insulin Sensitivity in Finnish Adults with Increased Risk for Type 2 Diabetes: The StopDia Study

A healthy diet prevents type 2 diabetes but is often difficult to adhere to. This cross-sectional study aimed to investigate whether eating competence is associated with diet or risk factors and prevalence of type 2 diabetes in individuals screened for type 2 diabetes risk. Eating competence is an indicator of food acceptance, positive attitudes, internal regulation and contextual skills related to food and eating. In total, 3147 Finnish adults aged 18-74 at an increased risk for type 2 diabetes identified via online risk screening participated in the baseline examinations of the Stop Diabetes (StopDia) study. The participants filled out the digital questionnaire on food intake, physical activity and sleep, and the Satter Eating Competence Inventory 2.0^TM (ecSI 2.0^TM). In addition, anthropometric and laboratory measurements were performed at primary healthcare centres. Eating competent individuals (37%, classified by ecSI 2.0^TM) had a better quality of diet (p < 0.05 for all). Additionally, eating competence was associated with a lower prevalence of previously undiagnosed type 2 diabetes, abdominal obesity, metabolic syndrome and hypertriglyceridaemia, and with better insulin sensitivity (p < 0.05 for all). However, these associations, except for metabolic syndrome, were at least partly mediated by body mass index. Eating competence is associated with a healthy diet and could, thus, in the long term, support the prevention of type 2 diabetes.

Diversity in the Era of Precision Medicine - From Bench to Bedside Implementation

Recent evidence shows how patients' unique genetic makeup can affect disease outcomes and the increasing availability of targeted treatments promises a future in health care, whereby treatments will be tailored to individual needs. This article reports on the topics discussed at the 13th Annual Texas Conference on Health Disparities, organized by the Texas Center for Health Disparities at the University of North Texas Health Science Center; the meeting focused on the theme, "Diversity in the Era of Precision Medicine" and was held during June 2018 in Fort Worth, Texas. The primary focus of this conference, which brought together clinical and basic scientists, was on the inclusion of diversity in precision medicine to bridge the gap in health disparities. Here, we present the highlights of the conference that include the potential application of precision medicine at the population level, the effects of precision medicine and direct-to-consumer testing on health disparities, genetic basis of health disparities, pharmacogenomics, and strategies to enhance participation of under-represented populations in precision medicine. Furthermore, we conclude with recommendations for future implementation, including how to mitigate disparities in genomics services and enhance participation of diverse groups in clinical trials.

Consumption of Fruits and Vegetables Among Individuals 15 Years and Older in 28 Low- and Middle-Income Countries

BACKGROUND

The WHO recommends 400 g/d of fruits and vegetables (the equivalent of ∼5 servings/d) for the prevention of noncommunicable diseases (NCDs). However, there is limited evidence regarding individual-level correlates of meeting these recommendations in low- and middle-income countries (LMICs). In order to target policies and interventions aimed at improving intake, global monitoring of fruit and vegetable consumption by socio-demographic subpopulations is required.

OBJECTIVES

The aims of this study were to 1) assess the proportion of individuals meeting the WHO recommendation and 2) evaluate socio-demographic predictors (age, sex, and educational attainment) of meeting the WHO recommendation.

METHODS

Data were collected from 193,606 individuals aged ≥15 y in 28 LMICs between 2005 and 2016. The prevalence of meeting the WHO recommendation took into account the complex survey designs, and countries were weighted according to their World Bank population estimates in 2015. Poisson regression was used to estimate associations with socio-demographic characteristics.

RESULTS

The proportion (95% CI) of individuals aged ≥15 y who met the WHO recommendation was 18.0% (16.6-19.4%). Mean intake of fruits was 1.15 (1.10-1.20) servings per day and for vegetables, 2.46 (2.40-2.51) servings/d. The proportion of individuals meeting the recommendation increased with increasing country gross domestic product (GDP) class (P < 0.0001) and with decreasing country FAO food price index (FPI; indicating greater stability of food prices; P < 0.0001). At the individual level, those with secondary education or greater were more likely to achieve the recommendation compared with individuals with no formal education: risk ratio (95% CI), 1.61 (1.24-2.09).

CONCLUSIONS

Over 80% of individuals aged ≥15 y living in these 28 LMICs consumed lower amounts of fruits and vegetables than recommended by the WHO. Policies to promote fruit and vegetable consumption in LMICs are urgently needed to address the observed inequities in intake and prevent NCDs.

Dietary patterns and management of type 2 diabetes: A systematic review of randomised clinical trials

BACKGROUND AND AIM

The aim of the present review is to examine evidence from published studies on the effectiveness of six or more months of low carbohydrate, macrobiotic, vegan, vegetarian, Mediterranean and intermittent fasting (IF) diets compared to low fat diets on diabetes control and management.

METHODS AND RESULTS

In accordance with PRISMA guidelines, Cochrane CENTRAL, PubMed and Scopus databases were systematically searched for relevant studies. Twenty randomised controlled trials (RCTs) > 6 months that investigated the effectiveness of various dietary patterns on type 2 diabetes mellitus (T2DM) were included. Risk of bias was assessed using the Cochrane tool. There were no significant differences in glycemic control, weight and lipids for the majority of low carbohydrate diets (LCDs) compared to low fat diets (LFDs). Four out of fifteen LCD interventions showed better glycemic control while weight loss was greater in one study. The Mediterranean dietary pattern demonstrated greater reduction in body weight and HbA1c levels and delayed requirement for diabetes medications. The vegan and macrobiotic diet demonstrated improved glycemic control, while the vegetarian diet showed greater body weight reduction and insulin sensitivity.

CONCLUSIONS

Although more long-term intervention trials are required, mounting evidence supports the view that vegan, vegetarian and Mediterranean dietary patterns should be implemented in public health strategies, in order to better control glycemic markers in individuals with T2DM.

Polyoxomolybdates as α-glucosidase inhibitors: Kinetic and molecular modeling studies

Noninsulin dependent diabetes mellitus is a serious global disease that is treated by inhibiting α-glucosidase to reduce the glucose content in the blood. Several incompletely satisfactory therapeutic drugs are already on the market. In this report, we showed that polyoxomolybdates based on Keggin-type architecture are promising candidates. Kinetic studies indicate that H₃PMo₁₂O₄₀, Na₄PMo₁₁VO₄₀, Na₆PMo₁₁FeO₄₀ and Na₇PMo₁₁CoO₄₀ strongly inhibit α-glucosidase with IC₅₀ values of 6.14 ± 0.38 μM, 52.33 ± 1.41 μM, 161.90 ± 7.68 μM and 103.10 ± 2.88 μM, respectively. Moreover, H₃PMo₁₂O₄₀, Na₄PMo₁₁VO₄₀, and Na₇PMo₁₁CoO₄₀ are reversible, competitive inhibitors with K_I values of 0.018 mM, 0.146 mM and 0.121 mM, respectively. Na₆PMo₁₁FeO₄₀ inhibited α-glucosidase in a reversible noncompetitive manner with K_I and K_IS of 0.312 mM and 0.412 mM, respectively. Molecular docking simulation suggested that H₃PMo₁₂O₄₀ binds into the substrate binding site in accordance with competitive inhibition behavior and offered, in addition, an initial insight into the polypeptide-inhibitor interactions. This work presents a promising new perspective for designing effective α-glucosidase inhibitors and further demonstrates the enormous potential of polyoxomolybdates as enzyme inhibitors.

Health behaviour changes after type 2 diabetes diagnosis: Findings from the English Longitudinal Study of Ageing

Healthy lifestyle is key for type 2 diabetes (T2D) management. It is unclear whether individuals change health behaviours in response to T2D diagnosis. We compared smoking, physical activity, fruit and vegetable intake and alcohol consumption at three times (pre-diagnosis, at diagnosis, 2-4 years post-diagnosis) in individuals who developed T2D and controls. Behaviours were assessed in 6877 individuals at waves 3-7 of the English Longitudinal Study of Ageing. Generalized estimating equations were used to examine differences by group and time and group-by-time interactions. The T2D group were less active (p < 0.001) and consumed less alcohol (p < 0.001). Smoking (p < 0.001), alcohol consumption (p = 0.037) and physical activity (p = 0.042) decreased over time in the overall sample, fruit and vegetable intake (p = 0.012) and sedentary activity (p < 0.001) increased. A group-by-time interaction was found for smoking, with the T2D group having greater reductions in smoking over time (p < 0.001). No significant interactions were detected for other behaviours. We found limited evidence that T2D diagnosis encourages behaviour change, other than a reduction in smoking. Given the importance of lifestyle for T2D outcomes, strategies for motivating behaviour change need to be identified.

Dietary manganese and type 2 diabetes mellitus: two prospective cohort studies in China

AIMS/HYPOTHESIS

The association between dietary Mn and type 2 diabetes is unclear. We aimed to elucidate whether dietary Mn is associated with type 2 diabetes, to investigate whether this association is independent of dietary total antioxidant capacity (TAC) and to explore the underlying mechanisms in their association.

METHODS

Two prospective cohorts of 3350 and 7133 Chinese adults (20-74 years old) were enrolled including, respectively, 244 and 578 individuals newly diagnosed with type 2 diabetes, with mean values of 4.2 and 5.3 years of follow-up. Cox's proportional-hazards regression and linear regression were performed to investigate the association between dietary Mn and type 2 diabetes (diagnosed by OGTT) or HbA_lc and to analyse the joint association between dietary Mn and TAC. Restricted cubic spline (RCS) regression was applied to the non-linear association between dietary Mn and incidence of type 2 diabetes. Mediation analysis was applied to explore potential mediators in their association in a subgroup of 500 participants.

RESULTS

Dietary Mn intakes were 4.58 ± 1.04 and 4.61 ± 1.08 (mean ± SD) mg/day in the two cohorts. Dietary Mn was inversely associated with type 2 diabetes incidence and HbA_lc concentration in both cohorts (p_trend < 0.01 and <0.01 for type 2 diabetes, and p_trend < 0.01 and =0.02 for HbA_lc, respectively, in each cohort) independent of TAC, adjusted for age, sex, BMI, tobacco use, alcohol consumption, physical activity, diabetes inheritance, total energy, carbohydrate, total fatty acids, fibre, calcium, Mg, hypertension, hyperlipidaemia, and impaired glucose tolerance or FBG (all at baseline). Their inverse association was stronger in the presence of diets with high, compared with low, TAC. In RCS, intakes of >6.01 and 6.10-6.97 mg/day were associated with a significantly lower type 2 diabetes incidence in the two respective cohorts. Mediation analysis showed that high plasma Mn and low oxidative stress (increased Mn superoxide dismutase and decreased 8-hydroxydeoxyguanosine) contributed to the association between dietary Mn and both type 2 diabetes and HbA_lc.

CONCLUSIONS/INTERPRETATION

Dietary Mn was inversely associated with type 2 diabetes independently of TAC. In addition, this association was stronger in a high- rather than low-TAC diet. Plasma Mn and oxidative stress were mediators in the association between dietary Mn and type 2 diabetes. Future studies on absolute Mn intake should be conducted to study the potential non-linearity and optimal levels of dietary Mn and type 2 diabetes.

First results from the study 'Disease knowledge and information needs - Diabetes mellitus (2017)'

Very little research has been undertaken into what people in Germany know about diabetes, the information they may require about the condition, where they look for such information and how they rate the information currently available. In 2017, the Robert Koch Institute (RKI) carried out a nationwide telephone survey aimed at answering these questions. The study entitled 'Disease knowledge and information needs - Diabetes mellitus (2017)' focused on people aged at least 18 years. A total of 2,327 people without diabetes and 1,479 people with diagnosed diabetes were interviewed for the study. First results show that 56.7% of people without diabetes and 92.8% of those with diabetes rate their knowledge about the condition as 'very good' or 'good'. People without diabetes were found to have the strongest need for information in terms of 'lifestyle changes, health promotion and disease prevention', whereas respondents with diabetes stressed the strongest need for information about 'treatment and therapy'. Almost a third of respondents without diabetes have actively sought information about diabetes at least once, mostly via print media. Patients with diabetes stated that their general practitioner was their most frequent source of information about the condition. In both groups, about half of respondents reported that they found it difficult to judge the trustworthiness of the information published in the media about diabetes. The results of the study form part of the German National Diabetes Surveillance, which is coordinated by the RKI. The data are also intended to be used by the Federal Centre for Health Education to develop a strategy to improve the information provided about diabetes.

Legume consumption is inversely associated with type 2 diabetes incidence in adults: A prospective assessment from the PREDIMED study

BACKGROUND & AIMS

Legumes, a low-energy, nutrient-dense and low glycemic index food, have shown beneficial effects on glycemic control and adiposity. As such, legumes are widely recommended in diabetic diets, even though there is little evidence that their consumption protects against type 2 diabetes. Therefore the aim of the present study was to examine the associations between consumption of total legumes and specific subtypes, and type 2 diabetes risk. We also investigated the effect of theoretically substituting legumes for other protein- or carbohydrate-rich foods.

METHODS

Prospective assessment of 3349 participants in the PREvención con DIeta MEDiterránea (PREDIMED) study without type 2 diabetes at baseline. Dietary information was assessed at baseline and yearly during follow-up. We used Cox regression models to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for type-2 diabetes incidence according to quartiles of cumulative average consumption of total legumes, lentils, chickpeas, dry beans and fresh peas.

RESULTS

During a median follow-up of 4.3 years, 266 new cases of type 2 diabetes occurred. Individuals in the highest quartile of total legume and lentil consumption had a lower risk of diabetes than those in the lowest quartile (HR: 0.65; 95% CI: 0.43, 0.96; P-trend = 0.04; and HR: 0.67; 95% CI: 0.46-0.98; P-trend = 0.05, respectively). A borderline significant association was also observed for chickpeas consumption (HR 0.68; 95% CI: 0.46, 1.00; P-trend = 0.06). Substitutions of half a serving/day of legumes for similar servings of eggs, bread, rice or baked potato was associated with lower risk of diabetes incidence.

CONCLUSIONS

A frequent consumption of legumes, particularly lentils, in the context of a Mediterranean diet, may provide benefits on type 2 diabetes prevention in older adults at high cardiovascular risk.

TRIAL REGISTRATION

The trial is registered at http://www.controlled-trials.com (ISRCTN35739639). Registration date: 5th October 2005.

Selecting and defining indicators for diabetes surveillance in Germany

Mainly because of the large number of people affected and associated significant health policy implications, the Robert Koch Institute (RKI) is developing a public health surveillance system using diabetes as an example. In a first step to ensure long-term and comparable data collection and establish efficient surveillance structures, the RKI has defined a set of relevant indicators for diabetes surveillance. An extensive review of the available literature followed by a structured process of consensus provided the basis for a harmonised set of 30 core and 10 supplementary indicators. They correspond to the following four fields of activity: (1) reducing diabetes risk, (2) improving diabetes early detection and treatment, (3) reducing diabetes complications, (4) reducing the disease burden and overall costs of the disease. In future, in addition to the primary data provided by RKI health monitoring diabetes surveillance needs to also consider the results from secondary data sources. Currently, barriers to accessing this data remain, which will have to be overcome, and gaps in the data closed. The RKI intentends to continuously update this set of indicators and at some point apply it also to further chronic diseases with high public health relevance.