Diabetes risk assessment in Mexicans and Mexican Americans: effects of parental history of diabetes are modified by adiposity level

Cardiovascular health, lifestyle factors, and social determinants among Hispanic or Latino adults in the United States

BACKGROUND

Among Hispanic/Latino subgroups residing in the US, disparities in cardiovascular health status remain largely uncharacterized.

METHODS

This national study used the National Health Interview Survey to assess the burden of cardiometabolic risk factors (hypertension, hyperlipidemia, obesity, diabetes) and cardiovascular diseases (history of heart attack, coronary heart disease, angina, stroke) across Hispanic/Latino subgroups (Mexican, Cuban, Puerto Rican, Central/South American), and the extent to which differences are related to lifestyle factors (physical inactivity, smoking, and alcohol consumption) and/or social determinants of health (income, education, food security, and health insurance status).

RESULTS

The weighted study population included 35,549,841 Hispanic/Latino adults (26,008 respondents). In age- and sex-adjusted models, hypertension was more common among Puerto Rican adults (OR 1.34, 95% CI: 1.12-1.60) but less common among Central/South American adults (OR 0.71, 95% CI: 0.61-0.82) compared to Mexican adults (reference group). Central/South Americans were also less likely to have obesity (OR 0.63, 95% CI: 0.57-0.70) and diabetes (OR 0.50, 95% CI: 0.42-0.61). For cardiovascular diseases, Puerto Rican adults were more likely to have angina (OR 1.69, 95% CI: 1.06-2.71), whereas Central/South Americans were less likely to have angina (OR 0.50, 95% CI: 0.30-0.84), coronary heart disease (OR 0.70, 95% CI: 0.51-0.96), and heart attack (OR 0.49, 95% CI: 0.33-0.72). Moreover, Cuban adults were less likely to have hyperlipidemia (OR 0.73, 95% CI: 0.61-0.88), obesity (OR 0.58, 95% CI: 0.49-0.70), diabetes (OR 0.44. 95% CI: 0.34-0.57) and stroke (OR 0.54, 95% CI: 0.32-0.92) Differences persisted after sequentially adjusting for lifestyle factors and social determinants of health.

CONCLUSION

This study used disaggregated data to demonstrate the complex landscape of cardiovascular health among Hispanic/Latino adults in the US, emphasizing the need for targeted interventions and policy efforts to reduce health inequities in this rapidly growing population.

Posttransplantation diabetes mellitus after liver transplant and the impact of family history of diabetes in a Mexican cohort

INTRODUCTION AND AIMS

Posttransplantation diabetes mellitus (PTDM) is a serious long-term complication that has a negative impact on graft and patient survival. The purpose of the present study was to describe the incidence of PTDM in a Mexican cohort and evaluate its association with a previous family history of diabetes (FHD).

METHODS

A retrospective single-center cohort study was conducted on patients undergoing liver transplantation (LT). The primary outcome was time from LT to PTDM. The diagnosis of PTDM was established using the ADA criteria. A mediation analysis that used adjusted Cox regression models and considered pretransplant prediabetes a mediator was performed, to determine the total effect and direct effect of FHD on PTDM.

RESULTS

A total of 152 patients were included, with a median follow-up time of 41 months; 19.2% (n = 29) had pretransplant diabetes. During the follow-up time, 15% of patients developed PTDM (n = 23), with an incidence rate of 4.71 cases/100 person-years. PTDM was significantly higher in patients with FHD, compared with those with no FHD (8.72 cases/100 person-years vs 2.04 cases/100 person-years, respectively; p = 0.001). The adjusted hazard ratio of PTDM for FHD was 4.14 (95% CI 1.60-10.7), p = 0.005) and 3.48 (95% CI 1.35-9.01, p = 0.010), when further controlled for pretransplant prediabetes.

CONCLUSION

The occurrence of PTDM was similar to that reported in most international studies. As with type 2 diabetes, family history plays an important role in the development of PTDM, even after accounting for pretransplant prediabetes. Patients with FHD should undergo a stricter metabolic program.

Improving Relational Functioning in Mother-Daughter Dyads With Obesity

Family-level interventions have the potential to address intergenerational obesity among Mexican American women. Given that poor family functioning is associated with worse weight loss outcomes, this study tested a weight management program aimed at improving relational functioning in mothers and daughters with obesity. Mexican American mothers and their adult daughters were randomly assigned to participate in a 16-week group-based standard behavioral (SB) weight loss program without or with relationship skills training (SRT). Relational functioning was assessed via observational behavioral coding using the Global Structural Family Rating Scale. General relational functioning and specifically positive alliance patterns and conflict avoidance improved significantly more in the SRT group than in the SB group. Average weight changes included percent weight loss of -5.6% in the SRT group versus -3.9% in the SB group and body mass index reduction of -2.2 kg/m2 in the SRT group versus -1.2 kg/m2 in the SB group. More participants in the SRT group (75%) than in the SB group (40%) tended to achieve at least 3% weight loss. Greater changes in positive alliance patterns increased the likelihood of losing 3% of body weight. Improving relational functioning in mother-daughter dyads may promote favorable outcomes in a behavioral weight loss intervention.

A Comparison of Nutritional Status, Knowledge and Type 2 Diabetes Risk Among Malaysian Young Adults With and Without Family History of Diabetes

BACKGROUND

Genetic factors increase the risk of type 2 diabetes mellitus (T2DM). Thus, family history status may be a useful public health tool for disease prevention. This study compared the nutritional status, knowledge level, and T2DM risk among young adults with and without a family history of diabetes in Malaysia.

METHODS

A total of 288 university students aged 18 to 29 years participated in this comparative cross-sectional study. We assessed dietary intake, level of physical activity, knowledge of diabetes and T2DM risk.

RESULTS

Respondents with a family history of diabetes had significantly higher weight (P = 0.003), body mass index (P < 0.001), waist circumference (P < 0.001), diabetes knowledge level (P < 0.005) and T2DM risk (P < 0.001). Ethnicity, fibre intake, T2DM risk score and knowledge about diabetes were significant contributors toward family history of diabetes (P = 0.025, 0.034, < 0.001 and 0.004, respectively).

CONCLUSION

Young adults with a family history of diabetes had suboptimal nutritional status. Despite being more knowledgeable about diabetes, they did not practice a healthy lifestyle. Family history status can be used to screen young adults at the risk of developing T2DM for primary disease prevention.

Risk of developing pre-diabetes or diabetes over time in a cohort of Mexican health workers

AIM

To determine the association between known risk factors (e.g., obesity, metabolic syndrome and its components) and the development of pre-diabetes or diabetes over time in a cohort of Mexican health workers.

METHODS

Participants in the Mexican Health Worker Cohort Study with complete information at two waves of data collection, 2004-2006 (W1) and 2011-2013 (W2), were included in the analysis (n = 1,174). Multivariable binary and multinomial logistic regression were used to examine the cross-sectional associations between specific risk factors and diabetes status (diabetes, pre-diabetes, or neither) at W1 and the longitudinal associations between changes in risk factors and progression of diabetes status from W1 to W2, respectively.

RESULTS

Mean time between waves was 7.0 years (SD 1.1). Prevalence of pre-diabetes and diabetes was 16% and 10% at W1 and increased to 30% and 16% at W2, respectively. The cross-sectional prevalence of pre-diabetes and diabetes was significantly higher among men, participants over the age of 45 years, and individuals who were overweight or obese or had metabolic syndrome (MS), three or more components of the MS, elevated alanine aminotransferase (ALT) levels, or elevated uric acid. In longitudinal analyses, remaining obese or gaining weight between waves was associated with an increased risk of developing pre-diabetes. A greater risk of developing pre-diabetes or diabetes was also observed among individuals who either maintained or acquired MS, elevated ALT, or elevated uric acid (only for diabetes) from W1 to W2.

CONCLUSIONS

Weight gain and acquiring or maintaining MS, elevated ALT levels, or elevated uric acid were associated with a significant risk of developing pre-diabetes or diabetes. Our findings, especially in the context of the obesity epidemic in Mexico, point towards an urgent need for initiatives to help reduce excess weight in order to avert future cases of pre-diabetes and diabetes.

Influence of obesity, parental history of diabetes, and genes in type 2 diabetes: A case-control study

Obesity, parental history (PH) of type 2 diabetes (T2D), and genes play an important role in T2D development. However, the influence of each factor on T2D variability is unclear. This study aimed to investigate the influence of obesity (body mass index [BMI], waist/hip ratio), PH, and 16 single-nucleotide polymorphisms (SNPs) associated with T2D on T2D variability in Mexico, comparing 1234 non-diabetic controls and 1219 diabetic patients. To replicate the data, a case-control (n = 2904) and a cross-sectional (n = 1901) study were also included. In a multivariate logistic regression model, all factors accounted for only 27.3% of T2D variability: SNPs (8.4%); PH (11.8%) and obesity (7.1%). These factors contributed more in men (33.2%) than in women (25%), specifically when the disease was diagnosed before the age of 46 (46.7% vs. 30%). Genes played a substantially more important role in men than in women (14.9% vs. 5.5%), while obesity and PH played a similar role in both genders. Genes and PH appeared to play a greater role than obesity in T2D. However, obesity contribution was calculated at the time of recruitment and may be underestimated in patients because the BMI decreased linearly with the number of years with the disease. The data suggest that sexual hormones may play important roles in genes that are associated with T2D.

The relationship between age of onset and risk factors including family history and life style in Korean population with type 2 diabetes mellitus

[Purpose] The purpose of the present study was to assess the relationship between age of onset and risk factors including family history and life style in Korean population with type 2 diabetes mellitus (T2D). [Subjects and Methods] Subjects with T2D patients who received outpatient care for blood sugar control were randomly sampled at 13 general hospitals and 969 subjects were included. Cox proportional hazard models were used to confirm associations between age of onset and risk factors including family history and life style in Korean population with T2D. [Results] Parent history of T2D was significantly associated with age of onset. Compared to none of family members with T2D, those whose both father and mother had a history showed the highest the risk of early-onset (HR=2.36; 95% CI=1.45–3.85). Mother and father’s history of T2D (HR=1.73; 95% CI=1.46–2.05; HR=1.83; 95% CI=1.40–2.37) were associated with the risk of early-onset. Moreover, exercise (HR=1.23, CI=1.08–1.40) smoking status (HR=1.62, CI=1.32–1.99), and drinking (HR=1.32, CI=1.13–1.54) were associated with a higher risk for the early-onset. [Conclusion] Family history as well as life style including exercise, smoking, and drinking are the risk factors for early-onset factor in Korean population with T2D.

Developing Shared Appraisals of Diabetes Risk Through Family Health History Feedback: The Case of Mexican-Heritage Families

Background

Collecting complete and accurate family health history is critical to preventing type 2 diabetes.

Purpose

We seek to identify the optimal risk feedback approach that facilitates risk communication between parents and their adult children and helps them develop shared appraisals of family history of type 2 diabetes.

Methods

In a sample of parent-adult child dyads from 125 Mexican-heritage families residing in Houston, Texas, we examine change in parent-child dyadic (dis)agreement with respect to their shared family health history from baseline to 10 months after receipt of risk feedback generated by Family Healthware. A 2 × 2 factorial design is applied to test how the recipient (one parent or all family members) and the content (risk assessment with or without behavioral recommendations) of the feedback affect (dis)agreement through interpersonal ties, particularly dyadic risk communication.

Results

Providing risk assessment without behavioral recommendations to the parent, but not the adult child, shifts the dyads toward agreement (relative risk ratio [RRR]= 1.78, 95% confidence interval [CI] [1.18-2.67]), by activating reciprocal risk communication between parents and children (RRR =2.70, 95% CI [1.81-4.03]). Dyads with close interpersonal ties are more likely to shift toward agreement (RRR = 3.09, 95% CI [1.89-5.07]).

Conclusion

Programs aimed at improving family health history knowledge and accuracy of reports should tailor risk feedback strategically for better intervention effect and leverage a network approach in disease prevention among at-risk minority and/or immigrant populations.

Trial Registration Number

NCT00469339.

Parental History of Diabetes, Positive Affect, and Diabetes Risk in Adults: Findings from MIDUS

BACKGROUND

Family history of diabetes is one of the major risk factors for diabetes, but significant variability in this association remains unexplained, suggesting the presence of important effect modifiers.

PURPOSE

To our knowledge, no previous work has examined whether psychological factors moderate the degree to which family history of diabetes increases diabetes risk.

METHODS

We investigated the relationships among parental history of diabetes, affective states (positive affect, negative affect, and depressed affect), and diabetes in 978 adults from the MIDUS 2 national sample.

RESULTS

As expected, parental history of diabetes was associated with an almost threefold increase in diabetes risk. We found a significant interaction between positive affect and parental history of diabetes on diabetes (p = .009): higher positive affect was associated with a statistically significant lower relative risk for diabetes in participants who reported having a parental history of diabetes (RR = .66 per unit increase in positive affect; 95 % CI = .47; .93), but it did not influence diabetes risk for participants who reported no parental history of diabetes (p = .34). This pattern persisted after adjusting for an extensive set of health and sociodemographic covariates and was independent of negative and depressed affect.

CONCLUSIONS

These results suggest that psychological well-being may protect individuals at increased risk from developing diabetes. Understanding such interactions between non-modifiable risk factors and modifiable psychological resources is important for delineating biopsychosocial pathways to diabetes and informing theory-based, patient-centered interventions to prevent the development of diabetes.

The impact of parental history of type 2 diabetes on hyperinsulinemia and insulin resistance in subjects from central Mexico

AIMS

Hyperinsulinemia and insulin resistance are both associated with the development of Type 2 Diabetes and other pathologies; however, the influence of parental history of Type 2 diabetes (PH-T2D) has yet to be investigated. Therefore, this study was conducted to determine the effect of PH-T2D has on the risk of developing hyperinsulinemia and IR.

MATERIALS AND METHODS

1092 subjects (703 non-pregnant females and 389 males) were enrolled for a cross-sectional study. Clinical and biochemical parameters were collected. Subjects were allocated according to their PH-T2D: no parents, one parent, or both parents. Insulin resistance was calculated using the HOMA1 equation (HOMA1-IR). Logistic regression was used to determine the association (odds ratio) between PH-T2D and hyperinsulinemia or insulin resistance.

RESULTS

Increasing degrees of PH-T2D were associated with significant increases in fasting plasma glucose, insulin, and HOMA1-IR (p <0.05). Subjects having one or both parents were associated with an increase risk of developing hyperinsulinemia (odds ratio=1.53, 95%CI: 1.12-2.09, and odds ratio=1.92, 95%CI: 1.21-3.06, respectively) and insulin resistance (odds ratio=1.47, 95%CI: 1.08-2.00 and odds ratio=1.77, 95%CI: 1.09-2.87, respectively), when adjusting for age, sex, BMI, fasting plasma glucose, and triglycerides.

CONCLUSION

The presences of PH-T2D significantly increased the risk of developing hyperinsulinemia and insulin resistance.

Incidence and predictors of early adulthood pre-diabetes/type 2 diabetes, among Iranian adolescents: the Tehran Lipid and Glucose Study

PURPOSE

To evaluate the incidence and predictors of early adulthood pre-diabetes/type 2 diabetes (T2D) among Iranian adolescents during a median follow-up of 9.2 yr.

METHOD

A total of 2563 subjects aged 10-19 yr, without pre-diabetes/T2D at baseline, were entered in the study. Pre-diabetes was defined as those with fasting plasma glucose (FPG) 5.6 to <7 mmol/L. T2D was defined as anti-T2D drug consumption or FPG ≥7 mmol/L. Multivariate Cox-proportional analysis was applied to examine the association between different risk factors that showed attained statistical significance < 0.2 in univariate analysis, with incident pre-diabetes/T2D. Same method was repeated on 1803 subjects with complete parental data to find the relation between parental risk factors and pre-diabetes/T2D.

RESULT

The mean age of participants was 14.45 ± 2.78 yr, and 53.6% were female. During follow-up 208 cases of pre-diabetes/T2D occurred, resulting in an incidence rate of 9.61 per 1000 person-years. Multivariate-adjusted hazard ratios (HRs) for incident pre-diabetes/T2D showed significant risk for 1 standard deviation increase in FPG and body mass index with corresponding HR of 1.89 (1.6-2.23) and 1.435 (1.080-1.905), respectively. Among parental potential risk factors, the paternal history of T2D was independently associated with increased risk for pre-diabetes/T2D in the adolescence (HR = 1.63(1.02-2.60)).

CONCLUSION

About 1% of Iranian adolescents developed pre-diabetes/T2D each year. Among the non-modifiable risk factors paternal history of T2D and, among modifiable risk factors, the presence of general adiposity as well as the higher level of FPG should be considered among adolescents for development of pre-diabetes/T2D later in the young adulthood.

The Economic Impact of Lower Protein Infant Formula for the Children of Overweight and Obese Mothers

The global prevalence of obesity is rising rapidly, highlighting the importance of understanding risk factors related to the condition. Childhood obesity, which has itself become increasingly prevalent, is an important predictor of adulthood obesity. Studies suggest that the protein content consumed in infanthood is an important predictor of weight gain in childhood, which may contribute to higher body mass index (BMI). For instance, there is evidence that a lower protein infant formula (lpIF) for infants of overweight or obese mothers can offer advantages over currently-used infant formulas with regard to preventing excessive weight gain. The current study used health economic modelling to predict the long-term clinical and economic outcomes in Mexico associated with lpIF compared to a currently-used formula. A discrete event simulation was constructed to extrapolate the outcomes of trials on the use of formula in infanthood to changes in lifetime BMI, the health outcomes due to the changes in BMI and the healthcare system costs, productivity and quality of life impact associated with these outcomes. The model predicts that individuals who receive lpIF in infancy go on to have lower BMI levels throughout their lives, are less likely to be obese or develop obesity-related disease, live longer, incur fewer health system costs and have improved productivity. Simulation-based economic modelling suggests that the benefits seen in the short term, with the use of lpIF over a currently-used formula, could translate into considerable health and economic benefits in the long term. Modelling over such long timeframes is inevitably subject to uncertainty. Further research should be undertaken to improve the certainty of the model.

Genetics of Type 2 Diabetes in African Americans

Type 2 diabetes (T2D) is a global health problem showing substantial ethnic disparity in disease prevalence. African Americans have one of the highest prevalence of T2D in the USA but little is known about their genetic risks. This review summarizes the findings of genetic regions and loci associated with T2D and related glycemic traits using linkage, admixture, and association approaches in populations of African ancestry. In particular, findings from genome-wide association and exome chip studies suggest the presence of both ancestry-specific and shared loci for T2D and glycemic traits. Among the European-identified loci that are transferable to individuals of African ancestry, allelic heterogeneity as well as differential linkage disequilibrium and risk allele frequencies pose challenges and opportunities for fine mapping and identification of causal variant(s) by trans-ancestry meta-analysis. More genetic research is needed in African ancestry populations including the next-generation sequencing to improve the understanding of genetic architecture of T2D.

The association of body mass index with the risk of type 2 diabetes: a case-control study nested in an electronic health records system in the United States

OBJECTIVES

Obesity is a known risk factor for type 2 diabetes (T2D). We conducted a case-control study to assess the association between body mass index (BMI) and the risk of being diagnosed with T2D in the United States.

METHODS

We selected adults (≥ 18 years old) who were diagnosed with T2D (defined by ICD-9-CM diagnosis codes or use of anti-diabetic medications) between January 2004 and October 2011 ("cases") from an electronic health records database provided by an integrated health system in the Middle Atlantic region. Twice as many individuals enrolled in the health system without a T2D diagnosis during the study period ("controls") were selected based on age, sex, history of cardiac comorbidities or hyperinflammatory state (defined by C-reactive protein and erythrocyte sedimentation rate), and use of psychiatric or beta blocker medications. BMI was measured during one year prior to the first observed T2D diagnosis (for cases) or a randomly assigned date (for controls); individuals with no BMI measure or BMI < 18.5 kg/m2 were excluded. We assessed the impact of increased BMI (overweight: 25-29.9 kg/m2; Obesity Class I: 30-34.9 kg/m2; Obesity Class II: 35-39.9 kg/m2; Obesity Class III: ≥40 kg/m2), relative to normal BMI (18.5-24.9 kg/m2), on a T2D diagnosis using odds ratios (OR) and relative risks (RR) estimated from multiple logistic regression results.

RESULTS

We included 12,179 cases (mean age: 55, 43% male) and 25,177 controls (mean age: 56, 45% male). We found a positive association between BMI and the risk of a T2D diagnosis. The strength of this association increased with BMI category (RR [95% confidence interval]: overweight, 1.5 [1.4-1.6]; Obesity Class I, 2.5 [2.3-2.6]; Obesity Class II, 3.6 [3.4-3.8]; Obesity Class III, 5.1 [4.7-5.5]).

CONCLUSIONS

BMI is strongly and independently associated with the risk of being diagnosed with T2D. The incremental association of BMI category on the risk of T2D is stronger for people with a higher BMI relative to people with a lower BMI.