Policemen and firefighters have increased risk for type-2 diabetes mellitus probably due to their large body mass index: a follow-up study in Japanese men

Physical activity of daily life of Bundeswehr soldiers: a cross-sectional study

INTRODUCTION

Activity of daily life is an important key to maintaining and improving the health status. This is especially important for people in physically demanding jobs, such as firefighters, military and police.

METHODS

In order to record the actual state of activity of daily life among soldiers, a step count measurement with a pedometer was carried out on 196 soldiers of the German Armed Forces over 7 days and supplemented by a questionnaire on lifestyle factors.

RESULTS

The subjects exceeded the recommended 7000-8000 steps per day, with the rank and file moving the least and the commissioned officers the most. It was also striking that the soldiers in the study moved an average of 2600 steps less per day on weekends than on weekdays.

CONCLUSIONS

Based on these findings, targeted physical activity measures can be established for the identified target groups within the framework of corporate health management in order to ensure the physical fitness of soldiers on routine duty and on deployment.

Analysis of a State Police Academy Menu Cycle for Dietary Quality and Performance Nutrition Adequacy

Law enforcement officers have high rates of overweight and obesity. With diet as a leading risk factor, training academies present an opportunity for early-career nutrition intervention. Our purpose was to determine the dietary quality (DQ) and performance nutrition adequacy of a state police academy's cafeteria menu. This cross-sectional content analysis included six weeks (three daily meals, Monday-Friday) of a police academy menu. Nutrient content was determined by portioning menus, gathering food specifications, and performing nutrient analysis. DQ was assessed using the Healthy Eating Index (HEI) 2015. Statistical analyses included independent t-tests and Cohen's d. The total HEI score was 54/100. Subcomponent scores indicating adequacy included added sugar (5/5), total protein (4.97/5) and whole fruits (4.77/5). Seafood/plant proteins (0.33/5), fatty acid ratio (1.31/5), and dairy scores (1.59/10) needed significant improvement. The menu met the recommended intake for 13 of 19 nutrients investigated. Nutrients that did not meet adequacy were calories (% mean difference, needs-menu = 36.7%), carbohydrates (52.3%), vitamins D (82.5%) and E (66.7%), magnesium (44.1%), and potassium (41.8%). The academy menu leaves room for improvement in DQ and shortfall nutrients. By increasing low scores, the overall DQ of the menu will increase and supplement missing nutrients.

Persistent organic pollutants and β-cell toxicity: a comprehensive review

Persistent organic pollutants (POPs) are a diverse family of contaminants that show widespread global dispersion and bioaccumulation. Humans are continuously exposed to POPs through diet, air particles, and household and commercial products; POPs are consistently detected in human tissues, including the pancreas. Epidemiological studies show a modest but consistent correlation between exposure to POPs and increased diabetes risk. The goal of this review is to provide an overview of epidemiological evidence and an in-depth evaluation of the in vivo and in vitro evidence that POPs cause β-cell toxicity. We review evidence for six classes of POPs: dioxins, polychlorinated biphenyls (PCBs), organochlorine pesticides (OCPs), organophosphate pesticides (OPPs), flame retardants, and per- and polyfluoroalkyl substances (PFAS). The available data provide convincing evidence implicating POPs as a contributing factor driving impaired glucose homeostasis, β-cell dysfunction, and altered metabolic and oxidative stress pathways in islets. These findings support epidemiological data showing that POPs increase diabetes risk and emphasize the need to consider the endocrine pancreas in toxicity assessments. Our review also highlights significant gaps in the literature assessing islet-specific endpoints after both in vivo and in vitro POP exposure. In addition, most rodent studies do not consider the impact of biological sex or secondary metabolic stressors in mediating the effects of POPs on glucose homeostasis and β-cell function. We discuss key gaps and limitations that should be assessed in future studies.

Occupations associated with diabetes complications: A nationwide-multicenter hospital-based case-control study

AIM

Investigating the risks of diabetes complications among inpatients with diabetes associated with longest-held and current occupations.

METHOD

Using a Japanese nationwide, multicenter, hospital inpatient dataset (2005-2015), a matched case-control study with 39,550 inpatients with diabetes was conducted. We considered both the longest-held and current occupations of the study subjects.

RESULT

Diabetes complications such as retinopathy, nephropathy, neuropathy, and peripheral vascular complications occur more often in managers, sales workers, service workers, transportation workers, construction and mining workers and carrying, cleaning and packing workers. Among these occupations, particularly the service workers indicated consistently significant increased risks (OR = 1.36 (1.23-1.51)) in developing all the considered subtypes of diabetes complications, and the performed sensitivity analysis confirmed this conclusion. Moreover, among service workers, cooks, waiters, building service staff and other service workers were identified as having the highest risks in developing diabetes complications (ORs = 1.30 (1.12-1.51), 1.63 (1.36-1.95), 1.79 (1.21-2.67), and 2.05 (1.30-3.22), respectively).

CONCLUSIONS

Our study's potential translational impact should lead to subsequent investigations on the causes connected to certain occupations of various diabetes complications and particularly to more carefully dealing with patients with diabetes who work in the identified occupational areas and their health risks.

Hospital admissions due to endocrine diseases in Korean male firefighters

Background

The aim of this study was to investigate the relationship between occupational exposure to various hazards and hospital admission due to endocrine diseases in Korean male firefighters.

Methods

From 2000 to 2008, former and current male firefighters registered in the Korean National Emergency Management Agency were investigated based on their hospitalized health insurance admission data for the same period. Admission data for endocrine, nutritional, and metabolic diseases were obtained from the Korean National Health Insurance Service database. Standardized admission ratio (SAR) with reference to the general population of Korean men was analyzed.

Results

SAR for firefighters with endocrine, nutritional, and metabolic diseases was 0.56 (95% confidence interval [CI]: 0.49–0.65), which was significantly less than that of the general population of Korean men. For those with endocrine, nutritional, and metabolic diseases, SARs for those with a history of fire suppression tasks and those without experience of fire suppression tasks were 0.58 (95% CI: 0.49–0.68) and 0.53 (95% CI: 0.40–0.70), respectively.

Conclusions

The admission rate of Korean male firefighters due to endocrine, nutritional and metabolic diseases was significantly lower than that of the general Korean men population, the hazardous potential of endocrine disruptors remains an open question. Further studies of firefighters with longer follow-up are needed.

Life-course social position, obesity and diabetes risk in the EPIC-Spain Cohort

BACKGROUND

The literature has consistently shown that extreme social-economic groups predicted type 2 diabetes mellitus (T2D), rather than summarising the social gradient throughout all society stratification. Body mass index (BMI) was established as the principal mediator, with little support for other anthropometries. Our aim was to investigate an individual life-course social position (LiSoP) gradient and its mediators with T2D risk in the EPIC-Spain cohort.

METHODS

36 296 participants (62% women), mostly aged 30-65 years, and free of T2D at baseline (1992-1996) were followed up for a mean of 12.1 years. A combined score of paternal occupation in childhood and own adult education assessed individual life-course social risk accumulation. Hazard ratios of T2D were estimated using Cox regression, stratifying by centre and age, and adjusting for different explanatory models, including anthropometric indices; dietary history; smoking and physical activity lifestyles; and clinical information.

RESULTS

Final models evidenced significant risks in excess of 63% for middle and 90% for lower classes of LiSoP in men; and of 104 and 126%, respectively, in women. Concurrently, LiSoP presented significant social gradients for T2D risk (P < 0.01) in both sexes. Waist circumference (WC) accounted for most of the risk excess in women, and BMI and WC in men.

CONCLUSIONS

LiSoP gradient was related to T2D risk in Spanish men and women. WC mostly explained the relationship in both genders, together with BMI in men, yet LiSoP retained an independent effect in final models.

Stress and type 2 diabetes: a review of how stress contributes to the development of type 2 diabetes

Current policy and research around type 2 diabetes (T2D) interventions largely invoke a behavioral model. We suggest that activation of the physiologic stress response (PSR) from chronic exposure to stressors, low socioeconomic status (SES), severe mental health problems, or aggressive behavior increases the risk of T2D. This article is a comprehensive review of the literature on the link between T2D and psychosocial factors focusing on prospective studies of the risk for developing diabetes. The review found an increased risk for T2D in people: exposed to stressful working conditions or traumatic events; with depression; with personality traits or mental health problems that put them in conflict with others; of low SES, either currently or in childhood; and in racial/ethnic minority populations, independent of current SES. This review suggests that T2D prevention research would be more effective if (a) the PSR to psychosocial factors (especially social disparities) was recognized and (b) intervention programs evaluated reduction in social disparities as part of a comprehensive approach.

The effectiveness of health interventions in cardiovascular risk reduction among emergency service personnel

PURPOSE

The physical demands and hazards associated with emergency service work place particular stress on responders' cardiovascular systems. Indeed, cardiovascular disease (CVD) is a significant problem for emergency service personnel. Although it may be difficult to alter the cardiovascular health hazards associated with the work environment, it is possible for personnel to control their modifiable CVD risk factors, cardiovascular fitness levels and subsequently, reduce their CVD risk. This review aimed to determine the effectiveness and methodological quality of health interventions designed to mitigate CVD risk in emergency service personnel.

METHODS

A literature search of electronic journal databases was performed. Sixteen relevant studies were assessed for methodological quality using a standardised assessment tool. Data regarding the effectiveness of each intervention were extracted and synthesised in a narrative format.

RESULTS

Fifteen studies were rated 'Weak' and one study was rated 'Strong'. Interventions which combined behavioural counselling, exercise and nutrition were more effective in improving cardiovascular health than nutrition, exercise or CVD risk factor assessment-based interventions alone. Further, CVD risk factor assessment in isolation proved to be an ineffective intervention type to reduce CVD risk.

CONCLUSION

Combined interventions appear most effective in improving the cardiovascular health of emergency service personnel. Accordingly, fire and emergency service agencies should consider trialling multifaceted interventions to improve the cardiovascular health of personnel and avoid interventions focused only on one of nutrition, exercise or CVD risk factor assessment. However, as most studies were methodologically weak, further studies of a higher methodological quality are needed.

Associations between the occupational stress index and hypertension, type 2 diabetes mellitus, and lipid disorders in middle-aged men and women

INTRODUCTION

Retrospective and prospective studies show that stress at work is linked to an increased risk of hypertension, diabetes mellitus, and coronary heart disease. However, the nature of the contributory job stressors and biological mechanisms need further elucidation.

OBJECTIVES

The study is aimed to determine the associations between aspects of the occupational stress index (OSI) and arterial hypertension, diabetes mellitus (DM) type 2, and lipid disorders in working middle-aged men and women.

METHODS

The cross-sectional study involved 989 middle-aged men and women in different occupations. The OSI was calculated by using standardized questionnaires. The total participation rate was 93%. Occupational stressors were divided into seven groups: High Demands, Strictness, Underload, Extrinsic Time Pressure, Noxious Exposure, Avoidance, and Conflict/Uncertainty. Serum lipid levels, glucoregulation, blood pressure, and cardiovascular risk factors were measured.

RESULTS

For both women and men, the total OSI score associated significantly with DM (women: odds ratio [OR] 2.4, 95% confidence intervals [CI] 1.67-3.45; men: 1.21, 1.15-1.45), any type of dyslipidemia (women: 1.54, 1.17-2.03; men: 1.31, 1.24-1.39), and arterial hypertension (women: 1.15, 1.10-1.21; men: 1.58, 1.49-1.68). The group as a whole showed associations between total OSI and low high-density lipoprotein (HDL) cholesterol, high total cholesterol, and high triglyceride levels. Of the OSI aspects, Underload associated significantly in both men and women with arterial hypertension (women: 3.48, 1.91-6.31; men: 2.71, 1.96-3.75) and dyslipidemia (women: 3.26, 2.13-4.99; men: 2.11, 1.76-2.52). Underload was also associated with several lipid abnormalities in the group as a whole. It associated with DM in women only (4.7, 2.84-7.81). All remaining OSI aspects also associated significantly and positively with DM in women only. Conversely, in male workers, but not female workers, High Demand, Conflict/Uncertainty, and Extrinsic Time Pressure associated significantly with arterial hypertension. Strictness and Conflict/Uncertainty associated positively with dyslipidemia in women only. Noxious Exposures associated positively with DM and arterial hypertension in women only.

CONCLUSIONS

The study provides evidence for the association of work stress with metabolic disorders and hypertension. Total OSI associated significantly with DM type 2, arterial hypertension, and dyslipidemia in both genders. Different OSI aspects associated with these health issues in gender- and occupational-specific patterns. Underload, which represents lack of social communication, simple task preparation, and underestimation of working results, associated most strongly of all OSI aspects with disease in both the sexes.

Type 2 diabetes incidence and socio-economic position: a systematic review and meta-analysis

BACKGROUND

We conducted a systematic review and meta-analysis, the first to our knowledge, summarizing and quantifying the published evidence on associations between type 2 diabetes incidence and socio-economic position (SEP) (measured by educational level, occupation and income) worldwide and when sub-divided into high-, middle- and low-income countries.

METHODS

Relevant case-control and cohort studies published between 1966 and January 2010 were searched in PubMed and EMBASE using the keywords: diabetes vs educational level, occupation or income. All identified citations were screened by one author, and two authors independently evaluated and extracted data from relevant publications. Risk estimates from individual studies were pooled using random-effects models quantifying the associations.

RESULTS

Out of 5120 citations, 23 studies, including 41 measures of association, were found to be relevant. Compared with high educational level, occupation and income, low levels of these determinants were associated with an overall increased risk of type 2 diabetes; [relative risk (RR) = 1.41, 95% confidence interval (CI): 1.28-1.51], (RR = 1.31, 95% CI: 1.09-1.57) and (RR = 1.40, 95% CI: 1.04-1.88), respectively. The increased risks were independent of the income levels of countries, although based on limited data in middle- and low-income countries.

CONCLUSIONS

The risk of getting type 2 diabetes was associated with low SEP in high-, middle- and low-income countries and overall. The strength of the associations was consistent in high-income countries, whereas there is a strong need for further investigation in middle- and low-income countries.

Heart rate-corrected QT interval in resting ECG predicts the risk for development of type-2 diabetes mellitus

Chronic and subclinical sympathetic over-activity may underlie development of type-2 diabetes mellitus (DM). Since longer heart rate-corrected QT interval (QTc) represents predominance of sympathetic activity within autonomic balance, we investigated influences of QTc on the incidence of DM in a follow-up study. The subjects were 12,530 men and 7,163 women aged 30-59 years and apparently healthy at baseline. QTc in resting ECG was obtained using Bazett's formula (QTcB), Fridericia's formula (QTcF) and the linear regression technique (QTcLR). Incident DM was identified by 'fasting serum glucose > or =7.00 mmol l(-1) (126 mg dl(-1))' or/and 'on medication for DM'. Using Cox proportional hazard models, hazard ratio (HR) for incident DM was estimated according to the quartiles (Q1-Q4) of QTcB, QTcF or QTcLR, and its linear trends across the quartiles were checked. Baseline age, BMI, smoking, drinking, exercise and education were computed as conventional confounders. During the follow-up of 93,337 person-years for men and 51,517 person-years for women, 637 men and 192 women developed DM. The multivariate-adjusted HRs(95% confidence interval) for Q4 of QTcB, QTcF and QTcLR against corresponding Q1 were 1.85(1.46, 2.34), 1.31(1.04, 1.65) and 1.58(1.26, 1.99), respectively, for men, and 2.03(1.31, 3.16), 1.34(0.91, 2.00) and 1.58(1.04, 2.38), respectively, for women. Both sexes showed increasing trends in the HRs across the quartiles of QTcB, QTcF and QTcLR. In conclusion, QTc in resting ECG moderately but proportionally predicts the risk for development of DM in middle-aged healthy men and women. Moreover, the adverse effects of prolonged QTc are independent of those of conventional risk factors.

An assessment of key health indicators among emergency medical services professionals

INTRODUCTION

Ensuring the health and productivity of emergency medical services (EMS) professionals is important. However, there has been no known national baseline assessment of the health and wellness of EMS professionals in the United States. According to Healthy People 2010, top indicators of personal health include physical activity, body mass index (BMI), and smoking prevalence.

OBJECTIVES

The objectives of this study included quantifying existing health conditions and describing key health indicators among EMS professionals. It was hypothesized that work-life characteristics were associated with existing health conditions and key health indicators.

METHODS

Data utilized for this analysis were obtained from a 2007 questionnaire included in biennial national recertification packets. This questionnaire utilized validated items from the Behavioral Risk Factor Surveillance System (BRFSS) and the Longitudinal EMT Attributes and Demographics Study (LEADS). Along with common demographic characteristics, items inquired about existing health conditions (diabetes, asthma, hypertension, myocardial infarction, angina, stroke, and/or high blood cholesterol level), general health, physical activity, and smoking status. Descriptive analyses were performed utilizing chi-square tests, and logistic regression was utilized to describe associations between existing health conditions and the key health indicators.

RESULTS

There were 58,435 individuals who became recertified in 2007, with 30,560 (52%) returning questionnaires. Individuals with missing data were removed, leaving 19,960 individual records. There were 4,681 (23.5%) individuals who reported at least one existing health condition. The mean BMI for the study participants was 27.69 kg/m(2). There were 5,742 (28.8%) individuals classified as having normal weight and 5,146 (25.8%) who were obese. The overwhelming majority of individuals did not meet the Centers for Disease Control and Prevention (CDC) recommendations for physical activity (15,022, 75.3%). There were 3,394 (17.0%) individuals classified as current smokers. Finally, logistic regression analysis indicated that when controlling for work-life characteristics and age, BMI and level of physical fitness were associated with preexisting health conditions.

CONCLUSION

This study was the first known baseline assessment of EMS professionals regarding the key health indicators identified by Healthy People 2010. Investigations regarding the impact of health and wellness in relation to workforce stability should be undertaken. Further research should also be conducted to identify strategies to improve the health of the EMS workforce.

Biochemical and nutritional indices as cardiovascular risk factors among Iranian firefighters

Aim

Limited cardiovascular disease (CVD) risk data are available for firefighters worldwide. This comparative study was aimed at investigating the biochemical and nutritional indices of firefighters in Iran.

Materials and methods

Individuals’ anthropometric measurements, including weight, height, and waist and hip circumferences, were measured and the percent of body fat (BF%) was also obtained. Blood sampling was done in order to determine lipid profile, including total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), lipoprotein a (Lp(a)) and fasting blood sugar (FBS) concentrations. Systolic and diastolic blood pressures (SBP and DBP) were also measured.

Results

The mean ages of firefighters and administrative staff were 42.45 ± 6.75 and 44.64 ± 5.83 y, respectively. The prevalence of overweight and obesity was 45% and 24% in firefighters and 54% and 23% in administrative staff, respectively. High waist-to-hip and waist-to-stature ratios were detected in 26.4% and 81.3% of firefighters versus 33.3% and 89.7% of the control group, respectively. No significant differences were observed between the mean of TC, TG, HDL-C, LDL-C and FBS concentrations. The mean of Lp(a) was significantly higher among firefighters ( P<0.05). About half of the subjects in both groups had TC >5.17, TG >1.69, HDL-C <1.03 nmol/L and Lp(a) >25 mg/dL. There were no significant differences between the SBP and DBP of subjects. There was no significant difference in smoking habits between the two groups.

Conclusions

Considering the high prevalence of overweight and obesity, high TC, TG and Lp(a) and low HDL-C concentrations among all firefighters, it seems necessary to provide fitness-promotion and nutritional education programs for the prevention of obesity-related chronic diseases such as CVD.

Resting heart rate and blood pressure, independent of each other, proportionally raise the risk for type-2 diabetes mellitus

BACKGROUND

Fast heart rate and high blood pressure (BP) at rest may raise risk for the development of type-2 diabetes mellitus (DM). We therefore investigated dose-response and interactive effects of resting heart rate and BP on the incidence of DM in a Japanese population.

METHODS

A follow-up study was conducted for 16 828 men and 8368 women aged 30-59 years and apparently healthy at baseline. Incident DM was identified by 'fasting serum glucose > or =7.00 mmol/l (126 mg/dl)' or/and 'under medical treatment for DM'. Using Cox proportional hazard models, hazard ratio (HR) for incident DM were estimated according to the quartiles of heart rate, systolic or diastolic BP (SBP, DBP), and its linear trends were checked by computing the three indices as continuous variables. Subsequently, interactive effects of slow/fast heart rate (dichotomized by the median) and low/high SBP or DBP (dichotomized by the median) on HR were examined. Baseline age, body mass index, smoking, drinking, exercise and education were computed as conventional confounders.

RESULTS

During the follow-up of 125 106 person-years for men and 59 616 person-years for women, 869 men and 224 women developed DM. The multivariate-adjusted HR for incident DM increased across quartiles of heart rate, SBP and DBP in both sexes (linear trend P<0.001 for all). Neither sex showed any significant interactive effects of heart rate and SBP or DBP on HR.

CONCLUSIONS

Resting heart rate and BP proportionally raise the risk for DM in middle-aged healthy men and women. Moreover, the adverse effects of fast heart rate and high BP are independent of each other as well as of the influences of conventional confounders.

Effect of fire smoke on some biochemical parameters in firefighters of Saudi Arabia

BACKGROUND

Firefighters who are facing fires, are frequently exposed to hazardous materials including carbon monoxide, hydrogen cyanide, hydrogen chloride, benzene, sulphur dioxide, etc. This study aimed to evaluate some relevant serum biochemical and blood hematological changes in activity involved firefighters in comparison to normal subjects.

SUBJECTS AND METHODS

Two groups of male firefighters volunteered to participate in the study. The first included 28 firefighters from Jeddah, while the second included 21 firefighters from Yanbu, with overall age ranged 20-48 years. An additional group of 23 male non-firefighters volunteered from both cities as normal control subjects, of age range 20-43 years. Blood samples were collected from all volunteer subjects and investigated for some relevant serum biochemical and blood hematological changes.

RESULTS

The results obtained showed that, there were statistically significant differences in liver function, kidney function, serum lipid profile, cortisol, creatine kinase, lactate dehydrogenase, iron and its biologically active derivatives, and blood picture in firefighters as compared with the normal control group. These results indicate that, fire smoke mainly affects serum biochemical and blood hematological parameters. Such results might point out to the need for more health protective and prophylactic measures to avoid such hazardous health effects that might endanger firefighters under their highly drastic working conditions.

CONCLUSION

Besides using of personal protective equipments for firefighters to protect them against exposure to toxic materials of fire smoke, it is recommended that, firefighters must be under continuous medical follow up through a standard timetabled medical laboratory investigations to allow for early detection of any serum biochemical or blood hematological changes that might happen during their active service life and to allow for early treatment whenever necessary.

Incidence of type-2 diabetes mellitus in a large population of Japanese male white-collar workers

Since occupation, a major socio-economic factor, may be a risk factor for type-2 diabetes mellitus (DM), we compared DM incidence among four groups of white-collar workers in a follow-up study in 13,547 Japanese men. The subjects aged 30-59 years and free from DM at baseline consisted of: (a) 3725 clerical, (b) 5575 technical/professional, (c) 3474 manager/administrative and (d) 774 sales workers. Incident DM was identified by 'fasting serum glucose >or=7.00 mmol/l' or 'under medical treatment for DM'. Hazard ratio (HR) and 95% confidence interval (CI) for incident DM were estimated using clerical workers as the reference group (HR=1.00). Baseline age, body mass index (BMI), drinking, smoking, exercise and education were computed as confounders. During mean follow-up periods of 7.4 years, 176 clerical, 264 technical/professional, 195 manager/administrative and 49 sales workers developed DM (6.0, 6.1, 8.8 and 9.4 per 1000 person-years, respectively). Sales workers aged 40-49 and 50-59 years had increased multivariate-adjusted HRs (95% CIs) of 1.55 (1.02, 2.35) and 2.01 (0.98, 4.10), respectively. Manager/administrative workers aged 50-59 years had an increased crude HR (95% CI) of 1.64 (1.02, 2.63), but the significance disappeared after BMI-adjustment (HR (95% CI: 1.46 (0.91, 2.35)). Technical/professional workers had no significant HR in any model. In conclusion, sales workers in Japan aged >or=40 years may have increased risk for DM (+55 to +100%) independent of BMI, lifestyles and education, and manager/administrative workers aged >or=50 years may have increased risk (about +65%) due to their large BMI.