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Caeser R, Chiang J, Tan ES, Tai ES, Ngeow J. Cascade testing for hereditary cancer in Singapore: how population genomics help guide clinical policy. Fam Cancer 2024; 23:133-140. [PMID: 38662262 DOI: 10.1007/s10689-024-00376-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 03/14/2024] [Indexed: 04/26/2024]
Abstract
Hereditary Cancer makes up around 5-10% of all cancers. It is important to diagnose hereditary cancer in a timely fashion, as not only do patients require long-term care from a young age, but their relatives also require management. The main approach to capture at-risk relatives is cascade testing. It involves genetic testing of relatives of the first detected carrier of a pathogenic variant in a family i.e. the proband. The current standard of care for cascade testing is a patient-mediated approach. Probands are then advised to inform and encourage family members to undergo genetic testing. In Singapore, cascade testing is inefficient, around 10-15%, lower than the 30% global average. Here, we describe the cascade testing process and its effort to increase testing in Singapore. Precision Health Research, Singapore (PRECISE), was set up to coordinate Singapore's National Precision Medicine strategy and has awarded five clinical implementation pilots, with one of them seeking to identify strategies for how cascade testing for hereditary cancer can be increased in a safe and cost-efficient manner. Achieving this will be done through addressing barriers such as cost, manpower shortages, exploring a digital channel for contacting at-risk relatives, and getting a deeper insight into why genetic testing gets declined. If successful, it will likely result in care pathways that are a cost-effective public health intervention for identifying individuals at risk. Surveillance and management of those unaffected at-risk individuals, if caught early, will result in improved patient outcomes, and further reduce the healthcare burden for the economy.
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Affiliation(s)
- Rebecca Caeser
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, 169610, Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Jianbang Chiang
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, 169610, Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Ee Shien Tan
- Duke-National University of Singapore (NUS) Medical School, National University of Singapore, Singapore, Singapore
- Genetics Service, Department of Pediatrics, Kadang Kerbau (KK) Women's and Children's Hospital, Singapore, Singapore
| | - E Shyong Tai
- Duke-National University of Singapore (NUS) Medical School, National University of Singapore, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Precision Health Research, Singapore, Singapore
| | - Joanne Ngeow
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, 169610, Singapore.
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 308232, Singapore.
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Topriceanu CC, Chaturvedi N, Mathur R, Garfield V. Validity of European-centric cardiometabolic polygenic scores in multi-ancestry populations. Eur J Hum Genet 2024; 32:697-707. [PMID: 38182743 PMCID: PMC11153583 DOI: 10.1038/s41431-023-01517-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 10/29/2023] [Accepted: 11/28/2023] [Indexed: 01/07/2024] Open
Abstract
Polygenic scores (PGSs) provide an individual level estimate of genetic risk for any given disease. Since most PGSs have been derived from genome wide association studies (GWASs) conducted in populations of White European ancestry, their validity in other ancestry groups remains unconfirmed. This is especially relevant for cardiometabolic diseases which are known to disproportionately affect people of non-European ancestry. Thus, we aimed to evaluate the performance of PGSs for glycaemic traits (glycated haemoglobin, and type 1 and type 2 diabetes mellitus), cardiometabolic risk factors (body mass index, hypertension, high- and low-density lipoproteins, and total cholesterol and triglycerides) and cardiovascular diseases (including stroke and coronary artery disease) in people of White European, South Asian, and African Caribbean ethnicity in the UK Biobank. Whilst PGSs incorporated some GWAS data from multi-ethnic populations, the vast majority originated from White Europeans. For most outcomes, PGSs derived mostly from European populations had an overall better performance in White Europeans compared to South Asians and African Caribbeans. Thus, multi-ancestry GWAS data are needed to derive ancestry stratified PGSs to tackle health inequalities.
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Affiliation(s)
- Constantin-Cristian Topriceanu
- Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, University College London, Gower Street, London, WC1E 6BT, UK.
- MRC Unit for Lifelong Health and Ageing, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
| | - Nish Chaturvedi
- Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, University College London, Gower Street, London, WC1E 6BT, UK
- MRC Unit for Lifelong Health and Ageing, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Rohini Mathur
- Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Victoria Garfield
- Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, University College London, Gower Street, London, WC1E 6BT, UK
- MRC Unit for Lifelong Health and Ageing, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
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3
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Eastwood SV, Hemani G, Watkins SH, Scally A, Davey Smith G, Chaturvedi N. Ancestry, ethnicity, and race: explaining inequalities in cardiometabolic disease. Trends Mol Med 2024; 30:541-551. [PMID: 38677980 DOI: 10.1016/j.molmed.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/30/2024] [Accepted: 04/03/2024] [Indexed: 04/29/2024]
Abstract
Population differences in cardiometabolic disease remain unexplained. Misleading assumptions over genetic explanations are partly due to terminology used to distinguish populations, specifically ancestry, race, and ethnicity. These terms differentially implicate environmental and biological causal pathways, which should inform their use. Genetic variation alone accounts for a limited fraction of population differences in cardiometabolic disease. Research effort should focus on societally driven, lifelong environmental determinants of population differences in disease. Rather than pursuing population stratifiers to personalize medicine, we advocate removing socioeconomic barriers to receipt of and adherence to healthcare interventions, which will have markedly greater impact on improving cardiometabolic outcomes. This requires multidisciplinary collaboration and public and policymaker engagement to address inequalities driven by society rather than biology per se.
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Affiliation(s)
- Sophie V Eastwood
- MRC Unit for Lifelong Health and Ageing at UCL Population Sciences and Experimental Medicine, Institute of Cardiovascular Sciences Faculty of Population Health Sciences, University College London, London, UK
| | - Gibran Hemani
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah H Watkins
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Aylwyn Scally
- Department of Genetics, University of Cambridge, Downing Street, Cambridge, UK
| | - George Davey Smith
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nishi Chaturvedi
- MRC Unit for Lifelong Health and Ageing at UCL Population Sciences and Experimental Medicine, Institute of Cardiovascular Sciences Faculty of Population Health Sciences, University College London, London, UK.
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4
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De la Torre K, Song M, Abe SK, Rahman MS, Islam MR, Saito E, Min S, Huang D, Chen Y, Gupta PC, Sawada N, Tamakoshi A, Shu X, Wen W, Sakata R, Kim J, Nagata C, Ito H, Park SK, Shin M, Pednekar MS, Tsugane S, Kimura T, Gao Y, Cai H, Wada K, Oze I, Shin A, Ahn Y, Ahsan H, Boffetta P, Chia KS, Matsuo K, Qiao Y, Rothman N, Zheng W, Inoue M, Kang D. Diabetes and gastric cancer incidence and mortality in the Asia Cohort Consortium: A pooled analysis of more than a half million participants. J Diabetes 2024; 16:e13561. [PMID: 38751364 PMCID: PMC11096812 DOI: 10.1111/1753-0407.13561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/19/2024] [Accepted: 03/14/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Evidence suggests a possible link between diabetes and gastric cancer risk, but the findings remain inconclusive, with limited studies in the Asian population. We aimed to assess the impact of diabetes and diabetes duration on the development of gastric cancer overall, by anatomical and histological subtypes. METHODS A pooled analysis was conducted using 12 prospective studies included in the Asia Cohort Consortium. Among 558 981 participants (median age 52), after a median follow-up of 14.9 years and 10.5 years, 8556 incident primary gastric cancers and 8058 gastric cancer deaths occurred, respectively. Cox proportional hazard regression models were used to estimate study-specific hazard ratios (HRs) and 95% confidence intervals (CIs) and pooled using random-effects meta-analyses. RESULTS Diabetes was associated with an increased incidence of overall gastric cancer (HR 1.15, 95% CI 1.06-1.25). The risk association did not differ significantly by sex (women vs men: HR 1.31, 95% CI 1.07-1.60 vs 1.12, 1.01-1.23), anatomical subsites (noncardia vs cardia: 1.14, 1.02-1.28 vs 1.17, 0.77-1.78) and histological subtypes (intestinal vs diffuse: 1.22, 1.02-1.46 vs 1.00, 0.62-1.61). Gastric cancer risk increased significantly during the first decade following diabetes diagnosis (HR 4.70, 95% CI 3.77-5.86), and decreased with time (nonlinear p < .01). Positive associations between diabetes and gastric cancer mortality were observed (HR 1.15, 95% CI 1.03-1.28) but attenuated after a 2-year time lag. CONCLUSION Diabetes was associated with an increased gastric cancer incidence regardless of sex, anatomical subsite, or subtypes of gastric cancer. The risk of gastric cancer was particularly high during the first decade following diabetes diagnosis.
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Grants
- R37 CA070867 NCI NIH HHS
- 30-A-15,23-A-31(toku),26-A-2,29-A-4 National Cancer Center Japan Research and Development Fund
- 24H1080 National Cancer Center Korea Research Grant
- 0520160-1 National R&D Program for Cancer Control, Ministry of Health & Welfare, Republic of Korea
- 23-A-31 Ministry of Health, Labour and Welfare of Japan
- NRF-2016R1A2B4014552 National Research Foundation of Korea
- The Japanese Ministry of the Environment
- Ministry of Education, Culture, Sports, Science and Technology, Japan
- International Agency for Research on Cancer, Lyon, France
- 2210990 National Cancer Center Korea Research Grant
- US Department of Energy
- UM1 CA173640 NCI NIH HHS
- UM1 CA182910 NCI NIH HHS
- Ministry of Education, Culture, Sports, Science and Technology, Japan
- Ministry of Health, Labour and Welfare of Japan
- National Research Foundation of Korea
- Division of Cancer Prevention, National Cancer Institute
- The Japanese Ministry of the Environment
- International Agency for Research on Cancer, Lyon, France
- US Department of Energy
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Affiliation(s)
- Katherine De la Torre
- Department of Biomedical SciencesSeoul National University Graduate SchoolSeoulKorea
- Department of Preventive MedicineSeoul National University College of MedicineSeoulKorea
| | - Minkyo Song
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and GeneticsNational Cancer InstituteBethesdaMarylandUSA
- Laboratory of Epidemiology and Population SciencesNational Institute on Aging, National Institute of HealthBaltimoreMarylandUSA
| | - Sarah Krull Abe
- Division of PreventionNational Cancer Center Institute for Cancer ControlTokyoJapan
| | - Md. Shafiur Rahman
- Division of PreventionNational Cancer Center Institute for Cancer ControlTokyoJapan
- Research Center for Child Mental Development, Hamamatsu University School of MedicineTokyoJapan
| | - Md. Rashedul Islam
- Division of PreventionNational Cancer Center Institute for Cancer ControlTokyoJapan
- Hitotsubashi Institute for Advanced Study, Hitotsubashi UniversityTokyoJapan
| | - Eiko Saito
- Institute for Global Health Policy Research, National Center for Global Health and MedicineTokyoJapan
| | - Sukhong Min
- Department of Preventive MedicineSeoul National University College of MedicineSeoulKorea
| | - Dan Huang
- Department of Preventive MedicineSeoul National University College of MedicineSeoulKorea
- Integrated Major in Innovative Medical Science, Seoul National University Graduate SchoolSeoulKorea
| | - Yu Chen
- Department of Population Health and Environmental MedicineNYU Grossman School of MedicineNew YorkNew YorkUSA
| | | | - Norie Sawada
- Division of Cohort ResearchNational Cancer Center Institute for Cancer ControlTokyoJapan
| | - Akiko Tamakoshi
- Department of Public HealthHokkaido University Faculty of MedicineSapporoJapan
| | - Xiao‐Ou Shu
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center Vanderbilt‐Ingram Cancer CenterVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Wanqing Wen
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center Vanderbilt‐Ingram Cancer CenterVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Ritsu Sakata
- Radiation Effects Research FoundationHiroshimaJapan
| | - Jeongseon Kim
- Graduate School of Cancer Science and Policy, National Cancer CenterGoyangKorea
| | - Chisato Nagata
- Department of Epidemiology and Preventive MedicineGifu University Graduate School of MedicineGifuJapan
| | - Hidemi Ito
- Department of Preventive Medicine, Division of Cancer Information and ControlAichi Cancer Center Research InstituteNagoyaJapan
- Division of Descriptive Cancer EpidemiologyNagoya University Graduate School of MedicineNagoyaJapan
| | - Sue K. Park
- Department of Preventive MedicineSeoul National University College of MedicineSeoulKorea
| | - Myung‐Hee Shin
- Department of Social and Preventive MedicineSungkyunkwan University School of MedicineSeoulKorea
| | | | - Shoichiro Tsugane
- Division of Cohort ResearchNational Cancer Center Institute for Cancer ControlTokyoJapan
- International University of Health and Welfare Graduate SchoolTokyoJapan
| | - Takashi Kimura
- Department of Public HealthHokkaido University Faculty of MedicineSapporoJapan
| | - Yu‐Tang Gao
- Department of EpidemiologyShanghai Cancer InstituteShanghaiChina
- Renji Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Hui Cai
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center Vanderbilt‐Ingram Cancer CenterVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Keiko Wada
- Department of Epidemiology and Preventive MedicineGifu University Graduate School of MedicineGifuJapan
| | - Isao Oze
- Division of Cancer Epidemiology and PreventionAichi Cancer Center Research InstituteNagoyaJapan
| | - Aesun Shin
- Department of Preventive MedicineSeoul National University College of MedicineSeoulKorea
- Cancer Research Institute, Seoul National UniversitySeoulKorea
| | - Yoon‐Ok Ahn
- Department of Preventive MedicineSeoul National University College of MedicineSeoulKorea
| | - Habibul Ahsan
- Department of Public Health SciencesUniversity of ChicagoChicagoIllinoisUSA
| | - Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook UniversityStony BrookNew YorkUSA
- Department of Medical and Surgical SciencesUniversity of BolognaBolognaItaly
| | - Kee Seng Chia
- Saw Swee Hock School of Public Health, National University of SingaporeSingaporeSingapore
| | - Keitaro Matsuo
- Division of Cancer Epidemiology and PreventionAichi Cancer Center Research InstituteNagoyaJapan
- Department of Cancer EpidemiologyNagoya University Graduate School of Medicine NagoyaNagoyaJapan
| | - You‐Lin Qiao
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Nathaniel Rothman
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and GeneticsNational Cancer InstituteBethesdaMarylandUSA
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center Vanderbilt‐Ingram Cancer CenterVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Manami Inoue
- Division of PreventionNational Cancer Center Institute for Cancer ControlTokyoJapan
| | - Daehee Kang
- Department of Preventive MedicineSeoul National University College of MedicineSeoulKorea
- Integrated Major in Innovative Medical Science, Seoul National University Graduate SchoolSeoulKorea
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5
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Behera SM, Behera P, Mohanty SK, Singh RR, Patro BK, Mukherjee A, Epari V. Socioeconomic gradient of lean diabetes in India: Evidence from National Family Health Survey, 2019-21. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003172. [PMID: 38814943 PMCID: PMC11139297 DOI: 10.1371/journal.pgph.0003172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 04/09/2024] [Indexed: 06/01/2024]
Abstract
Diabetes is a global public health challenge, particularly in India, affecting millions. Among diabetic patients, lean type 2 diabetes is a severe subtype with higher microvascular complication risks. While studies on the prevalence, variations and risk factors of diabetes are increasingly available, there has been limited research on the prevalence, variations, and socioeconomic disparities of lean diabetes in India. This study used NFHS-5 microdata, and lean diabetes is defined as those with a BMI level of under 25 and random blood glucose levels of over 200 or under diabetic medication. Descriptive and multivariate analyses were conducted to understand lean diabetes variations and related factors. Socioeconomic disparities were measured using concentration curves and the concentration index. The study unveiled important insights into lean diabetes in India. 8.2% of men and 6.0% of women had elevated blood glucose levels, indicating a significant diabetes burden. Notably, 2.9% of men and 2.4% of women were diagnosed with lean diabetes. Among type 2 diabetics, 52.56% of males and 43.57% of females had lean type 2 diabetes. Lean diabetes prevalence varied from 11.6% in the poorest quintile to 1.1% in the richest. The odds of lean type 2 diabetes among those in the poorest quintile was 6.7 compared to the richest quintile. The concentration index of lean type 2 diabetes was -0.42 for men and -0.39 for women, suggesting a disproportionate impact on lower socioeconomic groups. This study advances our understanding of the complex interplay between socioeconomic factors and lean type 2 diabetes in India. To address the rising burden of lean diabetes among lower socioeconomic strata, policymakers and healthcare professionals must prioritise initiatives enhancing healthcare access, promoting healthy lifestyles, and ensuring effective diabetes management. By addressing socioeconomic disparities and implementing interventions for vulnerable populations, India can reduce diabetes-related mortality and enhance its citizens' overall health.
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Affiliation(s)
| | - Priyamadhaba Behera
- Dept of Community Medicine & Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Sanjay K. Mohanty
- Department of Population and Development, International Institute for Population Sciences, Mumbai, India
| | | | - Binod Kumar Patro
- Professor of Community Medicine & Dean, Dept of Community Medicine & Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Avinaba Mukherjee
- Dept of Community Medicine & Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Venkatarao Epari
- Department of Community Medicine, Siksha ’O’ Anusandhan (SOA University), Bhubaneswar, India
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6
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Kvist AAS, Sharma A, Sommer C, Qvigstad E, Gulseth HL, Sollid ST, Nermoen I, Sattar N, Gill J, Tannæs TM, Birkeland KI, Lee-Ødegård S. Adipose Tissue Insulin Resistance in South Asian and Nordic Women after Gestational Diabetes Mellitus. Metabolites 2024; 14:288. [PMID: 38786765 PMCID: PMC11123011 DOI: 10.3390/metabo14050288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/13/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024] Open
Abstract
South Asians (SAs) have a higher risk of developing type 2 diabetes (T2D) than white Europeans, especially following gestational diabetes mellitus (GDM). Despite similar blood glucose levels post-GDM, SAs exhibit more insulin resistance (IR) than Nordics, though the underlying mechanisms are unclear. This study aimed to assess markers of adipose tissue (AT) IR and liver fat in SA and Nordic women post-GDM. A total of 179 SA and 108 Nordic women in Norway underwent oral glucose tolerance tests 1-3 years post-GDM. We measured metabolic markers and calculated the AT IR index and non-alcoholic fatty liver disease liver fat (NAFLD-LFS) scores. Results showed that normoglycaemic SAs had less non-esterified fatty acid (NEFA) suppression during the test, resembling prediabetes/T2D responses, and higher levels of plasma fetuin-A, CRP, and IL-6 but lower adiponectin, indicating AT inflammation. Furthermore, normoglycaemic SAs had higher NAFLD-LFS scores, lower insulin clearance, and higher peripheral insulin than Nordics, indicating increased AT IR, inflammation, and liver fat in SAs. Higher liver fat markers significantly contributed to the ethnic disparities in glucose metabolism, suggesting a key area for intervention to reduce T2D risk post-GDM in SAs.
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Affiliation(s)
- Ahalya Anita Suntharalingam Kvist
- Institute of Clinical Medicine, University of Oslo, 0372 Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, 0424 Oslo, Norway
| | - Archana Sharma
- Institute of Clinical Medicine, University of Oslo, 0372 Oslo, Norway
- Department of Endocrinology, Akershus University Hospital, 1478 Lørenskog, Norway
| | - Christine Sommer
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, 0424 Oslo, Norway
| | - Elisabeth Qvigstad
- Institute of Clinical Medicine, University of Oslo, 0372 Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, 0424 Oslo, Norway
| | | | - Stina Therese Sollid
- Department of Medicine, Drammen Hospital, Vestre Viken Health Trust, 3004 Drammen, Norway
| | - Ingrid Nermoen
- Institute of Clinical Medicine, University of Oslo, 0372 Oslo, Norway
- Department of Endocrinology, Akershus University Hospital, 1478 Lørenskog, Norway
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, BHF Glasgow Cardiovascular Research Centre, 126 University Place, Glasgow G12 8TA, UK
| | - Jason Gill
- School of Cardiovascular and Metabolic Health, University of Glasgow, BHF Glasgow Cardiovascular Research Centre, 126 University Place, Glasgow G12 8TA, UK
| | - Tone Møller Tannæs
- EpiGen, Medical Division, Akershus University Hospital, 1478 Lørenskog, Norway
| | - Kåre Inge Birkeland
- Institute of Clinical Medicine, University of Oslo, 0372 Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, 0424 Oslo, Norway
| | - Sindre Lee-Ødegård
- Institute of Clinical Medicine, University of Oslo, 0372 Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, 0424 Oslo, Norway
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7
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Sambasivam R, Abdin E, AshaRani PV, Roystonn K, Devi F, Wang P, Lee ES, Sum CF, Subramaniam M. Public awareness of war on diabetes campaign and its association with behavioural outcomes. HEALTH EDUCATION RESEARCH 2024; 39:284-295. [PMID: 38394480 DOI: 10.1093/her/cyae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 02/01/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024]
Abstract
The War on Diabetes campaign was launched in 2016, encouraging Singapore residents to engage in regular exercise, adopt healthy dietary habits and screen for early detection of diabetes. This study aims to examine campaign awareness and its associations with sedentary behaviour, dietary habits and identifying diabetes. Data were obtained from the nationwide Knowledge, Attitudes and Practices study on diabetes in Singapore. A total of 2895 participants responded to a single question assessing campaign awareness. The Dietary Approaches to Stop Hypertension (DASH) diet screener assessed dietary habits, and the Global Physical Activity Questionnaire (GPAQ) measured sedentary behaviour. Recognition of diabetes was established using a vignette depicting a person with diabetes mellitus. Logistic and linear regression models were used to measure the associations. Most participants were 18- to 34-years old (29.9%) and females (51.6%). About 57.4% identified the campaign. Campaign awareness exhibited positive associations with identifying diabetes based on the vignette [odds ratio (OR): 1.5; 95% confidence interval (CI): 1.1-2.2; P = 0.022], lower odds of sedentary behaviour ≥7 h/day (OR: 0.7; CI: 0.5-0.9; P = 0.018) and higher DASH scores (β = 1.3; P < 0.001). The study recognized early significant associations between the behavioural outcomes and the campaign, emphasizing the need for ongoing campaign sustainability and evaluation of its long-term impact on population health.
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Affiliation(s)
- Rajeswari Sambasivam
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore
| | - P V AshaRani
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore
| | - Kumarasan Roystonn
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore
| | - Fiona Devi
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore
| | - Peizhi Wang
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore
| | - Eng Sing Lee
- National Healthcare Group Polyclinics, 3 Fusionopolis Link , Singapore 138543, Singapore
| | - Chee Fang Sum
- Khoo Teck Puat Hospital, Diabetes Centre, 90 Yishun Central, Singapore 768828, Singapore
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, Singapore 117549, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, 50 Nanyang Avenue, Singapore 639798, Singapore
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8
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Kurgan N, Kjærgaard Larsen J, Deshmukh AS. Harnessing the power of proteomics in precision diabetes medicine. Diabetologia 2024; 67:783-797. [PMID: 38345659 DOI: 10.1007/s00125-024-06097-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 12/20/2023] [Indexed: 03/21/2024]
Abstract
Precision diabetes medicine (PDM) aims to reduce errors in prevention programmes, diagnosis thresholds, prognosis prediction and treatment strategies. However, its advancement and implementation are difficult due to the heterogeneity of complex molecular processes and environmental exposures that influence an individual's disease trajectory. To address this challenge, it is imperative to develop robust screening methods for all areas of PDM. Innovative proteomic technologies, alongside genomics, have proven effective in precision cancer medicine and are showing promise in diabetes research for potential translation. This narrative review highlights how proteomics is well-positioned to help improve PDM. Specifically, a critical assessment of widely adopted affinity-based proteomic technologies in large-scale clinical studies and evidence of the benefits and feasibility of using MS-based plasma proteomics is presented. We also present a case for the use of proteomics to identify predictive protein panels for type 2 diabetes subtyping and the development of clinical prediction models for prevention, diagnosis, prognosis and treatment strategies. Lastly, we discuss the importance of plasma and tissue proteomics and its integration with genomics (proteogenomics) for identifying unique type 2 diabetes intra- and inter-subtype aetiology. We conclude with a call for action formed on advancing proteomics technologies, benchmarking their performance and standardisation across sites, with an emphasis on data sharing and the inclusion of diverse ancestries in large cohort studies. These efforts should foster collaboration with key stakeholders and align with ongoing academic programmes such as the Precision Medicine in Diabetes Initiative consortium.
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Affiliation(s)
- Nigel Kurgan
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Jeppe Kjærgaard Larsen
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Atul S Deshmukh
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark.
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Kiran A, Shah NA, Khan SM, Ahmed H, Kamran M, Yousafzai BK, Ahmad Z, Yoo S, Han H, Alasqah I, Raposo A. Assessment of knowledge, attitude, and practices regarding the relationship of obesity with diabetes among the general community of Pakistan. Heliyon 2024; 10:e29081. [PMID: 38644838 PMCID: PMC11033058 DOI: 10.1016/j.heliyon.2024.e29081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 04/23/2024] Open
Abstract
This study sought to evaluate the influence of knowledge, attitude, and practices assessment on diabetes related to obesity in Pakistani society. Data was collected both through door to door and online survey approaches from 518 participants by using a pre-validated questionnaire. A total of 15.6% were underweight, 61.2% were normal weight, 17.2% were overweight and 5.8% were in obesity class I and 2.9% were classified as obesity class II. The co-occurrence of obesity and diabetes was 29% (n = 22) among diabetic individuals (n = 84). A majority of the residents (59.1%) were from cities. While 94% of the participants responded to what obesity was, 83.8% knew what diabetes was. Fast food, soft drinks, and mayonnaise were deemed to be healthy by 75.1% of the respondents. Obesity was viewed as a disease by 94.8%, a major health issue by 78.2%, and a weight-loss necessity by 44.6% of participants. Only 24.9% exercised every day, and 23.9% engaged in any physical activity daily. The majority of respondents (50.6%) never tried to lose weight and 23.2% ate junk food daily. The sociodemographic variables showed that the age ranges of 25-34 years (P < 0.001; OR 0.531), 45-54 years (P < 0.05; OR 0.527), and urban residency (P < 0.001; OR 0.128) had a significant association with knowledge. The factors of urban residency (P < 0.001; OR 3.996), being unmarried (P < 0.001; OR 1.95), and having an income of 51,000-70,000 (P < 0.001; OR 11.29) showed a very highly significant association with a good attitude regarding the relationship of obesity with diabetes (P < 0.05). Similarly, practices of the participants showed significant association with BMI range of 18.5-24.9 and 25-29.9 (P < 0.001). Our study revealed significant knowledge and understanding of the relationship between obesity with diabetes. However, it was observed that majority of respondents exhibited fundamental knowledge regarding obesity and diabetes, there was a notable absence of understanding regarding crucial elements, such as the significance of maintaining a healthy body weight, participating in physical activity, and implementing appropriate dietary strategies for weight control. We recognize the necessity for education initiatives and strongly encourage them to assist individuals in managing diabetes resulting from obesity.
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Affiliation(s)
- Arooj Kiran
- Department of Biosciences, COMSATS University Islamabad, Islamabad, Pakistan
| | - Naseer Ali Shah
- Department of Biosciences, COMSATS University Islamabad, Islamabad, Pakistan
| | - Shujaul Mulk Khan
- Department of Plant Sciences, Quaid-i-Azam University Islamabad, Pakistan
- Pakistan Academy of Sciences Islamabad, Pakistan
- International Society of Ethnobiology, Marrakech, Morocco
| | - Haroon Ahmed
- Department of Biosciences, COMSATS University Islamabad, Islamabad, Pakistan
| | - Muhammad Kamran
- Department of Biosciences, COMSATS University Islamabad, Islamabad, Pakistan
| | | | - Zeeshan Ahmad
- Department of Plant Sciences, Quaid-i-Azam University Islamabad, Pakistan
| | - Sunghoon Yoo
- Hanmoo Convention (Oakwood Premier), 49, Teheran-ro 87-gil, Gangnam-gu, Seoul 06164, South Korea
| | - Heesup Han
- College of Hospitality and Tourism Management, Sejong University, 98 Gunja-Dong, Gwanjin-Gu, Seoul 143-747, South Korea
| | - Ibrahim Alasqah
- Department of Public Health, College of Applied Medical Sciences, Qassim University, Buraydah, 51452, P.O. Box 6666, Saudi Arabia
- School of Health, University of New England, Armidale, NSW, 2351, Australia
| | - António Raposo
- CBIOS (Research Center for Biosciences and Health Technologies), Universidade Lusófona de Humanidades e Tecnologias, Campo Grande 376, 1749-024, Lisboa, Portugal
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Fields ND, Narayan KMV, Ranjani H, Staimez LR, Anjana RM, Patel SA, Mohan V, Ali MK, Weber MB. Perceived stress and progression of cardiometabolic risk factors among South Asians with prediabetes in a lifestyle intervention trial. Prim Care Diabetes 2024; 18:183-187. [PMID: 38177017 PMCID: PMC11009057 DOI: 10.1016/j.pcd.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/06/2024]
Abstract
AIMS To examine associations between perceived stress and cardiometabolic risk factors in South Asians with prediabetes and assess whether a diabetes prevention program mitigates the impact of stress on cardiometabolic health. METHODS We conducted a secondary analysis of the Diabetes Community Lifestyle Improvement Program, a lifestyle modification trial for diabetes prevention in India (n = 564). Indicators for cardiometabolic health (weight, waist circumference, blood pressure, glucose, HbA1c, and lipids) were measured at each visit while perceived stress was assessed via questionnaire at baseline. Multivariable linear regression assessed associations between stress and cardiometabolic parameters at baseline and 3-year follow up. RESULTS At baseline, perceived stress was associated with higher weight (b=0.16; 95% CI: 0.04, 0.29) and waist circumference (b=0.11; 95% CI: 0.01, 0.21) but lower 30-minute postload glucose (b=-0.44; 95% CI: -0.76, -0.14) and LDL cholesterol (b=-0.40; 95% CI: -0.76, -0.03). Over the study period, perceived stress was associated with weight gain (b=0.20; 95% CI: 0.07, 0.33) and increased waist circumference (b=0.14; 95% CI: 0.04, 0.24). Additionally, higher perceived stress was associated with lower HDL cholesterol among the control arm (pinteraction = 0.02). CONCLUSIONS Baseline stress was associated with negative cardiometabolic risk factor outcomes over time in those with prediabetes.
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Affiliation(s)
- Nicole D Fields
- Department of Epidemiology, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA; Hubert Department of Global Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
| | - K M Venkat Narayan
- Hubert Department of Global Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Harish Ranjani
- Madras Diabetes Research Foundation, Chennai 600086, India
| | - Lisa R Staimez
- Hubert Department of Global Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation, Chennai 600086, India; Dr. Mohan's Diabetes Specialities Centre, IDF Centre of Excellence in Diabetes Care, Chennai 600086, India
| | - Shivani A Patel
- Department of Epidemiology, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA; Hubert Department of Global Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation, Chennai 600086, India; Dr. Mohan's Diabetes Specialities Centre, IDF Centre of Excellence in Diabetes Care, Chennai 600086, India
| | - Mohammed K Ali
- Hubert Department of Global Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA; Department of Family and Preventive Medicine, School of Medicine, Emory University, 100 Woodruff Circle, Atlanta, GA 30322, USA
| | - Mary Beth Weber
- Hubert Department of Global Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
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11
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Iqbal S, Iqbal H, Kagan C. Intergenerational differences in healthy eating beliefs among British Pakistanis with type 2 diabetes. Diabet Med 2024; 41:e15222. [PMID: 37690127 DOI: 10.1111/dme.15222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/31/2023] [Accepted: 09/06/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION There are growing concerns on how to prevent, slow down and induce remission of type 2 diabetes mellitus (T2DM). Recent evidence has found diet and lifestyle interventions can cause remission of T2DM, however, there are challenges for diverse groups such as British Pakistanis who are four times more at risk of T2DM. There is a need to understand the food behaviours of different generational groups to develop culturally appropriate strategies to support diabetes prevention programmes. AIMS This study explores beliefs about healthy eating and food practices related to T2DM among British Pakistanis to understand the challenges they face in implementing healthy diets. METHOD We carried out 26 semi-structured qualitative interviews via telephone and face-to-face. The sample included T2DM British Pakistanis living in Bradford (UK), aged between 18 and 71 with a mean age of 50 (SD = 17.04). Among the participants, 14 were women (54%) and 12 were men (46%), with interviews conducted in both English (76%) and Urdu (24%). Participants were grouped under three generation groups based on age (first generation 65+; second generation 40-64; younger generation 18-39 years). There was no biological link between the generational groups, and they were not part of the same family. Data were analysed using qualitative reflexive thematic analysis. RESULTS Findings were categorised into three themes: knowledge and awareness of diabetes symptoms; social and family context of food practices and making sense of healthy eating. The family was the fundamental unit of understanding food-related health behaviours. Eating traditional food was perceived as healthy and deemed practical for first generations who were the initial members of their family to settle in the UK as well as the second generations who had parents born in Pakistan. Younger British Pakistanis were born in the UK and reported that they struggled to eat alternative foods within the home and manage their T2DM. CONCLUSION These findings improve our understanding of how three generations of British Pakistanis with T2DM negotiate healthy diets. There is a need for culturally tailored diet modifications and interventions, where different generational needs can be specifically targeted to adopt healthier diets which should be shared and encouraged.
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Affiliation(s)
- Syka Iqbal
- Department of Psychology, Faculty of Management, Law and Social Sciences, University of Bradford, Bradford, UK
| | - Halima Iqbal
- Department of Public Health, Faculty of Health, University of Bradford, Bradford, UK
| | - Carolyn Kagan
- Research institute of Health and Social Change, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
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12
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Smith K, Deutsch AJ, McGrail C, Kim H, Hsu S, Huerta-Chagoya A, Mandla R, Schroeder PH, Westerman KE, Szczerbinski L, Majarian TD, Kaur V, Williamson A, Zaitlen N, Claussnitzer M, Florez JC, Manning AK, Mercader JM, Gaulton KJ, Udler MS. Multi-ancestry polygenic mechanisms of type 2 diabetes. Nat Med 2024; 30:1065-1074. [PMID: 38443691 PMCID: PMC11175990 DOI: 10.1038/s41591-024-02865-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/06/2024] [Indexed: 03/07/2024]
Abstract
Type 2 diabetes (T2D) is a multifactorial disease with substantial genetic risk, for which the underlying biological mechanisms are not fully understood. In this study, we identified multi-ancestry T2D genetic clusters by analyzing genetic data from diverse populations in 37 published T2D genome-wide association studies representing more than 1.4 million individuals. We implemented soft clustering with 650 T2D-associated genetic variants and 110 T2D-related traits, capturing known and novel T2D clusters with distinct cardiometabolic trait associations across two independent biobanks representing diverse genetic ancestral populations (African, n = 21,906; Admixed American, n = 14,410; East Asian, n =2,422; European, n = 90,093; and South Asian, n = 1,262). The 12 genetic clusters were enriched for specific single-cell regulatory regions. Several of the polygenic scores derived from the clusters differed in distribution among ancestry groups, including a significantly higher proportion of lipodystrophy-related polygenic risk in East Asian ancestry. T2D risk was equivalent at a body mass index (BMI) of 30 kg m-2 in the European subpopulation and 24.2 (22.9-25.5) kg m-2 in the East Asian subpopulation; after adjusting for cluster-specific genetic risk, the equivalent BMI threshold increased to 28.5 (27.1-30.0) kg m-2 in the East Asian group. Thus, these multi-ancestry T2D genetic clusters encompass a broader range of biological mechanisms and provide preliminary insights to explain ancestry-associated differences in T2D risk profiles.
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Affiliation(s)
- Kirk Smith
- Diabetes Unit, Endocrine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Aaron J Deutsch
- Diabetes Unit, Endocrine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Carolyn McGrail
- Biomedical Sciences Graduate Program, University of California, San Diego, La Jolla, CA, USA
| | - Hyunkyung Kim
- Diabetes Unit, Endocrine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Committee on Genetics, Genomics and Systems Biology, University of Chicago, Chicago, IL, USA
- Section of Genetic Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Sarah Hsu
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Alicia Huerta-Chagoya
- Diabetes Unit, Endocrine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Ravi Mandla
- Diabetes Unit, Endocrine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Philip H Schroeder
- Diabetes Unit, Endocrine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Kenneth E Westerman
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Lukasz Szczerbinski
- Diabetes Unit, Endocrine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
- Clinical Research Centre, Medical University of Bialystok, Bialystok, Poland
| | - Timothy D Majarian
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA
- Vertex Pharmaceuticals, Boston, MA, USA
| | - Varinderpal Kaur
- Diabetes Unit, Endocrine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Alice Williamson
- Precision Healthcare University Research Institute, Queen Mary University of London, London, UK
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Noah Zaitlen
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Computational Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Human Genetics, University of California, Los Angeles, Los Angeles, CA, USA
| | - Melina Claussnitzer
- Diabetes Unit, Endocrine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Novo Nordisk Foundation Center for Genomic Mechanisms of Disease, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Jose C Florez
- Diabetes Unit, Endocrine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Alisa K Manning
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Josep M Mercader
- Diabetes Unit, Endocrine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Kyle J Gaulton
- Department of Pediatrics, University of California, San Diego, San Diego, CA, USA
| | - Miriam S Udler
- Diabetes Unit, Endocrine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA.
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Department of Medicine, Harvard Medical School, Boston, MA, USA.
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Dhokte S, Czaja K. Visceral Adipose Tissue: The Hidden Culprit for Type 2 Diabetes. Nutrients 2024; 16:1015. [PMID: 38613048 PMCID: PMC11013274 DOI: 10.3390/nu16071015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
Type 2 diabetes (T2D) is a chronic metabolic disorder characterized by insulin resistance in various tissues. Though conventionally associated with obesity, current research indicates that visceral adipose tissue (VAT) is the leading determining factor, wielding more influence regardless of individual body mass. The heightened metabolic activity of VAT encourages the circulation of free fatty acid (FFA) molecules, which induce insulin resistance in surrounding tissues. Individuals most vulnerable to this preferential fat deposition are older males with ancestral ties to Asian countries because genetics and sex hormones are pivotal factors for VAT accumulation. However, interventions in one's diet and lifestyle have the potential to strategically discourage the growth of VAT. This illuminates the possibility that the expansion of VAT and, subsequently, the risk of T2D development are preventable. Therefore, by reducing the amount of VAT accumulated in an individual and preventing it from building up, one can effectively control and prevent the development of T2D.
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Affiliation(s)
| | - Krzysztof Czaja
- Department of Biomedical Sciences, College of Veterinary Medicine, University of Georgia, Athens, GA 30602, USA;
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14
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Magodoro IM, Aluoch A, Claggett B, Nyirenda MJ, Siedner MJ, Wilkinson KA, Wilkinson RJ, Ntusi N. Insulin resistance, and not β-cell impairment, mediates association between Mycobacterium tuberculosis sensitization and type II diabetes mellitus among US adults. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.10.24304039. [PMID: 38559227 PMCID: PMC10980119 DOI: 10.1101/2024.03.10.24304039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Type 2 diabetes mellitus (T2DM) may be a long-term sequela of infection with Mycobacterium tuberculosis (M.tb) by mechanisms that remain to be fully explained. We evaluated association between M.tb sensitization and T2DM among U.S adults and, via formal mediation analysis, the extent to which this association is mediated by insulin resistance and/or β-cell failure. These evaluations accounted for demographic, socio-economic, behavioral and clinical characteristics. T2DM was assessed by fasting plasma glucose, 2-hour oral glucose tolerance testing and HbA1c; homoeostasis model assessment 2 (HOMA2) was used to estimate β-cell dysfunction (HOMA2-B) and insulin resistance (HOMA2-IR); while M.tb sensitization status was ascertained by tuberculin skin testing (TST). Exposure to M.tb was associated with increased risk for T2DM, likely driven by an increase in insulin resistance. Definitive prospective studies examining incident T2DM following tuberculosis are warranted. Research in Context What is already known about this subject?: Accumulating evidence suggests that pre-diabetes and new-onset type 2 diabetes mellitus (T2DM) may be a long-term complication of exposure to Mycobacterium tuberculosis ( M.tb ) via mechanisms that remain to be unraveled What is the key question?: To what extent do insulin resistance and β-cell failure mediate the association between M.tb sensitization with T2DM among US adults? What are the new findings?: M.tb sensitization is characterized by distinct glucose metabolic disturbances manifesting as increased risk of T2DM and isolated impaired fasting glucose (IFG) Insulin resistance, and not β-cell impairment, likely independently mediate the observed diabetogenic effects of M.tb sensitization How might this impact on clinical and/or public health practice in the foreseeable future?: If corroborated by prospective studies, both TB programs and individual clinical care must incorporate monitoring of serum glucose and long-term metabolic outcomesThis will be particularly urgent in sub-Saharan Africa and South-East Asia where scarce health resources coincide with overlapping endemic TB and epidemic T2DM.
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Carrillo-Larco RM, Guzman-Vilca WC, Xu X, Bernabe-Ortiz A. Mean age and body mass index at type 2 diabetes diagnosis: Pooled analysis of 56 health surveys across income groups and world regions. Diabet Med 2024; 41:e15174. [PMID: 37422703 DOI: 10.1111/dme.15174] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/27/2023] [Accepted: 07/03/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Screening for type 2 diabetes mellitus (T2DM) targets people aged 35+ years and those with overweight/obesity. With mounting evidence on young-onset T2DM and T2DM patients with lean phenotypes, it is worth revising the screening criteria to include younger and leaner adults. We quantified the mean age and body mass index (BMI; kg/m2 ) at T2DM diagnosis in 56 countries. METHODS Descriptive cross-sectional analysis of WHO STEPS surveys. We analysed adults (25-69 years) with new T2DM diagnosis (not necessarily T2DM onset) as per fasting plasma glucose ≥126 mg/dL measured during the survey. For people with new T2DM diagnosis, we summarized the mean age and the proportion of each five-year age group; also, we summarized the mean BMI and the proportion of mutually exclusive BMI categories. RESULTS There were 8695 new T2DM patients. Overall, the mean age at T2DM diagnosis was 45.1 years in men and 45.0 years in women; and the mean BMI at T2DM diagnosis was 25.2 in men and 26.9 in women. Overall, in men, 10.3% were 25-29 years and 8.5% were 30-34 years old; in women, 8.6% and 12.5% were 25-29 years and 30-34 years old, respectively. 48.5% of men and 37.3% of women were in the normal BMI category. CONCLUSIONS A non-negligible proportion of new T2DM patients were younger than 35 years. Many new T2DM patients were in the normal weight range. Guidelines for T2DM screening may consider revising the age and BMI criteria to incorporate young and lean adults.
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Affiliation(s)
- Rodrigo M Carrillo-Larco
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Emory Global Diabetes Research Center, Emory University, Atlanta, Georgia, USA
| | - Wilmer Cristobal Guzman-Vilca
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Medicine "Alberto Hurtado", Universidad Peruana Cayetano Heredia, Lima, Peru
- Sociedad Científica de Estudiantes de Medicina Cayetano Heredia (SOCEMCH), Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Xiaolin Xu
- Department of Big Data in Health Science School of Public Health, and Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Antonio Bernabe-Ortiz
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Universidad Cientifica del Sur, Lima, Peru
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16
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Yuan L, Verhoeven A, Blomberg N, van Eyk HJ, Bizino MB, Rensen PCN, Jazet IM, Lamb HJ, Rabelink TJ, Giera M, van den Berg BM. Ethnic Disparities in Lipid Metabolism and Clinical Outcomes between Dutch South Asians and Dutch White Caucasians with Type 2 Diabetes Mellitus. Metabolites 2024; 14:33. [PMID: 38248836 PMCID: PMC10819672 DOI: 10.3390/metabo14010033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 12/26/2023] [Accepted: 12/30/2023] [Indexed: 01/23/2024] Open
Abstract
Type 2 diabetes mellitus (T2DM) poses a higher risk for complications in South Asian individuals compared to other ethnic groups. To shed light on potential mediating factors, we investigated lipidomic changes in plasma of Dutch South Asians (DSA) and Dutch white Caucasians (DwC) with and without T2DM and explore their associations with clinical features. Using a targeted quantitative lipidomics platform, monitoring over 1000 lipids across 17 classes, along with 1H NMR based lipoprotein analysis, we studied 51 healthy participants (21 DSA, 30 DwC) and 92 T2DM patients (47 DSA, 45 DwC) from the MAGNetic resonance Assessment of VICTOza efficacy in the Regression of cardiovascular dysfunction in type 2 dIAbetes mellitus (MAGNA VICTORIA) study. This comprehensive mapping of the circulating lipidome allowed us to identify relevant lipid modules through unbiased weighted correlation network analysis, as well as disease and ethnicity related key mediatory lipids. Significant differences in lipidomic profiles, encompassing various lipid classes and species, were observed between T2DM patients and healthy controls in both the DSA and DwC populations. Our analyses revealed that healthy DSA, but not DwC, controls already exhibited a lipid profile prone to develop T2DM. Particularly, in DSA-T2DM patients, specific lipid changes correlated with clinical features, particularly diacylglycerols (DGs), showing significant associations with glycemic control and renal function. Our findings highlight an ethnic distinction in lipid modules influencing clinical outcomes in renal health. We discover distinctive ethnic disparities of the circulating lipidome and identify ethnicity-specific lipid markers. Jointly, our discoveries show great potential as personalized biomarkers for the assessment of glycemic control and renal function in DSA-T2DM individuals.
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Affiliation(s)
- Lushun Yuan
- Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (L.Y.); (P.C.N.R.); (T.J.R.)
- Department of Internal Medicine, Division of Nephrology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Aswin Verhoeven
- Center for Proteomics and Metabolomics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (A.V.); (N.B.); (M.G.)
| | - Niek Blomberg
- Center for Proteomics and Metabolomics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (A.V.); (N.B.); (M.G.)
| | - Huub J. van Eyk
- Department of Internal Medicine, Division of Endocrinology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (H.J.v.E.); (I.M.J.)
| | - Maurice B. Bizino
- Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (M.B.B.); (H.J.L.)
| | - Patrick C. N. Rensen
- Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (L.Y.); (P.C.N.R.); (T.J.R.)
- Department of Internal Medicine, Division of Endocrinology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (H.J.v.E.); (I.M.J.)
| | - Ingrid M. Jazet
- Department of Internal Medicine, Division of Endocrinology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (H.J.v.E.); (I.M.J.)
| | - Hildo J. Lamb
- Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (M.B.B.); (H.J.L.)
| | - Ton J. Rabelink
- Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (L.Y.); (P.C.N.R.); (T.J.R.)
- Department of Internal Medicine, Division of Nephrology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Martin Giera
- Center for Proteomics and Metabolomics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (A.V.); (N.B.); (M.G.)
| | - Bernard M. van den Berg
- Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (L.Y.); (P.C.N.R.); (T.J.R.)
- Department of Internal Medicine, Division of Nephrology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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Narayanan N, Sahoo J, Kamalanathan S, Sagili H, Zachariah B, Naik D, Roy A, Merugu C. Insulin Sensitivity, Islet Cell Function, and Incretin Axis in Pregnant Women With and Without Gestational Diabetes Mellitus. Indian J Endocrinol Metab 2024; 28:71-79. [PMID: 38533283 PMCID: PMC10962776 DOI: 10.4103/ijem.ijem_7_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 05/29/2023] [Accepted: 09/04/2023] [Indexed: 03/28/2024] Open
Abstract
Introduction The aim of this study was to compare insulin sensitivity, islet cell function, and incretin axes in pregnant subjects with GDM and normal healthy controls. Methods Pregnant women at 24 to 28 weeks of gestation were subjected to a 75 g oral glucose tolerance test (OGTT). Samples for glucose, insulin, glucagon, glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) were collected at 0, 30, 60, and 120 min during the OGTT. The Matsuda index (MI) and insulin secretion and sensitivity index-2 (ISSI-2) were assessed. The glucagon suppression index (GSI) was calculated along with the area under the curve (AUC) for glucose, insulin, glucagon, GLP-1, and GIP. Results A total of 48 pregnant women (25 GDM and 23 controls) were finally analysed. The MI and ISSI-2 were low in the GDM group [4.31 vs. 5.42; P = 0.04], [1.99 vs. 3.18, P ≤ 0.01] respectively). Total AUCglucagon was higher in the GDM group (7411.7 vs. 6320.1, P = 0.02). GSI30 was significantly lower in the GDM group (-62.6 vs. -24.7, P = 0.03). Fasting GLP-1 levels were low in GDM women (17.3 vs. 22.2, P = 0.04). The total AUCGLP-1 positively correlated with total GSI in the GDM group. Conclusion Asian-Indian GDM women have high insulin insensitivity, islet cell dysfunction, and low fasting GLP-1. Incretin axis dysfunction plays a potential role in their islet cell dysfunction.
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Affiliation(s)
- Niya Narayanan
- Department of Endocrinology, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Jayaprakash Sahoo
- Department of Endocrinology, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Sadishkumar Kamalanathan
- Department of Endocrinology, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Haritha Sagili
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Bobby Zachariah
- Department of Biochemistry, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Dukhabandhu Naik
- Department of Endocrinology, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Ayan Roy
- Department of Endocrinology, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Chandhana Merugu
- Department of Endocrinology, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry, India
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Kanaya AM. Diabetes in South Asians: Uncovering Novel Risk Factors With Longitudinal Epidemiologic Data: Kelly West Award Lecture 2023. Diabetes Care 2024; 47:7-16. [PMID: 38117990 PMCID: PMC10733655 DOI: 10.2337/dci23-0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 10/03/2023] [Indexed: 12/22/2023]
Abstract
South Asian populations have a higher prevalence and earlier age of onset of type 2 diabetes and atherosclerotic cardiovascular diseases than other race and ethnic groups. To better understand the pathophysiology and multilevel risk factors for diabetes and cardiovascular disease, we established the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study in 2010. The original MASALA study cohort (n = 1,164) included 83% Asian Indian immigrants, with an ongoing expansion of the study to include individuals of Bangladeshi and Pakistani origin. We have found that South Asian Americans in the MASALA study had higher type 2 diabetes prevalence, lower insulin secretion, more insulin resistance, and an adverse body composition with higher liver and intermuscular fat and lower lean muscle mass compared with four other U.S. race and ethnic groups. MASALA study participants with diabetes were more likely to have the severe hyperglycemia subtype, characterized by β-cell dysfunction and lower body weight, and this subtype was associated with a higher incidence of subclinical atherosclerosis. We have found several modifiable factors for cardiometabolic disease among South Asians including diet and physical activity that can be influenced using specific social network members and with cultural adaptations to the U.S. context. Longitudinal data with repeat cardiometabolic measures that are supplemented with qualitative and mixed-method approaches enable a deeper understanding of disease risk and resilience factors. Studying and contrasting Asian American subgroups can uncover the causes for cardiometabolic disease heterogeneity and reveal novel methods for prevention and treatment.
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Affiliation(s)
- Alka M. Kanaya
- Division of General Internal Medicine, Departments of Medicine, Epidemiology, and Biostatistics, University of California, San Francisco, San Francisco, CA
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19
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Lucas A, Mlawer S, Weaver K, Caldwell J, Baig A, Zasadazinski L, Saunders M. Chicago Neighborhood Context and Racial/Ethnic Disparities in Maternal Diabetes. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01892-z. [PMID: 38157197 DOI: 10.1007/s40615-023-01892-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/17/2023] [Accepted: 11/29/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES To determine if rates of maternal diabetes vary by race, ethnicity, and neighborhood hardship. METHODS We conducted a secondary analysis of live births in Chicago from 2010 to 2017. Our sample was restricted to Non-Hispanic White, Non-Hispanic Black, Mexican, Non-Hispanic Asian, and Other Hispanic mothers between the ages of 15 and 50, with singleton births. The addresses of mothers were geocoded to specific neighborhoods, which we stratified into tertiles using the Economic Hardship Index. We used generalized logit mixed models to examine the interaction between race/ethnicity, neighborhood economic hardship, and maternal diabetes. RESULTS In our cohort of 299,053 mothers, 4.75% were diagnosed with gestational diabetes. Asian mothers had the highest frequency of gestational diabetes (8.3%), followed by Mexican mothers (6.8%). Within their respective racial/ethnic groups, Asian and Mexican mothers living in medium hardship neighborhoods had the highest odds of gestational diabetes compared to the reference group (OR 2.80, 95%CI 2.53, 3.19; OR 2.30, 95%CI 2.12, 2.49 respectively). Overall rates of preexisting diabetes were 0.9% and were highest among Mexican and Black mothers (1.26% and 1.06%, respectively). Asian mothers in medium hardship neighborhoods had the greatest odds of preexisting diabetes, among all Asian mothers and compared to the reference (OR 4.71 95% CI 3.60, 6.16). CONCLUSIONS For racial and ethnic minoritized mothers, gestational and preexisting diabetes do not increase in a step-wise fashion with neighborhood hardship; rates were often higher in low and medium hardship neighborhoods.
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Affiliation(s)
- Anika Lucas
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
- Durham Veterans Affairs Medical Center, Durham, NC, USA.
| | - Sophia Mlawer
- Data Science and Analytics, University of Chicago Medicine, Chicago, IL, USA
| | | | - Julia Caldwell
- Department of Public Health Los Angeles County, Los Angeles, CA, USA
| | - Arshiya Baig
- General Internal Medicine, University of Chicago Medicine, Chicago, IL, USA
| | | | - Milda Saunders
- General Internal Medicine, University of Chicago Medicine, Chicago, IL, USA
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20
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Muniyappa R, Narayanappa SBK. Disentangling Dual Threats: Premature Coronary Artery Disease and Early-Onset Type 2 Diabetes Mellitus in South Asians. J Endocr Soc 2023; 8:bvad167. [PMID: 38178904 PMCID: PMC10765382 DOI: 10.1210/jendso/bvad167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Indexed: 01/06/2024] Open
Abstract
South Asian individuals (SAs) face heightened risks of premature coronary artery disease (CAD) and early-onset type 2 diabetes mellitus (T2DM), with grave health, societal, and economic implications due to the region's dense population. Both conditions, influenced by cardiometabolic risk factors such as insulin resistance, hypertension, and central adiposity, manifest earlier and with unique thresholds in SAs. Epidemiological, demographic, nutritional, environmental, sociocultural, and economic transitions in SA have exacerbated the twin epidemic. The coupling of premature CAD and T2DM arises from increased obesity due to limited adipose storage, early-life undernutrition, distinct fat thresholds, reduced muscle mass, and a predisposition for hepatic fat accumulation from certain dietary choices cumulatively precipitating a decline in insulin sensitivity. As T2DM ensues, the β-cell adaptive responses are suboptimal, precipitating a transition from compensatory hyperinsulinemia to β-cell decompensation, underscoring a reduced functional β-cell reserve in SAs. This review delves into the interplay of these mechanisms and highlights a prediabetes endotype tied to elevated vascular risk. Deciphering these mechanistic interconnections promises to refine stratification paradigms, surpassing extant risk-prediction strategies.
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Affiliation(s)
- Ranganath Muniyappa
- Clinical Endocrine Section, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892, USA
| | - Satish Babu K Narayanappa
- Department of Medicine, Sri Madhusudan Sai Institute of Medical Sciences and Research, Muddenahalli, Karnataka 562101, India
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21
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Mandal S, Jaganathan S, Kondal D, Schwartz JD, Tandon N, Mohan V, Prabhakaran D, Narayan KMV. PM 2.5 exposure, glycemic markers and incidence of type 2 diabetes in two large Indian cities. BMJ Open Diabetes Res Care 2023; 11:e003333. [PMID: 37797962 PMCID: PMC10565186 DOI: 10.1136/bmjdrc-2023-003333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 08/29/2023] [Indexed: 10/07/2023] Open
Abstract
INTRODUCTION Exposure to fine particulate matter has been associated with several cardiovascular and cardiometabolic diseases. However, such evidence mostly originates from low-pollution settings or cross-sectional studies, thus necessitating evidence from regions with high air pollution levels, such as India, where the burden of non-communicable diseases is high. RESEARCH DESIGN AND METHODS We studied the associations between ambient PM2.5 levels and fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c) and incident type 2 diabetes mellitus (T2DM) among 12 064 participants in an adult cohort from urban Chennai and Delhi, India. A meta-analytic approach was used to combine estimates, obtained from mixed-effects models and proportional hazards models, from the two cities. RESULTS We observed that 10 μg/m3 differences in monthly average exposure to PM2.5 was associated with a 0.40 mg/dL increase in FPG (95% CI 0.22 to 0.58) and 0.021 unit increase in HbA1c (95% CI 0.009 to 0.032). Further, 10 μg/m3 differences in annual average PM2.5 was associated with 1.22 (95% CI 1.09 to 1.36) times increased risk of incident T2DM, with non-linear exposure response. CONCLUSIONS We observed evidence of temporal association between PM2.5 exposure, and higher FPG and incident T2DM in two urban environments in India, thus highlighting the potential for population-based mitigation policies to reduce the growing burden of diabetes.
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Affiliation(s)
| | | | - Dimple Kondal
- Centre for Chronic Disease Control, New Delhi, India
- Public Health Foundation of India, New Delhi, Delhi, India
| | - Joel D Schwartz
- Harvard T H Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Nikhil Tandon
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India
- Public Health Foundation of India, New Delhi, Delhi, India
| | - K M Venkat Narayan
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Nield L, Bhanbhro S, Steers H, Young A, Fowler Davis S. Impact of Voluntary, Community and Social Enterprise (VCSE) Organisations Working with Underserved Communities with Type 2 Diabetes Mellitus in England. Healthcare (Basel) 2023; 11:2499. [PMID: 37761696 PMCID: PMC10530582 DOI: 10.3390/healthcare11182499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/31/2023] [Accepted: 08/18/2023] [Indexed: 09/29/2023] Open
Abstract
The Voluntary, Community and Social Enterprise (VCSE) sector offers services and leadership within the health and care system in England and has a specialist role in working with underserved, deprived communities. This evaluation aims to identify best practices in self-management support for those living with type 2 diabetes mellitus (T2DM) and to develop a theory of change (TofC) through understanding the impact of VCSE organisations on diabetes management. An appreciative inquiry (AI) was carried out and co-delivered using qualitative interviews and an embedded analysis with VCSE partners. A voluntary service coordinated seven VCSE organisations who assisted with recruiting their service users and undertook interviews to identify the impact of existing activities and programmes. People living with T2DM were interviewed about services. Themes were as follows: (a) individual and group activities; (b) trusted services and relationships across the community; (c) long-term engagement; (d) sociocultural context of diet and nutritional choices; (e) experience of adaptation; and (f) culturally appropriate advice and independent VCSE organisations. The structured educational approach (DESMOND) for T2DM was accessed variably, despite these services being recommended by NICE guidelines as a standard intervention. The VCSE offered continuity and culturally appropriate services to more marginalised groups. This evaluation highlights the importance of targeted engagement with underserved communities, particularly where primary care services are more limited. The TofC is a unique insight into the impact of VCSE services, offering bespoke support to manage T2DM, suggesting areas for improvements in capacity and offering the capability to sustain the VCSE sector as an essential element of the T2DM care pathway in England.
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Affiliation(s)
- Lucie Nield
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield S10 2BP, UK
| | - Sadiq Bhanbhro
- Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield S1 1WB, UK;
| | - Helen Steers
- Voluntary Action Sheffield, Sheffield S1 4FW, UK;
| | - Anna Young
- Sheffield Hallam University Health Centre, Sheffield S1 1WB, UK;
| | - Sally Fowler Davis
- School of Allied Health, Anglia Ruskin University, Cambridge CB1 1PT, UK;
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23
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Carter JL, Abdullah N, Bragg F, Murad NAA, Taylor H, Fong CS, Lacey B, Sherliker P, Karpe F, Mustafa N, Lewington S, Jamal R. Body composition and risk factors for cardiovascular disease in global multi-ethnic populations. Int J Obes (Lond) 2023; 47:855-864. [PMID: 37460680 PMCID: PMC10439008 DOI: 10.1038/s41366-023-01339-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 06/21/2023] [Accepted: 07/04/2023] [Indexed: 08/20/2023]
Abstract
BACKGROUND No large-scale studies have compared associations between body composition and cardiovascular risk factors across multi-ethnic populations. METHODS Population-based surveys included 30,721 Malay, 10,865 Indian and 25,296 Chinese adults from The Malaysian Cohort, and 413,737 White adults from UK Biobank. Sex-specific linear regression models estimated associations of anthropometry and body composition (body mass index [BMI], waist circumference [WC], fat mass, appendicular lean mass) with systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C), triglycerides and HbA1c. RESULTS Compared to Malay and Indian participants, Chinese adults had lower BMI and fat mass while White participants were taller with more appendicular lean mass. For BMI and fat mass, positive associations with SBP and HbA1c were strongest among the Chinese and Malay and weaker in White participants. Associations with triglycerides were considerably weaker in those of Indian ethnicity (eg 0.09 [0.02] mmol/L per 5 kg/m2 BMI in men, vs 0.38 [0.02] in Chinese). For appendicular lean mass, there were weak associations among men; but stronger positive associations with SBP, triglycerides, and HbA1c, and inverse associations with LDL-C, among Malay and Indian women. Associations between WC and risk factors were generally strongest in Chinese and weakest in Indian ethnicities, although this pattern was reversed for HbA1c. CONCLUSION There were distinct patterns of adiposity and body composition and cardiovascular risk factors across ethnic groups. We need to better understand the mechanisms relating body composition with cardiovascular risk to attenuate the increasing global burden of obesity-related disease.
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Affiliation(s)
- Jennifer L Carter
- Clinical Trial Service Unit and Epidemiological Studies, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK.
| | - Noraidatulakma Abdullah
- UKM Medical Molecular Biology Institute (UMBI), Jalan Yaacob Latiff, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Fiona Bragg
- Clinical Trial Service Unit and Epidemiological Studies, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK
- Medical Research Council, Population Health Research Unit, University of Oxford, Oxford, UK
| | - Nor Azian Abdul Murad
- UKM Medical Molecular Biology Institute (UMBI), Jalan Yaacob Latiff, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Hannah Taylor
- Clinical Trial Service Unit and Epidemiological Studies, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK
| | - Chin Siok Fong
- UKM Medical Molecular Biology Institute (UMBI), Jalan Yaacob Latiff, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Benjamin Lacey
- Clinical Trial Service Unit and Epidemiological Studies, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK
| | - Paul Sherliker
- Clinical Trial Service Unit and Epidemiological Studies, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK
| | - Fredrik Karpe
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Churchill Hospital, Headington, OX3 7LE, UK
| | - Norlaila Mustafa
- Department of Medicine, Faculty of Medicine, University Kebangsaan Malaysia, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Sarah Lewington
- Clinical Trial Service Unit and Epidemiological Studies, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK
- UKM Medical Molecular Biology Institute (UMBI), Jalan Yaacob Latiff, 56000 Cheras, Kuala Lumpur, Malaysia
- Medical Research Council, Population Health Research Unit, University of Oxford, Oxford, UK
| | - Rahman Jamal
- UKM Medical Molecular Biology Institute (UMBI), Jalan Yaacob Latiff, 56000 Cheras, Kuala Lumpur, Malaysia
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Sharma P, Dilip TR, Mishra US, Kulkarni A. The lifetime risk of developing type II diabetes in an urban community in Mumbai: findings from a ten-year retrospective cohort study. BMC Public Health 2023; 23:1673. [PMID: 37653484 PMCID: PMC10469861 DOI: 10.1186/s12889-023-16596-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/23/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Incidence and prevalence do not capture the risk of developing diabetes during a defined period and only limited evidence exists on the lifetime risk of diabetes based on longer and continuous follow-up studies in India. Lacunae in evidence on lifetime risk can be attributed primarily to the absence of comprehensive and reliable information on diabetes incidence, mortality rates and lack of longitudinal studies in India. In light of the scarcity of evidence in India, the objective of this study was to estimate the incidence of diabetes and its lifetime risk in an urban community of Mumbai. METHODS The research study utilized data which is extracted from the electronic medical records of beneficiaries covered under the Contributory Health Service Scheme in Mumbai. The dataset included information on 1652 beneficiaries aged 40 years and above who were non-diabetic in 2011-2012, capturing their visit dates to medical center and corresponding laboratory test results over a span ten years from January, 2012- December, 2021. Survival analysis techniques are applied to estimate the incidence of diabetes. Subsequently, the remaining life years from the life table were utilized to estimate the lifetime risk of diabetes for each gender, stratified by age group. RESULTS A total of 546 beneficiaries developed diabetes in ten years, yielding an unadjusted incidence rate of 5.3 cases per 1000 person-years (95% CI: 4.9- 5.8 cases/ 1000 person years). The age-adjusted lifetime risk of developing type II diabetes in this urban community is estimated to be 40.3%. Notably, males aged 40 years and above had 41.5% chances of developing diabetes in their lifetime as compared to females with a risk of 39.4%. Moreover, the remaining lifetime risk of diabetes decreased with advancing age, ranging from 26.4% among 40-44 years old to 4.2% among those age 70 years and above. CONCLUSION The findings stress the significance of recognizing age specific lifetime risk and implementing early interventions to prevent or delay diabetes onset and to focus on diabetes management programs in India.
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Affiliation(s)
- Palak Sharma
- Department of Family and Generations, International Institute for Population Sciences, Mumbai, 400088, India.
| | - T R Dilip
- Department of Family and Generations, International Institute for Population Sciences, Mumbai, 400088, India
| | - Udaya Shankar Mishra
- Department of Bio-Statistics and Epidemiology, International Institute for Population Sciences, Mumbai, 400088, India
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25
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Hassan S, Gujral UP, Quarells RC, Rhodes EC, Shah MK, Obi J, Lee WH, Shamambo L, Weber MB, Narayan KMV. Disparities in diabetes prevalence and management by race and ethnicity in the USA: defining a path forward. Lancet Diabetes Endocrinol 2023; 11:509-524. [PMID: 37356445 PMCID: PMC11070656 DOI: 10.1016/s2213-8587(23)00129-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 05/01/2023] [Accepted: 05/01/2023] [Indexed: 06/27/2023]
Abstract
Type 2 diabetes disparities in the USA persist in both the prevalence of disease and diabetes-related complications. We conducted a literature review related to diabetes prevention, management, and complications across racial and ethnic groups in the USA. The objective of this review is to summarise the current understanding of diabetes disparities by examining differences between and within racial and ethnic groups and among young people (aged <18 years). We also examine the pathophysiology of diabetes as it relates to race and ethnic differences. We use a conceptual framework built on the socioecological model to categorise the causes of diabetes disparities across the lifespan looking at factors in five domains of health behaviours and social norms, public awareness, structural racism, economic development, and access to high-quality care. The range of disparities in diabetes prevalence and management in the USA calls for a community-engaged and multidisciplinary approach that must involve community partners, researchers, practitioners, health system administrators, and policy makers. We offer recommendations for each of these groups to help to promote equity in diabetes prevention and care in the USA.
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Affiliation(s)
- Saria Hassan
- Department of Medicine, Emory University, Atlanta, GA, USA; Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA.
| | - Unjali P Gujral
- Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA
| | - Rakale C Quarells
- Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Elizabeth C Rhodes
- Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA
| | - Megha K Shah
- Department of Family and Preventive Medicine, Emory University, Atlanta, GA, USA; Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA
| | - Jane Obi
- Emory School of Medicine, and the Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Emory University, Atlanta, GA, USA; Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA
| | - Wei-Hsuan Lee
- Department of Medicine, Emory University, Atlanta, GA, USA
| | - Luwi Shamambo
- Department of Medicine, Emory University, Atlanta, GA, USA
| | - Mary Beth Weber
- Emory School of Medicine, and the Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Emory University, Atlanta, GA, USA; Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA
| | - K M Venkat Narayan
- Department of Medicine, Emory University, Atlanta, GA, USA; Emory School of Medicine, and the Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Emory University, Atlanta, GA, USA; Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA
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Anjana RM, Unnikrishnan R, Deepa M, Pradeepa R, Tandon N, Das AK, Joshi S, Bajaj S, Jabbar PK, Das HK, Kumar A, Dhandhania VK, Bhansali A, Rao PV, Desai A, Kalra S, Gupta A, Lakshmy R, Madhu SV, Elangovan N, Chowdhury S, Venkatesan U, Subashini R, Kaur T, Dhaliwal RS, Mohan V. Metabolic non-communicable disease health report of India: the ICMR-INDIAB national cross-sectional study (ICMR-INDIAB-17). Lancet Diabetes Endocrinol 2023; 11:474-489. [PMID: 37301218 DOI: 10.1016/s2213-8587(23)00119-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Non-communicable disease (NCD) rates are rapidly increasing in India with wide regional variations. We aimed to quantify the prevalence of metabolic NCDs in India and analyse interstate and inter-regional variations. METHODS The Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study, a cross-sectional population-based survey, assessed a representative sample of individuals aged 20 years and older drawn from urban and rural areas of 31 states, union territories, and the National Capital Territory of India. We conducted the survey in multiple phases with a stratified multistage sampling design, using three-level stratification based on geography, population size, and socioeconomic status of each state. Diabetes and prediabetes were diagnosed using the WHO criteria, hypertension using the Eighth Joint National Committee guidelines, obesity (generalised and abdominal) using the WHO Asia Pacific guidelines, and dyslipidaemia using the National Cholesterol Education Program-Adult Treatment Panel III guidelines. FINDINGS A total of 113 043 individuals (79 506 from rural areas and 33 537 from urban areas) participated in the ICMR-INDIAB study between Oct 18, 2008 and Dec 17, 2020. The overall weighted prevalence of diabetes was 11·4% (95% CI 10·2-12·5; 10 151 of 107 119 individuals), prediabetes 15·3% (13·9-16·6; 15 496 of 107 119 individuals), hypertension 35·5% (33·8-37·3; 35 172 of 111 439 individuals), generalised obesity 28·6% (26·9-30·3; 29 861 of 110 368 individuals), abdominal obesity 39·5% (37·7-41·4; 40 121 of 108 665 individuals), and dyslipidaemia 81·2% (77·9-84·5; 14 895 of 18 492 of 25 647). All metabolic NCDs except prediabetes were more frequent in urban than rural areas. In many states with a lower human development index, the ratio of diabetes to prediabetes was less than 1. INTERPRETATION The prevalence of diabetes and other metabolic NCDs in India is considerably higher than previously estimated. While the diabetes epidemic is stabilising in the more developed states of the country, it is still increasing in most other states. Thus, there are serious implications for the nation, warranting urgent state-specific policies and interventions to arrest the rapidly rising epidemic of metabolic NCDs in India. FUNDING Indian Council of Medical Research and Department of Health Research, Ministry of Health and Family Welfare, Government of India.
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Affiliation(s)
- Ranjit Mohan Anjana
- Department of Diabetology, Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India.
| | - Ranjit Unnikrishnan
- Department of Diabetology, Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | - Mohan Deepa
- Department of Epidemiology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Rajendra Pradeepa
- Department of Research Operations & Diabetes Complications, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Nikhil Tandon
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Ashok Kumar Das
- Department of General Medicine & Endocrinology, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Shashank Joshi
- Department of Diabetology & Endocrinology, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Sarita Bajaj
- Department of Medicine, Moti Lal Nehru Medical College, Prayagraj, Uttar Pradesh, India
| | | | | | - Ajay Kumar
- Department of Diabetology, Diabetes Care and Research Centre, Patna, Bihar, India
| | | | - Anil Bhansali
- Department of Endocrinology, Gini Health, Mohali, Punjab, India
| | - Paturi Vishnupriya Rao
- Department of Endocrinology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Ankush Desai
- Department of Endocrinology, Goa Medical College, Bambolim, Goa, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
| | - Arvind Gupta
- Department of Diabetology, Jaipur Diabetes Research Centre, Jaipur, Rajasthan, India
| | - Ramakrishnan Lakshmy
- Department of Cardiac Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - Sri Venkata Madhu
- Department of Endocrinology, University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Nirmal Elangovan
- Department of Research Operations & Diabetes Complications, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Subhankar Chowdhury
- Department of Endocrinology & Metabolism, Institute of Post Graduate Medical Education & Research (IPGMER) & SSKM Hospital, Kolkata, West Bengal, India
| | | | - Radhakrishnan Subashini
- Department of Biostatistics, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Tanvir Kaur
- Non-Communicable Disease Division, Indian Council of Medical Research, New Delhi, India
| | | | - Viswanathan Mohan
- Department of Diabetology, Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
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Wild S. Cardiometabolic risk factor prevalence in a representative population of adults in India. Lancet Diabetes Endocrinol 2023; 11:444-446. [PMID: 37301219 DOI: 10.1016/s2213-8587(23)00163-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023]
Affiliation(s)
- Sarah Wild
- Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UK.
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Yesmin M, Ali M, Saha S. The prevalence and influencing factors of coexisting prediabetes and prehypertension among Bangladeshi adults. BMC Public Health 2023; 23:1184. [PMID: 37337196 DOI: 10.1186/s12889-023-16090-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/09/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Early detection of diabetes and hypertension is helpful to prevent and/or delay the onset of these diseases through proper interventions. Therefore, it is a prerequisite to know the prevalence of prediabetes and prehypertension and the factors associated with these conditions but people from developing countries including Bangladesh often remain undiagnosed and unaware of these conditions. In this study we investigate the prevalence of prediabetes and prehypertension and their associated factors in Bangladesh using nationally representative data. METHOD We used nationally representative Bangladesh Demographic and Health Survey (BDHS) 2017-18 survey data, which included a total sample of 14,704 adults aged 18 years and more from whom blood pressure and fasting plasma glucose were collected. Chi-square test was used to examine the differences between sociodemographic and outcome variables. The univariate and multivariate logistic regression was performed to identify the factors associated with prediabetes and prehypertension. RESULTS Overall, the prevalence of prediabetes and prehypertension was 8.6% with 14% of the sampled population having from prediabetes and prehypertension separately. Among the prediabetic and prehypertensive participants, one-fourth of the participant were from the richest families and around one-third were overweight/obese, while more than fifty percent had normal Body Mass Index (BMI) and completed secondary and higher education. In the univariate analysis, the richest wealth status (UOR 3.3, 95% CI: 2.46 -4.35) and overweight/obesity (UOR 3.2, 95% CI: 2.62-3.85) are the highest predictors for prediabetes and prehypertension. After adjusting the other variables, overweight/obesity remains the largest predictor for prediabetes and prehypertension (AOR:2.5, 95% CI:2.05-3.05). Further, people aged 31 and above and from the richest family had around 2 times and 1.8 times higher risk of being prediabetic and prehypertensive compared to the younger age people (18-30 years) and the poorest family (respectively). CONCLUSION The coexistence of prediabetes and prehypertension is an early sign of a greater burden of noncommunicable diseases (NCDs) in the near future for Bangladesh. To reduce the higher burden of NCDs, our findings call for a multisectoral approach to identify the precondition of NCDs with particular attention to maintaining body weight.
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Affiliation(s)
- Maksuda Yesmin
- Health Economics Unit, Department of Clinical Science (Malmö), Lund University, Medicon Village, Scheelevagen 2, 223 63, Lund, Sweden
| | - Masum Ali
- International Food Policy Research Institute (IFPRI), Dhaka, Bangladesh
| | - Sanjib Saha
- Health Economics Unit, Department of Clinical Science (Malmö), Lund University, Medicon Village, Scheelevagen 2, 223 63, Lund, Sweden.
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Choi Y, Kwon HK, Park S. Polygenic Variants Linked to Oxidative Stress and the Antioxidant System Are Associated with Type 2 Diabetes Risk and Interact with Lifestyle Factors. Antioxidants (Basel) 2023; 12:1280. [PMID: 37372010 DOI: 10.3390/antiox12061280] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Oxidative stress is associated with insulin resistance and secretion, and antioxidant systems are essential for preventing and managing type 2 diabetes (T2DM). This study aimed to explore the polygenic variants linked to oxidative stress and the antioxidant system among those associated with T2DM and the interaction of their polygenic risk scores (PRSs) with lifestyle factors in a large hospital-based cohort (n = 58,701). Genotyping, anthropometric, biochemical, and dietary assessments were conducted for all participants with an average body mass index of 23.9 kg/m2. Genetic variants associated with T2DM were searched through genome-wide association studies in participants with T2DM (n = 5383) and without T2DM (n = 53,318). The Gene Ontology database was searched for the antioxidant systems and oxidative stress-related genes among the genetic variants associated with T2DM risk, and the PRS was generated by summing the risk alleles of selected ones. Gene expression according to the genetic variant alleles was determined on the FUMA website. Food components with low binding energy to the GSTA5 protein generated from the wildtype and mutated GSTA5_rs7739421 (missense mutation) genes were selected using in silico analysis. Glutathione metabolism-related genes, including glutathione peroxidase (GPX)1 and GPX3, glutathione disulfide reductase (GSR), peroxiredoxin-6 (PRDX6), glutamate-cysteine ligase catalytic subunit (GCLC), glutathione S-transferase alpha-5 (GSTA5), and gamma-glutamyltransferase-1 (GGT1), were predominantly selected with a relevance score of >7. The PRS related to the antioxidant system was positively associated with T2DM (ORs = 1.423, 95% CI = 1.22-1.66). The active site of the GASTA proteins having valine or leucine at 55 due to the missense mutation (rs7739421) had a low binding energy (<-10 kcal/mol) similarly or differently to some flavonoids and anthocyanins. The PRS interacted with the intake of bioactive components (specifically dietary antioxidants, vitamin C, vitamin D, and coffee) and smoking status (p < 0.05). In conclusion, individuals with a higher PRS related to the antioxidant system may have an increased risk of T2DM, and there is a potential indication that exogenous antioxidant intake may alleviate this risk, providing insights for personalized strategies in T2DM prevention.
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Affiliation(s)
- Youngjin Choi
- Department of Food Science & Technology, Hoseo University, Asan 31499, Republic of Korea
| | - Hyuk-Ku Kwon
- Department of Environmental Engineering, Hoseo University, Asan 31499, Republic of Korea
| | - Sunmin Park
- Department of Food and Nutrition, Obesity/Diabetes Research Center, Hoseo University, Asan 31499, Republic of Korea
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Punnose J, Sukhija K, Rijhwani RM. Intermediate hyperglycemia in early pregnancy: A South Asian perspective. World J Diabetes 2023; 14:573-584. [PMID: 37273252 PMCID: PMC10236988 DOI: 10.4239/wjd.v14.i5.573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/28/2023] [Accepted: 04/07/2023] [Indexed: 05/15/2023] Open
Abstract
“Intermediate hyperglycemia in early pregnancy (IHEP)” refers to mild hyperglycemia detected before 24 gestational weeks (GW), satisfying the criteria for the diagnosis of gestational diabetes mellitus. Many professional bodies recommend routine screening for “overt diabetes” in early pregnancy, which identifies a significant number of women with mild hyperglycemia of undetermined significance. A literature search revealed that one-third of GDM women in South Asian countries are diagnosed before the conventional screening period of 24 GW to 28 GW; hence, they belong in the IHEP category. Most hospitals in this region diagnose IHEP by oral glucose tolerance test (OGTT) using the same criteria used for GDM diagnosis after 24 GW. There is some evidence to suggest that South Asian women with IHEP are more prone to adverse pregnancy events than women with a diagnosis of GDM after 24 GW, but this observation needs to be proven by randomized control trials. Fasting plasma glucose is a reliable screening test for GDM that can obviate the need for OGTT for GDM diagnosis among 50% of South Asian pregnant women. HbA1c in the first trimester predicts GDM in later pregnancy, but it is not a reliable test for IHEP diagnosis. There is evidence to suggest that HbA1c in the first trimester is an independent risk factor for several adverse pregnancy events. Further research to identify the patho-genetic mechanisms behind the fetal and maternal effects of IHEP is strongly recommended.
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Affiliation(s)
- John Punnose
- Department of Endocrinology and Metabolism, St. Stephen’s Hospital, Delhi 110054, India
| | - Komal Sukhija
- Department of Endocrinology, St.Stephen’s Hospital, Delhi 110054, India
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31
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Wetzel S, Geldsetzer P, Mani SS, Gupta A, Singh K, Ali MK, Prabhakaran D, Tandon N, Sudharsanan N. Changing socioeconomic and geographic gradients in cardiovascular disease risk factors among Indians aged 15-49 years - evidence from nationally representative household surveys. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 12:100188. [PMID: 37384058 PMCID: PMC10305936 DOI: 10.1016/j.lansea.2023.100188] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 03/21/2023] [Accepted: 03/23/2023] [Indexed: 06/30/2023]
Abstract
Background Cardiovascular diseases (CVDs) are the leading cause of death in most low- and middle-income countries (LMICs). CVDs and their metabolic risk factors have historically been concentrated among urban residents with higher socioeconomic status (SES) in LMICs such as India. However, as India develops, it is unclear whether these socioeconomic and geographic gradients will persist or change. Understanding these social dynamics in CVD risk is essential for mitigating the rising burden of CVDs and to reach those with the greatest needs. Methods Using nationally representative data with biomarker measurements from the fourth (2015-16) and fifth (2019-21) Indian National Family and Health Surveys, we investigated trends in the prevalence of four CVD risk factors: smoking (self-reported), unhealthy weight (BMI ≥25 kgm2), diabetes (random plasma glucose concentration ≥200 mg/dL or self-reported diabetes), and hypertension (one of: average systolic blood pressure ≥140 mmHg, average diastolic blood pressure ≥90 mmHg, self-reported past diagnosis, or self-reported current antihypertensive medication use) among adults aged 15-49 years. We first described changes at the national level and then trends stratified by place of residence (urban versus rural), geographic region (northern, northeastern, central, eastern, western, southern), regional level of development (Empowered Action Group member state or not), and two measures of socioeconomic status: level of education (no education, primary incomplete, primary complete, secondary incomplete, secondary complete, higher) and wealth (quintiles). Findings Unhealthy weight increased among all social and geographic groups but both the absolute and the relative changes were substantially higher among people with low SES (as measured by education or wealth) and in rural areas. For diabetes and hypertension, the prevalence increased for those from disadvantaged groups while staying constant or even decreasing among the wealthier and more educated. In contrast, smoking consumption declined for all social and geographic groups. Interpretation In 2015-16, CVD risk factors were higher among more advantaged subpopulations in India. However, between 2015-16 and 2019-21, the prevalence of these risk factors grew more rapidly for less wealthy and less educated subpopulations and those living in rural areas. These trends have resulted in CVD risk becoming far more widespread throughout the population; CVD can no longer be characterized as a wealthy urban phenomenon. Funding This work was supported by the Alexander von Humboldt Foundation (grant received by NS); the Stanford Diabetes Research Center [grant received by PG] and the Chan Zuckerberg Biohub [grant received by PG].
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Affiliation(s)
- Sarah Wetzel
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - Sneha Sarah Mani
- Graduate Group in Demography, University of Pennsylvania, PA, USA
| | - Aashish Gupta
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Harvard University, MA, USA
| | - Kavita Singh
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurugram, Haryana, India
| | - Mohammed K. Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, India
- Public Health Foundation of India, India
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, India
| | - Nikkil Sudharsanan
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Behavioral Science for Disease Prevention and Health Care, Technical University of Munich, Munich, Germany
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Farhat G. Culturally Tailored Dietary Interventions for Improving Glycaemic Control and Preventing Complications in South Asians with Type 2 Diabetes: Success and Future Implications. Healthcare (Basel) 2023; 11:healthcare11081123. [PMID: 37107956 PMCID: PMC10138081 DOI: 10.3390/healthcare11081123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/04/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
Glycaemic control is the basis of type 2 diabetes mellitus (T2DM) management and is crucial for preventing diabetes microvascular and macrovascular complications. The South Asian population is at higher risk of T2DM and resultant cardiovascular disease, peripheral vascular disease and death compared to Caucasians. Effective diabetes care has been deemed challenging in this population, but little is known about the usefulness of lifestyle interventions in improving glycaemic control and reducing complications. This narrative review aims to explore the efficacy of lifestyle interventions targeted to South Asians with T2DM in inducing clinically relevant improvements in HbA1c levels at such levels that reduce the risk of diabetes complications. A search of the literature using six databases (MEDLINE (EBSCOhost), PubMed, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials and Scopus) identified dietary-based, physical-activity-based and education-based interventions that aimed to manage T2DM in South Asians. Results showed that dietary and physical activity interventions (duration 3-12 months) have been effective in generating a clinically relevant decrease in HbA1c levels (≥0.5%) in South Asians with T2DM and could potentially assist in reducing diabetes complications. Education-based interventions produced small effects on glycaemic control. These outcomes support the development of comparable longer-term randomised clinical trials combining dietary and physical activity interventions with the aim to provide further evidence on specific interventions that can lower complications and ensure effective diabetes care in a high-risk population.
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Affiliation(s)
- Grace Farhat
- Faculty of Health and Education, Manchester Metropolitan University, Manchester M15 6BG, UK
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Katsiki N, Rizzo M, Mikhailidis DP. Epicardial, peripancreatic and other "orthotopic" excessive fat deposition in south Asians and Europeans: Are differences clinically relevant? J Diabetes Complications 2023; 37:108419. [PMID: 36871315 DOI: 10.1016/j.jdiacomp.2023.108419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 02/05/2023] [Indexed: 02/12/2023]
Affiliation(s)
- Niki Katsiki
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece
- School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Manfredi Rizzo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, School of Medicine, University of Palermo, Italy
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London, London, UK
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Narayan KMV, Varghese JS, Beyh YS, Bhattacharyya S, Khandelwal S, Krishnan GS, Siegel KR, Thomas T, Kurpad AV. A Strategic Research Framework for Defeating Diabetes in India: A 21st-Century Agenda. J Indian Inst Sci 2023; 103:1-22. [PMID: 37362852 PMCID: PMC10029804 DOI: 10.1007/s41745-022-00354-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 12/14/2022] [Indexed: 03/24/2023]
Abstract
Indian people are at high risk for type 2 diabetes (T2DM) even at younger ages and lower body weights. Already 74 million people in India have the disease, and the proportion of those with T2DM is increasing across all strata of society. Unique aspects, related to lower insulin secretion or function, and higher hepatic fat deposition, accompanied by the rise in overweight (related to lifestyle changes) may all be responsible for this unrelenting epidemic of T2DM. Yet, research to understand the causes, pathophysiology, phenotypes, prevention, treatment, and healthcare delivery of T2DM in India seriously lags behind. There are major opportunities for scientific discovery and technological innovation, which if tapped can generate solutions for T2DM relevant to the country's context and make leading contributions to global science. We analyze the situation of T2DM in India, and present a four-pillar (etiology, precision medicine, implementation research, and health policy) strategic research framework to tackle the challenge. We offer key research questions for each pillar, and identify infrastructure needs. India offers a fertile environment for shifting the paradigm from imprecise late-stage diabetes treatment toward early-stage precision prevention and care. Investing in and leveraging academic and technological infrastructures, across the disciplines of science, engineering, and medicine, can accelerate progress toward a diabetes-free nation.
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Affiliation(s)
- K. M. Venkat Narayan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322 USA
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center, Emory University, Atlanta, GA 30322 USA
| | - Jithin Sam Varghese
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322 USA
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center, Emory University, Atlanta, GA 30322 USA
| | - Yara S. Beyh
- Laney Graduate School, Nutrition and Health Sciences Doctoral Program, Emory University, Atlanta, USA
| | | | | | - Gokul S. Krishnan
- Robert Bosch Centre for Data Science and Artificial Intelligence, Indian Institute of Technology Madras, Chennai, India
| | - Karen R. Siegel
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322 USA
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center, Emory University, Atlanta, GA 30322 USA
| | - Tinku Thomas
- Department of Biostatistics, St. John’s Medical College, Bengaluru, India
| | - Anura V. Kurpad
- Department of Physiology, St. John’s Medical College, Bengaluru, India
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Agarwala A, Satish P, Rifai MA, Mehta A, Cainzos-Achirica M, Shah NS, Kanaya AM, Sharma GV, Dixon DL, Blumenthal RS, Natarajan P, Nasir K, Virani SS, Patel J. Identification and Management of Atherosclerotic Cardiovascular Disease Risk in South Asian Populations in the U.S. JACC. ADVANCES 2023; 2:100258. [PMID: 38089916 PMCID: PMC10715803 DOI: 10.1016/j.jacadv.2023.100258] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
South Asians (SAs, individuals with ancestry from Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka) are among the fastest growing ethnic subgroups in the United States. SAs typically experience a high prevalence of diabetes, abdominal obesity, and hypertension, among other cardiovascular disease risk factors, which are often under recognized and undermanaged. The excess coronary heart disease risk in this growing population must be critically assessed and managed with culturally appropriate preventive services. Accordingly, this scientific document prepared by a multidisciplinary group of clinicians and investigators in cardiology, internal medicine, pharmacy, and SA-centric researchers describes key characteristics of traditional and nontraditional cardiovascular disease risk factors, compares and contrasts available risk assessment tools, discusses the role of blood-based biomarkers and coronary artery calcium to enhance risk assessment and prevention strategies, and provides evidenced-based approaches and interventions that may reduce coronary heart disease disparities in this higher-risk population.
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Affiliation(s)
- Anandita Agarwala
- Center for Cardiovascular Disease Prevention, Baylor Scott and White Health Heart Hospital Baylor Plano, Plano, Texas, USA
| | - Priyanka Satish
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Mahmoud Al Rifai
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, South Asian Cardiovascular Health Initiative (SACHI), Baltimore, Maryland, USA
| | - Anurag Mehta
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Miguel Cainzos-Achirica
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, South Asian Cardiovascular Health Initiative (SACHI), Baltimore, Maryland, USA
- Institut Hospital del Mar d’Investigacions Mediques (IMIM), Barcelona, Spain
- Hospital del Mar, Parc Salut Mar, Barcelona, Spain
| | - Nilay S. Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alka M. Kanaya
- Division of General Internal Medicine, University of California San Francisco, San Francisco, California, USA
| | - Garima V. Sharma
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, South Asian Cardiovascular Health Initiative (SACHI), Baltimore, Maryland, USA
| | - Dave L. Dixon
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Roger S. Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, South Asian Cardiovascular Health Initiative (SACHI), Baltimore, Maryland, USA
| | - Pradeep Natarajan
- Cardiovascular Disease Initiative Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Cardiovascular Research Center Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
- Center for Outcomes Research, Houston Methodist, Houston, Texas, USA
| | - Salim S. Virani
- Aga Khan University, Karachi, Pakistan
- Texas Heart Institute, Baylor College of Medicine, Houston, Texas, USA
| | - Jaideep Patel
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, South Asian Cardiovascular Health Initiative (SACHI), Baltimore, Maryland, USA
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Mohan V, Joshi S, Mithal A, Kesavadev J, Unnikrishnan AG, Saboo B, Kumar P, Chawla M, Bhograj A, Kovil R. Expert Consensus Recommendations on Time in Range for Monitoring Glucose Levels in People with Diabetes: An Indian Perspective. Diabetes Ther 2023; 14:237-249. [PMID: 36705888 PMCID: PMC9943834 DOI: 10.1007/s13300-022-01355-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/05/2022] [Indexed: 01/28/2023] Open
Abstract
Keeping up with the global scenario, diabetes prevalence is on rise in India. Inadequate glycemic control is a major cause of diabetes-related morbidity and mortality. The conventional standards of care (SOC) in diabetes, including self-monitoring of blood glucose and measurement of glycated hemoglobin, have supported achievement of glycemic control, yet there are a few limitations. With the use of current technologies and metrics, such as continuous glucose monitoring (CGM) and standardized CGM data reporting, the continuous real-time glucose levels can be measured, and importantly, the percentage of time above, below, and within the target glucose range can be calculated, which facilitates patient-centric care, a current goal in diabetes management. International consensus recommendations endorse the incorporation of CGM and CGM data reporting in SOC for diabetes management. The guidelines provide time in range (TIR) thresholds for different patient populations and different types of diabetes. However, extrapolation of these global guidelines does not aptly cover the Indian population, which has diverse diet, culture, and religious practices. In this context, a consensus meeting was held in India in 2021 with experts in the field of diabetes care. The purpose of the meeting was to develop consensus recommendations for TIR thresholds for different patient profiles in India. Those expert recommendations, together with an evidence-based review, are reported here. The aim of this agreement is to aid clinicians across India to routinely use CGM and CGM data reports for optimizing individualized diabetes care, by implementing clinical targets for TIR.
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Affiliation(s)
| | - Shashank Joshi
- Department of Endocrinology, Lilavati Hospital, Mumbai, India
| | | | - Jothydev Kesavadev
- Department of Endocrinology, Jothydev's Diabetes Research Centres, Trivandrum, Kerala, India
| | - Ambika G Unnikrishnan
- Department of Endocrinology, Chellaram Hospital-Diabetes Care and Multispecialty, Bavdhan, Pune, India
| | - Banshi Saboo
- Department of Diabetology, Diabetes Care Hormone Clinic, Ambawadi, Ahmedabad, India
| | - Prasanna Kumar
- Department of Endocrinology, Center for Diabetes and Endocrine Care, Kalyanangar, Bengaluru, India
| | - Manoj Chawla
- Department of Endocrinology, SL Raheja Hospital, Mumbai, Maharashtra, India
| | - Abhijit Bhograj
- Department of Endocrinology, Manipal Hospital, Hebbal, Bengaluru, Karnataka, India
| | - Rajiv Kovil
- Department of Diabetology, Dr. Kovil's Diabetes Care, Centre Andheri (West), Mumbai, India
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Vijayan M, Deshpande K, Anand S, Deshpande P. Risk Amplifiers for Vascular Disease and CKD in South Asians: When Intrinsic β-Cell Dysfunction Meets a High-Carbohydrate Diet. Clin J Am Soc Nephrol 2023; 18:01277230-990000000-00039. [PMID: 36758530 PMCID: PMC10278793 DOI: 10.2215/cjn.0000000000000076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
South Asians, comprising almost one fourth of the world population, are at higher risk of type 2 diabetes mellitus, hypertension, cardiovascular disease, and CKD compared with other ethnic groups. This has major public health implications in South Asia and in other parts of the world to where South Asians have immigrated. The interplay of various modifiable and nonmodifiable risk factors confers this risk. Traditional models of cardiometabolic disease progression and CKD evaluation may not be applicable in this population with a unique genetic predisposition and phenotype. A wider understanding of dietary and lifestyle influences, genetic and metabolic risk factors, and the pitfalls of conventional equations estimating kidney function in this population are required in providing care for kidney diseases. Targeted screening of this population for metabolic and vascular risk factors and individualized management plan for disease management may be necessary. Addressing unhealthy dietary patterns, promoting physical activity, and medication management that adheres to cultural factors are crucial steps to mitigate the risk of cardiovascular disease and CKD in this population. In South Asian countries, a large rural and urban community-based multipronged approach using polypills and community health workers to decrease the incidence of these diseases may be cost-effective.
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Affiliation(s)
- Madhusudan Vijayan
- Barbara T. Murphy Division of Nephrology, Department of Medicine, Icahn School of Medicine at the Mount Sinai Hospital, New York, New York
- Institute for Critical Care Medicine, Icahn School of Medicine at the Mount Sinai Hospital, New York, New York
| | - Kavita Deshpande
- Department of Family Medicine, La Maestra Community Health Centers, San Diego, California
| | - Shuchi Anand
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Priya Deshpande
- Barbara T. Murphy Division of Nephrology, Department of Medicine, Icahn School of Medicine at the Mount Sinai Hospital, New York, New York
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Shivashri C, Hannah W, Deepa M, Ghebremichael-Weldeselassie Y, Anjana RM, Uma R, Mohan V, Saravanan P. Prevalence of prediabetes and type 2 diabetes mellitus in south and southeast Asian women with history of gestational diabetes mellitus: Systematic review and meta-analysis. PLoS One 2022; 17:e0278919. [PMID: 36508451 PMCID: PMC9744276 DOI: 10.1371/journal.pone.0278919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The burden of Gestational Diabetes Mellitus (GDM) is very high in south Asia (SA) and southeast Asia (SEA). Thus, there is a need to understand the prevalence and risk factors for developing prediabetes and type 2 diabetes mellitus (T2DM) postpartum, in this high-risk population. AIM To conduct a systematic review and meta-analysis to estimate the prevalence of prediabetes and T2DM among the women with history of GDM in SA and SEA. METHODS A comprehensive literature search was performed in the following databases: Medline, EMBASE, Web of Knowledge and CINHAL till December 2021. Studies that had reported greater than six weeks of postpartum follow-up were included. The pooled prevalence of diabetes and prediabetes were estimated by random effects meta-analysis model and I2 statistic was used to assess heterogeneity. RESULTS Meta-analysis of 13 studies revealed that the prevalence of prediabetes and T2DM in post-GDM women were 25.9% (95%CI 18.94 to 33.51) and 29.9% (95%CI 17.02 to 44.57) respectively. Women with history of GDM from SA and SEA seem to have higher risk of developing T2DM than women without GDM (RR 13.2, 95%CI 9.52 to 18.29, p<0.001). The subgroup analysis showed a rise in the prevalence of T2DM with increasing duration of follow-up. CONCLUSION The conversion to T2DM and prediabetes is very high among women with history of GDM in SA and SEA. This highlights the need for follow-up of GDM women for early identification of dysglycemia and to plan interventions to prevent/delay the progression to T2DM.
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Affiliation(s)
- Chockalingam Shivashri
- Division of Populations, Evidence, and Technologies of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Madras Diabetes Research Foundation and Dr. Mohan’s Diabetes Specialities Centre, ICMR Center for Advanced Research on Diabetes, Chennai, Tamil Nadu, India
| | - Wesley Hannah
- Madras Diabetes Research Foundation and Dr. Mohan’s Diabetes Specialities Centre, ICMR Center for Advanced Research on Diabetes, Chennai, Tamil Nadu, India
| | - Mohan Deepa
- Madras Diabetes Research Foundation and Dr. Mohan’s Diabetes Specialities Centre, ICMR Center for Advanced Research on Diabetes, Chennai, Tamil Nadu, India
| | - Yonas Ghebremichael-Weldeselassie
- Division of Populations, Evidence, and Technologies of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
- School of Mathematics and Statistics, The Open University, Milton Keynes, United Kingdom
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation and Dr. Mohan’s Diabetes Specialities Centre, ICMR Center for Advanced Research on Diabetes, Chennai, Tamil Nadu, India
| | - Ram Uma
- Seethapathy Clinic & Hospital, Chennai, Tamil Nadu, India
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr. Mohan’s Diabetes Specialities Centre, ICMR Center for Advanced Research on Diabetes, Chennai, Tamil Nadu, India
| | - Ponnusamy Saravanan
- Division of Populations, Evidence, and Technologies of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Department of Diabetes, Endocrinology, and Metabolism, George Eliot Hospital, Nuneaton, United Kingdom
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Tang Z, Xu W, Zhang M. Association between type 2 diabetes and 5-year overall survival in early-stage pancreatic cancer: a retrospective cohort study. PeerJ 2022; 10:e14538. [PMID: 36530401 PMCID: PMC9753753 DOI: 10.7717/peerj.14538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/17/2022] [Indexed: 12/14/2022] Open
Abstract
Background This study examined the association between type 2 diabetes mellitus (T2DM) and 5-year overall survival (OS) in patients with pancreatic cancer (PC). Methods This retrospective cohort study included patients diagnosed with stage I/II PC at Shengjing Hospital of China Medical University from January 2012 to December 2017. All patients had pancreatic ductal adenocarcinoma or its subtypes. The outcome was the 5-year OS rate based on data from the patient charts. Data analysis was performed using SPSS 22.0. Results A total of 238 patients were included: 72 with T2DM and 166 without T2DM. There were significant differences in blood glucose levels and OS between the two groups (all P < 0.05). The median OS was 11.4 (95% confidence interval CI [8.49-14.31]) months in the T2DM group and 16.3 (95% CI [12.44-20.16], P = 0.023) months in the non-T2DM group. After adjustment for confounders, T2DM was an independent factor affecting 5-year OS (P = 0.010). Compared with non-T2DM patients, T2DM patients had a higher risk of death (HR = 1.475, 95% CI [1.096-1.985]). Conclusions T2DM is associated with 5-year OS in patients with PC.
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Affiliation(s)
- Zhiyin Tang
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Wanfeng Xu
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Mingming Zhang
- Department of Pathology, Shengjing Hospital of China Medical University, Shenyang, China
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Sharma A, Lee-Ødegård S, Qvigstad E, Sommer C, Sattar N, Gill JMR, Gulseth HL, Sollid ST, Nermoen I, Birkeland KI. β-Cell Function, Hepatic Insulin Clearance, and Insulin Sensitivity in South Asian and Nordic Women After Gestational Diabetes Mellitus. Diabetes 2022; 71:2530-2538. [PMID: 36112815 DOI: 10.2337/db22-0622] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/14/2022] [Indexed: 01/11/2023]
Abstract
South Asian women have a higher risk of type 2 diabetes after gestational diabetes mellitus (GDM) than Nordic women; however, the mechanisms behind this difference remain unclear. We investigated insulin sensitivity, β-cell function, and hepatic insulin clearance in 179 South Asian and 108 Nordic women ∼17 months after GDM (mean age 35.3 years, BMI 29.1 kg/m2) by oral glucose tolerance test using deconvolution of C-peptide kinetics. Thirty-one percent of South Asian and 53% of Nordic participants were normoglycemic at the time of measurement. South Asian women had higher areas under the curve (AUCs) for glucose, prehepatic insulin, and peripheral insulin and lower insulin sensitivity, disposition index, and fasting hepatic insulin clearance than Nordic women. In the group with prediabetes or diabetes, South Asian women had similar AUCs for glucose and prehepatic insulin but a higher AUC for peripheral insulin, lower disposition index, and lower fasting hepatic insulin clearance than Nordic women. The waist-to-height ratio mediated ∼25-40% of the ethnic differences in insulin sensitivity in participants with normoglycemia. Overall, our novel data revealed that South Asian women with normoglycemia after GDM showed lower insulin secretion for a given insulin resistance and lower hepatic insulin clearance than Nordic women. South Asian women are at high risk of developing type 2 diabetes after GDM, and preventive efforts should be prioritized.
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Affiliation(s)
- Archana Sharma
- Department of Endocrinology, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Elisabeth Qvigstad
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Christine Sommer
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K
| | - Jason M R Gill
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K
| | | | - Stina T Sollid
- Department of Medicine, Drammen Hospital, Vestre Viken Health Trust, Drammen, Norway
| | - Ingrid Nermoen
- Department of Endocrinology, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kåre I Birkeland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
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Forouhi NG. Nutrition and Type 2 Diabetes: Computational Optimization Modeling to Expand the Evidence Base for South Asians. Diabetes Care 2022; 45:2811-2813. [PMID: 36455116 DOI: 10.2337/dci22-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
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Gadgil MD, Kanaya AM, Sands C, Chekmeneva E, Lewis MR, Kandula NR, Herrington DM. Diet Patterns Are Associated with Circulating Metabolites and Lipid Profiles of South Asians in the United States. J Nutr 2022; 152:2358-2366. [PMID: 36774102 PMCID: PMC10157813 DOI: 10.1093/jn/nxac191] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 08/03/2022] [Accepted: 08/18/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND South Asians are at higher risk for cardiometabolic disease than many other racial/ethnic minority groups. Diet patterns in US South Asians have unique components associated with cardiometabolic disease. OBJECTIVES We aimed to characterize the metabolites associated with 3 representative diet patterns. METHODS We included 722 participants in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) cohort study aged 40-84 y without known cardiovascular disease. Fasting serum specimens and diet and demographic questionnaires were collected at baseline and diet patterns previously generated through principal components analysis. LC-MS-based untargeted metabolomic and lipidomic analysis was conducted with targeted integration of known metabolite and lipid signals. Linear regression models of diet pattern factor score and log-transformed metabolites adjusted for age, sex, caloric intake, and BMI and adjusted for multiple comparisons were performed, followed by elastic net linear regression of significant metabolites. RESULTS There were 443 metabolites of known identity extracted from the profiling data. The "animal protein" diet pattern was associated with 61 metabolites and lipids, including glycerophospholipids phosphatidylethanolamine PE(O-16:1/20:4) and/or PE(P-16:0/20:4) (β: 0.13; 95% CI: 0.11, 0.14) and N-acyl phosphatidylethanolamines (NAPEs) NAPE(O-18:1/20:4/18:0) and/or NAPE(P-18:0/20:4/18:0) (β: 0.13; 95% CI: 0.11, 0.14), lysophosphatidylinositol (LPI) (22:6/0:0) (β: 0.14; 95% CI: 0.12, 0.17), and fatty acid (FA) (22:6) (β: 0.15; 95% CI: 0.13, 0.17). The "fried snacks, sweets, high-fat dairy" pattern was associated with 12 lipids, including PC(16:0/22:6) (β: -0.08; 95% CI: -0.09, -0.06) and FA (22:6) (β: 0.14; 95% CI: -0.17, -0.10). The "fruits, vegetables, nuts, and legumes" pattern was associated with 5 metabolites including proline betaine (β: 0.17; 95% CI: 0.09, 0.25) (P < 0.0002). CONCLUSIONS Three predominant dietary patterns in US South Asians are associated with circulating metabolites differentiated by lipids including glycerophospholipids and PUFAs and the amino acid proline betaine.
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Affiliation(s)
- Meghana D Gadgil
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | - Alka M Kanaya
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Caroline Sands
- National Phenome Centre, Imperial College London, London, United Kingdom
| | - Elena Chekmeneva
- National Phenome Centre, Imperial College London, London, United Kingdom
| | - Matthew R Lewis
- National Phenome Centre, Imperial College London, London, United Kingdom
| | - Namratha R Kandula
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David M Herrington
- Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Poudel P, Rawal LB, Kong A, Yadav UN, Sousa MS, Karmacharya B, Pradhan S, George A. Oral Health Knowledge, Attitudes and Practices of People Living with Diabetes in South Asia: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13851. [PMID: 36360731 PMCID: PMC9654734 DOI: 10.3390/ijerph192113851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 06/16/2023]
Abstract
Diabetes increases the risk of oral health complications. This review aimed to synthesise the current evidence on the oral health knowledge, attitudes and practices of people living with diabetes in South Asian countries and provide recommendations on possible strategies for addressing the gaps in oral health care in this population, including the role of non-dental professionals. Using a scoping review framework, six electronic databases (Ovid Medline, CINAHL, ProQuest Central, Scopus, Web of Science and Embase) were searched to identify the relevant literature published between January 2000 and December 2021. The data were extracted into three main categories based on the review's aims, and further refined into sub-categories. A total of 23 studies were included. The review identified that while people with diabetes living in South Asian countries had some level of awareness about oral health and limited care practices to maintain good oral health, there were gaps in knowledge, and there were areas where their oral health practices and attitudes could be improved. The findings suggest a need for developing targeted oral health policies as well as implementing integrated oral health care interventions involving non-dental professionals to improve the oral health outcomes of people with diabetes.
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Affiliation(s)
- Prakash Poudel
- eHealth, NSW Government, St Leonards, NSW 2065, Australia
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing & Midwifery, Western Sydney University, Liverpool, NSW 2170, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
| | - Lal B. Rawal
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney Campus, Sydney, NSW 2000, Australia
- Physical Activity Research Group, Appleton Institute, Central Queensland University, Norman Gardens, QLD 4710, Australia
- Translational Health Research Institute (THRI), Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Ariana Kong
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing & Midwifery, Western Sydney University, Liverpool, NSW 2170, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
| | - Uday N. Yadav
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, ACT 2601, Australia
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW 2052, Australia
| | - Mariana S. Sousa
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing & Midwifery, Western Sydney University, Liverpool, NSW 2170, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Broadway, NSW 2007, Australia
| | - Biraj Karmacharya
- Department of Community and Public Health Dentistry, Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Panauti 45209, Nepal
| | - Shaili Pradhan
- Department of Dental Surgery, National Academy of Medical Sciences, Bir Hospital, Mahabouddha, Kathmandu 44600, Nepal
| | - Ajesh George
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing & Midwifery, Western Sydney University, Liverpool, NSW 2170, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
- Translational Health Research Institute (THRI), Western Sydney University, Campbelltown, NSW 2560, Australia
- School of Dentistry, Faculty of Medicine and Health, University of Sydney, Surry Hills, NSW 2010, Australia
- La Trobe Rural Health School, La Trobe University, Bendigo, VIC 3552, Australia
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Al Rifai M, Kianoush S, Jain V, Joshi PH, Cainzos-Achirica M, Nasir K, Merchant AT, Dodani S, Wong SS, Samad Z, Mehta A, Chunara R, Kalra A, Virani SS. Association of U.S. birth, duration of residence in the U.S., and atherosclerotic cardiovascular disease risk factors among Asian adults. Prev Med Rep 2022; 29:101916. [PMID: 35898194 PMCID: PMC9309422 DOI: 10.1016/j.pmedr.2022.101916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 07/07/2022] [Accepted: 07/18/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Prior studies have shown a direct association between U.S. birth and duration of residence with atherosclerotic cardiovascular disease (ASCVD) though, few have specifically focused on Asian Americans. Methods We utilized cross-sectional data from the 2006 to 2015 National Health Interview Survey. We compared prevalent cardiovascular risk factors and ASCVD among Asian American individuals by U.S. birth and duration of time spent in the U.S. Results The study sample consisted of 18,150 Asian individuals of whom 20.5 % were Asian Indian, 20.5 % were Chinese, 23.4 % were Filipino, and 35.6 % were of other Asian ethnic groups. The mean (standard error) age was 43.8 (0.21) years and 53 % were women. In multivariable-adjusted logistic regression models, U.S. birth was associated with a higher prevalence odds ratio (95 % confidence interval) of current smoking 1.31 (1.07,1.60), physical inactivity 0.62 (0.54,0.72), obesity 2.26 (1.91,2.69), hypertension 1.33 (1.12,1.58), and CAD 1.96 (1.24,3.11), but lower prevalence of stroke 0.28 (0.11,0.71). Spending greater than 15 years in the U.S. was associated with a higher prevalence of current smoking 1.65 (1.24,2.21), obesity 2.33 (1.57,3.47), diabetes 2.68 (1.17,6.15), and hyperlipidemia 1.72 (1.09,2.71). Conclusion Heterogeneity exists in cardiovascular risk factor burden among Asian Americans according to Asian ethnicity, U.S. birth, and duration of time living in the U.S.
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Affiliation(s)
- Mahmoud Al Rifai
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Sina Kianoush
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Vardhmaan Jain
- Department of Medicine, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Parag H Joshi
- Department of Medicine, Division of Cardiology, UT Southwestern Medical Center, Dallas, TX, United States
| | - Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, United States
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, United States
| | - Anwar T Merchant
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Sunita Dodani
- Section of Cardiology, Department of Internal Medicine, Eastern Virginia Medical School (EVMS), Norfolk, VA, United States.,EVMS-Sentara Healthcare Analytics and Delivery Science Institute, Norfolk, VA, United States
| | - Sally S Wong
- Office of Science, Medicine and Health, The American Heart Association, Dallas, TX, United States
| | | | - Anurag Mehta
- Division of Cardiology, Department of Medicine, Virginia Commonwealth University Medical Center, Richmond, VA, United States
| | - Rumi Chunara
- Department of Biostatistics, School of Global Public Health, New York University & Department of Computer Science and Engineering, Tandon School of Engineering, New York University, New York, NY, United States
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Heart, Vascular, & Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Salim S Virani
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States.,Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States.,Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, United States.,Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
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Yu J, Balaji B, Tinajero M, Jarvis S, Khan T, Vasudevan S, Ranawana V, Poobalan A, Bhupathiraju S, Sun Q, Willett W, Hu FB, Jenkins DJA, Mohan V, Malik VS. White rice, brown rice and the risk of type 2 diabetes: a systematic review and meta-analysis. BMJ Open 2022; 12:e065426. [PMID: 36167362 PMCID: PMC9516166 DOI: 10.1136/bmjopen-2022-065426] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Intake of white rice has been associated with elevated risk for type 2 diabetes (T2D), while studies on brown rice are conflicting. To inform dietary guidance, we synthesised the evidence on white rice and brown rice with T2D risk. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, EMBASE and Cochrane databases were searched through November 2021. ELIGIBILITY CRITERIA Prospective cohort studies of white and brown rice intake on T2D risk (≥1 year), and randomised controlled trials (RCTs) comparing brown rice with white rice on cardiometabolic risk factors (≥2 weeks). DATA EXTRACTION AND SYNTHESIS Data were extracted by the primary reviewer and two additional reviewers. Meta-analyses were conducted using random-effects models and reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Risk of bias was assessed using the Newcastle Ottawa Scale for prospective cohort studies and the Cochrane Risk of Bias Tool for RCTs. Strength of the meta-evidence was assessed using NutriGrade. RESULTS Nineteen articles were included: 8 cohort studies providing 18 estimates (white rice: 15 estimates, 25 956 cases, n=5 77 426; brown rice: 3 estimates, 10 507 cases, n=1 97 228) and 11 RCTs (n=1034). In cohort studies, white rice was associated with higher risk of T2D (pooled RR, 1.16; 95% CI: 1.02 to 1.32) comparing extreme categories. At intakes above ~300 g/day, a dose-response was observed (each 158 g/day serving was associated with 13% (11%-15%) higher risk of T2D). Intake of brown rice was associated with lower risk of T2D (pooled RR, 0.89; 95% CI: 0.81 to 0.97) comparing extreme categories. Each 50 g/day serving of brown rice was associated with 13% (6%-20%) lower risk of T2D. Cohort studies were considered to be of good or fair quality. RCTs showed an increase in high-density lipoprotein-cholesterol (0.06 mmol/L; 0.00 to 0.11 mmol/L) in the brown compared with white rice group. No other significant differences in risk factors were observed. The majority of RCTs were found to have some concern for risk of bias. Overall strength of the meta-evidence was moderate for cohort studies and moderate and low for RCTs. CONCLUSION Intake of white rice was associated with higher risk of T2D, while intake of brown rice was associated with lower risk. Findings from substitution trials on cardiometabolic risk factors were inconsistent. PROSPERO REGISTRATION NUMBER CRD42020158466.
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Affiliation(s)
- Jiayue Yu
- Department of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Maria Tinajero
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Jarvis
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tauseef Khan
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sudha Vasudevan
- Department of Food and Nutrition Research, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Viren Ranawana
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Amudha Poobalan
- Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Shilpa Bhupathiraju
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Nutrition, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Qi Sun
- Department of Nutrition, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Walter Willett
- Department of Nutrition, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Frank B Hu
- Department of Nutrition, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - David J A Jenkins
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Viswanathan Mohan
- Department of Diabetology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Vasanti S Malik
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Nutrition, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
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Shah KS, Patel J, Rifai MA, Agarwala A, Bhatt AB, Levitzky YS, Palaniappan L. Cardiovascular Risk Management in the South Asian Patient: A Review. HEALTH SCIENCES REVIEW (OXFORD, ENGLAND) 2022; 4:100045. [PMID: 36438886 PMCID: PMC9699691 DOI: 10.1016/j.hsr.2022.100045] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
South Asians represent a growing percentage of the diverse population in the U.S. and are disproportionately impacted by a greater burden of aggressive and premature cardiovascular disease. There are multiple potential explanations for these findings including a high prevalence of traditional risk factors (particularly diabetes, dyslipidemia, and obesity), a genetic predisposition, and unique lifestyle factors. In this review, we discuss the cardiovascular risk stratification and disease management goals for South Asian adults. We review the pharmacologic and non-pharmacologic interventions studied in this population and discuss the role of specialized clinics and digital outreach to improve care for this vulnerable group of patients.
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Affiliation(s)
- Kevin S Shah
- University of Utah Health, United States of America
| | | | | | - Anandita Agarwala
- Baylor Scott & White Health Heart Hospital Plano, United States of America
| | - Ami B Bhatt
- Massachusetts General Brigham Hospital, United States of America
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Gupta Y, Goyal A, Kalaivani M, Tandon N. Cardiometabolic risk factors in young Indian men and their association with parameters of insulin resistance and beta-cell function. World J Cardiol 2022; 14:462-472. [PMID: 36160812 PMCID: PMC9453255 DOI: 10.4330/wjc.v14.i8.462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/29/2022] [Accepted: 07/22/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND There is an unmet need to evaluate the burden of cardiometabolic risk factors in young South Asian adults, who are not preselected for glycaemia.
AIM To evaluate young North Indian men (aged 20-50 years) for burden of cardiometabolic risk factors, in relation to parameters of homeostatic model assessment for insulin resistance (HOMA-IR) and beta-cell function (oral disposition index [oDI]).
METHODS Study participants were invited in a fasting state. Sociodemographic, anthropometric, and medical data were collected, and 75 g oral glucose tolerance test was performed with serum insulin and plasma glucose estimation at 0, 30, and 120 min. Participants were divided into quartiles for HOMA-IR and oDI (category 1: Best HOMA-IR/oDI quartile; category 3: Worst HOMA-IR/oDI quartile) and composite HOMA-IR/oDI phenotypes (phenotype 1: Best quartile for both HOMA-IR and oDI; phenotype 4: Worst quartile for both HOMA-IR and oDI) were derived.
RESULTS We evaluated a total of 635 men at a mean (± SD) age of 33.9 ± 5.1 years and body mass index of 26.0 ± 3.9 kg/m2. Diabetes and prediabetes were present in 34 (5.4%) and 297 (46.8%) participants, respectively. Overweight/obesity, metabolic syndrome, and hypertension were present in 388 (61.1%), 258 (40.6%), and 123 (19.4%) participants, respectively. The prevalence of dysglycaemia, metabolic syndrome, and hypertension was significantly higher in participants belonging to the worst HOMA-IR and oDI quartiles, either alone (category 3 vs 1) or in combination (phenotype 4 vs 1). The adjusted odds ratios for dysglycaemia (6.5 to 7.0-fold), hypertension (2.9 to 3.6-fold), and metabolic syndrome (4.0 to 12.2-fold) were significantly higher in individuals in the worst quartile of HOMA-IR and oDI (category 3), compared to those in the best quartile (category 1). The adjusted odds ratios further increased to 21.1, 5.6, and 13.7, respectively, in individuals with the worst, compared to the best composite HOMA-IR/oDI phenotypes (phenotype 4 vs 1).
CONCLUSION The burden of cardiometabolic risk factors is high among young Asian Indian men. Our findings highlight the importance of using parameters of insulin resistance and beta-cell function in phenotyping individuals for cardiometabolic risk.
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Affiliation(s)
- Yashdeep Gupta
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
| | - Alpesh Goyal
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
| | - Mani Kalaivani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
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Rahman MJ, Parvez SM, Rahman M, He FJ, Cunningham SA, Narayan KMV, Abedin J, Naser AM. Urinary Sodium Excretion and Obesity Markers among Bangladeshi Adult Population: Pooled Data from Three Cohort Studies. Nutrients 2022; 14:3000. [PMID: 35889957 PMCID: PMC9323227 DOI: 10.3390/nu14143000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/05/2022] [Accepted: 07/13/2022] [Indexed: 11/16/2022] Open
Abstract
We evaluated the relationship of urinary sodium excretion with a conditional mean, 10th and 90th percentiles of body mass index (BMI), and waist circumference among 10,034 person-visits of Bangladeshi population. We fitted linear mixed models with participant-level random intercept and restricted maximum likelihood estimation for conditional mean models; and quantile mixed-effect models with participant-level random intercept and Laplace estimation for 10th and 90th percentiles models. For each 100 mmol/24 h increase in urinary sodium excretion, participants had a 0.10 kg/m2 (95% CI: 0.00, 0.10) increase in the mean; a 0.39 kg/m2 (95% CI: 0.23, 0.54) increase in the 10th percentile; and a 0.59 kg/m2 (95% CI: 0.39, 0.78) increase in the 90th percentile of BMI. For each 100 mmol/24 h increase in urinary sodium excretion, participants had a 0.20 cm (95% CI: 0.10, 0.30) increase in mean; a 0.18 cm (95% CI: -0.03, 0.40) change in the 10th percentile; and a 0.23 cm (95% CI: 0.03, 0.43) increase in the 90th percentile of waist circumference. We found a modest association between urine sodium and conditional mean of BMI and waist circumference. The magnitude of associations between urine sodium and the 10th and 90th percentile BMI distributions were higher compared to the conditional mean models, suggesting high sodium intake could be more detrimental to underweight and obese participants.
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Affiliation(s)
- Musarrat J. Rahman
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
| | - Sarker M. Parvez
- Environmental Interventions Unit, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (S.M.P.); (M.R.)
| | - Mahbubur Rahman
- Environmental Interventions Unit, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (S.M.P.); (M.R.)
| | - Feng J. He
- Centre for Public Health and Policy, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK;
| | - Solveig A. Cunningham
- Emory Global Diabetes Research Center, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA; (S.A.C.); (K.M.V.N.)
| | - K. M. Venkat Narayan
- Emory Global Diabetes Research Center, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA; (S.A.C.); (K.M.V.N.)
| | - Jaynal Abedin
- Data Science Institute, National University of Ireland Galway, H91 TK33 Galway, Ireland;
| | - Abu Mohd Naser
- Division of Epidemiology, Biostatistics and Environmental Health, School of Public Health, University of Memphis, Memphis, TN 38152, USA
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49
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Ke C, Narayan KMV, Chan JCN, Jha P, Shah BR. Pathophysiology, phenotypes and management of type 2 diabetes mellitus in Indian and Chinese populations. Nat Rev Endocrinol 2022; 18:413-432. [PMID: 35508700 PMCID: PMC9067000 DOI: 10.1038/s41574-022-00669-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2022] [Indexed: 02/08/2023]
Abstract
Nearly half of all adults with type 2 diabetes mellitus (T2DM) live in India and China. These populations have an underlying predisposition to deficient insulin secretion, which has a key role in the pathogenesis of T2DM. Indian and Chinese people might be more susceptible to hepatic or skeletal muscle insulin resistance, respectively, than other populations, resulting in specific forms of insulin deficiency. Cluster-based phenotypic analyses demonstrate a higher frequency of severe insulin-deficient diabetes mellitus and younger ages at diagnosis, lower β-cell function, lower insulin resistance and lower BMI among Indian and Chinese people compared with European people. Individuals diagnosed earliest in life have the most aggressive course of disease and the highest risk of complications. These characteristics might contribute to distinctive responses to glucose-lowering medications. Incretin-based agents are particularly effective for lowering glucose levels in these populations; they enhance incretin-augmented insulin secretion and suppress glucagon secretion. Sodium-glucose cotransporter 2 inhibitors might also lower blood levels of glucose especially effectively among Asian people, while α-glucosidase inhibitors are better tolerated in east Asian populations versus other populations. Further research is needed to better characterize and address the pathophysiology and phenotypes of T2DM in Indian and Chinese populations, and to further develop individualized treatment strategies.
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Affiliation(s)
- Calvin Ke
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
- Department of Medicine, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
- Centre for Global Health Research, Unity Health Toronto, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
- Asia Diabetes Foundation, Shatin, Hong Kong SAR, China.
| | - K M Venkat Narayan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Nutrition and Health Sciences Program, Graduate Division of Biological and Biomedical Sciences, Laney Graduate School, Emory University, Atlanta, GA, USA
- Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Asia Diabetes Foundation, Shatin, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Prabhat Jha
- Centre for Global Health Research, Unity Health Toronto, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Baiju R Shah
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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50
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Seah JYH, Hong Y, Cichońska A, Sabanayagam C, Nusinovici S, Wong TY, Cheng CY, Jousilahti P, Lundqvist A, Perola M, Salomaa V, Tai ES, Würtz P, van Dam RM, Sim X. Circulating Metabolic Biomarkers Are Consistently Associated With Type 2 Diabetes Risk in Asian and European Populations. J Clin Endocrinol Metab 2022; 107:e2751-e2761. [PMID: 35390150 DOI: 10.1210/clinem/dgac212] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT While Asians have a higher risk of type 2 diabetes (T2D) than Europeans for a given body mass index (BMI), it remains unclear whether the same markers of metabolic pathways are associated with diabetes. OBJECTIVE We evaluated associations between metabolic biomarkers and incidence of T2D in 3 major Asian ethnic groups (Chinese, Malay, and Indian) and a European population. METHODS We analyzed data from adult males and females of 2 cohorts from Singapore (n = 6393) consisting of Chinese, Malays, and Indians and 3 cohorts of European-origin participants from Finland (n = 14 558). We used nuclear magnetic resonance to quantify 154 circulating metabolic biomarkers at baseline and performed logistic regression to assess associations with T2D risk adjusted for age, sex, BMI and glycemic markers. RESULTS Of the 154 metabolic biomarkers, 59 were associated with higher risk of T2D in both Asians and Europeans (P < 0.0003, Bonferroni-corrected). These included branched chain and aromatic amino acids, the inflammatory marker glycoprotein acetyls, total fatty acids, monounsaturated fatty acids, apolipoprotein B, larger very low-density lipoprotein particle sizes, and triglycerides. In addition, 13 metabolites were associated with a lower T2D risk in both populations, including omega-6 polyunsaturated fatty acids and larger high-density lipoprotein particle sizes. Associations were consistent within the Asian ethnic groups (all Phet ≥ 0.05) and largely consistent for the Asian and European populations (Phet ≥ 0.05 for 128 of 154 metabolic biomarkers). CONCLUSION Metabolic biomarkers across several biological pathways were consistently associated with T2D risk in Asians and Europeans.
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Affiliation(s)
- Jowy Yi Hoong Seah
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Yueheng Hong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | | | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Simon Nusinovici
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Pekka Jousilahti
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Annamari Lundqvist
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Markus Perola
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Veikko Salomaa
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - E Shyong Tai
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | | | - Rob M van Dam
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Departments of Exercise and Nutrition Sciences and Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Xueling Sim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
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