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Wu J, Guo J. Is weight-adjusted waist index more strongly associated with diabetes than body mass index and waist circumference?: Results from the database large community sample study. PLoS One 2024; 19:e0309150. [PMID: 39325793 PMCID: PMC11426486 DOI: 10.1371/journal.pone.0309150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 08/06/2024] [Indexed: 09/28/2024] Open
Abstract
BACKGROUND The uncertainty regarding the correlation between the weight-adjusted waist index (WWI) and diabetes within the National Health and Nutrition Examination Survey (NHANES) necessitates further exploration. As indicators of obesity, the differences in the intensity of association between WWI, body mass index (BMI), and waist circumference (WC) with diabetes are worth exploring. This investigation is undertaken to elucidate the association between WWI and diabetes in the NHANES dataset and to compare the extent to which BMI, WC, and WWI were closely associated with diabetes. Then, choose an obesity index that is more strongly associated with diabetes. METHODS A comprehensive cross-sectional stratified survey of 7,973 participants from the 2017-2020 NHANES was conducted. WWI is an anthropometric measure based on WC and weight. The formula is WWI (cm/√kg) = WC/√weight. The association between WWI and diabetes was investigated using weighted multiple logistic regression, smooth curve fitting, stratified analysis, and interaction testing. RESULTS The participants' average age was 50.84±17.34 years, and 50.68% of them were female. The detection rate of diabetes was 15.11%. This positive association was particularly notable among non-diabetic patients. For each unit increase in BMI and WC as continuous variables, the likelihood of developing diabetes in the fully adjusted model increased by 5% (OR = 1.05; 95%CI, 1.03-1.07) and 3% (OR = 1.03; 95%CI, 1.02-1.04), respectively, but for each one-unit increase in WWI, the likelihood of developing diabetes increased by 111% (OR = 2.11; 95% CI, 1.68-2.65). Tests of interactions revealed that in various subgroups, the association between diabetes and WWI remained steady. CONCLUSIONS We analyzed 2017-2020 NHANES data to explore the link between WWI and diabetes, finding a consistent positive correlation. The correlation between WWI and diabetes was stronger than that between WC and BMI. WWI seems to offer better potential aid in disease prevention and diagnosis.
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Affiliation(s)
- Jiabei Wu
- Shanxi Medical University, Taiyuan, China
| | - Jinli Guo
- The Second Hospital of Shanxi Medical University, Taiyuan, China
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Arueyingho O, Aprioku JS, Marshall P, O'Kane AA. Insights Into Sociodemographic Influences on Type 2 Diabetes Care and Opportunities for Digital Health Promotion in Port Harcourt, Nigeria: Quantitative Study. JMIR Diabetes 2024; 9:e56756. [PMID: 39167439 PMCID: PMC11375378 DOI: 10.2196/56756] [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: 01/29/2024] [Revised: 06/20/2024] [Accepted: 07/02/2024] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND A significant percentage of the Nigerian population has type 2 diabetes (T2D), and a notable portion of these patients also live with comorbidities. Despite its increasing prevalence in Nigeria due to factors such as poor eating and exercise habits, there are insufficient reliable data on its incidence in major cities such as Port Harcourt, as well as on the influence of sociodemographic factors on current self-care and collaborative T2D care approaches using technology. This, coupled with a significant lack of context-specific digital health interventions for T2D care, is our major motivation for the study. OBJECTIVE This study aims to (1) explore the sociodemographic profile of people with T2D and understand how it directly influences their care; (2) generate an accurate understanding of collaborative care practices, with a focus on nuances in the contextual provision of T2D care; and (3) identify opportunities for improving the adoption of digital health technologies based on the current understanding of technology use and T2D care. METHODS We designed questionnaires aligned with the study's objectives to obtain quantitative data, using both WhatsApp (Meta Platforms, Inc) and in-person interactions. A social media campaign aimed at reaching a hard-to-reach audience facilitated questionnaire delivery via WhatsApp, also allowing us to explore its feasibility as a data collection tool. In parallel, we distributed surveys in person. We collected 110 responses in total: 83 (75.5%) from in-person distributions and 27 (24.5%) from the WhatsApp approach. Data analysis was conducted using descriptive and inferential statistical methods on SPSS Premium (version 29; IBM Corp) and JASP (version 0.16.4; University of Amsterdam) software. This dual approach ensured comprehensive data collection and analysis for our study. RESULTS Results were categorized into 3 groups to address our research objectives. We found that men with T2D were significantly older (mean 61 y), had higher household incomes, and generally held higher academic degrees compared to women (P=.03). No statistically significant relationship was found between gender and the frequency of hospital visits (P=.60) or pharmacy visits (P=.48), and cultural differences did not influence disease incidence. Regarding management approaches, 75.5% (83/110) relied on prescribed medications; 60% (66/110) on dietary modifications; and 35.5% (39/110) and 20% (22/110) on traditional medicines and spirituality, respectively. Most participants (82/110, 74.5%) were unfamiliar with diabetes care technologies, and 89.2% (98/110) of those using technology were only familiar with glucometers. Finally, participants preferred seeking health information in person (96/110, 87.3%) over digital means. CONCLUSIONS By identifying the influence of sociodemographic factors on diabetes care and health or information seeking behaviors, we were able to identify context-specific opportunities for enhancing the adoption of digital health technologies.
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Tan JY, Guan A, Albers AE, Canchola AJ, Allen L, Shariff-Marco S, Gomez SL. Acculturating to multiculturalism: a new dimension of dietary acculturation among Asian American, Native Hawaiian, and Pacific Islander women in the San Francisco Bay Area, USA. BMC Public Health 2024; 24:2128. [PMID: 39107722 PMCID: PMC11302078 DOI: 10.1186/s12889-024-19435-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 07/10/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Dietary acculturation is the process by which diet and dietary practises from the environment of origin are retained or changed and/or those prevalent in a new environment are adopted. Despite rapid population growth the U.S., knowledge gaps exist on characterising dietary acculturation among Asian American, Native Hawaiian, and Pacific Islander communities (AANHPI). This study characterise dietary patterns in a sample representative of AANHPI on key demographic characteristics. METHODS Data were from a 2013-2014 population-based case-control study in the San Francisco Bay Area, U.S. Survey items were adapted from dietary acculturation scales developed for AANHPI populations. Validated measures assessed social capital, social standing, discrimination and immigration experiences. A principal components factor analysis was conducted to characterise dietary patterns of acculturation. RESULTS Three dietary patterns were identified: "Asian," "Western," and a distinct "Multicultural" factor. Respondents reporting a high-Asian diet tended to also report smaller social networks, higher levels of stress, and, among those born outside of the U.S., an educational standing that was better before immigration. Respondents reporting a high-Western diet tended to also report the highest level of discrimination. Those reporting a high-Multicultural diet tended to report higher neighbourhood collective efficacy. CONCLUSIONS The finding of a distinct "Multicultural" factor beyond the typical "Asian" and "Western" factors may reflect the multidirectional relationships between culture, diet, and dietary behavior, in which origin and destination cultures interact in complex ways and where foods from multiple ethnicities intermix.
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Affiliation(s)
- Judy Y Tan
- Cancer Research Center on Health Equity, Division of Population Sciences, Cedars-Sinai Medical Center, 6500 Wilshire Blvd., Los Angeles, CA, 90048, USA.
| | - Alice Guan
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, 94114, USA
| | | | - Alison J Canchola
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, 94114, USA
| | - Laura Allen
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, 94114, USA
| | - Salma Shariff-Marco
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, 94114, USA
| | - Scarlett Lin Gomez
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, 94114, USA
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Dhir P, Maynard M, Drew KJ, Homer CV, Bakhai C, Ells LJ. South Asian individuals' experiences on the NHS low-calorie diet programme: a qualitative study in community settings in England. BMJ Open 2023; 13:e079939. [PMID: 38154908 PMCID: PMC10759119 DOI: 10.1136/bmjopen-2023-079939] [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: 09/18/2023] [Accepted: 11/30/2023] [Indexed: 12/30/2023] Open
Abstract
BACKGROUND Existing literature examines barriers to the provision of ethnically diverse dietary advice, however, is not specific to total diet replacement (TDR). There is a lack of literature from the UK, limiting the potential applicability of existing findings and themes to the UK context. This study addresses this gap in research by interviewing participants of South Asian ethnicity who have undertaken the National Health Service (NHS) low-calorie diet programme (LCD) for people with type 2 diabetes living with overweight or obesity. This study explores factors that may affect the uptake and acceptability of its TDR, food reintroduction and weight maintenance stages. This aims to provide rich data that can inform effective tailoring of future programmes with South Asian participants. OBJECTIVE To explore the perspectives of individuals of South Asian ethnicity on an NHS programme using TDR approaches for the management of type 2 diabetes (T2D). DESIGN Qualitative study. SETTING Individuals in the community undertaking the NHS LCD programme. PARTICIPANTS Twelve one-to-one interviews were conducted with individuals from a South Asian ethnicity participating in the NHS LCD. MAIN OUTCOME MEASURES Qualitative semistructured interviews conducted through different stages of the programme. Reflexive thematic analysis was used to analyse the transcripts. RESULTS Key themes highlighted positive and negative experiences of the programme: (1) more work is needed in the programme for person centeredness; (2) it is not the same taste; (3) needing motivation to make changes and feel better; (4) a mixed relationship with the coach; (5) social experiences; (6) culture-related experiences. CONCLUSION This study provides important experience-based evidence of the need for culturally tailored T2D programmes. Action to address these findings and improve the tailoring of the NHS LCD may improve experience, retention and outcomes on the programme for people of South Asian ethnicity and thereby reduce inequalities.
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Affiliation(s)
- Pooja Dhir
- School of Health, Leeds Beckett University, Leeds, UK
| | - Maria Maynard
- School of Health, Leeds Beckett University, Leeds, UK
| | - Kevin J Drew
- School of Health, Leeds Beckett University, Leeds, UK
| | | | - Chirag Bakhai
- Arndale House, Bedfordshire, Luton and Milton Keynes, UK
| | - Louisa Jane Ells
- School of Health, Leeds Beckett University, Leeds, UK
- Obesity Institute, Leeds Beckett University, Leeds, UK
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Park L, Vang A, Yang B, Quanbeck A. Barriers to Type 2 Diabetes Mellitus Management for Older Hmong Patients with Minimal English Language Skills: Accounts from Caregivers, Case Managers, and Clinicians. J Racial Ethn Health Disparities 2023; 10:3062-3069. [PMID: 36512312 PMCID: PMC9746559 DOI: 10.1007/s40615-022-01480-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022]
Abstract
Type 2 diabetes mellitus prevalence rates for Hmong Americans in Wisconsin are more than double that of non-Hispanic Whites. The Hmong's history, lifestyle (dietary and behavioral patterns), and reliance on traditional medicine contribute to their increased risk of diabetes. This qualitative study aimed to better understand the barriers challenging older Hmong patients' ability to manage diabetes. Asian Americans have long been overlooked in health-related research, but recent disaggregated data of specific ethnic groups reveal significant health inequities. Among the different ethnic groups, there is a significant lack of research on the Hmong Americans. Three participant groups (Hmong American family caregivers, Hmong American case managers, and clinicians from different racial backgrounds who provide care for Hmong patients) were recruited from the community and interviewed to understand the barriers experienced by older Hmong patients with minimal English language skills in managing their diabetes. Directed content analysis of the data resulted in three major themes: adherence to culture, health inequity, and managing diabetes. Subthemes included Hmong herbs and shamans, lack of trust in Western medicine, the significance of rice, language barriers, lack of cultural sensitivity, health literacy, monitoring glucose, medicine compliance, and nutrition. Minimal English language skills and low literacy rates (health and education) contribute to their strong adherence to cultural practices which challenges Western medicine, creating difficulty for older Hmong patients to manage their diabetes. Recognizing cultural differences and barriers will enable healthcare providers to improve and cater the treatment options, bridging the gap between older Hmong patients and Western medicine.
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Affiliation(s)
- Linda Park
- Department of Family Medicine and Community Health, University of Wisconsin-Madison, Madison, WI, USA.
| | - Addison Vang
- University of Wisconsin-Madison, Madison, WI, USA
| | | | - Andrew Quanbeck
- Department of Family Medicine and Community Health, University of Wisconsin-Madison, Madison, WI, USA
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Cai Q, Shi S, Shen H, Ye B, Cheng W. Combined general and central obesity indices to predict gestational diabetes. J Matern Fetal Neonatal Med 2023; 36:2183765. [PMID: 36860096 DOI: 10.1080/14767058.2023.2183765] [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: 03/03/2023]
Abstract
OBJECTIVE To investigate the relationship between general and central obesity in the first trimester of pregnancy and gestational diabetes and its predicted value. MATERIALS AND METHODS We recruited 813 women who registered at 6-12 weeks of gestation. Anthropometric measurements were done at the first antenatal visit. At 24-28 weeks of pregnancy, gestational diabetes was diagnosed using the 75 g oral glucose tolerance test. Binary logistic regression was used to determine odds ratios and 95% confidence intervals. The receiver-operating characteristic curve was used to evaluate the ability of obesity indices to predict the risk of gestational diabetes. RESULTS Odds ratios (95% confidence intervals) of gestational diabetes across increasing quartiles of waist-to-hip ratio were 1.00, 1.54 (0.65-3.66), 2.63 (1.18-5.85), and 4.96 (2.27-10.85), respectively (p < .001), while those for waist-to-height ratio were 1.00, 1.21 (0.47-3.08), 2.99 (1.26-7.10), and 4.01 (1.57-10.19), respectively (p < .001). Areas under the curve for general and central obesity were similar. However, the area under the curve of body mass index combined with the waist-to-hip ratio was the biggest. CONCLUSION Higher waist-to-hip ratio and waist-to-height ratio in the first trimester of pregnancy are associated with increased risks of gestational diabetes in Chinese women. The combination of body mass index and waist-to-hip ratio in the first trimester of pregnancy is a good predictor for gestational diabetes.
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Affiliation(s)
- Qunying Cai
- Department of Gynecology and Obstetrics, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Shu Shi
- Department of Gynecology and Obstetrics, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Hong Shen
- Department of Gynecology and Obstetrics, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Baoying Ye
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China.,Department of Ultrasound, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Weiwei Cheng
- Department of Gynecology and Obstetrics, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China
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Bakoev SY, Korobeinikova AV, Mishina AI, Kabieva SS, Mitrofanov SI, Ivashechkin AA, Akinshina AI, Snigir EA, Yudin SM, Yudin VS, Getmantseva LV, Anderzhanova EA. Genomic Signatures of Positive Selection in Human Populations of the OXT, OXTR, AVP, AVPR1A and AVR1B Gene Variants Related to the Regulation of Psychoemotional Response. Genes (Basel) 2023; 14:2053. [PMID: 38002996 PMCID: PMC10670988 DOI: 10.3390/genes14112053] [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: 09/29/2023] [Revised: 11/03/2023] [Accepted: 11/04/2023] [Indexed: 11/26/2023] Open
Abstract
The neurobiological systems of maintenance and control of behavioral responses result from natural selection. We have analyzed the selection signatures for single nucleotide variants (SNV) of the genes of oxytocin (OXT, OXTR) and vasopressin (AVP, AVPR1A, AVPR1B) systems, which are associated with the regulation of social and emotional behavior in distinct populations. The analysis was performed using original WGS (whole genome sequencing) data on Eastern Slavs (SlEast), as well as publicly available data from the 1000 Genomes Project on GBR, FIN, IBR, PUR, BEB, CHB, and ACB populations (the latter were taken as reference). To identify selection signatures, we rated the integrated haplotype scores (iHS), the numbers of segregating sites by length (nSl), and the integrated haplotype homozygosity pooled (iHH12) measures; the fixation index Fst was implemented to assess genetic differentiation between populations. We revealed that the strongest genetic differentiation of populations was found with respect to the AVPR1B gene, with the greatest differentiation observed in GRB (Fst = 0.316) and CHB (Fst = 0.325) in comparison to ACB. Also, high Fst values were found for SNVs of the AVPR1B gene rs28499431, rs33940624, rs28477649, rs3883899, and rs28452187 in most of the populations. Selection signatures have also been identified in the AVP, AVPR1A, OXT, and OXTR genes. Our analysis shows that the OXT, OXTR, AVP, AVPR1A, and AVPR1B genes were subject to positive selection in a population-specific process, which was likely contributing to the diversity of adaptive emotional response types and social function realizations.
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Affiliation(s)
- Siroj Yu. Bakoev
- Federal State Budgetary Institution “Centre for Strategic Planning and Management of Biomedical Health Risks” of the Federal Medical Biological Agency (Centre for Strategic Planning of FMBA of Russia), Pogodinskaya Street, 10, Bld. 1, 119121 Moscow, Russia; (A.V.K.); (A.I.M.); (S.S.K.); (S.I.M.); (A.A.I.); (A.I.A.); (E.A.S.); (S.M.Y.); (V.S.Y.); (L.V.G.); (E.A.A.)
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Charitha Koneru S, Sikand G, Agarwala A. Optimizing Dietary Patterns and Lifestyle to Reduce Atherosclerotic Cardiovascular Risk Among South Asian Individuals. Am J Cardiol 2023; 203:113-121. [PMID: 37487405 DOI: 10.1016/j.amjcard.2023.06.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/01/2023] [Accepted: 06/14/2023] [Indexed: 07/26/2023]
Abstract
South Asians are at an elevated risk of atherosclerotic cardiovascular disease (ASCVD) when compared with other age-matched subjects of varied ethnicities. The elevated ASCVD risk is multifactorial including a constellation of hypertension, dyslipidemia, metabolic syndrome, overweight/obesity, prediabetes, and type 2 diabetes mellitus. Although traditional ASCVD risk factors remain highly prevalent in South Asians living in the United States, modifiable risk factors of diet, lack of physical activity/increased sedentary time, smoking (of all forms), and excessive alcohol consumption further accelerate the disease process. In this review, we take a deep dive into optimizing lifestyle to reduce the risk of cardiovascular disease in this high-risk ethnic group.
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Affiliation(s)
- Sri Charitha Koneru
- Center for Cardiovascular Disease Prevention, Cardiovascular Division, Baylor Scott and White Health Heart Hospital Baylor Plano, Plano, Texas
| | - Geeta Sikand
- Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, California
| | - Anandita Agarwala
- Center for Cardiovascular Disease Prevention, Cardiovascular Division, Baylor Scott and White Health Heart Hospital Baylor Plano, Plano, Texas.
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Crummett LT, Aslam MH. Diabetes websites lack information on dietary causes, risk factors, and preventions for type 2 diabetes. Front Public Health 2023; 11:1159024. [PMID: 37521964 PMCID: PMC10373935 DOI: 10.3389/fpubh.2023.1159024] [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: 02/05/2023] [Accepted: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Type 2 diabetes (T2D) is a growing public health burden throughout the world. Many people looking for information on how to prevent T2D will search on diabetes websites. Multiple dietary factors have a significant association with T2D risk, such as high intake of added sugars, refined carbohydrates, saturated fat, and red meat or processed meat; and decreased intake of dietary fiber, and fruits/vegetables. Despite this dietary information being available in the scientific literature, it is unclear whether this information is available in gray literature (websites). Objective In this study, we evaluate the use of specific terms from diabetes websites that are significantly associated with causes/risk factors and preventions for T2D from three term categories: (A) dietary factors, (B) nondietary nongenetic (lifestyle-associated) factors, and (C) genetic (non-modifiable) factors. We also evaluate the effect of website type (business, government, nonprofit) on term usage among websites. Methods We used web scraping and coding tools to quantify the use of specific terms from 73 diabetes websites. To determine the effect of term category and website type on the usage of specific terms among 73 websites, a repeated measures general linear model was performed. Results We found that dietary risk factors that are significantly associated with T2D (e.g., sugar, processed carbohydrates, dietary fat, fruits/vegetables, fiber, processed meat/red meat) were mentioned in significantly fewer websites than either nondietary nongenetic factors (e.g., obesity, physical activity, dyslipidemia, blood pressure) or genetic factors (age, family history, ethnicity). Among websites that provided "eat healthy" guidance, one third provided zero dietary factors associated with type 2 diabetes, and only 30% provided more than two specific dietary factors associates with type 2 diabetes. We also observed that mean percent usage of all terms associated with T2D causes/risk factors and preventions was significantly lower among government websites compared to business websites and nonprofit websites. Conclusion Diabetes websites need to increase their usage of dietary factors when discussing causes/risk factors and preventions for T2D; as dietary factors are modifiable and strongly associated with all nondietary nongenetic risk factors, in addition to T2D risk.
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Sperling MM, Leonard SA, Blumenfeld YJ, Carmichael SL, Chueh J. Prepregnancy body mass index and gestational diabetes mellitus across Asian and Pacific Islander subgroups in California. AJOG GLOBAL REPORTS 2023; 3:100148. [PMID: 36632428 PMCID: PMC9826825 DOI: 10.1016/j.xagr.2022.100148] [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] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The American College of Obstetricians and Gynecologists recommends early screening for gestational diabetes mellitus among pregnant Asian people with a prepregnancy body mass index ≥23.0 kg/m2, in contrast with the recommended screening at a body mass index ≥25 kg/m2 for other races and ethnicities. However, there is significant heterogeneity within Asian and Pacific Islander populations, and gestational diabetes mellitus and its association with body mass index among Asian and Pacific Islander subgroups may not be uniform across all groups. OBJECTIVE This study aimed to analyze the association between body mass index and gestational diabetes mellitus among Asian and Pacific Islander subgroups in California, specifically gestational diabetes mellitus rates among those with a body mass index above vs below 23 kg/m2, which is the cutoff point for the designation of being overweight among Asians populations. STUDY DESIGN Using a linked delivery hospitalization discharge and vital records database, we identified patients who gave birth in California between 2007 and 2017 and who self-reported to be 1 of 13 Asian and Pacific Islander subgroups, which was collected from birth and fetal death certificates. In each subgroup, we evaluated the association between body mass index and gestational diabetes mellitus using multivariable logistic regression models adjusted for age, education, parity, payment method, the trimester in which prenatal care was initiated, and nativity. We fit body mass index nonlinearly with splines and categorized body mass index as being above or below 23 kg/m2. Predicted probabilities of gestational diabetes mellitus with 95% confidence intervals were calculated across body mass index values using the nonlinear regression models. RESULTS The overall prevalence of gestational diabetes mellitus was 14.3% (83,400/584,032), ranging between 8.4% and 17.1% across subgroups. The highest prevalence was among Indian (17.1%), Filipino (16.7%), and Vietnamese (15.5%) subgroups. In these subgroups, gestational diabetes mellitus was diagnosed in 10% to 13% of those with a body mass index <23.0 kg/m2 and in 22% of those with a body mass index ≥23 kg/m2. Gestational diabetes mellitus was least common among Korean (8.4%), Japanese (9.0%), and Samoan (9.8%) subgroups with a gestational diabetes mellitus rate of 5% to 7% among those with a body mass index <23.0 kg/m2 and in 10% to 15% among those with a body mass index ≥23 kg/m2. Although Samoan patients had the highest rate of obesity, defined as body mass index ≥30 kg/m2 (57.4%), they had the third lowest prevalence of gestational diabetes mellitus. Conversely, Vietnamese patients had the second lowest rate of obesity (2.4%) but the highest rate of gestational diabetes mellitus at a body mass index of ≥23 kg/m2 (22.3%). CONCLUSION Gestational diabetes mellitus and its association with body mass index varied among Asian subgroups but increased as body mass index increased. Subgroups with the lowest prevalence of obesity trended toward a higher prevalence of gestational diabetes mellitus and those with a higher prevalence of obesity trended toward a lower prevalence of gestational diabetes mellitus.
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Affiliation(s)
- Meryl M. Sperling
- Departments of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA (Drs Sperling, Leonard, Blumenfeld, Carmichael, and Chueh)
| | - Stephanie A. Leonard
- Departments of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA (Drs Sperling, Leonard, Blumenfeld, Carmichael, and Chueh)
| | - Yair J. Blumenfeld
- Departments of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA (Drs Sperling, Leonard, Blumenfeld, Carmichael, and Chueh)
| | - Suzan L. Carmichael
- Departments of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA (Drs Sperling, Leonard, Blumenfeld, Carmichael, and Chueh)
- Pediatrics (Dr Carmichael), Stanford University School of Medicine, Stanford, CA
| | - Jane Chueh
- Departments of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA (Drs Sperling, Leonard, Blumenfeld, Carmichael, and Chueh)
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Kononenko IV, Shestakova MV, Elfimova AR, Khomyakova IA, Buzhilova AP, Mokrysheva NG. Ethnic differences in risk factors and prevalence of type 2 diabetes in the adult population of the Russian Federation. DIABETES MELLITUS 2022. [DOI: 10.14341/dm12935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND: Russia is one of the most multinational states in the world. Identification of ethnic groups with a higher risk of developing DM2, analysis of risk factors for the development of DM2 will allow developing personalized approaches to the prevention and treatment of DM2.AIMS: To reveal ethnic features of the prevalence of carbohydrate metabolism disorders and risk factors for the development of DM2 in the adult population of the Russian Federation.MATERIALS AND METHODS. A retrospective analysis of the database of the national epidemiological cross-sectional study NATION was carried out. Depending on the self-specified nationality, on the basis of anthropological characteristics, the following ethnic groups were identified: “Mongoloid population”, “Peoples of the Volga region”, “Peoples of the North Caucasus”, “Peoples of Transcaucasia”, “Russians”. The analysis consisted of several stages and included: analysis of the anthropometric features of the selected groups, taking into account the presence of carbohydrate metabolism disorders (MO); study of the prevalence of violations of the MA in the selected ethnic groups; analysis of ethnic characteristics of risk factors for the development of type 2 diabetes; analysis of the frequency of violations of the MA in various ethnic groups, taking into account the territory of residence. MR disorders were defined as the presence of DM and/or prediabetes. In accordance with the WHO criteria, HbA1c≥6.5% corresponded to the diagnosis of DM, HbA1c values in the range of 5.7%≤HbA1c<6.5% to the diagnosis of prediabetes.RESULTS: The highest frequency of violations of the MA was observed in the group «Peoples of the Volga region» (31.2%), the lowest in the «Peoples of the North Caucasus» (15.6%). BMI in the group “Peoples of the Volga region” was significantly lower than in the group “Peoples of the North Caucasus. Violations of MR were more often observed in the abdominal nature of obesity, obesity of the 1st stage, age over 45 years in the groups «Mongoloid population» and «Peoples of the Volga region» than in the peoples of the «Northern Caucasus» and «Transcaucasia». The frequency of occurrence of SR violations among representatives of the Volga Peoples group living in their historical territories was higher than among Russians living in the same regions: 32.5% and 24.3% (p<0.001 χ2 criterion), and also higher than in the Russian CFD: 32.5% and 27.4%, respectively, p=0.001 (χ2 test). The prevalence of violations of the MA among the peoples of the North Caucasus was less than among the Russians of the Central Federal District — 13.9% and 27.36%, respectively (p<0.001 χ2 criterion). The prevalence of MR violations among representatives of the “Peoples of the North Caucasus” group living in their historical territories (n=598) was less than among those living in other regions of the Russian Federation (n=164) (13.9% and 21.95%, p= 0.012 criterion χ2).CONCLUSION: In the present work, for the first time, we analyzed the prevalence of MR disorders in various ethnic groups of the population of the Russian Federation, identified certain ethnic characteristics of DM2 risk factors and their contribution to the development of the disease. The obtained results should be used for planning preventive programs in various regions of the Russian Federation.
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12
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Study the CAT-21 A/T (rs7943316) gene polymorphism and its correlation with physiological antioxidant index in the Iraqi patients with T2DM. Int J Health Sci (Qassim) 2022. [DOI: 10.53730/ijhs.v6ns2.6050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: A multi-gene inherited metabolic illness in which the body is unable to produce enough insulin and is characterized by abnormal glucose homeostasis has been now called Type 2 diabetes mellitus (T2DM). Objectives: This study aimed to evaluate the effect of CAT-21 A/T (rs7943316) gene polymorphism and antioxidant index (AOI) in the Iraqi patients with T2DM. Methods: In general, 135 individuals, 90 T2DM patients and 45 healthy control were employed in this research. The spectrophotometer method were used to assessment of TAO-C and MDA levels (antioxidant index TAO-C/MDA), while CAT-21 A/T (rs7943316) SNPs was an estimate by PCR-RFLP and restriction fragments by Hinf1 enzyme restriction. Results: In this study, the results propose profoundly tremendous contrasts in TAO-C, MDA, and AOI levels among T2DM and the benchmark group (p-value< 0.05). Then again, the outcomes propose the profoundly bad relationship (r=-0.765) between the periods of the T2DM bunch with TAO-C as well as, we tracked down an exceptionally certain connection (r=0.556) between the times of the T2DM bunch with MDA levels. Furthermore, in the genetic part of this work, the results indicated that the AA homozygote genotype implied a statistically significant effect (P-value=0.000) (OR=2.66(1.23-4.12)) for the risk of T2DM.
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13
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Lopes A, Roque F, Morgado S, Dinis C, Herdeiro MT, Morgado M. Behavioral Sciences in the Optimization of Pharmacological and Non-Pharmacological Therapy for Type 2 Diabetes. Behav Sci (Basel) 2021; 11:bs11110153. [PMID: 34821614 PMCID: PMC8614941 DOI: 10.3390/bs11110153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/21/2021] [Accepted: 10/25/2021] [Indexed: 11/21/2022] Open
Abstract
Type 2 diabetes mellitus is one of the main chronic diseases worldwide, with a significant impact on public health. Behavioral changes are an important step in disease prevention and management, so the way in which individuals adapt their lifestyle to new circumstances will undoubtedly be a predictor of the success of the treatments instituted, contributing to a reduction in the morbidity and mortality that may be associated with them. It is essential to prepare and educate all diabetic patients on the importance of changing behavioral patterns in relation to the disease, with health professionals assuming an extremely important role in this area, both from a pharmacological and non-pharmacological point of view, and also ensuring the monitoring of the progress of these measures. Diabetes is a chronic disease that requires a high self-management capacity on the part of patients in order to achieve success in treating the disease, and non-adherence to therapy or non-compliance with the previously defined plan, together with an erratic lifestyle, will contribute to failure in controlling the disease. The lower adherence to pharmacological and non-pharmacological treatment in diabetes is mainly correlated to socio-economic aspects, lower health literacy, the side effects associated with the use of antidiabetic therapy or even the concomitant use of several drugs. This article consists of a narrative review that aims to synthesize the findings published in the literature, retrieved by searching databases, manuals, previously published scientific articles and official texts, following the methodology of the Scale for Assessment of Narrative Review Articles (SANRA). We aim to address the importance of behavioral sciences in the treatment of diabetes, in order to assess behavior factors and barriers for behavior changes that have an impact on the therapeutic and non-therapeutic optimization in patients with type 2 diabetes mellitus control.
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Affiliation(s)
- António Lopes
- Pharmaceutical Services of Unity Local of Health of Guarda (ULS da Guarda), 6300-035 Guarda, Portugal; (A.L.); (C.D.)
- Health Sciences Faculty, University of Beira Interior (FCS-UBI), 6200-506 Covilhã, Portugal;
| | - Fátima Roque
- Research Unit for Inland Development, Polytechnic Institute of Guarda (UDI-IPG), 6300-559 Guarda, Portugal
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal
- Correspondence:
| | - Sandra Morgado
- Pharmaceutical Services of University Hospital Center of Cova da Beira, 6200-251 Covilhã, Portugal;
| | - Cristina Dinis
- Pharmaceutical Services of Unity Local of Health of Guarda (ULS da Guarda), 6300-035 Guarda, Portugal; (A.L.); (C.D.)
| | - Maria Teresa Herdeiro
- Institute of Biomedicine, Department of Medical Sciences (iBiMED-UA), University of Aveiro, 3810-193 Aveiro, Portugal;
| | - Manuel Morgado
- Health Sciences Faculty, University of Beira Interior (FCS-UBI), 6200-506 Covilhã, Portugal;
- Research Unit for Inland Development, Polytechnic Institute of Guarda (UDI-IPG), 6300-559 Guarda, Portugal
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal
- Pharmaceutical Services of University Hospital Center of Cova da Beira, 6200-251 Covilhã, Portugal;
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Porhcisaliyan VD, Wang Y, Tan NC, Jafar TH. Socioeconomic status and ethnic variation associated with type 2 diabetes mellitus in patients with uncontrolled hypertension in Singapore. BMJ Open Diabetes Res Care 2021; 9:e002064. [PMID: 34301679 PMCID: PMC8728350 DOI: 10.1136/bmjdrc-2020-002064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 06/30/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The burden of type 2 diabetes mellitus (T2DM) and related vascular complications is particularly high in Asians and ethnic minorities living in the West. However, the association of T2DM with socioeconomic status (SES) and ethnicity has not been widely studied in populations living in Asia. Therefore, we investigated these associations among the multiethnic population with uncontrolled hypertension in Singapore. RESEARCH DESIGN AND METHODS In a cross-sectional study using baseline data of a 2-year randomized trial in Singapore, we obtained demographic, SES, lifestyle and clinical factors from 915 patients aged ≥40 years with uncontrolled hypertension. T2DM was defined as having either: (i) self-reported 'physician-diagnosed diabetes confirmed through medical records' or taking antidiabetes medications, (ii) fasting blood glucose levels ≥7.0 mmol/dL or (iii) hemoglobin A1c ≥6.5%. The SES proxies included education, employment status, housing ownership and housing type, and the ethnicities were Chinese, Malays and Indians. Logistic regression analyses were used to evaluate the association of T2DM with SES and ethnicity. RESULTS Higher proportion of T2DM was observed in Malays (40.0%) and Indians (56.0%) than Chinese (26.8%) (p<0.001), and in patients with lower SES (ranging from 25.7% to 66.2% using different proxies) than those with higher SES (19.4% to 32.0%). In a multivariate model comprising age, gender, ethnicity and SES, Malay ethnicity (OR 1.59; 95% CI 1.04 to 2.44, p=0.031) or Indian ethnicity (OR 3.65; 95% CI 2.25 to 5.91, p<0.001) versus Chinese and housing type (residing in one to three rooms (OR 2.00; 95% CI 1.16 to 3.43, p=0.012) or four to five rooms public housing (OR 1.86; 95% CI 1.13 to 3.04, p=0.013) vs private housing) were associated with higher T2DM odds. The associations of Indians and one to three rooms public housing with T2DM met the significance after accounting for multiple testing (p≤0.0125). CONCLUSION Our study suggests that housing type and ethnic variation are independently associated with higher T2DM risk in patients with uncontrolled hypertension in Singapore. Further studies are needed to validate our results. TRIAL REGISTRATION NUMBER NCT02972619.
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Affiliation(s)
| | - Yeli Wang
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Ngiap Chuan Tan
- SingHealth Polyclinics, Singapore
- SingHealth-Duke NUS Family Academic Clinical Program, Singapore
| | - Tazeen H Jafar
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Department of Renal Medicine, Singapore General Hospital, Singapore
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
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15
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Öhlund M, Müllner E, Moazzami A, Hermansson U, Pettersson A, Anderson F, Häggström J, Hansson-Hamlin H, Holst BS. Differences in metabolic profiles between the Burmese, the Maine coon and the Birman cat-Three breeds with varying risk for diabetes mellitus. PLoS One 2021; 16:e0249322. [PMID: 33886598 PMCID: PMC8062062 DOI: 10.1371/journal.pone.0249322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 03/15/2021] [Indexed: 12/31/2022] Open
Abstract
Feline diabetes mellitus shares many features with type 2 diabetes in people, regarding clinical presentation, physiology, and pathology. A breed predisposition for type 2 diabetes has been identified, with the Burmese breed at a fivefold increased risk of developing the condition compared to other purebred cats. We aimed to characterize the serum metabolome in cats (n = 63) using nuclear magnetic resonance metabolomics, and to compare the metabolite pattern of Burmese cats with that of two cat breeds of medium or low risk of diabetes, the Maine coon (MCO) and Birman cat, respectively. Serum concentrations of adiponectin, insulin and insulin-like growth factor-1 were also measured (n = 94). Burmese cats had higher insulin and lower adiponectin concentrations than MCO cats. Twenty one metabolites were discriminative between breeds using a multivariate statistical approach and 15 remained significant after adjustment for body weight and body condition score. Burmese cats had higher plasma levels of 2-hydroxybutyrate relative to MCO and Birman cats and increased concentrations of 2-oxoisocaproic acid, and tyrosine, and lower concentrations of dimethylglycine relative to MCO cats. The metabolic profile of MCO cats was characterized by high concentrations of arginine, asparagine, methionine, succinic acid and low levels of acetylcarnitine while Birman cats had the highest creatinine and the lowest taurine plasma levels, compared with MCO and Burmese. The pattern of metabolites in Burmese cats is similar to that in people with insulin resistance. In conclusion, the metabolic profile differed between healthy cats of three breeds. Detection of an abnormal metabolome might identify cats at risk of developing diabetes.
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Affiliation(s)
- Malin Öhlund
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Elisabeth Müllner
- Department of Molecular Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Ali Moazzami
- Department of Molecular Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Ulrika Hermansson
- University Animal Hospital, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Ann Pettersson
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | | | - Jens Häggström
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Helene Hansson-Hamlin
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Bodil S. Holst
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
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16
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Do Diabetes Mellitus Differences Exist within Generations? Three Generations of Moluccans in the Netherlands. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020493. [PMID: 33435344 PMCID: PMC7827698 DOI: 10.3390/ijerph18020493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/24/2020] [Accepted: 01/06/2021] [Indexed: 11/16/2022]
Abstract
Background: Diabetes mellitus (DM) is known to be more prevalent among migrants compared to their host populations. It is unclear whether DM prevalence differs between generations among migrants. We investigated the differences in DM prevalence among three generations of Moluccans, who have been living for over 65 years in the Netherlands, compared to the Dutch population. Methods: In this cross-sectional study, data of a healthcare insurance database on hospital and medication use (Achmea Health Database) were used. The dataset contained 5394 Moluccans and 52,880 Dutch persons of all ages. DM differences were assessed by means of logistic regression, adjusting for age, sex, urbanization, and area socio-economic status. Results: The prevalence of DM was higher in all generations of Moluccans compared to the Dutch. The adjusted odds ratios (AORs) for DM were significantly higher in total group of Moluccans compared to the Dutch (AOR 1.60, 95% CI 1.42–1.80) and across the first and second generation of Moluccans compared to the Dutch (first generation (1.73, 1.47–2.04) and second generation (1.44, 1.19–1.75). Higher AOR were found for first generation men (1.55, 1.22–1.97) and first (1.90, 1.52–2.37) and second (1.63, 1.24–2.13) generation Moluccan women compared to the Dutch. AOR for the third generation Moluccans was increased to a similar extent (1.51, 0.97–2.34), although not statistical significant. Conclusions: Our findings show higher odds of DM across generations of Moluccans compared to the Dutch. DM prevention strategies for minorities should be targeted at all migrant generations in host countries.
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Shrivastava P, Prashar R, Khoury N, Patel A, Yeddula S, Kitajima T, Nagai S, Samaniego M. Acute Kidney Injury in a Predominantly African American Cohort of Kidney Transplant Recipients With COVID-19 Infection. Transplantation 2021; 105:201-205. [PMID: 33093403 DOI: 10.1097/tp.0000000000003498] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Renal involvement in severe or critical acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is frequent. Acute kidney injury (AKI) in African American (AA) kidney transplant recipients (KTRs) with COVID-19 is not well described. We report our experience with a predominantly AA cohort (79%) of KTRs with COVID-19 infections in the Detroit Metropolitan area. METHODS In this retrospective, single-center study, we identified 39 KTRs who tested positive for SARS-CoV-2 between March 16 and April 25, 2020. Data from electronic medical records were retrieved and compared between KTRs without AKI and KTRs with AKI. RESULTS One patient was excluded due to delayed graft function. Final analysis of AKI in KTRs with proven COVID-19 was done on 38 patients of which 30 were AA (79%). AKI occurred in 71.1% of COVID-19 KTRs (n = 27), of whom 6 (22.2%) patients required HD. The incidence of AKI in our cohort was 71% (27/38). AKI rate among AA was 76.7% versus 50% in non-AA cohort (P = 0.195). In a univariate logistic regression analysis, AA race was not significantly associated with AKI odds ratio (3.4; CI, 0.68-17.4; P = 0.14). After risk adjustment by race, patients with diabetes showed a significantly higher risk of AKI (adjusted odds ratio, 19.85; CI, 1.65-58.66; P = 0.012). KTRs with AKI had more preexisting renin angiotensin aldosterone system inhibitor use than KTRs without AKI (P = 0.03). CONCLUSIONS KTRs infected with SARS-CoV-2 have a high incidence of AKI, with associated increased morbidity and mortality. Although no racial differences in mortality were noted in our KTRs with AKI, we await data from registries to help elucidate this difference.
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Affiliation(s)
- Pritika Shrivastava
- Division of Nephrology, Department of Medicine, Henry Ford Transplant Institute, Henry Ford Health System, Detroit, MI
| | - Rohini Prashar
- Division of Nephrology, Department of Medicine, Henry Ford Transplant Institute, Henry Ford Health System, Detroit, MI
| | - Nadeen Khoury
- Division of Nephrology, Department of Medicine, Henry Ford Transplant Institute, Henry Ford Health System, Detroit, MI
| | - Anita Patel
- Division of Nephrology, Department of Medicine, Henry Ford Transplant Institute, Henry Ford Health System, Detroit, MI
- School of Medicine, Wayne State University, Detroit, MI
| | - Sirisha Yeddula
- Division of Transplant and Hepatobiliary Surgery, Department of Surgery, Henry Ford Transplant Institute, Henry Ford Health System, Detroit, MI
| | - Toshihiro Kitajima
- Division of Transplant and Hepatobiliary Surgery, Department of Surgery, Henry Ford Transplant Institute, Henry Ford Health System, Detroit, MI
| | - Shunji Nagai
- School of Medicine, Wayne State University, Detroit, MI
- Division of Transplant and Hepatobiliary Surgery, Department of Surgery, Henry Ford Transplant Institute, Henry Ford Health System, Detroit, MI
| | - Milagros Samaniego
- Division of Nephrology, Department of Medicine, Henry Ford Transplant Institute, Henry Ford Health System, Detroit, MI
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18
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Alkaf B, Blakemore AI, Järvelin MR, Lessan N. Secondary analyses of global datasets: do obesity and physical activity explain variation in diabetes risk across populations? Int J Obes (Lond) 2021; 45:944-956. [PMID: 33574565 PMCID: PMC8081659 DOI: 10.1038/s41366-021-00764-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 12/09/2020] [Accepted: 01/20/2021] [Indexed: 01/31/2023]
Abstract
Type 2 diabetes rates vary significantly across geographic regions. These differences are sometimes assumed to be entirely driven by differential distribution of environmental triggers, including obesity and insufficient physical activity (IPA). In this review, we discuss data which conflicts with this supposition. We carried out a secondary analysis of publicly available data to unravel the relative contribution of obesity and IPA towards diabetes risk across different populations. We used sex-specific, age-standardized estimates from Non-Communicable Disease Risk Factor Collaboration (NCD-RisC) on diabetes (1980-2014) and obesity (1975-2016) rates, in 200 countries, and from WHO on IPA rates in 168 countries in the year 2016. NCD-RisC and WHO organized countries into nine super-regions. All analyses were region- and sex-specific. Although obesity has been increasing since 1975 in every part of the world, this was not reflected in a proportional increase in diabetes rates in several regions, including Central and Eastern Europe, and High-income western countries region. Similarly, the association of physical inactivity with diabetes is not homogeneous across regions. Countries from different regions across the world could have very similar rates of diabetes, despite falling on opposite ends of IPA rate spectrum. The combined effect of obesity and IPA on diabetes risk was analyzed at the worldwide and country level. The overall findings highlighted the larger impact of obesity on disease risk; low IPA rates do not seem to be protective of diabetes, when obesity rates are high. Despite that, some countries deviate from this overall observation. Sex differences were observed across all our analyses. Overall, data presented in this review indicate that different populations, while experiencing similar environmental shifts, are apparently differentially subject to diabetes risk. Sex-related differences observed suggest that males and females are either subject to different risk factor exposures or have different responses to them.
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Affiliation(s)
- Budour Alkaf
- grid.488461.70000 0004 4689 699XImperial College London Diabetes Centre, Abu Dhabi, United Arab Emirates ,grid.7445.20000 0001 2113 8111Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Alexandra I. Blakemore
- grid.7728.a0000 0001 0724 6933College of Health, Medicine, and Life Sciences, Brunel University London, Uxbridge, UK ,grid.7445.20000 0001 2113 8111Department of Medicine, Imperial College London, London, UK
| | - Marjo-Riitta Järvelin
- grid.7445.20000 0001 2113 8111Department of Epidemiology and Biostatistics, Imperial College London, London, UK ,grid.7728.a0000 0001 0724 6933College of Health, Medicine, and Life Sciences, Brunel University London, Uxbridge, UK ,grid.10858.340000 0001 0941 4873Centre for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland ,grid.412326.00000 0004 4685 4917Unit of Primary Health Care and Medical Research Centre, Oulu University Hospital, Oulu, Finland
| | - Nader Lessan
- grid.488461.70000 0004 4689 699XImperial College London Diabetes Centre, Abu Dhabi, United Arab Emirates
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Alenaini W, Parkinson JRC, McCarthy JP, Goldstone AP, Wilman HR, Banerjee R, Yaghootkar H, Bell JD, Thomas EL. Ethnic Differences in Body Fat Deposition and Liver Fat Content in Two UK-Based Cohorts. Obesity (Silver Spring) 2020; 28:2142-2152. [PMID: 32939982 DOI: 10.1002/oby.22948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Differences in the content and distribution of body fat and ectopic lipids may be responsible for ethnic variations in metabolic disease susceptibility. The aim of this study was to examine the ethnic distribution of body fat in two separate UK-based populations. METHODS Anthropometry and body composition were assessed in two separate UK cohorts: the Hammersmith cohort and the UK Biobank, both comprising individuals of South Asian descent (SA), individuals of Afro-Caribbean descent (AC), and individuals of European descent (EUR). Regional adipose tissue stores and liver fat were measured by magnetic resonance techniques. RESULTS The Hammersmith cohort (n = 747) had a mean (SD) age of 41.1 (14.5) years (EUR: 374 men, 240 women; SA: 68 men, 22 women; AC: 14 men, 29 women), and the UK Biobank (n = 9,533) had a mean (SD) age of 55.5 (7.5) years (EUR: 4,483 men, 4,873 women; SA: 80 men, 43 women, AC: 31 men, 25 women). Following adjustment for age and BMI, no significant differences in visceral adipose tissue or liver fat were observed between SA and EUR individuals in the either cohort. CONCLUSIONS Our data, consistent across two independent UK-based cohorts, present a limited number of ethnic differences in the distribution of body fat depots associated with metabolic disease. These results suggest that the ethnic variation in susceptibility to features of the metabolic syndrome may not arise from differences in body fat.
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Affiliation(s)
- Wareed Alenaini
- Research Centre for Optimal Health, School of Life Sciences, College of Liberal Arts and Sciences, University of Westminster, London, UK
| | - James R C Parkinson
- Research Centre for Optimal Health, School of Life Sciences, College of Liberal Arts and Sciences, University of Westminster, London, UK
| | - John P McCarthy
- School of Healthcare Practice, University of Bedfordshire, Luton, Bedfordshire, UK
| | - Anthony P Goldstone
- PsychoNeuroEndocrinology Research Group, Neuro-psychopharmacology Unit, Centre for Psychiatry, Division of Brain Sciences, Imperial College London-Hammersmith Hospital, London, UK
| | - Henry R Wilman
- Research Centre for Optimal Health, School of Life Sciences, College of Liberal Arts and Sciences, University of Westminster, London, UK
- Perspectum Diagnostics, Oxford, UK
| | | | - Hanieh Yaghootkar
- Research Centre for Optimal Health, School of Life Sciences, College of Liberal Arts and Sciences, University of Westminster, London, UK
- Genetics of Complex Traits, Medical School, University of Exeter-Royal Devon & Exeter Hospital, Exeter, UK
- Division of Medical Sciences, Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
| | - Jimmy D Bell
- Research Centre for Optimal Health, School of Life Sciences, College of Liberal Arts and Sciences, University of Westminster, London, UK
| | - E Louise Thomas
- Research Centre for Optimal Health, School of Life Sciences, College of Liberal Arts and Sciences, University of Westminster, London, UK
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20
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Bonilla-Escobar BA, Borrell LN, Del Cura-González I, Sánchez-Perruca L, Escortell-Mayor E, Franco M. Type 2 diabetes prevalence among Andean immigrants and natives in a Southern European City. Acta Diabetol 2020; 57:1065-1072. [PMID: 32253608 DOI: 10.1007/s00592-020-01515-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 03/07/2020] [Indexed: 11/24/2022]
Abstract
AIMS Inequalities in diabetes prevalence among immigrants from Andean countries remain unknown. Andean populations are one of the largest groups of immigrants in Madrid city. We examined the association between country of birth and type 2 diabetes mellitus (T2DM) prevalence in Andean immigrant population relative to Spanish-natives; and whether this association varied by age, sex and length of residence. METHODS We analyzed 1,258,931 electronic medical records from Spanish native and Andean immigrant adults aged 40-75 years of Madrid city. We used logistic regression and test interaction terms to address our aims. RESULTS Andean immigrants showed 1.13 (95% CI 1.10-1.17) greater adjusted odds for T2DM than Spanish natives. This association was positive in Ecuadorians and Bolivians but protective in Peruvians and Colombians. There was heterogeneity of this association according to age and sex. Relative to Spanish natives, odds of T2DM in Andeans of all ages and women were higher but lower in men. CONCLUSION Andean adults showed greater odds of T2DM compared with Spanish native adults in Madrid, with variation observed by age and sex. These findings emphasize the need for studying immigrant populations in a disaggregated manner to implement specific clinical and preventive approaches.
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Affiliation(s)
- Bertha Angelica Bonilla-Escobar
- Social and Cardiovascular Epidemiology Research Group, School of Medicine, University of Alcala, Alcala de Henares, Madrid, Spain
| | - Luisa N Borrell
- Social and Cardiovascular Epidemiology Research Group, School of Medicine, University of Alcala, Alcala de Henares, Madrid, Spain.
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, 55 West 125th Street, 530, New York, NY, 10027, USA.
| | - Isabel Del Cura-González
- Research Unit, Assistance Office for Primary Care, Health Services of Madrid, Madrid, Spain
- Department of Preventive Medicine and Public Health, University Rey Juan Carlos, Madrid, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, ISCIII, Madrid, Spain
| | - Luis Sánchez-Perruca
- Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, ISCIII, Madrid, Spain
- Information Technology Systems, Assistance Office for Primary Care, Health Services of Madrid, Madrid, Spain
| | - Esperanza Escortell-Mayor
- Research Unit, Assistance Office for Primary Care, Health Services of Madrid, Madrid, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, ISCIII, Madrid, Spain
| | - Manuel Franco
- Social and Cardiovascular Epidemiology Research Group, School of Medicine, University of Alcala, Alcala de Henares, Madrid, Spain
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, 55 West 125th Street, 530, New York, NY, 10027, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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21
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Yaghootkar H, Whitcher B, Bell JD, Thomas EL. Ethnic differences in adiposity and diabetes risk - insights from genetic studies. J Intern Med 2020; 288:271-283. [PMID: 32367627 DOI: 10.1111/joim.13082] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Type 2 diabetes is more common in non-Europeans and starts at a younger age and at lower BMI cut-offs. This review discusses the insights from genetic studies about pathophysiological mechanisms which determine risk of disease with a focus on the role of adiposity and body fat distribution in ethnic disparity in risk of type 2 diabetes. During the past decade, genome-wide association studies (GWAS) have identified more than 400 genetic variants associated with the risk of type 2 diabetes. The Eurocentric nature of these genetic studies has made them less effective in identifying mechanisms that make non-Europeans more susceptible to higher risk of disease. One possible mechanism suggested by epidemiological studies is the role of ethnic difference in body fat distribution. Using genetic variants associated with an ability to store extra fat in a safe place, which is subcutaneous adipose tissue, we discuss how different ethnic groups could be genetically less susceptible to type 2 diabetes by developing a more favourable fat distribution.
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Affiliation(s)
- H Yaghootkar
- From the, Genetics of Complex Traits, University of Exeter Medical School, Royal Devon & Exeter Hospital, Exeter, UK.,School of Life Sciences, College of Liberal Arts and Science, University of Westminster, London, UK.,Division of Medical Sciences, Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
| | - B Whitcher
- School of Life Sciences, College of Liberal Arts and Science, University of Westminster, London, UK
| | - J D Bell
- School of Life Sciences, College of Liberal Arts and Science, University of Westminster, London, UK
| | - E L Thomas
- School of Life Sciences, College of Liberal Arts and Science, University of Westminster, London, UK
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22
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Hermans MP, Ahn SA, Sadikot S, Rousseau MF. Established and novel gender dimorphisms in type 2 diabetes mellitus: Insights from a multiethnic cohort. Diabetes Metab Syndr 2020; 14:1503-1509. [PMID: 32795742 DOI: 10.1016/j.dsx.2020.07.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 07/11/2020] [Accepted: 07/14/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS In type 2 diabetes mellitus (T2DM), sexual dimorphisms modulate the natural histories of hyperglycemia, anthropophysical/cardiometabolic phenotype, and susceptibility to chronic micro and macrovascular complications. The purpose of this work was to revisit known or new dimorphisms within a multiethnic cohort. METHODS Among 1238 T2DM patients, men (63%) were compared to women (37%), including leading ethnicities: Whites (67.4%; 542 men; 293 women); Maghrebians (9.4%; 62 men; 54 women); and Blacks (12.5%; 92 men; 63 women). RESULTS Age, BMI, diabetes duration, insulin sensitivity, B-cell function loss, HbA1c, and hyperglycemia index were similar in both genders. All-cause microangiopathy and cerebrovascular disease did not differ between sexes. Women had significantly more retinopathy (27% vs. 21%) and men more microalbuminuria (25% vs. 19%), all-cause macroangiopathy (40% vs. 26%), CAD (29% vs. 17%) and PAD (11% vs. 6%). Among Blacks, sexual dimorphism in terms of retinopathy was more pronounced (24% in women vs. 11%), while there was no sexual dimorphism in all-cause macroangiopathy, CAD or PAD. B-cell function loss was faster among North African men (+15%), who also had more hepatic steatosis (+27%) than women. CONCLUSIONS T2DM abolishes the CV protection provided by the female gender in Blacks. In White women, the loss of CV protection in diabetes is limited to cerebrovascular disease. In Black women, a markedly increased risk of retinopathy is present, despite glycemic exposure similat to men. Sexual dimorphisms do not affect glucose homeostasis and metabolic control in all ethnicities, except for lesser B-cell function loss in Maghrebian women.
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Affiliation(s)
- Michel P Hermans
- Division of Endocrinology & Nutrition, Cliniques universitaires St-Luc and Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium.
| | - Sylvie A Ahn
- Division of Cardiology, Cliniques universitaires St-Luc and Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium
| | - Shaukat Sadikot
- Department of Endocrinology/Diabetology, Jaslok Hospital and Research Centre, Mumbai, India
| | - Michel F Rousseau
- Division of Cardiology, Cliniques universitaires St-Luc and Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium
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23
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Regine I, Husain RSRA, Aswathi RP, Reddy DR, Ahmed SSSJ, Ramakrishnan V. Association between PPARγrs1801282 polymorphism with diabetic nephropathy and type-2 diabetes mellitus susceptibility in south India and a meta-analysis. Nefrologia 2020; 40:287-298. [PMID: 32417009 DOI: 10.1016/j.nefro.2020.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 12/19/2019] [Accepted: 01/19/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Diabetic Nephropathy (DN) is a major complication of Type 2 Diabetes Mellitus (T2DM) with high morbidity rates worldwide. OBJECTIVE To determine the association of PPARγ rs1801282 polymorphism in T2DM and DN in south Indian population. METHODS We have conducted a case-control study to test the association of rs1801282 polymorphism with T2DM and DN in 424 subjects (DN=128; T2DM=148 and controls=148) belonging to the south Indian population using ARMS-PCR and Sanger sequencing method. Further, a meta-analysis was performed for rs1801282 polymorphism from the published literature retrieved from various electronic databases to determine the susceptibility among T2DM and DN across various ethnic populations under five genetic models. RESULTS The genotyping of rs1801282 polymorphism showed significant (p-value<0.05) association with DN and T2DM compared to controls. In the meta-analysis, no significant association (p-value>0.05) was noticed for rs1801282 with DN vs. controls in homozygote, heterozygote, allelic, recessive and dominant genetic models. However, a significant association was observed between rs1801282 SNP and T2DM under heterozygote (Jj vs JJ) genetic model with OR=0.56, (95%CI [0.43-0.74]), p≤0.0001 of Asian and Caucasian populations. CONCLUSION Overall analysis suggests that the rs1801282 polymorphism might be associated with DN and T2DM. More case-control studies on the PPARγ gene with a larger sample size including all the confounding factors are required to corroborate the findings from this meta-analysis.
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Affiliation(s)
- Ilibagiza Regine
- Genetics Lab, Faculty of Allied Health Sciences, Chettinad Academy of Research and Education, Kelambakkam, Tamil Nadu, India
| | | | - Rajagopalan P Aswathi
- Genetics Lab, Faculty of Allied Health Sciences, Chettinad Academy of Research and Education, Kelambakkam, Tamil Nadu, India
| | - D Ramacharan Reddy
- Department of General Medicine, Chettinad Hospital and Research Institute, Chettinad Health City, Kelambakkam, Tamil Nadu, India
| | - Shiek S S J Ahmed
- Drug Discovery Lab, Faculty of Allied Health Sciences, Chettinad Academy of Research and Education, Kelambakkam, Tamil Nadu, India
| | - Veerabathiran Ramakrishnan
- Genetics Lab, Faculty of Allied Health Sciences, Chettinad Academy of Research and Education, Kelambakkam, Tamil Nadu, India.
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24
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Regine I, Husain RSRA, Aswathi RP, Reddy DR, Ahmed SSSJ, Ramakrishnan V. Association between PPARγrs1801282 polymorphism with diabetic nephropathy and type-2 diabetes mellitus susceptibility in south India and a meta-analysis. Nefrologia 2020; 40:287-298. [PMID: 32417009 DOI: 10.1016/j.nefroe.2020.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 12/19/2019] [Accepted: 01/19/2020] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Diabetic Nephropathy (DN) is a major complication of Type 2 Diabetes Mellitus (T2DM) with high morbidity rates worldwide. OBJECTIVE To determine the association of PPARγ rs1801282 polymorphism in T2DM and DN in south Indian population. METHODS We have conducted a case-control study to test the association of rs1801282 polymorphism with T2DM and DN in 424 subjects (DN=128; T2DM=148 and controls=148) belonging to the south Indian population using ARMS-PCR and Sanger sequencing method. Further, a meta-analysis was performed for rs1801282 polymorphism from the published literature retrieved from various electronic databases to determine the susceptibility among T2DM and DN across various ethnic populations under five genetic models. RESULTS The genotyping of rs1801282 polymorphism showed significant (p-value<0.05) association with DN and T2DM compared to controls. In the meta-analysis, no significant association (p-value>0.05) was noticed for rs1801282 with DN vs. controls in homozygote, heterozygote, allelic, recessive and dominant genetic models. However, a significant association was observed between rs1801282 SNP and T2DM under heterozygote (Jj vs JJ) genetic model with OR=0.56, (95%CI [0.43-0.74]), p≤0.0001 of Asian and Caucasian populations. CONCLUSION Overall analysis suggests that the rs1801282 polymorphism might be associated with DN and T2DM. More case-control studies on the PPARγ gene with a larger sample size including all the confounding factors are required to corroborate the findings from this meta-analysis.
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Affiliation(s)
- Ilibagiza Regine
- Genetics Lab, Faculty of Allied Health Sciences, Chettinad Academy of Research and Education, Kelambakkam, Tamil Nadu, India
| | | | - Rajagopalan P Aswathi
- Genetics Lab, Faculty of Allied Health Sciences, Chettinad Academy of Research and Education, Kelambakkam, Tamil Nadu, India
| | - D Ramacharan Reddy
- Department of General Medicine, Chettinad Hospital and Research Institute, Chettinad Health City, Kelambakkam, Tamil Nadu, India
| | - Shiek S S J Ahmed
- Drug Discovery Lab, Faculty of Allied Health Sciences, Chettinad Academy of Research and Education, Kelambakkam, Tamil Nadu, India
| | - Veerabathiran Ramakrishnan
- Genetics Lab, Faculty of Allied Health Sciences, Chettinad Academy of Research and Education, Kelambakkam, Tamil Nadu, India.
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25
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Fritz J, Lopez-Ridaura R, Choudhry S, Razo C, Lamadrid-Figueroa H. The association of Native American genetic ancestry and high-density lipoprotein cholesterol: A representative study of a highly admixed population. Am J Hum Biol 2020; 32:e23426. [PMID: 32329554 DOI: 10.1002/ajhb.23426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 03/11/2020] [Accepted: 04/08/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Hispanic populations typically show a high prevalence of dyslipidemias, especially of low high-density lipoproteins (HDLs) or HDL cholesterol. Highly admixed populations are ideal groups to clarify the role of genetic ancestry on HDL concentrations, isolating it from that of other factors. The objective of this study was to estimate the association between Native American genetic ancestry and HDL-cholesterol levels independent of socioeconomic factors in a representative sample of the Mexican population. METHODS We used data from the Mexican National Health Survey 2000, analyzing 1647 subjects from whom stored DNA samples and HDL measurements were available. To estimate proportional genetic ancestry (Native American, African, and European), we used a 107 genetic ancestry informative marker panel with the software STRUCTURE. To estimate the association between genetic ancestry and low HDL levels, we fitted logistic regression models with the percentage of Native American genetic ancestry, in quartiles, as the main predictor. RESULTS Mean HDL levels were 38.9 mg/dL, with 62% of subjects having levels below 40 mg/dL. Participants had on average 53.6% Native American, 39% European, and 7.3% African genetic ancestry. Those in the fourth quartile of Native American genetic ancestry had 35% higher odds of having low HDL-cholesterol relative to those in the first quartile (odds ratio, 1.35; 95% confidence interval, 0.99-1.81) after adjustment for socioeconomic level and other covariates, although the association is clearly nonlinear. CONCLUSION Native American genetic ancestry seems to play a small but distinct role in the development of low HDL cholesterol levels.
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Affiliation(s)
- Jimena Fritz
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Ruy Lopez-Ridaura
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Shweta Choudhry
- Human Genetics at Lung Biology Center, University of California San Francisco, San Francisco, California, USA
| | - Christian Razo
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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26
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Marlatt KL, Redman LM, Beyl RA, Smith SR, Champagne CM, Yi F, Lovejoy JC. Racial differences in body composition and cardiometabolic risk during the menopause transition: a prospective, observational cohort study. Am J Obstet Gynecol 2020; 222:365.e1-365.e18. [PMID: 31610152 DOI: 10.1016/j.ajog.2019.09.051] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 08/29/2019] [Accepted: 09/30/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Obesity disproportionately affects more women than men. The loss of ovarian function during the menopause transition coincides with weight gain, increases in abdominal adiposity, and impaired metabolic health. Racial differences in obesity prevalence that results from the menopause transition are not well understood. OBJECTIVE The purpose of the study was to assess longitudinal changes in body composition and cardiometabolic risk among black and white women during the menopausal transition. STUDY DESIGN In a secondary analysis of a prospective, observational cohort study (the Healthy Transitions study), 161 women ≥43 years old with a body mass index of 20-40 kg/m2 and who had not yet transitioned through menopause were enrolled at Pennington Biomedical Research Center. Women were seen annually for body composition by dual-energy X-ray absorptiometry, for abdominal adipose tissue distribution by computed tomography, for sex steroid hormones, and for cardiometabolic risk factors that include fasting glucose, insulin, and lipids. Surrogate measures of insulin sensitivity were also calculated. RESULTS Ninety-four women (25 black, 69 white) transitioned through menopause and were included within the analyses. At menopause onset, black women weighed more (77.8±3.0 vs 70.8±1.8 kg) and had a higher systolic (125±16 vs 118±14 mm Hg) and diastolic (80±8 vs 74±7 mm Hg) blood pressure compared with white women (all P≤.05). No other differences in body composition, sex steroid hormones, or cardiometabolic risk factors were observed at menopause onset. Before menopause, white women gained significant weight (3 kg), total body adiposity (6% percent body fat, 9% fat mass, 12% trunk fat mass) and abdominal adipose tissue (19% subcutaneous fat, 15% visceral fat, 19% total adipose tissue), which coincided with significant decreases in estradiol, sex hormone-binding globulin, and estrone sulfate and increases in follicle-stimulating hormone, total cholesterol, and low-density lipoprotein cholesterol. Conversely, black women had more abdominal adipose tissue before menopause, which was maintained across the menopause transition. Black women also had significant decreases in estrone sulfate and total testosterone and increases in follicle-stimulating hormone before menopause. In the postmenopausal years, abdominal subcutaneous adipose tissue, total adipose tissue, follicle-stimulating hormone, total cholesterol, and low-density and high-density lipoprotein cholesterol increased only in white women. CONCLUSION White women gained more abdominal adiposity during the menopause transition compared with black women, which, in part, may be due to differences in the pattern of sex steroid hormone changes between women of different racial backgrounds. The gains in abdominal adiposity in white women were observed in tandem with increased cardiometabolic risk factors. Future studies should consider comprehensive lifestyle approaches to target these increased gains in abdominal adiposity (ie, nutrition and physical activity coaching), while taking into account the potential interactions of race, body adiposity, sex steroid hormones, and their influence on cardiometabolic risk.
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Affiliation(s)
| | | | - Robbie A Beyl
- Pennington Biomedical Research Center, Baton Rouge, LA
| | - Steve R Smith
- Translational Research Institute for Metabolism and Diabetes, Advent Health, Orlando, FL
| | | | - Fanchao Yi
- Center for Collaborative Research, Advent Health, Orlando, FL
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27
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Chang TI, Lim H, Park CH, Rhee CM, Kalantar-Zadeh K, Kang EW, Kang SW, Han SH. Association Between Income Disparities and Risk of Chronic Kidney Disease: A Nationwide Cohort Study of Seven Million Adults in Korea. Mayo Clin Proc 2020; 95:231-242. [PMID: 32029084 PMCID: PMC7224965 DOI: 10.1016/j.mayocp.2019.09.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/10/2019] [Accepted: 09/30/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To examine the association between income level and incident chronic kidney disease (CKD) in adults with normal baseline kidney function. PATIENT AND METHODS We studied the association between income level categorized into deciles and incident CKD in a national cohort comprised of 7,405,715 adults who underwent National Health Insurance Service health examinations during January 1, 2009, to December 31, 2015, with baseline estimated glomerular filtration rates (eGFRs) ≥60 mL/min/1.73 m2. Incident CKD was defined as de novo development of eGFR <60 mL/min/1.73 m2 (model 1) or ≥25% decline in eGFR from baseline values accompanied by eGFR <60 mL/min/1.73 m2 (model 2). RESULTS During a median follow-up of 4.8 years, there were 122,032 of 7,405,715 (1.65%) and 55,779 of 7,405,715 (0.75%) incident CKD events based on model 1 and 2 definitions, respectively. Compared with income levels in the sixth decile, there was an inverse association between lower income level and higher risk for CKD up to the fourth decile, above which no additional reduction (model 1) or slightly higher risk for CKD (model 2) was observed at higher income levels. The multivariable-adjusted hazard ratios from the lowest to fourth deciles were 1.30 (95% CI, 1.26-1.33), 1.16 (95% CI, 1.13-1.19), 1.07 (95% CI, 1.05-1.10), and 1.06 (95% CI, 1.03-1.09) in model 1 and 1.32 (95% CI, 1.27-1.37), 1.18 (95% CI, 1.14-1.22), 1.08 (95% CI, 1.04-1.13), and 1.05 (95% CI, 1.01-1.09) in model 2, respectively. These associations persisted across various subgroups of age, sex, and comorbidity status. CONCLUSION In this large nationwide cohort, lower income levels were associated with higher risk for incident CKD.
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Affiliation(s)
- Tae Ik Chang
- Department of Internal Medicine, National Health Insurance Service Medical Center, Ilsan Hospital, Goyangshi, Gyeonggi-do, Republic of Korea
| | - Hyunsun Lim
- Research and Analysis Team, National Health Insurance Service Medical Center, Ilsan Hospital, Goyangshi, Gyeonggi-do, Republic of Korea
| | - Cheol Ho Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Connie M Rhee
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange; Nephrology Section, Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA
| | - Ea Wha Kang
- Department of Internal Medicine, National Health Insurance Service Medical Center, Ilsan Hospital, Goyangshi, Gyeonggi-do, Republic of Korea
| | - Shin-Wook Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, College of Medicine, Severance Biomedical Science Institute, Brain Korea 21 PLUS, Yonsei University, Seoul, Republic of Korea
| | - Seung Hyeok Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Metabolic Syndrome in Arab Adults with Low Bone Mineral Density. Nutrients 2019; 11:nu11061405. [PMID: 31234393 PMCID: PMC6627685 DOI: 10.3390/nu11061405] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/13/2019] [Accepted: 06/20/2019] [Indexed: 12/16/2022] Open
Abstract
There are discrepancies in the reports on the association of metabolic syndrome (MetS) and its components with bone mineral density (BMD) and hence more population-based studies on this subject are needed. In this context, this observational study was aimed to investigate the association between T-scores of BMD at lumbar L1–L4 and full MetS and its individual components. A total of 1587 participants (84.7% females), >35 years and with risk factors associated with bone loss were recruited from February 2013 to August 2016. BMD was done at L1–L4 using dual-energy X-ray absorptiometry (DXA). T-Scores were calculated. Fasting blood samples and anthropometrics were done at recruitment. Fasting lipid profile and glucose were measured. Screening for full MetS and its components was done according to the National Cholesterol Education Programme Adult Treatment Panel III (NCEP ATP III) criteria. Logistic regression analysis revealed that the odds of having full MetS increased significantly from the lowest T-score tertile to the highest one in both sexes (OR, odd ratio (95% CI, confidence interval) of tertile 2 and 3 at 1.49 (0.8 to 2.8) and 2.46 (1.3 to 4.7), p = 0.02 in males and 1.35 (1.0 to 1.7) and 1.45 (1.1 to1.9), p < 0.01 in females). The odds remained significant even after adjustments with age, body mass index (BMI), and other risk factors associated with bone loss. Among the components of MetS, only central obesity showed a significant positive association with T-score. The study suggests a significant positive association of T-score (spine) with full MetS irrespective of sex, and among the components of MetS this positive association was seen specifically with central obesity.
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Prevalence of Known Risk Factors for Type 2 Diabetes Mellitus in Multiethnic Urban Youth in Edmonton: Findings From the WHY ACT NOW Project. Can J Diabetes 2019; 43:207-214. [DOI: 10.1016/j.jcjd.2018.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 09/26/2018] [Accepted: 10/01/2018] [Indexed: 01/15/2023]
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30
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Zhou J, Han J, Nutescu EA, Galanter WL, Walton SM, Gordeuk VR, Saraf SL, Calip GS. Similar burden of type 2 diabetes among adult patients with sickle cell disease relative to African Americans in the U.S. population: a six-year population-based cohort analysis. Br J Haematol 2019; 185:116-127. [PMID: 30714090 DOI: 10.1111/bjh.15773] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 11/29/2018] [Indexed: 12/15/2022]
Abstract
Conflicting evidence exists on the epidemiology of type 2 diabetes mellitus (T2DM) among patients with sickle cell disease (SCD). This study measured the prevalence, incidence and clinical outcomes associated with T2DM in a large US population of commercially-insured adults aged ≥20 years with SCD between 2009 and 2014. Among 7070 patients with SCD, the mean age (median) was 39 (37) years and 60·8% were female. The standardized prevalence of T2DM among patients with SCD showed a modest increase, from 15·7% to 16·5% (P trend = 0·026), and was comparable to African-American respondents to the National Health and Nutrition Examination Survey (18·2%). Over 17 024 person-years, the crude incidence rate for T2DM was 25·4 per 1000 person-years. Incident T2DM was associated with comorbid hypertension (hazard ratio [HR] = 1·45, 95% confidence interval [CI] 1·14-1·83), and dyslipidaemia (HR = 1·43, 95%CI 1·04-1·96). Compared to SCD patients without T2DM, more SCD patients with T2DM had diagnoses of nephropathy (28·0% vs. 9·5%; P < 0·001), neuropathy (17·7% vs. 5·2%; P < 0·001) and stroke (24·1% vs. 9·2%; P < 0·001). Prevalence of T2DM in SCD patients is similar to the general African American population with an increasing trend in recent years. These trends support routine screening for T2DM in aging patients with SCD, especially those with comorbid hypertension and/or dyslipidaemia.
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Affiliation(s)
- Jifang Zhou
- Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, IL, USA
| | - Jin Han
- Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, IL, USA.,Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA.,Division of Hematology & Oncology, Department of Medicine, Comprehensive Sickle Cell Center, University of Illinois at Chicago, Chicago, IL, USA
| | - Edith A Nutescu
- Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, IL, USA
| | - William L Galanter
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA.,Department of Medicine, Section of Academic Internal Medicine & Geriatrics, University of Illinois at Chicago, Chicago, IL, USA
| | - Surrey M Walton
- Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, IL, USA
| | - Victor R Gordeuk
- Division of Hematology & Oncology, Department of Medicine, Comprehensive Sickle Cell Center, University of Illinois at Chicago, Chicago, IL, USA
| | - Santosh L Saraf
- Division of Hematology & Oncology, Department of Medicine, Comprehensive Sickle Cell Center, University of Illinois at Chicago, Chicago, IL, USA
| | - Gregory S Calip
- Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, IL, USA.,Division of Public Health Sciences, Epidemiology Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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31
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Greater Glycaemic Response to an Oral Glucose Load in Healthy, Lean, Active and Young Chinese Adults Compared to Matched Caucasians. Nutrients 2018; 10:nu10040487. [PMID: 29661995 PMCID: PMC5946272 DOI: 10.3390/nu10040487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 03/23/2018] [Accepted: 03/27/2018] [Indexed: 01/19/2023] Open
Abstract
There are ethnic differences recorded in glycaemic response and rates of type 2 diabetes mellitus (DM) between Chinese and Caucasian populations. Whether these differences are evident in matched healthy, lean, active, young adults is unclear. This study compares the postprandial glycaemic response of a group of Chinese participants (n = 49) with a group of similar Caucasians, (n = 48) aged 23.8 (±4.35 years), body mass index (BMI) 22.7 (±2.6) kg/m2, healthy (free from non-communicable disease), and lean (body fat % 23.28% (±5.04)). Participants undertook an oral glucose tolerance test to identify any significant differences in postprandial blood glucose response. Body fat percentage, body mass, age, physical activity, baseline glucose and HbA1c did not significantly differ between groups. Data from food frequency questionnaires indicated that the Chinese participants consumed less starchy foods, candy and “other” sweets and sugary drinks, and more rice than the Caucasians (all p ≤ 0.001), but not a greater overall intake of carbohydrates or any other macronutrient (all p > 0.05). The two groups’ postprandial blood glucose responses and 2-h incremental area under the curve values (iAUC)—156.67 (74.12) mmol/L 120 min for Caucasians versus 214.03 (77.49) mmol/L 120 min for Chinese—indicate significant differences (p = 0.003 and p < 0.001 respectively) between groups. Findings suggest that the difference between the two groups’ iAUC values do not relate to obvious lifestyle factors. The Chinese group were eating the least sugary and starchy food but had the highest iAUC. It is argued that the Chinese group in this investigation have the most favourable BMI, body fat percentage, and body mass, yet “poorest” glycaemic response.
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Marzona I, Avanzini F, Tettamanti M, Vannini T, Fortino I, Bortolotti A, Merlino L, Genovese S, Roncaglioni MC. Prevalence and management of diabetes in immigrants resident in the Lombardy Region: the importance of ethnicity and duration of stay. Acta Diabetol 2018; 55:355-362. [PMID: 29357034 DOI: 10.1007/s00592-018-1102-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 12/27/2017] [Indexed: 10/18/2022]
Abstract
AIMS To describe the prevalence and management of diabetes among immigrants according to ethnic group and duration of stay, compared to Italian citizens. METHODS Diabetic immigrant and Italian residents aged 20-69 years in the administrative database of the Lombardy Region. Immigrants were classified by region of origin and as long-term residents (LTR) and short-term residents (STR). Age- and sex-adjusted prevalence and indicators of diabetes management were calculated for immigrants by region of origin and by length of stay using Cox proportional models. RESULTS In 2010 19,992 immigrants (mean age 49.1 ± 10.8, 53.7% males) and 195,049 Italians (mean age 58.7 ± 9.3, 61.1 males) with diabetes were identified. Immigrants had a higher adjusted diabetes prevalence than Italians (OR 1.48; 95% CI 1.45-1.50). STR received significantly fewer recommended cardiovascular drugs (antiplatelets, statins and ACE-inhibitors/ARBs) than Italians, although prescription was higher among LTR from some ethnic groups. Immigrants were less likely to be seen by a diabetologist and to do at least one HbA1c test per year. Although the recommended tests/visits were more often done for the LTR than the STR, in the majority of ethnic groups these indicators were still far from optimal. CONCLUSION The prevalence and management of diabetes differ between immigrants and Italians, although some improvement can be seen among LTR.
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Affiliation(s)
- Irene Marzona
- Laboratory of Cardiovascular Prevention, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Via Giuseppe La Masa 19, 20156, Milan, Italy.
| | - Fausto Avanzini
- Laboratory of Cardiovascular Prevention, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Via Giuseppe La Masa 19, 20156, Milan, Italy
| | - Mauro Tettamanti
- Laboratory of Geriatric Neuropsychiatry, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Tommaso Vannini
- Laboratory of Cardiovascular Prevention, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Via Giuseppe La Masa 19, 20156, Milan, Italy
| | - Ida Fortino
- Regional Health Ministry, Lombardy Region, Milan, Italy
| | | | - Luca Merlino
- Regional Health Ministry, Lombardy Region, Milan, Italy
| | - Stefano Genovese
- Diabetes, Endocrine and Metabolic Disease Unit, IRCCS Centro Cardiologico Monzino, Milan, Italy
| | - Maria Carla Roncaglioni
- Laboratory of Cardiovascular Prevention, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Via Giuseppe La Masa 19, 20156, Milan, Italy
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Eltom MA, Babiker Mohamed AH, Elrayah-Eliadarous H, Yassin K, Noor SK, Elmadhoun WM, Ahmed MH. Increasing prevalence of type 2 diabetes mellitus and impact of ethnicity in north Sudan. Diabetes Res Clin Pract 2018; 136:93-99. [PMID: 29203255 DOI: 10.1016/j.diabres.2017.11.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 11/01/2017] [Accepted: 11/28/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Diabetes mellitus constitutes a global health threat, with increasing burden of disease in low and middle-income countries witnessing ongoing epidemiological transition including Sudan. AIMS To study the prevalence of type 2 diabetes mellitus (T2DM) and prediabetes and determine the relationship to gender, age, waist circumference, body mass index, residence and ethnicity among the adult population in north Sudan. METHODS A cross-sectional, population-based study in Northern State and River Nile State using random multi-stage cluster sampling targeting 5376 participants from 14 localities divided into 60 urban and 40 rural clusters. In each cluster, 60 households were studied. Blood glucose level and anthropometric measurements were recorded and a questionnaire containing demographic data was obtained from each participant. RESULTS The prevalence of T2DM among participants was 18.7% and prediabetes was 12.9%. Among people living with T2DM, 694(71.0%) were known cases of T2DM, whereas 284(29.0%) were newly diagnosed cases. The significant associated risk factors for T2DM included urban residence (AOR 1.23, 95%CI 1.09-1.41), age above 60 years (AOR 4.77, 95%CI 4.04-5.63), obese BMI (AOR 1.26, 95%CI 1.03-1.55) and central obesity (AOR 1.39, 95%CI 1.14-1.68). Compared to indigenous population, individuals of Egyptian descents (AOR 1.28, 95%CI 1.04-1.57) and mixed origin (AOR 1.24, 95%CI 1.04-1.48) had increased risk of T2DM. CONCLUSION The prevalence of T2DM and prediabetes in north Sudan have increased significantly since 1996 with variations between ethnicities which showed to be an independent risk factor for T2DM. Health authorities are recommended to set plans to meet the health needs of these communities.
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Affiliation(s)
- Mohamed A Eltom
- Mulazmin Diabetes Center and Ahfad University for Women, Omdurman, Khartoum, Sudan
| | - Abubakr H Babiker Mohamed
- Mulazmin Diabetes Center and Ahfad University for Women, Omdurman, Khartoum, Sudan; International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Hind Elrayah-Eliadarous
- Department of Public Health Sciences, Global Health-Health System and Policy, Karolinska Institute, Sweden
| | - Kamal Yassin
- Mulazmin Diabetes Center and Ahfad University for Women, Omdurman, Khartoum, Sudan
| | - Sufian K Noor
- Department of Medicine, Faculty of Medicine and Health Sciences- Nile Valley University, Sudan
| | - Wadie M Elmadhoun
- Department of Medicine, Faculty of Medicine and Health Sciences- Nile Valley University, Sudan
| | - Mohamed H Ahmed
- Department of Medicine and HIV Metabolic Clinic, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, Buckinghamshire, UK
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Paprott R, Scheidt-Nave C, Heidemann C. Determinants of Change in Glycemic Status in Individuals with Prediabetes: Results from a Nationwide Cohort Study in Germany. J Diabetes Res 2018; 2018:5703652. [PMID: 30406150 PMCID: PMC6204174 DOI: 10.1155/2018/5703652] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 07/02/2018] [Accepted: 08/29/2018] [Indexed: 01/19/2023] Open
Abstract
Previous studies investigating determinants of changes in glycemic status among individuals with prediabetes mainly focused on glucose-defined prediabetes. In this study, we examined determinants of a regression to normoglycemia or a progression to diabetes among individuals with HbA1c-defined prediabetes. The study included 817 participants (18-79 years) with prediabetes (HbA1c 5.7-6.4% (39-47 mmol/mol)) at baseline. Glycemic status at follow-up was categorized as diagnosed diabetes (self-reported physician diagnosis or antidiabetic medication), undiagnosed diabetes (HbA1c ≥ 6.5% (≥48 mmol/mol)), prediabetes (as defined at baseline), and normoglycemia (HbA1c < 5.7% (<39 mmol/mol)). Determinants of glycemic changes were identified by multinomial logistic regression (OR (95% CI)), with those remaining in the prediabetic state as reference. During a mean follow-up time of 12.0 years, 33.8% of the participants reverted to normoglycemia, 7.2% progressed to undiagnosed diabetes, 12.8% progressed to diagnosed diabetes, and 46.2% remained prediabetic. Determinants of a regression to normoglycemia were female sex (male vs. female: 0.67 (0.46; 0.98)) and higher HDL cholesterol levels (1.17 (1.02; 1.35) per 10 mg/dl). Determinants of a progression to undiagnosed or diagnosed diabetes were higher values of BMI (1.10 (1.02; 1.18); 1.13 (1.06; 1.21) per kg/m2), waist circumference (1.04 (1.01; 1.07); 1.06 (1.03; 1.09) per cm), alanine aminotransferase (1.06 (1.03; 1.09); 1.07 (1.03; 1.10) per U/l), and gamma-glutamyl transferase (1.02 (1.00; 1.03); 1.03 (1.01; 1.04) per U/l). Higher age (1.04 (1.02; 1.06) per year), female sex (male vs. female: 0.56 (0.33; 0.97)), and parental history of diabetes (yes vs. no: 1.82 (1.05; 3.15)) were further associated with a progression to diagnosed diabetes, whereas higher triglyceride levels (1.03 (1.01; 1.06) per 10 mg/dl) were associated with a progression to undiagnosed diabetes. In conclusion, among the investigated determinants, potentially modifiable anthropometric and metabolic markers were associated with glycemic changes in individuals with HbA1c-defined prediabetes. The findings of this study demonstrate the need for more refined case finding strategies for diabetes prevention.
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Affiliation(s)
- Rebecca Paprott
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, 12101 Berlin, Germany
| | - Christa Scheidt-Nave
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, 12101 Berlin, Germany
| | - Christin Heidemann
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, 12101 Berlin, Germany
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Roshanzamir F, Miraghajani M, Rouhani MH, Mansourian M, Ghiasvand R, Safavi SM. The association between circulating fetuin-A levels and type 2 diabetes mellitus risk: systematic review and meta-analysis of observational studies. J Endocrinol Invest 2018. [PMID: 28643299 DOI: 10.1007/s40618-017-0697-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVE Fetuin-A is a liver-derived circulating protein that is associated with insulin resistance and diabetes. The objective of this systematic review and meta-analysis of published observational studies was to investigate mean levels of fetuin-A in T2D patients and the relationship between blood fetuin-A levels and T2D risk. MATERIALS AND METHODS PubMed, Embase, Google Scholar, Web of Science, and The Cochrane Library were systematically searched for potential relevant studies up to 1 December 2016. Natural logarithm-transformed estimate risks, standard mean differences on the basis of Hedges's adjusted g, and 95% confidence intervals (CIs) were calculated for all eligible studies and were combined to measure the pooled data using random-effects model. RESULTS A total of 32 studies including 27 case-control and 5 cohort studies were included in the current study. Fetuin-A levels in T2D patients were significantly higher than control groups [Hedges' g = 1.73, 95% CI (1.25-2.22), P < 0.001], with significant heterogeneity across studies (P < 0.001, I 2 = 98.46%). Findings from meta-analyses of cohort studies showed a statistically significant association between fetuin-A levels and T2D risk [rate ratio = 1.62, 95% CI (1.26-2.08), P < 0.001], with no significant heterogeneity (P = 0.10, I 2 = 46.06%). CONCLUSION We found a significant relationship between the fetuin-A levels with T2D risk. Although fetuin-A may be as a potential screening and prediction biomarker or a therapeutic target in T2D patients, further studies are required in this regard.
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Affiliation(s)
- F Roshanzamir
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Clinical Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - M Miraghajani
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M H Rouhani
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - M Mansourian
- Department of Biostatistics and Epidemiology, Health School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - R Ghiasvand
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - S M Safavi
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
- Department of Clinical Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.
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Inaishi J, Saisho Y. Ethnic Similarities and Differences in the Relationship between Beta Cell Mass and Diabetes. J Clin Med 2017; 6:jcm6120113. [PMID: 29483484 PMCID: PMC5742802 DOI: 10.3390/jcm6120113] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 11/24/2017] [Accepted: 11/28/2017] [Indexed: 12/27/2022] Open
Abstract
Recent evidence has revealed that a change of functional beta cell mass is an essential factor of the pathophysiology of type 2 diabetes (T2DM). Since beta cell dysfunction is not only present in T2DM but also progressively worsens with disease duration, to preserve or recover functional beta cell mass is important in both prevention of the development of T2DM and therapeutic strategies for T2DM. Furthermore, ethnic difference in functional beta cell mass may also need to be taken into account. Recent evidences suggest that Asians have less beta cell functional capacity compared with Caucasians. Preservation or recovery of functional beta cell mass seems to be further emphasized for Asians because of the limited capacity of beta cell. This review summarizes the current knowledge on beta cell dysfunction in T2DM and discusses the similarities and differences in functional beta cell mass between ethnicities in the face of obesity and T2DM.
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Affiliation(s)
- Jun Inaishi
- Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
| | - Yoshifumi Saisho
- Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
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Assari S, Lankarani MM. Income Gradient in Renal Disease Mortality in the United States. Front Med (Lausanne) 2017; 4:190. [PMID: 29164123 PMCID: PMC5681740 DOI: 10.3389/fmed.2017.00190] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 10/20/2017] [Indexed: 12/04/2022] Open
Abstract
Background Non-communicable diseases and associated mortality follow a social gradient and chronic kidney disease is not an exception to this rule. Intermediate behavioral and medical factors that may explain such social gradients are, however, still unknown. Objectives Using nationally representative data in the United States, this study was conducted to investigate the mediating effect of medical and behavioral risk factors on the association between socioeconomic status (SES) and renal disease mortality. Patients and methods Americans’ Changing Lives Study (ACL), 1986–2011, is a 25-year nationally representative prospective cohort study. ACL followed 3,361 adults for up to 25 years. Income, education, and unemployment were the main predictors of interest. Death due to renal disease was the main outcome. Health behaviors (smoking, drinking, and exercise) and medical risk factors (diabetes, hypertension, and obesity) were the mediators. Cox proportional hazards models were used for data analysis. Results Higher income (HR = 0.75; 95% CI = 0.62–0.89) was associated with lower risk of death due to renal disease over the 25-year follow-up period. Although health behaviors and medical risk factors at baseline were also predictors of the outcome, they failed to explain the effect of income on death due to renal disease. That is, income was associated with death due to renal disease above and beyond all potential mediators including behavioral and medical risk factors. Conclusion Socioeconomic inequalities in the United States cause disparities in renal disease mortality; however, such differences are not due to health behaviors (smoking and drinking) and medical risk factors (hypertension and diabetes). To reduce disparities in renal disease mortality in the United States, policies should go beyond health behaviors and medical risk factors. While programs should help low-income individuals maintain exercise and avoid smoking, reduction of income disparities should be regarded as a strategy for reduction of disparities in renal disease mortality. By increasing minimum pay and minimizing the income gap, we may reduce disparities in renal disease mortality.
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Affiliation(s)
- Shervin Assari
- Center for Research on Ethnicity, Culture, and Health, School of Public Health, University of Michigan, Ann Arbor, MI, United States.,Department of Psychiatry, School of Public Health, University of Michigan, Ann Arbor, MI, United States
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Jones V, Crowe M. How people from ethnic minorities describe their experiences of managing type-2 diabetes mellitus: A qualitative meta-synthesis. Int J Nurs Stud 2017; 76:78-91. [DOI: 10.1016/j.ijnurstu.2017.08.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 08/22/2017] [Accepted: 08/27/2017] [Indexed: 11/29/2022]
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Moghani Lankarani M, Assari S. Diabetes, hypertension, obesity, and long-term risk of renal disease mortality: Racial and socioeconomic differences. J Diabetes Investig 2017; 8:590-599. [PMID: 28075529 PMCID: PMC5497055 DOI: 10.1111/jdi.12618] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 12/21/2016] [Accepted: 01/06/2017] [Indexed: 01/13/2023] Open
Abstract
AIMS/INTRODUCTION Diabetes, hypertension, and obesity increase the risk of chronic kidney disease and associated mortality. Race and socioeconomic status (SES) differences in the effects of these risk factors are, however, still unknown. The current study aimed to investigate whether or not race and SES alter the effects of diabetes, hypertension, and obesity on mortality due to renal disease. MATERIALS AND METHODS Data came from the Americans' Changing Lives Study, 1986-2011, a nationally representative prospective cohort of adults with 25 years of follow up. The study included 3,361 adults aged 25 years and older who were followed for up to 25 years. The outcome was death from renal disease. Diabetes, hypertension, and obesity were the main predictors. Race and SES (education, income, and employment) were moderators. Health behaviors and health status at baseline were covariates. We used Cox proportional hazards models for data analysis. RESULTS In separate models, diabetes, hypertension, and obesity at baseline were associated with a higher risk of death from renal disease. From our SES indicators, education and income interacted with diabetes, hypertension, and obesity on death from renal disease. In a consistent pattern, diabetes, hypertension, and obesity showed stronger effects on the risk of death from renal disease among high-SES groups compared with low-SES individuals. Race and employment did not alter the effects of diabetes, hypertension and obesity on the risk of death from renal disease. CONCLUSIONS Social groups differ in how diabetes, hypertension, and obesity influence health outcomes over long-term periods. Elimination of disparities in renal disease mortality in the USA requires understanding of the complex and non-linear effects of socioeconomic and medical risk factors on health outcomes. Multidisciplinary programs and policies are required to reduce social inequality in renal disease burden caused by diabetes, hypertension, and obesity.
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Affiliation(s)
| | - Shervin Assari
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA.,Center for Research on Ethnicity, Culture, and Health, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
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Silventoinen K, Pankow J, Lindström J, Jousilahti P, Hu G, Tuomilehto J. The validity of the Finnish Diabetes Risk Score for the prediction of the incidence of coronary heart disease and stroke, and total mortality. ACTA ACUST UNITED AC 2017; 12:451-8. [PMID: 16210931 DOI: 10.1097/01.hjr.0000174793.31812.21] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background Cardiovascular disease shares several risk factors with type 2 diabetes. We tested whether the Finnish Diabetes Risk Score (FINDRISC), recently developed in a Finnish population to estimate the future risk of diabetes, would also identify individuals at high risk of coronary heart disease (CHD) and stroke, and total mortality in this same population. Design Independent risk factor surveys were conducted in 1987, 1992, and 1997 in Finland, comprising 8268 men and 9457 women aged 25-64 years and free of CHD and stroke at baseline. During the follow-up until the end of 2001, 699 incident acute CHD events, 324 acute stroke events, and 765 deaths occurred. Methods The data were analysed by using receiver operating characteristic (ROC) curves and the Cox-regression model. Results The areas under the ROC curves (AUC) were 71% for CHD, 73% for stroke, and 68% for total mortality in men and 78, 68, and 72% in women, respectively. The addition of systolic and diastolic blood pressures, total and high-density lipoprotein cholesterol, and smoking increased the AUC values modestly (the change of the absolute values from 2.6 to 6.5%), but the additional use of plasma glucose had only a slight effect on the AUC values for CHD and stroke. Conclusions The FINDRISC is a reasonably good predictor of CHD, stroke and total mortality.
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Cázarez-García D, Ramírez Loustalot-Laclette M, Ann Markow T, Winkler R. Lipidomic profiles of Drosophila melanogaster and cactophilic fly species: models of human metabolic diseases. Integr Biol (Camb) 2017; 9:885-891. [DOI: 10.1039/c7ib00155j] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Untargeted metabolomics, combined with data mining, reveals different sensibility of fly species against diet changes.
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Affiliation(s)
- Daniel Cázarez-García
- CINVESTAV Unidad Irapuato
- Department of Biochemistry and Biotechnology
- 36821 Irapuato Gto
- Mexico
| | | | - Therese Ann Markow
- Unidad de Genómica Avanzada (UGA) – Laboratorio Nacional de Genómica (LANGEBIO)
- 36821 Irapuato Gto
- Mexico
| | - Robert Winkler
- CINVESTAV Unidad Irapuato
- Department of Biochemistry and Biotechnology
- 36821 Irapuato Gto
- Mexico
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Affiliation(s)
- Akiko Goda
- Cardiovascular Division Department of Internal Medicine, Hyogo College of Medicine
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Mukerji G, Kainth S, Pendrith C, Lowe J, Feig DS, Banerjee AT, Wu W, Lipscombe LL. Predictors of low diabetes risk perception in a multi-ethnic cohort of women with gestational diabetes mellitus. Diabet Med 2016; 33:1437-44. [PMID: 26499170 DOI: 10.1111/dme.13009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/21/2015] [Indexed: 01/11/2023]
Abstract
AIM To determine what proportion of women with gestational diabetes underestimate their diabetes risk and identify factors associated with low diabetes risk perception. METHODS Participants included pregnant adult women with gestational diabetes between 2009 and 2012 across seven diabetes clinics in Ontario, Canada. Data were collected through chart review and a survey that included a diabetes risk perception question. RESULTS Of the 614 of 902 women (68% response rate) with gestational diabetes, 89% correctly responded that gestational diabetes increases the risk for developing diabetes. However, 47.1% of women perceived themselves to be at low risk for developing diabetes within 10 years. On multivariable analysis, BMI < 25 kg/m(2) , absent previous gestational diabetes history, absent diabetes family history and absent insulin use were appropriately associated with low diabetes risk perception. However, compared with Caucasian ethnicity, high-risk ethnicity (Aboriginal, Latin American, West Indian, South Asian, Middle Eastern, Filipino, Black, Pacific Islander) [odds ratio (OR) 2.07; 95% CI 1.30-3.31] and East and South East Asian ethnicity (OR 2.01; 1.10-3.67) were associated with low diabetes risk perception. After further adjustment for immigration, only high-risk ethnicity remained a predictor of low diabetes risk perception (OR 1.86; 1.09-3.19), whereas East and South East Asian ethnicity did not (OR 1.67; 0.86-3.22). CONCLUSIONS Although the majority of women recognized gestational diabetes as a risk factor for diabetes, almost half underestimated their personal high diabetes risk despite prenatal care. Furthermore, women from high-risk ethnic groups were more likely to underestimate their risk, even after adjusting for immigration. Interventions tailored to these groups are necessary to enhance perceived diabetes risk.
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Affiliation(s)
- G Mukerji
- Women's College Hospital, Toronto.
- Department of Medicine, University of Toronto, Toronto.
| | - S Kainth
- University of Western Ontario, London
| | | | - J Lowe
- Department of Medicine, University of Toronto, Toronto
- Sunnybrook Health Sciences Centre, Toronto
| | - D S Feig
- Department of Medicine, University of Toronto, Toronto
- Mount Sinai Hospital, Toronto
| | | | - W Wu
- Women's College Research Institute, Toronto, Ontario, Canada
| | - L L Lipscombe
- Women's College Hospital, Toronto
- Department of Medicine, University of Toronto, Toronto
- Mount Sinai Hospital, Toronto
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Effect of case management on patients with type 2 diabetes mellitus: a meta-analysis. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.cnre.2016.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Tsasis P, Wu J, An A, Wong HJ, An X, Mei Z, Hains T. Conceptualizing type 2 diabetes and its management. J Multidiscip Healthc 2016; 9:133-6. [PMID: 27099510 PMCID: PMC4820210 DOI: 10.2147/jmdh.s88684] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Type 2 diabetes is growing worldwide due to population growth, increased rates of obesity, unhealthy diet, and physical inactivity. Risk assessment methods can effectively evaluate the risk of diabetes, and a healthy lifestyle can significantly reduce risk or prevent complications of type 2 diabetes. However, risk assessment alone has not significantly improved poor adherence to recommended medical interventions and lifestyle changes. This paper focuses on the challenge of nonadherence and posits that improving adherence requires tailoring interventions that explicitly consider the social determinants of health.
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Affiliation(s)
- Peter Tsasis
- School of Health Policy and Management, York University, Toronto, ON, Canada
| | - Jianhong Wu
- Centre for Disease Modelling, York University, Toronto, ON, Canada
| | - Aijun An
- Department of Electrical Engineering of Computer Science, York University, Toronto, ON, Canada
| | - Hannah J Wong
- School of Health Policy and Management, York University, Toronto, ON, Canada
| | - Xiandong An
- Department of Electrical Engineering of Computer Science, York University, Toronto, ON, Canada; Manifold Data Mining Inc., Toronto, ON, Canada
| | - Zhen Mei
- Manifold Data Mining Inc., Toronto, ON, Canada
| | - Ted Hains
- Manifold Data Mining Inc., Toronto, ON, Canada
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Creamer J, Attridge M, Ramsden M, Cannings-John R, Hawthorne K. Culturally appropriate health education for Type 2 diabetes in ethnic minority groups: an updated Cochrane Review of randomized controlled trials. Diabet Med 2016. [PMID: 26202820 DOI: 10.1111/dme.12865] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AIMS To give an updated perspective of interventions from additional data collected since our first review, conducted in 2008. BACKGROUND This updated Cochrane Review incorporates new information from recent randomized controlled trials on culturally appropriate diabetes health education interventions. METHODS An electronic literature search of six databases was repeated, with databases of ongoing trials checked and three journals hand-searched. Meta-analysis was carried out for sufficiently homogeneous outcomes, and common themes among trials were highlighted. RESULTS A total of 22 new trials were added to the original 11. Meta-analysis of 28 trials containing suitable data showed significant improvements in glycaemic control (HbA1c ) and diabetes knowledge over a period of 24 months, after the delivery of culturally appropriate education to participants, compared with those receiving 'conventional' care. There were no consistent benefits over the control group in other selected outcome measures, and lack of data continued to make analysis of several outcome measures difficult. CONCLUSIONS Research activity in this field has increased considerably over the past 6 years, with culturally appropriate diabetes education showing consistent benefits over conventional care in terms of glycaemic control and diabetes knowledge, sustained in the short- to mid-term. Further research is needed to determine the clinical significance of these improvements and their cost-effectiveness.
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Affiliation(s)
- J Creamer
- Cardiff University School of Medicine, Cardiff University, Cardiff, UK
| | - M Attridge
- Cardiff University School of Medicine, Cardiff University, Cardiff, UK
| | - M Ramsden
- Cardiff University School of Medicine, Cardiff University, Cardiff, UK
| | - R Cannings-John
- Cardiff University School of Medicine, Cardiff University, Cardiff, UK
| | - K Hawthorne
- Cardiff University School of Medicine, Cardiff University, Cardiff, UK
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Janghorbani M, Soltanian N, Sirous M, Amini M, Iraj B. Risk of diabetes in combined metabolic abnormalities and body mass index categories. Diabetes Metab Syndr 2016; 10:S71-S78. [PMID: 26610402 DOI: 10.1016/j.dsx.2015.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 09/27/2015] [Indexed: 01/22/2023]
Abstract
AIM The present study was designed to estimate the progression rates from combination of normal weight, overweight, obesity, and number of metabolic abnormalities (MA) to type 2 diabetes (T2D) in a non-diabetic high risk population in Isfahan, Iran. METHODS A total of 1869 non-diabetic first-degree relatives (FDR) of patients with T2D 30-70 years old were examined and followed for a mean (SD) of 7.3 (2.2) years for T2D incidence. At baseline and through follow-up, participants underwent a standard 75-g 2-h oral glucose tolerance test. RESULTS The metabolically healthy overweight and obese at baseline were associated with incidence of T2D, independently of age and gender. Any one MA increased the risk of developing T2D among normal weight, overweight and obese individuals. Those with normal weight and ≥3 MA were over 20 times (odds ratios (OR) 20.21; 95% confidence intervals (CI) 2.4, 170.4) and those with overweight and ≥3 MA 22.5 times (OR 22.5; 95% CI 3.0, 167.0) and obese with ≥3 MA were 25.4 times (OR 25.4; 95% CI 3.4, 187) more likely to develop T2D than those with normal weight and without MA. Compared with participants without MA, obese individuals with concomitant MA were not significantly more likely to progress to T2D. CONCLUSION Our data provide further evidence that normal weight, overweight and obese individuals with MA had a higher risk of incident T2D than normal weight individuals without MA.
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Affiliation(s)
- Mohsen Janghorbani
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Norredin Soltanian
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehri Sirous
- Departement of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoud Amini
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bijan Iraj
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Basraon SK, Mele L, Myatt L, Roberts JM, Hauth JC, Leveno KJ, Varner MW, Wapner RJ, Thorp JM, Peaceman AM, Ramin SM, Sciscione A, Tolosa JE, Sorokin Y. Relationship of Early Pregnancy Waist-to-Hip Ratio versus Body Mass Index with Gestational Diabetes Mellitus and Insulin Resistance. Am J Perinatol 2016; 33:114-21. [PMID: 26352680 PMCID: PMC5283057 DOI: 10.1055/s-0035-1562928] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine the risk of gestational diabetes mellitus (GDM) and insulin resistance (IR) in obesity defined by body mass index (BMI), waist-to-hip ratio (WHR), or both combined. METHODS Secondary analysis of a randomized multicenter trial of antioxidant supplementation versus placebo in nulliparous low-risk women to prevent pregnancy associated hypertension. Women between 9 and 16 weeks with data for WHR and BMI were analyzed for GDM (n = 2,300). Those with fasting glucose and insulin between 22 and 26 weeks (n = 717) were analyzed for IR by homeostatic model assessment of IR (normal, ≤ 75th percentile). WHR and BMI were categorized as normal (WHR, < 0.80; BMI, < 25 kg/m(2)); overweight (WHR, 0.8-0.84; BMI, 25-29.9 kg/m(2)); and obese (WHR, ≥ 0.85; BMI ≥ 30 kg/m(2)). Receiver operating characteristic curves and logistic regression models were used. RESULTS Compared with normal, the risks of GDM or IR were higher in obese by BMI or WHR. The subgroup with obesity by WHR but not by BMI had no increased risk of GDM. BMI was a better predictor of IR (area under the curve [AUC]: 0.71 [BMI], 0.65 [WHR], p = 0.03) but similar to WHR for GDM (AUC: 0.68 [BMI], 0.63 [WHR], p = 0.18). CONCLUSION Increased WHR and BMI in early pregnancy are associated with IR and GDM. BMI is a better predictor of IR compared with WHR. Adding WHR to BMI does not improve its ability to detect GDM or IR.
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Affiliation(s)
- Sanmaan K Basraon
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
| | - Lisa Mele
- Biostatistics Center, George Washington University, Washington, District of Columbia
| | | | | | - John C Hauth
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | | | - John M Thorp
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Susan M Ramin
- University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, Texas
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Iizuka T, Iemitsu K, Takihata M, Takai M, Nakajima S, Minami N, Umezawa S, Kanamori A, Takeda H, Kawata T, Ito S, Kikuchi T, Amemiya H, Kaneshiro M, Mokubo A, Takuma T, Machimura H, Tanaka K, Asakura T, Kubota A, Aoyagi S, Hoshino K, Ishikawa M, Matsuzawa Y, Obana M, Sasai N, Kaneshige H, Minagawa F, Saito T, Shinoda K, Miyakawa M, Tanaka Y, Terauchi Y, Matsuba I. Efficacy and Safety of Ipragliflozin in Japanese Patients With Type 2 Diabetes: Interim Outcome of the ASSIGN-K Study. J Clin Med Res 2015; 8:116-25. [PMID: 26767080 PMCID: PMC4701067 DOI: 10.14740/jocmr2417w] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2015] [Indexed: 12/25/2022] Open
Abstract
Background Ipragliflozin is a sodium-glucose co-transporter 2 inhibitor that can improve glycemic control and reduce body weight and blood pressure in patients with type 2 diabetes mellitus (T2DM). We evaluated the efficacy and safety of ipragliflozin in the real-world clinical setting, with a focus on the changes of body composition up to 3 months of treatment. Methods This was a prospective multicenter interventional trial. We investigated changes of the blood pressure, body composition, blood glucose, hemoglobin A1c (HbA1c), ketone bodies, lipids, and insulin after treatment with ipragliflozin (50 - 100 mg/day) for 12 weeks in Japanese patients with T2DM who showed poor glycemic control despite receiving diet and exercise therapy with or without oral antidiabetic drugs for more than 12 weeks. Results Two hundred and fifty-seven subjects were included in the efficacy analysis up to 12 weeks of treatment and 301 subjects were included in the safety analysis. From baseline to 12 weeks, HbA1c showed a change of -0.68% (95% confidence interval (CI): -0.83, -0.53) and fasting blood glucose showed a change of -23.9 mg/dL (95% CI: -30.5, -17.2), with both parameters displaying a significant reduction (P < 0.001). The difference of body weight from baseline was -1.82 kg (95% CI: -2.14, -1.50), and it also showed significant reduction (P < 0.001). Analysis of body composition revealed that body fat changed by -1.46 kg (95% CI: -1.79, -1.14, P < 0.001) and body water changed by -0.37 kg (95% CI: -0.60, -0.14, P < 0.01). Laboratory tests demonstrated improvement of liver function and the lipid profile. Adverse events (AEs) occurred in 22.6% of the subjects, with frequent events being vulvovaginal candidiasis in 2.7% and cystitis in 2.0%. Serious AEs occurred in three subjects. Conclusions In patients with T2DM, ipragliflozin improved glycemic control after 1 month of treatment and caused weight loss by reducing body fat more than body water.
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Affiliation(s)
- Takashi Iizuka
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Kotaro Iemitsu
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Masahiro Takihata
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Masahiko Takai
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Shigeru Nakajima
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Nobuaki Minami
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Shinichi Umezawa
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Akira Kanamori
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Hiroshi Takeda
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Takehiro Kawata
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Shogo Ito
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Taisuke Kikuchi
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Hikaru Amemiya
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Mizuki Kaneshiro
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Atsuko Mokubo
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Tetsuo Takuma
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Hideo Machimura
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Keiji Tanaka
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Taro Asakura
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Akira Kubota
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Sachio Aoyagi
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Kazuhiko Hoshino
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Masashi Ishikawa
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Yoko Matsuzawa
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Mitsuo Obana
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Nobuo Sasai
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Hideaki Kaneshige
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Fuyuki Minagawa
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Tatsuya Saito
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Kazuaki Shinoda
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Masaaki Miyakawa
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Yasushi Tanaka
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan; Division of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Yasuo Terauchi
- Department of Endocrinology and Diabetes, Yokohama City University Medical Center, Kanagawa, Japan
| | - Ikuro Matsuba
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
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50
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Assari S. Distal, intermediate, and proximal mediators of racial disparities in renal disease mortality in the United States. J Nephropathol 2015; 5:51-9. [PMID: 27047811 PMCID: PMC4790188 DOI: 10.15171/jnp.2016.09] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 10/28/2015] [Indexed: 02/01/2023] Open
Abstract
Background: Kidney failure and associated mortality is one of the major components of racial disparities in the United States.
Objectives: The current study aimed to investigate the role of distal (socioeconomic status, SES), intermediate (chronic medical diseases), and proximal (health behaviors) factors that may explain Black-White disparities in mortality due to renal diseases.
Patients and Methods: This is a nationally representative prospective cohort with 25 years of follow up. Data came from the Americans’ Changing Lives (ACL) study, 1986 to 2011. The study included 3361 Black (n = 1156) or White (n = 2205) adults who were followed for up to 25 years. Race was the main predictor and death due to renal disease was the outcome. SES, chronic medical disease (diabetes, hypertension, obesity), and health behaviors (smoking, drinking, and exercise) at baseline were potential mediators. We used Cox proportional hazards models for data analysis.
Results: In age and gender adjusted models, Blacks had higher risk of death due to renal disease over the follow up period. Separate models suggested that SES, health behaviors and chronic medical disease fully explained the effect of race on renal disease mortality.
Conclusions: Black-White disparities in rate of death due to renal diseases in the United States are not genuine but secondary to racial differences in income, health behaviors, hypertension, and diabetes. As distal, intermediate, and proximal factors contribute to racial disparities in renal disease mortality, elimination of such disparities requires a wide range of policies and programs that target income, medical conditions, and health behaviors.
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Affiliation(s)
- Shervin Assari
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA ; Center for Research on Ethnicity, Culture and Health, School of Public Health, University of Michigan, Ann Arbor, MI, USA
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