Polygenic Variants Linked to Oxidative Stress and the Antioxidant System Are Associated with Type 2 Diabetes Risk and Interact with Lifestyle Factors

Oxidative stress is associated with insulin resistance and secretion, and antioxidant systems are essential for preventing and managing type 2 diabetes (T2DM). This study aimed to explore the polygenic variants linked to oxidative stress and the antioxidant system among those associated with T2DM and the interaction of their polygenic risk scores (PRSs) with lifestyle factors in a large hospital-based cohort (n = 58,701). Genotyping, anthropometric, biochemical, and dietary assessments were conducted for all participants with an average body mass index of 23.9 kg/m². Genetic variants associated with T2DM were searched through genome-wide association studies in participants with T2DM (n = 5383) and without T2DM (n = 53,318). The Gene Ontology database was searched for the antioxidant systems and oxidative stress-related genes among the genetic variants associated with T2DM risk, and the PRS was generated by summing the risk alleles of selected ones. Gene expression according to the genetic variant alleles was determined on the FUMA website. Food components with low binding energy to the GSTA5 protein generated from the wildtype and mutated GSTA5_rs7739421 (missense mutation) genes were selected using in silico analysis. Glutathione metabolism-related genes, including glutathione peroxidase (GPX)1 and GPX3, glutathione disulfide reductase (GSR), peroxiredoxin-6 (PRDX6), glutamate-cysteine ligase catalytic subunit (GCLC), glutathione S-transferase alpha-5 (GSTA5), and gamma-glutamyltransferase-1 (GGT1), were predominantly selected with a relevance score of >7. The PRS related to the antioxidant system was positively associated with T2DM (ORs = 1.423, 95% CI = 1.22-1.66). The active site of the GASTA proteins having valine or leucine at 55 due to the missense mutation (rs7739421) had a low binding energy (<-10 kcal/mol) similarly or differently to some flavonoids and anthocyanins. The PRS interacted with the intake of bioactive components (specifically dietary antioxidants, vitamin C, vitamin D, and coffee) and smoking status (p < 0.05). In conclusion, individuals with a higher PRS related to the antioxidant system may have an increased risk of T2DM, and there is a potential indication that exogenous antioxidant intake may alleviate this risk, providing insights for personalized strategies in T2DM prevention.

Prevalence of Obesity and Its Associated Factors Among Malaysian Adults: Finding From the National Health and Morbidity Survey 2019

In 2016, World Health Organization (WHO) estimated more than 650 million obese adults, resulting in a country's health burden. This study aims to determine the prevalence of obesity and its associated factors among Malaysian adults. A total of 5820 respondents, aged 18 to 59 years, from the National Health and Morbidity Survey 2019, were included for the data analysis. The prevalence of obesity was described and multivariate analyses were conducted to determine the factors associated with obesity. The prevalence of obesity among Malaysian adults was 20.1%, based on the findings from this study. Multivariate analyses showed that women, being Malays, Indians, and other Bumiputeras, were significantly associated with a higher risk of obesity. Besides, those diagnosed with diabetes mellitus and hypertension were also significantly associated with greater risk of obesity. This information is crucial for policy makers in formulating effective strategies or targeted programs in preventing obesity among Malaysian adults.

Body Mass Index Increases With Ageing and Risk Factors for Overweight/Obesity in a Representative Macau Population

The aim of this study was to investigate trends of body mass index (BMI) with age in westernizing Macau and to make comparisons with Australian data. A representative random sample (n = 1406, 18-93 years, 55% female) from Macau was recruited in 2012. The Australian sample was extracted from the Australian Health Survey 2011-2012 (n = 7958, 18 to ≥85 years, 52% female). BMI in Australians was greater than Macanese, mean difference 4.4 kg/m² ( P < .001). While BMI increases steadily with ageing in each population, the plateau for Macau subjects appears 5 to 10 years earlier than Australians. Prevalence of overweight/obesity in young Macanese adults (18-40 years) was 25% (men) and 22% (women), with the greatest increase in BMI from age 25 to 39 years and 24 to 45 years in men and women, respectively. BMI shifts in younger Macanese men and women, which may reflect emerging lifestyle and nutrition transitions, are a future population health concern in Macau.

Gestational Diabetes and Breastfeeding Outcomes: A Systematic Review

Studies of gestational diabetes mellitus in relation to breastfeeding are limited, while their findings are inconsistent. This systematic review was conducted to assess the associations between gestational diabetes and breastfeeding outcomes. An initial search of PubMed, Web of Science, and ProQuest identified 518 studies, and after applying the inclusion criteria, 16 studies were finally included in the review. Four studies reported that “exclusive/predominant/full breastfeeding” rates at discharge were lower in mothers with gestational diabetes than in those without gestational diabetes, and 2 studies showed a shorter duration of “exclusive/predominant breastfeeding” in the former than in the latter. However, most studies found no apparent difference in the rate of “breastfeeding initiation”, “any breastfeeding” duration, or “any breastfeeding” in hospital and at discharge between mothers with and without gestational diabetes. In summary, mothers with gestational diabetes were less likely to exclusively breastfeed their infants and may have a shorter breastfeeding duration than other mothers.

Patient Perspective on Factors Contributing to Nonadherence to Dietary Therapy: A Qualitative Study in Multicultural Population of Kedah, Malaysia

The purpose of this study is to explore diabetes patients' views on various factors contributing to nonadherence to dietary therapy. Using a qualitative approach, 17 in-depth interviews were conducted with type 2 diabetes mellitus patients at Hospital Sultanah Bahiyah, Kedah state, Malaysia. All interviews were audio recorded, transcribed verbatim, and translated before analysis. Thematic content analysis was used and three main themes emerged. The main factors that affect diabetes patients' dietary adherence were "individual preference," "family support," and "social and cultural activities." Difficulty to change the existing meals, poor family support, practice of eating out, and social and cultural gatherings were among the factors that influenced diabetes patients' adherence toward dietary therapy. Most challenges were related to the social role of food in the multicultural population. Therefore, in addition to the family and community involvement, dietary therapy should be individualized to improve patient adherence.

Ethnic predisposition of diabetes mellitus in the patients with previous history of gestational diabetes mellitus: a review

INTRODUCTION

The worldwide prevalence of Gestational Diabetes Mellitus (GDM) is increasing day by day. However, there is a knowledge gap regarding the effect of ethnic and geographical distribution on the risk of developing Diabetes Mellitus (DM) in women with history of GDM. This review was conducted to find out the role of ethnic and geographical distribution on the risk of developing DM is women with GDM.

AREAS COVERED

In this review we conducted a comprehensive search of published studies through different electronic databases (PubMed, Google Scholar, CINAHL, CINAHL plus and EMBASE) published between 1990 and 2017. The studies which were published in English investigated the risk of development of DM in women with previous history of GDM, reported outcome according to ethnicity with specific criteria of reporting DM and GDM, reported development of diabetes after 6 month of delivery in women with GDM during pregnancy were included. Initially, 350 articles were identified, among which 16 articles were included in the final review.

EXPERT COMMENTARY

Studies showed the increased risk of developing subsequent DM is associated with precedent GDM. Around 7-84% women developed diabetes after GDM in five years follow up, where some studies reported the risk continues to increase with increasing age. Risk of DM was found higher for some specific ethnicities, irrespective of the location of the study conducted. East Indian women showed the highest risk of postpartum DM after GDM and the crude prevalence remained almost similar in all form of study worldwide. Public health programme should focus more on women belonging to high-risk ethnicity of GDM for the prevention of postpartum DM.

The Role of Public Health Nutrition in Achieving the Sustainable Development Goals in the Asia Pacific Region

The Sustainable Development Goals (SDGs) replaced the Millennium Development Goals (MDCs) in 2015, which included several goals and targets primarily related to nutrition: to eradicate extreme poverty and hunger and to reduce child mortality and improve maternal health. In the Asia-Pacific Academic Consortium for Public Health (APACPH) member countries as a group, infant and child mortality were reduced by more than 65% between 1990 and 2015, achieving the MDG target of two-thirds reduction, although these goals were not achieved by several smaller countries. The SDGs are broader in focus than the MDGs, but include several goals that relate directly to nutrition: 2 (zero hunger-food), 3 (good health and well-being-healthy life), and 12 (responsible consumption and production-sustainability). Other SDGs that are closely related to nutrition are 4 and 5 (quality education and equality in gender-education and health for girls and mothers, which is very important for infant health) and 13 (climate action). Goal 3 is "good health and well-being," which includes targets for child mortality, maternal mortality, and reducing chronic disease. The Global Burden of Disease Project has confirmed that the majority of risk for these targets can be attributed to nutrition-related targets. Dietary Guidelines were developed to address public health nutrition risk in the Asia Pacific region at the 48th APACPH 2016 conference and they are relevant to the achievement of the SDGs. Iron deficiency increases the risk of maternal death from haemorrhage, a cause of 300000 deaths world-wide each year. Improving diets and iron supplementation are important public health interventions in the APACPH region. Chronic disease and obesity rates in the APACPH region are now a major challenge and healthy life course nutrition is a major public health priority in answering this challenge. This article discusses the role of public health nutrition in achieving the SDGs. It also examines the role of APACPH in education and advocacy and in fulfilling the educational needs of public health students in public health nutrition.