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Liberty IA, Septadina IS, Mariana, Novita E, Amalia R, Ananingsih ES, Hasyim H, Hanifah L. The characteristics and risk of obesity central and concomitant impaired fasting glucose: Findings from a cross-sectional study. PLoS One 2024; 19:e0305604. [PMID: 38917085 PMCID: PMC11198825 DOI: 10.1371/journal.pone.0305604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 06/03/2024] [Indexed: 06/27/2024] Open
Abstract
INTRODUCTION Obesity is associated with concomitant chronic conditions. An early metabolic consequence of obesity is disruption of glucose and insulin homeostasis. One of the consequences is impaired fasting glucose (IFG). Visceral fat is metabolically more harmful than subcutaneous fat, but few information is available regarding the association between the risk of abnormal glucose in increased waist circumference. METHODS This study is based on a cross sectional of 1,381 population-based from Palembang, Indonesia. The eligibility requirements subject were to be older than 18 and consent to taking fasting glucose and lipid profile tests as well as physical exams measuring their body weight, height, blood pressure, abdominal circumference, and waist circumference. RESULTS The number of subjects consisting of 798 noncentral obesity with normoglycemia, 376 central obesity with normoglycemia, and 207 central obesity with concomitant IFG. The prevalence central obesity with concomitant IFG was 35.51%. In subjects with central obesity, there were significant differences in proportions based on sex, age, marital status, education, and occupation. In multivariate analysis show that the risk factors that contribute to having a significant association with central obesity with concomitant IFG are sex (female), age (>40 years), blood pressure (hypertension), and HDL-C <50 mg/dL (p<0.001). The analysis also founded that there was a significant difference in the dietary pattern of sweet foods (p = 0.018), sweet drinks (p = 0.002), soft drinks (p = 0.001) and smoking habit (p<0.001) between subjects with obesity central and concomitant IFG compared to subjects with noncentral obesity. The majority of subjects with obesity central and concomitant IFG had consuming these risky foods >6 times/week. CONCLUSION The prevalence of central obesity with IFG is quite high. There are significant differences in the characteristics, lipid profile, blood pressure, dietary pattern, and smoking habit of central obesity with concomitant IFG was confirmed in this population-based observational study.
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Affiliation(s)
- Iche Andriyani Liberty
- Department of Public Health and Community Medicine, Faculty of Medicine, Universitas Sriwijaya, Palembang, Indonesia
| | - Indri Seta Septadina
- Department of Anatomy, Faculty of Medicine, Universitas Sriwijaya, Palembang, Indonesia
| | - Mariana
- Department of Public Health and Community Medicine, Faculty of Medicine, Universitas Sriwijaya, Palembang, Indonesia
| | - Emma Novita
- Department of Anatomy, Faculty of Medicine, Universitas Sriwijaya, Palembang, Indonesia
| | - Resi Amalia
- Faculty of Medicine, Universitas Muhammadiyah, Palembang, Indonesia
| | | | - Hamzah Hasyim
- Faculty of Public Health, Universitas Sriwijaya, Palembang, Indonesia
| | - Laily Hanifah
- Universitas Pembangunan Nasional Veteran Jakarta, Jakarta, Indonesia
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Guglielmi V, Dalle Grave R, Leonetti F, Solini A. Female obesity: clinical and psychological assessment toward the best treatment. Front Endocrinol (Lausanne) 2024; 15:1349794. [PMID: 38765954 PMCID: PMC11099266 DOI: 10.3389/fendo.2024.1349794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/19/2024] [Indexed: 05/22/2024] Open
Abstract
Obesity is a heterogeneous condition which results from complex interactions among sex/gender, sociocultural, environmental, and biological factors. Obesity is more prevalent in women in most developed countries, and several clinical and psychological obesity complications show sex-specific patterns. Females differ regarding fat distribution, with males tending to store more visceral fat, which is highly correlated to increased cardiovascular risk. Although women are more likely to be diagnosed with obesity and appear more motivated to lose weight, as confirmed by their greater representation in clinical trials, males show better outcomes in terms of body weight and intra-abdominal fat loss and improvements in the metabolic risk profile. However, only a few relatively recent studies have investigated gender differences in obesity, and sex/gender is rarely considered in the assessment and management of the disease. This review summarizes the evidence of gender differences in obesity prevalence, contributing factors, clinical complications, and psychological challenges. In addition, we explored gender differences in response to obesity treatments in the specific context of new anti-obesity drugs.
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Affiliation(s)
- Valeria Guglielmi
- Unit of Internal Medicine and Obesity Center, Department of Systems Medicine, Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, VR, Italy
| | - Frida Leonetti
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Anna Solini
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
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Mourougavelou V, Chowdhury TA. Management of hyperglycaemia in people with obesity. Clin Med (Lond) 2023; 23:364-371. [PMID: 38614651 PMCID: PMC10541039 DOI: 10.7861/clinmed.2023-0135] [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] [Indexed: 08/02/2023]
Abstract
Diabetes and obesity are closely interlinked. Obesity is a major risk factor for the development of type 2 diabetes mellitus and appears to be an important risk factor for diabetic micro- and macrovascular complications. Management of hyperglycaemia in people with diabetes is important to reduce diabetes-related complications. Previously, there was a significant tension between management of hyperglycaemia and mitigating weight gain. Older drugs, such as sulfonylureas, glitazones, and insulin, although effective antihyperglycaemic agents, tend to induce weight gain. There is now an increasing recognition in people with obesity and diabetes that the focus should be on aiding weight loss, initially with improvements in diet and physical activity, possibly with the use of low-calorie diet programmes. Subsequent addition of metformin and newer agents, such as sodium-glucose transporter-2 inhibitors and glucagon-like peptide-1 analogues, will aid glucose control and weight reduction, and offer cardiovascular and renal protection. These drugs are now much higher in the therapeutic pathway in many national and international guidelines. Bariatric surgery may also be an effective way to manage hyperglycaemia or induce remission in individuals with both obesity and diabetes.
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Elarbaoui M, Jafri A, Elkardi Y, Makhlouki H, Ellahi B, Derouiche A. Sodium and potassium intakes assessed by 24-h urine among Moroccan University students in Casablanca, Morocco: Cross-sectional study. NUTR CLIN METAB 2022. [DOI: 10.1016/j.nupar.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Åström MJ, von Bonsdorff MB, Haanpää M, Salonen MK, Kautiainen H, Eriksson JG. Glucose regulation and pain in older people-The Helsinki Birth Cohort Study. Prim Care Diabetes 2021; 15:561-566. [PMID: 33579570 DOI: 10.1016/j.pcd.2021.02.001] [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: 08/11/2020] [Revised: 01/27/2021] [Accepted: 02/01/2021] [Indexed: 11/21/2022]
Abstract
AIMS To assess if individuals with diabetes or prediabetes report more pain or have increased use of pain medication compared to normoglycaemic individuals. METHODS Using cross-sectional data, we studied 928 men and 1075 women from the Helsinki Birth Cohort Study in 2001-2004 at a mean age of 61.5 years. Glucose regulation was assessed with a 2-h 75 g oral glucose tolerance test, and applying World Health Organization criteria, participants were defined as having normoglycaemia, prediabetes (impaired fasting glucose or impaired glucose tolerance), newly diagnosed diabetes or previously diagnosed diabetes. Self-reported pain intensity and interference during the previous 4 weeks was estimated using the RAND 36-Item Health Survey 1.0. Information on use of pain medication during the past 12 months was obtained from the Social Insurance Institution of Finland. RESULTS There was no difference in pain intensity or interference between glucose regulation groups for neither men nor women after adjusting for covariates (age, body mass index, education years, Beck Depression Inventory and physical activity). In addition, use of pain medication was similar between glucose regulation groups. CONCLUSIONS Although pain is a common symptom in the general population, impairments in glucose regulation alone does not seem to increase pain among older individuals.
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Affiliation(s)
- Max J Åström
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Folkhälsan Research Center, Helsinki, Finland; Vaasa Central Hospital, Vaasa, Finland.
| | - Mikaela B von Bonsdorff
- Folkhälsan Research Center, Helsinki, Finland; Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Maija Haanpää
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland; Ilmarinen Mutual Pension Insurance Company, Vantaa, Finland
| | - Minna K Salonen
- Folkhälsan Research Center, Helsinki, Finland; Department of Public Health Solutions, Public Health Promotion Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Hannu Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Folkhälsan Research Center, Helsinki, Finland
| | - Johan G Eriksson
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Folkhälsan Research Center, Helsinki, Finland; Department of Public Health Solutions, Public Health Promotion Unit, National Institute for Health and Welfare, Helsinki, Finland; Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore; Obstetrics & Gynecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
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Vega-Galaviz D, Vecchyo-Tenorio GD, Alcántara-Suárez R, Méndez-García LA, Sánchez-Del Real AL, Villalobos-Molina R, Fragoso JM, León-Cabrera S, Ostoa-Saloma P, Pérez-Tamayo R, Escobedo G. M2 macrophage immunotherapy abolishes glucose intolerance by increasing IL-10 expression and AKT activation. Immunotherapy 2020; 12:9-24. [PMID: 31914828 DOI: 10.2217/imt-2019-0080] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Aim: Glucose intolerance associates with M1/M2 macrophage unbalance. We thus wanted to examine the effect of M2 macrophage administration on mouse model of glucose intolerance. Materials & methods: C57BL/6 mice fed a high-fat diet (HFD) for 12 weeks and then received thrice 20 mg/kg streptozotocin (HFD-GI). Bone marrow-derived stem cells were collected from donor mice and differentiated/activated into M2 macrophages for intraperitoneal administration into HFD-GI mice. Results: M2 macrophage treatment abolished glucose intolerance independently of obesity. M2 macrophage administration increased IL-10 in visceral adipose tissue and serum, but showed no effect on serum insulin. While nitric oxide synthase-2 and arginase-1 remained unaltered, M2 macrophage treatment restored AKT phosphorylation in visceral adipose tissue. Conclusion: M2 macrophage treatment abolishes glucose intolerance by increasing IL-10 and phosphorylated AKT.
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Affiliation(s)
- Diana Vega-Galaviz
- Laboratory for Proteomics & Metabolomics, Research Division, General Hospital of Mexico 'Dr. Eduardo Liceaga', 06720 Mexico City, Mexico
| | - Georgina Del Vecchyo-Tenorio
- Laboratory for Proteomics & Metabolomics, Research Division, General Hospital of Mexico 'Dr. Eduardo Liceaga', 06720 Mexico City, Mexico.,Unidad de Investigación en Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Raúl Alcántara-Suárez
- Laboratory for Proteomics & Metabolomics, Research Division, General Hospital of Mexico 'Dr. Eduardo Liceaga', 06720 Mexico City, Mexico
| | - Lucia A Méndez-García
- Laboratory for Proteomics & Metabolomics, Research Division, General Hospital of Mexico 'Dr. Eduardo Liceaga', 06720 Mexico City, Mexico
| | - Ana L Sánchez-Del Real
- Laboratory for Proteomics & Metabolomics, Research Division, General Hospital of Mexico 'Dr. Eduardo Liceaga', 06720 Mexico City, Mexico
| | - Rafael Villalobos-Molina
- Unidad de Biomedicina, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Mexico.,Departamento de Bioquímica, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - José M Fragoso
- Departamento de Biología Molecular, Instituto Nacional de Cardiología 'Ignacio Chávez', Mexico City, Mexico
| | - Sonia León-Cabrera
- Carrera de Médico Cirujano, Unidad de Biomedicina, Facultad de Estudios Superiores-Iztacala, Universidad Nacional Autónoma de México, Avenida de los Barrios 1, Los Reyes Iztacala 54090, Mexico
| | - Pedro Ostoa-Saloma
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico
| | - Ruy Pérez-Tamayo
- Unidad de Investigación en Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Galileo Escobedo
- Laboratory for Proteomics & Metabolomics, Research Division, General Hospital of Mexico 'Dr. Eduardo Liceaga', 06720 Mexico City, Mexico
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Wu CJ, Kao TW, Chen YY, Yang HF, Chen WL. Peripheral fat distribution versus waist circumference for predicting mortality in metabolic syndrome. Diabetes Metab Res Rev 2019; 35:e3116. [PMID: 30548993 DOI: 10.1002/dmrr.3116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 11/16/2018] [Accepted: 11/30/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To elucidate whether the peripheral fat (PF)-combined definition of metabolic syndrome (MetS) would show a better predictive ability for cause-specific mortality than the common MetS. METHODS Data were derived from the National Health and Nutrition Examination Survey from 1999 through 2002. We investigated three types of MetS including waist circumference MetS (WCMetS), PFMetS, and PF-combined definition of MetS. The main outcome was to evaluate the predictive ability of the newly defined MetS for time to cause-specific mortality. The secondary outcomes were the relationships between the PF percentage and C-reactive protein (CRP) and homeostasis model assessment of insulin resistance (HOMA-IR) to clarify the gender discrepancy. RESULTS For cardiovascular mortality, the adjusted hazard ratios for WCMetS, PFMetS, and PF-combined definition MetS were 1.867, 1.742, and 2.117, respectively (all P < 0.001). A positive association between PF percentage and CRP in men and a negative correlation between PF percentage and HOMA-IR in women after adjustment for all variates were found. CONCLUSIONS The PF-combined definition of MetS had a stronger predictive ability for all-cause and cardiovascular mortality than general MetS. Notably, the PF might have differential gender-specific health effects on cardiovascular events.
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Affiliation(s)
- Chen-Jung Wu
- Division of Family Medicine, Department of Community Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan, Republic of China
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Tung-Wei Kao
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Graduate Institute of Clinical Medical, College of Medicine, National Taiwan University, Taipei, Taiwan, Republic of China
| | - Yuan-Yuei Chen
- Department of Internal Medicine, Tri-Service General Hospital Songshan Branch, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Hui-Fang Yang
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Wei-Liang Chen
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, Republic of China
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Åström MJ, von Bonsdorff MB, Perälä MM, Salonen MK, Rantanen T, Kajantie E, Simonen M, Pohjolainen P, Osmond C, Eriksson JG. Glucose regulation and physical performance among older people: the Helsinki Birth Cohort Study. Acta Diabetol 2018; 55:1051-1058. [PMID: 30032324 PMCID: PMC6150438 DOI: 10.1007/s00592-018-1192-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 07/11/2018] [Indexed: 12/25/2022]
Abstract
AIMS To assess whether disturbances in glucose regulation are associated with impairment in physical performance during a 10-year follow-up. METHODS 475 Men and 603 women from the Helsinki Birth Cohort Study were studied. Glucose regulation was evaluated with a 2-h 75-g oral glucose tolerance test (OGTT) in 2001-2004. Subjects were categorised as having either impaired fasting glucose (IFG), impaired glucose tolerance (IGT), newly diagnosed diabetes or previously known diabetes. Physical performance was assessed approximately 10 years later using the validated senior fitness test (SFT). The relationship between glucose regulation and the overall SFT score was estimated using multiple linear regression models. RESULTS The mean age was 70.8 years for men and 71.0 years for women when physical performance was assessed. The mean SFT score for the whole population was 45.0 (SD 17.5) points. The SFT score decreased gradually with increased impairment in glucose regulation. Individuals with previously known diabetes had the lowest overall SFT score in the fully adjusted model (mean difference compared to normoglycaemic individuals - 11.56 points, 95% CI - 16.15 to - 6.98, p < 0.001). Both individuals with newly diagnosed diabetes and individuals with IGT had significantly poorer physical performance compared to those with normoglycaemia. No significant difference in physical performance was found between those with IFG and those with normoglycaemia. CONCLUSIONS Among older people, impaired glucose regulation is strongly related with poor physical performance. More severe disturbances in glucose regulation are associated with a greater decrease in physical function, indicating the importance of diagnosing these disturbances at an early stage.
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Affiliation(s)
- Max J Åström
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, PO Box 20, 00014, Helsinki, Finland.
- Folkhälsan Research Center, Helsinki, Finland.
| | - Mikaela B von Bonsdorff
- Folkhälsan Research Center, Helsinki, Finland
- Faculty of Sport and Health Sciences, Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland
| | - Mia M Perälä
- Folkhälsan Research Center, Helsinki, Finland
- Public Health Promotion Unit, Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Minna K Salonen
- Folkhälsan Research Center, Helsinki, Finland
- Public Health Promotion Unit, Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Taina Rantanen
- Faculty of Sport and Health Sciences, Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland
| | - Eero Kajantie
- Public Health Promotion Unit, Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
- Hospital for Children and Adolescents, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
- PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Mika Simonen
- Finnish Centre of Excellence in Intersubjectivity and Interaction, University of Helsinki, Helsinki, Finland
| | | | - Clive Osmond
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Johan G Eriksson
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, PO Box 20, 00014, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
- Public Health Promotion Unit, Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
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Similä T, Auvinen J, Puukka K, Keinänen-Kiukaanniemi S, Virtanen JI. Impaired glucose metabolism is associated with tooth loss in middle-aged adults: The Northern Finland Birth Cohort Study 1966. Diabetes Res Clin Pract 2018; 142:110-119. [PMID: 29857092 DOI: 10.1016/j.diabres.2018.05.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 05/22/2018] [Indexed: 01/02/2023]
Abstract
AIM We investigated the association of impaired glucose metabolism with tooth loss in adults in the Northern Finland Birth Cohort Study 1966 (NFBC1966). METHODS We examined 4394 participants from the 46-year follow-up of the NFBC1966. Self-reported number of teeth as well as insulin and glucose values, taken during a standard oral glucose tolerance test (OGTT), served as the primary study variables. A multinomial logistic regression model served to analyse (unadjusted, smoking-adjusted and fully adjusted) the association between number of teeth (0-24, 25-27, 28-32) and glucose metabolism in women and men. RESULTS Among women, type 2 diabetes - whether previously known or detected during screening - pointed to a higher likelihood of 0-24 teeth (fully adjusted OR = 2.99, 95%CI = 1.54-5.80) and 25-27 teeth (OR = 1.91, 95%CI = 1.18-3.08) than did normal glucose tolerance. Similarly, impaired fasting glucose and impaired glucose tolerance together indicated a higher likelihood of 0-24 teeth (OR = 1.71, 95%CI = 1.09-2.69) than did normal glucose tolerance. A similar, statistically non-significant, pattern emerged among men. Number of teeth associated with OGTT insulin and glucose curves as well as with the Matsuda index in both women and men. CONCLUSIONS Tooth loss strongly associated with impaired glucose metabolism in middle-aged Finnish women.
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Affiliation(s)
- Toni Similä
- Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, P.O. Box 5000, Oulu 90014, Finland; Medical Research Center Oulu, Oulu University Hospital, P.O. Box 5000, Oulu 90029, Finland.
| | - Juha Auvinen
- Medical Research Center Oulu, Oulu University Hospital, P.O. Box 5000, Oulu 90029, Finland; Center for Life Course Health Research, University of Oulu, P.O. Box 5000, Oulu 90014, Finland.
| | - Katri Puukka
- Medical Research Center Oulu, Oulu University Hospital, P.O. Box 5000, Oulu 90029, Finland; NordLab Oulu, Oulu University Hospital, P.O. Box 500, Oulu 90029, Finland.
| | - Sirkka Keinänen-Kiukaanniemi
- Medical Research Center Oulu, Oulu University Hospital, P.O. Box 5000, Oulu 90029, Finland; Center for Life Course Health Research, University of Oulu, P.O. Box 5000, Oulu 90014, Finland; Health Center of Oulu, Oulu, Finland.
| | - Jorma I Virtanen
- Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, P.O. Box 5000, Oulu 90014, Finland; Medical Research Center Oulu, Oulu University Hospital, P.O. Box 5000, Oulu 90029, Finland.
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Di Camillo B, Hakaste L, Sambo F, Gabriel R, Kravic J, Isomaa B, Tuomilehto J, Alonso M, Longato E, Facchinetti A, Groop LC, Cobelli C, Tuomi T. HAPT2D: high accuracy of prediction of T2D with a model combining basic and advanced data depending on availability. Eur J Endocrinol 2018; 178:331-341. [PMID: 29371336 DOI: 10.1530/eje-17-0921] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 01/25/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Type 2 diabetes arises from the interaction of physiological and lifestyle risk factors. Our objective was to develop a model for predicting the risk of T2D, which could use various amounts of background information. RESEARCH DESIGN AND METHODS We trained a survival analysis model on 8483 people from three large Finnish and Spanish data sets, to predict the time until incident T2D. All studies included anthropometric data, fasting laboratory values, an oral glucose tolerance test (OGTT) and information on co-morbidities and lifestyle habits. The variables were grouped into three sets reflecting different degrees of information availability. Scenario 1 included background and anthropometric information; Scenario 2 added routine laboratory tests; Scenario 3 also added results from an OGTT. Predictive performance of these models was compared with FINDRISC and Framingham risk scores. RESULTS The three models predicted T2D risk with an average integrated area under the ROC curve equal to 0.83, 0.87 and 0.90, respectively, compared with 0.80 and 0.75 obtained using the FINDRISC and Framingham risk scores. The results were validated on two independent cohorts. Glucose values and particularly 2-h glucose during OGTT (2h-PG) had highest predictive value. Smoking, marital and professional status, waist circumference, blood pressure, age and gender were also predictive. CONCLUSIONS Our models provide an estimation of patient's risk over time and outweigh FINDRISC and Framingham traditional scores for prediction of T2D risk. Of note, the models developed in Scenarios 1 and 2, only exploited variables easily available at general patient visits.
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Affiliation(s)
- Barbara Di Camillo
- Department of Information EngineeringUniversity of Padova, Padova, Italy
| | - Liisa Hakaste
- EndocrinologyAbdominal Centre, University of Helsinki and Helsinki University Hospital, Research Program for Diabetes and Obesity, University of Helsinki, Helsinki, Finland
- Folkhälsan Research CenterHelsinki, Finland
| | - Francesco Sambo
- Department of Information EngineeringUniversity of Padova, Padova, Italy
| | - Rafael Gabriel
- Department of International HealthNational School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
- Asociación Española Para el Desarrollo de la Epidemiología Clínica (AEDEC)Madrid, Spain
| | - Jasmina Kravic
- Lund University Diabetes CentreDepartment of Clinical Sciences Malmö, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Bo Isomaa
- Folkhälsan Research CenterHelsinki, Finland
| | - Jaakko Tuomilehto
- Asociación Española Para el Desarrollo de la Epidemiología Clínica (AEDEC)Madrid, Spain
- Dasman Diabetes InstituteDasman, Kuwait City, Kuwait
- Department of Neuroscience and Preventive MedicineDanube-University Krems, Krems, Austria
- Saudi Diabetes Research GroupKing Abdulaziz University, Jeddah, Saudi Arabia
| | - Margarita Alonso
- Department of International HealthNational School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
- Asociación Española Para el Desarrollo de la Epidemiología Clínica (AEDEC)Madrid, Spain
| | - Enrico Longato
- Department of Information EngineeringUniversity of Padova, Padova, Italy
| | - Andrea Facchinetti
- Department of Information EngineeringUniversity of Padova, Padova, Italy
| | - Leif C Groop
- Lund University Diabetes CentreDepartment of Clinical Sciences Malmö, Lund University, Skåne University Hospital, Malmö, Sweden
- Institute for Molecular Medicine Finland (FIMM)University of Helsinki, Helsinki, Finland
| | - Claudio Cobelli
- Department of Information EngineeringUniversity of Padova, Padova, Italy
| | - Tiinamaija Tuomi
- EndocrinologyAbdominal Centre, University of Helsinki and Helsinki University Hospital, Research Program for Diabetes and Obesity, University of Helsinki, Helsinki, Finland
- Folkhälsan Research CenterHelsinki, Finland
- Institute for Molecular Medicine Finland (FIMM)University of Helsinki, Helsinki, Finland
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11
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Rautio N, Varanka-Ruuska T, Vaaramo E, Palaniswamy S, Nedelec R, Miettunen J, Karppinen J, Auvinen J, Järvelin MR, Keinänen-Kiukaanniemi S, Sebert S, Ala-Mursula L. Accumulated exposure to unemployment is related to impaired glucose metabolism in middle-aged men: A follow-up of the Northern Finland Birth Cohort 1966. Prim Care Diabetes 2017; 11:365-372. [PMID: 28456438 DOI: 10.1016/j.pcd.2017.03.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 03/20/2017] [Accepted: 03/29/2017] [Indexed: 10/19/2022]
Abstract
AIMS We explored whether registered unemployment is associated with impaired glucose metabolism in general population. METHODS Based on Northern Finland Birth Cohort 1966 at 46 years, we analyzed the oral glucose tolerance tests of 1970 men and 2544 women in relation to their preceding three-year employment records in three categories of unemployment exposure: no (employed), low (≤1-year) and high exposure (>1-year). RESULTS Among men, pre-diabetes was found in 19.2% of those with no unemployment, 23.0% with low and 27.0% with high exposure, the corresponding figures for screen-detected type 2 diabetes were 3.8%, 3.8% and 9.2% (p<0.01). Among women, analogous figures for pre-diabetes were 10.0%, 12.6% and 16.2% and for screen-detected type 2 diabetes 1.7%, 3.4% and 3.6% (p<0.01). Men with high exposure to unemployment had a higher risk for pre-diabetes (OR 1.61, CI 95% 1.03-2.51) and screen-detected type 2 diabetes (OR 2.58 95% CI 1.23-5.44) than employed men, after adjustment for education, smoking, alcohol intake, physical activity and body mass index. Among women, associations were attenuated in the adjusted models. CONCLUSIONS High exposure to unemployment may predispose to type 2 diabetes in middle-aged men. For clinicians, awareness of the patient's unemployment status may be helpful in recognizing undiagnosed cases.
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Affiliation(s)
- Nina Rautio
- Center for Life Course Health Research, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland; Unit of Primary Health Care, Oulu University Hospital, OYS, P.O. Box 20, 90029 Oulu, Finland.
| | - Tuulia Varanka-Ruuska
- Center for Life Course Health Research, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland; Kallio Primary Health Care Unit, Kirkkotie 4, 84100 Ylivieska, Finland.
| | - Eeva Vaaramo
- Center for Life Course Health Research, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland.
| | - Saranya Palaniswamy
- Center for Life Course Health Research, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland; Biocenter Oulu, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland.
| | - Rozenn Nedelec
- Center for Life Course Health Research, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland; Biocenter Oulu, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland.
| | - Jouko Miettunen
- Center for Life Course Health Research, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, 90014 Oulu, Finland.
| | - Jaro Karppinen
- Center for Life Course Health Research, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, 90014 Oulu, Finland; Finnish Institute of Occupational Health, Aapistie 1, 90220 Oulu, Finland.
| | - Juha Auvinen
- Center for Life Course Health Research, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland; Unit of Primary Health Care, Oulu University Hospital, OYS, P.O. Box 20, 90029 Oulu, Finland.
| | - Marjo-Riitta Järvelin
- Center for Life Course Health Research, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland; Unit of Primary Health Care, Oulu University Hospital, OYS, P.O. Box 20, 90029 Oulu, Finland; MRC-PHE Centre for Environment and Health, Imperial College London, Praed Street Wing, St. Mary's Campus, Paddington, W2 IPG London, United Kingdom; Biocenter Oulu, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland
| | - Sirkka Keinänen-Kiukaanniemi
- Center for Life Course Health Research, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland; Unit of Primary Health Care, Oulu University Hospital, OYS, P.O. Box 20, 90029 Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, 90014 Oulu, Finland.
| | - Sylvain Sebert
- Center for Life Course Health Research, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland; Biocenter Oulu, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland; Department of Genomics, Imperial College London, South Kensington Campus, SW7 London, United Kingdom.
| | - Leena Ala-Mursula
- Center for Life Course Health Research, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland.
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12
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Ikäheimo TM, Jokelainen J, Hassi J, Hiltunen L, Keinänen-Kiukaanniemi S, Laatikainen T, Jousilahti P, Peltonen M, Moilanen L, Saltevo J, Näyhä S. Diabetes and impaired glucose metabolism is associated with more cold-related cardiorespiratory symptoms. Diabetes Res Clin Pract 2017; 129:116-125. [PMID: 28521195 DOI: 10.1016/j.diabres.2017.04.022] [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: 09/15/2015] [Revised: 03/07/2017] [Accepted: 04/21/2017] [Indexed: 10/19/2022]
Abstract
AIMS Diabetes and impaired glucose metabolism cause metabolic, neural and circulatory disturbances that may predispose to adverse cooling and related symptoms during the cold season. This study assessed the prevalence of cold-related cardiorespiratory symptoms in the general population according to glycaemic status. METHODS The study population consisted of 2436 men and 2708 women aged 45-74years who participated in the National FINRISK cold sub-studies in 2002 and 2007. A questionnaire assessed cold-related symptoms (respiratory, cardiac, peripheral circulation). Glycaemic status was determined based on fasting blood glucose, oral glucose tolerance tests or reported diagnosis of diabetes and categorized into normal glucose metabolism, impaired fasting blood glucose, impaired glucose tolerance, screening-detected type 2 diabetes and type 2 diabetes. RESULTS Type 2 diabetes was associated with increased odds for cold-related dyspnoea [Adjusted OR 1.72 (95% CI, 1.28-2.30)], chest pain [2.10 (1.32-3.34)] and respiratory symptoms [1.85 (1.44-2.38)] compared with normal glucose metabolism. Screened type 2 diabetes showed increased OR for cold-related dyspnoea [1.36 (1.04-1.77)], cough [1.41 (1.06-1.87)] and cardiac symptoms [1.51 (1.04-2.20)]. Worsening of glycaemic status was associated with increased odds for cold-related dyspnoea (from 1.16 in impaired fasting glucose to 1.72 in type 2 diabetes, P=0.000), cough (1.02-1.27, P=0.032), chest pain (1.28-2.10, P=0.006), arrhythmias (0.87-1.74, P=0.020), cardiac (1.11-1.99, P=0.000), respiratory (1.14-1.84, P=0.000) and all symptoms (1.05-1.66, P=0.003). CONCLUSIONS Subjects with diabetes and pre-diabetes experience more cold-related cardiorespiratory symptoms and need instructions for proper protection from cold weather to reduce adverse health effects.
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Affiliation(s)
- Tiina Maria Ikäheimo
- Center for Environmental and Respiratory Health Research, University of Oulu, FI-90014 Oulu, Finland; Medical Research Center, University of Oulu and University Hospital of Oulu, Oulu, Finland.
| | - Jari Jokelainen
- Medical Faculty, P.O. Box 5000, University of Oulu, FI-90014 Oulu, Finland; Unit of Primary Health Care, Oulu University Hospital, FI-90029 Oulu, Finland; Center for Life Course Health Research, University of Oulu, FI-90014 Oulu, Finland
| | - Juhani Hassi
- Center for Environmental and Respiratory Health Research, University of Oulu, FI-90014 Oulu, Finland
| | | | - Sirkka Keinänen-Kiukaanniemi
- Unit of Primary Health Care, Oulu University Hospital, FI-90029 Oulu, Finland; Center for Life Course Health Research, University of Oulu, FI-90014 Oulu, Finland; Health Centre of Oulu, FI-90015 Oulu, Finland
| | - Tiina Laatikainen
- National Institute for Health and Welfare, Public Health Solutions, FI-00271 Helsinki, Finland; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, FI-70211 Kuopio, Finland; Hospital District of North Karelia, FI-80210 Joensuu, Finland
| | - Pekka Jousilahti
- National Institute for Health and Welfare, Public Health Solutions, FI-00271 Helsinki, Finland
| | - Markku Peltonen
- National Institute for Health and Welfare, Public Health Solutions, FI-00271 Helsinki, Finland
| | - Leena Moilanen
- Department of Medicine, Kuopio University Hospital, FI-70029 Kuopio, Finland
| | - Juha Saltevo
- Department of Medicine, Central Finland Central Hospital, FI-40620 Jyväskylä, Finland
| | - Simo Näyhä
- Center for Environmental and Respiratory Health Research, University of Oulu, FI-90014 Oulu, Finland
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13
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Tan X, Alén M, Wang K, Tenhunen J, Wiklund P, Partinen M, Cheng S. Effect of Six-Month Diet Intervention on Sleep among Overweight and Obese Men with Chronic Insomnia Symptoms: A Randomized Controlled Trial. Nutrients 2016; 8:nu8110751. [PMID: 27886073 PMCID: PMC5133133 DOI: 10.3390/nu8110751] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 11/11/2016] [Accepted: 11/16/2016] [Indexed: 11/16/2022] Open
Abstract
Growing evidence suggests that diet alteration affects sleep, but this has not yet been studied in adults with insomnia symptoms. We aimed to determine the effect of a six-month diet intervention on sleep among overweight and obese (Body mass index, BMI ≥ 25 kg/m2) men with chronic insomnia symptoms. Forty-nine men aged 30–65 years with chronic insomnia symptoms were randomized into diet (n = 28) or control (n = 21) groups. The diet group underwent a six-month individualized diet intervention with three face-to-face counseling sessions and online supervision 1–3 times per week; 300–500 kcal/day less energy intake and optimized nutrient composition were recommended. Controls were instructed to maintain their habitual lifestyle. Sleep parameters were determined by piezoelectric bed sensors, a sleep diary, and a Basic Nordic sleep questionnaire. Compared to the controls, the diet group had shorter objective sleep onset latency after intervention. Within the diet group, prolonged objective total sleep time, improved objective sleep efficiency, lower depression score, less subjective nocturnal awakenings, and nocturia were found after intervention. In conclusion, modest energy restriction and optimized nutrient composition shorten sleep onset latency in overweight and obese men with insomnia symptoms.
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Affiliation(s)
- Xiao Tan
- Exercise Health and Technology Center, Shanghai Jiao Tong University, Shanghai 200240, China.
- Department of Health Sciences, University of Jyväskylä, Jyväskylä 40014, Finland.
| | - Markku Alén
- Department of Health Sciences, University of Jyväskylä, Jyväskylä 40014, Finland.
- Department of Medical Rehabilitation, Oulu University Hospital and Center for Life Course Health Research, University of Oulu, Oulu 90220, Finland.
| | - Kun Wang
- Exercise Health and Technology Center, Shanghai Jiao Tong University, Shanghai 200240, China.
| | - Jarkko Tenhunen
- Department of Health Sciences, University of Jyväskylä, Jyväskylä 40014, Finland.
| | - Petri Wiklund
- Exercise Health and Technology Center, Shanghai Jiao Tong University, Shanghai 200240, China.
- Department of Health Sciences, University of Jyväskylä, Jyväskylä 40014, Finland.
| | - Markku Partinen
- VitalMed Research Center, Helsinki Sleep Clinic and Department of Neurosciences, University of Helsinki, Helsinki 00380, Finland.
| | - Sulin Cheng
- Exercise Health and Technology Center, Shanghai Jiao Tong University, Shanghai 200240, China.
- Department of Health Sciences, University of Jyväskylä, Jyväskylä 40014, Finland.
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14
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Lehtisalo J, Lindström J, Ngandu T, Kivipelto M, Ahtiluoto S, Ilanne-Parikka P, Keinänen-Kiukaanniemi S, Eriksson JG, Uusitupa M, Tuomilehto J, Luchsinger JA. Diabetes, glycaemia, and cognition-a secondary analysis of the Finnish Diabetes Prevention Study. Diabetes Metab Res Rev 2016; 32:102-10. [PMID: 26172529 DOI: 10.1002/dmrr.2679] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 06/28/2015] [Accepted: 06/30/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND Type 2 diabetes is linked with cognitive dysfunction and dementia in epidemiological studies, but these observations are limited by lack of data on the exact timing of diabetes onset. We investigated diabetes, dysglycaemia, and cognition in the Finnish Diabetes Prevention Study, in which the timing and duration of diabetes are well documented. METHODS The Finnish Diabetes Prevention Study comprised middle-aged, overweight participants with impaired glucose tolerance but no diabetes at baseline (n = 522), randomized to lifestyle intervention or a control group. After an intervention period (mean duration 4 years) and follow-up (additional 9 years), cognitive assessment with the CERAD test battery and Trail Making Test A (TMT) was executed twice within a 2-year interval. Of the 364 (70%) participants with cognitive assessments, 171 (47%) had developed diabetes. RESULTS Cognitive function did not differ between those who developed diabetes and those who did not. Lower mean 2-h glucose at an oral glucose tolerance test (OGTT) and HbA1C during the intervention period predicted better performance in the TMT (p = 0.012 and 0.024, respectively). Those without diabetes or with short duration of diabetes improved in CERAD total score between the two assessments (p = 0.001) whereas those with long duration of diabetes did not (p = 0.844). CONCLUSIONS Better glycemic control among persons with baseline impaired glucose tolerance predicted better cognitive performance 9 years later in this secondary analysis of the Finnish Diabetes Prevention Study population. In addition, learning effects in cognitive testing were not evident in people with long diabetes duration. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Jenni Lehtisalo
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
- Department of Public Health, University of Helsinki, Finland
| | - Jaana Lindström
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
| | - Tiia Ngandu
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
| | - Miia Kivipelto
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
- Aging Research Center, Karolinska Institutet, Stockholm, Sweden
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Satu Ahtiluoto
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
- Espoo City Hospital, Espoo, Finland
| | - Pirjo Ilanne-Parikka
- Science Center, Tampere University Hospital, Tampere, Finland
- The Diabetes Center, Finnish Diabetes Association, Tampere, Finland
| | - Sirkka Keinänen-Kiukaanniemi
- Institute of Health Sciences (General Practice), University of Oulu, Oulu, Finland
- Unit of General Practice, Oulu University Hospital and Health Centre of Oulu, Oulu, Finland
| | - Johan G Eriksson
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
- Unit of General Practice, Helsinki University Central Hospital, Helsinki, Finland
| | - Matti Uusitupa
- Institute of Public Health and Clinical Nutrition, Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Research Unit, Kuopio University Hospital, Kuopio, Finland
| | - Jaakko Tuomilehto
- Center for Vascular Prevention, Danube University Krems, Krems, Austria
- Instituto de Investigacion Sanitaria del Hospital Universario LaPaz (IdiPAZ), Madrid, Spain
- Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
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15
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Tsirona S, Katsaros F, Bargiota A, Polyzos SA, Arapoglou G, Koukoulis GN. Prevalence and determinants of type 2 diabetes mellitus in a Greek adult population. Hormones (Athens) 2016; 15:88-98. [PMID: 27086683 DOI: 10.1007/bf03401407] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 01/10/2016] [Indexed: 12/30/2022]
Abstract
The prevalence of diabetes mellitus (DM) is increasing worldwide reaching epidemic proportions. The aim of the present study was to estimate the prevalence of DM in Thessaly, a large region of Central Greece, and to extrapolate our results to the population of the entire country. A random sample of 805 adults (421 females and 384 men) living in Thessaly, aged 18-80 years, was surveyed. After completing a questionnaire about health status and a thorough physical examination, a blood sample was obtained from each participant for biochemical analysis. Participants with fasting glucose levels between 100-125 mg/dl underwent an oral glucose tolerance test (OGTT). A second survey was also conducted, via telephone call-interviews, in a randomly selected sample age- and sex-stratified to the country's adult population in order to extrapolate the DM data from Thessaly to the whole country. The frequency of DM based on patient history and fasting blood glucose levels was 6.96%, comparable to that observed in the telephone-based nationwide survey (7.38%, p=0.669). However, after the OGTT an additional 3.72% of the population had undiagnosed DM, increasing DM prevalence to 10.68% (age adjusted 11.77%). The prevalence of pre-diabetes was 8.70%, with impaired fasting glucose at 5.84% and impaired glucose tolerance at 2.86%. The prevalence of DM was significantly higher in men (14.58%) than in women (7.13%, p<0.001), increased with age in both sexes and was more prevalent in hypertensive (p<0.001) and obese subjects (p=0.001) and in those living in rural areas (p=0.003). In the multiple logistic regression analysis, significant predictors of pre-diabetes and DM together were age, homeostasis model of assessment of insulin resistance (HOMA-IR), alcohol consumption and educational status, whereas those of DM alone were age, HOMA-IR and triglycerides. Extrapolating our data to the whole country, the age-adjusted prevalence of DM was estimated at 11.97% (men 13.98%, women 9.25%), clearly indicating a major public health problem.
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Affiliation(s)
- Sofia Tsirona
- Department of Endocrinology and Metabolic Diseases, University Hospital, School of Medicine, University of Thessaly, Biopolis, Larissa, Greece
| | - Fotis Katsaros
- Department of Endocrinology and Metabolic Diseases, University Hospital, School of Medicine, University of Thessaly, Biopolis, Larissa, Greece
| | - Alexandra Bargiota
- Department of Endocrinology and Metabolic Diseases, University Hospital, School of Medicine, University of Thessaly, Biopolis, Larissa, Greece
| | - Stergios A Polyzos
- Department of Endocrinology and Metabolic Diseases, University Hospital, School of Medicine, University of Thessaly, Biopolis, Larissa, Greece
| | - George Arapoglou
- Department of Endocrinology and Metabolic Diseases, University Hospital, School of Medicine, University of Thessaly, Biopolis, Larissa, Greece
| | - George N Koukoulis
- Department of Endocrinology and Metabolic Diseases, University Hospital, School of Medicine, University of Thessaly, Biopolis, Larissa, Greece
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16
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Fujioka K. Current and emerging medications for overweight or obesity in people with comorbidities. Diabetes Obes Metab 2015; 17:1021-32. [PMID: 26040215 PMCID: PMC4744746 DOI: 10.1111/dom.12502] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 05/27/2015] [Accepted: 06/01/2015] [Indexed: 12/13/2022]
Abstract
Recently, the recognition of obesity as a complex disease that requires chronic management has become more widespread. There has also been a movement away from a focus on body mass index alone, and toward the management of obesity-related comorbidities as well as excess weight. This article examines the current and emerging pharmacological options for weight management in people with overweight or obesity who have, or are at a high risk of, weight-related comorbidities. In the USA, the current options for pharmacological weight management are phentermine (indicated for short-term use only), orlistat, combined phentermine/topiramate extended release, lorcaserin, naltrexone/bupropion and liraglutide 3.0 mg. Currently, orlistat, naltrexone/bupropion and liraglutide 3.0 mg are approved in Europe. All of the above-mentioned medications have shown weight-loss efficacy versus placebo. Those approved for long-term weight management have also been associated with improvements in weight-related comorbidities, such as hypertension, prediabetes, diabetes or dyslipidaemia, or related biomarkers. As with all drugs, the safety and tolerability profiles of medications for weight management should be considered alongside their efficacy to ensure correct use. Additional medications for weight management that are in clinical development include bupropion/zonisamide and beloranib. The field of obesity treatment is advancing with a number of medications being recently approved, and with other pharmacological options emerging.
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Affiliation(s)
- K Fujioka
- Department of Endocrinology, Scripps Clinic, La Jolla, CA, USA
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17
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Cos FX, Barengo NC, Costa B, Mundet-Tudurí X, Lindström J, Tuomilehto JO. Screening for people with abnormal glucose metabolism in the European DE-PLAN project. Diabetes Res Clin Pract 2015; 109:149-56. [PMID: 25931281 DOI: 10.1016/j.diabres.2015.04.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 03/09/2015] [Accepted: 04/12/2015] [Indexed: 01/08/2023]
Abstract
AIMS The aim of this report is to describe the application of the FINDRISC in clinical practice within the DE-PLAN project as a step to screen for Type 2 diabetes. METHODS Nine out of 24 possible centers were included. Six centers used opportunistic screening methods for participant recruitment whereas three centers provided study participants of a random population sample. Men (n=1621) and women (n=2483) were evaluated separately. In order to assess the prevalence of abnormal glucose tolerance (AGT) disorders across different risk categories, the FINDRISC was used. Anthropometric measurements included blood pressure, height, weight, and waist circumference. Blood lipids and an oral glucose tolerance test were performed in all participants. The primary outcome was identified risk of AGT and type 2 diabetes. RESULTS There was no difference in the prevalence of smoking between the FINDRISC categories, people with a FINDRISC below 15 points tend to be more physically active and to eat more frequently fruits and vegetables. Men with a FINDRISC from 15 to 19 points had a prevalence of abnormal glucose tolerance of approximately 60% and women 50%. The prevalence for men and women with a FINDRISC >20 points was 80%. 30% of men and 20% of women with a FINDRISC between 15 and 19 points had Type 2 diabetes. Among people with a FINDRISC more than 20 points, 50% had previously undiagnosed Type 2 diabetes. CONCLUSIONS The FINDRISC may be a practical tool to be used in primary health-care systems throughout the European population.
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Affiliation(s)
- Francesc Xavier Cos
- DE-PLAN-CAT Research Group, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona & Reus, Tarragona, Spain
| | - Noël C Barengo
- HJELT Institute, University of Helsinki, Helsinki, Finland; Observatorio de Diabetes de Colombia, Organización para la Excelencia de la Salud, Ibagué, Colombia.
| | - Bernardo Costa
- DE-PLAN-CAT Research Group, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona & Reus, Tarragona, Spain
| | - Xavier Mundet-Tudurí
- DE-PLAN-CAT Research Group, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona & Reus, Tarragona, Spain
| | - Jaana Lindström
- Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Jaakko O Tuomilehto
- Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland; Department of Vascular Prevention, Danube-University Krems, Krems, Austria; Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
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18
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Secular trends and educational differences in the incidence of type 2 diabetes in Finland, 1972-2007. Eur J Epidemiol 2015; 30:649-59. [PMID: 25837966 DOI: 10.1007/s10654-015-0008-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Accepted: 03/03/2015] [Indexed: 12/22/2022]
Abstract
Type 2 diabetes prevalence is rising globally, and varies by socio-economic position. Amongst other factors, rising prevalence may reflect increasing incidence. Worldwide, few studies have examined population-level longitudinal trends in incident type 2 diabetes, and reports on secular trends in diabetes incidence by socio-economic measures such as educational attainment are lacking. Finland has a long-standing, comprehensive disease surveillance infrastructure. Using data collected over four decades from serial FINRISK surveys, the National Drug Reimbursement Register and the National Causes of Death Register, we examined secular trends in type 2 diabetes incidence in Finland from the 1970s to 2007. The diabetes status of 38,689 FINRISK participants aged 30-59 years at baseline assessment and without diagnosed diabetes at the time was followed for 10 years. Among men, incidence of diagnosed, pharmacologically managed type 2 diabetes increased over time. Compared with men surveyed in the 1970s, diabetes incidence was higher among men in the 1980s (adjusted HR 1.44, 95% CI 1.13-1.84) and 1990s (adjusted HR 1.72, 1.32-2.24). Body mass index explained some, but not all of this variation. Increases occurred predominantly among men with low (adjusted HR 1980s: 2.07, 95% CI 1.28-3.35; adjusted HR 1990s: 2.12, 95% CI 1.28-3.53) and middle (adjusted HR 1980s: 1.30, 95% CI 0.85-1.99; adjusted HR 1990s: 1.65, 95% CI 1.05-2.60) educational attainment. No secular changes were apparent among women. This rising diabetes incidence among men over recent decades has occurred despite Finland's sustained health promotion efforts. Renewed public health campaigns are urgently required. In addition to population-level initiatives, lower educational strata should be specifically targeted.
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19
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Viitasalo K, Hemiö K, Puttonen S, Hyvärinen HK, Leiviskä J, Härmä M, Peltonen M, Lindström J. Prevention of diabetes and cardiovascular diseases in occupational health care: feasibility and effectiveness. Prim Care Diabetes 2015; 9:96-104. [PMID: 25128324 DOI: 10.1016/j.pcd.2014.07.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 07/04/2014] [Accepted: 07/22/2014] [Indexed: 10/24/2022]
Abstract
AIMS To evaluate feasibility and effectiveness of lifestyle counseling in occupational setting on decreasing risk for diabetes and cardiovascular disease. METHODS A health check-up including physical examination, blood tests, questionnaires and health advice was completed on 2312 employees of an airline company. Participants with elevated risk for type 2 diabetes based on FINDRISC score and/or blood glucose measurement (n=657) were offered 1-3 additional lifestyle counseling sessions and 53% of them agreed to participate. After 2.5 years, 1347 employees of 2199 invited participated in a follow-up study. RESULTS Among women and men with low baseline diabetes risk, cardiovascular risk factors increased slightly during follow-up. Larger proportion of the men who attended interventions lost weight at least 5% compared with the non-attendees (18.4% vs. 8.4%, p=0.031) and their FINDRISC score increased less (0.6 vs. 1.5, p=0.037). Older age associated with participation in follow-up and higher baseline FINDRISC score and presence of clinical and lifestyle risk factors and problems in sleep and mood increased attendance in interventions. CONCLUSIONS Identification of employees with cardiovascular and diabetes risk, and the low intensity lifestyle intervention were feasible in occupational health-care setting. However, the health benefits were modest and observed only for men with increased risk.
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Affiliation(s)
| | - Katri Hemiö
- National Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland.
| | - Sampsa Puttonen
- Finnish Institute of Occupational Health, Topeliuksenkatu 41 a A, FI-00250 Helsinki, Finland.
| | - Hanna-Kaisa Hyvärinen
- Finnish Institute of Occupational Health, Topeliuksenkatu 41 a A, FI-00250 Helsinki, Finland.
| | - Jaana Leiviskä
- National Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland.
| | - Mikko Härmä
- Finnish Institute of Occupational Health, Topeliuksenkatu 41 a A, FI-00250 Helsinki, Finland.
| | - Markku Peltonen
- National Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland.
| | - Jaana Lindström
- National Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland.
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Jämsen E, Nevalainen PI, Eskelinen A, Kalliovalkama J, Moilanen T. Risk factors for perioperative hyperglycemia in primary hip and knee replacements. Acta Orthop 2015; 86:175-82. [PMID: 25409255 PMCID: PMC4404767 DOI: 10.3109/17453674.2014.987064] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 09/08/2014] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Perioperative hyperglycemia has been associated with adverse outcomes in several fields of surgery. In this observational study, we identified factors associated with an increased risk of hyperglycemia following hip and knee replacement. PATIENTS AND METHODS We prospectively monitored changes in glucose following primary hip and knee replacements in 191 patients with osteoarthritis. Possible associations of patient characteristics and operation-related factors with hyperglycemia (defined as glucose > 7.8 mmol/L in 2 consecutive measurements) and severe hyperglycemia (glucose > 10 mmol/L) were analyzed using binary logistic regression with adjustment for age, sex, operated joint, and anesthesiological risk score. RESULTS 76 patients (40%) developed hyperglycemia, and 48 of them (25% of the whole cohort) had severe hyperglycemia. Glycemic responses were similar following hip replacement and knee replacement. Previously diagnosed diabetes was associated with an increased risk of hyperglycemia and severe hyperglycemia, compared to patients with normal glucose metabolism, whereas newly diagnosed diabetes and milder glucose metabolism disorders had no effect. In patients without previously diagnosed diabetes, increased values of preoperative glycosylated hemoglobin (HbA1c) and fasting glucose on the day of operation were associated with hyperglycemia. Higher anesthesiological risk score-but none of the operation-related factors analyzed-was associated with an increased risk of hyperglycemia. INTERPRETATION Perioperative hyperglycemia is common in primary hip and knee replacements. Previously diagnosed diabetes is the strongest risk factor for hyperglycemia. In patients with no history of diabetes, preoperative HbA1c and fasting glucose on the day of operation can be used to stratify the risk of hyperglycemia.
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Affiliation(s)
- Esa Jämsen
- Coxa, Hospital for Joint Replacement, Tampere
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Tyrovolas S, Koyanagi A, Garin N, Olaya B, Ayuso-Mateos JL, Miret M, Chatterji S, Tobiasz-Adamczyk B, Koskinen S, Leonardi M, Haro JM. Diabetes mellitus and its association with central obesity and disability among older adults: a global perspective. Exp Gerontol 2015; 64:70-7. [PMID: 25688991 DOI: 10.1016/j.exger.2015.02.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 02/11/2015] [Accepted: 02/13/2015] [Indexed: 11/25/2022]
Abstract
The aim of the study was to evaluate the association between various factors and diabetes type II (DM) with a particular emphasis on indicators of central obesity, and to compare the effect of DM on disability among elder populations (≥ 50 years old) in nine countries. Data were available for 52,946 people aged ≥ 18 years who participated in the WHO Study on global AGEing and adult health and the Collaborative Research on Ageing in Europe studies conducted between 2007 and 2012. DM was defined as self-report of physician diagnosis. Height, weight, and waist circumference were measured. Disability status was assessed with the WHODAS II questionnaire. The overall prevalence of DM was 7.9% and ranged from 3.8% (Ghana) to 17.6% (Mexico). A 10 cm increase in waist circumference and waist-to-height ratio of >0.5 were associated with a significant 1.26 (India) to 1.77 (Finland), and 1.68 (China, Spain) to 5.40 (Finland) times higher odds for DM respectively. No significant associations were observed in Mexico and South Africa. DM was associated with significantly higher disability status in all countries except Mexico in the model adjusted for demographics and smoking. The inclusion of chronic conditions associated with diabetes in the model attenuated the coefficients in varying degrees depending on the country. A considerable proportion of the studied older population had DM. Central obesity may be a key factor for the prevention of DM among older populations globally. Prevention of DM especially among the older population globally may contribute to reducing the burden of disability.
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Affiliation(s)
- Stefanos Tyrovolas
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr. Antoni Pujades, 42, 08830 Sant Boi de Llobregat, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5, Pabellón 11, 28029 Madrid, Spain
| | - Ai Koyanagi
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr. Antoni Pujades, 42, 08830 Sant Boi de Llobregat, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5, Pabellón 11, 28029 Madrid, Spain
| | - Noe Garin
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Institut d'Investigacions Biomèdiques Sant Pau (IIB Sant Pau), Sant Antoni Maria Claret 167, 08025 Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra 08193 Cerdanyola del Vallès, Spain
| | - Beatriz Olaya
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr. Antoni Pujades, 42, 08830 Sant Boi de Llobregat, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5, Pabellón 11, 28029 Madrid, Spain
| | - Jose Luis Ayuso-Mateos
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5, Pabellón 11, 28029 Madrid, Spain; Department of Psychiatry, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria Princesa (IP), Hospital Universitario la Princesa, Madrid, Spain
| | - Marta Miret
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5, Pabellón 11, 28029 Madrid, Spain; Department of Psychiatry, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria Princesa (IP), Hospital Universitario la Princesa, Madrid, Spain
| | - Somnath Chatterji
- Department of Health Statistics and Information Systems, World Health Organization, Geneva, Switzerland
| | - Beata Tobiasz-Adamczyk
- Department of Medical Sociology, Jagiellonian University Medical College, Krakow, Poland
| | - Seppo Koskinen
- National Institute for Health and Welfare, Helsinki, Finland
| | - Matilde Leonardi
- Neurology, Public Health and Disability Unit, Neurological Institute "Carlo Besta" Foundation IRCCS (Istituto di ricovero e cura a carattere scientifico), Milan, Italy
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr. Antoni Pujades, 42, 08830 Sant Boi de Llobregat, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5, Pabellón 11, 28029 Madrid, Spain.
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Lohi V, Hannula S, Ohtonen P, Sorri M, Mäki-Torkko E. Hearing impairment among adults: The impact of cardiovascular diseases and cardiovascular risk factors. Int J Audiol 2014; 54:265-73. [DOI: 10.3109/14992027.2014.974112] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Banerjee A, Rathod H, Konda M, Bhawalkar J. Comparison of some risk factors for diabetes across different social groups: a cross-sectional study. Ann Med Health Sci Res 2014; 4:915-21. [PMID: 25506486 PMCID: PMC4250991 DOI: 10.4103/2141-9248.144913] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: In fast, developing economies such as India, the population is undergoing rapid social transition, which can increase the risk profile for diabetes. Market forces promoting lifestyles such as sedentary habits, alcohol and tobacco use, which earlier were more prevalent among affluent urban populations are now trickling into the urban poor and rural populations. Aim: The aim of the present research was to compare the prevalence of risk factors for diabetes among three distinct social groups-the urban affluent, the urban poor and the rural poor. Subjects and Methods: A total of 775 adult population over 18 years and belonging to both genders were surveyed for prevalence of some of the risk factors for diabetes such as physical inactivity, obesity, alcohol, and tobacco use. The sample comprised of three distinct social groups as follows; 125 medical students representing the affluent, 400 subjects from urban slums, and 250 subjects from rural areas. Obesity was measured by body mass index (BMI) while central obesity was ascertained by waist hip ratio (WHR). Alcohol and tobacco use were elicited by interview. Results: The overall response rate was 88.52% (686/775). Medical students were more sedentary with mean hours spent each day sitting or reclining at 10.47 (3.25) h, compared to corresponding figures of 6.34 (3.1) h and 7.49 (3.74) h for the rural and urban slum residents respectively (P < 0.001). However, all types of leisure time physical activities were significantly more among the medical students compared to the other groups (P < 0.001). BMI was significantly highest among the rural population with mean of 24.22 (4.17) kg/m2 when compared to the other groups, (P < 0.001). Villagers also had higher WHR and had a higher proportion of persons above the WHR cut-off for gender (P < 0.001). Experimentation with alcohol was more prevalent among the medical students while the urban slum residents were more frequent and heavy drinkers. Smoking was most prevalent among the medical students, while smokeless tobacco use was more among the other groups. Conclusions: Physical inactivity, obesity, including central obesity, alcohol and tobacco use were found in various degrees in the study samples. An important finding was that both obesity and central obesity ascertained by BMI and WHR respectively were highest among the rural population implying the impact of social change on diabetic risk factors.
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Affiliation(s)
- A Banerjee
- Department of Community Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India
| | - Hk Rathod
- Department of Community Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India
| | - M Konda
- Medical Student, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India
| | - Js Bhawalkar
- Department of Community Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India
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Li S, Xiao J, Ji L, Weng J, Jia W, Lu J, Zhou Z, Guo X, Liu J, Shan Z, Zhu D, Chen L, Zhao Z, Tian H, Ji Q, Ge J, Li Q, Lin L, Yang Z, He J, Yang W. BMI and waist circumference are associated with impaired glucose metabolism and type 2 diabetes in normal weight Chinese adults. J Diabetes Complications 2014; 28:470-6. [PMID: 24809931 PMCID: PMC5600198 DOI: 10.1016/j.jdiacomp.2014.03.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 03/25/2014] [Accepted: 03/25/2014] [Indexed: 02/05/2023]
Abstract
AIMS To examine the associations of BMI and waist circumference with glucose metabolism and (pre)diabetes among adults with BMI < 25 kg/m². METHODS We conducted a cross-sectional study in a nationally representative sample (10,098 men and 17,454 women) of Chinese adults aged ≥ 20 years with BMI < 25 kg/m². Glucose levels after at least 10 hours of overnight fasting, at 30 minutes and at 120 minutes after a standard 75-g oral glucose load were measured. Associations of BMI and waist circumference with outcomes were examined by general linear models for continuous outcomes and by logistic regression models for dichotomous outcomes. RESULTS Among those with BMI < 25 kg/m², 18.8% of men and 17.1% of women had abnormal glucose metabolism, including 4.9% of men and 3.8% of women with undiagnosed type 2 diabetes. For each SD increase in BMI (2.1 kg/m²) and waist circumference (8.3 cm), fasting glucose levels increased by 0.128 and 0.170 mmol/L in men, and by 0.112 and 0.167 mmol/L in women, respectively; the corresponding increases for 2-hour post-load glucose levels were 0.121 and 0.217 mmol/L in men, and 0.241 and 0.362 mmol/L in women. When simultaneously included in the same model, these associations with waist circumference were stronger than with BMI. CONCLUSION Obesity measures are associated with abnormal glucose metabolism and diabetes, with central obesity playing a more prominent role than general obesity in Chinese population with BMI < 25 kg/m². Chinese diabetes prevention and treatment programs should incorporate targeting of normal weight adults with central obesity.
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Affiliation(s)
- Shengxu Li
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA
| | | | - Linong Ji
- Peking University Peoples' Hospital, Beijing, China
| | - Jianping Weng
- Sun Yat-sen University Third Hospital, Guangzhou, China
| | - Weiping Jia
- Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Juming Lu
- Chinese PLA General Hospital, Beijing, China
| | | | - Xiaohui Guo
- Peking University First Hospital, Beijing, China
| | - Jie Liu
- Shanxi Province People's Hospital, Shanxi, China
| | - Zhongyan Shan
- The First Affiliated Hospital, Chinese Medical University, Liaoning, China
| | - Dalong Zhu
- The Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu, China
| | - Li Chen
- Qilu Hospital, Qilu Hospital of Shandong University, Shandong, China
| | | | - Haoming Tian
- West China Hospital, Sichuan University, Sichuan, China
| | - Qiuhe Ji
- Xijing Hospital, Fourth Military Medical University, Shaanxi, China
| | - Jiapu Ge
- Xinjiang Uygur Autonomous Region's Hospital, Xinjiang, China
| | - Qiang Li
- The Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | | | | | - Jiang He
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA
| | - Wenying Yang
- China-Japan Friendship Hospital, Beijing, China.
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Tamayo T, Rosenbauer J, Wild SH, Spijkerman AMW, Baan C, Forouhi NG, Herder C, Rathmann W. Diabetes in Europe: an update. Diabetes Res Clin Pract 2014; 103:206-17. [PMID: 24300019 DOI: 10.1016/j.diabres.2013.11.007] [Citation(s) in RCA: 156] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Diabetes is among the leading causes of death in the IDF Europe Region (EUR), continues to increase in prevalence with diabetic macro- and microvascular complications resulting in increased disability and enormous healthcare costs. In 2013, the number of people with diabetes is estimated to be 56 million in EUR with an overall estimated prevalence of 8.5%. However, estimates of diabetes prevalence in 2013 vary widely in the 56 diverse countries in EUR from 2.4% in Moldova to 14.9% in Turkey. Trends in diabetes prevalence also vary between countries with stable prevalence since 2002 for many countries but a doubling of diabetes prevalence in Turkey. For 2035, a further increase of nearly 10 million people with diabetes is projected for the EUR. Prevalence of type 1 has also increased over the past 20 years in EUR and there was estimated to be 129,350 cases in children aged 0-14 years in 2013. Registries provide valid information on incidence of type 1 diabetes with more complete data available for children than for adults. There are large differences in distribution of risk factors for diabetes at the population level in EUR. Modifiable risk factors such as obesity, physical inactivity, smoking behaviour (including secondhand smoking), environmental pollutants, psychosocial factors and socioeconomic deprivation could be tackled to reduce the incidence of type 2 diabetes in Europe. In addition, diabetes management is a major challenge to health services in the European countries. Improved networking practices of health professionals and other stakeholders in combination with empowerment of people with diabetes and continuous quality monitoring need to be further developed in Europe.
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Affiliation(s)
- T Tamayo
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - J Rosenbauer
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - S H Wild
- Centre for Population Health Sciences, University of Edinburgh, UK
| | - A M W Spijkerman
- Centre for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - C Baan
- Centre for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - N G Forouhi
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - C Herder
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - W Rathmann
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
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26
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Guía de práctica clínica de la ESC sobre diabetes, prediabetes y enfermedad cardiovascular, en colaboración con la European Association for the Study of Diabetes. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2013.10.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Nestvold TK, Nielsen EW, Lappegård KT. Bariatric surgery reduces risk factors for development of type 2 diabetes mellitus in morbidly obese, nondiabetic patients. Metab Syndr Relat Disord 2013; 11:441-6. [PMID: 24044780 DOI: 10.1089/met.2013.0085] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Patients with morbid obesity have a high risk of developing type 2 diabetes mellitus (T2DM). Important risk factors include body mass index (BMI), waist circumference, and insulin resistance. In this prospective study, we investigated if preoperative lifestyle changes followed by bariatric surgery could reduce these risk factors. METHODS Forty nondiabetic obese patients aged 27-57 years participated. Baseline BMI was 36.1-65.6 kg/m(2). Fasting glucose, C-peptide, and glycated hemoglobin (HbA1c) were measured at baseline and 1 year after surgery. The patients underwent lifestyle changes for a period of 3 months prior to bariatric surgery and were followed for 1 year after surgery. The correlations between risk factors and weight reduction were assessed by a Pearson test. RESULTS Lifestyle changes resulted in a mean weight reduction of 14.3 kg. One year after bariatric surgery, the patients had a mean reduction in BMI of 17.6. Mean waist circumference was reduced from 136.5 cm to 100.7 cm. At baseline, all 40 patients had a waist circumference >100 cm; 1 year after surgery 18 of 40 patients did. At baseline, 11 out of 40 had insulin resistance (as defined by a homeostasis model score >3.99), whereas 1 year after surgery none of the patients did. There was a statistically significant correlation between change in waist circumference and change in insulin resistance (P<0.02), and between HbA1c and weight loss (P<0.002). CONCLUSIONS Our study shows that, in morbidly obese individuals, lifestyle changes followed by bariatric surgery led to a significant weight loss and a reduction in risk factors for development of T2DM.
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Vehmas T, Shiri R, Luoma K, Viikari-Juntura E. The Relations of Obesity Indicators and Early Metabolic Disturbance with Upper Extremity Pain. PAIN MEDICINE 2013; 14:1081-7. [DOI: 10.1111/pme.12132] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Cha E, Umpierrez G, Kim KH, Bello MK, Dunbar SB. Characteristics of American young adults with increased risk for type 2 diabetes: a pilot study. DIABETES EDUCATOR 2013; 39:454-63. [PMID: 23640300 DOI: 10.1177/0145721713486199] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of the study was to examine the characteristics of American young adults with increased risk for type 2 diabetes (T2D). METHODS Participants ages 18 to 29, overweight/obese, and sedentary were recruited from the metro Atlanta area in the United States. Variables included demographics, anthropometric and clinical variables, and physical activity. Of 107 participants, 3 participants had undiagnosed diabetes and 1 participant did not complete the modifiable activity questionnaire. Thus, 103 young adults remained for the final data analysis. RESULTS Most participants were females and African Americans. About 30% of participants had prediabetes, either impaired fasting glucose, an A1C of 5.7% to 6.4%, or both. Overall, prediabetes young adults were heavier and did less physical activity than Diabetes Prevention Program (DPP) trial participants. In addition, these young adults had a higher prevalence of parental T2D history and lower level of physical activity compared to young adults with normoglycemia. CONCLUSIONS Physical activity and parent T2D history are key risk factors for identifying young adults with prediabetes. Multilevel strategies are necessary to raise awareness of diabetes risk and to prevent T2D in young adults.
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Affiliation(s)
- Eunseok Cha
- Emory University, Atlanta, Georgia (Drs Cha, Umpierrez, Dunbar, Ms Bello)
| | | | - Kevin H Kim
- University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Kim)
| | - Morenike K Bello
- Emory University, Atlanta, Georgia (Drs Cha, Umpierrez, Dunbar, Ms Bello)
| | - Sandra B Dunbar
- Emory University, Atlanta, Georgia (Drs Cha, Umpierrez, Dunbar, Ms Bello)
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Jung SP, Lee KM, Kang JH, Yun SI, Park HO, Moon Y, Kim JY. Effect of Lactobacillus gasseri BNR17 on Overweight and Obese Adults: A Randomized, Double-Blind Clinical Trial. Korean J Fam Med 2013; 34:80-9. [PMID: 23560206 PMCID: PMC3611107 DOI: 10.4082/kjfm.2013.34.2.80] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 03/05/2013] [Indexed: 01/15/2023] Open
Abstract
Background Lactobacillus gasseri BNR17 is a type of probiotic strain isolated from human breast milk. A study was reported regarding the fact that BNR17 was an inhibitor of obesity and diabetic activities in the human body through previous animal experiments. This study was furthered to investigate the effect of BNR17, a probiotic strain isolated from human breast milk, on obese and overweight adults. Methods Sixty-two obese volunteers aged 19 to 60 with body mass index ≥ 23 kg/m2 and fasting blood sugar ≥ 100 mg/dL participated in a placebo controlled, randomized, and double-blind trial. For 12 weeks, 57 participants were given either placebo or BNR17 and were tested by measuring body fat, body weight, various biochemical parameters, vital signs, and computed tomography at the start of the study and at weeks 4, 8, and 12. The subjects assumed usual daily activities without having to make behavioral or dietary modifications during the course of the study. Results At the 12th week, a slight reduction in body weight was noted in the BNR17 group, but there were no significant weight changes between groups. Decrease of waist and hip circumferences in the BNR17 group was more pronounced than those in the placebo group. The two groups had no special or severe adverse reactions. Conclusion Despite there being no change in behavior or diet, administration of only the supplement of BNR17 reduced weight and waist and hip circumference. However, there were no significant differences between the two groups. These findings warrant a subsequent longer-term prospective clinical investigation with a large population.
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Affiliation(s)
- Seung-Pil Jung
- Department of Family Medicine, Obesity Clinic, Yeungnam University College of Medicine, Daegu, Korea
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31
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Rautio N, Jokelainen J, Oksa H, Saaristo T, Peltonen M, Niskanen L, Saltevo J, Korpi-Hyövälti E, Uusitupa M, Tuomilehto J, Keinänen-Kiukaanniemi S. Participation, socioeconomic status and group or individual counselling intervention in individuals at high risk for type 2 diabetes: one-year follow-up study of the FIN-D2D-project. Prim Care Diabetes 2012; 6:277-283. [PMID: 22868007 DOI: 10.1016/j.pcd.2012.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 12/27/2011] [Accepted: 07/11/2012] [Indexed: 10/28/2022]
Abstract
AIMS To describe socioeconomic characteristics of participants and their effect on uptake and completion of the implementation project (FIN-D2D) for the National Type 2 Diabetes Prevention Programme. Furthermore, to assess the effectiveness of individual vs. group intervention during one-year follow-up. METHODS At baseline, 2820 men and 5764 women aged <65 years participated in the non-randomized implementation project in primary health care setting; one-year follow-up was available for 1067 men and 2122 women. Socioeconomic status included education and occupation. Interventions were individual and/or group-based. The changes in cardiovascular risk factors and glucose tolerance were used as measures of the effectiveness of intervention. RESULTS 68.4% of the men and 69.8% of the women participated in some of the intervention modalities offered. Low education and not working were related to active participation in the intervention in men. 88.2% of men and 76.1% of women selected the individual instead of group intervention. The effectiveness of individual vs. group interventions did not differ, except for minor changes in systolic blood pressure in women and glucose tolerance in men. CONCLUSIONS Socioeconomic status modulated participation in interventions. Both types of intervention worked equally well, but participation in group intervention was low.
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Affiliation(s)
- Nina Rautio
- Pirkanmaa Hospital District, Tampere, Finland.
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Pei L, Yang J, Du J, Liu H, Ao N, Zhang Y. Downregulation of chemerin and alleviation of endoplasmic reticulum stress by metformin in adipose tissue of rats. Diabetes Res Clin Pract 2012; 97:267-75. [PMID: 22445233 DOI: 10.1016/j.diabres.2012.02.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Revised: 01/16/2012] [Accepted: 02/23/2012] [Indexed: 11/30/2022]
Abstract
AIMS To investigate whether metformin regulates chemerin expression in vivo by alleviating ER stress. METHODS Male Sprague-Dawley rats were fed a high-fat or normal diet for 10 weeks to induce insulin resistance. During the following 6 weeks, the rats were divided into four groups: normal diet without treatment (NC), normal diet with metformin treatment (NM), high-fat diet without metformin (HF), and high-fat diet with metformin (HM). Body weight, fasting glucose, basal insulin level, insulin sensitivity, chemerin expression in serum and adipose tissue, ER stress marker and its pathway were measured. RESULTS After 6 weeks treatment, metformin reduced the body weight gain and enhanced insulin sensitivity of high-fat fed rats. The basal insulin level in the HM group was lower than in the HF group. Metformin reduced chemerin expression in the HM group compared with HF. Metformin reduced the GRP78 mRNA expression in HM rats. Activation of IRE1 alpha was lower in the HM group than the HF group. CONCLUSIONS Metformin treatment decreased the chemerin expression and alleviated the ER stress in the visceral adipose tissue of high-fat diet-induced insulin-resistant rats. These data may also provide a further rationale for exploring the use of metformin in the treatment of insulin resistance.
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Affiliation(s)
- Lina Pei
- Department of Endocrinology and Metabolism, The 1st Affiliated Hospital, China Medical University, Shenyang, China
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Marinho NBP, Vasconcelos HCAD, Alencar AMPG, Almeida PCD, Damasceno MMC. Diabetes mellitus: fatores associados entre usuários da Estratégia Saúde da Família. ACTA PAUL ENFERM 2012. [DOI: 10.1590/s0103-21002012005000018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Identificar os fatores associados ao Diabetes Mellitus tipo 2 (DM2) em usuários da Estratégia Saúde da Família (ESF) da cidade de Itapipoca-Ceará. MÉTODOS: Estudo transversal, realizado no período de março/2009 a outubro/2010, em 11 unidades básicas de saúde, nas quais foram coletados dados sociodemográficos e clínicos de amostra de 419 usuários dessas unidades. RESULTADOS: Entre os participantes do estudo, 250 (59,7%) estavam com excesso de peso, 352 (84,0%) com obesidade central, 349 (83,3%) eram sedentários e 225 (53,7%) não comiam frutas e/ou verduras diariamente. Houve associação estatisticamente significante entre as variáveis obesidade central e sexo (p<0,001), idade (p=0,001) e estado civil (p<0,001); e entre investigação nutricional e escolaridade (p=0,033) e classe econômica (p=0,007). CONCLUSÃO: Diante dos fatores de risco modificáveis para DM2 identificados com maior prevalência sugere-se o desenvolvimento de intervenções educativas para mudanças no estilo de vida dos indivíduos e o acompanhamento sistemático dessas mudanças, objetivando reduzir ou retardar o aparecimento da doença.
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Jämsen E, Nevalainen P, Eskelinen A, Huotari K, Kalliovalkama J, Moilanen T. Obesity, diabetes, and preoperative hyperglycemia as predictors of periprosthetic joint infection: a single-center analysis of 7181 primary hip and knee replacements for osteoarthritis. J Bone Joint Surg Am 2012; 94:e101. [PMID: 22810408 DOI: 10.2106/jbjs.j.01935] [Citation(s) in RCA: 270] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Diabetes and obesity are common in patients undergoing joint replacement. Studies analyzing the effects of diabetes and obesity on the occurrence of periprosthetic joint infection have yielded contradictory results, and the combined effects of these conditions are not known. METHODS The one-year incidence of periprosthetic joint infections was analyzed in a single-center series of 7181 primary hip and knee replacements (unilateral and simultaneous bilateral) performed between 2002 and 2008 to treat osteoarthritis. The data regarding periprosthetic joint infection (defined according to Centers for Disease Control and Prevention criteria) were collected from the hospital infection register and were based on prospective, active surveillance. Patients diagnosed with diabetes were identified from the registers of the Social Insurance Institution of Finland. The odds ratios (ORs) for infection and the accompanying 95% confidence intervals (CIs) were calculated with use of binary logistic regression with adjustment for age, sex, American Society of Anesthesiologists risk score, arthroplasty site, body mass index, and diabetic status. RESULTS Fifty-two periprosthetic joint infections occurred during the first postoperative year (0.72%; 95% CI, 0.55% to 0.95%). The infection rate increased from 0.37% (95% CI, 0.15% to 0.96%) in patients with a normal body mass index to 4.66% (95% CI, 2.47% to 8.62%) in the morbidly obese group (adjusted OR, 6.4; 95% CI, 1.7 to 24.6). Diabetes more than doubled the periprosthetic joint infection risk independent of obesity (adjusted OR, 2.3; 95% CI, 1.1 to 4.7). The infection rate was highest in morbidly obese patients with diabetes; this group contained fifty-one patients and periprosthetic infection developed in five (9.8%; 95% CI, 4.26% to 20.98%). In patients without a diagnosis of diabetes at the time of the surgery, there was a trend toward a higher infection rate in association with a preoperative glucose level of ≥6.9 mmol/L (124 mg/dL) compared with <6.9 mmol/L. The infection rate was 1.15% (95% CI, 0.56% to 2.35%) in the former group compared with 0.28% (95% CI, 0.15% to 0.53%) in the latter, and the adjusted OR was 3.3 (95% CI, 0.96 to 11.0). The type of diabetes medication was not associated with the infection rate. CONCLUSIONS Diabetes and morbid obesity increased the risk of periprosthetic joint infection following primary hip and knee replacement. The benefits of joint replacement should be carefully weighed against the incidence of postoperative infection, especially in morbidly obese patients. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Esa Jämsen
- Coxa, Hospital for Joint Replacement, P.O. Box 652, FIN-33101, Tampere, Finland.
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Korniloff K, Häkkinen A, Koponen HJ, Kautiainen H, Järvenpää S, Peltonen M, Mäntyselkä P, Kampman O, Oksa H, Vanhala M. Relationships between depressive symptoms and self-reported unintentional injuries: the cross-sectional population-based FIN-D2D survey. BMC Public Health 2012; 12:516. [PMID: 22781103 PMCID: PMC3506522 DOI: 10.1186/1471-2458-12-516] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 06/25/2012] [Indexed: 02/27/2023] Open
Abstract
Background There is a lack of knowledge on the influence of different levels of physical activity (PA) on unintentional injuries among those with depressive symptoms (DS). The aim of this study was to evaluate the relationship between PA categories and unintentional injuries among participants with and without DS based on a cross-sectional population–based FIN-D2D survey conducted in 2007. Methods Out of 4500, 2682 participants (60%) aged 45–74 years attended in this study. The unintentional injuries over the past year were captured in a questionnaire. DS were determined with the Beck Depression Inventory (≥ 10 points) and PA with the International Physical Activity Questionnaire. The statistical significance between DS and unintentional injury categories was evaluated by using t-test, chi-square test, or permutation test, analysis of covariance, or regression models. The factors related to unintentional injuries were estimated by univariate and multivariate logistic regression models. Results The proportion of subjects with unintentional injuries was higher among those with DS (17%) compared to those without DS (10%) (age- and gender-adjusted p = 0.023). The median (range) number of activity-loss days after injury was 22 (0–365) in participants with DS and 7 (0–120) in participants without DS ( p = 0.009). The percentage of subjects with unintentional injuries was not significantly different between PA categories in participants with DS and without DS. A stepwise multivariate logistic regression analysis showed that DS, functional ability, and musculoskeletal diseases were related to unintentional injuries. Conclusions PA level was not related to unintentional injuries, whereas those with DS had a higher prevalence of unintentional injuries and prolonged activity-loss after injury. These results underline the importance of injury prevention, especially among those who have DS and additional risk factors.
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Viitasalo K, Lindström J, Hemiö K, Puttonen S, Koho A, Härmä M, Peltonen M. Occupational health care identifies risk for type 2 diabetes and cardiovascular disease. Prim Care Diabetes 2012; 6:95-102. [PMID: 22306176 DOI: 10.1016/j.pcd.2012.01.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2011] [Revised: 01/06/2012] [Accepted: 01/13/2012] [Indexed: 11/21/2022]
Abstract
AIMS To assess the risk for type 2 diabetes (T2D) and cardiovascular disease (CVD) among employees of a Finnish airline; to study the association of shift work with T2D and CVD risk; and to test the feasibility of risk screening in occupational health care setting. METHODS Altogether 4169 employees were invited for a health check-up and 2312 participated in this study. The check-up included physical examinations, questionnaires on working hours, sleep, and lifestyle, diabetes risk score FINDRISC, and blood tests. Lifestyle counselling was offered for those with increased T2D risk. RESULTS Altogether 15% of participants had a high T2D risk (FINDRISC≥15 and/or elevated, but non-diabetic blood glucose), and a further 15% had a moderate T2D risk (FINDRISC 10-14 and normal blood glucose). Of those 60% agreed to attend lifestyle counselling. Metabolic syndrome was more common, lipid profile more unfavorable and hsCRP higher by increasing FINDRISC score category. Risk factor profiles linked to shift work status were not self-evident. CONCLUSIONS The renewed health check-up process effectively identified those employees with increased T2D and CVD risk who would benefit from lifestyle intervention. The use of FINDRISC questionnaire was a feasible first-step screening method in occupational health care setting.
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Salmela SM, Vähäsarja K, Villberg J, Vanhala M, Saaristo T, Lindström J, Oksa H, Korpi-Hyövälti E, Niskanen L, Keinänen-Kiukaanniemi S, Poskiparta M. The reporting of previous lifestyle counseling by persons at high risk of Type 2 diabetes. PATIENT EDUCATION AND COUNSELING 2012; 87:178-185. [PMID: 21943790 DOI: 10.1016/j.pec.2011.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Revised: 08/01/2011] [Accepted: 08/26/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To assess (i) whether the reporting of counseling previously received is associated with high-risk individuals' agreement to participate in lifestyle intervention, (ii) whether the reporting of previous counseling differed within such a high-risk group, and (iii) the associations between lifestyles and previous lifestyle counseling. METHODS Cross-sectional data were drawn from 10149 adults at high risk of Type 2 diabetes, who were participating in a Finnish national diabetes prevention project (FIN-D2D). Bivariate analysis and multivariate logistic regression were used. RESULTS In relation to the reporting of previous counseling, no difference was found between persons who had agreed and persons who had not agreed to participate in the lifestyle intervention. Persons who were more educated or who had dyslipidemia or diabetes were more likely than the others to report previous counseling. A generally healthy lifestyle, or certain health behaviors (being a non-smoker or eating large amounts of fruit and vegetables) may make the reporting of previous counseling more likely. CONCLUSION The results raise questions about the amount and quality of the previously received lifestyle counseling. PRACTICE IMPLICATIONS There is a need for sustainable lifestyle counseling structures, within vigorously implemented diabetes prevention projects, if long-lasting lifestyle changes are to be achieved.
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Affiliation(s)
- Sanna M Salmela
- Research Centre for Health Promotion, Faculty of Sport and Health Sciences, Department of Health Sciences, University of Jyväskylä, Finland.
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Salmela SM, Vähäsarja KA, Villberg JJ, Vanhala MJ, Saaristo TE, Lindström J, Oksa HH, Korpi-Hyövälti EAL, Moilanen L, Keinänen-Kiukaanniemi S, Poskiparta ME. Perceiving need for lifestyle counseling: findings from Finnish individuals at high risk of type 2 diabetes. Diabetes Care 2012; 35:239-41. [PMID: 22190673 PMCID: PMC3263895 DOI: 10.2337/dc11-1116] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 11/05/2011] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate the proportion of individuals at high risk of type 2 diabetes who perceive the need for lifestyle counseling, factors associated with this perception, and whether the perceived need is associated with subsequent attendance in lifestyle intervention. RESEARCH DESIGN AND METHODS Baseline and intervention data were obtained from 10,149 participants in a Finnish National Diabetes Prevention Project. RESULTS In total, 36% of men and 52% of women perceived the need for counseling. Most of the risk factors did not increase the perceived need for counseling. Those agreeing to attend supervised lifestyle intervention were more likely to report a perceived need than those who agreed on a self-initiated lifestyle change or those who refused to attend lifestyle intervention. The perceived need was associated with actual attendance in the lifestyle intervention only among women. CONCLUSIONS It will be vital to find additional means to support lifestyle change.
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Affiliation(s)
- Sanna M Salmela
- Research Centre for Health Promotion, Faculty of Sport and Health Sciences, Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
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Pajunen P, Kotronen A, Korpi-Hyövälti E, Keinänen-Kiukaanniemi S, Oksa H, Niskanen L, Saaristo T, Saltevo JT, Sundvall J, Vanhala M, Uusitupa M, Peltonen M. Metabolically healthy and unhealthy obesity phenotypes in the general population: the FIN-D2D Survey. BMC Public Health 2011; 11:754. [PMID: 21962038 PMCID: PMC3198943 DOI: 10.1186/1471-2458-11-754] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Accepted: 10/01/2011] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The aim of this work was to examine the prevalence of different metabolical phenotypes of obesity, and to analyze, by using different risk scores, how the metabolic syndrome (MetS) definition discriminates between unhealthy and healthy metabolic phenotypes in different obesity classes. METHODS The Finnish type 2 diabetes (FIN-D2D) survey, a part of the larger implementation study, was carried out in 2007. The present cross-sectional analysis comprises 2,849 individuals aged 45-74 years. The MetS was defined with the new Harmonization definition. Cardiovascular risk was estimated with the Framingham and SCORE risk scores. Diabetes risk was assessed with the FINDRISK score. Non-alcoholic fatty liver disease (NAFLD) was estimated with the NAFLD score. Participants with and without MetS were classified in different weight categories and analysis of regression models were used to test the linear trend between body mass index (BMI) and various characteristics in individuals with and without MetS; and interaction between BMI and MetS. RESULTS A metabolically healthy but obese phenotype was observed in 9.2% of obese men and in 16.4% of obese women. The MetS-BMI interaction was significant for fasting glucose, 2-hour plasma glucose, fasting plasma insulin and insulin resistance (HOMA-IR)(p < 0.001 for all). The prevalence of total diabetes (detected prior to or during survey) was 37.0% in obese individuals with MetS and 4.3% in obese individuals without MetS (p < 0.001). MetS-BMI interaction was significant (p < 0.001) also for the Framingham 10 year CVD risk score, NAFLD score and estimated liver fat %, indicating greater effect of increasing BMI in participants with MetS compared to participants without MetS. The metabolically healthy but obese individuals had lower 2-hour postload glucose levels (p = 0.0030), lower NAFLD scores (p < 0.001) and lower CVD risk scores (Framingham, p < 0.001; SCORE, p = 0.002) than normal weight individuals with MetS. CONCLUSIONS Undetected Type 2 diabetes was more prevalent among those with MetS irrespective of the BMI class and increasing BMI had a significantly greater effect on estimates of liver fat and future CVD risk among those with MetS compared with participants without MetS. A healthy obese phenotype was associated with a better metabolic profile than observed in normal weight individuals with MetS.
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Affiliation(s)
- Pia Pajunen
- Diabetes Prevention Unit, Division of Welfare and Health Promotion, National Institute for Health and Welfare, Helsinki, Finland
| | - Anna Kotronen
- Diabetes Prevention Unit, Division of Welfare and Health Promotion, National Institute for Health and Welfare, Helsinki, Finland
- Department of Medicine, Division of Diabetes, University of Helsinki, Helsinki, Finland
- Minerva Medical Research Institute, Helsinki, Finland
| | - Eeva Korpi-Hyövälti
- Department of Internal Medicine, South Ostrobothnia Central Hospital, Seinäjoki, Finland
| | - Sirkka Keinänen-Kiukaanniemi
- Institute of Health Sciences (General Practice), University of Oulu, Finland
- Unit of General Practice, Oulu University Hospital and Health Centre of Oulu, Oulu, Finland
| | - Heikki Oksa
- Tampere University Hospital, Tampere, Finland
| | - Leo Niskanen
- Department of Medicine/Diabetology and Endocrinology, Kuopio University Hospital, Kuopio, Finland
| | - Timo Saaristo
- Tampere University Hospital, Tampere, Finland
- Finnish Diabetes Association, Tampere, Finland
| | - Juha T Saltevo
- Department of Medicine, Central Finland Central Hospital, Jyväskylä, Finland
| | - Jouko Sundvall
- Disease Risk Unit, Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
| | - Mauno Vanhala
- School of Medicine, Unit of Primary Health Care, University of Eastern Finland, Kuopio, Finland
- Unit of Family Practice, Central Hospital of Central Finland, Jyväskylä, Finland
| | - Matti Uusitupa
- Institute of Public Health and Clinical Nutrition, Clinical Nutrition, University of Eastern Finland, and Research Unit, Kuopio University Hospital, Kuopio, Finland
| | - Markku Peltonen
- Diabetes Prevention Unit, Division of Welfare and Health Promotion, National Institute for Health and Welfare, Helsinki, Finland
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Zadeh-Vakili A, Tehrani FR, Hosseinpanah F. Waist circumference and insulin resistance: a community based cross sectional study on reproductive aged Iranian women. Diabetol Metab Syndr 2011; 3:18. [PMID: 21831271 PMCID: PMC3170572 DOI: 10.1186/1758-5996-3-18] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 08/10/2011] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Although the positive relationship between insulin resistance (IR) and central obesity is well known, the direct relationship between waist circumference and IR is not clear yet and there is no consensus regarding the cut off value for waist circumference as a surrogate index for central obesity. The present study was aimed to determine the optimal cut-off value of waist circumference (WC) for predicting IR in reproductive aged Iranian women. METHODS Using the stratified, multistage probability cluster sampling method 1036 women were randomly selected from among reproductive aged women of different geographic regions of Iran. Following implementation of exclusion criteria, complete data for 907 women remained for analysis. Insulin resistance was evaluated by the homeostasis model assessment (HOMA-IR) and its cut off value was defined as the 95th percentile of HOMA-IR value for 129 subjects, without any metabolic abnormality. The optimal cut-off of WC in relation to HOMA-IR was calculated based on the receiver operating characteristics (ROC) curve analysis using the Youden index and the area under curve (AUC). RESULTS The mean age of the total sample of 907 subjects was 34.4 ± 7.6 years (range, 18 - 45 years). After adjustment for age the odds ratios (OR) of elevated HOMA-IR were progressively higher with increasing levels of waist circumference; the age adjusted OR of IR for women with WC > 95 cm in comparison to those subjects with WC < 80 cm, was 9.5 (95% CI 5.6-16.1). The optimal cutoff value for WC predicting IR was 88.5 cm; with a sensitivity and specificity of 71% and 64%, respectively. CONCLUSIONS Waist circumference is directly related to insulin resistance and the optimal cut-off value for waist circumference reflecting insulin resistance is considered to be 88.5 cm for reproductive aged Iranian women.
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Affiliation(s)
- Azita Zadeh-Vakili
- Obesity Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahimeh R Tehrani
- Reproductive Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhad Hosseinpanah
- Obesity Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Bandaru P, Rajkumar H, Nappanveettil G. Altered or Impaired Immune Response to Hepatitis B Vaccine in WNIN/GR-Ob Rat: An Obese Rat Model with Impaired Glucose Tolerance. ISRN ENDOCRINOLOGY 2011; 2011:980105. [PMID: 22363894 PMCID: PMC3262630 DOI: 10.5402/2011/980105] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2011] [Accepted: 06/19/2011] [Indexed: 02/02/2023]
Abstract
Obesity is shown to increase the incidence and severity of infectious diseases and
individuals seem to exhibit poor antibody response to vaccination due to several inherent immune defects. With the increasing prevalence of impaired glucose tolerance (IGT) seen in obese individuals, the present study was aimed to investigate the basal immune response and immune response upon Hepatitis B vaccination (HBV) in an obese rat model WNIN/GR-Ob with impaired glucose tolerance (IGT). Decreased proportions of splenic CD4+ T helper cells and CD3+ T cells were observed in obese animals compared to lean animals. Upon HBV, obese animals showed reduced cell-mediated immunity and humoral immunity in terms of splenic lymphocyte proliferative response to Concanavalin A (Con A) and Hepatitis B surface antigen (HBsAg) and HBsAg-specific IgG response. Innate immunity as assessed in terms of Tumor Necrosis Factor α (TNF α) and Nitric oxide (NO) production by peritoneal macrophages upon HBV was low and unchanged, respectively, in obese animals. Thus long-term immunological memory is impaired or altered upon HBV.
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Affiliation(s)
- Prathibha Bandaru
- Department of Microbiology, National Institute of Nutrition, Jamai Osmania, Hyderabad 500 604, India
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Tyrovolas S, Psaltopoulou T, Pounis G, Papairakleous N, Bountziouka V, Zeimbekis A, Gotsis E, Antonopoulou M, Metallinos G, Polychronopoulos E, Lionis C, Panagiotakos DB. Nutrient intake in relation to central and overall obesity status among elderly people living in the Mediterranean islands: the MEDIS study. Nutr Metab Cardiovasc Dis 2011; 21:438-445. [PMID: 20153615 DOI: 10.1016/j.numecd.2009.10.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Revised: 09/02/2009] [Accepted: 10/26/2009] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND AIM The aim of the present work was to evaluate the relationship between energy-generating nutrients and the presence of central and overall obesity after correcting for socio-demographic, lifestyle and clinical characteristics, among healthy elders. METHODS AND RESULTS During 2005-2007, 553 elderly men and 637 elderly women (mean age 74±7years) from eight Mediterranean islands in Greece and Cyprus, were enrolled. The retrieved information included demographic, bio-clinical and dietary characteristics. MedDietScore assessed adherence to the Mediterranean dietary pattern. The prevalence of obesity was 27% in males and 39% in females (p<0.001), while 73% of males and 87% of females had central obesity. The prevalence of diabetes, hypercholesterolemia and hypertension was higher in the obese than in the non-obese participants (p<0.01). After adjusting for various confounders, a 1% increase in carbohydrate consumption was associated with a 12% (95% CI 0.78-0.99) lower likelihood of having central obesity, while a 1% increase in carbohydrate and protein consumption was associated with a 14% (95% CI 0.78-0.95) and 16% (95% CI 0.72-0.97) lower likelihood of being obese, respectively. Vegetable protein was found to be associated with a 15% (95% CI 0.77-0.93) lower likelihood of being obese while, only low glycemic index carbohydrates seem to be associated with a 6% (95% CI 0.90-0.98) lower likelihood of having central obesity. CONCLUSIONS The presented findings suggest that a diet high in carbohydrates and vegetable protein is associated with a lower likelihood of being obese and may help elderly people to preserve normal weight.
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Affiliation(s)
- S Tyrovolas
- Department of Nutrition Science--Dietetics, Harokopio University, Athens, Greece
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Rautio N, Jokelainen J, Oksa H, Saaristo T, Peltonen M, Niskanen L, Puolijoki H, Vanhala M, Uusitupa M, Keinänen-Kiukaanniemi S. Socioeconomic position and effectiveness of lifestyle intervention in prevention of type 2 diabetes: one-year follow-up of the FIN-D2D project. Scand J Public Health 2011; 39:561-70. [PMID: 21622677 DOI: 10.1177/1403494811408482] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS Lifestyle intervention is effective in prevention of type 2 diabetes (T2D) in high-risk individuals. However, health behaviour and health outcomes are modified by socioeconomic position through various mechanisms. It is therefore possible that success in lifestyle intervention may be determined by factors such as level of education or occupation. In this study we assessed the impact of the level of education and occupation on the baseline anthropometric and clinical characteristics and their changes during a one-year follow-up in a cohort of Finnish men and women at high risk for T2D aged 20-64 years. METHODS As part of a Finnish national diabetes prevention programme 2003-2007 (FIN-D2D), high-risk individuals were identified using opportunistic screening for lifestyle intervention in primary health care. 1,067 men and 2,122 women had one-year follow-up data. Education and occupation were used as factors of socioeconomic position. Measures of anthropometric and clinical characteristics included weight, body mass index (BMI), waist circumference, systolic and diastolic blood pressure, total, HDL and LDL cholesterol, triglycerides, FINDRISC scores and glucose tolerance status. RESULTS The effect of intervention was similar in all socioeconomic groups, but the level of education was related to glucose tolerance status in both genders. In addition, socioeconomic differences existed in blood pressure, weight, BMI, waist circumference and HDL cholesterol. CONCLUSIONS Socioeconomic position did not seem to have any impact on the effectiveness of lifestyle intervention in individuals at high risk for T2D, which is encouraging from the point of view of reducing health inequalities.
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Salopuro TM, Saaristo T, Oksa H, Puolijoki H, Vanhala M, Ebeling T, Niskanen L, Tuomilehto J, Uusitupa M, Peltonen M. Population-level effects of the national diabetes prevention programme (FIN-D2D) on the body weight, the waist circumference, and the prevalence of obesity. BMC Public Health 2011; 11:350. [PMID: 21595955 PMCID: PMC3118241 DOI: 10.1186/1471-2458-11-350] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Accepted: 05/19/2011] [Indexed: 11/30/2022] Open
Abstract
Background The implementation project of the national diabetes prevention programme in Finland, FIN-D2D, was carried out in primary health care in the area of five hospital districts during 2003-2007. Methods The population strategy of FIN-D2D was primarily aimed at increasing the awareness of type 2 diabetes and preventing obesity. To investigate the effects of this strategy, we studied the changes in the prevalence of obesity, overweight, and central obesity among a random independent sample of individuals aged 45-74 years in the FIN-D2D area; and assessed whether they differed from a sample of individuals in the control area, which consisted of four geographical areas not participating in FIN-D2D (FINRISK study). Data was obtained for 5850/ 6406 (in the beginning/ in the end) individuals. The duration of the observation period varied from three to five years. Results The mean body weight decreased from 78.7 to 78.1 kg (p = 0.041) in the FIN-D2D area, and from 78.7 to 78.0 kg (p = NS) in the control area. The prevalence of obesity (BMI ≥30 kg/m2) decreased in the FIN-D2D area (26.5% vs. 24.4%, p = 0.015), and in the control area (28.4% vs. 25.2%, p = 0.005). The prevalence of morbid obesity (BMI ≥40 kg/m2) remained unchanged in the FIN-D2D area, but increased in the control area (1.2% vs. 2.3%, p = 0.007). The mean waist circumference remained unchanged in the FIN-D2D area, but increased in the control area (92.8 vs. 94.0 cm, p = 0.005). Conclusions The prevalence of obesity may be decreasing among 45-74 year old Finns. We still need a longer time perspective and future studies to see whether this favourable trend can be sustained in Finland. The actions of this implementation project can at least partly explain the differences in the mean waist circumference and the prevalence of morbid obesity between the intervention and control areas.
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Moraes SAD, Freitas ICMD, Gimeno SGA, Mondini L. [Diabetes mellitus prevalence and associated factors in adults in Ribeirão Preto, São Paulo, Brazil, 2006: OBEDIARP Project]. CAD SAUDE PUBLICA 2010; 26:929-41. [PMID: 20563393 DOI: 10.1590/s0102-311x2010000500015] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Accepted: 03/11/2010] [Indexed: 02/06/2023] Open
Abstract
To identify diabetes mellitus prevalence and associated factors, a cross-sectional epidemiological study was developed including participants aged 30 years and older living in Ribeirão Preto, São Paulo State, Brazil. Using three-stage cluster sampling, probability weights were applied, resulting in a weighted sample of 2,197 participants. Diabetes mellitus diagnosis was based on previous medical history or World Health Organization (WHO) cut-offs after oral glucose tolerance test. To investigate associated factors, crude and adjusted prevalence ratios were estimated by points and confidence intervals, using Poisson regression. Diabetes mellitus prevalence was 15.02%. After adjusting for potential confounding, factors associated with diabetes mellitus in the final model were: age; family history of diabetes mellitus; waist hip ratio; waist height ratio; number of medicines taken; and use of outpatient services. The results showed high diabetes mellitus prevalence and identified associated factors amenable to intervention.
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Affiliation(s)
- Suzana Alves de Moraes
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
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Saaristo T, Moilanen L, Jokelainen J, Korpi-Hyövälti E, Vanhala M, Saltevo J, Niskanen L, Peltonen M, Oksa H, Cederberg H, Tuomilehto J, Uusitupa M, Keinänen-Kiukaanniemi S. Cardiometabolic profile of people screened for high risk of type 2 diabetes in a national diabetes prevention programme (FIN-D2D). Prim Care Diabetes 2010; 4:231-239. [PMID: 21134669 DOI: 10.1016/j.pcd.2010.05.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Revised: 05/10/2010] [Accepted: 05/21/2010] [Indexed: 02/04/2023]
Abstract
AIMS To study screening of high-risk individuals as part of a national diabetes prevention programme in primary health care settings in Finland between 2003 and 2007, and evaluate the cardiometabolic risk profile of persons identified for intervention. METHODS High-risk individuals were identified by the Finnish Diabetes Risk Score (FINDRISC), history of impaired fasting glucose (IFG), impaired glucose tolerance (IGT), cardiovascular disease (CVD), or gestational diabetes. Participants subsequently underwent an oral glucose tolerance test. CVD morbidity risk was estimated by the Framingham Study Risk Equation and CVD mortality risk by the Systematic Coronary Risk Evaluation Formula (SCORE). RESULTS A high-risk cohort of 10,149 (of whom 30.3% men) was identified (mean age 54.7 for men, 53.0 for women). Altogether 18.8% of men and 11.5% of women had screen-detected diabetes. In total 68.1% of men and 49.4% of women had abnormal glucose tolerance (IFG, IGT or screen-detected diabetes). Furthermore, 43.2% and 41.5% of men, and 13.3% and 11.3% of women, respectively, had a high predicted risk of CVD morbidity or mortality. CONCLUSION Prevalence of dysglycemia including undiagnosed diabetes and the predicted risk for CVD was alarmly high in the identified high-risk cohort, particularly in men.
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Wikström K, Lindström J, Tuomilehto J, Saaristo TE, Korpi-Hyövälti E, Oksa H, Vanhala M, Niskanen L, Keinänen-Kiukaanniemi S, Uusitupa M, Peltonen M. Socio-economic differences in dysglycemia and lifestyle-related risk factors in the Finnish middle-aged population. Eur J Public Health 2010; 21:768-74. [PMID: 21088078 DOI: 10.1093/eurpub/ckq164] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the association of socio-economic status (SES) with dysglycemia and the lifestyle-related risk factors, and to analyze to which extent known risk factors explain socio-economic differences in diabetes risk. METHODS Two population-based cross-sectional surveys in Finland including 1696 men and 1946 women aged 45-64 years who participated in a health examination in 2004 or 2007. Dysglycemia was determined by an oral glucose tolerance test. Total type 2 diabetes (including previously known and screen-detected type 2 diabetes), impaired glucose tolerance and impaired fasting glucose formed the category of total dysglycemia. Questionnaires and clinical examination were completed to assess risk factors for dysglycemia. SES was defined by education and household income. RESULTS In both genders, the prevalence of total dysglycemia differed statistically significantly between educational groups. Low education was statistically significantly associated with higher risk of total type 2 diabetes in women. The household income level was inversely associated with total type 2 diabetes in women and with total dysglycemia in men. Obesity, unhealthy diet and smoking were all inversely related to SES in both men and women. The observed association between education and dysglycemia was slightly attenuated after adjustment for obesity and other risk factors for diabetes. CONCLUSIONS Low education was associated with an increased risk of dysglycemia more strongly than the low household income. Risk factors, especially obesity, explained only partly the observed associations between dysglycemia and education.
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Affiliation(s)
- Katja Wikström
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland.
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Vermunt PWA, Milder IEJ, Wielaard F, van Oers JAM, Westert GP. An active strategy to identify individuals eligible for type 2 diabetes prevention by lifestyle intervention in Dutch primary care: the APHRODITE study. Fam Pract 2010; 27:312-9. [PMID: 20089573 DOI: 10.1093/fampra/cmp100] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Several trials have shown the potential of lifestyle intervention programmes for prevention of type 2 diabetes. The effectiveness of implementation of these programmes into daily practice is now being studied in several countries. The 'Active Prevention in High Risk individuals of Diabetes Type 2 in Eindhoven' (APHRODITE) study investigates whether type 2 diabetes prevention by lifestyle intervention is effective in Dutch primary care. In this article we describe the process of recruiting the study participants. OBJECTIVE To assess the reach of an active strategy to recruit participants for a programme on type 2 diabetes prevention by lifestyle intervention in Dutch primary care. METHODS A diabetes risk questionnaire was sent to general practice patients aged 40-70 years. Individuals with a risk score above threshold were invited for an admission interview with the GP and an oral glucose tolerance test (OGTT). All individuals with non-diabetic glucose levels were asked to participate in the intervention study. RESULTS In total, 8752 (54.6%) of the individuals returned the questionnaire in time. Of all high-risk individuals (n = 1533), 73.1% contacted their practice to schedule a consultation with the GP. Response rates varied significantly among practices. CONCLUSIONS Using invitational letters, a substantial amount of individuals could be motivated to participate in a programme on type 2 diabetes prevention by lifestyle intervention in Dutch primary care. Further research is needed on what kind of strategy would be most effective and efficient to screen for individuals at high risk for type 2 diabetes in primary care.
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Affiliation(s)
- P W A Vermunt
- Scientific Centre for Transformation in Care and Welfare (Tranzo), University of Tilburg, Tilburg
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Non-alcoholic and alcoholic fatty liver disease - two diseases of affluence associated with the metabolic syndrome and type 2 diabetes: the FIN-D2D survey. BMC Public Health 2010; 10:237. [PMID: 20459722 PMCID: PMC2873937 DOI: 10.1186/1471-2458-10-237] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2009] [Accepted: 05/10/2010] [Indexed: 11/20/2022] Open
Abstract
Background Non-alcoholic fatty liver disease (NAFLD) is known to be associated with the metabolic syndrome (MetS) and abnormal glucose tolerance. Whether alcoholic fatty liver disease (AFLD) is associated with similar metabolic abnormalities has not been examined in a population-based study. We aimed at assessing the prevalences of NAFLD and AFLD, and to examine to what extent these conditions are associated with MetS and abnormal glucose tolerance. Methods The cohort included 2766 Finnish subjects (45-74 years) from the population-based FIN-D2D survey. Features of insulin resistance, components of the MetS, glucose tolerance status by oral glucose tolerance test, serum liver enzyme concentrations, and daily alcohol consumption were assessed. Results Subjects with NAFLD and AFLD were equally obese and had similar fasting and insulin concentrations. The prevalences of NAFLD and AFLD were 21% (95% CI: 19%-22%) and 7% (95% CI: 6%-8%). The MetS was slightly more prevalent in AFLD (73%) than in NAFLD (70%, p = 0.028), and type 2 diabetes was similarly prevalent in NAFLD and AFLD (24-25%). The MetS and type 2 diabetes were more prevalent in subjects with NAFLD or AFLD compared to subjects with normal LFTs (53% and 14%, p < 0.0001 for both). Discussion and conclusion In Finnish middle-aged population, the prevalence of NAFLD is 3-fold higher than that of AFLD. The prevalences of MetS and type 2 diabetes are, however, significantly increased in both NAFLD and AFLD compared to subjects with normal LFTs. Subjects with AFLD are thus similarly metabolically unhealthy as subjects with NAFLD.
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Fasting plasma glucose in the screening for type 2 diabetes in morbidly obese subjects. Obes Surg 2009; 20:302-7. [PMID: 19949889 DOI: 10.1007/s11695-009-0022-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Accepted: 10/27/2009] [Indexed: 01/14/2023]
Abstract
BACKGROUND Higher mortality rates among morbidly obese (BMI of > or =40 or > or =35 kg/m2 with weight-related comorbidities) subjects are mainly explained by comorbidities such as type 2 diabetes. As bariatric surgery ameliorates diabetes, obese diabetic subjects will receive great benefits from bariatric surgery. Screening for diabetes prior to surgical referral is therefore crucial. METHODS We studied 1,253 consecutively recruited (2005-2008) morbidly obese subjects (67% women). Among subjects without known diabetes, 70% (670/961) performed an oral glucose tolerance test (OGTT). Screen-detected diabetes was defined as fasting plasma glucose (fPG) > or =7.0 mmol/l and/or 2-h glucose concentration (2hPG) > or = 11.1 mmol/l. RESULTS Within the study population, 31% had diabetes, of which 8% were screen-detected. Eighty percent of those with screen-detected diabetes were diagnosed by fPG. In subjects with nondiabetic fPG concentrations, elevating the fPG cutoff value from 5.2 mmol/l to the World Health Organization's (WHO's) recommended value of 6.1 mmol/l reduced the percentage of the population needing an OGTT considerably (78-23%), but only slightly reduced the sensitivity of fPG in detecting a diabetic 2hPG concentration (100-77%). Only 7% of the patients with fPG between 6.1 and 6.9 mmol/l had a diabetic 2hPG concentration. Following the WHO's recommendations, we found that 95% of all subjects with unknown diabetes were identified. CONCLUSIONS Fasting glucose identified four out of five morbidly obese subjects with unknown diabetes. A supplemental OGTT in selected persons identified the majority of the remaining diabetic cases.
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