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Jane Ling MY, Ahmad N, Noor Aizuddin A, Ja’afar MH. A systematic review on the level of risk perception of diabetes mellitus: The role of environmental factor. PLoS One 2024; 19:e0308152. [PMID: 39078862 PMCID: PMC11288419 DOI: 10.1371/journal.pone.0308152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 07/15/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Risk perception plays important role in motivating preventive health behaviours. The objective of this systematic review was to explore the level of diabetes risk perception among individuals with and without apparent risk for diabetes, and to consider the effect of environmental factors on the level of diabetes risk perception. METHODS This systematic review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The literature search was carried out through PubMed, Web of Science, and Scopus. Original articles written in English and published between 2013 and 2023 were considered. Study quality was appraised using the Mixed Methods Appraisal Tool. Narrative synthesis was undertaken due to methodological heterogeneity in the included studies. RESULTS A total of 13 cross-sectional studies, two randomized controlled trials, two cohort studies, two mixed methods studies and one quasi-experiment with a control group were included. An overall low level of diabetes risk perception was reported particularly in those without apparent risk for diabetes. The 20 included studies reported widely varied measures for calculating diabetes risk perception. The influence of environmental factors on the risk perception of diabetes was highlighted. LIMITATIONS The use of study-specific and non-validated measures in the included studies weakens the authors' ability to compare across studies. The role of language and publication bias within this systematic review should be acknowledged as we included only English-language studies published in peer-reviewed journals. Another limitation is the exclusion of dimensions of risk perception such as optimistic bias as search terms. CONCLUSION The overall low risk perception of diabetes calls for urgent need of public health interventions to increase the risk perception of diabetes. In the future, researchers should ensure the validity and reliability of the measures being used. The influence of environmental factors on the diabetes risk perception indicates that diabetes preventive interventions targeting environmental factors may be effective in increasing the risk perception of diabetes.
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Affiliation(s)
- Miaw Yn Jane Ling
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Norfazilah Ahmad
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Azimatun Noor Aizuddin
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Mohd Hasni Ja’afar
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
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Glick AA, Winham DM, Heer MM, Shelley MC, Hutchins AM. Health Belief Model Predicts Likelihood of Eating Nutrient-Rich Foods among U.S. Adults. Nutrients 2024; 16:2335. [PMID: 39064780 PMCID: PMC11279385 DOI: 10.3390/nu16142335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 07/06/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
Despite decades of messaging, most Americans still consume excess fats and sugars, but inadequate fiber, potassium, and calcium. Nutrient-rich foods (NRFs) have a high density of favorable nutrients related to calories. Choosing NRFs could lower risk of nutrition-related chronic diseases and aid in their control. We hypothesized that having greater knowledge of NRFs, the presence of a nutrition-related chronic disease or risk factor, and positive Health Belief Model (HBM) views would be predictive of the likelihood of eating NRFs. Through a national online survey panel, 976 adults aged 18-80 completed demographic, health, NRF knowledge, attitudes, and HBM construct questions. Participants were 77% White, 52% women, and 55% had a nutrition-related disease or risk factor. Multivariable HBM scales were generated by theory, principal components, and reliability analysis. NRF knowledge was significantly higher for women, Whites, households without children, and persons without a nutrition-related disease (all p ≤ 0.015). 'Likelihood of eating NRFs' was significantly higher for persons with a nutrition-related disease, Whites, married participants, main food shoppers, and households with children (all p ≤ 0.022). Regressing demographic and HBM constructs on the 'likelihood of eating NRFs' resulted in R2 of 0.435. Nutrition-related disease and HBM constructs of self-efficacy, perceived benefits, and cues to action were predictive of the likelihood of eating NRFs, but higher NRF knowledge was negatively associated.
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Affiliation(s)
- Abigail A. Glick
- Department of Food Science & Human Nutrition, Iowa State University, Ames, IA 50011, USA; (A.A.G.); (M.M.H.)
| | - Donna M. Winham
- Department of Food Science & Human Nutrition, Iowa State University, Ames, IA 50011, USA; (A.A.G.); (M.M.H.)
| | - Michelle M. Heer
- Department of Food Science & Human Nutrition, Iowa State University, Ames, IA 50011, USA; (A.A.G.); (M.M.H.)
| | - Mack C. Shelley
- Departments of Political Science and Statistics, Iowa State University, Ames, IA 50011, USA;
| | - Andrea M. Hutchins
- Department of Human Physiology & Nutrition, University of Colorado Colorado Springs, Colorado Springs, CO 80918, USA;
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3
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Ölcer S, Scheipers M, Erbsland M, Sharma C. Innovative approaches in discussions of diabetes among healthcare sector actors in Germany. J Public Health Policy 2024:10.1057/s41271-024-00509-x. [PMID: 39003331 DOI: 10.1057/s41271-024-00509-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2024] [Indexed: 07/15/2024]
Abstract
The dramatic growth in the rate of diabetes prompts serious debates about awareness, early diagnosis, and care interventions. This Viewpoint aims to explore, from the perspectives of healthcare sector representatives, what challenges and difficulties they face in dealing with diabetes and how these can be overcome. We applied the World Café method for group discussions, which enabled us to bring together 50 stakeholders. They identified challenges at institutional and structural levels under the concepts of awareness, digitalisation, and new forms of care and shared their suggestions for feasible solutions. We learned there is a need for a diabetes map of Germany to identify risk groups and that hybrid solutions should be implemented for treatment, care, prevention, and early diagnosis, considering digital infrastructure. Also, the demand for digital innovation in the healthcare system raised concerns about information transparency and data management.
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Affiliation(s)
- Sabahat Ölcer
- Clinic for Palliative Medicine, University Medical Center Göttingen, University of Göttingen, Göttingen, Germany.
- Department of Human-Centred Technological Development, Institute of Computer Science, Ruhr West University of Applied Sciences, Campus Bottrop, Germany.
- Institute for Management, Economics and Care in the Health Sector, Ludwigshafen University of Business and Society, Ludwigshafen am Rhein, Germany.
| | - Maike Scheipers
- Institute for Management, Economics and Care in the Health Sector, Ludwigshafen University of Business and Society, Ludwigshafen am Rhein, Germany
| | - Manfred Erbsland
- Institute for Management, Economics and Care in the Health Sector, Ludwigshafen University of Business and Society, Ludwigshafen am Rhein, Germany
| | - Constanze Sharma
- Institute for Management, Economics and Care in the Health Sector, Ludwigshafen University of Business and Society, Ludwigshafen am Rhein, Germany
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Lange de Luna J, Nounu A, Neumeyer S, Sinke L, Wilson R, Hellbach F, Matías-García PR, Delerue T, Winkelmann J, Peters A, Thorand B, Beekman M, Heijmans BT, Slagboom E, Gieger C, Linseisen J, Waldenberger M. Epigenome-wide association study of dietary fatty acid intake. Clin Epigenetics 2024; 16:29. [PMID: 38365790 PMCID: PMC10874013 DOI: 10.1186/s13148-024-01643-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 02/09/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Dietary intake of n-3 polyunsaturated fatty acids (PUFA) may have a protective effect on the development of cardiovascular diseases, diabetes, depression and cancer, while a high intake of n-6 PUFA was often reported to be associated with inflammation-related traits. The effect of PUFAs on health outcomes might be mediated by DNA methylation (DNAm). The aim of our study is to identify the impact of PUFA intake on DNAm in the Cooperative Health Research in the Region of Augsburg (KORA) FF4 cohort and the Leiden Longevity Study (LLS). RESULTS DNA methylation levels were measured in whole blood from the population-based KORA FF4 study (N = 1354) and LLS (N = 448), using the Illumina MethylationEPIC BeadChip and Illumina HumanMethylation450 array, respectively. We assessed associations between DNAm and intake of eight and four PUFAs in KORA and LLS, respectively. Where possible, results were meta-analyzed. Below the Bonferroni correction threshold (p < 7.17 × 10-8), we identified two differentially methylated positions (DMPs) associated with PUFA intake in the KORA study. The DMP cg19937480, annotated to gene PRDX1, was positively associated with docosahexaenoic acid (DHA) in model 1 (beta: 2.00 × 10-5, 95%CI: 1.28 × 10-5-2.73 × 10-5, P value: 6.98 × 10-8), while cg05041783, annotated to gene MARK2, was positively associated with docosapentaenoic acid (DPA) in our fully adjusted model (beta: 9.80 × 10-5, 95%CI: 6.25 × 10-5-1.33 × 10-4, P value: 6.75 × 10-8). In the meta-analysis, we identified the CpG site (cg15951061), annotated to gene CDCA7L below Bonferroni correction (1.23 × 10-7) associated with eicosapentaenoic acid (EPA) intake in model 1 (beta: 2.00 × 10-5, 95% CI: 1.27 × 10-5-2.73 × 10-5, P value = 5.99 × 10-8) and we confirmed the association of cg19937480 with DHA in both models 1 and 2 (beta: 2.07 × 10-5, 95% CI: 1.31 × 10-5-2.83 × 10-5, P value = 1.00 × 10-7 and beta: 2.19 × 10-5, 95% CI: 1.41 × 10-5-2.97 × 10-5, P value = 5.91 × 10-8 respectively). CONCLUSIONS Our study identified three CpG sites associated with PUFA intake. The mechanisms of these sites remain largely unexplored, highlighting the novelty of our findings. Further research is essential to understand the links between CpG site methylation and PUFA outcomes.
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Affiliation(s)
- Julia Lange de Luna
- Research Unit Molecular Epidemiology, Institute of Epidemiology, Helmholtz Zentrum Munich, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
- Institute of Epidemiology, Helmholtz Zentrum Munich, German Research Center for Environmental Health, 85764, Neuherberg, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology-IBE, LMU Munich, 80539, Munich, Germany
| | - Aayah Nounu
- Research Unit Molecular Epidemiology, Institute of Epidemiology, Helmholtz Zentrum Munich, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
- Institute of Epidemiology, Helmholtz Zentrum Munich, German Research Center for Environmental Health, 85764, Neuherberg, Germany
| | - Sonja Neumeyer
- Research Unit Molecular Epidemiology, Institute of Epidemiology, Helmholtz Zentrum Munich, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
- Institute of Epidemiology, Helmholtz Zentrum Munich, German Research Center for Environmental Health, 85764, Neuherberg, Germany
| | - Lucy Sinke
- Molecular Epidemiology, Department of Biomedical Data Science, Leiden University Medical Center, 2333 ZC, Leiden, The Netherlands
| | - Rory Wilson
- Research Unit Molecular Epidemiology, Institute of Epidemiology, Helmholtz Zentrum Munich, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
- Institute of Epidemiology, Helmholtz Zentrum Munich, German Research Center for Environmental Health, 85764, Neuherberg, Germany
| | - Fabian Hellbach
- Epidemiology, Faculty of Medicine, University of Augsburg, University Hospital of Augsburg, 86156, Augsburg, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology-IBE, LMU Munich, 80539, Munich, Germany
| | - Pamela R Matías-García
- Research Unit Molecular Epidemiology, Institute of Epidemiology, Helmholtz Zentrum Munich, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
- Institute of Epidemiology, Helmholtz Zentrum Munich, German Research Center for Environmental Health, 85764, Neuherberg, Germany
| | - Thomas Delerue
- Research Unit Molecular Epidemiology, Institute of Epidemiology, Helmholtz Zentrum Munich, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
- Institute of Epidemiology, Helmholtz Zentrum Munich, German Research Center for Environmental Health, 85764, Neuherberg, Germany
| | - Juliane Winkelmann
- Institute of Neurogenomics, Helmholtz Zentrum Munich, German Research Center for Environmental Health, 85764, Neuherberg, Germany
- Klinikum Rechts Der Isar, Chair Neurogenetics, Technical University of Munich, Munich, Germany
- Klinikum Rechts Der Isar, Institute of Human Genetics, Technical University of Munich, Munich, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum Munich, German Research Center for Environmental Health, 85764, Neuherberg, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology-IBE, LMU Munich, 80539, Munich, Germany
| | - Barbara Thorand
- Institute of Epidemiology, Helmholtz Zentrum Munich, German Research Center for Environmental Health, 85764, Neuherberg, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology-IBE, LMU Munich, 80539, Munich, Germany
| | - Marian Beekman
- Molecular Epidemiology, Department of Biomedical Data Science, Leiden University Medical Center, 2333 ZC, Leiden, The Netherlands
| | - Bastiaan T Heijmans
- Molecular Epidemiology, Department of Biomedical Data Science, Leiden University Medical Center, 2333 ZC, Leiden, The Netherlands
| | - Eline Slagboom
- Molecular Epidemiology, Department of Biomedical Data Science, Leiden University Medical Center, 2333 ZC, Leiden, The Netherlands
| | - Christian Gieger
- Research Unit Molecular Epidemiology, Institute of Epidemiology, Helmholtz Zentrum Munich, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
- Institute of Epidemiology, Helmholtz Zentrum Munich, German Research Center for Environmental Health, 85764, Neuherberg, Germany
| | - Jakob Linseisen
- Epidemiology, Faculty of Medicine, University of Augsburg, University Hospital of Augsburg, 86156, Augsburg, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology-IBE, LMU Munich, 80539, Munich, Germany
| | - Melanie Waldenberger
- Research Unit Molecular Epidemiology, Institute of Epidemiology, Helmholtz Zentrum Munich, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.
- Institute of Epidemiology, Helmholtz Zentrum Munich, German Research Center for Environmental Health, 85764, Neuherberg, Germany.
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5
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Kowall B, Girschik C, Stolpe S. Inconsistencies in self-reported diabetes in a large panel study: the Survey of Health, Ageing and Retirement in Europe (SHARE). BMC Med Res Methodol 2024; 24:7. [PMID: 38212700 PMCID: PMC10782784 DOI: 10.1186/s12874-023-02137-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/22/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND The validity of self-reported chronic conditions has been assessed by comparing them with medical records or register data in several studies. However, the reliability of self-reports of chronic diseases has less often been examined. Our aim was to assess the proportion and determinants of inconsistent self-reports of diabetes in a long panel study. METHODS SHARE (Survey of Health, Ageing and Retirement in Europe) includes 140,000 persons aged ≥ 50 years from 28 European countries and Israel. We used data from waves 1 to 7 (except wave 3) collected between 2004 and 2017. Diabetes was assessed by self-report. An inconsistent report for diabetes was defined as reporting the condition in one wave, but denying it in at least one later wave. The analysis data set included 13,179 persons who reported diabetes, and answered the question about diabetes in at least one later wave. Log-binomial regression models were fitted to estimate crude and adjusted relative risks (RR) with 95% confidence intervals (CI) for the associations between various exposure variables and inconsistent report of diabetes. RESULTS The proportion of persons with inconsistent self-reports of diabetes was 33.0% (95% CI: 32.2%-33.8%). Inconsistencies occurred less often in persons taking antidiabetic drugs (RR = 0.53 (0.53-0.56)), persons with BMI ≥ 35 kg/m2 versus BMI < 25 kg/m2 (RR = 0.70, (0.64-0.77)), and poor versus excellent subjective health (RR = 0.87 (0.75-1.01)). Inconsistencies occurred more often in older persons (RR = 1.15 (1.12-1.18) per 10 years increase of age), and persons not reporting their age at diabetes onset (RR = 1.38 (1.31-1.45)). CONCLUSION In SHARE, inconsistent self-report of diabetes is frequent. Consistent reports are more likely for persons whose characteristics make diabetes more salient, like intake of antidiabetic medication, obesity, and poor subjective health. However, lack of attention in answering the questions, and poor wording of the items may also play a role.
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Affiliation(s)
- Bernd Kowall
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany.
| | - Carolin Girschik
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Susanne Stolpe
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
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Keshawarz A, Joehanes R, Ma J, Lee GY, Costeira R, Tsai PC, Masachs OM, Bell JT, Wilson R, Thorand B, Winkelmann J, Peters A, Linseisen J, Waldenberger M, Lehtimäki T, Mishra PP, Kähönen M, Raitakari O, Helminen M, Wang CA, Melton PE, Huang RC, Pennell CE, O’Sullivan TA, Ochoa-Rosales C, Voortman T, van Meurs JB, Young KL, Graff M, Wang Y, Kiel DP, Smith CE, Jacques PF, Levy D. Dietary and supplemental intake of vitamins C and E is associated with altered DNA methylation in an epigenome-wide association study meta-analysis. Epigenetics 2023; 18:2211361. [PMID: 37233989 PMCID: PMC10228397 DOI: 10.1080/15592294.2023.2211361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 04/28/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Dietary intake of antioxidants such as vitamins C and E protect against oxidative stress, and may also be associated with altered DNA methylation patterns. METHODS We meta-analysed epigenome-wide association study (EWAS) results from 11,866 participants across eight population-based cohorts to evaluate the association between self-reported dietary and supplemental intake of vitamins C and E with DNA methylation. EWAS were adjusted for age, sex, BMI, caloric intake, blood cell type proportion, smoking status, alcohol consumption, and technical covariates. Significant results of the meta-analysis were subsequently evaluated in gene set enrichment analysis (GSEA) and expression quantitative trait methylation (eQTM) analysis. RESULTS In meta-analysis, methylation at 4,656 CpG sites was significantly associated with vitamin C intake at FDR ≤ 0.05. The most significant CpG sites associated with vitamin C (at FDR ≤ 0.01) were enriched for pathways associated with systems development and cell signalling in GSEA, and were associated with downstream expression of genes enriched in the immune response in eQTM analysis. Furthermore, methylation at 160 CpG sites was significantly associated with vitamin E intake at FDR ≤ 0.05, but GSEA and eQTM analysis of the top most significant CpG sites associated with vitamin E did not identify significant enrichment of any biological pathways investigated. CONCLUSIONS We identified significant associations of many CpG sites with vitamin C and E intake, and our results suggest that vitamin C intake may be associated with systems development and the immune response.
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Affiliation(s)
| | - Roby Joehanes
- Framingham Heart Study, Framingham, Framingham, MA, USA
- Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jiantao Ma
- Framingham Heart Study, Framingham, Framingham, MA, USA
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Gha Young Lee
- Framingham Heart Study, Framingham, Framingham, MA, USA
- Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ricardo Costeira
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Pei-Chien Tsai
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
- Department of Biomedical Sciences, Chang Gung University, Taoyuan, Taiwan
- Genomic Medicine Research Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Olatz M. Masachs
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Jordana T. Bell
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Rory Wilson
- Research Unit of Molecular Epidemiology, Institute of Epidemiology, Helmholtz Zentrum München, Ingolstädter Landstrasse 1, Neuherberg, Germany
| | - Barbara Thorand
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, München, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Juliane Winkelmann
- Institute of Neurogenomics, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
- Institute of Human Genetics, School of Medicine, Technical University of Munich, Munich, Germany
- Chair of Neurogenetics, School of Medicine, Technical University of Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, München, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Chair of Epidemiology, Medical Faculty, Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany
- German Center for Cardiovascular Research (DZHK), München Heart Alliance, Munich, Germany
| | - Jakob Linseisen
- Chair of Epidemiology, University Augsburg at University Hospital Augsburg, Augsburg, Germany
| | - Melanie Waldenberger
- Research Unit of Molecular Epidemiology, Institute of Epidemiology, Helmholtz Zentrum München, Ingolstädter Landstrasse 1, Neuherberg, Germany
- German Center for Cardiovascular Research (DZHK), München Heart Alliance, Munich, Germany
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland
| | - Pashupati P. Mishra
- Department of Clinical Chemistry, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland
| | - Mika Kähönen
- Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Olli Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Mika Helminen
- Tays Research Services, Tampere University Hospital, Tampere, Finland
- Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland
| | - Carol A. Wang
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Phillip E. Melton
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Rae-Chi Huang
- Nutrition & Health Innovation Research Institute, Edith Cowan University, Perth, Australia
| | - Craig E. Pennell
- Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | | | - Carolina Ochoa-Rosales
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Centro de Vida Saludable, Universidad de Concepción, Concepción, Chile
| | - Trudy Voortman
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Joyce B.J. van Meurs
- Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Kristin L. Young
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Hebrew Senior Life, Chapel Hill, North Carolina, USA
| | - Misa Graff
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Hebrew Senior Life, Chapel Hill, North Carolina, USA
| | - Yujie Wang
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Hebrew Senior Life, Chapel Hill, North Carolina, USA
| | - Douglas P. Kiel
- Department of Medicine, Beth Israel Deaconess Medical Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Caren E. Smith
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Paul F. Jacques
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Daniel Levy
- Framingham Heart Study, Framingham, Framingham, MA, USA
- Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
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7
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Costeira R, Evangelista L, Wilson R, Yan X, Hellbach F, Sinke L, Christiansen C, Villicaña S, Masachs OM, Tsai PC, Mangino M, Menni C, Berry SE, Beekman M, van Heemst D, Slagboom PE, Heijmans BT, Suhre K, Kastenmüller G, Gieger C, Peters A, Small KS, Linseisen J, Waldenberger M, Bell JT. Metabolomic biomarkers of habitual B vitamin intakes unveil novel differentially methylated positions in the human epigenome. Clin Epigenetics 2023; 15:166. [PMID: 37858220 PMCID: PMC10588110 DOI: 10.1186/s13148-023-01578-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/04/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND B vitamins such as folate (B9), B6, and B12 are key in one carbon metabolism, which generates methyl donors for DNA methylation. Several studies have linked differential methylation to self-reported intakes of folate and B12, but these estimates can be imprecise, while metabolomic biomarkers can offer an objective assessment of dietary intakes. We explored blood metabolomic biomarkers of folate and vitamins B6 and B12, to carry out epigenome-wide analyses across up to three European cohorts. Associations between self-reported habitual daily B vitamin intakes and 756 metabolites (Metabolon Inc.) were assessed in serum samples from 1064 UK participants from the TwinsUK cohort. The identified B vitamin metabolomic biomarkers were then used in epigenome-wide association tests with fasting blood DNA methylation levels at 430,768 sites from the Infinium HumanMethylation450 BeadChip in blood samples from 2182 European participants from the TwinsUK and KORA cohorts. Candidate signals were explored for metabolite associations with gene expression levels in a subset of the TwinsUK sample (n = 297). Metabolomic biomarker epigenetic associations were also compared with epigenetic associations of self-reported habitual B vitamin intakes in samples from 2294 European participants. RESULTS Eighteen metabolites were associated with B vitamin intakes after correction for multiple testing (Bonferroni-adj. p < 0.05), of which 7 metabolites were available in both cohorts and tested for epigenome-wide association. Three metabolites - pipecolate (metabolomic biomarker of B6 and folate intakes), pyridoxate (marker of B6 and folate) and docosahexaenoate (DHA, marker of B6) - were associated with 10, 3 and 1 differentially methylated positions (DMPs), respectively. The strongest association was observed between DHA and DMP cg03440556 in the SCD gene (effect = 0.093 ± 0.016, p = 4.07E-09). Pyridoxate, a catabolic product of vitamin B6, was inversely associated with CpG methylation near the SLC1A5 gene promoter region (cg02711608 and cg22304262) and with SLC7A11 (cg06690548), but not with corresponding changes in gene expression levels. The self-reported intake of folate and vitamin B6 had consistent but non-significant associations with the epigenetic signals. CONCLUSION Metabolomic biomarkers are a valuable approach to investigate the effects of dietary B vitamin intake on the human epigenome.
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Affiliation(s)
- Ricardo Costeira
- Department of Twin Research and Genetic Epidemiology, King's College London, London, SE1 7EH, UK.
| | - Laila Evangelista
- Department of Twin Research and Genetic Epidemiology, King's College London, London, SE1 7EH, UK
| | - Rory Wilson
- Research Unit Molecular Epidemiology, Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, 85764, Neuherberg, Germany
| | - Xinyu Yan
- Department of Twin Research and Genetic Epidemiology, King's College London, London, SE1 7EH, UK
| | - Fabian Hellbach
- Epidemiology, Medical Faculty, University Augsburg, University Hospital Augsburg, 86156, Augsburg, Germany
| | - Lucy Sinke
- Molecular Epidemiology, Department of Biomedical Data Sciences, Leiden University Medical Center, 2333 ZC, Leiden, The Netherlands
| | - Colette Christiansen
- Department of Twin Research and Genetic Epidemiology, King's College London, London, SE1 7EH, UK
| | - Sergio Villicaña
- Department of Twin Research and Genetic Epidemiology, King's College London, London, SE1 7EH, UK
| | - Olatz M Masachs
- Department of Twin Research and Genetic Epidemiology, King's College London, London, SE1 7EH, UK
| | - Pei-Chien Tsai
- Department of Twin Research and Genetic Epidemiology, King's College London, London, SE1 7EH, UK
- Department of Biomedical Sciences, Chang Gung University, Taoyuan City, Taiwan
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Massimo Mangino
- Department of Twin Research and Genetic Epidemiology, King's College London, London, SE1 7EH, UK
| | - Cristina Menni
- Department of Twin Research and Genetic Epidemiology, King's College London, London, SE1 7EH, UK
| | - Sarah E Berry
- Department of Nutritional Sciences, King's College London, London, SE1 9NH, UK
| | - Marian Beekman
- Molecular Epidemiology, Department of Biomedical Data Sciences, Leiden University Medical Center, 2333 ZC, Leiden, The Netherlands
| | - Diana van Heemst
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, 2300RC, Leiden, The Netherlands
| | - P Eline Slagboom
- Molecular Epidemiology, Department of Biomedical Data Sciences, Leiden University Medical Center, 2333 ZC, Leiden, The Netherlands
| | - Bastiaan T Heijmans
- Molecular Epidemiology, Department of Biomedical Data Sciences, Leiden University Medical Center, 2333 ZC, Leiden, The Netherlands
| | - Karsten Suhre
- Department of Biophysics and Physiology, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Gabi Kastenmüller
- Institute of Computational Biology, Helmholtz Zentrum München, German Research Center for Environmental Health, 85764, Neuherberg, Germany
| | - Christian Gieger
- Research Unit Molecular Epidemiology, Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, 85764, Neuherberg, Germany
- German Research Center for Cardiovascular Disease (DZHK), Partner Site Munich Heart Alliance, 80802, Munich, Germany
| | - Annette Peters
- Research Unit Molecular Epidemiology, Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, 85764, Neuherberg, Germany
- German Research Center for Cardiovascular Disease (DZHK), Partner Site Munich Heart Alliance, 80802, Munich, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Ludwig-Maximilians-Universität München, 81377, Munich, Germany
| | - Kerrin S Small
- Department of Twin Research and Genetic Epidemiology, King's College London, London, SE1 7EH, UK
| | - Jakob Linseisen
- Epidemiology, Medical Faculty, University Augsburg, University Hospital Augsburg, 86156, Augsburg, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Ludwig-Maximilians-Universität München, 81377, Munich, Germany
| | - Melanie Waldenberger
- Research Unit Molecular Epidemiology, Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, 85764, Neuherberg, Germany
- German Research Center for Cardiovascular Disease (DZHK), Partner Site Munich Heart Alliance, 80802, Munich, Germany
| | - Jordana T Bell
- Department of Twin Research and Genetic Epidemiology, King's College London, London, SE1 7EH, UK.
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Jane Ling MY, Ahmad N, Aizuddin AN. Risk perception of non-communicable diseases: A systematic review on its assessment and associated factors. PLoS One 2023; 18:e0286518. [PMID: 37262079 DOI: 10.1371/journal.pone.0286518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 05/17/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND The burden of non-communicable diseases (NCDs) is increasing. Risk perception of NCDs is an important factor towards the uptake of preventive health interventions. There are various questionnaires assessing risk perception of NCDs, but no internationally standardized questionnaire has been available. Identification of factors associated with risk perception of NCDs may facilitate the development of targeted interventions. This systematic review aims to identify available questionnaire assessing risk perception of NCDs and the factors associated with risk perception of NCDs. METHODS The reporting of this systematic review is in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We carried out a literature search through three databases (Scopus, PubMed, Web of Science) and targeted original article published in English between 2012 and 2021. Quality appraisal of the eligible articles was conducted using the Mixed Methods Appraisal Tool. Findings were synthesized using content analysis. RESULTS A total of 86 studies were included. We found a variety of questionnaires assessing risk perception of NCDs, with many differences in their development, domains, items and validity. We also identified several personal, sociopsychological and structural factors associated with risk perception of NCDs. LIMITATIONS Most of the included studies were of cross-sectional design, and therefore the quality of evidence was considered low and exhibit a high risk of bias. The role of publication bias within this systematic review should be acknowledged as we did not include grey literature. Additionally, language bias must be considered as we only included English-language publications. CONCLUSION Further development and testing of available questionnaire is warranted to ensure their robustness and validity in measuring risk perception of NCDs. All the identified factors deserve further exploration in longitudinal and experimental studies.
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Affiliation(s)
- Miaw Yn Jane Ling
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Norfazilah Ahmad
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Azimatun Noor Aizuddin
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
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9
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Rodriguez SA, Tiro JA, Baldwin AS, Hamilton-Bevil H, Bowen M. Measurement of Perceived Risk of Developing Diabetes Mellitus: A Systematic Literature Review. J Gen Intern Med 2023; 38:1928-1954. [PMID: 37037984 PMCID: PMC10272015 DOI: 10.1007/s11606-023-08164-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 03/10/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND This systematic review describes approaches to measuring perceived risk of developing type 2 diabetes among individuals without diagnoses and describes the use of theories, models, and frameworks in studies assessing perceived risk. While a systematic review has synthesized perceived risk of complications among individuals with diabetes, no reviews have systematically assessed how perceived risk is measured among those without a diagnosis. METHODS Medline, PubMed, PsycINFO, and CINAHAL databases were searched for studies conducted through October 2022 with measures of perceived risk among adults ≥ 18 years without a diabetes diagnosis. Extracted data included study characteristics, measures, and health behavior theories, models, or frameworks used. RESULTS Eighty-six studies met inclusion criteria. Six examined perceived risk scales' psychometric properties. Eighty measured perceived risk using (1) a single item; (2) a composite score from multiple items or subconstructs; and (3) multiple subconstructs but no composite score. Studies used items measuring "comparative risk," "absolute or lifetime risk," and "perceived risk" without defining how each differed. Sixty-four studies used cross-sectional designs. Twenty-eight studies mentioned use of health behavior theories in study design or selection of measures. DISCUSSION There was heterogeneity in how studies operationalized perceived risk; only one third of studies referenced a theory, model, or framework as guiding design or scale and item selection. Use of perceived lifetime risk, absolute risk, or comparative risk limits comparisons across studies. Consideration of context, target population, and how data are utilized is important when selecting measures; we present a series of questions to ask when selecting measures for use in research and clinical settings. This review is the first to categorize how perceived risk is measured in the diabetes prevention domain; most literature focuses on perceived risk among those with diabetes diagnoses. Limitations include exclusion of non-English and gray literature and single reviewer screening and data extraction.
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Affiliation(s)
- Serena A. Rodriguez
- Department of Health Promotion & Behavioral Sciences, The University of Texas Health Science Center Houston (UTHealth Houston) School of Public Health, Trinity Towers, 2777 N Stemmons Fwy, Ste 8400, TX 75207 Dallas, USA
- UTHealth Houston School of Public Health, Center for Health Promotion & Prevention Research, 7000 Fannin Street, Houston, TX 77030 USA
| | - Jasmin A. Tiro
- Department of Public Health Sciences, University of Chicago, 5841 S. Maryland Ave., Chicago, IL 60637 USA
- University of Chicago Medicine Comprehensive Cancer Center, 5841 S. Maryland Avenue, Chicago, IL 60637 USA
| | - Austin S. Baldwin
- Department of Psychology, Southern Methodist University, Expressway Tower, PO Box 750442, Dallas, TX 75275 USA
| | - Hayley Hamilton-Bevil
- University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 75229 USA
| | - Michael Bowen
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390 USA
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10
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Alzaben AS, Bakry HM, Alnashwan NI, Alatr AA, Alneghamshi NA, Alshatowy A, Alshimali N, Bawazeer NM. The influence of a diabetes awareness program on diabetes knowledge, risk perception, and practices among university students. Prim Care Diabetes 2023:S1751-9918(23)00094-3. [PMID: 37150643 DOI: 10.1016/j.pcd.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/13/2023] [Accepted: 04/30/2023] [Indexed: 05/09/2023]
Abstract
AIM To compare diabetes mellitus (DM) knowledge, risk perception, and health practices before and after a mass awareness program among Princess Nourah bint Abdulrahman University students, Riyadh, Saudi Arabia. METHODS A DM awareness program was conducted between November 2020 and February 2021 in three phases (total 13 weeks). The program comprised educational messages, short videos, virtual lectures, and peer-to-peer education. A total of 558 participants (before group, n = 360; after group, n = 198) were included in the study. RESULTS Majority of the students had normal body mass index (BMI). The knowledge scores were significantly higher after the program (median 16, quartile range 13-18) than before (median 14, quartile range 12-16) (p < 0.001). No significant differences were observed in risk perception between the two groups (p > 0.05). In addition, increased moderate practice score and decreased poor practice score (p < 0.001) were observed. Factors influencing DM knowledge were higher education and awareness. Factors influencing health practices were higher BMI and knowledge after the program. CONCLUSION DM awareness program improved DM knowledge and health practices among university students.
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Affiliation(s)
- Abeer S Alzaben
- Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Huny M Bakry
- Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia; Community, Environmental and Occupational Medicine Department, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Noha I Alnashwan
- Nutrition Department-Deanship of Students Affairs, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Afnan A Alatr
- Nutrition Department-Deanship of Students Affairs, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Nourah A Alneghamshi
- Nutrition Department-Deanship of Students Affairs, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Anfal Alshatowy
- Nutrition Department-Deanship of Students Affairs, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Norah Alshimali
- Nutrition Department-Deanship of Students Affairs, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Nahla M Bawazeer
- Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia.
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11
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Hellbach F, Sinke L, Costeira R, Baumeister SE, Beekman M, Louca P, Leeming ER, Mompeo O, Berry S, Wilson R, Wawro N, Freuer D, Hauner H, Peters A, Winkelmann J, Koenig W, Meisinger C, Waldenberger M, Heijmans BT, Slagboom PE, Bell JT, Linseisen J. Pooled analysis of epigenome-wide association studies of food consumption in KORA, TwinsUK and LLS. Eur J Nutr 2023; 62:1357-1375. [PMID: 36571600 PMCID: PMC10030421 DOI: 10.1007/s00394-022-03074-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 12/12/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE Examining epigenetic patterns is a crucial step in identifying molecular changes of disease pathophysiology, with DNA methylation as the most accessible epigenetic measure. Diet is suggested to affect metabolism and health via epigenetic modifications. Thus, our aim was to explore the association between food consumption and DNA methylation. METHODS Epigenome-wide association studies were conducted in three cohorts: KORA FF4, TwinsUK, and Leiden Longevity Study, and 37 dietary exposures were evaluated. Food group definition was harmonized across the three cohorts. DNA methylation was measured using Infinium MethylationEPIC BeadChip in KORA and Infinium HumanMethylation450 BeadChip in the Leiden study and the TwinsUK study. Overall, data from 2293 middle-aged men and women were included. A fixed-effects meta-analysis pooled study-specific estimates. The significance threshold was set at 0.05 for false-discovery rate-adjusted p values per food group. RESULTS We identified significant associations between the methylation level of CpG sites and the consumption of onions and garlic (2), nuts and seeds (18), milk (1), cream (11), plant oils (4), butter (13), and alcoholic beverages (27). The signals targeted genes of metabolic health relevance, for example, GLI1, RPTOR, and DIO1, among others. CONCLUSION This EWAS is unique with its focus on food groups that are part of a Western diet. Significant findings were mostly related to food groups with a high-fat content.
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Affiliation(s)
- Fabian Hellbach
- Institute for Medical Information Processing, Biometry, and Epidemiology, Medical Faculty, Ludwig-Maximilian University Munich, Marchioninistr. 15, 81377, Munich, Germany.
- Epidemiology, Faculty of Medicine, University of Augsburg, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany.
| | - Lucy Sinke
- Molecular Epidemiology, Department of Biomedical Data Sciences, Leiden University Medical Center, Einthovenweg 20, 2333 ZC, Leiden, The Netherlands
| | - Ricardo Costeira
- Department of Twin Research and Genetic Epidemiology, King's College London, London, SE1 7EH, England, UK
| | - Sebastian-Edgar Baumeister
- Institute of Health Services Research in Dentistry, Medical Faculty, University of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Marian Beekman
- Molecular Epidemiology, Department of Biomedical Data Sciences, Leiden University Medical Center, Einthovenweg 20, 2333 ZC, Leiden, The Netherlands
| | - Panayiotis Louca
- Department of Twin Research and Genetic Epidemiology, King's College London, London, SE1 7EH, England, UK
| | - Emily R Leeming
- Department of Twin Research and Genetic Epidemiology, King's College London, London, SE1 7EH, England, UK
| | - Olatz Mompeo
- Department of Twin Research and Genetic Epidemiology, King's College London, London, SE1 7EH, England, UK
| | - Sarah Berry
- Department of Nutritional Sciences, King's College London, London, UK
| | - Rory Wilson
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
- Research Unit Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
| | - Nina Wawro
- Institute for Medical Information Processing, Biometry, and Epidemiology, Medical Faculty, Ludwig-Maximilian University Munich, Marchioninistr. 15, 81377, Munich, Germany
- Epidemiology, Faculty of Medicine, University of Augsburg, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
| | - Dennis Freuer
- Epidemiology, Faculty of Medicine, University of Augsburg, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Hans Hauner
- Else Kröner-Fresenius-Center for Nutritional Medicine, TUM School of Life Sciences, Technical University of Munich, 85354, Freising, Germany
- Institute of Nutritional Medicine, School of Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992, Munich, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
- German Center for Diabetes Research (DZD E.V.), Ingolstädter Landstr. 1, 85764, Munich-Neuherberg, Germany
| | - Juliane Winkelmann
- Institute of Neurogenomics, Helmholtz Zentrum München, German Research Center for Environmental Health (HmbH), Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
| | - Wolfgang Koenig
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Pettenkoferstr. 8A & 9, 80336, Munich, Germany
- German Heart Centre Munich, Technical University Munich, Lazarettstr. 36, 80636, Munich, Germany
- Institute of Epidemiology and Medical Biometry, University of Ulm, Helmholtzstr. 22, 89081, Ulm, Germany
| | - Christa Meisinger
- Epidemiology, Faculty of Medicine, University of Augsburg, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Melanie Waldenberger
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
- Research Unit Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
- German Center for Diabetes Research (DZD E.V.), Ingolstädter Landstr. 1, 85764, Munich-Neuherberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Pettenkoferstr. 8A & 9, 80336, Munich, Germany
| | - Bastiaan T Heijmans
- Molecular Epidemiology, Department of Biomedical Data Sciences, Leiden University Medical Center, Einthovenweg 20, 2333 ZC, Leiden, The Netherlands
| | - P Eline Slagboom
- Molecular Epidemiology, Department of Biomedical Data Sciences, Leiden University Medical Center, Einthovenweg 20, 2333 ZC, Leiden, The Netherlands
| | - Jordana T Bell
- Department of Twin Research and Genetic Epidemiology, King's College London, London, SE1 7EH, England, UK
| | - Jakob Linseisen
- Institute for Medical Information Processing, Biometry, and Epidemiology, Medical Faculty, Ludwig-Maximilian University Munich, Marchioninistr. 15, 81377, Munich, Germany
- Epidemiology, Faculty of Medicine, University of Augsburg, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
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König AN, Linkohr B, Peters A, Ladwig K, Laxy M, Schwettmann L. Relating the visceral factor of pain to domain‐specific risk attitudes. JOURNAL OF BEHAVIORAL DECISION MAKING 2023. [DOI: 10.1002/bdm.2323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2023]
Affiliation(s)
- Adriana N. König
- Munich School of Management and Munich Center of Health Sciences Ludwig‐Maximilians‐Universität München Munich Germany
- Department Environmental Health Helmholtz Zentrum München Neuherberg Germany
| | - Birgit Linkohr
- Institute of Epidemiology, Helmholtz Zentrum München German Research Center for Environmental Health (GmbH) Neuherberg Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München German Research Center for Environmental Health (GmbH) Neuherberg Germany
- Institute for Medical Information Processing, Biometry and Epidemiology Ludwig‐Maximilians‐Universität München Munich Germany
- German Centre for Diabetes Research (DZD) Neuherberg Germany
| | - Karl‐Heinz Ladwig
- Institute of Epidemiology, Helmholtz Zentrum München German Research Center for Environmental Health (GmbH) Neuherberg Germany
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar Technische Universität München (TUM) Munich Germany
| | - Michael Laxy
- Department Environmental Health Helmholtz Zentrum München Neuherberg Germany
- German Centre for Diabetes Research (DZD) Neuherberg Germany
- Department of Sport and Health Sciences Technische Universität München Munich Germany
| | - Lars Schwettmann
- Department Environmental Health Helmholtz Zentrum München Neuherberg Germany
- Department of Health Services Research, School of Medicine and Health Sciences Carl von Ossietzky University of Oldenburg Oldenburg Germany
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Bosch-Frigola I, Coca-Villalba F, Pérez-Lacasta MJ, Carles-Lavila M. Diabetes mellitus and inequalities in the equipment and use of information technologies as a socioeconomic determinant of health in Spain. Front Public Health 2023; 10:1033461. [PMID: 36699934 PMCID: PMC9868750 DOI: 10.3389/fpubh.2022.1033461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/14/2022] [Indexed: 01/11/2023] Open
Abstract
Inequalities in the equipment and use of information and communications technology (ICT) in Spanish households can lead to users being unable to access certain information or to carry out certain procedures. Accessibility to ICT is considered a social determinant of health (SDOH) because it can generate inequalities in access to information and in managing access to health services. In the face of a chronic illness such as diabetes mellitus (DM)-for which a comprehensive approach is complex and its complications have a direct impact on current healthcare systems-all the resources that patients may have are welcome. We aimed to analyze hospitalizations and amputations as direct consequences of DM among the autonomous communities of Spain (ACS) in 2019, along with socioeconomic factors related to health, including inequalities in access to ICT between territories, as well as citizens' interest in online information searches about DM. We used different databases such as that of the Ministerio de Sanidad (Spain's health ministry), Ministerio de Asuntos Económicos y transformación (Ministry of Economic Affairs and Digital Transformation), Google Trends (GT), and the Instituto Nacional de Estadística (Spain's national institute of statistics). We examined the data with R software. We employed a geolocation approach and performed multivariate analysis (specifically factor analysis of mixed data [FAMD]) to evaluate the aggregate interest in health information related to DM in different regions of Spain grounded in online search behavior. The use of FAMD allowed us to adjust the techniques of principal component analysis (PCA) and multiple correspondence analysis (MCA) to detect differences between the direct consequences of DM, citizen's interest in this non-communicable disease, and socioeconomic factors and inequalities in access to ICT in aggregate form between the country's different ACS. The results show how SDOH, such as poverty and education level, are related to the ACS with the highest number of homes that cite the cost of connection or equipment as the reason for not having ICT at home. These regions also have a greater number of hospitalizations due to DM. Given that in Spain, there are certain differences in accessibility in terms of the cost to households, in the case of DM, we take this issue into account from the standpoint of an integral approach by health policies.
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Affiliation(s)
- Irene Bosch-Frigola
- Department of Economics, Rovira i Virgili University, Reus, Spain,Facultad de Comunicación y Ciencias Sociales, Universidad San Jorge, Zaragoza, Spain,*Correspondence: Irene Bosch-Frigola
| | | | - María Jose Pérez-Lacasta
- Department of Economics, Rovira i Virgili University, Reus, Spain,Research Group on Statistics, Economic Evaluation and Health (GRAEES), Reus, Spain,Research Center on Economics and Sustainability (ECO-SOS), Reus, Spain
| | - Misericordia Carles-Lavila
- Department of Economics, Rovira i Virgili University, Reus, Spain,Research Group on Statistics, Economic Evaluation and Health (GRAEES), Reus, Spain,Research Center on Economics and Sustainability (ECO-SOS), Reus, Spain
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Hawley NL, Rivara AC, Naseri J, Faumuina K, Potoa’e-Solaita N, Iopu F, Faiai M, Naveno E, Tasele S, Lefale T, Lantini R, Carlson JC, Rabin TL, Semaia P, Mugadza P, Rosen RK. Protocol: Implementation and evaluation of an adolescent-mediated intervention to improve glycemic control and diabetes self-management among Samoan adults. PLoS One 2023; 18:e0279084. [PMID: 36795707 PMCID: PMC9934313 DOI: 10.1371/journal.pone.0279084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 11/25/2022] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Diagnoses of Type 2 Diabetes in the United States have more than doubled in the last two decades. One minority group at disproportionate risk are Pacific Islanders who face numerous barriers to prevention and self-care. To address the need for prevention and treatment in this group, and building on the family-centered culture, we will pilot test an adolescent-mediated intervention designed to improve the glycemic control and self-care practices of a paired adult family member with diagnosed diabetes. METHODS We will conduct a randomized controlled trial in American Samoa among n = 160 dyads (adolescent without diabetes, adult with diabetes). Adolescents will receive either a six-month diabetes intervention or a leadership and life skills-focused control curriculum. Aside from research assessments we will have no contact with the adults in the dyad who will proceed with their usual care. To test our hypothesis that adolescents will be effective conduits of diabetes knowledge and will support their paired adult in the adoption of self-care strategies, our primary efficacy outcomes will be adult glycemic control and cardiovascular risk factors (BMI, blood pressure, waist circumference). Secondarily, since we believe exposure to the intervention may encourage positive behavior change in the adolescent themselves, we will measure the same outcomes in adolescents. Outcomes will be measured at baseline, after active intervention (six months post-randomization) and at 12-months post-randomization to examine maintenance effects. To determine potential for sustainability and scale up, we will examine intervention acceptability, feasibility, fidelity, reach, and cost. DISCUSSION This study will explore Samoan adolescents' ability to act as agents of familial health behavior change. Intervention success would produce a scalable program with potential for replication in other family-centered ethnic minority groups across the US who are the ideal beneficiaries of innovations to reduce chronic disease risk and eliminate health disparities.
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Affiliation(s)
- Nicola L. Hawley
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America
- * E-mail:
| | - Anna C. Rivara
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America
| | - Joshua Naseri
- Obesity, Lifestyle and Genetic Adaptations Study Group, Pago Pago, American Samoa
| | - Kitiona Faumuina
- Obesity, Lifestyle and Genetic Adaptations Study Group, Pago Pago, American Samoa
| | | | - Francine Iopu
- Department of Public Health, Portland State University, Portland, OR, United States of America
| | - Mata’uitafa Faiai
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America
| | | | - Susie Tasele
- Obesity, Lifestyle and Genetic Adaptations Study Group, Pago Pago, American Samoa
| | - Temukisa Lefale
- Obesity, Lifestyle and Genetic Adaptations Study Group, Pago Pago, American Samoa
| | - Ryan Lantini
- Center for Behavioral and Preventative Medicine, The Miriam Hospital, Providence, RI, United States of America
| | - Jenna C. Carlson
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Tracy L. Rabin
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, United States of America
| | - Penny Semaia
- Athletic Department, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Phyllis Mugadza
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America
| | - Rochelle K. Rosen
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
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15
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Optimized Metabotype Definition Based on a Limited Number of Standard Clinical Parameters in the Population-Based KORA Study. Life (Basel) 2022; 12:life12101460. [PMID: 36294895 PMCID: PMC9604647 DOI: 10.3390/life12101460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/07/2022] [Accepted: 09/16/2022] [Indexed: 11/23/2022] Open
Abstract
The aim of metabotyping is to categorize individuals into metabolically similar groups. Earlier studies that explored metabotyping used numerous parameters, which made it less transferable to apply. Therefore, this study aimed to identify metabotypes based on a set of standard laboratory parameters that are regularly determined in clinical practice. K-means cluster analysis was used to group 3001 adults from the KORA F4 cohort into three clusters. We identified the clustering parameters through variable importance methods, without including any specific disease endpoint. Several unique combinations of selected parameters were used to create different metabotype models. Metabotype models were then described and evaluated, based on various metabolic parameters and on the incidence of cardiometabolic diseases. As a result, two optimal models were identified: a model composed of five parameters, which were fasting glucose, HDLc, non-HDLc, uric acid, and BMI (the metabolic disease model) for clustering; and a model that included four parameters, which were fasting glucose, HDLc, non-HDLc, and triglycerides (the cardiovascular disease model). These identified metabotypes are based on a few common parameters that are measured in everyday clinical practice. These metabotypes are cost-effective, and can be easily applied on a large scale in order to identify specific risk groups that can benefit most from measures to prevent cardiometabolic diseases, such as dietary recommendations and lifestyle interventions.
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16
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Hashim J, Smith HE, Tai ES, Yi H. Lay perceptions of diabetes mellitus and prevention costs and benefits among adults undiagnosed with the condition in Singapore: a qualitative study. BMC Public Health 2022; 22:1582. [PMID: 35987615 PMCID: PMC9392359 DOI: 10.1186/s12889-022-14020-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 08/17/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Therapeutic lifestyle changes can reduce individual risk of type 2 diabetes (T2D) by up to 58%. In Singapore, rates of preventive practices were low, despite a high level of knowledge and awareness of T2D risk and prevention. The study explored the context of the discrepancy between knowledge and practices in T2D prevention among adults undiagnosed with the condition.
Methods
In-depth interviews with 41 adults explored lay beliefs of T2D and the sources of these perceptions, subjective interpretation of how T2D may impact lives, and perceived costs and benefits of practising preventative behaviours. Purposive sampling was used to maximise the variability of participants in demographic characteristics. Thematic analysis was conducted to identify themes related to the domains of inquiry.
Results
Participants’ risk perceptions were influenced by familial, social, and cultural contexts of the representation and management of T2D conditions. The adverse effects of T2D were often narrated in food culture. The cost of adopting a healthy diet was perceived at a high cost of life pleasure derived from food consumption and social interactions. Inconveniences, loss of social functions, dependency and distress were the themes related to T2D management. Participants’ motivation to preventive practices, such as exercise and weight loss, were influenced by short-term observable benefits.
Conclusions
T2D risk communication needs to be addressed in emotionally impactful and interpersonally salient ways to increase the urgency to adopt preventative behaviours. Shifting perceived benefits from long-term disease prevention to short-term observable wellbeing could reduce the response cost of healthy eating.
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17
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Bayked EM, Kahissay MH, Workneh BD. Patients' perceptions, associations, and justifications for the causes of diabetes in North-East Ethiopia: A qualitative study. Diabetes Metab Syndr 2022; 16:102502. [PMID: 35597056 DOI: 10.1016/j.dsx.2022.102502] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/08/2022] [Accepted: 05/10/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Diabetes management is strongly influenced by patients' beliefs about its causes. The study examined type 2 diabetes patients' perceptions of the causes of their illness in North-East Ethiopia. METHODS The study used a phenomenological approach triangulated with modified grounded theory based on the Causative Dimension of Self-Regulated Model, and was conducted from July 2019 to January 2020. Purposive sampling was used to select the participants. Semi-structured in-depth face-to-face interviews with twenty-four (11 males and 13 females) participants were used to collect data until saturation. QDA Miner Lite v2.0.8 was used to perform analysis, which was then discussed based on the themes that emerged. RESULTS The patients expressed and justified the causes of their illness by evidencing the temporal proximity of the onset of symptoms or indicators and specific misfortune. As such, diabetes has been attributed to emotional reactions, psycho-economic situations, supernatural evil spirits, substance use, nutritional problems, and other illness; emotional reactions, with psycho-economic and supernatural spirits being the most common. These causes were justified by referring to a specific earlier misfortune that related to the onset of the indicators. CONCLUSION Patients' perceptions for attributing their illness were linked with emotional, psycho-economic, and supernatural evil spirits and justified by a specific life calamity by establishing the temporal association of symptoms with that adversity; which entails culture-specific psycho-social and educational interventions in diabetes care. Moreover, the finding necessitates that the causality justifications and linkages to misfortunes be included in the Causality Dimension of the Self-Regulated Model.
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Affiliation(s)
- Ewunetie Mekashaw Bayked
- Department of Pharmacy, College of Medicine and Health Sciences (CMHS), Wollo University, Dessie, Ethiopia.
| | - Mesfin Haile Kahissay
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Birhanu Demeke Workneh
- Department of Pharmacy, College of Medicine and Health Sciences (CMHS), Wollo University, Dessie, Ethiopia
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18
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Brandl C, Günther F, Zimmermann ME, Hartmann KI, Eberlein G, Barth T, Winkler TW, Linkohr B, Heier M, Peters A, Li JQ, Finger RP, Helbig H, Weber BHF, Küchenhoff H, Mueller A, Stark KJ, Heid IM. Incidence, progression and risk factors of age-related macular degeneration in 35-95-year-old individuals from three jointly designed German cohort studies. BMJ Open Ophthalmol 2022; 7:e000912. [PMID: 35047672 PMCID: PMC8728420 DOI: 10.1136/bmjophth-2021-000912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/06/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To estimate age-related macular degeneration (AMD) incidence/progression across a wide age range. Methods and analysis AMD at baseline and follow-up (colour fundus imaging, Three Continent AMD Consortium Severity Scale, 3CACSS, clinical classification, CC) was assessed for 1513 individuals aged 35–95 years at baseline from three jointly designed population-based cohorts in Germany: Kooperative Gesundheitsforschung in der Region Augsburg (KORA-Fit, KORA-FF4) and Altersbezogene Untersuchungen zur Gesundheit der Universität Regensburg (AugUR) with 18-year, 14-year or 3-year follow-up, respectively. Baseline assessment included lifestyle, metabolic and genetic markers. We derived cumulative estimates, rates and risk factor association for: (1) incident early AMD, (2) incident late AMD among no AMD at baseline (definition 1), (3) incident late AMD among no/early AMD at baseline (definition 2), (4) progression from early to late AMD. Results Incidence/progression increased by age, except progression in 70+-year old. We observed 35–55-year-old with 3CACSS-based early AMD who progressed to late AMD. Predominant risk factor for incident late AMD definition 2 was early AMD followed by genetics and smoking. When separating incident late AMD definition 1 from progression (instead of combined as incident late AMD definition 2), estimates help judge an individual’s risk based on age and (3CACSS) early AMD status: for example, for a 65-year old, 3-year late AMD risk with no or early AMD is 0.5% or 7%, 3-year early AMD risk is 3%; for an 85-year old, these numbers are 0.5%, 21%, 12%, respectively. For CC-based ‘early/intermediate’ AMD, incidence was higher, but progression was lower. Conclusion We provide a practical guide for AMD risk for ophthalmology practice and healthcare management and document a late AMD risk for individuals aged <55 years.
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Affiliation(s)
- Caroline Brandl
- Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany.,Department of Ophthalmology, University Hospital Regensburg, Regensburg, Germany
| | - Felix Günther
- Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany.,Statistical Consulting Unit StaBLab, Department of Statistics, Ludwig Maximilians University Munich, Munich, Germany
| | - Martina E Zimmermann
- Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany
| | - Kathrin I Hartmann
- Department of Ophthalmology, University Hospital Augsburg, Augsburg, Germany
| | - Gregor Eberlein
- Department of Ophthalmology, University Hospital Augsburg, Augsburg, Germany
| | - Teresa Barth
- Department of Ophthalmology, University Hospital Regensburg, Regensburg, Germany
| | - Thomas W Winkler
- Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany
| | - Birgit Linkohr
- Institute for Epidemiology, Helmholtz Zentrum München Deutsches Forschungszentrum für Gesundheit und Umwelt, Neuherberg, Germany
| | - Margit Heier
- Institute for Epidemiology, Helmholtz Zentrum München Deutsches Forschungszentrum für Gesundheit und Umwelt, Neuherberg, Germany.,KORA Study Centre, University Hospital Augsburg, Augsburg, Germany
| | - Annette Peters
- Institute for Epidemiology, Helmholtz Zentrum München Deutsches Forschungszentrum für Gesundheit und Umwelt, Neuherberg, Germany.,Chair of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig Maximilians University Munich, Munich, Germany
| | - Jeany Q Li
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Robert P Finger
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Horst Helbig
- Department of Ophthalmology, University Hospital Regensburg, Regensburg, Germany
| | - Bernhard H F Weber
- Institute of Human Genetics, University of Regensburg, Regensburg, Germany
| | - Helmut Küchenhoff
- Statistical Consulting Unit StaBLab, Department of Statistics, Ludwig Maximilians University Munich, Munich, Germany
| | - Arthur Mueller
- Department of Ophthalmology, University Hospital Augsburg, Augsburg, Germany
| | - Klaus J Stark
- Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany
| | - Iris M Heid
- Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany
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19
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Van Rhoon L, McSharry J, Byrne M. Development and testing of a digital health acceptability model to explain the intention to use a digital diabetes prevention programme. Br J Health Psychol 2021; 27:716-740. [PMID: 34719099 DOI: 10.1111/bjhp.12569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/22/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Digitally-delivered diabetes prevention programmes (DPPs) may improve population health by reversing the escalating trend of type 2 diabetes (T2D) incidence. Understanding the factors which determine digital health acceptability is critical to developing effective interventions. This study aimed to develop and test a digital health acceptability model of the factors influencing the intention of adults living in Ireland to use a digital DPP. DESIGN A 61-item cross-sectional survey was issued online or in hard copy to a sample of adults. METHODS Participants viewed a brochure for a smartphone-based digital DPP. The FINDRISC assessed their risk of developing T2D, and Likert scale items assessed the personal health, social influence, eHealth literacy, and intervention factors of the model. Structural equation modelling was used to assess the relationships between these factors. RESULT Three-hundred-and-sixteen eligible participants (Mage = 36) completed the survey, 42% of which had a slightly elevated T2D risk or higher. Twelve direct factor relationships were statistically significant. Subjective norm had a moderate-to-large impact on T2D risk perceptions. Health status, perceived susceptibility to T2D, eHealth readiness, communicative eHealth literacy and image had significant impacts on use intentions through mediators of perceived ease of use and perceived usefulness. The model explained 65% of the variance in digital DPP use intentions. CONCLUSION Personal health beliefs, social influence, and eHealth literacy collectively influence a digital DPP's acceptability. These findings may inform the development of future digital DPPs and other digital health interventions. Future research should test the model with adults that have a higher T2D risk status.
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Affiliation(s)
- Luke Van Rhoon
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
| | - Jenny McSharry
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
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20
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Pestoni G, Riedl A, Breuninger TA, Wawro N, Krieger JP, Meisinger C, Rathmann W, Thorand B, Harris C, Peters A, Rohrmann S, Linseisen J. Association between dietary patterns and prediabetes, undetected diabetes or clinically diagnosed diabetes: results from the KORA FF4 study. Eur J Nutr 2021; 60:2331-2341. [PMID: 33125578 PMCID: PMC8275503 DOI: 10.1007/s00394-020-02416-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 10/13/2020] [Indexed: 11/07/2022]
Abstract
PURPOSE Diet is one of the most important modifiable risk factors for the development of type 2 diabetes. Here, we aim to identify dietary patterns and to investigate their association with prediabetes, undetected diabetes and prevalent diabetes. METHODS The present study included 1305 participants of the cross-sectional population-based KORA FF4 study. Oral glucose tolerance test (OGTT) measurements together with a physician-confirmed diagnosis allowed for an accurate categorization of the participants according to their glucose tolerance status into normal glucose tolerance (n = 698), prediabetes (n = 459), undetected diabetes (n = 49), and prevalent diabetes (n = 99). Dietary patterns were identified through principal component analysis followed by hierarchical clustering. The association between dietary patterns and glucose tolerance status was investigated using multinomial logistic regression models. RESULTS A Prudent pattern, characterized by high consumption of vegetables, fruits, wholegrains and dairy products, and a Western pattern, characterized by high consumption of red and processed meat, alcoholic beverages, refined grains and sugar-sweetened beverages, were identified. Participants following the Western pattern had significantly higher chances of having prediabetes (odds ratio [OR] 1.92; 95% confidence interval [CI] 1.35, 2.73), undetected diabetes (OR 10.12; 95% CI 4.19, 24.43) or prevalent diabetes (OR 3.51; 95% CI 1.85, 6.67), compared to participants following the Prudent pattern. CONCLUSION To our knowledge, the present study is one of the few investigating the association between dietary patterns and prediabetes or undetected diabetes. The use of a reference group exclusively including participants with normal glucose tolerance might explain the strong associations observed in our study. These results suggest a very important role of dietary habits in the prevention of prediabetes and type 2 diabetes.
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Affiliation(s)
- Giulia Pestoni
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, (GmbH), Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
| | - Anna Riedl
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, (GmbH), Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
- Chair of Epidemiology, Ludwig-Maximilians-Universität München, UNIKA-T Augsburg, Augsburg, Germany
| | - Taylor A Breuninger
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, (GmbH), Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
- Chair of Epidemiology, Ludwig-Maximilians-Universität München, UNIKA-T Augsburg, Augsburg, Germany
| | - Nina Wawro
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, (GmbH), Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
- Chair of Epidemiology, Ludwig-Maximilians-Universität München, UNIKA-T Augsburg, Augsburg, Germany
| | - Jean-Philippe Krieger
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Christa Meisinger
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, (GmbH), Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
- Chair of Epidemiology, Ludwig-Maximilians-Universität München, UNIKA-T Augsburg, Augsburg, Germany
| | - Wolfgang Rathmann
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD E.V.), Neuherberg, Germany
| | - Barbara Thorand
- German Center for Diabetes Research (DZD E.V.), Neuherberg, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Carla Harris
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
- Division of Metabolic and Nutritional Medicine, Dr. Von Hauner Children's Hospital, University of Munich Medical Center, Munich, Germany
| | - Annette Peters
- German Center for Diabetes Research (DZD E.V.), Neuherberg, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Sabine Rohrmann
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Jakob Linseisen
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, (GmbH), Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.
- Chair of Epidemiology, Ludwig-Maximilians-Universität München, UNIKA-T Augsburg, Augsburg, Germany.
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21
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Marttila S, Viiri LE, Mishra PP, Kühnel B, Matias-Garcia PR, Lyytikäinen LP, Ceder T, Mononen N, Rathmann W, Winkelmann J, Peters A, Kähönen M, Hutri-Kähönen N, Juonala M, Aalto-Setälä K, Raitakari O, Lehtimäki T, Waldenberger M, Raitoharju E. Methylation status of nc886 epiallele reflects periconceptional conditions and is associated with glucose metabolism through nc886 RNAs. Clin Epigenetics 2021; 13:143. [PMID: 34294131 PMCID: PMC8296652 DOI: 10.1186/s13148-021-01132-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/13/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Non-coding RNA 886 (nc886) is coded from a maternally inherited metastable epiallele. We set out to investigate the determinants and dynamics of the methylation pattern at the nc886 epiallele and how this methylation status associates with nc886 RNA expression. Furthermore, we investigated the associations between the nc886 methylation status or the levels of nc886 RNAs and metabolic traits in the YFS and KORA cohorts. The association between nc886 epiallele methylation and RNA expression was also validated in induced pluripotent stem cell (iPSC) lines. RESULTS We confirm that the methylation status of the nc886 epiallele is mostly binomial, with individuals displaying either a non- or hemi-methylated status, but we also describe intermediately and close to fully methylated individuals. We show that an individual's methylation status is associated with the mother's age and socioeconomic status, but not with the individual's own genetics. Once established, the methylation status of the nc886 epiallele remains stable for at least 25 years. This methylation status is strongly associated with the levels of nc886 non-coding RNAs in serum, blood, and iPSC lines. In addition, nc886 methylation status associates with glucose and insulin levels during adolescence but not with the indicators of glucose metabolism or the incidence of type 2 diabetes in adulthood. However, the nc886-3p RNA levels also associate with glucose metabolism in adulthood. CONCLUSIONS These results indicate that nc886 metastable epiallele methylation is tuned by the periconceptional conditions and it associates with glucose metabolism through the expression of the ncRNAs coded in the epiallele region.
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Grants
- 755320 Horizon 2020 (Taxinomisis)
- WA 4081/1-1 German Research Foundation
- BB/S020845/1 Biotechnology and Biological Sciences Research Council
- 134309, 126925, 121584, 124282, 129378, 117787, 41071 Academy of Finland
- 286284 and 322098 Academy of Finland
- 01EA1902A Joint Programming Initiative A healthy diet for a healthy life (DIMENSION)
- 848146 Horizon 2020 (To_Aition)
- 9X047, 9S054, and 9AB059 Tampere University Hospital Medical Funds
- 742927 European Research Council (MULTIEPIGEN)
- 285902, 330809 and 338395 academy of finland
- X51001 Tampere University Hospital Medical Funds
- the Social Insurance Institution of Finland
- Kuopio, Tampere, and Turku University Hospital Medical Funds
- Juho Vainion Säätiö
- Paavo Nurmen Säätiö
- Sydäntutkimussäätiö
- Suomen Kulttuurirahasto
- Tampereen Tuberkuloosisäätiö
- Emil Aaltosen Säätiö
- Yrjö Jahnssonin Säätiö
- Signe ja Ane Gyllenbergin Säätiö
- Diabetesliitto
- the Tampere University Hospital Supporting Foundation
- the Finnish Society of Clinical Chemistry
- Foundation of Clinical Chemistry
- Laboratoriolääketieteen edistämissäätiö sr.
- Orionin Tutkimussäätiö
- the Paulo Foundation
- Deutsches Forschungszentrum für Gesundheit und Umwelt, Helmholtz Zentrum München
- German Federal Ministry of Education and Research
- State of Bavaria
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Affiliation(s)
- Saara Marttila
- Department of Clinical Chemistry, Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Technology, Tampere University, Pirkanmaa Hospital District and Fimlab Laboratories, Tampere, Finland.
- Gerontology Research Center, Tampere University, Tampere, Finland.
| | - Leena E Viiri
- Heart Group, Finnish Cardiovascular Research Center, Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Pashupati P Mishra
- Department of Clinical Chemistry, Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Technology, Tampere University, Pirkanmaa Hospital District and Fimlab Laboratories, Tampere, Finland
| | - Brigitte Kühnel
- Research Unit Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, 85764, Neuherberg, Bavaria, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Bavaria, Germany
| | - Pamela R Matias-Garcia
- Research Unit Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, 85764, Neuherberg, Bavaria, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Bavaria, Germany
| | - Leo-Pekka Lyytikäinen
- Department of Clinical Chemistry, Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Technology, Tampere University, Pirkanmaa Hospital District and Fimlab Laboratories, Tampere, Finland
| | - Tiina Ceder
- Department of Clinical Chemistry, Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Technology, Tampere University, Pirkanmaa Hospital District and Fimlab Laboratories, Tampere, Finland
| | - Nina Mononen
- Department of Clinical Chemistry, Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Technology, Tampere University, Pirkanmaa Hospital District and Fimlab Laboratories, Tampere, Finland
| | - Wolfgang Rathmann
- German Center for Diabetes Research (DZD), Munich, Neuherberg, Germany
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research At Heinrich Heine University, Düsseldorf, Germany
- Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Juliane Winkelmann
- Institute of Neurogenomics, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Department of Neurogenetics and Institute of Human Genetics, Technical University of Munich, Munich, Germany
| | - Annette Peters
- Research Unit Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, 85764, Neuherberg, Bavaria, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Mika Kähönen
- Department of Clinical Physiology, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Nina Hutri-Kähönen
- Tampere Centre for Skills Training and Simulation, Tampere University, Tampere, Finland
| | - Markus Juonala
- Division of Medicine, Department of Medicine, Turku University Hospital, University of Turku, Turku, Finland
| | - Katriina Aalto-Setälä
- Heart Group, Finnish Cardiovascular Research Center, Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Heart Hospital, Tampere University Hospital, Tampere University, Tampere, Finland
| | - Olli Raitakari
- Centre for Population Health Research, University of Turku, Turku University Hospital, Turku, Finland
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Department of Clinical Physiology and Nuclear Medicine, University of Turku, Turku University Hospital, Turku, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Technology, Tampere University, Pirkanmaa Hospital District and Fimlab Laboratories, Tampere, Finland
| | - Melanie Waldenberger
- Research Unit Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, 85764, Neuherberg, Bavaria, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Bavaria, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Emma Raitoharju
- Department of Clinical Chemistry, Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Technology, Tampere University, Pirkanmaa Hospital District and Fimlab Laboratories, Tampere, Finland.
- Centre for Population Health Research, University of Turku, Turku University Hospital, Turku, Finland.
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22
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Marttila S, Viiri LE, Mishra PP, Kühnel B, Matias-Garcia PR, Lyytikäinen LP, Ceder T, Mononen N, Rathmann W, Winkelmann J, Peters A, Kähönen M, Hutri-Kähönen N, Juonala M, Aalto-Setälä K, Raitakari O, Lehtimäki T, Waldenberger M, Raitoharju E. Methylation status of nc886 epiallele reflects periconceptional conditions and is associated with glucose metabolism through nc886 RNAs. Clin Epigenetics 2021. [PMID: 34294131 DOI: 10.1186/s13148‐021‐01132‐3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Non-coding RNA 886 (nc886) is coded from a maternally inherited metastable epiallele. We set out to investigate the determinants and dynamics of the methylation pattern at the nc886 epiallele and how this methylation status associates with nc886 RNA expression. Furthermore, we investigated the associations between the nc886 methylation status or the levels of nc886 RNAs and metabolic traits in the YFS and KORA cohorts. The association between nc886 epiallele methylation and RNA expression was also validated in induced pluripotent stem cell (iPSC) lines. RESULTS We confirm that the methylation status of the nc886 epiallele is mostly binomial, with individuals displaying either a non- or hemi-methylated status, but we also describe intermediately and close to fully methylated individuals. We show that an individual's methylation status is associated with the mother's age and socioeconomic status, but not with the individual's own genetics. Once established, the methylation status of the nc886 epiallele remains stable for at least 25 years. This methylation status is strongly associated with the levels of nc886 non-coding RNAs in serum, blood, and iPSC lines. In addition, nc886 methylation status associates with glucose and insulin levels during adolescence but not with the indicators of glucose metabolism or the incidence of type 2 diabetes in adulthood. However, the nc886-3p RNA levels also associate with glucose metabolism in adulthood. CONCLUSIONS These results indicate that nc886 metastable epiallele methylation is tuned by the periconceptional conditions and it associates with glucose metabolism through the expression of the ncRNAs coded in the epiallele region.
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Affiliation(s)
- Saara Marttila
- Department of Clinical Chemistry, Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Technology, Tampere University, Pirkanmaa Hospital District and Fimlab Laboratories, Tampere, Finland. .,Gerontology Research Center, Tampere University, Tampere, Finland.
| | - Leena E Viiri
- Heart Group, Finnish Cardiovascular Research Center, Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Pashupati P Mishra
- Department of Clinical Chemistry, Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Technology, Tampere University, Pirkanmaa Hospital District and Fimlab Laboratories, Tampere, Finland
| | - Brigitte Kühnel
- Research Unit Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, 85764, Neuherberg, Bavaria, Germany.,Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Bavaria, Germany
| | - Pamela R Matias-Garcia
- Research Unit Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, 85764, Neuherberg, Bavaria, Germany.,Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Bavaria, Germany
| | - Leo-Pekka Lyytikäinen
- Department of Clinical Chemistry, Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Technology, Tampere University, Pirkanmaa Hospital District and Fimlab Laboratories, Tampere, Finland
| | - Tiina Ceder
- Department of Clinical Chemistry, Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Technology, Tampere University, Pirkanmaa Hospital District and Fimlab Laboratories, Tampere, Finland
| | - Nina Mononen
- Department of Clinical Chemistry, Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Technology, Tampere University, Pirkanmaa Hospital District and Fimlab Laboratories, Tampere, Finland
| | - Wolfgang Rathmann
- German Center for Diabetes Research (DZD), Munich, Neuherberg, Germany.,Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research At Heinrich Heine University, Düsseldorf, Germany.,Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Juliane Winkelmann
- Institute of Neurogenomics, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.,Department of Neurogenetics and Institute of Human Genetics, Technical University of Munich, Munich, Germany
| | - Annette Peters
- Research Unit Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, 85764, Neuherberg, Bavaria, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Mika Kähönen
- Department of Clinical Physiology, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Nina Hutri-Kähönen
- Tampere Centre for Skills Training and Simulation, Tampere University, Tampere, Finland
| | - Markus Juonala
- Division of Medicine, Department of Medicine, Turku University Hospital, University of Turku, Turku, Finland
| | - Katriina Aalto-Setälä
- Heart Group, Finnish Cardiovascular Research Center, Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Heart Hospital, Tampere University Hospital, Tampere University, Tampere, Finland
| | - Olli Raitakari
- Centre for Population Health Research, University of Turku, Turku University Hospital, Turku, Finland.,Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Department of Clinical Physiology and Nuclear Medicine, University of Turku, Turku University Hospital, Turku, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Technology, Tampere University, Pirkanmaa Hospital District and Fimlab Laboratories, Tampere, Finland
| | - Melanie Waldenberger
- Research Unit Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, 85764, Neuherberg, Bavaria, Germany.,Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Bavaria, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Emma Raitoharju
- Department of Clinical Chemistry, Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Technology, Tampere University, Pirkanmaa Hospital District and Fimlab Laboratories, Tampere, Finland. .,Centre for Population Health Research, University of Turku, Turku University Hospital, Turku, Finland.
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23
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Prediction of type 2 diabetes mellitus based on nutrition data. J Nutr Sci 2021; 10:e46. [PMID: 34221364 PMCID: PMC8223171 DOI: 10.1017/jns.2021.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/20/2021] [Accepted: 05/14/2021] [Indexed: 11/28/2022] Open
Abstract
Numerous predictive models for the risk of type 2 diabetes mellitus (T2DM) exist, but a minority of them has implemented nutrition data so far, even though the significant effect of nutrition on the pathogenesis, prevention and management of T2DM has been established. Thus, in the present study, we aimed to build a predictive model for the risk of T2DM that incorporates nutrition data and calculates its predictive performance. We analysed cross-sectional data from 1591 individuals from the population-based Cooperative Health Research in the Region of Augsburg (KORA) FF4 study (2013–14) and used a bootstrap enhanced elastic net penalised multivariate regression method in order to build our predictive model and select among 193 food intake variables. After selecting the significant predictor variables, we built a logistic regression model with these variables as predictors and T2DM status as the outcome. The values of area under the receiver operating characteristic (ROC) curve, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of our predictive model were calculated. Eleven out of the 193 food intake variables were selected for inclusion in our model, which yielded a value of area under the ROC curve of 0⋅79 and a maximum PPV, NPV and accuracy of 0⋅37, 0⋅98 and 0⋅91, respectively. The present results suggest that nutrition data should be implemented in predictive models to predict the risk of T2DM, since they improve their performance and they are easy to assess.
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25
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Schwarz M, Wolf K, Schneider A, Schramm KW, Bongaerts B, Henkelmann B, Herder C, Roden M, Peters A, Ziegler D, Rathmann W. Association of persistent organic pollutants with sensorimotor neuropathy in participants with and without diabetes or prediabetes: Results from the population-based KORA FF4 study. Int J Hyg Environ Health 2021; 235:113752. [PMID: 34020228 DOI: 10.1016/j.ijheh.2021.113752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 04/01/2021] [Accepted: 04/05/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Concentrations of persistent organic pollutants (POPs) have been associated with an increased type 2 diabetes (T2D) risk. It remains unclear whether POPs are also associated with the risk of diabetes complications including neuropathy and evidence on this topic is scarce. We aimed to investigate the hypothesis that low-dose background concentrations of POPs were positively associated with distal sensorimotor polyneuropathy (DSPN). METHODS This cross-sectional study was based on data from the second follow-up (FF4, 2013-2014, N = 2279) of the population-based KORA S4 study (Augsburg, Germany). The study sample consisted of 200 participants, including four groups of 50 persons each with known T2D, prediabetes, newly diagnosed diabetes, and normal glucose tolerance (NGT) based on an oral glucose tolerance test. We analyzed the association of six most abundant serum concentrations of POPs, including polychlorinated biphenyls (PCBs) as well as organochlorine (OC) pesticides, with DSPN by multivariable logistic regression adjusted for age, sex, glycaemic status, body mass index, physical activity, smoking and alcohol consumption. We assessed effect modification by age, sex, glycaemic status and obesity and conducted two-pollutant models to check the robustness of the estimates. RESULTS For all pollutants, the main models indicated no significant association of having DSPN but pointed to rather decreased odds for DSPN. Two-pollutant models supported these findings, though only the association between the combination of PCB-138 and beta-hexachlorocyclohexane (β-HCH) (OR: 0.59; 95% CI: 0.35-0.99) with DSPN became significant. No effect modification was found by age, sex, glycaemic status and obesity. CONCLUSION Low-dose concentrations of POPs were not associated with increased odds of having DSPN in T2D, prediabetes and NGT.
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Affiliation(s)
- Maximilian Schwarz
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, LMU Munich, Munich, Germany; Pettenkofer School of Public Health, Munich, Germany; Institute of Epidemiology, Helmholtz Zentrum München GmbH - German Research Center for Environmental Health, Neuherberg, Germany.
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München GmbH - German Research Center for Environmental Health, Neuherberg, Germany
| | - Alexandra Schneider
- Institute of Epidemiology, Helmholtz Zentrum München GmbH - German Research Center for Environmental Health, Neuherberg, Germany
| | - Karl-Werner Schramm
- Molecular EXposomics, Helmholtz Zentrum München GmbH - German Research Center for Environmental Health, Neuherberg, Germany; Research Department Biosciences, Campus Life Science Weihenstephan, Technical University Munich, Freising, Germany
| | - Brenda Bongaerts
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany; German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Bernhard Henkelmann
- Molecular EXposomics, Helmholtz Zentrum München GmbH - German Research Center for Environmental Health, Neuherberg, Germany
| | - Christian Herder
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany; German Center for Diabetes Research (DZD), Neuherberg, Germany; Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Michael Roden
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany; German Center for Diabetes Research (DZD), Neuherberg, Germany; Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Annette Peters
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, LMU Munich, Munich, Germany; Institute of Epidemiology, Helmholtz Zentrum München GmbH - German Research Center for Environmental Health, Neuherberg, Germany
| | - Dan Ziegler
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany; German Center for Diabetes Research (DZD), Neuherberg, Germany; Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Wolfgang Rathmann
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany; German Center for Diabetes Research (DZD), Neuherberg, Germany
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26
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Ydirin CSB. Health literacy and health-promoting behaviors among adults at risk for diabetes in a remote Filipino community. BELITUNG NURSING JOURNAL 2021; 7:88-97. [PMID: 37469942 PMCID: PMC10353656 DOI: 10.33546/bnj.1298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/17/2021] [Accepted: 03/01/2021] [Indexed: 07/21/2023] Open
Abstract
Background Diabetes risk assessment is an essential preboarding tool before implementing health literacy programs to change an adult's health behavior positively. Research has shown an association between health literacy and health behaviors, but there is a dearth of literature that delineates the difference between the health literacy and health behaviors of adults according to their diabetes risks; high risk vs. low risk. Objective This study aimed to determine the difference between the health literacy and health behaviors of adults and establish the relationship between the two variables when classified according to their diabetes risks. Methods This study utilized a descriptive cross-sectional design with 400 adults in a remote Filipino community in November 2019. Data were gathered using the Health Promoting Lifestyle Profile II (HPLP II) and Health Literacy Survey-Short Form 12 (HLS-SF12) questionnaires. Descriptive statistics, independent t-test, and Pearson's r were used to analyze the data. Results There is a significant difference between the health literacy index scores (p < .05); but no significant difference between the health behavior mean scores (p > .05) of adults when grouped according to their diabetes risks. Health literacy is significantly (p < .05) correlated with health behaviors of adults, with a moderate positive correlation in the high-risk group (r = .43), and both weak positive correlation in the low-risk group (r = .13) and entire group (r = .17). Conclusion All adult inclusion efforts in promoting health literacy, with emphasis on the high-risk group, are needed to improve awareness of the degree of diabetes risks. Nurses should take an active role in the assessment of diabetes risks, evaluation of results, and implementation of interventions that could increase health literacy to facilitate the development of healthy behaviors. Stakeholders are urged to advance the availability of evidence-based lifestyle interventions to reduce the growth in new cases of diabetes.
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27
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Breuninger TA, Wawro N, Breuninger J, Reitmeier S, Clavel T, Six-Merker J, Pestoni G, Rohrmann S, Rathmann W, Peters A, Grallert H, Meisinger C, Haller D, Linseisen J. Associations between habitual diet, metabolic disease, and the gut microbiota using latent Dirichlet allocation. MICROBIOME 2021; 9:61. [PMID: 33726846 PMCID: PMC7967986 DOI: 10.1186/s40168-020-00969-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/06/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND The gut microbiome impacts human health through various mechanisms and is involved in the development of a range of non-communicable diseases. Diet is a well-known factor influencing microbe-host interaction in health and disease. However, very few findings are based on large-scale analysis using population-based studies. Our aim was to investigate the cross-sectional relationship between habitual dietary intake and gut microbiota structure in the Cooperative Health Research in the Region of Augsburg (KORA) FF4 study. RESULTS Fecal microbiota was analyzed using 16S rRNA gene amplicon sequencing. Latent Dirichlet allocation (LDA) was applied to samples from 1992 participants to identify 20 microbial subgroups within the study population. Each participant's gut microbiota was subsequently described by a unique composition of these 20 subgroups. Associations between habitual dietary intake, assessed via repeated 24-h food lists and a Food Frequency Questionnaire, and the 20 subgroups, as well as between prevalence of metabolic diseases/risk factors and the subgroups, were assessed with multivariate-adjusted Dirichlet regression models. After adjustment for multiple testing, eight of 20 microbial subgroups were significantly associated with habitual diet, while nine of 20 microbial subgroups were associated with the prevalence of one or more metabolic diseases/risk factors. Subgroups 5 (Faecalibacterium, Lachnospiracea incertae sedis, Gemmiger, Roseburia) and 14 (Coprococcus, Bacteroides, Faecalibacterium, Ruminococcus) were particularly strongly associated with diet. For example, participants with a high probability for subgroup 5 were characterized by a higher Alternate Healthy Eating Index and Mediterranean Diet Score and a higher intake of food items such as fruits, vegetables, legumes, and whole grains, while participants with prevalent type 2 diabetes mellitus were characterized by a lower probability for subgroup 5. CONCLUSIONS The associations between habitual diet, metabolic diseases, and microbial subgroups identified in this analysis not only expand upon current knowledge of diet-microbiota-disease relationships, but also indicate the possibility of certain microbial groups to be modulated by dietary intervention, with the potential of impacting human health. Additionally, LDA appears to be a powerful tool for interpreting latent structures of the human gut microbiota. However, the subgroups and associations observed in this analysis need to be replicated in further studies. Video abstract.
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Affiliation(s)
- Taylor A. Breuninger
- Independent Research Unit Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
- Ludwig-Maximilians-Universität München, UNIKA-T Augsburg, Neusässer Str. 47, 86156 Augsburg, Germany
| | - Nina Wawro
- Independent Research Unit Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
- Ludwig-Maximilians-Universität München, UNIKA-T Augsburg, Neusässer Str. 47, 86156 Augsburg, Germany
| | | | - Sandra Reitmeier
- Technische Universität München, Gregor-Mendel-Str. 2, 85354 Freising, Germany
- ZIEL - Institute for Food & Health, Technische Universität München, Weihenstephaner Berg 3, 85354 Freising, Germany
| | - Thomas Clavel
- ZIEL - Institute for Food & Health, Technische Universität München, Weihenstephaner Berg 3, 85354 Freising, Germany
- Functional Microbiome Research Group, Institute of Medical Microbiology, RWTH University Hospital, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Julia Six-Merker
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Giulia Pestoni
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, CH-8001 Zurich, Switzerland
| | - Sabine Rohrmann
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, CH-8001 Zurich, Switzerland
| | - Wolfgang Rathmann
- Institute for Biometrics and Epidemiology, Deutsches Diabetes-Zentrum (DDZ), Auf’m Hennekamp 65, 40225 Düsseldorf, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Harald Grallert
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Christa Meisinger
- Independent Research Unit Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
- Ludwig-Maximilians-Universität München, UNIKA-T Augsburg, Neusässer Str. 47, 86156 Augsburg, Germany
| | - Dirk Haller
- Technische Universität München, Gregor-Mendel-Str. 2, 85354 Freising, Germany
- ZIEL - Institute for Food & Health, Technische Universität München, Weihenstephaner Berg 3, 85354 Freising, Germany
| | - Jakob Linseisen
- Independent Research Unit Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
- Ludwig-Maximilians-Universität München, UNIKA-T Augsburg, Neusässer Str. 47, 86156 Augsburg, Germany
- ZIEL - Institute for Food & Health, Technische Universität München, Weihenstephaner Berg 3, 85354 Freising, Germany
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Kowall B, Rathmann W, Kuss O, Herder C, Roden M, Stang A, Huth C, Thorand B, Meisinger C, Peters A. Reversion from prediabetes to normoglycaemia after weight change in older persons: The KORA F4/FF4 study. Nutr Metab Cardiovasc Dis 2021; 31:429-438. [PMID: 33594985 DOI: 10.1016/j.numecd.2020.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/04/2020] [Accepted: 09/07/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS In a non-interventional study of older persons, we assessed the impact of changes in BMI and waist circumference (WC) on reversion from glucose- and HbA1c-defined prediabetes to normoglycaemia (in short: reversion) and on persistence of normoglycaemia. Moreover, we studied whether reversion reduced cardiovascular risk. METHODS AND RESULTS From the population-based KORA S4/F4/FF4 cohort study conducted in Southern Germany, we utilized data from the second and third visit to the study center (median follow-up 6.5 years). We used two overlapping data sets, one with 563 persons with HbA1c<6.5% (mean age 69 years, 51.5% men), one with 510 persons with glucose-based prediabetes or normal glucose tolerance. We calculated proportions of reversion, and estimated adjusted relative risks for the association between initial BMI/WC and change of BMI/WC, respectively, and reversion (and persistence of normoglycaemia, respectively). We estimated 10-year cardiovascular risks using the Framingham 2008 score. Overall, 27.3% of persons with HbA1c-defined prediabetes and 9.2% of persons with glucose-based prediabetes returned to normoglycaemia during follow-up. Lower initial BMI/WC and reduction of BMI/WC were associated with larger probabilities of returning to normoglycaemia (e.g., for HbA1c 5.7-6.4%, RR = 1.24 (95% CI: 1.09-1.41) per 1 kg/m2 decline of BMI). Moreover, reduction of BMI/WC increased probabilities of maintaining normoglycaemia (e.g., for glucose-based prediabetes, RR = 1.09 (1.02-1.16) per 1 kg/m2 decline of BMI). 10-year cardiovascular risk was 5.6 (1.7-9.6) percentage points lower after reversion from glucose-based prediabetes to normoglycaemia. CONCLUSION In older adults, even moderate weight reduction contributes to reversion from prediabetes to normoglycaemia and to maintaining normoglycaemia.
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Affiliation(s)
- Bernd Kowall
- Center of Clinical Epidemiology, Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany.
| | - Wolfgang Rathmann
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany; German Center for Diabetes Research (DZD), München, Neuherberg, Germany
| | - Oliver Kuss
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany; German Center for Diabetes Research (DZD), München, Neuherberg, Germany
| | - Christian Herder
- German Center for Diabetes Research (DZD), München, Neuherberg, Germany; Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany; Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Michael Roden
- German Center for Diabetes Research (DZD), München, Neuherberg, Germany; Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany; Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Andreas Stang
- Center of Clinical Epidemiology, Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - Cornelia Huth
- German Center for Diabetes Research (DZD), München, Neuherberg, Germany; Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Barbara Thorand
- German Center for Diabetes Research (DZD), München, Neuherberg, Germany; Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Christa Meisinger
- Chair of Epidemiology, Ludwig-Maximilian-Universität München, UNIKA-T Augsburg, Augsburg, Germany; Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Annette Peters
- German Center for Diabetes Research (DZD), München, Neuherberg, Germany; Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
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Voss S, Schneider A, Huth C, Wolf K, Markevych I, Schwettmann L, Rathmann W, Peters A, Breitner S. ENVINT-D-20-01309: Long-term exposure to air pollution, road traffic noise, residential greenness, and prevalent and incident metabolic syndrome: Results from the population-based KORA F4/FF4 cohort in Augsburg, Germany. ENVIRONMENT INTERNATIONAL 2021; 147:106364. [PMID: 33421766 DOI: 10.1016/j.envint.2020.106364] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/12/2020] [Accepted: 12/21/2020] [Indexed: 05/28/2023]
Abstract
BACKGROUND A growing number of epidemiological studies show associations between environmental factors and impaired cardiometabolic health. However, evidence is scarce concerning these risk factors and their impact on metabolic syndrome (MetS). This analysis aims to investigate associations between long-term exposure to air pollution, road traffic noise, residential greenness, and MetS. METHODS We used data of the first (F4, 2006-2008) and second (FF4, 2013-2014) follow-up of the population-based KORA S4 survey in the region of Augsburg, Germany, to investigate associations between exposures and MetS prevalence at F4 (N = 2883) and MetS incidence at FF4 (N = 1192; average follow-up: 6.5 years). Residential long-term exposures to air pollution - including particulate matter (PM) with a diameter < 10 µm (PM10), PM < 2.5 µm (PM2.5), PM between 2.5 and 10 µm (PMcoarse), absorbance of PM2.5 (PM2.5abs), particle number concentration (PNC), nitrogen dioxide (NO2), ozone (O3) - and road traffic noise were modeled by land-use regression models and noise maps. For greenness, the Normalized Difference Vegetation Index (NDVI) was obtained. We estimated Odds Ratios (OR) for single and multi-exposure models using logistic regression and generalized estimating equations adjusted for confounders. Joint Odds Ratios were calculated based on the Cumulative Risk Index. Effect modifiers were examined with interaction terms. RESULTS We found positive associations between prevalent MetS and interquartile range (IQR) increases in PM10 (OR: 1.15; 95% confidence interval [95% CI]: 1.02, 1.29), PM2.5 (OR: 1.14; 95% CI: 1.02, 1.28), PMcoarse (OR: 1.14; 95% CI: 1.02, 1.27), and PM2.5abs (OR: 1.17; 95% CI: 1.03, 1.32). Results further showed negative, but non-significant associations between exposure to greenness and prevalent and incident MetS. No effects were seen for exposure to road traffic noise. Joint Odds Ratios from multi-exposure models were higher than ORs from models with only one exposure.
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Affiliation(s)
- Stephan Voss
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, LMU Munich, Munich, Germany; Pettenkofer School of Public Health, Munich, Germany; Institute of Epidemiology, Helmholtz Zentrum München GmbH - German Research Center for Environmental Health, Neuherberg, Germany.
| | - Alexandra Schneider
- Institute of Epidemiology, Helmholtz Zentrum München GmbH - German Research Center for Environmental Health, Neuherberg, Germany
| | - Cornelia Huth
- Institute of Epidemiology, Helmholtz Zentrum München GmbH - German Research Center for Environmental Health, Neuherberg, Germany
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München GmbH - German Research Center for Environmental Health, Neuherberg, Germany
| | - Iana Markevych
- Institute of Epidemiology, Helmholtz Zentrum München GmbH - German Research Center for Environmental Health, Neuherberg, Germany; Institute and Clinic for Occupational, Social and Environmental Medicine, LMU Munich, Munich, Germany; Institute of Psychology, Jagiellonian University, Cracow, Poland
| | - Lars Schwettmann
- Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany
| | - Wolfgang Rathmann
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Duesseldorf, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München GmbH - German Research Center for Environmental Health, Neuherberg, Germany
| | - Susanne Breitner
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, LMU Munich, Munich, Germany; Institute of Epidemiology, Helmholtz Zentrum München GmbH - German Research Center for Environmental Health, Neuherberg, Germany
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Yost O, DeJonckheere M, Stonebraker S, Ling G, Buis L, Pop-Busui R, Kim N, Mizokami-Stout K, Richardson C. Continuous Glucose Monitoring With Low-Carbohydrate Diet Coaching in Adults With Prediabetes: Mixed Methods Pilot Study. JMIR Diabetes 2020; 5:e21551. [PMID: 33325831 PMCID: PMC7773517 DOI: 10.2196/21551] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/21/2020] [Accepted: 10/26/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is preventable; however, few patients with prediabetes participate in prevention programs. The use of user-friendly continuous glucose monitors (CGMs) with low-carbohydrate diet coaching is a novel strategy to prevent T2DM. OBJECTIVE This study aims to determine the patient satisfaction and feasibility of an intervention combining CGM use and low-carbohydrate diet coaching in patients with prediabetes to drive dietary behavior change. METHODS We conducted a mixed methods, single-arm pilot and feasibility study at a suburban family medicine clinic. A total of 15 adults with prediabetes with hemoglobin A1c (HbA1c) levels between 5.7% and 6.4% and a BMI >30 kg/m2 were recruited to participate. The intervention and assessments took place during 3 in-person study visits and 2 qualitative phone interviews (3 weeks and 6 months after the intervention). During visit 1, participants were asked to wear a CGM and complete a food intake and craving log for 10 days. During visit 2, the food intake and craving log along with the CGM results of the participants were reviewed and the participants received low-carbohydrate diet coaching, including learning about carbohydrates and personalized feedback. A second CGM sensor, with the ability to scan and record glucose trends, was placed, and the participants logged their food intake and cravings as they attempted to reduce their total carbohydrate intake (<100 g/day). During visit 3, the participants reviewed their CGM and log data. The primary outcome was satisfaction with the use of CGM and low-carbohydrate diet. The secondary outcomes included feasibility, weight, and HbA1c change, and percentage of time spent in hyperglycemia. Changes in attitudes and risk perception of developing diabetes were also assessed. RESULTS The overall satisfaction rate of our intervention was 93%. The intervention induced a weight reduction of 1.4 lb (P=.02) and a reduction of HbA1c levels by 0.71% (P<.001) since enrollment. Although not significantly, the percentage of time above glucose goal and average daily glucose levels decreased slightly during the study period. Qualitative interview themes indicated no major barriers to CGM use; the acceptance of a low-carbohydrate diet; and that CGMs helped to visualize the impact of carbohydrates on the body, driving dietary changes. CONCLUSIONS The use of CGMs and low-carbohydrate diet coaching to drive dietary changes in patients with prediabetes is feasible and acceptable to patients. This novel method merits further exploration, as the preliminary data indicate that combining CGM use with low-carbohydrate diet coaching drives dietary changes, which may ultimately prevent T2DM.
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Affiliation(s)
- Olivia Yost
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Melissa DeJonckheere
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States
| | - Spring Stonebraker
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Grace Ling
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Lorraine Buis
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States
| | - Rodica Pop-Busui
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Noa Kim
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Kara Mizokami-Stout
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States.,Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Caroline Richardson
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States
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Seear KH, Atkinson DN, Henderson-Yates LM, Lelievre MP, Marley JV. Maboo wirriya, be healthy: Community-directed development of an evidence-based diabetes prevention program for young Aboriginal people in a remote Australian town. EVALUATION AND PROGRAM PLANNING 2020; 81:101818. [PMID: 32512400 DOI: 10.1016/j.evalprogplan.2020.101818] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 12/17/2019] [Accepted: 04/18/2020] [Indexed: 06/11/2023]
Abstract
Supporting healthy lifestyle behaviours is a key aspect of preventing type 2 diabetes which disproportionately affects disadvantaged groups from a younger age. Formative participatory research was undertaken to design a program for young Aboriginal people in a remote town in North West Australia with a high level of health needs and relatively few prevention initiatives. Focus groups and advisory discussions with Aboriginal community members were used to determine the nature of the program. The need for a comprehensive program was consistently expressed and limited healthy lifestyle knowledge and difficulties with healthy eating influenced by food environments were noted to be important. With guidance from the Derby Aboriginal Health Service, findings were integrated with previous international research evidence to develop a program tailored to local Aboriginal people aged 15-25 years and refine it after piloting. This 8-session program, 'Maboo wirriya, be healthy' involved an education component consistent with the US Diabetes Prevention Program and practical activities including group exercise. Changes to program structure and documentation were made after piloting for future use. The community-directed approach used in this study is vital to ensure relevance of localised chronic disease prevention programs in a range of settings.
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Affiliation(s)
- Kimberley H Seear
- The Rural Clinical School of Western Australia, University of Western Australia, 12 Napier Terrace (PO Box 1377), Broome WA 6725, Australia.
| | - David N Atkinson
- The Rural Clinical School of Western Australia, University of Western Australia, 12 Napier Terrace (PO Box 1377), Broome WA 6725, Australia.
| | | | - Matthew P Lelievre
- Derby Aboriginal Health Service, 1 Stanley Street (PO Box 1155) Derby WA 6728, Australia.
| | - Julia V Marley
- The Rural Clinical School of Western Australia, University of Western Australia, 12 Napier Terrace (PO Box 1377), Broome WA 6725, Australia; Kimberley Aboriginal Medical Services, 12 Napier Terrace (PO Box 1377), Broome WA 6725, Australia.
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Wawro N, Pestoni G, Riedl A, Breuninger TA, Peters A, Rathmann W, Koenig W, Huth C, Meisinger C, Rohrmann S, Linseisen J. Association of Dietary Patterns and Type-2 Diabetes Mellitus in Metabolically Homogeneous Subgroups in the KORA FF4 Study. Nutrients 2020; 12:nu12061684. [PMID: 32516903 PMCID: PMC7352280 DOI: 10.3390/nu12061684] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/02/2020] [Accepted: 06/03/2020] [Indexed: 12/16/2022] Open
Abstract
There is evidence that a change in lifestyle, especially physical activity and diet, can reduce the risk of developing type-2 diabetes mellitus (T2DM). However, the response to dietary changes varies among individuals due to differences in metabolic characteristics. Therefore, we investigated the association between dietary patterns and T2DM while taking into account these differences. For 1287 participants of the population-based KORA FF4 study (Cooperative Health Research in the Region of Augsburg), we identified three metabolically-homogenous subgroups (metabotypes) using 16 clinical markers. Based on usual dietary intake data, two diet quality scores, the Mediterranean Diet Score (MDS) and the Alternate Healthy Eating Index (AHEI), were calculated. We explored the associations between T2DM and diet quality scores. Multi-variable adjusted models, including metabotype subgroup, were fitted. In addition, analyses stratified by metabotype were carried out. We found significant interaction effects between metabotype and both diet quality scores (p < 0.05). In the analysis stratified by metabotype, significant negative associations between T2DM and both diet quality scores were detected only in the metabolically-unfavorable homogenous subgroup (Odds Ratio (OR) = 0.62, 95% confidence interval (CI) = 0.39-0.90 for AHEI and OR = 0.60, 95% CI = 0.40-0.96 for MDS). Prospective studies taking metabotype into account are needed to confirm our results, which allow for the tailoring of dietary recommendations in the prevention of T2DM.
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Affiliation(s)
- Nina Wawro
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstr. 1, 85764 Neuherberg, Germany; (G.P.); (A.R.); (T.A.B.); (C.M.); (J.L.)
- Chair of Epidemiology, Ludwig-Maximilians-Universität München at UNIKA-T (Universitäres Zentrum für Gesundheitswissenschaften am Klinikum Augsburg), Neusässer Str. 47, 86156 Augsburg, Germany
- Correspondence:
| | - Giulia Pestoni
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstr. 1, 85764 Neuherberg, Germany; (G.P.); (A.R.); (T.A.B.); (C.M.); (J.L.)
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, CH-8001 Zurich, Switzerland;
| | - Anna Riedl
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstr. 1, 85764 Neuherberg, Germany; (G.P.); (A.R.); (T.A.B.); (C.M.); (J.L.)
| | - Taylor A. Breuninger
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstr. 1, 85764 Neuherberg, Germany; (G.P.); (A.R.); (T.A.B.); (C.M.); (J.L.)
- Chair of Epidemiology, Ludwig-Maximilians-Universität München at UNIKA-T (Universitäres Zentrum für Gesundheitswissenschaften am Klinikum Augsburg), Neusässer Str. 47, 86156 Augsburg, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstr. 1, 85764 Neuherberg, Germany; (A.P.); (C.H.)
- German Center for Diabetes Research (DZD e.V.), Ingolstädter Landstr. 1, 85764 München-Neuherberg, Germany;
| | - Wolfgang Rathmann
- German Center for Diabetes Research (DZD e.V.), Ingolstädter Landstr. 1, 85764 München-Neuherberg, Germany;
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Auf’m Hennekamp 65, 40225 Düsseldorf, Germany
| | - Wolfgang Koenig
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Pettenkoferstr. 8a & 9, 80336 Munich, Germany;
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636 Munich
- Institute of Epidemiology and Medical Biometry, University of Ulm, Helmholtzstr. 22, 89081 Ulm, Germany
| | - Cornelia Huth
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstr. 1, 85764 Neuherberg, Germany; (A.P.); (C.H.)
- German Center for Diabetes Research (DZD e.V.), Ingolstädter Landstr. 1, 85764 München-Neuherberg, Germany;
| | - Christa Meisinger
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstr. 1, 85764 Neuherberg, Germany; (G.P.); (A.R.); (T.A.B.); (C.M.); (J.L.)
- Chair of Epidemiology, Ludwig-Maximilians-Universität München at UNIKA-T (Universitäres Zentrum für Gesundheitswissenschaften am Klinikum Augsburg), Neusässer Str. 47, 86156 Augsburg, Germany
| | - Sabine Rohrmann
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, CH-8001 Zurich, Switzerland;
| | - Jakob Linseisen
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstr. 1, 85764 Neuherberg, Germany; (G.P.); (A.R.); (T.A.B.); (C.M.); (J.L.)
- Chair of Epidemiology, Ludwig-Maximilians-Universität München at UNIKA-T (Universitäres Zentrum für Gesundheitswissenschaften am Klinikum Augsburg), Neusässer Str. 47, 86156 Augsburg, Germany
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Lim RBT, Wee WK, For WC, Ananthanarayanan JA, Soh YH, Goh LML, Tham DKT, Wong ML. Health education and communication needs among primary care patients with prediabetes in Singapore: A mixed methods approach. Prim Care Diabetes 2020; 14:254-264. [PMID: 31558372 DOI: 10.1016/j.pcd.2019.08.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 08/08/2019] [Accepted: 08/29/2019] [Indexed: 01/12/2023]
Abstract
AIMS To assess factors associated with ever receiving prediabetes education, and to explore the health education and communication needs among primary care patients with prediabetes in Singapore. METHODS A mixed methods study, consisting of a cross-sectional survey involving 433 patients with prediabetes aged 21-79, and in-depth interviews (IDIs) with 48. Multivariable regression was used to analyse the survey results, while thematic analysis was used to analyse the IDIs. RESULTS The prevalence of ever receiving prediabetes education was 26.6%. This was positively associated with school education, impaired glucose tolerance, number of co-morbidities, having family or peer with diabetes, having support to reduce diabetes risk, confidence to self-manage prediabetes, and negatively associated with age. A common reason among those not receiving such education was not being referred by doctors. The preferred content of health communication messages were to focus on risk and prevention of diabetes, health and family, and to avoid the term 'prediabetes' in messages. The top 2 preferred education components were healthy eating and physical activity, and the most desired setting was the community centre. CONCLUSIONS More efforts are needed to increase the take-up rate of prediabetes education. Polyclinic healthcare professionals could provide preliminary advice, and subsequently refer patients to community-based programmes or resources.
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Affiliation(s)
- Raymond Boon Tar Lim
- Health Systems & Behavioural Sciences, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore City, Singapore.
| | - Wei Keong Wee
- Health Promotion & Preventive Care, National Healthcare Group Polyclinics, Singapore City, Singapore
| | - Wei Chek For
- Health Promotion & Preventive Care, National Healthcare Group Polyclinics, Singapore City, Singapore
| | | | - Ying Hua Soh
- Health Promotion & Preventive Care, National Healthcare Group Polyclinics, Singapore City, Singapore
| | - Lynette Mei Lim Goh
- Clinical Services, National University Polyclinics and National University Health System, Singapore City, Singapore
| | - Dede Kam Tyng Tham
- Health Systems & Behavioural Sciences, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore City, Singapore
| | - Mee Lian Wong
- Health Systems & Behavioural Sciences, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore City, Singapore
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Antwi J, Lavin R, Sullivan S, Bellavia M. Perception of and risk factors for type 2 diabetes among students attending an upstate New York college: a pilot study. Diabetol Metab Syndr 2020; 12:25. [PMID: 32256715 PMCID: PMC7106855 DOI: 10.1186/s13098-020-00535-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 03/18/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Detecting early type 2 diabetes (T2D) risk factors may reduce or prevent the development of the disease. We conducted a pilot study to generate preliminary data on the perception of T2D and further determined the prevalence of T2D risk factors among college students at an upstate New York campus. METHODS Metabolic profiles were available for 44 college students for cross-sectional analysis. The American Diabetes Association screening guidelines were used to determine risk factors, and perceived susceptibility, perceived seriousness, and self-efficacy were determined with the Health Belief Model's constructs. Sociodemographic and anthropometric data, nutrition knowledge, and metabolic profiles were obtained. RESULTS The most common T2D risk factors were lack of physical activity (61.4%), decreased high-density lipoprotein cholesterol (HDL-c, 56.8%), high fasting blood glucose (FBG, 45.5%), family history of T2D (43.2%), increased body mass index (BMI, 36.4%), and high blood pressure (15.9%). A high proportion (70%) of participants with detected impaired FBG perceived they were at low risk of developing T2D. Participants with a family history of T2D (mean rank = 24.2) perceived the seriousness of T2D at a similar level as those without family history (mean rank = 21.2), with no significant difference (U = 205, P = 0.430). Nearly 30% of students did not feel confident they could prevent the development of T2D. Pearson's correlations revealed direct relationships between perceived risk of T2D and BMI (r = 0.49, P = 0.001), fat mass percent (r = 0.51, P < 0.001), and waist circumference (r = 0.42, P = 0.005), and an inverse relationship was found with HDL-c (r = - 0.41, P = 0.005). The association of perceived risk of T2D with a family history of T2D revealed a trend toward significance (Chi-squared = 5.746, P = 0.057), and the association of perceived risk of T2D with physical activity was not significant (Chi-squared = 1.520, P = 0.468). The nutrition knowledge score was 74.32 ± 15.97 (recommended is > 75). However, knowledge scores regarding recommended intake of fruits, vegetables, high sodium foods, and whole grains to prevent T2D were only 36.36%, 34.09%, 47.73%, and 63.6%, respectively. CONCLUSIONS The discordance between college students' perceived risk and prevalence of T2D risk factors warrants strategies to address misperceptions of T2D risk and improve lifestyle behaviors among this study sample.
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Affiliation(s)
- Janet Antwi
- Department of Agriculture, Nutrition and Human Ecology, Nutrition and Dietetics, Prairie View A&M University, 100 University Dr, Prairie View, TX 77446 USA
| | - Rebecca Lavin
- Department of Human Ecology, Nutrition and Dietetics, State University of New York at Oneonta, Oneonta, NY USA
| | - Stacey Sullivan
- Department of Human Ecology, Nutrition and Dietetics, State University of New York at Oneonta, Oneonta, NY USA
| | - Maria Bellavia
- Department of Human Ecology, Nutrition and Dietetics, State University of New York at Oneonta, Oneonta, NY USA
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Wang J, Smail-Crevier R, Nannarone M, Manuel D, MacQueen G, Patten SB, Lashewicz B, Schmitz N. The accuracy of depression risk perception in high risk Canadians. J Affect Disord 2020; 265:410-415. [PMID: 32090767 DOI: 10.1016/j.jad.2020.01.099] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 12/21/2019] [Accepted: 01/20/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Prevention and early detection of depression is a top public health priority. Accurate perception of depression risk may play an important role in health behavior change and prevention of depression. However, the way in which people in the community perceive their risk of developing depression is currently unknown. METHODS We analyzed the baseline data from a randomized controlled trial in 358 men and 356 women who are at high risk of having a major depressive episode (MDE). The predicted risk was assessed by sex-specific multivariable risk predictive algorithms for MDE. We compared participants' perceived risk and their predicted risk. Accurate risk perception was defined as perceived risk is in the range of predicted risk ± 10%. RESULTS In men, 29.7% perceived their risk accurately; 47.5% overestimated their risk; 22.8% underestimated their risk. In women, the proportions were 21.7%, 59.6% and 18.7%, respectively. Compared to men, women were more likely to overestimate their risk and less likely to be accurate. Regression modeling revealed that poor self-rated health and higher predicted depression risk were associated with inaccuracy of risk perception in men; a family history of MDE, higher psychological distress and lower predicted risk were associated with inaccuracy of risk perception in women. CONCLUSIONS Individuals who are at high risk of developing depression tend to overestimate their risk, especially women. Inaccurate depression risk perception is related to people's health status. Educational interventions are needed to enhance the accuracy of risk perception to encourage positive behavior change and uptake of preventive strategies.
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Affiliation(s)
- JianLi Wang
- The Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - Rachel Smail-Crevier
- The Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada
| | - Molly Nannarone
- The Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada
| | - Douglas Manuel
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Glenda MacQueen
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Scott B Patten
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Bonnie Lashewicz
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Norbert Schmitz
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Canada
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Chen A, Chidarikire T, Sarswat D, Parissi C, Nwose EU. Diabetes mellitus literacy in a regional community of a developed country. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:482-488. [PMID: 31910173 PMCID: PMC7233777 DOI: 10.23750/abm.v90i4.7687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 09/19/2019] [Indexed: 11/30/2022]
Abstract
Background: Prevalence of diabetes mellitus (DM) is on the increase. Yet discrepancies exist in research reports regarding the level of knowledge of the disease in ‘rural versus metropolitan communities’, and ‘developed versus developing countries’. This study examines the level of general knowledge of diabetes among adult community members of a regional city of Australia, whether it is comparable to reports from low-mid income countries. Methods: The study was designed to be a cross-sectional day-time-population survey. Major shopping centres were chosen for convenience sampling of community’s daytime population. A total of 315 participants’ (154 males and 161 females) responses were received. Data were analysed using SPSS – 20 software to identify differences between sub-groups of age stratifications, educational status, gender and the participants assumed knowledgee. The participant’s average knowledge of diabetes symptoms and complications were also assessed. Results: The major finding is that the subgroup who claimed to know ‘very little’ showed equivalent knowledge levels with those who thought they had ‘considerable knowledge’. The females know more about diabetes management than males (P < 0.004); level of knowledge increased with educational status (p < 0.01). These observations were comparable with reports from developing countries. Conclusions: The limited knowledge of diabetes symptoms and complications in the population can be mitigating against early reporting of patients to diabetes clinics in the community. To ensure continuous decline in prevalence rates of diabetes and its complications, the ongoing efforts of diabetes awareness and educational programs need to be improved, particularly with regard to males and school children. (www.actabiomedica.it)
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Diabetes Prevention: Knowledge and Perception of Risk among Italian Population. BIOMED RESEARCH INTERNATIONAL 2019; 2019:2753131. [PMID: 31781605 PMCID: PMC6875189 DOI: 10.1155/2019/2753131] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/03/2019] [Indexed: 11/17/2022]
Abstract
The risk perception for developing diabetes has not been well established. The aim of this study is to evaluate knowledge and perception of risk for developing diabetes. A cross-sectional study was conducted among a sample of 527 parents of children attending public schools in Naples (Italy). A self-administered anonymous questionnaire was used to collect the data. In total, 97.3% of participants have heard about diabetes, but only 16.7% knew the main risk and protective factors. This knowledge was statistically significantly higher in those who had close relatives with diabetes. Moreover, those who had middle school or lower and high school education, compared with those who had a college degree or higher, were less knowledgeable. The mean total value of the risk perception for developing diabetes was 1.9. Females those who had more than 40 years of age, those who needed of additional information, those who had a higher BMI, those who had close relatives with diabetes, those who had at least one chronic disease, and those who reported a lower value of self-rated health status were more likely to perceive a higher risk for developing diabetes. Moreover, this perception was statistically significantly lower among those who had a middle school or lower and high school education, compared with those who had a college degree or higher. The knowledge about diabetes needs to be improved, and the low risk perception for developing diabetes among the sample is worrying given the severity of the disease and the preventive measures available.
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Timpel P, Harst L, Reifegerste D, Weihrauch-Blüher S, Schwarz PEH. What should governments be doing to prevent diabetes throughout the life course? Diabetologia 2019; 62:1842-1853. [PMID: 31451873 DOI: 10.1007/s00125-019-4941-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 06/05/2019] [Indexed: 11/25/2022]
Abstract
Health systems and governments are increasingly required to implement measures that target at-risk populations to prevent noncommunicable diseases. In this review we lay out what governments should be doing to prevent diabetes throughout the life course. The following four target groups were used to structure the specific recommendations: (1) pregnant women and young families, (2) children and adolescents, (3) working age population, and (4) the elderly. The evidence to date supports the effectiveness of some known government policy measures, such as sugar taxes and regulatory measures in the (pre-)school setting for children and adolescents. Many of these appear to be more effective if they are part of a bundle of strategies and if they are supplemented by communication strategies. Although there is a current focus on strategies that target the individual, governments can make use of evidence-based population-level prevention strategies. More research and continuous evaluation of the overall and subgroup-specific effectiveness of policy strategies using high-quality longitudinal studies are needed.
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Affiliation(s)
- Patrick Timpel
- Department for Prevention and Care of Diabetes, Department of Medicine III, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
| | - Lorenz Harst
- Research Association Public Health Saxony/Center for Evidence-Based Healthcare, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Doreen Reifegerste
- Department of Media and Communication Science, University of Erfurt, Erfurt, Germany
| | - Susann Weihrauch-Blüher
- Department of Pediatrics I, Pediatric Endocrinology and Diabetology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Peter E H Schwarz
- Department for Prevention and Care of Diabetes, Department of Medicine III, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
- Paul Langerhans Institute Dresden of the Helmholtz Center Munich at University Hospital and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- German Center for Diabetes Research (DZD), Munich, Neuherberg, Germany
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Breuninger TA, Wawro N, Meisinger C, Artati A, Adamski J, Peters A, Grallert H, Linseisen J. Associations between fecal bile acids, neutral sterols, and serum lipids in the KORA FF4 study. Atherosclerosis 2019; 288:1-8. [DOI: 10.1016/j.atherosclerosis.2019.06.911] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 04/17/2019] [Accepted: 06/21/2019] [Indexed: 01/06/2023]
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Lutter JI, Szentes B, Wacker ME, Winter J, Wichert S, Peters A, Holle R, Leidl R. Are health risk attitude and general risk attitude associated with healthcare utilization, costs and working ability? Results from the German KORA FF4 cohort study. HEALTH ECONOMICS REVIEW 2019; 9:26. [PMID: 31471778 PMCID: PMC6734302 DOI: 10.1186/s13561-019-0243-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 08/21/2019] [Indexed: 05/05/2023]
Abstract
BACKGROUND Risk attitudes influence decisions made under uncertainty. This paper investigates the association of risk attitudes with the utilization of preventive and general healthcare services, work absence and resulting costs to explore their contribution to the heterogeneity in utilization. METHODS Data of 1823 individuals (56.5 ± 9.5 years), participating in the German KORA FF4 population-based cohort study (2013/2014) were analyzed. Individuals' general and health risk attitude were measured as willingness to take risk (WTTR) on 11-point scales. Utilization of preventive and medical services and work absence was assessed and annual costs were calculated from a societal perspective. Generalized linear models with log-link function (logistic, negative-binomial and gamma regression) adjusted for age, sex, and height were used to analyze the association of WTTR with the utilizations and costs. RESULTS Higher WTTR was significantly associated with lower healthcare utilization (physician visits, physical therapy, and medication intake), work absence days and indirect costs. Regarding preventive services, an overall negative correlation between WTTR and utilization was examined but this observation remained non-significant except for the outcome medical check-up. Here, higher WTTR was significantly associated with a lower probability of participation. For all associations mentioned, Odds Ratios ranged between 0.90 and 0.79, with p < 0.05. Comparing the two risk attitudes (general and regarding health) we obtained similar results regarding the directions of associations. CONCLUSIONS We conclude that variations in risk attitudes contribute to the heterogeneity of healthcare utilization. Thus, knowledge of their associations with utilization might help to better understand individual decision-making - especially in case of participation in preventive services.
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Affiliation(s)
- Johanna I. Lutter
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Ingolstaedter Landstr 1, 85764 Neuherberg, Germany
- Ludwig-Maximilians-Universität München, Institute for Medical Informatics, Biometry and Epidemiology, Marchioninistr 15, 81377 Munich, Germany
| | - Boglárka Szentes
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Ingolstaedter Landstr 1, 85764 Neuherberg, Germany
| | - Margarethe E. Wacker
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Ingolstaedter Landstr 1, 85764 Neuherberg, Germany
| | - Joachim Winter
- Department of Economics, Ludwig-Maximilians-Universität München, Ludwigstr 33, 80539 Munich, Germany
| | - Sebastian Wichert
- ifo Institute – Leibniz Institute for Economic Research at the University of Munich, Poschingerstr 5, 81679 Munich, Germany
| | - Annette Peters
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology, Ingolstaedter Landstr 1, 85764 Neuherberg, Germany
| | - Rolf Holle
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Ingolstaedter Landstr 1, 85764 Neuherberg, Germany
| | - Reiner Leidl
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Ingolstaedter Landstr 1, 85764 Neuherberg, Germany
- Ludwig-Maximilians-Universität München, Munich Center of Health Sciences, Ludwigstr 28 RG, 80539 Munich, Germany
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Porat T, Marshall IJ, Sadler E, Vadillo MA, McKevitt C, Wolfe CDA, Curcin V. Collaborative design of a decision aid for stroke survivors with multimorbidity: a qualitative study in the UK engaging key stakeholders. BMJ Open 2019; 9:e030385. [PMID: 31420396 PMCID: PMC6701575 DOI: 10.1136/bmjopen-2019-030385] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/27/2019] [Accepted: 07/01/2019] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Effective secondary stroke prevention strategies are suboptimally used. Novel development of interventions to enable healthcare professionals and stroke survivors to manage risk factors for stroke recurrence are required. We sought to engage key stakeholders in the design and evaluation of an intervention informed by a learning health system approach, to improve risk factor management and secondary prevention for stroke survivors with multimorbidity. DESIGN Qualitative, including focus groups, semistructured interviews and usability evaluations. Data was audio recorded, transcribed and coded thematically. PARTICIPANTS Stroke survivors, carers, health and social care professionals, commissioners, policymakers and researchers. SETTING Stroke survivors were recruited from the South London Stroke Register; health and social care professionals through South London general practices and King's College London (KCL) networks; carers, commissioners, policymakers and researchers through KCL networks. RESULTS 53 stakeholders in total participated in focus groups, interviews and usability evaluations. Thirty-seven participated in focus groups and interviews, including stroke survivors and carers (n=11), health and social care professionals (n=16), commissioners and policymakers (n=6) and researchers (n=4). Sixteen participated in usability evaluations, including stroke survivors (n=8) and general practitioners (GPs; n=8). Eight themes informed the collaborative design of DOTT (Deciding On Treatments Together), a decision aid integrated with the electronic health record system, to be used in primary care during clinical consultations between the healthcare professional and stroke survivor. DOTT aims to facilitate shared decision-making on personalised treatments leading to improved treatment adherence and risk control. DOTT was found acceptable and usable among stroke survivors and GPs during a series of evaluations. CONCLUSIONS Adopting a user-centred data-driven design approach informed an intervention that is acceptable to users and has the potential to improve patient outcomes. A future feasibility study and subsequent clinical trial will provide evidence of the effectiveness of DOTT in reducing risk of stroke recurrence.
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Affiliation(s)
- Talya Porat
- Dyson School of Design Engineering, Imperial College London, London, UK
| | - Iain J Marshall
- School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - Euan Sadler
- School of Health Sciences, University of Southampton, UK
| | - Miguel A Vadillo
- Departamento de Psicología Básica, Universidad Autónoma de Madrid, Madrid, Spain
| | - Christopher McKevitt
- School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - Charles D A Wolfe
- School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - Vasa Curcin
- School of Population Health and Environmental Sciences, King’s College London, London, UK
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Heidemann C, Paprott R, Stühmann LM, Baumert J, Mühlenbruch K, Hansen S, Schiborn C, Zahn D, Gellert P, Scheidt-Nave C. Perceived diabetes risk and related determinants in individuals with high actual diabetes risk: results from a nationwide population-based survey. BMJ Open Diabetes Res Care 2019; 7:e000680. [PMID: 31297223 PMCID: PMC6590966 DOI: 10.1136/bmjdrc-2019-000680] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 04/26/2019] [Accepted: 05/16/2019] [Indexed: 12/31/2022] Open
Abstract
Objective The purpose of this study was first, to examine perceived diabetes risk compared with actual diabetes risk in the general population and second, to investigate which factors determine whether persons at increased actual risk also perceive themselves at elevated risk. Research design and methods The study comprised adults (aged 18-97 years) without known diabetes from a nationwide survey on diabetes-related knowledge and information needs in Germany in 2017. Actual diabetes risk was calculated by an established risk score estimating the 5-year probability of developing type 2 diabetes and was compared with perceived risk of getting diabetes over the next 5 years (response options: 'almost no risk', 'slight risk', 'moderate risk', 'high risk'; n = 2327). Among adults with an increased actual diabetes risk (n=639), determinants of perceived risk were investigated using multivariable logistic regression analysis. Results Across groups with a 'low' (<2%), 'still low' (2% to<5%), 'elevated' (5% to <10%), and 'high' (≥10%) actual diabetes risk, a proportion of 89.0%, 84.5%, 79.3%, and 78.9%, respectively, perceived their diabetes risk as almost absent or slight. Among those with an increased (elevated/high) actual risk, independent determinants of an increased (moderate/high) perceived risk included younger age (OR 0.92 (95% CI 0.88 to 0.96) per year), family history of diabetes (2.10 (1.06-4.16)), and being informed about an increased diabetes risk by a physician (3.27 (1.51-7.07)), but none of further diabetes risk factors, healthcare behaviors or beliefs about diabetes. Conclusions Across categories of actual diabetes risk, perceived diabetes risk was low, even if actual diabetes risk was high. For effective strategies of primary diabetes prevention, attention should be directed to risk communication at the population level as well as in primary care practice.
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Affiliation(s)
- Christin Heidemann
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Rebecca Paprott
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Lena M Stühmann
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
- Institute of Medical Sociology, Charité-Universitätsmedizin, Berlin, Germany
| | - Jens Baumert
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Kristin Mühlenbruch
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Sylvia Hansen
- Office for National Education and Communication on Diabetes mellitus, Federal Centre for Health Education, Cologne, Germany
| | - Catarina Schiborn
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Daniela Zahn
- Office for National Education and Communication on Diabetes mellitus, Federal Centre for Health Education, Cologne, Germany
| | - Paul Gellert
- Institute of Medical Sociology, Charité-Universitätsmedizin, Berlin, Germany
| | - Christa Scheidt-Nave
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
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Modifying effect of metabotype on diet-diabetes associations. Eur J Nutr 2019; 59:1357-1369. [PMID: 31089867 PMCID: PMC7230059 DOI: 10.1007/s00394-019-01988-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 05/05/2019] [Indexed: 12/18/2022]
Abstract
Purpose Inter-individual metabolic differences may be a reason for previously inconsistent results in diet–diabetes associations. We aimed to investigate associations between dietary intake and diabetes for metabolically homogeneous subgroups (‘metabotypes’) in a large cross-sectional study. Methods We used data of 1517 adults aged 38–87 years from the German population-based KORA FF4 study (2013/2014). Dietary intake was estimated based on the combination of a food frequency questionnaire and multiple 24-h food lists. Glucose tolerance status was classified based on an oral glucose tolerance test in participants without a previous diabetes diagnosis using American Diabetes Association criteria. Logistic regression was applied to examine the associations between dietary intake and diabetes for two distinct metabotypes, which were identified based on 16 biochemical and anthropometric parameters. Results A low intake of fruits and a high intake of total meat, processed meat and sugar-sweetened beverages (SSB) were significantly associated with diabetes in the total study population. Stratified by metabotype, associations with diabetes remained significant for intake of total meat (OR 1.67, 95% CI 1.04–2.67) and processed meat (OR 2.23, 95% CI 1.24–4.04) in the metabotypes with rather favorable metabolic characteristics, and for intake of fruits (OR 0.83, 95% CI 0.68–0.99) and SSB (OR:1.21, 95% CI 1.09–1.35) in the more unfavorable metabotype. However, only the association between SSB intake and diabetes differed significantly by metabotype (p value for interaction = 0.01). Conclusions Our findings suggest an influence of metabolic characteristics on diet–diabetes associations, which may help to explain inconsistent previous results. The causality of the observed associations needs to be confirmed in prospective and intervention studies. Electronic supplementary material The online version of this article (10.1007/s00394-019-01988-5) contains supplementary material, which is available to authorized users.
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Kabeza CB, Harst L, Schwarz PEH, Timpel P. Assessment of Rwandan diabetic patients' needs and expectations to develop their first diabetes self-management smartphone application (Kir'App). Ther Adv Endocrinol Metab 2019; 10:2042018819845318. [PMID: 31065334 PMCID: PMC6487763 DOI: 10.1177/2042018819845318] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 04/01/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Knowledge of and coping with diabetes is still poor in some communities in Rwanda. While smartphone applications (or apps) have demonstrated improving diabetes self-care, there is no current study on the use of smartphones in the self-management of diabetes in Rwanda. METHODS The main objective of this study was to assess the needs and expectations of Rwandan diabetic patients for mobile-health-supported diabetes self-management in order to develop a patient-centred smartphone application (Kir'App). RESULTS Convenience sampling was used to recruit study participants at the Rwanda Diabetes Association. Twenty-one patients participated in semi-structured, in-depth, face-to-face interviews. Thematic analysis was performed using Mayring's method of qualitative content analysis. CONCLUSIONS The study included 21 participants with either type 1 (female = 5, male = 6) or type 2 (female = 6, male = 4) diabetes. Participants' age ranged from 18 to 69 years with a mean age of 35 and 29 years, respectively. Eight main themes were identified. These were (a) diabetes education and desired information provision; (b) lack of diabetes knowledge and awareness; (c) need for information in crisis situations; (d) required monitoring and reminder functions; (e) information on nutrition and alcohol consumption; (f) information on physical activity; (g) coping with burden of disease, through social support and network; (h) app features. This study provides recommendations that will be used to design the features of the first Rwandan diabetes self-management smartphone application (Kir'App). The future impact of the application on the Rwandan diabetic patients' self-management capacity and quality of life will be evaluated afterwards.
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Affiliation(s)
| | - Lorenz Harst
- Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Peter E. H. Schwarz
- German Centre for Diabetes Research (DZD e.V.), Neuherberg, Germany Helmholtz Centre Munich, University Hospital, Munich, Germany Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Patrick Timpel
- Department for Prevention and Care of Diabetes, Technische Universität Dresden, Dresden, Germany
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Differential associations between diet and prediabetes or diabetes in the KORA FF4 study. J Nutr Sci 2018; 7:e34. [PMID: 30627431 PMCID: PMC6313408 DOI: 10.1017/jns.2018.25] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 11/06/2018] [Accepted: 11/09/2018] [Indexed: 12/18/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a global public health epidemic. Diet and lifestyle changes have been demonstrated as effective measures in managing T2DM and preventing or delaying the progression from prediabetes to diabetes, yet the relationship between diet, prediabetes and diabetes is still not entirely clear. The present study aimed to further elucidate the relationship between diet, diabetes and especially prediabetes. A total of 1542 participants of the cross-sectional, population-based Cooperative Health Research in the Region of Augsburg (KORA) FF4 study (2013/2014) were included in this analysis. Dietary intake was derived using a method combining information from a FFQ and repeated 24-h food lists. Glucose tolerance status was assessed via oral glucose tolerance tests in all participants without a previous physician-confirmed diagnosis of T2DM, and was classified according to the 2003 American Diabetes Association criteria. Crude and fully adjusted multinomial logistic regression models were fitted to examine associations between diet and prediabetes, undetected diabetes mellitus (UDM) and prevalent T2DM. After adjusting for major covariates, fruit was significantly inversely and total meat, processed meat, sugar-sweetened beverages and moderate alcohol significantly associated with UDM and/or prevalent diabetes. Sex-specific analyses showed that in men, coffee was significantly inversely (OR 0·80; 95 % CI 0·67, 0·96) and heavy alcohol significantly (OR 1·84; 95 % CI 1·14, 2·95) associated with prediabetes. Our findings on diet and T2DM are consistent with current literature, while our results regarding coffee, heavy alcohol consumption and prediabetes highlight new possible targets for primary prevention of the derangement of glucose homeostasis.
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Karl FM, Tremmel M, Luzak A, Schulz H, Peters A, Meisinger C, Holle R, Laxy M. Direct healthcare costs associated with device assessed and self-reported physical activity: results from a cross-sectional population-based study. BMC Public Health 2018; 18:966. [PMID: 30075768 PMCID: PMC6090754 DOI: 10.1186/s12889-018-5906-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 07/26/2018] [Indexed: 11/21/2022] Open
Abstract
Background Physical inactivity (PIA) is an important risk factor for many chronic conditions and therefore might increase healthcare utilization and costs. This study aimed to analyze the association of PIA using device assessed and self-reported physical activity (PA) data with direct healthcare costs. Methods Cross-sectional data was retrieved from the population based KORA FF4 study (Cooperative Health Research in the Region of Augsburg) that was conducted in southern Germany from 2013 to 2014 (n = 2279). Self-reported PA was assessed with two questions regarding sports related PA in summer and winter and categorized into “high activity”, “moderate activity”, “low activity” and “no activity”. In a subsample (n = 477), PA was assessed with accelerometers and participants were categorized into activity quartiles (“very high”, “high”, “low” and “very low”) according to their mean minutes per day spent in light intensity, or in moderate-vigorous PA (MVPA). Self-reported healthcare utilization was used to estimate direct healthcare costs. We regressed direct healthcare costs on PA using a two-part gamma regression, adjusted for age, sex and socio-demographic variables. Additional models, including and excluding potential additional confounders and effect mediators were used to check the robustness of the results. Results Annual direct healthcare costs of individuals who reported no sports PA did not differ from those who reported high sports PA [+€189, 95% CI: -188, 598]. In the subsample with accelerometer data, participants with very low MVPA had significantly higher annual costs than participants with very high MVPA [+€986, 95% CI: 15, 1982]. Conclusion Device assessed but not self-reported PIA was associated with higher direct healthcare costs. The magnitude and significance of the association depended on the choice of covariates in the regression models. Larger studies with device assessed PA and longitudinal design are needed to be able to better quantify the impact of PIA on direct healthcare costs. Electronic supplementary material The online version of this article (10.1186/s12889-018-5906-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Florian M Karl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr.1, 85764, Neuherberg, Germany.
| | - Maximilian Tremmel
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr.1, 85764, Neuherberg, Germany.,Institute for Medical Information Processing, Biometrics and Epidemiology (IBE), Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Agnes Luzak
- Institute of Epidemiology I, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr.1, 85764, Neuherberg, Germany
| | - Holger Schulz
- Institute of Epidemiology I, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr.1, 85764, Neuherberg, Germany
| | - Annette Peters
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr.1, 85764, Neuherberg, Germany
| | - Christa Meisinger
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr.1, 85764, Neuherberg, Germany
| | - Rolf Holle
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr.1, 85764, Neuherberg, Germany
| | - Michael Laxy
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr.1, 85764, Neuherberg, Germany
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Yang K, Baniak LM, Imes CC, Choi J, Chasens ER. Perceived Versus Actual Risk of Type 2 Diabetes by Race and Ethnicity. THE DIABETES EDUCATOR 2018; 44:269-277. [PMID: 29661088 DOI: 10.1177/0145721718770983] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
Purpose The purpose of this study was to examine associations between perceived risk and actual risk of type 2 diabetes by race and/or ethnicity. Methods The study sample included 10 999 adults from the 2011 to 2014 National Health and Nutrition Examination Survey. Sociodemographic, clinical, and behavioral data were collected using interviews and physical examinations. Participants were asked if they felt at risk for diabetes or prediabetes and then asked the reasons why. Data analyses were conducted with SAS to properly analyze complex survey data. Results About 86% of the sample (n = 9496) answered the risk perception question for diabetes, and among those, 28.4% indicated having a high perceived risk. Among this subsample, 38.3% were identified as having an actual risk for prediabetes or diabetes according to the American Diabetes Association guidelines. Across all race groups, the most frequently reported risk factors participants believed to contribute to their risk for diabetes were family history of diabetes, obesity, and poor diet habits. When the percentage of participants with an actual risk factor who correctly perceived it as a risk factor was examined, fewer Asians correctly perceived weight status and physical activity level as a risk for diabetes in contrast to the other racial/ethnic groups. Conclusions Our study showed that when perception was compared to actual risks, associations differed statistically by race. It will be essential to discuss their risk perception to proper screening for diabetes and relevant lifestyle modifications to prevent and delay the onset of diabetes.
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Affiliation(s)
- Kyeongra Yang
- School of Nursing, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Lynn M Baniak
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - JiYeon Choi
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Eileen R Chasens
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
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Ziegler D, Landgraf R, Lobmann R, Reiners K, Rett K, Schnell O, Strom A. Painful and painless neuropathies are distinct and largely undiagnosed entities in subjects participating in an educational initiative (PROTECT study). Diabetes Res Clin Pract 2018. [PMID: 29518491 DOI: 10.1016/j.diabres.2018.02.043] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
AIMS We conducted a nationwide educational initiative to determine the prevalence and risk factors of diagnosed and undiagnosed painful and painless distal sensory polyneuropathy (DSPN). METHODS Among 1850 participants, 781 had no history of diabetes (ND), 126 had type 1 diabetes (T1D), and 943 had type 2 diabetes (T2D). Painful DSPN was defined as polyneuropathy detected by bedside tests with pain and/or burning in the feet, while painless DSPN was defined as polyneuropathy with paresthesias, numbness, or absence of symptoms. RESULTS DSPN was detected in 48.2% of ND, 44.3% of T1D, and 55.3% of T2D subjects. DSPN was painful, painless, or atypical in 62.1, 24.8, and 13.1% of the participants. Painful DSPN was more severe than painless DSPN. Painful and painless DSPN were previously undiagnosed in 61.5 and 81.1% of the participants, respectively. In T2D subjects, painful and painless DSPN were associated with a higher and lower BMI, respectively. Among ND participants 39.2% had HbA1c levels indicating prediabetes/diabetes. CONCLUSIONS Around half of participants in an educational initiative had DSPN, 62% of whom had the painful entity that correlated with BMI in T2D. Since many cases of neuropathy and diabetes remain undiagnosed, effective strategies to timely detect both conditions should be implemented.
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Affiliation(s)
- Dan Ziegler
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany; Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.
| | | | - Ralf Lobmann
- Clinic for Endocrinology, Diabetology and Geriatrics, Klinikum Stuttgart - Bad Cannstatt, Stuttgart, Germany
| | | | | | - Oliver Schnell
- Forschergruppe Diabetes e.V. at the Helmholtz Center Munich, Neuherberg, Germany
| | - Alexander Strom
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
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Risøy AJ, Kjome RLS, Sandberg S, Sølvik UØ. Risk assessment and HbA1c measurement in Norwegian community pharmacies to identify people with undiagnosed type 2 diabetes - A feasibility study. PLoS One 2018; 13:e0191316. [PMID: 29474501 PMCID: PMC5825028 DOI: 10.1371/journal.pone.0191316] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 01/03/2018] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Determine the feasibility of using a diabetes risk assessment tool followed by HbA1c-measurement in a community-pharmacy setting in Norway. METHODS In this longitudinal study two pharmacists in each of three community pharmacies were trained to perform risk assessments, HbA1c-measurements and counselling. Pharmacy customers who were > 18 years old and could understand and speak Norwegian or English were recruited in the pharmacies during a two-months-period. Information about the service was presented in local newspapers, social media, leaflets and posters at the pharmacy. Customers wishing to participate contacted the pharmacy staff. Participants completed a validated diabetes risk test and a background questionnaire including a validated instrument for self-rated health. A HbA1c measurement was performed for individuals with a moderate to high risk of developing diabetes. If HbA1c ≥ 6.5% they were recommended to visit their general practitioner for follow-up. The pharmacies performed internal and external quality control of the HbA1c instrument. RESULTS Of the 211 included participants 97 (46%) were > 50 years old. HbA1c was measured for the 47 participants (22%) with high risk. Thirty-two (15%) had HbA1c values < 5.7%, twelve (5.4%) had values between 5.7%-6.4%, and three (1.4%) had an HbA1c ≥ 6.5%. Two participants with HbA1 ≥ 6.5% were diagnosed with diabetes by their general practitioner. The third was lost to follow-up. Results from internal and external quality control for HbA1c were within set limits. CONCLUSION The pharmacists were able to perform the risk assessment and measurement of HbA1c, and pharmacy customers were willing to participate. The HbA1c measurements fulfilled the requirements for analytical quality. Thus, it is feasible to implement this service in community pharmacies in Norway. In a large-scale study the inclusion criteria should be increased to 45 years in accordance with the population the risk test has been validated for.
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Affiliation(s)
- Aslaug Johanne Risøy
- Department of Global Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
- Centre for pharmacy, Faculty of Medicine, University of Bergen, Bergen, Norway
- * E-mail:
| | - Reidun Lisbet Skeide Kjome
- Department of Global Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
- Centre for pharmacy, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Sverre Sandberg
- Department of Global Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
- Norwegian Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
- Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway
| | - Una Ørvim Sølvik
- Department of Global Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
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Lintelmann J, Wu X, Kuhn E, Ritter S, Schmidt C, Zimmermann R. Detection of monohydroxylated polycyclic aromatic hydrocarbons in urine and particulate matter using LC separations coupled with integrated SPE and fluorescence detection or coupled with high-resolution time-of-flight mass spectrometry. Biomed Chromatogr 2018; 32:e4183. [DOI: 10.1002/bmc.4183] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 11/10/2017] [Accepted: 12/15/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Jutta Lintelmann
- Joint Mass Spectrometry Centre, Cooperation Group ‘Comprehensive Molecular Analytics’; Helmholtz Zentrum München GmbH; Neuherberg Germany
| | - Xiao Wu
- Joint Mass Spectrometry Centre, Cooperation Group ‘Comprehensive Molecular Analytics’; Helmholtz Zentrum München GmbH; Neuherberg Germany
| | - Evelyn Kuhn
- Joint Mass Spectrometry Centre, Cooperation Group ‘Comprehensive Molecular Analytics’; Helmholtz Zentrum München GmbH; Neuherberg Germany
| | - Sebastian Ritter
- Joint Mass Spectrometry Centre, Cooperation Group ‘Comprehensive Molecular Analytics’; Helmholtz Zentrum München GmbH; Neuherberg Germany
| | - Claudia Schmidt
- Institute of Epidemiology II; Helmholtz Zentrum München GmbH; Neuherberg Germany
| | - Ralf Zimmermann
- Joint Mass Spectrometry Centre, Cooperation Group ‘Comprehensive Molecular Analytics’; Helmholtz Zentrum München GmbH; Neuherberg Germany
- Joint Mass Spectrometry Centre, Institute of Chemistry, Chair of Analytical Chemistry; University of Rostock; Rostock Germany
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