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Wang S, Shen J, Koh WP, Yuan JM, Gao X, Peng Y, Xu Y, Shi S, Huang Y, Dong Y, Zhong VW. Comparison of race- and ethnicity-specific BMI cutoffs for categorizing obesity severity: a multicountry prospective cohort study. Obesity (Silver Spring) 2024; 32:1958-1966. [PMID: 39223976 PMCID: PMC11421961 DOI: 10.1002/oby.24129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 07/03/2024] [Accepted: 07/03/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE The objective of this study was to compare race- and ethnicity-specific BMI cutoffs for the three classes of obesity based on equivalent risk of type 2 diabetes (T2D). METHODS Participants without T2D were included from the UK Biobank, the China Health and Nutrition Survey, and the Singapore Chinese Health Study. Poisson regressions with restricted cubic splines were applied to determine BMI cutoffs for each non-White race and ethnicity for equivalent incidence rates of T2D at BMI values of 30.0, 35.0, and 40.0 kg/m2 in White adults. RESULTS During a median follow-up of 13.8 years among 507,763 individuals, 5.2% developed T2D. In women, BMI cutoffs for an equivalent incidence rate of T2D as observed at 40.0 kg/m2 in White adults were 31.6 kg/m2 in Black, 29.2 kg/m2 in British Chinese, 27.3 kg/m2 in South Asian, 26.9 kg/m2 in Native Chinese, and 25.1 kg/m2 in Singapore Chinese adults. In men, the corresponding BMI cutoffs were 31.9 kg/m2 in Black, 30.6 kg/m2 in British Chinese, 29.0 kg/m2 in South Asian, 29.6 kg/m2 in Native Chinese, and 27.6 kg/m2 in Singapore Chinese adults. The race and ethnicity order was consistent when equivalent BMI cutoffs were estimated for class I and II obesity. CONCLUSIONS Establishing a race- and ethnicity-tailored classification of the three classes of obesity is urgently needed.
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Affiliation(s)
- Sujing Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Shen
- Medical Records and Statistics Office, Shanghai Sixth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Woon-Puay Koh
- Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jian-Min Yuan
- UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Xiang Gao
- Department of Nutrition and Food Hygiene, School of Public Health, Institute of Nutrition, Fudan University, Shanghai, China
| | - Yinshun Peng
- Department of Nutrition and Food Hygiene, School of Public Health, Institute of Nutrition, Fudan University, Shanghai, China
| | - Yaqing Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuxiao Shi
- Department of Epidemiology and Biostatistics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yue Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Dong
- Department of Epidemiology and Biostatistics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Victor W Zhong
- Department of Epidemiology and Biostatistics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Kibirige D, Olum R, Kyazze AP, Morgan B, Bongomin F, Lumu W, Nyirenda MJ. Differential manifestation of type 2 diabetes in Black Africans and White Europeans with recently diagnosed type 2 diabetes: A systematic review. Diabetes Metab Syndr 2024; 18:103115. [PMID: 39244907 DOI: 10.1016/j.dsx.2024.103115] [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: 04/04/2024] [Revised: 09/02/2024] [Accepted: 09/03/2024] [Indexed: 09/10/2024]
Abstract
AIMS The clinical manifestation of type 2 diabetes (T2D) varies across populations. We compared the phenotypic characteristics of Black Africans and White Europeans with recently diagnosed T2D to understand the ethnic differences in the manifestation of T2D. METHODS We searched Medline, EMBASE, CINAHL, Google Scholar, African Index Medicus, and Global Health for studies reporting information on phenotypic characteristics in Black Africans and White Europeans with recently diagnosed T2D. RESULTS A total of 28 studies were included in this systematic review (14 studies conducted on 2586 Black Africans in eight countries and 14 studies conducted on 279,621 White Europeans in nine countries). Compared with White Europeans, Black Africans had a lower pooled mean (95 % confidence interval) age (51.5 [48.5-54.4] years vs. 60.2 [57.9-62.6] years), body mass index (27.0 [24.2-29.8] kg/m2 vs. 31.3 [30.5-32.1] kg/m2), and a higher pooled median glycated haemoglobin (9.0 [8.0-10.3]% vs. 7.1 [6.7-7.7]%). Ugandan and Tanzanian participants had lower markers of beta-cell function and insulin resistance when compared with four White European populations. CONCLUSION These findings provide evidence of the ethnic differences in the manifestation of T2D, underscoring the importance of understanding the underlying factors influencing these differences and formulating ethnic-specific approaches for managing and preventing T2D.
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Affiliation(s)
- Davis Kibirige
- Non-Communicable Diseases Program, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda; Department of Medicine, Uganda Martyrs Hospital Lubaga, Kampala, Uganda.
| | - Ronald Olum
- School of Public Health, College of Health Sciences, Makerere University Kampala, Uganda
| | - Andrew Peter Kyazze
- Department of Medicine, College of Health Sciences, Makerere University Kampala, Uganda
| | - Bethan Morgan
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Felix Bongomin
- Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - William Lumu
- Department of Medicine, Mengo Hospital, Kampala, Uganda
| | - Moffat J Nyirenda
- Non-Communicable Diseases Program, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda; Department of Non-Communicable Diseases Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, UK
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3
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Chen P, Sun Q, Xu L, Li F, Liu H. Patients with type 2 diabetes who achieve reduced postprandial glucose levels during insulin intensive therapy may have a better recovery of β-cell function. Diabetes Res Clin Pract 2024; 215:111805. [PMID: 39102987 DOI: 10.1016/j.diabres.2024.111805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/29/2024] [Accepted: 07/30/2024] [Indexed: 08/07/2024]
Abstract
OBJECTIVES To explore parameters that may determine the improvement in C-peptide levels in patients with type 2 diabetes (T2D) receiving continuous subcutaneous insulin infusion (CSII) therapy. METHODS The trial included a lead-in period for collecting baseline parameters and correcting hyperglycemia, a 4-day CGM period, and a 2-3 weeks treatment period. After screening, patients were hospitalized and randomized to the metformin add-on NovoRapid group or the Prandilin group. Once the glycemic target was reached, all patients underwent a 4-day CGM, with treatments maintained for 2-3 weeks. OGTTs were performed at baseline and endpoint. The primary endpoint was identifying factors contributing to better β-cell function recovery after CSII therapy. RESULTS A total of 99 recruited patients were admitted as inpatients and achieved glycemic control within 3.8 ± 1.1 days. Of these, 83 (84 %) patients showed improvement in C-peptide levels, while 16 (16 %) did not show any change in C-peptide levels at the endpoint. Pearson analysis showed a negative correlation between the incremental AUC of glucose concentration (from 0700 to 1000) and the increase in incremental AUC of C-peptide levels (r = -0.199, P < 0.05). CONCLUSIONS Drug-naïve T2D patients with lower postprandial glucose concentration during CSII therapy exhibit better β-cell function recovery.
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Affiliation(s)
- Ping Chen
- Department of Endocrinology, Honghua Community Health Service Center, Nanjing, China
| | - Qi Sun
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Liying Xu
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Fengfei Li
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
| | - Hao Liu
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
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McLaren J, Gao X, Ghouri N, Freeman DJ, Richardson J, Sattar N, Gill JMR. Weight gain leads to greater adverse metabolic responses in South Asian compared with white European men: the GlasVEGAS study. Nat Metab 2024; 6:1632-1645. [PMID: 39152223 DOI: 10.1038/s42255-024-01101-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 07/09/2024] [Indexed: 08/19/2024]
Abstract
South Asians (SAs) develop type 2 diabetes at lower body mass index values than white Europeans (WEs). This basic human experimental study aimed to compare the metabolic consequences of weight gain in SA and WE men without overweight or obesity. Fourteen SAs and 21 WEs had assessments of body composition, metabolic responses to mixed-meal ingestion, cardiorespiratory fitness and physical activity, and a subcutaneous abdominal adipose tissue biopsy, before and after 4-6 weeks of overfeeding to induce 5-7% weight gain. Here we show that body mass index and whole-body adipose tissue volume increases similarly between ethnic groups, but SAs gain less lean tissue. SAs experience a substantially greater decrease in insulin sensitivity compared with WEs (38% versus 7% decrease, P = 0.009), have fewer small (37.1% versus 60.0%, P = 0.003) and more large (26.2% versus 9.1%, P = 0.005) adipocytes at baseline and have a smaller decrease in very small adipocytes with weight gain (-0.1% versus -1.9%, P < 0.0001). Ethnic differences in adipocyte morphology are associated with SA's greater adverse metabolic changes with weight gain. ClinicalTrials.gov registration: NCT02399423 .
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Affiliation(s)
- James McLaren
- School of Cardiovascular and Metabolic Health, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Xuan Gao
- School of Cardiovascular and Metabolic Health, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Nazim Ghouri
- School of Cardiovascular and Metabolic Health, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
- Department of General Medicine, Queen Elizabeth University Hospital, Glasgow, UK
| | - Dilys J Freeman
- School of Cardiovascular and Metabolic Health, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Janice Richardson
- School of Cardiovascular and Metabolic Health, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Jason M R Gill
- School of Cardiovascular and Metabolic Health, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
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5
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Lean ME, Leslie WS, Barnes AC, Brosnahan N, Thom G, McCombie L, Kelly T, Irvine K, Peters C, Zhyzhneuskaya S, Hollingsworth KG, Adamson AJ, Sniehotta FF, Mathers JC, McIlvenna Y, Welsh P, McConnachie A, McIntosh A, Sattar N, Taylor R. 5-year follow-up of the randomised Diabetes Remission Clinical Trial (DiRECT) of continued support for weight loss maintenance in the UK: an extension study. Lancet Diabetes Endocrinol 2024; 12:233-246. [PMID: 38423026 DOI: 10.1016/s2213-8587(23)00385-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 12/11/2023] [Accepted: 12/20/2023] [Indexed: 03/02/2024]
Abstract
BACKGROUND In DiRECT, a randomised controlled effectiveness trial, weight management intervention after 2 years resulted in mean weight loss of 7·6 kg, with 36% of participants in remission of type 2 diabetes. Of 36 in the intervention group who maintained over 10 kg weight loss at 2 years, 29 (81%) were in remission. Continued low-intensity dietary support was then offered up to 5 years from baseline to intervention participants, aiming to maintain weight loss and gain clinical benefits. This extension study was designed to provide observed outcomes at 5 years. METHODS The DiRECT trial took place in primary care practices in the UK. Participants were individuals aged 20-65 years who had less than 6 years' duration of type 2 diabetes, a BMI greater than 27 kg/m2, and were not on insulin. The intervention consisted of withdrawal of antidiabetic and antihypertensive drugs, total diet replacement (825-853 kcal per day formula diet for 12-20 weeks), stepped food reintroduction (2-8 weeks), and then structured support for weight-loss maintenance. After sharing the 2-year results with all participants, UK National Health Service data were collected annually until year 5 from remaining intervention participants who received low-intensity dietary support, intervention withdrawals, and the original randomly allocated groups. The primary outcome was remission of type 2 diabetes; having established in the DiRECT trial that sustained weight loss was the dominant driver of remission, this was assumed for the Extension study. The trial is registered with the ISRCTN registry, number 03267836. FINDINGS Between July 25, 2014, and Aug 5, 2016, 149 participants were randomly assigned to the intervention group and 149 were assigned to the control group in the original DiRECT study. After 2 years, all intervention participants still in the trial (101 [68%] of 149) were approached to receive low-intensity support for a further 3 years. 95 (94%) of 101 were able to continue and consented and were allocated to the DiRECT extension group. 54 participants were allocated to the non-extension group, where intervention was withdrawn. At 5 years, DiRECT extension participants (n=85) lost an average of 6·1 kg, with 11 (13%) of 85 in remission. Compared with the non-extension group, DiRECT extension participants had more visits with HbA1c <48 mmol/mol (<6·5%; 36% vs 17%, p=0·0004), without glucose-lowering medication (62% vs 30%, p<0·0001), and in remission (34% vs 12%, p<0·0001). Original control participants (n=149) had mean weight loss 4·6 kg (n=82), and 5 (5%) of 93 were in remission. Compared with control participants, original intervention participants had more visits with weight more than 5% below baseline (61% vs 29%, p<0·0001), HbA1c below 48 mmol/mol (29% vs 15%, p=0·0002), without antidiabetic medication (51% vs 16%, p<0·0001), and in remission (27% vs 4%, p<0·0001). Of those in remission at year 2, 26% remained in remission at 5 years. Serious adverse events in the original intervention group (4·8 events per 100 patient-years) were under half those in the control group (10·2 per 100 patient-years, p=0·0080). INTERPRETATION The extended DiRECT intervention was associated with greater aggregated and absolute weight loss, and suggested improved health status over 5 years. FUNDING Diabetes UK.
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Affiliation(s)
- Michael Ej Lean
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
| | - Wilma S Leslie
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Alison C Barnes
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK; Human Nutrition Research and Exercise Centre, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Naomi Brosnahan
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK; Counterweight, London, UK
| | - George Thom
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Louise McCombie
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Tara Kelly
- Newcastle Magnetic Resonance Centre, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Keaton Irvine
- Newcastle Magnetic Resonance Centre, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Carl Peters
- Newcastle Magnetic Resonance Centre, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Sviatlana Zhyzhneuskaya
- Newcastle Magnetic Resonance Centre, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Kieren G Hollingsworth
- Newcastle Magnetic Resonance Centre, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Ashley J Adamson
- Human Nutrition Research and Exercise Centre, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Falko F Sniehotta
- Centre for Preventive Medicine and Digital Health (CPD), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - John C Mathers
- Human Nutrition Research and Exercise Centre, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Yvonne McIlvenna
- General Practice and Primary Care, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Paul Welsh
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alasdair McIntosh
- Robertson Centre for Biostatistics, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Roy Taylor
- Newcastle Magnetic Resonance Centre, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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Smith K, Deutsch AJ, McGrail C, Kim H, Hsu S, Huerta-Chagoya A, Mandla R, Schroeder PH, Westerman KE, Szczerbinski L, Majarian TD, Kaur V, Williamson A, Zaitlen N, Claussnitzer M, Florez JC, Manning AK, Mercader JM, Gaulton KJ, Udler MS. Multi-ancestry polygenic mechanisms of type 2 diabetes. Nat Med 2024; 30:1065-1074. [PMID: 38443691 PMCID: PMC11175990 DOI: 10.1038/s41591-024-02865-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/06/2024] [Indexed: 03/07/2024]
Abstract
Type 2 diabetes (T2D) is a multifactorial disease with substantial genetic risk, for which the underlying biological mechanisms are not fully understood. In this study, we identified multi-ancestry T2D genetic clusters by analyzing genetic data from diverse populations in 37 published T2D genome-wide association studies representing more than 1.4 million individuals. We implemented soft clustering with 650 T2D-associated genetic variants and 110 T2D-related traits, capturing known and novel T2D clusters with distinct cardiometabolic trait associations across two independent biobanks representing diverse genetic ancestral populations (African, n = 21,906; Admixed American, n = 14,410; East Asian, n =2,422; European, n = 90,093; and South Asian, n = 1,262). The 12 genetic clusters were enriched for specific single-cell regulatory regions. Several of the polygenic scores derived from the clusters differed in distribution among ancestry groups, including a significantly higher proportion of lipodystrophy-related polygenic risk in East Asian ancestry. T2D risk was equivalent at a body mass index (BMI) of 30 kg m-2 in the European subpopulation and 24.2 (22.9-25.5) kg m-2 in the East Asian subpopulation; after adjusting for cluster-specific genetic risk, the equivalent BMI threshold increased to 28.5 (27.1-30.0) kg m-2 in the East Asian group. Thus, these multi-ancestry T2D genetic clusters encompass a broader range of biological mechanisms and provide preliminary insights to explain ancestry-associated differences in T2D risk profiles.
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Affiliation(s)
- Kirk Smith
- Diabetes Unit, Endocrine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Aaron J Deutsch
- Diabetes Unit, Endocrine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Carolyn McGrail
- Biomedical Sciences Graduate Program, University of California, San Diego, La Jolla, CA, USA
| | - Hyunkyung Kim
- Diabetes Unit, Endocrine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Committee on Genetics, Genomics and Systems Biology, University of Chicago, Chicago, IL, USA
- Section of Genetic Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Sarah Hsu
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Alicia Huerta-Chagoya
- Diabetes Unit, Endocrine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Ravi Mandla
- Diabetes Unit, Endocrine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Philip H Schroeder
- Diabetes Unit, Endocrine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Kenneth E Westerman
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Lukasz Szczerbinski
- Diabetes Unit, Endocrine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
- Clinical Research Centre, Medical University of Bialystok, Bialystok, Poland
| | - Timothy D Majarian
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA
- Vertex Pharmaceuticals, Boston, MA, USA
| | - Varinderpal Kaur
- Diabetes Unit, Endocrine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Alice Williamson
- Precision Healthcare University Research Institute, Queen Mary University of London, London, UK
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Noah Zaitlen
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Computational Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Human Genetics, University of California, Los Angeles, Los Angeles, CA, USA
| | - Melina Claussnitzer
- Diabetes Unit, Endocrine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Novo Nordisk Foundation Center for Genomic Mechanisms of Disease, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Jose C Florez
- Diabetes Unit, Endocrine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Alisa K Manning
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Josep M Mercader
- Diabetes Unit, Endocrine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Kyle J Gaulton
- Department of Pediatrics, University of California, San Diego, San Diego, CA, USA
| | - Miriam S Udler
- Diabetes Unit, Endocrine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA.
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Department of Medicine, Harvard Medical School, Boston, MA, USA.
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7
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Venkatesan U, Amutha A, Jones AG, Shields BM, Anjana RM, Unnikrishnan R, Mappillairaju B, Mohan V. Performance of European prediction models for classification of type 1 and type 2 diabetes in Indians. Diabetes Metab Syndr 2024; 18:103007. [PMID: 38636306 DOI: 10.1016/j.dsx.2024.103007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 03/15/2024] [Accepted: 04/07/2024] [Indexed: 04/20/2024]
Abstract
AIM We aimed to determine the performance of European prediction models in an Indian population to classify type 1 diabetes(T1D) and type 2 diabetes(T2D). METHODS We assessed discrimination and calibration of published models of diabetes classification, using retrospective data from electronic medical records of 83309 participants aged 18-50 years living in India. Diabetes type was defined based on C-peptide measurement and early insulin requirement. Models assessed combinations of clinical measurements: age at diagnosis, body mass index(mean = 26.6 kg/m2), sex(male = 64.9 %), Glutamic acid decarboxylase(GAD) antibody, serum cholesterol, serum triglycerides, and high-density lipoprotein(HDL) cholesterol. RESULTS 67955 participants met inclusion criteria, of whom 0.8 % had T1D, which was markedly lower than model development cohorts. Model discrimination for clinical features was broadly similar in our Indian cohort compared to the European cohort: area under the receiver operating characteristic curve(AUC ROC) was 0.90 vs. 0.90 respectively, but was lower in the subset of young participants with measured GAD antibodies(n = 2404): and an AUC ROC of 0.87 when clinical features, sex, lipids and GAD antibodies were combined. All models substantially overestimated the likelihood of T1D, reflecting the lower prevalence of T1D in the Indian population. However, good model performance was achieved after recalibration by updating the model intercept and slope. CONCLUSION Models for diabetes classification maintain the discrimination of T1D and T2D in this Indian population, where T2D is far more common, but require recalibration to obtain appropriate model probabilities. External validation and recalibration are needed before these tools can be used in non-European populations.
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Affiliation(s)
- Ulagamadesan Venkatesan
- Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India; School of Public Health, SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu, India.
| | | | - Angus G Jones
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, EX2 5DW, UK
| | - Beverley M Shields
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, EX2 5DW, UK
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India; Dr. Mohan's Diabetes Specialties Centre, Chennai, Tamil Nadu, India
| | - Ranjit Unnikrishnan
- Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India; Dr. Mohan's Diabetes Specialties Centre, Chennai, Tamil Nadu, India
| | - Bagavandas Mappillairaju
- Centre for Statistics, SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu, India
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India; Dr. Mohan's Diabetes Specialties Centre, Chennai, Tamil Nadu, India
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8
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Su D, Yang H, Chen Z, Kong Y, Na X, Lin Q, Zhao A, Zheng Y, Ma Y, Li X, Li Z. Ethnicity-specific blood pressure thresholds based on cardiovascular and renal complications: a prospective study in the UK Biobank. BMC Med 2024; 22:54. [PMID: 38317131 PMCID: PMC10845677 DOI: 10.1186/s12916-024-03259-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 01/15/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND The appropriateness of hypertension thresholds for triggering action to prevent cardiovascular and renal complications among non-White populations in the UK is subject to question. Our objective was to establish ethnicity-specific systolic blood pressure (SBP) cutoffs for ethnic minority populations and assess the efficacy of these ethnicity-specific cutoffs in predicting adverse outcomes. METHODS We analyzed data from UK Biobank, which included 444,418 participants from White, South Asian, Black Caribbean, and Black African populations with no history of cardiorenal complications. We fitted Poisson regression models with continuous SBP and ethnic groups, using Whites as the referent category, for the composite outcome of atherosclerotic cardiovascular disease, heart failure, and chronic kidney disease. We determined ethnicity-specific thresholds equivalent to the risks observed in Whites at SBP levels of 120, 130, and 140 mm Hg. We adjusted models for clinical characteristics, sociodemographic factors, and behavioral factors. The performance of ethnicity-specific thresholds for predicting adverse outcomes and associated population-attributable fraction (PAF) was assessed in ethnic minority groups. RESULTS After a median follow-up of 12.5 years (interquartile range, 11.7-13.2), 32,662 (7.4%) participants had incident composite outcomes. At any given SBP, the predicted incidence rate of the composite outcome was the highest for South Asians, followed by White, Black Caribbean, and Black African. For an equivalent risk of outcomes observed in the White population at an SBP level of 140 mm Hg, the SBP threshold was lower for South Asians (123 mm Hg) and higher for Black Caribbean (156 mm Hg) and Black African (165 mm Hg). Furthermore, hypertension defined by ethnicity-specific thresholds was a stronger predictor and resulted in a larger PAF for composite outcomes in South Asians (21.5% [95% CI, 2.4,36.9] vs. 11.3% [95% CI, 2.6,19.1]) and Black Africans (7.1% [95% CI, 0.2,14.0] vs. 5.7 [95% CI, -16.2,23.5]) compared to hypertension defined by guideline-recommended thresholds. CONCLUSIONS Guideline-recommended blood pressure thresholds may overestimate risks for the Black population and underestimate risks for South Asians. Using ethnicity-specific SBP thresholds may improve risk estimation and optimize hypertension management toward the goal of eliminating ethnic disparities in cardiorenal complications.
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Affiliation(s)
- Donghan Su
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Huanhuan Yang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Zekun Chen
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Yuhao Kong
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Xiaona Na
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Queran Lin
- Clinical Research Design Division, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ai Zhao
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Yan Zheng
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, China
| | - Yanan Ma
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Shenyang, China
| | - Xiaoyu Li
- Department of Sociology, Tsinghua University, Beijing, China
| | - Zhihui Li
- Vanke School of Public Health, Tsinghua University, Beijing, China.
- Institute for Healthy China, Tsinghua University, Beijing, China.
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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9
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Thomas P, Gallagher MT, Da Silva Xavier G. Beta cell lipotoxicity in the development of type 2 diabetes: the need for species-specific understanding. Front Endocrinol (Lausanne) 2023; 14:1275835. [PMID: 38144558 PMCID: PMC10739424 DOI: 10.3389/fendo.2023.1275835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/13/2023] [Indexed: 12/26/2023] Open
Abstract
The propensity to develop type 2 diabetes (T2D) is known to have both environmental and hereditary components. In those with a genetic predisposition to T2D, it is widely believed that elevated concentrations of circulatory long-chain fatty acids (LC-FFA) significantly contribute towards the demise of insulin-producing pancreatic β-cells - the fundamental feature of the development of T2D. Over 25 years of research support that LC-FFA are deleterious to β-cells, through a process termed lipotoxicity. However, the work underpinning the theory of β-cell lipotoxicity is mostly based on rodent studies. Doubts have been raised as to whether lipotoxicity also occurs in humans. In this review, we examine the evidence, both in vivo and in vitro, for the pathogenic effects of LC-FFA on β-cell viability and function in humans, highlighting key species differences. In this way, we aim to uncover the role of lipotoxicity in the human pathogenesis of T2D and motivate the need for species-specific understanding.
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Affiliation(s)
- Patricia Thomas
- Centre for Systems Modelling and Quantitative Biomedicine, University of Birmingham, Birmingham, United Kingdom
- Institute for Metabolism and Systems Research, Birmingham Medical School, University of Birmingham, Birmingham, United Kingdom
| | - Meurig T. Gallagher
- Centre for Systems Modelling and Quantitative Biomedicine, University of Birmingham, Birmingham, United Kingdom
- Institute for Metabolism and Systems Research, Birmingham Medical School, University of Birmingham, Birmingham, United Kingdom
| | - Gabriela Da Silva Xavier
- Institute for Metabolism and Systems Research, Birmingham Medical School, University of Birmingham, Birmingham, United Kingdom
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10
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Reed RM, Whyte MB, Goff LM. Cardiometabolic disease in Black African and Caribbean populations: an ethnic divergence in pathophysiology? Proc Nutr Soc 2023:1-11. [PMID: 38230432 DOI: 10.1017/s0029665123004895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
In the UK, populations of Black African and Caribbean (BAC) ethnicity suffer higher rates of cardiometabolic disease than White Europeans (WE). Obesity, leading to increased visceral adipose tissue (VAT) and intrahepatic lipid (IHL), has long been associated with cardiometabolic risk, driving insulin resistance and defective fatty acid/lipoprotein metabolism. These defects are compounded by a state of chronic low-grade inflammation, driven by dysfunctional adipose tissue. Emerging evidence has highlighted associations between central complement system components and adipose tissue, fatty acid metabolism and inflammation; it may therefore sit at the intersection of various cardiometabolic disease risk factors. However, increasing evidence suggests an ethnic divergence in pathophysiology, whereby current theories fail to explain the high rates of cardiometabolic disease in BAC populations. Lower fasting and postprandial TAG has been reported in BAC, alongside lower VAT and IHL deposition, which are paradoxical to the high rates of cardiometabolic disease exhibited by this ethnic group. Furthermore, BAC have been shown to exhibit a more anti-inflammatory profile, with lower TNF-α and greater IL-10. In contrast, recent evidence has revealed greater complement activation in BAC compared to WE, suggesting its dysregulation may play a greater role in the high rates of cardiometabolic disease experienced by this population. This review outlines the current theories of how obesity is proposed to drive cardiometabolic disease, before discussing evidence for ethnic differences in disease pathophysiology between BAC and WE populations.
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Affiliation(s)
- Reuben M Reed
- Department of Nutritional Sciences, Faculty of Life Sciences & Medicine, King's College London, London SE1 9NH, UK
| | - Martin B Whyte
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey GU2 7WG, UK
| | - Louise M Goff
- Leicester Diabetes Research Centre, University of Leicester, Leicester, UK
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11
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Smith K, Deutsch AJ, McGrail C, Kim H, Hsu S, Mandla R, Schroeder PH, Westerman KE, Szczerbinski L, Majarian TD, Kaur V, Williamson A, Claussnitzer M, Florez JC, Manning AK, Mercader JM, Gaulton KJ, Udler MS. Multi-ancestry Polygenic Mechanisms of Type 2 Diabetes Elucidate Disease Processes and Clinical Heterogeneity. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.28.23296294. [PMID: 37808749 PMCID: PMC10557820 DOI: 10.1101/2023.09.28.23296294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
We identified genetic subtypes of type 2 diabetes (T2D) by analyzing genetic data from diverse groups, including non-European populations. We implemented soft clustering with 650 T2D-associated genetic variants, capturing known and novel T2D subtypes with distinct cardiometabolic trait associations. The twelve genetic clusters were distinctively enriched for single-cell regulatory regions. Polygenic scores derived from the clusters differed in distribution between ancestry groups, including a significantly higher proportion of lipodystrophy-related polygenic risk in East Asian ancestry. T2D risk was equivalent at a BMI of 30 kg/m2 in the European subpopulation and 24.2 (22.9-25.5) kg/m2 in the East Asian subpopulation; after adjusting for cluster-specific genetic risk, the equivalent BMI threshold increased to 28.5 (27.1-30.0) kg/m2 in the East Asian group, explaining about 75% of the difference in BMI thresholds. Thus, these multi-ancestry T2D genetic subtypes encompass a broader range of biological mechanisms and help explain ancestry-associated differences in T2D risk profiles.
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Affiliation(s)
- Kirk Smith
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Aaron J. Deutsch
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Carolyn McGrail
- Department of Pediatrics, University of California San Diego, San Diego, CA, USA
| | - Hyunkyung Kim
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Committee on Genetics, Genomics and Systems Biology, University of Chicago, Chicago, IL, USA
- Section of Genetic Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Sarah Hsu
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Ravi Mandla
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Philip H. Schroeder
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Kenneth E. Westerman
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Lukasz Szczerbinski
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
- Clinical Research Centre, Medical University of Bialystok, Bialystok, Poland
| | - Timothy D. Majarian
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Varinderpal Kaur
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Alice Williamson
- Precision Healthcare University Research Institute, Queen Mary University of London, London, UK
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Melina Claussnitzer
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- The Novo Nordisk Foundation Center for Genomic Mechanisms of Disease, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Jose C. Florez
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Alisa K. Manning
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Josep M. Mercader
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Kyle J. Gaulton
- Department of Pediatrics, University of California San Diego, San Diego, CA, USA
| | - Miriam S. Udler
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
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12
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Krasuska M, Davidson EM, Beune E, Jenum AK, Gill JM, Stronks K, van Valkengoed IG, Diaz E, Sheikh A. A Culturally Adapted Diet and Physical Activity Text Message Intervention to Prevent Type 2 Diabetes Mellitus for Women of Pakistani Origin Living in Scotland: Formative Study. JMIR Form Res 2023; 7:e33810. [PMID: 37713245 PMCID: PMC10541642 DOI: 10.2196/33810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/20/2022] [Accepted: 01/31/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Individuals of South Asian origin are at an increased risk of developing type 2 diabetes mellitus (T2DM) compared with other ethnic minority groups. Therefore, there is a need to develop interventions to address, and reduce, this heightened risk. OBJECTIVE We undertook formative work to develop a culturally adapted diet and physical activity text message intervention to prevent T2DM for women of Pakistani origin living in Scotland. METHODS We used a stepwise approach that was informed by the Six Steps in Quality Intervention Development framework, which consisted of gathering evidence through literature review and focus groups (step 1), developing a program theory for the intervention (step 2), and finally developing the content of the text messages and an accompanying delivery plan (step 3). RESULTS In step 1, we reviewed 12 articles and identified 3 key themes describing factors impacting on diet and physical activity in the context of T2DM prevention: knowledge on ways to prevent T2DM through diet and physical activity; cultural, social, and gender norms; and perceived level of control and sense of inevitability over developing T2DM. The key themes that emerged from the 3 focus groups with a total of 25 women were the need for interventions to provide "friendly encouragement," "companionship," and a "focus on the individual" and also for the text messages to "set achievable goals" and include "information on cooking healthy meals." We combined the findings of the focus groups and literature review to create 13 guiding principles for culturally adapting the text messages. In step 2, we developed a program theory, which specified the main determinants of change that our text messages should aim to enhance: knowledge and skills, sense of control, goal setting and planning behavior, peer support, and norms and beliefs guiding behavior. In step 3, we used both the intervention program theory and guiding principles to develop a set of 73 text messages aimed at supporting a healthy diet and 65 text messages supporting increasing physical activity. CONCLUSIONS We present a theory-based approach to develop a culturally adapted diet and physical activity text message intervention to prevent T2DM for women of Pakistani origin living in Scotland. This study outlines an approach that may also be applicable to the development of interventions for other ethnic minority populations in diverse settings. There is now a need to build on this formative work and undertake a feasibility trial of a text message-based diet and physical activity intervention to prevent T2DM for women of Pakistani origin living in Scotland.
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Affiliation(s)
- Marta Krasuska
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Emma M Davidson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Erik Beune
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, Netherlands
| | - Anne Karen Jenum
- General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jason Mr Gill
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, Netherlands
| | - Irene Gm van Valkengoed
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, Netherlands
| | - Esperanza Diaz
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
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13
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Foster PJ, Atan D, Khawaja A, Lotery A, MacGillivray T, Owen CG, Patel PJ, Petzold A, Rudnicka A, Sun Z, Sheard S, Allen N. Cohort profile: rationale and methods of UK Biobank repeat imaging study eye measures to study dementia. BMJ Open 2023; 13:e069258. [PMID: 37355273 PMCID: PMC10314584 DOI: 10.1136/bmjopen-2022-069258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 05/22/2023] [Indexed: 06/26/2023] Open
Abstract
PURPOSE The retina provides biomarkers of neuronal and vascular health that offer promising insights into cognitive ageing, mild cognitive impairment and dementia. This article described the rationale and methodology of eye and vision assessments with the aim of supporting the study of dementia in the UK Biobank Repeat Imaging study. PARTICIPANTS UK Biobank is a large-scale, multicentre, prospective cohort containing in-depth genetic, lifestyle, environmental and health information from half a million participants aged 40-69 enrolled in 2006-2010 across the UK. A subset (up to 60 000 participants) of the cohort will be invited to the UK Biobank Repeat Imaging Study to collect repeated brain, cardiac and abdominal MRI scans, whole-body dual-energy X-ray absorptiometry, carotid ultrasound, as well as retinal optical coherence tomography (OCT) and colour fundus photographs. FINDINGS TO DATE UK Biobank has helped make significant advances in understanding risk factors for many common diseases, including for dementia and cognitive decline. Ophthalmic genetic and epidemiology studies have also benefited from the unparalleled combination of very large numbers of participants, deep phenotyping and longitudinal follow-up of the cohort, with comprehensive health data linkage to disease outcomes. In addition, we have used UK Biobank data to describe the relationship between retinal structures, cognitive function and brain MRI-derived phenotypes. FUTURE PLANS The collection of eye-related data (eg, OCT), as part of the UK Biobank Repeat Imaging study, will take place in 2022-2028. The depth and breadth and longitudinal nature of this dataset, coupled with its open-access policy, will create a major new resource for dementia diagnostic discovery and to better understand its association with comorbid diseases. In addition, the broad and diverse data available in this study will support research into ophthalmic diseases and various other health outcomes beyond dementia.
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Affiliation(s)
- Paul J Foster
- Moorfields Eye Hospital NHS Foundation Trust, NIHR Moorfields Biomedical Research Centre, London, UK
| | - Denize Atan
- Medical School, University of Bristol, Bristol, UK
| | - Anthony Khawaja
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, UK
| | - Andrew Lotery
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Tom MacGillivray
- Clinical Research Imaging Centre, Queens Medical Research Institution, Edinburgh, UK
| | - Christopher G Owen
- Population Health Research Institute, St Georges Medical School, University of London, London, UK
| | - Praveen J Patel
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Axel Petzold
- Department of Molecular Neurosciences, Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, UCL, London, UK
- Departments of Neurology, Ophthalmology and Expertise Center for Neuro-ophthalmology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Alicja Rudnicka
- Population Health Research Institute, St Georges Medical School, University of London, London, UK
| | - Zihan Sun
- Institute of Ophthalmology, University College London, London, UK
| | | | - Naomi Allen
- UK Biobank, Stockport, UK
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
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14
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Aas AM, Axelsen M, Churuangsuk C, Hermansen K, Kendall CWC, Kahleova H, Khan T, Lean MEJ, Mann JI, Pedersen E, Pfeiffer A, Rahelić D, Reynolds AN, Risérus U, Rivellese AA, Salas-Salvadó J, Schwab U, Sievenpiper JL, Thanopoulou A, Uusitupa EM. Evidence-based European recommendations for the dietary management of diabetes. Diabetologia 2023; 66:965-985. [PMID: 37069434 DOI: 10.1007/s00125-023-05894-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
Diabetes management relies on effective evidence-based advice that informs and empowers individuals to manage their health. Alongside other cornerstones of diabetes management, dietary advice has the potential to improve glycaemic levels, reduce risk of diabetes complications and improve health-related quality of life. We have updated the 2004 recommendations for the nutritional management of diabetes to provide health professionals with evidence-based guidelines to inform discussions with patients on diabetes management, including type 2 diabetes prevention and remission. To provide this update we commissioned new systematic reviews and meta-analyses on key topics, and drew on the broader evidence available. We have strengthened and expanded on the previous recommendations to include advice relating to dietary patterns, environmental sustainability, food processing, patient support and remission of type 2 diabetes. We have used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach to determine the certainty of evidence for each recommendation based on findings from the commissioned and identified systematic reviews. Our findings indicate that a range of foods and dietary patterns are suitable for diabetes management, with key recommendations for people with diabetes being largely similar for those for the general population. Important messages are to consume minimally processed plant foods, such as whole grains, vegetables, whole fruit, legumes, nuts, seeds and non-hydrogenated non-tropical vegetable oils, while minimising the consumption of red and processed meats, sodium, sugar-sweetened beverages and refined grains. The updated recommendations reflect the current evidence base and, if adhered to, will improve patient outcomes.
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15
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Vijayan M, Deshpande K, Anand S, Deshpande P. Risk Amplifiers for Vascular Disease and CKD in South Asians: When Intrinsic β-Cell Dysfunction Meets a High-Carbohydrate Diet. Clin J Am Soc Nephrol 2023; 18:681-688. [PMID: 36758530 PMCID: PMC10278793 DOI: 10.2215/cjn.0000000000000076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
South Asians, comprising almost one fourth of the world population, are at higher risk of type 2 diabetes mellitus, hypertension, cardiovascular disease, and CKD compared with other ethnic groups. This has major public health implications in South Asia and in other parts of the world to where South Asians have immigrated. The interplay of various modifiable and nonmodifiable risk factors confers this risk. Traditional models of cardiometabolic disease progression and CKD evaluation may not be applicable in this population with a unique genetic predisposition and phenotype. A wider understanding of dietary and lifestyle influences, genetic and metabolic risk factors, and the pitfalls of conventional equations estimating kidney function in this population are required in providing care for kidney diseases. Targeted screening of this population for metabolic and vascular risk factors and individualized management plan for disease management may be necessary. Addressing unhealthy dietary patterns, promoting physical activity, and medication management that adheres to cultural factors are crucial steps to mitigate the risk of cardiovascular disease and CKD in this population. In South Asian countries, a large rural and urban community-based multipronged approach using polypills and community health workers to decrease the incidence of these diseases may be cost-effective.
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Affiliation(s)
- Madhusudan Vijayan
- Barbara T. Murphy Division of Nephrology, Department of Medicine, Icahn School of Medicine at the Mount Sinai Hospital, New York, New York
- Institute for Critical Care Medicine, Icahn School of Medicine at the Mount Sinai Hospital, New York, New York
| | - Kavita Deshpande
- Department of Family Medicine, La Maestra Community Health Centers, San Diego, California
| | - Shuchi Anand
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Priya Deshpande
- Barbara T. Murphy Division of Nephrology, Department of Medicine, Icahn School of Medicine at the Mount Sinai Hospital, New York, New York
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16
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Hanyuda A, Goto A, Katagiri R, Koyanagi YN, Nakatochi M, Sutoh Y, Nakano S, Oze I, Ito H, Yamaji T, Sawada N, Iwagami M, Kadota A, Koyama T, Katsuura-Kamano S, Ikezaki H, Tanaka K, Takezaki T, Imoto I, Suzuki M, Momozawa Y, Takeuchi K, Narita A, Hozawa A, Kinoshita K, Shimizu A, Tanno K, Matsuo K, Tsugane S, Wakai K, Sasaki M, Yamamoto M, Iwasaki M. Investigating the association between glycaemic traits and colorectal cancer in the Japanese population using Mendelian randomisation. Sci Rep 2023; 13:7052. [PMID: 37120602 PMCID: PMC10148817 DOI: 10.1038/s41598-023-33966-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 04/21/2023] [Indexed: 05/01/2023] Open
Abstract
Observational studies suggest that abnormal glucose metabolism and insulin resistance contribute to colorectal cancer; however, the causal association remains unknown, particularly in Asian populations. A two-sample Mendelian randomisation analysis was performed to determine the causal association between genetic variants associated with elevated fasting glucose, haemoglobin A1c (HbA1c), and fasting C-peptide and colorectal cancer risk. In the single nucleotide polymorphism (SNP)-exposure analysis, we meta-analysed study-level genome-wide associations of fasting glucose (~ 17,289 individuals), HbA1c (~ 52,802 individuals), and fasting C-peptide (1,666 individuals) levels from the Japanese Consortium of Genetic Epidemiology studies. The odds ratios of colorectal cancer were 1.01 (95% confidence interval [CI], 0.99-1.04, P = 0.34) for fasting glucose (per 1 mg/dL increment), 1.02 (95% CI, 0.60-1.73, P = 0.95) for HbA1c (per 1% increment), and 1.47 (95% CI, 0.97-2.24, P = 0.06) for fasting C-peptide (per 1 log increment). Sensitivity analyses, including Mendelian randomisation-Egger and weighted-median approaches, revealed no significant association between glycaemic characteristics and colorectal cancer (P > 0.20). In this study, genetically predicted glycaemic characteristics were not significantly related to colorectal cancer risk. The potential association between insulin resistance and colorectal cancer should be validated in further studies.
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Grants
- 28-A-19 and 31-A-18 National Cancer Center Research and Development Fund
- 28-A-19 and 31-A-18 National Cancer Center Research and Development Fund
- 28-A-19 and 31-A-18 National Cancer Center Research and Development Fund
- 28-A-19 and 31-A-18 National Cancer Center Research and Development Fund
- 28-A-19 and 31-A-18 National Cancer Center Research and Development Fund
- 28-A-19 and 31-A-18 National Cancer Center Research and Development Fund
- No. 16H06277[CoBia] Japan Society for the Promotion of Science (JSPS) KAKENHI Grant
- No. 16H06277[CoBia] Japan Society for the Promotion of Science (JSPS) KAKENHI Grant
- No. 16H06277[CoBia] Japan Society for the Promotion of Science (JSPS) KAKENHI Grant
- JP20km0105001, JP20km0105002, JP20km0105003, JP20km0105004 Japan Agency for Medical Research and Development
- JP20km0105001, JP20km0105002, JP20km0105003, JP20km0105004 Japan Agency for Medical Research and Development
- JP20km0105001, JP20km0105002, JP20km0105003, JP20km0105004 Japan Agency for Medical Research and Development
- JP20km0105001, JP20km0105002, JP20km0105003, JP20km0105004 Japan Agency for Medical Research and Development
- JP20km0105001, JP20km0105002, JP20km0105003, JP20km0105004 Japan Agency for Medical Research and Development
- JP20km0105001, JP20km0105002, JP20km0105003, JP20km0105004 Japan Agency for Medical Research and Development
- JP20km0105001, JP20km0105002, JP20km0105003, JP20km0105004 Japan Agency for Medical Research and Development
- JP20km0105001, JP20km0105002, JP20km0105003, JP20km0105004 Japan Agency for Medical Research and Development
- 15ck0106095h0002, 16ck0106095h0003, and 17ck0106266h001 Japan Agency for Medical Research and Development
- a Grant-in-Aid for Cancer Research Ministry of Health, Labour and Welfare
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Affiliation(s)
- Akiko Hanyuda
- Division of Epidemiology, National Cancer Center Institute for Cancer Control, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Atsushi Goto
- Division of Epidemiology, National Cancer Center Institute for Cancer Control, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan.
- Department of Health Data Science, Graduate School of Data Science, Yokohama City University, 22-2 Seto, Kanazawa-Ku, Yokohama, 236-0027, Japan.
| | - Ryoko Katagiri
- Division of Epidemiology, National Cancer Center Institute for Cancer Control, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Yuriko N Koyanagi
- Division of Cancer Information and Control, Aichi Cancer Center, Nagoya, Aichi, Japan
| | - Masahiro Nakatochi
- Public Health Informatics Unit, Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yoichi Sutoh
- Division of Biomedical Information Analysis, Iwate Tohoku Medical Megabank, Morioka, Iwate, Japan
| | - Shiori Nakano
- Division of Epidemiology, National Cancer Center Institute for Cancer Control, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Isao Oze
- Division of Cancer Epidemiology and Prevention, Aichi Cancer Center, Nagoya, Aichi, Japan
| | - Hidemi Ito
- Division of Cancer Information and Control, Aichi Cancer Center, Nagoya, Aichi, Japan
- Division of Descriptive Cancer Epidemiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Taiki Yamaji
- Division of Epidemiology, National Cancer Center Institute for Cancer Control, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Norie Sawada
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Masao Iwagami
- Division of Epidemiology, National Cancer Center Institute for Cancer Control, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Aya Kadota
- NCD Epidemiology Research Center, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Teruhide Koyama
- Department of Epidemiology for Community Health and Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Sakurako Katsuura-Kamano
- Department of Preventive Medicine, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Hiroaki Ikezaki
- Department of Comprehensive General Internal Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keitaro Tanaka
- Department of Preventive Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Toshiro Takezaki
- Department of International Island and Community Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Issei Imoto
- Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan
| | - Midori Suzuki
- Core Facilities, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan
| | - Yukihide Momozawa
- Laboratory for Genotyping Development, RIKEN Center for Integrative Medical Sciences, Yokohama, Kanagawa, Japan
| | - Kenji Takeuchi
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Akira Narita
- Department of Integrative Genomics, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Miyagi, Japan
| | - Atsushi Hozawa
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Miyagi, Japan
| | - Kengo Kinoshita
- Department of Integrative Genomics, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Miyagi, Japan
| | - Atsushi Shimizu
- Division of Biomedical Information Analysis, Iwate Tohoku Medical Megabank, Morioka, Iwate, Japan
| | - Kozo Tanno
- Division of Clinical Research and Epidemiology, Iwate Tohoku Medical Megabank Organization, Iwate Medical University, Morioka, Iwate, Japan
| | - Keitaro Matsuo
- Division of Cancer Epidemiology and Prevention, Aichi Cancer Center, Nagoya, Aichi, Japan
- Division of Cancer Epidemiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shoichiro Tsugane
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
| | - Kenji Wakai
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Makoto Sasaki
- Iwate Tohoku Medical Megabank Organization, Iwate Medical University, Morioka, Iwate, Japan
| | - Masayuki Yamamoto
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Miyagi, Japan
| | - Motoki Iwasaki
- Division of Epidemiology, National Cancer Center Institute for Cancer Control, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
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Yang J, Xia Y, Sun Y, Guo Y, Shi Z, Cristina do Vale Moreira N, Zuo H, Hussain A. Effect of lifestyle intervention on HbA1c levels in overweight and obese adults with type 2 diabetes across ethnicities: A systematic review and meta-analysis of randomized controlled trials. Diabetes Res Clin Pract 2023; 199:110662. [PMID: 37028602 DOI: 10.1016/j.diabres.2023.110662] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 03/31/2023] [Indexed: 04/09/2023]
Abstract
AIMS Weight reduction is fundamental for the management and remission of diabetes. We aimed to assess ethnic differences in the effects of lifestyle weight-loss interventions on HbA1c levels in overweight or obese adults with type 2 diabetes mellitus (T2DM). METHODS We systematically searched PubMed/MEDLINE and Web of Science online databases up to 31 Dec 2022. Randomized controlled trials using lifestyle weight-loss interventions in overweight or obese adults with T2DM were selected. We performed subgroup analyses to explore the heterogeneity across different ethnicities (Asians, White/Caucasians, Black/Africans and Hispanics). A random effects model was applied to calculate weighted mean difference (WMD) with 95% confidence interval (CI). RESULTS Thirty studies including 7580 subjects from different ethnicities were identified according to the predefined inclusion and exclusion criteria. HbA1c levels were significantly reduced by lifestyle weight-loss intervention. Notably, a significantly beneficial effect on HbA1c was observed in White/Caucasians (WMD = -0.59, 95% CI: -0.90, -0.28, P < 0.001) and Asians (WMD = -0.48, 95% CI: -0.63, -0.33, P < 0.001), but not in the Black/African or Hispanic group (both P > 0.05). The findings remained essentially unchanged in the sensitivity analysis. CONCLUSIONS Lifestyle weight-loss interventions had distinct beneficial effects on HbA1c levels in different ethnic groups with T2DM, especially in Caucasians and Asians.
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Affiliation(s)
- Jie Yang
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Yujia Xia
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Yanan Sun
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Yufei Guo
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Zumin Shi
- Department of Human Nutrition, College of Health Sciences, QU Health, Qatar University, Qatar
| | | | - Hui Zuo
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China; Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China.
| | - Akhtar Hussain
- Faculty of Health Sciences, NORD University, Bodø, Norway; Faculty of Medicine, Federal University of Ceará (FAMED-UFC), Brazil; International Diabetes Federation. 166 Chaussee de La Hulpe B-1170, Brussels, Belgium.
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Salvatore T, Galiero R, Caturano A, Rinaldi L, Criscuolo L, Di Martino A, Albanese G, Vetrano E, Catalini C, Sardu C, Docimo G, Marfella R, Sasso FC. Current Knowledge on the Pathophysiology of Lean/Normal-Weight Type 2 Diabetes. Int J Mol Sci 2022; 24:ijms24010658. [PMID: 36614099 PMCID: PMC9820420 DOI: 10.3390/ijms24010658] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/21/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023] Open
Abstract
Since early times, being overweight and obesity have been associated with impaired glucose metabolism and type 2 diabetes (T2D). Similarly, a less frequent adult-onset diabetes in low body mass index (BMI) people has been known for many decades. This form is mainly found in developing countries, whereby the largest increase in diabetes incidence is expected in coming years. The number of non-obese patients with T2D is also on the rise among non-white ethnic minorities living in high-income Western countries due to growing migratory flows. A great deal of energy has been spent on understanding the mechanisms that bind obesity to T2D. Conversely, the pathophysiologic features and factors driving the risk of T2D development in non-obese people are still much debated. To reduce the global burden of diabetes, we need to understand why not all obese people develop T2D and not all those with T2D are obese. Moreover, through both an effective prevention and the implementation of an individualized clinical management in all people with diabetes, it is hoped that this will help to reduce this global burden. The purpose of this review is to take stock of current knowledge about the pathophysiology of diabetes not associated to obesity and to highlight which aspects are worthy of future studies.
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Affiliation(s)
- Teresa Salvatore
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, I–80138 Naples, Italy
| | - Raffaele Galiero
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, I–80138 Naples, Italy
| | - Alfredo Caturano
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, I–80138 Naples, Italy
| | - Luca Rinaldi
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, I–80138 Naples, Italy
| | - Livio Criscuolo
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, I–80138 Naples, Italy
| | - Anna Di Martino
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, I–80138 Naples, Italy
| | - Gaetana Albanese
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, I–80138 Naples, Italy
| | - Erica Vetrano
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, I–80138 Naples, Italy
| | - Christian Catalini
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, I–80138 Naples, Italy
| | - Celestino Sardu
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, I–80138 Naples, Italy
| | - Giovanni Docimo
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, I–80138 Naples, Italy
| | - Raffaele Marfella
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, I–80138 Naples, Italy
- Mediterrannea Cardiocentro, I–80122 Napoli, Italy
| | - Ferdinando Carlo Sasso
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, I–80138 Naples, Italy
- Correspondence:
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Preechasuk L, Khaedon N, Lapinee V, Tangjittipokin W, Srivanichakorn W, Sriwijitkamol A, Plengvidhya N, Likitmaskul S, Thongtang N. Cluster analysis of Thai patients with newly diagnosed type 2 diabetes mellitus to predict disease progression and treatment outcomes : A prospective cohort study. BMJ Open Diabetes Res Care 2022; 10:10/6/e003145. [PMID: 36581330 PMCID: PMC9806077 DOI: 10.1136/bmjdrc-2022-003145] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/15/2022] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Type 2 diabetes mellitus (T2D) is highly heterogeneous in disease progression and risk of complications. This study aimed to categorize Thai T2D into subgroups using variables that are commonly available based on routine clinical parameters to predict disease progression and treatment outcomes. RESEARCH DESIGN AND METHODS This was a cohort study. Data-driven cluster analysis was performed using a Python program in patients with newly diagnosed T2D (n=721) of the Siriraj Diabetes Registry using five variables (age, body mass index (BMI), glycated hemoglobin (HbA1c), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C)). Disease progression and risk of diabetic complications among clusters were compared using the Χ2 and Kruskal-Wallis test. Cox regression and the Kaplan-Meier curve were used to compare the time to diabetic complications and the time to insulin initiation. RESULTS The mean age was 53.4±11.3 years, 58.9% were women. The median follow-up time was 21.1 months (9.2-35.2). Four clusters were identified: cluster 1 (18.6%): high HbA1c, low BMI (insulin-deficiency diabetes); cluster 2 (11.8%): high TG, low HDL-C, average age and BMI (metabolic syndrome group); cluster 3 (23.3%): high BMI, low HbA1c, young age (obesity-related diabetes); cluster 4 (46.3%): older age and low HbA1c at diagnosis (age-related diabetes). Patients in cluster 1 had the highest prevalence of insulin treatment. Patients in cluster 2 had the highest risk of diabetic kidney disease and diabetic retinopathy. Patients in cluster 4 had the lowest prevalence of diabetic retinopathy, nephropathy, and insulin use. CONCLUSIONS We were able to categorize Thai patients with newly diagnosed T2D into four clusters using five routine clinical parameters. This clustering method can help predict disease progression and risk of diabetic complications similar to previous studies using parameters including insulin resistance and insulin sensitivity markers.
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Affiliation(s)
- Lukana Preechasuk
- Siriraj Diabetes Center of Excellence, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Naichanok Khaedon
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Varisara Lapinee
- Siriraj Diabetes Center of Excellence, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Watip Tangjittipokin
- Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Weerachai Srivanichakorn
- Siriraj Diabetes Center of Excellence, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Apiradee Sriwijitkamol
- Siriraj Diabetes Center of Excellence, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nattachet Plengvidhya
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Supawadee Likitmaskul
- Siriraj Diabetes Center of Excellence, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nuntakorn Thongtang
- Siriraj Diabetes Center of Excellence, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Ding L, Fan Y, Qiao J, He J, Wang R, He Q, Cui J, Ma Z, Zheng F, Gao H, Dai C, Wei H, Li J, Cao Y, Hu G, Liu M. Distribution of lean mass and mortality risk in patients with type 2 diabetes. Prim Care Diabetes 2022; 16:824-828. [PMID: 36272915 DOI: 10.1016/j.pcd.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 05/27/2022] [Accepted: 09/04/2022] [Indexed: 11/07/2022]
Abstract
AIMS The aim of the study is to evaluate the association of distribution of lean mass with the risk of all-cause mortality among patients with type 2 diabetes. METHODS The present cohort study included 2 335 patients with type 2 diabetes. Lean mass was assessed by dual energy X-ray absorptiometry. Cox proportional hazards regressions were used to estimate the association of lean mass distribution on the risk of mortality. RESULTS The average age of the patients was 58 years at baseline and 51.4% of patients were women. During a median follow-up of 4.31 years, 128 patients died. The multivariable-adjusted hazards ratios for all-cause mortality were 1.00, 1.63 (0.89-2.99), and 2.68(1.51-4.76) across the tertiles of android-to-gynoid lean mass ratio (P for trend < 0.001), respectively. The positive association of android-to-gynoid lean mass ratio with the risk of all-cause mortality was present among patients of different ages, body mass index ≥ 24 kg/m2, hemoglobin A1c ≥ 7.0%, nonsmokers, men, patients using insulin, and patients with diabetes durations of more than 10 years. CONCLUSIONS Higher android-to-gynoid lean mass ratio, assessed by dual energy X-ray absorptiometry, was significantly associated with increased risk of all-cause mortality among patients with type 2 diabetes.
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Affiliation(s)
- Li Ding
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, China
| | - Yuxin Fan
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, China; Chronic Disease Epidemiology Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA
| | - Jingting Qiao
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, China
| | - Jing He
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, China
| | - Ruodan Wang
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, China
| | - Qing He
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, China
| | - Jingqiu Cui
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, China
| | - Zhongshu Ma
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, China
| | - Fangqiu Zheng
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, China
| | - Hua Gao
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, China
| | - Chenlin Dai
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, China
| | - Hongyan Wei
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, China
| | - Jun Li
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, China
| | - Yuming Cao
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, China
| | - Gang Hu
- Chronic Disease Epidemiology Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA.
| | - Ming Liu
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, China.
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21
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Razieh C, Zaccardi F, Miksza J, Davies MJ, Hansell AL, Khunti K, Yates T. Differences in the risk of cardiovascular disease across ethnic groups: UK Biobank observational study. Nutr Metab Cardiovasc Dis 2022; 32:2594-2602. [PMID: 36064688 DOI: 10.1016/j.numecd.2022.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIMS To describe sociodemographic, lifestyle, environmental and traditional clinical risk factor differences between ethnic groups and to investigate the extent to which such differences confound the association between ethnic groups and the risk of cardiovascular disease (CVD) METHODS AND RESULTS: A total of 440,693 white European (55.9% women), 7305 South Asian (48.6%) and 7628 black African or Caribbean (57.7%) people were included from UK Biobank. Associations between ethnicity and cardiovascular outcomes (composite of non-fatal stroke, non-fatal myocardial infarction and CVD death) were explored using Cox-proportional hazard models. Models were adjusted for sociodemographic, lifestyle, environmental and clinical risk factors. Over a median (IQR) of 12.6 (11.8, 13.3) follow-up years, there were 22,711 (5.15%) cardiovascular events in white European, 463 (6.34%) in South Asian and 302 (3.96%) in black African or Caribbean individuals. For South Asian people, the cardiovascular hazard ratio (HR) compared to white European people was 1.28 (99% CI [1.16, 1.43]). For black African or Caribbean people, the HR was 0.80 (0.66, 0.97). The elevated risk of CVD in South Asians remained after adjusting for differences in sociodemographic, lifestyle, environmental and clinical factors, whereas the lower risk in black African or Caribbean was largely attenuated. CONCLUSIONS South Asian, but not black African or Caribbean individuals, have a higher risk of CVD compared to white European individuals. This higher risk in South Asians was independent of sociodemographic, lifestyle, environmental and clinical factors.
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Affiliation(s)
- Cameron Razieh
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK; National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, LE5 4PW, UK; Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK; Office for National Statistics, Newport, NP10 8XG, UK.
| | - Francesco Zaccardi
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK; Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Joanne Miksza
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK; Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK; National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, LE5 4PW, UK; Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - Anna L Hansell
- Centre for Environmental Health and Sustainability, University of Leicester, Leicester, LE1 7RH, UK; NIHR Health Protection Research Unit (HPRU) in Environmental Exposures and Health at the University of Leicester, Leicester, LE1 7RH, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK; Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK; Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK; NIHR Applied Research Collaboration - East Midlands (ARC-EM), Leicester General Hospital, Leicester, UK
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK; National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, LE5 4PW, UK
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22
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Capuno J, Kraft A, Calicdan KG, O’Donnell O. Associations between health-related quality of life and measures of adiposity among Filipino adults. PLoS One 2022; 17:e0275798. [PMID: 36288388 PMCID: PMC9605333 DOI: 10.1371/journal.pone.0275798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/23/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Estimate associations between the health-related quality of life (HRQoL) and adiposity in a low-income population. METHODS In a cluster random sample of 3796 Filipinos aged 40-70 years in Nueva Ecija province, we measured body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and six dimensions of HRQoL using the 20-item Short Form Health Survey. We stratified by sex and used nonparametric regression to graph mean HRQoL in each dimension by BMI, WC, and WHR. We used ordinary least squares regression to estimate differences in each HRQoL dimension by categories of BMI, WC, and WHR adjusted for sociodemographic characteristics and smoking. RESULTS Mean HRQoL was lowest for health perception (Males: 67.5 (SD = 15.9); Females: 66.7 (15.8)) and highest for role functioning (Males: 97.5 (12.9); Females: 97.4 (13.3)). Mean (SD) values of BMI, WC, and WHR were 22.1 (3.6), 84.8 cm (9.5), and 0.9 (0.1), respectively for males, and 23.7 (4.2), 86.5 cm (10.2), and 0.9 (0.1), respectively, for females. There was no evidence that higher BMI was associated with lower HRQoL. Adjusted mean social functioning was 4.92 (p = 0.076) higher for males with high BMI risk (8.6% prevalence) compared with acceptable BMI risk (50.3%). Mean social functioning was 3.61 (p = 0.012) and 5.48 (p = 0.017) lower for females with high WC (44.7%) and WHR (83.1%), respectively, compared with those with low WC (23.8%) and WHR (3.6%). Mean physical functioning was lower by 2.70 (p = 0.204) and 1.07 (p = 0.198) for males and females, respectively, with high compared with low WC. Mean physical functioning was 3.93 (p = 0.037) lower for males with high (7.6%) compared with low (38.8%) WHR. Mean role functioning was 1.09 (p = 0.124) and 2.46 (p = 0.158) lower for males with borderline and high WHR, respectively. CONCLUSIONS There is discordance between future adiposity-related health risk and current experience of HRQoL.
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Affiliation(s)
- Joseph Capuno
- School of Economics, University of the Philippines, Diliman, Quezon City, Philippines
| | - Aleli Kraft
- School of Economics, University of the Philippines, Diliman, Quezon City, Philippines
| | - Kayleen Gene Calicdan
- School of Economics, University of the Philippines, Diliman, Quezon City, Philippines
| | - Owen O’Donnell
- Department of Applied Economics, Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, Netherlands
- Tinbergen Institute, Amsterdam, Netherlands
- University of Lausanne, Lausanne, Switzerland
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23
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Lin YY, Weng SF, Hsu CH, Huang CL, Lin YP, Yeh MC, Han AY, Hsieh YS. Effect of metformin monotherapy and dual or triple concomitant therapy with metformin on glycemic control and lipid profile management of patients with type 2 diabetes mellitus. Front Med (Lausanne) 2022; 9:995944. [PMID: 36314019 PMCID: PMC9614085 DOI: 10.3389/fmed.2022.995944] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 09/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background In this study, we aimed to compare the effects of metformin-based dual therapy versus triple therapy on glycemic control and lipid profile changes in Taiwanese patients with type 2 diabetes mellitus (T2DM). Methods In total, 60 patients were eligible for participation in this study. Patients received at least 24 months of metformin monotherapy, dual therapy, or triple therapy with metformin plus linagliptin (a dipeptidyl peptidase 4 (DPP-4) inhibitor) or dapagliflozin (a sodium-glucose cotransporter-2 (SGLT2) inhibitor). Blood samples were collected from each patient, followed by evaluation of changes in their blood glucose control and lipid profile-related markers. Results A combination of metformin and DPP4 and SGLT2 inhibitor therapy more effectively reduced low-density lipoprotein cholesterol (LDL-C) (p = 0.016) than metformin monotherapy. A combination of metformin and DPP4 and SGLT2 inhibitor therapy more effectively improved total cholesterol (Chol, p = 0.049) and high-density lipoprotein cholesterol (HDL-C) than metformin monotherapy (p = 0.037). Metformin plus linagliptin dual therapy was more effective than metformin monotherapy in reducing glycosylated hemoglobin (HbA1C, p = 0.011). Patients who received a combination of linagliptin and empagliflozin showed a significant reduction in their fasting blood glucose (p = 0.019), HbA1c (p = 0.036), and Chol (p = 0.010) compared with those who received linagliptin dual therapy. Furthermore, patients who received metformin plus dapagliflozin and saxagliptin showed significantly reduced Chol (p = 0.011) and LDL-C (p = 0.035) levels compared with those who received metformin plus dapagliflozin. Conclusion In conclusion, dual therapy with metformin and linagliptin yields similar glycemic control ability to triple therapy. Among metformin combination triple therapy, triple therapy of empagliflozin and linagliptin might have a better glycemic control ability than dual therapy of linagliptin. Moreover, Triple therapy of dapagliflozin and saxagliptin might have a better lipid control ability than dual therapy of dapagliflozin.
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Affiliation(s)
- Yan-Yu Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei City, Taiwan
| | - Shuen-Fu Weng
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei City, Taiwan,Division of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Chung-Huei Hsu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei City, Taiwan
| | - Chen-Ling Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei City, Taiwan
| | - Yu-Pei Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei City, Taiwan
| | - Min-Chun Yeh
- Department of Internal Medicine, Taipei Medical University Hospital, Taipei City, Taiwan
| | - A-Young Han
- Department of Nursing, College of Life Science and Industry, Sunchon National University, Suncheon, South Korea
| | - Yu-Shan Hsieh
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan,*Correspondence: Yu-Shan Hsieh,
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24
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Misra S, Gable D, Khunti K, Barron E, Young B, Kar P, Valabhji J. Developing services to support the delivery of care to people with early-onset type 2 diabetes. Diabet Med 2022; 39:e14927. [PMID: 35900910 PMCID: PMC9542364 DOI: 10.1111/dme.14927] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 05/16/2022] [Accepted: 07/26/2022] [Indexed: 12/01/2022]
Abstract
Early-onset type 2 diabetes occurring in childhood or early adulthood carries a significant excess burden of microvascular diabetes complications, cardiovascular disease and premature death, compared to later onset type 2 diabetes along with adverse pregnancy outcomes in women of child-bearing age. National audit data in England reveal that 122,780 individuals under the age of 40 years are currently living with type 2 diabetes, with an over-representation of people from minority ethnicities and those in the most socioeconomically deprived quintiles. A diagnosis of type 2 diabetes earlier in life poses some unique challenges to healthcare providers that are not routinely encountered when type 2 diabetes presents later. These include; (1) the need to ensure correct diabetes classification in an age group that carries a higher probability of other types of diabetes, (2) overcoming difficulties in engaging with individuals who are of working age or in full-time education, (3) appreciating and addressing the lower attainment of diabetes treatment targets and (4) proactively supporting women of child-bearing age to optimise their future pregnancy outcomes through better preparation for pregnancy, including achieving optimum glycaemic control at the time of conception. Meanwhile, approaches to prevent type 2 diabetes in younger age groups are challenged by difficulties in identifying those at highest risk, by poorer attendance at lifestyle interventions to prevent or delay the onset of type 2 diabetes and by attenuation of associated weight loss in those that do attend. In this article, we discuss the importance of recognising and addressing the distinct challenges in delivering healthcare to those with early-onset type 2 diabetes, the greater challenges in preventing type 2 diabetes at younger ages, and key components of strategies that might address these challenges to drive improvements in pregnancy outcomes, microvascular and cardiovascular outcomes.
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Affiliation(s)
- Shivani Misra
- Division of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
- Department of Diabetes and Endocrinology, St Mary's HospitalImperial College Healthcare NHS TrustLondonUK
- National Diabetes Audit Programme, NHS England and NHS ImprovementLondonUK
| | - David Gable
- Department of Diabetes and Endocrinology, St Mary's HospitalImperial College Healthcare NHS TrustLondonUK
| | - Kamlesh Khunti
- Diabetes Research CentreUniversity of Leicester, Leicester General HospitalLeicesterUK
| | | | - Bob Young
- National Diabetes Audit Programme, NHS England and NHS ImprovementLondonUK
| | - Partha Kar
- NHS England and NHS ImprovementLondonUK
- Portsmouth Hospitals NHS TrustPortsmouthUK
| | - Jonathan Valabhji
- Division of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
- Department of Diabetes and Endocrinology, St Mary's HospitalImperial College Healthcare NHS TrustLondonUK
- NHS England and NHS ImprovementLondonUK
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25
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Dialsingh I, Mohammed SR, Medford RS, Budhoo E, White-Gittens I, Maharaj D. Conservative therapy significantly reduces patients' chronic venous disease symptoms: A Caribbean insight into the VEIN Act Program. Phlebology 2022; 37:651-661. [PMID: 35848710 DOI: 10.1177/02683555221114542] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We sought to determine the baseline demographic and clinical characteristics of patients with Chronic Venous Disease (CVD) across the Caribbean, and to evaluate patients' compliance to conservative therapy and the effectiveness of such therapy in reducing patients' CVD symptoms. METHOD Patients were enrolled into the VEIN Act Program, and their demographic data, CVD symptoms (and their intensity) and CEAP C-classification was recorded at the first visit. Patients were prescribed conservative therapy, and symptom intensity and patient compliance and satisfaction evaluated at a follow-up visit. RESULTS We enrolled 193 patients into the study, most of which (76%) were female, between 39-78 years (80%) and within the C2-C4a classes (56.1%). Pain (61.1%) and heaviness (58.5%) were the most common symptoms. Patient compliance to the prescribed treatment was relatively high for all modalities (>75%) and most patients (92.1%) were at least somewhat satisfied with their treatment. CONCLUSIONS Patient compliance to conservative therapy for management of CVD is high across the Caribbean, and such therapy is effective in reducing intensity of CVD symptoms.
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Affiliation(s)
- Isaac Dialsingh
- Department of Mathematics and Statistics, Faculty of Science and Technology, 37612The University of the West Indies, St Augustine Campus, St Augustine, Trinidad
| | - Saeed Rashaad Mohammed
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, 37612The University of the West Indies, St Augustine Campus, St Augustine, Trinidad
| | - Rei Sebastian Medford
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, 37612The University of the West Indies, St Augustine Campus, St Augustine, Trinidad
| | - Emerson Budhoo
- Caribbean Orthopaedic Foot and Ankle Institute, Medical Associates Hospital, St Joseph, Trinidad
| | | | - Dale Maharaj
- Caribbean Vascular and Vein Clinic, St Clair Medical Center, Port of Spain, Trinidad
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26
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Siddiqui MK, Anjana RM, Dawed AY, Martoeau C, Srinivasan S, Saravanan J, Madanagopal SK, Taylor A, Bell S, Veluchamy A, Pradeepa R, Sattar N, Venkatesan R, Palmer CNA, Pearson ER, Mohan V. Young-onset diabetes in Asian Indians is associated with lower measured and genetically determined beta cell function. Diabetologia 2022; 65:973-983. [PMID: 35247066 PMCID: PMC9076730 DOI: 10.1007/s00125-022-05671-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/06/2021] [Indexed: 01/11/2023]
Abstract
AIMS/HYPOTHESIS South Asians in general, and Asian Indians in particular, have higher risk of type 2 diabetes compared with white Europeans, and a younger age of onset. The reasons for the younger age of onset in relation to obesity, beta cell function and insulin sensitivity are under-explored. METHODS Two cohorts of Asian Indians, the ICMR-INDIAB cohort (Indian Council of Medical Research-India Diabetes Study) and the DMDSC cohort (Dr Mohan's Diabetes Specialties Centre), and one of white Europeans, the ESDC (East Scotland Diabetes Cohort), were used. Using a cross-sectional design, we examined the comparative prevalence of healthy, overweight and obese participants with young-onset diabetes, classified according to their BMI. We explored the role of clinically measured beta cell function in diabetes onset in Asian Indians. Finally, the comparative distribution of a partitioned polygenic score (pPS) for risk of diabetes due to poor beta cell function was examined. Replication of the genetic findings was sought using data from the UK Biobank. RESULTS The prevalence of young-onset diabetes with normal BMI was 9.3% amongst white Europeans and 24-39% amongst Asian Indians. In Asian Indians with young-onset diabetes, after adjustment for family history of type 2 diabetes, sex, insulin sensitivity and HDL-cholesterol, stimulated C-peptide was 492 pmol/ml (IQR 353-616, p<0.0001) lower in lean compared with obese individuals. Asian Indians in our study, and South Asians from the UK Biobank, had a higher number of risk alleles than white Europeans. After weighting the pPS for beta cell function, Asian Indians have lower genetically determined beta cell function than white Europeans (p<0.0001). The pPS was associated with age of diagnosis in Asian Indians but not in white Europeans. The pPS explained 2% of the variation in clinically measured beta cell function, and 1.2%, 0.97%, and 0.36% of variance in age of diabetes amongst Asian Indians with normal BMI, or classified as overweight and obese BMI, respectively. CONCLUSIONS/INTERPRETATION The prevalence of lean BMI in young-onset diabetes is over two times higher in Asian Indians compared with white Europeans. This phenotype of lean, young-onset diabetes appears driven in part by lower beta cell function. We demonstrate that Asian Indians with diabetes also have lower genetically determined beta cell function.
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Affiliation(s)
- Moneeza K. Siddiqui
- grid.8241.f0000 0004 0397 2876National Institute for Health Research Global Health Unit for Diabetes Outcomes Research, Division of Population Health & Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Ranjit Mohan Anjana
- grid.410867.c0000 0004 1805 2183Dr Mohan’s Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India
| | - Adem Y. Dawed
- grid.8241.f0000 0004 0397 2876National Institute for Health Research Global Health Unit for Diabetes Outcomes Research, Division of Population Health & Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Cyrielle Martoeau
- grid.8241.f0000 0004 0397 2876National Institute for Health Research Global Health Unit for Diabetes Outcomes Research, Division of Population Health & Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Sundararajan Srinivasan
- grid.8241.f0000 0004 0397 2876National Institute for Health Research Global Health Unit for Diabetes Outcomes Research, Division of Population Health & Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Jebarani Saravanan
- grid.410867.c0000 0004 1805 2183Dr Mohan’s Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India
| | - Sathish K. Madanagopal
- grid.410867.c0000 0004 1805 2183Dr Mohan’s Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India
| | - Alasdair Taylor
- grid.8241.f0000 0004 0397 2876National Institute for Health Research Global Health Unit for Diabetes Outcomes Research, Division of Population Health & Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Samira Bell
- grid.8241.f0000 0004 0397 2876National Institute for Health Research Global Health Unit for Diabetes Outcomes Research, Division of Population Health & Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Abirami Veluchamy
- grid.8241.f0000 0004 0397 2876National Institute for Health Research Global Health Unit for Diabetes Outcomes Research, Division of Population Health & Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Rajendra Pradeepa
- grid.410867.c0000 0004 1805 2183Dr Mohan’s Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India
| | - Naveed Sattar
- grid.8756.c0000 0001 2193 314XInstitute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Radha Venkatesan
- grid.410867.c0000 0004 1805 2183Dr Mohan’s Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India
| | - Colin N. A. Palmer
- grid.8241.f0000 0004 0397 2876National Institute for Health Research Global Health Unit for Diabetes Outcomes Research, Division of Population Health & Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Ewan R. Pearson
- grid.8241.f0000 0004 0397 2876National Institute for Health Research Global Health Unit for Diabetes Outcomes Research, Division of Population Health & Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Viswanathan Mohan
- grid.410867.c0000 0004 1805 2183Dr Mohan’s Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India
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Wong K, Caskey FJ, Casula A, Ben-Shlomo Y, Bailey P. The UK Chinese population with kidney failure: Clinical characteristics, management and access to kidney transplantation using 20 years of UK Renal Registry and NHS Blood and Transplant data. PLoS One 2022; 17:e0264313. [PMID: 35226673 PMCID: PMC8884499 DOI: 10.1371/journal.pone.0264313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/08/2022] [Indexed: 11/18/2022] Open
Abstract
Background Little is known about the clinical demographics of and access to transplantation for Chinese diaspora populations with kidney disease. Methods The UK Renal Registry provided data on adults with ethnicity recorded as ‘Chinese’ or ‘White’ starting Kidney Replacement Therapy (KRT) 1/1/97-31/12/17. Baseline characteristics were compared between Chinese and White patients. Multivariable logistic regression models were used to investigate the relationships between Chinese ethnicity and i) being listed for deceased-donor transplantation at start of KRT, ii) being listed 2 years after start of KRT, iii) pre-emptive kidney transplantation, iv) kidney transplantation 3 years after start of KRT, and v) living-donor kidney transplantation (LDKT). Results UK Chinese patients were younger at start of KRT (61.6 vs 65.6 years, p <0.001) and had more diabetic kidney disease (29% vs 20%, p<0.001) and glomerulonephritis (21% vs 13%, p<0.001) than White patients. We found evidence of interaction between ethnicity and sex. Compared to UK White men, UK Chinese men had lower odds of pre-emptive transplant (aOR 0.28, 95% CI [0.10–0.76]) and transplant within 3 years of KRT start (aOR 0.65, [95% CI 0.49–0.87], P = 0.004). UK White women and Chinese women had the same likelihood of pre-emptive transplant (aOR 0.78, 95% CI [0.38–1.61]), or transplant within 3 years of KRT start (aOR 0.94, 95% CI [0.60–1.46]). Both UK Chinese men and women had markedly lower odds of LDKT compared to Whites aOR 0.34 [95% CI 0.21–0.53]. Conclusions UK Chinese are less likely to receive a LDKT. UK Chinese men have lower odds of accessing pre-emptive wait-listing and transplantation. Understanding whether these disparities reflect modifiable barriers will help ensure equitable access to transplantation.
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Affiliation(s)
- Katie Wong
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
- Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
- * E-mail:
| | - Fergus J. Caskey
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
- Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | | | - Yoav Ben-Shlomo
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Pippa Bailey
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
- Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
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Clark S, Lomax N, Birkin M, Morris M. A foresight whole systems obesity classification for the English UK biobank cohort. BMC Public Health 2022; 22:349. [PMID: 35180877 PMCID: PMC8856870 DOI: 10.1186/s12889-022-12650-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 01/18/2022] [Indexed: 12/20/2022] Open
Abstract
Background The number of people living with obesity or who are overweight presents a global challenge, and the development of effective interventions is hampered by a lack of research which takes a joined up, whole system, approach that considers multiple elements of the complex obesity system together. We need to better understand the collective characteristics and behaviours of those who are overweight or have obesity and how these differ from those who maintain a healthy weight. Methods Using the UK Biobank cohort we develop an obesity classification system using k-means clustering. Variable selection from the UK Biobank cohort is informed by the Foresight obesity system map across key domains (Societal Influences, Individual Psychology, Individual Physiology, Individual Physical Activity, Physical Activity Environment). Results Our classification identifies eight groups of people, similar in respect to their exposure to known drivers of obesity: ‘Younger, urban hard-pressed’, ‘Comfortable, fit families’, ‘Healthy, active and retirees’, ‘Content, rural and retirees’, ‘Comfortable professionals’, ‘Stressed and not in work’, ‘Deprived with less healthy lifestyles’ and ‘Active manual workers’. Pen portraits are developed to describe the characteristics of these different groups. Multinomial logistic regression is used to demonstrate that the classification can effectively detect groups of individuals more likely to be living with overweight or obesity. The group identified as ‘Comfortable, fit families’ are observed to have a higher proportion of healthy weight, while three groups have increased relative risk of being overweight or having obesity: ‘Active manual workers’, ‘Stressed and not in work’ and ‘Deprived with less healthy lifestyles’. Conclusions This paper presents the first study of UK Biobank participants to adopt this obesity system approach to characterising participants. It provides an innovative new approach to better understand the complex drivers of obesity which has the potential to produce meaningful tools for policy makers to better target interventions across the whole system to reduce overweight and obesity. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12650-x.
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Affiliation(s)
- Stephen Clark
- Consumer Data Research Centre and School of Geography, University of Leeds, LEEDS, LS2 9JT, UK.
| | - Nik Lomax
- School of Geography and Consumer Data Research Centre, University of Leeds, LEEDS, LS2 9JT, UK
| | - Mark Birkin
- Consumer Data Research Centre and School of Geography, University of Leeds, LEEDS, LS2 9JT, UK
| | - Michelle Morris
- School of Medicine and Consumer Data Research Centre, University of Leeds, LEEDS, UK
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Yates T, Summerfield A, Razieh C, Banerjee A, Chudasama Y, Davies MJ, Gillies C, Islam N, Lawson C, Mirkes E, Zaccardi F, Khunti K, Nafilyan V. A population-based cohort study of obesity, ethnicity and COVID-19 mortality in 12.6 million adults in England. Nat Commun 2022; 13:624. [PMID: 35110546 PMCID: PMC8810846 DOI: 10.1038/s41467-022-28248-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 01/05/2022] [Indexed: 12/19/2022] Open
Abstract
Obesity and ethnicity are known risk factors for COVID-19 outcomes, but their combination has not been extensively examined. We investigate the association between body mass index (BMI) and COVID-19 mortality across different ethnic groups using linked national Census, electronic health records and mortality data for adults in England from the start of pandemic (January 2020) to December 2020. There were 30,067 (0.27%), 1,208 (0.29%), 1,831 (0.29%), 845 (0.18%) COVID-19 deaths in white, Black, South Asian and other ethnic minority groups, respectively. Here we show that BMI was more strongly associated with COVID-19 mortality in ethnic minority groups, resulting in an ethnic risk of COVID-19 mortality that was dependant on BMI. The estimated risk of COVID-19 mortality at a BMI of 40 kg/m2 in white ethnicities was equivalent to the risk observed at a BMI of 30.1 kg/m2, 27.0 kg/m2, and 32.2 kg/m2 in Black, South Asian and other ethnic minority groups, respectively.
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Affiliation(s)
- Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK.
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), Leicester General Hospital, Leicester, LE5 4PW, UK.
| | | | - Cameron Razieh
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), Leicester General Hospital, Leicester, LE5 4PW, UK
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, UK
- Department of Cardiology, Barts Health NHS Trust, London, UK
| | - Yogini Chudasama
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), Leicester General Hospital, Leicester, LE5 4PW, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK
| | - Clare Gillies
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Applied Research Collaboration - East Midlands (ARC-EM), Leicester General Hospital, Leicester, UK
| | - Nazrul Islam
- Nuffield Department of Population Health, Big Data Institute, University of Oxford, Oxford, UK
| | - Claire Lawson
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Evgeny Mirkes
- Department of Mathematics, University of Leicester, Leicester, UK
| | - Francesco Zaccardi
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK
- NIHR Applied Research Collaboration - East Midlands (ARC-EM), Leicester General Hospital, Leicester, UK
| | - Vahé Nafilyan
- Office for National Statistics, Newport, UK
- Faculty of Public Health, Environment and Society, London School of Hygiene and Tropical Medicine, London, UK
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30
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Li L, Wang Z, Ruan H, Zhang M, Zhou L, Wei X, Zhu Y, Wei J, Chen X, He S. New metabolic health definition might not be a reliable predictor for diabetes in the nonobese Chinese population. Diabetes Res Clin Pract 2022; 184:109213. [PMID: 35085646 DOI: 10.1016/j.diabres.2022.109213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 01/10/2022] [Accepted: 01/18/2022] [Indexed: 11/24/2022]
Abstract
AIM To investigate the predictive values of the new metabolic health (MH) definition for future diabetes in a nonobese Chinese population, compared with the MH definition from metabolic syndrome (MetS). METHODS The data were collected in 1992 and then again in 2007 from the same group of 653 participants. The risk assessment of the new MH definition and the MH definition from MetS for future diabetes was performed by Cox regression analysis with overlap weighting as the primary analysis. RESULTS During the follow-up, 62 participants were diagnosed with diabetes. In the primary analysis with overlap weighting, there was no significant association between new MH and diabetes (HR: 1.12; 95% CI: 0.45-2.78, p = 0.803); conversely, based on the MH definition from MetS, the participants with MH were less likely to have had diabetes than the participants with MUHs (HR: 0.41; 95% CI: 0.22-0.78, p = 0.007). Furthermore, other analysis methods also confirmed the reproducibility of abovementioned results. In addition, sensitivity analysis excluding participants with prediabetes also demonstrated similar results with the primary analysis. CONCLUSION In contrast to the previous MH definition from MetS, the new MH definition was not a reliable predictor for future diabetes in the nonobese Chinese population.
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Affiliation(s)
- Liying Li
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Ziqiong Wang
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Haiyan Ruan
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China; Department of Cardiology, Traditional Chinese Medicine Hospital of Shuangliu District, Chengdu, China
| | - Muxin Zhang
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China; Department of Cardiology, First People's Hospital, Longquanyi District, Chengdu, China
| | - Linxia Zhou
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China; Department of Cardiology, Traditional Chinese Medicine Hospital of Shuangliu District, Chengdu, China
| | - Xin Wei
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China; Department of Cardiology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Ye Zhu
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Jiafu Wei
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Xiaoping Chen
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Sen He
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China.
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Reed RM, Nevitt SJ, Kemp GJ, Cuthbertson DJ, Whyte MB, Goff LM. Ectopic fat deposition in populations of black African ancestry: A systematic review and meta-analysis. Acta Diabetol 2022; 59:171-187. [PMID: 34518896 PMCID: PMC8841318 DOI: 10.1007/s00592-021-01797-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/02/2021] [Indexed: 02/07/2023]
Abstract
AIMS In populations of black African ancestry (BA), a paradox exists whereby lower visceral adipose tissue is found despite their high risk for type 2 diabetes (T2D). This systematic review investigates ethnic differences in other ectopic fat depots (intrahepatic lipid: IHL; intramyocellular lipid: IMCL and intrapancreatic lipid; IPL) to help contextualise their potential contribution to T2D risk. METHODS A systematic literature search was performed in December 2020 to identify studies reporting at least one ectopic fat comparison between BA and one/more other ethnicity. For IHL, a meta-analysis was carried out with studies considered comparable based on the method of measurement. RESULTS Twenty-eight studies were included (IHL: n = 20; IMCL: n = 8; IPL: n = 4). Meta-analysis of 11 studies investigating IHL revealed that it was lower in BA populations vs pooled ethnic comparators (MD -1.35%, 95% CI -1.55 to -1.16, I2 = 85%, P < 0.00001), white European ancestry (MD -0.94%, 95% CI -1.17 to -0.70, I2 = 79%, P < 0.00001), Hispanic ancestry (MD -2.06%, 95% CI -2.49 to -1.63, I2 = 81%, P < 0.00001) and South Asian ancestry comparators (MD -1.92%, 95% CI -3.26 to -0.57, I2 = 78%, P = 0.005). However, heterogeneity was high in all analyses. Most studies found no significant differences in IMCL between BA and WE. Few studies investigated IPL, however, indicated that IPL is lower in BA compared to WE and HIS. CONCLUSION The discordance between ectopic fat and greater risk for T2D in BA populations raises questions around its contribution to T2D pathophysiology in BA.
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Affiliation(s)
- Reuben M Reed
- Department of Nutritional Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Sarah J Nevitt
- Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Graham J Kemp
- Department of Musculoskeletal and Ageing Science. Institute of Life Course and Medical Sciences, Liverpool Magnetic Resonance Imaging Centre (LiMRIC), University of Liverpool, Liverpool, UK
| | - Daniel J Cuthbertson
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course Sciences, University of Liverpool, Liverpool, UK
| | - Martin B Whyte
- Faculty of Health & Medical Sciences, University of Surrey, Guildford, Surrey, UK
| | - Louise M Goff
- Department of Nutritional Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK.
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DeLacey S, Josefson JL. A Mini-Review of Pediatric Anthropometrics as Predictors of Future Insulin Resistance. Front Endocrinol (Lausanne) 2022; 13:826430. [PMID: 35185801 PMCID: PMC8848350 DOI: 10.3389/fendo.2022.826430] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/07/2022] [Indexed: 12/16/2022] Open
Abstract
The impact of rising rates of childhood obesity is far reaching. Metabolic syndrome in children is increasing, yet for most children the consequences of excess adiposity will manifest in adulthood. Excess early fat accrual is a risk factor for future insulin resistance. However, certain types of fat and patterns of fat distribution are more relevant than others to metabolic risk. Therefore, adiposity measures are important. The link between childhood obesity and future insulin resistance was initially established with body mass index (BMI), but BMI is an in imperfect measure of adiposity. It is worthwhile to evaluate other anthropometrics as they may more accurately capture metabolic risk. While measures such as waist to height ratio are established as superior screening measures in adulthood - the findings are not as robust in pediatrics. Emerging evidence suggests that alternative anthropometrics may be slightly superior to BMI in identifying those youth most at risk of developing insulin resistance, but the clinical significance of that superiority appears limited. Increasing study is needed in longitudinal and varied cohorts to identify which pediatric anthropometric best predicts adult insulin resistance. We review alternative anthropometrics as predictors of future insulin resistance and identify current gaps in knowledge and potential future directions of inquiry.
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Affiliation(s)
- Sean DeLacey
- Department of Pediatrics, Division of Endocrinology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, United States
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- *Correspondence: Sean DeLacey,
| | - Jami L. Josefson
- Department of Pediatrics, Division of Endocrinology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, United States
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Kaur S, Ming NC, Lli YW, Ai Ni T, Ling CW. Identifying dietary pattern associated with adiposity among Malaysian young adults. MEDITERRANEAN JOURNAL OF NUTRITION AND METABOLISM 2021. [DOI: 10.3233/mnm-211541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Recognizing food groups consumption in young adults offers an opportunity to improve dietary pattern in early adulthood. OBJECTIVE: Hence, this cross-sectional study aimed to determine food groups’ intake of young adults and to identify food groups associated with adiposity. METHODS: Youths aged 18–25 years old from private universities in Klang Valley, Malaysia, participated in the study (n = 294). Three days 24-hour dietary recall assessed youths’ food groups intake. Adiposity (BMI, body fat percentage, visceral fat level, waist circumference) was determined based on standard protocol. Height was measured using SECA 206 body meter, while weight, body fat percentage, and visceral fat level were measured using the Omron HBF-356 Body Fat Analyzer. Waist circumference was determined using a measuring tape. RESULTS: In total, 49.3% and 34.7% of youths were overweight/obese and abdominally obese, respectively. The median visceral fat level was 4 (6). Youths consumed 214 (247) kcal of ultra-processed foods daily and exceeded the sugar [32.43 (41.20) g] and sodium recommendation [2425.26 (1455.18) mg]. Fruits [0.29±0.72 servings/day], vegetables [0.95±0.77 servings/day] and milk [0.24±0.38 servings/day] were below recommendations. Increased intake of meat and sodium were associated with higher BMI, waist circumference, body fat percentage, and visceral fat (p < 0.001). Greater intake of ultra-processed food was associated with high BMI (p = 0.009), waist circumference (p = 0.046), and visceral fat (p = 0.014). Besides, high sugar intake was associated with greater BMI (p = 0.003), body fat percentage (p = 0.020), and visceral fat (p = 0.027). CONCLUSIONS: Meat, sugar, sodium, and ultra-processed foods were high-risk foods associated with adiposity among young adults. There is a need to improve education and support to promote healthy eating for chronic disease prevention related to metabolic abnormalities.
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Affiliation(s)
- Satvinder Kaur
- Faculty of Applied Sciences, UCSI University, Jalan Menara Gading, UCSI Heights Cheras, Kuala Lumpur, Malaysia
| | - Ng Choon Ming
- School of Pharmacy, Monash University Malaysia, South Lagoon Road, Bandar Sunway, Selangor, Malaysia
| | - Yap Wern Lli
- Faculty of Applied Sciences, UCSI University, Jalan Menara Gading, UCSI Heights Cheras, Kuala Lumpur, Malaysia
| | - Teoh Ai Ni
- Faculty of Applied Sciences, UCSI University, Jalan Menara Gading, UCSI Heights Cheras, Kuala Lumpur, Malaysia
| | - Chew Wan Ling
- Faculty of Applied Sciences, UCSI University, Jalan Menara Gading, UCSI Heights Cheras, Kuala Lumpur, Malaysia
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Brown JC, Yang S, Mire EF, Wu X, Miele L, Ochoa A, Zabaleta J, Katzmarzyk PT. Obesity and cancer death in white and black adults: A prospective cohort study. Obesity (Silver Spring) 2021; 29:2119-2125. [PMID: 34693655 PMCID: PMC9256081 DOI: 10.1002/oby.23290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/29/2021] [Accepted: 08/02/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This study aimed to determine whether race modifies the association between obesity and cancer death. METHODS The Pennington Center Longitudinal Study included 18,296 adults; 35.0% were male and 34.3% were Black. The primary end point was death from cancer. RESULTS During a follow-up of 14.3 years, 346 cancer deaths occurred. Among men, race modified the association of BMI and cancer death (pinteraction = 0.045); compared with a BMI of 22 kg/m2 , a BMI of 35 in White men was associated with a hazard ratio of 1.74 (95% CI: 1.38-2.21), and in Black men, the hazard ratio was 0.64 (95% CI: 0.45-0.90). Among women, race did not modify the association of BMI and cancer death (pinteraction =0.43); however, compared with a BMI of 22, a BMI of 35 in White women was associated with a hazard ratio of 1.42 (95% CI: 1.18-1.70) and in Black women, the hazard ratio was 0.99 (95% CI: 0.82-1.20). CONCLUSIONS In this diverse cohort of adults, having obesity was associated with an increased risk of cancer death in White men and women. In contrast, having obesity was associated with a reduced risk of cancer death in Black men and did not influence risk in Black women.
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Affiliation(s)
- Justin C. Brown
- Pennington Biomedical Research Center, 6400 Perkins Rd, Baton Rouge, LA 70808, USA
- LSU Health Sciences Center New Orleans School of Medicine, 1901 Perdido St, New Orleans, LA 70112
- Stanley S. Scott Cancer Center, Louisiana State University Health Sciences Center, 533 Bolivar St, New Orleans, LA 70112, USA
| | - Shengping Yang
- Pennington Biomedical Research Center, 6400 Perkins Rd, Baton Rouge, LA 70808, USA
| | - Emily F. Mire
- Pennington Biomedical Research Center, 6400 Perkins Rd, Baton Rouge, LA 70808, USA
| | - Xiaocheng Wu
- LSU Health Sciences Center New Orleans School of Medicine, 1901 Perdido St, New Orleans, LA 70112
- Stanley S. Scott Cancer Center, Louisiana State University Health Sciences Center, 533 Bolivar St, New Orleans, LA 70112, USA
- Louisiana State University Health Science Center School of Public Health/Louisiana Tumor Registry, 2020 Gravier St, New Orleans, LA 70122, USA
| | - Lucio Miele
- LSU Health Sciences Center New Orleans School of Medicine, 1901 Perdido St, New Orleans, LA 70112
- Stanley S. Scott Cancer Center, Louisiana State University Health Sciences Center, 533 Bolivar St, New Orleans, LA 70112, USA
| | - Augusto Ochoa
- LSU Health Sciences Center New Orleans School of Medicine, 1901 Perdido St, New Orleans, LA 70112
- Stanley S. Scott Cancer Center, Louisiana State University Health Sciences Center, 533 Bolivar St, New Orleans, LA 70112, USA
| | - Jovanny Zabaleta
- LSU Health Sciences Center New Orleans School of Medicine, 1901 Perdido St, New Orleans, LA 70112
- Stanley S. Scott Cancer Center, Louisiana State University Health Sciences Center, 533 Bolivar St, New Orleans, LA 70112, USA
| | - Peter T. Katzmarzyk
- Pennington Biomedical Research Center, 6400 Perkins Rd, Baton Rouge, LA 70808, USA
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Agyemang C, van der Linden EL, Bennet L. Type 2 diabetes burden among migrants in Europe: unravelling the causal pathways. Diabetologia 2021; 64:2665-2675. [PMID: 34657183 PMCID: PMC8563673 DOI: 10.1007/s00125-021-05586-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/17/2021] [Indexed: 12/16/2022]
Abstract
European populations are ethnically and culturally diverse due to international migration. Evidence indicates large ethnic inequalities in the prevalence of type 2 diabetes. This review discusses the burden of type 2 diabetes and its related complications, and the potential explanatory mechanisms among migrants in Europe. The current available data suggest that the rate of type 2 diabetes is higher in all migrant groups and that they develop this disease at an earlier age than the host European populations. The level of diabetes awareness among migrant populations is high, but glycaemic control remains suboptimal compared with Europeans. The culturally adapted lifestyle modification intervention trials to prevent type 2 diabetes mainly focus on South Asian adults in Europe. Diabetes-related microvascular and macrovascular complications remain a major burden among migrant populations in Europe. Earlier studies found higher mortality rates among migrants, but recent studies seem to suggest a shifting trend in favour of first-generation migrants. However, the extent of the burden of type 2 diabetes varies across migrant groups and European countries. Despite the higher burden of type 2 diabetes among migrants, the key underlying factors are not well understood mainly due to limited investment in basic science research and development of prospective cohort studies. We hypothesise that the underlying risk factors for the high burden of type 2 diabetes and its related complications in migrants are multifaceted and include pre-migration factors, post-migration factors and genetic predispositions. Given the multi-ethnic nature of the current European population, there is a clear need for investment in research among migrant populations to gain insight into factors driving the high burden of type 2 diabetes and related complications to facilitate prevention and treatment efforts in Europe.
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Affiliation(s)
- Charles Agyemang
- Department of Public & Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.
| | - Eva L van der Linden
- Department of Public & Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Louise Bennet
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
- Clinical Research and Trial Centre, Lund University Hospital, Lund, Sweden
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Catherine JP, Russell MV, Peter CH. The impact of race and socioeconomic factors on paediatric diabetes. EClinicalMedicine 2021; 42:101186. [PMID: 34805811 PMCID: PMC8585622 DOI: 10.1016/j.eclinm.2021.101186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/12/2021] [Accepted: 10/19/2021] [Indexed: 12/16/2022] Open
Abstract
There are over 29,000 children and young people (CYP) with Type 1 diabetes mellitus (T1DM) in England and Wales and another 726 with Type 2 diabetes mellitus (T2DM). There is little effect of deprivation on the prevalence of T1DM whereas the association of deprivation on the percentage of CYP with T2DM is striking with 45% of cases drawn from the most deprived backgrounds. A number that has not changed over the last 4 years. Data from the UK and USA as well as other countries demonstrate the impact of deprivation on outcomes in diabetes mellitus with clear effects on measures of long-term control and complications. In the UK black CYP had higher glycosylated haemoglobin (HbA1c) values compared to other groups. Within the black group, CYP from a Caribbean background had a higher mean HbA1c (77.0 mmol/mol (9.2%)) than those from Africa (70.4 mmol/mol (8.6%)). Treatment regimen (multiple daily injections or insulin pump therapy) explained the largest proportion of the variability in HbA1c followed by deprivation. Those in the least deprived areas had an average HbA1c 5.88 mmol/mol (0.5%) lower than those living in the most deprived areas. The picture is complex as UK data also show that deprivation and ethnicity is associated with less use of technology that is likely to improve diabetes control. Increased usage of pump therapy and continuous glucose monitoring was associated with a younger age of patient (less than 10 years of age), living in the least deprived areas and white ethnicity. This gap between pump usage amongst CYP with T1DM living in the most and least deprived areas has widened with time. In 2014/15 the gap was 7.9% and by 2018/19 had increased to 13.5%. To attain an equitable service for CYP with diabetes mellitus we need to consider interventions at the patient, health care professional, community, and health care system levels.
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Muilwijk M, Loh M, Siddiqui S, Mahmood S, Palaniswamy S, Shahzad K, Athauda LK, Jayawardena R, Batool T, Burney S, Glover M, Bamunuarachchi V, Panda M, Madawanarachchi M, Rai B, Sattar I, Silva W, Waghdhare S, Jarvelin MR, Rannan-Eliya RP, Wijemunige N, Gage HM, Valabhji J, Frost GS, Wickremasinghe R, Kasturiratne A, Khawaja KI, Ahmad S, van Valkengoed IG, Katulanda P, Jha S, Kooner JS, Chambers JC. Effects of a lifestyle intervention programme after 1 year of follow-up among South Asians at high risk of type 2 diabetes: a cluster randomised controlled trial. BMJ Glob Health 2021; 6:e006479. [PMID: 34725039 PMCID: PMC8562508 DOI: 10.1136/bmjgh-2021-006479] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/30/2021] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION South Asians are at high risk of type 2 diabetes (T2D). We assessed whether intensive family-based lifestyle intervention leads to significant weight loss, improved glycaemia and blood pressure in adults at elevated risk for T2D. METHODS This cluster randomised controlled trial (iHealth-T2D) was conducted at 120 locations across India, Pakistan, Sri Lanka and the UK. We included 3684 South Asian men and women, aged 40-70 years, without T2D but with raised haemoglobin A1c (HbA1c) and/or waist circumference. Participants were randomly allocated either to the family-based lifestyle intervention or control group by location clusters. Participants in the intervention received 9 visits and 13 telephone contacts by community health workers over 1-year period, and the control group received usual care. Reductions in weight (aim >7% reduction), waist circumference (aim ≥5 cm reduction), blood pressure and HbA1C at 12 months of follow-up were assessed. Our linear mixed-effects regression analysis was based on intention-to-treat principle and adjusted for age, sex and baseline values. RESULTS There were 1846 participants in the control and 1838 in the intervention group. Between baseline and 12 months, mean weight of participants in the intervention group reduced by 1.8 kg compared with 0.4 kg in the control group (adjusted mean difference -1.10 kg (95% CI -1.70 to -1.06), p<0.001). The adjusted mean difference for waist circumference was -1.9 cm (95% CI -2.5; to 1.3), p<0.001). No overall difference was observed for blood pressure or HbA1c. People who attended multiple intervention sessions had a dose-dependent effect on waist circumference, blood pressure and HbA1c, but not on weight. CONCLUSION An intensive family-based lifestyle intervention adopting low-resource strategies led to effective reduction in weight and waist circumference at 12 months, which has potential long-term benefits for preventing T2D. A higher number of attended sessions increased the effect on waist circumference, blood pressure and HbA1c. TRIAL REGISTRATION NUMBER EudraCT: 2016-001350-18; ClinicalTrials.gov: NCT02949739.
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Affiliation(s)
- Mirthe Muilwijk
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Marie Loh
- Lee Kon Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Samreen Siddiqui
- Institute of Endocrinology Diabetes and Metabolism, Max Healthcare, New Delhi, Delhi, India
| | - Sara Mahmood
- Department of Endocrinology & Metabolism, Services Institute of Medical Sciences, Lahore, Punjab, Pakistan
| | - Saranya Palaniswamy
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
| | | | - Lathika K Athauda
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Ranil Jayawardena
- Department of Physiology, Faculty of Medicine, University of Colombo, Colombo, Western, Sri Lanka
| | - Tayyaba Batool
- Department of Endocrinology and Metabolism, Services Institute of Medical Sciences, Lahore, Punjab, Pakistan
| | - Saira Burney
- Department of Endocrinology & Metabolism, Services Institute of Medical Sciences, Lahore, Punjab, Pakistan
| | - Matthew Glover
- School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK
| | - Vodathi Bamunuarachchi
- Diabetes Research Unit, Faculty of Medicine, University of Colombo, Colombo, Western, Sri Lanka
| | - Manju Panda
- Institute of Endocrinology Diabetes and Metabolism, Max Healthcare, New Delhi, Delhi, India
| | - Madawa Madawanarachchi
- Diabetes Research Unit, Faculty of Medicine, University of Colombo, Colombo, Western, Sri Lanka
| | - Baldeesh Rai
- School of Public Health, Imperial College London, London, UK
| | - Iqra Sattar
- Punjab Institute of Cardiology, Lahore, Punjab, Pakistan
| | - Wnurinham Silva
- School of Public Health, Imperial College London, London, UK
| | - Swati Waghdhare
- Institute of Endocrinology Diabetes and Metabolism, Max Healthcare, New Delhi, Delhi, India
| | - Marjo-Riitta Jarvelin
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
- School of Public Health, Imperial College London, London, UK
- Department of Life Sciences, College of Health and Life Sciences, Brunel University, London, UK
- Unit of Primary Care, Oulu University Hospital, Oulu, Finland
| | | | | | - Heather M Gage
- Surrey Health Economics Centre, Department of Clinical and Experimental Medicine, University of Surrey, Guildford, Surrey, UK
| | - Jonathan Valabhji
- Department of Diabetes and Endocrinology, Imperial College London, London, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Gary S Frost
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Rajitha Wickremasinghe
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Anuradhani Kasturiratne
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Khadija I Khawaja
- Department of Endocrinology & Metabolism, Services Institute of Medical Sciences, Lahore, Punjab, Pakistan
| | - Sajjad Ahmad
- Punjab Institute of Cardiology, Lahore, Punjab, Pakistan
| | - Irene Gm van Valkengoed
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Prasad Katulanda
- Department of Clinical Medicine, University of Colombo, Colombo, Sri Lanka
| | - Sujeet Jha
- Institute of Endocrinology Diabetes and Metabolism, Max Healthcare, New Delhi, Delhi, India
| | - Jaspal S Kooner
- London North West University Healthcare NHS Trust, Harrow, London, UK
- National Heart & Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - John C Chambers
- Lee Kon Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
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Dlamini SN, Lombard Z, Micklesfield LK, Crowther N, Norris SA, Snyman T, Crawford AA, Walker BR, Goedecke JH. Glucocorticoids associate with cardiometabolic risk factors in black South Africans. Endocr Connect 2021; 10:873-884. [PMID: 34261039 PMCID: PMC8346194 DOI: 10.1530/ec-21-0195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/14/2021] [Indexed: 01/10/2023]
Abstract
Circulating glucocorticoids are associated with metabolic syndrome and related cardiometabolic risk factors in non-Africans. This study investigated these associations in Africans, whose metabolic phenotype reportedly differs from Europeans. Adiposity, blood pressure, glycaemia, insulin resistance, and lipid profile, were measured in 316 African men and 788 African women living in Soweto, Johannesburg. The 2009 harmonized criteria were used to define metabolic syndrome. Serum glucocorticoids were measured using liquid chromatography-mass spectrometry. Cortisol was associated with greater odds presenting with metabolic syndrome (odds ratio (95% CI) =1.50 (1.04, 2.17) and higher systolic (beta coefficient, β (95% CI) =0.04 (0.01, 0.08)) and diastolic (0.05 (0.02, 0.09)) blood pressure, but higher HDL (0.10 (0.02, 0.19)) and lower LDL (-0.14 (-0.24, -0.03)) cholesterol concentrations, in the combined sample of men and women. In contrast, corticosterone was only associated with higher insulin sensitivity (Matsuda index; 0.22 (0.03, 0.41)), but this was not independent of BMI. Sex-specific associations were observed, such that both cortisol and corticosterone were associated with higher fasting glucose (standardized β (95% CI): 0.24 (0.12, 0.36) for cortisol and 0.12 (0.01, 0.23) for corticosterone) and HbA1c (0.13 (0.01, 0.25) for cortisol and 0.12 (0.01, 0.24) for corticosterone) in men only, but lower HbA1c (0.10 (-0.20, -0.01) for cortisol and -0.09 (-0.18, -0.03) for corticosterone) in women only. Our study reports for the first time that associations between circulating glucocorticoid concentrations and key cardiometabolic risk factors exhibit both glucocorticoid- and sex-specificity in Africans.
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Affiliation(s)
- Siphiwe N Dlamini
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Non-communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Zané Lombard
- Division of Human Genetics, National Health Laboratory Service, and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lisa K Micklesfield
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nigel Crowther
- Department of Chemical Pathology, National Health Laboratory Service and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shane A Norris
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tracy Snyman
- Department of Chemical Pathology, National Health Laboratory Service and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Andrew A Crawford
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Brian R Walker
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Institute of Genetic Medicine to Translational & Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Julia H Goedecke
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Non-communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
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Wade AN, Hambleton IR, Hennis AJM, Howitt C, Jeyaseelan SM, Ojeh NO, Rose AMC, Unwin N. Anthropometric cut-offs to identify hyperglycemia in an Afro-Caribbean population: a cross-sectional population-based study from Barbados. BMJ Open Diabetes Res Care 2021; 9:9/1/e002246. [PMID: 34400464 PMCID: PMC8370513 DOI: 10.1136/bmjdrc-2021-002246] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 07/27/2021] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Body mass index (BMI) and waist circumference (WC) cut-offs associated with hyperglycemia may differ by ethnicity. We investigated the optimal BMI and WC cut-offs for identifying hyperglycemia in the predominantly Afro-Caribbean population of Barbados. RESEARCH DESIGN AND METHODS A cross-sectional study of 865 individuals aged ≥25 years without known diabetes or cardiovascular disease was conducted. Hyperglycemia was defined as fasting plasma glucose ≥5.6 mmol/L or hemoglobin A1c ≥5.7% (39 mmol/mol). The Youden index was used to identify the optimal cut-offs from the receiver operating characteristic (ROC) curves. Further ROC analysis and multivariable log binomial regression were used to compare standard and data-derived cut-offs. RESULTS The prevalence of hyperglycemia was 58.9% (95% CI 54.7% to 63.0%). In women, optimal BMI and WC cut-offs (27 kg/m2 and 87 cm, respectively) performed similarly to standard cut-offs. In men, sensitivities of the optimal cut-offs of BMI ≥24 kg/m2 (72.0%) and WC ≥86 cm (74.0%) were higher than those for standard BMI and WC obesity cut-offs (30.0% and 25%-46%, respectively), although with lower specificity. Hyperglycemia was 70% higher in men above the data-derived WC cut-off (prevalence ratio 95% CI 1.2 to 2.3). CONCLUSIONS While BMI and WC cut-offs in Afro-Caribbean women approximate international standards, our findings, consistent with other studies, suggest lowering cut-offs in men may be warranted to improve detection of hyperglycemia. Our findings do, however, require replication in a new data set.
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Affiliation(s)
- Alisha N Wade
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | - Ian R Hambleton
- The University of the West Indies George Alleyne Chronic Disease Research Centre, Bridgetown, Barbados
| | - Anselm J M Hennis
- The University of the West Indies George Alleyne Chronic Disease Research Centre, Bridgetown, Barbados
| | - Christina Howitt
- The University of the West Indies George Alleyne Chronic Disease Research Centre, Bridgetown, Barbados
| | - Selvi M Jeyaseelan
- Faculty of Medical Sciences, The University of the West Indies Cave Hill Campus, Bridgetown, Barbados
| | - Nkemcho O Ojeh
- Faculty of Medical Sciences, The University of the West Indies Cave Hill Campus, Bridgetown, Barbados
| | - Angela M C Rose
- The University of the West Indies George Alleyne Chronic Disease Research Centre, Bridgetown, Barbados
- Epidemiology Department, Epiconcept SAS, Paris, France
| | - Nigel Unwin
- The University of the West Indies George Alleyne Chronic Disease Research Centre, Bridgetown, Barbados
- European Centre for Environment and Human Health, University of Exeter Medical School, Exeter, UK
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
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40
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Liu F, Liu Y, Liu M, Wu G, Zhang M, Zhang X, Cui N, Yin H, Chen L. Efficacy of once-daily glucagon-like peptide-1 receptor agonist lixisenatide as an add-on treatment to basal insulin in Asian and white adults with type 2 diabetes mellitus: An individual-level pooled analysis of phase III studies. J Diabetes Investig 2021; 12:1386-1394. [PMID: 33475222 PMCID: PMC8354505 DOI: 10.1111/jdi.13504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/11/2020] [Accepted: 01/01/2021] [Indexed: 11/29/2022] Open
Abstract
AIMS/INTRODUCTION The prevalence and pathophysiological background of type 2 diabetes mellitus vary across ethnicities, and can affect treatment responses. Adding lixisenatide to basal insulin (BI) in type 2 diabetes mellitus patients has shown improvements in glycated hemoglobin (HbA1c) and postprandial glycemic (PPG) excursions, without increasing hypoglycemic events. We aim to compare the efficacy of lixisenatide in Asian and white patients inadequately controlled with basal insulin. MATERIALS AND METHODS An individual-level pooled analysis of two multi-national phase III studies, GetGoal-L and GetGoal-L-C, was carried out to assess the efficacy of lixisenatide versus placebo as an add-on treatment to BI ± metformin in Asian and white patients with type 2 diabetes mellitus. Change in HbA1c, 2-h PPG and PPG excursion were analyzed, along with possible predictors of glycemic control. RESULTS Pooled data showed that baseline characteristics were similar between Asian and white patients with the exception of bodyweight, body mass index and BI dose being higher in white patients. After 24 weeks, lixisenatide reduced HbA1c in both ethnic groups, with no statistically significant difference between the two groups (Asian patients least squares mean difference -0.49, 95% confidence interval -0.68 to - 0.30 and white patients least squares mean difference -0.45, 95% confidence interval -0.63 to - 0.26; P = 0.6287). Similarly, no significant difference was found in 2-h PPG reduction between both groups (least squares mean difference for Asian vs white patients: -3.37 vs -3.93; P = 0.3203). Treatment with lixisenatide contributed to HbA1c reduction of -0.56% after adjustment of baseline HbA1c level in Asian patients, and -0.41% in white patients. CONCLUSIONS Adding lixisenatide to BI significantly reduced HbA1c and 2-h PPG levels in both Asian and white participants with type 2 diabetes mellitus. No differences in treatment effect were observed between the two populations.
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Affiliation(s)
- Fuqiang Liu
- Department of EndocrinologyQilu Hospital of Shandong UniversityJinanChina
| | - Yuan Liu
- Department of EndocrinologyQilu Hospital of Shandong UniversityJinanChina
| | - Minzhi Liu
- BDM Consulting, Inc.SomersetNew JerseyUSA
| | - Guangyu Wu
- Sanofi Investment Co., Ltd.ShanghaiChina
| | | | - Xia Zhang
- Sanofi Investment Co., Ltd.ShanghaiChina
| | - Nan Cui
- Sanofi Investment Co., Ltd.ShanghaiChina
| | - Huiqiu Yin
- Sanofi Investment Co., Ltd.ShanghaiChina
| | - Li Chen
- Department of EndocrinologyQilu Hospital of Shandong UniversityJinanChina
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41
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Manyara AM. Optimal cut-offs of five anthropometric indices and their predictive ability of type 2 diabetes in a nationally representative Kenyan study. AIMS Public Health 2021; 8:507-518. [PMID: 34395701 PMCID: PMC8334637 DOI: 10.3934/publichealth.2021041] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/06/2021] [Indexed: 11/18/2022] Open
Abstract
Background Type 2 diabetes (T2D) is one of the top non-communicable diseases in Kenya and prevention strategies are urgently needed. Intervening to reduce obesity is the most common prevention strategy. However, black populations develop T2D at lower obesity levels and it is unclear which anthropometric cut-offs could provide the best predictive ability for T2D risk. This study, therefore, aimed to determine the optimal anthropometric cut-offs and their predictive ability of T2D in Kenya. Methods The study included 2159 participants (59% women) aged 35-70 years from the Kenya STEPwise survey conducted in 2014. Five anthropometric indices were used-body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR), waist to height ratio (WHtR) and waist divided by height0.5(WHt.5R). Diabetes was defined as a fasting blood glucose of ≥7.0 mmol/l or a previous diagnosis by a health worker. Optimal anthropometric cut-offs and their receiver operating characteristics, such as the area under the curve (AUC), were computed. Results Overall, the optimal cut-off for BMI, WC, WHR, WHtR and WHt.5R were 24.8 kg.m-2, 90 cm, 0.88, 0.54 and 6.9. On disaggregation by sex, the optimal cut-off for BMI, WC, WHR WHtR and WHt.5R was 27.1 kg.m-2, 87 cm, 0.85, 0.55 and 6.9 in women, and 24.8 kg.m-2, 91 cm, 0.88, 0.54 and 6.9 in men. Overall, WC (AUC 0.71 (95% confidence interval 0.65, 0.76)) WHtR (AUC 0.71 (0.66, 0.76)) and WHt.5R (AUC 0.70 (0.65,0.75)) had a better predictive ability for T2D than BMI (AUC 0.68 (0.62, 0.73)). Conclusions WC, WHtR and WHt.5R were better predictors of T2D than BMI and should be used for risk stratification in Kenya. A WC cut-off of 87cm in women and 91cm in men, a WHtR cut-off of 0.54 or a WHt.5R of 6.9 in both men and women should be used to identify individuals at an elevated risk of T2D.
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Affiliation(s)
- Anthony Muchai Manyara
- Social and Political Sciences, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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42
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Hosoe J, Suzuki K, Miya F, Kato T, Tsunoda T, Okada Y, Horikoshi M, Shojima N, Yamauchi T, Kadowaki T. Structural basis of ethnic-specific variants of PAX4 associated with type 2 diabetes. Hum Genome Var 2021; 8:25. [PMID: 34226521 PMCID: PMC8257626 DOI: 10.1038/s41439-021-00156-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 11/09/2022] Open
Abstract
Recently, we conducted genome-wide association studies of type 2 diabetes (T2D) in a Japanese population, which identified 20 novel T2D loci that were not associated with T2D in Europeans. Moreover, nine novel missense risk variants, such as those of PAX4, were not rare in the Japanese population, but rare in Europeans. We report in silico structural analysis of ethnic-specific variants of PAX4, which suggests the pathogenic effect of these variants.
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Affiliation(s)
- Jun Hosoe
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ken Suzuki
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Statistical Genetics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Fuyuki Miya
- Department of Medical Science Mathematics, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan.,Laboratory for Medical Science Mathematics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan.,CREST, JST, Tokyo, Japan
| | - Takashi Kato
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tatsuhiko Tsunoda
- Department of Medical Science Mathematics, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan.,Laboratory for Medical Science Mathematics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan.,CREST, JST, Tokyo, Japan.,Laboratory for Medical Science Mathematics, Department of Biological Sciences, Graduate School of Science, The University of Tokyo, Tokyo, Japan
| | - Yukinori Okada
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Momoko Horikoshi
- Laboratory for Genomics of Diabetes and Metabolism, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Nobuhiro Shojima
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Toshimasa Yamauchi
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Takashi Kadowaki
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. .,Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. .,Department of Metabolism and Nutrition, Teikyo University Mizonokuchi Hospital, Kawasaki, Kanagawa, Japan. .,Toranomon Hospital, Tokyo, Japan.
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43
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Affiliation(s)
- David E Cummings
- UW Medicine Diabetes Institute, VA Puget Sound Health Care System, University of Washington, Seattle, WA, USA
| | - Francesco Rubino
- Department of Bariatric/Metabolic Surgery, King's College Hospital, London, UK; Department of Diabetes, School of Life Course Sciences, King's College London, London SE5 9NU, UK.
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44
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Yates T, Zaccardi F, Islam N, Razieh C, Gillies CL, Lawson CA, Chudasama Y, Rowlands A, Davies MJ, Docherty AB, Openshaw PJM, Baillie JK, Semple MG, Khunti K. Obesity, Ethnicity, and Risk of Critical Care, Mechanical Ventilation, and Mortality in Patients Admitted to Hospital with COVID-19: Analysis of the ISARIC CCP-UK Cohort. Obesity (Silver Spring) 2021; 29:1223-1230. [PMID: 33755331 PMCID: PMC8251439 DOI: 10.1002/oby.23178] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/05/2021] [Accepted: 03/17/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the association of obesity with in-hospital coronavirus disease 2019 (COVID-19) outcomes in different ethnic groups. METHODS Patients admitted to hospital with COVID-19 in the United Kingdom through the Clinical Characterisation Protocol UK (CCP-UK) developed by the International Severe Acute Respiratory and emerging Infections Consortium (ISARIC) were included from February 6 to October 12, 2020. Ethnicity was classified as White, South Asian, Black, and other minority ethnic groups. Outcomes were admission to critical care, mechanical ventilation, and in-hospital mortality, adjusted for age, sex, and chronic diseases. RESULTS Of the participants included, 54,254 (age = 76 years; 45.0% women) were White, 3,728 (57 years; 41.1% women) were South Asian, 2,523 (58 years; 44.9% women) were Black, and 5,427 (61 years; 40.8% women) were other ethnicities. Obesity was associated with all outcomes in all ethnic groups, with associations strongest for black ethnicities. When stratified by ethnicity and obesity status, the odds ratios for admission to critical care, mechanical ventilation, and mortality in black ethnicities with obesity were 3.91 (3.13-4.88), 5.03 (3.94-6.63), and 1.93 (1.49-2.51), respectively, compared with White ethnicities without obesity. CONCLUSIONS Obesity was associated with an elevated risk of in-hospital COVID-19 outcomes in all ethnic groups, with associations strongest in Black ethnicities.
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Affiliation(s)
- Thomas Yates
- Diabetes Research CentreUniversity of LeicesterLeicester General HospitalLeicesterUK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC)University Hospitals of Leicester NHS Trust and University of LeicesterLeicesterUK
| | - Francesco Zaccardi
- Diabetes Research CentreUniversity of LeicesterLeicester General HospitalLeicesterUK
- Leicester Real World Evidence UnitDiabetes Research CentreUniversity of LeicesterLeicesterUK
| | - Nazrul Islam
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU)Nuffield Department of Population HealthUniversity of OxfordOxfordUK
- Medical Research Council Epidemiology UnitUniversity of CambridgeCambridgeUK
| | - Cameron Razieh
- Diabetes Research CentreUniversity of LeicesterLeicester General HospitalLeicesterUK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC)University Hospitals of Leicester NHS Trust and University of LeicesterLeicesterUK
| | - Clare L. Gillies
- Diabetes Research CentreUniversity of LeicesterLeicester General HospitalLeicesterUK
- Leicester Real World Evidence UnitDiabetes Research CentreUniversity of LeicesterLeicesterUK
| | - Claire A. Lawson
- Diabetes Research CentreUniversity of LeicesterLeicester General HospitalLeicesterUK
| | - Yogini Chudasama
- Leicester Real World Evidence UnitDiabetes Research CentreUniversity of LeicesterLeicesterUK
| | - Alex Rowlands
- Diabetes Research CentreUniversity of LeicesterLeicester General HospitalLeicesterUK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC)University Hospitals of Leicester NHS Trust and University of LeicesterLeicesterUK
| | - Melanie J. Davies
- Diabetes Research CentreUniversity of LeicesterLeicester General HospitalLeicesterUK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC)University Hospitals of Leicester NHS Trust and University of LeicesterLeicesterUK
| | - Annemarie B. Docherty
- Centre for Medical InformaticsUsher InstituteUniversity of EdinburghEdinburghUK
- Intensive Care UnitRoyal Infirmary EdinburghEdinburghUK
| | | | | | - Malcolm G. Semple
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections and Institute of Translational Medicine, Faculty of Health and Life SciencesUniversity of LiverpoolLiverpoolUK
- Respiratory MedicineAlder Hey Children’s HospitalInstitute in The ParkUniversity of LiverpoolAlder Hey Children’s HospitalLiverpoolUK
| | | | - Kamlesh Khunti
- Diabetes Research CentreUniversity of LeicesterLeicester General HospitalLeicesterUK
- Leicester Real World Evidence UnitDiabetes Research CentreUniversity of LeicesterLeicesterUK
- NIHR Applied Research Collaboration – East Midlands (ARC‐EM)University Hospitals of Leicester NHS Trust and University of LeicesterLeicesterUK
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Caleyachetty R, Barber TM, Mohammed NI, Cappuccio FP, Hardy R, Mathur R, Banerjee A, Gill P. Ethnicity-specific BMI cutoffs for obesity based on type 2 diabetes risk in England: a population-based cohort study. Lancet Diabetes Endocrinol 2021; 9:419-426. [PMID: 33989535 PMCID: PMC8208895 DOI: 10.1016/s2213-8587(21)00088-7] [Citation(s) in RCA: 161] [Impact Index Per Article: 53.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND National and global recommendations for BMI cutoffs to trigger action to prevent obesity-related complications like type 2 diabetes among non-White populations are questionable. We aimed to prospectively identify ethnicity-specific BMI cutoffs for obesity based on the risk of type 2 diabetes that are risk-equivalent to the BMI cutoff for obesity among White populations (≥30 kg/m2). METHODS In this population-based cohort study, we used electronic health records across primary care (Clinical Practice Research Datalink) linked to secondary care records (Hospital Episodes Statistics) from a network of general practitioner practices in England. Eligible participants were aged 18 years or older, without any past or current diagnosis of type 2 diabetes, had a BMI of 15·0-50·0 kg/m2 and complete ethnicity data, were registered with a general practitioner practice in England at any point between Sept 1, 1990, and Dec 1, 2018, and had at least 1 year of follow-up data. Patients with type 2 diabetes were identified by use of a CALIBER phenotyping algorithm. Self-reported ethnicity was collapsed into five main categories. Age-adjusted and sex-adjusted negative binomial regression models, with fractional polynomials for BMI, were fitted with incident type 2 diabetes and ethnicity data. FINDINGS 1 472 819 people were included in our study, of whom 1 333 816 (90·6%) were White, 75 956 (5·2%) were south Asian, 49 349 (3·4%) were Black, 10 934 (0·7%) were Chinese, and 2764 (0·2%) were Arab. After a median follow-up of 6·5 years (IQR 3·2-11·2), 97 823 (6·6%) of 1 472 819 individuals were diagnosed with type 2 diabetes. For the equivalent age-adjusted and sex-adjusted incidence of type 2 diabetes at a BMI of 30·0 kg/m2 in White populations, the BMI cutoffs were 23·9 kg/m2 (95% CI 23·6-24·0) in south Asian populations, 28·1 kg/m2 (28·0-28·4) in Black populations, 26·9 kg/m2 (26·7-27·2) in Chinese populations, and 26·6 kg/m2 (26·5-27·0) in Arab populations. INTERPRETATION Revisions of ethnicity-specific BMI cutoffs are needed to ensure that minority ethnic populations are provided with appropriate clinical surveillance to optimise the prevention, early diagnosis, and timely management of type 2 diabetes. FUNDING National Institute for Health Research.
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Affiliation(s)
- Rishi Caleyachetty
- Nuffield Department of Population Health, University of Oxford, Oxford, UK; Warwick Medical School, University of Warwick, Coventry, UK.
| | - Thomas M Barber
- Warwick Medical School, University of Warwick, Coventry, UK; Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | | | - Rebecca Hardy
- Social Research Institute, University College London, London, UK
| | - Rohini Mathur
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, UK
| | - Paramjit Gill
- Warwick Medical School, University of Warwick, Coventry, UK
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46
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Perini W, van Valkengoed IGM, Snijder MB, Peters RJG, Kunst AE. The contribution of obesity to the population burden of high metabolic cardiovascular risk among different ethnic groups. The HELIUS study. Eur J Public Health 2021; 30:322-327. [PMID: 32053154 DOI: 10.1093/eurpub/ckz190] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The burden of cardiovascular risk is distributed unequally between ethnic groups. It is uncertain to what extent this is attributable to ethnic differences in general and abdominal obesity. Therefore, we studied the contribution of general and abdominal obesity to metabolic cardiovascular risk among different ethnic groups. METHODS We used data of 21 411 participants of Dutch, South-Asian Surinamese, African-Surinamese, Ghanaian, Turkish or Moroccan origin in Healthy Life in an Urban Setting (Amsterdam, the Netherlands). Obesity was defined using body-mass-index (general) or waist-to-height-ratio (abdominal). High metabolic risk was defined as having at least two of the following: triglycerides ≥1.7 mmol/l, fasting glucose ≥5.6 mmol/l, blood pressure ≥130 mmHg systolic and/or ≥85 mmHg diastolic and high-density lipoprotein cholesterol <1.03 mmol/l (men) or <1.29 mmol/l (women). RESULTS Among ethnic minority men, age-adjusted prevalence rates of high metabolic risk ranged from 32 to 59% vs. 33% among Dutch men. Contributions of general obesity to high metabolic risk ranged from 7.1 to 17.8%, vs. 10.1% among Dutch men, whereas contributions of abdominal obesity ranged from 52.1 to 92.3%, vs. 53.9% among Dutch men. Among ethnic minority women, age-adjusted prevalence rates of high metabolic risk ranged from 24 to 35% vs. 12% among Dutch women. Contributions of general obesity ranged from 14.6 to 41.8%, vs. 20% among Dutch women, whereas contributions of abdominal obesity ranged from 68.0 to 92.8%, vs. 72.1% among Dutch women. CONCLUSIONS Obesity, especially abdominal obesity, contributes significantly to the prevalence of high metabolic cardiovascular risk. Results suggest that this contribution varies substantially between ethnic groups, which helps explain ethnic differences in cardiovascular risk.
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Affiliation(s)
- Wilco Perini
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Irene G M van Valkengoed
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Marieke B Snijder
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Ron J G Peters
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Anton E Kunst
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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47
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Brown JC, Carson TL, Thompson HJ, Agurs-Collins T. The Triple Health Threat of Diabetes, Obesity, and Cancer-Epidemiology, Disparities, Mechanisms, and Interventions. Obesity (Silver Spring) 2021; 29:954-959. [PMID: 34029445 PMCID: PMC8152945 DOI: 10.1002/oby.23161] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/10/2021] [Accepted: 02/13/2021] [Indexed: 12/12/2022]
Abstract
Obesity and type 2 diabetes are both chronic, relapsing, progressive diseases that are recognized as risk factors for the development of multiple types of cancer. In a recent symposium titled "Hitting A Triple-Diabetes, Obesity, and the Emerging Links to Cancer Risk," convened by The Obesity Society during ObesityWeek 2019, experts in the field presented the current science and highlighted existing research gaps. Topics included (1) the epidemiology of obesity and diabetes and their links to cancer risk; (2) racial and ethnic differences in obesity, diabetes, and cancer risk; (3) biological mechanisms common to obesity and diabetes that may increase cancer risk; and (4) innovative interventions that can be used to prevent the development of cancers related to obesity and diabetes. This report provides an overview of the symposium and describes key research gaps and pressing questions in need of answers to advance the field. The collective burden of obesity, diabetes, and cancer represents one of the largest public health challenges of the century. Although the symposium was titled "hitting a triple," it was recognized that being able to disrupt the linkages among obesity, diabetes, and cancer would be a "grand slam" for public health and medicine.
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Affiliation(s)
- Justin C. Brown
- Pennington Biomedical Research Center, 6400 Perkins Rd, Baton Rouge, LA 70808, USA
- LSU Health Sciences Center New Orleans School of Medicine, 1901 Perdido St, New Orleans, LA 70112, USA
- Stanley S. Scott Cancer Center, Louisiana State University Health Sciences Center, 533 Bolivar St, New Orleans, LA, 70112, USA
| | - Tiffany L. Carson
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, 33617, USA
| | | | - Tanya Agurs-Collins
- National Cancer Institute, National Institutes of Health, Rockville, MD, 20850, USA
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48
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Brown JC, Yang S, Mire EF, Wu X, Miele L, Ochoa A, Zabaleta J, Katzmarzyk PT. Obesity and Cancer Risk in White and Black Adults: A Prospective Cohort Study. Obesity (Silver Spring) 2021; 29:960-965. [PMID: 34029447 PMCID: PMC8422242 DOI: 10.1002/oby.23163] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/27/2021] [Accepted: 02/22/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Anthropometric measures of obesity, including BMI and waist circumference (WC), do not quantify excess adiposity and metabolic abnormalities consistently across racial populations. This study tested the hypothesis that participant race modifies the association of anthropometric measures of obesity and cancer risk. METHODS This prospective cohort (The Pennington Center Longitudinal Study) included 18,296 adults, 6,405 (35.0%) male sex and 6,273 (34.3%) Black race. The primary exposures were BMI (weight in kilograms/height in meters squared) and WC (centimeters). The primary end point was the time from study enrollment to diagnosis of histologically confirmed invasive cancer. RESULTS During a median follow-up of 14.0 years (interquartile range: 9.8-19.0 years), invasive cancer occurred in 1,350 participants. Among men, race modified the association of BMI (Pinteraction = 0.02) and WC (Pinteraction = 0.01) with cancer incidence; compared with a BMI of 22 kg/m2 , a BMI of 35 kg/m2 in White men was associated with a hazard ratio of 1.83 (95% CI: 1.58-2.12), whereas in Black men, the hazard ratio was 0.89 (95% CI: 0.72-1.11). Among women, race did not modify the association of BMI (Pinteraction = 0.41) or WC (Pinteraction = 0.36) with cancer incidence. CONCLUSIONS In this diverse cohort of adults, participant race and sex modified the prognostic associations of anthropometric measures of obesity and cancer risk.
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Affiliation(s)
- Justin C. Brown
- Pennington Biomedical Research Center, 6400 Perkins Rd, Baton Rouge, LA 70808, USA
- LSU Health Sciences Center New Orleans School of Medicine, 1901 Perdido St, New Orleans, LA 70112
- Stanley S. Scott Cancer Center, Louisiana State University Health Sciences Center, 533 Bolivar St, New Orleans, LA 70112, USA
| | - Shengping Yang
- Pennington Biomedical Research Center, 6400 Perkins Rd, Baton Rouge, LA 70808, USA
| | - Emily F. Mire
- Pennington Biomedical Research Center, 6400 Perkins Rd, Baton Rouge, LA 70808, USA
| | - Xiaocheng Wu
- LSU Health Sciences Center New Orleans School of Medicine, 1901 Perdido St, New Orleans, LA 70112
- Stanley S. Scott Cancer Center, Louisiana State University Health Sciences Center, 533 Bolivar St, New Orleans, LA 70112, USA
- Louisiana State University Health Science Center School of Public Health/Louisiana Tumor Registry, 2020 Gravier St, New Orleans, LA 70122, USA
| | - Lucio Miele
- LSU Health Sciences Center New Orleans School of Medicine, 1901 Perdido St, New Orleans, LA 70112
- Stanley S. Scott Cancer Center, Louisiana State University Health Sciences Center, 533 Bolivar St, New Orleans, LA 70112, USA
| | - Augusto Ochoa
- LSU Health Sciences Center New Orleans School of Medicine, 1901 Perdido St, New Orleans, LA 70112
- Stanley S. Scott Cancer Center, Louisiana State University Health Sciences Center, 533 Bolivar St, New Orleans, LA 70112, USA
| | - Jovanny Zabaleta
- LSU Health Sciences Center New Orleans School of Medicine, 1901 Perdido St, New Orleans, LA 70112
- Stanley S. Scott Cancer Center, Louisiana State University Health Sciences Center, 533 Bolivar St, New Orleans, LA 70112, USA
| | - Peter T. Katzmarzyk
- Pennington Biomedical Research Center, 6400 Perkins Rd, Baton Rouge, LA 70808, USA
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49
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Lee MMY, Ghouri N, McGuire DK, Rutter MK, Sattar N. Meta-analyses of Results From Randomized Outcome Trials Comparing Cardiovascular Effects of SGLT2is and GLP-1RAs in Asian Versus White Patients With and Without Type 2 Diabetes. Diabetes Care 2021; 44:1236-1241. [PMID: 33707305 DOI: 10.2337/dc20-3007] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 01/31/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Results of cardiovascular outcome trials (CVOTs) suggest Asians may derive greater benefit than Whites from newer classes of antihyperglycemic medications. PURPOSE To provide summary hazard ratio (HR) estimates for cardiovascular efficacy of sodium-glucose cotransporter 2 inhibitors (SGLT2is) and glucagon-like peptide 1 receptor agonists (GLP-1RAs) stratified by race (Asian vs. White). DATA SOURCES A systematic review performed in PubMed from 1 January 2015 to 8 December 2020. STUDY SELECTION Randomized placebo-controlled CVOTs of SGLT2is and GLP-1RAs that reported HRs (95% CIs) for 1) major adverse cardiovascular event (MACE) in patients with diabetes and 2) cardiovascular (CV) death/hospitalization for heart failure (HHF) in patients with HF and reduced ejection fraction (HFrEF). DATA EXTRACTION AND SYNTHESIS HRs (95% CIs) for selected outcomes in Asians and Whites were extracted from each trial, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Random-effects meta-analyses were performed to examine differences between the selected outcomes in Asians versus Whites. RESULTS In four SGLT2i trials in type 2 diabetes, the MACE outcome HR (95% CI) in 3,298 Asians versus 20,258 Whites was 0.81 (0.57, 1.04) vs. 0.90 (0.80, 1.00), respectively (P interaction = 0.46). In two SGLT2i trials in patients with HFrEF, the CV death/HHF outcome HR in 1,788 Asians versus 5,962 Whites was 0.60 (0.47, 0.74) vs. 0.82 (0.73, 0.92), respectively (P interaction = 0.01). In six GLP-1RA trials, the MACE outcome HR in 4,195 Asians versus 37,530 Whites was 0.68 (0.53, 0.84) vs. 0.87 (0.81, 0.94), respectively (P interaction = 0.03). LIMITATIONS Lack of individual patient-level data, relatively short duration of trial observation, and lack of granular categorization of race within broadly defined Asian subgroups. CONCLUSIONS Compared with Whites, Asians may derive greater CV death/HHF benefit from SGLT2is in patients with HFrEF, and MACE benefit from GLP-1RAs in patients with type 2 diabetes.
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Affiliation(s)
- Matthew M Y Lee
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K
| | - Nazim Ghouri
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K
- Department of Diabetes and Endocrinology, Queen Elizabeth University Hospital, Glasgow, U.K
| | - Darren K McGuire
- University of Texas Southwestern Medical Center, Parkland Health and Hospital System, Dallas, TX
| | - Martin K Rutter
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, University of Manchester, Manchester, U.K
- Diabetes, Endocrinology and Metabolism Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, U.K
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K.
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50
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Nazeha N, Sathish T, Soljak M, Dunleavy G, Visvalingam N, Divakar U, Bajpai RC, Soh CK, Christopoulos G, Car J. A Comparative Study of International and Asian Criteria for Overweight or Obesity at Workplaces in Singapore. Asia Pac J Public Health 2021; 33:404-410. [PMID: 33715451 DOI: 10.1177/1010539521998855] [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] [Indexed: 01/29/2023]
Abstract
To compare the prevalence of and risk factors associated with overweight or obesity between the international (body mass index [BMI] ≥25 kg/m2) and Asian (BMI ≥23 kg/m2) criteria in a working population in Singapore. This was a cross-sectional analysis of a cohort study of 464 employees (aged ≥21 years) conducted at 4 workplaces in Singapore. The prevalence of overweight or obesity was 47.4% and 67.0% with the international and Asian criteria, respectively. With both the criteria, higher age, male sex, Malay ethnicity (vs Chinese), lower white rice intake, and consumption of sugar-sweetened beverages were positively associated with overweight or obesity. Participants with poorer mental health and higher levels of thermal comfort in the workplace were positively associated with overweight or obesity only with the Asian criteria. The use of international criteria alone in this population could have overlooked these risk factors that are highly relevant to the Singapore context.
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Affiliation(s)
| | | | - Michael Soljak
- Nanyang Technological University, Singapore.,Imperial College London, London, UK
| | | | | | | | - Ram Chandra Bajpai
- Nanyang Technological University, Singapore.,Keele University, Staffordshire, UK
| | - Chee Kiong Soh
- Nanyang Technological University, Singapore.,Southeast University, Nanjing, China
| | | | - Josip Car
- Nanyang Technological University, Singapore.,Imperial College London, London, UK
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