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Zhao X, Schalkwijk C, Kroon A, Schram MT, Stehouwer C, Houben A. Different Measures of Hyperglycemia Are Negatively Associated With Skin Microvascular Flowmotion: The Maastricht Study. Microcirculation 2024:e12882. [PMID: 39171989 DOI: 10.1111/micc.12882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 07/18/2024] [Accepted: 08/06/2024] [Indexed: 08/23/2024]
Abstract
OBJECTIVE Diabetes can lead to microvascular complications such as diabetic neuropathy, nephropathy, and retinopathy. Hyperglycemia may initiate microvascular function impairment early in the course of diabetes, even prior to its clinical establishment during the pre-diabetes stage. Microvascular vasomotion, that is, the rhythmic arteriolar constriction and dilation, is an important function that regulates oxygen and nutrient delivery within the tissue and regulates peripheral resistance. Using laser Doppler flowmetry (LDF), vasomotion in skin microcirculation can be measured as flowmotion. Changes in flowmotion have been shown in individuals with obesity, and type 1 or type 2 diabetes mellitus. However, no data are available on associations between hyperglycemia and flowmotion in the general population. Our aim was to study whether measures of hyperglycemia were associated with different components of skin microvascular flowmotion (SMF) in a population-based cohort (The Maastricht Study). METHODS Data from 7293 participants of The Maastricht Study were used. SMF was measured using LDF. Endothelial, neurogenic and myogenic component SMF power were used as dependent variables. We investigated the associations of glucose metabolism status (normal glucose metabolism, prediabetes, and type 2 diabetes mellitus), measures of hyperglycemia (fasting plasma glucose [FPG], 2-h post-load glucose [2 h-PG], HbA1c, advanced glycation end-products [AGEs] assessed as skin autofluorescence [SAF]), and indices of glucose variability (incremental glucose peak [IGP] and continuous glucose monitoring [CGM] -assessed as standard deviation [SD]) with each component of SMF power. We used linear regression analyses with adjustments for confounders, and trend analyses. RESULTS We observed consistent negative associations between HbA1c levels and all three (endothelial, neurogenic, and myogenic) skin microvascular flowmotion (SMF) powers in the additionally adjusted model. Similarly, in the conservative model, we found that multiple hyperglycemia metrics such as GMS trend, PreD, T2DM, FPG, 2 h-PG, and HbA1c were consistently negatively associated with all three SMF powers. CONCLUSIONS We showed that skin microvascular flowmotion is reduced in individuals with (pre)diabetes. In addition, different measures of hyperglycemia are negatively associated with skin microvascular flowmotion.
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Grants
- OP-Zuid, the Province of Limburg, the Dutch Ministry of Economic Affairs (grant 31O.041), Stichting De Weijerhorst (Maastricht, the Netherlands), the Pearl String Initiative Diabetes (Amsterdam, the Netherlands), the Cardiovascular Center (CVC, Maastricht, the Netherlands), CARIM School for Cardiovascular Diseases (Maastricht, the Netherlands), CAPHRI School for Public Health and Primary Care (Maastricht, the Netherlands), NUTRIM School for Nutrition and Translational Research in Metabolism (Maa
- X.Zhao is supported by the Chinese Scholarship Council (202009120014)
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Affiliation(s)
- X Zhao
- CARIM School for Cardiovascular Diseases, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - C Schalkwijk
- CARIM School for Cardiovascular Diseases, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - A Kroon
- CARIM School for Cardiovascular Diseases, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - M T Schram
- CARIM School for Cardiovascular Diseases, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
- Heart and Vascular Center, MUMC+, Maastricht, The Netherlands
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | - C Stehouwer
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium
| | - A Houben
- CARIM School for Cardiovascular Diseases, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
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Safieddine B, Grasshoff J, Geyer S, Sperlich S, Epping J, Beller J. Type 2 diabetes in the employed population: do rates and trends differ among nine occupational sectors? An analysis using German health insurance claims data. BMC Public Health 2024; 24:1231. [PMID: 38702701 PMCID: PMC11069294 DOI: 10.1186/s12889-024-18705-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 04/24/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Socioeconomic inequalities in type 2 diabetes (T2D) are well established in the literature. However, within the background of changing work contexts associated with digitalization and its effect on lifestyle and sedentary behavior, little is known on T2D prevalence and trends among different occupational groups. This study aims to examine occupational sector differences in T2D prevalence and trends thereof between 2012 and 2019. METHODS The study was done on 1.683.644 employed individuals using data from the German statutory health insurance provider in Lower Saxony, the "Allgemeine Ortskrankenkasse Niedersachsen" (AOKN). Predicted probabilities for T2D prevalence in four two-year periods between 2012 and 2019 were estimated based on logistic regression analyses for nine occupational sectors. Prevalence ratios were calculated to illustrate the effect of time period on the prevalence of T2D among the nine occupational sectors. Analyses were stratified by gender and two age groups. RESULTS Results showed differences among occupational sectors in the predicted probabilities for T2D. The occupational sectors "Transport, logistics, protection and security" and "Health sector, social work, teaching & education" had the highest predicted probabilities, while those working in the sector "Agriculture" had by far the lowest predicted probabilities for T2D. Over all, there appeared to be a rising trend in T2D prevalence among younger employed individuals, with gender differences among occupational sectors. CONCLUSION The study displayed different vulnerability levels among occupational sectors with respect to T2D prevalence overall and for its rising trend among the younger age group. Specific occupations within the vulnerable sectors need to be focused upon in further research to define specific target groups to which T2D prevention interventions should be tailored.
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Affiliation(s)
| | - Julia Grasshoff
- Medical Sociology Unit, Hannover Medical School, Hannover, Germany
| | - Siegfried Geyer
- Medical Sociology Unit, Hannover Medical School, Hannover, Germany
| | | | - Jelena Epping
- Medical Sociology Unit, Hannover Medical School, Hannover, Germany
| | - Johannes Beller
- Medical Sociology Unit, Hannover Medical School, Hannover, Germany
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3
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Been RA, Lameijer A, Gans ROB, van Beek AP, Kingsnorth AP, Choudhary P, van Dijk PR. The impact of socioeconomic factors, social determinants, and ethnicity on the utilization of glucose sensor technology among persons with diabetes mellitus: a narrative review. Ther Adv Endocrinol Metab 2024; 15:20420188241236289. [PMID: 38476216 PMCID: PMC10929059 DOI: 10.1177/20420188241236289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 02/08/2024] [Indexed: 03/14/2024] Open
Abstract
Continuous glucose monitoring (CGM) usage has been shown to improve disease outcomes in people living with diabetes by facilitating better glycemic management. However, previous research has suggested that access to these devices can be influenced by nonmedical factors such as socioeconomic status and ethnicity. It is critical that equitable access to CGM devices is ensured as people from those groups experience poorer diabetes-related health outcomes. In this narrative review, we provide an overview of the various healthcare systems worldwide and how socioeconomic status, social context, and ethnicity shape device usage and the associated health outcomes. In general, we found that having a lower socioeconomic status and belonging to an ethnic minority group negatively impact CGM usage. While financial means proved to be an important mediator in this process, it was not the sole driver as disparities persisted even after adjustment for factors such as income and insurance status. Recommendations to increase CGM usage for people of a lower socioeconomic status and ethnic minorities include increasing the availability of financial, administrative, and educational support, for both patients and healthcare providers. However, recommendations will vary due to local country-specific circumstances, such as reimbursement criteria and healthcare ecosystems.
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Affiliation(s)
- Riemer A. Been
- University of Groningen, University Medical Center Groningen, Department of Endocrinology, Groningen, The Netherlands
| | - Annel Lameijer
- University of Groningen, University Medical Center Groningen, Department of Endocrinology, Groningen, The Netherlands
| | - Reinold O. B. Gans
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, The Netherlands
| | - André P. van Beek
- University of Groningen, University Medical Center Groningen, Department of Endocrinology, Groningen, The Netherlands
| | - Andrew P. Kingsnorth
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Pratik Choudhary
- University of Leicester, Leicester General Hospital, Leicester, Leicester Diabetes Centre – Bloom, UK
| | - Peter R. van Dijk
- University of Groningen, University Medical Center Groningen, Department of Endocrinology, Hanzeplein 1, Groningen, 9713 GZ, The Netherlands
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Gharacheh L, Amini-Rarani M, Torabipour A, Karimi S. A Scoping Review of Possible Solutions for Decreasing Socioeconomic Inequalities in Type 2 Diabetes Mellitus. Int J Prev Med 2024; 15:5. [PMID: 38487697 PMCID: PMC10935579 DOI: 10.4103/ijpvm.ijpvm_374_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 05/17/2023] [Indexed: 03/17/2024] Open
Abstract
Background As socioeconomic inequalities are key factors in access and utilization of type 2 diabetes (T2D) services, the purpose of this scoping review was to identify solutions for decreasing socioeconomic inequalities in T2D. Methods A scoping review of scientific articles from 2000 and later was conducted using PubMed, Web of Science (WOS), Scopus, Embase, and ProQuest databases. Using the Arksey and O'Malley framework for scoping review, articles were extracted, meticulously read, and thematically analyzed. Results A total of 7204 articles were identified from the reviewed databases. After removing duplicate and nonrelevant articles, 117 articles were finally included and analyzed. A number of solutions and passways were extracted from the final articles. Solutions for decreasing socioeconomic inequalities in T2D were categorized into 12 main solutions and 63 passways. Conclusions Applying identified solutions in diabetes policies and interventions would be recommended for decreasing socioeconomic inequalities in T2D. Also, the passways could be addressed as entry points to help better implementation of diabetic policies.
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Affiliation(s)
- Laleh Gharacheh
- Student Research Committee, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mostafa Amini-Rarani
- Social Determinants of Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amin Torabipour
- Social Determinants of Health Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Saeed Karimi
- Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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5
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Sezer B, Koster A, Albers J, Meisters R, Schram M, Eussen S, Dukers N, de Rijk A, Stehouwer C, Bosma H. Socioeconomic Position and Type 2 Diabetes: The Mediating Role of Psychosocial Work Environment- the Maastricht Study. Int J Public Health 2023; 68:1606036. [PMID: 37744416 PMCID: PMC10511755 DOI: 10.3389/ijph.2023.1606036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/28/2023] [Indexed: 09/26/2023] Open
Abstract
Objective: We examined the association between low socioeconomic position (SEP) and Type 2 Diabetes Mellitus (T2DM), and the mediating role of psychosocial work environment by using counterfactual mediation analysis. Methods: Data from 8,090 participants of The Maastricht Study were analysed. SEP indicators (education, income, occupation), self-reported psychosocial work stressors, (pre)diabetes by oral glucose tolerance test were measured at baseline. Incident T2DM was self-reported per annum up to 9 years. Cox regression and causal mediation analyses were performed. Results: 2.8% (N = 172) of the participants without T2DM at baseline reported incident T2DM. People with lower SEP more often had prevalent T2DM (e.g., education OR = 2.49, 95% CI: 2.16-2.87) and incident T2DM (e.g., education HR = 2.21, 95% CI: 1.53-3.20) than higher SEP. Low job control was associated with prevalent T2DM (OR = 1.44 95% CI: 1.25-1.67). Job control partially explained the association between income and prevalent T2DM (7.23%). Job demand suppressed the associations of education and occupation with prevalent T2DM. The mediation models with incident T2DM and social support were not significant. Conclusion: Socioeconomic inequalities in T2DM were present, but only a small part of it was explained by the psychosocial work environment.
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Affiliation(s)
- Bengisu Sezer
- Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- Institute of Care and Public Health Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Annemarie Koster
- Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- Institute of Care and Public Health Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Jeroen Albers
- Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- Institute of Care and Public Health Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Rachelle Meisters
- Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- Institute of Care and Public Health Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Miranda Schram
- Department of Internal Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- Heart and Vascular Center, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Simone Eussen
- Institute of Care and Public Health Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- Department of Epidemiology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Nicole Dukers
- Institute of Care and Public Health Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- South Limburg Medical Health Service (GGD South Limburg), Heerlen, Netherlands
| | - Angelique de Rijk
- Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- Institute of Care and Public Health Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Coen Stehouwer
- Department of Internal Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Hans Bosma
- Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- Institute of Care and Public Health Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
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6
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Chan JA, Koster A, Eussen SJPM, Pinho MGM, Lakerveld J, Stehouwer CDA, Dagnelie PC, van der Kallen CJ, van Greevenbroek MMJ, Wesselius A, Bosma H. The association between the food environment and adherence to healthy diet quality: the Maastricht Study. Public Health Nutr 2023; 26:1775-1783. [PMID: 37340803 PMCID: PMC10478064 DOI: 10.1017/s1368980023001180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/19/2023] [Accepted: 06/05/2023] [Indexed: 06/22/2023]
Abstract
OBJECTIVE The purpose of this study is to determine if healthier neighbourhood food environments are associated with healthier diet quality. DESIGN This was a cross-sectional study using linear regression models to analyse data from the Maastricht Study. Diet quality was assessed using data collected with a FFQ to calculate the Dutch Healthy Diet (DHD). A buffer zone encompassing a 1000 m radius was created around each participant home address. The Food Environment Healthiness Index (FEHI) was calculated using a Kernel density analysis within the buffers of available food outlets. The association between the FEHI and the DHD score was analysed and adjusted for socio-economic variables. SETTING The region of Maastricht including the surrounding food retailers in the Netherlands. PARTICIPANTS 7367 subjects aged 40-75 years in the south of the Netherlands. RESULTS No relationship was identified between either the FEHI (B = 0·62; 95 % CI = -2·54, 3·78) or individual food outlets, such as fast food (B = -0·07; 95 % CI = -0·20, 0·07) and diet quality. Similar null findings using the FEHI were identified at the 500 m (B = 0·95; 95 % CI = -0·85, 2·75) and 1500 m (B = 1·57; 95 % CI = -3·30, 6·44) buffer. There was also no association between the food environment and individual items of the DHD including fruits, vegetables and sugar-sweetened beverages. CONCLUSION The food environment in the Maastricht area appeared marginally unhealthy, but the differences in the food environment were not related to the quality of food that participants reported as intake.
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Affiliation(s)
- Jeffrey Alexander Chan
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
- Department of Physical Medicine and Rehabilitation, Northern California VA Healthcare System, Martinez, CA, USA
| | - Annemarie Koster
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
| | - Simone JPM Eussen
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Maria Gabriela M Pinho
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jeroen Lakerveld
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Coen DA Stehouwer
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University, Maastricht, The Netherlands
| | - Pieter C Dagnelie
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University, Maastricht, The Netherlands
| | - Carla J van der Kallen
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University, Maastricht, The Netherlands
| | - Marleen MJ van Greevenbroek
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University, Maastricht, The Netherlands
| | - Anke Wesselius
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
- School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Hans Bosma
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
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7
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van der Heide FCT, Mokhtar S, Khanna A, Said M, Henry RMA, Kroon AA, Dagnelie PC, Eussen SJPM, Berendschot TTJM, Schouten JSAG, Schram MT, van der Kallen CJH, van Greevenbroek MMJ, Wesselius A, Savelberg HHCM, Schaper NC, Webers CAB, Stehouwer CDA. Retinal Functional and Structural Neural Indices: Potential Biomarkers for the Monitoring of Cerebral Neurodegeneration: The Maastricht Study. J Alzheimers Dis 2023:JAD230104. [PMID: 37182886 DOI: 10.3233/jad-230104] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND If retinal indices of neurodegeneration are to be biomarkers for the monitoring of cerebral neurodegeneration, it is important to establish whether potentially modifiable risk factors for dementia are associated with retinal neurodegenerative changes. OBJECTIVE To study associations of dementia risk factors with retinal sensitivity, an index of retinal neural function, and retinal nerve fiber layer (RNFL) thickness, an index of retinal neural structure. METHODS We used cross-sectional data from The Maastricht Study (up to 5,666 participants, 50.5% men, mean age 59.7), and investigated associations with regression analyses (adjusted for potential confounders). RESULTS Most risk factors under study (i.e., hyperglycemia, unhealthy diet, lower cardiorespiratory fitness, smoking, alcohol consumption, and hypertension) were significantly associated with lower retinal sensitivity and lower RNFL thickness. CONCLUSION Findings of this population-based study support the concept that retinal neural indices may be biomarkers for the monitoring of therapeutic strategies that aim to prevent early-stage cerebral neurodegeneration and, ultimately, dementia.
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Affiliation(s)
- Frank C T van der Heide
- CARIM School for Cardiovascular Diseases, Maastricht University (UM), The Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre+ (MUMC+), The Netherlands
- MHeNS School of Mental Health and Neuroscience, Maastricht University (UM), The Netherlands
- University Eye Clinic Maastricht, MUMC+, TheNetherlands
| | - Sara Mokhtar
- CARIM School for Cardiovascular Diseases, Maastricht University (UM), The Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre+ (MUMC+), The Netherlands
- MHeNS School of Mental Health and Neuroscience, Maastricht University (UM), The Netherlands
- University Eye Clinic Maastricht, MUMC+, TheNetherlands
| | - Anjani Khanna
- Department of Ophthalmology, Sharpsight eye hospital, New Delhi, India
| | - Mozhda Said
- CARIM School for Cardiovascular Diseases, Maastricht University (UM), The Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre+ (MUMC+), The Netherlands
| | - Ronald M A Henry
- CARIM School for Cardiovascular Diseases, Maastricht University (UM), The Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre+ (MUMC+), The Netherlands
- Heart and Vascular Centre, MUMC+ Maastricht, The Netherlands
| | - Abraham A Kroon
- CARIM School for Cardiovascular Diseases, Maastricht University (UM), The Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre+ (MUMC+), The Netherlands
| | - Pieter C Dagnelie
- CARIM School for Cardiovascular Diseases, Maastricht University (UM), The Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre+ (MUMC+), The Netherlands
| | - Simone J P M Eussen
- CARIM School for Cardiovascular Diseases, Maastricht University (UM), The Netherlands
- Department of Epidemiology, UM, The Netherlands
- CAPHRI Care and Public Health Research Institute, UM, The Netherlands
| | - Tos T J M Berendschot
- MHeNS School of Mental Health and Neuroscience, Maastricht University (UM), The Netherlands
- University Eye Clinic Maastricht, MUMC+, TheNetherlands
| | - Jan S A G Schouten
- University Eye Clinic Maastricht, MUMC+, TheNetherlands
- Department of Ophthalmology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Miranda T Schram
- CARIM School for Cardiovascular Diseases, Maastricht University (UM), The Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre+ (MUMC+), The Netherlands
- MHeNS School of Mental Health and Neuroscience, Maastricht University (UM), The Netherlands
- Heart and Vascular Centre, MUMC+ Maastricht, The Netherlands
| | - Carla J H van der Kallen
- CARIM School for Cardiovascular Diseases, Maastricht University (UM), The Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre+ (MUMC+), The Netherlands
| | - Marleen M J van Greevenbroek
- CARIM School for Cardiovascular Diseases, Maastricht University (UM), The Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre+ (MUMC+), The Netherlands
| | - Anke Wesselius
- Department of Genetics and Cell Biology, Complex Genetics, UM, The Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, UM, The Netherlands
| | - Hans H C M Savelberg
- NUTRIM School for Nutrition and Translational Research in Metabolism, UM, The Netherlands
- Department of Nutrition and Movement Sciences, UM, The Netherlands
| | - Nicolaas C Schaper
- CARIM School for Cardiovascular Diseases, Maastricht University (UM), The Netherlands
- Department of Social Medicine, MUMC+, The Netherlands
- Department of Internal Medicine, Division of Endocrinology and Metabolic Disease, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Carroll A B Webers
- MHeNS School of Mental Health and Neuroscience, Maastricht University (UM), The Netherlands
- University Eye Clinic Maastricht, MUMC+, TheNetherlands
| | - Coen D A Stehouwer
- CARIM School for Cardiovascular Diseases, Maastricht University (UM), The Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre+ (MUMC+), The Netherlands
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8
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van der Heide FCT, Eussen SJPM, Houben AJHM, Henry RMA, Kroon AA, van der Kallen CJH, Dagnelie PC, van Dongen MCJM, Berendschot TTJM, Schouten JSAG, Webers CAB, van Greevenbroek MMJ, Wesselius A, Schalkwijk CG, Koster A, Jansen JFA, Backes WH, Beulens JWJ, Stehouwer CDA. Alcohol consumption and microvascular dysfunction: a J-shaped association: The Maastricht Study. Cardiovasc Diabetol 2023; 22:67. [PMID: 36964536 PMCID: PMC10039613 DOI: 10.1186/s12933-023-01783-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/24/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Microvascular dysfunction (MVD) is an important contributor to major clinical disease such as stroke, dementia, depression, retinopathy, and chronic kidney disease. Alcohol consumption may be a determinant of MVD. OBJECTIVE Main objectives were (1) to study whether alcohol consumption was associated with MVD as assessed in the brain, retina, skin, kidney and in the blood; and (2) to investigate whether associations differed by history of cardiovascular disease or sex. DESIGN We used cross-sectional data from The Maastricht Study (N = 3,120 participants, 50.9% men, mean age 60 years, and 27.5% with type 2 diabetes [the latter oversampled by design]). We used regression analyses to study the association between total alcohol (per unit and in the categories, i.e. none, light, moderate, high) and MVD, where all measures of MVD were combined into a total MVD composite score (expressed in SD). We adjusted all associations for potential confounders; and tested for interaction by sex, and history of cardiovascular disease. Additionally we tested for interaction with glucose metabolism status. RESULTS The association between total alcohol consumption and MVD was non-linear, i.e. J-shaped. Moderate versus light total alcohol consumption was significantly associated with less MVD, after full adjustment (beta [95% confidence interval], -0.10 [-0.19; -0.01]). The shape of the curve differed with sex (Pinteraction = 0.03), history of cardiovascular disease (Pinteraction < 0.001), and glucose metabolism status (Pinteraction = 0.02). CONCLUSIONS The present cross-sectional, population-based study found evidence that alcohol consumption may have an effect on MVD. Hence, although increasing alcohol consumption cannot be recommended as a policy, this study suggests that prevention of MVD may be possible through dietary interventions.
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Affiliation(s)
- Frank C T van der Heide
- CARIM School for Cardiovascular Diseases, Maastricht University (UM), Maastricht, The Netherlands.
- Department of Internal Medicine, Maastricht University Medical Center+, P. Debyelaan 25, P.O. Box 5800, 6202AZ, Maastricht, The Netherlands.
| | - Simone J P M Eussen
- CARIM School for Cardiovascular Diseases, Maastricht University (UM), Maastricht, The Netherlands
- Department of Epidemiology, UM, Maastricht, The Netherlands
- CAPHRI Care and Public Health Research Institute, UM, Maastricht, The Netherlands
| | - Alfons J H M Houben
- CARIM School for Cardiovascular Diseases, Maastricht University (UM), Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+, P. Debyelaan 25, P.O. Box 5800, 6202AZ, Maastricht, The Netherlands
| | - Ronald M A Henry
- CARIM School for Cardiovascular Diseases, Maastricht University (UM), Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+, P. Debyelaan 25, P.O. Box 5800, 6202AZ, Maastricht, The Netherlands
- Heart and Vascular Center, MUMC+ Maastricht, Maastricht, The Netherlands
| | - Abraham A Kroon
- CARIM School for Cardiovascular Diseases, Maastricht University (UM), Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+, P. Debyelaan 25, P.O. Box 5800, 6202AZ, Maastricht, The Netherlands
| | - Carla J H van der Kallen
- CARIM School for Cardiovascular Diseases, Maastricht University (UM), Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+, P. Debyelaan 25, P.O. Box 5800, 6202AZ, Maastricht, The Netherlands
| | - Pieter C Dagnelie
- CARIM School for Cardiovascular Diseases, Maastricht University (UM), Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+, P. Debyelaan 25, P.O. Box 5800, 6202AZ, Maastricht, The Netherlands
| | - Martien C J M van Dongen
- Department of Epidemiology, UM, Maastricht, The Netherlands
- CAPHRI Care and Public Health Research Institute, UM, Maastricht, The Netherlands
| | | | - Jan S A G Schouten
- University Eye Clinic Maastricht, MUMC+, Maastricht, The Netherlands
- Department of Ophthalmology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | - Marleen M J van Greevenbroek
- CARIM School for Cardiovascular Diseases, Maastricht University (UM), Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+, P. Debyelaan 25, P.O. Box 5800, 6202AZ, Maastricht, The Netherlands
| | - Anke Wesselius
- Department of Epidemiology, NUTRIM School for Nutrition and Translational Research in Metabolism, UM, Maastricht, The Netherlands
| | - Casper G Schalkwijk
- CARIM School for Cardiovascular Diseases, Maastricht University (UM), Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+, P. Debyelaan 25, P.O. Box 5800, 6202AZ, Maastricht, The Netherlands
| | - Annemarie Koster
- CAPHRI Care and Public Health Research Institute, UM, Maastricht, The Netherlands
- Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
| | - Jacobus F A Jansen
- School of Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Dept. of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Walter H Backes
- School of Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Dept. of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Joline W J Beulens
- Department of Epidemiology and Data Science, Amsterdam University Medical Centres - location VUmc, Amsterdam Public Health Institute, Amsterdam, The Netherlands
| | - Coen D A Stehouwer
- CARIM School for Cardiovascular Diseases, Maastricht University (UM), Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+, P. Debyelaan 25, P.O. Box 5800, 6202AZ, Maastricht, The Netherlands
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9
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Gisinger T, Azizi Z, Alipour P, Harreiter J, Raparelli V, Kublickiene K, Herrero MT, Norris CM, El Emam K, Pilote L, Kautzky-Willer A. Sex and gender aspects in diabetes mellitus: Focus on access to health care and cardiovascular outcomes. Front Public Health 2023; 11:1090541. [PMID: 36817907 PMCID: PMC9932273 DOI: 10.3389/fpubh.2023.1090541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 01/13/2023] [Indexed: 02/05/2023] Open
Abstract
Aims The aim of this study was to elucidate whether sex and gender factors influence access to health care and/or are associated with cardiovascular (CV) outcomes of individuals with diabetes mellitus (DM) across different countries. Methods Using data from the Canadian Community Health Survey (8.4% of respondent reporting DM) and the European Health Interview Survey (7.3% of respondents reporting DM), were analyzed. Self-reported sex and a composite measure of socio-cultural gender was constructed (range: 0-1; higher score represent participants who reported more characteristics traditionally ascribed to women). For the purposes of analyses the Gender Inequality Index (GII) was used as a country level measure of institutionalized gender. Results Canadian females with DM were more likely to undergo HbA1c monitoring compared to males (OR = 1.26, 95% CI: 1.01-1.58), while conversely in the European cohort females with DM were less likely to have their blood sugar measured compared to males (OR = 0.88, 95% CI: 0.79-0.99). A higher gender score in both cohorts was associated with less frequent diabetes monitoring. Additionally, independent of sex, higher gender scores were associated with higher prevalence of self-reported heart disease, stroke, and hospitalization in all countries albeit European countries with medium-high GII, conferred a higher risk of all outcomes and hospitalization rates than low GII countries. Conclusion Regardless of sex, individuals with DM who reported characteristics typically ascribed to women and those living in countries with greater gender inequity for women exhibited poorer diabetes care and greater risk of CV outcomes and hospitalizations.
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Affiliation(s)
- Teresa Gisinger
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Zahra Azizi
- Centre for Outcomes Research and Evaluation, McGill University Health Centre Research Institute, Montreal, QC, Canada
| | - Pouria Alipour
- Centre for Outcomes Research and Evaluation, McGill University Health Centre Research Institute, Montreal, QC, Canada
| | - Jürgen Harreiter
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Valeria Raparelli
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy,University Center for Studies on Gender Medicine, University of Ferrara, Ferrara, Italy,Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Karolina Kublickiene
- Section for Renal Medicine, Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Maria Trinidad Herrero
- Clinical and Experimental Neuroscience (NiCE-IMIB-IUIE), School of Medicine, University of Murcia, Murcia, Spain
| | - Colleen M. Norris
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada,Heart and Stroke Strategic Clinical Networks-Alberta Health Services, Toronto, ON, Canada
| | - Khaled El Emam
- Electronic Health Information Laboratory, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada,Replica Analytics Ltd, Ottawa, ON, Canada
| | - Louise Pilote
- Centre for Outcomes Research and Evaluation, McGill University Health Centre Research Institute, Montreal, QC, Canada,Divisions of Clinical Epidemiology and General Internal Medicine, McGill University Health Centre Research Institute, Montreal, QC, Canada,Louise Pilote ✉
| | - Alexandra Kautzky-Willer
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria,Gender Institute La Pura, Gars am Kamp, Austria,*Correspondence: Alexandra Kautzky-Willer ✉
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10
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Zhu Y, Dekker LH, Mierau JO. Socio-economic gradients in diagnosed and undiagnosed Type 2 diabetes and its related health complications. Nutr Metab Cardiovasc Dis 2023; 33:90-94. [PMID: 36336549 DOI: 10.1016/j.numecd.2022.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/22/2022] [Accepted: 09/22/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND AIMS Diagnosed and undiagnosed Type 2 Diabetes (T2D) remains a challenge in high-income countries. In addition, the presence of T2D can cause further disease burden because of its high susceptibility to complications. Nevertheless, there is limited evidence of socio-economic gradients in undiagnosed T2D and its complications in a large population cohort. We investigated this using the Dutch Lifelines Cohort Study (Lifelines). METHODS AND RESULTS Within Lifelines, baseline data of 102 163 adults aged 30 and above were collected from 2007 to 2013. The associations of Socio-Economic Status (SES), indicated by monthly household income, with the prevalence of T2D status and the number of T2D complications were assessed using multinomial Poisson and linear regressions with adjustments for age and sex. The prevalence of diagnosed and undiagnosed T2D was, respectively, 3.0% and 3.0% in the low SES group compared to 1.1% and 1.8% in the high SES group. Individuals with lower SES were at higher risk of having undiagnosed T2D (relative risk ratio (rrr) [95% CI]: 1.63 [1.47-1.81] for low SES and 1.16 [1.05-1.29] for middle SES) and diagnosed T2D, compared with those with high SES. Lower SES was positively associated with the number of T2D complications (low SES vs. high SES (ref); B [95% CI]: 0.15 [0.13-0.16]). CONCLUSION Complementing the known socio-economic gradients in diagnosed T2D, we document socio-economic gradients in undiagnosed T2D and T2D complications in a single, large general representative population. Furthermore, individuals with low SES with diagnosed or undiagnosed T2D were more susceptible to T2D complications.
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Affiliation(s)
- Yinjie Zhu
- Division of Nephrology, Department of Internal Medicine, Division of Nephrology, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands.
| | - Louise H Dekker
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Jochen O Mierau
- Department of Economics, Econometrics & Finance, Faculty of Economics and Business, University of Groningen, University Complex, 9747 AJ, Groningen, the Netherlands; Lifelines Cohort Study and Biobank, Groningen, the Netherlands; Team Strategy & External Relations, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
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11
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Na-Ek N, Srithong J, Aonkhum A, Boonsom S, Charoen P, Demakakos P. Educational level as a cause of type 2 diabetes mellitus: Caution from triangulation of observational and genetic evidence. Acta Diabetol 2022; 59:127-135. [PMID: 34514530 PMCID: PMC8968222 DOI: 10.1007/s00592-021-01795-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 08/27/2021] [Indexed: 01/03/2023]
Abstract
UNLABELLED BACKGROUND AND OBJECTIVE: Education might be causal to type 2 diabetes mellitus (T2DM). We triangulated cohort and genetic evidence to consolidate the causality between education and T2DM. METHODS We obtained observational evidence from the English Longitudinal Study of Ageing (ELSA). Self-reporting educational attainment was categorised as high (post-secondary and higher), middle (secondary), and low (below secondary or no academic qualifications) in 6,786 community-dwelling individuals aged ≥ 50 years without diabetes at ELSA wave 2, who were followed until wave 8 for the first diabetes diagnosis. Additionally, we performed two-sample Mendelian randomisation (MR) using an inverse-variance weighted (IVW), MR-Egger, weighted median (WM), and weighted mode-based estimate (WMBE) method. Steiger filtering was further applied to exclude single-nucleotide polymorphisms (SNPs) that were correlated with an outcome (T2DM) stronger than exposure (education attainment). RESULTS We observed 598 new diabetes cases after 10.4 years of follow-up. The adjusted hazard ratios (95% CI) of T2DM were 1.20 (0.97-1.49) and 1.58 (1.28-1.96) in the middle- and low-education groups, respectively, compared to the high-education group. Low education was also associated with increased glycated haemoglobin levels. Psychosocial resources, occupation, and health behaviours fully explained these inverse associations. In the MR analysis of 210 SNPs (R2 = 0.0161), the odds ratio of having T2DM per standard deviation-decreasing years (4.2 years) of schooling was 1.33 (1.01-1.75; IVW), 1.23 (0.37-4.17; MR-Egger), 1.56 (1.09-2.27; WM), and 2.94 (0.98-9.09; WMBE). However, applying Steiger filtering attenuated most MR results towards the null. CONCLUSIONS Our inconsistent findings between cohort and genetic evidence did not support the causality between education and T2DM.
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Affiliation(s)
- Nat Na-Ek
- Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Phayao, 56000, Thailand.
- Unit of Excellence On Research in Health Outcomes and Patient Safety in Elderly (U-R-HOPE), School of Pharmaceutical Sciences, University of Phayao, Phayao, 56000, Thailand.
| | - Juthamanee Srithong
- Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Phayao, 56000, Thailand
| | - Authakorn Aonkhum
- Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Phayao, 56000, Thailand
| | - Suthida Boonsom
- Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Phayao, 56000, Thailand
- Unit of Excellence On Pharmacogenomic Pharmacokinetic and Pharmacotherapeutic Researches (UPPER), School of Pharmaceutical Sciences, University of Phayao, Phayao, 56000, Thailand
| | - Pimphen Charoen
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
- Integrative Computational BioScience (ICBS) Center, Mahidol University, Bangkok, 10400, Thailand
| | - Panayotes Demakakos
- Department of Epidemiology and Public Health, University College London, London, WC1E 7HB, UK
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12
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Mutambudzi M, Henkens K. Effects of Prevalent and Newly Diagnosed Arthritis on Changes in Perceived Physical Demands and Work Stress Among Older Workers: Results of a 3 Year Panel Study. J Aging Health 2021; 34:508-518. [PMID: 34551610 DOI: 10.1177/08982643211046427] [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: 11/16/2022]
Abstract
OBJECTIVES Examine the effects of prevalent and newly diagnosed arthritis on changes in perceived physical demands and general work stress. METHODS Conditional change logistic regression models examined the strength of association between arthritis and perceived (1) work stress and (2) physical demands, using data from the NIDI Pension Panel Study (n = 2099). RESULTS Prevalent and newly diagnosed arthritis were associated with increased odds of perceived work stress and high physical demands. Manual workers with newly diagnosed arthritis exhibited a 6.73-fold (95% CI = 2.87-15.77) increased odds of physical demands. Arthritis in three body extremities was differentially associated with increased odds of work stress and physical demands in manual and non-manual workers. DISCUSSION Prevalent and incident arthritis were associated with changes in work stress and physical demands in older workers. Policies and workplace interventions to reduce stress and physical demands and improve workability in older workers with arthritis are needed.
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Affiliation(s)
- Miriam Mutambudzi
- Falk College of Sport and Human Dynamics, 2029Syracuse University, Syracuse, NY, USA
| | - Kene Henkens
- 2865Netherlands Interdisciplinary Demographic Institute, The Hague, The Netherlands.,University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands.,University of Amsterdam, Amsterdam, The Netherlands
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13
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Mendivil CO, Gutiérrez Romero SA, Peláez-Jaramillo MJ, Nieves-Barreto LD, Montaño-Rodríguez A, Betancourt-Villamizar E. Diabetes and associated dietary intake among urban adults: COPEN (Colombian Nutritional Profiles)-a cross-sectional study. BMJ Open 2021; 11:e042050. [PMID: 34140339 PMCID: PMC8212409 DOI: 10.1136/bmjopen-2020-042050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Diabetes is increasing rapidly in low-income and middle-income countries. We aimed to estimate the prevalence of diabetes, describe its correlates and its associated dietary intake in urban adults from Colombia. SETTING The Colombian Study of Nutritional Profiles was a population-based, cross-sectional, multi-stage probabilistic sampling survey designed to represent the five main Colombian cities. PARTICIPANTS Between June and November 2018, we studied 736 non-pregnant participants aged 18 or older. Diabetes was defined as a random plasma glucose ≥200 mg/dL, self-reported prior diagnosis of diabetes or use of any oral or injectable antidiabetic medication(s). Participants also fulfilled a detailed 157-item food-frequency questionnaire. PRIMARY AND SECONDARY OUTCOME MEASURES Prevalence of diabetes, dietary intake of key nutrients, achievement of dietary goals among individuals with diabetes. RESULTS The overall estimated prevalence of diabetes was 10.1%, with no difference by sex (9.6% in women, 10.8% in men, p=0.43). The association between diabetes and education level depended on sex, diabetes was more prevalent among more educated men and less educated women. Abdominal obesity was associated with a 65% increase in diabetes prevalence among men, and a 163% increase in women. Individuals with diabetes reported lower mean consumption of all nutrients, but after adjustment by sex, age, socioeconomic level (SEL) and body mass index, only their lower sodium consumption remained significant (p=0.013). The proportion of non-achievement of dietary intake goals among participants with diabetes was 94.4% for saturated fats, 86.7% for sodium, 84.4% for fibre and 80% for trans fats. In multivariate logistic regression models, age was the strongest independent correlate of diabetes. CONCLUSIONS Diabetes by self-report, random plasma glucose or medication use was highly prevalent among Colombian adults. There were large differences by abdominal obesity status, region of residence, SEL and educational level. The proportion of individuals with diabetes meeting dietary recommendations was alarmingly low.
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Affiliation(s)
- Carlos O Mendivil
- School of Medicine, Universidad de los Andes, Bogota, Colombia
- Endocrinology Section, Department of Internal Medicine, Fundacion Santa Fe de Bogota, Bogota, Colombia
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14
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Abstract
BACKGROUND Microvascular dysfunction (MVD) contributes to stroke, dementia, depression, retinopathy and chronic kidney disease. However, the determinants of MVD are incompletely understood. Greater blood pressure variability (BPV) may be one such determinant. METHODS AND RESULTS We used cross-sectional data of The Maastricht Study (n = 2773, age 59.9 years; 51.9% men) to investigate whether greater very short- to mid-term BPV is associated with various MVD measures. We standardized and averaged within-visit, 24-h and 7-day BPV into a systolic and a diastolic BPV composite score. MVD measures included a composite score of MRI cerebral small vessel disease (CSVD) features (total brain parenchymal volume, white matter hyperintensity volume, lacunar infarcts and cerebral microbleeds), a composite score of flicker light-induced retinal arteriolar and venular dilation response, albuminuria, heat-induced skin hyperemia and a composite score of plasma biomarkers of MVD (sICAM-1, sVCAM-1, sE-selectin and von Willebrand Factor). We used linear regression adjusted for age, sex, glucose metabolism status, mean 24-h systolic or DBP, cardiovascular risk factors and antihypertensive medication. We found that higher systolic and diastolic BPV composite scores (per SD) were associated with higher albuminuria [higher ratio, 1.04 (95% CI 1.00-1.08) and 1.07 (1.03-1.11), respectively], but not with other measures of MVD tested. CONCLUSION Greater systolic and diastolic BPV was associated with higher albuminuria, but not with CSVD features, flicker light-induced retinal arteriolar and venular dilation response, heat-induced skin hyperemia and plasma biomarkers of MVD. This suggests that the microvasculature of the kidneys is most vulnerable to the detrimental effects of greater BPV.
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15
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van der Heide FCT, Zhou TL, Henry RMA, Houben AJHM, Kroon AA, Dagnelie PC, van Dongen MCJM, Eussen SJPM, Berendschot TTJM, Schouten JSAG, Webers CAB, Schram MT, van Greevenbroek MMJ, Wesselius A, Schalkwijk CG, Koster A, Savelberg HHCM, Schaper NC, Reesink KD, Stehouwer CDA. Carotid stiffness is associated with retinal microvascular dysfunction-The Maastricht study. Microcirculation 2021; 28:e12702. [PMID: 33905576 PMCID: PMC8459287 DOI: 10.1111/micc.12702] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/16/2021] [Accepted: 04/19/2021] [Indexed: 12/13/2022]
Abstract
Objective This study investigated whether arterial stiffening is a determinant of subtle retinal microvascular changes that precede diabetic retinopathy. Research design and methods This study used cross‐sectional data from the Maastricht Study, a type 2 diabetes‐enriched population‐based cohort study. We used multivariable linear regression analysis to investigate, in individuals without and with type 2 diabetes, the associations of carotid distensibility coefficient and carotid‐femoral pulse wave velocity with retinal microvascular diameters and flicker light‐induced dilation and adjusted for cardiovascular and lifestyle risk factors. Results The retinal microvascular diameter study population consisted of N = 2434 participants (51.4% men, mean ± SD age 59.8 ± 8.1 years, and 28.1% type 2 diabetes). No measures of arterial stiffness were significantly associated with microvascular diameters. Greater carotid distensibility coefficient (i.e., lower carotid stiffness) was significantly associated with greater retinal arteriolar flicker light‐induced dilation (per standard deviation, standardized beta [95% CI] 0.06 [0.00; 0.12]) and non‐significantly, but directionally similarly, associated with greater retinal venular flicker light‐induced dilation (0.04 [−0.02; 0.10]). Carotid‐femoral pulse wave velocity (i.e., aortic stiffness) was not associated with retinal microvascular flicker light‐induced dilation. The associations between carotid distensibility coefficient and retinal arteriolar and venular flicker light‐induced dilation were two‐ to threefold stronger in individuals with type 2 diabetes than in those without. Conclusion In this population‐based study greater carotid, but not aortic, stiffness was associated with worse retinal flicker light‐induced dilation and this association was stronger in individuals with type 2 diabetes. Hence, carotid stiffness may be a determinant of retinal microvascular dysfunction.
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Affiliation(s)
- Frank C T van der Heide
- CARIM School for Cardiovascular Diseases, Maastricht University (UM), Maastricht, The Netherlands.,Department of Internal Medicine, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
| | - Tan Lai Zhou
- CARIM School for Cardiovascular Diseases, Maastricht University (UM), Maastricht, The Netherlands.,Department of Internal Medicine, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
| | - Ronald M A Henry
- CARIM School for Cardiovascular Diseases, Maastricht University (UM), Maastricht, The Netherlands.,Department of Internal Medicine, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands.,Heart and Vascular Center, MUMC+ Maastricht, Maastricht, The Netherlands
| | - Alfons J H M Houben
- CARIM School for Cardiovascular Diseases, Maastricht University (UM), Maastricht, The Netherlands.,Department of Internal Medicine, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
| | - Abraham A Kroon
- CARIM School for Cardiovascular Diseases, Maastricht University (UM), Maastricht, The Netherlands.,Department of Internal Medicine, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
| | - Pieter C Dagnelie
- CARIM School for Cardiovascular Diseases, Maastricht University (UM), Maastricht, The Netherlands.,Department of Internal Medicine, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
| | - Martien C J M van Dongen
- CAPHRI Care and Public Health Research Institute, UM, Maastricht, The Netherlands.,Department of Epidemiology, UM, Maastricht, The Netherlands
| | - Simone J P M Eussen
- CARIM School for Cardiovascular Diseases, Maastricht University (UM), Maastricht, The Netherlands.,Department of Epidemiology, UM, Maastricht, The Netherlands
| | | | - Jan S A G Schouten
- University Eye Clinic Maastricht, MUMC+, Maastricht, The Netherlands.,Department of Ophthalmology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | - Miranda T Schram
- CARIM School for Cardiovascular Diseases, Maastricht University (UM), Maastricht, The Netherlands.,Department of Internal Medicine, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands.,Heart and Vascular Center, MUMC+ Maastricht, Maastricht, The Netherlands
| | - Marleen M J van Greevenbroek
- CARIM School for Cardiovascular Diseases, Maastricht University (UM), Maastricht, The Netherlands.,Department of Internal Medicine, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
| | - Anke Wesselius
- Department of Complex Genetics and Epidemiology, NUTRIM School for Nutrition and Translational Research in Metabolism, UM, Maastricht, The Netherlands
| | - Casper G Schalkwijk
- CARIM School for Cardiovascular Diseases, Maastricht University (UM), Maastricht, The Netherlands.,Department of Internal Medicine, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
| | - Annemarie Koster
- CAPHRI Care and Public Health Research Institute, UM, Maastricht, The Netherlands.,Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
| | - Hans H C M Savelberg
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.,Department of Human Movement Sciences, Maastricht University, Maastricht, The Netherlands
| | - Nicolaas C Schaper
- CARIM School for Cardiovascular Diseases, Maastricht University (UM), Maastricht, The Netherlands.,Department of Internal Medicine, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
| | - Koen D Reesink
- CARIM School for Cardiovascular Diseases, Maastricht University (UM), Maastricht, The Netherlands.,Heart and Vascular Center, MUMC+ Maastricht, Maastricht, The Netherlands.,Department of Biomedical Engineering, UM, Maastricht, The Netherlands
| | - Coen D A Stehouwer
- CARIM School for Cardiovascular Diseases, Maastricht University (UM), Maastricht, The Netherlands.,Department of Internal Medicine, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
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16
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Consolazio D, Koster A, Sarti S, Schram MT, Stehouwer CDA, Timmermans EJ, Wesselius A, Bosma H. Neighbourhood property value and type 2 diabetes mellitus in the Maastricht study: A multilevel study. PLoS One 2020; 15:e0234324. [PMID: 32511267 PMCID: PMC7279598 DOI: 10.1371/journal.pone.0234324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 05/24/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Low individual socioeconomic status (SES) is known to be associated with a higher risk of type 2 diabetes mellitus (T2DM), but the extent to which the local context in which people live may influence T2DM rates remains unclear. This study examines whether living in a low property value neighbourhood is associated with higher rates of T2DM independently of individual SES. RESEARCH DESIGN AND METHODS Using cross-sectional data from the Maastricht Study (2010-2013) and geographical data from Statistics Netherlands, multilevel logistic regression was used to assess the association between neighbourhood property value and T2DM. Individual SES was based on education, occupation and income. Of the 2,056 participants (aged 40-75 years), 494 (24%) were diagnosed with T2DM. RESULTS Individual SES was strongly associated with T2DM, but a significant proportion of the variance in T2DM was found at the neighbourhood level (VPC = 9.2%; 95% CI = 5.0%-16%). Participants living in the poorest neighbourhoods had a 2.38 times higher odds ratio of T2DM compared to those living in the richest areas (95% CI = 1.58-3.58), independently of individual SES. CONCLUSIONS Neighbourhood property value showed a significant association with T2DM, suggesting the usefulness of area-based programmes aimed at improving neighbourhood characteristics in order to tackle inequalities in T2DM.
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Affiliation(s)
- David Consolazio
- Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Department of Sociology and Social Research, Università degli Studi di Milano-Bicocca, Milan, Italy
| | - Annemarie Koster
- Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Simone Sarti
- Department of Political and Social Science, Università degli Studi di Milano, Milan, Italy
| | - Miranda T. Schram
- Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Heart and Vascular Center, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Coen D. A. Stehouwer
- Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Erik J. Timmermans
- Department of Epidemiology and Biostatistics, Amsterdam UMC, VU University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Anke Wesselius
- Department of Complex Genetics, Maastricht University, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Hans Bosma
- Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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Assessment of Common Risk Factors and Lifestyle Habits Associated with Atherogenic Risk and Lipid-Lowering Therapy in Men with Type 2 Diabetes. ROMANIAN JOURNAL OF DIABETES NUTRITION AND METABOLIC DISEASES 2020. [DOI: 10.2478/rjdnmd-2019-0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background and aims: Our objective was to determine common risk factors and lifestyle habits associated with atherogenic risk and with the use of lipid-lowering therapy in men with type 2 diabetes.
Material and Methods: A comparative cross-sectional study was performed in the northwestern Algeria during eleven months on adult men patients with type 2 diabetes. Anthropometric parameters, blood pressures and lipid profile were evaluated. Data of common risk factors and lifestyle habits associated to atherosclerosis were compared between two groups according to the lipid lowering therapy use based on statins.
Results: 147 adult men patients with type 2 diabetes were involved in the study, 68 (46.26%) were under statins therapy and 79 (53.74%) were not. Significant associations with statins use were observed regarding the age group of 61-70 years (OR: 0.156 [0.043-0.570]; p=0.005), a salary of less than 30000 Algerian dinars (≈250.60$) (OR: 5.758 [1.299-25.512]; p=0.021), age of diabetes of 2-3 years (OR: 0.105 [0.013-0.867]; p=0.036) as well as with lipid ratios and body mass index (BMI). However, no significant associations were noted regarding the other studied parameters (marital status, educational level, occupation, salary, and family history, smoking status, alcohol consumption and sports practices) with lipid lowering therapy.
Conclusion: Age of patients, diabetes duration, lipid ratios and the low income of patients are the strongest factors associated with the use of lipid lowering therapy (statins). However, largest longitudinal studies are needed to determine whether modifiable lifestyle habits could influence the lipid lowering therapies prescription in diabetic patients over time.
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