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Zheng G, Xia H, Shi H, Zheng D, Wang X, Ai B, Tian F, Lin H. Effect modification of dietary diversity on the association of air pollution with incidence, complications, and mortality of type 2 diabetes: Results from a large prospective cohort study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 908:168314. [PMID: 37926247 DOI: 10.1016/j.scitotenv.2023.168314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/30/2023] [Accepted: 11/01/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND It remains unknown whether the dietary diversity score (DDS) could modify the association of long-term exposure to individual air pollutants and the mixture of various pollutants with the incidence, complications, and mortality of type 2 diabetes (T2D). METHODS We included 162,579 participants from the UK Biobank who had ≥ one 24-h dietary assessment and were free of diabetes or diabetes complications before their last response date of the 24-h dietary assessment. Exposure to benzene, NOx, NO2, SO2, PM10, and PM2.5 was estimated at each participant's residential location using a bilinear interpolation algorithm based on air dispersion models on a 1 km × 1 km grid. The DDS was calculated based on repeated 24-h dietary assessments. The outcomes were the incidence, complications, and mortality of T2D. Associations of individual pollutants and multiple pollutants mixtures with outcomes were assessed using Cox proportional hazards regression models and the quantile g-computation approach, respectively. We further stratified these analyses by DDS. RESULTS During a median of 10.1 years of follow-up, 2978 participants developed incident T2D, 1181 developed T2D complications, and 242 died due to T2D. Long-term single-pollutant and multi-pollutant exposure were associated with elevated risk of incidence, complications, and mortality of T2D. For example, for incident T2D, the hazard ratio and 95 % confidence interval for each quantile increase were 1.155 (1.095, 1.215) for the air pollution mixture. We observed significant interactions between air pollution (benzene, NOx, NO2, PM10, PM2.5, and the air pollution mixture) and DDS (P-interaction <0.05), with the corresponding associations being significantly weaker in adults with high DDS than in those with low DDS. CONCLUSION Higher dietary diversity may attenuate the harmful impacts of air pollution on T2D-related outcomes. A higher diversity diet could be used to prevent the onset and progression of T2D induced by long-term exposure to various air pollutants.
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Affiliation(s)
- Guzhengyue Zheng
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, No. 74, 2nd Yat-sen Road, Yuexiu District, Guangzhou, Guangdong 510080, PR China
| | - Hui Xia
- Center for Health Care, Longhua District, Shenzhen 518109, PR China
| | - Hui Shi
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, No. 74, 2nd Yat-sen Road, Yuexiu District, Guangzhou, Guangdong 510080, PR China
| | - Dashan Zheng
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, No. 74, 2nd Yat-sen Road, Yuexiu District, Guangzhou, Guangdong 510080, PR China
| | - Xiaojie Wang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, No. 74, 2nd Yat-sen Road, Yuexiu District, Guangzhou, Guangdong 510080, PR China
| | - Baozhuo Ai
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, No. 74, 2nd Yat-sen Road, Yuexiu District, Guangzhou, Guangdong 510080, PR China
| | - Fei Tian
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, No. 74, 2nd Yat-sen Road, Yuexiu District, Guangzhou, Guangdong 510080, PR China
| | - Hualiang Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, No. 74, 2nd Yat-sen Road, Yuexiu District, Guangzhou, Guangdong 510080, PR China.
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Tammi R, Männistö S, Reinivuo H, Tapanainen H, Rautanen J, Kaartinen NE. The relation of whole grain surrogate estimates and food definition to total whole grain intake in the Finnish adult population. Eur J Nutr 2023; 62:1821-1831. [PMID: 36847883 DOI: 10.1007/s00394-023-03119-7] [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] [Received: 10/05/2022] [Accepted: 02/10/2023] [Indexed: 03/01/2023]
Abstract
OBJECTIVES Challenges in estimating total whole grain intake have led to the use of surrogate estimates, of which accuracy has not been assessed. We examined the suitability of five potential surrogates (dietary fiber; bread; rye bread; rye, oat and barley combined; rye) and a whole grain food definition to measure total whole grain intake in the Finnish adult population. METHODS Our data comprised 5094 Finnish adults participating in the national FinHealth 2017 Study. Dietary intake was assessed by a validated FFQ. Food and nutrient intakes, including total whole grain, were calculated utilizing the Finnish Food Composition Database. The Healthgrain Forum whole grain food definition was applied to examine definition-based whole grain intake. Spearman correlations and quintile cross-classifications were calculated. RESULTS Definition-based whole grain intake and consumption of rye, oat and barley combined had consistently the strongest correspondence with total whole grain intake. Rye and rye bread consumption also corresponded well with total whole grain intake. The correspondences of dietary fiber and bread with total whole grain were lower and more affected by the exclusion of energy under-reporters. Furthermore, their correlations with total whole grain intake varied the most between population subgroups. CONCLUSIONS Rye-based estimates, especially rye, oat and barley combined, and definition-based whole grain intake appeared suitable surrogate estimates of total whole grain intake for epidemiological research of Finnish adults. The variation between surrogate estimates in their correspondence with total whole grain intake demonstrated the need for further evaluation of their accuracy in different populations and regarding specific health outcomes.
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Affiliation(s)
- Rilla Tammi
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland.
| | - Satu Männistö
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland
| | - Heli Reinivuo
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland
| | - Heli Tapanainen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland
| | - Jenna Rautanen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland
| | - Niina E Kaartinen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland
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Type 2 Diabetes Prevention Programs-From Proof-of-Concept Trials to National Intervention and Beyond. J Clin Med 2023; 12:jcm12051876. [PMID: 36902668 PMCID: PMC10003211 DOI: 10.3390/jcm12051876] [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: 02/15/2023] [Revised: 02/19/2023] [Accepted: 02/21/2023] [Indexed: 03/08/2023] Open
Abstract
The prevention of type 2 diabetes (T2D) in high-risk people with lifestyle interventions has been demonstrated by several randomized controlled trials. The intervention effect has sustained up to 20 years in post-trial monitoring of T2D incidence. In 2000, Finland launched the national T2D prevention plan. For screening for high T2D risk, the non-laboratory Finnish Diabetes Risk Score was developed and widely used, also in other countries. The incidence of drug-treated T2D has decreased steadily since 2010. The US congress authorized public funding for a national diabetes prevention program (NDPP) in 2010. It was built around a 16-visit program that relies on referral from primary care and self-referral of persons with either prediabetes or by a diabetes risk test. The program uses a train-the-trainer program. In 2015 the program started the inclusion of online programs. There has been limited implementation of nationwide T2D prevention programs in other countries. Despite the convincing results from RCTs in China and India, no translation to the national level was introduced there. T2D prevention efforts in low-and middle-income countries are still limited, but results have been promising. Barriers to efficient interventions are greater in these countries than in high-income countries, where many barriers also exist. Health disparities by socioeconomic status exist for T2D and its risk factors and form a challenge for preventive interventions. It seems that a stronger commitment to T2D prevention is needed, such as the successful WHO Framework Convention on Tobacco Control, which legally binds the countries to act.
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Martikainen J, Lehtimäki AV, Jalkanen K, Lavikainen P, Paajanen T, Marjonen H, Kristiansson K, Lindström J, Perola M. Economic evaluation of using polygenic risk score to guide risk screening and interventions for the prevention of type 2 diabetes in individuals with high overall baseline risk. Front Genet 2022; 13:880799. [PMID: 36186460 PMCID: PMC9520240 DOI: 10.3389/fgene.2022.880799] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 08/18/2022] [Indexed: 11/29/2022] Open
Abstract
Type 2 diabetes (T2D) with increasing prevalence is a significant global public health challenge. Obesity, unhealthy diet, and low physical activity are one of the major determinants of the rise in T2D prevalence. In addition, family history and genetic risk of diabetes also play a role in the process of developing T2D. Therefore, solutions for the early identification of individuals at high risk for T2D for early targeted detection of T2D, prevention, and intervention are highly preferred. Recently, novel genomic-based polygenic risk scores (PRSs) have been suggested to improve the accuracy of risk prediction supporting the targeting of preventive interventions to those at highest risk for T2D. Therefore, the aim of the present study was to assess the cost-utility of an additional PRS testing information (as a part of overall risk assessment) followed by a lifestyle intervention and an additional medical therapy when estimated 10-year overall risk for T2D exceeded 20% among Finnish individuals screened as at the high-risk category (i.e., 10%–20% 10-year overall risk of T2D) based on traditional risk factors only. For a cost-utility analysis, an individual-level state-transition model with probabilistic sensitivity analysis was constructed. A 1-year cycle length and a lifetime time horizon were applied in the base-case. A 3% discount rate was used for costs and QALYs. Cost-effectiveness acceptability curve (CEAC) and estimates for the expected value of perfect information (EVPI) were calculated to assist decision makers. The use of the targeted PRS strategy reclassified 12.4 percentage points of individuals to be very high-risk individuals who would have been originally classified as high risk using the usual strategy only. Over a lifetime horizon, the targeted PRS was a dominant strategy (i.e., less costly, more effective). One-way and scenario sensitivity analyses showed that results remained dominant in almost all simulations. However, there is uncertainty, since the probability (EVPI) of cost-effectiveness at a WTP of 0€/QALY was 63.0% (243€) indicating the probability that the PRS strategy is a dominant option. In conclusion, the results demonstrated that the PRS provides moderate additional value in Finnish population in risk screening leading to potential cost savings and better quality of life when compared with the current screening methods for T2D risk.
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Affiliation(s)
- Janne Martikainen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
- *Correspondence: Janne Martikainen,
| | | | - Kari Jalkanen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Piia Lavikainen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Teemu Paajanen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Heidi Marjonen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Kati Kristiansson
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jaana Lindström
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Markus Perola
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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The Special Issue on “The Nutritional Value of Pulses and Whole Grains”: A Continued Endeavor to Delineate Their Benefits for Today and Addressing the Challenges of the Future. Nutrients 2022; 14:nu14163381. [PMID: 36014887 PMCID: PMC9416299 DOI: 10.3390/nu14163381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 08/05/2022] [Accepted: 08/16/2022] [Indexed: 11/17/2022] Open
Abstract
Dietary patterns are increasingly focusing on the interplay between nutritional adequacy, reduction of chronic disease, and environmental sustainability [...]
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Miller KB, Grafenauer SJ, Martikainen J. Nutrition economics: Four analyses supporting the case for whole grain consumption. J Cereal Sci 2022. [DOI: 10.1016/j.jcs.2022.103455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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van der Kamp JW, Jones JM, Miller KB, Ross AB, Seal CJ, Tan B, Beck EJ. Consensus, Global Definitions of Whole Grain as a Food Ingredient and of Whole-Grain Foods Presented on Behalf of the Whole Grain Initiative. Nutrients 2021; 14:138. [PMID: 35011013 PMCID: PMC8746580 DOI: 10.3390/nu14010138] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/20/2021] [Indexed: 12/22/2022] Open
Abstract
Proposed global definitions of whole grain as an ingredient and whole grain food are presented by the authors on behalf of the Whole Grain Initiative. Whole grains are an important pillar of healthy and sustainable diets. Internationally accepted credible definitions of whole grains as food ingredients and whole-grain foods are necessary to ensure that all global stakeholders have shared standards, and that consumers find them clear, credible, and useful. Based on widely accepted, existing definitions and new developments, the Definitions Working Group of the global Whole Grain Initiative, with experts from academia, government agencies and industry, developed definitions for global application. The key statements of the definition documents are as follows: "Whole grains shall consist of the intact, ground, cracked, flaked or otherwise processed kernel after the removal of inedible parts such as the hull and husk; all anatomical components, including the endosperm, germ, and bran must be present in the same relative proportions as in the intact kernel" and "A whole-grain food shall contain at least 50% whole-grain ingredients based on dry weight. Foods containing 25-50% whole-grain ingredients based on dry weight, may make a front-of-pack claim on the presence of whole grain but cannot be designated 'whole grain' in the product name". The definition documents have been ratified by the leading international scientific associations in this area. We urge that these consensus Whole Grain Initiative definitions be adopted as the basis for definitions used by national regulatory authorities and for health promotion organisations worldwide to use in nutrition education and food labelling.
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Affiliation(s)
- Jan-Willem van der Kamp
- The Netherlands Organization for Applied Scientific Research (TNO), Microbiology and Systems Biology, 3704 HE Zeist, The Netherlands
| | - Julie Miller Jones
- Department of Family, Consumer & Nutritional Sciences, St. Catherine University, St. Paul, MN 55105, USA;
| | - Kevin B. Miller
- General Mills, Bell Institute of Health and Nutrition, Minneapolis, MN 55427, USA;
| | | | - Chris J. Seal
- Human Nutrition Research Centre, Public Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, UK;
| | - Bin Tan
- Academy of National Food and Strategic Reserves Administration, Beijing 100037, China;
| | - Eleanor J. Beck
- School of Medicine, University of Wollongong and Illawarra Health & Medical Research Institute, Wollongong, NSW 2522, Australia;
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