Lifestyle and socioeconomic determinants of diabetes: Evidence from country-level data

Objective

The objectives of the study is to investigate the global socioeconomic risk factors associated with diabetes prevalence using evidence from available country-level data.

Design

A cross-sectional study based on (2010 & 2019) countrywide Health Nutrition and Population Statistics data.

Population

People ages 20–79 who have diabetes.

Setting

One hundred and thirty-two countries or territories in the world.

Primary outcome measure

Diabetes prevalence rates were determined from (2010 & 2019) countrywide Health Nutrition and Population Statistics (Health Stats, World Bank Group).

Results

In 2010, a 1% increase in per capita income and total tobacco consumption is associated with a 0.92% (95% CI 0.64% to 1.19%) and 0.02% (95% CI 0.006% to 0.047%) increase in diabetes prevalence respectively; and a 1% increase in alcohol consumption is associated with a -0.85% (95% CI -1.17% to -0.53%) decrease in diabetes prevalence. Statistically significant socioeconomic and lifestyle indices positively associated with diabetes prevalence included gross national income; overweight prevalence (BMI>25 kg/m²); and tobacco consumption. Statistically significant inverse associations with global diabetes prevalence included total population size; unemployment and alcohol consumption. The 2019 data was removed due to sparsity of data.

Conclusion

Statistically significant global lifestyle and socioeconomic determinants of diabetes prevalence include alcohol consumption; tobacco consumption; overweight prevalence; per capita income; total population and unemployment rates. Determinants of diabetes include modifiable risk factors which are consistent at both the micro and macro level and include tobacco consumption and overweight prevalence. Factors which are non-modifiable and warrant further investigation include total population and unemployment rates, which were inversely associated with diabetes prevalence and are a product of other underlying factors. Other determinants such as alcohol consumption was also inversely associated with diabetes prevalence, but has been observed to have both negative and positive associations with diabetes at the micro-level. These associations were dependent upon the amount of alcohol consumed. Global cut-off point of alcohol consumption is critical to establish global policies to reduce diabetes prevalence. Overall, the use of cross-sectional based study for country level aggregate data is a critical tool that should be considered when making global joint strategies or policies against diabetes in both data analysis and decision making.

Vitamin E and beta-carotene status of dairy cows: a survey of plasma levels and supplementation practices

Culling rate in dairy cattle has increased considerably, thereby reducing cowś longevity and raising sustainability concerns worldwide. In the last decades, feeding systems have changed towards larger inclusion of preserved forages and reduced fresh herbage, which may limit vitamin E and beta-carotene dietary supply to dairy cows. Because of higher oxidative stress, engendered by greater milk production of modern genetics, the requirement for these nutrients is increased. Therefore, this study aimed to assess the current status of vitamin E and beta-carotene of commercial dairy cows. Blood vitamin E and beta-carotene concentrations were measured in 2 467 dairy cows from 127 farms in Belgium, Germany, Iberia and The Netherlands, that were visited once. Five cows were randomly selected per lactation stage per farm: Dry (between 30 and 1 day(s) before calving), Very-early (from calving until 15 days in milk (DIM)), Early (between 16 and 119 DIM), and Mid-late (from 120 DIM onwards). In addition, a survey was conducted to retrieve data on vitamin E and beta-carotene supplementation and feeding practices. Vitamin E and beta-carotene blood concentrations dropped considerably around calving. Among all surveyed cows, more than 75 and 44% were deficient in vitamin E and beta-carotene (i.e., blood concentration below 3.0 and 3.5 mg/l, respectively). Of the Very-early group, more than 97 and 78% of the cows were deficient in vitamin E and beta-carotene, respectively, with respective blood concentrations of 1.15 and 2.71 mg/l, which was significantly lower than the other lactation stages. Vitamin E and beta-carotene blood concentrations, as well as their supplementation levels, significantly varied among countries. Vitamin E and beta-carotene blood concentrations were positively related to the total estimated daily intakes of vitamin E and beta-carotene. Therefore, blood concentrations of vitamin E and beta-carotene depend on their respective level of intake, which is generally below recommendations and varies greatly between countries. Supplementation could contribute to provide cows with adequate amounts of vitamin E and beta-carotene all along the lactation, to ensure their lifetime performance and improve their fertility.

Kinetic modelling of acyl glucuronide and glucoside reactivity and development of structure–property relationships

Detailed kinetic and transition structure modelling to rationalise the differences in reactivity observed between the acyl glucuronide and glucoside metabolites of a series of phenylacetic acid analogues.

Metabolic phenotype modulation by caloric restriction in a lifelong dog study

Modeling aging and age-related pathologies presents a substantial analytical challenge given the complexity of gene-environment influences and interactions operating on an individual. A top-down systems approach is used to model the effects of lifelong caloric restriction, which is known to extend life span in several animal models. The metabolic phenotypes of caloric-restricted (CR; n = 24) and pair-housed control-fed (CF; n = 24) Labrador Retriever dogs were investigated by use of orthogonal projection to latent structures discriminant analysis (OPLS-DA) to model both generic and age-specific responses to caloric restriction from the ¹H NMR blood serum profiles of young and older dogs. Three aging metabolic phenotypes were resolved: (i) an aging metabolic phenotype independent of diet, characterized by high levels of glutamine, creatinine, methylamine, dimethylamine, trimethylamine N-oxide, and glycerophosphocholine and decreasing levels of glycine, aspartate, creatine and citrate indicative of metabolic changes associated largely with muscle mass; (ii) an aging metabolic phenotype specific to CR dogs that consisted of relatively lower levels of glucose, acetate, choline, and tyrosine and relatively higher serum levels of phosphocholine with increased age in the CR population; (iii) an aging metabolic phenotype specific to CF dogs including lower levels of liproprotein fatty acyl groups and allantoin and relatively higher levels of formate with increased age in the CF population. There was no diet metabotype that consistently differentiated the CF and CR dogs irrespective of age. Glucose consistently discriminated between feeding regimes in dogs (≥312 weeks), being relatively lower in the CR group. However, it was observed that creatine and amino acids (valine, leucine, isoleucine, lysine, and phenylalanine) were lower in the CR dogs (<312 weeks), suggestive of differences in energy source utilization. ¹H NMR spectroscopic analysis of longitudinal serum profiles enabled an unbiased evaluation of the metabolic markers modulated by a lifetime of caloric restriction and showed differences in the metabolic phenotype of aging due to caloric restriction, which contributes to longevity studies in caloric-restricted animals. Furthermore, OPLS-DA provided a framework such that significant metabolites relating to life extension could be differentiated and integrated with aging processes.

Self-modeling curve resolution recovery of temporal metabolite signal modulation in NMR spectroscopic data sets: application to a life-long caloric restriction study in dogs

A novel model-free statistical approach (self modeling curve resolution, SMCR) has been applied to recover biochemical information from complex overlapping signals in (1)H NMR spectra of blood serum in a long-term study of caloric restriction (CR) in the dog (n = 24 control fed (CF) and n = 24 CR animals). A new statistical spectroscopic construct, the spectrotype, is proposed which is a spectroscopic subset description or component of a metabolic phenotype. Characterization of the (1)H NMR profiles according to their evolutionary contribution of each spectrotype gives clues to the kinetics of the macro-biochemical response profiles and the identity of the underlying biochemical constituents, governing the evolutionary global response to an intervention. This information can be used to monitor and predict the end point of the biological process and to identify the mechanisms responsible for those changes. Here a SMCR strategy together with a pattern recognition method, principal component analysis (PCA) was used to resolve sets of spectrotypes, without a priori information. From the (1)H NMR evolutionary response profiles, two spectrotypes were identified and resolved; spectrotype 1 dominated by lipids featuring contributions from phosphatidylcholine, lipoprotein lipid fatty acyl groups from triglycerides, phospholipids, and cholesteryl esters plus total cholesterol (i.e., both esterified and unesterified); spectrotype 2 comprising glucose signals and a poorly resolved envelope of albumin and N-acetylated glycoprotein resonances. The relative contributions of these spectrotypes in each sample were calculated. For both caloric restricted (CR) and control fed (CF) dogs between ages 1 and 9 years, the contribution of spectrotype 2 > spectrotype 1, whereas for dogs aged between 9 and 12 years spectrotype 1 > spectrotype 2. Therefore, SMCR analysis pinpointed ages where nutrition and aging metabolic changes became significant within serum samples as well as providing the individual longitudinal contribution profiles associated with each spectrotype, which could potentially be used as part of a strategy to monitor and predict longevity and morbidity in populations. Hence SMCR is a useful addition to the chemometric "toolbox" for metabolic analysis and should have diverse applications within other biomedical conditions characterized by subtle time-dependent changes.

Insulin and dexamethasone regulate stearoyl-CoA desaturase mRNA levels and fatty acid synthesis in ovine adipose tissue explants1,2

Sheep adipose tissue explants were maintained in culture for 24 h in the presence of insulin, dexamethasone, or insulin and dexamethasone, and stearoyl-CoA desaturase (SCD) messenger RNA (mRNA) levels and fatty acid synthesis were measured. Insulin increased SCD mRNA levels (P = 0.008) and synthesis of both saturated (P = 0.07) and unsaturated (P < 0.001) fatty acids but had the greatest effect on unsaturated fatty acid synthesis, resulting in the overall production of a greater (P < 0.001) proportion of monounsaturated fat. Dexamethasone, alone, had the opposite effect but actually potentiated the effect of insulin in stimulating SCD expression and both saturated and monounsaturated fatty acid synthesis, without affecting the relative proportions of each. Across adipose tissue depots, the effect of hormones was similar, although the increase in SCD mRNA levels (P = 0.008) and monounsaturated fatty acid synthesis (P < 0.001) was greater in subcutaneous adipose tissue than in the internal (omental and perirenal) depots. These data clearly show that, in ovine adipose tissue, changes in SCD gene expression in response to insulin and dexamethasone are associated with changes in monounsaturated fatty acid synthesis and suggest that it may be possible to develop strategies to manipulate sheep tissues to produce a less-saturated fatty acid profile.

Ovine adipose tissue monounsaturated fat content is correlated to depot-specific expression of the stearoyl-CoA desaturase gene

The basis for the variation in fatty acid composition in different ovine adipose tissue depots was investigated. The proportion of stearic (C18:0) and oleic (C18:1) acids vary in a site-specific fashion; abdominal depots (omental and perirenal) contain relatively more C18:0 than C18:1, and carcass depots, especially sternum, have a markedly higher proportion of C18:1. Additionally, expression of a number of lipogenic enzyme genes (stearoyl-CoA desaturase [SCD], acetyl-CoA carboxylase-alpha [ACC-alpha], lipoprotein lipase [LPL]) and the cytoskeletal protein gene alpha-tubulin vary among depots, although the pattern of variation differs for each mRNA. When these expression data were related to the mean cell volume of adipocytes pooled from all depots, a significant pattern emerged: expression of the ACC-alpha, LPL, and alpha-tubulin genes was highly correlated with the size of adipocytes. In contrast, when the expression of SCD mRNA was assessed as a function of mean cell volume, two populations of adipocytes emerged: no significant correlation was found between the expression of SCD mRNA per adipocyte and mean cell volume for the abdominal depots, although a highly significant correlation was observed between SCD gene expression and mean cell volume for the carcass and epicardial depots. Similarly, a highly significant correlation was found for the amount of C18:1 per adipocyte and the abundance of SCD mRNA per adipocyte for the carcass and epicardial depots, whereas no significant correlation was observed for these traits for the omental and perirenal depots. Thus, the SCD gene seems to be regulated in a depot-specific fashion and in a manner distinct from that of the ACC and LPL genes.

Stearoyl-CoA desaturase mRNA is transcribed from a single gene in the ovine genome

Clones corresponding to ovine stearoyl-CoA desaturase (SCD) cDNA were isolated from an adipose tissue cDNA library. All of these clones represented a single mRNA species as judged by restriction fragment and DNA sequence analysis. RNase protection analysis demonstrated that this SCD transcript is highly expressed in adipose tissue and liver, and in the mammary gland of lactating animals. A lower level of expression was detectable in a variety of other tissues including brain. Levels of the SCD transcript were decreased in adipose tissue during lactation, and this appears to be related to a marked decline in serum insulin and insulin-responsiveness of the tissue. Southern analysis of ovine and mouse genomic DNA demonstrated that the ovine SCD cDNA hybridised in a manner consistent with a single gene for SCD in ovine DNA; mouse genomic DNA produced a pattern of hybridisation consistent with the previously characterised mouse SCD-1 and SCD-2 genes. Three ovine cosmids were isolated that comprised the restriction fragments predicted by the genomic Southern analysis. The ovine SCD gene was predicted to be encompassed within a 23 kbp region that was present in all three cosmids. These results demonstrate that SCD is transcribed from a single gene in the ovine genome and this gene is insulin-responsive in ovine adipose tissue.

A closer look at case management

Healthcare organizations throughout the United States are attempting to find solutions to spiraling healthcare costs. Hospital administrators are questioning the cost-effectiveness of their care delivery models, while healthcare professionals are developing innovative measures to increase the cost-effective use of resources. This article explores hospital-based case management measures that are being used not only to control costs but also to de-escalate the continuously accelerating cost increases.

Designing a curriculum for healthy work: reflections on the United Automobile, Aerospace and Agricultural Implement Workers-General Motors Ergonomics Pilot Project

An ambitious ergonomics pilot project sponsored by UAW-GM sought to bypass traditional "top-down" methods of ergonomics training in favor of an in-house "bottom-up" approach that empowered workers to implement basic ergonomic improvements in their own work areas. UAW and GM eventually used the program as the model for a corporate-wide ergonomics program that they later implemented.