Weight change in later life and risk of death amongst the elderly: the European Prospective Investigation into Cancer and Nutrition‐Elderly Network on Ageing and Health study

Abstract. Bamia C, Halkjær J, Lagiou P, Trichopoulos D, Tjønneland A, Berentzen TL, Overvad K, Clavel‐Chapelon F, Boutron‐Ruault M‐C, Rohrmann S, Linseisen J, Steffen A, Boeing H, May AM, Peeters PH, Bas Bueno‐de‐Mesquita H, van den Berg SW, Dorronsoro M, Barricarte A, Rodriguez Suarez L, Navarro C, González CA, Boffetta P, Pala V, Hallmans G, Trichopoulou A (University of Athens, Athens, Greece; Institute of Cancer Epidemiology, Copenhagen, Denmark; Harvard School of Public Health, Boston, MA, USA; Bureau of Epidemiologic Research, Athens, Greece; Hellenic Health Foundation, Athens, Greece; Institute of Preventive Medicine, Copenhagen, Denmark; Institute of Public Health, Aarhus University, Aarhus, Denmark; Center for Cardiovascular Research, Aalborg, Denmark; Institut Gustave‐Roussy, Paris, France; German Cancer Research Centre, Heidelberg, Germany; Institute of Epidemiology, Potsdam, Germany; German Institute of Human Nutrition Potsdam‐Rehbruecke, Potsdam, Germany; University Medical Center Utrecht, Utrecht, the Netherlands; Public Health and Primary Care, London, UK; National Institute of Public Health and the Environment (RIVM), Bilthoven, the Netherlands; Public Health Department of Gipuzkoa & Ciberesp, San Sebastian, Spain; Health Institute of Navarra, Pamplona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Health and Healthcare services council, Asturias, Spain; Murcia Regional Health Council, Murcia, Spain; Catalan Institute of Oncology, Barcelona, Spain; International Agency for Research on Cancer, Lyon, France; Fondazione IRCSS Istituto Nazionale dei Tumori, Milan, Italy; and Nutritional Research, Umea, Sweden). Weight change in later life and risk of death amongst the elderly: the European Prospective Investigation into Cancer and Nutrition‐Elderly Network on Ageing and Health study. J Intern Med 2010; 268 : 133–144. Objective. Later life weight change and mortality amongst elders. Design. Nested case–control study. Setting. Six countries from the European Investigation into Cancer and nutrition – Elderly, Network on Ageing and Health. Subjects. A total of 1712 deceased (cases) and 4942 alive (controls) were selected from 34 239 participants, ≥ 60 years at enrolment (1992–2000) who were followed‐up until March 2007. Annual weight change was estimated as the weight difference from recruitment to the most distant from‐date‐of‐death re‐assessment, divided by the respective time. Outcome measures. Mortality in relation to weight change was examined using conditional logistic regression. Results. Weight loss >1 kg year^?1 was associated with statistically significant increased death risk (OR = 1.65; 95% CI: 1.41–1.92) compared to minimal weight change (±1 kg year^?1). Weight gain >1 kg year^?1 was also associated with increased risk of death (OR = 1.15; 95% CI: 0.98–1.37), but this was evident and statistically significant only amongst overweight/obese (OR = 1.55; 95% CI: 1.17–2.05). In analyses by time interval since weight re‐assessment, the association of mortality with weight loss was stronger for the interval proximal (<1 year) to death (OR = 3.10; 95% CI: 2.03–4.72). The association of mortality with weight gain was stronger at the interval of more than 3 years and statistically significant only amongst overweight/obese (OR = 1.58; 95% CI: 1.07–2.33). Similar patterns were observed regarding death from circulatory diseases and cancer. Conclusions. In elderly, stable body weight is a predictor of lower subsequent mortality. Weight loss is associated with increased mortality, particularly short‐term, probably reflecting underlying nosology. Weight gain, especially amongst overweight/obese elders, is also associated with increased mortality, particularly longer term.     

Chylomicronemia risk factors ranked by importance for the individual and community in 108 711 women and men

Background

Hypertriglyceridemia prevalence is increasing as more individuals become obese, and chylomicronemia risk factors for the individual and community have not been described previously.

Objective

To describe chylomicronemia risk factors in the general population for individuals and community.

Methods

A total of 108 711 individuals from the Copenhagen General Population Study were grouped as unlikely chylomicronemia (nonfasting triglycerides <2 mmol L^?1 (177 mg dL ^?1)), possible chylomicronemia (2–4.99 mmol L^?1 (177–442 mg dL ^?1)), probable chylomicronemia (5–9.99 mmol L^?1 (443–885 mg dL ^?1)) and definite chylomicronemia (≥10 mmol L^?1 (≥ 886 mg dL ^?1)). Relative risk (RR ) from Poisson regression ranked dichotomized chylomicronemia risk factors for individuals, and population attributable fractions (PAF ) for the community: type 2 diabetes, alcohol intake, obesity, fat intake, hypothyroidism, kidney function, education, sedentary lifestyle, menopause and hormone replacement (women).

Results

For women and men, chylomicronemia was unlikely in 81% and 64%, possible in 18% and 33%, probable in 1% and 3% and definite in 0.03% and 0.14%, respectively. For the individual, the three top‐ranked risk factors for probable/definite versus unlikely chylomicronemia in women were type 2 diabetes (RR : 4.21; 95% confidence interval: 3.30–5.36), menopause (RR : 3.74; 2.62–5.36) and obesity (RR : 3.44; 2.81–4.21). Corresponding top‐ranked risk factors in men were obesity (RR : 3.86; 3.46–4.30), type 2 diabetes (RR : 1.88; 1.61–2.19) and reduced kidney function (RR : 1.86; 1.48–2.34). For the community, top‐ranked risk factors in women were menopause (PAF : 63%), obesity (PAF : 29%) and type 2 diabetes (PAF : 15%). Corresponding top‐ranked risk factors in men were obesity (PAF : 29%), type 2 diabetes (PAF : 6.4%) and sedentary lifestyle (PAF : 6.0%).

Conclusions

Obesity and type 2 diabetes were the most important modifiable chylomicronemia risk factors in women and men, both for the individual and community. This could influence chylomicronemia prevention and help design randomized trials aimed at reducing triglycerides.

     

Gender difference of association between LDL cholesterol concentrations and mortality from coronary heart disease amongst Japanese: the Ibaraki Prefectural Health Study

Abstract. Noda H, Iso H, Irie F, Sairenchi T, Ohtaka E, Ohta H (Osaka University, Osaka, Japan; Harvard School of Public Health, Cambridge, MA, USA; Ibaraki Prefectural Office, Ibaraki; Dokkyo Medical University School of Medicine, Tochigi; Ibaraki Health Service Association, Ibaraki; Japan). Gender difference of association between LDL cholesterol concentrations and mortality from coronary heart disease amongst Japanese: the Ibaraki Prefectural Health Study. J Intern Med 2010; 267 :576–587. Objective. The aim of this study was to examine whether LDL cholesterol raises the risk of coronary heart disease in a dose–response fashion in a population with low LDL‐cholesterol levels. Design. Population‐based prospective cohort study in Japan. Subjects and main outcome measures. A total of 30 802 men and 60 417 women, aged 40 to 79 years with no history of stroke or coronary heart disease, completed a baseline risk factor survey in 1993. Systematic mortality surveillance was performed through 2003 and 539 coronary heart disease deaths were identified. Results. The mean values for LDL‐cholesterol were 110.5 mg dL^?1 (2.86 mmol L^?1) for men and 123.9 mg dL^?1 (3.20 mmol L^?1) for women. Men with LDL‐cholesterol ≥140 mg dL^?1 (≥3.62 mmol L^?1) had two‐fold higher age‐adjusted risk of mortality from coronary heart disease than did those with LDL‐cholesterol <80 mg dL^?1 (<2.06 mmol L^?1), whereas no such association for women was found. The multivariable hazard ratio for the highest versus lowest categories of LDL‐cholesterol was 2.06 (95 percent confidence interval: 1.34 to 3.17) for men and 1.16 (0.64 to 2.12) for women. Conclusion. Higher concentrations of LDL‐cholesterol were associated with an increased risk of mortality from coronary heart disease for men, but not for women, in a low cholesterol population.     

Association of boiled and filtered coffee with incidence of first nonfatal myocardial infarction: the SHEEP and the VHEEP study

Abstract. Hammar N, Andersson T, Alfredsson L, Reuterwall C, Nilsson T, Hallqvist J, Knutsson A, Ahlbom A (Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Stockholm Center of Public Health, Stockholm, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Västernorrland County Council, Sundsvall, Division of Social Medicine, Karolinska Institutet, Stockholm, Norrland University Hospital, Umeå, Sweden) Association of boiled and filtered coffee with incidence of first nonfatal myocardial infarction: the SHEEP and the VHEEP study. J Intern Med 2003; 253: 653–659. Objectives. To evaluate the influence of consumption of filtered and boiled coffee, on the incidence of first nonfatal myocardial infarction. Design. Population‐based case–control study. Setting and subjects. The study base consisted of the population 45–65/70 years‐old in two Swedish counties, Stockholm and Västernorrland, 1992/93–94. In all, 1943 cases of first nonfatal myocardial infarction were identified. For each case one control was selected from the study base concurrently with disease incidence by matching the sex, age and place of residence of the case. Information about coffee consumption and other factors was obtained by mailed questionnaire and a medical examination. The participation rate was 85% amongst cases and 74% amongst controls. Results. Men with a reported consumption of 7–9 dL filtered coffee per day showed an increased incidence of first myocardial infarction compared with consumers of 3 dL day^?1 or less (RR: 1.32; 95% CI: 1.03–1.70). A consumption of at least 10 dL day^?1 was associated with an RR of 1.93 (95% CI: 1.42–2.63) for filtered and 2.20 (95% CI: 1.17–4.15) for boiled coffee. Amongst women, no clear association was seen between consumption of filtered coffee and myocardial infarction but consumption of boiled coffee tended to be related to an increased incidence. Comparing subjects drinking boiled coffee with those drinking filtered coffee and adjusting for the amount consumed gave an increased incidence for boiled coffee amongst both men (RR: 1.41; 95% CI: 1.07–1.80) and women (RR: 1.63; 95% CI: 1.04–2.56). Conclusions. Consumption of boiled coffee appears to increase the incidence of first nonfatal myocardial infarction. This increased incidence is consistent with randomized trials showing an adverse impact of boiled coffee on blood lipids.     

Maternal and paternal transmission of type 2 diabetes: influence of diet, lifestyle and adiposity

Abstract. Abbasi A, Corpeleijn E, van der Schouw YT, Stolk RP, Spijkerman AMW, van der A DL, Navis G, Bakker SJL, Beulens JWJ (University Medical Center Groningen, Groningen; University Medical Centre Utrecht, Utrecht; and National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands) Maternal and paternal transmission of type 2 diabetes: influence of diet, lifestyle and adiposity. J Intern Med 2011; 270 : 388–396. Objective. Transmission of family history of type 2 diabetes to the next generation is stronger for maternal than paternal diabetes in some populations. The aim of the present study was to investigate whether this difference is explained by diet, lifestyle factors and/or adiposity. Methods. We analysed 35 174 participants from the Dutch contribution to the European Prospective Investigation into Cancer and Nutrition, a prospective population‐based cohort (aged 20–70 years) with a median follow‐up of 10.2 years. Parental history of diabetes was self‐reported. Occurrence of diabetes was mainly identified by self‐report and verified by medical records. Results. Amongst 35 174 participants, 799 incident cases of diabetes were observed. In age‐ and sex‐adjusted analyses, hazard ratio (HR) and 95% confidence intervals (CIs) for diabetes by maternal and paternal diabetes were 2.66 (2.26–3.14) and 2.40 (1.91–3.02), respectively. Maternal transmission of risk of diabetes was explained by diet (9.4%), lifestyle factors including smoking, alcohol consumption, physical activity and educational level (7.8%) and by adiposity, i.e. body mass index and waist and hip circumference (23.5%). For paternal transmission, the corresponding values were 2.9%, 0.0% and 9.6%. After adjustment for diet, lifestyle factors and adiposity, the HRs for maternal (2.20; 95% CI, 1.87–2.60) and paternal (2.23; 95% CI, 1.77–2.80) transmission of diabetes were comparable. Conclusions. Both maternal and paternal diabetes are associated with increased risk of type 2 diabetes, independently of diet, lifestyle and adiposity. The slightly higher risk conferred by maternal compared to paternal diabetes was explained by a larger contribution of diet, lifestyle factors and adiposity.     

Associations between interleukin-1 (IL-1) gene variations or IL-1 receptor antagonist levels and the development of type 2 diabetes

Abstract. Luotola K, Pietilä A, Zeller T, Moilanen L, Kähönen M, Nieminen MS, Kesäniemi YA, Blankenberg S, Jula A, Perola M, Salomaa V (Helsinki University Hospital, Helsinki; National Institute for Health and Welfare, Helsinki, Finland; University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany; University Hospital of Kuopio, Kuopio; Tampere University Hospital and Medical School, University of Tampere, Tampere; University of Oulu and Clinical Research Center, Oulu University Hospital, Oulu; National Institute for Health and Welfare, Turku; and Institute for Molecular Medicine Finland, Helsinki, Finland). Associations between interleukin‐1 (IL‐1) gene variations or IL‐1 receptor antagonist levels and the development of type 2 diabetes. J Intern Med 2010; 269 : 322–332. Objectives. To examine whether interleukin‐1 receptor antagonist (IL‐1Ra) is a predictor for clinically incident diabetes in subjects with metabolic syndrome (MetS) and whether its predictive power is independent of C‐reactive protein (CRP), an established marker of inflammation. We further examined whether genetic variants at the interleukin‐1 (IL‐1) locus would predict clinically incident diabetes. Design. Two observational prospective cohort studies. Setting. Two separate cohorts, Health 2000 and FINRISK 1997, followed up for an average of 7.1 and 10.8 years, respectively. Subjects. Random population samples consisting of 5511 subjects aged 30–74 years in Health 2000 and 7374 subjects aged 25–74 years in FINRISK 1997. Results. During follow‐up, 141 cases of clinically incident diabetes were observed amongst subjects with MetS at baseline in Health 2000 and 248 cases in FINRISK 97. After adjustment for multiple traditional risk factors of diabetes, including age and body mass index, IL‐1Ra was a significant (P < 0.01) predictor of incident diabetes amongst men in both cohorts and amongst women in FINRISK 1997. Further adjustment for CRP reduced the hazard ratios only slightly. Genetic analyses produced nominally significant associations for three single‐nucleotide polymorphisms: rs3213448 in IL‐1 receptor antagonist (IL1RN), rs1143634 in IL‐1 beta (IL1B) and rs1800587 in IL‐1 alpha (IL1A). The two latter variants had an interaction with gender (P = 0.023 and 0.002, respectively) suggesting the presence of gender‐specific associations with the risk of clinically incident diabetes. Conclusions. IL‐1Ra predicted the progression of MetS to clinically incident diabetes independently of CRP and other risk factors. Genetic variation in the IL‐1 locus may have gender‐specific associations with the risk of type 2 diabetes.     

Cardiovascular risk profile and type of alcohol beverage consumption: a population-based study

AIMS: To determine the association between several cardiovascular risk factors with total alcohol and types of alcoholic beverage consumption. METHODS: The subjects were Spanish men (n = 2,383) and women (n = 2,535) aged 25-74 years who were examined in 1994-1995 and 1999-2000, in two population-based cross-sectional surveys in the north-east of Spain (Gerona). Information of total amount and type of alcohol consumption, educational level, smoking, leisure-time physical, antihypertensive and hyperlipidemic drug treatment was obtained through structured questionnaires. The cardiovascular risk factors total cholesterol, HDL cholesterol, triglycerides, fasting glucose, fibrinogen, lipoprotein (a), heart rate and systolic and diastolic blood pressures were determined. RESULTS: Men consumed significantly more alcohol than women (19.5 vs. 4.5 g/day, respectively) and the prevalence of elevated alcohol consumption (>2 glasses of wine/day) also was higher in men (35.3%) than women (3.5%). Total alcohol intake was significantly related with HDL cholesterol and fibrinogen improvements in both genders. In contrast, total cholesterol, triglycerides, heart rate, and systolic and diastolic blood pressures were directly and significantly (p < 0.05) associated with total alcohol consumption in men but not in women. Wine drinking, particularly in women, was associated with a healthy cardiovascular risk profile. Most of the observed significant associations between type of alcohol beverage and CHD risk factors disappeared after controlling for total alcohol consumption and other confounders. CONCLUSIONS: Alcohol consumption was favorably related to the cardiovascular risk profile in women but not in men. The relationship of alcohol beverages seems to be mediated by the total alcohol content rather than by the type of beverage itself.     

Leptin levels and risk of type 2 diabetes: gender‐specific meta‐analysis

This meta‐analysis aimed to assess the gender‐specific differences in the relationship between circulating leptin levels and risk of type 2 diabetes. Published prospective studies that reported the association of leptin levels with risk of type 2 diabetes for a certain gender or those that reported gender‐specific associations were considered. Dose‐response relationships were assessed by the generalized least squares trend estimation and summary relative risks (RRs) with 95% confidence interval (CI) were computed with the random‐effects model. Stratified and sensitivity analyses were also performed to investigate potential sources of heterogeneity. Overall, 11 prospective studies were identified. The summary RR for an increment in leptin levels of 1‐log ng mL^?1 was 1.37 (95% CI, 1.13–1.66) for men and 0.96 (95% CI, 0.90–1.03) for women. The differences between genders were statistically significant (P for interaction = 0.006). Subgroup and sensitivity analyses generally confirmed the robustness of these findings. Furthermore, the increased risk in men appeared non‐linear, with a tendency to plateau at high levels (P for non‐linearity = 0.03). Little evidence of publication bias was found. Collectively, higher leptin levels were found to be associated with elevated risk of type 2 diabetes in men but not in women.     

Joint association of coffee consumption and other factors to the risk of type 2 diabetes: a prospective study in Finland

OBJECTIVe: To examine joint associations of coffee consumption and other factors (including physical activity, obesity and alcohol consumption) with the risk of type 2 diabetes. DESIGN: Prospective follow-up study. SUBJECTS: In all, 10 188 Finnish men and 11 197 women aged 35-74 years without a history of stroke, coronary heart disease or diabetes at baseline. MEASUREMENT: A self-administered questionnaire data on coffee, tea, alcohol and other food consumption, physical activity, smoking, socio-economic factors and medical history, together with measured height, weight and blood pressure using standardized protocol. RESULTS: During a mean follow-up of 13.4 years, there were 964 incident cases of type 2 diabetes. Multivariate-adjusted (age, study year, systolic blood pressure, education, smoking, physical activity, body mass index (BMI) and fruit, vegetable, sausage, bread, alcohol and tea consumption) hazard ratio of type 2 diabetes in participants who drank 0-2, 3-6 and > or =7 cups of coffee were 1.00, 0.77 and 0.66 (P=0.022 for trend) in men, 1.00, 0.71 and 0.52 (P=0.001 for trend) in women, and 1.00, 0.75 and 0.61 (P<0.001 for trend) in men and women combined (adjusted also for sex), respectively. This inverse association was consistent in subjects with any joint levels of physical activity and BMI, and in alcohol drinkers and non-drinkers. Among obese and inactive people, coffee drinking of seven cups or more daily reduced the risk of type 2 diabetes to half. CONCLUSIONS: Coffee drinking was associated with a reduced risk of type 2 diabetes in both men and women, and this association was observed regardless of the levels of physical activity, BMI and alcohol consumption.     

Association between alcohol consumption and plasma fetuin-A and its contribution to incident type 2 diabetes in women

Aims/hypothesis

The benefits of moderate alcohol consumption for type 2 diabetes have been postulated to involve a mechanism of improved insulin sensitivity. Fetuin-A, which is known to inhibit insulin signalling, has emerged as a biomarker for diabetes risk. Alcohol consumption may influence circulating fetuin-A concentrations and subsequently diabetes risk by altering the insulin signal. We therefore hypothesised that moderate alcohol consumption would be associated with lower fetuin-A concentration and that fetuin-A would partly explain the association between alcohol consumption and incident type 2 diabetes.

Methods

Among diabetes-free female participants in the Nurses’ Health Study (n?=?1,331), multiple linear regression was conducted to assess the association between alcohol consumption and plasma fetuin-A. Least-squares means (lsmeans) of fetuin-A were estimated in categories of alcohol consumption (0, 0.1–4.9, 5–14.9 and ≥15 g/day). The proportion of alcohol consumption and diabetes association explained by baseline fetuin-A was assessed in 470 matched incident diabetes case–control pairs with follow-up 2000–2006.

Results

Higher alcohol consumption was associated with lower plasma fetuin-A (p for trend?=?0.009): lsmean ± SE 476.5?±?5.9 μg/ml for abstainers, 468.9?±?5.2 μg/ml for 0.1–4.9 g/day consumers, 455.9?±?7.0 μg/ml for 5.0–14.9 g/day consumers, and 450.0?±?9.4 μg/ml for ≥15.0 g/day consumers. Fetuin-A and fasting insulin explained 18.4% and 54.8%, respectively, of the inverse association between alcohol consumption and diabetes after multiple adjustment (both p for contribution <0.04).

Conclusions/interpretation

Moderate alcohol consumption is associated with lower plasma fetuin-A in diabetes-free women. Fetuin-A and insulin explain a significant proportion of the association between alcohol consumption and incident type 2 diabetes. Further studies are needed to examine potential biological mechanisms underlying this association.     

Alcohol consumption and type 2 diabetes

To clarify the relationship between alcohol consumption and type 2 diabetes we conducted a meta-analysis of published epidemiological studies. Data from 13 cohorts were included in the analysis. The results of these studies are consistent with regard to moderate alcohol consumption, indicating a protective effect in the order of 30% (relative risk [RR]_meta=0.72, 95% CI=0.67–0.77). The reduced risk is seen in men as well as in women, although few studies investigated women. No protective effect of high alcohol consumption was seen and one cannot rule out that large intakes of alcohol may increase the risk of type 2 diabetes. Results from published studies suggest a U-shaped relationship between alcohol and type 2 diabetes, but this is based on rather few studies with heterogeneous design and definitions. It seems important to further investigate if, and to what extent, high alcohol consumption increases the risk of type 2 diabetes. Aspects of moderate alcohol consumption also need further investigation; these include type of drink, frequency of drinking, sex and ethnic differences.     

Timing of protein ingestion relative to resistance exercise training does not influence body composition, energy expenditure, glycaemic control or cardiometabolic risk factors in a hypocaloric, high protein diet in patients with type 2 diabetes

Aim: To investigate timing of protein ingestion relative to resistance exercise training (RT) on body composition, cardiometabolic risk factors, glycaemic control and resting energy expenditure (REE) during weight loss on a high‐protein (HP) diet in overweight and obese patients with type 2 diabetes (T2DM). Methods: Thirty‐four men/women with T2DM (age 57 ± 7 years and body mass index 34.9 ± 4.2 kg m^?2) were randomly assigned to the ingestion of a HP meal (860 kJ, 21 g protein, 0.7 g fat, 29.6 g carbohydrate) either immediately prior to RT or at least 2 h following RT. All participants followed a 16‐week, energy‐restricted (6–7 MJ day^?1), HP diet (carbohydrate : protein : fat 43 : 33 : 22) and participated in supervised RT (3 day week^?1). Outcomes were assessed pre‐ and postintervention at 16 weeks. Results: There was an overall reduction in bodyweight (?11.9 ± 6.1 kg), fat mass (?10.0 ± 4.4 kg), fat‐free mass (?1.9 ± 3.1 kg), waist circumference (?12.1 ± 5.3 cm), REE (?742 ± 624 kJ day^?1), glucose (?1.9 ± 1.7 mmol l^?1), insulin (?6.1 ± 6.7 mU l^?1) and glycosylated haemoglobin (?1.1 ± 0.1%), p ≤ 0.01 time for all variables, with no difference between groups (p ≥ 0.41 group effect). Strength improved and cardiometabolic risk factors were reduced similarly in both groups; single repetition maximum chest press 11.0 ± 8.7 kg, single repetition maximum lat pull down 9.9 ± 6.0 kg, total cholesterol ?0.6 ± 0.5 mmol l^?1, high‐density lipoprotein cholesterol ?0.1 ± 0.2 mmol l^?1, low‐density lipoprotein cholesterol ?0.3 ± 0.5 mmol l^?1, triglycerides ?0.6 ± 0.7 mmol l^?1, blood pressure (systolic/diastolic) ?13 ± 10/?7 ± 7 mmHg (p ≤ 0.04 time effect, p ≥ 0.24 group effect). Conclusion: A HP, energy‐restricted diet with RT was effective in improving glycaemic control, body composition, strength and cardiometabolic risk factors in overweight/obese patients with T2DM irrespective of altering the timing of protein ingestion relative to RT.     

Alcohol drinking patterns and risk of diabetes: a cohort study of 70,551 men and women from the general Danish population

Aims/hypothesis

Alcohol consumption is inversely associated with diabetes, but little is known about the role of drinking patterns. We examined the association between alcohol drinking patterns and diabetes risk in men and women from the general Danish population.

Methods

This cohort study was based on data from the Danish Health Examination Survey 2007–2008. Of the 76,484 survey participants, 28,704 men and 41,847 women were eligible for this study. Participants were followed for a median of 4.9 years. Self-reported questionnaires were used to obtain information on alcohol drinking patterns, i.e. frequency of alcohol drinking, frequency of binge drinking, and consumption of wine, beer and spirits, from which we calculated beverage-specific and overall average weekly alcohol intake. Information on incident cases of diabetes was obtained from the Danish National Diabetes Register. Cox proportional hazards model was applied to estimate HRs and 95% CIs.

Results

During follow-up, 859 men and 887 women developed diabetes. The lowest risk of diabetes was observed at 14 drinks/week in men (HR 0.57 [95% CI 0.47, 0.70]) and at 9 drinks/week in women (HR 0.42 [95% CI 0.35, 0.51]), relative to no alcohol intake. Compared with current alcohol consumers consuming <1 day/week, consumption of alcohol on 3–4 days weekly was associated with significantly lower risk for diabetes in men (HR 0.73 [95% CI 0.59, 0.94]) and women (HR 0.68 [95% CI 0.53, 0.88]) after adjusting for confounders and average weekly alcohol amount.

Conclusions/interpretation

Our findings suggest that alcohol drinking frequency is associated with risk of diabetes and that consumption of alcohol over 3–4 days per week is associated with the lowest risk of diabetes, even after taking average weekly alcohol consumption into account.

     

Changes in coffee intake and subsequent risk of type 2 diabetes: three large cohorts of US men and women

Aims/hypothesis

Coffee and tea consumption has been associated with a lower type 2 diabetes risk but little is known about how changes in coffee and tea consumption influence subsequent type 2 diabetes risk. We examined the associations between 4 year changes in coffee and tea consumption and risk of type 2 diabetes in the subsequent 4 years.

Methods

We prospectively followed 48,464 women in the Nurses’ Health Study (NHS; 1986–2006), 47,510 women in NHS II (1991–2007) and 27,759 men in the Health Professionals Follow-up Study (HPFS; 1986–2006). Diet was assessed every 4 years using a validated food-frequency questionnaire. Self-reported cases of incident type 2 diabetes were validated by supplementary questionnaires.

Results

During 1,663,319 person-years of follow-up, we documented 7,269 cases of incident type 2 diabetes. Participants who increased their coffee consumption by more than 1 cup/day (median change?=?1.69 cups/day) over a 4 year period had an 11% (95% CI 3%, 18%) lower risk of type 2 diabetes in the subsequent 4 years compared with those who made no changes in consumption. Participants who decreased their coffee intake by more than 1 cup/day (median change?=??2 cups/day) had a 17% (95% CI 8%, 26%) higher risk for type 2 diabetes. Changes in tea consumption were not associated with type 2 diabetes risk.

Conclusions/interpretation

Our data provide novel evidence that increasing coffee consumption over a 4 year period is associated with a lower risk of type 2 diabetes, while decreasing coffee consumption is associated with a higher risk of type 2 diabetes in subsequent years.     

Follow‐ups of the Cardiovascular Risk in Young Finns Study in 2001 and 2007: Levels and 6‐year changes in risk factors

Abstract. Raiko JRH, Viikari JSA, Ilmanen A, Hutri‐Kähönen N, Taittonen L, Jokinen E, Pietikäinen M, Jula A, Loo B.‐M, Marniemi J, Lehtimäki T, Kähönen M, Rönnemaa T, Raitakari OT, Juonala M (University of Turku; University of Tampere and Tampere University Hospital, Tampere; University of Oulu, Oulu; Vaasa Central Hospital, Vaasa; University of Helsinki, Helsinki; and Center of Social and Health Services, Kuopio; Finland). Follow‐ups of the Cardiovascular Risk in Young Finns Study in 2001 and 2007: Levels and 6‐year changes in risk factors. J Intern Med 2010; 267 : 370–384. Objectives. To examine cardiovascular risk factor levels in 2007 and their 6‐year changes between 2001 and 2007 using the data collected in the follow‐ups of the Cardiovascular Risk in Young Finns Study. Design. Population‐based follow‐up study. Subjects. A total of 2204 healthy Finnish adults aged 30–45 years (1210 women; 994 men). Main outcome measures. Levels in 2007 and changes between 2001 and 2007 of lipids, insulin, glucose, blood pressure, smoking, body mass index, alcohol consumption, waist and hip circumferences. Results. The mean serum total cholesterol, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol and triglyceride concentrations in 30‐ to 45‐year‐old adults were 5.05, 3.09, 1.34 and 1.40 mmol L^?1, respectively. Significant changes (P < 0.05) between 2001 and 2007 in 30‐ to 39‐year‐old subjects included a decrease in total cholesterol (?6.6% in men, ?5.8% in women), LDL‐cholesterol (?10.2% and ?11.6%) and an increase in diastolic blood pressure (3.5% and 3.9%). Waist circumference (1.8% and 5.5%) and systolic blood pressure increased in 36–39 year olds (2.3% and 2.3%). HDL‐cholesterol increased in 30‐ to 33‐year‐old women (5.8%) Glucose levels increased in 30‐ to 39‐year‐old women (3.7%) and 36‐ to 39‐year‐old men (3.6%). Smoking prevalence decreased in 36‐ to 39‐year‐old men from 29.8% to 22.2%. Conclusions. The 6‐year changes in total cholesterol, LDL‐cholesterol and HDL‐cholesterol in young Finns were favourable between 2001 and 2007. However, waist circumference, glucose and blood pressure levels increased. Therefore, continuous efforts are still needed in fighting against cardiovascular risk factors.     

Adiponectin in relation to insulin sensitivity and insulin secretion in the development of type 2 diabetes: a prospective study in 64-year-old women

Abstract. Fagerberg B, Kellis D, Bergström G, Behre CJ (Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden). Adiponectin in relation to insulin sensitivity and insulin secretion in the development of type 2 diabetes: a prospective study in 64‐year‐old women. J Intern Med 2011; 269 : 636–643. Objectives. To examine how serum adiponectin levels predict the incidence of type 2 diabetes, from different prediabetic states, in relation to insulin sensitivity and β‐cell function during 5.5 years of follow‐up. Methods. In a population‐based cohort of 64‐year‐old Caucasian women, we assessed glucose tolerance, insulin sensitivity as homeostasis model assessment, insulin secretion as acute insulin response, lifestyle factors and serum concentrations of adiponectin and high‐sensitivity C‐reactive protein. After 5.5 years of follow‐up, 167 women with normal glucose tolerance (NGT) and 174 with impaired glucose tolerance (IGT) at baseline were re‐examined and incidence of diabetes was assessed. Results. A total of 69 new cases of diabetes were detected during follow‐up. Diabetes incidence was independently predicted by low levels of serum adiponectin, insulin resistance and insulin secretion, cigarette smoking, impaired fasting glucose (IFG) and IGT at baseline. Serum adiponectin below 11.54 g L^?1 was associated with an odds ratio of 3.6 (95% confidence interval 1.4–8.6) for future type 2 diabetes. At baseline, a high serum adiponectin concentration correlated positively with high levels of insulin sensitivity and insulin secretion. Women with incident diabetes had lower serum adiponectin levels in the NGT, IFG and IGT groups at baseline compared to those who did not develop diabetes during follow‐up. Conclusions. Low adiponectin concentrations were associated with future diabetes independently of insulin secretion and sensitivity, as well as IGT, IFG, smoking and abdominal obesity.     

Gluten intake and risk of type 2 diabetes in three large prospective cohort studies of US men and women

Aims/hypothesis

We investigated the association between gluten intake and long-term type 2 diabetes risk among Americans.

Methods

We followed women from the Nurses’ Health Study (NHS, n?=?71,602, 1984–2012) and NHS II (n?=?88,604, 1991–2013) and men from the Health Professionals Follow-Up Study (HPFS, n?=?41,908, 1986–2012). Gluten intake was estimated using a validated food frequency questionnaire every 2–4 years. Incident type 2 diabetes was defined as self-reported physician-diagnosed diabetes confirmed using a supplementary questionnaire.

Result

Gluten intake was strongly correlated with intakes of carbohydrate components, especially refined grains, starch and cereal fibre (Spearman correlation coefficients >0.6). During 4.24 million years of follow-up, 15,947 people were confirmed to have type 2 diabetes. After multivariate adjustment, pooled HRs and 95% CIs for type 2 diabetes, from low to high gluten quintiles, were (p_trend?<?0.001): 1 (reference); 0.89 (0.85, 0.93); 0.84 (0.80, 0.88); 0.78 (0.74, 0.82) and 0.80 (0.76, 0.84). The association was slightly weakened after further adjusting for cereal fibre, with pooled HRs (95% CIs) of (p_trend?<?0.001): 1 (reference); 0.91 (0.87, 0.96); 0.88 (0.83, 0.93); 0.83 (0.78, 0.88) and 0.87 (0.81, 0.93). Dose–response analysis supported a largely linear inverse relationship between gluten intake up to 12 g/day and type 2 diabetes. The association between gluten intake and type 2 diabetes was stronger when intake of added bran was also higher (p_interaction?=?0.02).

Conclusions/interpretation

Gluten intake is inversely associated with type 2 diabetes risk among largely healthy US men and women. Limiting gluten in the diet is associated with lower intake of cereal fibre and possibly other beneficial nutrients that contribute to good health.

     

Nonfasting cholesterol and triglycerides and association with risk of myocardial infarction and total mortality: the Copenhagen City Heart Study with 31 years of follow-up

Abstract. Langsted A, Freiberg JJ, Tybjærg‐Hansen A, Schnohr P, Jensen GB, Nordestgaard BG (Herlev Hospital, Herlev; University of Copenhagen; Bispebjerg Hospital; and Rigshospitalet, Copenhagen Ø, Denmark). Nonfasting cholesterol and triglycerides and association with risk of myocardial infarction and total mortality: the Copenhagen City Heart Study with 31 years of follow‐up. J Intern Med 2011; 270 : 65–75. Objectives. We compared the ability of very high levels of nonfasting cholesterol and triglycerides to predict risk of myocardial infarction and total mortality. Design. Prospective study from 1976 to 1978 until 2007. Setting. Danish general population. Participants. Randomly selected population of 7581 women and 6391 men, of whom 768 and 1151 developed myocardial infarction and 4398 and 4416 died, respectively. Participation rate was 72%, and follow‐up was 100% complete. Less than 2% of participants were taking lipid‐lowering therapy. Results. Compared to women with cholesterol <5 mmol L^?1, multivariate‐adjusted hazard ratios for myocardial infarction ranged from 1.3 [95% confidence interval (CI): 0.9–1.8] for a cholesterol level of 5.0–5.99 mmol L^?1 to 2.5 (95%CI: 1.6–4.0) for cholesterol ≥9 mmol L^?1 (trend: P < 0.0001). Compared with women with nonfasting triglycerides <1 mmol L^?1, hazard ratios for myocardial infarction ranged from 1.5 (95%CI: 1.2–1.8) for triglycerides of 1.0–1.99 mmol L^?1 to 4.2 (95%CI: 2.5–7.2) for triglycerides ≥5 mmol L^?1 (p<0.0001). In men, corresponding hazard ratios ranged from 1.2 (95%CI: 1.0–1.5) to 5.3 (95%CI: 3.6–8.0) for cholesterol (P < 0.0001) and from 1.3 (95%CI: 1.0–1.6) to 2.1 (95%CI: 1.5–2.8) for triglycerides (P < 0.0001). Increasing cholesterol levels were not consistently associated with total mortality in women (trend: P = 0.39) or men (P = 0.02). By contrast, compared with women with triglycerides <1 mmol L^?1, multivariate‐adjusted hazard ratios for total mortality ranged from 1.1 (95%CI: 1.0–1.2) for triglycerides of 1.0–1.99 mmol L^?1 to 2.0 (95%CI: 1.5–2.9) for triglycerides ≥5 mmol L^?1 (trend: P < 0.0001); corresponding hazard ratios in men ranged from 1.1 (95%CI: 1.0–1.2) to 1.5 (95%CI: 1.2–1.7) (P < 0.0001). Conclusions. Stepwise increasing levels of nonfasting cholesterol and nonfasting triglycerides were similarly associated with stepwise increasing risk of myocardial infarction, with nonfasting triglycerides being the best predictor in women and nonfasting cholesterol the best predictor in men. Even more surprisingly, only increasing levels of nonfasting triglycerides were associated with total mortality, whereas increasing cholesterol levels were not.     

Lifestyle factors of people with exceptional longevity

OBJECTIVES: To assess lifestyle factors including physical activity, smoking, alcohol consumption, and dietary habits in men and women with exceptional longevity. DESIGN: Retrospective cohort study. SETTING: A cohort of community‐dwelling Ashkenazi Jewish individuals with exceptional longevity defined as survival and living independently at age 95 and older. PARTICIPANTS: Four hundred seventy‐seven individuals (mean 97.3±2.8, range 95–109; 74.6% women) and a subset of participants of the National Health and Nutrition Examination Survey (NHANES) I (n=3,164) representing the same birth cohort as a comparison group. MEASUREMENTS: A trained interviewer administrated study questionnaires to collect information on lifestyle factors and collected data on anthropometry. RESULTS: People with exceptional longevity had similar mean body mass index (men, 25.4±2.8 kg/m² vs 25.6±4.0 kg/m², P=.63; women, 25.0±3.5 kg/m² vs 24.9±5.4 kg/m²; P=.90) and a similar proportion of daily alcohol consumption (men, 23.9 vs 22.4, P=.77; women, 12.1 vs 11.3, P=.80), of regular physical activity (men: 43.1 vs 57.2; P=.07; women: 47.0 vs 44.1, P=.76), and of a low‐calorie diet (men: 20.8 vs 21.1, P=.32; women: 27.3 vs 27.1, P=.14) as the NHANES I population. CONCLUSION: People with exceptional longevity are not distinct in terms of lifestyle factors from the general population, suggesting that people with exceptional longevity may interact with environmental factors differently than others. This requires further investigation.     

Differential leucocyte count and the risk of future coronary artery disease in healthy men and women: the EPIC-Norfolk Prospective Population Study

Abstract. Rana JS, Boekholdt SM, Ridker PM, Jukema JW, Luben R, Bingham SA, Day NE, Wareham NJ, Kastelein JJP, Khaw K‐T. (Academic Medical Center, Amsterdam, The Netherlands; University of Pittsburgh, Pittsburgh, PA, USA; Leiden University Medical Center, The Netherlands; and Institute of Public Health, University of Cambridge, Cambridge, UK). Differential leucocyte count and the risk of future coronary artery disease in healthy men and women: the EPIC‐Norfolk Prospective Population Study. J Intern Med 2007; 262 : 678–689. Background: We examined the relationship between granulocyte, lymphocyte and monocyte counts and risk of coronary heart disease (CHD) and cardiovascular disease (CVD) in men and women. There is paucity of data on the differential leucocyte count and its relationship with the risk of CHD and CVD. Methods: This prospective study comprised 7073 men and 9035 women who were 45–79 years of age and were residents of Norfolk. United Kingdom. Results: During an average of 8 years of follow‐up we identified 857 incident CHD events and 2581 CVD incident events. Increased total leucocyte count was associated with increased risk for both CHD and CVD. The highest quartile of granulocyte count was associated with increased risk when compared to lowest quartile for CHD (men HR 1.70 95% CI: 1.30–2.21; women HR 1.24 95% CI: 0.91–1.69) and for CVD (men HR 1.46 95% CI: 1.24–1.71; women HR 1.20 95% CI: 1.02–1.42). The association remained unchanged when the analyses were restricted to nonsmokers and when risk was assessed for every 1000 cells L^?1 increase in cell count. In multivariable models, despite adjusting for C‐reactive protein (CRP), the granulocyte count remained an independent predictor of CHD and CVD risk, especially amongst men. Lymphocyte or monocyte counts were not significantly associated with increased risk. In all analyses, additionally adjusting for CRP did not affect the results materially. Conclusions: In conclusion, we found that the higher risk for CHD and CVD associated with increased total leucocyte count seems to be accounted for by the increased granulocyte count.