Prolonged sitting may increase diabetes risk in physically inactive individuals: an 11 year follow-up of the HUNT Study,Norway

Aims/hypothesis

We examined the association between sitting time and diabetes incidence, overall and by strata of leisure-time physical activity and BMI.

Methods

We followed 28,051 adult participants of the Nord-Trøndelag Health Study (the HUNT Study), a population-based study, for diabetes incidence from 1995–1997 to 2006–2008 and estimated HRs of any diabetes by categories of self-reported total daily sitting time at baseline.

Results

Of 28,051 participants, 1253 (4.5%) developed diabetes during 11 years of follow-up. Overall, sitting ≥8 h/day was associated with a 17% (95% CI 2, 34) higher risk of developing diabetes compared with sitting ≤4 h/day, adjusted for age, sex and education. However, the association was attenuated to a non-significant 9% (95% CI ?5, 26) increase in risk after adjustment for leisure-time physical activity and BMI. The association between sitting time and diabetes risk differed by leisure-time physical activity (p _Interaction?=?0.01). Among participants with low leisure-time physical activity (≤2 h light activity per week and no vigorous activity), sitting 5–7 h/day and ≥8 h/day were associated with a 26% (95% CI 2, 57) and 30% (95% CI 5, 61) higher risk of diabetes, respectively, compared with sitting ≤4 h/day. There was no corresponding association among participants with high leisure-time physical activity (≥3 h light activity or >0 h vigorous activity per week). There was no statistical evidence that the association between sitting time and diabetes risk differed by obesity (p _Interaction?=?0.65).

Conclusions/interpretation

Our findings suggest that total sitting time has little association with diabetes risk in the population as a whole, but prolonged sitting may contribute to an increased diabetes risk among physically inactive people.

     

Can “Healthy” Normal Alanine Aminotransferase Levels Identify the Metabolically Obese Phenotype? Findings from The Korea National Health and Nutrition Examination Survey 2008–2010

Background

There is no established parameter with which to screen metabolically obese phenotypes.

Aim

The aim of the study was to revise the upper limit of normal (ULN) of serum alanine aminotransferase (ALT) and to investigate the predictive value of updated ALT levels for metabolic obese phenotype stratified according to body mass index (BMI).

Methods

We analyzed a nationally representative data from the Fourth Korea National Health and Nutrition Examination Survey. This cross-sectional study included 2,416 healthy people aged 33.9 ± 0.3 years. The ULN of healthy ALT level was set at the 95th percentile of the healthy population. A metabolic obese phenotype was defined as having insulin resistance or metabolic syndrome. A logistic regression analysis was performed to assess the odds ratio for a metabolic obese phenotype according to the healthy ALT level.

Results

The revised ULN of serum ALT level in healthy participants were 30 IU/L and 22 IU/L for males and females, respectively. Serum ALT level was higher in individuals with metabolic obesity compared with those without metabolic obesity in both genders, stratified according to BMI. After adjusting for age, BMI, smoking, alcohol drinking, and regular physical activity, unhealthy normal ALT levels (males 30–40 IU/L, females 22–40 IU/L) were significantly associated with metabolic obesity, especially in both obese and non-obese women.

Conclusions

A newly revised threshold for ALT is proposed as a simple clinical metabolic parameter that can identify a metabolic obese phenotype. We suggest that people with unhealthy normal ALT levels may need further investigation for the presence of metabolic obesity.     

Sleep duration and body mass index in children and adolescents with and without obstructive sleep apnea

Purpose

The prevalence of pediatric obesity and short sleep duration has simultaneously increased in recent decades. Sleep plays a critical role in metabolic and endocrine regulation and insufficient sleep has been shown to be associated with changes in metabolism. Obesity, a major risk factor for obstructive sleep apnea (OSA), has been also associated with metabolic dysregulation. Despite this, no study investigating short sleep and obesity has addressed the potential confounder of OSA. The aim of this study was to investigate the association between short sleep duration and obesity in children with and without OSA.

Methods

In this retrospective study, 306 children who underwent polysomnography between January and December 2010 were included. A diagnosis of OSA was made if the apnea/hypopnea index on polysomnography is ≥1. Typical sleep times were obtained by parental report. Short sleep duration was defined as a reduction of >1 h from the minimum total sleep time (TST) recommended for age from the National Sleep Foundation (NSF).

Results

Overall, 32 % were obese, 39.5 % had short sleep duration, and 78 % had OSA. Children with OSA had a similar frequency of short sleep duration than those without (39.6 vs. 42.4 %, p?=?0.950). In children with short sleep duration, the odds ratio for obesity was 2.5 (95 % CI 1.3–4.9; p?=?0.009) compared to children with TST within normal limits even after accounting for the presence of OSA.

Conclusion

A parental history of total sleep duration of only 1 h less than recommended per age by the NSF is associated with a higher risk for obesity in children independently of the presence of OSA.     

N-terminal pro-brain natriuretic peptide and risk of cardiovascular events in older patients with type 2 diabetes: the Edinburgh Type 2 Diabetes Study

Aims/hypothesis

The aim of this study was to investigate the association of N-terminal pro-brain natriuretic peptide (NT-proBNP) with traditional cardiovascular risk factors and incident cardiovascular events in older people with type 2 diabetes.

Methods

In the prospective phase of the Edinburgh Type 2 Diabetes Study, 1066 men and women aged 60 to 75 years with type 2 diabetes mellitus were followed for 4 years; 112 participants had an incident cardiovascular event. At baseline, cardiovascular risk factors, pre-existing cardiovascular disease and levels of NT-proBNP were evaluated.

Results

Raised plasma NT-proBNP levels were associated with these classical cardiovascular risk factors: increased duration of diabetes, use of insulin, raised BMI, reduced HDL-cholesterol, reduced renal function and use of lipid-lowering and anti-hypertensive medication (all p?Conclusions/interpretation In older people with type 2 diabetes, NT-proBNP is associated with the development of coronary and cerebrovascular events, independent of a wide range of other vascular and metabolic risk factors, and may prove a useful addition to current vascular risk scores in diabetes populations.     

Non-Traditional Risk Factors are Important Contributors to the Racial Disparity in Diabetes Risk: The Atherosclerosis Risk in Communities Study

BACKGROUND

Traditional risk factors, particularly obesity, do not completely explain the excess risk of diabetes among African Americans compared to whites.

OBJECTIVE

We sought to quantify the impact of recently identified, non-traditional risk factors on the racial disparity in diabetes risk.

DESIGN

Prospective cohort study.

PARTICIPANTS

We analyzed data from 2,322 African-American and 8,840 white participants without diabetes at baseline from the Atherosclerosis Risk in Communities (ARIC) Study.

MAIN MEASURES

We used Cox regression to quantify the association of incident diabetes by race over 9 years of in-person and 17 years of telephone follow-up, adjusting for traditional and non-traditional risk factors based on literature search. We calculated the mediation effect of a covariate as the percent change in the coefficient of race in multivariate models without and with the covariate of interest; 95 % confidence intervals (95 % CI) were calculated using boot-strapping.

KEY RESULTS

African American race was independently associated with incident diabetes. Body mass index (BMI), forced vital capacity (FVC), systolic blood pressure, and serum potassium had the greatest explanatory effects for the difference in diabetes risk between races, with mediation effects (95 % CI) of 22.0 % (11.7 %, 42.2 %), 21.7 %(9.5 %, 43.1 %), 17.9 % (10.2 %, 37.4 %) and 17.7 % (8.2 %, 39.4 %), respectively, during 9 years of in-person follow-up, with continued effect over 17 years of telephone follow-up.

CONCLUSIONS

Non-traditional risk factors, particularly FVC and serum potassium, are potential mediators of the association between race and diabetes risk. They should be studied further to verify their importance and to determine if they mark causal relationships that can be addressed to reduce the racial disparity in diabetes risk.     

Lipopolysaccharide binding protein,obesity status and incidence of metabolic syndrome: a prospective study among middle-aged and older Chinese

Aims/hypothesis

Although microbiota-derived endotoxaemia has previously been shown to induce metabolic disorders, data from population-based longitudinal studies are scarce. This study therefore investigated the associations between lipopolysaccharide binding protein (LBP) levels and 6 year incident metabolic syndrome (MetS), as well as the potentially modifying effects of obesity status in middle-aged and older Chinese men and women.

Methods

A total of 2,529 men and women aged 50–70 years from Beijing and Shanghai, China, were followed for 6 years. Those free of MetS at baseline (1,312) were included in the analyses for the risk of developing MetS. Baseline plasma LBP was measured using an ELISA kit.

Results

During the 6 year follow-up, 449 (34.2%) participants developed MetS. Baseline LBP was significantly associated with BMI, waist circumference, blood lipid profile and C-reactive protein (CRP) both at baseline and during follow-up (all p?p _trend?=?0.002), but not in their overweight/obese counterparts (RR, comparing extreme tertiles, 0.99; 95% CI 0.80, 1.22; p _trend?=?0.880). A significant interaction was observed between LBP and obesity status (p _interaction?=?0.013).

Conclusions/interpretation

Our study suggested that elevated plasma LBP was associated with an increased risk of developing MetS among middle-aged and older Chinese, especially in normal-weight individuals.     

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.     

Association between objectively assessed sedentary time and physical activity with metabolic risk factors among people with recently diagnosed type 2 diabetes

Aims/hypothesis

The aim of our study was to examine the associations between sedentary time (SED-time), time spent in moderate-to-vigorous-intensity physical activity (MVPA), total physical activity energy expenditure (PAEE) and cardiorespiratory fitness with metabolic risk among individuals with recently diagnosed type 2 diabetes.

Methods

Individuals participating in the Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen Detected Diabetes in Primary Care (ADDITION)-Plus trial underwent measurement of SED-time, MVPA and PAEE using a combined activity and movement sensor (n?=?394), and evaluation of cardiorespiratory fitness (n?=?291) and anthropometric and metabolic status. Clustered metabolic risk was calculated by summing standardised values for waist circumference, triacylglycerol, HbA_1c, systolic blood pressure and the inverse of HDL-cholesterol. Multivariate linear regression analyses were used to quantify the associations between SED-time, MVPA, PAEE and cardiorespiratory fitness with individual metabolic risk factors and clustered metabolic risk.

Results

Each additional 1 h of SED-time was positively associated with clustered metabolic risk, independently of sleep duration and MVPA (β?=?0.16 [95% CI 0.03, 0.29]). After accounting for SED-time, MVPA was associated with systolic blood pressure (β?=??2.07 [?4.03, ?0.11]) but not with clustered metabolic risk (β?=?0.01 [?0.28, 0.30]). PAEE and cardiorespiratory fitness were significantly and independently inversely associated with clustered metabolic risk (β?=??0.03 [?0.05, ?0.02] and β?=??0.06 [?0.10, ?0.03], respectively). Associations between SED-time and metabolic risk were generally stronger in the low compared with the high fitness group.

Conclusions/interpretation

PAEE was inversely associated with metabolic risk, whereas SED-time was positively associated with metabolic risk. MVPA was not associated with clustered metabolic risk after accounting for SED-time. Encouraging this high-risk group to decrease SED-time, particularly those with low cardiorespiratory fitness, and increase their overall physical activity may have beneficial effects on disease progression and reduction of cardiovascular risk. Trial registration: ISRCTN99175498     

The impact of hip and knee osteoarthritis on the subsequent risk of incident diabetes: a population-based cohort study

Aims/hypothesis

This study examined the relationship between hip/knee osteoarthritis and incident diabetes. We hypothesised that hip/knee osteoarthritis would be independently related to an increased risk of incident diabetes and that this relationship would be due, at least in part, to walking difficulty. We also hypothesised a stronger relationship with incident diabetes for knee than hip osteoarthritis because of the higher prevalence in the former of obesity/the metabolic syndrome.

Methods

A population cohort aged ≥55 years recruited from 1996 to 1998 was followed through provincial health administrative data to 2014. Participants with baseline diabetes were excluded. Hip/knee osteoarthritis was defined as swelling, pain or stiffness in any joint lasting 6 weeks in the past 3 months and indication on a joint homunculus that a hip/knee was ‘troublesome’. Walking limitation was defined as self-reported difficulty standing or walking in the last 3 months (yes/no). Using Cox regressions, we examined the relationship of baseline hip/knee osteoarthritis with incident diabetes as defined from health administrative data, controlling for age, sex, BMI, income, prior hypertension, cardiovascular disease and primary care exposure. We tested whether the observed effect was mediated through walking limitation.

Results

In total, 16,362 participants were included: median age 68 years and 61% female. Of these, 1637 (10%) individuals met the criteria for hip osteoarthritis, 2431 (15%) for knee osteoarthritis and 3908 (24%) for walking limitation. Over a median follow-up of 13.5 years (interquartile range 7.3–17.8), 3539 individuals (22%) developed diabetes. Controlling for confounders, a significant relationship was observed between number of hip/knee joints with osteoarthritis and incident diabetes: HR for two vs no osteoarthritic hips 1.25 (95% CI 1.08, 1.44); HR for two vs no osteoarthritic knees 1.16 (95% CI 1.04, 1.29). From 37% to 46% of this relationship was explained by baseline walking limitation.

Conclusions/interpretation

In a large population cohort aged ≥55 years who were free of diabetes at baseline, and controlling for confounders, the presence and burden of hip/knee osteoarthritis was a significant independent predictor of incident diabetes. This association was partially explained by walking limitation. Increased attention to osteoarthritis and osteoarthritis-related functional limitations has the potential to reduce diabetes risk.

     

Homeostasis model assessment of insulin resistance and the risk of cardiovascular events in middle-aged non-diabetic Japanese men

Aims/hypothesis

Little is known about the relationship between the HOMA of insulin resistance (HOMA-IR) and the risk of cardiovascular events in Asian populations, which have lower levels of HOMA-IR than Western populations. Accordingly, we determined the predictive value of HOMA-IR for cardiovascular risk in a Japanese population that was apparently free of diabetes, addressing whether insulin resistance itself increases cardiovascular risk independently of other relevant metabolic disorders.

Methods

We followed 2,548 non-diabetic men aged 35 to 59 years for 11 years. The hazard ratios for the incidence of cardiovascular events due to increased HOMA-IR were estimated using a Cox proportional hazards model that was adjusted for potential confounding factors.

Results

The multivariate-adjusted hazard ratio for cardiovascular events compared with the first quartile of HOMA-IR (≤0.66) was 1.07 (95% CI 0.44–2.64) for the second (HOMA-IR 0.67–1.01), 1.36 (0.56–3.28) for the third (HOMA-IR 1.02–1.51) and 2.50 (1.02–6.10) for the fourth quartile (HOMA-IR ≥1.52). The hazard ratio associated with a one SD (0.61) increment in log-transformed HOMA-IR was 1.51 (1.13–2.02). A similar positive relationship was observed for coronary events and stroke. In addition, the relationship between HOMA-IR and cardiovascular risk was broadly similar in participants with and without hypertension, dyslipidaemia (elevated triacylglycerol and/or reduced HDL-cholesterol), abdominal obesity and current smoking.

Conclusions/interpretation

Increased HOMA-IR predicted subsequent cardiovascular events in non-diabetic Japanese men. The association was independent of traditional cardiovascular risk factors and other relevant metabolic disorders.     

Associations of objectively measured sedentary behaviour and physical activity with markers of cardiometabolic health

Aims/hypothesis

The study aimed to examine the associations between objectively measured sedentary time, breaks in sedentary time, moderate-to-vigorous physical activity (MVPA) and total physical activity with markers of cardiometabolic health in a population with known risk factors for type 2 diabetes mellitus.

Methods

This study reports data from two ongoing diabetes prevention programmes. Participants with known risk factors were recruited from primary care practices located within the East Midlands, UK, over the period 2010–2011. ActiGraph GT3X accelerometers (15 s epochs) were used to assess sedentary time (<25 counts per 15 s), MVPA (≥488 counts per 15 s) and total physical activity (total counts). A break was considered as any interruption in sedentary time (≥25 counts per 15 s). Linear regression examined the independent association of sedentary time, breaks in sedentary time, MVPA and total physical activity with markers of cardiometabolic health.

Results

The sample comprised 878 participants; 153 from Project STAND (Sedentary Time And Diabetes) (age 32.9?±?5.6 years, 28.8% male) and 725 from Walking Away from Diabetes (age 63.7?±?7.8 years, 64.8% male). Following adjustment for various covariates, including MVPA and BMI, there were detrimental linear associations of sedentary time with 2 h plasma glucose (standardised beta coefficient) (β?=?0.220, p?<?0.001), triacylglycerol (β?=?0.206, p?=?0.001) and HDL-cholesterol (β?=??0.123, p?=?0.029). Breaks in sedentary time, total physical activity and MVPA were significantly inversely associated with measures of adiposity, but not with any other cardiometabolic variables after adjustment for sedentary time and BMI.

Conclusions/interpretation

In adults at high risk of type 2 diabetes mellitus, time spent sedentary is strongly and adversely associated with cardiometabolic health and may be a more important indicator of poor health than MVPA.     

Breast-feeding and maternal risk of type 2 diabetes: a prospective study and meta-analysis

Aims/hypothesis

We aimed to examine the association between breast-feeding and maternal risk of type 2 diabetes and to investigate whether this association is mediated by anthropometric and biochemical factors.

Methods

A case–cohort study nested within the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam Study between 1994 and 2005 including 1,262 childbearing women (1,059 in a random sub-cohort and 203 incident cases) mainly aged between 35 and 64 years at baseline was applied. Self-reported lifetime duration of breast-feeding was assessed by questionnaire. Blood samples were used for biomarker measurement (HDL-cholesterol, triacylglycerols, C-reactive protein, fetuin-A, γ-glutamyltransferase, adiponectin). A systematic literature search and meta-analysis was conducted of prospective cohort studies investigating breast-feeding and risk of type 2 diabetes.

Results

The HR for each additional 6 months of breast-feeding was 0.73 (95% CI 0.56, 0.94) in EPIC-Potsdam. Meta-analysis of three previous prospective studies and the current study revealed an inverse association between breast-feeding duration and risk of diabetes (pooled HR for lifetime breast-feeding duration of 6–11 months compared with no breast-feeding 0.89; 95% CI 0.82, 0.97). Adjustment for BMI and waist circumference attenuated the association (HR per six additional months in EPIC-Potsdam 0.80; 95% CI 0.61, 1.04). Further controlling for potentially mediating biomarkers largely explained this association (HR 0.89; 95% CI 0.68, 1.16).

Conclusions/interpretation

Longer duration of breast-feeding may be related to a lower risk of diabetes. This potentially protective effect seems to be reflected by a more favourable metabolic profile; however, the role of body weight as a mediator or confounder remains uncertain.     

Prenatal and Perinatal Characteristics Associated with Pediatric-Onset Inflammatory Bowel Disease

Background

The majority of studies that report early life risk factors for pediatric-onset inflammatory bowel disease (IBD) do not account for potential confounding, which can lead to spurious associations and incorrect inferences.

Aims

To assess the relationship between prenatal and perinatal characteristics and the risk of pediatric-onset IBD accounting for potential confounding.

Methods

We conducted a nested case–control study of 189 cases aged ≤18 years and 3,080 age- and membership-matched controls born at a Kaiser Permanente Northern California facility between 1984 and 2006. The cases were diagnosed with IBD between 1996 and 2006 and diagnosis was confirmed by chart review. We obtained prenatal and perinatal characteristics from the electronic clinical records of the mother and child. Conditional logistic regression was used to assess the associations between these factors and risk of incident IBD, Crohn’s disease, and ulcerative colitis.

Results

In analyses accounting for confounding, maternal IBD (odds ratio [OR] 5.1, 95 % confidence interval [CI] 2.0–12.9) and white race (OR 2.3, 95 % CI 1.6–3.2) were the only factors statistically associated with pediatric-onset IBD. Maternal respiratory infection during pregnancy (OR 2.0, 95 % CI 1.0–4.0), age < 20 years (OR 2.0, 95 % CI 0.8–4.7) and gestational hypertension (OR 1.7, 95 % CI 1.0–2.7) were associated with pediatric-onset IBD, but did not achieve statistical significance.

Conclusions

Maternal history of IBD and race were the only characteristics of those that we examined that were associated with the development of pediatric IBD in this well-documented population of cases and matched controls.     

Nonalcoholic fatty liver disease in Japanese junior high school students: its prevalence and relationship to lifestyle habits

Background

Despite the increase in nonalcoholic fatty liver disease (NAFLD) in Japanese adults, its prevalence in adolescents remains unclear. This prompted us to evaluate the incidence and clinical characteristics of NAFLD among junior high school students.

Methods

A population-based cross-sectional study was conducted among students in a single junior high school in Nagano prefecture. Serum alanine aminotransferase (ALT) and γ-glutamyltransferase (γGT) measurements and abdominal ultrasonography were performed in 249 and 288 students in 2004 and 2007, respectively. In the latter survey, student lifestyle habits were also assessed, using questionnaires.

Results

The prevalence of NAFLD was 4.4% and 4.5% in 2004 and 2007, respectively, which was lower than that of obesity (10.0% and 5.9%). Body mass index and ALT and γGT levels increased significantly with hepatic steatosis severity. Multivariate logistic regression analysis demonstrated that the presence of obesity and an ALT level of 30 U/L or more were independent predictors of NAFLD (odds ratio 16.9, P < 0.001 and odds ratio 16.6, P = 0.001, respectively). The ratios of students commuting to and from school by car and not doing sports outside of school were higher in NAFLD students compared with non-NAFLD ones. Such tendencies were observed independently of the presence of obesity. Additionally, one obese student with severe steatosis and liver dysfunction was diagnosed as having nonalcoholic steatohepatitis (NASH).

Conclusions

Approximately 4% of junior high school students had NAFLD that was primarily associated with obesity and reduced daily physical activity. Serum ALT measurement during school check-ups is recommended for the early detection of young adolescent NAFLD/NASH.     

Eighteen year weight trajectories and metabolic markers of diabetes in modernising China

Aims/Hypothesis

Although obesity is a major risk factor for diabetes, little is known about weight gain trajectories across adulthood, and whether they are differentially associated with metabolic markers of diabetes.

Methods

We used fasting blood samples and longitudinal weight data for 5,436 adults (5,734 observations, aged 18–66 years) from the China Health and Nutrition Survey (1991–2009). Using latent class trajectory analysis, we identified different weight gain trajectories in six age and sex strata, and used multivariable general linear mixed effects models to assess elevated metabolic markers of diabetes (fasting glucose, HbA_1c, HOMA-IR, insulin) across weight trajectory classes. Models were fitted within age and sex strata, and controlled for baseline weight (or baseline weight by weight trajectory interaction terms), height, and smoking habit, with random intercepts to control for community-level correlations.

Results

Compared with weight gain, classes with weight maintenance, weight loss, or a switch from weight gain to loss had lower values for metabolic markers of diabetes. These associations were stronger among younger women (aged 18–29 and 30–39 years) and men (18–29 years) than in older (40–66 years) men and women. An exception was HOMA-IR, which showed class differences across all ages (at least p?Conclusion Trajectory analysis identified heterogeneity in adult weight gain associated with diabetes-related metabolic markers, independent of baseline weight. Our findings suggest that variation in metabolic markers of diabetes across patterns of weight gain is masked by a homogeneous classification of weight gain.     

Sex differences in the prevalence of metabolic syndrome and its components in hypopituitary patients: comparison with an age- and sex-matched nationwide control group

Purpose

Hypopituitary patients have a reduced life expectancy owing to cardiovascular events. We investigated the prevalence of metabolic syndrome in hypopituitary patients for a follow-up period of at least 1 year in comparison with an age- and sex-matched nationwide control group.

Methods

A total of 515 patients with hypopituitarism who visited Seoul National University Hospital between January 2000 and December 2010 were included. Data for an age- and sex-matched control group were obtained from the Korean National Health and Nutrition Examination Surveys (KNHANES) (n = 1545). Metabolic syndrome was defined according to the modified National Cholesterol Education Program (NCEP-ATPIII).

Results

The prevalence of metabolic syndrome did not differ significantly between the hypopituitary and control groups for men (34.9 versus 30.3 %), but the risk of metabolic syndrome was higher in hypopituitary women than in controls (39.8 versus 28.5 %). In both sexes, the risks of central obesity and dyslipidemia were higher in the hypopituitary group than in the control group. Men had lower risks of hypertension and hyperglycemia in the hypopituitary group, which attenuated the risk of metabolic syndrome. Age greater than 40 years and obesity (BMI ≥25 kg/m²) contributed to a higher risk of metabolic syndrome.

Conclusions

The metabolic syndrome prevalence was higher in the hypopituitry group than in the control group in Korean women, and this was attributed to an increased risk of central obesity and dyslipidemia. Accordingly, early intervention to reduce metabolic syndrome needed in hypopituitary patients, i.e. women.

     

High risk of primary liver cancer in a cohort of 179 patients with Acute Hepatic Porphyria

Background/aims

Previous studies have indicated a high risk of hepatocellular carcinoma in acute hepatic porphyrias. In this retrospective study we present the incidence of primary liver cancer and clinical characteristics in a cohort of 179 acute porphyria patients above the age of 50 years.

Methods

Twenty-three cases with primary liver cancer were found either by a surveillance program or due to clinical suspicion. Standardized rate ratio was used to estimate the relative risk of primary liver cancer after indirect standardization. Survival data were calculated using the Kaplan-Meier method.

Results

The mean age at diagnosis was 69 years. Hepatocellular carcinoma was found in 19 patients while four patients had cholangiocarcinoma or a combination of the two. Four patients had underlying cirrhosis. Mean tumour size was 4.3 cm in the surveillance group and 10.3 cm in the non-surveillance group (p?=?0.01). The overall relative risk of primary liver cancer was 86 above the age of 50: 150 for women and 37 for men. Mean survival time was 5.7 years.

Conclusion

Acute hepatic porphyria carries a high risk of primary liver cancer above the age of 50 which warrants ultrasound surveillance. Sex distribution and frequency of cirrhosis differs from more common aetiologies of primary liver cancer.     

Phase Angle, Frailty and Mortality in Older Adults

BACKGROUND

Frailty is a multidimensional phenotype that describes declining physical function and a vulnerability to adverse outcomes in the setting of physical stress such as illness or hospitalization. Phase angle is a composite measure of tissue resistance and reactance measured via bioelectrical impedance analysis (BIA). Whether phase angle is associated with frailty and mortality in the general population is unknown.

OBJECTIVE

To evaluate associations among phase angle, frailty and mortality.

DESIGN

Population-based survey.

SETTING

Third National Health and Nutritional Examination Survey (1988–1994).

PARTICIPANTS

In all, 4,667 persons aged 60 and older.

MEASUREMENTS

Frailty was defined according to a set of criteria derived from a definition previously described and validated.

RESULTS

Narrow phase angle (the lowest quintile) was associated with a four-fold higher odds of frailty among women and a three-fold higher odds of frailty among men, adjusted for age, sex, race-ethnicity and comorbidity. Over a 12-year follow-up period, the adjusted relative hazard for mortality associated with narrow phase angle was 2.4 (95 % confidence interval [95 % CI] 1.8 to 3.1) in women and 2.2 (95 % CI 1.7 to 2.9) in men. Narrow phase angle was significantly associated with mortality even among participants with little or no comorbidity.

LIMITATIONS

Analyses of BIA and frailty were cross-sectional; BIA was not measured serially and incident frailty during follow-up was not assessed. Participants examined at home were excluded from analysis because they did not undergo BIA.

CONCLUSIONS

Narrow phase angle is associated with frailty and mortality independent of age and comorbidity.     

Self-reported snoring and metabolic syndrome: the Korean Multi-Rural Communities Cohort Study

Purpose

We investigated the association between self-reported snoring and metabolic syndrome (MetS) and its components among a community-dwelling Korean population.

Methods

A total of 7,038 subjects participated in the Korean Multi-Rural Communities Cohort Study between January 2005 and February 2010 and were included in the analysis. Frequency of snoring was classified into never, rarely (<1 day/week), occasionally (1–3 days/week), and habitually (≥4 days/week).

Results

In the fully adjusted model, compared to non-snorers, the odds ratio (OR) for MetS of snorers was significantly higher in subjects with rare snoring (OR, 1.42; 95 % confidence interval (CI), 1.23–1.64), occasional snoring (OR, 1.79; 95 % CI, 1.55–2.07), and habitual snoring (OR, 2.03; 95 % CI, 1.77–2.33) than those who did not snore. The ORs for abdominal obesity were significantly higher in rare snoring subjects (OR, 1.51; 95 % CI, 1.30–1.75), occasional snoring (OR, 1.71; 95 % CI, 1.47–1.98), and habitual snoring (OR, 2.07; 95 % CI, 1.80–2.38) than in non-snorers after adjusting for covariates.

Conclusions

Snoring was significantly and linearly associated with MetS, and this association was consistently present in both sexes. Positive and graded associations were observed between snoring frequency and MetS components including high blood pressure, elevated fasting glucose levels, and abdominal obesity, independent of conventional risk factors and other MetS components.     

Age at natural menopause and risk of type 2 diabetes: a prospective cohort study

Aims/hypothesis

In this study, we aimed to examine the association between age at natural menopause and risk of type 2 diabetes, and to assess whether this association is independent of potential mediators.

Methods

We included 3639 postmenopausal women from the prospective, population-based Rotterdam Study. Age at natural menopause was self-reported retrospectively and was treated as a continuous variable and in categories (premature, <40 years; early, 40–44 years; normal, 45–55 years; and late menopause, >55 years [reference]). Type 2 diabetes events were diagnosed on the basis of medical records and glucose measurements from Rotterdam Study visits. HRs and 95% CIs were calculated using Cox proportional hazards models, adjusted for confounding factors; in another model, they were additionally adjusted for potential mediators, including obesity, C-reactive protein, glucose and insulin, as well as for levels of total oestradiol and androgens.

Results

During a median follow-up of 9.2 years, we identified 348 individuals with incident type 2 diabetes. After adjustment for confounders, HRs for type 2 diabetes were 3.7 (95% CI 1.8, 7.5), 2.4 (95% CI 1.3, 4.3) and 1.60 (95% CI 1.0, 2.8) for women with premature, early and normal menopause, respectively, relative to those with late menopause (p _trend <0.001). The HR for type 2 diabetes per 1 year older at menopause was 0.96 (95% CI 0.94, 0.98). Further adjustment for BMI, glycaemic traits, metabolic risk factors, C-reactive protein, endogenous sex hormone levels or shared genetic factors did not affect this association.

Conclusions/interpretation

Early onset of natural menopause is an independent marker for type 2 diabetes in postmenopausal women.