Physical activity, cardiovascular risk factors, and mortality among Finnish adults with diabetes

OBJECTIVE: The aim of this study was to examine both single and joint associations of physical activity and conventional cardiovascular risk factors with total and cardiovascular mortality among patients with diabetes. RESEARCH DESIGN AND METHODS: We prospectively followed 3,708 Finnish patients with type 2 diabetes aged 25-74 years. Physical activity, smoking status, blood pressure, height, weight, and serum cholesterol level were determined at baseline. Cox proportional hazard models were used to estimate single and joint effects of physical activity and other cardiovascular risk factors on the risk of mortality. RESULTS: During a mean follow-up of 18.7 years, 1,423 deaths were recorded, 906 of which were due to cardiovascular disease. Moderate or high levels of physical activity were associated with decreased total and cardiovascular mortality, whereas higher levels of BMI and blood pressure and current smoking were associated with increased total and cardiovascular mortality. High serum cholesterol levels also increased cardiovascular mortality. The protective effect of physical activity was consistent in diabetic patients with any levels of BMI, blood pressure, total cholesterol, and smoking. CONCLUSIONS: A moderate or high level of physical activity was associated with a reduced risk of total and cardiovascular mortality among patients with type 2 diabetes. The favorable association of physical activity with longevity was observed regardless of the levels of BMI, blood pressure, total cholesterol, and smoking.     

Influence of familial risk on diabetes risk-reducing behaviors among U.S. adults without diabetes

OBJECTIVE

To test the association of family history of diabetes with the adoption of diabetes risk–reducing behaviors and whether this association is strengthened by physician advice or commonly known factors associated with diabetes risk.

RESEARCH DESIGN AND METHODS

We used cross-sectional data from the 2005–2008 National Health and Nutrition Examination Survey (NHANES) to examine the effects of family history of diabetes on the adoption of selected risk-reducing behaviors in 8,598 adults (aged ≥20 years) without diabetes. We used multiple logistic regression to model three risk reduction behaviors (controlling or losing weight, increasing physical activity, and reducing the amount of dietary fat or calories) with family history of diabetes.

RESULTS

Overall, 36.2% of U.S. adults without diabetes had a family history of diabetes. Among them, ~39.8% reported receiving advice from a physician during the past year regarding any of the three selected behaviors compared with 29.2% of participants with no family history (P < 0.01). In univariate analysis, adults with a family history of diabetes were more likely to perform these risk-reducing behaviors compared with adults without a family history. Physician advice was strongly associated with each of the behavioral changes (P < 0.01), and this did not differ by family history of diabetes.

CONCLUSIONS

Familial risk for diabetes and physician advice both independently influence the adoption of diabetes risk–reducing behaviors. However, fewer than half of participants with familial risk reported receiving physician advice for adopting these behaviors.The Centers for Disease Control and Prevention (CDC) recently reported that 25.8 million people in the U.S. (8.3% of the population) have diabetes (1). A total of 1.9 million new cases of diabetes were diagnosed in people aged ≥20 years in 2010 in the U.S., and 25.6 million (11.3%) people in this age-group have diabetes. Worldwide, it is estimated that 280 million people had diabetes in 2010—a number that is projected to increase to 430 million by 2030 (2). Studies have reported strong and consistent evidence that lifestyle factors might prevent or delay type 2 diabetes among people at high risk, including those with a family history of the disease (3,4). In 2002, the World Health Report (5) identified risk-reducing behaviors (such as controlling or losing weight, increasing physical activity, and reducing fat or calories) as important lifestyle risk factors for a number of chronic diseases, including diabetes, cardiovascular disease, and cancer.Many variables, including genetic, environmental, medical, and socioeconomic factors, influence the development of diabetes (6). The association of family history of diabetes with risk for the disease has been well documented (7). Although a 2009 National Institutes of Health State of the Science conference concluded that there was insufficient evidence to support the routine use of family history as a screening tool for risk of common complex conditions in primary care (8), an individual patient’s family history remains a critical element in risk assessment for many chronic conditions, including diabetes (9). While accurate and complete family history information needs to be collected to identify high-risk individuals, substantial barriers exist to obtaining this information in primary care practice, though clinicians are trained to do so. These barriers include lack of time to collect the information, lack of proper training to interpret the information, and lack of reimbursement (10).Evidence also supports the effectiveness of physician advice on lifestyle modifications to prevent or delay the risk of chronic diseases (11). A recent study on diabetes risk reduction behaviors found that the proportion of adults with prediabetes who reported performing risk reduction behaviors was higher among those who received physician advice compared with those who did not receive such advice (12).In light of the evidence summarized above, we used data from the 2005–2008 National Health and Nutrition Examination Survey (NHANES), a large population-based and nationally representative survey of the U.S., to test the hypotheses that a family history of diabetes is associated with greater adoption of diabetes risk–reducing behaviors and that the association is strengthened by the receipt of physician advice regarding these behaviors, in addition to other commonly known factors associated with diabetes risk.     

Multivitamins, individual vitamin and mineral supplements, and risk of diabetes among older U.S. adults

OBJECTIVE

Understanding the relationship between multivitamin use and diabetes risk is important given the wide use of multivitamin supplements among U.S. adults.

RESEARCH DESIGN AND METHODS

We prospectively examined supplemental use of multivitamins and individual vitamins and minerals assessed in 1995–1996 in relation to self-reported diabetes diagnosed after 2000 among 232,007 participants in the National Institutes of Health–American Association of Retired Persons Diet and Health Study. Multivitamin use was assessed by a food-frequency questionnaire at baseline. Odds ratios (ORs) and 95% CIs were calculated by logistic regression models, adjusted for potential confounders. In total, 14,130 cases of diabetes diagnosed after 2000 were included in the analysis.

RESULTS

Frequent use of any multivitamins was not associated with risk of diabetes after adjustment for potential confounders and uses of individual supplements. Compared with nonusers of any multivitamins, the multivariate ORs among users were 1.07 (95% CI 0.94–1.21) for taking vitamins less than once per week, 0.97 (0.88–1.06) for one to three times per week, 0.92 (0.84–1.00) for four to six times per week, and 1.02 (0.98–1.06) for seven or more times per week (P for trend = 0.64). Significantly lower risk of diabetes was associated with the use of vitamin C or calcium supplements. The multivariate ORs comparing daily users with nonusers were 0.91 (0.86–0.97) for vitamin C supplements and 0.85 (0.80–0.90) for calcium supplements. Use of vitamin E or other individual vitamin and mineral supplements were not associated with diabetes risk.

CONCLUSIONS

In this large cohort of U.S. older adults, multivitamin use was not associated with diabetes risk. The findings of lower diabetes risk among frequent users of vitamin C or calcium supplements warrant further evaluations.Multivitamin supplements contain large amounts of many vitamins and minerals that approximate or exceed the recommended micronutrient intakes. With the relative safety and inexpensiveness, multivitamins are the most commonly used dietary supplements in the U.S. and are advocated as an attractive option for preventing chronic diseases, such as cancer, cardiovascular disease, and type 2 diabetes (1,2). Approximately 50% of U.S. adults routinely take multivitamins and spend ∼$23 billion annually (1).Type 2 diabetes is considered to be the epidemic of the 21st century, and its prevalence in the U.S. is growing rapidly (3). Given the rising health burden of type 2 diabetes and its complications, there is a great urgency to develop effective strategies for curbing this trend. Dietary supplements such as multivitamins have been commonly used for disease prevention. Evidence from basic research and observational studies has suggested that adequate intake of antioxidant vitamins or minerals may protect against the development of type 2 diabetes via reduction of oxidative stress and its associated metabolic abnormalities, including systemic inflammation, endothelial dysfunction, hypertension, and dyslipidemia (1,2,4,5). These metabolic abnormalities act individually or synergistically to impair pancreatic β-cell insulin secretion and interfere with glucose disposal in peripheral tissues (6) and thereby accelerate the development and progression of both atherosclerosis and type 2 diabetes. However, available epidemiological data on micronutrients and diabetes that focused on individual vitamin/antioxidant supplements have yielded inconsistent results.With their popularity, multivitamin supplement use contributes to a considerable proportion of micronutrient intake among users and sometimes excessive intakes of certain micronutrients in some subgroups of the population (2). There is a longstanding interest in the diabetes research community regarding the potential, yet unproven, benefits or risks of multivitamin use on the development and progression of type 2 diabetes. We therefore prospectively evaluate the association between the use of multivitamins or individual micronutrient supplements and diabetes risk in a large cohort of older adults in the National Institutes of Health–American Association of Retired Persons (NIH-AARP) Diet and Health Study.     

Body mass index, diabetes, and C-reactive protein among U.S. adults

OBJECTIVE: The author examined the relationship between C-reactive protein and BMI and diabetes status among 16,573 participants aged > or = 20 years of the Third National Health and Nutrition Examination Survey (1988-1994). RESEARCH DESIGN AND METHODS: The study had a cross-sectional design. RESULTS: Geometric mean concentrations of C-reactive protein were lowest among individuals with a BMI < 18.5 kg/m2 and increased with increasing BMI categories. Restricting the analysis to participants without various medical conditions did not change the relation. After adjusting for age, sex, race or ethnicity, and education, using logistic regression analysis, odds ratios for an elevated C-reactive protein concentration (> or = 85th percentile of the sex-specific C-reactive protein concentration distribution) among participants with a BMI of 25 to < 30, 30 to < 35, 35 to < 40, and > or = 40 kg/m2 were 1.51 (95% CI 1.23-1.86), 3.19 (2.60-3.91), 6.11 (4.67-7.98), and 9.30 (6.43-13.46), respectively, compared with participants with a BMI < 25 kg/m2. C-reactive protein concentrations were lowest among those individuals without diabetes or with impaired fasting glucose and highest among those with newly or previously diagnosed diabetes. Compared with participants with a normal fasting glucose, participants with impaired fasting glucose, newly diagnosed diabetes, and previously diagnosed diabetes had 0.99 (0.72-1.37), 1.84 (1.25-2.71), and 1.59 (1.25-2.01) odds of having an elevated C-reactive protein concentration after adjustment for age, sex, race or ethnicity, education, and BMI. CONCLUSIONS: These results confirm cross-sectional findings from previous studies that show elevated C-reactive protein concentrations among individuals who are obese or have diabetes. The implications of these findings, however, remain unclear.     

Dental and other health care visits among U.S. adults with diabetes

OBJECTIVE: This study compared yearly dental visits of diabetic adults with those of nondiabetic adults. For adults with diabetes, we compared the frequency of past-year dental visits with past-year visits for diabetes care, dilated eye examinations, and foot examinations. RESEARCH DESIGN AND METHODS: We conducted a cross-sectional study using a sample of 105,718 dentate individuals aged > or =25 years, including 4,605 individuals with diabetes who participated in the 1995-1998 Behavioral Risk Factor Surveillance System in 38 states. RESULTS: Dentate adults (i.e., those with at least some natural teeth) with diabetes were less likely than those without diabetes to have seen a dentist within the preceding 12 months (65.8 vs. 73.1%, P = 0.0000). Adults with diabetes were less likely to have seen a dentist than to have seen a health care provider for diabetes care (86.3%); the percentage who saw a dentist was comparable with the percentage who had their feet examined (67.7%) or had a dilated eye examination (62.3%). The disparity in dental visits among racial or ethnic groups and among socioeconomic groups was greater than that for any other type of health care visit for subjects with diabetes. CONCLUSIONS: Promotion of oral health among diabetic patients may be necessary, particularly in Hispanic and African-American communities. Information on oral health complications should be included in clinical training programs. Oral and diabetes control programs in state health departments should collaborate to promote preventive dental services, and the oral examination should be listed as a component of continuous care in the American Diabetes Association's standards of medical care for diabetic patients.     

Excess physical limitations among adults with diabetes in the U.S. population, 1997-1999

OBJECTIVE: To estimate the prevalence of physical limitations associated with diabetes among U.S. adults > or =18 years of age. RESEARCH DESIGN AND METHODS: We conducted a cross-sectional analysis of the association between diabetes status and physical limitations using the 1997-1999 National Health Interview Survey (NHIS). Physical limitation was defined from self-reported degree of difficulty with nine tasks. RESULTS: People with diabetes had a higher proportion of any physical limitation than did people without diabetes overall (66 vs. 29%, P < 0.001), for both men (59 vs. 24%, P < 0.001) and women (72 vs. 34%, P < 0.001). Compared with those without diabetes, a higher proportion of people with diabetes had some physical limitation among all age groups, and the difference declined (all P < 0.001) with increasing age (46 vs. 18% for 18-44 years, 63 vs. 35% for 45-64 years, 74 vs. 53% for 65-74 years, and 85 vs. 70% for those 75 years and older). After controlling for demographic characteristics and several other confounders, the odds ratio of physical limitation among adults with diabetes versus those without diabetes was 1.9 (95% CI: 1.8-2.1). CONCLUSIONS: People with diabetes are much more likely to have a physical limitation than those without diabetes. Interventions are needed in this population to reduce progression from impairment to physical limitation and from physical limitation to disability, especially because the prevalence of diabetes is projected to increase dramatically in the next several decades.     

Trying to lose weight, losing weight, and 9-year mortality in overweight U.S. adults with diabetes

OBJECTIVE: The aim of this study was to examine the relationships between intention to lose weight, actual weight loss, and all-cause mortality among overweight individuals with diabetes. RESEARCH DESIGN AND METHODS: We performed a prospective analysis among 1,401 overweight diabetic adults aged > or =35 years sampled in the National Health Interview Survey. The previous year intention to lose weight and weight change were assessed by self-report. Nine-year mortality rates were examined according to intent to lose weight and weight loss, which were adjusted for age, sex, education, ethnicity, smoking, initial body weight, and diabetes complications. RESULTS: Individuals trying to lose weight had a 23% lower mortality rate (hazard rate ratio [HRR] 0.77, 95% CI 0.61-0.99) than those who reported not trying to lose weight. This association was as strong for those who failed to lose weight (0.72, 0.55-0.96) as for those who succeeded in losing weight (0.83, 0.63-1.08). Trying to lose weight was beneficial for overweight (BMI 25-30 kg/m2) individuals (0.62, 0.46-0.83) but not for obese (BMI>30) individuals (1.17, 0.72-1.92). Overall weight loss, without regard to intent, was associated with an increase of 22% (1.22, 0.99-1.50) in the mortality rate. This increase was largely explained by unintentional weight loss, which was associated with a 58% (1.58, 1.08-2.31) higher mortality rate. CONCLUSIONS: Overweight diabetic adults trying to lose weight have a reduced risk of all-cause mortality, independent of whether they lose weight. Actual weight loss is associated with increased mortality only if the weight loss is unintentional.     

Association of brominated flame retardants with diabetes and metabolic syndrome in the U.S. population, 2003-2004

OBJECTIVE—Chlorinated persistent organic pollutants (POPs), endocrine disruptors accumulated in adipose tissue, were associated with diabetes and metabolic syndrome. Brominated flame retardants (BFRs), such as polybrominated diphenyl ethers (PBDEs) or polybrominated biphenyls (PBBs), are another class of POPs for which body burden is increasing. Cross-sectional associations of serum concentrations of BFRs with diabetes and metabolic syndrome were studied.RESEARCH DESIGN AND METHODS—In the National Health and Nutrition Examination Survey 2003–2004, 1,367 adults were examined with respect to diabetes status. Five PBDEs and one PBB were selected, detectable in ≥60% of participants. For the outcome metabolic syndrome, we restricted the analysis to 637 participants with a morning fasting sample.RESULTS—Compared with subjects with serum concentrations below the limit of detection, prevalent diabetes had differing dose-response associations with serum concentrations of PBB-153 and PBDE-153. Adjusted odds ratios across quartiles of serum concentrations for PBB-153 or PBDE-153 were 1.0, 0.7, 1.4, 1.6, and 1.9 (P for trend <0.01) and 1.0, 1.6, 2.6, 2.7, and 1.8 (P for quadratic term <0.01), respectively. PBB-153 was also positively associated with the prevalence of metabolic syndrome with adjusted odds ratios of 1.0, 1.5, 3.1, 3.1, and 3.1 (P for trend<0.01). As in its association with diabetes, PBDE-153 showed an inverted U-shaped association with metabolic syndrome.CONCLUSIONS—Pending confirmation in prospective studies, lipophilic xenobiotics, including brominated POPs stored in adipose tissue, may be involved in the pathogenesis of diabetes and metabolic syndrome.We have recently reported strong cross-sectional associations of serum concentrations of chlorinated persistent organic pollutants (POPs) with diabetes (1,2). In addition to diabetes, POPs were associated with most components of metabolic syndrome, although specific associations differed depending on chemicals (3). Based on both these epidemiological and previous experimental findings, we have proposed that POPs stored in adipose tissue may play a key role in the pathogenesis of metabolic syndrome and type 2 diabetes (4). As well-known endocrine disruptors, their persistence in adipose tissue may disturb normal function of lipid and glucose metabolism in adipose tissue (4).These lipophilic pollutants are a mixture of several hundred chemicals with similar properties, such as resistance to biodegradation and bioaccumulation in adipose tissue. Aside from the chlorinated POPs we studied before (dioxins, furans, polychlorinated biphenyls [PCBs], or organochlorine pesticides), there are other important subclasses of POPs. Among them, chemicals belonging to brominated flame retardants (BFRs) are of special interest because of the recent marked increase in levels of polybrominated diphenyl ethers (PBDEs), the most well-known class of BFR, in humans as well as in the environment (5,6). PBDEs are extensively used in a variety of consumer products, such as home/office furnishings and electronics, as flame retardants, and their body burdens in North America are much higher than those of Europeans (5).Similar to chlorinated POPs, BFRs bioaccumulate in adipose tissue in living organisms and are suspected to be endocrine disruptors (7). Such lipophilic xenobiotics in adipose tissue have been suspected to disrupt hormonal signaling in adipose tissue as endocrine disruptors (8,9). They are chemically and toxicologically similar to PCBs, which were strongly associated with hyperglycemia and dyslipidemia in our previous studies (5). Thus, BFRs may also be associated with disturbance of lipid and glucose metabolism.Serum concentrations of biologically important BFRs were measured in subsamples of the National Health and Examination Survey (NHANES) 2003–2004 (10). Our analyses were performed to investigate associations of prevalence of diabetes and metabolic syndrome with the serum concentrations of BFRs.     

Postchallenge hyperglycemia in a national sample of U.S. adults with type 2 diabetes

OBJECTIVE: Postchallenge hyperglycemia (PCH) is known to contribute to suboptimal glycemic control in adults with non-insulin-requiring type 2 diabetes. The objective of this study was to estimate the prevalence of PCH among individuals with diabetes. RESEARCH DESIGN AND METHODS: We conducted a cross-sectional analysis of data from the Third National Health and Nutrition Examination Survey (1988-1994) in adults aged 40-74 years with diabetes who were not using insulin (i.e., they used oral hypoglycemics or received no pharmacological therapy). Each respondent underwent a standard 75-g oral glucose tolerance test. PCH was defined as a 2-h glucose level >or=200 mg/dl. RESULTS: Overall, PCH was present in 74% of those with diagnosed diabetes. Although it was present in virtually all (99%) of the diabetic adults under suboptimal glycemic control (HbA(1c) >or=7.0%), PCH was also common (39%) among those under optimal control (HbA(1c) <7.0%). Likewise, among sulfonylurea users, PCH was present in 99% of those under suboptimal control and in 63% of those under good control. Similar patterns were observed in those with undiagnosed diabetes. Isolated PCH (2-h glucose >or=200 mg/dl and fasting glucose <126 mg/dl) was present in 9.8% of the adults with diagnosed diabetes. CONCLUSIONS: These data suggest that PCH is common among diabetic adults in the U.S., even in the setting of "optimal" glycemic control and sulfonylurea use. Interventions designed to lower postprandial glucose excursions may help improve overall glycemic control in the general population of U.S. adults with diabetes.     

Serum ferritin and risk of the metabolic syndrome in U.S. adults

OBJECTIVE: We examined the relationship among iron stores, the metabolic syndrome, and insulin resistance. RESEARCH DESIGN AND METHODS: We conducted a cross-sectional study of 6,044 adults >20 years of age who participated in the Third National Health and Nutrition Examination Survey. Metabolic syndrome was defined as the presence of at least three of the following: elevated blood pressure, low HDL cholesterol, elevated serum triglycerides, elevated plasma glucose, and abdominal obesity. Insulin resistance was estimated using homeostasis model assessment (for insulin resistance), fasting insulin, and triglyceride-to-HDL cholesterol ratio. RESULTS: After excluding individuals with likely hemochromatosis, mean serum ferritin values in premenopausal women, postmenopausal women, and men were 33.6, 93.4, and 139.9 microg/l, respectively. Metabolic syndrome was more common in those with the highest compared with the lowest levels of serum ferritin in premenopausal women (14.9 vs. 6.4%, P = 0.002), postmenopausal women (47.5 vs. 28.2%, P < 0.001), and men (27.3 vs. 13.8%, P < 0.001). Insulin resistance also increased across quartiles of serum ferritin for men and postmenopausal women and persisted after adjustment for age, race/ethnicity, C-reactive protein, smoking, alcohol intake, and BMI. CONCLUSIONS: Elevated iron stores were positively associated with the prevalence of the metabolic syndrome and with insulin resistance.     

Long-term and recent progress in blood pressure levels among U.S. adults with diagnosed diabetes, 1988-2008

OBJECTIVE

To examine whether there were long-term (between 1988–1994 and 2001–2008) and recent (between 2001–2004 and 2005–2008) changes in blood pressure (BP) levels among U.S. adults with diagnosed diabetes.

RESEARCH DESIGN AND METHODS

Using data from National Health and Nutrition Examination Surveys (NHANES), we examined changes in BP distributions, mean BPs, and proportion with BP <140/90 mmHg.

RESULTS

Between 1988–1994 and 2001–2008, for adults with diabetes, mean BPs decreased from 135/72 mmHg to 131/69 mmHg (P < 0.01) and the proportion with BP <140/90 mmHg increased from 64 to 69% (P = 0.01). Although hypertension prevalence increased, hypertension awareness, treatment, and control improved. However, there was no evidence of improvement for adults 20–44 years old. Between 2001–2004 and 2005–2008, there were no significant changes in BP levels.

CONCLUSIONS

BP levels among adults with diabetes improved between 1988–1994 and 2001–2008, but the progress stalled between 2001–2004 and 2005–2008. The lack of improvement among young adults is concerning.Hypertension is particularly deleterious for people with diabetes because it confers 2 ∼3 times the risk for cardiovascular morbidity and mortality as for people without diabetes (1,2). Studies demonstrated that blood pressure (BP) control is crucial to reduce vascular complications and improve survival for people with diabetes (3,4). The proportion of people with diabetes with poorly controlled BP declined considerably between the 1970s and the 1990s (5). However, in recent studies using the National Health and Nutrition Examination Surveys (NHANES) data, no improvements in BP levels among adults with diabetes were observed from 1988–1994 to early 2000s (6) or from 1999 to 2006 (7). We updated prior studies with the most recent NHANES 2007–2008 data to examine long-term (between 1988–1994 and 2001–2008) and recent (between 2001–2004 and 2005–2008) changes in BP levels among U.S. adults with diagnosed diabetes.     

Declining death rates from hyperglycemic crisis among adults with diabetes, U.S., 1985-2002

OBJECTIVE: To examine trends in death rates for hyperglycemic crisis (diabetic ketoacidosis or hyperglycemic hyperosmolar state) among adults with diabetes in the U.S. from 1985 to 2002. RESEARCH DESIGN AND METHODS: Deaths with hyperglycemic crisis as the underlying cause were identified from national mortality data. Death rates were calculated using estimates of adults with diabetes from the National Health Interview Survey as the denominator and age adjusted to the 2000 U.S. population. The trends from 1985 to 2002 were tested using joinpoint regression analysis. RESULTS: Deaths due to hyperglycemic crisis dropped from 2,989 in 1985 to 2,459 in 2002. During the time period, age-adjusted death rates decreased from 42.4 to 23.8 per 100,000 adults with diabetes (4.4% decrease per year, P for trend <0.01). Death rates declined in all age-groups, with the greatest decrease occurring among individuals aged > or =65 years. Age-adjusted death rates fell for all race-sex subgroups, with black men experiencing the smallest decline. About one-fifth of deaths occurred at home or on arrival at the hospital, and the death rates for hyperglycemic crisis occurring at these places declined only modestly over time (2.1% decrease per year, P for trend = 0.049). CONCLUSIONS: Overall death rates due to hyperglycemic crisis among adults with diabetes have declined in the U.S. However, scope for further improvement remains, especially to further reduce death rates among black men and to prevent deaths occurring at home.     

Prevalence of cardiovascular disease risk factors in U.S. children and adolescents with diabetes: the SEARCH for diabetes in youth study

OBJECTIVE: The purpose of this study was to determine the prevalence and correlates of selected cardiovascular disease (CVD) risk factors among youth aged <20 years with diabetes. RESEARCH DESIGN AND METHODS: The analysis included 1,083 girls and 1,013 boys examined as part of the SEARCH for Diabetes in Youth study, a multicenter, population-based study of youth 0-19 years of age with diabetes. Diabetes type was determined by a biochemical algorithm based on diabetes antibodies and fasting C-peptide level. CVD risk factors were defined as follows: HDL cholesterol <40 mg/dl; age- and sex-specific waist circumference >90th percentile; systolic or diastolic blood pressure >90th percentile for age, sex, and height or taking medication for high blood pressure; and triglycerides >110 mg/dl. RESULTS: The prevalence of having at least two CVD risk factors was 21%. The prevalence was 7% among children aged 3-9 years and 25% in youth aged 10-19 years (P < 0.0001), 23% among girls and 19% in boys (P = 0.04), 68% in American Indians, 37% in Asian/Pacific Islanders, 32% in African Americans, 35% in Hispanics, and 16% in non-Hispanic whites (P < 0.0001). At least two CVD risk factors were present in 92% of youth with type 2 and 14% of those with type 1A diabetes (P < 0.0001). In multivariate analyses, age, race/ethnicity, and diabetes type were independently associated with the odds of having at least two CVD risk factors (P < 0.0001). CONCLUSIONS: Many youth with diabetes have multiple CVD risk factors. Recommendations for weight, lipid, and blood pressure control in youth with diabetes need to be followed to prevent or delay the development of CVD as these youngsters mature.     

Presence of diabetes risk factors in a large U.S. eighth-grade cohort

OBJECTIVE: The study was conducted in 12 middle schools to determine the prevalence of diabetes, pre-diabetes, and diabetes risk factors in eighth-grade students who were predominantly minority and evaluate the feasibility of collecting physical and laboratory data in schools. RESEARCH DESIGN AND METHODS: Anthropometric measurements and fasting and 2-h post-glucose load blood draws were obtained from approximately 1,740 eighth-grade students. RESULTS: Mean recruitment rate was 50% per school, 49% had BMI > or = 85th percentile, 40.5% had fasting glucose > or = 100 mg/dl, 0.4% had fasting glucose > or = 126 mg/dl, and 2.0% had 2-h glucose > or = 140 mg/dl and 0.1% > or = 200 mg/dl. Mean fasting insulin value was 30.1 microU/ml, 36.2% had fasting insulin > or = 30 microU/ml, and 2-h mean insulin was 102.1 microU/ml. Fasting and 2-h glucose and insulin values increased across BMI percentiles, and fasting glucose was highest in Hispanic and Native American students. CONCLUSIONS: There was a high prevalence of risk factors for diabetes, including impaired fasting glucose (> or =100 mg/dl), hyperinsulinism suggestive of insulin resistance (fasting insulin > or = 30 microU/ml), and BMI > or = 85th percentile. These data suggest that middle schools are appropriate targets for population-based efforts to decrease overweight and diabetes risk.     

Cultural factors associated with physical activity among U.S. adults: An integrative review

AIMThe purpose of this integrative review is to identify the cultural factors associated with physical activity (PA) among United States (U.S.) adults.BACKGROUNDPhysical inactivity is a significant public health problem that requires comprehensive community-based efforts. Cultural factors influence behavior and attitudes towards PA. Therefore, identifying the cultural factors is a key requirement for the planning of specific measures to enhance the level of PA and are more promising than campaigns aimed at the general population. This integrative review examined existing research on cultural factors influencing adult PA to inform the development of culturally adapted PA interventions in adults.METHODSLiterature searches were conducted in key scientific databases (PubMed, Cumulative Index to Nursing and Allied Health, and PsycINFO) using several key words related to both culture and PA. Fifteen peer-reviewed articles were identified, reviewed, synthesized, and critically analyzed.RESULTSEight major categories of cultural factors were identified: 1) collectivism and cultural identity; 2) religiosity; 3) cultural attitudes and gender norms in regards to PA; 4) cultural perspectives on health in regards to PA; 5) cultural expectations of familism and lack of time; 6) lack of role models and lack of motivation; 7) lack of culturally appropriate exercise facilities; and 8) cultural expectations of body image and physical appearance.CONCLUSIONSReview findings emphasize the need for health promotion targeted toward improving cultural barriers to PA among U.S. Adults.     

Physical activity, fitness and cardiovascular disease risk in adults: interactions with insulin resistance and obesity

There is a considerable body of evidence gathered from studies over the past half a century indicating that a high level of physical activity and a moderately high or high degree of cardiorespiratory fitness reduces the risk of CVD (cardiovascular disease). Recent data suggest that high levels of physical activity or fitness may be particularly beneficial to individuals with insulin-resistant conditions, such as the metabolic syndrome, Type II diabetes or obesity. These individuals, if unfit and sedentary, exhibit increased CVD risk, but their dose-response relationship for physical activity/fitness appears to be particularly steep such that, when they undertake high levels of activity (or have high fitness), their level of risk becomes closer to that of their normal weight or nondiabetic peers. This may be due to effects of physical activity in normalizing the metabolic dysfunction particularly associated with insulin-resistant conditions.