Magnesium intake and risk of type 2 diabetes in men and women

OBJECTIVE: To examine the association between magnesium intake and risk of type 2 diabetes. RESEARCH DESIGN AND METHODS: We followed 85,060 women and 42,872 men who had no history of diabetes, cardiovascular disease, or cancer at baseline. Magnesium intake was evaluated using a validated food frequency questionnaire every 2-4 years. After 18 years of follow-up in women and 12 years in men, we documented 4,085 and 1,333 incident cases of type 2 diabetes, respectively. RESULTS: After adjusting for age, BMI, physical activity, family history of diabetes, smoking, alcohol consumption, and history of hypertension and hypercholesterolemia at baseline, the relative risk (RR) of type 2 diabetes was 0.66 (95% CI 0.60-0.73; P for trend <0.001) in women and 0.67 (0.56-0.80; P for trend <0.001) in men, comparing the highest with the lowest quintile of total magnesium intake. The RRs remained significant after additional adjustment for dietary variables, including glycemic load, polyunsaturated fat, trans fat, cereal fiber, and processed meat in the multivariate models. The inverse association persisted in subgroup analyses according to BMI, physical activity, and family history of diabetes. CONCLUSIONS: Our findings suggest a significant inverse association between magnesium intake and diabetes risk. This study supports the dietary recommendation to increase consumption of major food sources of magnesium, such as whole grains, nuts, and green leafy vegetables.     

Cardiovascular risk in women with type 2 diabetes

Type 2 DM appears to eliminate the relative survival advantage experienced by premenopausal nondiabetic women compared with men with regard to CVD. The role of traditional cardiovascular risk factors, while important, cannot fully account for the disparate increase in CVD among women with type 2 DM compared with nondiabetic women. The interplay between type 2 DM and female hormones may prove important. Other less traditional risk factors such as endothelial dysfunction and impaired fibrinolysis may also play a role. Impairments in cardiovascular exercise performance in women with type 2 DM may provide insight in the future as representative of a pre-CVD state. Future research should focus on the specific causes of CVD in women with DM. In the meantime, it is important to aggressively treat modifiable risk factors in this population (Table 1). The impact of this health problem will continue to increase in our aging society, because a steadily increasing proportion of the population will be women; furthermore, an increasing percentage of these women will have diabetes if current trends continue.     

Diet-quality scores and the risk of type 2 diabetes in men

OBJECTIVE

To 1) compare associations of diet-quality scores, which were inversely associated with cardiovascular disease, with incident type 2 diabetes and 2) test for differences in absolute-risk reduction across various strata.

RESEARCH DESIGN AND METHODS

Men from the Health Professionals Follow-Up Study, who were initially free of type 2 diabetes, cardiovascular disease, or cancer (n = 41,615), were followed for ≤20 years. The Healthy Eating Index (HEI) 2005, the alternative HEI (aHEI) the Recommended Food Score, the alternative Mediterranean Diet (aMED) Score, and the Dietary Approaches to Stop Hypertension (DASH) Score were calculated from food-frequency questionnaires. Cox proportional hazard models with time-varying covariates were used to assess risk by quintiles and continuous intervals.

RESULTS

There were 2,795 incident cases of type 2 diabetes. After multivariate adjustment, the aHEI, aMED, and DASH scores were significantly associated with reduced risk. A 1-SD increase was associated with 9–13% reduced risk (P < 0.01), and the DASH score was associated with lower risk independent of other scores. These scores were associated with lower absolute risk among those who were overweight or obese compared with normal weight (P for interaction < 0.01).

CONCLUSIONS

Several diet-quality scores were associated with a lower risk of type 2 diabetes and reflect a common dietary pattern characterized by high intakes of plant-based foods such as whole grains; moderate alcohol; and low intakes of red and processed meat, sodium, sugar-sweetened beverages, and trans fat. High-quality diets may yield the greatest reduction in diabetes cases when followed by those with a high BMI.Type 2 diabetes remains a major cause of morbidity and mortality worldwide. By 2030, nearly 400 million people will suffer from type 2 diabetes (1). Although the major cause of type 2 diabetes is overweight, which is determined by energy imbalance, diet quality plays an important role (2).“High-quality” or “prudent” diets are rich in fruits and vegetables, and are associated with a reduced risk of cardiovascular disease (CVD) (3). This is attributed to lower blood lipids, blood pressure, and inflammation (3) but may also be due to lower blood glucose and diabetes risk (2). Thus, high quality diets have the potential to substantially reduce the global burden of several important chronic diseases.Dietary guidelines for large populations are beginning to reflect high-quality diets. In 1994, the Healthy Eating Index (HEI) was developed from the Dietary Guidelines for Americans (4). This 100-point score awards points for dietary diversity; higher intakes of grains, vegetables, fruit, and milk; and lower intakes of meat, total fat, saturated fat, cholesterol, and sodium. In the Health Professionals Follow-Up Study and the Nurses’ Health Study, the HEI was associated with a modest reduction in the risk of CVD (5,6), however its relationship with type 2 diabetes has not been studied. Since the HEI does not award points for carbohydrate quality (e.g., amount of whole grains), it might not be strongly associated with type 2 diabetes. The relationship between other high-quality diet scores, such as the Dietary Approaches to Stop Hypertension (DASH) Score, and type 2 diabetes has also not been studied, despite them being inversely associated with CVD (7).It is also unclear whether preexisting diabetes risk factors, such as a high BMI, affect the extent to which high-quality diets are associated with lower absolute risk rather than lower relative risk. A deeper understanding of which subgroups benefit from high-quality diets in terms of number of cases could greatly improve the success of public health messages.For these reasons, we evaluated the relationship between several diet-quality scores designed for use in the U.S. population with risk of type 2 diabetes in a well-characterized cohort of men. We also tested whether age, smoking status, alcohol intake, family history, physical activity, and BMI altered these relationships when diabetes incidence was the outcome.     

Depressive symptoms and risk of type 2 diabetes in women

OBJECTIVE: To explore the relationship between depressive symptoms and incidence of type 2 diabetes in women. RESEARCH DESIGN AND METHODS: We conducted an analysis of 72,178 female nurses aged 45-72 years who did not have diagnosed diabetes and who answered the Medical Outcomes Study 36-Item Short-Form Health Status Survey (SF-36) at baseline in 1992. We calculated relative risks (RR) of type 2 diabetes for women with presence of depressive symptoms (i.e., Five-Item Mental Health Index [MHI-5] score >52). RESULTS: During 4 years of follow-up (282,317 person-years), 973 incident cases of type 2 diabetes were documented. Age-adjusted RR of developing type 2 diabetes for women with presence of depressive symptoms was 1.55 (95% CI 1.27-1.90). Additional adjustment for BMI resulted in a RR of developing type 2 diabetes of 1.36 (1.11-1.67). The multivariate RR of developing type 2 diabetes was 1.22 (1.00-1.50). After excluding women diagnosed with diabetes between 1992 and 1994, 472 incident cases of type 2 diabetes were documented for the follow-up period from 1994 to 1996 (148,889 person-years). The multivariate RR of developing type 2 diabetes for women with depressive symptoms was 1.29 (0.96-1.72). CONCLUSIONS: Our data suggest that depressive symptoms are associated with a modest increase in the risk of type 2 diabetes.     

Sex differences in cardiovascular disease risk and exercise in type 2 diabetes

Diabetes currently affects approximately 14% of the US population, and cardiovascular disease (CVD) is a leading cause of morbidity and mortality in those with diabetes. Although in the general population women are at lower risk than men for CVD, women have a disproportionately greater increase in risk for CVD than do men in the context of diabetes. Physical activity is considered a cornerstone in the prevention and treatment of CVD and its risk factors, but greater barriers to physical activity may exist for women with diabetes compared to their male counterparts. In this article, we review sex differences in CVD incidence and risk among diabetics, sex differences in physical activity behaviors, cardiovascular abnormalities and impaired exercise capacity in women living with diabetes, and the effects of exercise on prevention and treatment of CVD in diabetic women. Finally, we discuss future research needed to clarify potential sex differences in the cardiovascular effects of diabetes and to establish ways to reduce the barriers to exercise in women with diabetes.     

Circulating levels of resistin and risk of type 2 diabetes in men and women: results from two prospective cohorts

OBJECTIVE—The purpose of this study was to investigate the role of circulating resistin levels in the development of type 2 diabetes using two prospective cohorts of well-characterized men and women.RESEARCH DESIGN AND METHODS—We conducted two prospective case-control studies nested in the Women''s Health Study (WHS) and Physicians’ Health Study II (PHS II). In the WHS, during a median of 10-years of follow-up, 359 postmenopausal women, who were apparently healthy at baseline and later developed type 2 diabetes, were prospectively matched with 359 healthy control subjects. In the PHS II, with 8 years of total follow-up, 170 men, who were apparently healthy at baseline and later developed type 2 diabetes, were matched with 170 healthy control subjects. Control subjects were matched by age, race, and time of blood draw.RESULTS—Resistin levels at baseline were significantly higher in women than in men (P = 0.003) and in case patients than in control subjects for both women (P < 0.001) and men (P = 0.07). After adjustment for matching factors, physical activity, alcohol intake, smoking, and family history of diabetes, the relative risk of type 2 diabetes comparing the highest to the lowest quartile of resistin in women was 2.22 ([95% CI 1.32–3.73]; P_trend = 0.002). This association was attenuated after further adjustment for BMI (1.51 [0.86–2.65]; P_trend = 0.20) or C-reactive protein (1.18 [0.68–2.07]; P_trend = 0.60). A similar but weaker pattern was observed in men.CONCLUSIONS—Elevated levels of circulating resistin were significantly related to increased risk of type 2 diabetes, which appears to be partially accounted for by adiposity and the inflammatory process.Resistin (also known as adipocyte-secreted factor), an adipocyte-derived hormone, may serve as a critical molecular link between obesity and insulin resistance (1–3). Obese and diabetic mice exhibit high levels of resistin. In murine models, functional reductions in resistin protein (e.g., anti-resistin antibodies, resistin gene knockouts) have been demonstrated to improve insulin sensitivity as well as to decrease blood glucose (2–4), free fatty acid (2), and triglyceride levels (2). A reduction in the amount of functional resistin also increases adipocyte differentiation and adipose mass (2), which can be reversed upon administration of recombinant resistin (4).In humans, however, the contribution of resistin to the pathogenesis of type 2 diabetes remains elusive. Plasma resistin levels have been observed to be higher in diabetic individuals than in apparently healthy individuals (5–7). In addition, thiazolidinedione therapy lowered plasma resistin levels in clinical trials (8,9). However, the primary source of resistin in rodents is adipocytes, whereas the major source in humans has been shown to be macrophages (10,11), suggesting species-specific physiological effects. To this end, prospective data are needed in well-defined populations to examine the association of circulating levels of resistin with the incident diagnosis of type 2 diabetes.Therefore, we conducted two case-control studies nested within two large, prospective cohorts, the Women''s Health Study (WHS) and the Physicians’ Health Study II (PHS II), to investigate the associations of plasma resistin levels with type 2 diabetes risk in men and women. We also explored the potential role of BMI and inflammatory markers on the association between resistin and type 2 diabetes.     

Alcohol consumption and risk of type 2 diabetes among older women

OBJECTIVE: This study aimed to investigate the relation between alcohol consumption and type 2 diabetes among older women. RESEARCH DESIGN AND METHODS: Between 1993 and 1997, 16,330 women aged 49-70 years and free from diabetes were enrolled in one of the Dutch Prospect-EPIC (European Prospective Study Into Cancer and Nutrition) cohorts and followed for 6.2 years (range 0.1-10.1). At enrollment, women filled in questionnaires and blood samples were collected. RESULTS: During follow-up, 760 cases of type 2 diabetes were documented. A linear inverse association (P = 0.007) between alcohol consumption and type 2 diabetes risk was observed, adjusting for potential confounders. Compared with abstainers, the hazard ratio for type 2 diabetes was 0.86 (95% CI 0.66-1.12) for women consuming 5-30 g alcohol per week, 0.66 (0.48-0.91) for 30-70 g per week, 0.91 (0.67-1.24) for 70-140 g per week, 0.64 (0.44-0.93) for 140-210 g per week, and 0.69 (0.47-1.02) for >210 g alcohol per week. Beverage type did not influence this association. Lifetime alcohol consumption was associated with type 2 diabetes in a U-shaped fashion. CONCLUSIONS: Our findings support the evidence of a decreased risk of type 2 diabetes with moderate alcohol consumption and expand this to a population of older women.     

Menstrual cycle differences between women with type 1 diabetes and women without diabetes

OBJECTIVE: To evaluate menstrual cycle histories among women with type 1 diabetes, their sisters, and unrelated control subjects without diabetes across all reproductive ages. RESEARCH DESIGN AND METHODS: Menstrual and reproductive histories were obtained by questionnaire from 143 women with type 1 diabetes, 186 sisters without diabetes, and 158 unrelated control subjects without diabetes participating in the Familial Autoimmune and Diabetes study. RESULTS: Women with type 1 diabetes had more menstrual problems (long cycles, long menstruation, and heavy menstruation) before age 30 years than sisters and control subjects. These differences were all statistically significant, except for heavy menstruation at age <20 years. No differences were observed after age 30 years. Women with type 1 diabetes experienced later menarche, earlier natural menopause, fewer pregnancies, and more stillbirths than women without diabetes. Multiple regression analyses revealed that type 1 diabetes caused an approximate twofold increased risk of any menstrual problem before age 30 years. These were primarily related to long cycles and long menstruation in women aged <20 and 20-29 years, as well as with heavy menstruation from 20 to 29 years. Oral contraceptives were protective for any menstrual problem and heavy menstruation from 30 to 39 years of age. With history of pregnancy from 20 to 40 years of age, any menstrual problem and long menstruation were more likely. CONCLUSIONS: The results suggest that type 1 diabetes is an independent risk factor for menstrual disturbances in young adults. Future studies may determine whether addressing menstrual disturbances improves quality of life and health for these women.     

Non-invasive cardiovascular risk assessment in women with type 2 diabetes.

This study assessed and compared carotid intima-media thickness (IMT) in postmenopausal women with type 2 diabetes with that in postmenopausal women without type 2 diabetes and compared risk factors that contribute to increased carotid IMT in these groups of women. Carotid IMT, a non-invasive assessment of cardiovascular risk, was measured using high-resolution ultrasound in 20 postmenopausal women with type 2 diabetes and 20 postmenopausal women without type 2 diabetes who had no known coronary heart disease. Risk factors (age, race, family history, diabetes, hypertension, high cholesterol, years past menopause, use of hormone replacement therapy, perceived level of physical activity, and body mass index) known to contribute to coronary heart disease were also assessed. Mean carotid IMT was .88 mm for women with type 2 diabetes compared with .74 mm for women without type 2 diabetes. There were no differences between groups in age, race, cholesterol, and perceived level of physical activity. Women with type 2 diabetes, however, reported more hypertension ( P = .004), greater body mass index ( P = .026), and less use of hormone replacement therapy ( P = .027). Of concern is that 10% of the women with diabetes had stenosis that required surgical intervention. Findings suggest that carotid IMT is a valid way to screen for cardiovascular risk, particularly in postmenopausal women who are at high risk for coronary heart disease. It may also be a feasible, non-invasive method for the detection and prevention of the macrovascular complications of diabetes.     

Adiposity compared with physical inactivity and risk of type 2 diabetes in women

OBJECTIVE: The relative contribution of adiposity and physical inactivity to the risk of developing type 2 diabetes remains controversial. RESEARCH DESIGN AND METHODS: We prospectively examined the individual and joint association of obesity and physical activity with the development of type 2 diabetes in 68,907 female nurses who had no history of diabetes, cardiovascular disease, or cancer at baseline. Adiposity was measured by BMI and waist circumference. Physical activity was assessed through average hours of moderate or vigorous exercise and computation of an MET score. RESULTS: We documented 4,030 incident cases of type 2 diabetes during 16 years of follow-up (from 1986 to 2002). In a multivariate model including age, smoking, and other diabetes risk factors, risk of type 2 diabetes increased progressively with increasing BMI (P < 0.001) and waist circumference (P < 0.001) and with decreasing physical activity levels (P < 0.001). In joint analyses of BMI and physical activity, using women who had a healthy weight (BMI < 25 kg/m(2)) and were physically active (exercise > or = 21.8 MET h/week) as the reference group, the relative risks of type 2 diabetes were 16.75 (95% CI 13.99-20.04) for women who were obese (BMI > or = 30 kg/m(2)) and inactive (exercise < 2.1 MET h/week), 10.74 (8.74-13.18) for women who were active but obese, and 2.08 (1.66-2.61) for women who were lean but inactive. In combined analyses of waist circumference and physical activity, both variables were significant predictors of type 2 diabetes, but the association for waist circumference was substantially stronger than that for physical inactivity. CONCLUSIONS: Obesity and physical inactivity independently contribute to the development of type 2 diabetes; however, the magnitude of risk contributed by obesity is much greater than that imparted by lack of physical activity.     

Dietary patterns during adolescence and risk of type 2 diabetes in middle-aged women

OBJECTIVE Whether dietary habits early in life can affect risk of type 2 diabetes (T2DM) in adulthood is unknown. We evaluated the relationship between dietary patterns during adolescence and risk of T2DM in midlife. RESEARCH DESIGN AND METHODS We examined the 7-year incidence of T2DM in relation to dietary patterns during high school among 37,038 participants in the Nurses' Health Study II cohort, who completed a food-frequency questionnaire about their diet during high school. Dietary patterns were derived by factor analysis. Cox proportional hazards regression was used to estimate relative risk (RR) and 95% CI. RESULTS The prudent pattern, characterized by healthy foods, was not associated with risk of T2DM. The Western pattern, characterized by desserts, processed meats, and refined grains, was associated with 29% greater risk of T2DM (RR 1.29; 95% CI 1.00-1.66; P trend 0.04), after adjusting for high school and adult risk factors comparing extreme quintiles, but was attenuated after adjusting for adult weight change (1.19; 0.92-1.54). Women who had high Western pattern scores in high school and adulthood had an elevated risk of T2DM compared with women who had consistent low scores (1.82; 1.35-2.45), and this association was partly mediated by adult BMI (1.15; 0.85-1.56). CONCLUSIONS A Western dietary pattern during adolescence may increase risk of T2DM in later life, partly through adult weight gain. Preventive measures should be aimed at developing healthy dietary habits that begin in early life and continue through adulthood.     

Dietary fat and meat intake in relation to risk of type 2 diabetes in men

OBJECTIVE: To examine dietary fat and meat intake in relation to risk of type 2 diabetes. RESEARCH DESIGN AND METHODS: We prospectively followed 42,504 male participants of the Health Professionals Follow-Up Study who were aged 40-75 years and free of diagnosed diabetes, cardiovascular disease, and cancer in 1986. Diet was assessed by a validated food frequency questionnaire and updated in 1990 and 1994. During 12 years of follow-up, we ascertained 1,321 incident cases of type 2 diabetes. RESULTS: Intakes of total fat (multivariate RR for extreme quintiles 1.27, CI 1.04-1.55, P for trend=0.02) and saturated fat (1.34, 1.09-1.66, P for trend=0.01) were associated with a higher risk of type 2 diabetes. However, these associations disappeared after additional adjustment for BMI (total fat RR 0.97, CI 0.79-1.18; saturated fat 0.97, 0.79-1.20). Intakes of oleic acid, trans-fat, long-chain n-3 fat, and alpha-linolenic acid were not associated with diabetes risk after multivariate adjustment. Linoleic acid was associated with a lower risk of type 2 diabetes in men <65 years of age (RR 0.74, CI 0.60-0.92, P for trend=0.01) and in men with a BMI <25 kg/m(2) (0.53, 0.33-0.85, P for trend=0.006) but not in older and obese men. Frequent consumption of processed meat was associated with a higher risk for type 2 diabetes (RR 1.46, CI 1.14-1.86 for > or = 5/week vs. <1/month, P for trend <0.0001). CONCLUSIONS: Total and saturated fat intake were associated with a higher risk of type 2 diabetes, but these associations were not independent of BMI. Frequent consumption of processed meats may increase risk of type 2 diabetes.     

Changes in triglyceride levels over time and risk of type 2 diabetes in young men

OBJECTIVE—The association between changes in triglyceride concentrations over time and diabetes is unknown. We assessed whether two triglyceride determinations obtained 5 years apart can predict incident type 2 diabetes.RESEARCH DESIGN AND METHODS—Triglyceride levels at baseline (time 1) and 5 years later (time 2), followed by subsequent follow-up of 5.5 years, were measured in 13,953 apparently healthy men (age 26–45 years) with triglycerides <300 mg/dl (<3.39 mmol/l).RESULTS—During 76,742 person-years, 322 cases of diabetes occurred. A multivariate model adjusted for age, BMI, total cholesterol–to–HDL cholesterol ratio, family history of diabetes, fasting glucose, blood pressure, physical activity, and smoking status revealed a continuous independent rise in incident diabetes with increasing time 1 triglyceride levels (P_trend < 0.001). Men in the lowest tertile of time 1 triglyceride levels who progressed to the highest tertile over follow-up (low-high) exhibited a hazard ratio (HR) of 12.62 (95% CI 3.52–31.34) compared with those remaining in the lowest tertile at both time points (reference group: low-low). Whereas men who were at the top triglyceride level tertile throughout follow-up (high-high) had a HR for diabetes of 7.08 (2.52–14.45), those whose triglyceride level decreased to the lowest tertile (high-low) exhibited a HR of 1.97 (0.67–6.13). Alterations in triglyceride levels during follow-up were associated with changes in BMI, physical activity, and eating breakfast habit (P < 0.05), but remained an independent modifier of diabetes risk even after adjustment for such changes.CONCLUSIONS—Two measurements of fasting triglyceride levels obtained 5 years apart can assist in identifying apparently healthy young men at increased risk for diabetes, independent of traditional risk factors and of associated changes in BMI and lifestyle parameters.Elevated triglyceride levels are a common dyslipidemic feature accompanying type 2 diabetes and pre-diabetic states (1). A fasting triglyceride level of ≥150 mg/dl (≥1.70 mmol/l) is one of five accepted criteria for defining individuals at high risk for cardiovascular disease and type 2 diabetes, arguably termed the “metabolic syndrome” (2–4). Some evidence suggests that fasting triglyceride levels can aid in predicting future type 2 diabetes (5,6). However, this was shown mainly when triglyceride levels were combined with additional clinical parameters, such as BMI, blood pressure (7), and other classic risk factors for cardiovascular disease (8,9), or with “high-normal” fasting plasma glucose levels (10).The level of circulating triglycerides is highly influenced by the fed-fasted state, insulin sensitivity, and lifestyle factors such as diet and physical activity (1,11,12). These make triglyceride levels a highly sensitive lifestyle biomarker at a given time point but suggest that a triglyceride determination at a single time point may inaccurately reflect long-term triglyceridemia, particularly if lifestyle modification occurred during follow-up. Whether assessment of triglyceride levels at more than one time point could improve the association between triglyceride levels and diabetes is largely unknown. Recently, we reported in a large cohort of young (aged 26–45 years) men that significant changes between two fasting triglyceride measurements obtained 5 years apart corresponded with alterations in lifestyle parameters (13). Furthermore, such changes modified the risk for heart disease attributed to elevated triglyceride levels (13).Most studies assessing the risk factors for type 2 diabetes have overlooked the parameters specifically relevant for the apparently healthy young adult population. Although the incidence rate of diabetes in this group is relatively low, recent studies suggested a surge in type 2 diabetes in young adults (14). Identifying individuals in this group who have a high risk of developing diabetes is therefore challenging but potentially of significant benefit if preventive measures are used. Here, we used the cohort of young, apparently healthy men (10,13) to assess whether baseline triglyceride measurements as well as lifestyle-associated changes in triglyceride levels over time can predict the risk of diabetes.     

Risk factors for microvascular and macrovascular complications in men and women with type 2 diabetes

Objective - To evaluate the importance of risk factors for microvascular and macrovascular complications, separated by sex, in type 2 diabetes. Design - Cross-sectional surveys of diabetic patients registered with primary health services in 1995. Setting - Three community health centres in Stockholm County. Subjects - 407 subjects with type 2 diabetes in 1995. For 78 of these, data were also registered in 1992. Main outcome measures - Odds ratio (OR) by logistic regression for risk factors predicting microvascular and macrovascular complications, for age and duration in years. Results - For microvascular complications, the most important factors were in men the duration of diabetes (OR 1.13, p&lt;0.001) and in women the duration of diabetes (OR 1.08, p&lt;0.001) and age (OR 1.04, p&lt;0.05). For macrovascular complications, the most important factors were in men, age (OR 1.09, p&lt;0.001) and hypertension (OR 4.85, p&lt;0.001) and in women, age (OR 1.08, p&lt;0.001) and duration of diabetes (OR 1.08, p&lt;0.01). Conclusions - Hypertension is more important among men and the duration of diabetes among women as risk factor for macrovascular complications in type 2 diabetes.     

Racial and socioeconomic differences in risk factors for cardiovascular disease among Southern rural women

BACKGROUND: African American women living in the Southeast experience a higher mortality due to cardiovascular (CV) disease than their White counterparts. It is unclear if this vulnerability to CV disease is due to race, socioeconomic status, or health behaviors. OBJECTIVES: To examine the disparities in cardiovascular health between Southern rural, African American and White women to determine if a CV Risk-Index differed by race, education, or income levels and if differences persisted when controlling for body mass index (BMI). METHODS: Subjects were 1,110 women (27% African American, 73% White) residing in rural North Carolina. Data were collected by mailed questionnaire and analyzed using analysis of variance (ANOVA) and analysis of covariance (ANCOVA). RESULTS: African American women had significantly lower education and lower income than Whites, higher BMI, and a much greater prevalence of hypertension, angina, and diabetes. In a three-way ANOVA including race, income, and education, education and race were significant predictors of the CV Risk Index, but when adjusted for BMI race was no longer significant (p =.3039); the only significant predictors were BMI and educational level. DISCUSSION: Women with the least education had the highest CV Risk-Index, regardless of race. These findings suggest the need to focus risk reduction interventions on all Southern rural women with limited education, not only African American women. This supports the current literature that suggests race should be viewed as a risk marker rather than a risk factor.     

Serum gamma-glutamyltransferase and risk of metabolic syndrome and type 2 diabetes in middle-aged Japanese men

OBJECTIVE: To investigate the association between serum gamma-glutamyltransferase (GGT) and risk of metabolic syndrome and type 2 diabetes in Japanese male office workers. RESEARCH DESIGN AND METHODS: This study included 2,957 metabolic syndrome-free men and 3,260 nondiabetic men aged 35-59 years who did not have medication for hepatitis, alanine aminotransferase (ALT) levels higher than three times the upper limit of the reference range, or a history of cardiovascular disease at study entry. Subjects were reexamined at periodic annual health examinations over a 7-year period. We used a modified National Cholesterol Education Program definition of metabolic syndrome with BMI instead of waist circumference and the revised criteria of the American Diabetes Association for type 2 diabetes. RESULTS: With adjustment for age, family history of diabetes, BMI, alcohol intake, cigarette smoking, regular physical activity (fasting plasma glucose for the risk of type 2 diabetes), and white blood cell (WBC) count, the risk of metabolic syndrome and type 2 diabetes increased in correlation with the levels of serum GGT, ALT, aspartate aminotransferase (AST), and alkaline phosphatase. Additional adjustment for all of the other liver enzymes attenuated these associations, but serum GGT remained a significant risk factor for the risk of both metabolic syndrome and type 2 diabetes (P for trend <0.001 for both). Top one-fifth versus bottom one-fifth relative risks of metabolic syndrome and type 2 diabetes were 2.23 (95% CI 1.51-3.30) and 2.44 (1.34-4.46), respectively. CONCLUSIONS: These results indicate that serum GGT may be an important predictor for developing metabolic syndrome and type 2 diabetes in middle-aged Japanese men.     

Smoking as a modifiable risk factor for type 2 diabetes in middle-aged men

OBJECTIVE: To examine the effects of cigarette smoking, giving up smoking, and primary or secondary pipe or cigar smoking on the risk of type 2 diabetes. RESEARCH DESIGN AND METHODS: A prospective study followed 7,735 men aged 40-59 years from general practices in 24 British towns for an average of 16.8 years. Incident cases of physician-diagnosed diabetes were ascertained by repeated postal questionnaires and systematic reviews of primary care records. RESULTS: A total of 290 incident cases of diabetes were found in 7,124 men with no history of diabetes, coronary heart disease, or stroke. Cigarette smoking was associated with a significant increase in risk of diabetes, even after adjustment for age, BMI, and other potential confounders. The benefit of giving up smoking was only apparent after 5 years of smoking cessation, and risk reverted to that of never-smokers only after 20 years. The risk of diabetes in those who switched from smoking cigarettes to pipe or cigars remained equal to the risk in continuing cigarette smokers. Men who gave up smoking during the first 5 years of follow-up showed significant weight gain and subsequently higher risk of diabetes than continuing smokers. CONCLUSIONS: Cigarette smoking is an independent and modifiable risk factor for type 2 diabetes. Smoking cessation is associated with weight gain and a subsequent increase in risk of diabetes, but in the long term, the benefits of giving up smoking outweigh the adverse effects of early weight gain.     

Work stress and low sense of coherence is associated with type 2 diabetes in middle-aged Swedish women

OBJECTIVE: The risk of type 2 diabetes is suggested to be increased for individuals exposed to stress. We analyzed the association of work stress by high demands, low decision latitude, and job strain (combination of high demands and low decision latitude) with type 2 diabetes. We also studied low sense of coherence (SOC) (a factor for successful coping with stressors) in association with type 2 diabetes. Finally, we investigated the combination of SOC and demands or SOC and decision latitude in association with the disease. RESEARCH DESIGN AND METHODS: This cross-sectional study recruited 4821 healthy Swedish women (aged 35-56 years) residing in five municipalities in the Stockholm area. An oral glucose tolerance test identified 52 women with type 2 diabetes. Relative risks (RRs) with 95% CIs were estimated in a logistic multiple regression analysis. RESULTS: No association was found between high demands and type 2 diabetes (RR 1.1 [CI 0.5-2.2]). Low decision latitude was associated with type 2 diabetes with a RR of 2.2 (1.0-4.8). The RR of type 2 diabetes with low SOC was 3.7 (1.2-11.2). The combination of low SOC and low decision latitude was associated with type 2 diabetes with a RR of 2.6 (1.2-5.7). Homeostasis model assessment revealed an association of 4.2 (1.2-15.0) between low SOC and insulin resistance. CONCLUSIONS: This study provided new evidence that stress factors such as low decision latitude at work and low SOC were associated with type 2 diabetes in middle-aged Swedish women.