Anthropometric characteristics, dietary patterns and risk of type 2 diabetes mellitus in Vietnam

OBJECTIVE: To determine the impact of anthropometric characteristics and dietary patterns on Type 2 diabetes mellitus in Vietnam. METHODS: Data from 144 subjects (9m/39f newly diagnosed diabetics; 18m/78f control subjects) were analyzed in this case-control study. Height, weight, waist and hip circumferences and percent body fat were measured. Dietary intakes were assessed by 24-hour recall on three non-consecutive weekdays. Fasting blood samples were collected for the analysis of plasma glucose, fructosamine, protein and lipid concentrations. RESULTS: Although the body mass index (BMI, kg/m(2)) was similar between diabetic and control subjects, diabetic subjects had significantly greater percent body fat (31.1 +/- 5.8% vs. 27.7 +/- 6.2%) and waist-hip ratios (WHR, 0.91 +/- 0.07 vs. 0.86 +/- 0.08). Diabetic subjects had higher intakes of protein (p < 0.01), especially animal protein (p < 0.001), and consumed more meat (p < 0.01) than control subjects. Percent body fat and WHR were positively associated with diabetes (odds ratios [OR] 1.53 [95%CI 1.29-1.79] and 1.09 [95% CI 0.89-1.58], respectively) as were protein intake (OR 1.21 [95% CI 1.12-1.31]) and animal protein intake (OR 1.18 [95% CI 1.10-1.26]). CONCLUSIONS: This study indicates that percent body fat and WHR are risk factors associated with diabetes even when the BMI is normal. Evolving dietary patterns with increasingly more protein and meat consumption may also contribute to the deterioration of glucose metabolism among Vietnamese people.     

Association of Calcium Intake and Adiposity in Postmenopausal Women

Objective: The purpose of this study was to examine the relationship between calcium intake and 1) body composition and 2) body fat distribution in postmenopausal women.

Methods: Archived data from a previous study including forty-nine Caucasian women, aged 51–73 and at least three years postmenopausal, were used for analysis. Data included medical and diet history from a questionnaire, average nutrient intake from computerized analysis of a 3-day diet record, anthropometric measures including height, weight, body mass index (BMI), waist circumference, and waist-to-hip ratio (WHR). Calcium intake represented both food and supplement sources of calcium. Lean and fat mass were determined from dual energy x-ray absorptiometry (DXA) total body scans, and abdominal fat mass was defined as fat mass between the top of the iliac crest and L1 on the DXA scan.

Results: Subjects were 60.5 ± 0.9 y/o with an average BMI of 26.9 ± 0.7 and percent body fat of 42.8 ± 1.2. Average calcium intake was 1151 ± 83 g/d. There was a significant inverse relationship between calcium intake and percent body fat (r = ?0.36, p < 0.01) and abdominal fat mass (r = ?0.25, p < 0.05), but there was no significant correlation between calcium intake and body mass index, fat mass, lean mass, waist circumference, or WHR. When kcalories were controlled, the inverse correlation between dietary calcium intake and percent body fat remained (r = ?0.24, p < 0.05). Total fat was significantly greater (p < 0.05) in the low dairy intake (1–2 servings/d) vs. high dairy intake group (3–4 servings/d), but there were no significant differences between the groups in other body composition variables.

Conclusions: Increased calcium intake was associated with lower percent body fat and higher dairy intake was associated with lower fat mass in postmenopausal women, but there was no association between calcium intake and body fat distribution measures in this population.     

Healthier Dietary Pattern and Lower Risk of Metabolic Syndrome in Physically Active Postmenopausal Women

Objectives: To investigate the relationship between habitual physical activity and dietary intake, body composition, metabolic and hormonal variables, and cardiovascular risk factors in postmenopausal women with no evidence of cardiovascular disease.

Methods: In this cross-sectional study, 105 women (mean age: 55.2 ± 4.9 years) consulting for climacteric symptoms underwent anthropometric and hormonal assessment. Usual dietary intake was assessed with a food frequency questionnaire and habitual physical activity was assessed with a digital pedometer. Participants were classified as physically inactive (<6000 steps daily) or physically active (≥6000 steps daily).

Results: Compared to the inactive group, active women had higher protein, total fat, cholesterol, iron, calcium, and the antioxidant micronutrients zinc and selenium intake as well as differences on food groups: higher meat, egg, and whole-dairy intake and lower intake of chips. Active participants also presented lower diastolic blood pressure (p = 0.012), ultrasensitive C-reactive protein (us-CRP; p = 0.011), fasting glucose (p = 0.003), fasting insulin (p = 0.019), and homeostasis model assessment index (p = 0.017). After adjustment for age and time since menopause, the risk for metabolic syndrome increased with physical inactivity (odds ratio [OR] = 3.55, 95% confidence interval [CI], 1.08–11.66), us-CRP (OR = 6.57, 95% CI, 2.20–19.56), and percentage body fat (OR = 5.65, 95% CI, 1.19–28.89).

Conclusion: Both physical activity and dietary choices may have contributed toward a more favorable cardiovascular profile and lower risk of metabolic syndrome in postmenopausal women.     

Sources of Protein and Polyunsaturated Fatty Acids of the Diet and Microalbuminuria in Type 2 Diabetes Mellitus

Background: Albuminuria excretion rate above the reference range and below albustix positive proteinuria (20–199 μg/min) is known as microalbuminuria and has been associated with an increased risk of death and progression to renal failure. Besides hyperglicemia and high blood pressure levels, dietary factors can also influence albuminuria.

Objective: To evaluate possible associations of dietary components (macronutrients and selected foods) with microalbuminuria in type 2 diabetic patients.

Methods: In this cross-sectional study, 119 normoalbuminuric [NORMO; 24-h urinary albumin excretion (UAE) < 20 μg/min; immunoturbidimetry] and 62 microalbuminuric (MICRO; UAE 20–199 μg/min) type 2 diabetic patients, attending the Endocrine Division, Hospital de Clínicas de Porto Alegre (Brazil), without previous dietary counseling, underwent 3-day weighed-diet records, and clinical and laboratory evaluation.

Results: MICRO patients consumed more protein (20.5 ± 4.4 vs. 19.0 ± 3.5% of total energy; p = 0.01) with a higher intake from animal sources (14.5 ± 4.7 vs. 12.9 ± 3.8% of total energy; p = 0.015) than NORMO patients. The intakes of PUFAs (8.6 ± 2.9 vs. 9.7 ± 3.3% of total energy; p < 0.03), PUFAs from vegetable sources (7.3 ± 3.4 vs. 8.6 ± 3.7% of total energy; p = 0.029), plant oils [0.2 (0.1–0.6) vs. 0.3 (0.1–0.9) mg/kg weight; p = 0.02] and margarines [3.3 (0–75.7) vs. 7.0 (0–51.7) g/day; p = 0.01] were lower in MICRO than in NORMO. In multivariate logistic regression models, adjusted for age, gender, presence of hypertension and fasting plasma glucose, intake of total protein (% of total energy; OR 1.104; 95% CI 1.008–1.208; p = 0.032) was positively associated with microalbuminuria. The intakes of total PUFAs (% of total energy; OR 0.855; 95%CI 0.762–0.961; p = 0.008), PUFAs from vegetable sources (% of total energy; OR 0.874; 95%CI 0.787–0.971; p = 0.012) and plant oils (mg/kg weight; OR 0.036; 95% CI 0.003–0.522; p = 0.015) were negatively associated with microalbuminuria.

Conclusions: In type 2 diabetic patients, the high intake of protein and the low intake of PUFAs, particularly from plant oils, were associated with the presence of microalbuminuria. Reducing protein intake from animal sources and increasing the intake of lipids from vegetable origin might-reduce the risk of microalbuminuria.     

The Effect of a Vegetarian vs Conventional Hypocaloric Diabetic Diet on Thigh Adipose Tissue Distribution in Subjects with Type 2 Diabetes: A Randomized Study

Objective: The aim of our study was to compare the effects of a vegetarian and a conventional diet on thigh adipose tissue distribution in subjects with type 2 diabetes (T2D).

Methods: Seventy-four subjects with T2D were randomly assigned to either follow a vegetarian diet (V, n = 37) or a control group who followed an isocaloric conventional anti-diabetic diet (C, n = 37). Both diets were calorie restricted (?500 kcal/day). To measure insulin sensitivity, the hyperinsulinemic (1 mU.kg^?1.min^?1) isoglycemic clamp was conducted. β-Cell function was assessed using a mathematical model after a test meal. Magnetic resonance imaging of the thigh was performed. All subjects were examined at 0, 3, and 6 months. Statistical analyses were performed using repeated measures analysis of variance and a multivariate regression model.

Results: Greater reduction was observed in total leg area in V (?13.6 cm² [95% confidence interval [CI], ?14.2 to ?12.9] in V vs ?9.9 cm² [95% CI, ?10.6 to ?9.2] in C; Gxt p < 0.001). The reduction in subcutaneous fat was comparable in response to both diets (Gxt, p = 0.64). Subfascial fat was reduced only in response to a vegetarian diet (?0.82 [95% CI, ?1.13 to ?0.55] cm² in V vs ?0.44 [95% CI, ?0.78 to +0.02] cm² in C; Gxt, p = 0.04). The reduction in intramuscular fat tended to be greater in response to a vegetarian diet (?1.78 [95% CI, ?2.26 to ?1.27] cm² in V vs ?0.57 [95% CI, ?1.06 to ?0.09] cm² in C; Gxt, p = 0.12). Changes in subcutaneous and subfascial fat correlated with changes in glycated hemoglobin (HbA1c), fasting plasma glucose, and β-cell insulin sensitivity. After adjustment for changes in body mass index (BMI), correlations remained significant for changes in fasting plasma glucose and β-cell insulin sensitivity and with changes in triglycerides.

Conclusions: Our data indicate the importance of both subcutaneous and subfascial fat in relationship to glucose and lipid metabolism.

Abbreviations: BMI , body mass index; C , control group; FPG , fasting plasma glucose; Gxt , interaction between group and time; HbA1c , glycated hemoglobin; MCR , metabolic clearance rate of glucose; OPLS , orthogonal projections to latent structure; T2D , type 2 diabetes; V , vegetarian group     

Diabetes mellitus and obesity in the French Caribbean: A special vulnerability for women?

ABSTRACT

The objective of this study was to analyze the prevalence, awareness, treatment, and control of diabetes and its risk factors among French Caribbean adults. This cross-sectional study included 18–74-year olds (N = 2252; 56.5 percent women) who underwent a heath examination in Guadeloupe during July–December 2014. Diabetes was defined as using antidiabetic treatment, or fasting glucose ≥7 mmol/l, and glycated hemoglobin (HbA1c) ≥6.5 percent; diabetes control was defined as HbA1c < 7 percent. Multilevel logistic regression was used. Diabetes prevalence was 8.2 percent for women and 5 percent for men (age-adjusted odds ratio [aOR] for women = 2.0; 95 percent confidence interval [CI]: 1.4–2.9). The proportion of women with diabetes who were aware of it was 84.5 versus 67.3 percent in men (aOR = 2.7; 95 percent CI: 1.2–6.2). Nearly, all diagnosed participants were being treated. In less than a third of diabetics in both sexes was diabetes control obtained. Most women (55.3 percent) had a waist circumference at or above the National Cholesterol Education Program thresholds versus 14 percent of men (aOR = 9.3; 95 percent CI: 7.5–11.7), which wholly accounted for excess diabetes in women. In women, obesity and diabetes were associated with low education and income. In this French Caribbean sample, abdominal obesity and diabetes affected more women. Diabetes was rarely controlled. A comprehensive women’s health policy for the prevention of abdominal obesity and diabetes is needed.     

Association between the Frequency of Dining Out and the Risk of Obesity,Diabetes Mellitus,and Dyslipidemia among Korean Adults

ABSTRACT

This study aimed to clarify the association between the frequency of dining out and the risk of obesity, diabetes mellitus, and dyslipidemia among Korean adults. This cross-sectional study surveyed 640 participants aged 20–69 years in Korea. Daily intake of energy, fat, protein, and cholesterol significantly increased as the frequency of dining out increased (P < .001). Energy derived from carbohydrates significantly decreased with the frequency of dining out, while that derived from fat and protein increased (P < .001). Among participants who rarely dined out, the fully adjusted odds ratios (ORs) for hyperglycemia were significantly lower at 0.35 (95% CI, 0.16–0.76). Decreased risk of being hyperglycemia among participants who rarely dined out suggests that the frequency of dining out can be related to diabetes risk.     

Urban–Rural Differentials in Overweight and Obese Individuals with Diarrhea in Bangladesh

Objective: The study aimed to determine urban and rural differences in overweight and obesity (OO) with diarrhea regarding subjects’ sociodemographic, clinical characteristics, etiology, and antimicrobial susceptibility.

Methods: Relevant information from 2000 to 2011 were extracted from the data archive of the Diarrheal Disease Surveillance System of urban Dhaka (1248, 4.5%) and rural Matlab (615, 3.4%) hospitals of the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b).

Results: The proportion of OO significantly increased in both urban (3–7%; chi-square for trend p < 0.001) and rural (1–6%; p < 0.001) areas over the study period. In multivariate modeling, monthly income more than US$100 (odds ratio [OR] = 54.44, 95% confidence interval [CI], 25.37–116.82, p < 0.001), high wealth quintile (OR = 18.23, 95% CI, 8.63–38.49, p < 0.001), access to sanitary toilet (OR = 3.07. 95% CI. 1.76–5.26. p < 0.001), boiled drinking water (OR = 2.77, 95% CI, 1.09–7.05, p = 0.032), antimicrobial use before hospitalization (OR = 4.99, 95% CI, 2.85–8.74, p < 0.001), fever (OR = 0.14, 95% CI, 0.37, 0.50, p < 0.001), watery stools (OR = 5.59, 95% CI, 2.11–14.80, p < 0.001), dehydrating diarrhea (OR = 5.17, 95% CI, 2.54–10.52, p < 0.001), intravenous saline infusion after hospitalization (OR = 2.65, 95% CI, 1.28–5.49, p = 0.009), and Salmonella infection (OR = 0.20, 95% CI, 0.50–0.83, p = 0.027) remained significantly associated with urban OO individuals. At least 88% of Shigella isolates were susceptible to ciprofloxacin in both urban and rural areas; for mecillinum it was 90%. Ciprofloxacin had the least detected resistance for Vibrio cholerae (0%) and trimethoprim-sulfamethoxazole (TMP-SMX) showed the greatest resistance (Dhaka 86%; Matlab 98%). Susceptibility for Salmonella showed ampicillin (95%), chloramphenecol (100%), ciprofloxacin (95%), ceftraxone (93%), TMP-SMX (95%) at both sites.

Conclusion: Urban OO with diarrheal illnesses was significantly different from that in rural areas, including antimicrobial susceptibility.     

Differential Risk of Hypertension Among Lean and Nonlean Rural Subjects in Relation to Decadal Changes in Anthropometry

Objective: Assessing risk of hypertension in relation to decadal changes in anthropometry among cohort of young rural Indian men.

Methods: Subjects (n = 140) were measured in 2005 and 2015 for blood pressure, body mass index (BMI), body fat (BF), waist circumference (WC), waist-to-hip ratio (WHR), and additionally for visceral fat (VF) at follow-up.

Results: Decadal changes showed significant (p < 0.001) increase in mean anthropometric measures and in prevalence of overall obesity (BMI ≥25 kg/m²) from 3.6% to 37.1%; adiposity (BF ≥25%) from 5.1% to 40.9%; and central obesity (WHR ≥0.9) from 0.7% to 24.3%. Prevalence of hypertension increased (20.7% to 27.1%) but was not statistically significant. VF correlated significantly (p < 0.001) with decadal changes (Δ) in BMI, BF, WC, and WHR, and the correlations were stronger (r = 0.90, 0.78, 0.84, and 0.56, respectively) for lean (baseline BMI < median) subjects than nonlean (baseline BMI ≥median) subjects (r = 0.68, 0.40, 0.61, and 0.43, respectively). Risk of hypertension was significant (odds ratio [OR] = 11.0, 95% confidence interval [CI]: 2.8–42.8) for subjects with higher ΔBMI (≥4.7 kg/m²) compared with those with lower ΔBMI (<4.7 kg/m²) among lean but was not significant among nonlean subjects. This was also true for change in other adiposity indicators, indicating greater vulnerability of lean subjects. Further, among lean subjects, ORs reduced considerably after adjusting for VF, whereas among nonlean subjects ORs continued to remain nonsignificant but showing independent significance for VF.

Conclusions: For similar level of change in adiposity indicators, lean subjects were at greater risk of hypertension than nonlean subjects, probably due to higher VF deposition.     

Dietary Iron Intake and Risk of Endometrial Cancer: A Population-Based Case-Control Study in Shanghai,China

Dietary red meat and animal fat have been linked to endometrial cancer (EC) risk, but the impact of bioavailable iron in animal-derived foods has been less well studied. Our objective was to investigate the effects of iron and fats on the risk of EC in a large, population-based, case-control study. The Shanghai Endometrial Cancer Study enrolled 1,204 EC cases and 1,212 controls who completed in-person interviews, including a food frequency questionnaire. Animal-derived iron and fat intakes were calculated from dietary intakes and food composition tables. Logistic regression models were used to evaluate independent and joint effects of iron and fat on EC risk. Animal-derived iron intake was positively associated with EC risk [adjusted OR = 1.9; 95% CI = 1.4–2.7, P _trend < 0.01, highest vs. lowest quartile], predominantly after menopause (OR = 2.2; 95%CI = 1.4–3.4, P _trend < 0.01) and in women with BMI ≥ 25 kg/m ² (OR = 3.2; 95% CI = 1.4–7.5 in postmenopausal obese women, P _trend < 0.01). Animal-derived fat was also associated with postmenopausal EC risk (OR = 1.7; 95% CI = 1.2–2.5, P _trend < 0.01). Multiplicative interactions between animal-derived iron and BMI or animal-derived fat intake were not observed. Animal-derived iron intake is associated with increased risk of EC after menopause and among obese women. Avoidance of animal-derived (heme) iron may reduce the risk of EC in these women.     

Potato consumption and cardiovascular disease risk factors among Iranian population

Background: Previous studies investigated the effects of dietary glycaemic index and glycaemic load on cardiovascular risk factors. Little evidence is available regarding the association between potato intake and cardiovascular risk factors in Iran. Objective: This cross-sectional study was conducted in the first stage of Isfahan Healthy Heart Programme. Methods: A total of 4774 subjects were included in the present study. Dietary intake was assessed with a 49-item food frequency questionnaire. Biochemical assessments were done according to the standard protocol. Results: There were significant associations between potato consumption and diabetes mellitus (odds ratio (OR): 1.38; 95% CI: 1.14–1.67; p < 0.001), high fasting blood sugar level (OR: 1.40; 95% CI: 1.17–1.68; p < 0.001) and low serum high density lipoprotein level (OR: 1.10; 95% CI: 1.01–1.20; p = 0.02) remained after adjustments for possible confounding factors. Conclusion: We found a positive relation between potato consumption, high fasting blood glucose level and diabetes mellitus.     

Sociocultural hegemony,gendered identity,and use of traditional and complementary medicine in Ghana

ABSTRACT

This study investigated gender differences in the use of traditional and complementary medicine (TCM) in Ghana. Using an interviewer-administered questionnaire, we collected data from March to June 2013 from 324 randomly sampled adults in the Ashanti region. The prevalence of TCM use in the prior 12 months was 86 percent. Females constituted the majority (61 percent) of TCM users. Female TCM users were more likely than male users to have had only a basic education, been traders (p ? .0001), and have health insurance (p ? .05). Using multiple logistic regression, TCM use was associated with urban residence for females (odds ratio [OR] = 7.82; 95 percent confidence interval [CI]: 1.28–47.83) but negatively related for males (OR = 0.032; 95 percent CI: 0.002–0.63). Being self-employed was associated with TCM use among males (OR = 7.62; 95 percent CI: 1.22–47.60), while females’ TCM use was associated with higher income (OR = 3.72; 95 percent CI: 1.21–11.48) and perceived efficacy of TCM (OR = 5.60; 95 percent CI: 1.78–17.64). The African sociocultural structure vests household decision-making power in men but apparently not regarding TCM use, and the factors associated with TCM use largely differed by gender. These findings provide ingredients for effective health policy planning and evaluation. Adoption and modernization of TCM should apply a gendered lens.     

Low Adherence to Dietary Guidelines in Spain,Especially in the Overweight/Obese Population: The ANIBES Study

Objective: The objective of this study was to analyze the dietary intake of the Spanish population according to ponderal status and body fat distribution.

Methods: Data were obtained from ANIBES (Anthropometry, Intake, and Energy Balance in Spain), a cross-sectional study of a nationally representative sample (1013 men, 996 women) of the Spanish population (18–64 years). The final fieldwork was carried out from mid-September to November (three months) 2013. A 3-day dietary record provided information about food and beverage consumption. Height, weight, and waist circumference were assessed, and body mass index (BMI) and waist–height ratio (WHtR) calculated.

Results: The Spanish population had a low consumption of fruits and vegetables, cereals, whole cereals, and dairy and high consumption of meat products. Individuals with overweight/obesity (BMI ≥ 25 kg/m²) and abdominal adiposity (WHtR ≥ 0.5) showed lower compliance with dietary guidelines. In the male group, adjusting by age, inadequate consumption of cereals (<4 servings/day) and vegetables and fruit (<5 servings/day) was associated with higher risk of overweight (odds ratio [OR] = 1.704, 95% confidence interval [CI], 1.187–2.447, p = 0.001, for cereals and OR = 3.816, 95% CI, 1.947–7.480, p = 0.001, for vegetables and fruits) and abdominal adiposity (OR = 2.081, 95% CI, 1.419–3.053, p = 0.000 and OR = 4.289, 95% CI, 2.108–8.726, p = 0.001, respectively).

Conclusion: Nutritional campaigns should be conducted to improve the dietary habits of the Spanish population in general, especially men, who have poorer ponderal status and abdominal adiposity, due to their lower adherence to dietary guidelines.     

Physical Activity and Health Service Utilization Among Older People

BackgroundRising health care use among older people presents a challenge to medical care. Physical activity (PA) is beneficial; however, it is unknown if initiating PA among the very old reduces health service use. We examined the effects of changing PA levels on emergency room (ER) visits and hospitalization at ages 78 and 85.MethodsA representative sample (born 1920–1921) from the Jerusalem Longitudinal Cohort Study (1990–2010) were assessed at ages 78 and 85 for self-reported PA; ER visits and hospitalization; and social, functional, and medical domains.ResultsWe examined 896 and 1173 subjects at ages 78 and 85, respectively. ER usage at ages 78 and 85 respectively was lower among active subjects (15.8% vs 37.4%, P < .0001; 30.6% vs 50.8%, P < .0001), as was hospitalization (10.5% vs 16.7%, P < .05; 22.1% vs 37.8%, P < .0001). We adjusted for gender, education, loneliness, functional dependence, cognitive impairment, depression, diabetes, heart disease, hypertension, neoplasm, renal disease, self-rated health, body mass index, and smoking. PA at age 78 was associated with a reduced likelihood of ER visits (odds ratio [OR] 0.49, 95% confidence interval [CI] 0.27–0.89), but not hospitalization (OR 1.14, 95% CI 0.54–2.42); at age 85 with a reduced likelihood for ER visits (OR 0.72, 95% CI 0.52–0.99) and hospitalization (OR 0.68, 95% CI 0.48–0.98). Compared with subjects consistently active at ages 78 and 85, initiating PA between ages 78 and 85 resulted in similar lower likelihood of ER visits (OR 0.6, 95% CI 0.23–1.56) and hospitalization (OR 1.20, 95% CI 0.48–3.02); stopping PA and never being active between 78 and 85 were respectively associated with increased ER visits (OR 1.72, 95% CI 1.02–2.88; OR 2.18, 95% CI 1.04–4.57) and hospitalization (OR 1.85, 95% CI 1.06–3.23; OR 2.01, 95% CI 0.92–4.4).ConclusionsAmong the oldest old, not only continuing but also becoming physically active is associated with reduced health service use. Initiating PA among the very old should be encouraged.     

Inadequate diabetes knowledge is associated with poor glycemia control in patients with type 2 diabetes

ObjectiveTo identify the association between glycemia control with level of diabetes knowledge, diabetes education, and lifestyle variables in patients with type 2 diabetes.DesignCross-sectional analytical study.SiteClinics of the Mexican Institute of Social Security (IMSS), Mexico.ParticipantsPatients with type 2 diabetes.Main measurementsGlycated hemoglobin (HbA1c), glucose, and lipid profile levels were measured from fasting venous blood samples. Assessment of disease knowledge was performed using the Diabetes Knowledge Questionnaire (DKQ-24). Systolic and diastolic blood pressure was measured. Weight and abdominal circumference were measured, as well as body composition using bioimpedance. Sociodemographic, clinical, and lifestyle variables were obtained.ResultsA total of 297 patients were included, sixty-seven percent (67%) were women with a median of six years since the diagnosis of diabetes. Only 7% of patients had adequate diabetes knowledge, and 56% had regular knowledge. Patients with adequate diabetes knowledge had a lower body mass index (p = 0.016), lower percentage of fat (p = 0.008), and lower fat mass (p = 0.018); followed a diet (p = 0.004) and had received diabetes education (p = 0.002), and to obtain information about their illness (p = 0.001). Patients with low levels of diabetes knowledge had a higher risk of HbA1c ≥ 7% (OR: 4.68; 95% CI: 1.48,14.86; p = 0.009), as well as those who did not receive diabetes education (OR: 2.17; 95% CI: 1.21–3.90; p = 0.009) and those who did not follow a diet (OR: 2.37; 95% CI: 1.01,5.55; p = 0.046).ConclusionInadequate knowledge of diabetes, lack of diabetes education, and dietary adherence are associated with poor glycemia control in patients with diabetes.     

Revisiting the healthy immigrant effect with diabetes risk in Canada: why race/ethnicity matters

ABSTRACT

Objective: Evidence shows that recent immigrants are healthier than the native-born population, a phenomenon known as the healthy immigrant effect. With increasing duration of stay, this health gap significantly narrows as immigrants’ health deteriorates to either resemble or become worse than the host population. However, little is known about the category of immigrants for whom this decline is most pronounced since the extant research largely considers immigrants as a homogeneous group, thus overlooking important racial/ethnic differences.

Design: Using data from the 2014 Canadian Community Health Survey (CCHS), we categorised immigrants by race/ethnicity and duration of stay in Canada and compared them to their native-born white Canadian counterparts on the likelihood of having a chronic health condition, using type 2 diabetes (T2D) as a case.

Results: In the base model, recent visible minority (i.e. non-white or non-Caucasian) immigrants and recent white immigrants were less likely than the native-born white Canadian population to have T2D (recent visible minority immigrants OR?=?0.46, CI?=?0.27–0.79, p?=?0.005; recent white immigrants OR?=?0.26, CI?=?0.11–0.64, p?=?0.003). The odds of having T2D were significantly higher for long-term immigrants than the native-born white Canadian population (long-term visible minority immigrants OR?=?1.59, CI?=?1.27–2.00, p?=?0.000; long-term white immigrants OR?=?1.74, CI?=?1.44–2.10, p?=?0.000). In the multivariate model, long-term visible minority immigrants were about 2.3 times more likely than their white Canadian born counterparts to have T2D (CI?=?1.86–2.96, p?=?0.000). Long-term visible minority immigrants were about 2.1 times more likely than long-term white immigrants to have T2D (CI?=?1.49–2.94, p?=?0.000)

Conclusion: Immigrants’ health deterioration varies significantly across ethnic categories in Canada. Interventions for facilitating the integration of visible minority immigrants may help reduce these health inequities.     

Obese Mothers have Lower Odds of Experiencing Pro-breastfeeding Hospital Practices than Mothers of Normal Weight: CDC Pregnancy Risk Assessment Monitoring System (PRAMS), 2004–2008

Objectives This study examines the extent to which a mother’s pre-pregnancy body mass index (BMI) category is associated with her exposure to pro-breastfeeding hospital practices. Methods Data from the 2004–2008 CDC PRAMS were analyzed for three states (Illinois, Maine, and Vermont) that had administered an optional survey question about hospital pro-breastfeeding practices. Results Of 19,145 mothers surveyed, 19 % were obese (pre-pregnancy BMI ≥ 30). Obese mothers had lower odds than mothers of normal weight of initiating breastfeeding [70 vs. 79 % (unweighted), p < 0.0001]. Compared with women of normal weight, obese mothers had lower odds of being exposed to pro-breastfeeding hospital practices during the birth hospitalization. Specifically, obese mothers had higher odds of using a pacifier in the hospital [odds ratio (OR) 1.31, 95 % confidence interval (CI) (1.17–1.48), p < 0.0001] and lower odds of: a staff member providing them with information about breastfeeding [OR 0.71, 95 % CI (0.57–0.89), p = 0.002], a staff member helping them breastfeed [OR 0.69, 95 % CI (0.61–0.78), p < 0.0001], breastfeeding in the first hour after delivery [OR 0.55, 95 % CI (0.49–0.62), p < 0.0001], being given a telephone number for breastfeeding help [OR 0.65, 95 % CI (0.57–0.74), p < 0.0001], rooming in [OR 0.84, 95 % CI (0.73–0.97), p = 0.02], and being instructed to breastfeed on demand [OR 0.66, 95 % CI (0.58–0.75), p < 0.0001]. Adjusting for multiple covariates, all associations except rooming in remained significant. Conclusions Obesity stigma may be a determinant of breastfeeding outcomes for obese mothers. Breastfeeding support should be improved for this at-risk population.     

“NQO1 Gene C609T Polymorphism (dbSNP: rs1800566) and Digestive Tract Cancer Risk: A Meta-Analysis.”

Several studies reported that polymorphism C609T (rs1800566) in (NAD(P)H): quinoneoxidoreductase 1 (NQO1) gene is associated with risk to digestive tract (DT) cancers, like esophageal cancer (EC), gastric cancer (GC), and colorectal cancer (CRC). Authors conducted a meta-analysis to investigate association between C609T polymorphism and DT cancer risk. Eligible studies were extracted from the databases of PubMed, Google Scholar, Science Direct, and Springer Link. All retrieved articles were evaluated. All statistical analyses were performed using Open Meta-Analyst and MIX1.7 programs. A total of 34 studies including 12,043 DT cancer cases and 15,209 healthy controls were included in the present meta- analysis. Results of meta-analysis revealed a significant association between NQO1 C609T polymorphism and DT cancer risk adopting all 5 genetic models (T vs. C: OR = 1.21, 95% CI = 1.11–1.31, p < 0.001; TT vs. CC: OR = 1.48, 95% CI = 1.22–1.79, p < 0.001; TT + CT vs. CC: OR = 1.23, 95% CI = 1.12–1.35, p < 0.001; TT vs. CT + CC: OR = 1.36, 95% CI = 1.15–1.60, p < 0.001; CT vs. CC: OR = 1.16, 95% CI = 1.07–1.27, p < 0.001). In the stratified analysis based on cancer types, significant associations were observed between NQO1 C609T polymorphism and GC (OR = 1.38, 95% CI = 1.11–1.72, p = 0.003) and CRC (OR = 1.18, 95% CI = 1.06–1.30, p = 0.001), but not with EC (OR = 1.16, 95% CI = 0.99–1.35, p = 0.06). Furthermore, stratified analysis based on ethnicity indicated that there was a significant association between NQO1 C609T polymorphism and DT cancer risk in the Asian (TT vs. CC: OR = 1.55, 95% CI = 1.21–2.00, p ≤ 0.001) as well as in Caucasian populations (TT vs. CC: OR = 1.34, 95% CI = 1.04–1.73, p = 0.02). In conclusion, the results of meta-analysis suggested that the NQO1 C609T polymorphism is a risk factor for DT cancers, including GC and CRC.     

Percutaneous endoscopic gastrostomy (PEG) tube feeding of nursing home residents is not associated with improved body composition parameters

Objectives

To study differences in nutritional status and body composition, by feeding modality, among disabled nursing home residents.

Design

A retrospective chart-review study.

Setting

A nursing wing of a public urban geriatric center.

Participants

Three groups of patients: non-dysphagic, orally-fed dysphagic and percutaneous endoscopic gastrostomy -fed dysphagic patients. Intervention: Standard nursing care

Measurements

Basal metabolic rate, total energy expenditure and nitrogen balance under oral or percutaneous endoscopic gastrostomy feeding. Dietary intake was assessed during a 3-days period by daily-food intake protocols and a 24-hours urinary creatinine excretion to detect nitrogen balance and calculate body composition parameters.

Results

Data of 117 patients (55.5% females), mean age 84.6±7.5 (range 66–98 years) was analyzed. Dysphagic patients (60) differed from non-dysphagic patients (57) by lower body mass index (p=0.020), fat mass index (p=0.017), daily protein intake (p<0.0001), daily energy intake (p<0.001), protein related energy intake (p<0.001) and a negative nitrogen balance (p<0.001). In regression analyses, dysphagia was associated with increased risk of having a body mass index lower than 22.0kg/m2 (OR=2.60, 95% CI 1.135–5.943), a negative nitrogen balance (OR=2.33, 95% CI 1.063–4.669), a low fat mass index (OR=2.53, 95% CI 1.066–6.007), and low daily protein and energy intakes per body weight (OR=2.87, 95% CI 1.316–6.268 and OR=2.99, 95% CI 1.297–6.880). Compared with orally-fed dysphagic patients (21pts.), percutaneous endoscopic gastrostomy -fed patients (39pts.) received an additional mean energy intake of 30.5% kcal per day and mean protein intake of 26.0%. This additional intake was not associated with improved body composition parameters (such as fat free mass, skeletal mass or body mass index).

Conclusion

Dysphagic nursing home residents are characterized by worse nutritional, metabolic and body composition parameters, compared with non-dysphagic residents. Body composition parameters did not differ between orally-fed and percutaneous endoscopic gastrostomy-fed dysphagic patients, despite significantly better nutritional and metabolic parameters in PEG-fed patients. Other approaches (perhaps physical training, pharmacological etc.) should be sought to improve body composition of such patients.     

Ten-Year Changes in Healthy Eating Attitudes in the SUN Cohort

Objective: The objective of this study was to assess the within-subject longitudinal changes in self-perceived healthy eating attitudes after 10 years of follow-up and to identify predictors of long-term changes in a middle-aged adult cohort.

Methods: Four thousand five hundred seventy-two participants completed a validated food frequency questionnaire (FFQ) at baseline and after 10 years of follow-up. The FFQ was expanded with a brief 10-item questionnaire about eating attitudes with 2 possible answers: yes or no. A baseline score and a 10-year score were calculated with these 10 items (range from 0 to 10). Participants were categorized into 3 groups according to this score. Linear and logistic regressions were used to examine changes at follow-up and associations between baseline characteristics and improvement in the score.

Results: After 10 years of follow-up, a statistically significant favorable change (p < 0.001) was achieved in all questions about eating attitudes, particularly in these items: “Do you try to eat less sweets and pastries?” (12%), “Do you try to eat less meat?” (11.1%), and “Do you try to reduce your fat intake?” (10%). Being female (odds ratio [OR] = 1.19, 95% confidence interval [CI], 1.02–1.39), being 35–50 or ≥ 50 years old (OR = 1.24, 95% CI, 1.07–1.44 and OR = 1.74, 95% CI, 1.38–2.18, respectively), a high level of physical activity (OR for third vs first tertile = 1.20, 95% CI, 1.02–1.41), and a higher Mediterranean diet score (OR for second and third tertiles = 1.18, 95% CI, 1.01–1.37 and OR = 1.26, 95% CI, 1.04–1.52, respectively) were associated with a higher probability of improving the eating attitudes score, while a low body mass index (BMI; OR = 0.71, 95% CI, 0.51–1.00) and snacking between meals (OR = 0.84, 95% CI, 0.73–0.97) were associated with a lower probability of improving their score.

Conclusions: The eating attitudes of the participants in the Seguimiento Universidad de Navarra (SUN) cohort became more favorable after 10 years of follow-up. Certain sociodemographic or clinical variables may predict a positive change.