Legume and soy food intake and the incidence of type 2 diabetes in the Shanghai Women's Health Study

BACKGROUND: It has been postulated that a diet high in legumes may be beneficial for the prevention of type 2 diabetes mellitus (type 2 DM). However, data linking type 2 DM risk and legume intake are limited. OBJECTIVE: The objective of the study was to examine the association between legume and soy food consumption and self-reported type 2 DM. DESIGN: The study was conducted in a population-based prospective cohort of middle-aged Chinese women. We followed 64,227 women with no history of type 2 DM, cancer, or cardiovascular disease at study recruitment for an average of 4.6 y. Participants completed in-person interviews that collected information on diabetes risk factors, including dietary intake and physical activity in adulthood. Anthropometric measurements were taken. Dietary intake was assessed with a validated food-frequency questionnaire at the baseline survey and at the first follow-up survey administered 2-3 y after study recruitment. RESULTS: We observed an inverse association between quintiles of total legume intake and 3 mutually exclusive legume groups (peanuts, soybeans, and other legumes) and type 2 DM incidence. The multivariate-adjusted relative risk of type 2 DM for the upper quintile compared with the lower quintile was 0.62 (95% CI: 0.51, 0.74) for total legumes and 0.53 (95% CI: 0.45, 0.62) for soybeans. The association between soy products (other than soy milk) and soy protein consumption (protein derived from soy beans and their products) with type 2 DM was not significant. CONCLUSIONS: Consumption of legumes, soybeans in particular, was inversely associated with the risk type 2 DM.     

The association of whole grain consumption with incident type 2 diabetes: the Women's Health Initiative Observational Study

PurposeWhole grains may offer protection from diabetes by decreasing energy intake, preventing weight gain, and direct effects on insulin resistance. This study examined associations of whole and refined grains with incident type 2 diabetes (T2D) ascertained by self-reported medication use in a cohort of postmenopausal women.MethodsWe included 72,215 women free of diabetes at baseline from the Women's Health Initiative Observational Study. Whole grain consumption was categorized as 0, less than 0.5, 0.5 to 1.0, 1.0 to less than 1.5, 1.5 to less than 2.0, and 2.0 or more servings per day. Proportional hazards regression was performed to estimate hazard ratios (HR) and 95% confidence intervals adjusting for potential confounders.ResultsThere were 3465 cases of incident T2D over median follow-up of 7.9 years. Adjusted for age and energy intake per day, successively increasing categories of whole grain consumption were associated with statistically significant reduced risk of incident T2D (HRs, 1.00, 0.83, 0.73, 0.69, 0.61, and 0.57; P for trend < 0.0001). Results were attenuated after adjustment for confounders and other dietary components. The reduction in risk of T2D was greater among nonsmokers and those who maintained their weight within 5 pounds with higher consumption of whole grains than smokers and women who gained more weight.ConclusionsThis large, prospective study found an inverse dose–response relationship between whole grain consumption and incident T2D in postmenopausal women.     

Health-promoting behaviors among adults with type 2 diabetes: findings from the Health and Retirement Study

BACKGROUND: Type 2 diabetes has an enormous impact on the health care system and individuals. Dietary habits, exercise, weight management, and smoking status are critical to management and prevention of complications. This study describes the prevalence of these behaviors and their change over time in a national sample of adults with type 2 diabetes. The relationships between behavior change and sociodemographic and health status measures are explored. METHODS: Data are from the first and third longitudinal waves of the Health and Retirement Study. Surveys were conducted face-to-face or via telephone in 1992 and 1996. RESULTS: The sample consisted of 733 persons with type 2 diabetes, ages 50-62. The most common behaviors were being on a special diet (79.6%), and not smoking (76.6%). Sixty-six percent were engaged in some physical activity, and 58.4% were trying to lose weight. Reports of being on a special diet, trying to lose weight, and exercising all diminished over time. CONCLUSIONS: The prevalence of these behaviors is disappointing. Worse, they declined over the 4-year period. A better understanding of factors contributing to a person's decision to begin or discontinue health-promoting behaviors is needed to plan effective supportive or preemptive interventions.     

Soyfood consumption and risk of glycosuria: a cross-sectional study within the Shanghai Women's Health Study

OBJECTIVE: To assess the association between soyfood intake and risk of glycosuria. DESIGN AND METHODS: A cross-sectional study was conducted among participants of the Shanghai Women's Health Study, a population-based cohort study of women aged 40-70 y. Information on usual intake of soyfoods was obtained at baseline survey through an in-person interview using a validated food-frequency questionnaire. Included in this study were 39,385 cohort members screened for diabetes at the baseline survey and free of previously diagnosed diabetes, cardiovascular diseases, kidney diseases, and cancer. There were 323 women who tested positive for urine glucose. Odds ratios (ORs) and 95% confidence intervals (CIs) were employed to measure the association between soyfood intake and glycosuria using unconditional logistic regression. SETTING: Urban communities of Shanghai, China. RESULTS: Overall, soyfood intake was not related to the risk of glycosuria. Among postmenopausal women, however, intake of tofu and other soy products was inversely associated with risk of glycosuria after adjustment for potential confounders. The ORs across quintiles of intake were 1.0, 0.75 (95% CI=0.47-1.20), 0.79 (95% CI=0.51-1.25), 0.53 (95% CI=0.32-0.88), and 0.51 (95% CI=0.26-0.98; P for trend=0.05). Further analyses showed that the inverse association was primarily confined to postmenopausal women with a body mass index (BMI) of <25 kg/m2. The adjusted OR comparing the extreme quintiles was 0.36 (95% CI=0.13-0.97; P for trend=0.004). CONCLUSIONS: Soyfoods may play a role in the development of glycosuria, an important indicator of diabetes, among postmenopausal women with a low BMI.     

Reproducibility and validity of the Shanghai Women's Health Study physical activity questionnaire

In this investigation, the authors evaluated the reproducibility and validity of the Shanghai Women's Health Study (SWHS) physical activity questionnaire (PAQ), which was administered in a cohort study of approximately 75,000 Chinese women aged 40-70 years. Reproducibility (2-year test-retest) was evaluated using kappa statistics and intraclass correlation coefficients (ICCs). Validity was evaluated by comparing Spearman correlations (r) for the SWHS PAQ with two criterion measures administered over a period of 12 months: four 7-day physical activity logs and up to 28 7-day PAQs. Women were recruited from the SWHS cohort (n = 200). Results indicated that the reproducibility of adolescent and adult exercise participation (kappa = 0.85 and kappa = 0.64, respectively) and years of adolescent exercise and adult exercise energy expenditure (ICC = 0.83 and ICC = 0.70, respectively) was reasonable. Reproducibility values for adult lifestyle activities were lower (ICC = 0.14-0.54). Significant correlations between the PAQ and criterion measures of adult exercise were observed for the first PAQ administration (physical activity log, r = 0.50; 7-day PAQ, r = 0.62) and the second PAQ administration (physical activity log, r = 0.74; 7-day PAQ, r = 0.80). Significant correlations between PAQ lifestyle activities and the 7-day PAQ were also noted (r = 0.33-0.88). These data indicate that the SWHS PAQ is a reproducible and valid measure of exercise behaviors and that it demonstrates utility in stratifying women by levels of important lifestyle activities (e.g., housework, walking, cycling).     

The Shanghai Women's Health Study: rationale, study design, and baseline characteristics

Although cancer is a major cause of morbidity and mortality in most nations, the spectrum of cancer occurrence varies substantially worldwide. Most previous epidemiologic studies investigating cancer etiology were conducted in North American and western European countries that are relatively homogenous in terms of cancer spectrums and many lifestyle exposures. These limitations may have hindered these studies from evaluating some important etiologic hypotheses. From 1996 to 2000, the Shanghai Women's Health Study recruited 74,942 adult Chinese women from selected urban communities, with a 92% response rate. All participants completed a detailed baseline survey and anthropometrics. Approximately 88% of cohort members donated a urine sample (n = 65,755) and a blood (n = 56,832) or exfoliated buccal cell (n = 8,934) sample. Noteworthy characteristics of this cohort include low consumption of alcohol (1.9%) and use of tobacco (2.4%); high intake of fish (mean, 50.8 g/day), soy foods (mean, 142.3 g/day), and certain vegetables; low prevalence of obesity (5.1%); and nearly 100% employment outside the home. Currently, this cohort of women is being followed via biennial in-person recontact and periodic linkage to cancer and vital statistics registries. The resources from the cohort will be valuable in future studies of environmental exposures and biomarkers for the risk of cancer and other chronic diseases.     

Coffee, tea, and incident type 2 diabetes: the Singapore Chinese Health Study

BACKGROUND: Increasing coffee intake was inversely associated with risk of type 2 diabetes in populations of European descent; however, data from high-risk Asian populations are lacking as are data on tea intake in general. OBJECTIVE: We investigated the prospective associations between intakes of coffee, black tea, and green tea with the risk of type 2 diabetes in Singaporean Chinese men and women. DESIGN: We analyzed data from 36 908 female and male participants in the Singapore Chinese Health Study aged 45-74 y in 1993-1998 who had multiple diet and lifestyle measures assessed and then were followed up between 1999 and 2004. We used Cox regression models to investigate the association of baseline coffee and tea intakes with incident type 2 diabetes during follow-up, with adjustment for a number of possible confounding or mediating variables. RESULTS: In multivariate models participants reporting > or =4 cups of coffee/d had a 30% reduction in risk of diabetes [relative risk (RR): 0.70; 95% CI: 0.53, 0.93] compared with participants who reported nondaily consumption. Participants reporting > or =1 cup of black tea/d had a suggestive 14% reduction in risk of diabetes (RR: 0.86; 95% CI: 0.74, 1.00) compared with participants who reported 0 cups/d, and we observed no association with green tea. CONCLUSION: Regular consumption of coffee and potentially black tea, but not green tea, is associated with lower risk of type 2 diabetes in Asian men and women in Singapore.     

Dietary patterns and their correlates among middle-aged and elderly Chinese men: a report from the Shanghai Men's Health Study

Dietary patterns, which reflect the complexity of food preference, lifestyle and socio-economic status, may play a major role in health and longevity. Understanding dietary patterns and their correlates is important to the research of diet and health relationships. In the Shanghai Men's Health Study (SMHS) a total of 61,582 men aged 40-74 were recruited between 2002 and 2006. Their food intake over the previous year was collected using a validated FFQ. Study participants (75.6%) reported little or no change in meat and vegetable intake in the 5 years prior to recruitment. Using the baseline data of the SMHS, we assessed dietary patterns, as well as their relationship with socio-demographic and lifestyle factors and with prevalence of some chronic diseases. Three major dietary patterns, fruit-, vegetable- and meat-based diets, were identified in our population. Consumption of the fruit diet appeared to be more common among men who were older and more physically active, had higher income, and lower waist-to-hip ratio (WHR), while this diet was less common among manual labourers. The meat- or vegetable-based diets were less common among elderly men and more common among men with higher WHR. Dietary patterns appeared to be associated with the presence of health conditions. In general, subjects with a chronic disease were more likely to have the vegetable-based diet and less likely to have the fruit- or meat-based diets. Future studies of diet and health in this population will need to carefully take into account these potential confounders.     

Dietary patterns,dietary intakes and the risk of type 2 diabetes: results from the Hefei Nutrition and Health Study

A total of 1776 Chinese adults, aged 40–60 years, had been recruited to participate in the Hefei Nutrition and Health Study started in 2012. Three major dietary patterns were identified, “High-salt and high-fat”, “Traditional Chinese” and “Western” dietary patterns. After adjusting for potential confounders, there is no significant difference in the effect of different dietary pattern quintiles on the risk of type 2 diabetes (T2D). However, compared with lowest quintile intakes, the adjusted odds ratio of T2D for highest quintile intakes of bread and noodle, rice noodle and coarse grain were 2.45 (95% CI: 1.17, 5.12), 0.34 (95% CI: 0.17, 0.92), 0.27 (95% CI: 0.14, 0.51), with corresponding p trend being .002, .375, .003, respectively. Our study suggests that high intakes of bread and noodle are significantly associated with increased risk of T2D, while high intakes of rice noodle and coarse grain are remarkably correlated with decreased risk of T2D.     

Validity and reproducibility of the food frequency questionnaire used in the Shanghai Women's Health Study

To evaluate the validity and reliability of the food frequency questionnaire (FFQ) used in the Shanghai Women's Health Study (SWHS), 200 SWHS participants were recruited for a dietary calibration study. Study participants completed an FFQ at baseline and 24-h dietary recalls (24-HDR) twice per month consecutively for 12 months. At the end of the study, a second FFQ was administered. Of the 200 study participants, 196 completed 24 or more days of 24-h dietary recalls, 191 completed two FFQs from whom the results of this report were based. The FFQ included the foods that accounted for 86% of the foods recorded in the 24-HDR surveys. Validity of the FFQ was evaluated by comparing intake levels of major nutrients and foods obtained from the second FFQ with those derived from the multiple 24-HDR. The median intake for major nutrients, rice, poultry and meat derived from the second FFQ and the 24-HDR was similar, with the differences ranging from 1.3 to 12.1%. The FFQ tended to overestimate the intake level of total vegetables and total fruits, and the differences were explained mainly by over-reporting seasonal vegetables and fruits consumption in the FFQ. Nutrient and food intake assessed by the FFQ and the multiple 24-HDR correlated very well, with the correlation coefficients being 0.59-0.66 for macronutrients, 0.41-0.59 for micronutrients, and 0.41-0.66 for major food groups. The reliability of the FFQ was assessed by comparing the correlation and median intake of nutrients and food groups obtained from the two FFQs that were administered approximately 2 y apart. The median intake levels for selected nutrients and food groups derived from the two FFQs were similar with differences below 10%. At the individual level, the intake levels of these dietary variables obtained from two FFQs also correlated well. When nutrient and food group intakes were categorized into quartiles, FFQ and 24-HDR produced exact agreement rates between 33 and 50%. Misclassification to adjacent quartile was common, ranging from 34-48%, while misclassification to an extreme quartile was rare (1-6%). These data indicate that the SWHS FFQ can reliably and accurately measure usual intake of major nutrients and food groups among women in Shanghai.     

上海市2型糖尿病疾病经济负担研究

目的:探讨上海市2型糖尿病及其并发症的疾病经济负担,为制定有效的疾病健康促进方案提供经济学依据。方法:根据上海市2型糖尿病及其并发症的年直接医疗费用、年直接非医疗费用和间接费用计算2型糖尿病的疾病经济负担。结果:上海市2型糖尿痛及其并发症的人均年门诊费用是1413.88元,次均住院费用是5641.57元,年人均直接医疗费用是2 349.56元;上海市2型糖尿病患者的潜在疾病经济负担是28.96亿元,其中无并发症患者的疾病经济负担是12.45亿元,合并并发症患者的疾病经济负担是16.51亿元。     

Customer quality and type 2 diabetes from the patients' perspective: a cross-sectional study

Background: Quality in health care can be seen as having three principal dimensions: service, technical and customer quality. This study aimed to measure Customer Quality in relation to self-management of Type 2 diabetes. Methods: A cross-sectional survey of 577 Type 2 diabetes people was carried out in Australia. The 13-item Patient Activation Measure was used to evaluate Customer Quality based on self-reported knowledge, skills and confidence in four stages of self-management. All statistical analyses were conducted using SPSS 13.0. Results: All participants achieved scores at the level of stage 1, but ten percent did not achieve score levels consistent with stage 2 and a further 16% did not reach the actual action stage. Seventy-four percent reported capacity for taking action for self-management and 38% reported the highest Customer Quality score and ability to change the action by changing health and environment. Participants with a higher education attainment, better diabetes control status and those who maintain continuity of care reported a higher Customer Quality score, reflecting higher capacity for self-management. Conclusion: Specific capacity building programs for health care providers and people with Type 2 diabetes are needed to increase their knowledge and skills; and improve their confidence to self-management, to achieve improved quality of delivered care and better health outcomes.     

Women's Health Bridges and Barriers: A Qualitative Study

The authors aimed to understand the social bridges and social barriers to women's health in Iran. We used a qualitative content analysis method and interviewed 22 women. The participants identified appropriate employment, physical exercise, and cultural and educational development as social bridges to women's health. Social barriers to women's health included gender inequalities, burden of responsibility, and financial difficulties. Based on the results of this study, we suggest an interdisciplinary approach to plan social-based health programs in order to improve women's health outcomes in the developing countries such as Iran.