Eating Fish and Risk of Type 2 Diabetes: A population-based, prospective follow-up study

Objective: To investigate the relation between total fish, type of fish (lean and fatty), and EPA&DHA intake and risk of type 2 diabetes in a population-based cohort. Research design and methods: The analysis included 4,472 Dutch participants aged =55 years without diabetes at baseline. Dietary intake was assessed with a semi-quantitative food frequency questionnaire. Hazard ratios (RR) with 95% confidence intervals (95% CI) were used to examine risk associations adjusted for age, sex, lifestyle, and nutritional factors. Results: After 15 years of follow-up, 463 participants developed type 2 diabetes. Median fish intake, mainly lean fish (81% ), was 10 g/d. Total fish intake was associated positively with risk of type 2 diabetes; the RR was 1.32 (95% CI 1.02, 1.70) in the highest total fish group (=28 g/d) compared with non-fish eaters (p for trend= 0.04). Correspondingly, lean fish intake tended to be associated positively with type 2 diabetes (RR highest group (=23 g/d): 1.30 (95% CI 1.01, 1.68), p for trend= 0.06), but fatty fish was not. No association was observed between EPA&DHA intake and type 2 diabetes (RR highest group (=149.4 mg/d): 1.22 (95% CI 0.97, 1.53)). When additionally adjusted for intake of selenium, cholesterol, and vitamin D this RR decreased to 1.05 (95% CI 0.80, 1.38) (p for trend= 0.77). Conclusion: The findings do not support a beneficial effect of total fish, type of fish, or EPA&DHA intake on the risk of type 2 diabetes. Alternatively, other dietary components, like selenium, and unmeasured contaminants present in fish might explain our result

Dietary Patterns and Glucose Tolerance Abnormalities in Chinese Adults

OBJECTIVE To investigate the association of the dietary pattern with the presence of newly diagnosed glucose tolerance abnormalities among Chinese adults. RESEARCH DESIGN AND METHODS A total of 20,210 adults aged 45–69 years from the 2002 China National Nutrition and Health Survey were included. Information on dietary intake was collected using a validated food frequency questionnaire. Factor analysis and cluster analysis were used to identify the food factors and dietary pattern clusters. RESULTS Four dietary pattern clusters were identified (“Green Water,” “Yellow Earth,” “Western Adopter,” and “New Affluence”). The prevalence of glucose tolerance abnormalities ranged from 3.9% in the Green Water to 8.0% in the New Affluence. After adjustment for area, age, sex, current smoking, and physical activity, subjects in the Yellow Earth cluster (prevalence ratio 1.22 [95% CI 1.04–1.43]) and New Affluence cluster (2.05 [1.76–2.37]) had significantly higher prevalence rates compared with those for the Green Water cluster. After further adjustment for BMI and waist-to-height ratio, the elevated risk in the New Affluence remained statistically significant. CONCLUSIONS Dietary patterns and food factors are associated with the presence of glucose tolerance abnormalities in China, even independent of obesity. A New Affluence diet is an important modifiable risk factor, which needs attention from the prevention point of vie

HbA1c levels in non-diabetic older adults - No J-shaped associations with primary cardiovascular events, cardiovascular and all-cause mortality after adjustment for confoundersin a meta-analysis of individual participant data from six cohort studies

Background: To determine the shape of the associations of HbA1c with mortality and cardiovascular outcomes in non-diabetic individuals and explore potential explanations. Methods: The associations of HbA1c with all-cause mortality, cardiovascular mortality and primary cardiovascular events (myocardial infarction or stroke) were assessed in non-diabetic subjects >50years from six population-based cohort studies from Europe and the USA and meta-analyzed. Very low, low, intermediate and increased HbA1c were defined as <5.0, 5.0 to <5.5, 5.5 to <6.0 and 6.0 to <6.5% (equals <31, 31 to <37, 37 to <42 and 42 to <48mmol/mol), respectively, and low HbA1c was used as reference in Cox proportional hazards models. Results: Overall, 6,769 of 28,681 study participants died during a mean follow-up of 10.7years, of whom 2,648 died of cardiovascular disease. Furthermore, 2,493 experienced a primary cardiovascular event. A linear association with primary cardiovascular events was observed. Adjustment for cardiovascular risk factors explained about 50% of the excess risk and attenuated hazard ratios (95% confidence interval) for increased HbA1c to 1.14 (1.03-1.27), 1.17 (1.00-1.37) and 1.19 (1.04-1.37) for all-cause mortality, cardiovascular mortality and cardiovascular events, respectively. The six cohorts yielded inconsistent results for the association of very low HbA1c levels with the mortality outcomes and the pooled effect estimates were not statistically significant. In one cohort with a pronounced J-shaped association of HbA1c levels with all-cause and cardiovascular mortality (NHANES), the following confounders of the association of very low HbA1c levels with mortality outcomes were identified: race/ethnicity; alcohol consumption; BMI; as well as biomarkers of iron deficiency anemia and liver function. Associations for very low HbA1c levels lost statistical significance in this cohort after adjusting for these confounders. Conclusions: A linear association of HbA1c levels with primary cardiovascular events was observed. For cardiovascular and all-cause mortality, the observed small effect sizes at both the lower and upper end of HbA1c distribution do not support the notion of a J-shaped association of HbA1c levels because a certain degree of residual confounding needs to be considered in the interpretation of the results. \ua9 2016 Sch\uf6ttker et al

Interactions of dietary fat intake and the hepatic lipase -480C-->T polymorphism in determining hepatic lipase activity: the Hoorn Study

BACKGROUND: Gene-nutrient interactions affecting hepatic lipase (HL) activity may contribute to the interindividual variability of the cardiovascular disease risk associated with dietary fat intake. OBJECTIVE: We determined the associations of dietary fat intake with postheparin HL activity and the possible modifying effect of the HL -480C-->T polymorphism on these associations. DESIGN: Subjects were recruited from participants in the 2000-2001 follow-up examination of the Hoorn Study. HL activity was determined in postheparin plasma in a sample of 211 men and 218 women aged 60-87 y. Information about dietary intake of the participants was obtained with a validated food-frequency questionnaire. Linear regression was performed, adjusted for age. RESULTS: Total dietary fat was positively associated with HL activity (standardized beta: 0.11; 95% CI: 0.02, 0.21), and this association was also seen for saturated fat (0.10; 0.01, 0.20) and monounsaturated fatty acid (0.10; 0.01, 0.19). We observed a significant interaction of the HL polymorphism with the relation between total fat intake and HL activity. The association of total fat with HL activity was stronger in subjects with CT (0.27; 0.11, 0.43) and TT (0.39; -0.22, 1.00) genotypes than in subjects with the CC genotype (0.06; -0.06, 0.18; P for interaction T polymorphism, after adjustment for age, sex, carbohydrate and protein intakes, and insulin or body mass index

Study on lifestyle-intervention and impaired glucose tolerance Maastricht (SLIM): Design and screening results

The study on lifestyle-intervention and impaired glucose tolerance Maastricht (SLIM) is a 3 years randomised clinical trial designed to evaluate the effect of a combined diet and physical activity intervention program on glucose tolerance in a Dutch population at increased risk for developing type 2 diabetes. Here the design of the lifestyle-intervention study is described and results are presented from the preliminary population screening, conducted between March 1999 and June 2000. In total, 2820 subjects with an increased risk of having disturbances in glucose homeostasis (i.e. age >40 years and BMI > 25 kg/m2 or a family history of diabetes) underwent a first oral glucose tolerance test (OGTT). Abnormal glucose homeostasis was detected in 826 subjects (30.4%): 226 type 2 diabetes (type 2DM, 8.3%), 215 impaired fasting glucose (IFG, 7.9%) and 385 impaired glucose tolerance (IGT, 14.2%). Both increasing age and BMI were strongly related to the prevalence of IGT and diabetes. After a second OGTT, 114 subjects with glucose intolerance and in otherwise good health were eligible for participation in the intervention study (SLIM). The high prevalence of disturbances in glucose homeostasis observed in the preliminary screening underscore the importance of early (lifestyle) interventions in those at risk for developing diabetes. SLIM will address this topic in the Dutch population

The feasibility of implementing food-based dietary guidelines and food graphics in Ethiopia

This study aimed to test the acceptability, cultural appropriateness, consumers' understanding, and practicality of the Ethiopian food-based dietary guideline's messages, tips, and food graphics. A qualitative study design was applied with focus group discussions and key informant interviews. Four different participant groups were included: 40 consumers, 15 high-level nutrition experts, 30 frontline community health extension workers (HEWs), and 15 agriculture extension workers (AEWs) to incorporate different stakeholder perspectives. Data collection was conducted using 7 focus group discussions (FGDs) and 30 key informant interviews (KIIs). Collected data were coded and analyzed using QSR International NVivo V.11 software. Most of the study participants were highly interested in implementing the dietary guidelines once these guidelines are officially released. Based on the participants' views, most of the messages align with the current nutrition education materials implemented in the country except the messages about physical activity and alcohol intake. However, participants suggested defining technical terms such as ultra-processing, whole grain, safe and balanced diet in simpler terms for a better understanding. Practicality, affordability, availability, and access to the market were the major barriers reported for adherence to the guidelines. To be more inclusive of cultural and religious beliefs, findings show that the guideline should address fasting and traditional cooking methods. In conclusion, the dietary guidelines were well received by most stakeholders. They are thought to be feasible once feedback on wording, affordability, availability, and access is considered in the messages, tips, and graphic designs

Vitamin D and mortality: meta-analysis of individual participant data from a large consortium of cohort studies from Europe and the United States

Contains fulltext : 137188.pdf (publisher's version ) (Open Access)OBJECTIVE: To investigate the association between serum 25-hydroxyvitamin D concentrations (25(OH)D) and mortality in a large consortium of cohort studies paying particular attention to potential age, sex, season, and country differences. DESIGN: Meta-analysis of individual participant data of eight prospective cohort studies from Europe and the US. SETTING: General population. PARTICIPANTS: 26 018 men and women aged 50-79 years MAIN OUTCOME MEASURES: All-cause, cardiovascular, and cancer mortality. RESULTS: 25(OH)D concentrations varied strongly by season (higher in summer), country (higher in US and northern Europe) and sex (higher in men), but no consistent trend with age was observed. During follow-up, 6695 study participants died, among whom 2624 died of cardiovascular diseases and 2227 died of cancer. For each cohort and analysis, 25(OH)D quintiles were defined with cohort and subgroup specific cut-off values. Comparing bottom versus top quintiles resulted in a pooled risk ratio of 1.57 (95% CI 1.36 to 1.81) for all-cause mortality. Risk ratios for cardiovascular mortality were similar in magnitude to that for all-cause mortality in subjects both with and without a history of cardiovascular disease at baseline. With respect to cancer mortality, an association was only observed among subjects with a history of cancer (risk ratio, 1.70 (1.00 to 2.88)). Analyses using all quintiles suggest curvilinear, inverse, dose-response curves for the aforementioned relationships. No strong age, sex, season, or country specific differences were detected. Heterogeneity was low in most meta-analyses. CONCLUSIONS: Despite levels of 25(OH)D strongly varying with country, sex, and season, the association between 25(OH)D level and all-cause and cause-specific mortality was remarkably consistent. Results from a long term randomised controlled trial addressing longevity are being awaited before vitamin D supplementation can be recommended in most individuals with low 25(OH)D levels