Prevalence and gender distribution of the metabolic syndrome

<p>Abstract</p> <p>Background</p> <p>The Metabolic syndrome (MetS) is a cardiovascular risk factor of public health significance and of recent has become a topical issue. The prevalence of diabetes mellitus (DM) is on the increase and with this scenario, a possible increase in burden of DM which may be largely attributed to cardiovascular complications is expected. The objective of this report is to determine the prevalence of the MetS and compare gender characteristics in subjects with type 2 DM.</p> <p>Methods</p> <p>Subjects with type 2 DM were recruited from an urban hospital for the study. Clinical data was obtained by interviewing the patients and referring to their Case folders. The anthropometric indices and blood pressure measurements were documented. Laboratory parameters analysed for included total cholesterol, high density and low density cholesterol, triglyceride and glycosylated haemoglobin. Statistical analysis included usage of Student's t test and chi square.</p> <p>Results</p> <p>963 patients with type 2 DM aged between 35-85 years were recruited for the study. The main outcome measures included the prevalence of the metabolic syndrome and the gender differences of its components. The prevalence of the metabolic syndrome was 86%. The frequency of occurrence of the MetS was similar for men (83%) and women (86%) and increased with age in both sexes. The prevalence of MetS increased from 11% among participants aged 20 through 29 years to 89% in participants aged 70 through 79. In our patients with DM, the commonest occurring and least detected MetS defining parameters are central obesity and elevated triglyceride levels respectively. The components of the MetS that differed significantly in both sexes was HDL-C. The combination of the components of the MetS were comparable in both genders and 5.8% of the subjects with the MetS had all components of the MetS.</p> <p>Conclusion</p> <p>The prevalence of the MetS in type 2DM is high in both genders and increases with age thus posing a potential high cardiovascular risk in this group of patients. The modifiable risk factors for the MetS should be a focus point in the management of subjects with type 2 DM,</p

Task shifting to non-physician clinicians for integrated management of hypertension and diabetes in rural Cameroon: a programme assessment at two years

<p>Abstract</p> <p>Background</p> <p>The burden of non-communicable chronic diseases, such as hypertension and diabetes, increases in sub-Saharan Africa. However, the majority of the rural population does still not have access to adequate care. The objective of this study is to examine the effectiveness of integrating care for hypertension and type 2 diabetes by task shifting to non-physician clinician (NPC) facilities in eight rural health districts in Cameroon.</p> <p>Methods</p> <p>Of the 75 NPC facilities in the area, 69 (87%) received basic equipment and training in hypertension and diabetes care. Effectiveness was assessed after two years on status of equipment, knowledge among trained NPCs, number of newly detected patients, retention of patients under care, treatment cost to patients and changes in blood pressure (BP) and fasting plasma glucose (FPG) among treated patients.</p> <p>Results</p> <p>Two years into the programme, of 54 facilities (78%) available for re-assessment, all possessed a functional sphygmomanometer and stethoscope (65% at baseline); 96% stocked antihypertensive drugs (27% at baseline); 70% possessed a functional glucose meter and 72% stocked oral anti-diabetics (15% and 12% at baseline). NPCs' performance on multiple-choice questions of the knowledge-test was significantly improved. During a period of two years, trained NPCs initiated treatment for 796 patients with hypertension and/or diabetes. The retention of treated patients at one year was 18.1%. Hypertensive and diabetic patients paid a median monthly amount of 1.4 and 0.7 Euro respectively for their medication. Among hypertensive patients with ≥ 2 documented visits (n = 493), systolic BP decreased by 22.8 mmHg (95% CI: -20.6 to -24.9; p < 0.0001) and diastolic BP by 12.4 mmHg (-10.9 to -13.9; p < 0.0001). Among diabetic patients (n = 79) FPG decreased by 3.4 mmol/l (-2.3 to -4.5; p < 0.001).</p> <p>Conclusions</p> <p>The integration of hypertension and diabetes into primary health care of NPC facilities in rural Cameroon was feasible in terms of equipment and training, accessible in terms of treatment cost and showed promising BP- and FPG-trends. However, low case-detection rates per NPC and a very high attrition among patients enrolled into care, limited the effectiveness of the programme.</p

Circadian nutritional behaviours and risk of cardiovascular disease in NutriNet-Santé

International audienceAbstract Meal timings and daily night-time fasting periods can synchronise the circadian system, which regulates the cardiovascular system. The present study aims to evaluate the prospective associations between circadian nutritional behaviours, defined by meal timing and frequency, and the risk of cardiovascular diseases. We used data from 103,389 adults (79% females) in the French NutriNet-Santé study, 2009-2021. Circadian nutritional behaviours were assessed using repeated 24h food records during the first two years of follow-up. We examined the associations between circadian eating behaviours and risk of cardiovascular, coronary heart and cerebrovascular diseases by multivariable Cox proportional hazard models. During a median follow-up of 7.2 years, 2036 incident cardiovascular diseases were diagnosed. A later first meal of the day was associated with a higher risk of cardiovascular diseases (HR per hour increase = 1.06, 95% CI 1.01 - 1.12). A later last meal of the day was associated with a higher risk of cerebrovascular diseases (HR per hour increase = 1.08, 95% CI 1.01 - 1.15). Among women, a later last meal was also associated with a higher risk of cardiovascular disease (HR per hour increase = 1.08, 95% CI 1.01 - 1.15). We found no evidence for an association between night-time fasting duration nor meal frequency, with risk of cardiovascular diseases. This study suggests that the habit of eating a later first meal, and a later last meal (in women) could be associated with a higher risk of developing circulatory diseases. These results need to be confirmed in other largescale studies before they can be transferable to clinical practice. Key messages • Beyond nutritional quality of meals, meal timing could also be a risk factor for cardiovascular disease. • If confirmed in other largescale studies, early breakfast and dinner could be considered in preventive strategies of cardiovascular diseases

Circadian nutritional behaviours and risk of type 2 diabetes in NutriNet-Santé

International audienceAbstract Skipping breakfast and late-night-eating have been associated with risk factors for type 2 diabetes (T2D). However, less is known about the link between daily timing and frequency of food intake and risk of developing T2D. The objective of the present study is to investigate the associations between circadian nutritional behaviours, defined by meal timings and frequency, and risk of T2D. 103,312 adults (79% females, mean age at baseline=42.7) from the French NutriNet-Santé cohort were included. Participants’ circadian nutritional behaviours were assessed using repeated 24 h dietary records. Associations of time of first and last meal of the day, meal frequency and of nighttime fasting duration with risk of T2D were assessed by multivariable Cox proportional hazard models adjusted for known risk factors. During a median follow-up of 7.3 years, 963 new cases of T2D were ascertained. Compared with subjects reporting on average a first meal before 8AM, those having a first meal after 9AM had a higher risk of developing T2D, HR = 1.59 (1.30 to 1.94). A late time of last meal (after 9PM) was associated with a higher risk of T2D, HR = 1.28 (1.06 to 1.54), but this association was no longer significant after adjusting for time of first meal. Each additional eating episode was associated with a reduction of the risk of T2D, HR = 0.95 (0.90 to 0.99), p-value=0.01. Overall, nighttime fasting duration was not associated with risk of T2D, except in participants having breakfast before 8AM after a nighttime fasting duration of more than 13 hours (HR = 0.47, 0.27 to 0.82). In this large prospective study, circadian nutritional behaviours were associated with risk of T2D. Daytime nutritional behaviours and specifically an early first meal was associated with a lower risk of type 2 diabetes. If confirmed in other largescale studies, an early breakfast should be considered in preventive strategies for type 2 diabetes. Key messages • If confirmed in other largescale studies, an early breakfast could be considered in preventive strategies for type 2 diabetes. • Beyond nutritional quality of meals, meal timing could also be a risk factor for type-2 diabetes

Nutritional risk factors for SARS-CoV-2 infection: a prospective study within the NutriNet-Santé cohort

International audienceBackground: Nutritional factors are essential for the functioning of the immune system and could therefore play a role in COVID-19 but evidence is needed. Our objective was to study the associations between diet and the risk of SARS-CoV-2 infection in a large population-based sample.Methods: Our analyses were conducted in the French prospective NutriNet-Santé cohort study (2009-2020). Seroprevalence of anti-SARS-CoV-2 antibodies was assessed by ELISA on dried blood spots. Dietary intakes were derived from repeated 24 h dietary records (at least 6) in the two years preceding the start of the COVID-19 pandemic in France (February 2020). Multi-adjusted logistic regression models were computed.Results: A total of 7766 adults (70.3% women, mean age: 60.3 years) were included, among which 311 were positive for anti-SARS-CoV-2 antibodies. Dietary intakes of vitamin C (OR for 1 SD=0.86 (0.75-0.98), P=0.02), vitamin B9 (OR=0.84 (0.72-0.98), P=0.02), vitamin K (OR=0.86 (0.74-0.99), P=0.04), fibers (OR=0.84 (0.72-0.98), P=0.02), and fruit and vegetables (OR=0.85 (0.74-0.97), P=0.02) were associated to a decreased probability of SARS-CoV-2 infection while dietary intakes of calcium (OR=1.16 (1.01-1.35), P=0.04) and dairy products (OR=1.19 (1.06-1.33), P= 0.002) associated to increased odds. No association was detected with other food groups or nutrients or with the overall diet quality. Conclusions: Higher dietary intakes of fruit and vegetables and, consistently, of vitamin C, folate, vitamin K and fibers were associated with a lower susceptibility to SARS-CoV-2 infection. Beyond its established role in the prevention of non-communicable diseases, diet could therefore also contribute to prevent some infectious diseases such as COVID-19