The EPIC-InterAct Study: A Study of the Interplay between Genetic and Lifestyle Behavioral Factors on the Risk of Type 2 Diabetes in European Populations.

The rising prevalence of type 2 diabetes around the world and the global pattern of variation in risk between countries have been widely attributed to an interplay between rising rates of obesity and poor lifestyles, and genetic or developmental susceptibility to disease. Although this general hypothesis has been in existence for more than 50 years, the precise mechanisms that may explain it have remained uncertain. Advances in technology and the application of new methods in large scale population studies have made it possible to study these mechanisms. The InterAct project, funded by the European Commission, is a large case-cohort study which has verified 12,403 incident cases of type 2 diabetes, facilitating the study of genetic and lifestyle factors on the risk of type 2 diabetes among European populations.This is the final version. It was first published by Springer in Current Nutrition Reports at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4218968

Ethnic Differences in Disability Prevalence and Their Determinants Studied over a 20-Year Period: A Cohort Study.

BACKGROUND: To compare disability prevalence rates in the major ethnic groups in the UK and understand the risk factors contributing to differences identified. It was hypothesised that Indian Asian and African Caribbean people would experience higher rates of disability compared with Europeans. METHODS: Data was collected from 888 European, 636 Indian Asian and 265 African Caribbean men and women, aged 58-88 years at 20-year follow-up of community-based cohort study, based in West London. Disability was measured using a performance-based locomotor function test and self-reported questionnaires on functional limitation, and instrumental (IADL) and basic activities of daily living (ADL). RESULTS: The mean (SD) age of participants at follow-up was 69.6 (6.2) years. Compared with Europeans, Indian Asian people were significantly more likely to experience all of the disability outcomes than Europeans; this persisted after adjustment for socioeconomic, behavioural, adiposity and chronic disease risk factors measured at baseline (locomotor dysfunction: adjusted odds ratio (OR) 2.20, 95% CI 1.56-3.11; functional limitation: OR 2.77, 2.01-3.81; IADL impairment: OR 3.12, 2.20-4.41; ADL impairment: OR 1.58, 1.11-2.24). In contrast, a modest excess risk of disability was observed in African Caribbeans, which was abolished after adjustment (e.g. locomotor dysfunction: OR 1.37, 0.90-1.91); indeed a reduced risk of ADL impairment appeared after multivariable adjustment (OR from 0.99, 0.68-1.45 to 0.59, 0.38-0.93), compared with Europeans. CONCLUSIONS: Substantially elevated risk of disability was observed among Indian Asian participants, unexplained by known factors. A greater understanding of determinants of disability and normative functional beliefs of healthy aging is required in this population to inform intervention efforts to prevent disability

Nutritional basis of type 2 diabetes remission.

Roy Taylor and colleagues explain how type 2 diabetes can be reversed by weight loss and avoidance of weight regai

Dietary fat and cardiometabolic health: evidence, controversies, and consensus for guidance.

Although difficulties in nutrition research and formulating guidelines fuel ongoing debate, the complexities of dietary fats and overall diet are becoming better understood, argue Nita G Forouhi and colleague

Persistent financial hardship, 11-year weight gain, and health behaviors in the Whitehall II study.

OBJECTIVE: To ascertain prospectively gender-specific associations between types and amounts of financial hardship and weight gain, and investigate potential behavioral mechanisms. METHODS: Prospective study of 3701 adult British civil servants with repeated measures of difficulty paying bills or insufficient money to afford adequate for food/clothing (1985-1988; 1989-1990; 1991-1993; 1997-1999), and weight (1985-1988; 1997-1999). RESULTS: Persistent hardships were associated with adjusted mean weight change in women over 10.9 years, but no consistent pattern was seen in men. During follow-up, 46% of women gained ≥5 kg. Women reporting persistent insufficient money for food/clothing had a significantly greater odds of gaining ≥5 kg (1.42 [1.05, 1.92]) compared to no hardship history, which remained after socioeconomic status (SES) adjustment (1.45 [1.05, 2.01]). The association between persistent difficulty paying bills and odds of excess weight gain was also significant (1.42 [1.03, 1.97]) but attenuated after considering SES (1.39 [0.98, 1.97]). Four health behaviors as single measures or change variables did not attenuate associations. CONCLUSIONS: Results suggested strategies to tackle obesity must address employed women's everyday financial troubles which may influence weight through more biological pathways than classical correlates of economic disadvantage and weight.This is the final version, originally published in the journal Obesity here: http://onlinelibrary.wiley.com/doi/10.1002/oby.20875/abstract;jsessionid=EDA4F761217B492D16E7384EB67A7399.f02t02

Dietary and nutritional approaches for prevention and management of type 2 diabetes.

Common ground on dietary approaches for the prevention, management, and potential remission of type 2 diabetes can be found, argue Nita G Forouhi and colleagues Dietary factors are of paramount importance in the management and prevention of type 2 diabetes. Despite progress in formulating evidence based dietary guidance, controversy and confusion remain. In this article, we examine the evidence for areas of consensus as well as ongoing uncertainty or controversy about dietary guidelines for type 2 diabetes. What is the best dietary approach? Is it possible to achieve remission of type 2 diabetes with lifestyle behaviour changes or is it inevitably a condition causing progressive health decline? We also examine the influence of nutrition transition and population specific factors in the global context and discuss future directions for effective dietary and nutritional approaches to manage type 2 diabetes and their implementation.NGF receives funding from the Medical Research Council Epidemiology Unit (MC_UU_12015/5)

Associations of total legume, pulse, and soy consumption with incident type 2 diabetes : federated meta-analysis of 27 studies from diverse world regions

Background: The consumption of legumes is promoted as part of a healthy diet in many countries but associations of total and types of legume consumption with type 2 diabetes (T2D) are not well established. Analyses across diverse populations are lacking despite the availability of unpublished legume consumption data in prospective cohort studies. Objective: To examine the prospective associations of total and types of legume intake with the risk of incident T2D. Methods: Meta-analyses of associations between total legume, pulse, and soy consumption and T2D were conducted using a federated approach without physical data-pooling. Prospective cohorts were included if legume exposure and T2D outcome data were available and the cohort investigators agreed to participate. We estimated incidence rate ratios (IRRs) and CIs of associations using individual participant data including ≤42,473 incident cases among 807,785 adults without diabetes in 27 cohorts across the Americas, Eastern Mediterranean, Europe, and Western Pacific. Randomeffects meta-analysis was used to combine effect estimates and estimate heterogeneity. Results: Median total legume intake ranged from 0–140 g/d across cohorts. We observed a weak positive association between total legume consumption and T2D (IRR = 1.02, 95% CI: 1.01 to 1.04) per 20 g/d higher intake, with moderately high heterogeneity (I2 = 74%). Analysis by region showed no evidence of associations in the Americas, Eastern Mediterranean, andWestern Pacific. The positive association in Europe (IRR = 1.05, 95% CI: 1.01 to 1.10, I2 = 82%) was mainly driven by studies from Germany, UK, and Sweden. No evidence of associationswas observed for the consumption of pulses or soy. Conclusions: These findings suggest no evidence of an association of legume intakes with T2D in several world regions. The positive association observed in some European studies warrants further investigation relating to overall dietary contexts in which legumes are consumed, including accompanying foods which may be positively associated with T2D

A novel school-based intervention to improve nutrition knowledge in children: cluster randomised controlled trial.

BACKGROUND: Improving nutrition knowledge among children may help them to make healthier food choices. The aim of this study was to assess the effectiveness and acceptability of a novel educational intervention to increase nutrition knowledge among primary school children. METHODS: We developed a card game 'Top Grub' and a 'healthy eating' curriculum for use in primary schools. Thirty-eight state primary schools comprising 2519 children in years 5 and 6 (aged 9-11 years) were recruited in a pragmatic cluster randomised controlled trial. The main outcome measures were change in nutrition knowledge scores, attitudes to healthy eating and acceptability of the intervention by children and teachers. RESULTS: Twelve intervention and 13 control schools (comprising 1133 children) completed the trial. The main reason for non-completion was time pressure of the school curriculum. Mean total nutrition knowledge score increased by 1.1 in intervention (baseline to follow-up: 28.3 to 29.2) and 0.3 in control schools (27.3 to 27.6). Total nutrition knowledge score at follow-up, adjusted for baseline score, deprivation, and school size, was higher in intervention than in control schools (mean difference = 1.1; 95% CI: 0.05 to 2.16; p = 0.042). At follow-up, more children in the intervention schools said they 'are currently eating a healthy diet' (39.6%) or 'would try to eat a healthy diet' (35.7%) than in control schools (34.4% and 31.7% respectively; chi-square test p < 0.001). Most children (75.5%) enjoyed playing the game and teachers considered it a useful resource. CONCLUSIONS: The 'Top Grub' card game facilitated the enjoyable delivery of nutrition education in a sample of UK primary school age children. Further studies should determine whether improvements in nutrition knowledge are sustained and lead to changes in dietary behaviour.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

Job-loss and weight gain in British adults: Evidence from two longitudinal studies.

Overweight and obesity have been associated with unemployment but less is known about changes in weight associated with changes in employment. We examined weight changes associated with job-loss, retirement and maintaining employment in two samples of working adults in the United Kingdom. This was a prospective study of 7201 adults in the European Prospective Investigation of Cancer (EPIC)-Norfolk study (aged 39-76 years) and 4539 adults in the British Household Panel Survey (BHPS) who were followed up over 43 months and 26 months, respectively. In both samples, changes in measured (EPIC) and self-reported (BHPS) weight were computed for each participant and assessed in relation to three employment transitions: maintaining paid employment, retirement and job-loss. Regression models adjusted for potential confounders. Further analyses evaluated the contribution of diet, physical activity and smoking to weight gain. In EPIC-Norfolk, weight change differed across the three employment transitions for women but not men. The mean (95% CI) annualised change in weight for women who became unemployed over the follow-up period was 0.70 (0.55, 0.85) kg/y while those who maintained employment gained 0.49 (0.43, 0.55) kg/y (P = 0.007). Accounting for changes in smoking, diet and physical activity did not substantially alter the difference in weight gain among groups. In BHPS, job-loss was associated with weight gain of 1.56 (0.89, 2.23) kg/y, while those who maintained employment 0.60 (0.53, 0.68) kg/y (P < 0.001). In both samples, weight changes associated with retirement were similar to those staying in work. In BHPS, job-loss was also associated with significant declines in self-reported well-being and increases in sleep-loss. Two UK-based samples of working adults reveal strong associations between job-loss and excess weight gain. The mediating behaviours are so far unclear but psychosocial mechanisms and sleep-loss may contribute to the excess weight gain among individuals who become unemployed.This work was undertaken by the Centre for Diet and Activity Research, a UK Clinical Research Collaboration Public Health Research Centre of Excellence. Funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, National Institute for Health Research, and Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged