The relationship between body fat distribution, insulin sensitivity and postprandial lipids in Europeans and South Asians : a cross-sectional study.

Metabolic disturbances associated with central obesity and insulin resistance might underlie the higher rates of diabetes and coronary heart disease in South Asians compared with Europeans. A cross sectional study of 135 healthy South Asians and Europeans, aged 40-55 years, was performed to test whether lower insulin sensitivity in South Asians is explained by ethnic differences in body fat pattern and to establish if there are ethnic differences in postprandial triglyceride and intramyocellular lipid (IMCL) content that are associated with insulin sensitivity. Visceral fat area (VFA), measured by CT scan, was higher in South Asians than in Europeans in analyses adjusted for age, sex and body mass index (p=0.001). VFA was strongly associated with insulin sensitivity index (ISI), measured by the short insulin tolerance test, in both groups independently of total % body fat (measured by DEXA scan). In age and sex adjusted analyses ISI was 0.71 % min-1 lower in South Asians (95% CI -1.18 to -0.25, p=0.003). Adjustment for body fat pattern and triglyceride (fasting and 8 hour postprandial) reduced the ethnic difference in ISI to - 0.41 % min-1 (95% Cl -0.86 to 0.03, p=0.066). In both groups 8 hour postprandial triglyceride was highly correlated with ISI and VFA and the relationship of ISI to VFA was eliminated by adjusting for triglyceride. In a sub- study, mean IMCL content (measured by magnetic resonance spectroscopy) was higher in South Asians (p=0.046). In Europeans IMCL was correlated positively with % body fat, waist/hip ratio, VFA and negatively with ISI. In South Asians IMCL was not significantly related to ISI or obesity. We conclude that body fat pattern and IMCL cannot account for ethnic difference in insulin sensitivity. Alterations of lipid metabolism, possibly in the postprandial period, are likely to underlie the association of central obesity with insulin resistance

Epidemiology of diabetes.

The disease burden related to diabetes is high and rising in every country, fuelled by the global rise in the prevalence of obesity and unhealthy lifestyles. The latest estimates show a global prevalence of 382 million people with diabetes in 2013, expected to rise to 592 million by 2035. The aetiological classification of diabetes has now been widely accepted. Type 1 and type 2 diabetes are the two main types, with type 2 diabetes accounting for the majority (>85%) of total diabetes prevalence. Both forms of diabetes can lead to multisystem complications of microvascular endpoints, including retinopathy, nephropathy and neuropathy, and macrovascular endpoints including ischaemic heart disease, stroke and peripheral vascular disease. The premature morbidity, mortality, reduced life expectancy and financial and other costs of diabetes make it an important public health condition.NGF and NJW acknowledge support from the core Medical Research Council Epidemiology Unit Programmes ( MC_UU_12015/5 and MC_UU_12015/1 ).This is the author accepted manuscript. The final version is available from Elsevier via http://dx.doi.org/10.1016/j.mpmed.2014.09.00

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

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)

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

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