Aim: to evaluate the impact of obesity as defined by body mass index (BMI) on the prevalence of diabetes mellitus (DM) and impaired glucose tolerance (lGT) in Malta and compare it to other centres in Europe.peer-reviewe

Schranz, Antoine G.

OAR@UM

Obesity as a risk factor for DM and IGT in Malta compared to Europe Dr Antoine G SCHRANZ Aim: to evaluate the impact of obesity as defined by body mass index (BM!) on the prevalence of diabetes mellitus (DM) and impaired glucose tolerance (lGT) in Malta and compare it to other centres in Europe. Methodology: a study of cross-sectional data of European population based surveys on the prevalence of diabetes in which a standard oral Grr was performed and classification based according to WHO criteria (as was done in the Malta National Diabetes Study) Existing data on gender, age, height, and blood glucose (fasting and 2 hour) were analyzed and comparisons made between the different populations. This work was carried out within the DECODE-study project of the European Diabetes Epidemiology Group. Statistical analyses on pooled data were done with the collaboration of the National Public Health Institute in Helsinki, Finland. 12 VOLUME 16 ISSUE 01 JUNE 2007 Table 1. The Database Population Study size (n) Age % male Mean BMI Range Malta 2045 29-87 43 Monica - Poland 364 44-73 47 Glostrup70 - Denmark 481 69-71 51 Glostrup45 - Denmark 678 44-46 47 E&W men - Finland 414 70-89 100 Goodinge - England 1036 36-77 44 Ely - England 1115 40-69 57 Cremona - Italy 1821 40-89 44 NSW - Sweden 2129 30-74 51 Police - Finland 1037 35-75 100 Uppsala - Sweden 1182 69-74 100 Finrisk - Finland 4727 31-64 47 All 17029 29-89 55 Patients: a description of the European populations studied is seen in Table 1. Results: a large regional variation in prevalence of diabetes and impaired glucose tolerance was found between the 10 European centres; ranging from 2 to 24% for DM and from 5 to 34% for IGT In Maltese men and women aged 29-85 the levels of crude prevalence were respectively: 19 and 21 % DM and 6% IGT in both genders [Table2l. Differences clearly persisted even after stratifying for age - Malta showing the highest prevalence of DM in both sexes (particularly females) especially after age 50. Like elsewhere, the effect of age on the prevalence of DM in Malta, adjusted for BMI, was lower in men than in women: a 10 year increase in age was associated with odds ratios of 1.86 (95% Cl 161-215) in males and 2.12 (95% Cl 187-240) in females (p = 0.3 1). On the other hand the effect of age on the prevalence of IGT was similar in both genders 157 (95% Cl 129-190) This impact of age was consistent throughout Europe. As expected, BMI was also closely associated with DM and IGT prevalence. Overall, a rise of 1 kg/m' in BMI was associated with an increase in prevalence ofDM of 12% 00-14%) in males and 10% (8-11 %) in females. Correspondingly the prevalence of IGT was increased by 7% (5-9%) in both genders The general effect of BMI on DM was statistically significant [p<0.0034 in males and p<O.OOI (k~m2) 28 28 25 24 26 26 26 27 26 26 26 28 27 Maltese Family Doctor J[-Tabib tal-Familja ~ • in females] . Yet although obesity and DM are so common here, the ethnicity, diet and physical activity are important risk factors for DM, effect of BMI was surprisingly not as strong as in many other parts especially in Malta, and may very well account for a major part of of Europe. In fact in Malta the relative risk ratios, compared to the the variation in prevalence rates in different regions. other centres, were found to be in the lower end in both men and women [Table 3] Conclusion: The association in Malta between high levels Discussion: The findings confinn that the relationship between adiposity and DM in Malta is not a simple one. Nor it seems is it in other parts of Europe. In fact the non-systematic geographical variation in the prevalence of DM and IGT in the studied centres could not be explained by differences in age distribution or BM!. The overall effect of age on the prevalence of DM and IGT was found to be consistent and seemed somewhat larger than that of BMI - possibly due to the fact that a number of factors associated with deteriorating carbohydrate metabolism are also related to age. On the other hand the impact of BMI, even though quite unifonn, tended to differ slightly between the centres. The reason is not clear. This effect was stronger in men than in women possibly in part influenced by a known higher tendency towards central obesity in males. All this raises the probability that other factors including of obesity and DM is clearly conditioned by other factors. This seems to be also the case within Europe where differences in the prevalence rates of DM and IGT are highly variable and not explained by variations in age or BMI, even though the impact of these seems important and was rather similar in the centres studied. This suggests that other factors like diet, physical activity and genetic predisposition evidently play significant and interactive roles and supports the need for research and sustained action on the modifiable risks here. Dr Antoine G SHARNZ MD. , D.5c , MSc. , Dip Diab. Consultant Diabetologist, 5t Luke's Hospital, GHardamangia, Malta Table 2. Glucose Tolerance and age distribution by gender Population Age range Size (n) NGT% IGT% DM% Male Malta 29-85 871 74 6 19 Monica - Poland 44-73 172 63 28 9 Glostrup70 - Denmark 69-71 247 69 19 11 Glostrup45 - Denmark 44-46 318 42 34 24 E&:W men - Finland 70-89 414 46 31 23 Goodinge - England 40-75 455 91 6 3 Ely - England 40-69 631 65 28 6 Cremona - Italy 40-83 805 77 11 12 NSW - Sweden 30-74 1035 84 13 3 Police - Finland 35-75 1037 90 7 3 Upj2sala - Sweden 69-74 1182 53 30 17 Finrisk - Finland 31-64 2203 75 15 0 All 29-89 9371 74 16 10 Female Malta 29-87 1174 73 6 21 Monica - Poland 44-73 192 67 26 7 Glostrup 70 - Denmark 69-71 234 61 30 9 Glostrup45 - Denmark 44-46 360 59 31 10 Goodinge - England 36-77 581 92 5 2 Ely - England 40-67 484 56 35 8 Cremona - Italy 40-89 1016 79 10 11 NSW - Sweden 30-74 1094 85 12 3 Finrisk - Finland 38-64 2524 78 13 9 All 29-89 7659 78 13 10 Maltese Family Doctor It-Tabib tal-Familja VOLUME 16 ISSUE 01 JUNE 2007 13 Table 3. Effect of BMI on prevalence (odds ratio) of DM and IGT·age adjusted POEulation DM - O.R. 95% c.l. IGT - O.R. 95% c.l. Male Malta 1.05 1.01-1.09 1.04 0.98-110 Monica - Poland 0.99 0.87-114 1.06 0.98-115 Glostrup 70 - Denmark 1.02 0.91-114 1.08 0.99-118 Glostrup45 - Denmark 113 1.05-1.22 0.97 0.91-1.04 E&W men - Finland 1.09 1.02-116 1.03 0.98-1.09 Goodinge - England 118 1.05-132 110 1.01-119 Ely - England 115 1.09-121 1.08 1.04-112 Cremona - ltalz 114 1.08-120 1.04 0.98-110 NSW - Sweden 112 1.01-123 1.09 1.04-115 Police - Finland 118 1.04-134 115 1.05-125 Uppsala - Sweden 118 1.13-123 1.07 1.04-115 Finrisk - Finland 116 112-120 1.07 1.04-110 All 112 110-114 1.07 1.05-1.09 BMI centre interaction" P<00034 P<0.25 Female Malta 1.00 0.97-1.03 1.06 1.02-110 Monica - Poland 1.03 0.92-115 1.03 0.96-1.09 Glostrup70 - Denmark 1.08 1.03-1.21 1.08 1.02-115 Glostrup4S - Denmark 1.08 1.08-125 1.07 1.01-113 Goodinge - England 111 1.03-119 1.06 1.04-11 7 Ely - England 1.22 111-134 110 1.04-11 7 Cremona - Italz 115 110-119 114 1.08-1.22 NSW - Sweden 112 1.06-119 1.11 1.07-115 Finrisk - Finland 115 112-118 1.02 1.06-110 All 110 1.08-1.11 1.07 1.06-1.08 BMI centre interaction * P<OOOOl P<O.l3 * Chi2 test for the difference in effect on p,-evaience of DM and IGT between the centres Appreciation DR SAVIOUR CILIA The sad loss of our colleague, Dr. Saviour Cilia, rattled us to the heart and made us think about his presence amongst us and the void he will certainly leave . the profession in general. His motto for the association, "To promote and ensure a sustainable Primary Healthcare of a high standard which befits the Maltese population", describes his philosophy. In this moment of loss our thoughts are with his family. They were blessed with his presence and were generous to share him with us during his prolific life. Salvu, as he was affectionately known amongst his many friends, was a pleasant humble man who preferred to take action rather than remain passive. After a few days reflecting on the significance of his loss, Salvu's professional achievements can be summarized into three underlying themes - he was a man of action, his actions were guided by an altruistic disposition and he preferred to defend the underdog. Salvu was a keen teacher, who made sure to hone his teaching skills as each opportunity arose. He was looking forward to get involved as a tutor in the forthcoming General Practitioner Training Scheme. He was the Medical Association of Malta (MA M) Category Representative of the Health Centre General Practitioners where he was instrumental in promoting a more organized health centre service for the benefit of patients and indirectly general practitioners. What primarily made Salvu shine was his propensity to champion the cause of the underdog. He did not mince his words when it came to promoting the conditions of work for his colleagues. During the last few weeks, he was actively involved in setting up a Health Centre Doctors' Association with the purpose of creating a forum for the development of 14 VOLUME 16 ISSUE 01 JUNE 2007 His academic interest also reveals this man's desire to see people working together. He has just finished his Masters degree in teamwork in primary healthcare. His clinical special interest was mental health and chronic diseases. Salvu's role in the Malta College of Family Doctors was appreCiated by all of us, espeCially his role in maintaining a strong link with the general membership by means of the College newsletter. In this newsletter, he took every opportunity to sensitize the readership about important issues for the patient and practitioner. Salvu's humble disposition did not give due credit to his contributions in various fields. His authenticity and transparency made everybody feel comfortable with him. These attributes inevitably propelled him to contribute in the various fields of trade union representation, academic work and personal development. The strongly held belief about the essential role of general medical practice was the central tenant of his work Our profeSSion and his friends will definitely miss this gentleman doctor, not only because of the work he has done but also because he was such a rarity. We will endeavor to keep his memory alive as a beacon of light for us and future generations of General Practitioners. Dr. Philip SciOl-tino and D,~ Renzo De Gabriele Maltese Family Doctor It-Tabib tal-Familja 

Obesity as a risk factor for DM and IGT in Malta compared to Europe

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Obesity as a risk factor for DM and IGT in Malta compared to Europe

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