Diabetes In Middle-aged Adults Research Articles

Prediction of Diabetes in Middle-Aged Adults: A Machine Learning Approach

Abstract Background: Diabetes is a serious health concern requiring effective diagnostic strategies, particularly since its symptoms overlap with those of other conditions. Despite extensive research on early diabetes detection across various age groups, middle-aged adults have been relatively underexplored. This study focuses on this demographic to examine symptom-diabetes associations, examine the influence of symptoms in diabetes prediction, and determine an optimal machine learning (ML) model for diabetes prediction. Materials and Methods: This study utilized data from a previous cohort study conducted in Bangladesh. The original dataset included demographic and symptom-related information from 520 patients visiting the ABC Hospital in Bangladesh, India. The participants comprised both diabetic and non-diabetic individuals showing diabetes-like symptoms. For our study, data from 296 middle-aged adults (aged 40–60 years) were extracted. Chi-square tests assessed diabetes-symptom associations, and the Boruta algorithm examined feature influence. Seven ML classification models were evaluated for predictive accuracy. Results: Results showed that 60% of the 296 participants were diabetic. Symptoms like polyuria, polydipsia, weakness, sudden weight loss, partial paresis, polyphagia, and visual blurring were significantly associated with diabetes. All demographic and symptom-related features were influential in diabetes prediction, with polyuria, polydipsia, gender, alopecia, and irritability emerging as the most influential. Among the ML models tested, the random forest model exhibited the highest sensitivity (98.59%) and outperformed others in accuracy (96.58%) and area under the curve score (96.00%), making it the most efficient model for predicting diabetes in middle-aged adults. Conclusion: Diabetes associated symptoms provide valuable diagnostic opportunities for early diabetes detection in middle-aged adults. Future research should explore genetic, lifestyle, and environmental factors to improve diagnostic accuracy.

Comparison of Absolute and Relative Grip Strength to Predict Incidence of Diabetes Mellitus in Korea: A Prospective Cohort Study.

Background: This study aimed to investigate the association between absolute grip strength (AGS), relative grip strength (RGS) levels, and the risk of developing diabetes in middle-aged adults, utilizing longitudinal data. Methods: A total of 1935 participants, 51-81 years of age, were engaged in surveys both in 2017-2018 and during the subsequent follow-up survey in 2019-2020. Diabetes diagnosis and treatment were the criteria for categorizing individuals as "diabetic." Grip strength was measured using the JAMA-5030J1 equipment (SAEHAN, Korea), and AGS and RGS were also categorized into tertiles by gender. A proportional hazards Cox regression model was used to evaluate the relationship among AGS, RGS, and the risk of developing diabetes. Subsequently, we computed the hazard ratio (HR) and 95% confidence interval (95% CI) for the risk of developing diabetes. Results: After adjusting for various confounding variables, a significant reduction in diabetes risk was observed in the high grip strength group, adjusted for body mass index (RGS1) and body weight (RGS2), compared with the low RGS1 and RGS2 groups (RGS1 HR = 0.54, 95% CI = 0.36-0.80; RGS2 HR = 0.50, 95% CI = 0.34-0.73). However, there were no significant associations between AGS and diabetes risk. Furthermore, significant differences in the relationship among AGS, RGS levels, and the risk of developing diabetes were found across gender and insulin resistance levels. Conclusion: This study underscores the importance of RGS levels in predicting the incidence of diabetes, with AGS, RGS1, and RGS2 emerging as significant predictive indicators for assessing diabetes risk.

Joint Association of Relative Grip Strength and Resting Heart Rate with the Risk of Developing Diabetes in Middle-Aged Adults

Joint Association of Relative Grip Strength and Resting Heart Rate with the Risk of Developing Diabetes in Middle-Aged Adults

Gut microbiome and stages of diabetes in middle-aged adults: CARDIA microbiome study

BackgroundAnimal and human studies suggest the gut microbiome is linked to diabetes but additional data are needed on the associations of the gut microbiome to specific diabetes characteristics. The aim of this study was to examine the associations of gut microbiome composition to insulin resistance [Homeostatic Model Assessment of Insulin Resistance (HOMA-IR)], duration of diabetes, and 4 stages of diabetes [normoglycemia, pre-diabetes, and diabetes with (+) and without (−) medication for diabetes].MethodsData are from a sub-sample (n = 605) of Black and White participants from the 30-year follow-up exam of the prospectively followed community-based Coronary Artery Risk Development in Young Adults cohort (2015–2016; aged 48–60 years). Stool samples were collected and sequenced using the 16S ribosomal RNA method. Microbial measures included: α diversity (within-person), β diversity (between-person), and taxonomies. All analyses were adjusted for demographic, clinical, lifestyle factors, and use of relevant medications (full adjustment). Multivariate linear regression models were used to assess the association of diabetes characteristics with α diversity and genera abundance, while the association with β diversity was analyzed using permutational multivariate analysis of variance. Statistical significance was set to p-value < 0.05 for α and β diversity analyses and to q-value < 0.1 for genera abundance analyses.ResultsThere were 16.7% of participants with pre-diabetes, and 14.4% with diabetes (9% diabetes+) with median (interquartile range) diabetes duration of 5 (5–10) years. In the fully adjusted models, compared to those with no diabetes, longer diabetes duration and the diabetes + group had a lower α diversity. There were significant differences in β diversity across diabetes-related characteristics. A significantly reduced abundance of butyrate-producing genera was associated with higher HOMA-IR (ex., Anaerostipes and Lachnospiraceae_UCG.004), longer diabetes duration (ex., Agathobacter and Ruminococcus), and diabetes + (ex., Faecalibacterium and Romboutsia).ConclusionsOur results suggest that an adverse alteration of gut microbiome composition is related to higher insulin resistance, longer diabetes duration, and is present in those persons with diabetes using medications. These diabetes-related characteristics were also associated with lower levels of certain butyrate-producing bacteria that produce health-promoting short‐chain fatty acids. Understanding the role of gut microbiota in glucose regulation may provide new strategies to reduce the burden of diabetes.

More appendicular lean mass relative to body mass index is associated with lower incident diabetes in middle-aged adults in the CARDIA study

Background and aimsAlthough lower lean mass is associated with greater diabetes prevalence in cross-sectional studies, prospective data specifically in middle-aged Black and White adults are lacking. Relative appendicular lean mass (ALM), such as ALM adjusted for body mass index (BMI), is important to consider since muscle mass is associated with overall body size. We investigated whether ALM/BMI is associated with incident type 2 diabetes in the Coronary Artery Risk Development in Young Adults study. Methods and results1893 middle-aged adults (55% women) were included. ALM was measured by DXA in 2005-06. Incident type 2 diabetes was defined in 2010–11 or 2015–16 as fasting glucose ≥7 mmol/L (126 mg/dL), 2-h glucose on OGTT ≥11.1 mmol/L (200 mg/dL) (2010–11 only), HbA1C ≥48 mmol/mol (6.5%) (2010–11 only), or glucose-lowering medications. Cox regression models with sex stratification were performed.In men and women, ALM/BMI was 1.07 ± 0.14 (mean ± SD) and 0.73 ± 0.12, respectively. Seventy men (8.2%) and 71 women (6.8%) developed type 2 diabetes. Per sex-specific SD higher ALM/BMI, unadjusted diabetes risk was lower by 21% in men [HR 0.79 (0.62–0.99), p = 0.04] and 29% in women [HR 0.71 (0.55–0.91), p = 0.008]. After adjusting for age, race, smoking, education, physical activity, and waist circumference, the association was no longer significant. Adjustment for waist circumference accounted for the attenuation in men. ConclusionAlthough more appendicular lean mass relative to BMI is associated with lower incident type 2 diabetes in middle-aged men and women over 10 years, its effect may be through other metabolic risk factors such as waist circumference, which is a correlate of abdominal fat mass.

Effect of diabetes and prediabetes on the development of disability and mortality among middle-aged Japanese adults: A 22-year follow up of NIPPON DATA90.

To examine the association between diabetes and prediabetes at baseline, and disability, mortality over a 22-year period among middle-aged Japanese adults. Participants consisted of 1,788 adults aged 45-64 years at baseline from the cohort study National Integrated Project for Prospective Observation of Non-communicable Disease and its Trends in the Aged 1990 (NIPPON DATA90). Disability, defined as having a decline in activities of daily living (ADL), was assessed by a modified Katz questionnaire at four time points. Disability and death without disability for 22-year follow up were used as outcomes to test the association with a diagnosis of diabetes or prediabetes at baseline, using multinomial logistic regression. Adjusted odds ratios (ORs) were obtained from four models that contained appropriate adjustment factors, such as age, sex, smoking status, drinking status, body mass index and cardiovascular risk factors (hypertension, hypercholesterolemia, triglycerides, low serum high-density lipoprotein), at baseline. In the present study, 334 participants (18.7%) reported at least one disability, and 350 (19.6%) were reported dead without observation of disability during follow up. Adjusting sex and other risk factors, participants with diabetes and prediabetes had a higher risk for disability (OR 1.43, 95% confidence interval [CI] 1.07-1.91 and OR 1.66, 95% CI 1.10-2.50, respectively) and for mortality (OR 1.56, 95% CI 1.16-2.08 and OR 1.77, 95% CI 1.18-2.65, respectively) than individuals with normal glucose tolerance. In middle-aged Japanese adults, individuals with diabetes and prediabetes were more likely to be associated with disability and mortality. Our findings suggest that prediabetes and diabetes in middle-aged adults should be paid more attention, and requires more intervention to prevent disability and mortality in later life.

Plasma Levels of Bile Acids Are Related to Cardiometabolic Risk Factors in Young Adults

ContextBile acids (BA) are known for their role in intestinal lipid absorption and can also play a role as signaling molecules to control energy metabolism. Prior evidence suggests that alterations in circulating BA levels and in the pool of circulating BA are linked to an increased risk of obesity and a higher incidence of type 2 diabetes in middle-aged adults.ObjectiveWe aimed to investigate the association between plasma levels of BA with cardiometabolic risk factors in a cohort of well-phenotyped, relatively healthy young adults.MethodsBody composition, brown adipose tissue, serum classical cardiometabolic risk factors, and a set of 8 plasma BA (including glyco-conjugated forms) in 136 young adults (age 22.1 ± 2.2 years, 67% women) were measured.ResultsPlasma levels of chenodeoxycholic acid (CDCA) and glycoursodeoxycholic acid (GUDCA) were higher in men than in women, although these differences disappeared after adjusting for body fat percentage. Furthermore, cholic acid (CA), CDCA, deoxycholic acid (DCA), and glycodeoxycholic acid (GDCA) levels were positively, yet weakly associated, with lean body mass (LBM) levels, while GDCA and glycolithocholic acid (GLCA) levels were negatively associated with 18F-fluorodeoxyglucose uptake by brown adipose tissue. Interestingly, glycocholic acid (GCA), glycochenodeoxycholic acid (GCDCA), and GUDCA were positively associated with glucose and insulin serum levels, HOMA index, low-density lipoprotein cholesterol, tumor necrosis factor alpha, interleukin (IL)-2, and IL-8 levels, but negatively associated with high-density lipoprotein cholesterol, ApoA1, and adiponectin levels, yet these significant correlations partially disappeared after the inclusion of LBM as a confounder.ConclusionOur findings indicate that plasma levels of BA might be sex dependent and are associated with cardiometabolic and inflammatory risk factors in young and relatively healthy adults.

Abstract P052: Less Appendicular Lean Mass Adjusted For Body Mass Index Is Associated With Higher Incident Diabetes In Middle-aged Adults In The CARDIA Study

Although less muscle mass is associated with greater diabetes prevalence in cross-sectional studies, prospective data in middle-aged Black and White adults are lacking. Middle age is a critical window as accelerated muscle loss is yet to occur, and preventing diabetes reduces lifelong morbidity and mortality. We hypothesized that lower appendicular lean mass adjusted for body mass index (ALM/BMI) is associated with higher incident diabetes in middle-aged Black and White adults in the Coronary Artery Risk Development in Young Adults (CARDIA) study. ALM/BMI was measured by dual x-ray energy absorptiometry (DXA) in 2005-06 among middle-aged US men (n=855) and women (n=1045) in CARDIA. Incident diabetes occurred if any of the following were met in 2010-11 or 2015-16 among persons without diabetes in 2005-06: fasting glucose ≥7 mmol/L (126 mg/dL), 2-hour glucose ≥11.1 mmol/L (200 mg/dL) on a 75-gram glucose tolerance test, HbA 1C ≥48 mmol/mol (6.5%), or use of glucose-lowering medications. We used logistic regression models with sex stratification given sex differences in ALM. In men, mean age was 45.0 ± 3.5 y, BMI 28.0 ± 4.3 kg/m 2 , and ALM/BMI 1.07 ± 0.14 m 2 . In women, mean age was 45.2 ± 3.6 years, BMI 28.4 ± 6.4 kg/m 2 , and ALM/BMI 0.73 ± 0.12 m 2 . Diabetes developed in 70 men (8.2%) and 72 women (6.9%). For each standard deviation increase in ALM/BMI (m 2 ), the risk of diabetes decreased by 22% in men and 29% in women (Table 1). After adjusting for age, race, smoking, education, physical activity, and waist circumference, the association of ALM/BMI with diabetes incidence was no longer significant. Associations were similar between race-ethnic groups. In conclusion, less relative skeletal muscle mass is associated with a greater risk of developing diabetes in middle-aged men and women over 10 years, which is largely explained by the relationship of ALM/BMI to other metabolic risk factors. Low skeletal muscle mass in middle age is a marker for greater diabetes risk and may be a target for preventative interventions.

Visceral fat accumulation is associated with risk of diabetes in community‐dwelling Japanese older adults

The prevalence of diabetes generally increases with age, and older adults with diabetes are at a higher risk of adverse outcomes. Visceral fat accumulation is a well-known risk factor for diabetes in middle-aged adults, and its association with diabetes increases with age. The present study investigated the association between visceral fat and risk of diabetes in older adults that is yet to be completely elucidated. This cross-sectional study enrolled 2850 community-dwelling older adults. Participants underwent abdominal bioelectrical impedance analysis to estimate the visceral fat area (VFA). The risk of diabetes was assessed using the value of hemoglobin A1c according to the diagnostic criteria of diabetes. We examined the relationship of VFA and risk of diabetes, and explored the optimal cut-off value stratified by sex. In total, 47 of 1640 (2.9%) women and 41 of 1210 (3.4%) men had a high risk of diabetes. Higher values of VFA in units of 10 cm2 were significantly associated with a higher risk of diabetes for both women (adjusted odds ratio [aOR]: 1.17; 95% confidence interval [95% CI]: 1.02-1.34) and men (aOR: 1.18; 95% CI: 1.06-1.31) in multivariate logistic regression analysis. The cut-off value to classify 30% of subjects into high VFA (72 cm2 ) had a relatively higher sensitivity of 0.660 and was significantly associated with a higher risk of diabetes for women (aOR: 3.49; 95% CI: 1.54-8.12), whereas all cut-off values we examined had no relation in men. Increases in VFA is associated with a high risk of diabetes in older adults but the optimal cut-off value is inconclusive in men. Geriatr Gerontol Int 2021; ••: ••-••.

Psychological Stress Accompanied by a Low-Variety Diet Is Positively Associated with Type 2 Diabetes in Middle-Aged Adults.

Psychological stress is generally known to affect dietary intakes and cause chronic diseases. This study aims to investigate the association between psychological stress and the risk of type 2 diabetes in relation to dietary variety. A total of 126,405 middle-aged adults were enrolled in the Korean Genome and Epidemiology Study. Stress levels were measured using the psychosocial well-being index. Dietary variety score (DVS) was defined as the number of different foods consumed over a day. Stress levels were positively associated with the risks of diabetes (odds ratio (OR) for tertile 3 compared with tertile 1, men: OR = 1.34 (95% CI: 1.24–1.45); women: OR = 1.29 (1.19–1.4)). As the stress levels rose, the intake of grains increased, and the intake of fruits and vegetables decreased. Participants with higher stress levels showed lower DVS than those with lower stress levels. Furthermore, participants with higher stress levels and lower DVS had a significantly higher OR for diabetes than those with lower stress levels and higher DVS (men: OR = 1.83 (1.58–2.12); women: OR = 1.85 (1.59–2.51)). These results suggest that the high risk of type 2 diabetes for people with high stress levels may be associated with low dietary variety.

An Exploratory Study of Cognitive Functioning and Psychological Well-Being in Middle-Aged Adults with Diabetes Mellitus

Abstract Background Diabetes mellitus is a chronic metabolic disorder characterized by increased level of blood sugar for a prolonged period of time. Apart from its impact on the bodily functions, the disorder has its own psychological consequences, commonly in terms of stress reaction, anxiety, and depression. Diabetes is also known to affect cognitive functions, but it is less studied in the Indian population and relatively ignored in the management plan. Discerning the cognitive functions in middle-aged adults diagnosed with diabetes can give valuable insight into comprehensive management of the disorder. With this background, the study attempted to explore the cognitive functioning and psychological well-being of middle-aged adults with diabetes and compared with healthy individuals. Methods A total of 30 middle-aged adults of both sexes diagnosed with diabetes type 2 were undertaken for the study and compared with 30 healthy adults regarding measures of cognitive functioning and psychological well-being. The measures were also explored for relationship if any with illness duration. Results Middle-aged adults with diabetes differed significantly in terms of response inhibition and processing speed compared with healthy controls. The groups significantly differed on subjective Psychological well-being in terms of self-control, anxiety and depression, and vitality. Duration of illness was found to be related to anxiety symptoms. Conclusion Diabetes affects response inhibition and processing speed in middle-aged adults. Assessing and addressing impairment in cognitive functions is recommended for a comprehensive management of diabetes in middle-aged adults.

Regional disparities in the associations of cardiometabolic risk factors and healthy dietary factors in Korean adults.

BACKGROUND/OBJECTIVESRegional disparities in dietary factors might be related to regional disparities in cardiometabolic health. Therefore, this study investigated the associations of cardiometabolic risk factors and dietary factors with regional types in Korean adults.SUBJECTS/METHODSBased on data from the 2007–2017 Korea National Health and Nutrition Examination Survey, the study included 39,781 adults aged ≥ 19 years who completed the dietary survey and a health examination. Healthy and unhealthy dietary factors (fat, sodium, fruit, and vegetable intakes) were evaluated using 1-day 24-h dietary recall method, as well as the use of nutrition labels with a questionnaire.RESULTSOf the participants, 48.7%, 36.0%, and 15.2% lived in metropolitan, urban, and rural areas, respectively. Adults living in urban and rural had higher odds ratios (ORs) for obesity (OR for urban, 1.07; 95% confidence interval (CI), 1.01–1.14; OR for rural, 1.14; 95% CI, 1.05–1.24) than adults living in metropolitan areas; these associations were significantly observed in middle-aged adults. Compared to metropolitan residents, rural residents had lower ORs for hypertension in middle-aged (OR, 0.86; 95% CI, 0.76–0.96) and metabolic syndrome in older adults (OR, 0.78; 95% CI, 0.67–0.91). Regarding urban residents, a lower OR for diabetes in middle-aged adults (OR, 0.85; 95% CI, 0.74–0.97) and a higher OR for hypertension in older adults (OR, 1.19; 95% CI, 1.02–1.39) were observed. Overall rural residents had higher ORs of excessive carbohydrate, low fruit, and high salted-vegetable intakes than metropolitan residents. Low fruit intake was positively associated with obesity, metabolic syndrome, and hypertension, after adjustment for regional type and other confounders in total participants.CONCLUSIONSThese findings indicate that cardiometabolic risk and unhealthy dietary factors differ among regional types and age groups within Korea. Nutritional policy and interventions should consider regional types for prevention and management of cardiometabolic risk factors.

Associations of Dairy Intake with Incident Prediabetes or Diabetes in Middle-Aged Adults Vary by Both Dairy Type and Glycemic Status

Background: Inconsistent evidence describes the association between dietary intake of dairy and milk-based products and type 2 diabetes (T2D) risk.Objective: Our objective was to assess associations between consumption of milk-based products, incident prediabetes, and progression to T2D in the Framingham Heart Study Offspring Cohort.Methods: Total dairy and milk-based product consumption was assessed by ≤4 food-frequency questionnaires across a mean of 12 y of follow-up in 2809 participants [mean ± SD age: 54.0 ± 9.7 y; body mass index (in kg/m2): 27.1 ± 4.7; 54% female]. Prediabetes was defined as the first occurrence of fasting plasma glucose ≥5.6 to <7.0 mmol/L (≥100 to <126 mg/dL), and T2D was defined as the first occurrence of fasting plasma glucose ≥7.0 mmol/L (≥126 mg/dL) or diabetes treatment. Proportional hazards models were used to estimate the risk of incident outcomes relative to dairy product intake in subsets of the cohort who were at risk of developing the outcomes. Spline regressions were used to examine potential nonlinear relations.Results: Of 1867 participants free of prediabetes at baseline, 902 (48%) developed prediabetes. Total, low-fat, and high-fat dairy consumptions were associated with a 39%, 32%, and 25% lower risk of incident prediabetes, respectively, in the highest compared with the lowest intakes (≥14 compared with <4 servings/wk). Total, low-fat and skim milk, whole-milk, and yogurt intakes were associated nonlinearly with incident prediabetes; moderate intake was associated with the greatest relative risk reduction. Neither cheese nor cream and butter was associated with prediabetes. Of 925 participants with prediabetes at baseline, 196 (21%) developed T2D. Only high-fat dairy and cheese showed evidence of dose-response, inverse associations with incident T2D, with 70% and 63% lower risk, respectively, of incident T2D between the highest and lowest intake categories (≥14 compared with <1 serving/wk for high-fat dairy, ≥4 compared with <1 serving/wk for cheese).Conclusion: Associations of dairy with incident prediabetes or diabetes varied both by dairy product and type and by baseline glycemic status in this middle-aged US population. Baseline glycemic status may partially underlie prior equivocal evidence regarding the role of dairy intake in diabetes.

Lean diabetes in middle-aged adults: A joint analysis of the German DIVE and DPV registries.

AimsTo assess differences in demographics, treatment and outcome of lean (LD) compared to overweight and obese people with diabetes clinically classified as type 2 diabetes mellitus (T2DM).Materials and methodsWe combined data from the German DIVE (Diabetes Versorgungs-Evaluation) and DPV (Diabetes-Patienten-Verlaufsdokumentation) databases to produce a large cohort of people with T2DM. The characteristics of people with Body Mass Index (BMI) <25 kg/m2, ≥25–30 kg/m2 and ≥30 kg/m2 aged 30 to 50 years were compared, including demographics, cardiovascular (CV) risk factors, comorbidities and outcomes.ResultsA total of 37,870 people were included in the analysis, 3,191 of these (8.4%) had a BMI < 25 kg/m2. LD reported more nicotine (41.6% of 2,070 vs. 38.1% of 6,070 and 33.4% of 16,823; P<0.001)and alcohol consumption (12.0% of 1,282, 10.3% of 3,594 and 6.6% of 9,418; P<0.001)compared to overweight and obese people. More LD were treated with insulin in comparison to the other subgroups (short acting insulin 33.1% of 3,191 vs. 28.4% of 9,234 and 28.0% of 25,445; P <0.001; long acting insulin 31.3% of 3,191 vs. 28.9% of 9,234 and 29.3% of 25,445; P = 0.043). Regression models adjusted for age, gender and diabetes duration showed a 2.50 times higher odds ratio (OR) for hypoglycemia and a 2.52 higher OR for mortality in LD compared to the BMI subgroup ≥30 kg/m2.ConclusionsLD is associated with an increased risk of hypoglycaemia and death. Patients are characterized by male gender, lifestyle habits as smoking and alcohol consumption while cardiovascular comorbidities are less important. In comparison to patients of the other weight groups they are treated with insulin more often and considerably less with metformin.

Risk accuracy of type 2 diabetes in middle aged adults: Associations with sociodemographic, clinical, psychological and behavioural factors

ObjectiveTo identify the proportion of individuals with an accurate perception of their risk of type 2 diabetes (T2D) prior to, immediately after and eight weeks after receiving a personalised risk estimate. Additionally, we aimed to explore what factors are associated with underestimation and overestimation immediately post-intervention. MethodsCohort study based on the data collected in the Diabetes Risk Communication Trial. We included 379 participants (mean age 48.9 (SD 7.4) years; 55.1% women) who received a genotypic or phenotypic risk estimate for T2D. ResultsWhile only 1.3% of participants perceived their risk accurately at baseline, this increased to 24.7% immediately after receiving a risk estimate and then dropped to 7.3% at eight weeks. Those who overestimated their risk at baseline continued to overestimate it, whereas those who underestimated their risk at baseline improved their risk accuracy. We did not identify any other characteristics associated with underestimation or overestimation immediately after receiving a risk estimate. ConclusionUnderstanding a received risk estimate is challenging for most participants with many continuing to have inaccurate risk perception after receiving the estimate. Practice implicationsIndividuals who overestimate or underestimate their T2D risk before receiving risk information might require different approaches for altering their risk perception.

Interaction effect of PGC-1α rs10517030 variants and energy intake in the risk of type 2 diabetes in middle-aged adults.

PGC-1α is an important regulatory factor for energy and glucose metabolism. Therefore, we investigated whether the PGC-1α genotype (rs10517030 and rs10212638) affects the incidence of type 2 diabetes mellitus (T2DM) and sought to explain the interactions between their variants and nutrient intake on the development of T2DM. Subjects aged 40-65 years of both genders were from the Ansung/Ansan cohorts (8842 adults) in Korea. Associations of PGC-1α variants rs10517030 and rs10212638 with T2DM were analyzed in a dominant genetic model, and were tested for interactions of genotypes and nutrients with T2DM risk. It was adjusted for covariates related to glucose metabolism. Three variants, rs10517030, rs10517032 and rs10212638, were positively associated with T2DM prevalence. Single-nucleotide polymorphisms, rs10517030 and rs10517032, had strong association (r2=0.963). In the glucose tolerance tests, odds ratios (ORs) for serum glucose levels at 120 min were higher for subjects who were in the minor-allele group (minor allele homozygotes and heterozygotes) than for the major-allele group (major allele homozygotes) for rs10517030 variants. Serum insulin levels at 60 min had a lower ORs in the minor-allele group of rs10517030 variants. The interaction between energy intake and PGC-1α rs10517030 variants also affected T2DM risk. PGC-1α minor alleles were linked to T2DM prevalence and homeostasis model assessment estimate of insulin resistance (HOMA-IR) only in the low-energy groups, and HOMA-B was significantly negatively associated with the minor-allele group of PGC-1α rs10517030 variants, only in the low-energy-intake groups. These data suggest that Koreans with the minor alleles of PGC-1α rs10517030, rs10517032 and rs10212638 are at greater risk of T2DM, and that a low-energy diet is more protective against the development of T2DM in subjects with the major alleles of rs10517030 and rs10517032.

Interaction of BDNF rs6265 variants and energy and protein intake in the risk for glucose intolerance and type 2 diabetes in middle-aged adults

ObjectivesBrain-derived neurotrophic factor (BDNF) is associated with the risk for Alzheimer's disease and type 2 diabetes. The aim of this study was to examine the association of BDNF variants with type 2 diabetes and the interactions of different BDNF genotypes with dietary habits and food and nutrient intakes in middle-aged adults. MethodsThe study population included 8840 adults ages 40 to 65 y from the Ansan and Asung areas in the Korean Genome Epidemiology Study, a cross-sectional study of Korean adults, conducted from 2001 to 2002. Adjusted odd ratios for the prevalence of glucose intolerance and type 2 diabetes according to BDNF genotypes were calculated after adjusting for age, sex, residence area, body mass index, physical activity, and smoking and stress status. Nutrient intake was calculated from usual food intake determined by semiquantitative food frequencies using the nutrient assessment software. ResultsBDNF rs6265 Val/Met and Met/Met variants were negatively associated with the risk for type 2 diabetes after adjusting for covariates. Serum glucose levels after glucose loading and hemoglobin A1c, but not serum insulin levels, also were negatively associated with BDNF Val/Met and Met/Met. In subgroup analysis, sex and stress levels had an interaction with BDNF Val/Met in the risk for type 2 diabetes. Glucose-intolerant and diabetic, but not nondiabetic, patients with BDNF Met/Met had nominally, but significantly higher intakes of energy than those with BDNF Val/Val. BDNF rs6265 had consistent gene–diet interactions with energy and protein intake. With low-energy, low-protein, and high-carbohydrate intake, BDNF Val/Met lowered the risk for type 2 diabetes after adjusting for confounding factors. BDNF Val/Met did not compensate for developing type 2 diabetes with high-energy intake. Additionally, indexes of insulin resistance and insulin secretion showed the same gene–energy interaction as type 2 diabetes. ConclusionsBDNF Val/Met and Met/Met variants (rs6265) decreases the risk for glucose intolerance and type 2 diabetes. BDNF variants interacted with nutrient intake, especially energy and protein intake: Middle-aged individuals with BDNF Val/Val are prone to developing type 2 diabetes even with low energy and protein intake.

Longitudinal assessment of N-terminal pro-B-type natriuretic peptide and risk of diabetes in older adults: The cardiovascular health study

IntroductionNatriuretic peptides have a well-recognized role in cardiovascular homeostasis. Recently, higher levels of B-type natriuretic peptide (BNP) have also been associated with decreased risk of diabetes in middle-aged adults. Whether this association persists into older age, where the pathophysiology of diabetes changes, has not been established, nor has its intermediate pathways. MethodsWe investigated the relationship between N-terminal (NT)-proBNP and incident diabetes in 2359 older adults free of cardiovascular disease or chronic kidney disease in the Cardiovascular Health Study. ResultsWe documented 348 incident cases of diabetes over 12.6years of median follow-up. After adjusting for age, sex, race, body mass index, systolic blood pressure, anti-hypertensive treatment, smoking, alcohol use, and LDL, each doubling of NT-proBNP was associated with a 9% lower risk of incident diabetes (HR=0.91 [95% CI: 0.84–0.99]). Additional adjustment for waist circumference, physical activity, estimated glomerular filtration rate or C-reactive protein did not influence the association. Among putative mediators, HDL and triglycerides, adiponectin, and especially homeostasis model assessment of insulin resistance, all appeared to account for a portion of the lower risk associated with NT-proBNP. ConclusionIn older adults without prevalent cardiovascular or kidney disease, higher NT-proBNP is associated with decreased risk of incident diabetes even after adjustment for traditional risk factors. These findings suggest that the metabolic effects of natriuretic peptides persist late in life and offer a potential therapeutic target for prevention of diabetes in older people.

중년기 성인의 당뇨병 유병형태에 대한 생리적 지표 및 생활습관 비교

This study examined the effects of the biological markers and lifestyle factors on the presence of diabetes in middle-aged adults. A total of 5,363 adults aged 40-64 years were recruited from the 2010-2012 Fifth Korean National Health and Nutrition Examination Survey. The data were analyzed by descriptive statistics, Chi-square test, ANCOVA and logistic regression. The results were as follows. The body mass index was significantly higher in the prediabetes and diabetes group than in the normal group. Hypertension, abdominal obesity, hypercholesterolemia, hypertriglyceridemia, smoking, drinking, and carbohydrate intake were significantly different among three groups. Hypertension, hypercholesterolemia, hypertriglyceridemia, abdominal obesity, body mass index and drinking were the influencing biological markers and lifestyle factors in prediabetes. The significant factors influencing diabetes were hypertension, hypercholesterolemia, hypertriglyceridemia, abdominal obesity, body mass index, and smoking. Overall, the development of intervention programs for effective diabetes prevention in middle-aged adults by lifestyle modification of hypertension, obesity, dyslipidemia, drinking, and smoking is recommended.

The prevalence and determinants of undiagnosed and diagnosed type 2 diabetes in middle-aged irish adults.

BackgroundThe prevalence of type 2 diabetes within the Republic of Ireland is poorly defined, although a recent report suggested 135,000 cases in adults aged 45+, with approximately one-third of these undiagnosed. This study aims to assess the prevalence of undiagnosed and diagnosed diabetes in middle-aged adults, and compare features related to either condition, in order to investigate why certain individuals remain undetected.MethodsThis was a cross-sectional study involving a sample of 2,047 men and women, aged between 50–69 years, randomly selected from a large primary care centre. Univariate logistic regression was used to explore socio-economic, metabolic and other health related variable associations with undiagnosed or diagnosed diabetes. A final multivariate analysis was used to determine odds ratios and 95% confidence intervals for having undiagnosed compared to diagnosed diabetes, adjusted for gender, age and significant covariates determined from univariate models.Principle FindingsThe total prevalence of diabetes was 8.5% (95% CI: 7.4%–8.8%); 72 subjects (3.5%) had undiagnosed diabetes (95% CI: 2.8%–4.4%) and 102 subjects (5.0%) had diagnosed diabetes (95% CI: 4.1%–6.0%). Obesity, dyslipidaemia, and family history of diabetes were positively associated with both undiagnosed and diagnosed type 2 diabetes. Compared with diagnosed subjects, study participants with undiagnosed diabetes were significantly more likely to have low levels of physical activity and were less likely to be on treatment for diabetes-related conditions or to have private medical insurance.ConclusionsThe prevalence of diabetes within the Cork and Kerry Diabetes and Heart Disease Study is comparable to recent estimates from the Slán National Health and Lifestyle Survey, a study which was nationally representative of the general population. A considerable proportion of diabetes cases were undiagnosed (41%), emphasising the need for more effective detection strategies and equitable access to primary healthcare.