Diabetes Risk In Men Research Articles

Association between duration and type of androgen deprivation therapy and risk of diabetes in men with prostate cancer.

Androgen deprivation therapy (ADT) for prostate cancer (PCa) increases risk of type 2 diabetes (T2DM); however the association between types and duration of ADT has not been fully elucidated. We examined how type and duration of ADT affects risk of T2DM. Using data from Prostate Cancer database Sweden (PCBaSe) we investigated risk of T2DM in a cohort of 34,031 men with PCa on ADT; i.e., anti‐androgens (AA), orchiectomy, or gonadotropin‐releasing hormone (GnRH) agonists compared to an age‐matched, PCa‐free comparison cohort (n = 167,205) using multivariate Cox proportional hazard regression. T2DM was defined as a newly filled prescription for metformin, sulphonylurea, or insulin in the Prescribed Drug Register. A total of 21,874 men with PCa received GnRH agonists, 9,143 AA and 3,014 underwent orchiectomy. Risk of T2DM was increased in men in the GnRH agonists/orchiectomy group during the first 3 years of ADT [i.e., 1 − 1.5 years HR: 1.61 (95%CI: 1.36 − 1.91)], compared to PCa‐free men. The risk decreased thereafter (e.g., 3 − 4 years HR: 1.17 (95% CI: 0.98 − 1.40)). Conversely, no increased risk was seen in men on AA (HR: 0.74 (95%CI: 0.65 − 0.84). The incidence of T2DM per 1,000 person‐years was 10 for PCa‐free men, 8 for men on AA, and 13 for men on GnRH agonists/orchiectomy. Duration of ADT has a significant impact on risk of T2DM. With the peak after three years of treatment, our data indicates that men on ADT, even for a limited period of time, such as adjuvant to radiotherapy, are at increased risk of T2DM.

Parenthood and the risk of diabetes in men and women: a 7year prospective study of 0.5 million individuals.

Aims/hypothesisIn women, higher parity has been associated with increased risk of diabetes later in life. It is unclear, however, whether this association is mainly due to biological effects of childbearing, or to socioeconomic and lifestyle factors associated with childrearing. We assessed the association between number of children and diabetes risk separately in women and men.MethodsBetween 2004 and 2008, the nationwide China Kadoorie Biobank recruited 0.5 million individuals aged 30–79 (mean 51 years) from ten diverse regions across China. During 7 years of follow-up, 8,840 incident cases of diabetes were recorded among 463,347 participants without prior cardiovascular diseases or diabetes. Multivariable Cox regression yielded sex-specific HRs and 95% CIs for incident diabetes by number of children.ResultsOverall, ∼98% of all participants had children. In women, there was a J-shaped association between number of children and risk of diabetes. Compared with women with one child, the adjusted HRs for diabetes were 1.39 (95% CI 1.11, 1.73) for childless women, 1.12 (95% CI 1.07, 1.18) for those with two children, 1.23 (95% CI 1.16, 1.31) for those with three children, and 1.32 (95% CI 1.21, 1.44) for those with four or more children. In men, there was a similar association with risk of diabetes; the corresponding HRs were 1.28 (95% CI 1.02, 1.60), 1.19 (95% CI 1.12, 1.26), 1.32 (95% CI 1.21, 1.44) and 1.41 (95% CI 1.24, 1.60), respectively. In both sexes, the findings were broadly similar in different population subgroups.Conclusions/interpretationThe similarity between women and men in the association between number of children and risk of diabetes suggests that parenthood is most likely to affect diabetes risk through factors associated with childrearing rather than via biological effects of childbearing.Electronic supplementary materialThe online version of this article (doi:10.1007/s00125-016-3980-x) contains peer-reviewed but unedited supplementary material, which is available to authorised users.

Association between fruit, vegetable, seafood, and dairy intake and a reduction in the prevalence of type 2 diabetes in Qingdao, China.

Fruit, vegetable, seafood, and dairy intake may reduce the risk of type 2 diabetes, but this relationship is unclear. We aimed to examine the associations between fruit, vegetable, seafood, and dairy intake and type 2 diabetes prevalence in a Chinese population. A total of 4,343 individuals aged 35-74 years participated in a population-based cross-sectional study in Qingdao, China. The frequency and quantity of fruit, vegetable, seafood, and dairy intake were determined using a standard food frequency questionnaire. Diabetes was classified according to the WHO/IDF 2006 criteria. Logistic regression analysis was employed to estimate odds ratio (OR) for type 2 diabetes in relation to fruit, vegetable, seafood, and dairy intake in a multivariable model. The multivariate-adjusted ORs (95% confidence interval) for the presence of type 2 diabetes were 0.68 (0.46-0.98), 0.50 (0.37-0.68), and 0.91 (0.66-1.25), respectively, for the highest versus the lowest groups regarding total fruit and vegetable, fruit or vegetable intake in women. The ORs for type 2 diabetes prevalence regarding the quantity of fruit and vegetable, fruit, and yogurt intake were 0.88 (0.78-0.99), 0.71 (0.61-0.82), and 0.56 (0.32-0.98) in women, but not in men. Seafood consumption was inversely associated with diabetes risk in men, but not in women; the corresponding figures were 0.58 (0.35-0.96) and 0.92 (0.63-1.36), respectively. Fruit, vegetable, and yogurt intake in women and seafood intake in men were inversely associated with type 2 diabetes prevalence in this Chinese population. These findings require confirmation in a prospective study.

Risk of Diabetes among Patients Receiving Primary Androgen Deprivation Therapy for Clinically Localized Prostate Cancer

Androgen deprivation therapy may increase diabetes risk. As the benefits of primary androgen deprivation therapy for localized prostate cancer are controversial, and most prostate cancer survivors are of advanced age with comorbidities, it is important to determine if primary androgen deprivation therapy increases the risk of diabetes and to determine the susceptibility factors. We conducted a retrospective cohort study of 12,191 men diagnosed with incident localized prostate cancer during 1995 to 2008, age 35 to 100 years, and without diabetes or receipt of prostatectomy or radiation 1 year after diagnosis. Patients were enrolled in 1 of 3 managed health plans and followed through 2010. Primary androgen deprivation therapy was defined as androgen deprivation therapy within 1 year after diagnosis. Incident diabetes was ascertained using inpatient and outpatient diagnosis codes, diabetes medications and hemoglobin A1c values. We estimated primary androgen deprivation therapy associated diabetes risk using Cox proportional hazard models in conventional and propensity score analyses. Diabetes developed in 1,203 (9.9%) patients during followup (median 4.8 years) with incidence rates of 2.5 and 1.6 events per 100 person-years in the primary androgen deprivation therapy and nonprimary androgen deprivation therapy groups, respectively. Primary androgen deprivation therapy was associated with a 1.61-fold increased diabetes risk (95% CI 1.38-1.88). The number needed to harm was 29. The association was stronger in men age 70 or younger than in older men (HR 2.25 vs 1.40, p value for interaction=0.008). Primary androgen deprivation therapy may increase diabetes risk by 60% and should be used with caution when managing localized prostate cancer. Because of the consistent association between androgen deprivation therapy and greater diabetes risk across disease states, we recommend routine screening and lifestyle interventions to reduce the risk of diabetes in men receiving androgen deprivation therapy.

Relationship between anthropometric measures and the prevalence of diabetes in adults of Suzhou city, Jiangsu province

To explore the relationships between anthropometric measures as body mass index (BMI), percentage body fat, waist circumference (WC), hip circumference (HC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and the risks of diabetes. We analyzed the baseline data of 53 260 participants who were aged 30-79 years and had been enrolled into the China Kadoorie Biobank (CKB) study from Suzhou city,Jiangsu province. Unconditional logistic regression analyses were conducted with adjustment for potential confounders. Overall, 5.3% of the participants had diabetes, with about a half of them being newly detected through on-site screening tests. The prevalence of diabetes increased with age, 61% higher (OR = 1.61, 95% confidence interval: 1.54-1.67) risk of diabetes, with 10 years increase of age. In both genders, all anthropometric measures were positively and significantly associated with diabetes, with the associations of measures in central adiposity stronger than those in general obesity, with WHR as the strongest. Each standard deviation (1- s) with greater WHR (<0.06 in men and 0.07 in women) was associated with 72% (61%-83%) higher risk of diabetes in men and 93% (83%-102%) in women. After adjusting for HC, each WC with 5 cm larger, showing 65% and 57% higher risks in men and women respectively. However, after adjusting for WC, every 5cm greater HC appeared and associated with respective 38% and 34% lower risks. Measures on adiposity including BMI, percentage body, WC, WHR and WHtR fat were all positively associated with the prevalence of diabetes. Measures of central obesity, particularly WHR, were more strongly associated with diabetes than measures of general obesity. When WC was under control, HC appeared inversely associated with diabetes.

Cholesterol and egg intakes and the risk of type 2 diabetes: The Japan Public Health Center-based Prospective Study

Limited and inconsistent associations between cholesterol and egg consumption and type 2 diabetes risk have been observed in Western countries. In the present study, the association of dietary cholesterol and egg intakes with type 2 diabetes risk was examined prospectively. The study subjects comprised 27, 248 men and 36,218 women aged 45-75 years who participated in the second survey of the Japan Public Health Center-based Prospective Study and had no histories of type 2 diabetes or other serious diseases. Dietary cholesterol and egg intakes were estimated using a validated 147-item FFQ. The OR of self-reported, physician-diagnosed type 2 diabetes over 5 years were estimated using multiple logistic regression. A total of 1165 newly diagnosed cases of type 2 diabetes were self-reported. Although dietary cholesterol intake was not associated with type 2 diabetes risk in men, it was found to be associated with a 23 % lower odds of type 2 diabetes risk in women in the highest quartile of intake, albeit not statistically significant, compared with those in the lowest quartile (P trend= 0·08). Such risk reduction was somewhat greater among postmenopausal women; the multivariable-adjusted OR for the highest quartile of cholesterol intake compared with the lowest quartile was 0·68 (95 % CI 0·49, 0·94; P trend= 0·04). No association between egg intake and type 2 diabetes risk was found in either men or women. In conclusion, higher intake of cholesterol or eggs may not be associated with an increased risk of type 2 diabetes in Japanese populations. The observed association between decreased type 2 diabetes risk and higher dietary cholesterol intake in postmenopausal women warrants further investigation.

Higher ferritin levels, but not serum iron or transferrin saturation, are associated with Type 2 diabetes mellitus in adult men and women free of genetic haemochromatosis.

Iron overload predisposes to diabetes and higher ferritin levels have been associated with diabetes. However, it is unclear whether ferritin reflects differences in iron-related parameters between diabetic and nondiabetic persons. We examined associations of serum ferritin, iron and transferrin saturation with Type 2 diabetes in adults without genetic predisposition to iron overload. Cross-sectional analysis of community-dwelling men and women aged 17-97years from the Busselton Health Survey, Western Australia. Men and women carrying genotypes associated with haemochromatosis (C282Y/C282Y or C282Y/H63D) were excluded. Serum ferritin, iron and transferrin saturation were assayed. There were 1834 men (122 with diabetes, 6·6%) and 2351 women (141 with diabetes, 6%). In men, higher serum ferritin was associated with diabetes after adjusting for age, smoking, alcohol, cardiovascular history, body mass index (BMI), waist, blood pressure, lipids, C-reactive protein (CRP), adiponectin, alanine transaminase (ALT) and gamma-glutamyl transpeptidase (GGT) [odds ratio (OR): 1·29 per 1unit increase log ferritin, 95% confidence interval (CI)=1·01-1·65, P=0·043]. In women, higher serum ferritin was associated with diabetes [fully adjusted OR: 1·31 per 1unit increase log ferritin, 95% CI=1·04-1·63, P=0·020; 1·84 for tertile (T) 3 vs T1, 95% CI=1·09-3·11]. Neither iron levels nor transferrin saturation were associated with diabetes risk in men or women. Higher ferritin was not associated with insulin resistance in nondiabetic adults. In adults, higher ferritin levels are independently associated with prevalent diabetes while iron and transferrin saturation are not. Ferritin is a robust biomarker for diabetes risk, but further investigation is needed to clarify whether this relationship is mediated via iron metabolism.

Plasma apelin: A novel biomarker for predicting diabetes

BackgroundApelin regulates insulin sensitivity and secretion in animals. However, whether plasma apelin predicts incident diabetes in humans remains unknown. MethodsWe studied a cohort including 447 subjects (148 men, 299 women) without diabetes and followed for an average of 3y. Diabetes was diagnosed by an oral glucose tolerance test, plasma hemoglobin A1c, and if the subject was taking medications for diabetes. Plasma apelin-12 at baseline was measured with a commercial kit. ResultsPlasma apelin concentrations were higher in women than in men at baseline (p=0.007). During follow-up, 43 subjects developed type 2 diabetes. Higher plasma apelin concentrations were associated with a higher risk of diabetes in men (p=0.049) but not in women. Plasma apelin predicted incident type 2 diabetes in men (hazard ratio, 2.13, 95% CI 1.29–3.51, p<0.05), but not in women, adjusted for age, family history of diabetes, hemoglobin A1c, body mass index, hypertension, and HOMA2-IR. Apelin could improve the prediction ability beyond traditional risk factors in men, and the sensitivity and specificity of plasma apelin at 0.9ng/ml for this prediction were 63.2% and 58.9%, respectively. In men at risk for diabetes (HbA1c 5.7–6.4%, FPG 100–125mg/dl, or OGTT-2h-PG 140–199mg/dl), the risk for developing diabetes was higher in those with higher plasma apelin concentration than in those with lower plasma apelin concentrations (10.6%/year vs. 5.1%/year, p<0.001). ConclusionsPlasma apelin is a novel biomarker for predicting type 2 diabetes in men.

Circulating Estrone Levels Are Associated Prospectively With Diabetes Risk in Men of the Framingham Heart Study

OBJECTIVEIn postmenopausal women and preclinical murine models, estrogen administration reduces diabetes risk; however, the relationship of estradiol and estrone to diabetes in men is poorly understood. We determined the relationship between circulating estradiol and estrone levels and diabetes risk in community-dwelling men of the Framingham Heart Study (FHS).RESEARCH DESIGN AND METHODSCross-sectional relationships of estradiol and estrone levels with diabetes were assessed at examination 7 (1998–2001) in FHS generation 2 men (n = 1,458); prospective associations between hormone levels at examination 7 and incident diabetes were assessed 6.8 years later at examination 8. Type 2 diabetes mellitus was defined as fasting glucose >125 mg/dL, medication use, or both. Estradiol, estrone, and testosterone levels were measured with liquid chromatography–tandem mass spectrometry, and free estradiol and estrone were calculated.RESULTSIn cross-sectional models, men with elevated estrone and estradiol had 40% and 62% increased likelihoods of existing diabetes per cross-sectional doubling of estrone and estradiol levels, respectively. Free estrone (cross-sectional odds ratio 1.28 [95% CI 1.02–1.62], P = 0.04) was associated with impaired fasting glucose at examination 7. There was an increase in risk of existing diabetes with increasing quartiles of total and free estrone and estradiol and an increase in risk of incident diabetes with increasing quartiles of estrone levels. In multivariate longitudinal analyses, a twofold increase in total or free estrone levels at examination 7 was associated with 77 and 93% increases, respectively, in odds of incident diabetes at examination 8.CONCLUSIONSAlthough both estradiol and estrone exhibit cross-sectional associations with diabetes in men, in longitudinal analyses estrone is a more sensitive marker of diabetes risk than is estradiol.

Eating patterns and type 2 diabetes risk in men: breakfast omission, eating frequency, and snacking

Little is known about the association between eating patterns and type 2 diabetes (T2D) risk. The objective of this study was to prospectively examine associations between breakfast omission, eating frequency, snacking, and T2D risk in men. Eating patterns were assessed in 1992 in a cohort of 29,206 US men in the Health Professionals Follow-Up Study who were free of T2D, cardiovascular disease, and cancer and were followed for 16 y. We used Cox proportional hazards analysis to evaluate associations with incident T2D. We documented 1944 T2D cases during follow-up. After adjustment for known risk factors for T2D, including BMI, men who skipped breakfast had 21% higher risk of T2D than did men who consumed breakfast (RR: 1.21; 95% CI: 1.07, 1.35). Compared with men who ate 3 times/d, men who ate 1-2 times/d had a higher risk of T2D (RR: 1.25; 95% CI: 1.08, 1.45). These findings persisted after stratification by BMI or diet quality. Additional snacks beyond the 3 main meals (breakfast, lunch, and dinner) were associated with increased T2D risk, but these associations were attenuated after adjustment for BMI. Breakfast omission was associated with an increased risk of T2D in men even after adjustment for BMI. A direct association between snacking between meals and T2D risk was mediated by BMI.

Abstract P036: Socioeconomic Status and Risk of Diabetes over 35 Years

Background and aim: The link between low socioeconomic status (SES) and CHD is well established but whether low SES is also an independent predictor for development of diabetes type 2 is not clear. The aim of this study was to investigate whether SES, measured as occupational class, predicted subsequent development of diabetes type 2 over an extended follow-up. Methods: A total of 6941 men 47-55 years old, without prior diabetes, from a population sample of 9998 men, were investigated during 1970-73. Of the men, 23.7% were unskilled workers, 27.2% were skilled workers, 19.7% occupied either a supervisory manual position or were lower officials, 17.9% were officials at an intermediate position, and 11.6% were professionals, executives or senior officials. Follow-up was achieved through the national Swedish patient registry. Results: A total of 900 men (13%) were registered at any time with a diagnosis of diabetes over a 35-year follow-up. Compared with men in the highest occupational class, men with intermediate non-manual occupations had a multiple-adjusted hazard ratio (HR) of 1.10, 95% confidence interval (CI) 0.84-1.44, lower officials and foremen had an HR of 1.37 (1.06-1.78), semiskilled and skilled workers 1.39 (1.08-1.78), and unskilled workers 1.66 (1.30-2.13) after adjustment for smoking at baseline, BMI, blood pressure, serum cholesterol, treatment for hypertension and leisure time physical activity. Conclusions: Low SES is an independent risk factor for long-term risk of diabetes in men, with a 66% independent higher risk in unskilled workers, compared to professionals/senior officials.

Association between modifiable lifestyle factors and residual lifetime risk of diabetes

Background and aimsWhile clinical trials have reported beneficial effects of diet, exercise, and weight loss on incident diabetes in subjects with obesity or impaired glucose tolerance, little is known about the incremental benefit of not smoking and moderate drinking on diabetes risk. We sought to examine the association between modifiable lifestyle factors and residual lifetime risk of diabetes. Methods and ResultsProspective cohorts involving 20,915 men (1982–2008) and 36,594 women (1992–2008). Modifiable lifestyle factors and adiposity were ascertained at baseline in each cohort and incident diabetes was ascertained during follow up. The mean age at baseline was 53.5 y in men and 54.6 y in women. During an average follow up of 22.6 y in men and 13.0 y in women, 2096 men and 2390 women developed diabetes. At age 45 y, the residual lifetime risk of diabetes (95% CI) for men with 0, 1, 2, 3, and 4 + healthy lifestyle factors was 30.5 (27.3–33.7); 21.5 (19.9–23.0); 15.1 (13.9–16.3); 10.3 (9.1–11.5); and 7.3 (5.7–8.9) percent; respectively. Corresponding values for women were 31.4 (28.3–34.5); 24.1 (21.8–26.5); 14.2 (12.7–15.7); 11.6 (9.7–13.5); and 6.4 (4.2–8.6) percent, respectively. ConclusionsThese data show an inverse and graded relation between desirable lifestyle factors and residual lifetime risk of diabetes in men and women. Not smoking and moderate drinking may have additional benefits when added to exercise, weight control, and diet.

Changes in Waist Circumference and the Incidence of Diabetes in Middle-Aged Men and Women

BackgroundWaist circumference (WC) is positively associated with diabetes, but the association with changes in WC (DWC) is less clear. We investigated the association between DWC and the subsequent risk of diabetes in middle-aged men and women, and evaluated the influence from concurrent changes in body mass index (DBMI).Methodology/Principal FindingsData on 15,577 men and 20,066 women from the Danish Diet, Cancer and Health study were analyzed. Anthropometry was assessed in 1993–97 and 1999–02. Information on diabetes was obtained from The Danish National Diabetes Register. Hazard ratios (HR) were calculated from Cox' proportional hazard models with individuals considered at risk from 1999–02 until December 31 2006. During 5.4 years of follow-up, 1,027 and 876 new cases of diabetes occurred among men and women, respectively. WC was positively associated with diabetes in both sexes also with adjustment for covariates and BMI. DWC was positively associated with diabetes in women, but not in men (HR per 5 cm change = 1.09 (1.04∶1.15) in women, and 1.00 (0.94, 1.07) in men with adjustment for covariates, baseline WC, BMI and DBMI). Associations with DWC were not notably different in sub-groups stratified according to baseline WC or DBMI, or when individuals with diseases or diabetes occurring within the first years of follow-up were excluded.Conclusions/SignificanceWhile this study confirmed that WC is positively associated with the risk of diabetes in middle-aged men and women, it surprisingly showed that changes in WC were not associated with the subsequent risk of diabetes in men, and only weakly positively associated with the risk of diabetes in women. Accordingly, these findings suggest that a reduction in WC may be a weak or insufficient or target for prevention of diabetes in middle-aged men and women.

Body fat distribution and their associations with cardiovascular risk, insulin resistance and β-cell function: are there differences between men and women?

The objective was to examine the independent and gender-specific effects of WC and BMI on CVD risk factors, insulin resistance and β-cell function. A cross-sectional study of 2931 adults aged 20-79 years was carried out in Fujian province by multi-stratified sampling from July 2007 to May 2008. Gender-specific differences of WC and BMI on CVD risk factors, insulin resistance and β-cell function were displayed jointly by WC and BMI tertiles. The homeostasis model assessment of insulin resistance (HOMA-IR) index and the quantitative insulin-sensitivity check index (QUICKI): l/(log G0 ± log I0) were used to estimate insulin sensitivity; insulin secretion was assessed using the HOMA-β index; β-cell function was quantified as the ratio of the incremental insulin to glucose responses over the first 30 min during the OGTT (△I30/△G30). The oral disposition index (DIo) was calculated as ΔI(30) /ΔG(30) × 1/fasting insulin. The Matsuda index is defined as 10,000/sqrt (FBG × FPI × [G × I]) where FPG is fasting glucose, FPI is fasting insulin, G is mean glucose during the OGTT (calculated from glucose samples at 0, 30, and 120 min), and I is mean insulin during the OGTT (calculated from insulin samples at 0, 30, and 120 min). Waist circumference and BMI correlated with each other in both men (0.756, p < 0.001) and women (0.728, p < 0.001). The two indexes were independently associated with CVD risk factors (such as hypertension, metabolic syndrome, and dyslipidaemia) in both men and women. BMI was better than WC in assessing the risk of diabetes in men (p = 0.003 for BMI, and p = 0.234 for WC), while WC was better than BMI in predicting diabetes in women (p < 0.001 for WC, and p = 0.831 for BMI). There were significant associations between BMI and insulin resistance or β-cell function even after adjustment for WC except for DIo in male subjects, but WC only associated with HOMA-IR positively or the Matsuda index and QUICKI negatively after adjustment for BMI. For women, associations between WC and insulin resistance or β-cell function remained strong even after adjustment for BMI besides DIo. However, there were no independent relations of BMI to insulin resistance and β-cell function except for Matsuda index with a significant negative association after adjustment for WC in women. Body mass index and WC were independently associated with CVD risk factors. There were differences in the gender-specific relevance of measures of body fat distribution in assessing the insulin resistance, β-cell function and thus the risk of diabetes. Therefore, WC should be measured in addition to BMI to assess CVD risk accurately and implement efficient treatment strategies.

Physical activity and risk of type 2 diabetes in a multiethnic cohort in Hawaii

Aim: Incidence rates of type 2 diabetes vary considerably by ethnicity. Physical inactivity is an established risk factor for diabetes; however little is known about this association across ethnic groups with different rates of diabetes. Therefore, we evaluated the association between physical activity and diabetes risk and potential effect modification by ethnicity in the Hawaiian component of the Multiethnic cohort. Methods: From 1993 to 1996, 103,898 subjects (34% Caucasian, 14% Native Hawaiian, 43% Japanese-American) living in Hawaii (USA), aged 45–75 years, were enrolled by completing a questionnaire on demographics, diet, and lifestyle. Information on weekly hours of strenuous sports, vigorous work and moderate activity was assessed. Incident cases of diabetes were identified by self-report, a medication questionnaire, and through record linkage with the major health plans in Hawaii. We performed Cox proportional hazard regression to calculate hazard ratios (HR) and 95% confidence intervals (CI) for diabetes associated with physical activity, adjusted for body-mass-index, ethnicity, education and age. Results: After a mean follow-up time of 13 years, 8587 incident diabetes cases were identified. Engaging in strenuous sports was significantly inversely associated with diabetes risk with adjusted HRs [&gt;4h/week vs. no sports] of 0.67 (CI: 0.57–0.79) in women and 0.79 (CI: 0.71–0.88) in men. Stratified by ethnicity, we found HRs [&gt;4h/week vs. no sports] of 0.54 (CI: 0.38–0.77), 0.65 (CI: 0.47–0.91), and 0.77 (CI: 0.62–0.96) in Caucasian, Native Hawaiian, and Japanese-American women (pinteraction 0.23) and of 0.72 (CI: 0.58–0.89), 0.82 (CI: 0.65–1.04), and 0.85 (CI: 0.73–0.98) in men, respectively (pinteraction 0.05). Vigorous work was inversely associated with diabetes risk in men only, while engaging in moderate activity was inversely associated with diabetes risk only in Caucasian men and women. Conclusion: Our results underline the importance of physical activity in diabetes prevention among men and women of different ethnic backgrounds.

Meat consumption and risk of type 2 diabetes: the Multiethnic Cohort

To examine the association of meat consumption with diabetes risk in the Hawaii component of the Multiethnic Cohort and to assess effect modification by ethnicity. A prospective cohort study. Baseline information on diet and lifestyle was assessed by questionnaire. The cohort was followed up for incident cases of diabetes, which were identified through self-reports, medication questionnaires, or health plan linkages. Cox regression was used to calculate hazard ratios (HR) and 95% confidence intervals for diabetes associated with quintile of meat consumption. Hawaii, USA. A total of 29,759 Caucasian, 35,244 Japanese-American and 10,509 Native Hawaiian men and women, aged 45-75 years at baseline. During a mean follow-up time of 14 years, 8587 incident diabetes cases were identified. Intake of red meat was positively associated with diabetes risk in men (fifth v. first quintile: HR=1.43; 95% CI 1.29, 1.59) and women (fifth v. first quintile: HR=1.30; 95% CI 1.17, 1.45) in adjusted models. The respective HR for processed red meat intake were 1.57 (95% CI 1.42, 1.75) and 1.45 (95% CI 1.30, 1.62). The association for processed poultry was weaker than for processed red meat, and fresh poultry intake was not associated with diabetes risk. For men only, we observed significant interactions of ethnicity with the red and processed red meat associations, with Caucasians experiencing slightly higher risks than Japanese-Americans. Our findings support the growing evidence that red and processed meat intake increase risk for diabetes irrespective of ethnicity and level of BMI.

Dietary Patterns and Risk for Diabetes

OBJECTIVEThe high diabetes incidence among Japanese Americans and Native Hawaiians cannot be explained by BMI. Therefore, we examined the influence of three dietary patterns of “fat and meat,” “vegetables,” and “fruit and milk” on diabetes risk in the Hawaii component of the Multiethnic Cohort with 29,759 Caucasians, 35,244 Japanese Americans, and 10,509 Native Hawaiians.RESEARCH DESIGN AND METHODSSubjects aged 45–75 years completed a baseline food frequency questionnaire. After 14 years of follow-up, 8,587 subjects with incident diabetes were identified through self-reports or health plan linkages. Risk was assessed using Cox regression stratified by age and adjusted for ethnicity, BMI, physical activity, education, total energy, smoking, alcohol intake, marital status, and hypertension.RESULTSFat and meat was significantly associated with diabetes risk in men (hazard ratio 1.40 [95% CI 1.23–1.60], Ptrend < 0.0001) and women (1.22 [1.06–1.40], Ptrend = 0.004) when extreme quintiles were compared. Except in Hawaiian women, the magnitude of the risk was similar across ethnic groups although not always significant. After stratification by BMI, fat and meat remained a predictor of disease primarily among overweight men and among overweight Japanese women. Vegetables lowered diabetes risk in men (0.86 [0.77–0.95], Ptrend = 0.004) but not in women, whereas fruit and milk seemed to be more beneficial in women (0.85 [0.76–0.96], Ptrend = 0.005) than in men (0.92 [0.83–1.02], Ptrend = 0.04).CONCLUSIONSFoods high in meat and fat appear to confer a higher diabetes risk in all ethnic groups, whereas the effects of other dietary patterns vary by sex and ethnicity.

Physical Activity, Body Mass Index, and Diabetes Risk in Men: A Prospective Study

Objective Physical activity has been associated with lower diabetes risk, but several prospective studies among women found that activity only slightly attenuated the diabetes risk associated with high body mass index (BMI). We investigated the independent and joint associations between vigorous activity and BMI on diabetes risk in men. Methods This was a prospective cohort design within the Physicians' Health Study, using Cox proportional hazards models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of incident diabetes in 20,757 men without diabetes at baseline. Models were based on self-reported BMI and exercise frequency at baseline, first separately and then with a 6-category joint variable combining World Health Organization BMI category (normal/overweight/obese) with activity status (active/inactive) using weekly vigorous activity as the threshold. Results After a median follow-up of 23.1 years, there were 1836 cases of incident diabetes. Compared with active participants with normal BMIs, active but overweight and obese men had multivariable-adjusted HRs of 2.39 (95% CI, 2.11-2.71) and 6.22 (95% CI, 5.12-7.56). Inactive men with normal, overweight, or obese BMIs had multivariable-adjusted HRs of 1.41 (95% CI, 1.19-1.67), 3.14 (95% CI, 2.73-3.62), and 6.57 (95% CI, 5.25-8.21). Conclusion Active men with normal and overweight BMIs had lower diabetes hazards than their inactive counterparts, but no difference by weekly activity was seen in obese men. Elevated BMI is a key driver of diabetes risk, with relatively modest attenuation by activity.

Genetic predisposition, Western dietary pattern, and the risk of type 2 diabetes in men

BackgroundA widely held hypothesis is that interactions between genetic predisposition and Western-type lifestyle contribute to the epidemic of type 2 diabetes (T2D). No study has tested this hypothesis. Objective:The objective was to assess whether established genetic variants, mainly from genomewide association studies, modify dietary patterns in predicting diabetes risk. Design:We determined 10 polymorphisms in a prospective, nested, case-control study of 1196 diabetic and 1337 nondiabetic men. A genetic risk score (GRS) was generated by using an allele counting method. Baseline dietary intakes were collected by using a semiquantitative food-frequency questionnaire. We used factor analysis to derive Western and “Prudent” dietary patterns from 40 food groups. Results:A significant interaction (P = 0.02) was observed between the GRS and Western dietary pattern. The multivariable odds ratios (ORs) of T2D across increasing quartiles for the Western dietary pattern were 1.00, 1.23 (95% CI: 0.88, 1.73), 1.49 (1.06,2.09), and 2.06 (1.48, 2.88) among men with a high GRS (≥12 risk alleles; P for trend = 0.01). The Western dietary pattern was not associated with diabetes risk among those with a lower GRS. In addition, we found that intakes of processed meat, red meat, and heme iron, which characterized the Western dietary pattern, showed significant interactions with GRS in relation to diabetes risk (P for interaction = 0.029, 0.02, and 0.0004, respectively). The diet-diabetes associations were more evident among men with a high GRS (≥12) than in those with a low GRS. Conclusion:Genetic predisposition may synergistically interact with a Western dietary pattern in determining diabetes risk in men.

Alcohol consumption and risk of type 2 diabetes mellitus in Japanese: a systematic review.

To evaluate the association between alcohol consumption and the risk for type 2 diabetes (DM) in Japanese. We searched the MEDLINE data base with the key words 'alcohol intake' (or 'alcohol consumption') and 'Japanese' cross-linked with 'diabetes mellitus' (or 'impaired glucose tolerance'). The reports we sought were restricted to prospective cohort studies, randomized controlled trials, meta-analyses and systematic reviews. Computerized and hand searches were conducted in June 2007. Seven prospective cohort studies were adopted. We previously reported that in lean Japanese men (BMI < or =22.0 kg/m2), moderate to heavy alcohol intake is a risk factor for diabetes. One study found heavy alcohol intake to be associated with an increased risk in low-BMI men while moderate alcohol intake was associated with a reduced risk in higher-BMI men. Another study suggested daily alcohol consumption to be a risk factor in low-BMI participants, while being protective in middle-BMI participants. Yet another study demonstrated a U-shaped association between alcohol consumption and the risk of diabetes in men. Three other studies, which did not divide the subjects in terms of BMI values, indicated alcohol intake to be an increased risk for diabetes, two being in men and one being in women, respectively. For a large number of Japanese men who have relatively low BMI, alcohol intake is an established risk factor for diabetes.