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1.
Nutrients ; 13(3)2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33652581

RESUMO

The aim of this study was to evaluate the association between handgrip strength, nutritional status and vitamin D deficiency in Mexican community-dwelling older women. A cross sectional study in women ≥ 60 years-old was performed. Plasma 25-hydroxyvitamin D (25(OH)D) concentrations were measured by a quantitative immunoassay technique. Handgrip strength was assessed using a dynamometer, while nutritional status was assessed through the Full Mini Nutritional Assessment (Full-MNA). A total of 116 women participated in the study, their mean age was 70.3 ± 5.8 years; 49.1% of the study group had plasma 25(OH)D levels lower than 40 nmol/L [16 ng/mL]. Meanwhile, 28.45% of participants had low handgrip strength (<16 kg), and 23.1% were identified at risk of malnutrition/malnourished according with Full-MNA score. Women with 25(OH)D deficiency (<40 nmol/L [16 ng/mL]) were more likely to have low handgrip strength (OR = 2.64, p = 0.025) compared with those with higher 25(OH)D values. Additionally, being malnourished or at risk of malnutrition (OR = 2.53, p = 0.045) or having type 2 diabetes mellitus (T2DM) (OR = 2.92, p = 0.044) was also associated with low 25(OH)D. The prevalence of low plasma 25(OH)D concentrations was high among Mexican active older women. Low handgrip strength, being at risk of malnutrition/malnourished, or diagnosed with T2DM was also associated with Vitamin D deficiency.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Força da Mão , Vida Independente/estatística & dados numéricos , Estado Nutricional , Deficiência de Vitamina D/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/etnologia , Feminino , Humanos , México/epidemiologia , Pessoa de Meia-Idade , Avaliação Nutricional , Prevalência , Vitamina D/análogos & derivados , Vitamina D/sangue , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/etnologia
2.
Aust N Z J Public Health ; 45(2): 143-149, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33749953

RESUMO

OBJECTIVE: The objective of this study was to evaluate an Aboriginal-led diabetes lifestyle program catering to urban Aboriginal people in an Aboriginal organisation. METHODS: Mixed-methods study that employed routinely collected physiological data and audio-recorded focus group sessions. Physiological data were analysed using a multi-level model to account for participant clustering. Qualitative data were subject to thematic analysis. RESULTS: Participants were overwhelmingly positive about the program. They lost weight and improved their diastolic blood pressure and glycaemic control; however, it was the feelings of belonging and optimism about their ability to improve their health that they most valued. Qualitative analysis revealed three main themes. These were: 'With the Mob', 'For the Mob' and 'Program Elements. The strengths of the program lay in its indigeneity, low-cost and easy-to-prepare diet, and cultural and communication skills of the director. CONCLUSIONS: Recommendations for improvement included educating participants on the pathophysiology of diabetes, the refinement of online elements and the introduction of face-to-face group exercise. Implications for public health: Programs of this nature should be expanded and evaluated longitudinally with multiple cohorts.


Assuntos
Diabetes Mellitus Tipo 2/terapia , Estilo de Vida Saudável , Avaliação de Programas e Projetos de Saúde/métodos , Adulto , Diabetes Mellitus Tipo 2/etnologia , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Grupo com Ancestrais Oceânicos , Pesquisa Qualitativa , População Urbana , Perda de Peso
4.
Acta Diabetol ; 58(4): 485-493, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33399989

RESUMO

AIMS: Data on the effect of liraglutide on glycemic endpoints in people with T2DM using multiple daily insulin injections (MDI) are scarce, especially in the context of ethnicity. METHODS: This is a secondary analysis of the placebo-controlled randomized clinical "MAGNA VICTORIA" trials in Western European (WE) and South Asian (SA) people with T2DM. Participants had inadequate glycemic control despite using metformin and/or sulfonylurea derivatives and/or insulin. Participants were assigned to liraglutide (1.8 mg) or placebo for 6 months, in addition to standard care. The primary endpoint number of participants reaching target HbA1c was compared for liraglutide versus placebo in the complete dataset and MDI-treated participants using Chi-square test. Liraglutide's efficacy in WE and SA was compared using a generalized linear model. RESULTS: Forty-five subjects were randomized to liraglutide and 51 to placebo. In each group, one participant did not complete the study. Liraglutide-treated patients reached target HbA1c more frequently: 23/45 (51%) vs 11/51 (22%), relative probability 2.4 (1.3-4.3), p = 0.002. Subgroup analysis in 43 MDI participants showed that the proportion reaching target HbA1c using liraglutide was significantly higher than in placebo: 9/22 (41%) vs 1/21 (5%), p = 0.005. There was no difference between WE and SA in terms of liraglutide efficacy (p = 0.18). CONCLUSIONS: Liraglutide treatment resulted in increased chance of reaching target HbA1c as compared to placebo. Liraglutide efficacy was sustained in participants using MDI regimens and those of SA descent. Liraglutide should be considered for T2DM people with inadequate glycemic control despite MDI.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/etnologia , Controle Glicêmico/estatística & dados numéricos , Insulina/administração & dosagem , Liraglutida/administração & dosagem , Adolescente , Adulto , Idoso , Ásia/etnologia , Glicemia/efeitos dos fármacos , Glicemia/metabolismo , Diabetes Mellitus Tipo 2/sangue , Esquema de Medicação , Quimioterapia Combinada , Europa (Continente)/etnologia , Feminino , Seguimentos , Hemoglobina A Glicada/análise , Hemoglobina A Glicada/efeitos dos fármacos , Hemoglobina A Glicada/metabolismo , Humanos , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/efeitos adversos , Injeções Subcutâneas , Insulina/efeitos adversos , Liraglutida/efeitos adversos , Masculino , Metformina/uso terapêutico , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Placebos , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
5.
J Diabetes Res ; 2021: 8816996, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33490286

RESUMO

Background: The apolipoprotein E (APOE) gene polymorphisms have been intensively studied in patients with type 2 diabetes mellitus (T2DM) and ischemic stroke (IS) in recent years. However, it is unclear whether APOE gene polymorphisms are correlated with increased risk for developing IS in T2DM patients. Thus, this study was designed to examine the association between APOE gene polymorphisms and risks of IS in Chinese patients with T2DM. Methods: This case-control study enrolled 243 subjects with T2DM as controls, and 210 subjects with T2DM complicated with IS as case patients. The genotypes were determined using real-time PCR while HbA1c and lipid levels were detected using commercially available kits. Results: The systolic blood pressure (SBP), diastolic blood pressure (DBP), and the proportion of patients with a history of hypertension were higher in the case patients than that in the controls. We confirmed that the ε2/ε3 genotype, as well as SBP and history of hypertension, was the independent risk factor for developing IS in T2DM patients. Conclusions: We conclude that the ε2/ε3 genotype might contribute to the increased risk for developing IS in Chinese patients with T2DM.


Assuntos
Apolipoproteínas E/genética , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/genética , AVC Isquêmico/genética , Idoso , Grupo com Ancestrais do Continente Asiático/genética , Estudos de Casos e Controles , China/epidemiologia , Diabetes Mellitus Tipo 2/etnologia , Angiopatias Diabéticas/etnologia , Angiopatias Diabéticas/genética , Feminino , Frequência do Gene , Estudos de Associação Genética , Predisposição Genética para Doença , Genótipo , Humanos , AVC Isquêmico/etnologia , Masculino , Pessoa de Meia-Idade , Polimorfismo Genético , Fatores de Risco
6.
BMJ Open ; 11(1): e043166, 2021 01 27.
Artigo em Inglês | MEDLINE | ID: mdl-33504558

RESUMO

OBJECTIVE: High blood pressure (BP) is a risk factor for cardiovascular disease. Examining the role of inflammatory mediators on BP is important since vitamin D (VD) is a modifiable risk factor, which possibly modulates inflammatory cytokines. This study simulated what are known as average 'controlled direct effects (CDE)' of inflammatory markers, C reactive protein (CRP), tumour necrosis factor-α (TNF-α), and interlukin-6 (IL-6) on continuous BP measures, while fixing VD, an intermediate variable to specific level. DESIGN: Cross-sectional study. SETTING: We analysed data from the Multi-Community Environment-and-Health Study, 2005-2009, conducted in Eeyou Istchee, Quebec, Canada. PARTICIPANTS: This study recruited 1425 study Indigenous Cree participants from seven Cree communities. Only adults with serum VD levels, inflammatory markers and BP measures were included in this data analysis. PRIMARY AND SECONDARY OUTCOMES MEASURES: Inflammatory markers examined the top 25th exposure percentiles. VD 'insufficiency' (ie, 25-hydroxyvitamin-D levels<50 nmol/L) defined by the Institute of Medicine. CDE for each inflammatory marker in the presence and absence of population VD insufficiency simulated the average direct effect change for systolic and diastolic BP (SBP and DBP) measures. All models were adjusted for exposure-and-mediator outcome relationship. RESULTS: Among 161 participants, 97 (60 %) were female. The prevalence of VD insufficiency was 32%. CDE estimates show in the presence and absence of population vitamin D insufficiency, inflammatory markers have a slightly different association on BP. TNF-α significantly and inversely associated with SBP in the presence of vitamin D insufficiency, fully adjusted model ß = -13.61 (95% CI -24.42 to -2.80); however, TNF-α was not associated with SBP in the absence of vitamin D insufficiency. CRP, IL-6 were also not significantly associated with BP measures, although the magnitude of association was greater for those with elevated inflammation and VD insufficiency. CONCLUSION: This novel analysis shows in the presence of VD insufficiency, inflammation (particularly TNF-α) may affect SBP. Additional research is needed to elucidate these findings, and the temporal relationship between these variables.


Assuntos
Hipertensão/sangue , Hipertensão/fisiopatologia , Inflamação/sangue , Interleucina-6/sangue , Deficiência de Vitamina D/etnologia , Adolescente , Adulto , Idoso , Pressão Sanguínea , Canadá , Criança , Pré-Escolar , Estudos Transversais , Diabetes Mellitus Tipo 2/etnologia , Feminino , Humanos , Lactente , Recém-Nascido , Inflamação/fisiopatologia , Masculino , Pessoa de Meia-Idade , Quebeque/epidemiologia , Fator de Necrose Tumoral alfa/sangue , Vitamina D , Adulto Jovem
7.
Nutrients ; 12(12)2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33322261

RESUMO

In this study, we aimed to assess ethnic differences in visceral (VAT), deep subcutaneous (dSAT), and superficial subcutaneous (sSAT) adipose tissue and their relationships with inflammatory markers between white European (WE) and black West African (BWA) men with normal glucose tolerance (NGT) and type 2 diabetes (T2D). Forty-two WE (23 NGT/19 T2D) and 43 BWA (23 NGT/20 T2D) men underwent assessment of plasma inflammatory markers using immunoassays alongside Dixon magnetic resonance imaging to quantify L4-5 VAT, dSAT and sSAT. Despite no ethnic differences in sSAT and dSAT, BWA men exhibited lower VAT (p = 0.002) and dSAT:sSAT (p = 0.047) than WE men. Adiponectin was inversely associated with sSAT in WE (p = 0.041) but positively associated in BWA (p = 0.031) men with T2D. Interleukin-6 (IL-6) was associated with VAT in WE but not in BWA men with NGT (WE: p = 0.009, BWA: p = 0.137) and T2D (WE: p = 0.070, BWA: p = 0.175). IL-6 was associated with dSAT in only WE men with NGT (WE: p = 0.030, BWA: p = 0.833). The only significant ethnicity interaction present was for the relationship between adiponectin and sSAT (Pinteraction = 0.003). The favourable adipose tissue distribution and the weaker relationships between adiposity and inflammation in BWA men suggest that adipose tissue inflammation may play a lesser role in T2D in BWA than WE men.


Assuntos
Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Diabetes Mellitus Tipo 2/etnologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Mediadores da Inflamação/sangue , Obesidade/etnologia , Adiponectina/sangue , Tecido Adiposo/diagnóstico por imagem , Tecido Adiposo/fisiopatologia , Adolescente , Adulto , Idoso , Biomarcadores/análise , Distribuição da Gordura Corporal , Estudos Transversais , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Obesidade/sangue , Obesidade/complicações , Adulto Jovem
8.
JAMA Netw Open ; 3(12): e2027744, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33337491

RESUMO

Importance: Identifying effective weight loss interventions for Latino adults at risk of diabetes is of critical public health importance. Objective: To determine whether a culturally adapted behavioral intervention for Latino adults was more effective than usual care for weight loss over 24 months. Design, Setting, and Participants: In this randomized clinical trial, Latino adults with a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 24 or greater and a high risk for type 2 diabetes were recruited in primary care practices in the San Francisco, California, area, randomized to receive the Vida Sana intervention or usual care, and followed up for 24 months. The study was conducted from November 2015 to May 2019, and data were analyzed from July 2019 to Septmeber 2020. Interventions: The treatment group received Vida Sana, a culturally adapted lifestyle intervention that included a family-based orientation session and 22 group sessions over 12 months. Participants were encouraged to use a wearable activity tracker and mobile applications to track their physical activity and dietary intake. Participants received monthly email messages for an additional 12 months. The control group received usual care. Main Outcomes and Measures: The primary outcome was weight loss at 24 months. Secondary outcomes included weight loss at 12 months and achieving at least 5% weight loss at 12 and 24 months. Associations of baseline characteristics and intervention adherence with weight loss outcomes were also examined. Results: Among 191 participants (mean [SD] age, 50.2 [12.2] years; 118 [61.8%] women; 107 participants [57.2%] of Mexican origin; mean [SD] baseline BMI, 32.4 [5.7]) randomized, 92 participants were randomized to the intervention and 99 participants were randomized to usual care. Of these, 185 participants (96.9%) completed 24-month follow-up. Mean (SD) weight loss did not differ significantly by group at 24 months (intervention: -1.1 [5.7] kg; control: -1.1 [7.1] kg; P = .93). However, mean (SD) weight loss was significantly greater in the intervention group (-2.6 [6.0] kg) than the control group (-0.3 [4.2] kg) at 12 months (mean difference, -2.1 [95% CI, -3.6 to -0.7] kg; P = .005). Intervention participants were more likely to achieve at least 5% weight loss than control participants at 12 months (22 participants [25.9%] vs 9 participants [9.2%]; P = .003), and participants who achieved at least 5% weight loss attended more intervention sessions than those who did not (mean [SD], 16.6 [7.6] sessions vs 12.4 [7.5] sessions; P = .03). Conclusions and Relevance: These findings suggest that among Latino adults with high diabetes risk, a culturally adapted behavioral lifestyle intervention was effective for weight loss over 12 months but not 24 months. Trial Registration: ClinicalTrials.gov Identifier: NCT02459691.


Assuntos
Terapia Comportamental/métodos , Assistência à Saúde Culturalmente Competente/métodos , Diabetes Mellitus Tipo 2/prevenção & controle , Sobrepeso/terapia , Programas de Redução de Peso/métodos , Adulto , Índice de Massa Corporal , Diabetes Mellitus Tipo 2/etnologia , Diabetes Mellitus Tipo 2/etiologia , Feminino , Hispano-Americanos , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Sobrepeso/complicações , Sobrepeso/etnologia , São Francisco , Resultado do Tratamento , Perda de Peso
9.
Nutrients ; 12(12)2020 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-33333780

RESUMO

Recent studies on whether dairy consumption is associated with type 2 diabetes mellitus (T2DM) have yielded inconsistent results, so we explored the relationship between dairy consumption and T2DM through a large-sample, cross-sectional study and a meta-analysis. In the meta-analysis, summary relative risks (RRs) of 23 articles were compiled with a random effects model, and a restricted cubic spline regression model was used to explore whether there is a nonlinear relationship between dairy intake and T2DM risk. This cross-sectional study used baseline data from 38,735 participants of the Henan Rural Cohort study and the association between dairy consumption and T2DM was analyzed by a logistic regression model. The meta-analysis revealed a borderline negative significant association between total dairy intake and risk of T2DM, the RR and 95% confidence interval (CI) was 0.94; (0.89, 1.00), and the risk was lowest at 270 g daily dairy intake. In the cross-sectional study, there were 3654 T2DM patients and 68.3 percent of the respondents had no dairy intake. The average intake of dairy in the total population was 12 g per day. Fully adjusted analyses suggested positive associations, with an odds ratio (OR) comparing the highest with the zero intake of 1.34 (95% CI: 1.22, 1.48) for all participants, which was unaffected by sex. Dairy intake in rural areas of Henan province is low, and we found, in the context of overall low dairy intake, that a high intake was positively associated with T2DM, which is inconsistent with the meta-analysis results suggesting that dairy has marginal protective effects against T2DM.


Assuntos
Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Laticínios/estatística & dados numéricos , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/etiologia , Dieta/estatística & dados numéricos , Adulto , China/epidemiologia , Estudos Transversais , Laticínios/efeitos adversos , Diabetes Mellitus Tipo 2/etnologia , Dieta/efeitos adversos , Inquéritos sobre Dietas , Feminino , Humanos , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prevalência , Estudos Prospectivos , Risco , Fatores de Risco , População Rural/estatística & dados numéricos
10.
Nat Commun ; 11(1): 3865, 2020 07 31.
Artigo em Inglês | MEDLINE | ID: mdl-32737319

RESUMO

Polygenic scores (PGS) have been widely used to predict disease risk using variants identified from genome-wide association studies (GWAS). To date, most GWAS have been conducted in populations of European ancestry, which limits the use of GWAS-derived PGS in non-European ancestry populations. Here, we derive a theoretical model of the relative accuracy (RA) of PGS across ancestries. We show through extensive simulations that the RA of PGS based on genome-wide significant SNPs can be predicted accurately from modelling linkage disequilibrium (LD), minor allele frequencies (MAF), cross-population correlations of causal SNP effects and heritability. We find that LD and MAF differences between ancestries can explain between 70 and 80% of the loss of RA of European-based PGS in African ancestry for traits like body mass index and type 2 diabetes. Our results suggest that causal variants underlying common genetic variation identified in European ancestry GWAS are mostly shared across continents.


Assuntos
Asma/genética , Diabetes Mellitus Tipo 2/genética , Hipertensão/genética , Modelos Genéticos , Herança Multifatorial , Polimorfismo de Nucleotídeo Único , Adulto , África/epidemiologia , Idoso , Alelos , Ásia/epidemiologia , Asma/diagnóstico , Asma/epidemiologia , Asma/etnologia , Índice de Massa Corporal , Colesterol/sangue , Simulação por Computador , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/etnologia , Europa (Continente)/epidemiologia , Feminino , Frequência do Gene , Estudo de Associação Genômica Ampla , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/etnologia , Desequilíbrio de Ligação , Masculino , Pessoa de Meia-Idade , Prognóstico , Característica Quantitativa Herdável , Risco
11.
J Natl Black Nurses Assoc ; 31(1): 32-40, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32853494

RESUMO

The prevalence of type 2 diabetes mellitus (T2DM) is 19.7% in Haiti (DeGennaro et al., 2018). Haitian American women (HAW) experience difficulties with adherence to T2DM treatment and management (Bivins, 2016; Magny-Normilus et al., 2019; Vimalananda et al., 2011; Huffman et al., 2013); however, no previous study was found that focused exclusively on Haitian American women with T2DM. Van Manen's six research activities guided this phenomenological qualitative inquiry. Recruitment included 25 Haitian American women (N = 25) with T2DM from three South Florida counties. Data were collected using a vignette and audio-recorded semi-structured interviews with open-ended questions. Recordings were then transcribed and analyzed to identify thematic concepts and patterns. Themes of spiritualizing and shifting cultural norms with the subtheme of dietary restrictions were found. In conclusion, to promote health outcomes nurses must incorporate these salient factors in the care of Haitian American women with T2DM.


Assuntos
Diabetes Mellitus Tipo 2/etnologia , Assistência à Saúde Culturalmente Competente/organização & administração , Diabetes Mellitus Tipo 2/enfermagem , Feminino , Haiti/etnologia , Humanos , Pesquisa Qualitativa , Estados Unidos
12.
Nutr Metab Cardiovasc Dis ; 30(10): 1785-1794, 2020 09 24.
Artigo em Inglês | MEDLINE | ID: mdl-32605881

RESUMO

BACKGROUND AND AIMS: Metabolic syndrome (MetS) increases the risk of cardiovascular disease and type 2 diabetes. Despite a higher prevalence of MetS in African American (AA) women, little is known about the effectiveness of lifestyle interventions in improving metabolic markers in this high-risk group. This study investigated the effectiveness of a community-based lifestyle intervention delivered by lay health coaches in reducing MetS among AA women. METHODS AND RESULTS: A cluster-randomized diabetes prevention program (DPP) was implemented in 11 churches utilizing a community-based participatory research (CBPR) approach to develop and deliver the interventions. A total of 221 adults, AA women who were overweight or obese, and did not have diabetes were included in this study. The prevalence of MetS was 42.08% before receiving the DPP intervention and 31.22% after the intervention that represented a 10.86% absolute reduction and a 25.81% relative reduction from baseline. The adjusted odds ratio (OR) of being free from MetS at post-intervention in contrast to baseline was 2.14 (p = 0.02). Factors that increased the odds of being free from MetS were younger age, reduction in intake of total calories, total fat, saturated and trans-fat, and dietary sodium. CONCLUSION: A faith adapted lifestyle intervention held in church settings and delivered by minimally trained lay health coaches reduced the prevalence of MetS in AA women who were overweight or obese. Findings from this study can be used to translate evidence into public health programs at the community level for the prevention of type 2 diabetes and cardiovascular disease. CLINICAL TRIAL REGISTRATION NUMBER: NCT04082702 (www.clinicaltrials.gov).


Assuntos
Afro-Americanos , Serviços de Saúde Comunitária , Diabetes Mellitus Tipo 2/prevenção & controle , Organizações Religiosas , Estilo de Vida Saudável , Síndrome Metabólica/prevenção & controle , Obesidade/terapia , Comportamento de Redução do Risco , Adulto , Cristianismo , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/etnologia , Feminino , Humanos , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/etnologia , Pessoa de Meia-Idade , Obesidade/diagnóstico , Obesidade/etnologia , Prevalência , Fatores de Risco , Fatores Sexuais , Texas/epidemiologia , Resultado do Tratamento
13.
BMC Public Health ; 20(1): 1024, 2020 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-32600448

RESUMO

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a metabolic disorder which accounts for high morbidity and mortality due to complications like renal failure, amputations, cardiovascular disease, and cerebrovascular events. METHODS: We collected medical reports, lifestyle details, and blood samples of individuals and used the polymerase chain reaction-ligase detection reaction method to genotype the SNPs, and a visit was conducted in August 2016 to obtain the incidence of Type 2 diabetes in the 2113 eligible people. To explore which genes and environmental factors are associated with type 2 diabetes mellitus in a Chinese Han population, we used elastic net to build a model, which is to explain which variables are strongly associated with T2DM, rather than predict the occurrence of T2DM. RESULT: The genotype of the additive of rs964184, together with the history of hypertension, regular intake of meat and waist circumference, increased the risk of T2DM (adjusted OR = 2.38, p = 0.042; adjusted OR = 3.31, p < 0.001; adjusted OR = 1.05, p < 0.001). The TT genotype of the additive and recessive models of rs12654264, the CC genotype of the additive and dominant models of rs2065412, the TT genotype of the additive and dominant models of rs4149336, together with the degree of education, regular exercise, reduced the risk of T2DM (adjusted OR = 0.46, p = 0.017; adjusted OR = 0.53, p = 0.021; adjusted OR = 0.59, p = 0.021; adjusted OR = 0.57, p = 0.01; adjusted OR = 0.59, p = 0.021; adjusted OR = 0.57, p = 0.01; adjusted OR = 0.50, p = 0.007; adjusted OR = 0.80, p = 0.032) . CONCLUSION: Eventually we identified a set of SNPs and environmental factors: rs5805 in the SLC12A3, rs12654264 in the HMGCR, rs2065412 and rs414936 in the ABCA1, rs96418 in the ZPR1 gene, waistline, degree of education, exercise frequency, hypertension, and the intake of meat. Although there was no interaction between these variables, people with two risk factors had a higher risk of T2DM than those only having one factor. These results provide the theoretical basis for gene and other risk factors screening to prevent T2DM.


Assuntos
Transportador 1 de Cassete de Ligação de ATP/genética , Grupo com Ancestrais do Continente Asiático/genética , Diabetes Mellitus Tipo 2/genética , Hidroximetilglutaril-CoA Redutases/genética , Proteínas de Membrana Transportadoras/genética , Idoso , Carbolinas , China/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/etnologia , Feminino , Predisposição Genética para Doença/epidemiologia , Predisposição Genética para Doença/etnologia , Genótipo , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único , Fatores de Risco , Circunferência da Cintura/etnologia , Circunferência da Cintura/genética
14.
Cardiovasc Diabetol ; 19(1): 94, 2020 06 20.
Artigo em Inglês | MEDLINE | ID: mdl-32563247

RESUMO

BACKGROUND: Studies assessing the efficacy of pioglitazone solely for primary stroke prevention in Asian patients with type 2 diabetes mellitus (DM) and present multiple cardiovascular (CV) risk factors are rare. Thus, we aimed to assess the effect of pioglitazone on primary stroke prevention in Asian patients with type 2 DM without established CV diseases but with risk factors for CV diseases. METHODS: Between 2000 and 2012, we enrolled patients aged ≥ 18 years, who were newly diagnosed with type 2 diabetes and had at least one of the following CV risk factors: hypertension and hyperlipidemia. Patients with a history of stroke and those using insulin or glucagon-like peptide-1 agonist for more than 3 months were excluded. Patients were divided into the pioglitazone and non-pioglitazone groups based on their receipt of pioglitazone during the follow-up period. Propensity-score matching (1:1) was used to balance the distribution of the baseline characteristics and medications. Follow-up was terminated upon ischemic stroke development, withdrawal from the insurance system, or on December 31, 2013, whichever occurred first. The overall incidence of new-onset ischemic stroke in the two groups was subsequently compared. The subgroup analyses of ischemic stroke were conducted using different baseline features. Additionally, the effect of pioglitazone exposure dose on the occurrence of ischemic stroke was evaluated. Chi square test, Student's t-test, competing risk regression models, Kaplan-Meier method, and log-rank test were some of the statistical tests conducted. RESULTS: A total of 13 078 patients were included in the pioglitazone and non-pioglitazone groups. Compared with patients who did not receive pioglitazone, those administered pioglitazone had a lower risk of developing ischemic stroke (adjusted hazard ratio: 0.78; 95% confidence interval: 0.62-0.95). The subgroup analyses defined by different baseline features did not reveal significant alterations in the observed effect of pioglitazone. Moreover, a significant decreasing trend in ischemic stroke risk with an increase in pioglitazone dose (p-value for trend = 0.04) was observed. CONCLUSION: Pioglitazone use decreased the risk of new-onset ischemic stroke in Asian patients with type 2 DM and CV risk factors. Trial registration number CMUH104-REC2-115-CR4.


Assuntos
Grupo com Ancestrais do Continente Asiático , Isquemia Encefálica/prevenção & controle , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Pioglitazona/uso terapêutico , Prevenção Primária , Acidente Vascular Cerebral/prevenção & controle , Idoso , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/etnologia , Bases de Dados Factuais , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/etnologia , Feminino , Humanos , Hipoglicemiantes/efeitos adversos , Masculino , Pessoa de Meia-Idade , Pioglitazona/efeitos adversos , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etnologia , Taiwan/epidemiologia , Fatores de Tempo , Resultado do Tratamento
15.
Nat Genet ; 52(7): 680-691, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32541925

RESUMO

We investigated type 2 diabetes (T2D) genetic susceptibility via multi-ancestry meta-analysis of 228,499 cases and 1,178,783 controls in the Million Veteran Program (MVP), DIAMANTE, Biobank Japan and other studies. We report 568 associations, including 286 autosomal, 7 X-chromosomal and 25 identified in ancestry-specific analyses that were previously unreported. Transcriptome-wide association analysis detected 3,568 T2D associations with genetically predicted gene expression in 687 novel genes; of these, 54 are known to interact with FDA-approved drugs. A polygenic risk score (PRS) was strongly associated with increased risk of T2D-related retinopathy and modestly associated with chronic kidney disease (CKD), peripheral artery disease (PAD) and neuropathy. We investigated the genetic etiology of T2D-related vascular outcomes in the MVP and observed statistical SNP-T2D interactions at 13 variants, including coronary heart disease (CHD), CKD, PAD and neuropathy. These findings may help to identify potential therapeutic targets for T2D and genomic pathways that link T2D to vascular outcomes.


Assuntos
Complicações do Diabetes/genética , Diabetes Mellitus Tipo 2/genética , Predisposição Genética para Doença , Afro-Americanos , Cromossomos Humanos X , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/etnologia , Angiopatias Diabéticas/genética , Europa (Continente) , Feminino , Estudos de Associação Genética , Humanos , Hipoglicemiantes/uso terapêutico , Masculino , Polimorfismo de Nucleotídeo Único , Medição de Risco
16.
Nefrología (Madrid) ; 40(3): 287-298, mayo-jun. 2020.
Artigo em Inglês | IBECS | ID: ibc-201529

RESUMO

ANTECEDENTES: La nefropatía diabética (ND) es una complicación importante de la diabetes mellitus de tipo 2 (DMT2) con altas tasas de morbilidad mundial. OBJETIVO: Determinar la asociación del polimorfismo rs1801282 de PPAR en la DMT2 y la ND en la población del sur de India. MÉTODOS: Hemos llevado a cabo un estudio de casos y controles para analizar la asociación del polimorfismo rs1801282 con la DMT2 y la ND en 424 sujetos (ND = 128; DMT2 = 148 y controles = 148) pertenecientes a la población del sur de India mediante RCP-ARMS y método de secuenciación de Sanger. Además, se realizó un metaanálisis para el polimorfismo de rs1801282 a partir de la literatura publicada en varias bases de datos electrónicas para determinar la sensibilidad entre la DMT2 y la ND en varias poblaciones étnicas con 5 modelos genéticos. RESULTADOS: El genotipado de polimorfismo rs1801282 demostró una asociación significativa (valor de p < 0,05) con la ND y la DMT2 en comparación con los controles. En el metaanálisis no se observó asociación significativa (valor de p > 0,05) de rs1801282 con la ND frente a los controles en modelos genéticos homocigóticos, heterocigóticos, alélicos, recesivos y dominantes. Sin embargo, se observó una asociación significativa entre el polimorfismo de nucleótido único (PNU) rs1801282 SNP y la DMT2 en el modelo genético heterocigótico (Jj frente a JJ) con OR = 0,56, (IC del 95%: 0,43-0,74; p ≤ 0,0001 de poblaciones asiáticas y caucásicas. CONCLUSIÓN: El análisis general sugiere que el polimorfismo rs1801282 puede asociarse a ND y a DMT2. Se precisan más estudios de casos y controles sobre el gen PPAR con un taman˜ o de la muestra mayor que incluya todos los factores de confusión para corroborar los resultados de este metaanálisis


BACKGROUND: Diabetic Nephropathy (DN) is a major complication of Type 2 Diabetes Mellitus (T2DM) with high morbidity rates worldwide. OBJECTIVE: To determine the association of PPAR rs1801282 polymorphism in T2DM and DN in south Indian population. METHODS: We have conducted a case-control study to test the association of rs1801282 polymorphism with T2DM and DN in 424 subjects (DN = 128; T2DM = 148 and controls = 148) belonging to the south Indian population using ARMS-PCR and Sanger sequencing method. Further, a meta-analysis was performed for rs1801282 polymorphism from the published literature retrieved from various electronic databases to determine the susceptibility among T2DM and DN across various ethnic populations under five genetic models. RESULTS: The genotyping of rs1801282 polymorphism showed significant (p-value < 0.05) association with DN and T2DM compared to controls. In the meta-analysis, no significant association (p-value > 0.05) was noticed for rs1801282 with DN vs. controls in homozygote, heterozygote, allelic, recessive and dominant genetic models. However, a significant association was observed between rs1801282 SNP and T2DM under heterozygote (Jj vs JJ) genetic model with OR = 0.56, (95%CI [0.43-0.74]), p ≤ 0.0001 of Asian and Caucasian populations. CONCLUSION: Overall analysis suggests that the rs1801282 polymorphism might be associated with DN and T2DM. More case-control studies on the PPAR gene with a larger sample size including all the confounding factors are required to corroborate the findings from this meta-analysis


Assuntos
Humanos , Pessoa de Meia-Idade , Idoso , Diabetes Mellitus Tipo 2/genética , Nefropatias Diabéticas/genética , PPAR gama/genética , Polimorfismo de Nucleotídeo Único , Estudos de Casos e Controles , Fatores de Confusão Epidemiológicos , Grupos de Populações Continentais/genética , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/etnologia , Nefropatias Diabéticas/epidemiologia , Nefropatias Diabéticas/etnologia , Grupos Étnicos/genética , Frequência do Gene , Predisposição Genética para Doença , Genótipo , Índia/epidemiologia , Modelos Genéticos , Tamanho da Amostra
17.
Am J Med Sci ; 359(5): 266-270, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32359533

RESUMO

BACKGROUND: Cross-sectional surveys report a higher prevalence of diagnosed type 2 diabetes mellitus (T2DM) in African Americans (AA) than European Americans (EA). We studied 5-year glycemic excursions among AA and EA in the Pathobiology of Prediabetes in A Biracial Cohort study, to assess ethnic disparities. MATERIALS AND METHODS: Pathobiology of Prediabetes in A Biracial Cohort followed normoglycemic offspring of parents with T2DM for 5 years, with serial assessments of oral glucose tolerance test , anthropometry, body fat, insulin sensitivity and beta-cell function. The primary outcome was progression to prediabetes (impaired fasting glucose and/or impaired glucose tolerance). We further analyzed 5-year changes in fasting (FPG) and 2-hour plasma glucose (2hrPG). RESULTS: One hundred and one (52 AA, 49 EA) out of 343 subjects developed prediabetes during follow-up. The change in FPG ranged from -24 mg/dl to +38 mg/dl. The FPG remained stable (± 5 mg/dl from baseline) in 50% of EA and 46.8% of AA and the 2hrPG remained stable (± 25 mg/dl from baseline) in 73.7% of EA and 71.0 % of AA during follow-up. The proportions with change in FPG of 5mg/dl to >25 mg/dl and 2hrPG of 25 mg/dl to >50 mg/dl were similar in EA and AA offspring, as were the 10th - 90th percentiles of the distribution of 5-year changes in FPG and 2hrPG. CONCLUSIONS: During 5 years of follow-up, black and white offspring of parents with T2DM exhibited remarkable phenotypic concordance of glycemic trajectories. Thus, parental history of T2DM may be a stronger factor than race/ethnicity in the prediction of longitudinal glycemic trends.


Assuntos
Diabetes Mellitus Tipo 2/etnologia , Estado Pré-Diabético/etnologia , Adulto , Afro-Americanos , Antropometria , Glicemia/análise , Índice de Massa Corporal , Diabetes Mellitus Tipo 2/sangue , Grupo com Ancestrais do Continente Europeu , Saúde da Família , Feminino , Seguimentos , Intolerância à Glucose/diagnóstico , Teste de Tolerância a Glucose , Hemoglobina A Glicada/análise , Disparidades em Assistência à Saúde , Humanos , Hiperglicemia/sangue , Insulina/sangue , Resistência à Insulina , Células Secretoras de Insulina/citologia , Masculino , Pessoa de Meia-Idade , Pais , Fenótipo , Estado Pré-Diabético/sangue , Prevalência , Resultado do Tratamento , Estados Unidos/epidemiologia
18.
PLoS One ; 15(5): e0230815, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32379818

RESUMO

Smoking is a potentially causal behavioral risk factor for type 2 diabetes (T2D), but not all smokers develop T2D. It is unknown whether genetic factors partially explain this variation. We performed genome-environment-wide interaction studies to identify loci exhibiting potential interaction with baseline smoking status (ever vs. never) on incident T2D and fasting glucose (FG). Analyses were performed in participants of European (EA) and African ancestry (AA) separately. Discovery analyses were conducted using genotype data from the 50,000-single-nucleotide polymorphism (SNP) ITMAT-Broad-CARe (IBC) array in 5 cohorts from from the Candidate Gene Association Resource Consortium (n = 23,189). Replication was performed in up to 16 studies from the Cohorts for Heart Aging Research in Genomic Epidemiology Consortium (n = 74,584). In meta-analysis of discovery and replication estimates, 5 SNPs met at least one criterion for potential interaction with smoking on incident T2D at p<1x10-7 (adjusted for multiple hypothesis-testing with the IBC array). Two SNPs had significant joint effects in the overall model and significant main effects only in one smoking stratum: rs140637 (FBN1) in AA individuals had a significant main effect only among smokers, and rs1444261 (closest gene C2orf63) in EA individuals had a significant main effect only among nonsmokers. Three additional SNPs were identified as having potential interaction by exhibiting a significant main effects only in smokers: rs1801232 (CUBN) in AA individuals, rs12243326 (TCF7L2) in EA individuals, and rs4132670 (TCF7L2) in EA individuals. No SNP met significance for potential interaction with smoking on baseline FG. The identification of these loci provides evidence for genetic interactions with smoking exposure that may explain some of the heterogeneity in the association between smoking and T2D.


Assuntos
Glicemia/análise , Fumar Cigarros/genética , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/genética , Jejum/sangue , Genótipo , Adulto , Grupo com Ancestrais do Continente Africano/genética , Idoso , Fumar Cigarros/etnologia , Estudos de Coortes , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/etnologia , Grupo com Ancestrais do Continente Europeu/genética , Estudos de Viabilidade , Feminino , Loci Gênicos , Estudo de Associação Genômica Ampla , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único , Risco
19.
BMC Public Health ; 20(1): 684, 2020 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-32410708

RESUMO

BACKGROUND: Toxic stress (TS), minority race and their interaction are evaluated as determinants of change in quality of life (QOL) over 8 years follow-up in a nationally representative sample of United States (US) adults (≥50 years old) with heart disease (HD) and/or type-2 diabetes (T2DM) diagnosed by 2006 as part of the Health and Retirement Study (HRS). METHODS: Recent and life-course stress plus experiences of lifetime discrimination were measured every 2 years using the stressful life experiences questionnaire. QOL was assessed by participant self-rated health (SRH) and operationally defined as improved, unchanged or declined in current year versus two years prior. Repeated measures multinomial logistic regressionusing generalized estimating equations (GEEs) was implemented to estimate race-, TS and their interaction- related odds of worse SRH from2006-2014. Odds ratios (OR) and 95% confidence intervals (CIs) were calculated with adjustment for time, age, sex and socio-economic status. RESULTS: Three thousand nine hundred four adults with HD/T2DM, mean age 71.1 ± 9.3 years old, 80.9, 14.7 and 4.4% that respectively self-identified as Caucasian, African-American and Other race, were included. Over the eight-year follow-up, the odds of worse SRH for African-American and Other race were respectively 1.46 (95% CI: 1.25-1.70) and 1.43 (95% CI, 1.10-1.86) times higher relative to Caucasians. Relative to older Americans that reported ≥2 lifetime discrimination events, the odds of poor SRH was respectively 33% (OR = 0.67, 95%CI: 0.50-0.89) and 17% (OR = 0.83, 95%CI: 0.59-1.17) lower for those that reported none vs one lifetime discrimination experience. Furthermore, the relationship of life-course stress to SRH decline over 8 years varied by race (time*stress*race, p = 0.1173). Specifically, increasing life-course stress predicted worse QOL among Caucasians (p = 0.0063) and among African-American (p = 0.0820) but not among Other race (p = 0.9943). CONCLUSION: Toxic stress and minority race are social determinants of deterioration in QOL among older Americans with chronic diseases (HD/T2DM). The types and prevalence of toxic stressors varied by race/ethnicity. Policy interventions to address root causes of TS while targeted at proximate drivers of TS by race/ethnicity represent a viable strategy for mitigating racial disparities in overall wellbeing and improving QOL in all aging Americans regardless of race.


Assuntos
Grupos de Populações Continentais , Diabetes Mellitus Tipo 2 , Cardiopatias , Grupos Minoritários , Qualidade de Vida , Racismo , Estresse Psicológico/complicações , Afro-Americanos , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Diabetes Mellitus Tipo 2/etnologia , Diabetes Mellitus Tipo 2/psicologia , Grupos Étnicos , Grupo com Ancestrais do Continente Europeu , Feminino , Cardiopatias/etnologia , Cardiopatias/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prevalência , Aposentadoria , Classe Social , Determinantes Sociais da Saúde , Inquéritos e Questionários , Estados Unidos
20.
Womens Health Issues ; 30(3): 191-199, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32340896

RESUMO

BACKGROUND: Diabetes is increasingly prevalent among women of reproductive age, yet little is known about quality of diabetes care for this population at increased risk of diabetes complications and poor maternal and infant health outcomes. Previous studies have identified racial/ethnic disparities in diabetes care, but patterns among women of reproductive age have not been examined. METHODS: This retrospective cohort study analyzed 2016 data from Kaiser Permanente Northern California, a large integrated delivery system. Outcomes were quality of diabetes care measures-glycemic testing, glycemic control, and medication adherence-among women ages 18 to 44 with type 1 or type 2 diabetes (N = 9,923). Poisson regression was used to estimate the association between patient race/ethnicity and each outcome, adjusting for other patient characteristics and health care use. RESULTS: In this cohort, 83% of participants had type 2 diabetes; 31% and 36% of women with type 2 and type 1 diabetes, respectively, had poor glycemic control (hemoglobin A1c of ≥9%), and approximately one-third of women with type 2 diabetes exhibited nonadherence to diabetes medications. Compared with non-Hispanic White women with type 2 diabetes, non-Hispanic Black women (adjusted risk ratio, 1.2; 95% confidence interval, 1.1-1.3) and Hispanic women (adjusted risk ratio, 1.2; 95% confidence interval, 1.1-1.3) were more likely to have poor control. Findings among women with type 1 diabetes were similar. CONCLUSIONS: Our findings indicate opportunities to decrease disparities and improve quality of diabetes care for reproductive-aged women. Elucidating the contributing factors to poor glycemic control and medication adherence in this population, particularly among Black, Hispanic, and Asian women, should be a high research and practice priority.


Assuntos
Prestação Integrada de Cuidados de Saúde/normas , Diabetes Mellitus Tipo 1/etnologia , Diabetes Mellitus Tipo 2/etnologia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde , Adolescente , Adulto , Afro-Americanos/estatística & dados numéricos , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Glicemia , Estudos de Coortes , Grupos Étnicos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hemoglobina A Glicada , Hispano-Americanos/estatística & dados numéricos , Humanos , Adesão à Medicação/etnologia , Prevalência , Estudos Retrospectivos , Risco , Estados Unidos , Adulto Jovem
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