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1.
Adv Exp Med Biol ; 1268: 115-122, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32918215

RESUMO

Increasing sun exposure is related to lower prevalence of death in cardiovascular disease (CVD), type 2 diabetes, and other noncancer non-CVD. In this chapter we aim to make a short update on the knowledge regarding sun exposure and all-cause mortality. Data support the hypothesis that low sun exposure habits are a major risk factor for all-cause mortality. Low sun exposure is related to an increased risk of death due to CVD and noncancer/non-CVD, and a minor reduction in risk of cancer. Active sun exposure habits have a dual effect; it increases the incidence of skin cancer, but also improves the prognosis in terms of all-cause mortality. In a low solar intensity region, we should carefully assess both risk and benefits of sun exposure in order to obtain balanced recommendations.


Assuntos
Causas de Morte , Luz Solar , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/prevenção & controle , Humanos , Fatores de Risco , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/etiologia
2.
Nat Commun ; 11(1): 4737, 2020 09 23.
Artigo em Inglês | MEDLINE | ID: mdl-32968070

RESUMO

Innate immune signaling through the NLRP3 inflammasome is activated by multiple diabetes-related stressors, but whether targeting the inflammasome is beneficial for diabetes is still unclear. Nucleoside reverse-transcriptase inhibitors (NRTI), drugs approved to treat HIV-1 and hepatitis B infections, also block inflammasome activation. Here, we show, by analyzing five health insurance databases, that the adjusted risk of incident diabetes is 33% lower in patients with NRTI exposure among 128,861 patients with HIV-1 or hepatitis B (adjusted hazard ratio for NRTI exposure, 0.673; 95% confidence interval, 0.638 to 0.710; P < 0.0001; 95% prediction interval, 0.618 to 0.734). Meanwhile, an NRTI, lamivudine, improves insulin sensitivity and reduces inflammasome activation in diabetic and insulin resistance-induced human cells, as well as in mice fed with high-fat chow; mechanistically, inflammasome-activating short interspersed nuclear element (SINE) transcripts are elevated, whereas SINE-catabolizing DICER1 is reduced, in diabetic cells and mice. These data suggest the possibility of repurposing an approved class of drugs for prevention of diabetes.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Reposicionamento de Medicamentos , Inflamassomos/efeitos dos fármacos , Resistência à Insulina , Inibidores da Transcriptase Reversa/farmacologia , Adipócitos/metabolismo , Animais , Sobrevivência Celular , RNA Helicases DEAD-box/metabolismo , Diabetes Mellitus Tipo 2/prevenção & controle , Dieta Hiperlipídica/efeitos adversos , HIV-1/efeitos dos fármacos , Hepatite B , Humanos , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Células Musculares/metabolismo , Ribonuclease III/metabolismo
3.
PLoS One ; 15(8): e0237974, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32841271

RESUMO

BACKGROUND: Cardiometabolic disorders are frequently observed among those who have obesity as measured by body mass index (BMI). However, there is limited data available on the cardiometabolic profile of those who are non-obese by BMI but with a high body fat percentage (BFP), a phenotype frequently observed in the Indian population. We examined the prevalence of individuals with normal weight obesity (NWO) and the cardiometabolic profile of NWO individuals at high risk for type 2 diabetes(T2D) in a south Asian population. MATERIAL AND METHODS: In the Kerala Diabetes Prevention Program, individuals aged between 30 to 60 years were screened using the Indian Diabetes Risk Score(IDRS) in 60 rural communities in the Indian state of Kerala. We used data from the baseline survey of this trial for this analysis which included 1147 eligible high diabetes risk individuals(IDRS >60). NWO was defined as BMI within the normal range and a high BFP (as per Asia-pacific ethnicity based cut-off); Non-obese (NO) as normal BMI and BFP and overtly obese (OB) as BMI ≥25 kg/m2 irrespective of the BFP. Data on demographic, clinical and biochemical characteristics were collected using standardized questionnaires and protocols. Body fat percentage was assessed using TANITA body composition analyser (model SC330), based on bioelectrical impedance. RESULTS: The mean age of participants was 47.3 ± 7.5 years and 46% were women. The proportion with NWO was 32% (n = 364; 95% CI: 29.1 to 34.5%), NO was 17% (n = 200) and OB was 51% (n = 583). Among those with NWO, 19.7% had T2D, compared to 18.7% of those who were OB (p value = 0.45) and 8% with NO (p value = 0.003). Among those with NWO, mean systolic and diastolic blood pressure were 129 ± 20; 78 ± 12 mmHg, compared to 127 ± 17; 78±11 mmHg among those with OB (p value = 0.12;0.94) and 120 ± 16; 71±10 mmHg among with NO (p value<0.001; 0.001), respectively. A similar pattern of association was observed for LDL cholesterol and triglycerides. After adjusting for other risk factors, the odds of having diabetes (OR:2.72[95% CI:1.46-5.08]) and dyslipidemia (2.37[1.55-3.64]) was significantly more in individuals with NWO as compared to non-obese individuals. CONCLUSIONS: Almost one-third of this South Asian population, at high risk for T2D, had normal weight obesity. The significantly higher cardiometabolic risk associated with increased adiposity even in lower BMI individuals has important implications for recognition in clinical practice.


Assuntos
Tecido Adiposo/patologia , Peso Corporal , Bases de Dados Factuais , Diabetes Mellitus Tipo 2/prevenção & controle , Miocárdio/metabolismo , Obesidade/epidemiologia , Obesidade/metabolismo , Adulto , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Obesidade/patologia , Fenótipo , Prevalência , Fatores de Risco
4.
BMJ ; 370: m2206, 2020 07 08.
Artigo em Inglês | MEDLINE | ID: mdl-32641435

RESUMO

OBJECTIVE: To examine the associations between the intake of total and individual whole grain foods and the risk of type 2 diabetes. DESIGN: Prospective cohort studies. SETTING: Nurses' Health Study (1984-2014), Nurses' Health Study II (1991-2017), and Health Professionals Follow-Up Study (1986-2016), United States. PARTICIPANTS: 158 259 women and 36 525 men who did not have type 2 diabetes, cardiovascular disease, or cancer at baseline. MAIN OUTCOME MEASURES: Self-reports of incident type 2 diabetes by participants identified through follow-up questionnaires and confirmed by a validated supplementary questionnaire. RESULTS: During 4 618 796 person years of follow-up, 18 629 participants with type 2 diabetes were identified. Total whole grain consumption was categorized into five equal groups of servings a day for the three cohorts. After adjusting for lifestyle and dietary risk factors for diabetes, participants in the highest category for total whole grain consumption had a 29% (95% confidence interval 26% to 33%) lower rate of type 2 diabetes compared with those in the lowest category. For individual whole grain foods, pooled hazard ratios (95% confidence intervals) for type 2 diabetes in participants consuming one or more servings a day compared with those consuming less than one serving a month were 0.81 (0.77 to 0.86) for whole grain cold breakfast cereal, 0.79 (0.75 to 0.83) for dark bread, and 1.08 (1.00 to 1.17) for popcorn. For other individual whole grains with lower average intake levels, comparing consumption of two or more servings a week with less than one serving a month, the pooled hazard ratios (95% confidence intervals) were 0.79 (0.75 to 0.83) for oatmeal, 0.88 (0.82 to 0.94) for brown rice, 0.85 (0.80 to 0.90) for added bran, and 0.88 (0.78 to 0.98) for wheat germ. Spline regression showed a non-linear dose-response association between total whole grain intake and the risk of type 2 diabetes where the rate reduction slightly plateaued at more than two servings a day (P<0.001 for curvature). For whole grain cold breakfast cereal and dark bread, the rate reduction plateaued at about 0.5 servings a day. For consumption of popcorn, a J shaped association was found where the rate of type 2 diabetes was not significantly raised until consumption exceeded about one serving a day. The association between higher total whole grain intake and lower risk of type 2 diabetes was stronger in individuals who were lean than in those who were overweight or obese (P=0.003 for interaction), and the associations did not vary significantly across levels of physical activity, family history of diabetes, or smoking status. CONCLUSION: Higher consumption of total whole grains and several commonly eaten whole grain foods, including whole grain breakfast cereal, oatmeal, dark bread, brown rice, added bran, and wheat germ, was significantly associated with a lower risk of type 2 diabetes. These findings provide further support for the current recommendations of increasing whole grain consumption as part of a healthy diet for the prevention of type 2 diabetes.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Dieta Saudável , Grãos Integrais , Adulto , Diabetes Mellitus Tipo 2/prevenção & controle , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Inquéritos e Questionários , Estados Unidos/epidemiologia
5.
BMJ ; 370: m2194, 2020 07 08.
Artigo em Inglês | MEDLINE | ID: mdl-32641421

RESUMO

OBJECTIVE: To investigate the association of plasma vitamin C and carotenoids, as indicators of fruit and vegetable intake, with the risk of type 2 diabetes. DESIGN: Prospective case-cohort study. SETTING: Populations from eight European countries. PARTICIPANTS: 9754 participants with incident type 2 diabetes, and a subcohort of 13 662 individuals from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort of 340 234 participants: EPIC-InterAct case-cohort study. MAIN OUTCOME MEASURE: Incident type 2 diabetes. RESULTS: In a multivariable adjusted model, higher plasma vitamin C was associated with a lower risk of developing type 2 diabetes (hazard ratio per standard deviation 0.82, 95% confidence interval 0.76 to 0.89). A similar inverse association was shown for total carotenoids (hazard ratio per standard deviation 0.75, 0.68 to 0.82). A composite biomarker score (split into five equal groups), comprising vitamin C and individual carotenoids, was inversely associated with type 2 diabetes with hazard ratios 0.77, 0.66, 0.59, and 0.50 for groups 2-5 compared with group 1 (the lowest group). Self-reported median fruit and vegetable intake was 274 g/day, 396 g/day, and 508 g/day for participants in categories defined by groups 1, 3, and 5 of the composite biomarker score, respectively. One standard deviation difference in the composite biomarker score, equivalent to a 66 (95% confidence interval 61 to 71) g/day difference in total fruit and vegetable intake, was associated with a hazard ratio of 0.75 (0.67 to 0.83). This would be equivalent to an absolute risk reduction of 0.95 per 1000 person years of follow up if achieved across an entire population with the characteristics of the eight European countries included in this analysis. CONCLUSIONS: These findings indicate an inverse association between plasma vitamin C, carotenoids, and their composite biomarker score, and incident type 2 diabetes in different European countries. These biomarkers are objective indicators of fruit and vegetable consumption, and suggest that diets rich in even modestly higher fruit and vegetable consumption could help to prevent development of type 2 diabetes.


Assuntos
Ácido Ascórbico/sangue , Carotenoides/sangue , Diabetes Mellitus Tipo 2/prevenção & controle , Frutas , Verduras , Biomarcadores/sangue , Estudos de Casos e Controles , Diabetes Mellitus Tipo 2/sangue , Dieta , Europa (Continente) , Feminino , Humanos , Masculino , Estudos Prospectivos
7.
Diabetes Res Clin Pract ; 166: 108273, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32590009

RESUMO

BACKGROUND: Many countries worldwide have developed diabetes prevention programmes (DPPs) that involve lifestyle modification. Research has shown that uptake and retention of DPPs are important and by exploring recruitment strategies and behaviour change techniques (BCTs) used, factors that are most effective in promoting uptake and retention can be identified. OBJECTIVES: This review aims to identify recruitment strategies of group-based DPPs that are associated with high uptake and common BCTs associated with high retention. METHODS: Papers were identified with a systematic literature search. Programmes that were predominantly group-based and involved lifestyle modification and in which uptake and/or retention could be determined, were included. Intervention details were extracted, recruitment strategies and BCTs identified, and response, uptake and retention rates were calculated. RESULTS: A range of recruitment strategies were used making it difficult to discern associations with uptake rates. For BCTs, all programmes used a credible source, 81% used instruction on how to perform a behaviour and 71% used goal setting (behaviour). BCTs more commonly found in high retention programmes included problem-solving, demonstrating the behaviour, using behavioural practice and reducing negative emotions. CONCLUSIONS: Recommendations include that DPPs incorporate BCTs like problem-solving and demonstrating the behaviour to maximise retention.


Assuntos
Terapia Comportamental/métodos , Diabetes Mellitus Tipo 2/prevenção & controle , Idoso , Humanos , Pessoa de Meia-Idade
8.
PLoS One ; 15(5): e0232250, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32401778

RESUMO

AIMS: Type 2 diabetes mellitus (T2DM) and gestational diabetes (GDM) are globally on the rise, accompanied by comorbidities and associated health costs. Increased physical activity, healthy nutrition, and weight loss have shown the potential to prevent T2DM/GDM. Despite this, reaching vulnerable groups remains a key challenge. The aim of this scoping review was to identify barriers and facilitating factors in the prevention of T2DM/GDM in vulnerable groups. METHODS: We conducted a systematic literature search in May 2018, updated in September 2019, in several databases (e.g. PubMed, Embase) to identify barriers and facilitating factors in the prevention of T2DM/GDM in vulnerable groups. Two reviewers independently screened the results. Extracted data was charted, categorized, and summarized. RESULTS: We included 125 articles. Ninety-eight studies were extracted, and eight categories of barriers and facilitating factors were formed. The most common categories of barriers were limited knowledge, family/friends, and economic factors, and the most common categories of facilitating factors were family/friends, social support, and knowledge. CONCLUSION: This scoping review identified various barriers and facilitating factors in vulnerable groups. Preventive interventions should consider these barriers and facilitating factors in developing preventive interventions or in adapting existing ones.


Assuntos
Diabetes Mellitus Tipo 2/prevenção & controle , Diabetes Gestacional/prevenção & controle , Prevenção Primária/métodos , Diabetes Mellitus Tipo 2/economia , Diabetes Mellitus Tipo 2/psicologia , Diabetes Gestacional/economia , Diabetes Gestacional/psicologia , Feminino , Humanos , Gravidez , Prevenção Primária/economia , Prevenção Primária/estatística & dados numéricos
9.
Am J Clin Nutr ; 112(3): 619-630, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32453379

RESUMO

BACKGROUND: Whether egg consumption is associated with the risk of type 2 diabetes (T2D) remains unsettled. OBJECTIVES: We evaluated the association between egg consumption and T2D risk in 3 large US prospective cohorts, and performed a systematic review and meta-analysis of prospective cohort studies. METHODS: We followed 82,750 women from the Nurses' Health Study (NHS; 1980-2012), 89,636 women from the NHS II (1991-2017), and 41,412 men from the Health Professionals Follow-up Study (HPFS; 1986-2016) who were free of T2D, cardiovascular disease, and cancer at baseline. Egg consumption was assessed every 2-4 y using a validated FFQ. We used Cox proportional hazard models to estimate HRs and 95% CIs. RESULTS: During a total of 5,529,959 person-years of follow-up, we documented 20,514 incident cases of T2D in the NHS, NHS II, and HPFS. In the pooled multivariable model adjusted for updated BMI, lifestyle, and dietary confounders, a 1-egg/d increase was associated with a 14% (95% CI: 7%, 20%) higher T2D risk. In random-effects meta-analysis of 16 prospective cohort studies (589,559 participants; 41,248 incident T2D cases), for each 1 egg/d, the pooled RR of T2D was 1.07 (95% CI: 0.99, 1.15; I2 = 69.8%). There were, however, significant differences by geographic region (P for interaction = 0.01). Each 1 egg/d was associated with higher T2D risk among US studies (RR: 1.18; 95% CI: 1.10, 1.27; I2 = 51.3%), but not among European (RR: 0.99; 95% CI: 0.85, 1.15; I2 = 73.5%) or Asian (RR: 0.82; 95% CI: 0.62, 1.09; I2 = 59.1%) studies. CONCLUSIONS: Results from the updated meta-analysis show no overall association between moderate egg consumption and risk of T2D. Whether the heterogeneity of the associations among US, European, and Asian cohorts reflects differences in egg consumption habits warrants further investigation.This systematic review was registered at www.crd.york.ac.uk/prospero as CRD42019127860.


Assuntos
Diabetes Mellitus Tipo 2/etiologia , Dieta , Ovos , Ásia/epidemiologia , Estudos de Coortes , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/prevenção & controle , Ovos/efeitos adversos , Europa (Continente)/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Medição de Risco , Estados Unidos/epidemiologia
10.
BMC Public Health ; 20(1): 638, 2020 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-32380967

RESUMO

BACKGROUND: Individuals living in deprived inner cities have disproportionately high rates of cancers, Type 2 diabetes and obesity, which have stress- and physical inactivity-related etiologies. This study aims to quantify effects of ecological park restoration on physical activity, stress and cardio-metabolic health outcomes. METHODS: The Study of Active Neighborhoods in Detroit is a quasi-experimental, longitudinal panel natural experiment with two conditions (restored park intervention (INT) and control (CNT)) and annual measurements at baseline and 3-years post-restoration. Individuals (sampled within 500 m of an INT/CNT park) serve as the unit of analysis. Restoration (n = 4 parks) involves replacing non-native plants and turf with native plants; creating trails; posting signage; and leading community stewardship events. The CNT condition (n = 5) is an unmaintained park, matched to INT based on specified neighborhood conditions. Recruitment involves several avenues, with a retention goal of 450 participants. Park measures include plant/avian diversity; usage of the park (SOPARC); signs of care; auditory environment recordings; and visual greenness using 360 imagery. Health outcomes include device-based physical activity behavior (primary outcome); salivary cortisol (secondary outcome); and several downstream health outcomes. Exposure to the INT will be assessed through visual contact time and time spent in the park using GPS data. Changes in health outcomes between years and INT versus CNT will be tested using generalized linear (mixed) models. DISCUSSION: Our study will examine whether restored urban greenspaces increase physical activity and lower stress, with public health planning implications, where small changes in neighborhood greenspaces may have large health benefits in low-income neighborhoods. STUDY REGISTRATION: Registration: OSF Preregistration registered March 31, 2020. Accessible from https://osf.io/surx7.


Assuntos
Exercício Físico , Promoção da Saúde/organização & administração , Parques Recreativos/organização & administração , Características de Residência/estatística & dados numéricos , Diabetes Mellitus Tipo 2/prevenção & controle , Planejamento Ambiental/estatística & dados numéricos , Feminino , Humanos , Masculino , Michigan , Atividade Motora , Obesidade/prevenção & controle , Pobreza/estatística & dados numéricos , Recreação , Comportamento Sedentário , Meio Social , Fatores Socioeconômicos
11.
Braz Oral Res ; 34(supp1 1): e026, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32294679

RESUMO

Gingivitis and periodontitis are associated with a negative impact on Oral Health Related Quality of Life (OHRQoL), exerting a significant influence on aspects related to the patients' function and esthetics. Periodontitis has been associated with several systemic conditions, including adverse pregnancy outcomes, cardiovascular diseases, type 2 diabetes mellitus (DM), respiratory disorders, fatal pneumonia in hemodialysis patients, chronic renal disease and metabolic syndrome. The aim of this paper was to review the results of different periodontal treatments and their impacts on patients' OHRQoL and systemic health. Non-surgical and surgical periodontal treatments are predictable procedures in terms of controlling infection, reducing probing pocket depth and gaining clinical attachment. In addition, the treatment of periodontitis may significantly improve OHRQoL and promote a reduction in the levels of systemic markers of inflammation, including some cytokines associated with cardiovascular diseases. Studies have also suggested that periodontal treatment may improve glycemic control in patients with DM. Strategies and actions for preventing the onset and recurrence of periodontitis, and the challenges facing the field of periodontology in the XXI century are presented in this review.


Assuntos
Periodontite/fisiopatologia , Periodontite/terapia , Doenças Cardiovasculares/fisiopatologia , Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus Tipo 2/fisiopatologia , Diabetes Mellitus Tipo 2/prevenção & controle , Humanos , América Latina , Saúde Bucal , Periodontia/tendências , Qualidade de Vida
12.
Adv Exp Med Biol ; 1228: 91-105, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32342452

RESUMO

The epidemic of diabetes mellitus has already become a serious global health threat. In the past three decades, the number of people with diabetes mellitus has quadrupled globally, and diabetes mellitus is known as the ninth major cause of death in the world nowadays. The increasing prevalence of type 2 diabetes mellitus is in coincidence with the augmentation of obesity in most developed countries as well as in developing countries. A sedentary lifestyle is well-known as one of the major reasons for the rising epidemic of type 2 diabetes mellitus besides the other reasons such as adopting energy-dense diets relative to the actual need for energy and population aging. Exercise as a regular physical activity at a medium to vigorous intensity is found to be an efficient influencer that would switch back most of the known type 2 diabetes mellitus factors toward healthier positions. Exercise is proven to have clinical benefits, such as improved insulin sensitivity, reductions in glycosylated hemoglobin (A1C) and increased peak oxygen consumption (VO2peak) which are definitely preventive toward diabetes. Exercise training can favorably affect glycemic parameters, the lipid profile, blood pressure, and high-sensitivity C-reactive protein. Exercise improves blood glucose control in type 2 diabetes, reduces cardiovascular risk factors, and regulates body weight by reducing body fat percentage and enhancing lean mass. In this chapter, the effect of regular exercise on the prevention of diabetes and short-term glucose and energy metabolism will be discussed. In addition, the effect of exercise on most common complications of type 2 diabetes including cardiovascular diseases, dyslipidemia, nephropathy, neuropathy, and retinopathy will be reviewed.


Assuntos
Diabetes Mellitus Tipo 2 , Exercício Físico , Glicemia/metabolismo , Diabetes Mellitus Tipo 2/fisiopatologia , Diabetes Mellitus Tipo 2/prevenção & controle , Hemoglobina A Glicada/metabolismo , Humanos , Resistência à Insulina
14.
Nutr Metab Cardiovasc Dis ; 30(6): 853-871, 2020 06 09.
Artigo em Inglês | MEDLINE | ID: mdl-32278608

RESUMO

BACKGROUND AND AIMS: Despite the proven evidence of high glycemic index (GI) and glycemic load (GL) diets to increase cardiometabolic risks, knowledge about the meta-evidence for carbohydrate quality within world geographic regions is limited. We conducted a meta-analysis to synthesize the evidence of GI/GL studies and carbohydrate quality, gathering additional exposures for carbohydrate, high glycemic carbohydrate, total dietary fiber, and cereal fiber and risks for type 2 diabetes (T2DM), coronary heart disease (CHD), stroke, and mortality, grouped into the US, Europe, and Asia. Secondary aims examined cardiometabolic risks in overweight/obese individuals, by sex, and dose-response dietary variable trends. METHODS AND RESULTS: 40-prospective observational studies from 4-Medline bibliographical databases (Ovid, PubMed, EBSCOhost, CINAHL) were search up to November 2019. Random-effects hazard ratios (HR) and 95% confidence intervals (CI) for highest vs. lowest categories and continuous form combined were reported. Heterogeneity (I2>50%) was frequent in US GI/GL studies due to differing study characteristics. Increased risks ((HRGI,T2DM,US=1.14;CI:1.06,1.21), HRGL,T2DM,US=1.02 (1.01, 1.03)), HRGI,T2DM,Asia=1.25;1.02,1.53), and HRGL,T2DM,Asia=1.37 (1.17, 1.60)) were associated with cardiometabolic diseases. GI/GL in overweight/obese females had the strongest magnitude of risks in US-and Asian studies. Total dietary fiber (HRT2DM,US = 0.92;0.88,0.96) and cereal fiber (HRT2DM,US = 0.83;0.77,0.90) decreased risk of developing T2DM. Among females, we found protective dose-response risks for total dietary fiber (HR5g-total-dietary-fiber,T2DM,US = 0.94;0.92,0.97), but cereal fiber showed better ability to lower T2DM risk (HR5g-cereal-fiber,T2DM,US = 0.67;0.60,0.74). Total dietary-and cereal fibers' dose-response effects were nullified by GL, but not so for cereal fiber with GI. CONCLUSIONS: Overweight/obese females could shift their carbohydrate intake for higher cereal fiber to decrease T2DM risk, but higher GL may cancel-out this effect.


Assuntos
Glicemia/metabolismo , Doença das Coronárias/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Carboidratos da Dieta/administração & dosagem , Índice Glicêmico , Carga Glicêmica , Acidente Vascular Cerebral/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Ásia/epidemiologia , Biomarcadores/sangue , Doença das Coronárias/diagnóstico , Doença das Coronárias/mortalidade , Doença das Coronárias/prevenção & controle , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/mortalidade , Diabetes Mellitus Tipo 2/prevenção & controle , Carboidratos da Dieta/efeitos adversos , Carboidratos da Dieta/sangue , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Estudos Observacionais como Assunto , Prognóstico , Medição de Risco , Fatores de Risco , Fatores Sexuais , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/prevenção & controle , Estados Unidos/epidemiologia , Adulto Jovem
15.
PLoS Negl Trop Dis ; 14(3): e0008101, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32126084

RESUMO

BACKGROUND: The prevalence of helminth infections exhibits an inverse association with the prevalence of Type 2 diabetes mellitus (T2DM), and helminths are postulated to mediate a protective effect against T2DM. However, the biological mechanism behind this effect is not known. AIMS/METHODS: We postulated that helminth infections act by modulating the pro-inflammatory cytokine and chemokine milieu that is characteristic of T2DM. To examine the association of cytokines and chemokines in helminth-diabetes co-morbidity, we measured the plasma levels of a panel of pro-inflammatory cytokines and chemokines in individuals with Strongyloides stercoralis infection (Ss+) and T2DM at the time of Ss diagnosis and then 6 months after definitive anthelmintic treatment along with uninfected control individuals with T2DM alone (Ss-). PRINCIPAL FINDINGS: Ss+ individuals exhibited significantly diminished levels of the pro-inflammatory cytokines-IL-1α, IL-1ß, IL-6, IL-12, IL-18, IL-23, IL-27, G-CSF and GM-CSF and chemokines-CCL1, CCL2, CCL3, CCL11, CXCL1, CXCL2, CXCL8, CXCL9, CXCL10 and CXCL11. In contrast, Ss+ individuals exhibited significantly elevated levels of IL-1Ra. Anthelmintic treatment resulted in increased levels of all of the cytokines and chemokines. CONCLUSIONS: Thus, helminth infections alleviate and anthelmintic therapy partially restores the plasma cytokine and chemokine levels in helminth-diabetes co-morbidity. Our data therefore offer a plausible biological mechanism for the protective effect of helminth infections against T2DM.


Assuntos
Anti-Helmínticos/administração & dosagem , Citocinas/sangue , Diabetes Mellitus Tipo 2/fisiopatologia , Strongyloides stercoralis/imunologia , Estrongiloidíase/tratamento farmacológico , Estrongiloidíase/patologia , Adulto , Animais , Diabetes Mellitus Tipo 2/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
16.
Intern Med ; 59(5): 601-609, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32115517

RESUMO

Objective To examine the add-on effects, compared to the existing antidiabetes treatment, of the sodium-glucose cotransporter 2 inhibitor ipragliflozin on glycemic control and the risk factors of cardiovascular disease (CVD) and chronic kidney disease (CKD) in patients with inadequately controlled type 2 diabetes. Methods This 12-week, randomized, open-label, active-controlled trial included 30 patients with type 2 diabetes who were randomized 1:1 to ipragliflozin and control groups (n=15 each). The ipragliflozin group received 50 mg of ipragliflozin once daily in addition to conventional therapy. The primary outcome was the change in hemoglobin A1c (HbA1c) from the baseline. Secondary outcomes were changes from the baseline in indices of glycemic control, uric acid (UA), renal function, and arterial stiffness. Results The patients' diminished estimated glomerular filtration rate (eGFR) was alleviated in the ipragliflozin group compared to the control group [difference between groups (Δ) =4.6 (95% confidence interval (CI): 1.5-7.7) mL/min/1.73 m2, p=0.006] prior to significant improvements in HbA1c and other parameters, including anthropometric indices and arterial stiffness. Furthermore, ipragliflozin add-on therapy resulted in a greater reduction in serum UA levels than control therapy [Δ=-52.3 (95% CI: -85.5-19.1) µmol/L, p=0.003]. The changes in the eGFR with ipragliflozin treatment were associated with ipragliflozin-mediated changes in the UA, even after adjusting for the age, sex, baseline HbA1c, baseline UA, and baseline eGFR (standardized regression coefficient=-0.535, p=0.010). Conclusion Ipragliflozin add-on therapy was associated with beneficial renal effects in parallel with reducing serum UA levels.


Assuntos
Diabetes Mellitus Tipo 2/prevenção & controle , Glucosídeos/administração & dosagem , Hipoglicemiantes/administração & dosagem , Insuficiência Renal Crônica/prevenção & controle , Inibidores do Transportador 2 de Sódio-Glicose/administração & dosagem , Tiofenos/administração & dosagem , Adulto , Idoso , Glicemia/efeitos dos fármacos , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/fisiopatologia , Angiopatias Diabéticas/sangue , Angiopatias Diabéticas/fisiopatologia , Angiopatias Diabéticas/prevenção & controle , Nefropatias Diabéticas/sangue , Nefropatias Diabéticas/fisiopatologia , Nefropatias Diabéticas/prevenção & controle , Esquema de Medicação , Quimioterapia Combinada , Feminino , Hemoglobina A Glicada/efeitos dos fármacos , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/fisiopatologia , Fatores de Risco , Resultado do Tratamento , Ácido Úrico/metabolismo , Adulto Jovem
18.
BMC Public Health ; 20(1): 161, 2020 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-32013897

RESUMO

BACKGROUND: To reflect the health literacy (HL) skills needed for managing type 2 diabetes (T2DM) in everyday life, HL in people with T2DM should be measured from a broader perspective than basic skills, such as proficiency in reading and writing. The HLS-Q12, based on the European Health Literacy Survey Questionnaire (HLS-EU-Q47), assesses four cognitive domains across three health domains. International studies on people with T2DM show inconsistent results regarding the association between HL and general health and the association between HL and glycaemic control. Moreover, knowledge is needed related to the link between HL and empowerment for those with T2DM. The aims of this study were to examine the association between i) HL and general health and diabetes outcomes, ii) HL and health behaviours and iii) HL and empowerment in people with T2DM. METHODS: During March and April 2015, 388 adults with T2DM responded to a paper-and-pencil self-administered questionnaire. A sequential multiple regression analysis was applied to explore the association between HL, as measured by the HLS-Q12, and health conditions, HbA1c, health behaviours and empowerment. RESULTS: For people with T2DM, higher levels of HL were associated with higher levels of education, better overall health conditions and higher self-perceived empowerment. No empirical evidence strengthening either the link between HL and glycaemic control or the link between HL and health behaviours was found. CONCLUSIONS: The independent variables education level, overall health condition and empowerment explained about one-third of the total observed variance in HL.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Letramento em Saúde/estatística & dados numéricos , Idoso , Diabetes Mellitus Tipo 2/prevenção & controle , Empoderamento , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Inquéritos e Questionários
19.
REME rev. min. enferm ; 24: e-1279, fev.2020.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1051306

RESUMO

Objetivo: verificar a associação entre a adesão ao tratamento medicamentoso e não medicamentoso e as práticas assistenciais prestadas às pessoas com diabetes Mellitus tipo 2 (DM2) pelas equipes da Estratégia Saúde da Família (ESF). Método: estudo transversal, do tipo inquérito domiciliar, realizado com pessoas com DM2 cadastradas nas 65 equipes urbanas da ESF, selecionadas aleatoriamente e de forma estratificada por equipe. Os dados foram coletados no primeiro semestre 2014 mediante entrevista estruturada e na análise, usando-se regressão logística, considerando-se associação significativa quando p≤0,05. Resultados: as 408 pessoas participantes tinham idade média de 66,5 anos, 84,1% relataram aderir ao tratamento medicamentoso, 29,4% realizavam atividade física regularmente e 24% tinham alimentação adequada. Após ajustes, as variáveis que permaneceram associadas ao tratamento medicamentoso foram: não participação em atividade de educação em saúde (p=0,012) e ser atendido pelo mesmo enfermeiro (p=0,048). Em relação ao medicamentoso, a adoção de alimentação adequada apresentou associação com verificação trimestral da glicemia capilar (p=0,011) e ser questionado, durante o atendimento, sobre a prática de atividade física (p=0,012) e a prática de atividade física regular com participação em atividades de educação em saúde (p=0,031), estar satisfeito com a assistência (p=0,04), ser atendido no mesmo dia em que procurou a UBS (p=0,017) e os profissionais perguntarem sobre sua saúde (p=0,011). Conclusão: as pessoas com DM2 apresentaram boa adesão ao tratamento medicamentoso e baixa adesão ao não medicamentoso, indicando que as equipes da ESF precisam ampliar a implementação de ações de promoção da saúde, prevenção e controle da doença e suas complicações.(AU)


Objective: to verify the association between adherence to medication and nonmedication treatment and the care practices provided to people with type 2 diabetes Mellitus (DM2) by the Family Health Strategy (ESF) teams. Method: cross-sectional study, of the household survey type, carried out with people with DM2 registered in the 65 urban teams of the ESF, randomly selected and stratified by team. Data were collected in the first semester of 2014 through a structured interview and in the analysis, using logistic regression, considering a significant association when p≤0.05. Results: the 408 people participating had an average age of 66.5 years, 84.1% reported adhering to drug treatment, 29.4% performed regular physical activity and 24% had adequate nutrition. After adjustments, the variables that remained associated with drug treatment were non-participation in health education activities (p=0.012) and being attended by the...(AU)


Objetivo: verificar la asociación entre la adhesión al tratamiento con medicación y sin medicación y las prácticas de atención de los equipos de la Estrategia de salud familiar (ESF) a las personas con diabetes Mellitus tipo 2 (DM2). Método: estudio transversal, tipo encuesta domiciliaria, realizado con personas con DM2 inscritas en los 65 equipos urbanos de la ESF, seleccionados al azar y estratificados por equipo. Los datos se recogieron el primer semestre de 2014 a través de una entrevista estructurada y durante el análisis, utilizando regresión logística, considerando la asociación significativa cuando p≤0.05. Resultados: las 408 personas que participaron tenían edad promedio de 66,5 años; el 84,1% indicó adhesión al tratamiento farmacológico; el 29,4% realizó actividad física regular y el 24% tenía nutrición adecuada. Después de los ajustes, las variables que permanecieron asociadas con el tratamiento farmacológico fueron: la no participación en actividades de educación para la salud (p = 0,012) y atención del mismo enfermero (p = 0,048). Con respecto a la medicación, la adopción de la alimentación adecuada se asoció con el control trimestral de la glucemia capilar (p = 0,011) y que le preguntasen, mientras lo atendían, sobre la práctica de actividad física (p = 0,012) y la práctica de actividad física regular con participación en actividades de educación para la salud (p = 0,031), estar satisfecho con la atención brindada (p = 0,04), ser atendido el mismo día que fue a la UBS (p = 0,017) y que los profesionales preguntasen sobre su salud (p = 0,011). Conclusión: las personas con DM2 mostraron buena adhesión al tratamiento con medicación y baja adhesión al tratamiento sin medicación, lo que indica que los equipos de ESF deben ampliar la implementación de acciones para promover la salud, prevenir y controlar la enfermedad y sus complicaciones.(AU)


Assuntos
Humanos , Idoso , Atenção Primária à Saúde , Diabetes Mellitus , Diabetes Mellitus Tipo 2/prevenção & controle , Cooperação e Adesão ao Tratamento , Estratégia Saúde da Família , Promoção da Saúde
20.
Ann Epidemiol ; 43: 44-50, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32061471

RESUMO

PURPOSE: Five health practices are recognized to be essential for the prevention of chronic disease, viz. avoiding smoking, drinking in moderation, healthy diet, regular physical activity, and adequate sleep. However, how much of these behaviors contribute to socioeconomic disparities in health continues to be debated-some claim "hardly any," while others say "nearly all." METHODS: The data were from the NHANES 2015-16. Selected outcomes were self-rated health, hypertension, cardiovascular disease, and diabetes. Socioeconomic status was measured by education and household income. We implemented Oaxaca-Blinder decomposition to examine the extent to which socioeconomic inequalities in health could be explained by socioeconomic differences in adherence to health practices. RESULTS: 55%-90% of education-based inequalities in hypertension (89%), cardiovascular diseases (56%), and diabetes (75%) could be explained by health practices-especially current smoking and overweight. By contrast, most income-related inequalities in health outcomes could not be explained by health practices. CONCLUSIONS: How much heath practices can account for socioeconomic inequalities in health depends on the indicator of socioeconomic status. Educational disparities in health is explained by the higher prevalence of smoking and overweight in educationally disadvantaged groups. However, income-related gaps in health may require further consideration besides lifestyle modification.


Assuntos
Doença Crônica/prevenção & controle , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Disparidades nos Níveis de Saúde , Renda , Serviços Preventivos de Saúde , Adulto , Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus Tipo 2/prevenção & controle , Escolaridade , Feminino , Humanos , Hipertensão/prevenção & controle , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Fatores Sexuais , Classe Social , Fatores Socioeconômicos
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