1,752 research outputs found
The Clinical and Public Health Challenges of Diabetes Prevention: A Search for Sustainable Solutions.
No full textIn an Editorial accompanying PLOS Medicine's Special Issue on Diabetes Prevention, Guest Editors Nicholas Wareham and William Herman discuss some of the challenges for researchers and policy makers in developing effective and equitable solutions to the worldwide problem of type 2 diabetes
Do different dimensions of the metabolic syndrome change together over time?. Evidence supporting obesity as the central feature
No full textOBJECTIVE—The metabolic syndrome is a loosely defined cluster of cardiovascular risk factors including low HDL cholesterol, hypertriglyceridemia, glucose intolerance, and hypertension. Evidence for inclusion of these features in the syndrome has mostly come from cross-sectional studies, and a few studies have examined how the various factors change together over time. RESEARCH DESIGN AND METHODS—We conducted a prospective population-based cohort study of 937 individuals aged 40–65 years who underwent oral glucose tolerance testing on two occasions at 4.5-year intervals. Changes in the components of the metabolic syndrome were analyzed by principal component analysis in the entire population and in a subgroup of 471 individuals who did not receive pharmaceutical therapy for hypertension and dyslipidemia. RESULTS—Principal component analysis identified three independent factors in men: a blood pressure factor (systolic and diastolic blood pressure and BMI), a glucose factor (fasting and 120-min postload glucose, BMI, waist-to-hip ratio [WHR], and fasting insulin level), and a lipid factor (triglycerides and HDL cholesterol, BMI, WHR, and fasting insulin level). In women, an additional factor was identified, which included BMI, WHR, fasting insulin, and triglycerides. Analysis of the contribution of these variables to the different subdimensions indicated that BMI was the central feature of the syndrome in both sexes. CONCLUSIONS—This analysis of change in the features of the metabolic syndrome over time provides evidence of the fundamental importance of obesity in the origin of this disorder. <br/
sj-pdf-1-jtt-10.1177_1357633X221093434 - Supplemental material for The development, validation and application of remote blood sample collection in telehealth programmes
No full textSupplemental material, sj-pdf-1-jtt-10.1177_1357633X221093434 for The development, validation and application of remote blood sample collection in telehealth programmes by Albert Koulman, Kirsten L Rennie, Damon Parkington, Carina SB Tyrrell, Michael Catt, Effrossyni Gkrania-Klotsas, and Nicholas J Wareham in Journal of Telemedicine and Telecare</p
Physical activity intensity, sedentary time, and body composition in preschoolers
No full textBACKGROUND: Detailed associations between physical activity (PA) subcomponents, sedentary time, and body composition in preschoolers remain unclear.OBJECTIVE: We examined the magnitude of associations between objectively measured PA subcomponents and sedentary time with body composition in 4-y-old children.DESIGN: We conducted a cross-sectional study in 398 preschool children recruited from the Southampton Women's Survey. PA was measured by using accelerometry, and body composition was measured by using dual-energy X-ray absorptiometry. Associations between light physical activity, moderate physical activity (MPA), vigorous physical activity (VPA), and moderate-to-vigorous physical activity (MVPA) intensity; sedentary time; and body composition were analyzed by using repeated-measures linear regression with adjustment for age, sex, birth weight, maternal education, maternal BMI, smoking during pregnancy, and sleep duration. Sedentary time and PA were also mutually adjusted for one another to determine whether they were independently related to adiposity.RESULTS: VPA was the only intensity of PA to exhibit strong inverse associations with both total adiposity [P < 0.001 for percentage of body fat and fat mass index (FMI)] and abdominal adiposity (P = 0.002 for trunk FMI). MVPA was inversely associated with total adiposity (P = 0.018 for percentage of body fat; P = 0.022 for FMI) but only because of the contribution of VPA, because MPA was unrelated to fatness (P ? 0.077). No associations were shown between the time spent sedentary and body composition (P ? 0.11).CONCLUSIONS: In preschoolers, the time spent in VPA is strongly and independently associated with lower adiposity. In contrast, the time spent sedentary and in low-to-moderate-intensity PA was unrelated to adiposity. These results indicate that efforts to challenge pediatric obesity may benefit from prioritizing VPA
Variation in the promoter of the human hormone sensitive lipase gene shows gender specific effects on insulin and lipid levels: results from the Ely study
No full textWe previously identified a hormone sensitive lipase (HSL) promoter variant, ?60C>G, which in vitro exhibits 40% reduced promoter activity. In this study we examined the effect of the ?60C>G on glycemic and lipid measures in the population based Ely study of metabolic function and insulin resistance in 218 middle-aged men and 276 middle-aged women. Adipose tissue HSL is the rate-limiting step in triglyceride lipolysis, generating free fatty acids for energy utilization. HSL is also expressed in pancreatic ?-cells where its activity therefore may affect insulin secretion. In the women, carriers of the HSL ?60G allele had significantly lower fasting insulin levels (P=0.0005) and a lower total area under the curve for insulin during the oral glucose tolerance test (P=0.005). There was no demonstrable association in men with these measures of insulin sensitivity but carriers of the ?60G allele had significantly lower fasting non-esterified fatty acid (NEFA) levels (P=0.025) and higher low density lipoprotein cholesterol levels (P=0.02) than men who were non-carriers. This study provides additional evidence for a role for HSL in the development of insulin resistance, from which carriers of the ?60G allele, associated here with markers of insulin sensitivity in women, and with lower NEFA levels in men, might be protected
Concurrent changes in diet quality and physical activity and association with adiposity in adults
No full textIMPORTANCE: Diet and physical activity (PA) are both associated with body weight, but less is understood about how long-term changes in these behaviors may be associated with changes in adiposity in the general population.OBJECTIVE: To evaluate associations of concurrent changes in diet quality and PA with different body composition indices.DESIGN, SETTING, AND PARTICIPANTS: This cohort study was conducted among participants in the UK population-based Fenland study, with repeated measurements of health behaviors and adiposity. Data collection occurred in 2005 to 2015 and 2014 to 2020, with a mean (SD) follow-up of 7.2 (2.0) years. Data were analyzed from January 2024 through April 2025.EXPOSURES: Mediterranean diet score (MDS), a measure of adherence to the Mediterranean diet (range, 0-15 points), was assessed with a food frequency questionnaire. PA energy expenditure (PAEE), measured in kilojoules per kilogram per day, was assessed and calibrated with heart rate and movement sensing. Change variables were derived.MAIN OUTCOMES AND MEASURES: Indices of total adiposity (weight, body mass index and body fat) and regional adiposity (waist circumference, visceral adipose tissue [VAT], and subcutaneous adipose tissue) were assessed with anthropometry and dual-energy x-ray absorptiometry. Hepatic steatosis was ascertained by abdominal ultrasonography.RESULTS: The analysis included 7256 participants (mean [SD; range] age at recruitment, 48.8 [7.4; 29-65] years; 3748 female [51.7%]). In multivariable linear regression models after adjustment for potential confounders and baseline values, changes in both exposures were negatively associated with changes in all adiposity indices. For example, each 1-SD (1.27 points) increase in the change in MDS was negatively associated with changes in adiposity measures (change in body fat: β = -0.47 kg; 95% CI, -0.58 to -0.36 kg; change in VAT: β = -45 g; 95% CI, -55 to -35 g), and each 1-SD (19.0 kJ/kg/d) in the change in PAEE was similarly negatively associated with changes in adiposity measures (change in body fat: β = -1.40 kg; 95% CI, -1.51 to -1.26 kg; change in VAT: β = -108 g; 95% CI, -118 to -98 g) . Despite no evidence for a diet-PA interaction, simultaneous increases in MDS and PAEE were associated with a greater magnitude of decrease in adiposity, with a β of -149 g (95% CI, -187 to -111 g) for change in VAT among participants in higher joint change in MDS and change in PAEE tertiles. Associations had higher β values among individuals with overweight or obesity or who were physically inactive at baseline; for example, for each 1-SD increase in the change in PAEE, the β for change in body fat was -0.96 kg (95% CI, -1.10 to -0.81 kg) when baseline BMI was less than 25 and -1.74 kg (95% CI, -1.91 to -1.57 kg) when baseline BMI was 25 or greater (P for interaction < .001).CONCLUSIONS AND RELEVANCE: In this study, improved diet quality and increased PA were independently associated with weight loss or less weight gain and a healthier adiposity profile. Combining these health behaviors was associated with the greatest adiposity-related benefits.</p
Mothers after Gestational Diabetes in Australia (MAGDA): A Randomised Controlled Trial of a Postnatal Diabetes Prevention Program
No full textThis is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Background
Gestational diabetes mellitus (GDM) is an increasingly prevalent risk factor for type 2 diabetes. We evaluated the effectiveness of a group-based lifestyle modification program in mothers with prior GDM within their first postnatal year.
Methods and Findings
In this study, 573 women were randomised to either the intervention (n = 284) or usual care (n = 289). At baseline, 10% had impaired glucose tolerance and 2% impaired fasting glucose. The diabetes prevention intervention comprised one individual session, five group sessions, and two telephone sessions. Primary outcomes were changes in diabetes risk factors (weight, waist circumference, and fasting blood glucose), and secondary outcomes included achievement of lifestyle modification goals and changes in depression score and cardiovascular disease risk factors. The mean changes (intention-to-treat [ITT] analysis) over 12 mo were as follows: −0.23 kg body weight in intervention group (95% CI −0.89, 0.43) compared with +0.72 kg in usual care group (95% CI 0.09, 1.35) (change difference −0.95 kg, 95% CI −1.87, −0.04; group by treatment interaction p = 0.04); −2.24 cm waist measurement in intervention group (95% CI −3.01, −1.42) compared with −1.74 cm in usual care group (95% CI −2.52, −0.96) (change difference −0.50 cm, 95% CI −1.63, 0.63; group by treatment interaction p = 0.389); and +0.18 mmol/l fasting blood glucose in intervention group (95% CI 0.11, 0.24) compared with +0.22 mmol/l in usual care group (95% CI 0.16, 0.29) (change difference −0.05 mmol/l, 95% CI −0.14, 0.05; group by treatment interaction p = 0.331). Only 10% of women attended all sessions, 53% attended one individual and at least one group session, and 34% attended no sessions. Loss to follow-up was 27% and 21% for the intervention and control groups, respectively, primarily due to subsequent pregnancies. Study limitations include low exposure to the full intervention and glucose metabolism profiles being near normal at baseline.
Conclusions
Although a 1-kg weight difference has the potential to be significant for reducing diabetes risk, the level of engagement during the first postnatal year was low. Further research is needed to improve engagement, including participant involvement in study design; it is potentially more effective to implement annual diabetes screening until women develop prediabetes before offering an intervention.
Trial Registration
Australian New Zealand Clinical Trials Registry ACTRN1261000033806
Supported Telemonitoring and Glycemic Control in People with Type 2 Diabetes: the Telescot Diabetes Pragmatic Multicenter Randomized Controlled Trial
No full textBackgroundSelf-monitoring of blood glucose among people with type 2 diabetes not treated with insulin does not appear to be effective in improving glycemic control. We investigated whether health professional review of telemetrically transmitted self-monitored glucose results in improved glycemic control in people with poorly controlled type 2 diabetes.Methods and Findings We performed a randomized, parallel, investigator-blind controlled trial with centralised randomization in family practices in four regions of the United Kingdom among 321 people with type 2 diabetes and glycated haemoglobin (HbA1c) >58 mmol/mol. The supported telemonitoring intervention involved self-measurement and transmission to a secure website of twice weekly morning and evening glucose for review by family practice clinicians who were not blinded to allocation group. The control group received usual care, with at least annual review and more frequent reviews for people with poor glycemic or blood pressure control.. HbA1c assessed at nine months was the primary outcome. Intention-to-treat analyses were performed. 160 people were randomized to the intervention group and 161 to the usual care group between June 6, 2011 and July 19, 2013. HbA1c data at follow-up were available for 146 people in the intervention group and 139 people in the control group. The mean (SD) HbA1c at follow-up was 63.0 (15.5) mmol/mol in the intervention group and 67.8 (14.7) mmol/mol in the usual care group. For primary analysis, adjusted mean HbA1c was 5.60 mmol/mol / 0.51% lower (95% CI 2.38 to 8.81 mmol/mol/ 95% CI 0.22% to 0.81%, p=0·0007). For secondary analyses, adjusted mean ambulatory systolic blood pressure was 3.06mm Hg lower (95% CI 0.56-5.56 mmHg, p=0.017 ) and mean ambulatory diastolic blood pressure was 2.17mm Hg lower (95% CI 0.62 to 3.72, p=0.006) among people in the intervention group when compared with usual care after adjustment for baseline differences and minimisation strata . No significant differences were identified between groups in weight, treatment pattern, in adherence to medication or3quality of life in secondary analyses. There were few adverse events and these were equally distributed between the intervention and control groups. In secondary analysis, there was a greater number of telephone calls between practice nurses and patients in the intervention compared with control group (rate ratio 7.50 (95% CI 4.45 to 12.65, p<0.0001) but no other significant differences between groups in use of health services were identified between groups. Key limitations include potential lack of representativeness of trial participants, inability to blind participants and health professionals and uncertainty about the mechanism, the duration of the effect and the optimal length of the intervention.Conclusions Supported telemonitoring resulted in clinically important improvements in control of glycaemia in patients with type 2 diabetes in family practice. Current Controlled Trials, registration number ISRCTN71674628</p
Intrahepatic Lipid Content and Insulin Resistance Are More Strongly Associated with Impaired NEFA Suppression after Oral Glucose Loading Than with Fasting NEFA Levels in Healthy Older Individuals
No full textIntroduction. The mechanisms underlying the association between insulin resistance and intrahepatic lipid (IHL) accumulation are not completely understood. We sought to determine whether this association was explained by differences in fasting non-esterified fatty acid (NEFA) levels and/or NEFA suppression after oral glucose loading. Materials and Methods. We performed a cross-sectional analysis of 70 healthy participants in the Hertfordshire Physical Activity Trial (39 males, age 71.3 ± 2.4 years) who underwent oral glucose tolerance testing with glucose, insulin, and NEFA levels measured over two hours. IHL was quantified with magnetic resonance spectroscopy. Insulin sensitivity was measured with the oral glucose insulin sensitivity (OGIS) model, the leptin: adiponectin ratio (LAR), and the homeostasis model assessment (HOMA). Results. Measures of insulin sensitivity were not associated with fasting NEFA levels, but OGIS was strongly associated with NEFA suppression at 30 minutes and strongly inversely associated with IHL. Moreover, LAR was strongly inversely associated with NEFA suppression and strongly associated with IHL. This latter association (beta = 1.11 [1.01, 1.21], ) was explained by reduced NEFA suppression ( after adjustment). Conclusions. Impaired postprandial NEFA suppression, but not fasting NEFA, contributes to the strong and well-established association between whole body insulin resistance and liver fat accumulation
Development and validation of total and regional body composition prediction equations from anthropometry and single frequency segmental bioelectrical impedance with DEXA
No full textAims Single-frequency segmental Bioelectrical Impedance Analysis (BIA) is commonly used to estimate body composition. To enhance the value of information derived from BIA, especially for use in large-scale epidemiological studies, we developed and validated equations to predict total and regional (arms, legs, trunk, android, gynoid, visceral) body composition parameters (lean mass and fat mass) from anthropometry and single-frequency (50 kHz) segmental BIA variables, using Dual Energy X-ray Absorptiometry (DEXA) as the criterion method.Methods The 11,559 adults (age 30 to 65) from the UK population-based Fenland Study with data on DEXA, BIA and anthropometry were randomly assigned to a Derivation sample (4,827 men; 5,732 women) or a Validation sample (500 men; 500 women). Prediction equations based on anthropometry and BIA variables were derived using forward stepwise multiple linear regression in the Fenland Derivation sample. These were validated in the Fenland Validation sample and also in the UK Biobank Imaging Study (2,392 men; 2,606 women) using Pearson correlations and Bland–Altman models.Results and Conclusions Bland Altman analyses revealed no significant mean bias for any predicted DEXA parameter (all P>0.05) for the fenland population. Bias expressed as % of the mean was between -0.6% and 0.5% for all parameters in both men and women, except for visceral FM and subcutaneous abdominal FM (range -3.6 to 1.1%). However, in UK Biobank most predicted parameters showed significant bias: % mean bias was <2% in both sexes only for total fat mass and total lean mass, and was >10% for leg and visceral fat mass in both sexes. In conclusion, new equations based on anthropometry and BIA variables predicted DEXA parameters with sufficient accuracy to assess relative differences between individuals, and were sufficiently accurate to predict absolute values for total body but not regional fat and lean mass
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