Anxiety, depression and timing of insulin treatment among people with type 2 diabetes: Nine-year follow-up of the Nord-Trøndelag Health Study, Norway

Abstract 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.

Download Full-text

Mushroom consumption, biomarkers, and risk of cardiovascular disease and type 2 diabetes: a prospective cohort study of US women and men

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqz057 ◽

2019 ◽

Vol 110 (3) ◽

pp. 666-674 ◽

Cited By ~ 7

Author(s):

Dong Hoon Lee ◽

Meng Yang ◽

Edward L Giovannucci ◽

Qi Sun ◽

Jorge E Chavarro

Keyword(s):

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Chronic Diseases ◽

Prospective Cohort ◽

Cox Proportional Hazards ◽

Health Study ◽

Potential Health ◽

Cardiometabolic Diseases

ABSTRACT Background Mushrooms are good dietary sources of important vitamins, minerals, and bioactive compounds which may be important in the prevention of chronic diseases. However, studies have not prospectively evaluated the potential health effects of mushrooms with respect to major cardiometabolic diseases. Objectives The aim of this study was to examine the association of mushroom consumption with major cardiometabolic diseases and mediating biomarkers in 2 large prospective US cohorts. Methods We followed 67,139 women from the Nurses’ Health Study (1986–2012) and 43,541 men from the Health Professionals Follow-up Study (1986–2012) who were free of chronic diseases. Mushroom consumption was assessed at baseline through the use of a food-frequency questionnaire. Cardiometabolic biomarkers were collected in subpopulations of the 2 cohorts. Cox proportional hazards models were used to estimate HRs and 95% CIs of cardiovascular disease (CVD), including coronary heart disease (CHD) and stroke, and type 2 diabetes (T2D), associated with mushroom consumption. Results We identified total 11,894 CVD (7,616 CHD; 4,278 stroke), and 10,206 T2D cases in >2 million person-years of follow-up. In the pooled multivariable-adjusted analysis, participants who consumed ≥5 servings of mushrooms per week had no significantly different risk of total CVD (HR: 1.02; 95% CI: 0.91, 1.14), CHD (HR: 1.00; 95% CI: 0.87, 1.16), stroke (HR: 1.05; 95% CI: 0.87, 1.25), or T2D (HR: 1.04; 95% CI: 0.93, 1.16) than participants who consumed mushrooms <1 time/mo. We consistently found no association between mushroom consumption and the aforementioned cardiometabolic diseases, in subgroups of sex, lifestyle factors, and medical conditions. Moreover, mushroom consumption was not associated with plasma biomarkers of lipids, insulin, and inflammation. Conclusions We found no association of mushroom consumption with biomarkers and risks of CVD and T2D in US adults. More large prospective cohort studies are warranted to investigate this association in other racial/ethnic groups.

Download Full-text

Carbohydrate Quantity and Quality and Risk of Type 2 Diabetes: Results from Three Large Prospective US Cohorts

Current Developments in Nutrition ◽

10.1093/cdn/nzaa061_008 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1380-1380

Author(s):

Kim Braun ◽

Marta Liu Guasch-Ferré ◽

Vasanti Malik ◽

Hala Alessa ◽

Walter Willett ◽

...

Keyword(s):

Type 2 Diabetes ◽

Saturated Fat ◽

Whole Grains ◽

Health Study ◽

Monounsaturated Fat ◽

Funding Sources ◽

Cox Proportional Hazard Regression ◽

Time Varying Covariates

Abstract Objectives Carbohydrate intake has been reported to be associated with higher type 2 diabetes (T2D) risk, but high and low quality of carbohydrate may have different effects. Furthermore, these effects may differ depending on overall macronutrient composition. We aimed to examine associations of isocalorically substituting high quality carbohydrates (HQC) and low quality carbohydrates (LQC) with other macronutrients on T2D risk. Methods We included 69,949 women from the Nurses’ Health Study, 90,239 women from the Nurses’ Health Study 2, and 40,539 men from the Health Professionals Follow-up Study. Dietary data were collected every 2–4 years using a semi-quantitative food frequency questionnaire, from which dietary intake of LQC and HQC were calculated. LQC was defined as the percentage of energy (E%) from carbohydrates from refined grains, sugary foods, and potatoes, and HQC as E% from carbohydrate from whole grains. Hazard ratios were estimated using Cox proportional hazard regression analyses with time-varying covariates. Results During 4389,996 years of follow-up, we documented 11,872 T2D cases. In pooled multivariable-adjusted analyses, substituting 5E% from saturated fat with 5E% from LQC was associated with a higher T2D (HR[95% CI] = 1.05[1.00–1.09]) while substitution with HQC was associated with a lower T2D risk (HR[95% CI] = 0.93[0.87–0.99]). Isocaloric substitution of other macronutrients with LQC was not associated with T2D risk. On the other hand, isocaloric substitution of HQC was associated with lower T2D risk when the replacement nutrient was monounsaturated fat (HR[95% CI] = 0.88[0.83–0.94]), polyunsaturated fat (HR[95% CI] = 0.92[0.86–0.98]), trans fat (HR[95% CI] = 0.90[0.85–0.97]), animal protein (HR[95% CI] = 0.88[0.83–0.93]), and vegetable protein (HR[95% CI] = 0.90[0.84–0.96]). Conclusions Our study suggests that higher intake of HQC, especially from whole grains, is associated with a lower T2D risk, irrespective of the macronutrient it replaces. In contrast, a higher intake of LQC is associated with a higher risk of type 2 diabetes, but only when it replaces saturated fat. Our findings highlight the importance of making a distinction between carbohydrate from high and low quality sources and taking into account different substitutions when examining macronutrients. Funding Sources National Institutes of Health.

Download Full-text

Abstract MP42: Dietary Linoleic Acid Intake Is Inversely Associated With Type 2 Diabetes Risk In Three Large Prospective Cohort Studies Of U.s. Men And Women.

Circulation ◽

10.1161/circ.137.suppl_1.mp42 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Geng Zong ◽

Gang Liu ◽

Anne J Wanders ◽

Marjan Alssema ◽

Peter L Zock ◽

...

Keyword(s):

Type 2 Diabetes ◽

Fatty Acids ◽

Linoleic Acid ◽

Total Energy ◽

Disease Incidence ◽

Self Report ◽

Health Study ◽

Refined Carbohydrates

Introduction: Recent studies reported inverse associations between circulating levels of n-6 polyunsaturated fatty acids (PUFAs) and type 2 diabetes (T2D) risk, although whether intake of these fatty acids is associated T2D risk remains to be elucidated. Hypothesis: We examined the hypothesis that long-term intake of n-6 PUFAs, especially linoleic acid (LA), is associated with lower T2D risk. Methods: Diet was assessed using validated food-frequency questionnaires every 4 years in women participating in Nurses' Health Study (NHS, n=83,648) and NHSII (n=88,610), and men participating in the Health Professionals Follow-Up Study (n=41,771). Incident T2D was identified by self-report and confirmed by a supplemental questionnaire. Results: N-6 PUFAs accounted for 4.7-6.8% total energy on average, and 98% of n-6 PUFA intake was from LA. We identified 18,442 T2D cases during 4.93 million person-years of follow-up. In multivariate-adjusted models, HRs (95%CIs) of T2D comparing extreme quintiles (high vs low) were 0.92 (0.88, 0.97; P trend =0.01) for LA intake, and 1.14 (1.08, 1.20; P trend <0.001) for arachidonic acid (AA) intake. It was further estimated that T2D risk were 6% lower when SFAs (2% of total energy) were iso-calorically replaced by LA intake ( table below). For each 2% energy from LA intake, T2D risk was 17% lower for iso-calorically replacing trans fats, and 4% lower for iso-calorically replacing total carbohydrates, and refined carbohydrates (All P values <0.05). These findings remained after adjusting for baseline BMI instead updated BMI, further adjusting for incident hypertension and hypercholesterolemia, or placing a 4-year lag between dietary assessments and disease incidence. Conclusion: Higher LA consumption is associated with a lower T2D risk, especially when substituting for SFAs, trans fats, or refined carbohydrates. AA mainly comes from poultry and meats, and is associated with higher T2D risk.

Download Full-text

Abstract 17285: Frequent Consumption of Meals Prepared at Home and Risk of Type 2 Diabetes Among American Men and Women

Circulation ◽

10.1161/circ.132.suppl_3.17285 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Geng Zong ◽

David M Eisenberg ◽

Frank B Hu ◽

Qi Sun

Keyword(s):

Type 2 Diabetes ◽

Weight Gain ◽

Lower Risk ◽

Fruits And Vegetables ◽

Hazard Ratio ◽

Health Study ◽

Sugar Sweetened Beverage ◽

At Home

Introduction: The frequency of eating meals prepared at home (MPAH) decreased among Americans over the last 50 years. Eating out has been associated with poor diet quality and weight gain in adolescents and adult. Few studies have examined MPAH frequency in relation to diabetes risk. Hypothesis: Having MPAH is associated with lower risk of Type 2 Diabetes (T2D). Methods: We followed 57,994 women in the Nurses’ Health Study and 41,679 men in the Health Professionals Follow-up Study from 1986 to 2012. Participants were free of diabetes, cardiovascular disease, and cancer at baseline. Weekly frequencies of consuming MPAH were collected at baseline, and summed up as overall MPAH. Results: Participants with more MPAH had higher intake of whole grains, total and low-fat dairy products, fruits, and vegetables, and lower sugar sweetened beverage (SSB) at baseline. However, MPAH turned to be associated with more red meat and low coffee intakes. MPAH was moderately associated with less weight gain during follow-up. Compared to those with 0-6 overall MPAH/week, women with 11-14 MPAH/week had 0.45±0.08kg less weight gain over 8 years, whereas men had 0.41±0.07 kg less weight gain (P<0.001) for the same comparison. During 2.3 million person-years of follow-up, 8959 T2D cases were identified and confirmed in both cohorts. After multivariate adjustment of demographic and lifestyle factors, pooled hazard ratio (95% confidence interval) of T2D were 0.96 (0.90, 1.01), 0.96 (0.87, 1.06), 0.88 (0.83, 0.94) for participants who had 7-8, 9-10, and 11-14 MPAH/week (P for trend<0.001), comparing with those eating 0-6 MPAH/week. Each additional MPAH for lunch was associated with 2% lower risk of T2D, whereas the corresponding value was 4% for dinner (P<0.001 for both). These findings were attenuated when BMI or SSB were further adjusted: the hazard ratio comparing participants with 11-14 MPAH/week to those with 0-6 MPAH/week were 0.95 (0.90, 1.01; P for trend=0.13) with adjusting of BMI, and 0.94 (0.89, 1.00; P for trend=0.09) with adjustment of SSB. Conclusions: These findings suggest that eating more MPAH is associated with a lower risk of T2D overtime, and this relationship may be partly ascribed to less weight gain and lower SSB intake by those who prepare their own meals at home more often.

Download Full-text

Dairy fat intake and risk of type 2 diabetes in 3 cohorts of US men and women

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqz176 ◽

2019 ◽

Vol 110 (5) ◽

pp. 1192-1200 ◽

Cited By ~ 8

Author(s):

Andres V Ardisson Korat ◽

Yanping Li ◽

Frank Sacks ◽

Bernard Rosner ◽

Walter C Willett ◽

...

Keyword(s):

Type 2 Diabetes ◽

Dairy Products ◽

Lower Risk ◽

Whole Grains ◽

Health Study ◽

Fat Intake ◽

Men And Women ◽

Dairy Fat

ABSTRACT Background Previous studies have examined dairy products with various fat contents in relation to type 2 diabetes (T2D) risk, although data regarding dairy fat intake per se are sparse. Objectives We aimed to evaluate the association between dairy fat intake and risk of T2D in 3 prospective cohorts. We also examined associations for isocalorically replacing dairy fat with other macronutrients. Methods We prospectively followed 41,808 men in the Health Professionals Follow-Up Study (HPFS; 1986–2012), 65,929 women in the Nurses’ Health Study (NHS; 1984–2012), and 89,565 women in the NHS II (1991–2013). Diet was assessed quadrennially using validated FFQs. Fat intake from dairy products and other relevant sources was expressed as percentage of total energy. Self-reported incident T2D cases were confirmed using validated supplementary questionnaires. Time-dependent Cox proportional hazards regression was used to estimate the HR for dairy fat intake and T2D risk. Results During 4,219,457 person-years of follow-up, we documented 16,511 incident T2D cases. Dairy fat was not associated with risk of T2D when compared with calories from carbohydrates (HR for extreme quintiles: 0.98; 95% CI: 0.95, 1.02). Replacing 5% of calories from dairy fat with other sources of animal fat or carbohydrate from refined grains was associated with a 17% (HR: 1.17; 95% CI: 1.13, 1.21) and a 4% (HR: 1.04; 95% CI: 1.00, 1.08) higher risk of T2D, respectively. Conversely, a 5% calorie replacement with carbohydrate from whole grains was associated with a 7% lower risk of T2D (HR: 0.93; 95% CI: 0.88, 0.98). Conclusions Dairy fat intake was not associated with T2D risk in these cohort studies of US men and women when compared with calories from carbohydrate. Replacing dairy fat with carbohydrates from whole grains was associated with lower risk of T2D. Replacement with other animal fats or refined carbohydrates was associated with higher risk.

Download Full-text

Increased healthcare utilization costs following initiation of insulin treatment in type 2 diabetes: A long-term follow-up in clinical practice

Primary Care Diabetes ◽

10.1016/j.pcd.2016.11.002 ◽

2017 ◽

Vol 11 (2) ◽

pp. 184-192 ◽

Cited By ~ 5

Author(s):

Almina Kalkan ◽

Johan Bodegard ◽

Johan Sundström ◽

Bodil Svennblad ◽

Carl Johan Östgren ◽

...

Keyword(s):

Type 2 Diabetes ◽

Clinical Practice ◽

Healthcare Utilization ◽

Insulin Treatment ◽

Long Term Follow Up

Download Full-text

An Important Form of Diabetes for Clinicians: Ketosis-Prone Diabetes

Dubai Diabetes and Endocrinology Journal ◽

10.1159/000513667 ◽

2021 ◽

pp. 1-4

Author(s):

Esra Ekiz ◽

Tahsin Celepkolu ◽

Yavuz Karahan

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 1 Diabetes ◽

Insulin Treatment ◽

Short Term ◽

Hybrid Form ◽

Important Form

Ketosis-prone diabetes (KPD) is defined as a hybrid form of diabetes mellitus, which is predominantly seen in overweight-to-obese men. Although the diagnosis is based on diabetic ketoacidosis (DKA) as a presenting feature, which also is characteristic of type 1 diabetes, the course of the disease differs from type 1. Recognition of this form by the clinicians is important as these patients are negative for autoantibodies and share the characteristics of type 2 diabetes during follow-up. Here we report 2 cases of KPD presenting with DKA and maintaining normoglycemia without insulin after receiving short-term intensive insulin treatment.

Download Full-text

Erythrocyte n-6 polyunsaturated fatty acids, gut microbiota and incident type 2 diabetes: a prospective cohort study

10.2337/figshare.12624821 ◽

2020 ◽

Author(s):

Zelei Miao ◽

Jie-sheng Lin ◽

Yingying Mao ◽

Geng-dong Chen ◽

Fang-fang Zeng ◽

...

Keyword(s):

Type 2 Diabetes ◽

Gut Microbiota ◽

Health Study ◽

Diabetes Incidence ◽

Incident Type ◽

Β Diversity ◽

Α Diversity ◽

Incident Type 2 Diabetes

OBJECTIVE To examine the association of erythrocyte n-6 polyunsaturated fatty acid (PUFA) biomarkers with incident type 2 diabetes and explore the potential role of gut microbiota in the association. RESEARCH DESIGN AND METHODS We evaluated 2,731 participants without type 2 diabetes recruited between 2008-2013 in the Guangzhou Nutrition and Health Study, China. Type 2 diabetes cases were identified with clinical and biochemical information collected at follow-up visits. Using stool samples collected during the follow-up in the subset (n=1,591), 16S rRNA profiling was conducted. Using multivariable-adjusted Poisson or linear regression, we examined associations of erythrocyte n-6 PUFA biomarkers with incident type 2 diabetes, and diversity and composition of gut microbiota. RESULTS Over 6.2 years of follow-up, 276 type 2 diabetes cases were identified (risk=0.10). Higher levels of erythrocyte <a>γ-linolenic acid</a> (GLA), but not linoleic or arachidonic acid, were associated with higher type 2 diabetes incidence. Comparing the top to the bottom quartile groups of GLA levels, relative risk was 1.72 (95% confidence intervals: 1.21, 2.44) adjusted for potential confounders. Baseline GLA was inversely associated with gut microbial richness and diversity (α-diversity, both p<0.05) during follow-up, and significantly associated with microbiota β-diversity (p=0.002). α-diversity acted as a potential mediator in the association between GLA and type 2 diabetes (p<0.05). Seven genera (Butyrivibrio, Blautia, Oscillospira, Odoribacter, S24-7 other, Rikenellaceae other, and Clostridiales other) were enriched in quartile 1 of GLA, and in participants without type 2 diabetes. CONCLUSIONS Relative concentrations of erythrocyte GLA were positively associated with incident type 2 diabetes in a Chinese population and also with gut microbial profiles. These results highlight that gut microbiota may play an important role linking n-6 PUFA metabolism and type 2 diabetes etiology.

Download Full-text

Restricted AccessChanges in Plant-Based Diet Indices and Subsequent Risk of Type 2 Diabetes in Women and Men: Three U.S. Prospective Cohorts

10.2337/figshare.13312577.v1 ◽

2021 ◽

Author(s):

Zhangling Chen ◽

Jean-Philippe Drouin-Chartier ◽

Yanping Li ◽

Megu Y. Baden ◽

JoAnn E. Manson ◽

...

Keyword(s):

Type 2 Diabetes ◽

Lower Risk ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Diabetes Risk ◽

Health Study ◽

Weight Changes ◽

Subsequent Risk

Objective We evaluated the associations between changes in plant-based diets and subsequent risk of type 2 diabetes. Methods We prospectively followed 76,530 women in the Nurses’ Health Study (NHS, 1986-2012), 81,569 women in NHS II (1991-2017), and 34,468 men in the Health Professionals’ Follow-up Study (1986-2016). Adherence to plant-based diets was assessed every 4 years using the overall plant-based diet index (PDI), healthful PDI (hPDI), and unhealthful PDI (uPDI). We used multivariable Cox proportional hazards models to estimate hazard ratios (HRs). Results of the three cohorts were pooled using meta-analysis. Results We documented 12,627 cases of type 2 diabetes during 2,955,350 person-years of follow-up. <a>After adjustment for initial BMI, initial and 4-year changes in alcohol intake, smoking, physical activity, and other factors, </a><a>compared with participants whose indices remained relatively stable (±3%), </a><a>participants with the largest decrease (>10%) in PDI and hPDI over 4 years had a 12%-23% higher diabetes risk in the subsequent 4 years (pooled HR: PDI, 1.12 (95% CI 1.05, 1.20), hPDI, 1.23 (1.16, 1.31)). </a>Each 10% increment in PDI and hPDI over 4 years was associated with a 7%-9% lower risk (PDI, 0.93 (0.91, 0.95), hPDI, 0.91 (0.87, 0.95)). Changes in uPDI were not associated with diabetes risk. Weight changes accounted for 6.0%-35.6% of the associations between changes in PDI and hPDI and diabetes risk. Conclusions Improving adherence to overall and healthful plant-based diets was associated with a lower risk of type 2 diabetes, whereas decreased adherence to such diets was associated with a higher risk.

Download Full-text