Abstract P213: Marital status and Risk of type 2 Diabetes in the Health Professionals Follow-up Study

Married individuals may enjoy better physical and mental health than their unmarried counterparts. Previous work has suggested that never entering marriage or marital termination by death or divorce increases risk of premature mortality and cardiovascular disease, with more pronounced effects among men. Few studies to date have investigated the role of marital status in the development of type 2 diabetes (T2D). We tested the hypothesis that men who are not married have increased risk of incident T2D in the Health Professionals Follow-up Study, an on-going cohort of men. A total of 41,379 men ages 40 to 75 without diabetes at baseline in 1986 were followed until 2008. T2D, marital status and covariates were assessed by questionnaires biennially. New cases of T2D were confirmed by a supplementary questionnaire validated by medical record review. Cox proportional hazards models estimated the effect of time-dependent measures of marital status on incident T2D. Potential confounders and components of the causal pathway were included as time-dependent covariates. During 22 years of follow-up (801,850 person-years), we documented 2952 incident cases of T2D. Strongest associations were evident for widowed men, while associations among men who were either never married or divorced/separated were less consistent. Compared to married men, RRs (95% CIs) of developing T2D for divorced/separated, widowed and never married men were 1.09 (0.94–1.27), 1.29 (1.06–1.57), and 1.17 (0.91–1.52), respectively, after adjusting for age, family history of diabetes and ethnicity. The RR of T2D associated with widowhood was attenuated after adjusting for lifestyle and dietary factors [RR: 1.21 (1.00–1.48)] and no longer significant when further adjusting for BMI [RR: 1.16 (0.95–1.41)]. The opposite trend was observed for divorced/separated men: when adjusting for lifestyle and dietary factors [RR: 1.12 (0.96–1.30)] as well as BMI [1.14 (0.98–1.32)] the RR of T2D increased slightly. Among men who were never married, diet and lifestyle did not alter RR of T2D [1.17 (0.91–1.52)], however, after further adjusting for BMI there was a notable enhanced RR of T2D [1.23 (0.95–1.60)]. When allowing for a 2-year lag period between marital status and disease, RRs of T2D for widowers were augmented and when further adjusting for BMI remained borderline significant [RR: 1.24 (1.00–1.55)]. In conclusion, being widowed is associated with an increased risk of T2D in men and this may be mediated, in part, through unfavorable changes in lifestyle, diet and adiposity. Together with prior work, our findings suggest that widowhood has important implications for metabolic functioning and greater attention to the cardiometabolic health of this population is warranted.

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Discovering missing heritability and early risk prediction for type 2 diabetes: a new perspective for genome-wide association study analysis with the Nurses’ Health Study and the Health Professionals’ Follow-Up Study

TURKISH JOURNAL OF MEDICAL SCIENCES ◽

10.3906/sag-1310-77 ◽

2014 ◽

Vol 44 ◽

pp. 946-954 ◽

Cited By ~ 4

Author(s):

Hüsamettin GÜL ◽

Yeşim AYDIN SON ◽

Cengizhan AÇIKEL

Keyword(s):

Health Professionals ◽

Genome Wide Association Study ◽

Genome Wide Association ◽

Health Study ◽

Follow Up Study ◽

Early Risk ◽

Genome Wide ◽

New Perspective

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Impact of marital status on prostate cancer-specific mortality and overall mortality after radical prostatectomy.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.5_suppl.73 ◽

2012 ◽

Vol 30 (5_suppl) ◽

pp. 73-73

Author(s):

Kenneth Gerard Nepple ◽

Adam Stuart Kibel ◽

Gurdarshan S Sandhu ◽

Dorina Kallogjeri ◽

Seth A. Strope ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Marital Status ◽

Medical Comorbidity ◽

Never Married ◽

Increased Risk ◽

Married Men ◽

Specific Mortality ◽

Cancer Specific Mortality ◽

Overall Mortality

73 Background: Analysis from population-based cancer registry data has suggested that being married is associated with improved survival in men with prostate cancer. However, a limitation of such analysis is the inability to control for PSA or medical comorbidity which may differ by marital status. We investigated the association between marital status and both prostate cancer specific mortality (PCSM) and overall mortality (OM) in men treated with radical prostatectomy. Methods: The study population included 3596 men treated with radical prostatectomy at a single institution between 1994 and 2004 and followed for a median of 72 months. Disease specific factors (PSA, clinical stage, and biopsy Gleason grade), comorbidity (validated ACE-27 comorbidity index), ethnicity, age, and marital status at time of treatment were retrieved from an institutional cancer registry. Differences between marital status groups were evaluated by Chi square or ANOVA. Multivariable Cox proportional hazard regression models were used to estimate the hazard ratio (HR) of PCSM and OM by marital status. Results: 86.9% of men were married, 5.3% divorced, 2.4% widowed, and 5.5% never married. Marital status was associated with differences in PSA (p<0.01), comorbidity (p=0.04), and age (p<0.01). Married men had the lowest mean PSA at diagnosis and never married men were younger and the most likely to have no known medical comorbidity. A total of 386(11%) men were dead at the end of follow up, but only 55 of them died of prostate cancer. In multivariable analyses (Table), never married men had a significantly increased risk of PCSM and OM compared to married men, whereas no additional risk was observed for divorced or widowed men. Conclusions: Never married men had an increased risk of PCSM and OM. Factors associated with social isolation or unhealthy behaviors may have a detrimental effect on survival after prostatectomy. [Table: see text]

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Abstract 20: Carbohydrate Quality, Measured Using Multiple Carbohydrate Quality Metrics, is Negatively Associated with Risk of Type 2 Diabetes in US Women

Circulation ◽

10.1161/circ.131.suppl_1.20 ◽

2015 ◽

Vol 131 (suppl_1) ◽

Author(s):

Hala AlEssa ◽

Shilpa Bhupathiraju ◽

Vasanti Malik ◽

Nicole Wedick ◽

Hannia Campos ◽

...

Keyword(s):

Type 2 Diabetes ◽

Quality Metrics ◽

Dietary Factors ◽

Increased Risk ◽

Carbohydrate Quality ◽

Cereal Fiber ◽

High Starch ◽

Incident Cases

Background: Carbohydrate quality may be an important determinant of type 2 diabetes (T2D), however, the relationships between various carbohydrate quality metrics and T2D risk have not been systematically investigated. Objective: To prospectively examine the association between carbohydrate, starch, fiber, and different combinations of these nutrients in relation to the risk of T2D in US women. Methods: We prospectively collected information on diet and lifestyle behaviors among 70,041 women from the Nurses Health Study every 2-4 years, after baseline in 1984. These participants were free of diagnosed cardiovascular disease, cancer, or diabetes at baseline. We used Cox proportional hazards regression models to assess the association between dietary factors of interest and incidence of T2D. Results: With 24 years of follow-up we ascertained 6,934 incident cases of T2D during 1,484, 213 person years of follow-up. After adjusting for age, lifestyle and dietary variables, total carbohydrate intake was not associated with T2D (RR=0.98, 95% CI: 0.89 - 1.08, p for trend=0.84), while starch was positively associated with T2D (RR=1.23, 95%CI: 1.12 - 1.35), p for trend <0.0001), comparing the highest to lowest quintile. Total fiber (RR= 0.80, 95%CI: 0.72 - 0.89, p for trend < 0.0001), cereal fiber (RR= 0.71, 95%CI: 0.65 - 0.78, p for trend < 0.0001) and fruit fiber (RR= 0.80, 95%CI: 0.73 - 0.88, p for trend < 0.0001) were all inversely associated with T2D, comparing extreme quintiles. . There was a borderline significant positive association between the ratio of carbohydrate to total fiber intake and risk of T2D (RR= 1.09, 95%CI: 1.00 - 1.20, p for trend = 0.039), and stronger positive associations between the ratios of carbohydrate to cereal fiber (RR= 1.28, 95%CI: 1.17 - 1.39, p for trend < 0.0001), starch to total fiber (RR= 1.12, 95%CI: 1.02 - 1.23, p for trend = 0.030) and starch to cereal fiber (RR= 1.39, 95%CI: 1.27 - 1.53, p for trend < 0.0001) with T2D, comparing extreme quintiles.. Conclusion: Diets with high starch, low fiber and high starch to cereal fiber ratio were associated with increased risk of T2D. Using the starch to cereal fiber ratio of the overall diet is a potentially useful way of assessing carbohydrate quality in relation to T2D.

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Diet, Lifestyle, and Genetic Risk Factors for Type 2 Diabetes: A Review from the Nurses’ Health Study, Nurses’ Health Study 2, and Health Professionals’ Follow-Up Study

Current Nutrition Reports ◽

10.1007/s13668-014-0103-5 ◽

2014 ◽

Vol 3 (4) ◽

pp. 345-354 ◽

Cited By ~ 69

Author(s):

Andres V. Ardisson Korat ◽

Walter C. Willett ◽

Frank B. Hu

Keyword(s):

Risk Factors ◽

Type 2 Diabetes ◽

Health Professionals ◽

Genetic Risk ◽

Genetic Risk Factors ◽

Health Study ◽

Follow Up Study

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Policemen and firefighters have increased risk for type-2 diabetes mellitus probably due to their large body mass index: A follow-up study in Japanese men

American Journal of Industrial Medicine ◽

10.1002/ajim.20238 ◽

2005 ◽

Vol 49 (1) ◽

pp. 30-35 ◽

Cited By ~ 13

Author(s):

Teruo Nagaya ◽

Hideyo Yoshida ◽

Hidekatsu Takahashi ◽

Makoto Kawai

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Body Mass Index ◽

Type 2 Diabetes Mellitus ◽

Large Body ◽

Japanese Men ◽

Follow Up Study ◽

Increased Risk

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Dietary Insulinemic Potential and Risk of Total and Cause-Specific Mortality in the Nurses' Health Study and the Health Professionals Follow-up Study

10.2337/figshare.16906060.v1 ◽

2021 ◽

Author(s):

Yi Wan ◽

Fred K. Tabung ◽

Dong Hoon Lee ◽

Teresa T. Fung ◽

Walter C. Willett ◽

...

Keyword(s):

Health Professionals ◽

Insulin Response ◽

Premature Death ◽

Health Study ◽

Follow Up Study ◽

Risk Of Mortality ◽

Increased Risk ◽

Specific Mortality ◽

Design And Methods

Objective: Insulin response is related to overall health. Diet modulates insulin response. We aimed to investigate whether insulinemic potential of diet are associated with risk of all-cause and cause-specific mortality. Research Design and Methods: We prospectively followed 63,464 women from the Nurses’ Health Study (1986-2016) and 42,880 men from the Health Professionals Follow-up Study (1986-2016). Diet was assessed by food frequency questionnaires every 4 years. The insulinemic potential of diet was evaluated using a food-based empirical dietary index for hyperinsulinemia (EDIH), which was pre-defined based on predicting circulating C-peptide concentrations. Results: During <a>2,792,550</a> person-years of follow-up, 38,329 deaths occurred. In the pooled multivariable-adjusted analyses, a higher dietary insulinemic potential was associated with an increased risk of mortality from all-cause (hazard ratio [HR] comparing extreme quintiles: 1.33; 95% confidence interval [CI]: 1.29, 1.38; P-trend<0.001), cardiovascular disease (CVD) (HR: 1.37; 95% CI: 1.27, 1.46; P-trend<0.001), and cancers (HR: 1,20; 95% CI: 1.13, 1.28; P-trend<0.001). <a>These associations were independent of body mass index and remained significant after further adjustment for other well-known dietary indices. </a>Furthermore, <a></a><a></a><a></a><a></a><a></a><a></a><a></a><a></a><a></a><a></a><a></a><a></a><a></a><a></a><a></a><a></a><a></a><a>compared with participants whose EDIH scores were stable over an 8-year period, those with the greatest increases had a higher subsequent risk of all-cause (HR: 1.13; 95%CI: 1.09, 1.18; P-trend<0.001)</a> and CVD (HR: 1.10; 95% CI: 1.01, 1.21; P-trend=0.006) mortality. Conclusions: Higher insulinemic potential of diet was associated with increased risk of all-cause, CVD, and cancer mortality. Adopting a diet with low insulinemic potential might be an effective approach to improve overall health and prevent premature death.

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Increased Risk of Adverse Cardiovascular Events by Strict Glycemic Control after Percutaneous Coronary Intervention (HbA1c < 6.5% at 2 Years) in Type 2 Diabetes Mellitus Combined with Acute Coronary Syndrome: a 5-years follow-up study

Current Medical Research and Opinion ◽

10.1080/03007995.2021.1947219 ◽

2021 ◽

pp. 1-1

Author(s):

Tiangui Yang ◽

Peng Fu ◽

Jie Chen ◽

Xi Fu ◽

Changlu Xu ◽

...

Keyword(s):

Diabetes Mellitus ◽

Cardiovascular Events ◽

Coronary Intervention ◽

Coronary Syndrome ◽

Follow Up Study ◽

Strict Glycemic Control ◽

Increased Risk ◽

Percutaneous Coronary

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Abstract MP94: Consumption of Specific Fruits and Incidence of Type 2 Diabetes in Men and Women

Circulation ◽

10.1161/circ.127.suppl_12.amp94 ◽

2013 ◽

Vol 127 (suppl_12) ◽

Author(s):

Isao Muraki ◽

Fumiaki Imamura ◽

Frank B Hu ◽

Walter C Willett ◽

Rob van Dam ◽

...

Keyword(s):

Type 2 Diabetes ◽

Lower Risk ◽

Fruit Juice ◽

Dietary Factors ◽

Health Study ◽

Significant Heterogeneity ◽

Men And Women ◽

Increased Risk

Background: Consumption of whole fruits, but not fruit juice, has been associated with lower risk of type 2 diabetes. However, individual fruits have different compositions of carbohydrate, phytochemicals and other nutrients, and may thus have different effects on diabetes risk. We examined whether consumption of specific fruits was prospectively associated with risk of type 2 diabetes in US men and women. In addition, we evaluated whether the associations of fruits with diabetes were determined by the glycemic load (GL) of fruits consumption. Methods: After excluding participants with chronic diseases at baseline, we evaluated 66,720 women from the Nurses' Health Study (1984-2008); 85,961 women from the Nurses’ Health Study II (1991-2009); and 26,149 men from the Health Professionals Follow-up Study (1986-2008). Validated semi-quantitative food frequency questionnaires were administered to assess habitual consumption of fruits and other foods every two to four years. Incidences of type 2 diabetes were identified using biennial self-reported questionnaires and confirmed using supplementary questionnaires. The associations were prospectively assessed in each cohort, using Cox proportional hazard regression. Sociodemographics, lifestyle, caloric intakes, intakes of other fruits, and other dietary factors were adjusted for to control for confounding. Cohort-specific estimates were pooled by a random-effects meta-analysis. Results: During 3,447,866 person-years of follow-up, 11,521 participants were newly diagnosed with type 2 diabetes. The pooled multivariable-adjusted hazard ratios (HRs) for type 2 diabetes (for every 3 servings/week increase of fruit intake) were 0.74 [95% confidence interval (CI): 0.66, 0.83] for blueberries; 0.86 (0.80, 0.93) for grapes or raisins; 0.86 (0.75, 0.99) for prunes; 0.91 (0.81, 1.03) for bananas; 0.93 (0.88, 0.97) for apples or pears; 0.95 (0.91, 1.00) for grapefruits; 0.96 (0.90, 1.02) for peaches, plums or apricots; 1.01 (0.97, 1.05) for oranges; 1.06 (0.96, 1.19) for strawberries; and 1.11 (1.03, 1.20) for cantaloupe. No significant heterogeneity was found among the three cohorts, except associations with banana consumption. In contrast, each drink per day of fruit juice was associated with a HR (95% CI) of 1.07 (1.00, 1.14). The HRs for type 2 diabetes were 0.81 (0.69, 0.96) per 1 serving/day of high GL fruits, 0.96 (0.86, 1.07) for moderate GL fruits, and 1.05 (0.92, 1.19) for low GL fruits. Conclusion: Our data suggest that intakes of certain whole fruits, including grapes or raisins, prunes, apples or pears, grapefruits, and blueberries, are associated with lower risk of type 2 diabetes, whereas high consumption of fruit juice may lead to increased risk. Future research is needed to confirm our findings and elucidate mechanism underlying the associations for individual fruits.

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