Diabetic retinopathy is a microvascular complication of diabetes that threatens all individuals with diabetes, leading to vision loss or blindness if left untreated. It is frequently associated with ...diabetic macular edema, which can occur at any point during the development of diabetic retinopathy. The key factors known to lead to its development include hyperglycemia, hypertension, and the duration of diabetes. Though the diet is important in the development of diabetes, its role in diabetic retinopathy has not been clearly identified. In this systematic review, we aimed to identify, summarize and interpret the literature on the association between the diet and dietary intakes of specific foods, nutrients, and food groups, and the risk of diabetic retinopathy. We searched PubMed and Web of Science for English-language studies evaluating the association between the dietary intake of individual foods, macro or micronutrients, dietary supplements, and dietary patterns and their association with retinopathy or macular edema. After reviewing potentially relevant abstracts and, when necessary, full texts, we identified 27 relevant studies. Identified studies investigated intakes of fruit, vegetables, fish, milk, carbohydrates, fibre, fat, protein, salt, potassium, vitamins C, D, and E, carotenoids, dietary supplements, green tea and alcohol. Studies suggest that adherence to the Mediterranean diet and high fruit, vegetable and fish intake may protect against the development of diabetic retinopathy, although the evidence is limited. Studies concerning other aspects of the diet are not in agreement. The role of the diet in the development of diabetic retinopathy is an area that warrants more attention.
Advanced glycation end products are involved in the vascular complications of diabetes, in chronic kidney disease, and in the aging process. Their accumulation in the elderly people, as reflected by ...skin autofluorescence (sAF), may be a marker of metabolic memory. We aimed to examine the association of sAF with glycemic and renal status 10 years earlier in older persons.
In retrospective cohort study, 328 elderly community dwellers aged of 75 years and over had sAF measurement 10 years after their inclusion in the Three-City cohort. Fasting plasma glucose and serum creatinine were measured at baseline and at 10-year follow-up. In 125 participants, HbA1c was available at these two times. Associations between sAF and the glycemic and renal status 10 years before were analyzed by multivariate linear regression adjusted for age, sex, hypertension, body mass index, hypertriglyceridemia, and smoking.
Participants were 82.4 (standard deviation = 4.1) years on average, and their mean sAF was 2.8 (standard deviation = 0.7) arbitrary units (AU). After adjustment, sAF was higher in participants with long-standing diabetes (+0.38 AU, p = .01) or chronic kidney disease (+0.29 AU, p = .02) compared with healthy participants. sAF was related to fasting plasma glucose (+1 mmol/L associated with +0.08 AU, p = .01) and HbA1c (+1% associated with +0.15 AU, p = .03) 10 years earlier, but not to the current fasting plasma glucose (p = .82) and HbA1c (p = .32). sAF was also related to the distal and current estimated glomerular filtration rates (p = .002 and .004, respectively).
sAF reflects glycemic and renal status 10 years before, supporting its value as a marker of metabolic memory in the elderly people.
We analyzed the cross-sectional and prospective relationships between the accumulation of advanced glycation end products (AGE), assessed by skin autofluorescence (AF) and frailty and its components.
...A total of 423 participants of the Bordeaux sample of the Three-City study 75 years of age or older in 2009-2010 were included in the cross-sectional analysis. Among them, 255 initially non-frail participants were re-examined 4 years later. Skin AF (arbitrary units (AU)) was measured using the AGE Reader. Frailty was defined using Fried's criteria. Associations were assessed with logistic regression models.
Mean skin AF at baseline was 2.81 ±0.68 AU and 16.8% participants were frail. Adjusted for sociodemographic and health characteristics, skin AF was associated neither with prevalent frailty as a whole (Odds Ratio (OR) = 1.2; 95% Confidence Interval: 0.8-1.9) nor with any of its components. Among 255 non-frail participants, 32 became frail over 4 years. In multivariate analyses, skin AF was not associated with incident frailty as a whole (OR = 1.0; 0.5-2.0) but with a doubled risk of incident exhaustion (OR = 2.0; 1.2-3.6) and low energy expenditure (OR = 2.0; 1.1-3.7). No association was observed with other criteria.
In French older community-dwellers aged 75 years and over, the accumulation of AGEs evaluated by skin AF was not associated with prevalent or incident frailty but with the 4-year risk of exhaustion and low energy expenditure. Further studies with larger samples are needed to confirm our results.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background
Although many type 2 diabetes mellitus (T2DM) risk factors have been identified, little is known regarding their contributions to the diabetes burden at the population level.
Methods
The ...study included 72 655 French women from the Etude Epidemiologique de Femmes de la Mutuelle Générale de l'Education Nationale (E3N) prospective cohort followed between 1993 and 2011. Cox multivariable models including the main T2DM risk factors (metabolic, dietary, clinical, socioeconomic and hormonal) and a healthy lifestyle index combining five characteristics (smoking, body mass index BMI, alcohol consumption, fruit and vegetable consumption, and physical activity) were used to estimate hazard ratios and population attributable fractions (PAFs) for T2DM.
Results
In multivariate models, factors with the strongest effect on T2DM risk were, in decreasing order, BMI ≥ 30 kg/m2 (PAF = 43%; 95% confidence interval CI 37–47), high adherence to a Western dietary pattern (PAF = 30%; 95% CI 20–40), hypertension (PAF = 26%; 95% CI 20–32), an acidogenic diet (PAF = 24%; 95% CI 16–32), a family history of diabetes (PAF = 20%; 95% CI 17–22), and, with a negative correlation, moderate alcohol consumption (PAF–19%; 95% CI –34, −4). The PAF for an unhealthy lifestyle was 57% (95% CI 50–63).
Conclusions
We have been able to sort out and quantify the effect of various dietary and biological T2DM risk factors simultaneously in a single population, and to highlight the importance of a healthy lifestyle for primary prevention: more than half the T2DM cases could have been prevented through a healthier lifestyle.
摘要
背景
虽然目前已经确定了2型糖尿病(T2DM)的多个危险因素，但是有关它们在人群水平对糖尿病负担所造成的影响却知之甚少。
方法
研究纳入了72655名法国女性患者，患者来自于法国国家教育互助会的一项流行病学前瞩性队列研究(Etude Epidemiologique de Femmes de la Mutuelle Générale de l'Education Nationale，E3N)，随访时间为1993至2011年。使用包括T2DM主要危险因素(代谢、饮食、临床、社会经济以及激素方面因素)以及结合5个方面特征(吸烟、体重指数BMI、酒精消耗量、水果与蔬菜消耗量、以及体力活动)的健康生活方式指数的Cox多变量模型来评估T2DM的危险比以及人群归因分数(population attributable fractions，PAFs)。
结果
在多变量模型中，对T2DM风险影响最强的因素按照降序分别是BMI ≥ 30 kg/m2(PAF = 43%；95%置信区间CI为37‐47)、长期坚持西方饮食模式(PAF=30%；95% CI为20‐40)、高血压(PAF = 26%；95% CI为20‐32)、产酸饮食(PAF = 24%；95% CI为16‐32)、糖尿病家族史(PAF = 20%；95% CI为17‐22)以及呈负相关的适量饮酒(PAF = ‐19%；95% CI为‐34, ‐4)。不健康生活方式的PAF为57%(95% CI为50‐63)。
结论
我们已经能够在单一人群中同时对T2DM的各种饮食与生物危险因素的影响进行分类与量化，并且强调了健康生活方式对一级预防的重要性:超过一半的T2DM是可以通过更健康的生活方式来预防发生的。
Highlights
If all the women from the E3N study had followed a healthy lifestyle, 57% of cases of type 2 diabetes mellitus (T2DM) cases could have been prevented.
This study helps sort out and quantify the effects of various dietary and biological T2DM risk factors, and highlights the importance of a healthy lifestyle for primary prevention.
Clinicians could use these results to explain to their patients how lifestyle changes can directly affect their risks of developing T2DM.
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FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UL, UM, UPUK
Background
Micronutrients play a key role in type 2 diabetes mellitus (T2DM), but methodological difficulties arise from their collinearity and interdependencies with foods. The aim of the present ...study was to identify micronutrient dietary patterns in the E3N‐EPIC (Etude Epidémiologique auprès de femmes de l'Education Nationale) cohort and to investigate their association with risk of T2DM.
Methods
Principal component analysis was used to identify micronutrient patterns among 71 270 women from the E3N‐EPIC cohort. Associations between micronutrient patterns and risk of T2DM were quantified by hazard ratios (HRs) and 95% confidence intervals (CIs) from Cox proportional hazards regression models, adjusted for potential confounders.
Results
Six micronutrient patterns were identified explaining 78% of the total variance in micronutrient intake. A positive association was found between T2DM and a pattern highly correlated with intake of vitamins B2 and B5 (HR 1.34; 95% CI 1.16–1.56). Similarly, a positive association was found with a pattern characterized by high intakes of vitamin B12 and retinol, and a low intake of vitamin C (HR 1.30; 95% CI 1.15–1.48). An inverse association was observed between T2DM and another two patterns: one correlated with magnesium and vitamin B3 (HR 0.75; 95% CI 0.66–0.86), and the other correlated with manganese intake (HR 0.82; 95% CI 0.72–0.94).
Conclusions
The findings of the present study identify micronutrients that have an effect on the risk of T2DM, and enable better understanding of the complexity of the diet when investigating the association between micronutrients and T2DM.
摘要
背景
微量营养物质对于2型糖尿病(T2DM)具有重要的影响, 但是对其的研究却很困难, 因为它们与食物之间具有共线性以及相互依赖性。当前这项研究的目的是在国家妇女教育改革计划(Etude Epidémiologique auprès de femmes de l’Education Nationale, E3N‐EPIC)队列研究中鉴定出相关的微量营养物质膳食模式, 并且调查它们与T2DM风险之间的关系。
方法
使用主成分分析法明确了71270名来自E3N‐EPIC队列研究的妇女的微量营养物质膳食模式。使用Cox比例风险回归模型, 校正潜在混杂因素后, 根据危险比(HRs)以及95%置信区间(CIs)进行量化, 评估微量营养物质膳食模式与T2DM风险之间的关系。
结果
明确了6种微量营养物质膳食模式, 在摄入的微量营养物质总方差中占比为78%。发现T2DM与摄入维生素B2以及B5的膳食模式呈高度正相关(HR 1.34;95% CI 1.16‐1.56)。同样, 还发现T2DM与大量摄入B12以及视黄醇, 并且较少摄入维生素C的膳食模式呈正相关(HR 1.30;95% CI 1.15‐1.48)。观察到T2DM与另外两种膳食模式呈负相关:一种与镁以及维生素B3的摄入量有关(HR 0.75;95% CI 0.66‐0.86), 另一种与锰的摄入量有关(HR 0.82;95% CI 0.72‐0.94)。
结论
当前这项研究结果表明微量营养物质可以影响T2DM的风险, 有助于我们在进一步研究微量营养物质与T2DM之间关系时能够更好地理解饮食的复杂性。
Highlights
This study shows how the use of micronutrient patterns enables investigation of the association between diet and type 2 diabetes mellitus (T2DM), explaining the complexity of the diet.
The results suggest a protective effect of vitamins C and B3, magnesium, and manganese against T2DM.
A positive association was found between the intake of vitamins B2, B12, and retinol and the risk of T2DM.
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FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UL, UM, UPUK
The metabolic effects of omega-6 polyunsaturated fatty acids (PUFAs) remain contentious, and little evidence is available regarding their potential role in primary prevention of type 2 diabetes. We ...aimed to assess the associations of linoleic acid and arachidonic acid biomarkers with incident type 2 diabetes.
We did a pooled analysis of new, harmonised, individual-level analyses for the biomarkers linoleic acid and its metabolite arachidonic acid and incident type 2 diabetes. We analysed data from 20 prospective cohort studies from ten countries (Iceland, the Netherlands, the USA, Taiwan, the UK, Germany, Finland, Australia, Sweden, and France), with biomarkers sampled between 1970 and 2010. Participants included in the analyses were aged 18 years or older and had data available for linoleic acid and arachidonic acid biomarkers at baseline. We excluded participants with type 2 diabetes at baseline. The main outcome was the association between omega-6 PUFA biomarkers and incident type 2 diabetes. We assessed the relative risk of type 2 diabetes prospectively for each cohort and lipid compartment separately using a prespecified analytic plan for exposures, covariates, effect modifiers, and analysis, and the findings were then pooled using inverse-variance weighted meta-analysis.
Participants were 39 740 adults, aged (range of cohort means) 49-76 years with a BMI (range of cohort means) of 23·3-28·4 kg/m
, who did not have type 2 diabetes at baseline. During a follow-up of 366 073 person-years, we identified 4347 cases of incident type 2 diabetes. In multivariable-adjusted pooled analyses, higher proportions of linoleic acid biomarkers as percentages of total fatty acid were associated with a lower risk of type 2 diabetes overall (risk ratio RR per interquintile range 0·65, 95% CI 0·60-0·72, p<0·0001; I
=53·9%, p
=0·002). The associations between linoleic acid biomarkers and type 2 diabetes were generally similar in different lipid compartments, including phospholipids, plasma, cholesterol esters, and adipose tissue. Levels of arachidonic acid biomarker were not significantly associated with type 2 diabetes risk overall (RR per interquintile range 0·96, 95% CI 0·88-1·05; p=0·38; I
=63·0%, p
<0·0001). The associations between linoleic acid and arachidonic acid biomarkers and the risk of type 2 diabetes were not significantly modified by any prespecified potential sources of heterogeneity (ie, age, BMI, sex, race, aspirin use, omega-3 PUFA levels, or variants of the FADS gene; all p
≥0·13).
Findings suggest that linoleic acid has long-term benefits for the prevention of type 2 diabetes and that arachidonic acid is not harmful.
Funders are shown in the appendix.
We aimed to determine whether adherence to the Australian dietary guidelines and an index of healthy behavior was associated with a lower risk of type 2 diabetes (T2D) and to provide estimates of the ...proportion of preventable cases. Participants of the AusDiab cohort study were followed for 12 years (n = 6242), starting from May 1999, during which T2D cases were identified. The associations between T2D risk and a score of adherence to the dietary guidelines, its components, and a score of adherence to an index of healthy behaviors, (which included smoking, recreational physical activity, waist circumference and adherence to the dietary guidelines), were estimated using Cox proportional hazards ratios (HR) and 95% confidence intervals. The proportion of preventable cases was estimated using the population attributable fraction (PAF). Strong adherence to the dietary guidelines was not associated with T2D risk (HR = 0.64 95% CI 0.39–1.06), unless moderate alcohol consumption was considered as beneficial instead of no alcohol consumption (HR = 0.59 0.36–0.96). However, strong adherence to the guidelines regarding fruit and dairy intake were both associated with decreased risk of T2D (HR = 0.68 0.51–0.91; 0.56 0.38–0.84, respectively) and could have prevented 23–37% of cases (PAF = 23.3% 7.3–38.2; 37.1% 14.6–56.0, respectively). Strong adherence to the index of healthy behaviors was associated with decreased risk of T2D (HR = 0.30 0.17–0.51) and estimated to prevent almost 60% of T2D (PAF = 59.4% 34.3–76.6). More than half of T2D cases could be preventable in Australia through modifying health behavior. These results could serve as a basis for prevention programs based on lifestyle modification.
•Adequate fruit and dairy intake could have prevented almost 40% of type 2 diabetes.•Excessive intake of protein foods was positively associated with type 2 diabetes.•A healthy behavior index was associated with a 70% reduced risk of type 2 diabetes.•Approximately 60% of incident type 2 diabetes cases could have been prevented.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
We aimed to investigate prospective associations of circulating or adipose tissue odd-chain fatty acids 15:0 and 17:0 and trans-palmitoleic acid, t16:1n-7, as potential biomarkers of dairy fat ...intake, with incident type 2 diabetes (T2D).
Sixteen prospective cohorts from 12 countries (7 from the United States, 7 from Europe, 1 from Australia, 1 from Taiwan) performed new harmonised individual-level analysis for the prospective associations according to a standardised plan. In total, 63,682 participants with a broad range of baseline ages and BMIs and 15,180 incident cases of T2D over the average of 9 years of follow-up were evaluated. Study-specific results were pooled using inverse-variance-weighted meta-analysis. Prespecified interactions by age, sex, BMI, and race/ethnicity were explored in each cohort and were meta-analysed. Potential heterogeneity by cohort-specific characteristics (regions, lipid compartments used for fatty acid assays) was assessed with metaregression. After adjustment for potential confounders, including measures of adiposity (BMI, waist circumference) and lipogenesis (levels of palmitate, triglycerides), higher levels of 15:0, 17:0, and t16:1n-7 were associated with lower incidence of T2D. In the most adjusted model, the hazard ratio (95% CI) for incident T2D per cohort-specific 10th to 90th percentile range of 15:0 was 0.80 (0.73-0.87); of 17:0, 0.65 (0.59-0.72); of t16:1n7, 0.82 (0.70-0.96); and of their sum, 0.71 (0.63-0.79). In exploratory analyses, similar associations for 15:0, 17:0, and the sum of all three fatty acids were present in both genders but stronger in women than in men (pinteraction < 0.001). Whereas studying associations with biomarkers has several advantages, as limitations, the biomarkers do not distinguish between different food sources of dairy fat (e.g., cheese, yogurt, milk), and residual confounding by unmeasured or imprecisely measured confounders may exist.
In a large meta-analysis that pooled the findings from 16 prospective cohort studies, higher levels of 15:0, 17:0, and t16:1n-7 were associated with a lower risk of T2D.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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