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Erschienen in: European Journal of Epidemiology 2/2010

01.02.2010 | DIABETES MELLITUS

The relative importance of modifiable potential risk factors of type 2 diabetes: a meta-analysis of two cohorts

verfasst von: Maarit A. Laaksonen, Paul Knekt, Harri Rissanen, Tommi Härkänen, Esa Virtala, Jukka Marniemi, Arpo Aromaa, Markku Heliövaara, Antti Reunanen

Erschienen in: European Journal of Epidemiology | Ausgabe 2/2010

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Abstract

Lifestyle factors predict type 2 diabetes occurrence, but their effect in high- and low-risk populations is poorly known. This study determines the prediction of low-risk lifestyle on type 2 diabetes in those with and without metabolic syndrome in a pooled sample of two representative Finnish cohorts, collected in 1978–1980 and 2000–2001. Altogether 8,627 individuals, aged 40–79 years, and free of diabetes and cardiovascular disease at baseline were included in this study. A low-risk lifestyle was defined based on body mass index, exercise, alcohol consumption, smoking, and serum vitamin D concentration. The metabolic syndrome was defined according to the International Diabetes Federation including obesity, blood pressure, serum HDL cholesterol, serum triglycerides, and fasting glucose. During a 10-year follow-up, altogether 226 type 2 diabetes cases occurred. Overweight was the strongest predictor of type 2 diabetes (population attributable fraction (PAF) = 77%, 95% confidence interval (CI): 53, 88%). Together with lack of exercise, unsatisfactory alcohol consumption, smoking, and low vitamin D concentration it explained 82% of the cases. Altogether 62% (CI: 47, 73%) of the cases were attributable to the metabolic syndrome and 92% (CI: 67, 98%) to the most unfavourable combination of its components. The metabolic syndrome did not modify the prediction of lifestyle factors but persons with normal blood pressure benefited more from positive changes in exercise, alcohol consumption, and smoking than those with elevated blood pressure (P for interaction = 0.01). In conclusion, modification of lifestyle factors apparently reduces type 2 diabetes risk, especially in persons with normal blood pressure.
Literatur
1.
Zurück zum Zitat Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27(5):1047–53.CrossRefPubMed Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27(5):1047–53.CrossRefPubMed
2.
Zurück zum Zitat van Dam RM. The epidemiology of lifestyle and risk for type 2 diabetes. Eur J Epidemiol. 2003;18(12):1115–25.PubMed van Dam RM. The epidemiology of lifestyle and risk for type 2 diabetes. Eur J Epidemiol. 2003;18(12):1115–25.PubMed
3.
Zurück zum Zitat Hu FB, Manson JE, Stampfer MJ, Colditz G, Liu S, Solomon CG, et al. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med. 2001;345(11):790–7.CrossRefPubMed Hu FB, Manson JE, Stampfer MJ, Colditz G, Liu S, Solomon CG, et al. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med. 2001;345(11):790–7.CrossRefPubMed
4.
Zurück zum Zitat Schulze MB, Hoffmann K, Boeing H, Linseisen J, Rohrmann S, Möhlig M, et al. An accurate risk score based on anthropometric, dietary, and lifestyle factors to predict the development of type 2 diabetes. Diabetes Care. 2007;30(3):510–5.CrossRefPubMed Schulze MB, Hoffmann K, Boeing H, Linseisen J, Rohrmann S, Möhlig M, et al. An accurate risk score based on anthropometric, dietary, and lifestyle factors to predict the development of type 2 diabetes. Diabetes Care. 2007;30(3):510–5.CrossRefPubMed
5.
Zurück zum Zitat Mozaffarian D, Kamineni A, Carnethon M, Djoussé L, Mukamal KJ, Siskovick D. Lifestyle risk factors and new-onset diabetes mellitus in older adults. Arch Intern Med. 2009;169(8):798–807.CrossRefPubMed Mozaffarian D, Kamineni A, Carnethon M, Djoussé L, Mukamal KJ, Siskovick D. Lifestyle risk factors and new-onset diabetes mellitus in older adults. Arch Intern Med. 2009;169(8):798–807.CrossRefPubMed
6.
Zurück zum Zitat Knekt P, Laaksonen M, Mattila C, Härkänen T, Marniemi J, Heliövaara M, et al. Serum vitamin D and subsequent occurrence of type 2 diabetes. Epidemiology. 2008;19(5):666–71.CrossRefPubMed Knekt P, Laaksonen M, Mattila C, Härkänen T, Marniemi J, Heliövaara M, et al. Serum vitamin D and subsequent occurrence of type 2 diabetes. Epidemiology. 2008;19(5):666–71.CrossRefPubMed
7.
Zurück zum Zitat Pittas AG, Lau J, Hu FB, Dawson-Hughes B. The role of vitamin D and calcium in type 2 diabetes. A systematic review and meta-analysis. J Clin Endocrinol Metab. 2007;92(3):2017–29.CrossRefPubMed Pittas AG, Lau J, Hu FB, Dawson-Hughes B. The role of vitamin D and calcium in type 2 diabetes. A systematic review and meta-analysis. J Clin Endocrinol Metab. 2007;92(3):2017–29.CrossRefPubMed
8.
Zurück zum Zitat Alberti KG, Zimmet P, Shaw J. Metabolic syndrome—a new world-wide definition. A consensus statement from the International Diabetes Federation. Diabet Med. 2006;23(5):469–80.CrossRefPubMed Alberti KG, Zimmet P, Shaw J. Metabolic syndrome—a new world-wide definition. A consensus statement from the International Diabetes Federation. Diabet Med. 2006;23(5):469–80.CrossRefPubMed
9.
Zurück zum Zitat Cheung BM, Wat NM, Man YB, Tam S, Thomas GN, Leung GM, et al. Development of diabetes in Chinese with the metabolic syndrome: a 6-year prospective study. Diabetes Care. 2007;30(6):1430–6.CrossRefPubMed Cheung BM, Wat NM, Man YB, Tam S, Thomas GN, Leung GM, et al. Development of diabetes in Chinese with the metabolic syndrome: a 6-year prospective study. Diabetes Care. 2007;30(6):1430–6.CrossRefPubMed
10.
Zurück zum Zitat Hanson RL, Imperatore G, Bennett PH, Knowler WC. Components of the “metabolic syndrome” and incidence of type 2 diabetes. Diabetes. 2002;51(10):3120–7.CrossRefPubMed Hanson RL, Imperatore G, Bennett PH, Knowler WC. Components of the “metabolic syndrome” and incidence of type 2 diabetes. Diabetes. 2002;51(10):3120–7.CrossRefPubMed
11.
Zurück zum Zitat Stern MP, Williams K, Haffner SM. Identification of persons at high risk for type 2 diabetes mellitus: do we need the oral glucose tolerance test? Ann Intern Med. 2002;136(8):575–81.PubMed Stern MP, Williams K, Haffner SM. Identification of persons at high risk for type 2 diabetes mellitus: do we need the oral glucose tolerance test? Ann Intern Med. 2002;136(8):575–81.PubMed
12.
Zurück zum Zitat Cameron AJ, Magliano DJ, Zimmet PZ, Welborn TA, Colagiuri S, Tonkin AM, et al. The metabolic syndrome as a tool for predicting future diabetes: the AusDiab study. J Intern Med. 2008;264(2):177–86.CrossRefPubMed Cameron AJ, Magliano DJ, Zimmet PZ, Welborn TA, Colagiuri S, Tonkin AM, et al. The metabolic syndrome as a tool for predicting future diabetes: the AusDiab study. J Intern Med. 2008;264(2):177–86.CrossRefPubMed
13.
Zurück zum Zitat Ford ES, Li C, Sattar N. Metabolic syndrome and incident diabetes: current state of the evidence. Diabetes Care. 2008;31(9):1898–904.CrossRefPubMed Ford ES, Li C, Sattar N. Metabolic syndrome and incident diabetes: current state of the evidence. Diabetes Care. 2008;31(9):1898–904.CrossRefPubMed
14.
Zurück zum Zitat Kanaya AM, Wassel Fyr CL, de Rekeneire N, Shorr RI, Schwartz AV, Goodpaster BH, et al. Predicting the development of diabetes in older adults: the derivation and validation of a prediction rule. Diabetes Care. 2005;28(2):404–8.CrossRefPubMed Kanaya AM, Wassel Fyr CL, de Rekeneire N, Shorr RI, Schwartz AV, Goodpaster BH, et al. Predicting the development of diabetes in older adults: the derivation and validation of a prediction rule. Diabetes Care. 2005;28(2):404–8.CrossRefPubMed
15.
Zurück zum Zitat Lindström J, Tuomilehto J. The diabetes risk score: a practical tool to predict type 2 diabetes risk. Diabetes Care. 2003;26(3):725–31.CrossRefPubMed Lindström J, Tuomilehto J. The diabetes risk score: a practical tool to predict type 2 diabetes risk. Diabetes Care. 2003;26(3):725–31.CrossRefPubMed
16.
Zurück zum Zitat McNeely MJ, Boyko EJ, Leonetti DL, Kahn SE, Fujimoto WY. Comparison of a clinical model, the oral glucose tolerance test, and fasting glucose for prediction of type 2 diabetes risk in Japanese Americans. Diabetes Care. 2003;26(3):758–63.CrossRefPubMed McNeely MJ, Boyko EJ, Leonetti DL, Kahn SE, Fujimoto WY. Comparison of a clinical model, the oral glucose tolerance test, and fasting glucose for prediction of type 2 diabetes risk in Japanese Americans. Diabetes Care. 2003;26(3):758–63.CrossRefPubMed
17.
Zurück zum Zitat Norberg M, Eriksson JW, Lindahl B, Andersson C, Rolandsson O, Stenlund H, et al. A combination of HbA1c, fasting glucose and BMI is effective in screening for individuals at risk of future type 2 diabetes: OGTT is not needed. J Intern Med. 2006;260(3):263–71.CrossRefPubMed Norberg M, Eriksson JW, Lindahl B, Andersson C, Rolandsson O, Stenlund H, et al. A combination of HbA1c, fasting glucose and BMI is effective in screening for individuals at risk of future type 2 diabetes: OGTT is not needed. J Intern Med. 2006;260(3):263–71.CrossRefPubMed
18.
Zurück zum Zitat Schmidt MI, Duncan BB, Bang H, Pankow JS, Ballantyne CM, Golden SH, et al. Identifying individuals at high risk for diabetes: the Atherosclerosis Risk in Communities study. Diabetes Care. 2005;28(8):2013–8.CrossRefPubMed Schmidt MI, Duncan BB, Bang H, Pankow JS, Ballantyne CM, Golden SH, et al. Identifying individuals at high risk for diabetes: the Atherosclerosis Risk in Communities study. Diabetes Care. 2005;28(8):2013–8.CrossRefPubMed
19.
Zurück zum Zitat Narayan KM, Kanaya AM, Gregg EW. Lifestyle intervention for the prevention of type 2 diabetes mellitus: putting theory to practice. Treat Endocrinol. 2003;2(5):315–20.CrossRefPubMed Narayan KM, Kanaya AM, Gregg EW. Lifestyle intervention for the prevention of type 2 diabetes mellitus: putting theory to practice. Treat Endocrinol. 2003;2(5):315–20.CrossRefPubMed
20.
Zurück zum Zitat Hu G, Lakka TA, Lakka HM, Tuomilehto J. Lifestyle management in the metabolic syndrome. Metab Syndr Relat Disord. 2006;4(4):270–86.CrossRefPubMed Hu G, Lakka TA, Lakka HM, Tuomilehto J. Lifestyle management in the metabolic syndrome. Metab Syndr Relat Disord. 2006;4(4):270–86.CrossRefPubMed
21.
Zurück zum Zitat Liberopoulos EN, Tsouli S, Mikhailidis DP, Elisaf MS. Preventing type 2 diabetes in high risk patients: an overview of lifestyle and pharmacological measures. Curr Drug Targets. 2006;7(2):211–28.CrossRefPubMed Liberopoulos EN, Tsouli S, Mikhailidis DP, Elisaf MS. Preventing type 2 diabetes in high risk patients: an overview of lifestyle and pharmacological measures. Curr Drug Targets. 2006;7(2):211–28.CrossRefPubMed
22.
Zurück zum Zitat Taslim S, Tai ES. The relevance of the metabolic syndrome. Ann Acad Med Singapore. 2009;38(1):29–33.PubMed Taslim S, Tai ES. The relevance of the metabolic syndrome. Ann Acad Med Singapore. 2009;38(1):29–33.PubMed
23.
Zurück zum Zitat Aromaa A, Heliövaara M, Impivaara O, Knekt P, Maatela J. Aims, methods and study population. Part 1. In: Aromaa A, Heliövaara M, Impivaara O, Knekt P, Maatela J, editors. The execution of the Mini-Finland Health Survey (in Finnish, English summary). Helsinki and Turku: Publications of the Social Insurance Institution, Finland ML:88; 1989. Aromaa A, Heliövaara M, Impivaara O, Knekt P, Maatela J. Aims, methods and study population. Part 1. In: Aromaa A, Heliövaara M, Impivaara O, Knekt P, Maatela J, editors. The execution of the Mini-Finland Health Survey (in Finnish, English summary). Helsinki and Turku: Publications of the Social Insurance Institution, Finland ML:88; 1989.
24.
Zurück zum Zitat Aromaa A, Koskinen S, editors. Health and functional capacity in Finland. Baseline results of the Health 2000 health examination survey. Helsinki: Publications of the National Public Health Institute B12; 2004. Aromaa A, Koskinen S, editors. Health and functional capacity in Finland. Baseline results of the Health 2000 health examination survey. Helsinki: Publications of the National Public Health Institute B12; 2004.
25.
Zurück zum Zitat Lehtonen R, Kuusela V. Statistical efficiency of the Mini-Finland Health Survey’s sampling design. Part 5. In: Aromaa A, Heliövaara M, Impivaara O, Knekt P, Maatela J, editors. The execution of the Mini-Finland Health Survey (in Finnish, English summary). Helsinki and Turku: Publications of the Social Insurance Institution, Finland ML:65; 1986. Lehtonen R, Kuusela V. Statistical efficiency of the Mini-Finland Health Survey’s sampling design. Part 5. In: Aromaa A, Heliövaara M, Impivaara O, Knekt P, Maatela J, editors. The execution of the Mini-Finland Health Survey (in Finnish, English summary). Helsinki and Turku: Publications of the Social Insurance Institution, Finland ML:65; 1986.
26.
Zurück zum Zitat Kostner GM. Enzymatic determination of cholesterol in high-density lipoprotein fractions prepared by polyanion precipitation (Letter). Clin Chem. 1976;22(5):695.PubMed Kostner GM. Enzymatic determination of cholesterol in high-density lipoprotein fractions prepared by polyanion precipitation (Letter). Clin Chem. 1976;22(5):695.PubMed
27.
Zurück zum Zitat Reunanen A, Kangas T, Martikainen J, Klaukka T. Nationwide survey of comorbidity, use, and costs of all medications in Finnish diabetic individuals. Diabetes Care. 2000;23(9):1265–71.CrossRefPubMed Reunanen A, Kangas T, Martikainen J, Klaukka T. Nationwide survey of comorbidity, use, and costs of all medications in Finnish diabetic individuals. Diabetes Care. 2000;23(9):1265–71.CrossRefPubMed
28.
Zurück zum Zitat World Health Organization. Diabetes mellitus: report of a WHO study group. Geneva: World Health Organization; 1985. World Health Organization. Diabetes mellitus: report of a WHO study group. Geneva: World Health Organization; 1985.
29.
Zurück zum Zitat Heliövaara M, Reunanen A, Aromaa A, Knekt P, Aho K, Suhonen O. Validity of hospital discharge data in a prospective epidemiological study on stroke and myocardial infarction. Acta Med Scand. 1984;216(3):309–15.PubMed Heliövaara M, Reunanen A, Aromaa A, Knekt P, Aho K, Suhonen O. Validity of hospital discharge data in a prospective epidemiological study on stroke and myocardial infarction. Acta Med Scand. 1984;216(3):309–15.PubMed
30.
Zurück zum Zitat Reunanen A, Aromaa A, Pyörälä K, Punsar S, Maatela J, Knekt P. The Social Insurance Institution’s coronary heart disease study. Baseline data and 5-year mortality experience. Acta Med Scand Suppl. 1983;673:1–120.PubMed Reunanen A, Aromaa A, Pyörälä K, Punsar S, Maatela J, Knekt P. The Social Insurance Institution’s coronary heart disease study. Baseline data and 5-year mortality experience. Acta Med Scand Suppl. 1983;673:1–120.PubMed
31.
Zurück zum Zitat Cox DR. Regression models and life tables (with discussion). J R Stat Soc B. 1972;34:187–220. Cox DR. Regression models and life tables (with discussion). J R Stat Soc B. 1972;34:187–220.
32.
Zurück zum Zitat Friedman M. Piecewise constant hazards models for survival data with covariates. Ann Statist. 1982;10(1):101–13.CrossRef Friedman M. Piecewise constant hazards models for survival data with covariates. Ann Statist. 1982;10(1):101–13.CrossRef
33.
Zurück zum Zitat Benichou J. A review of adjusted estimators of attributable risk. Stat Methods Med Res. 2001;10(3):195–216.CrossRefPubMed Benichou J. A review of adjusted estimators of attributable risk. Stat Methods Med Res. 2001;10(3):195–216.CrossRefPubMed
34.
Zurück zum Zitat Laaksonen M, Härkänen T, Knekt P, Virtala E, Oja H. Estimation of population attributable fraction (PAF) for disease occurrence in a cohort study design. Stat Med (in press). Laaksonen M, Härkänen T, Knekt P, Virtala E, Oja H. Estimation of population attributable fraction (PAF) for disease occurrence in a cohort study design. Stat Med (in press).
35.
Zurück zum Zitat Knekt P, Ritz J, Pereira MA, O’Reilly EJ, Augustsson K, Fraser GE, et al. Antioxidant vitamins and coronary heart disease risk: a pooled analysis of 9 cohorts. Am J Clin Nutr. 2004;80(6):1508–20.PubMed Knekt P, Ritz J, Pereira MA, O’Reilly EJ, Augustsson K, Fraser GE, et al. Antioxidant vitamins and coronary heart disease risk: a pooled analysis of 9 cohorts. Am J Clin Nutr. 2004;80(6):1508–20.PubMed
36.
Zurück zum Zitat DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7(3):177–88.CrossRefPubMed DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7(3):177–88.CrossRefPubMed
37.
Zurück zum Zitat Stram DO. Meta-analysis of published data using a linear mixed-effects model. Biometrics. 1996;52(2):536–44.CrossRefPubMed Stram DO. Meta-analysis of published data using a linear mixed-effects model. Biometrics. 1996;52(2):536–44.CrossRefPubMed
38.
Zurück zum Zitat Schulze MB, Hu FB. Primary prevention of diabetes: what can be done and how much can be prevented? Annu Rev Public Health. 2005;26:445–67.CrossRefPubMed Schulze MB, Hu FB. Primary prevention of diabetes: what can be done and how much can be prevented? Annu Rev Public Health. 2005;26:445–67.CrossRefPubMed
39.
Zurück zum Zitat Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403.CrossRefPubMed Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403.CrossRefPubMed
40.
Zurück zum Zitat Orchard TJ, Temprosa M, Goldberg R, Haffner S, Ratner R, Marcovina S, et al. The effect of metformin and intensive lifestyle intervention on the metabolic syndrome: the Diabetes Prevention Program randomized trial. Ann Intern Med. 2005;142(8):611–9.PubMed Orchard TJ, Temprosa M, Goldberg R, Haffner S, Ratner R, Marcovina S, et al. The effect of metformin and intensive lifestyle intervention on the metabolic syndrome: the Diabetes Prevention Program randomized trial. Ann Intern Med. 2005;142(8):611–9.PubMed
41.
Zurück zum Zitat Alberti KG, Zimmet P, Shaw J. International Diabetes Federation: a consensus on type 2 diabetes prevention. Diabet Med. 2007;24(5):451–63.CrossRefPubMed Alberti KG, Zimmet P, Shaw J. International Diabetes Federation: a consensus on type 2 diabetes prevention. Diabet Med. 2007;24(5):451–63.CrossRefPubMed
Metadaten
Titel
The relative importance of modifiable potential risk factors of type 2 diabetes: a meta-analysis of two cohorts
verfasst von
Maarit A. Laaksonen
Paul Knekt
Harri Rissanen
Tommi Härkänen
Esa Virtala
Jukka Marniemi
Arpo Aromaa
Markku Heliövaara
Antti Reunanen
Publikationsdatum
01.02.2010
Verlag
Springer Netherlands
Erschienen in
European Journal of Epidemiology / Ausgabe 2/2010
Print ISSN: 0393-2990
Elektronische ISSN: 1573-7284
DOI
https://doi.org/10.1007/s10654-009-9405-0

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