Fanny Petermann

Associations between diabetes and both cardiovascular disease and all-cause mortality are modified by grip strength: evidence from UK Biobank, a prospective population-based cohort study

OBJECTIVE Grip strength and diabetes are predictors of mortality and cardiovascular disease (CVD), but whether these risk factors interact to predispose to adverse health outcomes is unknown. This study determined the interactions between diabetes and grip strength and their association with health outcomes. RESEARCH DESIGN AND METHODS We undertook a prospective, general population cohort study by using UK Biobank. Cox proportional hazards models were used to explore the associations between both grip strength and diabetes and the outcomes of all-cause mortality and CVD incidence/mortality as well as to test for interactions between diabetes and grip strength. RESULTS A total of 347,130 UK Biobank participants with full data available (mean age 55.9 years, BMI 27.2 kg/m2, 54.2% women) were included in the analysis, of which 13,373 (4.0%) had diabetes. Over a median follow-up of 4.9 years (range 3.3–7.8 years), 6,209 died (594 as a result of CVD), and 4,301 developed CVD. Participants with diabetes were at higher risk of all-cause and CVD mortality and CVD incidence. Significant interactions (P < 0.05) existed whereby the risk of CVD mortality was higher in participants with diabetes with low (hazard ratio [HR] 4.05 [95% CI 2.72, 5.80]) versus high (HR 1.46 [0.87, 2.46]) grip strength. Similar results were observed for all-cause mortality and CVD incidence. CONCLUSIONS Risk of adverse health outcomes among people with diabetes is lower in those with high grip strength. Low grip strength may be useful to identify a higher-risk subgroup of patients with diabetes. Intervention studies are required to determine whether resistance exercise can reduce risk.

Dietary fat and total energy intake modifies the association of genetic profile risk score on obesity: evidence from 48 170 UK Biobank participants

Background:Obesity is a multifactorial condition influenced by both genetics and lifestyle. The aim of this study was to investigate whether the association between a validated genetic profile risk score for obesity (GPRS-obesity) and body mass index (BMI) or waist circumference (WC) was modified by macronutrient intake in a large general population study.Methods:This study included cross-sectional data from 48u2009170 white European adults, aged 37–73 years, participating in the UK Biobank. Interactions between GPRS-obesity and macronutrient intake (including total energy, protein, fat, carbohydrate and dietary fibre intake) and its effects on BMI and WC were investigated.Results:The 93-single-nucleotide polymorphism (SNP) GPRS was associated with a higher BMI (β: 0.57u2009kgu2009m−2 per s.d. increase in GPRS (95% confidence interval: 0.53–0.60); P=1.9 × 10−183) independent of major confounding factors. There was a significant interaction between GPRS and total fat intake (P(interaction)=0.007). Among high-fat-intake individuals, BMI was higher by 0.60 (0.52, 0.67) kgu2009m−2 per s.d. increase in GPRS-obesity; the change in BMI with GPRS was lower among low-fat-intake individuals (β: 0.50 (0.44, 0.57) kgu2009m−2). Significant interactions with similar patterns were observed for saturated fat intake (high β: 0.66 (0.59, 0.73) versus low β: 0.49 (0.42, 0.55) kgu2009m−2, P(interaction)=2 × 10−4) and for total energy intake (high β: 0.58 (0.51, 0.64) versus low β: 0.49 (0.42, 0.56) kgu2009m−2, P(interaction)=0.019), but not for protein intake, carbohydrate intake and fibre intake (P(interaction) >0.05). The findings were broadly similar using WC as the outcome.Conclusions:These data suggest that the benefits of reducing the intake of fats and total energy intake may be more important in individuals with high genetic risk for obesity.

Joint effect of physical activity and sedentary behaviour on cardiovascular risk factors in Chilean adults

BackgroundnTo investigate the associations between combined categories of moderate-to-vigorous physical activity (MVPA) and sedentary behaviour (SB) with markers of adiposity and cardiovascular risk in adults.nnnMethodsnOverall, 5040 participants (mean age 46.4 years and 59.3% women) from the cross-sectional Chilean National Health Survey 2009-2010 were included in this study. MVPA and SB were measured using the Global Physical Activity questionnaire. Four categories were computed using MVPA- and SB-specific cut-offs (High-SB & Active, Low-SB & Active, High-SB & Inactive and Low-SB & Inactive).nnnResultsnCompared to the reference group (High-SB & Inactive), those in High-SB & Active and Low-SB & Active were less likely to have an obese BMI (OR: 0.67 [0.54; 0.85], P = 0.0001 and 0.74 [0.59; 0.92] P = 0.0007, respectively) and less likely to have metabolic syndrome (OR: 0.63 [0.49; 0.82], P < 0.0001 and 0.72 [0.57; 0.91], P = 0.007), central obesity (OR: 0.79 [0.65; 0.96], P = 0.016 and 0.71 [0.59; 0.84], P < 0.0001), diabetes (OR: 0.45 [0.35; 0.59], P < 0.0001 and 0.44 [0.34; 0.56], P < 0.0001) and hypertension (OR: 0.52 [0.43; 0.63], P < 0.0001 and 0.60 [0.50; 0.72], P < 0.0001), respectively.nnnConclusionsnBeing physically active and spending less time in SBs was associated with lower adiposity and improvements in cardiovascular risk factors.

Associations of grip strength with cardiovascular, respiratory, and cancer outcomes and all cause mortality: prospective cohort study of half a million UK Biobank participants

Abstract Objective To investigate the association of grip strength with disease specific incidence and mortality and whether grip strength enhances the prediction ability of an established office based risk score. Design Prospective population based study. Setting UK Biobank. Participants 502u2009293 participants (54% women) aged 40-69 years. Main outcome measures All cause mortality as well as incidence of and mortality from cardiovascular disease, respiratory disease, chronic obstructive pulmonary disease, and cancer (all cancer, colorectal, lung, breast, and prostate). Results Of the participants included in analyses, 13u2009322 (2.7%) died over a mean of 7.1 (range 5.3-9.9) years’ follow-up. In women and men, respectively, hazard ratios per 5 kg lower grip strength were higher (all at P<0.05) for all cause mortality (1.20, 95% confidence interval 1.17 to 1.23, and 1.16, 1.15 to 1.17) and cause specific mortality from cardiovascular disease (1.19, 1.13 to 1.25, and 1.22, 1.18 to 1.26), all respiratory disease (1.31, 1.22 to 1.40, and 1.24, 1.20 to 1.28), chronic obstructive pulmonary disease (1.24, 1.05 to 1.47, and 1.19, 1.09 to 1.30), all cancer (1.17, 1.13 to 1.21, 1.10, 1.07 to 1.13), colorectal cancer (1.17, 1.04 to 1.32, and 1.18, 1.09 to 1.27), lung cancer (1.17, 1.07 to 1.27, and 1.08, 1.03 to 1.13), and breast cancer (1.24, 1.10 to 1.39) but not prostate cancer (1.05, 0.96 to 1.15). Several of these relations had higher hazard ratios in the younger age group. Muscle weakness (defined as grip strength <26 kg for men and <16 kg for women) was associated with a higher hazard for all health outcomes, except colon cancer in women and prostate cancer and lung cancer in both men and women. The addition of handgrip strength improved the prediction ability, based on C index change, of an office based risk score (age, sex, diabetes diagnosed, body mass index, systolic blood pressure, and smoking) for all cause (0.013) and cardiovascular mortality (0.012) and incidence of cardiovascular disease (0.009). Conclusion Higher grip strength was associated with a range of health outcomes and improved prediction of an office based risk score. Further work on the use of grip strength in risk scores or risk screening is needed to establish its potential clinical utility.

Active commuting is associated with a lower risk of obesity, diabetes and metabolic syndrome in Chilean adults

BackgroundnThere is limited evidence on how active commuting is associated with health benefits in developing countries. The aim of this study therefore was to investigate the associations between active commuting and markers of adiposity and cardiometabolic risk in the Chilean adult population.nnnMethodsnIn total, 5157 participants from the Chilean National Health Survey 2009-10 were included in this cross-sectional study. Active commuting was measured using the Global Physical Activity Questionnaire (GPAQ v2). Body mass index (BMI) and waist circumference (WC) were measured and used to define obesity and central obesity. Type 2 diabetes (T2D) and metabolic syndrome were determined using WHO and updated ATPIII-NCEP criteria, respectively.nnnResultsnThe main finding of this study is that a 30 min increase in active commuting is associated with lower odds for BMI > 25.0 kg m-2 (0.93 [95% CI: 0.88-0.98, P = 0.010]). Similarly, the odds for central obesity was 0.87 [0.82-0.92, P < 0.0001]. Similar associations were found for T2D (0.81 [0.75-0.88], P < 0.0001) and metabolic syndrome (OR: 0.86 [0.80-0.92], P < 0.0001).nnnConclusionnOur findings show that active commuting is associated with lower adiposity and a healthier metabolic profile including lower risk for obesity, diabetes and metabolic syndrome.

Tiempo destinado a estar sentado y niveles de adiposidad ¿cuál es su efecto sobre el desarrollo de diabetes mellitus Tipo 2?

Background: Obesity and sedentary behavior are risk factors acting independently in the development of type 2 diabetes. Aim: To investigate whether the association between diabetes and obesity is modified by the levels of sitting time (ST) in the Chilean population. Material and Methods: We included 4,611 participants from the cross-sectional 2009-2010 Chilean National Health Survey in this study. Diabetes was determined as fasting glucose levels ≥126 mg/dl. Body mass index (BMI) and waist circumference (WC) were measured using standardized protocols. Sitting time was assessed using the Global Physical Activity Questionnaire. The association among diabetes, obesity and ST was determined using logistic regression. Results: The odds for diabetes increased by 3.1-fold in people with high levels of ST and obesity in comparison to those with low levels of ST and normal BMI (Odds ratio (OR): 4.17 [95% confidence intervals (CI): 2.87 to 6.05], P < 0.01). The odds for diabetes increased by 2.7fold in highly sedentary subjects with central obesity (OR: 3.73 [95% IC: 2.61 to 5.33], P < 0.01) in comparison to those with low levels of ST and normal WC. Conclusions: Elevated levels of sitting time and obesity are associated with a higher odds of developing diabetes. (Rev Med Chile 2018; 146: 433-441)

Factores asociados a sedentarismo en Chile: evidencia de la Encuesta Nacional de Salud 2009-2010

BACKGROUNDnSedentary behaviors are one of the major risk factors for cardiovascular diseases.nnnAIMnTo identify factors associated with high sedentary behaviors in the Chilean population.nnnMATERIAL AND METHODSnWe included 5,040 participants from the Chilean National Health Survey 2009-2010. Physical activity level and sedentary behavior (sitting time) were measured using the Global Physical Activity Questionnaire (GPAQ v2). Highly sedentary behaviors were determined as > 4 hours per day of sitting time. Logistic regression was used to identify correlates of highly sedentary behavior.nnnRESULTSnForty seven percent of the study population reported spending more than 4 hours per day sitting. The prevalence was higher in women. The main factors associated with high sedentary behavior were: high income levels (Odds ratio (OR):1.91 [95% Confidence intervals (CI:1.61-2.27]); being woman (OR:1.39 [95% CI:1.24-1.56]): having central obesity (OR:1.15 [95% CI:1.02-1.30]), being physically inactive (OR:2.35 [95% CI:2.06-2.68]), and living in an urban area (OR:1.92 [95% CI:1.63-2.26]). Other factors associates with high sedentary behavior were: being smoker, having a television set, computer and private car at their homes. Participants reporting a poor self-reported health and wellbeing and those with diabetes or metabolic syndrome were more likely to be highly sedentary.nnnCONCLUSIONSnThe main factors associated with high levels of sedentary behavior are socio-demographic issues, lifestyles and health status.

Asociación entre el polimorfismo rs9939609 del gen FTO y marcadores de adiposidad en población adulta chilena.

BACKGROUNDnNumerous studies have identified the role of Fat-mass-associated-gene (FTO) in the development of obesity.nnnAIMnTo investigate the association of FTO gene with adiposity markers in Chilean adults.nnnMATERIAL AND METHODSn409 participants were included in this cross-sectional study. The association between FTO (rs9939609) genotype and adiposity markers was determined using linear regression analyses. Adiposity markers included were: body weight, body mass index, fat mass, waist circumference, hip circumference and waist/hip ratio.nnnRESULTSnA fully adjusted model showed a significant association between FTO genotype and body weight (2.16 kg per each extra copy of the risk allele [95% confidence intervals (CI): 0.45 to 3.87], p = 0.014), body mass index (0.61 kg.m-2 [95% CI: 0.12 to 1.20], p = 0.050) and fat mass (1.14% [95% CI: 0.39 to 1.89], p = 0.010). The greater magnitude of association was found between the FTO gene and fat mass when the outcomes were standardized to z-score.nnnCONCLUSIONSnThis study confirms an association between the FTO gene and adiposity markers in Chilean adults, which is independent of major confounding factors.

Factores asociados al desarrollo de diabetes mellitus tipo 2 en Chile

BACKGROUNDnworldwide, prevalence of type 2 diabetes has doubled in the last years, mainly due to unhealthy lifestyle behaviours. They are many risk factors associated with diabetes, however, which factors are associated with diabetes in the Chilean population remains unknown. Therefore, the aim was to determine what risk factors are associated with the development of diabetes in Chile.nnnMETHODSnfour thousand and seven hundred participants from the cross-sectional 2009-2010 National Health Survey were included in this study (4,162 normal; 538 diabetics). Risk factors assessed were socio-demographic, anthropometric, lifestyle, well-being and comorbidities. The association between diabetes and risk factors was examined using logistic regression.nnnRESULTSnthe main non-modifiable risk factors associated with diabetes were age ≥ 45 year, female and family history of diabetes; whereas the main modifiable risk factors were hypertension, overweight, obesity, central obesity, physical inactivity and higher levels of sitting time.nnnCONCLUSIONnthe identification of modifiable risk factors for DMT2 is key to control and decrease the prevalence of this pathology and to improve the quality of life of the population.

Associations of dietary protein intake with fat free mass and grip strength: cross-sectional study in 146,816 UK Biobank participants

Adequate dietary protein intake is important for the maintenance of fat-free mass (FFM) and muscle strength, but optimal requirements remain unknown. Our aim in the current study was to explore the associations of protein intake with FFM and grip strength. We used baseline data from the UK Biobank (a study of 146,816 participants aged 40-69 years with data collected across the United Kingdom in 2007-2010) to examine the associations of protein intake with FFM and grip strength. Protein intake was positively associated with FFM (men: 5.1% (95% confidence interval (CI): 5.0, 5.2); women: 7.7% (95% CI: 7.7, 7.8)) and grip strength (men: 0.076 kg/kg (95% CI: 0.074, 0.078); women: 0.074 kg/kg (95% CI: 0.073, 0.076)) per 0.5-g/kg/day (grams per kg of body mass per day) increment in protein intake. FFM and grip strength were higher with higher intakes across the full range of intakes (i.e., highest in persons who reported consuming ≥2.00 g/kg/day) independently of sociodemographic factors, other dietary measures, physical activity, and comorbidity. FFM and grip strength were lower with age, but this association did not differ by category of protein intake (P > 0.05). The current recommendation for all adults (ages 40-69 years) to maintain a protein intake of 0.8 g/kg/day may need to be increased to optimize FFM and grip strength.