Raquel Villegas

Dietary calcium and magnesium intakes and the risk of type 2 diabetes: the Shanghai Women's Health Study

BACKGROUND Diet plays a key role in the development of type 2 diabetes (T2D), but little is known about the contributions of specific nutrients in populations in which dietary patterns differ from Western populations. OBJECTIVE We examined associations between calcium and magnesium intakes and the risk of T2D in a Chinese population. DESIGN We used data from a population-based, prospective study of 64,191 women who were free of T2D or other chronic diseases at study recruitment and were living in urban Shanghai, China. Dietary intake, physical activity, and anthropometric measurements were assessed through in-person interviews. A Cox regression model was used to evaluate the association of the exposures under study with the risk of T2D. RESULTS An inverse association between calcium and magnesium intakes and T2D risk was observed. The relative risks for the lowest to the highest quintiles of calcium intake were 1.00, 0.82, 0.73, 0.67, and 0.74 (P for trend < 0.001), and for magnesium they were 1.00, 0.84, 0.84, 0.79, and 0.86 (P for trend < 0.001). Milk intake was also inversely associated with the risk of T2D. CONCLUSION Our data suggest that calcium and magnesium intakes may protect against the development of T2D in this population.

Validity and reproducibility of the food-frequency questionnaire used in the Shanghai men's health study.

We evaluated the validity and reproducibility of the FFQ used in the Shanghai Mens Health Study (SMHS). The study included 195 randomly selected participants of the SMHS who completed one FFQ at baseline, twelve 24-hour dietary recalls (24-HDR) (once a month for twelve consecutive months) and a second FFQ at the end of the study. The FFQ accounted for 88.78% of the foods recorded in the 24-HDR surveys. The validity of the FFQ was evaluated by comparing nutrient and food group intake levels from the second FFQ and the multiple 24-HDR. Correlation coefficients ranged from 0.38 to 0.64 for macronutrients, 0.33 to 0.58 for micronutrients and 0.35 to 0.72 for food groups. Misclassification to opposite quartiles for nutrients and food groups was rare, ranging from 1.5 to 7.7%, while exact agreement rates were between 31.8 and 53.3%. The reliability of the FFQ was assessed by comparing the intake levels from the two FFQ. Correlation coefficients were 0.39 to 0.53 for macronutrients, 0.38 to 0.52 for micronutrients and 0.39 to 0.64 for food groups. Exact agreement rates for quartile distribution were between 31.8 and 49.2%, while misclassification to opposite quartiles was between 1.5 and 6.2%. These data indicate that the SMHS FFQ can reasonably categorise usual intake of nutrients and food groups among men living in urban Shanghai.

Fish, shellfish, and long-chain n−3 fatty acid consumption and risk of incident type 2 diabetes in middle-aged Chinese men and women

BACKGROUND Long-chain polyunsaturated n-3 (omega-3) fatty acids, found mainly in fish, have been postulated to reduce type 2 diabetes (T2D) risk. However, the role of long-chain n-3 fatty acids and fish intake in the development of T2D remains unresolved. OBJECTIVE We examined associations between fish, shellfish, and long-chain n-3 fatty acids and the risk of T2D in a middle-aged Chinese population. DESIGN This was a prospective population-based cohort study in 51,963 men and 64,193 women free of T2D, cardiovascular disease, and cancer at baseline with valid dietary information. Dietary intake, physical activity, and anthropometric measurements were collected. A Cox regression model was used to evaluate the association of fish, shellfish, and long-chain n-3 fatty acid (in g/d) with risk of T2D. RESULTS Fish, shellfish, and long-chain n-3 fatty acid intakes were inversely associated with T2D in women. The relative risks [RRs (95% CI)] for quintiles of fish intake were 1.00, 0.96 (0.86, 1.06), 0.84 (0.75, 0.94), 0.80 (0.71, 0.90), and 0.89 (0.78, 1.01) (P for trend = 0.003) and for shellfish were 1.00, 0.91 (0.82, 1.01), 0.79 (0.71, 0.89), 0.80 (0.71, 0.91), and 0.86 (0.76, 0.99) (P for trend = 0.006). In men, only the association between shellfish intake and T2D was significant. The RRs (95% CI) for quintiles of fish intake were 1.00, 0.92 (0.75, 1.13), 0.80 (0.65, 1.00), 0.89 (0.72, 1.11), and 0.94 (0.74, 1.17) (P for trend = 0.50) and for shellfish intake were 1.00, 0.93 (0.76, 1.12), 0.70 (0.56, 086), 0.66 (0.53, 0.82), and 0.82 (0.65, 1.02) (P for trend = 0.003). CONCLUSIONS An inverse association between fish and shellfish intake and T2D in women was found. No evidence of a detrimental effect of fish intake in this population was observed.

Dietary patterns are associated with lower incidence of type 2 diabetes in middle-aged women: the Shanghai Women’s Health Study

BACKGROUND Data linking risk of type 2 diabetes (T2D) and dietary patterns in Chinese populations are scarce. METHODS A population-based prospective study of 64,191 middle-aged women in urban Shanghai, China, who were free of T2D and other chronic diseases at study recruitment, was conducted. Dietary intake, physical activity and anthropometric measurements were assessed through in-person interviews. Dietary patterns were assessed by using K-means cluster analysis. Cox regression model was used to evaluate the association of dietary patterns with the risk of T2D. RESULTS We identified three dietary clusters in this population. Cluster 1 (56.3%; N = 36,159) had the highest intake of staples, cluster 2 (40.4%: N = 25,948) had the highest intake of dairy milk, and cluster 3 (2.9%; N = 1843) had the highest energy intake. Participants in cluster 2 had lower prevalence of obesity, central obesity and hypertension at baseline. Using cluster 1 as the reference, participants in cluster 2 had a lower incidence of T2D after 6.9 years of follow-up [relative risk (RR) 0.78; 95% confidence interval (CI) 0.71-0.86]. The RR for the incidence of T2D for cluster 3 compared with cluster 1 was 1.05 (95% CI 0.81-1.35). The association was not modified by age category, body mass index category, waist-to-hip ratio category or exercise participation. CONCLUSIONS We identified and characterized dietary patterns in middle-aged Chinese women by using cluster analysis. We identified a dietary pattern low in staple foods and high in dairy milk, which was associated with lower risk of T2D. Study of dietary patterns will help elucidate links between diet and disease, and contribute to the development of healthy eating guidelines for health promotion.

Physical activity, smoking, and alcohol consumption in association with incidence of type 2 diabetes among middle-aged and elderly Chinese men.

Background Type 2 diabetes mellitus (T2DM) is a prevalent chronic disease worldwide. The prevalence of T2DM is increasing rapidly in China. Understanding the contribution of modifiable lifestyle factors on T2DM risk is imperative to prevent the development of T2DM in China. Methods We examined associations between lifestyle factors including physical activity, smoking and alcohol consumption with incidence of T2DM among middle-aged and elderly men in urban Shanghai. Information on socio-demographics, lifestyle habits, dietary habits, and disease history was collected via in-person interviews. Anthropometric measurements were taken. A total of 51 464 Chinese men aged 40–74 years free of T2DM, coronary heart disease (CHD), and stroke at baseline were included in the current study. Incident T2DM was identified through follow-up surveys conducted every 2–3 years. Cox proportional hazard analyses were conducted to evaluate associations between lifestyle risk factors and incidence of T2DM. Results We documented 1304 new cases of T2DM during 276 929 person-years of follow-up (average: 5.4 years). Physical activity was inversely associated with T2DM risk. Daily living, commuting, and total physical activity METs had inverse negative dose-response relationships with T2DM (P-trend = 0.0033, 0.0022, and <0.0001, respectively). Regular participation in exercise or sports reduced T2DM risk (HR = 0.86, 95%CI: 0.76–0.98). Moderate alcohol intake (1–3 drinks/day) was inversely related to T2DM risk (HR = 0.80, 95%CI: 0.67–0.94). Cigarette smoking, on the other hand, was associated with increased T2DM risk; HRs were 1.25 (95%CI: 1.00–1.56) for smoking more than 20 cigarettes per day and 1.28 (95%CI: 1.04–1.57) for smoking more than 40 pack-years. Conclusions Physical activity and moderate alcohol intake are inversely associated with T2DM risk, whereas smoking was positively associated with T2DM risk among middle-age and elderly Chinese men. Preventive measures should be developed to focus on these modifiable lifestyle habits to reduce the upward trend of T2DM.

Predictors of Late Presentation for HIV Diagnosis: A Literature Review and Suggested Way Forward

Early commencement of antiretroviral treatment can be beneficial and economical in the long run. Despite global advances in access to care, a significant proportion of adults presenting at HIV/AIDS care facilities present with advanced HIV disease. Understanding factors associated with late presentation for HIV/AIDS services is critical to the development of effective programs and treatment strategies. Literature on factors associated with late presentation for an HIV diagnosis is reviewed. Highlighted is the current emphasis on socio-demographic factors, the limited exploration of psychosocial correlates, and inconsistencies in the definition of late presentation that make it difficult to compare findings across different studies. Perspectives based on experiences from resource limited settings are underreported. Greater exploration of psychosocial predictors of late HIV diagnosis is advocated for, to guide future intervention research and to inform public policy and practice targeted at ‘difficult to reach’ populations.ResumenLa iniciación del tratamiento antirretroviral (TAR) precoz puede ser beneficiosa y económica a largo plazo. A pesar de los avances mundiales en el acceso a la atención y tratamiento de VIH/SIDA, una proporción significativa de adultos que acuden a los establecimientos de atención del VIH / SIDA se presentan con la enfermedad avanzada. El entender los factores asociados con la presentación tardía del VIH / SIDA es fundamental para el desarrollo de programas y estrategias eficaces de tratamiento. En este articulo, presentamos una revisión de la literatura sobre los factores asociados con la presentación tardía del diagnóstico de VIH. Observamos que en la literatura hay un énfasis en estudiar los factores socio-demográficos, a la vez que hay una exploración limitada de correlaciones psicosociales, y también observamos inconsistencias en la definición de “presentación tarde de VIH” que hacen difícil comparar resultados entre los diferentes estudios. Tambien presentamos perspectivas sobre las experiencias de entornos de recursos limitados. Recomendamos una mayor exploración de factores psicosociales asociados con presentación tarde de VIH para poder guiar la futura intervención y formulación de políticas públicas y prácticas dirigidas a poblaciones que son difíciles de alcanzar.

Purine-rich foods, protein intake, and the prevalence of hyperuricemia: The Shanghai Men’s Health Study

BACKGROUND AND AIMS Diet may play an important role in the development of hyperuricemia and gout. However, the association between dietary factors and hyperuricemia remains unclear, and few studies have investigated direct links between food intake and hyperuricemia. The aim of this study was to investigate associations between high purine-content foods and protein intake with the prevalence of hyperuricemia by using data from a cross-sectional study of 3978 men aged 40-74 yrs living in Shanghai, China. METHODS AND RESULTS Hyperuricemia was defined as blood uric acid level >7.0 mg/dl. One quarter of this population had hyperuricemia. Dietary information was collected by using a food frequency questionnaire. We collected information on anthropometric measurements and lifestyle factors and other potential confounding factors and disease history via interviews. Total protein consumption was not associated with hyperuricemia. We found a positive association between protein from animal sources and prevalence of hyperuricemia and an inverse association between protein from plant sources and hyperuricemia. However, these associations failed to reach significance in mutually adjusted analysis. Seafood intake was associated with higher prevalence of hyperuricemia. The ORs for quintiles of seafood intake (including fish and shellfish) were 1.00, 1.49, 1.35, 1.34, and 1.56 (p for trend: 0.01). An inverse association approaching significance between soy food consumption and hyperuricemia was observed (ORs: 1.00, 0.90, 0.70, 0.89, and 0.77 for quintiles of intake; p for trend: 0.07). No associations between consumption of purine-rich vegetables or meat and prevalence of hyperuricemia were observed. CONCLUSIONS Our data suggest a direct association between seafood consumption and hyperuricemia and an inverse association between consumption of soy food and hyperuricemia among middle-aged, Chinese men.

LIFESTYLE DETERMINANTS OF C-REACTIVE PROTEIN IN MIDDLE-AGED, URBAN CHINESE MEN

BACKGROUND AND AIM Increased levels of C-reactive protein (CRP), common in aging populations, are associated with higher risk for chronic diseases, including diabetes and coronary heart disease. The aim of this study was to investigate associations between lifestyle factors and high CRP among middle-aged men living in Shanghai, China. METHODS AND RESULTS In this cross-sectional study, 3978 urban Chinese men aged 40-74 years who were free of type-2 diabetes at baseline provided fasting blood samples, anthropometric measurements and information on lifestyle factors and disease history. Dietary patterns were assessed by factor analysis. Participants were categorised into two groups according to CRP level: normal (≤ 3 mg/L) and high (> 3 mg/L). Associations between CRP categories and lifestyle factors were investigated by using logistic regression. Obesity, weight gain, cigarette smoking and alcohol intake were positively associated with high CRP levels, while physical activity and a dietary pattern with high consumption of fruit were inversely related to high CRP levels. A positive trend of marginal significance between quintiles of a dietary pattern with high consumption of meat and high CRP levels was also observed. No association between tea intake and CRP level was observed. CONCLUSIONS Components of an adverse lifestyle were associated with high CRP levels. Obesity, smoking and alcohol intake were associated with high CRP, a biomarker of low-grade inflammation in middle-aged men, while a dietary pattern rich in fruit and high physical activity were inversely associated with the prevalence of high CRP.

Prevalence and Determinants of Hyperuricemia in Middle-Aged, Urban Chinese Men

BACKGROUND Hyperuricemia is associated with metabolic syndrome and has emerged as a marker for both type 2 diabetes and cardiovascular disease. We estimated the prevalence and lifestyle risk factors of hyperuricemia in middle-aged, urban Chinese men. METHODS The study included 3,978 urban Chinese men 40-74 years of age from a population-based cohort study, the Shanghai Mens Health Study, who were free of type 2 diabetes at baseline and had provided fasting blood samples. Uric acid concentrations were measured by the uricase method. Hyperuricemia was defined as >7.0 mg/dL. Anthropometric measurements and information on lifestyle factors and disease history were collected by in-person interviews. RESULTS One quarter of the study subjects had hyperuricemia. Participants with metabolic syndrome had a higher prevalence of hyperuricemia. Body mass index (BMI), waist-to-hip ratio (WHR), waist circumference, and weight gain (since age 20) were positively associated with the prevalence of hyperuricemia. Physical activity was inversely related to the prevalence of hyperuricemia. The odds ratios for hyperuricemia for quintiles of nonoccupational physical activity were 1.00, 0.80, 0.73, 0.75, and 0.57 (P trend <0.001). Participants with hyperuricemia were less likely to be current smokers, but were more likely to drink alcohol regularly. Beer consumption was associated with higher risk of hyperuricemia compared with consumption of wine or liquor. CONCLUSIONS In this representative sample of middle-aged, urban Chinese men, hyperuricemia is highly prevalent. Obesity, weight gain in adulthood, and alcohol intake were associated with a higher prevalence of hyperuricemia, whereas daily physical activity and smoking were inversely related to the prevalence of hyperuricemia.

HTR1B, ADIPOR1, PPARGC1A, and CYP19A1 and Obesity in a Cohort of Caucasians and African Americans: An Evaluation of Gene-Environment Interactions and Candidate Genes

The World Health Organization estimates that the number of obese and overweight adults has increased to 1.6 billion, with concomitant increases in comorbidity. While genetic factors for obesity have been extensively studied in Caucasians, fewer studies have investigated genetic determinants of body mass index (BMI; weight (kg)/height (m)(2)) in African Americans. A total of 38 genes and 1,086 single nucleotide polymorphisms (SNPs) in African Americans (n = 1,173) and 897 SNPs in Caucasians (n = 1,165) were examined in the Southern Community Cohort Study (2002-2009) for associations with BMI and gene × environment interactions. A statistically significant association with BMI survived correction for multiple testing at rs4140535 (β = -0.04, 95% confidence interval: -0.06, -0.02; P = 5.76 × 10(-5)) in African Americans but not in Caucasians. Gene-environment interactions were observed with cigarette smoking and a SNP in ADIPOR1 in African Americans, as well as between a different SNP in ADIPOR1 and physical activity in Caucasians. A SNP in PPARGC1A interacted with alcohol consumption in African Americans, and a different SNP in PPARGC1A was nominally associated in Caucasians. A SNP in CYP19A1 interacted with dietary energy intake in African Americans, and another SNP in CYP191A had an independent association with BMI in Caucasians.