SOCIO IOECONOMIC IC, A ANTHROPOMETRIC ETRIC A AND BEH BEHAVIORAL D DIM IMENS ENSIONS OF OF PRE-DIAB IABETES ETES IN A AUCKLAND AND Hannah Chisholm, in collaboration with the PREVIEW:NZ team
OUTLINE • Background und: o obe besity, pred ediabetes es and and d dia iabetes in in PREVIEW New Z w Zeala land • Overvie iew o of t the P PREVIEW T Trial ial • Outl tlin ine o of m my r ration tional ale a and h hypo poth these ses • Meth thods • Summary s statistic atistics • Prelim imin inar ary f findin ings • Conc nclus usion
O BES BESITY IN N EW EW Z EALAND EALAND 1/3, 1 1/3, 1 1/3 NZ Ministry of Health Men & Women; All ethnicities 37 40 % of 35 35 popn 28 30 25 20 2 nd nd in n OECD CD 15 10 5 0 Overweight Obese Lean http://www.health.govt.nz/publication/health-new-zealand-adults-2011-12
PREDIABETES AND OBESITY IN NEW ZEALAND Obesity/overweight A AND diabetes • Obese g grou oups w within New Z Zealand ha have hi highe her r rates of of prediabetes and nd • diabetes ( (Cop oppell, 2013) Rec ecent es estimates o of d diabetes pr prevalen ence 7% and pr pre-diab iabetes p preval alenc nce • 18.2% ( % (Cop oppell, 2 2013) ) Diabetes a and nd prediabetes par artic icularly p prevalent in in Mao aori i an and P Pac acif ific • peo peopl ples (C (Cop oppell, 20 2013) 1/ 1/4 4 of in indiv ividuals w wit ith predia iabetes deve velo lop diabetes ( (Knowle wler, 2002; 2002; • Lindstrom om, 2003; 2003; Tuomile lehto, 2003; 2003; Nathan, 200 2007) 7) This s progre ressi ssion i is amenab nable to weight lo loss s in interventio ion •
PREVIEW: PREVENTION OF DIABETES THROUGH LIFESTYLE INTERVENTION IN NEW ZEALAND, AUSTRALIA AND EUROPE Multinational c l clinical t l trial • $1 $10 0 million fu funding fr from om E Europ opean U Union on • 2, 2,500 a 500 adults a and chi children • Aims t Aim to in inform polic icy an and c clin inical al recommendations f for d diab iabetes • preventio ion Lar argest w weig ight l loss an and diab iabetes p prevention trial ial in internatio ionally over the • nex ext f few ew y years Most ef efficacious diet a and exer ercise pa patterns f for pr preven enting diabetes • thr hrou ough long t ter erm m wei eight ma mainten enance PREVIEW Prevention of diabetes in New Zealand, Australia and Europe
PREVIEW:NZ TEAM Amy Liu Professor Sally D Dr Anne-Thea McGill Poppitt Dr Marta Silvestre, Wonjoo Lee, Hannah Chisholm
RATIONALE FOR PREVIEW Positive effect of weight loss o on metab abolic heal alth • Large ge body dy of eviden dence t e to s support the e effec ect of w wei eigh ght loss in lowering plas asma a glucose levels ls in in o obesit ity relat ated ad adverse metab aboli lic states (Knowler, W W., ., Barrett, E., ., Fowler, S., ., Ham amman man, R R., ., Lachli lin, J J., ., Walker, E E., N ., Nathan, , D., 2 ., 2002; Maruth thur et a al., ., 2013; 13; Katula la et a al., ., 2013; ; Allende- Vigo go, , 2011; B ; Bergman, , 2012; G Gillett et a al., ., 20 2012 12; Mout utzouri, , Tsimihod odimos os, , Ri Rizos, , & & Elisaf, , 201 011; Yates, D , Davies es, & & Khunt nti, , 2009; 2009; Ratne ner & & Sat athas asivam am, 2 201 011) Protein in o or c carbohyd ydrat ate for weight loss and maintenan ance • Diogen genes s study dy (Larsen 010) vs vs Fin innish Diab abetes Pr Prevention en et et al., 201 • Study y (Lind ndstrom, J., Louh uheranta, A A., ., Manne nnelin, M , M., ., Ras astas as, M M., ., Salmi minen, V V., ., Eriksso sson, J J., Tuomi mileh ehto, J J., 2003) 2003)
A STUDY WITHIN A STUDY Adver erti tisement t Low Rec ecruitm tment t Energy Weight M Maint ntena nance Through D Diet a t and nd Screeni ning a g and nd Diet et Exer ercise ( (148 w week eeks) base seli line (LED) D) (8 weeks) My Study PREVIEW Trial
PRE-DIABETES? (IMPAIRED FASTING GLUCOSE AND/OR IMPARIED GLUCOSE TOLERANCE) Fasting: Normal b blood d gluco cose le levels: s: 3.9-5.5 mmo mmol/L /L Predia iabetic glu lucose se le levels s (impaired fa fasting g glucos ose) ) : 5. 5.6 t 6 to 6. o 6.9 9 mmo mmol/L /L Diabe betic g glu lucose se le levels: : ≥7.0 mmo mmol/L /L Post O Ora ral l Glu lucose se ( (OGTT): Normal l blood g d gluco cose l levels: : ≤ 7.8 mmo mmol/L /L Predia iabetic glu lucose se le levels s (im impair ired glucos ose t tolerance) ) : : 7.8-11.1 .1 mmo mmol/L /L Diabetic glu lucose se leve vels ls: : ≥11.2mmol/L World Health Organisation, 2006
RATIONALE: WHY ARE SOICODOMOGRAPHIC, BEHAVIOURAL AND ANTHROMOMETIRC DIMENSIONS IMPORTANT? Bi Biology gy: ap appetite an and f food as as a a potential ally ad addictive s substan ance Soc ocial a and phys ysical e environment: OBESOGENIC IC Sub uboptimal d diet and nd ph physical a activity Obe besit ity Obesity y related pre-diabet etes es Diabet etes es
Diab abetes i is D DIFFI FFICULT a and Sneaky aky Diab iabetes is is VERY Expensive for t the He Heal alth C Car are Sys ystem Diabe betes h has L Large rge Person sonal a and F Famil ilial ial C Costs sts Prediab diabetes ≠ Diab Diabetes
RESEARCH QUESTIONS 1. 1. Whi hich h charac acterist stics s ( so socio ioeconomic mic and d ethnic icit ity, anthropo pometry, eati ting behavio iours ) pu put in indi dividu duals at at increase ased r d risk sk o of prediab diabetes in n Auckl ckland? 2. . Is a a controlle lled, sho hort t term low energy diet a potentially f feasible m method od t to o reduce at risk i k individuals ls risk k of type 2 diabetes m mellitus i in A Auckla land ( (prior to the 3 year diet and e exerci cise coaching) s ) study? 3. Which char arac acteristics ar are e as associated ed wi with gr great eater er w wei eigh ght loss an and lower er OGGT results s after a a low w en ener ergy gy d diet?
WHICH CHARACTERISTICS PUT INDIVIDUALS AT INCREASED RISK OF PREDIABETES IN AUCKLAND? : HYPOTHESES BMI SES ES Ethn Ethnicit ity Eatin Eating behavio viour
STUDY DESIGN Cross S Sectio ional nal S Study: y: Intervent ntio ion: n: We Weight Sociode demographic loss o lo s over r an 8 n 8 week eek Anthropo pome metr tric & & perio iod o on a a LE LED ( (lo low w Metaboli lic marke kers en ener ergy d diet) At b baseli line
At Least st 8% W Weight loss r oss required 3386 386KJ ¼ of the ty f the typic ical in intak take
VARIABLES OF INTEREST ANTH THROMETR ETRY Body w weight ( ght (base seline and post post L LED ED) BMI (bod ody m mass ss index) ( (base seline and post L LED) Waist st c circumfere rence ( (base seline an and post L LED) BODY C Y COMPO POSTION DEXA DEXA ( (dual x-ray a absorpti tiometr try) ( (base seline and post L LED) EATIN ING B BEHAVIO IOUR Eating b behavi vior ors measu sure red b by the t three f factor e or eating quest stion onnaire re (base seline) Demo mographics & SOC OCIOE IOECON ONOM OMICS Are rea b base sed soc socioeconomic d depr privation ( (base seline) VERSUS US METABOLI OLIC o or PreDi Diabetes Fast sting p plasm sma g glucos ose OGTT TT (base seline and post L LED) Po Post oral al plasm sma g glucose ose O OGTT ( TT (baseline)
METHODS BLOOD ANALYSIS QUESTIONNAIRES Post oral plasma Fasting plasma glucose TFEQ glucose Prescreening ANTHROPOMETRY BMI DEXA Weight Waist
468 Respondents 257 Not Yet Assessed 107 screened 62 Ineligible 45 Eligible and enrolled 3 Withdrawal 42 Low Energy Diet 3 Withdrawal ? Successful ?Unsuccessful Completion (~60%)
468 Respondents 257 Not Yet Assessed 107 screened 62 Ineligible Normoglyceamic 45 Eligible and Abnormal ECG enrolled Prediabetic 3 Withdrawal 42 Low Energy Diet 3 Withdrawal ? Successful Completion ~60%
SUMMARY STATISTICS: WHO ARE THESE PEOPLE? Characteristic Normogly lyceamic Predia iabetic Age 47.3 47.2 Gender 81% Female 73% Female Ethnicity 67% NZEuropean 12% PI 53% NZEuropean 24% PI Area based 3 (NZDep06 quintile) 3.2 (NZDep06 Quintile) socioeconomic status BMI 38 kg/m2 (class 2 obesity) 38 kg/m2 (class 2 obesity) Weight 108kg 110kg Fasting Plasma 5.1 mmol/L 5.8 mmol/L Glucose Post Oral Plasma 5.7 mmol/L 6.6 mmol/L Glucose
WHICH CHARACTERISTICS PUT INDIVIDUALS AT INCREASED RISK OF PREDIABETES IN AUCKLAND: BMI One w way y ANOVA of of BMI c I categor ories (overweight, , ob obese c class 1, , ob obese c class 2 2, , obes ese c e clas ass 3) an and f fas asting g plas asma a gl glucose an and p post o oral al p plas asma gl a glucose e le levels ls. No signi nificant nt r relations nship b p between n blood gluc ucose ( (at fasting and po post oral) ) and B BMI. I. In Independent s samples T-test of of BMI I between No Normo mogl glyceam eamic an and Predia iabe betic ic groups ps. No No signi nificant nt relations nship b p between n blood gluc ucose ( (at fasting a g and po post oral) ) and d BMI c I categor ory.
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