SOCIO IOECONOMIC IC, A ANTHROPOMETRIC ETRIC A AND BEH - - PowerPoint PPT Presentation

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

• be

besity, pred ediabetes es and and d dia iabetes in in New Z w Zeala land

• Overvie

iew o

• f t

the P PREVIEW T Trial ial

• Outl

tlin ine o

• f 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

PREVIEW

OBES

BESITY IN NEW EW ZEALAND EALAND

1/3, 1 1/3, 1 1/3

37 28 35

5 10 15 20 25 30 35 40

NZ Ministry of Health Men & Women; All ethnicities

% of popn Overweight Obese Lean

http://www.health.govt.nz/publication/health-new-zealand-adults-2011-12

2nd

nd in

n OECD CD

PREDIABETES AND OBESITY IN NEW ZEALAND

• Obesity/overweight A

AND diabetes

• Obese g

grou

• ups w

within New Z Zealand ha have hi highe her r rates of

• f prediabetes and

nd diabetes ( (Cop

• ppell, 2013)
• Rec

ecent es estimates o

• f d

diabetes pr prevalen ence 7% and pr pre-diab iabetes p preval alenc nce 18.2% ( % (Cop

• ppell, 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

• ppell, 20

2013)

• 1/

1/4 4 of in indiv ividuals w wit ith predia iabetes deve velo lop diabetes ( (Knowle wler, 2002; 2002; Lindstrom

• m, 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

• m E

Europ

• pean U

Union

• n
• 2,

2,500 a 500 adults a and chi children

• Aim

Aims t 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

• ugh long t

ter erm m wei eight ma mainten enance

PREVIEW

Prevention of diabetes in New Zealand, Australia and Europe

PREVIEW:NZ TEAM

Professor Sally D Poppitt Dr Anne-Thea McGill Dr Marta Silvestre, Hannah Chisholm Wonjoo Lee, Amy Liu

RATIONALE FOR PREVIEW

• Positive effect of weight loss o
• n 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

• besit

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

• dimos
• s,

, 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

• r c

carbohyd ydrat ate for weight loss and maintenan ance

• Diogen

genes s study dy (Larsen

en et et al., 201 010) vs

vs Fin innish Diab abetes Pr Prevention 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 Rec ecruitm tment t Screeni ning a g and nd

base seli line

Low Energy Diet et (LED) D) (8 weeks)

Weight M Maint ntena nance Through D Diet a t and nd Exer ercise ( (148 w week eeks) PREVIEW Trial My Study

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

• se)

) : 5. 5.6 t 6 to 6.

• 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

• se 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

• cial 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

• f 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

• d t

to

• 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: Sociode demographic Anthropo pome metr tric & & Metaboli lic marke kers At b baseli line Intervent ntio ion: n: We Weight lo loss o s over r an 8 n 8 week eek perio iod o

• n a

a LE LED ( (lo low w en ener ergy d diet)

At Least st 8% W Weight loss r

• ss required

¼ of the ty f the typic ical in intak take 3386 386KJ

VARIABLES OF INTEREST

ANTH THROMETR ETRY Body w weight ( ght (base seline and post post L LED ED) BMI (bod

• dy 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

• rs measu

sure red b by the t three f factor e

• r eating quest

stion

• nnaire

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

• r PreDi

Diabetes Fast sting p plasm sma g glucos

• se OGTT

TT (base seline and post L LED) Po Post oral al plasm sma g glucose

• se O

OGTT ( TT (baseline)

METHODS

QUESTIONNAIRES BLOOD ANALYSIS ANTHROPOMETRY TFEQ Prescreening Post oral plasma glucose Fasting plasma glucose BMI Weight DEXA Waist

468 Respondents 257 Not Yet Assessed 107 screened 62 Ineligible 45 Eligible and enrolled 3 Withdrawal 42 Low Energy Diet 3 Withdrawal ? Successful Completion (~60%) ?Unsuccessful

468 Respondents 257 Not Yet Assessed 107 screened 62 Ineligible 45 Eligible and enrolled 3 Withdrawal 42 Low Energy Diet 3 Withdrawal ? Successful Completion ~60% Normoglyceamic Abnormal ECG Prediabetic

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 socioeconomic status 3 (NZDep06 quintile) 3.2 (NZDep06 Quintile) BMI 38 kg/m2 (class 2 obesity) 38 kg/m2 (class 2 obesity) Weight 108kg 110kg Fasting Plasma Glucose 5.1 mmol/L 5.8 mmol/L Post Oral Plasma Glucose 5.7 mmol/L 6.6 mmol/L

WHICH CHARACTERISTICS PUT INDIVIDUALS AT INCREASED RISK OF PREDIABETES IN AUCKLAND: BMI

One w way y ANOVA of

• f BMI c

I categor

• ries (overweight,

, ob

• bese c

class 1, , ob

• bese c

class 2 2, ,

• bes

ese c e clas ass 3) an and f fas asting g plas asma a gl glucose an and p post o

• ral

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

• f 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

• ry.

BUT… A SIGNIFICANT CORRELATION BETWEEN PERCENT BODY FAT (DEXA) AND POST ORAL PLASMA GLUCOSE (R2=0.28) (P=0.000)

WHICH CHARACTERISTICS PUT INDIVIDUALS AT INCREASED RISK OF PREDIABETES IN AUCKLAND: SES

One way A y ANOVA t to

• te

test the d differences i in socioecono nomic status us in relation to fa fasting and nd po post oral pl plasma g gluc

• ucose. No signi

nificant nt d differenc nce f foun und Independ ndent nt samp mples t t-test to to compar are e the ar e area b ea bas ased ed socioecono nomic s status us between prediabet etic an and normogl glycea eami mic groups

• ps. There was n

no s signi nificant nt differenc nce i in t the area based socioecono nomic status us scores for predia iabe betic and d normo mogl glyceamic groups ups.

BUT.. CORRELATION: INCREASING BMI WAS SEEN WITH INCREASING NZDEP06 DECILE (R2=0.05) (P= 0.000)

WHICH CHARACTERISTICS PUT INDIVIDUALS AT INCREASED RISK OF PREDIABETES IN AUCKLAND: ETHNICITY

One way A y ANOVA t to

• test the d

differences i in ethnic icit ity* in n relation to fasting and nd po post oral al plas asma gl a glucose.

• e. No signi

nificant nt d differenc nce foun und

*Ethnicity o

• utput a

and a analysi sis u s usi sing mu multiple r respo sponse se

WHICH CHARACTERISTICS PUT INDIVIDUALS AT INCREASED RISK OF PREDIABETES IN AUCKLAND: EATING BEHAVIOUR: EMOTIONAL EATING

Emo motional al E Eat ating w g was as correl elated ed wi with post pran andial al p plas asma a gl glucose.

• e. I

Increa easing g tendency towards e emotion

• nal e

eating w was cor

• rrelated w

with higher BMI I (n=45) (r=0.09) 09) (p=0.05) 05)

SUMMARY OF PRELIMINARY FINDINGS: LED INTERVENTION

• Total of 267

f 267.4 kg g lost

• Average of
• f 8.6

.6 kg per person

• n

HOW ARE THEY FEELING NOW? A FEW REFLECTIONS FROM PARTICIPANTS:

• Mor
• re energy f

for

• r life: mor

: more fami mily time me a and help a arou

• und the h

hou

• use
• Better b

blood

• od pressure
• Feeling and

nd l looking healthie ier

• Old c

clothes fit and nd pe peopl ple no notice!

• Developing healthi

hier r r relationshi hips with h food and g getting t to know their r body’s sign gnals

LIMITATIONS

• Ex

Excl clusion o

• f

f th the 46 46-54 age age gr group

• Participants w

were s self s selected (may b y be different t to

• the rest of
• f the pop
• pulation w

with respe pect t ct to charact cteristics cs under study)

STRENGTHS

• Ne

New w Zeal Zealan and s spec ecific

• FPG

PG + + PPPG PPPG

CONCLUSIONS

• Socioeconomic, b

behavioral a and nd a ant nthropometric inf nfluences on n gluc ucose metabo bolis ism are bo both p plausibl ble and nd c compl plex (Litera rature re) (Knowler, W W., ., Barrett, E., ., Fowler, , S., ., Ham amman man, R R., ., Lachli lin, J J., ., Walker, E E., ., Nathan, D., ., 2002; ; Maruth thur et a al., ., 2013; 13; Katula la et al., ., 2013; Allende-Vi Vigo, 2 , 2011; B Bergman, , 2012; ; Gillet ett et et al., 20 2012 12; Mout utzouri, , Tsimihod

• dimos
• s,

, Ri Rizos, & , & Elisaf, 2 201 011; Yates es, , Davies, & , & Khunt nti, , 2009 2009; Ratner er & & Sathasivam, , 201 011)

• Som
• me common

n associations were m mirrored (increa easing emo g emotional al eat eating an g and increa easing g BM BMI, increas asing b body f fat at an and plas asma a gl glucose e concen entration, BM BMI an and SES)

• Others w

weren’ n’t (pl plasma gluc ucose a and nd ethnicity, BM BMI an and plas asma gl a glucose) e)

• LED

D suc uccessful m method f for weight loss in n a mul ulticultural Auc uckland po popul pulation (weight lo loss m maintenance through li lifestyle i is the next step)

THANK YOU SUPER SUPERVISORS AND THE PREVIEW TEAM

• Prof. Sally D Poppitt

Dr Anne-Thea McGill

REFERENCES

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