The case group included 100 pre-diabetic subjects, and the control group comprised of 200 non pre-diabetic subjects, who were randomly selected from a previous cross sectional study, mat
Trang 1JOURNAL OF SCIENCE, Hue University, N 0 61, 2010
RISK FACTORS OF PRE-DIABETES IN ADULTS AGED 45 YEARS AND OLDER IN CAU NGANG DISTRICT, TRA VINH PROVINCE
Cao My Phuong Tra Vinh General Hospital Dinh Thanh Hue, Nguyen Hai Thu College of Medicine and Pharmacy, Hue University
SUMMARY
A case - control study in the population aged 45 years and older was conducted in Cau Ngang district, Tra vinh province The case group included 100 pre-diabetic subjects, and the control group comprised of 200 non pre-diabetic subjects, who were randomly selected from a previous cross sectional study, matched in 7 risk factors including age, sex, ethnic group, place
of living, standard of living, having a family member with diabetes, and giving birth to a baby weighing more than 4 kg The result showed that risk factors of pre-diabetic patients included: overweight/obesity, high waist circumference, high body fat percentage, sweet drinking – eating habit, daily excessive sugar consumption, and daily excessive fatty food intake
Key words: Prediabetes, risk factors, obesity, waist circumference
1 Introduction
Pre-diabetes is a condition in which blood glucose levels are higher than normal, but not high enough for a diagnosis of diabetes Pre-diabetes has been defined by The American Diabetes Association with the WHO’s agreement of having impaired fasting glucose (fasting blood glucose levels between 100 and 125 mg/dl) or impaired glucose tolerance (2 hour post-glucose load, plasma glucose levels between 140 and 199 mg/dl)
Impaired fasting glucose and impaired glucose tolerance may progress to type 2 diabetes mellitus People with pre-diabetes are likely to develop type 2 diabetes within
10 years, unless they take steps to prevent or delay diabetes Moreover, diabetes is associated with aging However, recently, diabetes mellitus has tended to happen in the younger people, especially people from the age of 45 years
Most of researches have demonstrated that risk factors of hyperglycemia included overweight/obesity, hypertension, lack of physical activities, malnutrition, having a family background of diabetes and giving birth to a baby weighting more than
4 kg…The complications of diabetes mellitus can occur in the stage of pre-diabetes and pre-diabetic patients are also at increased risk for developing cardiovascular disease For
Trang 2a long period of time before diabetes is detected, the degree of hyperglycemia above sufficient threshold can cause pathologic and functional changes in various target tissues but without clinical symptoms
Pre-diabetes is becoming more common in the United States The U.S Department of Health and Human Services estimates that about a quarter of U.S adults aged 20 years or older—or 57 million people—had pre-diabetes in 2007
A cross – sectional study in Cau Ngang district, Tra Vinh province in December
2009 has pointed out that prevalence of pre-diabetes in participants aged 45 years and older was 19.5% which seemed slightly high This research was designed to explore which risk factors have contributed to this high percentage of pre-diabetes
2 Method
2.1 Subjects
The study sample consisted of individuals aged of 45 or older, who were permanent residents living in Cau Ngang district, Tra Vinh province
2.2 Research method: A case – control study
2 3
2 3 3 β
α
p f
q p f 1 f Z u 1 2u Z n
With:
1 OR f 1
OR 1
f 2
1
1 f OR 1
fOR
p3
Predicted: f = 0,30; OR = 2,5; accepted: = 0,05; = 0,10; → n 100
In December 2009, we carried out a cross sectional study in a random sample selected from a population of people aged 45 and older in Cau Ngang district, Tra Vinh province, with a sample size of n = 1226 There were 239 pre – diabetic subjects and
115 diabetic subjects found The rest included 872 subjects with normal blood glucose levels Based on that result, we selected participants for this study
+ The case group: of the 239 pre-diabetic subjects, 100 individuals were selected for the case group using a simple random method
Trang 3- Data collection:
A face to face interview method, using a prepared questionnaire was used to collect necessary information
Interviewers were health professionals of Phu Yen hospital and Phu Yen Medical College
- Data analysis: Using Epi-info version 3.5.1 (2008)
Data is presented in the 2x 2 table for each related factor:
From the table, the necessary results are calculated Using 2 of Yates, p = 0.05
3 Results
3.1 Factors related to present health
group
Contro
l group
OR
Hypertension
(mmHg) ( BSP≥
140 and/or
BDP≥90)
Yes
No
50
50
90
110
1.2 (0.8 – 2.0) > 0.05
BMI
≥ 23
< 23
38
62
50
146
1.8 (1.1– 3.0) < 0.01
WC (Waist
circumferences)
cm
-Male≥ 90, Female≥80
- Male
<90, Female<80
66
34
101
99
1.9 (1.2 – 3.1) < 0.01
Trang 4Body fat
percentage Index
(%)
- Male≥
20, Female≥30
- Male<
20, Female<30
74
26
109
91
2.4 (1.4 – 4.0)
< 0.001
Visceral fat index
(%)
≥ 10
< 10
15
85
24
171
1.3 (0.6 – 2.5) > 0.05
3.2 Factors related to health behavior
group
Control group
OR
No
23
77
34
161
1.4 (0.8 – 2.6) > 0.05 Excessive
alcohol intake
Yes
No
19
81
30
165
1.3 (0.7 – 2.4) > 0.05 Sweet drinking -
eating habit
Yes
No
42
58
57
138
1.8 (1.1 – 2.9) < 0.05 Excessive sugar
consumption
Yes
No
34
66
34
160
2.4 (1.4 – 4.3)
< 0.01
Excessive fatty
food intake
Yes
No
27
73
23
172
2.8 (1.5 – 5.1)
< 0.01
Daily vegetable
intake
Yes
No
31
68
64
131
0.9 (0.6 – 1.6)
> 0.05
Eating after 20h
habit
Yes
No
7
93
14
181
1.0 (0.4 – 2.5) > 0.05
Trang 54 Discussions
4.1 Factors related to present health
Hypertension: Hypertension is able to occur in a metabolic syndrome
Hypertension in a pre-diabetic state results from insulin resistance/hyperinsulinism and
is also considered as a risk factor of diabetes Diabetes is normally associated with hypertension However, this research has not showed clearly that hypertension is related
to pre-diabetes (OR = 1.2, p > 0.05)
Waist circumferences: the results of this study demonstrated that there was a
correlation between a waist circumference index based on the Asian standard and pre-diabetes The group who had a high waist circumference index (male ≥ 90 cm, female ≥
80 cm) had approximately 1.9 times greater risk of pre-diabetes than the normal waist circumference group (OR = 1.9; p < 0.01) Therefore, the high waist circumference is clearly a risk factor of pre-diabetes in this community
BMI: obesity is a traditional risk factor which may lead to diabetes, hypertension,
cardio-vascular diseases, gallbladder diseases, and several cancers BMI is a measured tool to diagnose obesity Based on the Asian standard of BMI, this research also shows that the group of overweight/obesity with high BMI (≥ 23 kg/m2) is probably at risk of pre-diabetes 1.8 times higher than the group with low or normal BMI (OR= 1.8, p < 0.05)
Body fat percentages index: According to Nguyen Thi Kim Hung, individuals
who gained a high body fat percentage index had more than 2.5 times higher risk of elevating blood glucose The result of this study showed that body fat percentage index related dramatically to pre-diabetes Respondents with slightly high or high body fat percentage index got more than 2.4 times higher risk of pre-diabetes than the other Hence, the body fat index was presented as one of the new risk factors of pre-diabetes (OR = 2.4, p < 0.001)
Visceral fat index: the results of our study demonstrated that the group with high
visceral fat index did not have significantly higher risk of pre-diabetes than the one with normal visceral fat index (OR = 1.3, p > 0,05)
4.2 Factors related to health behaviors
Smoking: smoking may increase insulin resistance and excite to produce stress
hormones – Both factors elevate the blood glucose level In this research, smoking status appeared to not be related to pre-diabetes (OR = 1.4, p > 0.05)
Excessive alcohol drinking habits: the excessive beer and alcohol intake for a
long time can cause hypertriglyceridemia and increase of blood glucose level in diabetes patients The study showed that, in this community, the excessive alcohol drinking habit
Trang 6was not related to diabetes (OR = 1,3; p > 0,05)
Sweet drinking – eating habit: A number of authors said that sweet
drinking/eating habits did not directly relate to diabetes However, this research showed that subjects with sweet drinking/eating habits have more than 1.8 times higher risk of pre-diabetes than the others (OR = 1.8; p < 0.05) It may be supposed that people with sweet drinking/ eating habit often eat and drink sweet food and consume high calorie drinking substances, which can have a reserve of excessive energy that may lead to obesity and insulin resistance The relationship of over carbohydrate consumption and the increase of obesity – a risk factor of diabetes – have been proved previously
Daily excessive sugar consumption: In this study, there is a relationship between
daily excessive sugar consumption and pre-diabetes The ones with daily excessive sugar intake have more than 2.4 times higher risk of pre-diabetes than the other group (OR = 2.4, p < 0.01)
Excessive fatty food intake: reducing levels of LDL.C and plasma triglycerides
and/or raising levels of HDL.C is associated with reduced rates of CHD events in diabetic patients The consumption of a number of unsaturated fat is related to dyslipidemia The low fat consumption contributes to a reduction in total cholesterol, LDL.cholesterol, triglycerides and to an elevation of HDL.cholesterol levels Ta Van Binh (2007), who conducted a survey with 1200 subjects living in Ha Noi announced that people with the habit of eating excessive fatty foods might have more than 4 times the risk of acquiring diabetes than the control group In our research, people with excessive fatty food eating habits had approximately a 2.8 times greater risk of pre-diabetes than the control group (OR = 2.8; p < 0.01)
Daily vegetable intake: According to Ta Van Binh (2007), the prevalence and
risk of diabetes is high in people without daily vegetable intake habit However, in this study, risk of pre-diabetes in people with and without daily vegetable intake habit is not significantly different (OR = 0.9; p > 0.05) It may be supposed that the population in this study lived in the countryside, and so vegetables were often one part of their daily food
Eating after 20:00pm habit: Eating after 20:00pm probably leads to elevated
blood sugar level at night and in the morning As a result, this study showed that eating after 20h habit was not a risk factor of pre-diabetes (OR = 1.0; p > 0.05)
Trang 7and therefore this factor had no clear effect
Stress: the insulin resistance caused by stress may lead to diabetes Stress results
in an increase of catecholamine and steroid cortical in blood, which may lead to overweight and obesity 10 However, stress has not been showed as a pre-diabetes risk factor in this study (OR = 1.6, p > 0.05)
5 Conclusion
From the result of our research, the following conclusions can be drawn:
The risk factors of pre-diabetic adults aged 45 years and older in this community included:
Overweight/Obesity (OR = 1,8 );
High waist circumference (OR = 1,9);
High body fat percentage (OR = 2,4);
Sweet drinking/ eating habits (OR = 1,8);
Daily excessive sugar consumption (OR = 2,4 );
Daily excessive fatty food intake (OR = 2,8)
REFERENCES
1 Alan JG Diagnosis and management of pre-diabetes in continuum of hyperglycemia- when do the risk diabetes begin? A consensus statement from the American college of endocrinology and the American association of clinical endocrinologists Endocrine
practice Medscape 2008
2 http://www.ehow.com/how_4795590_reverse-prediabetes.html, How to Reverse Pre-Diabetes, Copyright © 1999-2010 eHow
3 Nguyen HT, Huynh VM, Doan PT, Ho TTV Pre-diabetes in Thua Thien Hue Scientific
conference of Internal Medcine and Radiative surgery by Gamma ray 2009: 344-356
4 Tran HD, Nguyen HT Obesity Post-graduated textbook of endocrinology – metabolism
Hue university publish house 2008:304-310
5 Ta VB Overview of diabetes and glucose blood increase Fundamental principles: The diabetes and glucose blood increase diseases Health Publisher 2007: 11-68
6 Dinh TH Causality arguement and analysis study by observing Epidemiological methodology Health Publisher 2004: 93-117
7 Screening for Type 2 Diabetes Diabetes Care American Diabetes Association 2009
Trang 88 Smoking, pre-diabetes & diabetes A diabetes information series from State Territory
Organizations of Diabetes Australia Article 2007
9 Evidence-Based Nutrition Principles and Recommendations for the Treatment and Prevention of Diabetes and Related Complications Diabetes Care American Diabetes Association 2009
10 http://pre-diabetes.insulitelabs.com/pre_diabetes stress.php , Pre-diabetes and stress, Insulite Laboratories, Inc., Louisville, CO 8002, USA