35171 - (II) 2009 - : : : Normal IGT Type 2 DM...

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Unformatted text preview: (II) 2009 - : : : Normal IGT Type 2 DM Complications Disability Death : : " " - () : . 30 . . . . . Kahn et al., Nature, 2006 : 40 30 % 20 10 0 l In di a ba nI nd ia Ur ba nF iji l n 52 00 al d l ra ba on i ze ra 19 20 Ru Ru po ga Ur iw Ta an re it i rn st e ad Sin Tr Ru ra Nauru New Guinea Australian Aborigines We Chinese Indian King, Diabetes Care, 1993; 1998; Diamond J, Nature, 2003 Ur Schulz et al., Diabetes Care, 2006 Franco et al., Am J Epidemiol, 2007 10 8 BMI Category -20 74 8.83% 1.37 1.42 5.03% 6 (Obese III (> 40 (Obese II (35-40 (Obese I (30 -35 (Overweight (25 -30 Normal / underweight ((<25 Total 4 2 0 0.4 0.56 1.05 1.5 1.57 1976-1980 2.26 2.5 1.28 1999-2004 Age and sex adjusted Year ( ) ( ) - 1971 74 20 2000 2800 60 Total Intake (kcals) 50 40 30 20 10 0 2600 2400 2200 % Carbs 2000 1800 1600 1400 1200 1000 1971-1974 1976-1980 1988-1994 1999-2000 % fats % saturated fats % protein Total Energy MMWR, 2004 ) ( ) ( Gross et al., Am J Clin Nutr, 2004 1996 - 1977 Sn a c k s M e a l s 80 75 70 65 60 55 50 197778 198991 199496 % Me a ls e a t e n a t h om e 1950 k c a l s /d a y 1800 1650 1500 197778 198991 199496 Nielsen and Popkin, JAMA, 2003 . 1996 - 1977 25 Food int ak e per oc c asion, oz 20 15 10 5 0 td rin Fr en ks ch F H am r ie bu s rg er s Pi zz a M ex ic an ts ks er ks 1 9 7 7 -7 8 1 9 8 9 -9 1 1 9 9 4 -9 8 ac ss sn De ft So dr lt y Nielsen and Popkin, JAMA, 2003 Sa Fr ui in 1. 2. 3. 4. 1. 2. 3. 4. 5. 6. Luckovich, Atlanta Journal Constitution Trends in Leisure-Time Physical Inactivity by Age, Sex, and Race/Ethnicity - United States, 1994-2004 Centers for Disease Control and Prevention, MMWR, 2005 (Ford ES et al. AJE 1997;146:214-22) BMI 1-y Risk (%) <22 0. 224 22-<23 0. 255 23-<24 0. 428 24-<25 0. 539 250. 553 <27 0. 899 27-<29 1.074 29-<31 1.480 31-<33 1.892 33-<35 2.461 35+ %- Point Increase per RR Absolute Increase 100,000 0 0 1 0.031 31 1.18 0.204 204 2.44 0.315 315 2.97 0.329 329 3.04 0.675 675 5.07 0.850 850 5.70 1.256 1,256 8.21 1.668 1,668 10.89 2.237 2,237 14.64 Cumulative Increase 0 550 1,554 7,565 32 Vasquez, Epidemiol Rev, 2007 Hu et al., Arch Intern Med, 2001 Young Adult Adult Mid-aged Older Adult - Adolescent - 0 20 30 40 50 60 70 80 90 Lifestyle forming, habituation, and maintenance Obesity Diabetes CVD Physical Function Falls Fracture Stroke Cancers Quality of life / Mental health : Diabetes OR per 1kg Birth weight=0.78 ) ) A systematic review (Kim et al., Diabetes Care, 2002) Systematic Review of the Incidence of Diabetes Associated with Various Categories of Glycemia Number Regress to of normal studies (median %) Impaired Glucose Tolerance IGT Isolated IFG IFG Isolated 26 8% Progress Relative Risk of to Diabetes Diabetes (median %) 7% (7.8 4.9) 6.4 3 6 3 n/a 29% 13 n/a n/a 6% *5-20% (7.9 3.1) 5.5 (6.9 2.5) 4.7 7% (10.5 4.6) 7.5 10-15% ( 1-7% 4.3 *extremely variable;20 in ) 12.1 European pops; 23-34% in Asian pops. 3 IGT and IFG Gerstein et al., Diab Res Clin Pract, 2007 Serum Concentration ND Cases/n 25%> 2/643 25-50% 34/505 50-75% 53/527 75-90% 65/275 90-100% 246 / 63 Prevalenc e Adjusted OR Adjusted OR --- 0.4 Referent 6.7 14.9 0 .3) (65.0 Ref 10.1 14.7 (63.9 3.4) 1.1 (1.7 0.6) 23.6 38.2 (183.1 8.0) 2.7 (4.9 1.5) 25.6 37.7 7.8) (182.0 2.7 (4.8 1.5) --- 0.07 0.02) (0.33 Lee et al., Diab Care, 2007 Countylevel Estimates of Diagnosed Diabetes for Adults aged 20 years: United States 2005 : : : (II) () 50 40 30 Proportion of Participants Developing Diabetes During the Finnish and U.S. Diabetes Prevention Studies Finland United States 50 40 30 Control Control Metformin % 20 Lifestyle % 20 Lifestyle 10 0 10 0 1 2 3 Study Year 4 5 6 0 0 0.5 1 1.5 2 2.5 3 3.5 4 Study Year omilehto, N Engl J Med, 2001; DPP Research Group, N Engl J Med, 2002 Follow-up Da Qing, China, 1997 Finland, 2001 DPP, USA, 2002 Kosaka, Japan 2004 , IDPP India, 2006 6 3 3 4 3 Risk status Mean BMI IGT , IGT BMI > 25 IGT BMI > 24 IGT IGT 26 31 34 24 26 Net Weight change kg 1.8 kg 2.5kg 5.2kg 1.8kg 0.3Relative Risk 0.56 0.42 0.42 0.33 0.72 Pan et al., 1997; Tuomilehto et al., 2001, Knowler et al., 2002 Application of Risk Scores to Public Health Intervention Risk Score Diabetes incidence, % 100 90 80 70 60 50 40 30 20 10 0 Men Women 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Schwarz, Horm Metab Res, 2008 ...
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