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Change in cardiovascular risk factors following early diagnosis of type 2 diabetes: a cohort analysis of a cluster-randomised trial.

https://arctichealth.org/en/permalink/ahliterature266383
Source
Br J Gen Pract. 2014 Apr;64(621):e208-16
Publication Type
Article
Date
Apr-2014
Author
James A Black
Stephen J Sharp
Nicholas J Wareham
Annelli Sandbæk
Guy E H M Rutten
Torsten Lauritzen
Kamlesh Khunti
Melanie J Davies
Knut Borch-Johnsen
Simon J Griffin
Rebecca K Simmons
Source
Br J Gen Pract. 2014 Apr;64(621):e208-16
Date
Apr-2014
Language
English
Publication Type
Article
Keywords
Biological Markers - blood
Body mass index
Cardiovascular Diseases - blood - prevention & control
Cholesterol, HDL - blood
Cluster analysis
Cohort Studies
Creatinine - blood
Denmark
Diabetes Mellitus, Type 2 - blood - diagnosis - drug therapy
Early Diagnosis
England
Female
Follow-Up Studies
Hemoglobin A, Glycosylated - metabolism
Humans
Hypoglycemic agents - therapeutic use
Male
Middle Aged
Netherlands
Questionnaires
Risk assessment
Risk factors
Serum Albumin - metabolism
Triglycerides - blood
Abstract
There is little evidence to inform the targeted treatment of individuals found early in the diabetes disease trajectory.
To describe cardiovascular disease (CVD) risk profiles and treatment of individual CVD risk factors by modelled CVD risk at diagnosis; changes in treatment, modelled CVD risk, and CVD risk factors in the 5 years following diagnosis; and how these are patterned by socioeconomic status.
Cohort analysis of a cluster-randomised trial (ADDITION-Europe) in general practices in Denmark, England, and the Netherlands.
A total of 2418 individuals with screen-detected diabetes were divided into quartiles of modelled 10-year CVD risk at diagnosis. Changes in treatment, modelled CVD risk, and CVD risk factors were assessed at 5 years.
The largest reductions in risk factors and modelled CVD risk were seen in participants who were in the highest quartile of modelled risk at baseline, suggesting that treatment was offered appropriately. Participants in the lowest quartile of risk at baseline had very similar levels of modelled CVD risk at 5 years and showed the least variation in change in modelled risk. No association was found between socioeconomic status and changes in CVD risk factors, suggesting that treatment was equitable.
Diabetes management requires setting of individualised attainable targets. This analysis provides a reference point for patients, clinicians, and policymakers when considering goals for changes in risk factors early in the course of the disease that account for the diverse cardiometabolic profile present in individuals who are newly diagnosed with type 2 diabetes.
Notes
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PubMed ID
24686885 View in PubMed
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Change in lifestyle behaviors and diabetes risk: evidence from a population-based cohort study with 10 year follow-up.

https://arctichealth.org/en/permalink/ahliterature283465
Source
Int J Behav Nutr Phys Act. 2017 Mar 29;14(1):39
Publication Type
Article
Date
Mar-29-2017
Author
Adina L Feldman
Gráinne H Long
Ingegerd Johansson
Lars Weinehall
Eva Fhärm
Patrik Wennberg
Margareta Norberg
Simon J Griffin
Olov Rolandsson
Source
Int J Behav Nutr Phys Act. 2017 Mar 29;14(1):39
Date
Mar-29-2017
Language
English
Publication Type
Article
Keywords
Adult
Diabetes Mellitus, Type 2 - epidemiology
Dietary Fats - administration & dosage
Dietary Fiber - administration & dosage
Energy intake
Exercise
Female
Follow-Up Studies
Health Behavior
Humans
Incidence
Life Style
Logistic Models
Male
Middle Aged
Prospective Studies
Risk factors
Self Report
Socioeconomic Factors
Sweden - epidemiology
Abstract
Promoting positive changes in lifestyle behavior in the whole population may be a feasible and effective approach to reducing type 2 diabetes burden, but the impact of population shifts of modifiable risk factors remains unclear. Currently most of the evidence on modifiable lifestyle behavior and type 2 diabetes risk on a population level comes from studies of between-individual differences. The objective of the study was to investigate the association and potential impact on disease burden for within-individual change in lifestyle behavior and diabetes risk.
Population-based prospective cohort study of 35,680 participants aged 30-50 at baseline in 1990-2003 in Västerbotten County, Sweden (follow-up until 2013). Five self-reported modifiable lifestyle behaviors (tobacco use, physical activity, alcohol intake, dietary fiber intake and dietary fat intake) were measured at baseline and 10 year follow-up. Lifestyle behaviors were studied separately, and combined in a score. Incident diabetes was detected by oral glucose tolerance tests. Multivariate logistic regression models and population attributable fractions (PAF) were used to analyze the association between change in lifestyle behavior between baseline and 10 year follow-up, and risk of incident diabetes.
Incident diabetes was detected in 1,184 (3.3%) participants at 10 year follow-up. There was a reduced diabetes risk associated with increase in dietary fiber intake, odds ratio (OR) 0.79 (95% confidence interval (CI) 0.66, 0.96) for increase of at least one unit standard deviation (3.0 g/1,000 kcal) of the baseline distribution, PAF 16.0% (95% CI 4.2, 26.4%). Increase in the lifestyle behavior score was associated with reduced diabetes risk, OR 0.92 (95% CI 0.85, 0.99) per unit increase of the score.
These results support a causal link between lifestyle behavior and type 2 diabetes incidence. A small shift in lifestyle behaviors, in particular intake of dietary fiber, has the potential to reduce diabetes burden in the population and might be a suitable target for public health intervention.
Notes
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PubMed ID
28351358 View in PubMed
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Early Detection and Treatment of Type 2 Diabetes Reduce Cardiovascular Morbidity and Mortality: A Simulation of the Results of the Anglo-Danish-Dutch Study of Intensive Treatment in People With Screen-Detected Diabetes in Primary Care (ADDITION-Europe).

https://arctichealth.org/en/permalink/ahliterature270214
Source
Diabetes Care. 2015 Aug;38(8):1449-55
Publication Type
Article
Date
Aug-2015
Author
William H Herman
Wen Ye
Simon J Griffin
Rebecca K Simmons
Melanie J Davies
Kamlesh Khunti
Guy E H M Rutten
Annelli Sandbaek
Torsten Lauritzen
Knut Borch-Johnsen
Morton B Brown
Nicholas J Wareham
Source
Diabetes Care. 2015 Aug;38(8):1449-55
Date
Aug-2015
Language
English
Publication Type
Article
Keywords
Adult
Aged
Blood Glucose - metabolism
Blood Pressure - physiology
Cholesterol - blood
Computer simulation
Critical Care
Denmark - epidemiology
Diabetes Mellitus, Type 2 - mortality - prevention & control
Diabetic Angiopathies - mortality - prevention & control
Early Diagnosis
Female
Great Britain - epidemiology
Humans
Mass Screening - methods
Middle Aged
Netherlands - epidemiology
Primary Health Care
Risk factors
Abstract
To estimate the benefits of screening and early treatment of type 2 diabetes compared with no screening and late treatment using a simulation model with data from the ADDITION-Europe study.
We used the Michigan Model, a validated computer simulation model, and data from the ADDITION-Europe study to estimate the absolute risk of cardiovascular outcomes and the relative risk reduction associated with screening and intensive treatment, screening and routine treatment, and no screening with a 3- or 6-year delay in the diagnosis and routine treatment of diabetes and cardiovascular risk factors.
When the computer simulation model was programmed with the baseline demographic and clinical characteristics of the ADDITION-Europe population, it accurately predicted the empiric results of the trial. The simulated absolute risk reduction and relative risk reduction were substantially greater at 5 years with screening, early diagnosis, and routine treatment compared with scenarios in which there was a 3-year (3.3% absolute risk reduction [ARR], 29% relative risk reduction [RRR]) or a 6-year (4.9% ARR, 38% RRR) delay in diagnosis and routine treatment of diabetes and cardiovascular risk factors.
Major benefits are likely to accrue from the early diagnosis and treatment of glycemia and cardiovascular risk factors in type 2 diabetes. The intensity of glucose, blood pressure, and cholesterol treatment after diagnosis is less important than the time of its initiation. Screening for type 2 diabetes to reduce the lead time between diabetes onset and clinical diagnosis and to allow for prompt multifactorial treatment is warranted.
Notes
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Comment In: Diabetes Care. 2015 Aug;38(8):1399-40126207050
PubMed ID
25986661 View in PubMed
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Effect of early intensive multifactorial therapy on 5-year cardiovascular outcomes in individuals with type 2 diabetes detected by screening (ADDITION-Europe): a cluster-randomised trial.

https://arctichealth.org/en/permalink/ahliterature133438
Source
Lancet. 2011 Jul 9;378(9786):156-67
Publication Type
Article
Date
Jul-9-2011
Author
Simon J Griffin
Knut Borch-Johnsen
Melanie J Davies
Kamlesh Khunti
Guy E H M Rutten
Annelli Sandbæk
Stephen J Sharp
Rebecca K Simmons
Maureen van den Donk
Nicholas J Wareham
Torsten Lauritzen
Author Affiliation
MRC Epidemiology Unit, Institute of Metabolic Science, Cambridge, UK. simon.griffin@mrc-epid.cam.ac.uk
Source
Lancet. 2011 Jul 9;378(9786):156-67
Date
Jul-9-2011
Language
English
Publication Type
Article
Keywords
Aged
Cluster analysis
Denmark - epidemiology
Diabetes Mellitus, Type 2 - diagnosis - drug therapy - mortality - therapy
Diabetic Angiopathies - mortality - prevention & control
Female
Great Britain - epidemiology
Humans
Hypoglycemic agents - therapeutic use
Intention to Treat Analysis
Male
Mass Screening
Middle Aged
Netherlands - epidemiology
Outcome Assessment (Health Care)
Risk factors
Abstract
Intensive treatment of multiple cardiovascular risk factors can halve mortality among people with established type 2 diabetes. We investigated the effect of early multifactorial treatment after diagnosis by screening.
In a pragmatic, cluster-randomised, parallel-group trial done in Denmark, the Netherlands, and the UK, 343 general practices were randomly assigned screening of registered patients aged 40-69 years without known diabetes followed by routine care of diabetes or screening followed by intensive treatment of multiple risk factors. The primary endpoint was first cardiovascular event, including cardiovascular mortality and morbidity, revascularisation, and non-traumatic amputation within 5 years. Patients and staff assessing outcomes were unaware of the practice's study group assignment. Analysis was done by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00237549.
Primary endpoint data were available for 3055 (99
9%) of 3057 screen-detected patients. The mean age was 60
3 (SD 6
9) years and the mean duration of follow-up was 5
3 (SD 1
6) years. Improvements in cardiovascular risk factors (HbA(1c) and cholesterol concentrations and blood pressure) were slightly but significantly better in the intensive treatment group. The incidence of first cardiovascular event was 7
2% (13
5 per 1000 person-years) in the intensive treatment group and 8
5% (15
9 per 1000 person-years) in the routine care group (hazard ratio 0
83, 95% CI 0
65-1
05), and of all-cause mortality 6
2% (11
6 per 1000 person-years) and 6
7% (12
5 per 1000 person-years; 0
91, 0
69-1
21), respectively.
An intervention to promote early intensive management of patients with type 2 diabetes was associated with a small, non-significant reduction in the incidence of cardiovascular events and death.
National Health Service Denmark, Danish Council for Strategic Research, Danish Research Foundation for General Practice, Danish Centre for Evaluation and Health Technology Assessment, Danish National Board of Health, Danish Medical Research Council, Aarhus University Research Foundation, Wellcome Trust, UK Medical Research Council, UK NIHR Health Technology Assessment Programme, UK National Health Service R&D, UK National Institute for Health Research, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, Novo Nordisk, Astra, Pfizer, GlaxoSmithKline, Servier, HemoCue, Merck.
Notes
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PubMed ID
21705063 View in PubMed
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Effect of early multifactorial therapy compared with routine care on microvascular outcomes at 5 years in people with screen-detected diabetes: a randomized controlled trial: the ADDITION-Europe Study.

https://arctichealth.org/en/permalink/ahliterature258858
Source
Diabetes Care. 2014 Jul;37(7):2015-23
Publication Type
Article
Date
Jul-2014
Author
Annelli Sandbæk
Simon J Griffin
Stephen J Sharp
Rebecca K Simmons
Knut Borch-Johnsen
Guy E H M Rutten
Maureen van den Donk
Nicholas J Wareham
Torsten Lauritzen
Melanie J Davies
Kamlesh Khunti
Source
Diabetes Care. 2014 Jul;37(7):2015-23
Date
Jul-2014
Language
English
Publication Type
Article
Keywords
Adult
Aged
Cluster analysis
Denmark - epidemiology
Diabetes Mellitus, Type 2 - complications - therapy
Diabetic Angiopathies - epidemiology
Diabetic Neuropathies - epidemiology
Female
Follow-Up Studies
General Practice - methods
Great Britain - epidemiology
Humans
Male
Mass Screening - methods
Middle Aged
Netherlands - epidemiology
Primary Health Care - methods
Questionnaires
Secondary Prevention
Abstract
To determine the benefit of multifactorial treatment on microvascular complications among people with type 2 diabetes detected by screening.
This study was a multicenter cluster randomized controlled trial in primary care with randomization at the practice level. In four centers in Denmark; Cambridge, U.K.; the Netherlands; and Leicester, U.K., 343 general practices participated in the trial. Eligible for follow-up were 2,861 of the 3,057 people with diabetes detected by screening included in the original trial. Biomedical data on nephropathy were collected in 2,710 (94.7%) participants, retinal photos in 2,190 (76.6%), and questionnaire data on peripheral neuropathy in 2,312 (80.9%). The prespecified microvascular end points were analyzed by intention to treat. Results from the four centers were pooled using fixed-effects meta-analysis.
Five years after diagnosis, any kind of albuminuria was present in 22.7% of participants in the intensive treatment (IT) group and in 24.4% in the routine care (RC) group (odds ratio 0.87 [95% CI 0.72-1.07]). Retinopathy was present in 10.2% of the IT group and 12.1% of the RC group (0.84 [0.64-1.10]), and severe retinopathy was present in one patient in the IT group and seven in the RC group. Neuropathy was present in 4.9% and 5.9% (0.95 [0.68-1.34]), respectively. Estimated glomerular filtration rate increased between baseline and follow-up in both groups (4.31 and 6.44 mL/min, respectively).
Compared with RC, an intervention to promote target-driven, intensive management of patients with type 2 diabetes detected by screening was not associated with significant reductions in the frequency of microvascular events at 5 years.
PubMed ID
24784827 View in PubMed
Less detail

Effect of population screening for type 2 diabetes and cardiovascular risk factors on mortality rate and cardiovascular events: a controlled trial among 1,912,392 Danish adults.

https://arctichealth.org/en/permalink/ahliterature292701
Source
Diabetologia. 2017 Nov; 60(11):2183-2191
Publication Type
Controlled Clinical Trial
Journal Article
Date
Nov-2017
Author
Rebecca K Simmons
Simon J Griffin
Daniel R Witte
Knut Borch-Johnsen
Torsten Lauritzen
Annelli Sandbæk
Author Affiliation
MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK. rks34@cam.ac.uk.
Source
Diabetologia. 2017 Nov; 60(11):2183-2191
Date
Nov-2017
Language
English
Publication Type
Controlled Clinical Trial
Journal Article
Keywords
Adult
Aged
Blood Glucose - metabolism
Cardiovascular Diseases - etiology - prevention & control
Denmark
Diabetes Mellitus, Type 2 - complications - diagnosis - metabolism
Female
Glycated Hemoglobin A - metabolism
Humans
Male
Mass Screening - methods
Middle Aged
Risk factors
Abstract
Health check programmes for chronic disease have been introduced in a number of countries. However, there are few trials assessing the benefits and harms of these screening programmes at the population level. In a post hoc analysis, we evaluated the effect of population-based screening for type 2 diabetes and cardiovascular risk factors on mortality rates and cardiovascular events.
This register-based, non-randomised, controlled trial included men and women aged 40-69 years without known diabetes who were registered with a general practice in Denmark (n = 1,912,392). Between 2001 and 2006, 153,107 individuals registered with 181 practices participating in the Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care (ADDITION)-Denmark study were sent a diabetes risk score questionnaire. Individuals at moderate-to-high risk were invited to visit their GP for assessment of diabetes status and cardiovascular risk (screening group). The 1,759,285 individuals registered with all other general practices in Denmark constituted the retrospectively constructed no-screening (control) group. Outcomes were mortality rate and cardiovascular events (cardiovascular disease death, non-fatal ischaemic heart disease or stroke). The analysis was performed according to the intention-to-screen principle.
Among the screening group, 27,177 (18%) individuals attended for assessment of diabetes status and cardiovascular risk. Of these, 1,533 were diagnosed with diabetes. During a median follow-up of 9.5 years, there were 11,826 deaths in the screening group and 141,719 in the no-screening group (HR 0.99 [95% CI 0.96, 1.02], p = 0.66). There were 17,941 cardiovascular events in the screening group and 208,476 in the no-screening group (HR 0.99 [0.96, 1.02], p = 0.49).
A population-based stepwise screening programme for type 2 diabetes and cardiovascular risk factors among all middle-aged adults in Denmark was not associated with a reduction in rate of mortality or cardiovascular events between 2001 and 2012.
Notes
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PubMed ID
28831535 View in PubMed
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Effect of screening for type 2 diabetes on risk of cardiovascular disease and mortality: a controlled trial among 139,075 individuals diagnosed with diabetes in Denmark between 2001 and 2009.

https://arctichealth.org/en/permalink/ahliterature292700
Source
Diabetologia. 2017 Nov; 60(11):2192-2199
Publication Type
Controlled Clinical Trial
Journal Article
Date
Nov-2017
Author
Rebecca K Simmons
Simon J Griffin
Torsten Lauritzen
Annelli Sandbæk
Author Affiliation
Department of Public Health, Section of General Practice, Aarhus University, Aarhus, Denmark. rks34@cam.ac.uk.
Source
Diabetologia. 2017 Nov; 60(11):2192-2199
Date
Nov-2017
Language
English
Publication Type
Controlled Clinical Trial
Journal Article
Keywords
Adult
Aged
Blood Glucose - metabolism
Cardiovascular Diseases - etiology - mortality - prevention & control
Denmark
Diabetes Mellitus, Type 2 - complications - diagnosis
Female
Humans
Male
Mass Screening - methods
Middle Aged
Primary Health Care
Risk factors
Abstract
There is continuing debate about the net benefits of population screening for type 2 diabetes. We compared the risk of cardiovascular disease (CVD) and mortality among incident cases of type 2 diabetes in a screened group with those in an unscreened group.
In this register-based non-randomised controlled trial, eligible individuals were all men and women aged 40-69 years without known diabetes, registered with a general practice in Denmark (n = 1,912,392). Between 2001 and 2006, 153,107 individuals registered with 181 practices participating in the Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care (ADDITION)-Denmark study were sent a diabetes-risk-score questionnaire. Individuals at moderate-to-high risk were invited to visit their family doctor for assessment of diabetes status and cardiovascular risk (screening group). The 1,759,285 individuals registered with all other practices in Denmark constituted the retrospectively constructed no-screening (control) group. In this post hoc analysis, we identified individuals from the screening and no-screening groups who were diagnosed with diabetes between 2001 and 2009 (n = 139,075), and compared risk of CVD and mortality in these groups between 2001 and 2012.
In the screening group, 27,177/153,107 (18%) individuals attended for screening, of whom 1533 were diagnosed with diabetes. Between 2001 and 2009, 13,992 people were newly diagnosed with diabetes in the screening group (including those diagnosed by screening) and 125,083 in the no-screening group. Between 2001 and 2012, the risks of CVD and mortality were lower among individuals with diabetes in the screening group compared with individuals with diabetes in the no-screening (control) group (CVD HR 0.84, 95% CI 0.80, 0.89; mortality HR 0.79, 95% CI 0.74, 0.84).
A single round of diabetes screening and cardiovascular risk assessment in middle-aged Danish adults in general practice was associated with a significant reduction in risk of all-cause mortality and CVD events in those diagnosed with diabetes.
Notes
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PubMed ID
28831539 View in PubMed
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Impact of weight maintenance and loss on diabetes risk and burden: a population-based study in 33,184 participants.

https://arctichealth.org/en/permalink/ahliterature285389
Source
BMC Public Health. 2017 Feb 06;17(1):170
Publication Type
Article
Date
Feb-06-2017
Author
Adina L Feldman
Simon J Griffin
Amy L Ahern
Grainne H Long
Lars Weinehall
Eva Fhärm
Margareta Norberg
Patrik Wennberg
Source
BMC Public Health. 2017 Feb 06;17(1):170
Date
Feb-06-2017
Language
English
Publication Type
Article
Keywords
Adult
Body mass index
Body Weight
Cohort Studies
Diabetes Mellitus, Type 2 - epidemiology - prevention & control
Female
Follow-Up Studies
Humans
Incidence
Longitudinal Studies
Male
Middle Aged
Prospective Studies
Risk
Risk factors
Sweden - epidemiology
Weight Loss - physiology
Abstract
Weight loss in individuals at high risk of diabetes is an effective prevention method and a major component of the currently prevailing diabetes prevention strategies. The aim of the present study was to investigate the public health potential for diabetes prevention of weight maintenance or moderate weight loss on a population level in an observational cohort with repeated measurements of weight and diabetes status.
Height, weight and diabetes status were objectively measured at baseline and 10 year follow-up in a population-based cohort of 33,184 participants aged 30-60 years between 1990 and 2013 in Västerbotten County, Sweden. The association between risk of incident diabetes and change in BMI or relative weight was modelled using multivariate logistic regression. Population attributable fractions (PAF) were used to assess population impact of shift in weight.
Mean (SD) BMI at baseline was 25.0 (3.6) kg/m(2). Increase in relative weight between baseline and follow-up was linearly associated with incident diabetes risk, odds ratio (OR) 1.05 (95% confidence interval (CI) 1.04-1.06) per 1% change in weight. Compared to weight maintenance (±1.0 kg/m(2)), weight gain of?>?+1.0 kg/m(2) was associated with an increased risk of incident diabetes, OR 1.52 (95% CI 1.32, 1.74), representing a PAF of 21.9% (95% CI 15.8, 27.6%). For moderate weight loss (-1.0 to -2.0 kg/m(2)) the OR was 0.72 (95% CI 0.52, 0.99).
Weight maintenance in adulthood is strongly associated with reduced incident diabetes risk and there is considerable potential for diabetes prevention in promoting this as a whole population strategy.
Notes
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PubMed ID
28166764 View in PubMed
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Sociocultural correlates of physical activity in children and adolescents: findings from the Danish arm of the European Youth Heart study.

https://arctichealth.org/en/permalink/ahliterature101954
Source
Pediatr Exerc Sci. 2008 Aug;20(3):319-32
Publication Type
Article
Date
Aug-2008
Author
Alison M McMinn
Esther M F van Sluijs
Neils Wedderkopp
Karsten Froberg
Simon J Griffin
Author Affiliation
MRC Epidemiology Unit, Institute of Metabolic Sciences, Addenbrooke's Hospital, Cambridge, UK.
Source
Pediatr Exerc Sci. 2008 Aug;20(3):319-32
Date
Aug-2008
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Child
Cultural Characteristics
Denmark
Exercise
Fathers
Female
Humans
Linear Models
Male
Middle Aged
Monitoring, Ambulatory
Mothers
Parent-Child Relations
Questionnaires
Socioeconomic Factors
Abstract
Cross-sectional associations between sociocultural factors and objectively-measured physical activity in a sample of 397 children (aged 9) and 213 adolescents (aged 15) were investigated. Associations with children's physical activity were found for mothers' physical activity (Beta = 80, p
PubMed ID
18714121 View in PubMed
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Temporal shifts in cardiovascular risk factor distribution.

https://arctichealth.org/en/permalink/ahliterature257401
Source
Am J Prev Med. 2014 Feb;46(2):112-21
Publication Type
Article
Date
Feb-2014
Author
Gráinne H Long
Rebecca K Simmons
Margareta Norberg
Patrik Wennberg
Bernt Lindahl
Olov Rolandsson
Simon J Griffin
Lars Weinehall
Author Affiliation
MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom.
Source
Am J Prev Med. 2014 Feb;46(2):112-21
Date
Feb-2014
Language
English
Publication Type
Article
Keywords
Adult
Blood glucose
Blood pressure
Body mass index
Cardiovascular Diseases - blood - epidemiology - prevention & control
Cholesterol - blood
Female
Health promotion
Humans
Male
Metabolic Diseases - blood - epidemiology - prevention & control
Middle Aged
Obesity - blood - epidemiology - prevention & control
Prevalence
Risk factors
Sweden - epidemiology
Abstract
Complementary strategies to shift risk factor population distributions and target high-risk individuals are required to reduce the burden of type 2 diabetes and cardiovascular disease (CVD).
To examine secular changes in glucose and CVD risk factors over 20 years during an individual and population-based CVD prevention program in Västerbotten County, Sweden.
Population-based health promotion intervention was conducted and annual invitation for individuals turning 40, 50, and 60 years to attend a health assessment, including an oral glucose tolerance test, biochemical measures, and a questionnaire. Data were collected between 1991 and 2010, analyzed in 2012 and available for 120,929 individuals. Linear regression modeling examined age-adjusted differences in CVD risk factor means over time. Data were direct-age-standardized to compare disease prevalence.
Between 1991-1995 and 2006-2010, mean age-adjusted cholesterol (men=-0.53, 95% CI=-0.55, -0.50 mmol/L; women=-0.48, 95% CI=-0.50, -0.45 mmol/L) and systolic blood pressure declined (men=-3.06, 95% CI=-3.43, -2.70 mm Hg; women=-5.27, 95% CI=-5.64, -4.90 mm Hg), with corresponding decreases in the age-standardized prevalence of hypertension and hyperlipidemia. Mean age-adjusted 2-hour plasma glucose (men=0.19, 95% CI=0.15, 0.23 mmol/L; women=0.08, 95% CI=0.04, 0.11 mmol/L) and BMI increased (men=1.12, 95% CI=1.04, 1.21; women=0.65, 95% CI=0.55, 0.75), with increases in the age-standardized prevalence of diabetes and obesity.
These data demonstrate the potential of combined individual- and population-based approaches to CVD risk factor control and highlight the need for additional strategies addressing hyperglycemia and obesity.
Notes
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PubMed ID
24439344 View in PubMed
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