Modifiable Risk Factors

Hu et al. (39) published results from the Nurses' Heath Study including 84,941 female nurses followed from 1980 to 1996, and who were free of diagnosed cardiovascular disease and diabetes at baseline. During the 16 years follow-up 3300 new cases of type 2 diabetes were diagnosed. As shown in Figure 4 obesity was the single most important predictor of diabetes. Women whose body mass index was at least 35.0 km/m2 had almost 40-fold risk of becoming diabetic compared to women whose body mass index was < 23.0 kg/m2. Weekly exercised at least 7h/wk reduced the risk of type 2 diabetes by 39% compared to women who exercise < 0.5h/wk. Smoking of > 14 cigarettes/day increased the diabetes risk by 39%, but alcohol intake > 10 g/day reduced the risk by 41%. The study also indicated that a diet high in cereal fiber and polysaturated fat and low in saturated and trans fats and glycemic load reduced the risk of developing diabetes. A combination of several lifestyle factors, including low body mass index (< 25 kg/m ), a diet high in cereal fiber and polysaturated fat and low in saturated fat and trans fats and glycemic load, regular exercise, abstinence from smoking and moderate alcohol intake, was associated with a reduction of type 2 diabetes incidence by 90% compared to women without these factors.

n: 126 233 232 123

Fasting insulin Low High Low High

FIGURE 2 The risk of developing type 2 diabetes by fasting insulin concentration and insulin secretion (change in insulin divided by change in glucose concentrations over the first 30 minutes of an oral glucose tolerance test [A/30/AG3o]). Source: From Ref. 35.

n: 126 233 232 123

Fasting insulin Low High Low High

FIGURE 2 The risk of developing type 2 diabetes by fasting insulin concentration and insulin secretion (change in insulin divided by change in glucose concentrations over the first 30 minutes of an oral glucose tolerance test [A/30/AG3o]). Source: From Ref. 35.

TABLE 4 Risk Factors for Type 2 Diabetes

Modifiable

Nonmodifiable

Obesity

Central obesity

Lack of physical activity

Smoking

Alcohol abstinence

Low fiber in the diet

High saturated fat in the diet

Ethnicity

Genetic factors

Family history of type 2 diabetes Prior gestational diabetes Prior glucose intolerance History of cardiovascular disease History of hypertension History of dyslipidemia Low birth weight

Visceral adiposity precedes the development of type 2 diabetes. Boyko et al. (40) showed in their study of Japanese Americans that intra-abdominal fat area measured by computed tomography (CT) remained a significant predictor of diabetes incidence even after adjustment for body mass index, total body fat area, and subcutaneous fat area and other risk factors for diabetes. Interestingly, high insulin resistance and low insulin secretion predicted diabetes independently of directly measured visceral adiposity suggesting that visceral adiposity could contribute to the development of diabetes through actions independent of its effect on insulin sensitivity. Van Dam et al. (41) showed that in Dutch subjects the association between abdominal obesity (waist circumference) and hyperglycemia was stronger in the presence of a parental history of diabetes.

Physical inactivity is a major risk factor for the development of type 2 diabetes. For example, sedentary lifestyle, indicated by television viewing time, worsens glucose tolerance (42). Physical activity reduces insulin resistance and total and visceral fat mass (43). In contrast, the association of total dietary fat with type 2 diabetes or insulin sensitivity is less

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