Non-cardiovascular disease mortality and diabetes mellitus.
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Adult↗
Biomedical subjects
B Balkau
Publications and source records attributed to B Balkau.
Prevalence of NIDDM and impaired glucose tolerance in a rural and an urban population in Cameroon.
The adoption of Western lifestyles is known to lead to increasing prevalence of non-insulin-dependent diabetes mellitus in Africa, yet epidemiological studies using standardised methods are rare. The prevalence of diabetes and impaired glucose tolerance was determined in a rural and an urban community in Cameroon using the 75-g oral glucose tolerance test and the World Health Organization diagnostic criteria in 719 rural (292 men, 427 women) and 1048 urban (458 men, 590 women) subjects aged 24-74 years. The response rate was 95 and 91% for the rural and urban population, respectively. The age-standardized prevalence of diabetes in the rural and urban population was respectively 0.9% (95% confidence interval (0.2-2.7)) and 0.8% (0.2-1.8) for men and 0.5% (0.1-1.6) and 1.6% (0.7-3.1) for women, and that of impaired glucose tolerance was 5.8% (3.3-9.4) and 1.8% (0.9-3.2) for men, and for women, 2.2% (1.0-4.0) and 2.0% (0.6-4.5). Although for both men and women the body mass index was higher at all ages in the urban than in the rural area, the 2-h plasma glucose, even after adjustment for age and body mass index, was significantly higher in the rural than in the urban area (p < 0.005, p < 0.002 for men and women, respectively). There was a female excess of diabetes in the urban area and an equal sex distribution in the rural area. In the rural area 67% (4 of 6) of diabetic subjects were unknown before the survey, compared with 57% (8 of 14) in the urban area. These data indicate a low prevalence of diabetes in Cameroon; however, the prevalence of impaired glucose tolerance suggests an early stage of a diabetes epidemic.
Adult↗
The role of non-esterified fatty acids in the deterioration of glucose tolerance in Caucasian subjects: results of the Paris Prospective Study.
Although an increased plasma non-esterified fatty acid (NEFA) concentration has been shown to increase insulin resistance (Randle cycle), decrease insulin secretion and increase hepatic gluconeogenesis, the effect of NEFA on the deterioration of glucose tolerance has not been studied prospectively in Caucasian subjects. Therefore, we investigated whether plasma NEFA may be regarded as predictors of deterioration of glucose tolerance in subjects with normal (NGT, n = 3671) or impaired (IGT, n = 418) glucose tolerance who were participants in the Paris Prospective study. The subjects were first examined between 1967 and 1972 and underwent two 75-g oral glucose tolerance tests 2 years apart with measurements of plasma glucose, insulin and NEFA concentrations. Glucose tolerance deteriorated from NGT to IGT or non-insulin-dependent diabetes (NIDDM) in 177 subjects and from IGT to NIDDM in 32 subjects. In multivariate analysis, high fasting plasma NEFA in NGT subjects and high 2-h plasma NEFA and low 2-h plasma insulin concentrations in IGT subjects were significant independent predictors of deterioration along with older age, high fasting and 2-h plasma glucose concentrations and high iliac to thigh ratio. When subjects were divided by tertiles of plasma NEFA concentration at baseline, there was an increase in 2-h glucose concentration with increasing NEFA in the subjects who did not deteriorate, but no effect of plasma NEFA in those who deteriorated. In subjects with IGT who deteriorated compared with those who did not 2-h plasma insulin concentration was lower but there was no evidence that this resulted from an effect of plasma NEFA. Our data suggest that a high plasma NEFA concentration is a risk marker for deterioration of glucose tolerance independent of the insulin resistance or the insulin secretion defect that characterize subjects at risk for NIDDM.
Basal Metabolism↗
Ischemic heart disease and alcohol-related causes of death: a view of the French paradox.
PURPOSE: In France the low rates of death due to ischemic heart disease have been attributed to the high consumption of alcohol. However, the question remains: are the higher death rates for causes associated with alcohol consumption an explanation? METHODS: Diseases were defined according to the International Classification of Diseases, revision 9. World Health Organization data on country- and age-specific death rates were used. RESULTS: Official causes-of-death statistics for men 40-74 years of age show that in 1990 French men under 50 years old had low death rates from ischemic heart disease but a relatively high all-cause mortality rate, in contrast to low rates for men 60 to 74 years of age. Among French men aged 40-44 years in 1960, 34% had died before reaching the age of 70-74 years. In comparison, 37% in the United States and 36% in England and Wales, had died by this age, with 4.5%, 14.1%, and 15.2% of deaths, respectively, due to ischemic heart disease. If all of the men who died early of causes associated with alcohol had died of ischemic heart disease, there would still be a lower rate in France (21%) than in the United States (26%) or in England and Wales (25%). CONCLUSION: Thus, although some of the chronic heavy drinkers in France die early of causes associated with excessive alcohol consumption, this is not the only reason for the low ischemic heart disease death rates.
Adult↗
Determinants and nature of dietary underreporting in a free-living population: the Fleurbaix Laventie Ville Santé (FLVS) Study.
OBJECTIVE: To study the determinants and nature of dietary underreporting in a free-living population. DESIGN: Cross-sectional study of nutritional and behavioural characteristics. SUBJECTS: 1030 weight-stable subjects, 501 women and 529 men older than 15 y, included in the Fleurbaix Laventie Ville Santé study. MEASUREMENTS: Dietary intake was assessed using a 3 dy dietary record. Self assessed body weight and height were also recorded. Behavioural and socio-economic data were obtained from a questionnaire. Underreporters were defined as people with a reported ratio of energy intake to estimated basal metabolic rate lower than 1.05. RESULTS: Underreporting concerned 16% of the population and was significantly more frequent in obese than in non obese subjects (P < 0.001). Underreporting was significantly associated with a high socio-professional class (P < 0.05), having dieted at least once (P < 0.01) and to be in dietary restraint (P < 0.05). Furthermore, the contribution of protein to energy intake was significantly higher in underreporters than in non underreporters, independently of weight status. CONCLUSIONS: These data underline that underreporting may bias the assessment of energy and macronutrient intake, particularly in studies on obesity and dietary restraint. Questions about weight concern, dieting and dietary restraint may be useful to identify subjects who underestimate their food intake.
Adolescent↗
Is insulin an independent risk factor for hypertension? The Paris Prospective Study.
BACKGROUND: The link between hyperinsulinaemia and hypertension has been examined in few prospective studies and often diminished after adjustment for obesity, central adiposity and baseline blood pressures. METHODS: The incidence of hypertension was studied as a function of baseline insulin and glucose in 4149 Caucasian, non-hypertensive, non-diabetic middle-aged men from the Paris Prospective Study. Blood pressures were measured over the 3 years of follow-up; hypertension incidence was defined as systolic blood pressure > or = 160 mmHg or diastolic blood pressure > or = 95 mmHg or drug treatment for hypertension. RESULTS: Fasting and 2-hour glucose and insulin were predictive of hypertension, after controlling for the known risk factors: age, excessive alcohol consumption and family history of hypertension (FHH). However, after further controlling for body mass index and central adiposity (the iliac circumference), insulin was no longer predictive in men without an FHH. When weight variation was also taken into account, and further adjustment made for baseline blood pressure and heart rate, fasting insulin, only, was predictive when the subject had a weight increase, independently of FHH. Fasting glucose was predictive of hypertension except in the case of no change or weight decrease and a negative FHH; 2-hour glucose was predictive in the presence of a positive FHH. CONCLUSIONS: Insulin and glucose levels were both risk factors for hypertension, and this risk was enhanced in the case of a positive FHH. However, obesity, especially central obesity, confounded these relationships and might be an intermediary factor in the relationship between insulin and hypertension.
Adult↗
The French paradox and diabetic patients.
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Adult↗
Proposed criteria for the diagnosis of diabetes: evidence from a French epidemiological study (D.E.S.I.R.).
The American Diabetes Association and a working group of the International Diabetes Federation and the World Health Organisation are considering the possibility of lowering the level of fasting glucose for diagnosis of diabetes from 7.8 mM to 7.0 mM (126 mg/dl) and adding a "hyperglycaemia" category (6.1-6.9 mM). This report studied the resulting change in the frequency of diabetes in the French D.E.S.I.R. cohort and evaluated cardiovascular risk factors according to the proposed limits. The frequency of treated diabetes was 1.0% in this cohort of more than 5,000 French men and women 30 to 64 years of age, 0.7% had a fasting glucose > or = 7.8 mM versus 1.6% for the proposed > or = 7.0 mM. Using the new criteria, 3.8% of men and 1.6% of women would be diabetic. For many cardiovascular risk factors, men with fasting glucose > or = 7.8 mM had a significantly higher risk than those in the (7.0-7.7 mM) range, whereas no significant differences were found for women. There were few differences between the (7.0-7.7 mM) and (6.1-6.9 mM) ranges, but highly significant differences were apparent for both sexes between the normoglycaemic (< 6.1 mM) and hyperglycaemic (6.1-6.9 mM) categories. The percentage of men with two or more of ten risk factors increased with fasting glucose: 36% in the normoglycaemic (< 6.1 mM) and 49% in the hyperglycaemic (6.1-6.9 mM) categories; 73% with fasting glucose in (7.0-7.7 mM) versus 90% with fasting glucose > or = 7.8 mM. In women, the corresponding percentages were lower: 26% and 60%, 32% versus 64% respectively. The major increase in cardiovascular risk factors would appear to occur at 6.1 mM, for men, whereas the increase in the combination of risk factors was at the more conservative cut-off of 7.0 mM.
Adult↗
Revision of diagnostic criteria for diabetes.
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Adult↗
Case counting in epidemiology: limitations of methods based on multiple data sources.
BACKGROUND: The application of capture-recapture methods in epidemiology has been proposed as an alternative to field surveys. This methodology is important for the future of epidemiology and deserves a critical analysis. METHODS: This paper reviews conditions for applying the capture-recapture models to epidemiological data, taking into account practical considerations, in particular the problem of case definition. RESULTS: The underlying assumptions are particularly restrictive resulting in a theoretical limitation of their applicability. In spite of the statistical developments designed to overcome these difficulties, the practical conditions for using the existing lists are often not fulfilled (availability, confidentiality). The major restriction is on the quality of the data which are often far below the standards required in specific prevalence surveys and which may differ between lists. This may result in a dramatic lack of specificity. The definition of the virtual subgroup of patients missing in all lists as generated by the statistical procedure, is questionable particularly when counting living patients. Field studies would be necessary for validation. CONCLUSIONS: In some particular situations (e.g. deceased patients, rare diseases), this methodology may provide a useful approximation to the number of ill subjects events, but users should be aware of their poor specificity. It can also be useful to complement data from surveillance systems by careful cross-checking with independent sources of information. Currently, this method cannot, in any way, replace direct population prevalence or incidence surveys.
Epidemiologic Methods↗
Effect of maternal diabetes on the pattern of selected insulin resistance syndrome parameters in normal glucose tolerant subjects of two Algonquin Indian communities in Quebec.
OBJECTIVE: To determine whether a maternal antecedent with diabetes has an effect on insulin resistance syndrome parameters. RESEARCH DESIGN AND METHODS: We studied 352 Algonquin Indians from Quebec aged at least 15 years who had no personal antecedents with diabetes. Data concerned clinical and biological parameters and the parental antecedents with diabetes. RESULTS: For subjects over > 30 years, fasting insulin and cholesterol levels were significantly higher in the group with a maternal history of diabetes than in the group with a paternal history. Significant differences were observed for serum triglyceride, BMI, and subscapular skinfold thickness when comparing subjects with a maternal history and those with no parental history of diabetes. Blood pressure and fasting glucose did not differ according to parental history. CONCLUSIONS: Subjects of maternal antecedents with diabetes have known risk factors for NIDDM. This study does not identify whether there is a genetic or maternal environmental reason for this association.
Adolescent↗
Development of food frequency questionnaires in three population samples of African origin from Cameroon, Jamaica and Caribbean migrants to the UK.
OBJECTIVES: To develop the methods for assessment of food and nutrient intake using standardized food frequency questionnaires (FFQ) in three African origin populations from Cameroon, Jamaica and Caribbean migrants to the United Kingdom. DESIGN: Cross-sectional assessment of diet from a representative sample in each site, using either a 2-day food diary or a 24-h recall method to determine foods for inclusion on the food frequency questionnaire. SETTING: A rural and urban site in Cameroon, Evodoula and Cite Verte in Yaounde, respectively; a district in Kingston Jamaica; African-Caribbeans living in central Manchester, UK. SUBJECTS: Aged 25-79 years, 61 from the Cameroonian urban site, 62 from the village site; 102 subjects from Jamaica (additional analysis on a subsample of 20): 29 subjects from Manchester, UK. MAIN OUTCOME MEASURES: Foods contributing to nutrients in each site to allow the development of a FFQ. RESULTS: A high response rate was obtained in each site. Comparison of macronutrient intakes between the sites showed that carbohydrate was the most important contributor to energy intake in Jamaica (55%) and the least in rural Cameroon. In rural Cameroon, fat (mainly palm oil) was the most important contributor to energy intake (44%). Manchester had the highest contribution of protein to energy (17%). Foods contributing to total energy, protein, fat and carbohydrate were determined. In rural Cameroon, the top 10 food items contributed 66% of the total energy intake compared to 37% for the top 10 foods in Manchester. Foods contributing to energy were similar in Jamaica and Manchester. Cassava contributed 44% of the carbohydrate intake in rural Cameroon and only 6% in urban Cameroon. One FFQ has been developed for use in both sites in Cameroon containing 76 food items. The FFQ for Jamaica contains 69 foods and for Manchester 108 food items. CONCLUSION: Considerable variations exist within sites (Cameroon) and between sites in foods which are important contributors to nutrient intakes. With careful exploration of eating habits it has been possible to develop standardized, but locally appropriate FFQs for use in African populations in different countries.
Adult↗
[An epidemiologic survey from a network of French Health Examination Centres, (D.E.S.I.R.): epidemiologic data on the insulin resistance syndrome].
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Adult↗
Arterial hypertension in the adult population of Guadeloupe, and associated factors in subjects of African origin.
This study was designed to estimate the prevalence of hypertension in Guadeloupe, the French West Indies, and to evaluate the risk factors associated with hypertension in the largest ethnic group, that of African origin. Households were randomly selected using a two-stage systematic sample of districts and then of houses; all adults aged 18 years in the household were included. In total, 1043 men and women were studied. Blood pressure, plasma glucose concentrations and gamma-glutamyl transferase activity were measured, hypertensive treatment and lifestyle factors recorded. The prevalence of hypertension, age-standardized to the Guadeloupe population was 21% and 26% in men and women of African origin, 28% and 22% in those of Indian-origin and 18% and 16% for other origins. The vast majority of subjects were unaware of their hypertension (90% of men, 74% of women). After adjustment for age, factors associated with high blood pressure in the 826 adults of African origin were: obesity, hyperglycemia, low educational level and family history of hypertension and of stroke. Additional factors in women were alcohol consumption, gamma-glutamyl transferase activity, physical inactivity, occupational category and a retired status, even after adjustment for age. Measures must be taken to diagnose hypertension early, particularly in individuals of African and Indian origin. An effective education program is needed, with an emphasis on life-style factors associated with obesity: diet and physical activity.
Adolescent↗
Distribution of fasting serum insulin measured by enzyme immunoassay in an unselected population of 4,032 individuals. Reference values according to age and sex. D.E.S.I.R. Study Group. Données Epidémiologiques sur le Syndrome d'Insulino-Résistance.
As hyperinsulinaemia has been shown to be a risk factor for non-insulin-dependent diabetes, cardiovascular disease and hypertension, the measurement of serum insulin levels may provide an additional early screening test for these diseases. Biological assaying of insulin is now facilitated by the IMx-Abbott kit, an enzyme immunoassay which does not cross-react with proinsulin and thus provides more specific insulin determination than conventional methods. Fasting insulin concentrations were determined in a population of 4,032 men and women 30 to 64 years of age, all volunteers for a medical check-up. Concentrations were slightly higher for men in all age-classes (median values of 5.9 and 5.4 microU/ml respectively for men and women). Although significant differences were found in serum insulin concentrations between the four age-classes for men and women, there were no significant differences between the three age-classes for men up to 59 years (median: 5.8 microU/ml, 95th percentile 14.0 microU/ml) or between the two age-classes for women up to 49 years (5.2, 12.5). Fasting concentrations were increased above these age thresholds: men (6.4, 15.6), women (5.6, 14.0). The reference population consisted of 3,081 non-diabetic, glycosuria-negative subjects with a body mass index and glucose concentration lower than the 95th percentiles for their age and sex. The reference values for fasting insulin concentrations were: 1) women 30-49 years: median 5.1 microU/ml (95% confidence interval: 4.9-5.3), 95th percentile 11.2 microU/ml (10.9-11.9); and 2) men 30-64 years and women 50-64 years: median 5.6 microU/ml (5.4-5.7), 95th percentile 12.6 microU/ml (12.0-13.0).
Adult↗
Risk factors and their identification second part: study designs for identification of risk factors.
This is the second a series of three articles which reviews the identification of risk factors of a disease, here: diabetes or complications of diabetes. In the first of the series [1], we gave the definition of a risk factor, along with measures of its force-relative risk and odds ratio, followed by the epidemiological definitions of the diseases: diabetes, coronary heart disease and hypertension. Risk factors were further discussed and we completed the discussion by some observations on the bias which can arise from a study or from its analysis, which can lead the researcher to the wrong conclusion. In this second article we define the three types of epidemiological studies which are used to determine whether factors are associated with a disease: observational or cross-sectional studies, cohort studies and casecohort studies. Examples are provided of each of these study types; their advantages and disadvantages are discussed. The final paper will provide some examples of the identification of risk factors from the literature. The first example involves diabetes and pancreatic cancer, the second birth weight and non-insulin dependent diabetes. Having found an association between a risk factor and diabetes, we will discuss whether it can be considered to be a risk factor, and if so whether it is likely to be a cause of the disease.
Case-Control Studies↗
Risk factors and their identification. First Part: What is a risk factor?
This series of three articles reviews the designs of studies which can be used to identify risk factors of a disease, here: diabetes or complications of diabetes. In the present issue of Diabete & Metabolisme, the first article of the series, we give the definition of a risk factor, along with measures of its force--relative risk and odds ratio, followed by the epidemiological definitions of the diseases: diabetes, coronary heart disease and hypertension. Risk factors are further discussed and we complete the discussion by some observations on the bias which can arise from a study or from its analysis, which can lead the researcher to the wrong conclusion. The three types of epidemiological studies which are used to determine whether factors are associated with a disease: observational or cross-sectional studies, cohort studies and case-cohort studies will be described in the second of the series in the next issue of the journal. Examples will be provided of each of these study types; their advantages and disadvantages will be discussed. In a third issue, the final paper will provide some examples of the study types and the identification of risk factors. The first examples involve diabetes and pancreatic cancer, the second birth weight and non-insulin dependent diabetes. Having found an association between a risk factor and diabetes, then we will discuss whether it can be considered to be a risk factor and if so and whether it is likely to be a cause of the disease.
Adult↗
Prevalence of non-insulin dependent diabetes as perceived by general practitioners in France.
A representative, random sample of French general practitioners, reported the number of diabetic patients they treated in their practices. The resulting NIDDM prevalence rate for France was 1.71% (SE +/- 0.03), compatible with the rates found in other studies. Prevalence rates for NIDDM were also calculated by region and a multivariate covariance model was used to correlate the prevalence with known risk factors. The three significant factors were: the quantity of wine consumed, the female/male sex ratio of people over 45 years of age, both positively correlated, and the consumption of animal fats, which was negatively correlated with NIDDM prevalence.
Aged↗