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Dairy product consumption and type 2 diabetes among Korean adults: a prospective cohort study based on the Health Examinees (HEXA) study
Jiaqi Zhang, Kyungjoon Lim, Sangah Shin
Epidemiol Health. 2022;44:e2022019.   Published online February 4, 2022
DOI: https://doi.org/10.4178/epih.e2022019
  • 9,030 View
  • 448 Download
  • 6 Web of Science
  • 7 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
It has been suggested that the consumption of dairy products helps lower the prevalence of type 2 diabetes (T2D). We investigated the association between the consumption of dairy products and T2D events in middle-aged Korean adults.
METHODS
We followed up 53,288 participants (16,895 male and 36,393 female) in the Health Examinees (HEXA) study. The consumption of dairy products was assessed using the self-administered food frequency questionnaire, and T2D was defined according to the 2015 treatment guidelines of the Korean Diabetes Association. Hazard ratios (HRs) and 95% confidence intervals (CIs) between the consumption of dairy products and the risk of T2D were calculated using Cox proportional hazards models after adjusting for potential confounders. Spline regression was used to better represent the association between the consumption of dairy products and the risk of T2D.
RESULTS
Among male, those with higher consumption of dairy products had a significantly lower risk of T2D than those who consumed essentially no dairy products (HR, 0.73; 95% CI, 0.58 to 0.91). In particular, consumption of yogurt (HR, 0.75; 95% CI, 0.60 to 0.93; p<sub>trend</sub>=0.035) and cheese (HR, 0.66; 95% CI, 0.49 to 0.89; p<sub>trend</sub>=0.005) was negatively associated with the incidence of T2D in male. In female, daily consumption of 1 serving of yogurt decreased the risk of T2D by 11%.
CONCLUSIONS
The association between the consumption of dairy products and the risk of T2D differed by sex and dairy product type. Further prospective studies are needed to confirm these associations.
Summary
Korean summary
본 연구는 한국인유전체역학조사사업의 도시코호트 기반조사와 추적조사에 참여한 40-69세 한국 성인 53 288명의 유제품 섭취와 제2형 당뇨병 발생 위험도를 분석하였다. 요거트와 치즈를 포함한 유제품 섭취가 많을수록 남성의 제2형 당뇨병 위험도가 낮아졌다. 요거트 섭취량을 하루에 한번 증가하면 여성의 제2형 당뇨병 위험도가 감소하다. 유제품 소비와 제2형 당뇨병의 위험도의 연관성은 성별과 유제품에 따라 다르다. 이를 확인하기 위해서는 추가 연구가 필요하다.
Key Message
The study aimed to assess the association between the consumption of dairy products and type 2 diabetes events in Korean adults. Data was from the Health Examinees Study among 53 288 participants. Higher consumption of dairy products including yogurt and cheese was associated with a lower risk of developing type 2 diabetes in men. Increasing yogurt intake by one serving/day reduces the risk of type 2 diabetes in women. The association between the consumption of dairy products and the risk of type 2 diabetes differed by gender and dairy product type. Further studies are needed to confirm this.

Citations

Citations to this article as recorded by  
  • Cheese consumption and multiple health outcomes: an umbrella review and updated meta-analysis of prospective studies
    Mingjie Zhang, Xiaocong Dong, Zihui Huang, Xue Li, Yue Zhao, Yingyao Wang, Huilian Zhu, Aiping Fang, Edward L. Giovannucci
    Advances in Nutrition.2023; 14(5): 1170.     CrossRef
  • Effect of Milk and Cultured Milk Products on Type 2 Diabetes: A Global Systematic Review and Meta-analysis of Prospective Cohort Studies
    Viswanathan Mohan, Kuzhandhaivelu Abirami, Valangaiman Sriram Manasa, Anandakumar Amutha, Balaji Bhavadharini, Rinky Rajput, Nagarajan Lakshmipriya, Chowdary Sruthi, Ranjit Mohan Anjana, Ranjit Unnikrishnan, Vasudevan Sudha, Kamala Krishnaswamy
    Journal of the Indian Institute of Science.2023; 103(1): 167.     CrossRef
  • Probiotic potential of fermented foods and their role in non-communicable diseases management: An understanding through recent clinical evidences
    A. Nithya, Sourav Misra, Chirasmita Panigrahi, Chandrakant Genu Dalbhagat, Hari Niwas Mishra
    Food Chemistry Advances.2023; 3: 100381.     CrossRef
  • Dairy intake and risk of type 2 diabetes: results of a large prospective cohort
    Shunming Zhang, Ge Meng, Qing Zhang, Li Liu, Hongmei Wu, Yeqing Gu, Xuena Wang, Juanjuan Zhang, Shaomei Sun, Xing Wang, Ming Zhou, Qiyu Jia, Kun Song, Yan Borné, Emily Sonestedt, Le Ma, Lu Qi, Kaijun Niu
    Food & Function.2023; 14(21): 9695.     CrossRef
  • Association of milk consumption with management and incidence of hypertension among South Korean adults: A prospective analysis of the health examinees study cohort
    Hyein Jung, Geongu Lee, Kyungjoon Lim, Sangah Shin
    Nutrition, Metabolism and Cardiovascular Diseases.2022; 32(11): 2515.     CrossRef
  • Association between dairy consumption and the risk of diabetes: A prospective cohort study from the China Health and Nutrition Survey
    Yucheng Yang, Xiaona Na, Yuandi Xi, Menglu Xi, Haibing Yang, Zhihui Li, Ai Zhao
    Frontiers in Nutrition.2022;[Epub]     CrossRef
  • Association of dairy consumption patterns with the incidence of type 2 diabetes: Findings from Alberta's Tomorrow Project
    Emad Yuzbashian, Mohammadreza Pakseresht, Jennifer Vena, Catherine B. Chan
    Nutrition, Metabolism and Cardiovascular Diseases.2022; 32(12): 2760.     CrossRef
Effects of early medication treatment and metformin use for cancer prevention in diabetes patients: a nationwide sample cohort study in Korea using extended landmark time analysis
Hwa Jeong Seo, Hyun Sook Oh
Epidemiol Health. 2021;43:e2021103.   Published online December 17, 2021
DOI: https://doi.org/10.4178/epih.e2021103
  • 7,210 View
  • 183 Download
  • 4 Web of Science
  • 2 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study investigated the effectiveness of early medication treatment and metformin use for cancer prevention in type 2 diabetes patients.
METHODS
Population-based cohort data were used from the Korean National Health Insurance Service-National Sample Cohort database (KNHIS-NSC) for 2002-2013. Patient-specific medication prescription status was defined by the landmark time (LMT; a fixed time after cohort entry), considering both pre- and post-LMT prescriptions to control methodological biases in observational research. The LMT was set to 2 years. Logistic regression analysis with multivariable adjustment was conducted to analyze cancer incidence by patient-specific medication prescription status.
RESULTS
Only 33.4% of the subjects were prescribed medication early (before the LMT) with compliance. Cancer incidence in individuals with early prescription and compliance was 25% lower (odds ratio [OR], 0.75; 95% confidence interval [CI], 0.67 to 0.84) than in those without. As early-prescribed medications, metformin monotherapy and metformin combination therapy were associated with 34% (OR, 0.66; 95% CI, 0.51 to 0.83) and 25% (OR, 0.75; 95% CI, 0.64 to 0.88) lower cancer risk than non-use, respectively. Patients who were prescribed late (post-LMT) but did not comply with the prescription had a 24% (OR, 1.24; 95% CI, 0.97 to 1.58) higher cancer incidence than non-users. Among patients who started monotherapy early without changes throughout the entire follow-up period, those who started on metformin had a 37% (OR, 0.63; 95% CI, 0.41 to 0.99) lower risk of cancer than non-metformin users.
CONCLUSIONS
Doctors must prescribe antidiabetic medication early, and patient compliance is required, regardless of the prescription time, to prevent cancer. Metformin monotherapy or combination therapy is recommended as an early prescription.
Summary
Korean summary
당뇨 환자는 암 발병 위험이 높으며 암은 주요 사망 원인이다. 당뇨환자의 암발생 예방을 위한 관리로서, 당뇨병 진단 후 약물 치료 시기에 대한 연구는 부족하다. 또한, 전 세계적으로 가장 흔히 처방되는 당뇨병 치료제인 메트포민은 암 예방 효과가 있다고 알려져 왔으나 관측연구에서 발생하는 선택 편향의 문제가 제기되었고, 최근 일부 연구에서 기존의 암 예방 효과와 상충되는 결과가 나오고 있어 논쟁이 이어지고 있다. 본 연구는 선택 편향을 통제한 코호트 연구에서 조기 약물 치료와 메트포민 사용이 당뇨환자의 암 예방에 효과적임을 밝혔다. 따라서 의사들은 처음 당뇨 진단을 받은 환자에게 조기에 약물 처방을 하고, 환자들은 처방에 잘 따라야 한다. 조기 처방 약물로서 메트포민이 권장된다.
Key Message
Diabetic patients have a high risk of developing cancer, and cancer is the leading cause of death. There are few studies on the timing of medication treatment after diagnosis of diabetes. In addition, metformin, the most commonly prescribed diabetes treatment worldwide, is known to have cancer-preventive effects, but the problem of selection bias that occurs in observational studies has been raised, and some studies have recently been contradicting the existing cancer-preventing effects of metformin. This study, in a cohort study controlled for selection bias, demonstrated that early medication treatment and metformin use were effective in preventing cancer in diabetic patients.

Citations

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  • Metformin and HER2-positive breast cancer: Mechanisms and therapeutic implications
    Sara S Bashraheel, Hadeel Kheraldine, Sarah Khalaf, Ala-Eddin Al Moustafa
    Biomedicine & Pharmacotherapy.2023; 162: 114676.     CrossRef
  • Effects of millimeter-wave for preventing joint stiffness in the immobilized knee rat model
    Xiao-ping Shui, Feng Ye, Chun-ying Li, Xin Zhang, Min-jia Wang, Bin Li, Ke Chen, Ying-ying Liao
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Systematic Review
The effect of peer support in diabetes self-management education on glycemic control in patients with type 2 diabetes: a systematic review and meta-analysis
Akhmad Azmiardi, Bhisma Murti, Ratih Puspita Febrinasari, Didik Gunawan Tamtomo
Epidemiol Health. 2021;43:e2021090.   Published online October 22, 2021
DOI: https://doi.org/10.4178/epih.e2021090
  • 10,137 View
  • 262 Download
  • 9 Web of Science
  • 13 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Diabetes self-management education (DSME) programs are a strategy to maintain healthy behaviors. Nevertheless, limited evidence has been reported from systematic evaluations of the effects of DSME integrated with peer support on glycemic control. This study aimed to review the effectiveness of DSME interventions integrated with peer support on glycemic control in patients with type 2 diabetes.
METHODS
A systematic search was carried out in electronic databases, including PubMed, Cochrane Library, ProQuest, SpringerLink, ScienceDirect, Scopus, and Google Scholar, for English-language articles published from 2005 until 2020. The effect size was estimated as the standard mean difference (SMD). The Cochrane Collaboration’s Risk of Bias tool was employed to assess the risk of bias.
RESULTS
Twelve studies were included in this study. DSME integrated with peer support effectively reduced glycated hemoglobin A1c (HbA1c) levels, with a statistically significant effect (SMD, -0.41; 95% confidence interval [CI], -0.69 to -0.13; p<0.001). Programs with a sample size <100 (SMD, -0.45; 95% CI, -0.79 to -0.11; p=0.009), duration of intervention ≤6 months (SMD, -0.52; 95% CI, -0.96 to -0.07; p=0.020), baseline HbA1c <8.5% (SMD, -0.42; 95% CI, -0.77 to -0.07; p=0.020), delivery by group (SMD, -0.28; 95% CI, -0.51 to -0.06; p=0.010), and high frequency of contact (SMD, -0.29; 95% CI, -0.48 to -0.10; p=0.003) had statistically significant effects on reducing HbA1c levels in patients with type 2 diabetes.
CONCLUSIONS
DSME integrated with peer support effectively enhances glycemic control in patients with type 2 diabetes. Programs with smaller participants groups, shorter interventions, weekly meetings, and closer group sessions improved glycemic control in patients with type 2 diabetes.
Summary
Key Message
We reviewed and assessed the quality of the twelve articles included in this systematic review and meta-analysis. The findings of this review show that peer support integrated with diabetes self-management education programs can significantly enhance glycemic control in type 2 diabetes patients. Peer support is a critical component of a successful diabetes self-management programme in patients with type 2 diabetes. interventions programme with smaller groups, shorter durations, lower HbA1c baseline levels, group sessions, and high frequencies of sessions significantly enhanced glycemic control.

Citations

Citations to this article as recorded by  
  • Impact of Diabetes Self-Management Education on A1C Levels Among Black/African Americans: A Systematic Review
    Hilda M. Okeyo, Martha Biddle, Lovoria B. Williams
    The Science of Diabetes Self-Management and Care.2024; 50(1): 87.     CrossRef
  • The effects of diabetes clubs on peer-support, disclosure of diabetes status, and sources of information regarding diabetes management: results of a pilot-intervention in rural Vietnam
    D.W. Meyrowitsch, N.-A. Thi Dang, T.V. Phong, J. Nielsen, J. Søndergaard, N.D. Cuong, H. Le Minh, T.K.D. Vu, I.C. Bygbjerg, T.M. Gammeltoft, N.D. Thanh
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    Ian Litchfield, Tim Barrett, Julian Hamilton-Shield, Theresa Moore, Parth Narendran, Sabi Redwood, Aidan Searle, Suma Uday, Jess Wheeler, Sheila Greenfield
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Original Articles
Associations between diabetes self-management and microvascular complications in patients with type 2 diabetes
Fatemeh Mehravar, Mohammad Ali Mansournia, Kourosh Holakouie-Naieni, Ensie Nasli-Esfahani, Nasrin Mansournia, Amir Almasi-Hashiani
Epidemiol Health. 2016;38:e2016004.   Published online January 25, 2016
DOI: https://doi.org/10.4178/epih.e2016004
  • 18,470 View
  • 290 Download
  • 32 Web of Science
  • 24 Crossref
AbstractAbstract PDF
Abstract
OBJECTIVES
Diabetes is a major public health problem that is approaching epidemic proportions globally. Diabetes self-management can reduce complications and mortality in type 2 diabetic patients. The purpose of this study was to examine associations between diabetes self-management and microvascular complications in patients with type 2 diabetes.
METHODS
In this cross-sectional study, 562 Iranian patients older than 30 years of age with type 2 diabetes who received treatment at the Diabetes Research Center of the Endocrinology and Metabolism Research Institute of the Tehran University of Medical Sciences were identified. The participants were enrolled and completed questionnaires between January and April 2014. Patients’ diabetes self-management was assessed as an independent variable by using the Diabetes Self-Management Questionnaire translated into Persian. The outcomes were the microvascular complications of diabetes (retinopathy, nephropathy, and neuropathy), identified from the clinical records of each patient. A multiple logistic regression model was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) between diabetes self-management and the microvascular complications of type 2 diabetes, adjusting for potential confounders.
RESULTS
After adjusting for potential confounders, a significant association was found between the diabetes self-management sum scale and neuropathy (adjusted OR, 0.64; 95% CI, 0.45 to 0.92, p=0.01). Additionally, weak evidence was found of an association between the sum scale score of diabetes self-management and nephropathy (adjusted OR, 0.71; 95% CI, 0.47 to 1.05, p=0.09).
CONCLUSIONS
Among patients with type 2 diabetes, a lower diabetes self-management score was associated with higher rates of nephropathy and neuropathy.
Summary

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Comparison of Prevalence of Metabolic Syndrome Between Korean Emigrants and Host Country Residents in Japan and China-The Korean Emigrant Study
Myung-Hee Shin, Mi Kyung Kim, Zhong Min Li, Hyun-Kyung Oh, Soo Ryang Kim, Miyuki Taniguchi, Jinnv Fang
Epidemiol Health. 2010;32:e2010005.   Published online May 7, 2010
DOI: https://doi.org/10.4178/epih/e2010005
  • 15,622 View
  • 116 Download
  • 4 Crossref
AbstractAbstract PDF
Abstract
<sec><title>OBJECTIVES</title><p>This study aims to compare the prevalence of metabolic syndrome between Korean emigrants (KEs) and their host country residents in Japan and China.</p></sec><sec><title>METHODS</title><p>The Korean Emigrant Study (KES) is a cohort study initiated in 2005 to elucidate the effect of genetic susceptibility and environmental change on hypertension, diabetes, and metabolic syndrome. Equal numbers of KEs and host country residents, aged 30 or over, were recruited from three regions; Kobe-Osaka in Japan (total number=965), Yanbian in China (n=1,019), and Changchun in China (n=949).</p></sec><sec><title>RESULTS</title><p>The age-adjusted prevalences of metabolic syndrome among KEs in Kobe-Osaka were significantly higher than those among Japanese (in men 24.0% vs. 15.6%, p=0.04, in women 8.4% vs. 2.7%, p=0.01), while the age-adjusted prevalences among KEs in Changchun were similar to those among Chinese (in men 11.7% vs. 16.1%, p=0.37, in women 28.3% vs. 30.1%, p=0.91). The age-adjusted prevalences were generally higher in Yanbian than other regions, and KEs had higher prevalence than Chinese in men but not in women (in men 37.9% vs. 28.3%, p=0.03, women 46.0% vs. 50.6%, p=0.44). The components with significant ethnic differences in prevalence were high blood pressure and abdominal obesity in Japan, and triglyceride in China. The most influential component in diagnosing metabolic syndrome was abdominal obesity in men and triglyceride in women.</p></sec><sec><title>CONCLUSION</title><p>The prevalence of metabolic syndrome was higher in KEs than in host country residents in Japan but not in China. Abdominal obesity and triglyceride are both discriminating and influential components in metabolic syndrome.</p></sec>
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The association between insulin resistance and Framingham risk score among type 2 diabetes.
Hee Sook Park, Ji Eun Yun, Soo Jin Yoon, Eurin Cho, Kyung A Ahn, Seok Won Park, Chul Woo Ahn, Dae Jung Kim, Young Duk Song, Young Ju Choi, Mi Ae Cho, Eun Jig Lee, Kap Bum Huh, Sun Ha Jee
Korean J Epidemiol. 2007;29(1):46-58.
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Abstract
BACKGROUND
AND PURPOSE: Insulin resistance has been known to be associated with the risk of cardiovascular diseases. However, the relationship with Framingham risk score among type 2 diabetes has not been well known. We investigated the relationship between insulin resistance (IR) and the Framingham risk score(FRS) among type 2 diabetes in Korea.
METHODS
We estimated the 5-year risk of ischemic heart disease(IHD) based on Framingham equation among 1,941 diabetes patients(1,294 men and 647 women), who visited Huh's clinic, enrolled from January 2003 to June 2006. IR, which was measured by insulin tolerance test (ITT), was divided into five groups(Q1 to Q5). High risk of IHD was defined as upper 10 percentile of FRS. Multivariate regression and logistic regression models were used to see independent association of higher quintiles of IR level, compared with lowest quintile(Q1) for the risk of IHD.
RESULTS
Mean (+/-standard deviation) 5-year FRS of study subjects were 8.40%(+/-6.89) for men and 5.92%(+/-5.23) for women. There were significant correlation between IR, body mass index, HbA1C, fasting glucose, triglyceride, LDL-cholesterol, C-peptide and FRS in both men and women. After adjusting for triglyceride, LDL-cholesterol, C-peptide, multivariate regression model analysis showed that IR was independently associated with the FRS. A positive association between IR and high risk of IHD was observed in men: highest versus lowest quintile of IR (odds ratio 5.45 in men and 4.71 in women).
CONCLUSION
Increased IR level was independently associated with risk of IHD measured by FRS among type 2 diabetes in Korea.
Summary
Risk Factors of Impaired Fasting Glucose and Type 2 Diabetes Mellitus: Using Datamining.
Jongseon Ryu, Soonduck Kim, Jongsoon Park, Jesuk Lee
Korean J Epidemiol. 2006;28(2):138-151.
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Abstract
PURPOSE
This study aimed to contribute to overall public health by examining the prevalence rates of impaired fasting blood glucose and type 2 diabetes mellitus and developing a model to predict high risk factors for impaired fasting blood glucose and type 2 diabetes mellitus.
METHODS
The 1998 Public Health Nutrition Survey data was used for this study. Subjects were 7,702 adult at the age of 20 or over. The frequency analysis, chisquared test was performed. A decision tree was utilized to define a model designed to predict high risk factors for impaired fasting glucose and type 2 diabetes mellitus.
RESULTS
The prevalence rates of impaired fasting blood glucose was 10.8% and prevalence rates of type 2 diabetes mellitus was 9.4%. The decision tree analysis exhibited that age was strong factors for impaired fasting blood glucose. HDL cholesterol and kind of economic activities were high risk factors for impaired fasting blood glucose and type 2 diabetes mellitus on those in 20s. BMI, total cholesterol level, marriage status, sex for impaired fasting blood glucose and type 2 diabetes mellitus on those in 30s. The total cholesterol level, drinking and waist size were identified as risk factors on those in 40s. BMI, education level and hypertension seemed to have an impact on those in 50s. The waist size, sex and income had an impact on those in 60s.
CONCLUSIONS
This study underscores the need for the public health infrastructure to improve various health promotion programs for those who have risk factors for impaired fasting blood glucose and type 2 diabetes mellius. The implementation of effective nutrition, workout and anti-drinking programs will boost public health.
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Epidemiol Health : Epidemiology and Health