Essay on "Evidence for Association Between Type 2 Diabetes"

Essay 9 pages (4051 words) Sources: 10

[EXCERPT] . . . .

Type 2 Diabetes

and intake of Fruits and Vegetables

Diabetes Mellitus has become one of the major chronic diseases affecting more than 220 million people around the world. [WHO, 2009] In Australia too the incidence of diabetes is on the rise with current estimates indicating that more than 1.7 million people are affected by the condition. Of these more than 85 to 90% are type 2 diabetes and on an average 275 people are diagnosed with diabetes everyday. [Diabetes Australia, (2010)] What is more alarming is the increasing prevalence of type 2 diabetes among younger generation. However, it is believed that healthy eating habits, active lifestyles and effective blood glucose control can help prevent up to 60% of type 2 diabetes cases. [Diabetes Australia] Healthy eating, in particular, regular consumption of fruits and vegetables have been regarded as highly protective of type 2 diabetes. This paper focuses on several studies pertaining to this association between fruits and vegetables intake and its effect on Type 2 diabetes. A brief overview and analysis of the studies would provide more insight into this important health topic.

Sargeant et.al (2001)

Sargeant et.al (2001) is one of the rare cross sectional studies to analyze the relationship between the frequency of fruits and vegetable intake and glycosylated Hemoglobin HbA1C levels. This study was conducted from 1993 to 1998 and all the subjects were asked to complete a comprehensive Health and Lifestyle questionnaire. The study subjects were recruited from the European Prospective Investigation into Cancer (EPIC Norfolk ) database. A total of 6089 subjects who completed HbA1C ass

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essment were asked to answer the health and lifestyle questionnaires. Statistical analysis including variance analysis (ANOVA), t-tests comparisons and chi-square tests were performed on the gathered data.

It was deduced that participants who reported very low or no consumption of fruits and vegetables had the highest mean HbA1C values of 5.49 (0.67) among men and 5.40 (0.63) among women. The similar ratios for those reporting high consumption (5 or more times per week) are 5.34 (0.75) for men and 5.31(0.64) for women. Plasma vitamin C levels are also significantly different between the high and low consumption groups for both sexes. 50.9 (18.1) vs. 33.9 (19.2) for men and 61.3 (19.0) vs. 41.7 (23.3) for women. The mean HbA1C values calculated based on the vegetable consumption also reflected a similar pattern. The HbA1C values for those consuming five or more times was 5.36 (0.71) vs. 5.49 (0.60) for the low or no consumption group. Overall it was obvious that participants with the least intake of fruits and vegetables had the highest mean HbA1C values. Even after adjusting for dietary supplements, age, BMI, alcohol and smoking habits, etc. The differences in HbA1C was significant at 5.35 (0.01) for the high consumption group vs. 5.47 (0.05) for the low or no consumption group. Overall, this cross sectional study suggests that fruits and vegetables have a positive effect on glucose metabolism. The higher plasma vitamin C levels (50.9 (18.1) vs. 33.9 (19.2)) and dietary fiber levels (20.1 (6.2) vs. 13.3 (4.8)) in the high consumption group suggests that these may have a role to play. [Sargeant et.al (2001)]

The study authors did not find a significant difference in HbA1C values even after adjusting for vitamin C and dietary fibers and so Vitamin C and dietary fibers could not clearly explain the results. The authors conclude that other components in fruits and vegetables (flavanoids and other secondary metabolites) may be involved in the protective role. This study is significant because of the large sample size and for the proven association between fruits and vegetable intake on reducing glycosylated Hemoglobin levels which is a marker for type 2 diabetes.

Montonen Et.al (2005)

This cohort study recruited participants from the Finnish mobile clinic health examination survey. In all, a total of 4304 men and women aged between 40 and 69 from 30 different communities in Finland were followed up for a period of 23 years. In this population group, the researchers studied the effects of different foods such as Green vegetables, fruits and berries, oil and margarine and poultry and their effect on the incidence of type 2 diabetes. Dietary patterns were gathered using dietary history interview by trained interviewers. Cox Model was used to calculate the relative risk RR for the different quartiles of consumption of the different food items. The following were the data for the RR of developing diabetes between the highest and lowest consumption. 0.69 (95% confidence interval (CI)1/40.50 -- 0.93; P. For trend (P)1/40.02) for green vegetables, 0.69 (CI1/40.51 -- 0.92; P1/40.03) for fruit and berries, 0.71 (CI1/40.52 -- 0.98; P1/40.01) for margarine and oil, and 0.71 (CI1/40.54 -- 0.94; P1/40.01) for poultry. [Montonen Et.al (2005)] The study also revealed that RR for consumption of potatoes was high at RR = (1.42). This study clearly shows an inverse relationship between the prudent diet choice of green vegetables, fruits and berries, oil and margarine and poultry with the risk of developing T2D. The only major shortcoming of the study is that there is no way of identifying diabetics undergoing only dietary therapy in its subject pool. This would have affected the estimation of the relationship between food intake and diabetes risk.

Villegas et.al (2008)

This population-based prospective cohort study analyzed 64,191 women in the age group of 40 to 70 drawn from the Shanghai Women's Health Study (SWHS) database. The participants were evaluated for their intake of vegetables and fruits using baseline food frequency questionnaires. (FFQ) The dietary information was again gathered at the follow up survey. During the follow up after 4.6 years 1608 participants reported diagnosis of diabetes. The researchers applied the Cox proportional hazards model to understand the association between fruit and vegetable intake and the incidence of type2 diabetes. Confounding variables such as age, BMI, WHR, total energy, meat intake, smoking status, physical activity etc. were adjusted for.

The relative risk (RR) comparing the lowest intake of vegetables across the various intake levels of vegetables was found to be 1.00, 0.74, 0.68, 0.72, and 0.72 (P-trend < 0.001) . The RR comparing the lowest intakes of fruit across the various intake levels was 1.00, 0.76, 0.79, 0.87, and 1.05 (P-trend 0.30). After adjusting for antioxidants, fiber, magnesium, etc. The RR for T2D across the different quintiles of vegetable consumption were 1.00, 0.71, 0.63, 0.63, and 0.56 (P-trend <.001). Thus study authors concluded that higher intake of vegetables was inversely associated with increased risk for T2D. The fact that adjusting for vitamin C, fiber, Magnesium and other confounding variables did not significantly alter the RR value for vegetable intake indicates these factors alone cannot explain the protective effect of vegetables. The authors presume that other vegetable components such as phytates, lignans, and isoflavones, etc. may also play an important role in T2D control action of vegetables. Like the previous study, this study also could not clearly define the mechanism of action by which vegetables impact glucose tolerance.

Anne et.al (2008)

Anne et.al (2008) studied the intake of fruits and vegetables and the related plasma Vitamin C levels and tried to ascertain if Plasma vitamin C level could be associated with the risk of T2D. This prospective population-based study also utilized the (European Prospective Investigation of Cancer -- Norfolk) EPIC database and a total of 21,831 subjects were recruited. Semi-quantitative food frequency questionnaires were used to gather data pertaining to the participants' intake of fruits and vegetables. The study participants were between 40 and 75 years of age (male and female). Their plasma vitamin C levels were measured at baseline and they were regularly followed up to analyze their fruit and vegetable intake. This exhaustive longitudinal study began in Feb 1993 and ended in Dec 2005. During this period a total of 735 clinical cases of diabetes were identified. Statistical analysis of the gathered information revealed some interesting facts. After adjusting for demographic and anthropometric variables it was found that the odds ratio of diabetes and the Plasma vitamin C levels was 0.38 (95% confidence interval, 0.28-0.52) clearly suggesting that Plasma vitamin C level is inversely associated with the risk for T2D. Similarly the Odds ratio of diabetes and highest intake levels of fruits and vegetables was 0.78 (95% confidence interval, 0.60-1.00) implying that fruits and vegetables intake have a protective effect. This study had a large sample size and so the results can be generalized across the population.

Bazzano et.al (2008)

A longitudinal cohort study by Bazzano et.al (2008) focused on the relationship between the consumption of fruits, vegetables and fruit juices on the development of Type 2 Diabetes. This study which began in 1984 followed 71, 346 healthy, non-diabetic, nurses over a period of 18 years and their dietary information was collected every 4 years using the Semi-quantitative Frequent food questionnaire. During the entire follow up period, a total of 4529 nurses in the subject pool reported as being diabetic. The Cox regression model was used to study the linear trends. The multivariate adjusted hazard ratio (HR)… READ MORE

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Quoted Instructions for "Evidence for Association Between Type 2 Diabetes" Assignment:

“

Critical review of evidence for association between Type 2 Diabetes

Mellitus and intake of fruit and vegetables.

Provide a written report (2000 words) summarising and appraising the evidence from

eight * studies that helps answer the following research question. What is the

association between Type 2 Diabetes Mellitus (T2DM) and fruit and vegetable intake?

These studies may relate to the role of fruit and vegetables in either the prevention or

the management of T2DM. Write a 500 word conclusion from this evidence including a

brief discussion of the quality (strengths and weaknesses) of the epidemiological

evidence that you have presented.

* 2 relevant studies will be reviewed in class tutorials in weeks 11 and 12 and can count

as 2 of the 8 studies that you summarise. In addition to the written summary you must

summarise each study using an evidence table which provides details of the sample,

exposure and outcome measures and key findings. Tables should be single spaced

Maximum length is 2000 words for the study summary plus 500 words for an overall

conclusion. The content of the table will not contribute to the total word count but you

must use the table effectively to complement your text.

You must also hand in a photocopy of the abstract of each of the papers you choose to

review, with full reference for the paper.

Guidelines for Assessment Task:

This task requires you to provide a list of primary papers (not review articles or text

book chapters) including full bibliographic details, a short summary of the content and

critique/appraisal of each of the papers. This requires you to summarise the content of

the paper in condensed form and provide some interpretation and evaluation of the

evidence provided in the paper. You need to decide what are the key points/findings of

the paper in the context of the assessment task and present these main ideas, in your

own words. It is important to be as concise as possible, to provide the essential details

in as few words as possible.

Where available you should use at least two examples from each of the major

categories of epidemiological study designs, that is cross-sectional, case-control,

longitudinal cohort and randomised control trial. If a category of design is not available

you should substitute additional studies from another design category. In addition you

should provide a statement giving reasons why the missing study design has not been

used in this context

You need to

Provide full bibliographical details of each study in Harvard format

Describe the content, the main aim of the study, the central hypothesis, the

subjects/population and methods used (including study design) and the

relevant exposures and outcomes and conclusions.

o It is important to give size and direction of effect and measures of

statistical significance. For example do not just say the intervention

group had a higher incidence of an outcome, say how much higher and

provide details of the level of confidence around this estimate or the p

value. Provide odds ratios (OR) or relative risk ratios (RR) and the 95%

confidence intervals. Imagine that the assessor has not read the text and

in many cases they will not have done so

An***** the strengths and limitations of the evidence. Consideration of study

design/type, assessment of exposures and outcomes, and potential for bias and

confounding will be an important component of analysis

Evaluate the overall quality of the evidence and the conclusion drawn by the

authors. If a paper reports different results or conclusions to other studies that

you have reviewed try to identify some factors that may explain the different

results.

Ensure you focus on the particular research question identified in the

assessment task.

In your conclusion consider the overall strength and consistency of the evidence

across the different study types. What recommendations would you make on the

basis of the evidence that you have reviewed?

Managing your time

This is a large assignment task and you do not want to leave it until the end of

semester before you start working on this task.

Week 4 By the end of this week you should have sufficient understanding of the

research question, the terms exposure and outcome and the study

design types to be able to start your literature search to identify suitable

studies which address the research question

Week 7 By the end of this week you should have a sufficient understanding of

disease frequency and effect size, and errors, confounding and bias

to be able to start your written summary of the individual studies

Week 10 By the end of this week you will have had some practice in summarising a

study in an evidence table

Useful references:

Greenhalgh, P. How to read a paper: Getting your bearings (deciding what the paper is

about). http://bmj.bmjjournals.com/cgi/content/full/315/7102/243

Langseth L. Nutritional epidemiology: Possibilities and limitations. ILSI Europe 1996

Margetts, M and Nelson, M. Design Concepts in Nutritional Epidemiology, 2nd Ed.

Oxford Medical Publications, 1997.

Beaglehole, R and Bonita R. Kjellstrom. Basic Epidemiology. WHO, 2000, Geneva.

Sempos et al Am J Clin Nutr 1999; 69 (suppl): 1330S-8S

(Whole supplement is devoted to nutritional epidemiology)

Assessment Criteria

1. Summary of evidence (30 marks)

Synthesises and integrates evidence, does more than describe studies

Relevant focus on and accurate presentation of the measures of dietary

exposure and outcomes

Sufficient study details, size and direction of effect

Good understanding of diet-disease link

Evidence of wide reading

2. Critical approach to individual studies (20 marks)

Considers strength and weaknesses of study design

Considers hierarchy of evidence

Considers overall quality of evidence

Justifies absence of study design if necessary

3. Overall conclusion & critical approach (10 marks)

Acknowledges controversy and limitations to overall quality of evidence

Clear conclusions, consistent with evidence presented

Considers broader nutrition implications

4. Evidence tables (5 marks)

Table structure well organised, logical, flows well, easy to follow

Tables stand alone

Provides sufficient detail of sample

Adequately defines exposure measure or intervention

Adequately defines outcome measure(s)

Provides sufficient detail of effect size and statistical significance

Provides additional comments, where appropriate

5. Presentation and Referencing (5 marks)

Adequate number and range of study designs

Study details and results referenced in the text

Adequate in-text citation

References cited in bibliography according to Harvard format

Well written according to normal academic standards

When you write this task : this my teacher*****'s notes.

- introduction

- summary study and description every study and you must write 200-250 words every study ( 8 studies) / so 8 studies paragraphs.

- conclusion ( summary all studies 500 words)

- One table for all 8 studies

- you reasearch 6 studies and add 2 studies . 2 studies and tables in my resources

There are main points: this my teacher*****'s notes

Assignment cor criteria

8 relevant primary studies

# Exposure:

- How measured?

-How quantified?

- How were comparion group categorised?

# Outcome:

- What?

- How measured?

# Effect size:

-Odds ratios

- Relative risk

-95% confidence intervals

I will add resources for lectures and articls and you can research like two sutdies in my resources . 2 studies as model when you reaserch you find the articles the first paper and find main point like this :

Objective: The consumption of different foods was studied for their ability to predict type II diabetes mellitus.

Design: The study design was a cohort study, based on the Finnish Mobile Clinic Health Examination Survey.

Setting: A total of 30 communities from different parts of Finland.

Subjects: A total of 4304 men and women, 40*****69 y of age and free of diabetes at baseline in 1967*****1972 and followed up for

incidence of diabetes medication during 23 y (383 incident cases).

Results: Higher intakes of green vegetables, fruit and berries, oil and margarine, and poultry were found to predict a reduced

risk of type II diabetes. The relative risks of developing type II diabetes between the extreme quartiles of the intakes were 0.69

(95% confidence interval (CI)Â¼0.50*****0.93; P for trend (P)Â¼0.02) for green vegetables, 0.69 (CIÂ¼0.51*****0.92; PÂ¼0.03) for fruit

and berries, 0.71 (CIÂ¼0.52*****0.98; PÂ¼0.01) for margarine and oil, and 0.71 (CIÂ¼0.54*****0.94; PÂ¼0.01) for poultry.

Conclusion: The results suggest that prevention of type II diabetes might be aided by consumption of certain foods that are rich

in nutrients with hypothesized health benefits.

European Journal of Clinical Nutrition (2005) 59, 441*****448. doi:10.1038/sj.ejcn.1602094

Published online 12 January 2005.... etc . >>>>>> you must see 2 studies in my resucese what I meaning

And you reaserch 6 studies and you summary every study 200 words for every study for 8 studies.

I will put my friend*****'s answer but my friend*****'s answer not comeplet you can just see it. I will give you Web.

I don*****'t know this report or essay, but I put my teacher*****'s notes.

when you write refrences for example:

In tex refrences

(Kelehare & MacDougall 2009, pp.3-16)

In the list refrences

Keleher, H & MacDougall, C 2009, *****'Understanding health*****', in H Keleher & C MacDougall (eds) , Understanding health a determinants approach, 2nd edn, Oxford University Press, Melbourne, pp.3-16.

Also ,

In tex refrence

(WHO 2010)

In the list

World Health Organisation 2010, Social determinants of health, n.d., viewed 18 April 2010,< http://www.who.int/social_determinants/en/>.

I have resources ( lectures) and I have an example from my friend*****'s answer that help you. you can ues it and make paraphrase

*****

*****

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