Patrick Campbell

A new study from a team at Brigham and Women’s Hospital and Harvard Medical School details the benefit of adhering to a Mediterranean diet for preventing 

Results of the study, which assessed impact of dietary choices in a cohort of 25,000 women over 20 years, indicate greater adherence to a Mediterranean diet was associated with a 30% lower risk of type 2 diabetes.

"Our findings support the idea that by improving their diet, people can improve their future risk of type 2 diabetes, particularly if they are overweight or have obesity," said study investigator Samia Mora, MD, MHS, of the Brigham's divisions of Preventive Medicine and Cardiovascular Medicine and an associate professor at Harvard Medical School, 

. "A lot of the benefit we see can be explained through just a few pathways. And it's important to note that many of these changes don't happen right away -- while metabolism can change over a short period of time, our study indicates that there are longer term changes happening that may provide protection over decades."

With an interest in closing the knowledge gap related to diabetes onset and nutrition, investigators designed their study as an analysis of data from the Women’s Health Study. From the study, which included 28,345 women who voluntarily provided blood samples, investigators identified 25,317 women for inclusion in their study.

All patients included in the current study were free of diabetes and had completed validated semiquantitative food-frequency questionnaires, which assessed intake of 131 food items, at baseline. The mean age of the study population was 52.9 (9.9) years and they had a mean follow-up time of 198 (5.8)years.

For the purpose of the analysis, Mediterranean intake scores ranging from 0-9 were calculated for each patient. The primary endpoint of the study was incident cases of type 2 diabetes. Investigators also hoped to assess what proportion of risk reduction was explained by risk factors and biomarker changes.

Upon analysis, investigators found scores of 6 or more were associated with as much as a 30% lower risk of developing type 2 diabetes (age-adjusted and energy-adjusted HR, 0.70; 95% CI, 0.62-0.79; when regression models were additionally adjusted with BMI: HR, 0.85; 95% CI, 0.76-0.96) compared to those with scores of 3 or less. Further analysis indicated biomarkers of insulin resistance were responsible for the largest proportion of risk reduction (65.5%), followed by BMI (55.5%), high-density lipoprotein measures (53.0%), and inflammation (52.5%). Results suggested smaller contributions were linked to changes in branched-chain amino acids (34.5%), very low-density lipoprotein measures (32.0%), low-density lipoprotein measures (31.0%), blood pressure (29.0%), and apolipoproteins (23.5%)—changes in HbA1c accounted for less than 2% of the risk reduction.

In potshot analyses, investigators found the inverse associations of adherence to a Mediterranean diet and type 2 diabetes was only present in women with a BMI of 25 or greater at baseline (age- and energy-adjusted HR, 1.01; 95% CI, 0.77-1.33; 

"Most of this reduced risk associated with the Mediterranean diet and type 2 diabetes was explained through the biomarkers related to insulin resistance, adiposity, lipoprotein metabolism and inflammation," said study investigator Shafqat Ahmad, PhD, a researcher in the Molecular Epidemiology Unit at Uppsala University, Sweden, in the aforementioned statement. "This understanding may have important downstream consequences for the primary prevention of diabetes disease."

Association of the Mediterranean Diet With Onset of Diabetes in the Women’s Health Study

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An analysis of data from more than 25k women suggests greater adherence to a Mediterranean diet was linked to a lower risk of developing diabetes.  

Mediterranean Diet Linked to 30% Lower Diabetes Risk in Women

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Results from an analysis of data from the Women’s Health Initiative is detailing the impact of increased sedentary behavior on heart failure risk in older women.

Results of the study suggest women spending 9.5 hours or more sitting or lying down each day had a 42% higher risk of being hospitalized with heart failure than women who spent 6.5 hours or less engaged in sedentary behavior, underlining the importance of emphasizing physical activity in aging patients.

"For heart failure prevention, we need to promote taking frequent breaks from prolonged sitting or lying down, in addition to trying to achieve guideline levels of physical activity, such as those recommended by the American Heart Association," said lead investigator Michael LaMonte, PhD, MPH, research associate professor of epidemiology in the School of Public Health and Health Professions at the University at Buffalo, in a 

statement from the American Heart Association

. "Very few studies have been published on sedentary time and heart failure risk, and even fewer have focused on older women in whom both sedentary behavior and heart failure are quite common."

With a knowledge gap related to associations of heart failure and sedentary behavior in older patient populations, LaMonte and a team of colleagues from institutions across the US designed their study with the aim of determining the impact of sedentary behaviors on heart failure risk in older women. Investigators designed their study as a prospective analysis of data from the Women’s Health Initiative, which contains data on more than nearly 90,000 postmenopausal women.

Eliminating women with heart failure at enrollment and those with the inability to walk one block without assistance, investigators identified a cohort of 80,982 women aged 50-79 years for inclusion in their analysis. Women included in the study were also required to have completed questionnaires, which included assessments of sedentary behavior, at baseline and years 3, 6, and 9.

Sedentary behavior was assessed using 2 questions. The first question assessed how many hours per day were spent sitting, including time at work, sitting at the table eating, driving or riding a car or bus, and sitting up watching TV or talking. The second question assessed how many hours per day were spent lying down or with their feet up, including time spent sleeping or trying to sleep at night, resting or napping, and lying down watching TV. Respondents were given 8 response options ranging from less than 4 hours to 16 or more hours per day.

The mean age of the study cohort was 63 years, 84.9% were White, 45% reported menopausal therapy use, and the mean reported time spent engaging in sedentary behavior per day was 7 hours. Investigators pointed out 11% of patients reported no recreational physical activity. A total of 1402 incident cases of heart failure hospitalization were observed over a mean follow-up of 9 years.

For the purpose of analysis, women were categorized according to sedentary time. These groups were defined as having less than 6.5, 6.6-9.5, or more than 9.5 hours per day of time spent sitting or lying down and, for additional analysis, as 4.5 or less, 4.6-8.5, or more than 8.5 hours per day spent sitting. Of note, the groups spending less than 6.5 hours per day sitting or lying down and those spending 4.5 or less hours per day sitting were used as reference groups.

When controlling for confounding factors, including age, race-ethnicity, education, income, smoking, alcohol, menopausal hormone therapy, and hysterectomy status, results of the analysis indicated heart failure risk increased across incremental trestles of total sedentary behavior ([6.6-9.5 hours: HR, 1.15; 95% CI, 1.01-1.31], [More than 9.5 hours: HR, 1.42; 95% CI, 1.25-1.61], 

 for trend <.001) and sitting time ([4.6-8.5 hours: HR, 1.14; 95% CI, 1.01-1.28], [More than 8.5 hours: HR, 1.54; 95% CI, 1.34-1.78], 

for trend<.001) compared to reference groups.

Further analysis indicated these trends remained significant after adjusting for additional factors, such as time-varying myocardial infarction and coronary revascularization (Total sedentary behavior HRs, 1.00, 1.11, 1.27; sitting HRs, 1.00, 1.09, 1.37; trend 

<.001 each) and for baseline physical activity (Total sedentary behavior HRs, 1.00, 1.10, 1.24; sitting HRs, 1.00, 1.08, 1.33; trend 

<.001 each). Investigators pointed out associations with sedentary behavior exposures did not differ based on age, race-ethnicity, BMI, physical activity, physical functioning, diabetes, hypertension, or coronary heart disease.

"These findings are consistent with other studies confirming that people with more daily sedentary time are more likely to develop chronic health conditions such as diabetes, high blood pressure, heart attack, stroke and premature death from heart disease and other causes," LaMonte added.

Association of Sedentary Time and Incident Heart Failure Hospitalization in Postmenopausal Women,

An analysis of data from the Women's Health Initiative suggests spending more than 6.5 hours engaged in sedentary behaviors each day was linked to a 42% increase in risk of heart failure in older women.

Increased Sedentary Behavior Raises Heart Failure Risk in Women

Improving treatment and diagnosis of osteoporosis is an issue that clinicians have been attempting to address for years. Unfortunately, what many specialists consider to be the most effective treatments can come with the potential for adverse side effects. However, some of these same specialists argue the risk of adverse events is sometimes misunderstood or overblown.

With an interest in learning more about this issue and the use of biphosphonates in treatment of osteoporosis, we reached out to Jeffrey Curtis, MD, MS, MPH, a professor of medicine at the University of Alabama at Birmingham.

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Jeffrey Curtis, MD, MS, MPH, details how the perception of biphosphonates has been detrimental to efforts to improve treatment and diagnosis of osteoporosis.

Controversies in Using Biphosphonates for Treating Osteoporosis 

While politics in medicine may seem like a new trend in 2020. Some clinicians will tell you bluntly, there are a lot of politics going on in medicine. One of the areas where lines have been blurred the most in recent memory is the field of diabetes care.

In the year 2000, the thought of somebody besides an endocrinologist taking lead in the treatment of diabetes might have been a laughable notion, but now it is a serious discussion with input from a slew of parties. While everyone has their own opinion, there are multiple facts to account for when discussing the topic.

As it stands, endocrinologists are in short supply, they treat dozens of conditions, and the number of patients with diabetes is growing. Just based on this alone, some would suggest an intervention, such as the creation of a new subspecialty, is already overdue. However, many endocrinologists would argue they are still the best equipped to treat these patients and arguing for the creation of a cardiometabolic subspecialty only detracts from endocrinology as a field.

In this 3-part feature series, we attempt to tackle to topic from the perspective of the 3 specialists most often to be included in the conversation: an endocrinologist, a cardiologist, and an internal medicine practitioner. With their own unique viewpoints, each approaches the discussion from the outlook of specialists in their field and whether the creation of a cardiometabolic subspecialty would help in the management of these patients.


Cardiometabolic Health Fellowships: The Answer or Part of the Problem?

Gregory Weiss, MD: Has the Time Come for a Cardiometabolic Subspecialty?

Simon Murray, MD: Who Should Be Treating Patients with Diabetes?

In this 3-part feature series, an endocrinologist, a cardiologist, and an internist tackle the topic of who should be in charge of treating patients with diabetes and whether the creation of a cardiometabolic specialty is a worthwhile endeavor.

Patrick Campbell

Articles

Mediterranean Diet Linked to 30% Lower Diabetes Risk in Women

Increased Sedentary Behavior Raises Heart Failure Risk in Women

Controversies in Using Biphosphonates for Treating Osteoporosis

Cardiometabolic Health: The Future of Diabetes Care or an Unnecessary Diversion?