11. cao my phuong risk factors of pre diabetes in adults aged 45Presentation Transcript
RISK FACTORS OF PRE-DIABETES IN ADULTS AGED 45 YEARS AND OLDER IN CAU NGANG DISTRICT, TRAVINH PROVINCE Cao Mỹ Phượng Đinh Thanh Huề Nguyễn Hải Thủy
1. INTRODUCTION Tra Vinh is a province in the south of Vietnam. There’re 7 dictricts and city in the province. Khmer people: 30%. X
Pre-diabetes is a condition in which blood glucose levels’re higher than normal but not high enough to diagnose diabetes.
Diabetes is associated with aging.
Diabetes has tended to happen in the youngers, especially from the age of 45.
Most of researches’ve demonstrated risk factors to elevate blood sugar such as:
Lack of physical activities
Having a family background of diabetes
Giving birth to a baby weighting more than 4 kg.
The complications of diabetes mellitus have been producing in the stage of pre-diabetes.
People with pre-diabetes are also at increased risk for developing cardiovascular diseases.
For a long period of time before diabetes detected, the degree of hyperglycemia above sufficient to cause pathologic and functional changes in various target tissues without clinical symptoms.
A cross – sectional study in Cau Ngang district, Tra Vinh province in December 2009 has pointed out the prevalence of pre-diabetes in participants aged 45 years and older is 19.5%, which seems slightly high.
What risk factors have processed to this percentage? This research is designed to answer that question.
2. RESEARCH METHOD AND SUBJECTS
The population sample is the group ones from the age of 45 being permanent residences and living at Cau Ngang district, Tra Vinh province.
2.2. Research method a case – control study
A random sample selected from a cross sectional study in Cau Ngang district with a sample size n = 1226 (239 pre – diabetes subjects found).
The case group: 100 ones randomised from 239 pre-diabetes subjects.
The control group: 200 ones ramdomised from 872 subjects with normal blood sugar levels.
1 pre-diabetes subject matched 2 control subjects in 7 factors:
Place of living
Standard of living
Having a family member with diabetes
Giving birth to a baby weigh ≥ 4kg.
Epi-info version 3.5.1 (2008).
3. RESULT AND DISCUSSION
3.1. Factors related to present health Hypertension
Hypertension is able to happen in a metabolic syndrome.
Hypertension is also considered as a risk factor of diabetes.
However, this research has not showed clearly that hypertension relates to pre-diabetes (OR = 1.2, p > 0.05).
300 200 100 150 100 50 Non-expose 140 90 50 Expose Control Case
Waist circumferences (cm)
There is a relation between a waist circumference index based on the Asian standard and pre-diabetes.
The group who have high waist circumference index (male ≥ 90 cm, female ≥ 80 cm) approximately get 1.9 times greater risk of pre-diabetes than the normal waist circumference group (OR = 1.9; p < 0.01).
Therefore, the high waist circumference is a clearly risk factor of pre-diabetes in this community.
300 200 100 133 99 34 Non-expose 167 101 66 Expose Control Case
Body mass index (BMI)
Obesity is one of risk factors which may reach to diabetes.
BMI is a measured tool to diagnose obesity.
Based on the Asian standard of BMI, this research also shows that the group of overweight/obesity with high BMI (≥ 23 kg/m 2 ) is probably at risk of pre-diabetes 1.8 times higher than the group with low or normal BMI (OR= 1.8, p < 0.05).
300 200 100 212 150 62 Non-expose 88 50 38 Expose Control Case
Body fat percentage Index (%)
According to Nguyen Thi Kim Hung, the subject who gains a high body fat percentage index would have more 2.5 times risks of elevating blood sugar.
The result of this study has been showed that the body fat percentage index dramatically relate to pre-diabetes.
The group people with slight high or high body fat percentage index would get more 2.4 times risks of pre-diabetes than the other.
Hence, the body fat index is presented as one of the risk factors of pre-diabetes (OR = 2.4, p < 0.001).
300 200 100 117 91 26 Non-expose 183 109 74 Expose Control Case
Visceral fat index The result of our study has not been demonstrated that the group with the high visceral fat index have more risks of pre-diabetes than the group with the normal visceral fat index (OR = 1.3, p > 0.05). 300 200 100 256 171 85 Non-expose 39 24 15 Expose Control Case
3.2. Factors related to health behavior SMOKING
Smoking may increase insulin resistances and excite to produce stress hormones – Both factors elevate the blood sugar level.
In this research, smoking seems not to be related to pre-diabetes (OR = 1.4, p > 0.05).
300 200 100 238 161 77 Non-expose 57 34 23 Expose Control Case
Excessive alcohol drinking habit
The excessive beer and alcohol intake for a long time should increase insulin resistance.
The study shows that in this community, the excessive alcohol drinking habit has not presented to be related to pre-diabetes (OR = 1.3; p > 0.05).
300 200 100 251 170 81 Non-expose 49 30 19 Expose Control Case
Sweet drinking – eating habit
The number of authors said that the sweet drinking – eating habit doesn’t relate directly to diabetes.
The subjects with sweet drinking – eating habit have more 1.8 times at risk of pre-diabetes than the others (OR = 1.8; p < 0.05).
It may be supposed that people with sweet drinking – eating habit would have frequently eaten and drunk sweet food and drink including high calories, which would have a reserve of excessive energy leading to obesity and insulin resistances. The relation of over carbohydrate consumption with the increase of obesity – a risk factor of diabetes – has been proved previously.
300 200 100 246 143 58 Non-expose 54 57 42 Expose Control Case
Daily excessive sugar consumption
There’s a relation between daily excessive sugar consumption with pre-diabetes.
The ones with daily excessive sugar intake have more 2.4 times risks of pre-diabetes than the other group (OR = 2.4, p < 0.01).
300 200 100 251 166 66 Non-expose 49 34 34 Expose Control Case
Excessive fatty food intake
Ta Van Binh (2007) who researched in 1200 subjects living in Ha Noi announced that people with excessive fatty food eating habit may gain a percentage and risks of diabetes more 4 times than the control group.
In our research, people with excessive fatty food eating habit approximately get 2.8 times greater risks of pre-diabetes than the control group (OR = 2.8; p < 0.01).
300 200 100 251 166 66 Non-expose 49 34 34 Expose Control Case
Daily vegetable intake
According to Ta Van Binh (2007), the prevalence and risk of diabetes is high in people without daily vegetable intake habit
In this study, risk of pre-diabetes in people with and without daily vegetable intake habit is not significantly different (OR = 0.9; p > 0.05).
It may be supposed that the population of this study is living in the countryside so that vegetable is frequently a part of their daily food.
300 200 100 205 136 69 Non-expose 95 64 31 Expose Control Case
Eating after 8 P.M. habit
Eating after 8 P.M. probably leads to grow blood sugar level at night and in the morning.
This research shows that eating after 8 P.M. habit is not a risk factor of pre-diabetes (OR = 1.0; p > 0.05).
300 200 100 279 186 93 Non-expose 21 14 7 Expose Control Case
Physical activity ≥ 30’/day, > 5 days/week
Physical activity is significantly related to diabetes. A lifestyle lacking of physical activities is demonstrated to be a risk of pre-diabetes.
The result of this research has not been presented that the risk of pre-diabetes is different between people with or without physical activities ≥ 30’/day, >5 days/week (OR = 1.0, p > 0.05). It may be supposed that the studied population contains most of physical labors in the countryside therefore this factor has not effected clearly.
300 200 100 179 120 59 Non-expose 121 80 41 Expose Control Case
The insulin resistance caused by stress may lead to diabetes.
Stress gives an increase of catecholamine and steroid cortisol in blood which may lead to overweight and obesity.
However, stress has not been showed as a pre-diabetes risk factor in this study (OR = 1.6, p > 0.05).
300 200 100 258 176 82 Non-expose 42 24 18 Expose Control Case
The risk factors of pre-diabetes in this community include: