Anthropometric features and dietary factors of Vietnamese with type 2 diabetes

Transcription

1 Anthropometric features and dietary factors of Vietnamese with type 2 diabetes Duc Son N. T. Le 1, Bui Thi Nhung 2, Pei-ying Lin 3 and Shigeru Yamamoto 3 1 Nutrition Center of Ho Chi Minh City, Vietnam, 2 National Institute of Nutrition, Vietnam, 3 Fooyin University,Taiwan, 4 Ochanomizu University Graduate School, Japan

2 Studies 1. Prevalence of DM 2. Body Characteristics of DM 3. Prevalence of MS 4. Dietary factor of DM 5. Energy Metabolism

3 Prevalence of Diabetes Sampling method: multi-stage sampling Listing 303 administrative units in both urban and rural areas of Ho Chi Minh City 60 units were randomly selected In each selected units, 50 subjects were invited. Of the 3000 subjects, 2932 responded (97.7%).

4 Prevalence of Diabetes and IFG (%) Diabetes IFG Previous New Total Crude prevalence Adjusted prevalence Data were presented as %. IFG, impaired fasting glucose. Le DSNT, Diabetic Med. 2004

5 Age specific prevalence of diabetes and IFG (%) χ 2 trend = 26.7, P < Diabetes IFG >=65 IFG, impaired fasting glucose Le DSNT, Diabetic Med. 2004

6 Body characteristics of newly diagnosed DM Variables Diabetes Normal N BMI ± ± 3.7 WHR 0.91 ± 0.07 * 0.86 ± 0.08 Body (%) fat 31.1 ± ± 6.2 Our suggested Cutoff Points of T2DM BMI 23 WHR male 0.9 female 0.85 Data were presented as mean ± SD *,P<0.01; P< Le DSNT, Diabetes care 2003

7 Metabolic syndrome Definition: Presence of three or more of the following components High fasting glucose (> 110mg/dL) High triglyceride ( 150mg/dL) Low HDL-cholesterol (<mg/dl for males, <50mg/dL for females) Abdominal obesity (WC 90 cm for males and 88cm for females) High blood pressure (systolic 130mmHg or diastolic 85mmHg) Adult Treatment Panel III 2001 criteria - Circulation 2002)

8 Prevalence of Metabolic syndrome Sampling method: multi-stage sampling Listing 238 administrative units in urban areas of Ho Chi Minh City 20 units were randomly selected In each selected units, 35 subjects were invited. Of the 700 subjects, 611 responded (87.3%).

9 Prevalence of Metabolic Syndrome Age group (y) MS (%) Overall 18.5 Adjusted prevalence (95% CI) 12 ( ) Data were presented as %. MS, metabolic syndrome. Le NTDS et al., DRCP 2005

10 Adjusted prevalence of MS components (%) Abdominal obesity High TG Low HDLC High BP High FPG Males Females Le NTDS et al., DRCP 2005

11 Dietary Factor of DM -high white rice intake-

12 Design: cross-over study Subjects: 30 subjects, divided into 3 groups by age (20-29y; -49y; 60-69) Exclusion criteria: hypertension, hyperlipidemia, diabetes, alcohol-drinking, and smoking Experimental design Methods Test meal Blood drawn Overnight fast Areas under the curve (AUC) were calculated and compared among the four test meals.

13 血糖値 (mg/dl) 基準対象時間 (min) Areas under the curve (AUC) were calculated and compared among the four test meals.

14 Subjects: 30 healthy female subjects with similar BMI Subjects of Forties

15 Characteristics of the study population Twenties Forties Sixties (n=10) (n=9) (n=10) Age (y) 23.4 ± ± ± 0.4 Height (cm) ± ± ± 1.1 Weight (kg) 44.0 ± ± ± 1.7 BMI (kg/m 2 ) 18.2 ± ± ± 0.8 FBG (mg/dl) 85.0 ± ± ± 1.3 Data were presented as means ± SE. Lin PY, JNSV 2007

16 Test meal

17 Protein:Fat:Carbohydrate Ratio (PFC ratio) Vietnam America USA

18 Dietary composition and PFC ratios of test meals Meal A* Meal B Meal C Meal D White Rice (g) Oil (g) Pork lean (g) Vegetable(g; cabbage) Fish sauce (g) Protein (g) Fat (g) Carbohydrate (g) Fiber (g) P:F:C ratio 15:14:71 13:30:57 14:15:71 13:26:61 Total energy (MJ) *Meal A was designed to be a Vietnam common diet. (1 kcal = kj)

19 Results 100 * Subjects of Twenties Subjects of Forties 80 Subjects of Sixties AUC (mg/dl/h) A B C D Test meal High CHO High Oil High CHO+Low Oil High CHO+High Oil Postprandial glycemic responses (AUCs) of the same test meals when compared among the three groups. * p<0.01, p<0.05. Lin PY, JNSV 2007

20 Food Guide Pyramid by USDA

21 by Walter C. Willett, Harvard Medical School Oil

22 Energy Metabolism

23 Linear regression of measured and predicted RMR by FAO/WHO/UNU 1985 in adult RMR (Kcal/day) P< RMR (Kcal/day) P< RMR WHO (1985) y=12.8x+712 RMR STUDY y=15.3x RMR WHO (1985) y=14.7x+496 RMR STUDY y=15.4x+364 Body weight (kg) Figure 1: Male years old Body weight (kg) Figure 2: Female years old RMR (Kcal/day) P< RMR WHO (1985) RMR (Kcal/day) P< RMR WHO (1985) y=11.6x+879 RMR STUDY y=12.3x y=8.7x+829 RMR STUDY y=11.6x+525 Body weight (kg) Figure 3: Male years old Body weight (kg) Figure 4: Female years old

24 Linear regression of measured and predicted RMR by FAO/WHO/UNU 1985 in adolescent and elderly RMR (MJ/day) 7 6 RMR (MJ/day) RMR WHO 1985 y=17.5x RMR WHO1985 y=12.2x RMR study y=21.2x RMR study y=15.3x+443 Body weight (kg) Figure 5: Adolescent boy 8.0 Body weight (kg) Figure 7: Adolescent girl RMR (MJ/day) RMR (MJ/day) Body weight (kg) RMR WHO 1985 y=13.5x+487 RMR study 10.8x Body weight (kg) 70 RMR WHO 1985 y=10.5x+506 RMR study y=10.2x+443 Figure 7: Elder male Figure 8: Elder female

25 Resting metabolic rate (RMR) in different ethnic subjects within a month after moving to mild climate areas 27.5 (11 Asian) Henry (11 British) Henry (15 British) Geissler (15 Asians) Geissler (15 African) Geissler (10 W. Afri) Dieng (10 French) Dieng (9 trop) Hayter & Henry (93) 27.5 (9 temp) Hayter & Henry (93) 28.2 (21 trop) Hayter & Henry (93) 27.2 (20 temp) Hayter & Henry (93) Estimated by the equation of Shetty et al. for male cm, 64.7kg and female 158.1cm, 51.2kg Differences among the ethnic groups were not observed

26 Equations and regression lines of REE reviewed by Wang, Heymsfield et al. ( J Physiol Endocrinot Metab) O 28 M 25 L 22 J17 R 30 R 31 E 6 Mc24 H 14 Cu 5 R 29 O 27 H 13 O 26 K 18 Japan Ref No Equation O 28: REE = 19.7 x FFM M 25: REE = 19.7 x FFM L 22: REE = 20.0 x FFM J 17: REE = 20.0 x FFM R 30: REE = x FFM R 31: REE = x FFM E 6: REE = x FFM Mc 24: REE = 21.5 x FFM H 14: REE = 21.6 x FFM Cu 5: REE = 21.6 x FFM R 29: REE = 21.8 x FFM O 27: REE = 22.3 x FFM より (FFM = BM 0.8 x BM1.19 男女の差は?) H 13: REE = x FFM O 26: REE = 23.6 x FFM K 18: REE = 24.5 x FFM + 304

27 Conclusions T2DM and MS are the health problems now in Vietnamese. T2DM subjects had normal BMI and high body fat. Our suggested Cutoff points of DM for Vietnamese (tentative) BMI 23 WHR male 0.9 female 0.85 Traditional meal (high white rice) was suggested one of the factors of T2DM and MS. Resting metabolic rates of Vietnamese were lower than those of FAO/WHO/UNU. However, we can not find the differences in different ethnic groups by reviewing the previous publications. Further studies are necessary.

28 Thank you very much.