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Exposure to Cardioprotective Drugs in Elderly with Diabetes is Dependent on Age
MONTREAL 2008 ABSTRACTS
| 307
ABSTRACT #76
ORAL PRESENTATIONS
C&SS
21
22 Sugar-Sweetened Beverages and the Metabolic Syndrome in the Inuit of Nunavik (Northern Québec) ÉMILIE COUNIL*,
MARIE-LUDIVINE CHATEAU-DEGAT, ANNIE FERLAND, PIERRE JULIEN, ÉRIC DEWAILLY, Public Health Research Unit, CHUL-(CHUQ), Québec, QUEBEC
Higher intakes of sugar-sweetened beverages (SSB) have been associated with weight gain, type 2 diabetes and the metabolic syndrome. In spite of large body size and increasingly high intakes of bad nutritional quality foods, including soft drinks, the Inuit still experience a low prevalence of diabetes and favourable blood lipid profiles. Our aim was to examine the association between the consumption of SSB, the prevalence of the metabolic syndrome and its components in the Inuit of Nunavik. Among the adults enrolled in the baseline of the Inuit Health in Transition Cohort Study, 712 answered a food frequency questionnaire and passed clinical examinations, including venipuncture. Metabolic syndrome was assessed according to the International Diabetes Federation definition. Covariates in logistic regression were age and gender. Median consumption of SSB was 886ml/day (soda contributing the most) and was higher in the young (p=0.02). The prevalence of central obesity, diabetes and metabolic syndrome were respectively 58.4%, 4.9% and 15.5%. Consumption of rd 2½ cans of SSB or more per day (3 tertile) was associated with a higher prevalence of metabolic syndrome (OR=1.69, 95% CI [1.03;2.76]) and reduced HDL-c (OR=1.64, [1.00;2.70]), but not with diabetes and impaired glucose tolerance (OR=1.21, [0.59;2.51]) or central obesity (OR=0.83, [0.54;1.29]). Thus, although the Inuit may still be protected by their omega-3 and selenium rich traditional foods, the dietary shift towards store-bought food particularly rich in refined sugars could already affect their cardio-metabolic profile.
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24
Waist-to-hip associated with A1C in type 2 diabetes. PRIYA MANJOO*, LAWRENCE JOSEPH, LOUISE PILOTE, KABERI DASGUPTA, Department of Medicine, McGill University, Montréal, QC. Aim. Among ambulatory overweight adults with type 2 diabetes, we separately assessed for associations of hemoglobin A1C to body mass index (BMI), waist circumference (WC), hip circumference (HC), and waist to hip ratio (WHR). Methods. First evaluation data from the Walking Behaviour and Glycemic Control cohort were used, including anthropometric measures, demographic variables, A1C (Biorad II HPLC), and daily steps (Yamax SW-200). Multiple linear regression was used to evaluate the strength of the associations between different anthropometric parameters and A1C. Results. A 0.1 unit increase in WHR was associated with a 0.7 increase in A1C (Table 2); a one standard deviation increase in WHR was associated with a 0.42 increase in A1C in both men and women. Interpretation. These findings support the possibility that overall fat distribution is an important determinant of glycemic control. Table 1. Subject characteristics Mean (SD) Men (n=79) Age, years 61.0 (11.20) A1C, % 7.77 (1.62) Waist circumference, cm 99.53 (12.26) Waist-to-hip ratio 0.96 (0.06) Hip circumference, cm 108.0 (11.56) 2 29.85 (5.80) BMI, kg/m
Cardiometabolic Risk Factors in Children of Parents with the Metabolic Syndrome. MARIE LAMBERT, MÉLANIE HENDERSON, KATHERINE GRAY-DONALD, JENNIFER O’LOUGHLIN. Depts of Pediatrics and Social and Preventive Medicine, U. of Montreal; Dept of Epidemiology and Biostatistics, and School of Dietetics and Human Nutrition, McGill U.; Montréal, QC. Our objective was to determine the impact of having one or both parents with metabolic syndrome (MS) on cardiometabolic risk in offspring. The sample comprised the first 300 families enrolled in QUALITY, a cohort of Caucasian children aged 8-10 years in Quebec among whom one or both biological parents had overall or abdominal obesity. Parental MS status was defined according to ATP III criteria. Plasma fasting lipids and glucose, and 2h post-load glucose were measured in children. Mean (SD) age (years) was 9.8 (0.8) in the 166 boys and 9.5 (0.9) in the 128 girls. Most boys (91%) and 60% of girls were Tanner stage 1. The proportion of children with none, one or both parents with MS was 38%, 50% and 12%. Fasting triglycerides (TG) levels and the proportion of children with high TG (>1.25 mmol/L) increased significantly according to parental MS status (none, 1 or both parents with MS; p<0.0001). After adjustment for child age, sex, BMI Z score and Tanner stage, children with one or both parents with MS had TG concentrations 15% and 28% higher, respectively, than children with no parent with MS. In contrast, we detected no significant association between child TG concentrations and either parents’ BMI (both p>0.6 after adjustment). Although mean fasting and 2h post-load glucose in children were similar across parental MS status (both p>0.4), there was a trend towards increasing prevalence of impaired glucose tolerance according to parental MS status: 5%, 10% and 17% of children with none, 1 or both parents with MS, respectively (p=0.07). In conclusion, childhood cardiometabolic risk increases according to parental MS status independently of child BMI.
Women (n=64) 61.0 (10.40) 7.69 (1.36) 104.24 (13.48) 0.87 (0.06) 113.83 (11.69) 31.43 (5.82)
Table 2. Associations with A1C adjusted for background (White/ nonwhite), age and daily steps. A1C increase (95% CI) Men Women Waist (cm) 0.022 (-0.009, 0.053) 0.009 (-0.022, 0.040) Hip (cm) 0.003 (-0,033, 0.038) -0.013 (-0.043, 0.017) 0.024 (-0.048, 0.096) -0.037 (-0.091, 0.029) BMI (kg/m2) WHR (0.1 unit) 0.696 (0.089, 1.303) 0.707 (0.150, 1.265)
Exposure to Cardioprotective Drugs in Elderly with Diabetes is Dependent on Age. CAROLINE SIROIS*, JOCELYNE MOISAN, PAUL POIRIER, JEAN-PIERRE GRÉGOIRE, Faculté de pharmacie, Université Laval; Unité de recherche en santé des populations, Institut natinal de santé publique, Québec, QC The purpose of the study was to measure the effect of age on the initiation of: 1) antihypertensive (AHD), 2) antiplatelet (APD) and 3) lipid-lowering drugs (L-LD) in the year following initiation of oral antidiabetic therapy. Using the Quebec Health Insurance Board database, we conducted a population-based cohort study of patients aged 66 years for whom an oral antidiabetic drug was first claimed between 1 January 1998 and 31 December 2002. Patients who had a claim for an AHD, APD or L-LD before initiating the antidiabetic drug were excluded. Initiation of each of the 3 cardioprotective drugs was defined as at least one claim for an AHD, APD or L-LD, respectively. The effect of age on the initiation of each cardioprotective drug was assessed using a logistic regression model adjusting for calendar year, sex, residency area, cardiovascular disease, hospitalization and number of medical visits. Among individuals with no prior use of AHD (n=15,290), APD (n=34,427) and L-LD (n=34,404), a respective total of 5,709 (37.3%), 6,763 (19.6%) and 6,283 (18.3%) patients initiated those therapies. Compared to patients aged 66-70 years, the odds of initiating an AHD decreased with increasing age. Adjusted odds ratio were 0.81 (95% CI: 0.740.87), 0.77 (0.70-0.85) and 0.71 (0.63-0.80) for those aged 7175 years, 76-80 years, and 81 years, respectively. Similar patterns were observed for APD [0.92 (0.86-0.99); 0.86 (0.790.93); 0.80 (0.73-0.88)] and L-LD [0.73 (0.68-0.78); 0.46 (0.420.50); 0.20 (0.18-0.23)]. These results suggest that exposure to cardioprotective drugs in the year following oral antidiabetic therapy initiation is dependent on patients’ age. Older patients may not be exposed to the cardioprotective therapy they would benefit from.
PEDIATRICS
ABSTRACT #41 C&SS
POPULATION HE
| 307
ABSTRACT #76
ORAL PRESENTATIONS
C&SS
21
22 Sugar-Sweetened Beverages and the Metabolic Syndrome in the Inuit of Nunavik (Northern Québec) ÉMILIE COUNIL*,
MARIE-LUDIVINE CHATEAU-DEGAT, ANNIE FERLAND, PIERRE JULIEN, ÉRIC DEWAILLY, Public Health Research Unit, CHUL-(CHUQ), Québec, QUEBEC
Higher intakes of sugar-sweetened beverages (SSB) have been associated with weight gain, type 2 diabetes and the metabolic syndrome. In spite of large body size and increasingly high intakes of bad nutritional quality foods, including soft drinks, the Inuit still experience a low prevalence of diabetes and favourable blood lipid profiles. Our aim was to examine the association between the consumption of SSB, the prevalence of the metabolic syndrome and its components in the Inuit of Nunavik. Among the adults enrolled in the baseline of the Inuit Health in Transition Cohort Study, 712 answered a food frequency questionnaire and passed clinical examinations, including venipuncture. Metabolic syndrome was assessed according to the International Diabetes Federation definition. Covariates in logistic regression were age and gender. Median consumption of SSB was 886ml/day (soda contributing the most) and was higher in the young (p=0.02). The prevalence of central obesity, diabetes and metabolic syndrome were respectively 58.4%, 4.9% and 15.5%. Consumption of rd 2½ cans of SSB or more per day (3 tertile) was associated with a higher prevalence of metabolic syndrome (OR=1.69, 95% CI [1.03;2.76]) and reduced HDL-c (OR=1.64, [1.00;2.70]), but not with diabetes and impaired glucose tolerance (OR=1.21, [0.59;2.51]) or central obesity (OR=0.83, [0.54;1.29]). Thus, although the Inuit may still be protected by their omega-3 and selenium rich traditional foods, the dietary shift towards store-bought food particularly rich in refined sugars could already affect their cardio-metabolic profile.
23
24
Waist-to-hip associated with A1C in type 2 diabetes. PRIYA MANJOO*, LAWRENCE JOSEPH, LOUISE PILOTE, KABERI DASGUPTA, Department of Medicine, McGill University, Montréal, QC. Aim. Among ambulatory overweight adults with type 2 diabetes, we separately assessed for associations of hemoglobin A1C to body mass index (BMI), waist circumference (WC), hip circumference (HC), and waist to hip ratio (WHR). Methods. First evaluation data from the Walking Behaviour and Glycemic Control cohort were used, including anthropometric measures, demographic variables, A1C (Biorad II HPLC), and daily steps (Yamax SW-200). Multiple linear regression was used to evaluate the strength of the associations between different anthropometric parameters and A1C. Results. A 0.1 unit increase in WHR was associated with a 0.7 increase in A1C (Table 2); a one standard deviation increase in WHR was associated with a 0.42 increase in A1C in both men and women. Interpretation. These findings support the possibility that overall fat distribution is an important determinant of glycemic control. Table 1. Subject characteristics Mean (SD) Men (n=79) Age, years 61.0 (11.20) A1C, % 7.77 (1.62) Waist circumference, cm 99.53 (12.26) Waist-to-hip ratio 0.96 (0.06) Hip circumference, cm 108.0 (11.56) 2 29.85 (5.80) BMI, kg/m
Cardiometabolic Risk Factors in Children of Parents with the Metabolic Syndrome. MARIE LAMBERT, MÉLANIE HENDERSON, KATHERINE GRAY-DONALD, JENNIFER O’LOUGHLIN. Depts of Pediatrics and Social and Preventive Medicine, U. of Montreal; Dept of Epidemiology and Biostatistics, and School of Dietetics and Human Nutrition, McGill U.; Montréal, QC. Our objective was to determine the impact of having one or both parents with metabolic syndrome (MS) on cardiometabolic risk in offspring. The sample comprised the first 300 families enrolled in QUALITY, a cohort of Caucasian children aged 8-10 years in Quebec among whom one or both biological parents had overall or abdominal obesity. Parental MS status was defined according to ATP III criteria. Plasma fasting lipids and glucose, and 2h post-load glucose were measured in children. Mean (SD) age (years) was 9.8 (0.8) in the 166 boys and 9.5 (0.9) in the 128 girls. Most boys (91%) and 60% of girls were Tanner stage 1. The proportion of children with none, one or both parents with MS was 38%, 50% and 12%. Fasting triglycerides (TG) levels and the proportion of children with high TG (>1.25 mmol/L) increased significantly according to parental MS status (none, 1 or both parents with MS; p<0.0001). After adjustment for child age, sex, BMI Z score and Tanner stage, children with one or both parents with MS had TG concentrations 15% and 28% higher, respectively, than children with no parent with MS. In contrast, we detected no significant association between child TG concentrations and either parents’ BMI (both p>0.6 after adjustment). Although mean fasting and 2h post-load glucose in children were similar across parental MS status (both p>0.4), there was a trend towards increasing prevalence of impaired glucose tolerance according to parental MS status: 5%, 10% and 17% of children with none, 1 or both parents with MS, respectively (p=0.07). In conclusion, childhood cardiometabolic risk increases according to parental MS status independently of child BMI.
Women (n=64) 61.0 (10.40) 7.69 (1.36) 104.24 (13.48) 0.87 (0.06) 113.83 (11.69) 31.43 (5.82)
Table 2. Associations with A1C adjusted for background (White/ nonwhite), age and daily steps. A1C increase (95% CI) Men Women Waist (cm) 0.022 (-0.009, 0.053) 0.009 (-0.022, 0.040) Hip (cm) 0.003 (-0,033, 0.038) -0.013 (-0.043, 0.017) 0.024 (-0.048, 0.096) -0.037 (-0.091, 0.029) BMI (kg/m2) WHR (0.1 unit) 0.696 (0.089, 1.303) 0.707 (0.150, 1.265)
Exposure to Cardioprotective Drugs in Elderly with Diabetes is Dependent on Age. CAROLINE SIROIS*, JOCELYNE MOISAN, PAUL POIRIER, JEAN-PIERRE GRÉGOIRE, Faculté de pharmacie, Université Laval; Unité de recherche en santé des populations, Institut natinal de santé publique, Québec, QC The purpose of the study was to measure the effect of age on the initiation of: 1) antihypertensive (AHD), 2) antiplatelet (APD) and 3) lipid-lowering drugs (L-LD) in the year following initiation of oral antidiabetic therapy. Using the Quebec Health Insurance Board database, we conducted a population-based cohort study of patients aged 66 years for whom an oral antidiabetic drug was first claimed between 1 January 1998 and 31 December 2002. Patients who had a claim for an AHD, APD or L-LD before initiating the antidiabetic drug were excluded. Initiation of each of the 3 cardioprotective drugs was defined as at least one claim for an AHD, APD or L-LD, respectively. The effect of age on the initiation of each cardioprotective drug was assessed using a logistic regression model adjusting for calendar year, sex, residency area, cardiovascular disease, hospitalization and number of medical visits. Among individuals with no prior use of AHD (n=15,290), APD (n=34,427) and L-LD (n=34,404), a respective total of 5,709 (37.3%), 6,763 (19.6%) and 6,283 (18.3%) patients initiated those therapies. Compared to patients aged 66-70 years, the odds of initiating an AHD decreased with increasing age. Adjusted odds ratio were 0.81 (95% CI: 0.740.87), 0.77 (0.70-0.85) and 0.71 (0.63-0.80) for those aged 7175 years, 76-80 years, and 81 years, respectively. Similar patterns were observed for APD [0.92 (0.86-0.99); 0.86 (0.790.93); 0.80 (0.73-0.88)] and L-LD [0.73 (0.68-0.78); 0.46 (0.420.50); 0.20 (0.18-0.23)]. These results suggest that exposure to cardioprotective drugs in the year following oral antidiabetic therapy initiation is dependent on patients’ age. Older patients may not be exposed to the cardioprotective therapy they would benefit from.
PEDIATRICS
ABSTRACT #41 C&SS
POPULATION HE