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JOURNAL OF SCIENCE, Hue University, N0 61, 2010 RISK FACTORS OF PRE-DIABETES IN ADULTS AGED 45 YEARS AND OLDER IN CAU NGANG DISTRICT, TRA VINH PROVINCE Cao My Phuong Tra Vinh General Hospital Dinh Thanh Hue, Nguyen Hai Thu College of Medicine and Pharmacy, Hue University SUMMARY A case - control study in the population aged 45 years and older was conducted in Cau Ngang district, Tra vinh province The case group included 100 pre-diabetic subjects, and the control group comprised of 200 non pre-diabetic subjects, who were randomly selected from a previous cross sectional study, matched in risk factors including age, sex, ethnic group, place of living, standard of living, having a family member with diabetes, and giving birth to a baby weighing more than kg The result showed that risk factors of pre-diabetic patients included: overweight/obesity, high waist circumference, high body fat percentage, sweet drinking – eating habit, daily excessive sugar consumption, and daily excessive fatty food intake Key words: Prediabetes, risk factors, obesity, waist circumference Introduction Pre-diabetes is a condition in which blood glucose levels are higher than normal, but not high enough for a diagnosis of diabetes Pre-diabetes has been defined by The American Diabetes Association with the WHO’s agreement of having impaired fasting glucose (fasting blood glucose levels between 100 and 125 mg/dl) or impaired glucose tolerance (2 hour post-glucose load, plasma glucose levels between 140 and 199 mg/dl) Impaired fasting glucose and impaired glucose tolerance may progress to type diabetes mellitus People with pre-diabetes are likely to develop type diabetes within 10 years, unless they take steps to prevent or delay diabetes Moreover, diabetes is associated with aging However, recently, diabetes mellitus has tended to happen in the younger people, especially people from the age of 45 years Most of researches have demonstrated that risk factors of hyperglycemia included overweight/obesity, hypertension, lack of physical activities, malnutrition, having a family background of diabetes and giving birth to a baby weighting more than kg…The complications of diabetes mellitus can occur in the stage of pre-diabetes and pre-diabetic patients are also at increased risk for developing cardiovascular disease For 367 a long period of time before diabetes is detected, the degree of hyperglycemia above sufficient threshold can cause pathologic and functional changes in various target tissues but without clinical symptoms Pre-diabetes is becoming more common in the United States The U.S Department of Health and Human Services estimates that about a quarter of U.S adults aged 20 years or older—or 57 million people—had pre-diabetes in 2007 A cross – sectional study in Cau Ngang district, Tra Vinh province in December 2009 has pointed out that prevalence of pre-diabetes in participants aged 45 years and older was 19.5% which seemed slightly high This research was designed to explore which risk factors have contributed to this high percentage of pre-diabetes Method 2.1 Subjects The study sample consisted of individuals aged of 45 or older, who were permanent residents living in Cau Ngang district, Tra Vinh province 2.2 Research method: A case – control study - Sample: using the formula of Schlesselman6: Z n With: u α 2u 1 u Z β f 1 f p q f p 2 ; OR f 1 f OR p3 fOR ; 1 f OR 1 q3 p3 ; Predicted: f = 0,30; OR = 2,5; accepted: = 0,05; = 0,10; → n 100 In December 2009, we carried out a cross sectional study in a random sample selected from a population of people aged 45 and older in Cau Ngang district, Tra Vinh province, with a sample size of n = 1226 There were 239 pre – diabetic subjects and 115 diabetic subjects found The rest included 872 subjects with normal blood glucose levels Based on that result, we selected participants for this study + The case group: of the 239 pre-diabetic subjects, 100 individuals were selected for the case group using a simple random method + The control group: of the 872 subjects with normal blood glucose levels, 200 respondents were chosen using a simple random method One pre-diabetic subject with two control subjects were matched in age, sex, ethnic group, place of living, standard of living, having a family member with diabetes, and giving birth to a baby weigh more than kg 368 - Data collection: A face to face interview method, using a prepared questionnaire was used to collect necessary information Interviewers were health professionals of Phu Yen hospital and Phu Yen Medical College - Data analysis: Using Epi-info version 3.5.1 (2008) Data is presented in the 2x table for each related factor: Case Control Expose A C m1 Non-expose B D m2 n1 n2 n From the table, the necessary results are calculated Using 2 of Yates, p = 0.05 Results 3.1 Factors related to present health Hypertension (mmHg) ( BSP≥ 140 and/or BDP≥90) BMI WC (Waist circumferences) cm OR Case group Contro l group (95% CI) Yes 50 90 1.2 No 50 110 (0.8 – 2.0) ≥ 23 38 50 1.8 < 23 62 146 (1.1– 3.0) 66 101 1.9 34 99 (1.2 – 3.1) Risk Factors p > 0.05 -Male≥ 90, Female≥80 - Male 0.05 < 0.05 < 0.01 < 0.01 > 0.05 > 0.05 > 0.05 Stress > 0.05 370 Discussions 4.1 Factors related to present health Hypertension: Hypertension is able to occur in a metabolic syndrome Hypertension in a pre-diabetic state results from insulin resistance/hyperinsulinism and is also considered as a risk factor of diabetes Diabetes is normally associated with hypertension However, this research has not showed clearly that hypertension is related to pre-diabetes (OR = 1.2, p > 0.05) Waist circumferences: the results of this study demonstrated that there was a correlation between a waist circumference index based on the Asian standard and prediabetes The group who had a high waist circumference index (male ≥ 90 cm, female ≥ 80 cm) had approximately 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 clearly a risk factor of pre-diabetes in this community BMI: obesity is a traditional risk factor which may lead to diabetes, hypertension, cardio-vascular diseases, gallbladder diseases, and several cancers 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/m2) 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) Body fat percentages index: According to Nguyen Thi Kim Hung, individuals who gained a high body fat percentage index had more than 2.5 times higher risk of elevating blood glucose The result of this study showed that body fat percentage index related dramatically to pre-diabetes Respondents with slightly high or high body fat percentage index got more than 2.4 times higher risk of pre-diabetes than the other Hence, the body fat index was presented as one of the new risk factors of pre-diabetes (OR = 2.4, p < 0.001) Visceral fat index: the results of our study demonstrated that the group with high visceral fat index did not have significantly higher risk of pre-diabetes than the one with normal visceral fat index (OR = 1.3, p > 0,05) 4.2 Factors related to health behaviors Smoking: smoking may increase insulin resistance and excite to produce stress hormones – Both factors elevate the blood glucose level In this research, smoking status appeared to not be related to pre-diabetes (OR = 1.4, p > 0.05) Excessive alcohol drinking habits: the excessive beer and alcohol intake for a long time can cause hypertriglyceridemia and increase of blood glucose level in diabetes patients The study showed that, in this community, the excessive alcohol drinking habit 371 was not related to diabetes (OR = 1,3; p > 0,05) Sweet drinking – eating habit: A number of authors said that sweet drinking/eating habits did not directly relate to diabetes However, this research showed that subjects with sweet drinking/eating habits have more than 1.8 times higher risk of pre-diabetes than the others (OR = 1.8; p < 0.05) It may be supposed that people with sweet drinking/ eating habit often eat and drink sweet food and consume high calorie drinking substances, which can have a reserve of excessive energy that may lead to obesity and insulin resistance The relationship of over carbohydrate consumption and the increase of obesity – a risk factor of diabetes – have been proved previously Daily excessive sugar consumption: In this study, there is a relationship between daily excessive sugar consumption and pre-diabetes The ones with daily excessive sugar intake have more than 2.4 times higher risk of pre-diabetes than the other group (OR = 2.4, p < 0.01) Excessive fatty food intake: reducing levels of LDL.C and plasma triglycerides and/or raising levels of HDL.C is associated with reduced rates of CHD events in diabetic patients The consumption of a number of unsaturated fat is related to dyslipidemia The low fat consumption contributes to a reduction in total cholesterol, LDL.cholesterol, triglycerides and to an elevation of HDL.cholesterol levels Ta Van Binh (2007), who conducted a survey with 1200 subjects living in Ha Noi announced that people with the habit of eating excessive fatty foods might have more than times the risk of acquiring diabetes than the control group In our research, people with excessive fatty food eating habits had approximately a 2.8 times greater risk of prediabetes than the control group (OR = 2.8; p < 0.01) Daily vegetable intake: According to Ta Van Binh (2007), the prevalence and risk of diabetes is high in people without daily vegetable intake habit However, 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 in this study lived in the countryside, and so vegetables were often one part of their daily food Eating after 20:00pm habit: Eating after 20:00pm probably leads to elevated blood sugar level at night and in the morning As a result, this study showed that eating after 20h habit was not a risk factor of pre-diabetes (OR = 1.0; p > 0.05) 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 factor of pre-diabetes Nevertheless, the results of this research did not show that the risk of acquiring pre-diabetes was different between individuals with and without physical activities of ≥ 30’/day, >5 days/week (OR = 1.0, p > 0.05) It may be supposed that the studied population experienced most of their physical labors in the countryside, 372 and therefore this factor had no clear effect Stress: the insulin resistance caused by stress may lead to diabetes Stress results in an increase of catecholamine and steroid cortical in blood, which may lead to overweight and obesity 10 However, stress has not been showed as a pre-diabetes risk factor in this study (OR = 1.6, p > 0.05) Conclusion From the result of our research, the following conclusions can be drawn: The risk factors of pre-diabetic adults aged 45 years and older in this community included: Overweight/Obesity (OR = 1,8 ); High waist circumference (OR = 1,9); High body fat percentage (OR = 2,4); Sweet drinking/ eating habits (OR = 1,8); Daily excessive sugar consumption (OR = 2,4 ); Daily excessive fatty food intake (OR = 2,8) REFERENCES Alan JG Diagnosis and management of pre-diabetes in continuum of hyperglycemiawhen the risk diabetes begin? A consensus statement from the American college of endocrinology and the American association of clinical endocrinologists Endocrine practice Medscape 2008 http://www.ehow.com/how_4795590_reverse-prediabetes.html, How to Reverse PreDiabetes, Copyright © 1999-2010 eHow Nguyen HT, Huynh VM, Doan PT, Ho TTV Pre-diabetes in Thua Thien Hue Scientific conference of Internal Medcine and Radiative surgery by Gamma ray 2009: 344-356 Tran HD, Nguyen HT Obesity Post-graduated textbook of endocrinology – metabolism Hue university publish house 2008:304-310 Ta VB Overview of diabetes and glucose blood increase Fundamental principles: The diabetes and glucose blood increase diseases Health Publisher 2007: 11-68 Dinh TH Causality arguement and analysis study by observing Epidemiological methodology Health Publisher 2004: 93-117 Screening for Type Diabetes Diabetes Care American Diabetes Association 2009 373 Smoking, pre-diabetes & diabetes A diabetes information series from State Territory Organizations of Diabetes Australia Article 2007 Evidence-Based Nutrition Principles and Recommendations for the Treatment and Prevention of Diabetes and Related Complications Diabetes Care American Diabetes Association 2009 10 http://pre-diabetes.insulitelabs.com/pre_diabetes stress.php, Pre-diabetes and stress, Insulite Laboratories, Inc., Louisville, CO 8002, USA 374 ... 1999-2010 eHow Nguyen HT, Huynh VM, Doan PT, Ho TTV Pre-diabetes in Thua Thien Hue Scientific conference of Internal Medcine and Radiative surgery by Gamma ray 2009: 344-356 Tran HD, Nguyen HT Obesity... percentage of pre-diabetes Method 2.1 Subjects The study sample consisted of individuals aged of 45 or older, who were permanent residents living in Cau Ngang district, Tra Vinh province 2.2 Research... carried out a cross sectional study in a random sample selected from a population of people aged 45 and older in Cau Ngang district, Tra Vinh province, with a sample size of n = 1226 There were