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      Socio-economic disparities in the association of diet quality and type 2 diabetes incidence in the Dutch Lifelines cohort

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          Abstract

          Background

          It is unknown whether a socio-economic difference exists in the association of diet quality with type 2 diabetes incidence, nor how diet influences the socioeconomic inequality in diabetes burden.

          Methods

          In 91,025 participants of the population-based Lifelines Cohort (aged ≥30, no diabetes or cardiovascular diseases at baseline), type 2 diabetes incidence was based on self-report, fasting glucose ≥ 7·0 mmol/l and/or HbA1c ≥ 6·5%. The evidence-based Lifelines Diet Score was calculated with data of a 110-item food frequency questionnaire. Socio-economic status (SES) was defined by educational level. Cox proportional hazards models were adjusted for age, gender, smoking, energy intake, alcohol intake and physical activity.

          Findings

          In 279,796 person-years of follow-up, 1045 diabetes cases were identified. Incidence rate was 5·7, 3·2 and 2·4 cases/1000 person-years in low, middle and high SES, respectively. Diet was associated with greater diabetes risk (HR(95%CI) in Q1 (poor diet quality) vs. Q5 (high diet quality) = 2·11 (1·70–2·62)). SES was a moderator of the association(p INTERACTION = 0·038). HRs for Q1 vs. Q5 were 1·66 (1·22–2·.27) in low, 2·76 (1·86–4·08) in middle and 2·46 (1·53–3·97) in high SES. With population attributable fractions of 14·8%, 40·1% and 37·3%, the expected number of cases/1000 person-years preventable by diet quality improvement was 0·85 in low, 1·28 in middle and 0·90 in high SES.

          Interpretation

          Diet quality improvement can potentially prevent one in three cases of type 2 diabetes, but because of a smaller impact in low SES, it will not narrow the socioeconomic health gap in diabetes burden.

          Funding

          None.

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          Most cited references 25

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          Reproducibility and relative validity of the short questionnaire to assess health-enhancing physical activity

           G. Wendel-Vos (2003)
          The purpose of this study is to determine reproducibility and relative validity of the Short QUestionnaire to ASsess Health-enhancing physical activity (SQUASH). Participants (36 men and 14 women, aged 27-58) were asked to complete the SQUASH twice with an inbetween period of approximately 5 weeks. In addition, participants wore the Computer Science and Applications (CSA) Activity Monitor for a 2-week period following the first questionnaire. The Spearman correlation for overall reproducibility of the SQUASH was 0.58 (95%-CI 0.36-0.74). Correlations for the reproducibility of the separate questions varied between 0.44 and 0.96. Spearman's correlation coefficient between CSA readings and the total activity score was 0.45 (95%-CI 0.17-0.66). In conclusion, the SQUASH is a fairly reliable and reasonably valid questionnaire and may be used to order subjects according to their level of physical activity in an adult population. Because the SQUASH is a short and simple questionnaire, it may proof to be a very useful tool for the evaluation of health enhancing physical activity in large populations.
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            Does social class predict diet quality?

            A large body of epidemiologic data show that diet quality follows a socioeconomic gradient. Whereas higher-quality diets are associated with greater affluence, energy-dense diets that are nutrient-poor are preferentially consumed by persons of lower socioeconomic status (SES) and of more limited economic means. As this review demonstrates, whole grains, lean meats, fish, low-fat dairy products, and fresh vegetables and fruit are more likely to be consumed by groups of higher SES. In contrast, the consumption of refined grains and added fats has been associated with lower SES. Although micronutrient intake and, hence, diet quality are affected by SES, little evidence indicates that SES affects either total energy intakes or the macronutrient composition of the diet. The observed associations between SES variables and diet-quality measures can be explained by a variety of potentially causal mechanisms. The disparity in energy costs ($/MJ) between energy-dense and nutrient-dense foods is one such mechanism; easy physical access to low-cost energy-dense foods is another. If higher SES is a causal determinant of diet quality, then the reported associations between diet quality and better health, found in so many epidemiologic studies, may have been confounded by unobserved indexes of social class. Conversely, if limited economic resources are causally linked to low-quality diets, some current strategies for health promotion, based on recommending high-cost foods to low-income people, may prove to be wholly ineffective. Exploring the possible causal relations between SES and diet quality is the purpose of this review.
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              Predicting basal metabolic rate, new standards and review of previous work.

              After reviewing the literature on basal metabolism, this paper discusses and reviews recent attempts to predict BMR from age, sex and anthropometric measurements. Criticism is made of the scientific and statistical integrity of a widely used table of standard metabolic rates for weight. The statistical screening of data from the literature of the past 50 years is described and equations computed from these screened data are presented. In these equations, BMR is predicted simply from weight or from weight and height with sex and age taken into account. Information is given on error, and tables estimating error for predictions on new data both for individuals and for means of groups of subjects are included. A table of BMRs for weights from 3 to 84 kg for males and females separately is also included. Cross-validation techniques are used to estimate possible threats to validity from various sources including, for example, different procedures of early workers. It was found that in the data available subjects from developing countries not only were smaller and had lower metabolic rates (as was expected) but also had lower rates per unit body weight than European or North American subjects. It is argued that at an individual level the error of prediction must be high since the global operationalisation of BMR confounds separate effects known to participate in complex relations with sex, age and anthropometric indices. The work reported is aimed at meeting a practical need for equations which are simple to apply. However, it was found that little was gained by the use of more complex equations, although they remain of scientific interest.
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                Author and article information

                Contributors
                Journal
                EClinicalMedicine
                EClinicalMedicine
                EClinicalMedicine
                Elsevier
                2589-5370
                15 January 2020
                February 2020
                15 January 2020
                : 19
                Affiliations
                [a ]Department of Epidemiology, University Medical Center Groningen, University of Groningen (FA40), P.O. Box 30 001, 9700 RB Groningen, the Netherlands
                [b ]Department of Nephrology, University Medical Center Groningen, University of Groningen (AA52), P.O. Box 30 001, 9700 RB Groningen, the Netherlands
                Author notes
                [* ]Corresponding author. p.c.vinke@ 123456umcg.nl
                Article
                S2589-5370(19)30261-5 100252
                10.1016/j.eclinm.2019.100252
                7046499
                © 2019 Published by Elsevier Ltd.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                Categories
                Research paper

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