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OBJECTIVE -The goal of the study was to examine risk factors in the prediction of coronary heart disease (CHD) and differences in men and women in the EURODIAB Prospective Complications Study. RESEARCH DESIGN AND METHODS -Baseline risk factors and CHD at follow-upwere assessed in 2,329 type 1 diabetic patients without prior CHD. CHD was defined as physician-diagnosed myocardial infarction, angina pectoris, coronary artery bypass graft surgery, and/or Minnesota-coded ischemic electrocardiograms or fatal CHD.RESULTS -There were 151 patients who developed CHD, and the 7-year incidence rate was 8.0 (per 1,000 person-years) in men and 10.2 in women. After adjustment for age and/or duration of diabetes, the following risk factors were related to CHD in men: age, GHb, waistto-hip ratio (WHR), HDL cholesterol, smoking, albumin excretion rate (AER), and autonomic neuropathy. The following risk factors were related to CHD in women: age, systolic blood pressure (BP), fasting triglycerides, AER, and retinopathy. Multivariate standardized Cox proportional hazards models showed that age (hazard ratio 1.5), AER (1.3 in men and 1.6 in women), WHR (1.3 in men), smoking (1.5 in men), fasting triglycerides (1.3 in women) or HDL cholesterol (0.74 in women), and systolic BP (1.3 in women) were predictors of CHD.CONCLUSIONS -This study supports the evidence for a strong predictive role of baseline albuminuria in the pathogenesis of CHD in type 1 diabetes. Furthermore, sex-specific risk factors such as systolic BP, fasting triglycerides (or HDL cholesterol), and WHR were found to be important in the development of CHD. Diabetes Care 27:530 -537, 2004T ype 1 diabetes is associated with a four-(in men) to eightfold (in women) excess risk of coronary heart disease (CHD) (1,2). This substantially elevated risk in women with diabetes effectively obliterates the sex difference in CHD observed in the general population (3,4).Established risk factors do not appear to account for the excess risk of CHD in type 1 diabetes, and reasons for the greater impact in women are not clear. But there is a lack of large prospective studies in type 1 diabetic patients. Much of the research into CHD risk in diabetes has focused on type 2 diabetes and insulin resistance. Type 1 diabetes has a different pathogenesis from type 2 diabetes, and although there are similarities between the diseases such as hyperglycemia, inferences cannot be made from one type to the other for all risk factors, such as lipids and obesity. For example, type 1 diabetes is associated with a favorable lipid pattern compared with the general population, which is clearly not true for type 2 diabetes (5).Previous studies of type 1 diabetic patients suggest that albuminuria (4,6 -9) and raised blood pressure (BP) (4,6 -9) are important risk factors for CHD, but these studies had insufficient power to stratify analyses by sex. The case for an independent relationship between obesity measures and CHD is unclear, the role of the other complications of diabetes uncertain, and findings for lip...

This study in European patients with type 1 diabetes showed that a lower dietary GI is related to lower Hb A(1c) concentrations, independently of fiber intake. The consumption of bread and pasta had the biggest effect on the overall dietary GI of European outpatients.

Aims/hypothesis The aim of this study was to examine the association of physical activity (PA) with all-cause mortality and incident and prevalent cardiovascular disease (CVD) among patients with type 1 diabetes. Methods The EURODIAB Prospective Complications Study is a cohort including 3,250 male and female patients with type 1 diabetes (mean age 32.7±10.2 years) from 16 European countries, of whom 1,880 participated in followup examinations. In analysis 1 (longitudinal), the association of baseline PA (based on the reported number of hours per week spent in mild, moderate and vigorous PA) with allcause mortality and incident CVD was examined by performing survival analysis. In analysis 2 (cross-sectional), we focused on the association between PA at follow-up (data on sports, walking distance and regular bicycling) and prevalent CVD by performing logistic regression analysis. Adjustments were made for age, sex, BMI, smoking, consumption of alcohol, consumption of certain nutrients and diabetic complications. Results Analysis 1 (longitudinal): participation in moderate or vigorous PA once a week or more was borderline inversely associated with all-cause mortality (men and women combined) (HR 0.66, 95% CI 0.42, 1.03) and incident CVD (women only) (HR 0.66, 95% CI 0.40, 1.08). No association was found in men. Analysis 2 (cross-sectional): total PA (indexed by sports, walking, bicycling) and distance walked were inversely associated with prevalent CVD (OR totalPA 0.66, 95% CI 0.45, 0.97; and OR walking 0.61, 95% CI 0.42, 0.89). Conclusions/interpretation PA showed a borderline inverse association with both all-cause mortality (both sexes) and incident CVD (women only) in patients with type 1 diabetes. Since this is an under-researched clinical population, future longitudinal studies with objective PA measurements are needed to expand on these results.

The EURODIAB IDDM Complications Study, a cross-sectional, clinic-based study, was designed to measure the prevalence of diabetic complications in stratified samples of European insulin-dependent diabetic (IDDM) patients. As diet may be related to diabetic complications, nutritional intake was analysed in the study population. The aims of this first nutritional paper are to describe the nutrient intake in 2868 IDDM patients from 30 centres in 16 countries throughout Europe, to investigate the degree of regional differences in nutrient intake and to compare current intakes with recommended levels. Nutritional intake from 1458 male and 1410 female IDDM patients was assessed by a validated 3-day record (two weekdays, Sunday) and centrally analysed. Mean energy intake for all patients was 2390 +/- 707 kcal/day. Mean protein intake was 1.5 +/- 0.5 g/kg body weight. Carbohydrate intake was 43% and fibre intake 18 g/day. Alcohol intake for the total cohort was 2% of energy. Total fat contributed 38% of energy, with 14% from saturated fat. The Italian centres reported lower total and saturated fat intakes compared with other centres. Recommendations from the Diabetes and Nutrition Study Group of the EASD for total fat, saturated fatty acids and carbohydrate were only achieved by 14%, 14% and 15% of patients, respectively. The data of the present study clearly indicate current problems in the nutritional intake of European IDDM patients. These findings contribute to the definition of future targets in the nutritional management of IDDM patients, to be achieved as part of the initiatives taken by the St. Vincent Declaration action programme.

BACKGROUND: Overweight and obesity are also found among persons with type 1 diabetes. OBJECTIVE: The present study examined which nutrients predict the body mass index (BMI), the waist-to-hip ratio (WHR) and the waist circumference (WC) of European persons with type 1 diabetes. DESIGN: Cross-sectional, clinic-based study (EURODIAB Complications Study). SUBJECTS AND METHODS: Nutrient intakes (assessed by a 3-day dietary record) predicting measures of body weight (BMI, WHR and WC) were determined by stepwise forward regression analysis in 1458 males and 1410 females with type 1 diabetes (P 0.05 for inclusion). RESULTS: In men, a higher carbohydrate intake was a significant independent predictor for lower levels of BMI, WHR and WC, an increased saturated fat intake and a lower intake of cereal fibre predicted a higher WHR, a higher monounsaturated fat intake and a lower glycaemic index of the diet determined lower levels of WHR and WC, and a moderate consumption of alcohol determined an increased WC. In women, a higher carbohydrate intake predicted a lower BMI and a thinner WC, no alcohol consumption determined a lower BMI, and an increased intake of saturated fat and a lower consumption of cereal fibre were significant independent predictors for a higher WHR. CONCLUSIONS: A modified fat intake, an increase of carbohydrate and cereal fibre intake and a preferred consumption of low glycaemic index foods are independently related to lower measures of body weight in European persons with type 1 diabetes.

and 2 see Acknowledgements for complete list of participating hospitals and clinicsObjectives: Repeatability of a dietary method is important in determining the quality of nutritional data. It should be assessed in the population of interest. This study evaluated the repeatability of nutritional data from standardized three-day dietary records, from the clinic-based, cross-sectional multi-centre EURODIAB IDDM Complications Study. Design and Subjects: 15% of the total EURODIAB cohort was randomly selected to test the repeatability of nutritional intake data. Two three-day records, completed three weeks apart, were available for 216 diabetic patients (7.5%) representative of the total cohort. All records were analysed centrally, for intakes of protein (animal and vegetable), fat (saturated fat and cholesterol), carbohydrate, ®bre, alcohol and energy. Repeatability was measured comparing mean intakes, determining the proportion of patients classi®ed into the same/opposite quartile by the two three-day records and assessing mean differences with standard deviations (s.d. d ).Results There were no signi®cant differences in mean energy and nutrient intakes between the ®rst and second records. Classi®cation of individuals into the opposite quartile occurred only in 0±4% of patients and overall about 50% (range 44±74%) of the subjects were classi®ed into the same quartiles of intakes. Only small mean differences were found for energy intake (7156 (1633) kJ; 95% con®dence limits 7375, 63 kJ) and nutrients with s.d. d s comparable to intra-individual variations in the general population. The differences in energy intake were randomly distributed over the range of intakes. Conclusions: The present study demonstrates that standardized three day dietary records show a high degree of repeatability within a short period of time in a sample of European IDDM patients. The good repeatability strengthens the conclusions drawn from the nutritional data in the EURODIAB IDDM Complications Study.

Kidney disease is a common and costly complication [1,2] of diabetes mellitus, with individuals often requiring dialysis or renal transplantation. More than 30 % of people with insulin-dependent diabetes mellitus (IDDM) are at risk of manifest renal disease [3][4][5]. In the EURODIAB IDDM Complications Study 30.6 % of a stratified European sample of individuals with IDDM aged 15-60 years (mean diabetes duration: 15 years) had albumin excretion rates (AER) of 20 m g/min or higher. In persons with a diabetes duration of 1-5 years the rate of elevated AER was 19.3 % [6]. This high prevalence of micro-and macroalbuminuria even early in IDDM and its predictive association for both clinical nephropathy [7][8][9][10][11][12] and increased cardiovascular disease risk [6,[13][14][15] highlight the potential for early detection and effective prevention of diabetic vascular complications.The use of low protein diets has been shown to reduce the progression of nephropathy in patients with clinically overt diabetic nephropathy [16][17][18][19]. In Diabetologia (1997) Summary For people with insulin-dependent diabetes mellitus (IDDM) renal disease represents a lifethreatening and costly complication. The EURODI-AB IDDM Complications Study, a cross-sectional, clinic-based study, was designed to determine the prevalence of renal complications and putative risk factors in stratified samples of European individuals with IDDM. The present study examined the relationship between dietary protein intake and urinary albumin excretion rate (AER). Food intake was assessed centrally by a standardized 3-day dietary record. Urinary AER was determined in a central laboratory from a timed 24-h urine collection. Complete data were available from 2696 persons with IDDM from 30 centres in 16 European countries. In individuals who reported protein consumption less than 20 % of total food energy intake, mean AER was below 20 m g/min. In those in whom protein intake constituted more than 20 %, mean AER increased, a trend particularly pronounced in individuals with hypertension and/or poor metabolic control. Trends reached statistical significance for intakes of total protein (% of energy, p = 0.01) and animal protein (% of energy, p = 0.02), while no association was seen for vegetable protein (p = 0.83). These findings support the current recommendation for people with diabetes not to exceed a protein intake of 20 % of total energy. Monitoring and adjustment of dietary protein appears particularly desirable for individuals with AER exceeding 20 m g/min (approximately 30 mg/24 h), especially when arterial pressure is raised and/or diabetic control is poor. [Diabetologia (1997[Diabetologia ( ) 40: 1219[Diabetologia ( -1226