OBJECTIVE -The purpose of this study was to prospectively examine the association between vitamin D and calcium intake and risk of type 2 diabetes.RESEARCH DESIGN AND METHODS -In the Nurses' Health Study, we followed 83,779 women who had no history of diabetes, cardiovascular disease, or cancer at baseline for the development of type 2 diabetes. Vitamin D and calcium intake from diet and supplements was assessed every 2-4 years. During 20 years of follow-up, we documented 4,843 incident cases of type 2 diabetes.RESULTS -After adjusting for multiple potential confounders, there was no association between total vitamin D intake and type 2 diabetes. However, the relative risk (RR) of type 2 diabetes was 0.87 (95% CI 0.75-1.00; P for trend ϭ 0.04) comparing the highest with the lowest category of vitamin D intake from supplements. The multivariate RRs of type 2 diabetes were 0.79 (0.70 -0.90; P for trend Ͻ0.001) comparing the highest with the lowest category of calcium intake from all sources and 0.82 (0.72-0.92; P for trend Ͻ0.001) comparing the highest with the lowest category of calcium intake from supplements. A combined daily intake of Ͼ1,200 mg calcium and Ͼ800 IU vitamin D was associated with a 33% lower risk of type 2 diabetes with RR of 0.67 (0.49 -0.90) compared with an intake of Ͻ600 mg and 400 IU calcium and vitamin D, respectively.CONCLUSIONS -The results of this large prospective study suggest a potential beneficial role for both vitamin D and calcium intake in reducing the risk of type 2 diabetes. Diabetes Care 29:650 -656, 2006T here is evidence to suggest that altered vitamin D and calcium homeostasis may play a role in the development of type 2 diabetes. The role of vitamin D in type 2 diabetes is suggested by cross-sectional studies showing that low serum concentrations of 25-hydroxyvitamin D [25(OH)D] are associated with impaired glucose tolerance and diabetes (1-3). The role of calcium in the development of type 2 diabetes is suggested indirectly by cross-sectional studies in which high calcium intake has been found to be inversely associated with body weight and fatness (4 -6). The results from small clinical trials have been inconsistent (7-11).The purpose of the present study was to prospectively evaluate the association between vitamin D and calcium intake and the risk of type 2 diabetes in a large cohort of women followed for 20 years. For the present analysis, follow-up began in 1980, when the first dietary questionnaires were mailed to women who were free of diabetes, coronary heart disease, stroke, or cancer. After excluding participants with incomplete data on variables required for the analysis, a total of 83,779 women contributed to the analysis with follow-up completed in June 2000. RESEARCH DESIGN AND METHODS Assessment of dietary intakeDietary intake was assessed with the semiquantitative validated Food Frequency Questionnaire (13), first in 1980 and subsequently in 1984, 1986, 1990, 1994, and 1998. Dietary intake of vitamin D, calcium, and other nutrients was calculated by multip...
Adiponectin, predominantly synthesized in the adipose tissue, seems to have substantial anti-inflammatory properties and to be a major modulator of insulin resistance and dyslipidemia, mechanisms that are associated with an increased atherosclerotic risk in diabetic patients. However, it is unknown whether higher levels of adiponectin are associated with a reduced risk for coronary heart disease (CHD) among diabetic individuals. We investigated the association between plasma adiponectin levels and incidence of CHD among 745 men with confirmed type 2 diabetes in the Health Professionals Follow-up Study. A diponectin, predominantly synthesized in the adipose tissue, seems to play an important role in carbohydrate and lipid metabolism and vascular biology (1). It has been found to be a major modulator of insulin action and resistance (2) and to predict the development of type 2 diabetes (3-8). Furthermore, it seems to have substantial anti-inflammatory properties (1). Adiponectin is also related to lipid metabolism, particularly higher levels of HDL cholesterol and lower levels of triglycerides (9). These data suggest that high adiponectin levels may be related to lower risk for coronary heart disease (CHD), and we demonstrated recently that adiponectin levels are associated with a lower risk for myocardial infarction among healthy men in the Health Professionals Follow-up Study (10). Lifestyle and pharmaceutical approaches that increase adiponectin levels therefore might be valuable in decreasing atherosclerotic risk, particularly in individuals with type 2 diabetes, who are at high risk. However, it remains unclear whether adiponectin levels predict CHD risk among individuals with type 2 diabetes, in whom a complex array of metabolic abnormalities most likely contributes to the elevated risk. Glycemia, blood lipids, and inflammatory markers seem to be independently associated with adiponectin levels (11), but it also remains unresolved which pathways may mediate the potential association between adiponectin and CHD risk among diabetic individuals. We therefore evaluated whether adiponectin levels predict CHD events among diabetic men and whether inflammatory markers, cholesterol levels, or HbA 1c mediates this association. RESEARCH DESIGN AND METHODSThe Health Professionals Follow-up Study is a prospective cohort study of 51,529 U.S. male health professionals (dentists, veterinarians, pharmacists, optometrists, osteopathic physicians, and podiatrists) who were aged 40 -75 years at study initiation in 1986. This cohort is followed through biennial mailed questionnaires that focus on various lifestyle factors and health outcomes. In addition, between 1993 and 1994, 18,159 study participants provided blood samples by overnight courier. Among participants who returned blood samples, 1,000 had a confirmed diagnosis of type 2 diabetes (as reported on a supplementary questionnaire sent to all men who reported a diagnosis of diabetes) at baseline or during follow-up through 1998. The present study included 745 men who di...
Both increased adiposity and reduced physical activity are strong and independent predictors of death.
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