Inverse association between diabetes and altitude: A cross‐sectional study in the adult population of the United States

Abstract

ObjectiveTo determine whether geographical elevation is inversely associated with diabetes, while adjusting for multiple risk factors.Design and MethodsThis is a cross-sectional analysis of publicly available online data from the Behavioral Risk Factor Surveillance System, 2009. Final dataset included 285,196 US adult subjects. Odds ratios were obtained from multilevel mixed-effects logistic regression analysis.ResultsAmong US adults (≥20 years old), the odds ratio for diabetes were 1.00 between 0−499 m of altitude (reference), 0.95 (95% confidence interval, 0.90 to 1.01) between 500−1,499 m, and 0.88 (0.81 to 0.96) between 1,500−3,500 m, adjusting for age, sex, body mass index, ethnicity, self-reported fruit and vegetable consumption, self-reported physical activity, current smoking status, level of education, income, health status, employment status, and county-level information on migration rate, urbanization, and latitude. The inverse association between altitude and diabetes in the US was found among men [0.84 (0.76 to 0.94)], but not women [1.09 (0.97 to 1.22)].ConclusionsAmong US adults, living at high altitude (1,500−3,500 m) is associated with lower odds of having diabetes than living between 0−499 m, while adjusting for multiple risk factors. Our findings suggest that geographical elevation may be an important factor linked to diabetes.

Ultraviolet radiation, vitamin D and the development of obesity, metabolic syndrome and type-2 diabetes

“…74 This study also reported reduced odds of obesity in men living at altitudes ≥1500 m compared to ≤500 m above sea level. 74 Military personnel (n>98,000, >90% male) assigned to duty in higher altitude locations (>1.96 m above sea level) had reduced odds of being obese compared to those living at locations <0.98 m altitude, although this was not adjusted for physical activity. 75 Similar findings are reported in a number of other studies (reviewed in 76 ).…”

“…75 Similar findings are reported in a number of other studies (reviewed in 76 ). Increased altitude may also reduce fasting glucose levels and improve glucose tolerance (reviewed by 74,76 ). The most likely explanation of these observations is thought to be increased hypoxia (reduced atmospheric oxygen levels) 76,77 , with less recognition for other environmental effects of increased altitude, such as greater UVR.…”

Increased Cardiometabolic Risk and Worsening Hypoxemia at High Altitude

“…There is conflicting evidence that high-altitude dwellers may have either increased (Baracco et al, 2007;Malaga et al, 2010) or decreased odds of having metabolic syndrome (Woolcott et al, 2014) when compared with sea-level counterparts. Laboratory studies have demonstrated that intermittent hypoxemia leads to insulin resistance (Polotsky et al, 2004) and low-grade systemic inflammation (Ryan et al, 2005), likely contributing to the development of cardiovascular disease; however, a better understanding of underlying mechanisms of hypoxemia-associated cardiometabolic disease risk is lacking.…”

Obesidad en la altura

“…El objetivo fue observar la relación de sobrepeso, obesidad y diabetes con la altura entre los años 2004 al 2009. Los niveles de altura escogidos fueron entre 0 y 499 m, 500 a 1 499 m y entre 1 500 y 3 500 m. Se encontró que la población de los Estados Unidos que vive entre 1 500 y 3 500 m estuvo asociada con un menor OR de ser obeso y tener diabetes que viviendo por debajo de 500 m. Esta relación inversa entre altura y obesidad y entre altura y diabetes en los Estados Unidos fue encontrada solo en varones, no en mujeres (43) Figura 1. Prevalencias de obesidad en poblaciones adultas ubicadas por encima de los 1 500 m de altitud comparadas con las prevalencias en EE UU y a nivel mundial (28) .…”

“…Correlación entre altitud y prevalencia de obesidad en adultos de Estados Unidos, datos obtenidos de centros de control y prevención de enfermedades (CDC) del año 2009 (43) . Con lo cual se demostró la presencia de una relación inversa entre la obesidad y el nivel de altitud.…”