Physical activity, dietary intake and metabolic risk factors in non-diabetic daughters of patients with type II diabetes
Introduction
The incidence of type II diabetes is increasing rapidly [1] and this is primarily believed to be due to increases in the prevalence of inactivity and obesity. Indeed, it has been suggested that being overweight with an abdominal fat distribution probably accounts for 80–90% [2], and a sedentary lifestyle accounts for at least 25% [3], of all type II diabetes incidence.
However, not all obese people develop diabetes, suggesting that while environmental factors, such as obesity, are probably necessary, they are not in themselves sufficient to precipitate this disease [2]. There is a high concordance of type II diabetes between monozygotic twins [4]. In addition, first degree relatives of patients with type II diabetes have a threefold higher risk of developing diabetes than their counterparts with no family history of diabetes [5], [6] and are often more insulin resistant than matched control subjects [7], [8], [9]. Furthermore, offspring of type II diabetic patients have increased levels of obesity [7], [8], [10] and greater susceptibility to the adverse effect of obesity on glycemia than their counterparts with no family history of diabetes [10]. Thus, the precipitation of metabolic dysfunction and type II diabetes is likely to be influenced not only by environmental factors but also by genetic susceptibility. However, because close family members live in a similar environment, familial lifestyle habits may also contribute to the increased incidence of diabetes seen in certain families.
Insulin resistance, a central feature of the metabolic syndrome, plays a primary role in the pathogenesis of type II diabetes and predates onset of the disease by one or two decades [11], [12]. Accumulating evidence suggests that the deterioration of insulin sensitivity and therefore impairment in insulin-mediated glucose disposal in the major glucose-utilising tissue, such as muscle, could be prevented by exercise. Epidemiological [13], [14], [15], [16] and controlled exercise training [17], [18], [19] studies demonstrate a clear link between physical activity and insulin resistance. Furthermore, several recent large-scale lifestyle intervention trials [20], [21], [22], [23] have shown that increased levels of physical activity can substantially reduce risk of developing type II diabetes in high-risk groups. It could therefore be hypothesised that the adverse metabolic risk profile evident in the offspring of patients with type II diabetes could be modulated by their habitual level of physical activity and/or by dietary intake.
Therefore, the aims of this study were to assess daily activity levels, dietary profile, and metabolic risk factors in the offspring of patients with type II diabetes and age- and sex-matched control subjects and to investigate the impact of habitual physical activity and diet on physical and metabolic profile in offspring and control groups.
Section snippets
Subjects
Subjects were recruited through workplace newsletter advertisements and posters. We also sent 140 letters to patients with type II diabetes asking their adult female offspring to take part in the study. Subjects were from similar socioeconomic backgrounds, with the majority being hospital workers (mainly nurses) and university staff of various grades. This study was carried out at two centres, namely, the University of Glasgow, United Kingdom, and the Lithuanian Academy of Physical Education,
Results
Physical and metabolic characteristics of the subjects are presented in Table 1. The offspring had higher BMI, percentage body fat, and waist circumference than the control subjects (all P < 0.01). The offspring were also more insulin resistant than the control subjects with higher fasting glucose and insulin concentrations and higher HOMAIR (all P < 0.01). There were no significant differences between groups for TG, total, LDL, or HDL cholesterol concentrations. Energy expenditure expressed
Discussion
The aim of this study was firstly to assess daily activity levels, dietary profile, and metabolic risk factors in the offspring of patients with type II diabetes and matched control subjects to determine whether activity levels or dietary profile differed between these two groups. Our second aim was to investigate whether the impact of habitual physical activity and diet on the physical and metabolic profile is different in offspring and control subjects.
In agreement with previous reports [7],
Acknowledgements
The authors acknowledge the financial support of Mars Incorporated. We would also like to thank Ms. Donna Taylor, Ms. Jill Sommerville, Ms. Abigail Fisher, and Ms. Sarah Crymble for their assistance in data collection.
References (40)
- et al.
Role of glucose and insulin resistance in development of type 2 diabetes mellitus: results of a 25-year follow-up study
Lancet
(1992) - et al.
Equations for predicting the energy requirements of healthy adults aged 18–81 y
Am. J. Clin. Nutr
(1999) - et al.
Global burden of diabetes, 1995–2025: prevalence, numerical estimates, and projections
Diabetes Care
(1998) - et al.
Redefining type 2 diabetes: ‘diabesity’ or ‘obesity dependent diabetes mellitus’?
Obes. Rev
(2000) - et al.
A prospective study of exercise and incidence of diabetes among US male physicians
JAMA
(1992) - et al.
Concordance rate for type II diabetes mellitus in monozygotic twins: actuarial analysis
Diabetologia
(1999) - et al.
Risk factors for type 2 (non-insulin-dependent) diabetes mellitus. Thirteen and one-half years of follow-up of the participants in a study of Swedish men born in 1913
Diabetologia
(1988) - et al.
Empirical risk factors for first degree relatives of non insulin dependent diabetes
- et al.
Multiple metabolic abnormalities in normal glucose tolerant relatives of NIDDM families
Diabetologia
(1997) - et al.
Evaluation of features of syndrome X in offspring of Caribbean patients with Type 2 diabetes
Scand. J. Clin. Lab. Invest
(2001)
Metabolic defects in lean nondiabetic offspring of NIDDM parents: a cross-sectional study
Diabetes
Parental history of diabetes modifies the association between abdominal adiposity and hyperglycemia
Diabetes Care
Slow glucose removal rate and hyperinsulinemia precede the development of type II diabetes in the offspring of diabetic parents
Ann. Intern. Med
Relationship between habitual physical activity and insulin levels among nondiabetic men and women
Diabetes Care
Weight, adiposity, and physical activity as determinants of an insulin sensitivity index in Pima Indian children
Diabetes Care
Factors associated with glucose and insulin levels in healthy postmenopausal women
Diabetes Care
Association of physical activity and serum insulin concentrations in two populations at high risk for type 2 diabetes but differing by BMI
Diabetes Care
Physical training and insulin sensitivity
Diabetes Metab. Rev
Invited review: effects of acute exercise and exercise training on insulin resistance
J. Appl. Physiol
Impact of aerobic exercise training on age-related changes in insulin sensitivity and muscle oxidative capacity
Diabetes
Cited by (8)
Association between family history of diabetes and cardiovascular disease and lifestyle risk factors in the United States population: The 2009–2012 National Health and Nutrition Examination Survey
2017, Preventive MedicineCitation Excerpt :Therefore, the significance of family history as a way of identifying individuals who should receive more intensive lifestyle modification counseling by health care providers should be a priority. Case-control studies comparing offspring of parents with and without diabetes showed that offspring of parents with diabetes were more likely to be obese, have higher waist circumference and higher blood pressure (p-value < 0.01) (Higgins et al., 2005; Sheikh Rashid et al., 2008). Insulin resistance was also found to be higher among children of diabetic parents compared to controls (Higgins et al., 2005).
Family history of diabetes and parental consanguinity: Important risk for impaired fasting glucose in South East Asians
2012, West Indian Medical JournalEffect of genetic testing for risk of type 2 diabetes mellitus on health behaviors and outcomes: Study rationale, development and design
2012, BMC Health Services ResearchErythrocyte fatty acid composition and insulin sensitivity in daughters of Type 2 diabetic patients and women with no family history of diabetes
2010, Journal of Endocrinological InvestigationManagement of the metabolic syndrome and type 2 diabetes through lifestyle modification
2009, Annual Review of Nutrition