OBJECTIVE: Combined low-risk lifestyle behaviors (LRLBs) have been associated with a reduction in type 2 diabetes risk. This relationship has not been systematically quantified. RESEARCH DESIGN AND METHODS: A systematic review and meta-analysis was conducted to assess the association of combined LRLBs with type 2 diabetes. Databases were searched up to September 2022. Prospective cohort studies reporting the association between a minimum of three combined LRLBs (including healthy diet) with incident type 2 diabetes were included. Independent reviewers extracted data and assessed study quality. Risk estimates of extreme comparisons were pooled using a random-effects model. Global dose-response meta-analysis (DRM) for maximum adherence was estimated using a one-stage linear mixed model. The certainty of the evidence was assessed using GRADE (Grading of Recommendations, Assessment, Development and Evaluations). RESULTS: Thirty cohort comparisons (n = 1,693,753) involving 75,669 incident type 2 diabetes cases were included. LRLBs, with author-defined ranges, were healthy body weight, healthy diet, regular exercise, smoking abstinence or cessation, and light alcohol consumption. LRLBs were associated with 80% lower risk of type 2 diabetes (relative risk [RR] 0.20; 95% CI 0.17-0.23), comparing the highest with lowest adherence. Global DRM for maximum adherence to all five LRLBs reached 85% protection (RR 0.15; 95% CI 0.12-0.18). The overall certainty of the evidence was graded as high. CONCLUSIONS: There is a very good indication that a combination of LRLBs that includes maintaining a healthy bodyweight, healthy diet, regular exercise, smoking abstinence or cessation, and light alcohol consumption is associated with a lower risk of incident type 2 diabetes.
BACKGROUND: Adverse associations of low- and no-calorie sweetened beverages (LNCSB) with cardiometabolic outcomes in observational studies may be explained by reverse causality and residual confounding. PURPOSE: To address these limitations we used change analyses of repeated measures of intake and substitution analyses to synthesize the association of LNCSB with cardiometabolic outcomes. DATA SOURCES: MEDLINE, Embase, and the Cochrane Library were searched up to 10 June 2021 for prospective cohort studies with ≥1 year of follow-up duration in adults. STUDY SELECTION: Outcomes included changes in clinical measures of adiposity, risk of overweight/obesity, metabolic syndrome, type 2 diabetes (T2D), cardiovascular disease, and total mortality. DATA EXTRACTION: Two independent reviewers extracted data, assessed study quality, and assessed certainty of evidence using GRADE. Data were pooled with a random-effects model and expressed as mean difference (MD) or risk ratio (RR) and 95% CI. DATA SYNTHESIS: A total of 14 cohorts (416,830 participants) met the eligibility criteria. Increase in LNCSB intake was associated with lower weight (5 cohorts, 130,020 participants; MD -0.008 kg/year [95% CI -0.014, -0.002]). Substitution of LNCSB for sugar-sweetened beverages (SSB) was associated with lower weight (three cohorts, 165,579 participants; MD, -0.12 [-0.14, -0.10,] kg/y) and lower incidence of obesity (OB) (one cohort, 15,765 participants; RR 0.88 [95% CI 0.88, 0.89]), coronary heart disease (six cohorts, 233,676 participants; 0.89 [0.81, 0.98]), cardiovascular disease mortality (one cohort, 118,363 participants; 0.95 [0.90, 0.99]), and total mortality (one cohort, 118,363 participants; 0.96 [0.94, 0.98]) with no adverse associations across other outcomes. Substitution of water for SSB showed lower weight (three cohorts, 165,579 participants; MD -0.10 kg/year [-0.13, -0.06]), lower waist circumference (one cohort, 173 participants; -2.71 cm/year [-4.27, -1.15]) and percent body fat (one cohort, 173 participants; -1.51% per year [-2.61, -0.42]), and lower incidence of OB (one cohort, 15,765 participants; RR 0.85 [0.75, 0.97]) and T2D (three cohorts, 281,855 participants; 0.96 [0.94, 0.98]). Substitution of LNCSB for water showed no adverse associations. LIMITATIONS: The evidence was low to very low certainty owing to downgrades for imprecision, indirectness, and/or inconsistency. CONCLUSIONS: LNCSB were not associated with cardiometabolic harm in analyses that model the exposure as change or substitutions. The available evidence provides some indication that LNCSB in their intended substitution for SSB may be associated with cardiometabolic benefit, comparable with the standard of care, water.
- MeSH
- cukrem slazené nápoje * škodlivé účinky MeSH
- diabetes mellitus 2. typu * epidemiologie MeSH
- dospělí MeSH
- kardiovaskulární nemoci * epidemiologie etiologie MeSH
- kohortové studie MeSH
- lidé MeSH
- obezita MeSH
- prospektivní studie MeSH
- voda MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- metaanalýza MeSH
- práce podpořená grantem MeSH
- systematický přehled MeSH
Maskovaná hypertenze je definována jako normální hodnota krevního tlaku při měření v ordinaci a hypertenzní hodnoty zachycené mimo ni. Její prevalence bývá uváděna kolem 15 %. Častěji bývá přítomna u osob, které měly v ordinaci naměřený tlak krve v pásmu vysokého normálního tlaku krve, tedy 130–139/80–89 mmHg. Dále je její výskyt častější u mužů, kuřáků. Pojí se rovněž s konzumací alkoholu, stresem na pracovišti, obezitou, diabetem nebo chronickým onemocněním ledvin. Kardiovaskulární morbidita a mortalita pacientů s maskovanou hypertenzí se téměř blíží té při setrvalé hypertenzi. Vhodnou metodou pro její screening je ambulantní 24hodinové monitorování krevního tlaku. Doporučení Evropské kardiologické společnosti a American College of Cardiology/American Heart Association uvádí jako jednoznačnou indikaci ke screeningu maskované hypertenze přítomnost orgánových komplikací spojených s hypertenzí u jedinců, kterým hypertenze dosud diagnostikována nebyla. Jasná doporučení stran terapie maskované hypertenze prozatím vydána nejsou, terapie je tedy empirická.
Masked hypertension is defined as normal level of blood pressure when measured in doctor's office and hypertension levels outside of it. Prevalence is usually reported to be around 15%. It is more often detected among patients who had pressure measured in the office at the upper limit of normal blood pressure, or 130–139/80–89 mmHg. More common occurrence is among men, smokers. It is associated with alcohol consumption, stress in workplace, obesity, diabetes or chronic kidney disease. Cardiovascular morbidity and mortality in patients with masked hypertension are almost close to those with persistent hypertension. The recommendations of the European Society of Cardiology and the American College of Cardiology/American Heart Association state that the presence of organ complications associated with hypertension in individuals who have not yet been diagnosed with hypertension as a clear indication for screening of masked hypertension. There haven't been issued any clear recommendation for masked hypertension, hence therapy is empirical.
