The authors conducted a systematic review of published data on the association between diabetes mellitus and fracture. The authors searched MEDLINE through June 2006 and examined the reference lists of pertinent articles (limited to studies in humans). Summary relative risks and 95% confidence intervals were calculated with a random-effects model. The 16 eligible studies (two case-control studies and 14 cohort studies) included 836,941 participants and 139,531 incident cases of fracture. Type 2 diabetes was associated with an increased risk of hip fracture in both men (summary relative risk (RR) = 2.8, 95% confidence interval (CI): 1.2, 6.6) and women (summary RR = 2.1, 95% CI: 1.6, 2.7). Results were consistent between studies of men and women and between studies conducted in the United States and Europe. The association between type of diabetes and hip fracture incidence was stronger for type 1 diabetes (summary RR = 6.3, 95% CI: 2.6, 15.1) than for type 2 diabetes (summary RR = 1.7, 95% CI: 1.3, 2.2). Type 2 diabetes was weakly associated with fractures at other sites, and most effect estimates were not statistically significant. These findings strongly support an association between both type 1 and type 2 diabetes and increased risk of hip fracture in men and women.

Summary Background Elevated blood pressure and glucose, serum cholesterol, and body mass index (BMI) are risk factors for cardiovascular diseases (CVDs); some of these factors also increase the risk of chronic kidney disease (CKD) and diabetes. We estimated CVD, CKD, and diabetes mortality attributable to these four cardio-metabolic risk factors for all countries and regions between 1980 and 2010. Methods We used data on risk factor exposure by country, age group, and sex from pooled analysis of population-based health surveys. Relative risks for cause-specific mortality were obtained from pooling of large prospective studies. We calculated the population attributable fractions (PAF) for each risk factor alone, and for the combination of all risk factors, accounting for multi-causality and for mediation of the effects of BMI by the other three risks. We calculated attributable deaths by multiplying the cause-specific PAFs by the number of disease-specific deaths from the Global Burden of Diseases, Injuries, and Risk Factors 2010 Study. We propagated the uncertainties of all inputs to the final estimates. Findings In 2010, high blood pressure was the leading risk factor for dying from CVDs, CKD, and diabetes in every region, causing over 40% of worldwide deaths from these diseases; high BMI and glucose were each responsible for about 15% of deaths; and cholesterol for 10%. After accounting for multi-causality, 63% (10.8 million deaths; 95% confidence interval 10.1–11.5) of deaths from these diseases were attributable to the combined effect of these four metabolic risk factors, compared with 67% (7.1 million deaths; 6.6–7.6) in 1980. The mortality burden of high BMI and glucose nearly doubled between 1980 and 2010. At the country level, age-standardised death rates attributable to these four risk factors surpassed 925 deaths per 100,000 among men in Belarus, Mongolia, and Kazakhstan, but were below 130 deaths per 100,000 for women and below 200 for men in some high-income countries like Japan, Singapore, South Korea, France, Spain, The Netherlands, Australia, and Canada. Interpretations The salient features of the cardio-metabolic epidemic at the beginning of the twenty-first century are the large role of high blood pressure and an increasing impact of obesity and diabetes. There has been a shift in the mortality burden from high-income to low- and middle-income countries.

OBJECTIVE -The purpose of this study was to determine whether women with type 1 and type 2 diabetes are at higher risk of hip fractures.RESEARCH DESIGN AND METHODS -A total of 109,983 women aged 34 -59 years in 1980 were followed through 2002 for the occurrence of hip fracture. At baseline and through biennial follow-up, women were asked about their history and treatment of diabetes and other potential risk factors for hip fracture.RESULTS -During 2.22 million person-years of follow-up, 1,398 women had a hip fracture. Compared with women without diabetes, the age-adjusted relative risk (RRs) of hip fracture was 7.1 (95% CI 4.4 -11.4) for women with type 1 diabetes and 1.7 (1.4 -2.0) for those with type 2 diabetes. After further adjustment for BMI, smoking, physical activity, menopausal status, daily intake of calcium, vitamin D, protein, and postmenopausal hormone use, the multivariate RR of incident hip fracture in individuals with type 1 diabetes compared with individuals without diabetes was 6.4 (3.9 -10.3) and with type 2 diabetes was 2.2 (1.8 -2.7). The RRs increased with longer duration of type 2 diabetes (3.1 [2.3-4.0] for Ն12 years compared with no diabetes, P for trend Ͻ 0.001) and ever use of insulin.CONCLUSIONS -These data indicate that both type 1 and type 2 diabetes are associated with an increased risk of hip fracture. The results of this study highlight the need for fractureprevention strategies in women with diabetes. Diabetes Care 29:1573-1578, 2006T he role of diabetes as a risk factor for osteoporosis and fracture remains unsettled. Bone mineral density (BMD) appears to be reduced in patients with type 1 diabetes in most (1-4) but not all studies (5,6). There have also been conflicting reports about BMD in patients with type 2 diabetes (3,4,7-18); in some studies BMD was reduced (7,9), whereas in other studies BMD was increased (8,10 -12) or unchanged (13-18). Uncertainty also exists about the relationship between diabetes and fracture incidence. Only a few studies have examined the risk of fracture in people with type 1 diabetes (9,14 -16,19,20); the risk of hip fracture appeared to be increased in some (9,14,19,20) but not all studies (15,16). Studies of the association between type 2 diabetes and the risk of fracture also demonstrated inconsistent conclusions (4,8,9,11,12,(21)(22)(23)(24)(25). Several of these studies showed a positive association (12,(22)(23)(24)(25), whereas others reported no association (4,8,9) or even an inverse relation (11,21). However, most of these studies have been conducted with relatively small numbers of participants, have had limited ability to adjust for potential confounders, or were not able to distinguish between type 1 and type 2 diabetes (24,25). Given the conflicting results in previous studies, we used the large ongoing Nurses' Health Study (NHS) to examine the risk of hip fracture in women with type 1 or type 2 diabetes. RESEARCH DESIGN AND METHODS Ascertainment of fractureIncident cases of hip fracture that occurred before 1 June 2002 were identifie...

The selection was conducted by stratified probability cluster sampling through household family members in Iran. Weight, height, and waist circumference (WC) of 89,404 men and women 15 to 65 years of age (mean, 39.2 years) were measured. The criteria for underweight, normal-weight, overweight, and Class I, II, and III obesity were BMI Ͻ18.5, 18.5 to 24.9, 25 to 29.9, 30 to 34.9, 35 to 39.9, and Ն40 (kg/m 2 ), respectively. Abdominal obesity was defined as WC Ն102 cm in men and Ն88 cm in women. Results: The age-adjusted means for BMI and WC were 24.6 kg/m 2 in men and 26.5 kg/m 2 in women and 86.6 cm in men and 89.6 cm in women, respectively. The ageadjusted prevalence of overweight or obesity (BMI Ն25) was 42.8% in men and 57.0% in women; 11.1% of men and 25.2% of women were obese (BMI Ն30), while 6.3% of men and 5.2% of women were underweight. Age, low physical activity, low educational attainment, marriage, and residence in urban areas were strongly associated with obesity. Abdominal obesity was more common among women than men (54.5% vs. 12.9%) and greater with older age. Discussion: Excess body weight appears to be common in Iran. More women than men present with overweight and abdominal obesity. Prevention and treatment strategies are urgently needed to address the health burden of obesity.

BACKGROUND: Although several observational and experimental studies have investigated the effect of dairy consumption on weight and body composition, results are inconsistent. OBJECTIVE: This systematic review and meta-analysis was conducted to summarize the published evidence from randomized controlled clinical trials (RCTs) regarding the effect of dairy consumption on weight, body fat mass, lean mass and waist circumference (WC) in adults. DESIGN: PubMed, ISI Web of Science, SCOPUS, Science Direct and EMBASE were searched from January 1960 to October 2011 for relevant English and non-English publications. Sixteen studies were selected for the systematic review and fourteen studies were included in meta-analysis. RESULTS: Our search led to 14, 12, 6 and 8 eligible RCTs that had data on weight, body fat mass, lean mass and WC, respectively. Overall, mean difference for the effect of dairy on body weight was À0.61 kg (95% confidence interval (CI): À1.29, 0.07, P ¼ 0.08). Increased dairy intake resulted in 0.72 kg (95% CI: À1.29, À0.14, P ¼ 0.01) greater reduction in fat mass, 0.58 kg (95% CI: 0.18, 0.99, Po0.01) gain in lean mass and 2.19 cm (95% CI: À3.42, À0.96, P-value o0.001) further reduction in WC than that in controls. Subgroup analysis revealed that increasing dairy intake without energy restriction in both intervention and control groups does not significantly affect weight, body fat mass, lean mass and WC; consumption of high-dairy weight loss diets led to 1.29 kg (95% CI: À1.98, À0.6, Po0.001) greater weight loss, 1.11 kg (95% CI: À1.75, À0.47, P ¼ 0.001) greater reduction in body fat mass, 0.72 kg (95% CI: 0.12, 1.32, P ¼ 0.02) gain in body lean mass and 2.43 cm (95% CI: À3.42, À1.44, Po0.001) additional reduction in WC compared with controls. CONCLUSION: Increased dairy consumption without energy restriction might not lead to a significant change in weight or body composition; whereas inclusion of dairy products in energy-restricted weight loss diets significantly affects weight, body fat mass, lean mass and WC compared with that in the usual weight loss diets.

This is the accepted version of the paper.This version of the publication may differ from the final published version. Arabia, and to some extent in Turkey, reduced ORs were observed for Austria, China, Italy, Japan and the USA. Elevated ORs for psychological distress were seen in Japan, Jordan, Palestine, Saudi Arabia, Tunisia and Turkey but reduced ORs were noted in Austria, China, Iran, Italy and the USA. Psychological distress was strongly associated with reports of suicide ideation and attempts. Suicide ideation, suicide attempt and psychological distress are common in university students but their rates vary depending on the sociocultural context. Permanent repository linkDue attention should be devoted to the mental health needs of young adults enrolled in higher educational institutions and more cross-cultural research is warranted to better understand the etiology of the observed intersocietal variations in suicidal behavior and psychological distress.

OBJECTIVE -The aim of this study was to examine the relationship between type 1 and type 2 diabetes and risk of stroke subtypes in women.RESEARCH DESIGN AND METHODS -We followed 116,316 women aged 30 -55 years in 1976 through 2002 for incidence of stroke. At baseline and through biennial follow-up, women were asked about their history and treatment of diabetes and other potential risk factors for stroke.RESULTS -During 2.87 million person-years of follow-up, 3,463 incident strokes occurred. In multivariate analyses, the incidence of total stroke was fourfold higher in women with type 1 diabetes (relative risk [RR] I n many (1-11) but not all (12-15) epidemiological studies, type 2 diabetes has been an important risk factor for ischemic stroke; however, relative risks (RRs) have varied widely, from 1.3 to 4.9 (1-11). The disparate RRs may be explained in part by differences in populations, definitions of diabetes, types of stroke studied, and analytical methods. The increased risk of stroke has been linked to the pathophysiological changes seen in the cerebral vessels of individuals with diabetes (1). In contrast, the association with hemorrhagic stroke remains controversial; reported associations have been positive (3,5), null (16,17), or even inverse (1,18 -20). Further, only a few small studies have examined the risk of stroke in patients with type 1 diabetes (18 -21), and this relationship remains unsettled. We used the large ongoing Nurses' Health Study to examine the risk of total stroke and its subtypes in women with type 1 or type 2 diabetes. RESEARCH DESIGN AND METHODS Data collectionThe Nurses' Health Study is an ongoing cohort established in 1976 when 121,701 female registered nurses aged 30 -55 years completed a mailed questionnaire on their health status and various lifestyle and behavioral risk factors. Participants complete biennial follow-up questionnaires to update risk factors and report newly diagnosed diseases including stroke. The biennial follow-up rate exceeds 90%, and mortality follow-up is estimated as Ͼ98% complete (22). The human research committees at the Harvard School of Public Health and Brigham and Women's Hospital approved the study. Ascertainment of strokeIncident strokes were defined as the first nonfatal stroke or stroke death occurring after the baseline questionnaire in 1976 but before 1 June 2002. Women who reported a stroke were asked for permission to access their medical records, which were reviewed by a physician without knowledge of the participant's exposure status. Women for whom medical record release was refused or for whom medical records were unavailable were classified as probable if supporting information was provided. Cerebrovascular pathology due to infection, trauma, or malignancy was excluded, as were "silent" strokes discovered only by radiological imaging. Stroke was classified according to criteria established by the National Survey of Stroke (23), which required evidence of a neurological deficit with sudden or rapid onset that persisted for Ͼ24 h or u...

No abstract