Universal approach to tackling lifestyles more appropriate for combating diabetes than focusing on genetic risk

cjb250 — Tue, 20 May 2014 21:00:00 +0000

Over 380 million people worldwide are estimated to be affected by diabetes, with serious consequences for the health and economy of both developed and developing countries. Type 2 diabetes is thought to originate from a complex interplay of a large number of genetic risk variants and lifestyle factors, such as diet and exercise. Lifestyle interventions can reduce the risk of developing diabetes in high-risk individuals by 50%; however, whether there is value in targeted lifestyle interventions according to a person’s genetic susceptibility is unclear.

In an attempt to answer this question, a team of researchers led by the ̽��ֱ�� of Cambridge studied 12,403 middle-aged individuals from the 340,234 person European Prospective Investigation into Cancer and Nutrition (EPIC) cohort who developed type 2 diabetes and a further control subset of 16,154 participants. ̽��ֱ��researchers calculated a genetic risk score for type 2 diabetes for these individuals based on which of 49 known genetic variants for the disease each person carried, and arranged the individuals into four equally-sized groups from lowest to highest genetic risk score. They then examined the combined effects of the genetic score and lifestyle factors on the development of diabetes. ̽��ֱ��results of the study, which was mainly funded by the European Commission under its Framework 6 programme, are published today in the open access journal PLoS Medicine.

̽��ֱ��researchers found that the percentage of people of normal weight who developed type 2 diabetes over a ten-year period varied between 0.25% for those with the lowest genetic risk to 0.89% for those with the greatest genetic risk. In obese people, these figures ranged from 4.22% to 7.99%. In other words, obese individuals had the highest risk of developing type 2 diabetes regardless of their genetic risk score, emphasising the role of lifestyle as being much more important in the development of the disease than genetics.

Professor Nick Wareham, Director of the MRC Epidemiology Unit, says: “We have known for a long time that there is no one cause for type 2 diabetes – it’s a complex interaction of dozens of genes and our lifestyles. Recent genetic breakthroughs have provided the promise of targeted lifestyle interventions based on a person’s genetic make-up. However, genetic risk factors are greatly outweighed by lifestyle factors.

“We need effective strategies in place if we are going to stem the rapid rise in the number of cases of type 2 diabetes and the burden this places on our health systems. Our research suggests that focusing on tackling the lifestyle factors that lead to obesity at a population level will have a much greater impact than tailoring prevention strategies according to an individual’s genetic risk.”

Professor David Lomas, Chair of the MRC’s Population and Systems Medicine Board, adds: “One of the most effective ways to reduce the impact of type 2 diabetes is to stop people developing the condition in the first place, and this large international study reinforces the idea that broad promotion of a healthy diet and lifestyle is the way to go. Genomic information has already given us important insights into the diabetes disease mechanism, and grouping patients based on their genes and other biological factors still holds a great deal of promise for directing more targeted treatments for type 2 diabetes.”

Public health strategies aimed at tackling obesity at a population level through lifestyle changes are more appropriate for preventing type 2 diabetes than targeted interventions based on an individual’s genetic risk, according to a study led by the Medical Research Council Epidemiology Unit at the ̽��ֱ�� of Cambridge.

We need effective strategies in place if we are going to stem the rapid rise in the number of cases of type 2 diabetes

Nick Wareham

Ralph Aichinger

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A landmark study of health and lifestyle celebrates its 20th birthday

amb206 — Wed, 09 Oct 2013 15:00:00 +0000

Participants in the EPIC-Norfolk Study will be meeting in Norwich tomorrow to celebrate a project that is making substantial contributions to our understanding of the role of lifestyle, in particular, diet and physical activity, and biological factors in health and disease.

̽��ֱ��research, which has helped us understand what we can do to maintain health in later life and has important implications for policy-makers, is sponsored by the ̽��ֱ�� of Cambridge. It is currently led by principal investigators Professor Kay-Tee Khaw and Professor Nick Wareham.

Continuing support from thousands of participants living in Norwich and the surrounding area is at the heart of the success of this study which relies on people giving up their time on a voluntary basis to contribute to the research.

Around 25,000 men and women living in Norfolk agreed to take part at the start of the study in 1993 and have been followed up to the present. Today the oldest participant is more than 90. All receive regular communications supplying them with updates on the research findings.

EPIC-Norfolk is part of one of the world’s biggest population studies with components in ten countries across Europe. When the programme was launched in the early 1990s, the people recruited were aged between 40 and 79.

̽��ֱ��research has led to a succession of papers which have added to knowledge about key aspects of health including common conditions such as heart disease and cancer, obesity, diabetes, eye health, and cognitive skills, and how these might be linked to lifestyle and genetic factors. Quality of life is an important strand of the research.

“We’re holding our Public Meeting event at St Andrews Hall, in Norwich as a way of thanking all the thousands of people who have helped us over the years – and will, we hope, continue to help us as we move into the next stage of the study,” said EPIC-Norfolk research co-ordinator, Shabina Hayat. “ ̽��ֱ��generosity of our participants is tremendous – their input makes the research possible.”

Though the original focus was on diet and cancer, from the outset of the study, the scope was widened to look at major causes of disability and loss of quality of life – including cardiovascular disease, osteoporosis and fractures, musculo-skeletal conditions such as arthritis, and more recently, memory loss, physical function, and eye diseases.

“Essentially data from the study represents a hugely valuable resource that can be used by our research partners and will eventually be used to inform future health policies and interventions to improve health,” said Ms Hayat.

̽��ֱ��EPIC-Norfolk study is unique in the detail with which it has examined diet, collecting data on 200 nutrients and more than 1,200 food groups. Food diaries were at the core of this strand of the work, enabling researchers to see patterns in food consumption. It was shown, for example, that just as alcohol consumption gets higher towards the end of the week and on Saturday, so does that of cakes and pies.

Key findings have included: the effects of ageing are highly variable with some older people having better physical and cognitive function than those 30 years younger; red and processed meat is associated with greater colorectal cancer risk, especially in individuals with low fibre consumption; and participants reporting higher television viewing (long periods of inactivity) have a particular risk of cardiovascular disease.

̽��ֱ��study has shown that people following four health behaviours (not smoking, being physically active, moderate alcohol intake and intake of five or more vegetables per day) can expect, on average, to live 14 years longer than those who don’t. Another finding is that it is better to eat a large breakfast and a small evening meal in terms of minimising weight gain.

̽��ֱ��current phase of the study is focusing on physical activity and body composition. When people put on weight, they collect fat in different areas of their body: some take on a pear shape and others an apple shape. Current research suggests that those with an apple shape (fat around the waist) have an increased risk of developing health-related problems such as diabetes.

By scanning participants to reveal distribution of fat around the body, EPIC-Norfolk aims to throw further light on this finding.

A landmark longitudinal study of health in the community will celebrate its 20th anniversary in Norwich tomorrow (10 October). ̽��ֱ��research, which adds significantly to our knowledge of public health, relies on volunteers who consistently give their time to science.

̽��ֱ��generosity of our participants is tremendous – their input makes the research possible.

Shabina Hayat

EPIC-Norfolk

A volunteer in the EPIC-Norfolk study

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Universal approach to tackling lifestyles more appropriate for combating diabetes than focusing on genetic risk

A landmark study of health and lifestyle celebrates its 20th birthday