Nutritional Risk Factors for Type 2 Diabetes in the Multiethnic Cohort

描述(由申请人提供)：在具有非高加索种族背景的个人中，患2型糖尿病的风险相当高。夏威夷原住民患糖尿病的风险极高，尽管日裔美国人的体重相对较低，但他们患糖尿病的比例也不成比例。体重和营养成分的重要性似乎因种族背景而异。多种族队列(MEC)成立于1993-96年，目的是调查不同种族之间的饮食和癌症。夏威夷部分由103,898名40岁及以上的人组成，主要是高加索人、日本人和夏威夷原住民祖先。参与者通过完成一项自我管理的邮寄调查进入研究，其中包括一份定量食物频率问卷。数据显示，无论是在种族内部还是在种族之间，饮食摄入量和非饮食风险因素都存在很大差异。该项目的具体目标是将MEC与夏威夷两家主要保险公司的登记处联系起来，以确定确诊为糖尿病的患者；估计MEC中高加索人、日本人和夏威夷原住民糖尿病的当前患病率和年发病率；检查超重、肥胖、成人体重变化、腰围、体力活动、过量能量摄入、膳食纤维、血糖指数和饮食模式与糖尿病发生的关系；并按种族探讨这些人体测量、行为和营养因素在高加索人、日本人和夏威夷原住民研究对象中的不同作用。夏威夷的两个健康计划覆盖了大约90%的MEC成员，并保持着糖尿病登记。通过使用姓名、性别、出生日期和居住邮政编码的基于概率的关联程序，这些诊断将被添加到MEC数据库中。将制定一项符合现行隐私规则并对所有健康记录保密的链接协议。我们预计有一个关联的数据集，大约有16,000名被诊断为2型糖尿病的队列成员；在这些人中，估计有7,000例是进入队列后被诊断的新病例。我们将应用考克斯回归来确定自进入与超重、肥胖、体重增加、体力活动、过量能量摄入、膳食纤维、血糖指数和饮食模式相关的队列以来发生糖尿病的相对风险，同时调整混杂变量并按性别和种族分层。糖尿病的流行导致大量过早死亡。该项目将为预防这种疾病做出贡献，这种疾病本身不仅带来巨大的发病率和死亡率负担，而且使其携带者容易患心血管疾病和其他严重疾病，特别是在夏威夷土著和亚裔美国人中。更好地了解日本人和夏威夷原住民中与超重和糖尿病相关的饮食和行为因素，将有助于制定预防策略，以改变生活方式因素。

DESCRIPTION (provided by applicant): The risk to develop type 2 diabetes is considerably higher among individuals with ethnic backgrounds other than Caucasian. Native Hawaiians experience an extremely high risk for diabetes and Japanese-Americans also suffer a disproportionate rate of the disease despite their relatively low body weight. The importance of body weight and nutritional composition appears to differ by ethnic background. The Multiethnic Cohort (MEC) was established in 1993-96 to investigate diet and cancer among different ethnic groups. The Hawaii component consists of 103,898 individuals 40 years and older, primarily of Caucasian, Japanese, and Native Hawaiian ancestry. Participants entered the study by completing a self-administered mailed survey that included a quantitative food frequency questionnaire. The data show substantial variations in dietary intakes and non-dietary risk factors both within and among ethnic groups. The specific aims of this project are to link the MEC with registries from the two major insurers in Hawaii that identify patients with a confirmed diagnosis of diabetes; to estimate the current prevalence and the annual incidence of diabetes among Caucasians, Japanese, and Native Hawaiians in the MEC; examine the association of overweight, obesity, adult weight change, waist circumference, physical activity, excess energy intake, dietary fiber, glycemic index, and dietary patterns with the occurrence of diabetes; and explore the differential role of these anthropometric, behavioral, and nutritional factors by ethnicity among Caucasian, Japanese, and Native Hawaiian study subjects. Two health plans in Hawaii cover an estimated 90% of MEC members and maintain diabetes registries. Through a probability based linkage procedure using name, sex, date of birth, and ZIP code of residence, these diagnoses will be added to the MEC data base. A linking protocol that agrees with current privacy rules and maintains the confidentiality of all health records will be developed. We expect a linked dataset with approximately 16,000 cohort members who were diagnosed with type 2 diabetes; of those, 7,000 are estimated to be new cases diagnosed since entry into the cohort. We will apply Cox's regression to determine the relative risk of developing diabetes since entry into the cohort associated with overweight, obesity, weight gain, physical activity, excess energy intake, dietary fiber, glycemic index, and dietary patterns while adjusting for confounding variables and stratifying by sex and ethnicity. The epidemic of diabetes leads to a large number of premature deaths. This project will make a contribution to the prevention of this disease that not only carries a huge burden of morbidity and mortality by itself, but also predisposes its carriers to cardiovascular disease and other serious conditions, in particular among Native Hawaiians and Asian-Americans. A better understanding of dietary and behavioral factors related to excess body weight and diabetes in Japanese and Native Hawaiians will help in developing preventive strategies to modify lifestyle factors.