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Journal of the American College of Nutrition, Vol. 24, No. 4, 229-234 (2005)
Published by the American College of Nutrition

Anthropometric Characteristics, Dietary Patterns and Risk of Type 2 Diabetes Mellitus in Vietnam

Le Nguyen Trung Duc Son, MD, PhD, Tran Thi Minh Hanh, MD, PhD, Kaoru Kusama, MS, Daisuke Kunii, MS, Tohru Sakai, PhD, Nguyen Thi Kim Hung, MD and Shigeru Yamamoto, PhD

Department of Nutrition, School of Medicine, The University of Tokushima, JAPAN (L.N.T.D.S., K.K., D.K., T.S., S.Y.)
Nutrition Center of Ho Chi Minh City, VIETNAM (L.N.T.D.S., T.T.M.H., N.T.K.H.)

Address reprint requests to: Shigeru Yamamoto, PhD, Applied Nutrition Laboratory, Department of Nutrition, School of Medicine, The University of Tokushima, 3 Kuramoto, Tokushima City 770-8503, JAPAN. E-mail: syamamoto{at}nutr.med.tokushima-u.ac.jp


   ABSTRACT
TOP
 ABSTRACT
INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 ACKNOWLEDGMENTS
 REFERENCES
 
Objective: To determine the impact of anthropometric characteristics and dietary patterns on Type 2 diabetes mellitus in Vietnam.

Methods: Data from 144 subjects (9m/39f newly diagnosed diabetics; 18m/78f control subjects) were analyzed in this case-control study. Height, weight, waist and hip circumferences and percent body fat were measured. Dietary intakes were assessed by 24-hour recall on three non-consecutive weekdays. Fasting blood samples were collected for the analysis of plasma glucose, fructosamine, protein and lipid concentrations.

Results: Although the body mass index (BMI, kg/m2) was similar between diabetic and control subjects, diabetic subjects had significantly greater percent body fat (31.1 ± 5.8% vs. 27.7 ± 6.2%) and waist-hip ratios (WHR, 0.91 ± 0.07 vs. 0.86 ± 0.08). Diabetic subjects had higher intakes of protein (p < 0.01), especially animal protein (p < 0.001), and consumed more meat (p < 0.01) than control subjects. Percent body fat and WHR were positively associated with diabetes (odds ratios [OR] 1.53 [95%CI 1.29–1.79] and 1.09 [95% CI 0.89–1.58], respectively) as were protein intake (OR 1.21 [95% CI 1.12–1.31]) and animal protein intake (OR 1.18 [95% CI 1.10–1.26]).

Conclusions: This study indicates that percent body fat and WHR are risk factors associated with diabetes even when the BMI is normal. Evolving dietary patterns with increasingly more protein and meat consumption may also contribute to the deterioration of glucose metabolism among Vietnamese people.

Key words: body fat, protein intake, diabetes type 2 diabetes mellitus, Vietnam


   INTRODUCTION
TOP
 ABSTRACT
 INTRODUCTION
MATERIALS AND METHODS
 RESULTS
 ACKNOWLEDGMENTS
 REFERENCES
 
The prevalence of diabetes mellitus is increasing worldwide [1]. This increase is primarily the result of lifestyle changes known as the "Nutrition Transition," characterized by over-consumption of food, increased consumption of total fat, animal fat, and protein, and decreased physical activity [2]. The relationship between Type 2 diabetes mellitus (T2DM) and dietary intake and physical activity has been examined in several recent studies [3–5].

In Vietnam, as in other parts of Asia, the economy has been rapidly expanding during the last decade, leading to profound changes in society. As a result, there is a polarization in disease patterns, with undernutrition and its related diseases coexisting with chronic diseases such as diabetes and obesity that are typically associated with industrialized populations [2,6]. According to a screening survey conducted on 2,932 people in Ho Chi Minh City in 2001, the prevalence of diabetes in rural and urban areas was 4.8% and 6.9%, respectively. The reported prevalence of diabetes in urban areas in 2001 was approximately 2.8 times higher than that observed in 1993 [7]. Thus, diabetes mellitus has become a major public health problem in Ho Chi Minh City. In addition, diabetes and its complications are risk factors for chronic diseases with significant morbidity and mortality [8,9]. A recent study of 175 diabetic patients found that 41% had hypertension, 27% had cerebral circulation disorders, and 19% had myocardial ischaemia [10]. Although cross-sectional screening surveys suggest several risk factors that may be associated with diabetes, there are no studies investigating risk factors for diabetes in community settings in Vietnam. The purpose of the present study, therefore, was to determine the impact of anthropometric characteristics and dietary patterns on Type 2 diabetes mellitus in Vietnam.


   MATERIALS AND METHODS
TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
RESULTS
 ACKNOWLEDGMENTS
 REFERENCES
 
Study Population
The results of a previous screening survey of 2,932 randomly selected adults indicated a 3.8% adjusted prevalence rate of diabetes in Ho Chi Minh City (urban and rural areas combined) [7]. Approximately 40% of the diabetic subjects identified were unaware of their condition; 50 of these individuals who were newly diagnosed with T2DM (10 m/40 f) were recruited by a simple random sampling method to create the case group. The control group consisted of 100 normoglycemic subjects who were matched for age (± one year), sex and place of residence to case subjects. Matching for place of residence was done with consideration of the same ward for urban or the same village for rural areas. Two control subjects were chosen for each case subject. The sample size of this study was calculated using {alpha} = 0.05, ß = 0.2 and the standard effect size = 0.5. This study was conducted for 2 months from April to May 2001. Further details of subject recruitment are reported in the screening survey [7].

Diabetes was diagnosed based on the 1998 WHO diagnosis criteria [11] and the American Diabetes Association diagnosis criteria [12]. After participating, the diabetic subjects were immediately referred to the Diabetes Care Unit of the Nutrition Center of Ho Chi Minh City for treatment.

This study was approved by the Research and Ethnical Review Board of the Health Service of Ho Chi Minh City and written informed consent was obtained from all participants.

Anthropometry Measurements
Body weight, height, waist and hip circumferences, and percent body fat were measured with the participant in the standing position wearing light clothing and no shoes. Body weight was determined using a digital scale Tanita 1609 (Tanita, Tokyo, Japan) to the nearest 0.1 kg. Height was measured with a portable Seca stadiometer 208 (Vogel & Halke, Hamburg, Germany) to the nearest 0.1 cm. Body mass index (BMI) was computed as the ratio of weight (kg) per height squared (m2). Waist circumference was measured at the minimum circumference between the umbilicus and iliac crest; hip circumference was measured at the widest circumference around the buttocks; waist-to-hip ratio was calculated from these circumferences. Percent body fat was determined by bioelectrical impedance using a body fat analyzer (BF-511, Tanita Co. Ltd., Tokyo, Japan) which has four tactile electrodes that fit on the soles of the feet. With the subject standing on the sole electrodes, the microprocessor-controlled switches and impedance analyzer are started and segmental resistance of the right leg, left leg and trunk are measured. Percent body fat is calculated from the sum of each body segment using gender-specific equations provided by the manufacturer. Prior to the measurement, the subjects were asked to remove all metallic objects, and washed and dried their feet thoroughly. Blood pressure was measured twice by mercury sphygmomanometer in the sitting position after participants rested for at least 5 minutes. The mean of the two values was used in the analysis.

Assessment of Socio-Economic Status and Lifestyle
Each participant completed a questionnaire assessing the family history of diabetes (is there anyone in your family who has diabetes?), smoking habit (yes or no) and socio-economic status, including level of education and household income. Education level was classified into three groups: low including illiterate, literate, and primary school; medium including junior high school; and high including high school, college and university. Household income was estimated based on the number of valuable household items owned among a total of 12 items and classified into three groups: low (≤4); medium (5–8) and high (>8). This indirect way of evaluating household income has been shown to be more practical for community surveys than directly asking about family income [13].

Dietary and Nutrient Assessments
All subjects were asked to recall all foods consumed during the previous 24 hours on three nonconsecutive weekdays [14]. Tableware items such as bowls, dishes, spoons and glasses in commonly-used sizes, food models and pictures of common foods were used to assess food intake. Twenty-four hour energy and nutrient intakes for the 3 days were determined with computer software based on Vietnamese food composition tables [15–16]. The means of these values were used in the analysis.

Analytical Measurements
A single, fasting 7 mL venous blood sample was collected and centrifuged immediately. Aliquots of plasma were stored at –20°C in Vietnam and then transported on dry ice to Japan where they were stored at –80°C until analysis. Plasma glucose was measured by the glucose oxidase method and fructosamine by the reduction of nitro-blue tetrazorium (SRL Co. Ltd, Tokyo, Japan). Plasma total cholesterol and triacylglycerol concentrations were determined by enzymatic assay (Wako Pure Chemicals Co., Ltd., Osaka, Japan). Plasma high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were determined by enzymatic assay (Daiichi Pure Chemicals Co., Ltd., Tokyo, Japan). Plasma protein and albumin concentrations were determined by assay kits (Wako Pure Chemicals Industries, Osaka, Japan).

Statistical Analysis
Data in the tables are presented as means or geometric means with 95% confidence intervals (CIs) for each gender and for the total groups. Plasma glucose, fructosamine, HDL-C, LDL-C, triacylglycerol, intake of several nutrients (i.e. animal lipid, cholesterol, vitamin C, sodium, magnesium) and intake of selected food items (such as rice, meat, fish, vegetable and fruits intake) were log10 transformed to normalize the distributions. Statistical analyses were done using SPSS for windows 10.0 (SPSS, Chicago, IL).

The independent sample t-test was used to compare means and test for significant differences in anthropometric and biochemical indices, nutritive intakes and the quantity of food consumed between the groups. The conditional logistic regression model, adjusted for family history of diabetes, socio-economic status, smoking habit, and energy intake, was used to analyze the relationship between the various factors and diabetes; associations were considered statistically significant at p < 0.05.


   RESULTS
TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
ACKNOWLEDGMENTS
 REFERENCES
 
A total of 150 subjects were enrolled in this study; however, two diabetic subjects (one male and one female) were excluded from the analysis due to acute influenza during the dietary data collection period. As a result, four matched controls (two males and two females) were also excluded. Thus, data from 144 participants were available for analysis.

The clinical characteristics and biochemical parameters of the study population are shown in Table 1. There were no significant differences in the gender-adjusted BMI between diabetic subjects and controls. However, diabetic subjects had significantly higher levels of body fat and WHR than controls (Table 1). Compared with the controls, diabetic subjects had significantly higher fasting plasma glucose and fructosamine concentrations as well as significantly higher concentrations of plasma total cholesterol, LDL-C and triacylglycerol (Table 1).


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  		Table 1. The Clinical Characteristics and Biochemical Parameters of the Study Population

 
The energy and nutrient intakes from the repeated 24-hour recalls are shown in Table 2. Significantly higher intakes of protein (p < 0.01) especially animal protein (p < 0.001) were observed in diabetic compared to control subjects. Diabetic subjects had lower intakes of carbohydrates (p < 0.01) including less rice (p < 0.05) and greater consumption of meat (p < 0.01) than control subjects (Table 3). Micronutrients including cholesterol, Vitamin C, calcium, sodium, potassium and magnesium were not significantly different between the groups (data not shown).


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  		Table 2. Average Dietary Intake of Energy, Macronutrients of the Study Population

 

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  		Table 3. Average Food Intake as Measured by Repeated 24-Hour Recalls

 
After adjusting for family history of diabetes, socio-economic status, smoking habit and energy intake, conditional logistic regression revealed that diabetes was significantly and positively associated with percent body fat, WHR, protein intake and specifically animal protein intake (Table 4). Odds ratios (OR) for the positive associations between percent body fat and WHR and diabetes were 1.53 (95% CI 1.29–1.79) and 1.09 (95% CI 0.89–1.58), respectively. There was a positive association between diabetes and protein intake (OR 1.21 [95% CI 1.12–1.31]) as well as animal protein intake (OR 1.18 [95% CI 1.10–1.26]). Meat consumption was positively associated with diabetes, whereas the association between rice intake and diabetes was somewhat protective (Table 4).


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  		Table 4. Associated Factors or Diabetes (Adjusted for Family History of Diabetes, Socio-Economic Status, Smoking, Energy Intake)

 

   DISCUSSION
 
The prevalence of diabetes in Vietnam has been increasing rapidly and constitutes a significant public health problem and priority. Understanding the characteristics of diabetes in Vietnam is essential for developing programs to prevent and control this disease.

In the current study, we found that percent body fat and WHR were associated with an increased risk of diabetes. Overweight, using a BMI cut-off point of 25 kg/m2, as well as central obesity, have been identified as risk factors for diabetes [5,17–18]. Whereas the BMI level of diabetic subjects in our study was within the normal range, diabetic subjects had higher percentages of body fat and WHR compared with controls. Although percent body fat and BMI are correlated [18], a high percent body fat and a high WHR in the context of a normal BMI may be an anthropometric characteristic of diabetes in Vietnam. Our finding supports the WHO expert conclusion that "...Asians have a higher body fat than Caucasians of the same age, sex and BMI. Also, the proportion of Asian people with risk factors for Type 2 diabetes and cardiovascular disease is substantial even below the existing WHO-BMI cut off point of 25 kg/m2" [19]. Moreover, a recent study found that percent body fat was higher in Vietnamese than Japanese people [18]. Additional studies indicate that abdominal fat and percent body fat are increasing in Vietnamese people, especially in females [20–21]. As the relationship between percent body fat and diabetes becomes clearer, percent body fat data could be helpful in predicting future increases in diabetes in Vietnam.

The accumulation of body fat is a continuous process that is influenced by energy and fat intake in excess of requirements, decreased physical activity and a sedentary lifestyle [22]. Although the percent body fat of the diabetic subjects in our study was higher than that of controls, the energy intake of the diabetic subjects was similar compared to the controls. We believe our dietary assessments accurately reflect the eating habits of the subjects because we did 24-hour food recalls on three nonconsecutive weekdays and used standard tableware items, food models and pictures of commonly eaten foods [14]. Furthermore, the diabetic subjects were unaware of their condition during the study period, so it is unlikely they intentionally modified their diets. However, a limitation of our study is that we were unable to assess physical activity. Future studies examining the relationships between body composition and diabetes should include assessments of physical activity and energy expenditure.

Dietary intake appears to be one of the most important factors related to diabetes [3,4], and the dietary patterns of the Vietnamese people are changing [2]. In comparison with earlier studies on dietary intakes of the Vietnamese people [21,23–25], protein intake and specifically animal protein intake and consumption of meat were higher in this study than previously reported. Furthermore, we found significant positive associations between diabetes and protein intake and between diabetes and animal protein intake. These findings are in agreement with other studies showing positive associations between meat intake and increased risk of diabetes [3,26–28].

The role of dietary protein in the pathogenesis of diabetes may be through increased glucagon secretion. Increased protein intake may result in increased concentrations of gluconeogenic amino acids, which stimulate glucagon secretion. In subjects with T2DM, high glucagon concentrations despite adequate insulin concentrations appear to partially explain high blood glucose concentrations [29]. Dietary protein is also known to stimulate insulin secretion [29] and hyperinsulinemia increases insulin resistance [30], a known risk factor for the development of T2DM. Although the relationship between protein intake and risk of diabetes is consistent with previous studies [31–32], the effect of high protein intakes on the development of diabetes is purely speculative at this stage. Further evaluation is needed in the Vietnamese people and among other populations with dietary intake patterns that are becoming increasingly richer in protein.

Consistent with other studies [33–34], we also found that diabetic subjects had significantly higher total cholesterol, LDL-cholesterol and triacylglycerol concentrations than controls. Because of the danger presented by early-onset diabetes on the incidence of the metabolic syndrome and the increased risk of coronary events [8,9,35], early detection and control of diabetes is critical.

In conclusion, our results indicate that elevated percent body fat and WHR are associated with an increased risk of developing diabetes in Vietnamese people, even when the BMI is within normal limits. Our data also suggest that higher intakes of protein, especially meat protein may also contribute to the deterioration of glucose metabolism in Vietnam.


   ACKNOWLEDGMENTS
TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 ACKNOWLEDGMENTS
REFERENCES
 
The authors would like to thank the all participants for their cooperation and the staff of the Nutrition Center of Ho Chi Minh City and local health centers of Ho Chi Minh City for their assistance. We are grateful to Ms. Truong Thi Nhan, Dr. Tran Thi Hang, Dr. Pham Thi Ngan Ha, and Dr. Tran Thi Ngu Uyen for their assistance in the collection of dietary data, and Dr. Tran Thi Hong Loan and Dr. Hoang Anh Vu for their advice in the analysis of data. We also appreciate Dr. Jonathan Siekmann and Dr. Arline D. Salbe for the revision of this manuscript.

Received January 5, 2004. Accepted February 11, 2005.


   REFERENCES
TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 ACKNOWLEDGMENTS
 REFERENCES
 

  1. King H, Aubert RE, Hernan WH: Global burden of diabetes, 1995–2025: prevalence, numerical estimates, and projections. Diabetes Care21 :1414 –1431,1998 .[Abstract]
  2. Khoi HH: Problems of nutrition in transition period. In Khoi HH (ed): "Problems of Nutrition in Transition Period in Vietnam." Hanoi: Medical Publisher,pp 153 –226,1996 .
  3. van Dam RM, Rimm EB, Willet WC, Stampfer MJ, Hu FB: Dietary patterns and risk for type 2 diabetes mellitus in U.S. men. Annu Intern Med136 :201 –209,2002 .[Abstract/Free Full Text]
  4. Feskens EJM, Virtanen SM, Rasanen L, Tuomlilehto J, Stengard J, Pekkanen J, Nissinen A, Kromhout D: Dietary factors determining diabetes and impaired glucose tolerance: A 20-year follow-up of the Finish and Dutch cohorts of the seven countries study. Diabetes Care18 :1104 –1110,1995 .[Abstract]
  5. Ramachandran A, Snehalatha C, Latha E, Manoharan M, Vijay V: Impacts of urbanization on the lifestyle and on the prevalence of diabetes in native Asian Indian population. Diabetes Res Clin Pract44 :207 –213,1999 .[Medline]
  6. Loan TTH, Hung NTK: The overweight and obesity status in demographic strata in Ho Chi Minh City. "The Technical, Public Health and Preventive Medicine Symposium." Ho Chi Minh City Dec 2002,pp: 28 –36,2002 .
  7. Duc Son LENT, Kusama K, Hung NTK, Loan TTH, Van Chuyen N, Kunii D, Sakai T, Yamamoto S: Prevalence and risk factors for diabetes in Ho Chi Minh City, Vietnam. Diabetic Med21 :371 –376,2004 .[Medline]
  8. Stamler J, Vaccaro O, Neaton JD, Wentworth D: Diabetes, other risk factors and 12-year cardiovascular mortality for men screened in the Multi Risk Factors Intervention Trial (MRFIT). Diabetes Care16 :434 –444,1993 .[Abstract]
  9. Jarrett R, Mc Cartney P, Keen H: The Bedford survey: ten year mortality rates in newly diagnosed diabetics, borderline diabetics and normoglycemic controls and risk indices for coronary heart disease in borderline diabetics. Diabetologia22 :79 –84,1982 .[Medline]
  10. Toan TD, Chinh NT: Observations on diabetes mellitus patients treated at Friendship hospital in two years (1994–1995). Magazine Pract Med6 :1 ,1996 .
  11. Alberti KGMM, Zimmet P: Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: Diagnosis and classification of diabetes mellitus. Provisional report of a WHO consultation. Diabetic Med15 :539 –553,1998 .[Medline]
  12. The expert committee on the diagnosis and classification of diabetes mellitus: Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care23 (Suppl.1):S4 –S19,2000 .
  13. General Statistical Office: Housing and durable assets. In: "Vietnam Living Standard Survey 1997–1998." Hanoi: Hanoi Publisher,pp 326 –368,1999 .
  14. Witschi JC: Short-term dietary recall and recording methods. In Willet W (ed): "Nutrition epidemiology," 2nd ed. New York: Oxford University Press,pp 52 –68,1988 .
  15. Ministry of Public Health, National Institute of Nutrition: "Nutritive Composition Table of Vietnamese Food." Hanoi: Medical Publisher,2000 .
  16. Hanh TTM, Hung NTK, Chuyen NV, Yoshimura Y, Takahashi K, Yamamoto S: The composition of commonly prepared foods in Ho Chi Minh City and a dietary assessment software. The Fifth International Conference on Dietary Assessment Methods. Chiang Rai, Thailand, E3.6,2003 .
  17. Motala AA, Prie FJ, Gouws E, Amod A, Omar MAK: High incidence of type 2 diabetes mellitus in south Africa Indians: a 10-year follow-up study. Diabetic Med20 :23 –30,2000 .
  18. Tomisaka K, Lako J, Maruyama C: Dietary patterns and risk factors for type 2 diabetes mellitus in Fijian, Japanese and Vietnamese populations. Asia Pacific J Clin Nutr11 :8 –12,2002 .[Medline]
  19. WHO Expert Consultation: Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet363 :157 –163,2004 .[Medline]
  20. Tho TD, Thang P, Thanh HK: "Disorder Factors in Relation to Obesity in Elderly." Geriatric Symposium. Hanoi: Gerontology Institute,2002 .
  21. Lien DTK, Anh NTL, Khoi HH, Chuyen NV: Screening test research of diabetes, dietary intake and everyday life of 50–59 year old subjects in 2 urban quarter of Hanoi. In "Actual Nutrition Problems of Vietnam and Japan." Hanoi: Medical Publisher,pp 172 –186,1998 .
  22. WHO: "Obesity: Preventing and Managing the Global Epidemic." Report of a WHO Consultation on Obesity. Geneva: WHO, June1997 .
  23. Anh NTL, Do TT, Lien DTK, Khoi HH, Chuyen NV: Food intake and lipid status of three Vietnamese populations with different incomes. J Nutr Sci Vitaminol47 :64 –68,2001 .
  24. Hanh TTM, Komatsu T, Hung NTK, Chuyen NV, Yoshimura Y, Tien PG, Yamamoto S: Nutrition status of middle-aged Vietnamese in Ho Chi Minh City. J Am Coll Nutr20 :616 –622,2001 .[Abstract/Free Full Text]
  25. Hanh TTM, Komatsu T, Hung NTK, Chuyen NV, Yoshimura Y, Takahashi K, Wariishi M, Yamamoto S: Blood pressure, serum cholesterol concentration and their related factors in urban and rural elderly of Ho Chi Minh City. J Nutr Sci Vitaminol47 :147 –155,2001 .
  26. van Dam RM, Willet WC, Rimm EB, Stampfer MJ, Hu FB: Dietary fat and meat intake in relation to risk of type 2 diabetes in men. Diabetes Care25 :417 –424,2002 .[Abstract/Free Full Text]
  27. Williams DEM, Prevost AT, Whichelow MJ, Cox BD, Day NE, Wareham NJ: A cross-sectional study of dietary patterns with glucose intolerance and other features of the metabolic syndrome. Br J Nutr83 :257 –266,2000 .[Medline]
  28. Shimakawa T, Acena MGH, Colditz GA, Manson JE, Stamper MJ, Willett WC: Comparison of diets of diabetic and non diabetic women. Diabetes Care16 :1356 –1362,1993 .[Abstract]
  29. Carlson SK: Identifying protein needs in persons with diabetes. In: Powers MA (ed): "Handbook of Diabetes Medical Nutrition Therapy." Baltimore: Apsen Publishers Inc,pp 320 –325,1996 .
  30. Del Prato S, Leonetti F, Simonson DC, Sheehan P, Matsuda M, De Fronzo RA: Effect of sustained physiologic hyperinsulinaemia and hyperglycaemia on the insulin secretion and insulin sensitivity in man. Diabetologia37 :1025 –1035,1994 .[Medline]
  31. Wolever TMS, Hamad S, Gittelsohn J, Gao J, Hanley AJG, Harris SB, Zinman B: Low dietary and high protein intakes associated with newly diagnosed diabetes in a remote aboriginal community. Am J Clin Nutr66 :1470 –1474,1997 .[Abstract/Free Full Text]
  32. Costa MB, Ferreira SRG, Franco LJ, Gimeno SGA, Iunes M: dietary patterns in high-risk population for glucose intolerance. J Epidemiol10 :111 –117,2000 .[Medline]
  33. Goldberg IJ: Clinical review 124: Diabetic dyslipidemia: Causes and consequences. J Clin Endocrinol Metab86 :965 –971,2001 .[Free Full Text]
  34. Ko GTC, Chan JCN, Tsang LWW, Yeung VTF, Chow CC, Cockram CS: Outcomes of screening for diabetes in high-risk Hong Kong Chinese subjects. Diabetes Care23 :1290 –1294,2000 .[Abstract/Free Full Text]
  35. Shichiri M, Kishikawa H, Ohkubo Y, Wake N: Long term results of the Kumamoto Study on optimal diabetes control in type 2 diabetes. Diabetes Care23 (Suppl.2):B21 –B29,2000 .




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