Diabetes mellitus and associate diseases in the Japanese-Brazilian community from Bauru: Phase II

Abstract

Population with well defined characteristics have been studied in order to evaluate the importance of environmental factors for the etiology of chronic diseases such as diabetes mellitus, hypertension, cerebrovascular disease and ischemic heart disease. Epidemiological studies involving imigrant populations have provided important keys for the understanding of the etiopathogenesis of these diseases, allowing the use of prevention measures. Population of Japanese ancestry, who originally had low morbidity due to as diabetes mellitus and cardiovascular disease, after marked sociocultural changes, became a high risk population to this group of disease. Consistent data have shown that type 2 as diabetes mellitus (DM2) is a importantpublic health problem among the Japanese-Brazilians. Actually, studies conducted by our research group confirmed the importance of DM2 in this community. The first phase of our studies in Bauru showed that DM2 is more prevalent in first - and second-generation Japanese-Brazilians as compared with those living in Japan and with the general Brazilian population. The present study is aimed to investigate the incidence and prevalence of DM2 in the Japanese-Brazilians from Bauru, analyzing the risk factors for the development of DM2. In addition to glucose intolerance, other conditions associated to DM2 (hypertension, dyslipidemia and obesity) and its chronic complications (micro- and macrovascular disease) will be focused. Our basic hypothesis to be tested is that the increased prevalence of DM2 in this community results from environmental factors and lifestyle changes ( westernization),such as nutritional and physical activity habits and emotional stress. On the other hand, a strong genetic predisposition interacting with these environmental factors contributes to insulin resistance, hyperinsulinemia, central obesity and DM2 as a result. The study is cross-sectional but, considering the subjects who will participate in two phases, this study may be seen as a cohort study. One-thousand three hundred Japanese-Brazilians will be invited to participate in this second phase, being 507 subjects already included in the first one, and all the Japanese second-generation, aged 30 years or above. Sub-studies will be included such as: a) incidence and prevalence of DM2 and impared glucose tolerance (IGT); b) analysis of the risk factors for the conversion of normal glucose tolerance to intolerance; c) incidence and prevalence of other associated diseases; d) incidence and prevalence of diabetic chronic complications; e) mortality studies; f) genetic studies (family studies, gene mutations associated with the genesis of DM2, studies on the frequency of mutation of the CETP and its relations to the DM2 and risk of atherosclerotic disease). The data analysis will be performed considering the subjects participating in both phases of the study (cohort) from and those who will participate only in the second phase cross-sectional). Parametric and non-parametric survival analysis techniques will be used to describe the data. morbidity strenght by DM2, arterial hypertension, dyslipidemia, coronary heart disease, nephropathy, retinopathy and neuropathy will be examined according to the point and interval estimates of the respective rates.The main interest associations will be examined by crude analysis and using unconditional logistic regression model. (AU)