Abstract
Objectives
Unhealthy dietary and physical inactivity patterns inspired many initiatives promoting healthy youth and healthy schools in Alberta between 2005 and 2008. The purpose of this study was to examine differences in the prevalence of lifestyle risk factors for type 2 diabetes (T2D) between two province-wide samples of Alberta adolescents (2005 and 2008).
Methods
The dietary and physical activity (PA) patterns of Alberta youth were assessed in two cross-sectional studies of grade 7-10 students, one in 2005 (n=4936) and one in 2008 (n=5091), using a validated web-survey. For each diabetes risk factor, participants were classified as either at risk or not at risk, depending on their survey results relative to cut-off values. Chi-square tests and logistic regression models were used to determine differences in risk factor prevalence between 2005 and 2008.
Results
Compared to 2005, mean BMI, energy intake, fat intake, glycemic index (GI) and glycemic load (GL) were lower in 2008 (p<0.05); and carbohydrate, protein, fibre and vegetable and fruit intakes were higher in 2008 (p<0.05). In 2008, a lower proportion of students were: overweight, obese, consuming high GI, high GL, high fat, low fibre, low veg/fruit intake (p<0.05). No differences existed in magnesium or PA levels between the two time points.
Conclusions
Improvements were observed between 2005 and 2008 in terms of the proportion of adolescents having specific risk factors for T2D. The cause of these changes could not be determined. Continued monitoring of adolescent lifestyle habits and monitoring of exposure to health promotion programming is recommended.
Key words: Type 2 Diabetes Mellitus, adolescents, prevalence, risk factors, diet, physical activity
Résumé
Objectifs
Les habitudes alimentaires malsaines et l’inactivité physique ont inspiré de nombreuses initiatives de promotion de la santé des jeunes et des écoles en Alberta entre 2005 et 2008. Nous avons cherché à examiner les différences dans la prévalence des facteurs de risque liés aux habitudes de vie pour le diabète de type 2 (DT2) entre deux échantillons provinciaux d’adolescents albertains (2005 et 2008).
Méthode
Les habitudes d’alimentation et d’activité physique des jeunes de l’Alberta ont été évaluées à la faveur de deux études transversales auprès d’élèves de la 7e à la 10e année, l’une en 2005 (n=4 936) et l’autre en 2008 (n=5 091), à l’aide d’un sondage en ligne validé. Pour chaque facteur de risque du diabète, les participants ont été classés comme étant à risque ou non à risque selon leurs réponses au sondage par rapport aux valeurs limites. Des tests du khi-carré et des modèles de régression logistique ont servi à déterminer les différences dans la prévalence des facteurs de risque entre 2005 et 2008.
Résultats
Comparativement à 2005, l’IMC moyen, l’apport énergétique, l’apport en matières grasses, l’indice glycémique (IG) et la charge glycémique (CG) étaient plus faibles en 2008 (p<0,05); et les apports en glucides, en protéines, en fibres et en fruits et légumes étaient plus élevés en 2008 (p<0,05). En 2008, une moindre proportion d’élèves était en surpoids ou obèse et consommait une diète avec IG élevé, CG élevée, riche en gras, faible en fibres et faible en fruits et légumes (p<0,05). Aucune différence n’a été relevée dans les niveaux de magnésium ou d’activité physique entre les deux dates.
Conclusions
Des améliorations ont été observées entre 2005 et 2008 dans la proportion d’adolescents présentant les facteurs de risque propres au DT2. Nous n’avons pas pu déterminer la cause de ces changements. Il est recommandé de continuer à surveiller les habitudes de vie des adolescents et leur exposition aux programmes de promotion de la santé.
Mots clés: diabète de type 2, adolescent, prévalence, facteurs de risque, régime alimentaire, exercice physique
Footnotes
Acknowledgements: The authors thank our funders and all the students, parents and teachers who participated in this study.
Funding Sources: Canadian Institutes of Health Research/Heart and Stroke Foundation, Alberta Innovates: Health Solutions, and the Alberta Centre for Child, Family and Community Research.
Conflict of Interest: None to declare.
References
- 1.Active Healthy Kids Canada. 2013 Active Healthy Kids Canada Report Card on Physical Activity for Children and Youth. Toronto, ON: Active Healthy Kids Canada; 2013. [Google Scholar]
- 2.Health Canada. Do Canadian Adolescents Meet Their Nutrient Requirements Through Food Intake Alone? Ottawa, ON: Health Canada; 2012. [Google Scholar]
- 3.Toth G. Diabetes Q. 2005. Type 2 diabetes occurs in Aboriginal youth in Manitoba? [Google Scholar]
- 4.Hu FB, Manson JE, Stampfer MJ, Colditz G, Liu S, Solomon CG, et al. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med. 2001;345(11):790–97. doi: 10.1056/NEJMoa010492. [DOI] [PubMed] [Google Scholar]
- 5.Barclay AW, Petocz P, McMillan-Price J, Flood VM, Prvan T, Mitchell P, et al. Glycemic index, glycemic load, and chronic disease risk—a meta-analysis of observational studies. Am J Clin Nutr. 2008;87(3):627–37. doi: 10.1093/ajcn/87.3.627. [DOI] [PubMed] [Google Scholar]
- 6.Schulze MB, Liu S, Rimm EB, Manson JE, Willett WC, Hu FB. Glycemic index, glycemic load, and dietary fiber intake and incidence of type 2 diabetes in younger and middle-aged women. Am J Clin Nutr. 2004;80(2):348–56. doi: 10.1093/ajcn/80.2.348. [DOI] [PubMed] [Google Scholar]
- 7.Lopez-Ridaura R, Willett WC, Rimm EB, Liu S, Stampfer MJ, Manson JE, et al. Magnesium intake and risk of type 2 diabetes in men and women. Diabetes Care. 2004;27(1):134–40. doi: 10.2337/diacare.27.1.134. [DOI] [PubMed] [Google Scholar]
- 8.Liu S, Serdula M, Janket SJ, Cook NR, Sesso HD, Willett WC, et al. A prospective study of fruit and vegetable intake and the risk of type 2 diabetes in women. Diabetes Care. 2004;27(12):2993–96. doi: 10.2337/diacare.27.12.2993. [DOI] [PubMed] [Google Scholar]
- 9.van Dam RM, Willett WC, Rimm EB, Stampfer MJ, Hu FB. Dietary fat and meat intake in relation to risk of type 2 diabetes in men. Diabetes Care. 2002;25(3):417–24. doi: 10.2337/diacare.25.3.417. [DOI] [PubMed] [Google Scholar]
- 10.Hsia J, Wu L, Allen C, Oberman A, Lawson WE, Torrens J, et al. Physical activity and diabetes risk in postmenopausal women. Am J Prev Med. 2005;28(1):19–25. doi: 10.1016/j.amepre.2004.09.012. [DOI] [PubMed] [Google Scholar]
- 11.Alberta coalition for healthy school communities historical timeline. 2009. Available at: https://doi.org/wwwwww.achsc.org/history.htm (Accessed May 1, 2013).
- 12.Alberta healthy school community wellness fund website. 2012. Available at: https://doi.org/wwwwww.publichealth.ualberta.ca/collaborators_partners/community_engagement/ahscwf.aspx (Accessed May 1, 2013).
- 13.Alberta Education. Daily physical activity survey report 2007. Edmonton, AB: Alberta Education; 2008. [Google Scholar]
- 14.Edmonton public school board health and wellness of staff and students policy. 2007. Available at: https://doi.org/wwwwww.epsb.ca/policy/gbe.bp.shtml (Accessed May 1, 2013).
- 15.Fung C, Kuhle S, Lu C, Purcell M, Schwartz M, Storey K, et al. From “best practice” to “next practice”: The effectiveness of school-based health promotion in improving healthy eating and physical activity and preventing childhood obesity. Int J Behav Nutr Phys Act. 2012;9:27. doi: 10.1186/1479-5868-9-27. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Mullally ML, Taylor JP, Kuhle S, Bryanton J, Hernandez KJ, MacLellan DL, et al. A province-wide school nutrition policy and food consumption in elementary school children in Prince Edward Island. Can J Public Health. 2010;101(1):40–43. doi: 10.1007/BF03405560. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Storey KE, Forbes LE, Fraser SN, Spence JC, Plotnikoff RC, Raine KD, et al. Diet quality, nutrition and physical activity among adolescents: The web-SPAN (web-survey of physical activity and nutrition) project. Public Health Nutr. 2009;12(11):2009–17. doi: 10.1017/S1368980009990292. [DOI] [PubMed] [Google Scholar]
- 18.Plotnikoff RC, Karunamuni N, Spence JC, Storey K, Forbes L, Raine K, et al. Chronic disease-related lifestyle risk factors in a sample of Canadian adolescents. J Adolesc Health. 2009;44(6):606–9. doi: 10.1016/j.jadohealth.2008.11.004. [DOI] [PubMed] [Google Scholar]
- 19.Sin DD, Svenson LW, Man SF. Do area-based markers of poverty accurately measure personal poverty? Can J Public Health. 2001;92(3):184–87. doi: 10.1007/BF03404301. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Hanning RM, Royall D, Toews JE, Blashill L, Wegener J, Driezen P. Web-based food behaviour questionnaire: Validation with grades six to eight students. Can J Diet Pract Res. 2009;70(4):172–78. doi: 10.3148/70.4.2009.172. [DOI] [PubMed] [Google Scholar]
- 21.Canadian nutrient file [electronic version]. 2001. Available at: https://doi.org/wwwwww.hcsc.gc.ca/food-aliment/ns-sc/nr-rn/surveillance/cnf-fcen/e_index.html (Accessed May 1, 2013).
- 22.Eating Well With Canada’s Food Guide. 2007. Available at: https://doi.org/wwwwww.hcsc.gc.ca/fn-an/alt_formats/hpfb-dgpsa/pdf/food-guide-aliment/view_eatwell_vue_bienmang-eng.pdf (Accessed May 1, 2013).
- 23.Forbes LE, Storey KE, Fraser SN, Spence JC, Plotnikoff RC, Raine KD, et al. Dietary patterns associated with glycemic index and glycemic load among alberta adolescents. Appl Physiol Nutr Metab. 2009;34(4):648–58. doi: 10.1139/H09-051. [DOI] [PubMed] [Google Scholar]
- 24.Kowalski KC, Crocker ORE, Donen RM. The physical activity questionnaire for older children (PAQ-C) and adolescents (PAQ-A) manual. 2004. [Google Scholar]
- 25.Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: International survey. BMJ. 2000;320(7244):1240–43. doi: 10.1136/bmj.320.7244.1240. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26.Morrison JA, Glueck CJ, Horn PS, Schreiber GB, Wang P. Pre-teen insulin resistance predicts weight gain, impaired fasting glucose, and type 2 diabetes at age 18–19 y: A 10-y prospective study of black and white girls. Am J Clin Nutr. 2008;88(3):778–88. doi: 10.1093/ajcn/88.3.778. [DOI] [PubMed] [Google Scholar]
- 27.Statistics Canada. Census . families include couple families, with or without children, and lone-parent families CANSIM, table 111-0009. 2010. [Google Scholar]
- 28.Shields M. Overweight and obesity among children and youth. Health Rep. 2006;17(3):27–42. [PubMed] [Google Scholar]
- 29.Statistics Canada. Canadian community health survey (CCHS 3.1), CANSIM table 1050449. 2005. [Google Scholar]
- 30.U.S. Department of Agriculture, Agricultural Research Service. Nutrient intakes from food: Mean amounts consumed per individual, by race/ethnicity and age, one day, 2005–2006. 2008. [Google Scholar]
- 31.Lindstrom J, Peltonen M, Eriksson JG, Louheranta A, Fogelholm M, Uusitupa M, et al. High-fibre, low-fat diet predicts long-term weight loss and decreased type 2 diabetes risk: The Finnish diabetes prevention study. Diabetologia. 2006;49(5):912–20. doi: 10.1007/s00125-006-0198-3. [DOI] [PubMed] [Google Scholar]
- 32.Zhou K, Su L, Yu LL. Phytochemicals and antioxidant properties in wheat bran. J Agric Food Chem. 2004;52(20):6108–14. doi: 10.1021/jf049214g. [DOI] [PubMed] [Google Scholar]
- 33.Carter LM, Whiting SJ, Drinkwater DT, Zello GA, Faulkner RA, Bailey DA. Selfreported calcium intake and bone mineral content in children and adolescents. J Am Coll Nutr. 2001;20(5):502–9. doi: 10.1080/07315724.2001.10719059. [DOI] [PubMed] [Google Scholar]
- 34.O’Gorman DJ, Karlsson HK, McQuaid S, Yousif O, Rahman Y, Gasparro D, et al. Exercise training increases insulin-stimulated glucose disposal and GLUT4 (SLC2A4) protein content in patients with type 2 diabetes. Diabetologia. 2006;49(12):2983–92. doi: 10.1007/s00125-006-0457-3. [DOI] [PubMed] [Google Scholar]
- 35.Janssen I, Boyce WF, Simpson K, Pickett W. Influence of individual- and arealevel measures of socioeconomic status on obesity, unhealthy eating, and physical inactivity in Canadian adolescents. Am J Clin Nutr. 2006;83(1):139–45. doi: 10.1093/ajcn/83.1.139. [DOI] [PubMed] [Google Scholar]