Self-rated health and type 2 diabetes risk in the European Prospective Investigation into Cancer and Nutrition-InterAct study: a case-cohort study

• Published in: BMJ open Vol. 3; no. 3; p. e002436
• Main Authors: Wennberg, Patrik, Rolandsson, Olov, van der A, Daphne L, Spijkerman, Annemieke M W, Kaaks, Rudolf, Boeing, Heiner, Feller, Silke, Bergmann, Manuela M, Langenberg, Claudia, Sharp, Stephen J, Forouhi, Nita, Riboli, Elio, Wareham, Nicholas
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.01.2013; BMJ Publishing Group
• Subjects: diabetes; Diabetes and Endocrinology; Systematic review
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2012-002436

Objectives To investigate the association between self-rated health and risk of type 2 diabetes and whether the strength of this association is consistent across five European centres. Design Population-based prospective case-cohort study. Setting Enrolment took place between 1992 and 2000 in five European centres (Bilthoven, Cambridge, Heidelberg, Potsdam and Umeå). Participants Self-rated health was assessed by a baseline questionnaire in 3399 incident type 2 diabetic case participants and a centre-stratified subcohort of 4619 individuals from the European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct study which was drawn from a total cohort of 340 234 participants in the EPIC. Primary outcome measure Prentice-weighted Cox regression was used to estimate centre-specific HRs and 95% CIs for incident type 2 diabetes controlling for age, sex, centre, education, body mass index (BMI), smoking, alcohol consumption, energy intake, physical activity and hypertension. The centre-specific HRs were pooled across centres by random effects meta-analysis. Results Low self-rated health was associated with a higher hazard of type 2 diabetes after adjusting for age and sex (pooled HR 1.67, 95% CI 1.48 to 1.88). After additional adjustment for health-related variables including BMI, the association was attenuated but remained statistically significant (pooled HR 1.29, 95% CI 1.09 to 1.53). I2 index for heterogeneity across centres was 13.3% (p=0.33). Conclusions Low self-rated health was associated with a higher risk of type 2 diabetes. The association could be only partly explained by other health-related variables, of which obesity was the strongest. We found no indication of heterogeneity in the association between self-rated health and type 2 diabetes mellitus across the European centres.