Could Where Tom Hanks Lived and Worked Affected his Risk for Diabetes?
Last night actor Tom Hanks revealed he was diagnosed with high blood pressure 20 years ago and has just been diagnosed with type 2 diabetes. He is not alone. Hypertension affects one third of adults in the United States with the highest prevalence in African Americans. The most recent statistics (2011 CDC) find that 25.6 million Americans, 11.3% of those over 20y, have diabetes.
Type 2 diabetes is a disease where blood glucose levels are above normal. It occurs because the pancreas cannot produce enough insulin to help move glucose from the bloodstream into cells. Risk factors include being older, being overweight or obese, a family history, prior history of gestational diabetes, impaired glucose tolerance, physical activity, and race/ethnicity.
Many of these risk factors may be interrelated. Did Tom Hanks career affect his risk of diabetes? Or could his health have been affected because he lived and worked much of his life along the coastline near sea level? Interesting thought.
Using cross-sectional, nationally-representative data from 422,603 US adults, Voss and colleagues examined the relationship between obesity with elevation, ambient temperature and urbanization data. They report that males and females living <500m above sea level had 5.1 and 2.9 times greater risk of obesity (after controlling for urbanization, temperature, and behavioral and demographic factors). Basically, people living at higher elevations, e.g . Colorado, were more likely to be normal weight than those living in Los Angeles. They also report that the variation in body mass index (BMI) narrows at higher elevations. There isn’t a good explanation for this relationship, just many hypotheses to be tested: hypoxia, metabolic demands, etc.
News anchors were speculating today that Tom Hanks may have increased his risk of type 2 diabetes by gaining and losing weight for different acting roles. There is evidence that gaining weight does increase risk of type 2 diabetes. However, the same cannot be said for losing weight. The Finnish Diabetes Prevention (DPS) follow-up study concluded that adherence to a healthy lifestyle ( sustained engagement in moderate-to-vigorous physical activity and adherence to healthier dietary choices) resulted in a 43% reduction in risk of diabetes. New results from the Longitudinal Study of Australian Children (LSAC) also find that poor health-related quality of life (HRQoL) indicators are a consequence of higher BMI, not a cause (Jansen et al., 2013).
Maintaining healthy heart and blood vessels is important. The challenge facing many, such as Tom Hanks, with hypertension and diabetes is their increased risk of arterial stiffness and accelerated atherosclerosis. Flow-mediated dilatation is one tool to monitor vascular elasticity. Another is the pulse wave velocity measured by Dabalea et al. (2013) in their assessment of risk factors associated with arterial stiffness in youth. More studies are needed using these tools to assess the interaction of essential nutrient status with environmental risk factors, e.g. particulate matter air pollution, or our own genetics, e.g. haptoglobin polymorphisms, on health and quality of life.
Voss JD, Masuoka P, Webber BJ, Scher AI, Atkinson RL. Association of elevation, urbanization and ambient temperature with obesity prevalence in the United States. 2013 Int J Obesity doi:10.1038/ijo.2013.5
Jansen PW, Mensah FK, Clifford S, Nicholson JM, Wake M. Bidirectional associations between overweight and health-related quality of life from 4-11 years: Longitudinal Study of Australian Children. 2013 Int J Obesity doi:10.1038/ijo.2013.71
Dabelea D, Talton JW, D’Agosino Jr R, Wadwa RP, Urbina EM, Dolan LM, Daniels SR, Marcovina SM, Hamman RF. Cardiovascular risk factors are associated with increased arterial stiffness in youth with type 1 diabetes: The SEARCH CVD study. 2013 Diab Care doi:10.2337/dc13-0851
Lindstrom J, Peltonen M, Eriksson JG, Ilanne-Parikka P, Aunola S, Keinanen-Kiukaanniemi S, Uusitupa M, Tuomilehto J, and for the Finnish Diabetes Prevention Study (DPS). Improved lifestyle and decreased diabetes risk over 13 years: long-term follow-up of the randomized Finnish Diabetes Prevention Study (DPS) 2012 Diabetologia doi:10.1007/s00125-012-2752-5
AHA Scientific Statement. Particulate Matter Air Pollution and Cardiovascular Disease. 2010 Circulation doi:10.1161/CIR.0b013e3181dbecel