Marjan Alssema - Academia.edu (original) (raw)
Papers by Marjan Alssema
Endocrine, Jan 3, 2016
We aimed to examine heterogeneity in glucose response curves during an oral glucose tolerance tes... more We aimed to examine heterogeneity in glucose response curves during an oral glucose tolerance test with multiple measurements and to compare cardiometabolic risk profiles between identified glucose response curve groups. We analyzed data from 1,267 individuals without diabetes from five studies in Denmark, the Netherlands and the USA. Each study included between 5 and 11 measurements at different time points during a 2-h oral glucose tolerance test, resulting in 9,602 plasma glucose measurements. Latent class trajectories with a cubic specification for time were fitted to identify different patterns of plasma glucose change during the oral glucose tolerance test. Cardiometabolic risk factor profiles were compared between the identified groups. Using latent class trajectory analysis, five glucose response curves were identified. Despite similar fasting and 2-h values, glucose peaks and peak times varied greatly between groups, ranging from 7-12 mmol/L, and 35-70 min. The group with t...
British Journal of Nutrition, 2016
European journal of nutrition, Jan 14, 2016
Data on the relation between linoleic acid (LA) and alpha-linolenic acid (ALA) and type 2 diabete... more Data on the relation between linoleic acid (LA) and alpha-linolenic acid (ALA) and type 2 diabetes mellitus (T2DM) risk are scarce and inconsistent. The aim of this study was to investigate the association of serum LA and ALA with fasting and 2 h post-load plasma glucose and glycated hemoglobin (HbA1c). This study included 667 participants from third examination (2000) of the population-based Hoorn study in which individuals with glucose intolerance were overrepresented. Fatty acid profiles in serum total lipids were measured at baseline, in 2000. Diabetes risk markers were measured at baseline and follow-up in 2008. Linear regression models were used in cross-sectional and prospective analyses. In cross-sectional analyses (n = 667), serum LA was inversely associated with plasma glucose, both in fasting conditions (B = -0.024 [-0.045, -0.002]) and 2 h after glucose tolerance test (B = -0.099 [-0.158, -0.039]), but not with HbA1c (B = 0.000 [-0.014, 0.013]), after adjustment for rele...
Circulation, Mar 10, 2015
Circulation, Nov 23, 2010
Circulation, Mar 25, 2014
American Journal of Clinical Nutrition, 2016
The association between saturated fatty acid (SFA) intake and ischemic heart disease (IHD) risk i... more The association between saturated fatty acid (SFA) intake and ischemic heart disease (IHD) risk is debated. We sought to investigate whether dietary SFAs were associated with IHD risk and whether associations depended on 1) the substituting macronutrient, 2) the carbon chain length of SFAs, and 3) the SFA food source. Baseline (1993-1997) SFA intake was measured with a food-frequency questionnaire among 35,597 participants from the European Prospective Investigation into Cancer and Nutrition-Netherlands cohort. IHD risks were estimated with multivariable Cox regression for the substitution of SFAs with other macronutrients and for higher intakes of total SFAs, individual SFAs, and SFAs from different food sources. During 12 y of follow-up, 1807 IHD events occurred. Total SFA intake was associated with a lower IHD risk (HR per 5% of energy: 0.83; 95% CI: 0.74, 0.93). Substituting SFAs with animal protein, cis monounsaturated fatty acids, polyunsaturated fatty acids (PUFAs), or carbohydrates was significantly associated with higher IHD risks (HR per 5% of energy: 1.27-1.37). Slightly lower IHD risks were observed for higher intakes of the sum of butyric (4:0) through capric (10:0) acid (HRSD: 0.93; 95% CI: 0.89, 0.99), myristic acid (14:0) (HRSD: 0.90; 95% CI: 0.83, 0.97), the sum of pentadecylic (15:0) and margaric (17:0) acid (HRSD: 0.91: 95% CI: 0.83, 0.99), and for SFAs from dairy sources, including butter (HRSD: 0.94; 95% CI: 0.90, 0.99), cheese (HRSD: 0.91; 95% CI: 0.86, 0.97), and milk and milk products (HRSD: 0.92; 95% CI: 0.86, 0.97). In this Dutch population, higher SFA intake was not associated with higher IHD risks. The lower IHD risk observed did not depend on the substituting macronutrient but appeared to be driven mainly by the sums of butyric through capric acid, the sum of pentadecylic and margaric acid, myristic acid, and SFAs from dairy sources. Residual confounding by cholesterol-lowering therapy and trans fat or limited variation in SFA and PUFA intake may explain our findings. Analyses need to be repeated in populations with larger differences in SFA intake and different SFA food sources.
Atherosclerosis, Jan 2, 2008
Circulation, Mar 26, 2013
![Research paper thumbnail of [Estimating the individual risk of diabetes: not on the grounds of overweight only]](https://attachments.academia-assets.com/53751008/thumbnails/1.jpg)
](Nederlands tijdschrift voor geneeskunde
Overweight (BMI level > or =25 kg/m2) and in particular high abdominal fat levels (waist circu... more Overweight (BMI level > or =25 kg/m2) and in particular high abdominal fat levels (waist circumference > or =88 cm in women and > or =102 cm in men), are among the main risk factors for the development of type 2 diabetes mellitus. Results from the Hoorn Study show that 16.3% of overweight participants with high abdominal fat levels developed diabetes within 6 years, compared with 6.8% of those who were not overweight and had low abdominal fat levels. Information on overweight and abdominal fat level is not enough to properly estimate the risk of type 2 diabetes in an individual patient. The combination of information on overweight with information on other important risk factors for diabetes, such as family history, age, blood pressure and elevated blood glucose levels in the form of a calculated diabetes risk score, gives a better estimate of the individual diabetes risk.
Wereldwijd komt type 2 diabetes steeds meer voor, tegenwoordig lijden bijna 250 miljoen mensen aa... more Wereldwijd komt type 2 diabetes steeds meer voor, tegenwoordig lijden bijna 250 miljoen mensen aan deze ziekte. Hart- en vaatziekten zijn de meest voorkomende complicatie bij type 2 diabetes. Metabole omstandigheden na de maaltijd (postprandiaal) spelen mogelijk een rol in het verhoogde risico op hart- en vaatziekten bij patiënten met type 2 diabetes. Het doel van de studies die beschreven zijn in dit proefschrift is het onderzoeken van mogelijke associaties tussen het postprandiale metabolisme en hart- en vaatziekten. De bijdrage van nuchtere en postprandiale glucose, vetten (triglyceriden) en van nuchter cholesteryl ester transfer protein (CETP) aan risico het risico op hart- en vaatziekten is onderzocht. We vonden dat verstoringen in zowel de glucose- als de vetstofwisseling na de maaltijd bijdragen aan het risico op hart- en vaatziekten. Glucosewaarden na de maaltijd blijken zelfs in gezonde personen samen te hangen met het ontwikkelen van aderverkalking. We vonden geen relatie ...
Nederlands tijdschrift voor geneeskunde, 2011
The aim of the practice guideline 'The Prevention Visit' is the prevention of cardiovascu... more The aim of the practice guideline 'The Prevention Visit' is the prevention of cardiovascular diseases, type 2 diabetes and chronic kidney injury in adults not previously diagnosed with hypertension, hypercholesterolaemia, or the above-mentioned cardiometabolic disorders. This is done by actively offering risk assessment combined with relevant treatment and advice (if indicated), integrated into primary health care. A self-report questionnaire is used to identify persons at high risk of developing cardiometabolic disease. Individuals with a risk score above the established threshold are advised to visit their general practitioner for measurement of height, weight, waist circumference, blood pressure, fasting glucose, cholesterol, and HDL cholesterol. At a subsequent practice visit, a risk assessment is performed according to the Dutch College of General Practitioners' practice guideline 'Cardiovascular Risk Management', at which time the patient's lifestyle is...
![Research paper thumbnail of [Finnish questionnaire reasonably good predictor of the incidence of diabetes in The Netherlands]](https://attachments.academia-assets.com/53750996/thumbnails/1.jpg)
](Nederlands tijdschrift voor geneeskunde, 2008
To establish whether the Finnish diabetes risk score for predicting the incidence of diabetes (FI... more To establish whether the Finnish diabetes risk score for predicting the incidence of diabetes (FINDRISK) is also valid in the Netherlands, and to choose cut-off points suitable for the Dutch situation. . Descriptive. The FINDRISK was validated in 3 Dutch cohort studies by means of repeated glucose measurements: the Hoorn study (n=5434), the PREVEND study (n=2713) and part of the Maastricht cohort from the MORGEN study (n=863). The predictive value was evaluated using receiver operating characteristic (ROC) analyses. The risk categories were defined on the basis of sensitivity, specificity and positive predictive value. The predictive value of the FINDRISK was best in the PREVEND cohort (area under the ROC curve 0.77) and was lower for the Hoorn study and the Maastricht cohort (area under the ROC-curve 0.71 for both). The scores were divided into three risk categories: low risk (score lower than 7), slightly increased risk (score 7-9) and increased risk (score so or higher). The perc...
European Journal of Clinical Nutrition, 2009
Epidemiology, 2009
Abstract: In recent studies an association between long term exposure to air pollution and type 2... more Abstract: In recent studies an association between long term exposure to air pollution and type 2 Diabetes Mellitus (T2DM) is suggested. The present study aims to investigate this relationship using data from a Diabetes Screening study conducted between 1998 and ...
Diabetic Medicine, 2011
The Finnish Diabetes Risk Score (FINDRISC) is widely used for risk stratification in Type 2 diabe... more The Finnish Diabetes Risk Score (FINDRISC) is widely used for risk stratification in Type 2 diabetes prevention programmes. Estimates of β-cell function vary widely in people without diabetes and reduced insulin secretion has been described in people at risk for diabetes. The aim of this analysis was to evaluate FINDRISC as a tool to characterize reduced β-cell function in individuals without known diabetes. In this population-based cohort from the Hoorn municipal registry, subjects received an oral glucose tolerance test and a meal tolerance test on separate days, in random order, within 2 weeks. One hundred and eighty-six subjects, age 41-66 years, with no known Type 2 diabetes were included. Of those, 163 (87.6%) had normal glucose metabolism and 23 (12.4%) had abnormal glucose metabolism (19 with impaired glucose metabolism; four with newly diagnosed Type 2 diabetes based on study results). Insulin sensitivity and β-cell function (classical: insulinogenic index; ratio of areas under insulin/glucose curves; model-based: glucose sensitivity; rate sensitivity; potentiation) estimates were calculated from oral glucose tolerance test and meal tolerance test data. FINDRISC was associated with insulin sensitivity (r = -0.41, P < 0.0001), insulin/glucose areas under the curve (meal tolerance test: r = 0.29, P < 0.0001; oral glucose tolerance test: r = 0.21, P = 0.01) and potentiation factor (meal tolerance test: r = 0.21, P = 0.01). After adjusting for insulin sensitivity, these associations with β-cell function were no longer significant. After adjustment for insulin sensitivity, FINDRISC was not associated with reduced β-cell function in subjects without known Type 2 diabetes. While insulin secretion and insulin sensitivity are both components in Type 2 diabetes development, insulin sensitivity appears to be the dominant component behind the association between FINDRISC and diabetes risk.
Endocrine, Jan 3, 2016
We aimed to examine heterogeneity in glucose response curves during an oral glucose tolerance tes... more We aimed to examine heterogeneity in glucose response curves during an oral glucose tolerance test with multiple measurements and to compare cardiometabolic risk profiles between identified glucose response curve groups. We analyzed data from 1,267 individuals without diabetes from five studies in Denmark, the Netherlands and the USA. Each study included between 5 and 11 measurements at different time points during a 2-h oral glucose tolerance test, resulting in 9,602 plasma glucose measurements. Latent class trajectories with a cubic specification for time were fitted to identify different patterns of plasma glucose change during the oral glucose tolerance test. Cardiometabolic risk factor profiles were compared between the identified groups. Using latent class trajectory analysis, five glucose response curves were identified. Despite similar fasting and 2-h values, glucose peaks and peak times varied greatly between groups, ranging from 7-12 mmol/L, and 35-70 min. The group with t...
British Journal of Nutrition, 2016
European journal of nutrition, Jan 14, 2016
Data on the relation between linoleic acid (LA) and alpha-linolenic acid (ALA) and type 2 diabete... more Data on the relation between linoleic acid (LA) and alpha-linolenic acid (ALA) and type 2 diabetes mellitus (T2DM) risk are scarce and inconsistent. The aim of this study was to investigate the association of serum LA and ALA with fasting and 2 h post-load plasma glucose and glycated hemoglobin (HbA1c). This study included 667 participants from third examination (2000) of the population-based Hoorn study in which individuals with glucose intolerance were overrepresented. Fatty acid profiles in serum total lipids were measured at baseline, in 2000. Diabetes risk markers were measured at baseline and follow-up in 2008. Linear regression models were used in cross-sectional and prospective analyses. In cross-sectional analyses (n = 667), serum LA was inversely associated with plasma glucose, both in fasting conditions (B = -0.024 [-0.045, -0.002]) and 2 h after glucose tolerance test (B = -0.099 [-0.158, -0.039]), but not with HbA1c (B = 0.000 [-0.014, 0.013]), after adjustment for rele...
Circulation, Mar 10, 2015
Circulation, Nov 23, 2010
Circulation, Mar 25, 2014
American Journal of Clinical Nutrition, 2016
The association between saturated fatty acid (SFA) intake and ischemic heart disease (IHD) risk i... more The association between saturated fatty acid (SFA) intake and ischemic heart disease (IHD) risk is debated. We sought to investigate whether dietary SFAs were associated with IHD risk and whether associations depended on 1) the substituting macronutrient, 2) the carbon chain length of SFAs, and 3) the SFA food source. Baseline (1993-1997) SFA intake was measured with a food-frequency questionnaire among 35,597 participants from the European Prospective Investigation into Cancer and Nutrition-Netherlands cohort. IHD risks were estimated with multivariable Cox regression for the substitution of SFAs with other macronutrients and for higher intakes of total SFAs, individual SFAs, and SFAs from different food sources. During 12 y of follow-up, 1807 IHD events occurred. Total SFA intake was associated with a lower IHD risk (HR per 5% of energy: 0.83; 95% CI: 0.74, 0.93). Substituting SFAs with animal protein, cis monounsaturated fatty acids, polyunsaturated fatty acids (PUFAs), or carbohydrates was significantly associated with higher IHD risks (HR per 5% of energy: 1.27-1.37). Slightly lower IHD risks were observed for higher intakes of the sum of butyric (4:0) through capric (10:0) acid (HRSD: 0.93; 95% CI: 0.89, 0.99), myristic acid (14:0) (HRSD: 0.90; 95% CI: 0.83, 0.97), the sum of pentadecylic (15:0) and margaric (17:0) acid (HRSD: 0.91: 95% CI: 0.83, 0.99), and for SFAs from dairy sources, including butter (HRSD: 0.94; 95% CI: 0.90, 0.99), cheese (HRSD: 0.91; 95% CI: 0.86, 0.97), and milk and milk products (HRSD: 0.92; 95% CI: 0.86, 0.97). In this Dutch population, higher SFA intake was not associated with higher IHD risks. The lower IHD risk observed did not depend on the substituting macronutrient but appeared to be driven mainly by the sums of butyric through capric acid, the sum of pentadecylic and margaric acid, myristic acid, and SFAs from dairy sources. Residual confounding by cholesterol-lowering therapy and trans fat or limited variation in SFA and PUFA intake may explain our findings. Analyses need to be repeated in populations with larger differences in SFA intake and different SFA food sources.
Atherosclerosis, Jan 2, 2008
Circulation, Mar 26, 2013
Nederlands tijdschrift voor geneeskunde
Overweight (BMI level > or =25 kg/m2) and in particular high abdominal fat levels (waist circu... more Overweight (BMI level > or =25 kg/m2) and in particular high abdominal fat levels (waist circumference > or =88 cm in women and > or =102 cm in men), are among the main risk factors for the development of type 2 diabetes mellitus. Results from the Hoorn Study show that 16.3% of overweight participants with high abdominal fat levels developed diabetes within 6 years, compared with 6.8% of those who were not overweight and had low abdominal fat levels. Information on overweight and abdominal fat level is not enough to properly estimate the risk of type 2 diabetes in an individual patient. The combination of information on overweight with information on other important risk factors for diabetes, such as family history, age, blood pressure and elevated blood glucose levels in the form of a calculated diabetes risk score, gives a better estimate of the individual diabetes risk.
Wereldwijd komt type 2 diabetes steeds meer voor, tegenwoordig lijden bijna 250 miljoen mensen aa... more Wereldwijd komt type 2 diabetes steeds meer voor, tegenwoordig lijden bijna 250 miljoen mensen aan deze ziekte. Hart- en vaatziekten zijn de meest voorkomende complicatie bij type 2 diabetes. Metabole omstandigheden na de maaltijd (postprandiaal) spelen mogelijk een rol in het verhoogde risico op hart- en vaatziekten bij patiënten met type 2 diabetes. Het doel van de studies die beschreven zijn in dit proefschrift is het onderzoeken van mogelijke associaties tussen het postprandiale metabolisme en hart- en vaatziekten. De bijdrage van nuchtere en postprandiale glucose, vetten (triglyceriden) en van nuchter cholesteryl ester transfer protein (CETP) aan risico het risico op hart- en vaatziekten is onderzocht. We vonden dat verstoringen in zowel de glucose- als de vetstofwisseling na de maaltijd bijdragen aan het risico op hart- en vaatziekten. Glucosewaarden na de maaltijd blijken zelfs in gezonde personen samen te hangen met het ontwikkelen van aderverkalking. We vonden geen relatie ...
Nederlands tijdschrift voor geneeskunde, 2011
The aim of the practice guideline 'The Prevention Visit' is the prevention of cardiovascu... more The aim of the practice guideline 'The Prevention Visit' is the prevention of cardiovascular diseases, type 2 diabetes and chronic kidney injury in adults not previously diagnosed with hypertension, hypercholesterolaemia, or the above-mentioned cardiometabolic disorders. This is done by actively offering risk assessment combined with relevant treatment and advice (if indicated), integrated into primary health care. A self-report questionnaire is used to identify persons at high risk of developing cardiometabolic disease. Individuals with a risk score above the established threshold are advised to visit their general practitioner for measurement of height, weight, waist circumference, blood pressure, fasting glucose, cholesterol, and HDL cholesterol. At a subsequent practice visit, a risk assessment is performed according to the Dutch College of General Practitioners' practice guideline 'Cardiovascular Risk Management', at which time the patient's lifestyle is...
Nederlands tijdschrift voor geneeskunde, 2008
To establish whether the Finnish diabetes risk score for predicting the incidence of diabetes (FI... more To establish whether the Finnish diabetes risk score for predicting the incidence of diabetes (FINDRISK) is also valid in the Netherlands, and to choose cut-off points suitable for the Dutch situation. . Descriptive. The FINDRISK was validated in 3 Dutch cohort studies by means of repeated glucose measurements: the Hoorn study (n=5434), the PREVEND study (n=2713) and part of the Maastricht cohort from the MORGEN study (n=863). The predictive value was evaluated using receiver operating characteristic (ROC) analyses. The risk categories were defined on the basis of sensitivity, specificity and positive predictive value. The predictive value of the FINDRISK was best in the PREVEND cohort (area under the ROC curve 0.77) and was lower for the Hoorn study and the Maastricht cohort (area under the ROC-curve 0.71 for both). The scores were divided into three risk categories: low risk (score lower than 7), slightly increased risk (score 7-9) and increased risk (score so or higher). The perc...
European Journal of Clinical Nutrition, 2009
Epidemiology, 2009
Abstract: In recent studies an association between long term exposure to air pollution and type 2... more Abstract: In recent studies an association between long term exposure to air pollution and type 2 Diabetes Mellitus (T2DM) is suggested. The present study aims to investigate this relationship using data from a Diabetes Screening study conducted between 1998 and ...
Diabetic Medicine, 2011
The Finnish Diabetes Risk Score (FINDRISC) is widely used for risk stratification in Type 2 diabe... more The Finnish Diabetes Risk Score (FINDRISC) is widely used for risk stratification in Type 2 diabetes prevention programmes. Estimates of β-cell function vary widely in people without diabetes and reduced insulin secretion has been described in people at risk for diabetes. The aim of this analysis was to evaluate FINDRISC as a tool to characterize reduced β-cell function in individuals without known diabetes. In this population-based cohort from the Hoorn municipal registry, subjects received an oral glucose tolerance test and a meal tolerance test on separate days, in random order, within 2 weeks. One hundred and eighty-six subjects, age 41-66 years, with no known Type 2 diabetes were included. Of those, 163 (87.6%) had normal glucose metabolism and 23 (12.4%) had abnormal glucose metabolism (19 with impaired glucose metabolism; four with newly diagnosed Type 2 diabetes based on study results). Insulin sensitivity and β-cell function (classical: insulinogenic index; ratio of areas under insulin/glucose curves; model-based: glucose sensitivity; rate sensitivity; potentiation) estimates were calculated from oral glucose tolerance test and meal tolerance test data. FINDRISC was associated with insulin sensitivity (r = -0.41, P < 0.0001), insulin/glucose areas under the curve (meal tolerance test: r = 0.29, P < 0.0001; oral glucose tolerance test: r = 0.21, P = 0.01) and potentiation factor (meal tolerance test: r = 0.21, P = 0.01). After adjusting for insulin sensitivity, these associations with β-cell function were no longer significant. After adjustment for insulin sensitivity, FINDRISC was not associated with reduced β-cell function in subjects without known Type 2 diabetes. While insulin secretion and insulin sensitivity are both components in Type 2 diabetes development, insulin sensitivity appears to be the dominant component behind the association between FINDRISC and diabetes risk.