Diabesity & Associated Disorders in Australia

Transcription

1 Diesity & Associted Disorders in Austrli The Accelerting Epidemic The Austrlin Dietes, Oesity nd Lifestyle Study (AusDi)

2 Authors Dr D Dunstn, Professor P Zimmet, Professor T Welorn, Dr R Sicree, Dr T Armstrong, Professor R Atkins, Mr A Cmeron, Dr J Shw, nd Dr S Chdn on ehlf of the AusDi Steering Committee Contriutors Dr S Bennett Dr M de Courten Ms G Hodgson Mr A Meehn Ms S Murry Ms N Wtson Dr J Willims List of sponsors The Federl Government Commonwelth Dept of Helth nd Aged Cre (Minister: The Hon Dr Michel Wooldridge, Federl Minister for Helth nd Aged Cre) Eli Lilly (Aust) Pty Ltd Jnssen - Cilg (Aust) Pty Ltd Knoll Austrli Pty Ltd Merck Liph s.. Alphphrm Pty Ltd Merck Shrp & Dohme (Aust) Pty Ltd Phrmci nd Upjohn Pty Ltd Roche Dignostics Servier Lortories (Aust) Pty Ltd SmithKline Beechm Interntionl BioRd Lortories Pty Ltd HITECH Pthology Pty Ltd Qnts Airwys Ltd Stte Governments of: Queenslnd, South Austrli, Tsmni, Western Austrli nd Victori Territory Helth Services Austrlin Kidney Foundtion Dietes Austrli - Northern Territory The Interntionl Dietes Institute Copyright 2001 y the Interntionl Dietes Institute ISBN Pulished y the Interntionl Dietes Institute, Melourne 2001 Cover Design y S.O.D.A. Grphic Design. Puliction grphics nd design y A Meehn. Printed y RB Print Imging. ii Authors nd sponsors

3 Dietes mellitus is metolic disese chrcterised y high lood glucose levels (hyperglycemi) resulting from defects in insulin secretion, insulin ction or oth. The chronic hyperglycemi of dietes is ssocited with longterm dmge, dysfunction nd filure of virtully every ody orgn, especilly the eyes, kidneys, nerves, hert nd lood vessels. Wht is Dietes? Type 1 dietes results from utoimmune destruction of the pncretic et cells, the cells which produce insulin. In this form of dietes, insulin is required for survivl. It ccounts for 10% of ll persons with dietes in Austrli. It cn pper t ny ge, lthough usully efore 40 yers. Type 2 dietes is chrcterised y resistnce to insulin's ction nd impired insulin production y the pncres, either of which my predominte. It is the most common form of dietes ccounting for more thn 85% of persons with dietes in Austrli. It hs strong genetic (fmilil) propensity which is unmsked y lifestyle fctors such s oesity (hence the term diesity ) nd lck of exercise. In most instnces, the moleculr or metolic custion is not yet known. Wht is Dietes? iii

4 Ministeril foreword iv Ministeril foreword

5 Foreword Interntionl Dietes Federtion Professor Sir K George MM Alerti Messge from the IDF This work represents lndmrk in the history of dietes in Austrli. Amongst the erliest hints of the emerging dietes pndemic were the studies y Austrlins of dietes in the Pcific Islnds nd susequent work with the indigenous popultions. Both of these pointed to Westernistion of lifestyle s crucil fctor. Studies from Western Austrli t tht time suggested tht there ws less of prolem in those of Europen origin. However, no Austrli-wide dt hve een ville. This hs finlly een rectified. The results should focus ttention on the incontrovertile truth: tht dietes is now one of the iggest helth prolems ssiling Austrli. The prevlence rtes mtch or exceed those in most Western countries nd re similr to those in the USA. This, together with the presumptive much higher rtes in the Indigenous popultion, should e tken y ll s cll to ction on two fronts: first, prevention of Type 2 dietes y tckling the horrendous twin prolems of oesity nd lck of physicl ctivity; nd second, improved tretment fcilities to hold t y the dedly complictions. Austrli led the wy y erly identifiction of the world pndemic. Now the IDF chllenges Austrli to led the wy y implementing the first successful ntionwide preventive strtegy. Professor Sir K George MM Alerti President, Interntionl Dietes Federtion Foreword v

6 Tle of contents Authors nd sponsors Wht is Dietes? Ministeril foreword Foreword - Interntionl Dietes Federtion ii iii iv v Executive summry 1 Chpter 1: Bckground 4 Chpter 2: Dietes mellitus 7 Chpter 3: Overweight nd oesity 13 Chpter 4: Dyslipidemi 18 Chpter 5: Hypertension 22 Chpter 6: Smoking 26 Chpter 7: Physicl ctivity 29 Chpter 8: Crdiovsculr disese risk fctors 31 Chpter 9: Indictors of renl disese 33 Chpter 10: Survey methodology 35 Appendix 1: Summry tle with confidence intervls 40 Appendix 2: Survey sites 41 References 42 Steering committee 44 Acknowledgements 45 Austrlin Dietes Declrtion 46 vi Contents

7 Executive summry In oth humn nd economic terms, dietes mellitus is lredy one of Austrli's most costly diseses with the numer of new cses nd its impct ccelerting. It is mjor risk fctor for hert disese, kidney filure, lindness, mputtions nd irth defects. Dietes shortens life expectncy y up to 15 yers nd its nnul cost to the ntion exceeds $1.2 illion. Alredy in the United Sttes, dietes relted costs ccount for 12% of the ntionl helth udget. The prolifertion of studies descriing the epidemiology nd impct of dietes over the lst 20 yers in mny countries hs een extrordinry. Surprisingly however, there hs never een ntionl study performed in Austrli. Aginst this ckground, the Ntionl Dietes Strtegy (NDS), lunched in 1998 nd sperheded y Dr Michel Wooldridge, the Federl Minister for Helth nd Aged Cre, ws visionry nd innovtive pulic helth inititive. Arising from the NDS, the Austrlin Dietes, Oesity nd Lifestyle Study (AusDi) ws conducted to determine the prevlence of dietes, oesity nd other crdiovsculr disese risk fctors including hypertension nd norml serum lipid profiles (dyslipidemi). In comprison to people with norml glucose tolernce, those with dietes were more likely to hve hypertension (69.3% vs. 21.1%), to e oese (44.4% vs. 15.9%), to hve elevted triglycerides (42.9% vs. 16.0%), nd to hve depressed HDL- cholesterol (23.1% vs. 10.6%). Until recent yers, our governments nd pulic helth plnners in Austrli were lrgely unwre of the mgnitude of dietes nd its costs nd, more importntly, the predicted escltion of the numer of persons with dietes nd its serious complictions. For this reson, dietes ws not prioritised s mjor pulic helth chllenge efore However, in recognition of the impct of dietes on the Austrlin community, Austrlin Helth Ministers greed in 1996 tht dietes would ecome one of the Ntionl Helth Priorities nd commitment ws mde to ddress dietes in its mjor forms: Type 1, Type 2 nd gesttionl dietes. In 1999, the Helth Ministers endorsed the Ntionl Dietes Strtegy with the signing of the Austrlin Dietes Declrtion. Thus AusDi ws commissioned s the first ccurte ntionl study of dietes prevlence. The findings will provide the seline dt for the evlution of the success of ny intervention progrms introduced s prt of the NDS. Dietes mellitus The prevlence of dietes in the Austrlin popultion ged 25 yers nd older ws 7.5% : 8.0% for mles nd 7.0% for femles. The prevlence of dietes rose from 2.5% in people 35 to 44 yers to 23.6% in those 75 yers nd over. For every known cse of dietes, there ws one undignosed cse. There re out 940,000 people over the ge of 25 yers with dietes in Austrli. The numer of dults in Austrli with dietes hs treled since The prevlence of impired glucose metolism (eing either impired glucose tolernce or impired fsting glycemi) in the popultion ws 16.3%: 17.3% for mles nd 15.3% for femles. Overweight nd oesity The prevlence of eing mildly overweight 2 (BMI kg/m ) ws 39.1%: 48.2% for mles nd 30.2% for femles. 2 The prevlence of oesity (BMI 30 kg/m ) Almost 1 in 4 Austrlins 25 yers nd over hs either dietes or condition of impired glucose metolism. This condition is ssocited with sustntilly incresed immedite risk of hert disese s well s incresed risk of dietes in the future. ws 20.5%: 19.1% for mles nd 21.8% for femles. This is more thn doule the rte oserved in Thus 59.6% of the prticipnts were mildly overweight or oese. The rte for mles ws 67.4%, nd for femles, 52.0%. Executive summry 1

8 Dyslipidemi (norml cholesterol nd other lood fts) The prevlence of elevted totl cholesterol ( 5.5 mmol/l) ws 51.2%: 51.1% for mles nd 51.2% for femles. The prevlence of elevted triglycerides ( 2.0 mmol/l) ws 20.5%: 24.5% for mles nd 16.6% for femles. Lipid lowering gents were eing tken y only 7.3% of the popultion. Hypertension The prevlence of hypertension ws 28.8%: 30.6% for mles nd 27.1% for femles. or clustering with dietes of other risk fctors such s dominl (centrl) oesity, dyslipidemi nd hypertension i.e. the Metolic Syndrome or wht is sometimes clled the Dedly Qurtet. Over 50% of Austrlin dults hve t lest one component of the Dedly Qurtet nd the consequent risk of crdiovsculr disese. This percentge does not tke into ccount other crdiovsculr disese risk fctors such s cigrette smoking, sedentry ehviour nd fmily history of hert disese. Renl disese Renl disese is mjor helth urden, nd currently consumes 5.7% of the Austrlin helth cre udget. Anti-hypertensive mediction ws eing tken Proteinuri ws detected in 2.5% of the y 13.4% of the popultion: 11.5% of mles, survey popultion, hemturi in 6.4% nd nd 15.3% of femles. 1.1% hd n elevted serum cretinine. Of those with hypertension, only 37.6% of Together with dietes nd hypertension, this mles nd 56.5% of femles were on indictes over one third of Austrlin dults mediction for hypertension. Thus, for every re t incresed risk of renl disese. known cse of hypertension, there ws t lest one untreted cse. There is trend to lowering of prevlence of hypertension over the lst two decdes. Smoking The rte for current smoking ws 15.6%: 18.2% of mles nd 13.1% of femles. Physicl ctivity Of those who hd ever smoked, 63.3% hd cesed smoking: the sme for oth mles nd femles. Only hlf (49.8%) of the Austrlin dults ged 25 yers nd ove were undertking 'sufficient' physicl ctivity to mintin good helth. Approximtely 1 in 6 people (15.6%) reported no prticiption in physicl ctivity t ll. Crdiovsculr disese risk fctors - the Dedly Qurtet A mjor reson for the high rtes of crdiovsculr disese in persons with dietes is the co-existence A lter report will exmine the prolem of renl disese in greter detil including informtion on renl disese in people with nd without dietes. Conclusions The prevlence of dietes nd its co-moridities in Austrli is very high y world stndrds for Western ntion. The numer of people with dietes hs treled since Aprt from the esclting rte of dietes, there is high prevlence of impired glucose metolism, condition ssocited with incresed risk of hert disese nd future dietes. The high rtes of dietes nd impired glucose metolism, coupled with those of oesity, dyslipidemi nd hypertension, constitute significnt thret in terms of the future socio-economic urden of crdiovsculr disese nd dietes complictions for Austrli. Dietes nd its complictions re ssocited with very high socil nd economic costs for oth the person with dietes, nd Stte nd Federl governments. The high rtes of dietes nd crdiovsculr disese risk fctors represent 2 Executive summry

9 significnt pulic helth urden tht requires urgent mesures oth for prevention of dietes nd its ssocited complictions. The mgnitude of the dietes epidemic in Austrli, coupled with the significnt premture moridity nd mortlity due to the enormous urden ssocited with dietic complictions, including hert nd kidney disese, herlds the need for incresed ttention nd resources. The fct tht potent environmentl risk fctors for Type 2 dietes such s oesity nd exercise re modifile, points to lifestyle intervention. This involves the incorportion of helthy diet with n increse in physicl ctivity, s mens of curing the impct of this epidemic. Finlly, we propose: A 5 yer follow-up study e undertken to monitor outcomes in the people who prticipted in the AusDi survey to exmine the nturl history of dietes, its complictions, impired glucose metolism s well s crdiovsculr disese nd stroke. A comprle study is urgently needed to ssess the mgnitude of the chllenge t ntionl level in Austrli's Indigenous community given the epidemic rtes nd huge helth urden of dietes. Such study will provide the first ccurte ssessment of the urden of dietes, dietes complictions nd ssocited chronic diseses in the Indigenous popultion. Executive summry 3

10 1 Bckground Dietes mellitus is now recognised s serious importntly, the future potentil for increses in glol helth prolem often resulting in sustntil dietes nd its serious complictions in Austrli. moridity nd mortlity, primrily from crdiovsculr complictions, eye nd kidney Austrli is ntion tht y world stndrds diseses nd lim mputtions. It will undoutedly provides high proportion of its popultion with the e one of the mjor helth prolems fcing opportunities for good helth. Life expectncy is 1 Austrli in the 21st century. high, ut, incresingly n geing popultion nd some susceptile groups in the community re World-wide, dietes is ecoming epidemic. suffering from lifestyle diseses. This is the result of Recently, in collortion with the World Helth the pulic helth triumphs of the 20th century with Orgniztion (WHO) in Genev, the Interntionl the ner elimintion of the infectious diseses tht Dietes Institute produced new glol predictions were the mjor cuses of deth in the 19th century, of the numer of people with dietes for vrious nd the unfvourle effects on lifestyle tht hve countries for the yer 2025 (unpulished, April, come with moderniztion nd industriliztion of 2001). It ws estimted tht in the yer 2000 there our society. For exmple, exercise is eing were pproximtely 160 million people with engineered out of our lives with the mechnistion dietes in the world. This will clim to over 280 nd computeriztion of our society. million people y the yer 2025, the mjority of them with Type 2 dietes. It ws estimted tht for The mjor cuses of deth in Austrli re currently Austrli there will e 1.23 million persons with 9 coronry hert disese, cncer nd stroke. Much dietes in the yer From Figure 1.1, the of this mortlity is the result of life-style chnges tht predicted numer t the time of this survey is nerly hve led to lower levels of physicl ctivity nd 950,000. This figure illustrtes the drmtic rise in unfvourle chnges in our diet with consequent dietes cses over the lst two decdes nd shows 3 increse in oesity nd detrimentl chnges to the estimted numer of persons with dietes in lipid profiles. Indictions tht dietes rtes were Austrli lso on the rise led to the AusDi inititive. The numer of studies descriing the epidemiology of dietes over the lst twenty yers in mny countries hs een extrordinry, yet there hs not een ntionl study in Austrli. For this reson, governments nd pulic helth plnners in this country hd not prioritised dietes. They remined lrgely unwre of the current mgnitude, or, more The ove fctors nd the geing of the Austrlin popultion hve led to high levels of moridity from numer of chronic diseses which contriute gretly to the ntionl helth costs. Dietes mellitus nd crdiovsculr disese (CVD) re two 1,3 of these conditions. As result they hve een included y the Federl, Stte nd Territory Figure 1.1: Estimted dietes cses in Austrli:: numer of persons 1400 e d Thousnds c Yer For the questionnire sed studies (1983, , 1995), the totl numer of people with dietes is clculted on 1-3 the sis of there eing one undignosed cse for every dignosed cse. 4 5, Busselton, 1981 ;. NHF, 1983 ; c. ABS, ; d. ABS, 1995 ; e. (Estimte). 4 Bckground

11 governments mongst the six Ntionl Helth Priority Ares, which lso include cncer, injury prevention, sthm nd mentl helth. lower lim mputtion, nd one of the most common chronic diseses in 11 children. As n inititive of the Federl Helth Minister, Ntionl Dietes Strtegy nd Implementtion For Austrli (s for mny other countries), there 10 Pln ws produced in It hd s its ims to: hs up till now een pucity of relile prevlence nd incidence dt for Type 2 dietes, its 1. Prevent or dely the development of Type 1 complictions nd ssocited conditions. nd Type 2 dietes, Dietes in Austrli - pre Improve qulity of life nd reduce Wht informtion hs een ville to dte? The complictions nd premture mortlity in most recent estimtes of the ntionl prevlence people with dietes, 12 come from the 1995 ABS Ntionl Helth Survey, on which sis 430,700 Austrlins were 3. Achieve mternl nd child outcomes for determined s eing wre of hving dietes. This gesttionl dietes nd for women with ws n increse on the figure of 309,000 pre-existing dietes equivlent to those of non-dietic pregnncies, 7 previously estlished y the survey. It is unlikely tht this increse during such reltively short intervl cn e solely ttriuted to the geing 4. Achieve progress towrds cure for Type 1 of the popultion or improved dignosis. dietes, The most recent figures, lthough otined from n 5. Advnce knowledge nd understnding essentilly representtive smple of the urn out the prevention, cure nd cre of popultion, lck the reliility tht would e dietes, through comprehensive reserch otined from the tking of lood smples to effort. dignose dietes. Type 2 dietes cn e symptomtic for mny yers, nd self reported 6. Improve the cpcity of the helth system to dietes represents only out one hlf of ctul deliver, mnge nd monitor services for the cses. The true prevlence of dietes cn only e prevention of dietes nd the cre of people estlished y lood testing. In ddition, lood withdietes. smpling provides importnt helth-relted informtion tht is otherwise not ville through To chieve these mitious ojectives, relile self-reported dt, nd it is essentil for ntionlly representtive informtion on dietes determining impired glucose tolernce (IGT), nd relted conditions is prerequisite. Such dt undignosed Type 2 dietes nd norml lipid will llow the plnning of progrms to prevent the profiles. Furthermore, the WHO will only ccept onset of dietes nd its complictions; they will survey dt on the dignosis of dietes tht lso provide n essentil seline to ssess the includes lortory lood glucose 13 impct of such progrms in the future. mesurements. Accurte prevlence dt for dietes in Austrli A numer of studies sed on lood glucose levels were unville or indequte prior to the hve previously een performed in Austrli. In AusDi study, lthough it ws recognised tht 1981, study from the rurl Western Austrli town dietes is: of Busselton using the orl glucose tolernce test (OGTT) reveled dietes prevlence of 3.4% the second most common cuse for (2.5% known cses nd 0.9% newly dignosed) in 4 commencing renl dilysis, sujects 25 yers nd over. The prevlence of IGT ws 2.9%. On the sis of these dt it ws the most common cuse of lindness in estimted tht nerly 285,000 Austrlins hd people under the ge of 60 yers, dietes, nd further 241,000 hd IGT. Between 1981 nd the present, the only popultion sed the most common cuse of non-trumtic study which included lood testing using the orl Bckground 5

12 glucose tolernce test (OGTT) ws conducted y 2 Guest et l in rurl Victori. They studied non- Ojectives of AusDi The specific ojectives of the AusDi Study were Indigenous dults ged 15 yers nd over, finding to: crude dietes prevlence of 3.4% (1.6% known nd 1.8% newly dignosed). The IGT prevlence 1. Estimte the prevlence of dietes nd other ws 6.0%. Neither of these studies is dequtely forms of norml glucose tolernce. representtive of the generl demogrphic fetures of Austrli. 2. Estimte the prevlence of relted conditions 13 of the Metolic Syndrome, including By fr the lrgest 'lood surveys' undertken in oesity, hypertension, nd lipid profile Austrli hve een the three surveys conducted normlities. during the 1980s y the Ntionl Hert Foundtion (NHF) to monitor the prevlence of crdiovsculr 3. Assess the distriution nd reltionships of the 5,14,15 risk fctors in dults in cpitl cities. The crdiovsculr risk fctors indicted ove. surveys, conducted in 1980, 1983 nd 1989, ech included questionnire, physicl mesurements, 4. Assess trends in risk fctor levels s compred lood pressure nd fsting lood smple in dults to those otined in previous surveys in ged over 25 yers. These re the only ntionwide Austrli. surveys of non-communicle disese risk fctors previously conducted. The fsting glucose level ws Survey report only collected in the 1983 survey. The use of only This report presents the min findings from the fsting lood level to dignose dietes would AusDi Study of sed on dt result in sustntil underestimte of true collected from strtified smple of 11, dietes prevlence, nd lso provides no dt Austrlins ged 25 yers or over, residing in 42 on IGT. rndomly selected urn nd non-urn res (Census Collector Districts) of the six sttes of Therefore, more thn decde hs pssed since Austrli nd the Northern Territory. iomedicl risk survey tht includes lood smples ws undertken throughout Austrli, nd there is All dt for prevlence, unless otherwise stted, no definite dte for susequent survey. As were weighted to the Austrlin popultion ged consequence, there re no current estimtes of the 25 yers nd over s projected to hve pplied t prevlence of mjor non-communicle disese 17 June 30, risk fctors, such s high levels of cholesterol or triglycerides or lood glucose, nd other importnt The findings with respect to the key mtters of fctors which require lood specimen. interest (disorders of glucose tolernce, weight nd Furthermore, since the NHF surveys were oesity sttus, lipid profile nd lood pressure, conducted only in cpitl cities, there remins smoking, physicl ctivity nd renl function) re deficiency of such dt for rurl res. presented seprtely. The dt re presented ccording to ge nd gender. For the conditions of Dietes 1999 nd eyond - the AusDi Study dietes nd hypertension, delinetion is mde of In recognition of the lck of dequte, recent those who were wre of, or eing treted for their representtive dt, the Austrlin Dietes, condition, nd those for whom ny positive findings Oesity nd Lifestyle Study (AusDi) is the first represented new dignosis. ntionl study to provide estimtes of the numer of people with dietes (sed on lood tests) nd its More detiled nlyses of the dt from the survey, pulic helth nd societl impct. This importnt with prticulr reference to the prevlence nd inititive is n integrl component of the Ntionl ssocitions of the complictions of dietes, will Dietes Strtegy tht resulted from the vision nd e pulished susequently in peer reviewed commitment of the Federl Minister, Dr Michel journls. Wooldridge, to tckle the mounting prolem of dietes nd its complictions in Austrli. 6 Bckground

13 2 Dietes mellitus Bckground The term dietes mellitus descries metolic dysfunction nd filure of vrious orgns nd disorder of multiple custion chrcterized y tissues. It predisposes those suffering from it to chroniclly elevted lood glucose mny severe conditions, including crdiovsculr (hyperglycemi) with disturnces of disese, s well s visul loss, lower lim crohydrte, ft nd protein metolism. The mputtions nd renl filure. effects of dietes include long-term dmge, Definition The dignostic criteri for the presence of dietes, 2. hving ever een told y doctor or nurse tht impired glucose tolernce (IGT) nd impired they hd dietes, nd hd fsting lood fsting glucose (IFG) were sed on vlues for the glucose or 2-hr post lod glucose level over orl glucose tolernce test (OGTT) venous plsm the cut-offs for dietes mellitus (see Tle glucose concentrtion (fsting nd 2-hr 2.1). mesurements) outlined in the WHO report on the 13 Dignosis nd Clssifiction of Dietes Mellitus. Newly dignosed dietes Newly dignosed cses of dietes consisted of Dietes ws further clssified into known nd those: undignosed dietes. 1. not presently receiving phrmcologicl Known dietes tretment for dietes, nor previously Prticipnts were clssified s hving known dignosed with dietes, nd dietes if they stisfied t lest one of the following criteri: 2. who hd fsting or 2-hour plsm glucose mesurements over the dietes cut-off rnge 1. receiving current tretment in the form of (see Tle 2.1). tlets or insulin (or oth) t the time of the study, or; Results Tle 2.1: Clssifiction of glucose tolernce sttus Clssifiction Plsm glucose (mmol/l) Fsting 2-hr Dietes 7.0 or 11.1 IGT < 7.0 & IFG & < 7.8 Norml < 6.1 & < 7.8 All prticipnts on hypoglycemic mediction were clssified s hving dietes. Glucose tolernce sttus Prevlence of dietes: known nd newly The AusDi survey found tht the prevlence of dignosed dietes ws 7.5%: 8.0% for mles nd 7.0% for The survey found tht only out one hlf of the femles. The prevlence of impired glucose persons found to hve dietes were wre of tolernce (IGT) ws 10.6%: 9.2% for mles nd hving the condition, hving een previously 12.0% for femles. Impired fsting glucose (IFG) dignosed. ws considerly more prevlent mongst mles thn femles, hving rtes respectively of 8.1% nd Overll, for every known cse of dietes, there 3.3%, comined rte of 5.7%. ws one newly dignosed cse: tht is, the rel dietes prevlence is twice tht self-reported. This discrepncy etween ctul, nd self-reported Dietes mellitus 7

14 Figure 2.1: Prevlence (%) of norml glucose tolernce mong Austrlin residents % 15 Mles 12.0 Femles 10.6 Totl IGT IFG Dietes Glucose tolernce sttus 2 dietes hs een well documented nd 11 descried. Tle 2.2 shows the prevlence of known nd newly dignosed dietes for the Austrlin popultion, nd Figure 2.2 the gender comined prevlence of dietes for the surveyed popultion. Figure 2.3 shows the ge-specific prevlences of dietes of ech gender. people ged over 25 yers with dietes, which is consistent with previous estimtes s shown in Figure 1.1, nd considerly higher thn other 11 previous estimtes. With the inclusion of Austrlins under the ge of 25 yers with Type 1 dietes this represents out one million Austrlins with dietes. Prevlence of impired glucose tolernce (IGT) nd impired fsting glucose (IFG) Applying the ge specific prevlence of dietes for The prevlence of IGT ws 10.6%: 9.2% in mles ech gender to the totl popultion of Austrli t nd 12.0% in femles. Although the prevlence 18 June produces n estimte of 938,700 incr ese d with ge for oth gend ers, its Tle 2.2: Age-nd gender-specific prevlence (%) of known nd newly dignosed dietes Clssifiction Age (yers) Totl Mles Known Newly dignosed Femles Known Newly dignosed Persons Known Newly dignosed Figure 2.2: % 30 Age-specific prevlence (%) of dietes mong Austrlin residents Age group (yers) 8 Dietes mellitus

15 Figure 2.3: Age-nd gender-specific prevlence (%) of dietes mong Austrlin residents % 30 Mles Femles Age group (yers) 9.9 predominnce in femles decresed with ge. The The totl prevlence of either of these forms of prevlence of IFG ws 5.7%: 8.1 % in mles nd impired glucose tolernce, for the totl Austrlin 3.3 % in femles. The ge distriution is distinctly popultion, would e nerly 2.1 million persons different from tht of IGT nd dietes with pek over the ge of 25 yers, which is more thn twice in middle ge nd lower rte in the older ge tht of dietes. This rtio ws mrkedly higher for groups. The prevlence of IFG ws found to e the younger groups. The ge specific prevlences considerly higher in mles thn femles except re indicted in Figures 2.4 nd 2.5. for the oldest prticipnts. Wheres for femles the prevlence incresed firly consistently with ge, Tle 2.3 shows the ge specific prevlence of IGT for mles it peked in the yer group nd nd IFG for the comined mle nd femle ws somewht lower for the oldest prticipnts. popultion, nd the comined prevlence of either of these forms of impired glucose tolernce. Tle 2.3: Age-specific prevlence (%) of IGT nd of IFG Clssifiction Age (yers) Totl IGT IFG IGT or IFG Figure 2.4: Age-specific prevlence (%) of IGT mong Austrlin residents % Mles Femles Age group (yers) Dietes mellitus 9

16 Figure 2.5: Age-specific prevlence (%) of IFG mong Austrlin residents % Mles Femles Age group (yers) Trends Dietes prevlence The ge-specific prevlence of dietes (for mles We compred the estimte of dietes prevlence nd femles comined) for the two survey 4 derived from the 1981 Busselton survey with tht popultions is shown in the Figure 2.6, which from this survey. The methodologies nd ge highlights the rte t which dietes prevlence hs distriutions of the surveys were similr. Using the incresed over the lst twenty yers, nd the criteri of tht survey (which involved fsting level younger ge t which its prevlence strts to of 7.8 mmol/l, rther thn the current 7.0 mmol/l) increse mrkedly. 17 nd ge-stndrdised to the 1998 popultion, the prevlence rtes for dietes were s shown in Tle 2.4. Tle 2.4: Trends in the ge-stndrdised prevlence (%) of dietes: Survey Mles Femles Busselton AusDi Age-stndrdised to the 1998 Austrlin popultion. 4 Busselton, Figure 2.6: Trends in the ge-specific dietes prevlence (%): % Age group (yers) 10 Dietes mellitus

17 Tle 2.5: Trends in the ge-stndrdised prevlence (%) of IGT: Survey Mles Femles Busselton AusDi Trends in IGT prevlence twice the prevlence. The prevlences (ge- 17 The IGT prevlence detected in the AusDi survey stndrdised to the 1998 Austrlin popultion ) ws over twice tht found in the Busselton survey of re shown in Tle (using the Busselton survey criteri) for ll ge groups of mles except those over 75 yers. For No dequte dt hve een pulished to ssess femles it ws nerly four times the prevlence up trends in IFG prevlence. to the ge of 64 yers, nd therefter more thn Anorml glucose metolism The overll frequency of impired glucose glucose metolism ws 23.8%: for mles 25.3% metolism in the AusDi smple ws clculted nd for femles 22.3%, which represents nerly 3 s the prevlence of individuls with either IGT or million Austrlins over the ge of 25 yers. IFG, or dietes. The prevlence of impired Dietes nd ssocited conditions The ssocition of dietes with numer of other difference in the demogrphics etween the metolic conditions hs een well documented in dietic nd non-dietic popultions, some of the 12 Austrli. Tle 2.6 shows the prevlence of differences in prevlence of ssocited conditions numer of these conditions mong the prticipnts were reduced. However, oesity nd ccording to glucose tolernce sttus. hypertriglyceridemi were pproximtely three times s frequent, nd hypertension nd depressed Tle 2.6 indictes strong ssocition of HDL pproximtely twice s frequent in the dietic norml glucose tolernce, in prticulr dietes, s in the norml popultion. with numer of other crdiovsculr risk fctors. After ge nd sex djustments to ccount for the Discussion Tle 2.6: Weighted prevlence (%) of ssocited conditions strtified y glucose tolernce sttus Associted condition Glucose tolernce sttus Dietes IFG IGT Norml Hypertension Oesity (BMI 30 kg/m ) LDL ( 3.5 mmol/l) HDL (<1.0 mmol/l) Triglycerides ( 2.0 mmol/l) On tretment, or systolic pressure 17 Age -stndrdised to the 1998 Austrlin popultion. 4 Busselton, mm Hg, or distolic pressure 90 mmhg. Dietes prevlence There were four findings of mjor importnce: Dietes remins condition for which dignosis nd hence therpy nd monitoring for complictions is only of The high solute prevlence of dietes the order of 50% of the prevlence. - nerly million people. The prevlence detected ws twice tht The onset of dietes is occurring erlier. detected in Busselton 20 yers go. All of these fctors hve mjor implictions for Dietes mellitus 11

18 pulic helth nd the ntionl helth urden, in IGT. The dt lso suggested n increse in the tht filure to dequtely tret is ssocited with n prevlence of IFG in men. In tht these conditions incresed rpidity of progression to the mny 13,21 re oth likely precursors to dietes, it is hoped 19,20 complictions of dietes. tht more prompt detection will provide n opportunity for intervention progrms to e IFG nd IGT prevlence implemented t n erly stge. In comprison with the Busselton dt, this survey detected sustntil increse in the prevlence of 12 Dietes mellitus

19 3 Overweight nd oesity Bckground Since oesity is strongly linked to Type 2 dietes, dyslipidemi nd rthritis. The distriution of the term diesity hs een recently used to dipose tissue is importnt in tht dominl rther emrce the two conditions. Oesity is mjor risk thn peripherl ft is prticulrly ssocited with fctor not only for Type 2 dietes, ut lso for other 22,23 more pronounced risks for dietes nd CVD. chronic conditions such s hypertension, CVD, Definition Weight sttus ws defined using the WHO Mesurement of wist circumference (cm) is lso clssifiction for Europids, sed on the Body used s n indictor of dominl oesity. Mss Index (BMI). The BMI = weight (kg) / height 2 (m). Results Tle 3.1: Clssifiction of weight sttus y BMI Clssifiction BMI (kg/m 2 ) Not Overweight < 25.0 Overweight Pre-oese Oese 30.0 Tle 3.2: Clssifiction of dominl oesity y wist circumference Clssifiction Wist circumference (cm) Mles Femles Not Overweight < 94.0 < 80.0 Overweight Pre-oese Oese Prevlence of overweight percentge of mles nd femles were overweight. Almost 60% of Austrlins were overweight using The prevlence ws nerly 40% for the youngest either BMI or wist circumference to clssify weight sugroup, ut incresed to out 75%, for those sttus. Using BMI s the index, 59.6% of etween the ges of 65 nd 74 yers. The eldest prticipnts were overweight: 67.4% of mles nd sugroup hd slightly lower prevlence of 52.0% of femles. For wist circumference, 55.9% overweight. of the prticipnts were overweight: 55.2% of mles nd 56.5% of femles. These prevlences Prevlence of oesity re shown in Figure 3.1. The ge-specific 2 Oesity, tht is BMI 30 kg/m, is the more severe prevlences of overweight ccording to the two ctegory of eing overweight. On the sis of BMI, prmeters re shown in Tle % of prticipnts were oese: 19.1% of mles nd 21.8% of femles. The prevlence ws even Over 60% of mles were overweight y the index of higher ( 30.3%) if wist circumference ws used s BMI for ll ge groups. Younger femles hd the index: 26.6% of mles, nd 33.9% of femles. considerly lower prevlence of overweight thn The prevlences of these two indices of oesity re did younger mles, ut the gender differences shown in Figure 3.2. Tle 3.4 shows tht using ecme much smller with incresing ge. either index oesity is very prevlent in Austrli. The rtes increse with ge, peking in the Using wist circumference s the index, similr yer ge group. Overweight nd oesity 13

20 Figure 3.1: Prevlence (%) of norml BMI or wist circumference mong Austrlin residents % 100 Mles Femles Totl BMI Wist circumference Index of Overweight 2 BMI 25 kg/m. Wist circumference: mles 94 cm; femles 80 cm. Tle 3.3: Clssifiction Age-specific prevlence (%) of overweight y BMI nd wist circumference Age (yers) Totl BMI Mles Femles Persons Wist Mles Femles Persons BMI 25 kg/m. Wist circumference: mles 94 cm; femles 80 cm. Figure 3.2: Age-djusted prevlence (%) of oesity mong Austrlin residents % 40 Mles Femles Totl BMI 2 BMI 30 kg/m. Wist circumference: mles 102 cm; femles 88 cm. Index of Oesity Wist circumference 14 Overweight nd oesity

21 Tle 3.4: Age-specific prevlence (%) of oesity y BMI nd wist circumference Clssifiction BMI Age (yers) Totl Mles Femles Persons Wist Mles Femles Persons BMI 30 kg/m. Wist circumference: mles 102 cm; femles 88 cm. Trends Overweight overweight detected in this study were considerly The proportions of prticipnts who were higher thn those reported y the NHF surveys, overweight nd oese were compred with dt lthough not mrkedly different from those of the otined during the 1980 nd 1989 NHF Risk ABS for Figure 3.3 indictes the extent to 14,15 Fctor Prevlence Studies nd the ABS Ntionl which the prevlence of overweight (BMI Nutrition Survey of For consistency kg/m ) hs incresed over the pst 20 yers (ge- 26 purposes, the dt were confined to the cpitl city stndrdised to the June 30, 1991 popultion ) pr tic ip nts of the se sur vey s (n d ur n nd supports the finding of n upwrd trend of prticipnts of the Ntionl Nutrition Survey), who excess weight descried in the 1998 AIHW Report were ged yers of ge. The levels of 3 Austrli's Helth, Figure 3.3: Trends in the ge-stndrdised prevlence (%) of overweight : % 80 Mles Femles Yer 26 Age -stndrdised to 1991 Austrlin popultion. 2 BMI 25 kg/m. Overweight nd oesity 15

22 Oesity Wheres Figure 3.3 shows the mrked trend for n Tle 3.5 nd Figures 3.4 nd 3.5 highlight the 2 increse in the prevlence of BMI 25 kg/m from extent to which the higher level of oesity hs 1980 to 2000, Figures 3.4 nd 3.5 suggest tht incresed over the pst 20 yers for oth men nd much of this increse hs occurred t the higher 2 women ged yers for the urn or cpitl level of BMI ( 30 kg/m ). For mles, the prevlence city residents in the 1995 survey, nd cpitl city of eing t lest overweight incresed from 1980 to residents of the other three surveys (ge y 17.5%, while the prevlence of oesity 26 stndrdised to the June 30, 1991 popultion ). incresed y 10%. For femles the increse in Figures 3.4 nd 3.5 show the ge specific overweight ws 18%, of which 12% ws in the prevlences of oesity, for the prticipnts of the oesity component. For men this increse hs een 14, nd 1989 NHF surveys nd AusDi more thn douling, nd for women ner cpitl city prticipnts. tripling, in oesity over the pst 20 yers. Tle 3.5: Trends in the ge-stndrdised prevlence (%) of oesity : Gender Yer c d e Mles Femles Age -stndrdised to 1991 Austrlin popultion. 2 BMI 30.0 kg/m. c 14 NHF Risk Fctor Prevlence Survey. d 15 NHF Risk Fctor Prevlence Survey. e 25 ABS Ntionl Nutrition Survey (includes urn prticipnts). Figure 3.4: Trends in the ge-specific prevlence (%) of oesity in mles: % Age group (yers) 2 BMI 30 kg/m. 17 Age -stndrdised to 1991 Austrlin popultion. Discussion The principl finding ws the high prevlence of The likelihood is tht the incresed levels of oesity eing overweight, oth in the pre-oese nd oese hve een significnt contriuting fctor in the rnges mongst the AusDi prticipnts. A esclting prevlence of dietes. The epidemic of comprison with previous dt from ntionwide oesity must e curtiled in order to reduce the 14,15 surveys shows tht there hs een impct on dietes, s well s other oesity-relted continution in the cler trend of incresing conditions. prevlence of excess weight, previously noted in the Austrlin Institute of Helth nd Welfre report of Overweight nd oesity

23 Figure 3.5: Trends in the ge-specific prevlence (%) of oesity in femles: % Age group (yers) BMI 30 kg/m. 17 Age -stndrdised to 1991 Austrlin popultion. Overweight nd oesity 17

24 4 Dyslipidemi Bckground Blood lipid levels reflect genetic ckground ut LDL nd depressed HDL cholesterol - oth of which re modified y diet, oesity nd other lifestyle re powe rful pred icto rs of CVD. Elev ted fctors. Totl cholesterol levels re crude ut triglycerides re lso CVD risk fctor, especilly consistent mesure of CVD risk, prticulrly for when comined with low HDL cholesterol s often coronry hert disese. The CVD risk relting to occurs in dietes nd the Metolic Syndrome. high totl cholesterol is further refined y considering cholesterol frctions, nmely elevted Definition The following criteri for norml lipid levels re sed on recommendtions y the Ntionl Hert Foundtion nd the Austrlin Dietes Society. Clssifiction ws mde on the sis of plsm level, irrespective of tretment sttus. Results Tle 4.1: Clssifiction of lipid vlues Clssifiction Blood lipid concentrtion (mmol/l) Cholesterol HDL-cholesterol LDL-cholesterol Triglycerides Norml < < 3.5 < 2.0 Anorml 5.5 < Prevlence of dyslipidemi dyslipidemis (Tle 4.2) peked in the The prevlence of elevted totl cholesterol levels ge group (prt from totl cholesterol, which (Figure 4.1) ws 51.2%: 51.1% for mles nd peked in the ge group). In femles, 51.2% for femles. The prevlence of elevted LDL however, the pek prevlence ws seen uniformly in cholesterol ws 45.8%: 49.8% for mles nd the ge group. The prevlence of low HDL 42.2% for femles, nd of reduced HDL cholesterol ws consistently higher in mles thn femles, 11.9%: 18.6% for mles nd 5.5% for eing 2.5 to 6.1 times greter in mles, depending femles.mles overll hd higher prevlence of on ge group. Elevted LDL nd elevted elevted triglycerides thn femles, with rtes of triglycerides were oth more prevlent in mles 24.5% nd 16.6% respectively - comined rte of thn femles up to the ge of 54; therefter, these 20.5%. normlities were seen slightly more frequently in femles. In mles, the prevlence of ech of the Figure 4.1: Prevlence (%) of norml lipid levels for Austrlin residents % Mles Femles Totl Totl cholesterol LDL cholesterol HDL cholesterol Triglycerides Lipid 18 Dyslipidemi

25 Tle 4.2: Age- nd gender-specific prevlence (%) of norml lipid levels Lipid Age (yers) Totl Mles Totl cholesterol c d LDL cholesterol c HDL cholesterol d Triglycerides Femles Totl cholesterol LDL cholesterol c HDL cholesterol d Triglycerides Persons Totl cholesterol LDL cholesterol c HDL cholesterol d Triglycerides Totl cholesterol 5.5 mmol/l. LDL cholesterol 3.5 mmol/l. HDL cholesterol < 1.0 mmol/l. Triglycerides 2.0 mmol/l. Lipid therpy incresed mrkedly with ge, from nerly no use for Lipid lowering gents were eing tken y 7.3% of the youngest prticipnts to over 20% for those the popultion, comprising 7.3% of the mle nd ged yers. At ll ges therpy occurred t 7.4% of the femle popultions respectively. Tle less thn 50% of the lipid normlity rte, nd 4.3 shows the prevlence of ny lipoprotein these figures rely chnged when n elevted normlity for those not on lipid therpy, nd triglyceride level ws removed from the usge rtes of lipid lowering therpy y ge nd co m in t io n pr od uc in g n y li po pr ot ei n gender. For oth genders, the use of lipid therpy normlity. Tle 4.3: Age nd gender-specific prevlence (%) of ny lipid normlity, nd usge of lipid-lowering therpy Clssifiction Age (yers) Totl Mles Anormlity Lipid Therpy Totl Femles Anormlity Lipid Therpy Totl Persons Anormlity Lipid Therpy Totl Anormlity: clculted s % of totl popultion, nd comprises prticipnts who were not tking lipid lowering therpy nd hd ny of: i. Totl cholesterol 5.5 mmol/l ii. LDL cholesterol 3.5 mmol/l iii. HDL cholesterol < 1.0 mmol/l iv. Triglyceride 2.0 mmol/l. Totls my not exctly equl the sum of the two lterntives ecuse of rounding. Dyslipidemi 19

26 Trends Totl cholesterol survey popultions s for the totl cholesterol. Despite the incresing wreness of the importnce of lipid control, there hs een no reduction in the Except for the 1983 dt, the prevlence of prevlence of elevted cholesterol levels since the hypertriglyceridemi in mles hs shown little NHF survey. The lck of cler trend of chnge in the lst two decdes. In the sme time men cholesterol during the 1980s hs een period, the prevlence in femles hs douled. 28 descried previously. Trends in lipid therpy Tle 4.4 shows the proportion of mles nd The rtes of lipid therpy use were similr to those femles with totl cholesterol 5.5 mmol/l, ge- 14 reported y the 1989 NHF study for men up to the 26 stndrdised to the 1991 Austrlin popultion, ge of 64 yers nd women up to the ge of 54 5,14,15 for the NHF nd cpitl city prticipnts of the yers, ut for older persons the current rtes of AusDi surveys ged up to 64 yers, in order to tretment re considerly higher thn the rtes ensure comprility with the erlier surveys. reported 10 yers go. The men totl cholesterol levels for these four The use of such therpy is mrkedly higher thn tht survey popultions hs lso chnged little since 5,13 reported y the 1980 nd 1983 NHF studies, 1980 s cn e seen in Tle 4.5. nd Tle 4.7 shows the ge nd gender stndrdised rtes of usge of such therpy. Only Triglyceride level trends cpitl city prticipnts of the AusDi survey ged Tle 4.6 shows the chnge in the prevlence of less thn 65 yers were included, for consistency. elevted triglycerides since 1980, for the sme Tle 4.4: Trends in the ge-stndrdised prevlence (%) of totl cholesterol 5.5 mmol/l: Gender Yer c d Mles Femles Age-stndrdised to 1991 Austrlin popultion. 13 NHF Risk Fctor Prevlence Survey. c 5 NHF Risk Fctor Prevlence Survey. d 14 NHF Risk Fctor Prevlence Survey. Tle 4.5: Trends in men ge-stndrdised totl cholesterol levels (mmol/l): Gender Yer c d Mles Femles Age-stndrdised to 1991 Austrlin popultion. 13 NHF Risk Fctor Prevlence Survey. c 5 NHF Risk Fctor Prevlence Survey. d 14 NHF Risk Fctor Prevlence Survey. Tle 4.6: Trends in the ge-stndrdised prevlence (%) of triglycerides 2.0 mmol/l: Gender Yer c d Mles Femles Age-stndrdised to 1991 Austrlin popultion. 13 NHF Risk Fctor Prevlence Survey. c 5 NHF Risk Fctor Prevlence Survey. d 14 NHF Risk Fctor Prevlence Survey. 20 Dyslipidemi

27 Discussion Tle 4.7: Trends in the ge-stndrdised usge (%) of lipid-lowering therpy: Gender Yer c d Mles Femles Age-stndrdised to 1991 Austrlin popultion. 13 NHF Risk Fctor Prevlence Survey. c 5 NHF Risk Fctor Prevlence Survey. d 14 NHF Risk Fctor Prevlence Survey. The most importnt findings from AusDi re the The use of mediction for lipoprotein normlities very high prevlence of normlities, prticulrly incresed consistently with ge. Although the usge for totl nd LDL cholesterol, even mongst the of such therpy hs incresed mrkedly mong younger prticipnts. As this section of the those ged over 55 yers during the lst ten yers, popultion ges over the next 20 yers, these levels over 75% of those not on therpy hd norml of dyslipidemi signl the potentil for mjor lipoprotein profiles. This figure ws considerly urden of crdiovsculr disese. higher for the younger prticipnts, with only smll frction of those with norml lipoprotein Anormlities in totl cholesterol nd LDL levels eing on drug tretment. Although over 40% cholesterol showed very similr profiles, with over of men ged etween 25 nd 44 yers hd hlf the popultion hving elevted levels. elevted totl cholesterol levels, fewer thn 2% Nonetheless, the rtes of elevtion of totl were on therpy. In this younger group, wreness cholesterol were similr to those detected in the of lipid levels should e promoted so s to 5,13,14 previous NHF surveys. encourge helthy dietry prctices (low sturted ft intke to reduce LDL levels) nd lifestyle Hypertriglyceridemi ws more common for mesures (exercise nd weight control to rise HDL mles thn femles, except for the oldest nd lower triglycerides). In the middle ged nd prticipnts, ut the increse in its prevlence since elderly, nd especilly where vsculr disese 1980 hs een especilly pronounced for femles. exists, drug therpy hs n importnt role. Possily this prmeter is more closely relted to oesity thn the other lipoprotein mesures, nd the rise in oesity prevlence hs unmsked this tendency in women. Dyslipidemi 21

28 5 Hypertension Bckground Elevted lood pressure represents n importnt complictions s well s eing n dditive risk risk fctor for crdiovsculr nd renl disese in f ct or fo r c rd io v sc ul r di se s e. Th us the generl popultion. Amongst those with hypertension is of mjor significnce to the whole 29,30 dietes, it is risk fctor for micro-vsculr popultion. Definition 31 The presence or sence of hypertension ws WHO guidelines, s shown in Tle 5.1. determined for ech prticipnt in ccordnce with Results Tle 5.1: Clssifiction of lood pressure Clssifiction Blood pressure (mmhg) Systolic Distolic Norml < 140 nd < 90 Hypertension 140 or 90 Prticipnts were lso clssified s hypertensive if they were on mediction for lood pressure, irrespective of their current hypertension sttus. Hypertension sttus Anti-hypertensive mediction use The ge-specific prevlences of hypertension for Th e di g no st ic cr it er i fo r hy pe rt en si on ech gender re shown in Figure 5.1, nd recommended y the WHO include oth untreted demonstrte the discrepncy etween mle nd persons with hypertension nd those who hve femle rtes, prticulrly t the younger ges, nd een dignosed nd re on tretment. At ll ges the extent to which prevlence increses with ge. untreted hypertension ws more common mong men thn women. Overll, for every person eing The overll prevlence of hypertension ws 28.8%: treted for hypertension there ws nother 30.6% for mles nd 27.1% for femles (Tle untreted person. Tle 5.2 shows whether the 5.2). prticipnts were clssified s hypertensive on the Figure 5.1: Age-specific prevlence (%) of hypertension in Austrlin residents % 100 Mles Femles Age group (yers) Hypertension