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Diet, diabetes and brain function: some quick wins from UKB data Naveed Sattar Professor of Metabolic Medicine University of Glasgow

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Page 1: Naveed Sattar Professor of Metabolic Medicine University ... · Naveed Sattar Professor of Metabolic Medicine University of Glasgow . Background • Doctor: heart risk clinic / diabetes,

Diet, diabetes and brain function:

some quick wins from UKB data

Naveed Sattar

Professor of Metabolic Medicine

University of Glasgow

Page 2: Naveed Sattar Professor of Metabolic Medicine University ... · Naveed Sattar Professor of Metabolic Medicine University of Glasgow . Background • Doctor: heart risk clinic / diabetes,

Background

• Doctor: heart risk clinic / diabetes, obesity research

– Blantyre and proud of it

• Multiple trials: weight loss, diabetes reversal (recent Lancet DiRECT)

• Guidelines:

– European Diabetes and Heart prevention guidelines 2013, 2016, 2019

– Chair Heart / stroke prevention guideline Scotland

– JBS3 Editorial Board: co-wrote DM section 2014

Page 3: Naveed Sattar Professor of Metabolic Medicine University ... · Naveed Sattar Professor of Metabolic Medicine University of Glasgow . Background • Doctor: heart risk clinic / diabetes,

UK Biobank

• Fabulous resource to answer big & small questions with power, and considering mitigating factors

– Small studies cannot answer questions well

– Choose questions to address

– May not be new or may be badly addressed

• Also opens up many new ways to answer questions

– Gets diff types of researchers together

– Combines genes, diets, outcomes, images in new ways

Page 4: Naveed Sattar Professor of Metabolic Medicine University ... · Naveed Sattar Professor of Metabolic Medicine University of Glasgow . Background • Doctor: heart risk clinic / diabetes,

Low hanging fruit

1. A weighty question: sugar or fat as cause of

obesity?

2. Who gets most diabetes, men or women?

3. Waist circumferences and diabetes risks

4. Is there an optimal weight for health? Is being too

thin also bad for you?

5. Brain function, diabetes and heart disease

Page 5: Naveed Sattar Professor of Metabolic Medicine University ... · Naveed Sattar Professor of Metabolic Medicine University of Glasgow . Background • Doctor: heart risk clinic / diabetes,

Sugar vs. fat vs. weight

• Diet questionnaires

• Worked out patterns (fat, protein,

sugars etc) of calorie intake in each

person

• Related to rising weight levels and

corrected for total calories

Page 6: Naveed Sattar Professor of Metabolic Medicine University ... · Naveed Sattar Professor of Metabolic Medicine University of Glasgow . Background • Doctor: heart risk clinic / diabetes,

Anderson JJ et al. International Journal of Epidemiology. 2017

Page 7: Naveed Sattar Professor of Metabolic Medicine University ... · Naveed Sattar Professor of Metabolic Medicine University of Glasgow . Background • Doctor: heart risk clinic / diabetes,

What did we conclude?

• Fat is largest contributor to overall energy

• % energy from fat, but not sugar, is higher

among overweight / obese individuals

• Public health messages on sugar may

mislead on the need to reduce fat and

overall energy consumption

Page 8: Naveed Sattar Professor of Metabolic Medicine University ... · Naveed Sattar Professor of Metabolic Medicine University of Glasgow . Background • Doctor: heart risk clinic / diabetes,

2. Men vs women

• Who is brighter sex?

• Who gets more heart disease?

• Who gets more diabetes?

• Who carries more fat?

Page 9: Naveed Sattar Professor of Metabolic Medicine University ... · Naveed Sattar Professor of Metabolic Medicine University of Glasgow . Background • Doctor: heart risk clinic / diabetes,

Ferguson LD. Diabet Med. 2017

Page 10: Naveed Sattar Professor of Metabolic Medicine University ... · Naveed Sattar Professor of Metabolic Medicine University of Glasgow . Background • Doctor: heart risk clinic / diabetes,

Why more diabetes in men?

Logue J et al. Diabetologia. 2011

Age at diagnosis of diabetes (years)

Avera

ge B

MI

(kg / m

^2)

30

35

40

30 40 50 60 70 80 90

Men Women

Page 11: Naveed Sattar Professor of Metabolic Medicine University ... · Naveed Sattar Professor of Metabolic Medicine University of Glasgow . Background • Doctor: heart risk clinic / diabetes,

Ntuk UE et al. Diabetes Care. 2014

Page 12: Naveed Sattar Professor of Metabolic Medicine University ... · Naveed Sattar Professor of Metabolic Medicine University of Glasgow . Background • Doctor: heart risk clinic / diabetes,

4. Body mass index and heart outcomes

– U – shaped link

• Lots of research suggests low weight

can also be bad for you

– But could be low weight as losing

weight, unintentionally

• Some researchers have even

suggested lowest risk for death

is when overweight

Page 13: Naveed Sattar Professor of Metabolic Medicine University ... · Naveed Sattar Professor of Metabolic Medicine University of Glasgow . Background • Doctor: heart risk clinic / diabetes,

What did we do?

• 296K (58% women) of white European

descent without prior heart disease or

stroke Hx at baseline

• Five different measures of adiposity

– BMI, waist circumference, WHR, WHtR,

percent fat mass

• Fatal and non-fatal heart attacks / strokes

Page 14: Naveed Sattar Professor of Metabolic Medicine University ... · Naveed Sattar Professor of Metabolic Medicine University of Glasgow . Background • Doctor: heart risk clinic / diabetes,

Adiposity and outcomes: UKB

EHJ in press

Page 15: Naveed Sattar Professor of Metabolic Medicine University ... · Naveed Sattar Professor of Metabolic Medicine University of Glasgow . Background • Doctor: heart risk clinic / diabetes,

Why the difference?

Page 16: Naveed Sattar Professor of Metabolic Medicine University ... · Naveed Sattar Professor of Metabolic Medicine University of Glasgow . Background • Doctor: heart risk clinic / diabetes,

Brain function and diseases

• Is there a link between brain function and

diabetes and heart disease

• We checked average brain function tests

and compared what happens if also have

– Diabetes

– High blood pressure

– Heart disease

Page 17: Naveed Sattar Professor of Metabolic Medicine University ... · Naveed Sattar Professor of Metabolic Medicine University of Glasgow . Background • Doctor: heart risk clinic / diabetes,

Reasoning differences with disease diabetes, HBP, heart attacks

-0.35

-0.3

-0.25

-0.2

-0.15

-0.1

-0.05

0

One disease

Two diseases

Three diseases

Additive dose effect

Page 18: Naveed Sattar Professor of Metabolic Medicine University ... · Naveed Sattar Professor of Metabolic Medicine University of Glasgow . Background • Doctor: heart risk clinic / diabetes,

What do we think are implications of

our work?

• Helping prevent or better treating

diabetes, HBP or heart disease should

help lessen brain decline

• But more work needed to prove this

Page 19: Naveed Sattar Professor of Metabolic Medicine University ... · Naveed Sattar Professor of Metabolic Medicine University of Glasgow . Background • Doctor: heart risk clinic / diabetes,

Final summary

• UK Biobank delivering some nice answers

to important questions

• BUT only in its infancy

• Much more to come

• In meantime, eat well and try to stay active

and keep your sense of humour