Papers by dianna Magliano
Obesity is a risk factor for type 2 diabetes and cardiovascular disease. However, a substantial p... more Obesity is a risk factor for type 2 diabetes and cardiovascular disease. However, a substantial proportion of patients with these conditions have a seemingly normal body mass index (BMI). Conversely, not all obese individuals present with metabolic disorders giving rise to the concept of “metabolically healthy obese”. Using comprehensive lipidomic datasets from two large independent population cohorts in Australia (n = 14,831), we developed models that predicted BMI and calculated a metabolic BMI score (mBMI) as a measure of metabolic dysregulation associated with obesity. We postulated that the mBMI score would be an independent metric for defining obesity and help identify a hidden risk for metabolic disorders regardless of the measured BMI. Based on the difference between mBMI and BMI (mBMI delta; “mBMIΔ”), we identified individuals with a similar BMI but differing in their metabolic health profiles. Participants in the top quintile of mBMIΔ (Q5) were more than four times more li...
PharmacoEconomics
Objective The aim was to project the health and economic outcomes of cardiovascular disease (CVD)... more Objective The aim was to project the health and economic outcomes of cardiovascular disease (CVD) among people with type 2 diabetes from Australian public healthcare and societal perspectives over the next decade. Methods A dynamic multistate model with yearly cycles was developed to project cardiovascular events among Australians with type 2 diabetes aged 40-89 years from 2022 to 2031. CVD risk (myocardial infarction [MI] and stroke) in the type 2 diabetes population was estimated using the 2013 pooled cohort equation, and recurrent cardiovascular event rates in the type 2 diabetes with established CVD population were obtained from the global Reduction of Atherothrombosis for Continued Health (REACH) registry. Costs and utilities were derived from published sources. Outcomes included fatal and non-fatal MI and stroke, years of life lived, quality-adjusted life years (QALYs), total healthcare costs, and total productivity losses. The annual discount rate was 5%, applied to outcomes and costs.
Diabetologia
Aims/hypothesis Whether sodium–glucose co-transporter 2 inhibitors (SGLT2is) or glucagon-like pep... more Aims/hypothesis Whether sodium–glucose co-transporter 2 inhibitors (SGLT2is) or glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are cost-effective based solely on their cardiovascular and kidney benefits is unknown. We projected the health and economic outcomes due to myocardial infarction (MI), stroke, heart failure (HF) and end-stage kidney disease (ESKD) among people with type 2 diabetes, with and without CVD, under scenarios of widespread use of these drugs. Methods We designed a microsimulation model using real-world data that captured CVD and ESKD morbidity and mortality from 2020 to 2040. The populations and transition probabilities were derived by linking the Australian Diabetes Registry (1.1 million people with type 2 diabetes) to hospital admissions databases, the National Death Index and the ESKD Registry using data from 2010 to 2019. We modelled four interventions: increase in use of SGLT2is or GLP-1 RAs to 75% of the total population with type 2 diabetes, and incr...
The Lancet Diabetes & Endocrinology, 2022
Trends in all-cause mortality among people with diagnosed diabetes: a multi-country analysis of a... more Trends in all-cause mortality among people with diagnosed diabetes: a multi-country analysis of aggregate data from 21 million deaths in diabetes in high-income settings
The Journal of Nutrition, 2021
Background The consumption of legumes is promoted as part of a healthy diet in many countries but... more Background The consumption of legumes is promoted as part of a healthy diet in many countries but associations of total and types of legume consumption with type 2 diabetes (T2D) are not well established. Analyses across diverse populations are lacking despite the availability of unpublished legume consumption data in prospective cohort studies. Objective To examine the prospective associations of total and types of legume intake with the risk of incident T2D. Methods Meta-analyses of associations between total legume, pulse, and soy consumption and T2D were conducted using a federated approach without physical data-pooling. Prospective cohorts were included if legume exposure and T2D outcome data were available and the cohort investigators agreed to participate. We estimated incidence rate ratios (IRRs) and CIs of associations using individual participant data including ≤42,473 incident cases among 807,785 adults without diabetes in 27 cohorts across the Americas, Eastern Mediterra...
Current Developments in Nutrition, 2020
Background The Health Star Rating (HSR) is the government-endorsed front-of-pack labeling system ... more Background The Health Star Rating (HSR) is the government-endorsed front-of-pack labeling system in Australia and New Zealand. Objectives We aimed to examine prospective associations of a dietary index (DI) based on the HSR, as an indicator of overall diet quality, with all-cause and cardiovascular disease (CVD) mortality. Methods We utilized data from the national population-based Australian Diabetes, Obesity and Lifestyle Study. The HSR-DI at baseline (1999–2000) was constructed by 1) calculation of the HSR points for individual foods in the baseline FFQ, and 2) calculation of the HSR-DI for each participant based on pooled HSR points across foods, weighted by the proportion of energy contributed by each food. Vital status was ascertained by linkage to the Australian National Death Index. Associations of HSR-DI with mortality risk were assessed by Cox proportional hazards regression. Results Among 10,025 eligible participants [baseline age: 51.6 ± 14.3 y (mean ± standard deviation...
The Lancet, 2020
Main text 28,166 'fragmented actions'. In high-income countries (HICs), the SMR for patients with... more Main text 28,166 'fragmented actions'. In high-income countries (HICs), the SMR for patients with T1D is 2.5 compared to that of 4.9-33.9 in LMICs. In 2017, 1.1 million young patients had T1D diagnosed under the age of 20 years and an estimated 14,466 aged less than 25 years died. If all patients with T1D were to receive guideline-based comprehensive care with access to intensive insulin therapy, personalised education and regular complications assessments, we estimate that 12,092 of these deaths could have been averted. For T2D, in 2017, 217 million affected individuals (age 30-69 years) lived in 10 LMICs and 3.2 million are estimated to have died after 3 years with 1.3 million of these deaths due to CVD. By ensuring access to essential medications and improving control of BP, HbA1c and LDL-cholesterol in 70% of diagnosed patients, we estimate 0.8 million of these premature deaths might have been prevented. If a society-community-individual strategy aimed at reducing illiteracy and social disparity as well as creating a health-enabling environment supported by a community-based health-promoting policy linked to an integrated care system were to be implemented, for a population of 1 million in China, we could potentially avert the occurrence of 11,065 cases of diabetes and 6617 CVD events in the next 5 years, which would increase to 33,773 and 51,863, respectively, after 20 years. These figures would translate to 44 million fewer cases of diabetes and 67 million fewer CVD events in the 1.3 billion Chinese population. Key messages 1. The ensured access to insulin, patient education and blood glucose monitoring tools can prevent premature deaths and emergencies in young patients with T1D especially in disadvantaged communities. 2. The impact of maternal hyperglycaemia on childhood obesity requires a multicomponent lifecourse strategy to prevent YOD which may benefit our next generation. 3. The complex aetiologies, notably psychosocial needs especially in YOD, call for structured assessment in order to personalise care for reducing premature NCD and death. 5 4. The diverse environmental, behavioural, and socioeconomic causes of T2D require a multitiered societal and population-based prevention strategy. 5. The marked differences in diabetes diagnosis, treatment and outcomes between LMICs and HICs are likely due to differences in investment, capacity, healthcare systems and care organisation. 6. The sustained reduction of common cardiometabolic risk factors including smoking cessation, and use of statins, RASi, SGLT2i and GLP1-RA therapies can reduce cardiovascular-renal diseases and all-cause death in patients with T2D. 7. The delivery of team-based care can enable systematic collection of data during routine clinical practice to improve the quality of electronic medical records (EMR) and establish registers for surveillance, prevention and treatment. 8. The strengthening of existing infrastructures for providing long-term care and creating career paths for physicians with knowledge and skills to re-organise diabetes care, train non-physician personnel and use technology effectively can improve the accessibility, sustainability and affordability of diabetes prevention and care.
Nutrients, 2021
The association between fish consumption and new-onset type 2 diabetes is inconsistent and differ... more The association between fish consumption and new-onset type 2 diabetes is inconsistent and differs according to geographical location. We examined the association between the total and types of fish consumption and type 2 diabetes using individual participant data from 28 prospective cohort studies from the Americas (6), Europe (15), the Western Pacific (6), and the Eastern Mediterranean (1) comprising 956,122 participants and 48,084 cases of incident type 2 diabetes. Incidence rate ratios (IRRs) for associations of total fish, shellfish, fatty, lean, fried, freshwater, and saltwater fish intake and type 2 diabetes were derived for each study, adjusting for a consistent set of confounders and combined across studies using random-effects meta-analysis. We stratified all analyses by sex due to observed interaction (p = 0.002) on the association between fish and type 2 diabetes. In women, for each 100 g/week higher intake the IRRs (95% CIs) of type 2 diabetes were 1.02 (1.01–1.03, I2 =...
European Journal of Nutrition, 2021
To investigate the relationship of habitual FV intake, different types of FV and vegetable divers... more To investigate the relationship of habitual FV intake, different types of FV and vegetable diversity with depressive symptoms. Methods: Australian men and women (n=4,105) aged >25 years from the Australian Diabetes, Obesity and Lifestyle Study were included. Dietary intake was assessed using a Food Frequency Questionnaire at baseline, 5 and 12 years. Depressive symptoms were assessed using the validated 10-item Centre for Epidemiology Studies Short Depression Scale at 12 years. Multiple logistic regression models were used to investigate the association between the exposures of interest and depressive symptoms using odds ratios (OR) and 95% confidence intervals (CI) across quartiles of FV intake and vegetable diversity. Analyses were multivariable adjusted for confounding factors. Results: At 12 years, 425 (10.4%) participants had "any depressive symptoms". Habitual FV intake was inversely associated with depressive symptoms at 12 years. After adjustment, participants in quartile 2 of FV intake (Q2; median 317 g/day) had a 20% lower odds of having any depressive symptoms (OR [95%CI]: 0.80 [0.69, 0.95]) in comparison to those in the lowest quartile of FV intake (Q1; median 223 g/d). Yellow/orange/red and leafy green vegetables were the key vegetable types driving this association. Higher vegetable diversity (4-6 different vegetables per day) was associated with a 24-42% lower odds of having depressive symptoms when compared to <3 different vegetables per day. The associations remained similar after further adjusting for diet quality. Conclusion: A FV-rich diet, consisting of a diverse range of vegetables, particularly yellow/orange/red and leafy green vegetables may help to lower depressive symptoms. Promoting such a diet, particularly in men and women with a low FV intake, may have a significant public health impact.
BMJ Open Diabetes Research & Care, 2019
ObjectiveThere are currently five widely used definition of prediabetes. We compared the ability ... more ObjectiveThere are currently five widely used definition of prediabetes. We compared the ability of these to predict 5-year conversion to diabetes and investigated whether there were other cut-points identifying risk of progression to diabetes that may be more useful.Research design and methodsWe conducted an individual participant meta-analysis using longitudinal data included in the Obesity, Diabetes and Cardiovascular Disease Collaboration. Cox regression models were used to obtain study-specific HRs for incident diabetes associated with each prediabetes definition. Harrell’s C-statistics were used to estimate how well each prediabetes definition discriminated 5-year risk of diabetes. Spline and receiver operating characteristic curve (ROC) analyses were used to identify alternative cut-points.ResultsSixteen studies, with 76 513 participants and 8208 incident diabetes cases, were available. Compared with normoglycemia, current prediabetes definitions were associated with four to ...
The Lancet, 2019
Background The relevance of blood lipid concentrations to long-term incidence of cardiovascular d... more Background The relevance of blood lipid concentrations to long-term incidence of cardiovascular disease and the relevance of lipid-lowering therapy for cardiovascular disease outcomes is unclear. We investigated the cardiovascular disease risk associated with the full spectrum of bloodstream non-HDL cholesterol concentrations. We also created an easy-to-use tool to estimate the long-term probabilities for a cardiovascular disease event associated with non-HDL cholesterol and modelled its risk reduction by lipid-lowering treatment. Methods In this risk-evaluation and risk-modelling study, we used Multinational Cardiovascular Risk Consortium data from 19 countries across Europe, Australia, and North America. Individuals without prevalent cardiovascular disease at baseline and with robust available data on cardiovascular disease outcomes were included. The primary composite endpoint of atherosclerotic cardiovascular disease was defined as the occurrence of the coronary heart disease event or ischaemic stroke. Sex-specific multivariable analyses were computed using non-HDL cholesterol categories according to the European guideline thresholds, adjusted for age, sex, cohort, and classical modifiable cardiovascular risk factors. In a derivation and validation design, we created a tool to estimate the probabilities of a cardiovascular disease event by the age of 75 years, dependent on age, sex, and risk factors, and the associated modelled risk reduction, assuming a 50% reduction of non-HDL cholesterol. Findings Of the 524 444 individuals in the 44 cohorts in the Consortium database, we identified 398 846 individuals belonging to 38 cohorts (184 055 [48•7%] women; median age 51•0 years [IQR 40•7-59•7]). 199 415 individuals were included in the derivation cohort (91 786 [48•4%] women) and 199 431 (92 269 [49•1%] women) in the validation cohort. During a maximum follow-up of 43•6 years (median 13•5 years, IQR 7•0-20•1), 54 542 cardiovascular endpoints occurred. Incidence curve analyses showed progressively higher 30-year cardiovascular disease eventrates for increasing non-HDL cholesterol categories (from 7•7% for non-HDL cholesterol <2•6 mmol/L to 33•7% for ≥5•7 mmol/L in women and from 12•8% to 43•6% in men; p<0•0001). Multivariable adjusted Cox models with non-HDL cholesterol lower than 2•6 mmol/L as reference showed an increase in the association between non-HDL cholesterol concentration and cardiovascular disease for both sexes (from hazard ratio 1•1, 95% CI 1•0-1•3 for non-HDL cholesterol 2•6 to <3•7 mmol/L to 1•9, 1•6-2•2 for ≥5•7 mmol/L in women and from 1•1, 1•0-1•3 to 2•3, 2•0-2•5 in men). The derived tool allowed the estimation of cardiovascular disease event probabilities specific for non-HDL cholesterol with high comparability between the derivation and validation cohorts as reflected by smooth calibration curves analyses and a root mean square error lower than 1% for the estimated probabilities of cardiovascular disease. A 50% reduction of non-HDL cholesterol concentrations was associated with reduced risk of a cardiovascular disease event by the age of 75 years, and this risk reduction was greater the earlier cholesterol concentrations were reduced. Interpretation Non-HDL cholesterol concentrations in blood are strongly associated with long-term risk of atherosclerotic cardiovascular disease. We provide a simple tool for individual long-term risk assessment and the potential benefit of early lipid-lowering intervention. These data could be useful for physician-patient communication about primary prevention strategies.
Scientific Reports, 2019
Aims: The objective of this study was to identify the determinants of glycaemic control among peo... more Aims: The objective of this study was to identify the determinants of glycaemic control among people with type 2 diabetes mellitus in Bangladesh. A cross-sectional study was carried out during March to September 2017, and 1253 adult patients with type 2 diabetes mellitus were recruited from six hospitals. Data were collected from patients via face-to-face interview, and their medical records were reviewed. Multiple logistic regression analysis was performed. Among the participants, 53.2% were male. Mean (±SD) age was 54.1 (±12.1) years and mean (±SD) duration of diabetes was 9.9 (±7.2) years. About 82% participants had inadequate glycaemic control (HbA1c ≥ 7%) and 54.7% had very poor control (HbA1c ≥ 9%). Low education level, rural residence, unhealthy eating habits, insulin use, infrequent follow up check-ups and history of coronary artery diseases found associated with inadequate and very poor controls. Being female and smokeless tobacco consumer appeared to be associated with ina...
International Journal of Cancer, 2019
We use contemporaneous exposure prevalence data to show that body fatness is overtaking smoking a... more We use contemporaneous exposure prevalence data to show that body fatness is overtaking smoking as the leading modifiable cause of the future kidney cancer burden in Australia. Overweight and obesity explain 29%, current and past smoking 16%, and these two exposures jointly 40% of the future kidney cancer burden. Current and past smoking explain 44% of future bladder cancers, with men, those under 65 years and those consuming excessive alcohol experiencing the highest modifiable burden.
Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 2018
The aim of this study is to identify lifestyle factors that place people with type 2 diabetes in ... more The aim of this study is to identify lifestyle factors that place people with type 2 diabetes in Saudi Arabia at a greater risk of macro-and microvascular complications. Methods: A survey was conducted among adults with type 2 diabetes who attended diabetes centres in three major cities in Saudi Arabia. Participants were interviewed and their medical files were reviewed for lab test results and documented comorbidities. Associations between complication and lifestyle factors were assessed using multiple logistic regression analysis. Results: A total of 1121 participants were recruited. Mean age was 57.6 (±11.1) years. The prevalence of coronary artery disease, diabetic foot, and stroke was 17.0%, 13.1% and 3.7%, and that of neuropathy, renal impairment, and retinopathy was 20.3%, 14.5%, and 42.8% respectively. Lifestyle factors associated with one or more of the complications were inadequate physical activity, longer sitting time, obesity, current or past smoking, passive smoking, hypertension, poor glycaemic control, low HDL and high triglycerides. Conclusions: Diabetes complications are common among people with type 2 diabetes in Saudi Arabia. Life style factors such as inadequate physical activity, longer sitting time, obesity, smoking, hypertension, and poor control of blood glucose and lipids should be assimilated into complications prevention program.
Osteoarthritis and Cartilage, 2016
International Journal of Epidemiology, 2017
Background: The 2016 Dar Es Salaam Call to Action on Diabetes and Other noncommunicable diseases ... more Background: The 2016 Dar Es Salaam Call to Action on Diabetes and Other noncommunicable diseases (NCDs) advocates national multi-sectoral NCD strategies and action plans based on available data and information from countries of sub-Saharan Africa and beyond. We estimated trends from 1980 to 2014 in age-standardized mean body mass index (BMI) and diabetes prevalence in these countries, in order to assess the coprogression and assist policy formulation. Methods: We pooled data from African and worldwide population-based studies which measured height, weight and biomarkers to assess diabetes status in adults aged 18 years. A Bayesian hierarchical model was used to estimate trends by sex for 200 countries and territories including 53 countries across five African regions (central, eastern, northern, southern and western), in mean BMI and diabetes prevalence (defined as either fasting plasma glucose of 7.0 mmol/l, history of diabetes diagnosis, or use of insulin or oral glucose control agents). Results: African data came from 245 population-based surveys (1.2 million participants) for BMI and 76 surveys (182 000 participants) for diabetes prevalence estimates. Countries with the highest number of data sources for BMI were South Africa (n ¼ 17), Nigeria (n ¼ 15) and Egypt (n ¼ 13); and for diabetes estimates, Tanzania (n ¼ 8), Tunisia (n ¼ 7), and Cameroon, Egypt and South Africa (all n ¼ 6). The age-standardized mean BMI increased from 21.0 kg/m 2 (95% credible interval: 20.3-21.7) to 23.0 kg/m 2 (22.7-23.3) in men, and from 21.9 kg/m 2 (21.3-22.5) to 24.9 kg/m 2 (24.6-25.1) in women. The agestandardized prevalence of diabetes increased from 3.4% (1.5-6.3) to 8.5% (6.5-10.8) in men, and from 4.1% (2.0-7.5) to 8.9% (6.9-11.2) in women. Estimates in northern and southern regions were mostly higher than the global average; those in central, eastern and western regions were lower than global averages. A positive association (correlation coefficient ' 0.9) was observed between mean BMI and diabetes prevalence in both sexes in 1980 and 2014. Conclusions: These estimates, based on limited data sources, confirm the rapidly increasing burden of diabetes in Africa.
PloS one, 2017
Identification of individuals who are at risk of suffering from acute coronary syndromes (ACS) ma... more Identification of individuals who are at risk of suffering from acute coronary syndromes (ACS) may allow to introduce preventative measures. We aimed to identify ACS-related urinary peptides, that combined as a pattern can be used as prognostic biomarker. Proteomic data of 252 individuals enrolled in four prospective studies from Australia, Europe and North America were analyzed. 126 of these had suffered from ACS within a period of up to 5 years post urine sampling (cases). Proteomic analysis of 84 cases and 84 matched controls resulted in the discovery of 75 ACS-related urinary peptides. Combining these to a peptide pattern, we established a prognostic biomarker named Acute Coronary Syndrome Predictor 75 (ACSP75). ACSP75 demonstrated reasonable prognostic discrimination (c-statistic = 0.664), which was similar to Framingham risk scoring (c-statistics = 0.644) in a validation cohort of 42 cases and 42 controls. However, generating by a composite algorithm named Acute Coronary Syndr...
Diabetes Care, 2015
OBJECTIVE To investigate infection-related mortality in individuals with type 1 and type 2 diabet... more OBJECTIVE To investigate infection-related mortality in individuals with type 1 and type 2 diabetes. RESEARCH DESIGN AND METHODS A total of 1,108,982 individuals with diabetes who were registered with the Australian Diabetes register between 2000 and 2010 were linked to the National Death Index. Mortality outcomes were defined as infection-relatedA-B death (ICD codes A99–B99), pneumonia (J12–J189), septicemia (A40 and A41), and osteomyelitis (M86). RESULTS During a median follow-up of 6.7 years, there were 2,891, 2,158, 1,248, and 147 deaths from infection-relatedA-B causes, pneumonia, septicemia, or osteomyelitis, respectively. Crude mortality rates from infectionsA-B were 0.147 and 0.431 per 1,000 person-years in type 1 and type 2 diabetes, respectively. Standardized mortality ratios (SMRs) were higher in type 1 and type 2 diabetes for all outcomes after adjustment for age and sex. For infection-relatedA-B mortality, SMRs were 4.42 (95% CI 3.68–5.34) and 1.47 (1.42–1.53) for type ...
PLoS ONE, 2013
The relationship between lipid metabolism with prediabetes (impaired fasting glucose and impaired... more The relationship between lipid metabolism with prediabetes (impaired fasting glucose and impaired glucose tolerance) and type 2 diabetes mellitus is poorly defined. We hypothesized that a lipidomic analysis of plasma lipids might improve the understanding of this relationship. We performed lipidomic analysis measuring 259 individual lipid species, including sphingolipids, phospholipids, glycerolipids and cholesterol esters, on fasting plasma from 117 type 2 diabetes, 64 prediabetes and 170 normal glucose tolerant participants in the Australian Diabetes, Obesity and Lifestyle Study (AusDiab) then validated our findings on 1076 individuals from the San Antonio Family Heart Study (SAFHS). Logistic regression analysis of identified associations with type 2 diabetes (135 lipids) and prediabetes (134 lipids), after adjusting for multiple covariates. In addition to the expected associations with diacylglycerol, triacylglycerol and cholesterol esters, type 2 diabetes and prediabetes were positively associated with ceramide, and its precursor dihydroceramide, along with phosphatidylethanolamine, phosphatidylglycerol and phosphatidylinositol. Significant negative associations were observed with the ether-linked phospholipids alkylphosphatidylcholine and alkenylphosphatidylcholine. Most of the significant associations in the AusDiab cohort (90%) were subsequently validated in the SAFHS cohort. The aberration of the plasma lipidome associated with type 2 diabetes is clearly present in prediabetes, prior to the onset of type 2 diabetes. Lipid classes and species associated with type 2 diabetes provide support for a number of existing paradigms of dyslipidemia and suggest new avenues of investigation.
Heart, Lung and Circulation, 2012
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Papers by dianna Magliano