| 摘要: | Background: Type 2 diabetes mellitus (T2DM), a chronic metabolic disorder characterized by inflammation, oxidative stress and increased glucose concentration. Consequently, T2DM has impaired quality of life (QoL) and has escalated the risk of mortality. Proper precautions to decline the burden of disease cases of T2DM are to enhance modifiable lifestyle factors including physical activity (PA), smoking habits, and dietary.
Objectives: The specific aims of this dissertation were to: (1) to examine the effects of physical inactivity and secondhand smoking (SHS) and their synergistic impacts on the incidents of T2DM-risk among the Indonesian population. Relationships of Neutrophil-lymphocyte ratio (NLRs) and white blood cells (WBCs) and with physical activity, smoking habits, and risk of T2DM were also investigated (paper I); (2) to examine the effect of PA and lower level of NLR and WBCs, as well as their synergistic impacts on QoL (paper II); (3) to examine the effect of alkaline electrolyzed water (AEW), regular walking and their combined synergistic effect on ameliorating inflammatory markers (the NLR and WBCs), oxidative stress (advanced oxidation protein products; AOPPs, malondialdehyde; MDA, glycation end products; AGEs), fasting blood glucose (FBG) as well as encouraging QoL among individuals with T2DM: a community based randomized controlled trial (RCT) (paper III).
Methods: Study I conducted 294 healthy controls and 294 patients with T2DM using a case-control based community study. All respondents full filled a standardized questionnaire on demographic information, level of PA, smoking habits, and consumption of food. Level of inflammation biomarkers were analyzed using an automated hematology analyzer. The multiple logistic regression model has been calculated using adjusted odds ratios (AORs) and 95% confidence intervals (CIs). Moreover, the synergistic impact was investigated using logistic regression with additive interaction. Study II conducted a community based cross-sectional study included 294 subjects with T2DM. A questionnaire about the 36-item Short Form Survey (SF-36) and PA habits was used to asses the QoL and metabolic equivalent of task (MET)-hr/week. The WBCs and NLR were calculated in fasting blood. AORs and 95% CIs were analyzed using multiple linear regression. Moreover, the synergistic effect was investigated using logistic regression with additive interaction. Study III conducted a community-based RCT with 81 eligible patients with T2DM. The first group recived 2 L AEW a day for 8 weeks (n = 20), the second group was performed to walk for a duration of 150 min (n = 20) a week for 8 weeks, the third group instructed a combination of AEW and regular walking (n = 20), and the control group continues their habitual activity and dietery (n = 21). All the data were collected at baseline and eight weeks after treatments with analyzed using the one-way analysis of variance, chi-squared and generalized estimating equation.
Results: Study I. SHS and <7.5 MET-h/week significantly and separately resulted in 2.63-fold (AOR = 2.63; 95% CI = 1.02–6.80) and 3.88-fold (AOR = 3.88; 95% CI = 1.92–7.84) increases in the risk of T2DM. Both NLR and WBC count (r = 0.352, p < 0.001; r = 0.402, p < 0.001, respectively) were significantly related with SHS exprosure. By contrast, both NLR and WBCs (r = −0.394, p < 0.001; r = −0.297, p < 0.001, respectively) were negatively related with PA. Importantly, physically inactive people (<7.5 MET-h/week) unprotected to SHS represented a synergistically escalated 7.35-fold risk of developing T2DM (AOR = 7.35; 95% CI = 2.30–23.47) compared with individuals who were not SHS exposed and who were ≥7.5 MET-h/week. Study II. Participants with PA presented significantly higher score of total QoL (β=8.41, 95% CI=6.04–10.78) and physical component score (PCS; β=13.90, 95% CI=10.52–17.29) than those with <7.5 MET-h/week. Individual who had low level NLR (<1.940) significantly higher PCS (β=6.89, 95% CI=4.97–8.82), mental component scores (MCS; β=2.62, 95% CI=0.75–4.49), and total QoL (β=4.76, 95% CI=3.41–6.11) than participants with low level of NLR. Notably, physical inactivity and low level of NLR presented a synergistic effect on the increase in PCS, MCS, and total QoL score. Paper III. Our results shown AEW group had decreased AOPPs (ß=-0.185, p<0.05), MDA (ß=-0.566, p<0.001), AGEs (ß=-0.298, p<0.001), NLRs (ß=-1.666, p<0.001), also WBCs (ß=-2.406, p<0.001). Regular walking group had lower AOPPs (ß=-0.184, p<0.05), MDA (ß=-0.579, p<0.001), AGEs (ß=-0.304, p<0.001), NLRs (ß=-1.623, p<0.001), and WBCs (ß=-2.020, p<0.001). The combination intervention group were also significantly reduced AOPPs (ß=-0.264, p<0.05), MDA (ß=-0.716, p<0.001), AGEs (ß=-0.364, p<0.001), NLRs (ß=-1.798, p<0.001), also WBCs (ß=-2.833, p<0.001). More, AEW group had higher PCS and a total QoL score (ß=14.034 and ß=6.828, respectively, both p<0.001). The walking group (PCS, ß=18.017; MCS ß=13.360; total QoL, ß=15.689) and the combined group (PCS, ß=24.483; MCS ß=25.649; total QoL, ß=25.068; all p<0.001) had higher scores in all components of QoL compared to the control group. Interestingly, both AEW supplementation and regular walking independently had a synergistic effect of decreasing oxidative stress and inflammatory biomarkers also improved the all domains of QoL.
Conclusions: SHS is closely interected with high levels of WBCs, NLR, and has a synergistic impact with PA of <7.5 MET-h/week on-T2DM susceptibility. Low level of PA and an NLR <1.94 had a positive synergistic impact of increasing QoL, along with MCS, PCS and total QoL score among participants with T2DM. Moreover, both AEW supplementation and regular walking independently had a synergistic effect of ameliorating inflammatory biomarkers, oxidative stress and improved the all domains of QoL among patients with T2DM. Finally, lifestyles such as physical activity, active smoking, SHS, and diet antioxidants were associated with inflammation, stress oxidative, and QoL among T2DM in Indonesia. |
