Vol.:(0123456789) 1 3 Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity https://doi.org/10.1007/s40519-018-0529-7 ORIGINAL ARTICLE Factors associated with progression to pre-diabetes: a recurrent events analysis Marjan Mansourian 1  · Akram Yazdani 2  · Elham Faghihimani 3  · Ashraf Aminorraya 3  · Masoud Amini 3  · Tohid Jafari‑Koshki 4,5 Received: 23 April 2018 / Accepted: 13 June 2018 © Springer International Publishing AG, part of Springer Nature 2018 Abstract Aims Pre-diabetes is a strong risk factor for type 2diabetes (T2D). The aim of this study was to explore factors associated with normal glucose maintenance and pre-diabetes prevention or delay. Methods Data of 1016 frst-degree relatives of T2D patients were retrieved from the Isfahan Diabetes Prevention Study (IDPS). Association of various variables including nutrients, serum tests and physical activity with the risk of pre-diabetes was assessed using recurrent events approach. Results Cumulative incidence of diabetes was 8.17, 9.44, and 4.91% for total sample and individuals with and without pre- diabetes experience in the follow-up. Risk of progression to pre-diabetes was higher in women and older people (p < 0.01). Additionally, BMI and blood pressure had signifcant association with the risk (p < 0.01) and individuals with higher intake of fat were at higher risk (HR = 2.26; 95% CI 1.66–3.07 for high-intake and HR = 1.52; 95% CI 1.27–1.83 for medium-intake compared to low-intake group). Carbohydrates and protein intake were positively associated with the risk of pre-diabetes with HR = 8.63 per 49 g extra carbohydrates per day and HR = 1.32 per 6 g extra protein per day (p < 0.01). The association was also signifcant for triglyceride (TG) with 7% risk increase per 1 SD = 1.14 increase in TG level. Conclusion Despite frequent studies on lifestyle modifcation for pre-diabetes prevention, less information is available about the role of nutritional components. We observed direct efects for intake of macronutrients including fat, carbohydrates, and protein in frst-degree relatives. Further research is warranted to assess these associations in general populations. Level of evidence Level III: Evidence obtained from a single-center cohort study. Keywords Pre-diabetes · Risk factor · Type 2 diabetes · Relatives Introduction Type 2 diabetes (T2D) is a heterogeneous disorder with a strong genetic component and an increasing global preva- lence [1]. Diet composition is believed to infuence the development of T2D through change in body weight [2]. Clinical studies in human subjects have shown that dietary factors, particularly fat and energy intake are strongly and positively associated with excess body weight and diabetes risk [2, 3]. However, inconsistent results from population- based studies on diet and obesity could be attributed, at least in part, to limitations in study design and systematic meas- urement errors in dietary data [4]. Elevated risk of diabetes in the frst-degree relatives (FDRs) ofT2D patients under- scores the importance of genetic and environmental factors in the genesis and progression of the disease [5, 6]. Marjan Mansourian and Akram Yazdani contributed equally to this research and share frst author position. * Tohid Jafari-Koshki tjkoshki@gmail.com; tjkoshki@tbzmed.ac.ir 1 Department of Biostatistics and Epidemiology, Health School, Isfahan University of Medical Sciences, Isfahan, Iran 2 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran 3 Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran 4 Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran 5 Road Trafc Injury research Center, Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Attar-Neyshabouri St., Tabriz, Iran