title: Major stressful life events in relation to prevalence of undetected type 2 diabetes: the Hoorn Study.
abstract: OBJECTIVE
  To test whether chronic psychological stress is positively associated 1) with the prevalence of type 2 diabetes; 2) with visceral adiposity; and to test whether 3) the relationship between stress and diabetes is mainly mediated by visceral adiposity
  
  
  METHODS
  In a general Caucasian population aged 50-74 years without a history of diabetes (n = 2,262), the number of major stressful life events experienced during the past 5 years was assessed by self-report before the administration of an oral glucose tolerance test.
  
  
  RESULTS
  Diabetes was newly diagnosed among 5% of the subjects. The number of stressful events was positively associated with the prevalence of hitherto undetected diabetes. The highest quintile had a 1.6-fold (95% CI 1.0-2.6) increased probability of undetected diabetes compared with the remaining four quintiles (P<0.05 by logistical regression analysis adjusted for age and sex). This increased probability remained significant after additional adjustment for family history of diabetes, heavy alcohol consumption, physical activity, and low level of education. The number of stressful events was weakly positively associated with waist-to-hip ratio (WHR) (men, P<0.01; women, P = 0.05 by multiple regression analysis adjusted for age). The age- and sex-adjusted association between stress and diabetes was only marginally reduced by adding the WHR into the logistical regression model (odds ratio 1.5 [0.9-2.4]; P = 0.08).
  
  
  CONCLUSIONS
  These cross-sectional findings are partially consistent with Björntorp's theory that stressful life events, which indicate chronic psychological stress, are indeed associated with undetected type 2 diabetes and with visceral adiposity. However, in this white middle-aged population, visceral adiposity does not seem to be the main link between stress and diabetes.
authors.affiliation: Institute for Research in Extramural Medicine, Vrije Universiteit, Amsterdam, The Netherlands. ggd.waterland@ggd.nl
authors.forename: J M
authors.initials: JM
authors.lastname: Mooy
authors.forename: H
authors.initials: H
authors.lastname: de Vries
authors.forename: P A
authors.initials: PA
authors.lastname: Grootenhuis
authors.forename: L M
authors.initials: LM
authors.lastname: Bouter
authors.forename: R J
authors.initials: RJ
authors.lastname: Heine
mesh_terms: D000368:Aged; D001824:Body Constitution; D003643:Death; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D009679:Nuclear Family; D015995:Prevalence; D011336:Probability; D012044:Regression Analysis; D013315:Stress, Psychological; D044465:White People