What is the clinical evidence from this study?

Study design: Cohort. Population: Diabetes Mellitus (n=55826). Intervention: High perceived mental stress vs. Low perceived mental stress. Primary outcome: 10-year incidence of diabetes mellitus in men (OR 1.36, 95% CI 1.13-1.63, p=0.001).

January 1, 2009Open Access

Psychological Factors, Coffee and Risk of Diabetes Mellitus among Middle-Aged Japanese: a Population-Based Prospective Study in the JPHC Study Cohort

Key Result

High perceived mental stress increased the 10-year risk of incident diabetes by 36% compared to low stress among middle-aged Japanese men (OR 1.36).

Study Design

Type

Cohort (n=55,826)

Multicenter

Yes

Structured PICO

Do perceived mental stress and type A behavior increase the risk of incident diabetes in middle-aged Japanese adults?

Population

55,826 middle-aged Japanese adults (24,826 men and 31,000 women) aged 40-69 years from the JPHC Study Cohort. Key exclusions: cardiovascular disease, chronic liver disease, kidney disease, cancer, or diabetes at baseline.

Intervention

High perceived mental stress, high type A behavior, and coffee consumption

Comparator

Low perceived mental stress, low type A behavior, and almost never drinking coffee

Outcome

Incident cases of diabetes during the 10-year follow-up period

Perceived mental stress in men and type A behavior in women are associated with an increased risk of incident diabetes, while coffee consumption shows a protective effect.

Main Result

Effect estimate: OR 1.36 (95% CI 1.13-1.63)

Absolute Event Rate: 7.1% vs 5.8%

p-value: p=0.001

Limitations

Assessment of diabetes mellitus was based on the results of a self-reported questionnaire.
Perceived mental stress was assessed based on a single simple question.
Potential misclassification with regard to diabetes and exposure.

Abstract

An association between psychological factors and diabetes has been suspected for a long time. However, epidemiological data on this association is limited. We investigated the association between psychological factors (perceived mental stress and type A behavior) and the onset of diabetes in a community-based, prospective cohort study in a large number of middle-aged Japanese adults. A total of 55,826 subjects (24,826 men and 31,000 women) aged 40-69 years were followed for 10 years. A self-administered questionnaire on medical conditions including diabetes and other lifestyle factors was performed at baseline and 5 and 10 years later. Psychological factors and diabetes were assessed based on the questionnaire results. During the 10-year follow-up period, we documented 1,601 incident cases (6.4%) of diabetes among men and 1,093 cases (3.5%) among women. The risk of diabetes increased with an increasing stress level, especially among men. Multivariate adjusted odds ratios for high stress compared with low stress were 1.36 (1.13 to 1.63) among men and 1.22 (0.98 to 1.51) among women. The risk of diabetes increased with an increasing level of type A behavior only among women. Multivariate adjusted odds ratios for high levels of type A behavior compared with low levels of type A behavior were 1.09 (0.94 to 1.27) among men and 1.22 (1.01 to 1.47) among women. We found an association between perceived mental stress and the incidence of diabetes, especially among men. We also found an association between type A behavior and the incidence of diabetes among women. In addition, inverse association between coffee consumption and the incidence of diabetes which was consistent with other studies was observed.

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