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Hba1c in Non-Diabetic Adults Using Nhanes 2013-2014 Data: The

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Hba1c in Non-Diabetic Adults Using Nhanes 2013-2014 Data: The HBA1C IN NON-DIABETIC ADULTS USING NHANES 2013-2014 DATA: THE RELATIONSHIP WITH CAFFEINE, CARBOHYDRATES, AND PHYSICAL ACTIVITY A Thesis Presented to The Graduate Faculty of The University of Akron In Partial Fulfillment Of the Requirements for the Degree Master of Science Hadia Meashi December, 2018 HBA1C IN NON-DIABETIC ADULTS USING NHANES 2013-2014 DATA: THE RELATIONSHIP WITH CAFFEINE, CARBOHYDRATES, AND PHYSICAL ACTIVITY Hadia Meashi Thesis Approved: Accepted: _______________________________ _______________________________ Committee Chair Interim Dean of the College Dr. Ronald Otterstetter Dr. Elizabeth Kennedy _____________________________ ______________________________ Committee Member Dean of the Graduate School Mr. Brian Miller Dr. Chand Midha _______________________________ _______________________________ Committee Member Interim School Director Dr. Laura A. Richardson Dr. Judith A. Juvancic-Heltzel _______________________________ ________________________________ Committee Member Date Dr. Mark Fridline ii TABLE OF CONTENTS Page LIST OF TABLES ...................................................................................................... v LIST OF FIGURES ................................................................................................... vi ABSTRACT ............................................................................................................... vii ACKNOWLEDGMENT............................................................................................. ix CHAPTER I. INTRODUCTION ......................................................................................... 1 II. REVIEW OF LITERATURE ......................................................................... 5 Glucose Homeostasis ................................................................................ 5 Diabetes Overview .................................................................................... 8 Caffeine and Type 2 Diabetes Mellitus .................................................... 12 Caffeine Consumption Trends in the United States ................................. 13 Caffeine (Forms and Basics) .................................................................... 14 Caffeine Function and Metabolism ........................................................... 15 Insulin ....................................................................................................... 17 Carbohydrates ........................................................................................... 20 Simple Carbohydrate Trends in the U.S. ................................................. 21 Carbohydrate Metabolism ......................................................................... 22 Physical Activity and type 2 diabetes ....................................................... 26 iii The Interrelationship of Carbohydrates, Caffeine, and HbA1c ................ 27 III. METHODOLOGY ......................................................................................... 32 Inclusion/Exclusion criteria ..................................................................... 33 Variable Inclusion ..................................................................................... 34 Statistical Analysis .................................................................................... 35 IV. RESULTS ...................................................................................................... 40 V. DISCUSSION ................................................................................................ 50 Limitations ................................................................................................ 59 Application and Future Studies ................................................................ 59 REFERENCES ........................................................................................................... 62 iv LIST OF TABLES Table Page 1. Demographic characteristics of study participants ................................................. 40 2. Descriptive characteristics of study participants ..................................................... 41 3. CHAID decision rules for the classification Diabetes or Pre-Diabetes based on HbA1C criteria ........................................................................................................ 49 v LIST OF FIGURES Figure Page 1. The full CHAID decision tree ................................................................................. 43 2. CHAID decision tree node 1 split ........................................................................... 45 3. CHAID decision tree node 4 split ........................................................................... 47 vi ABSTRACT According to the Centers for Disease Control (2018), more than 30 million Americans have diabetes with the majority of cases diagnosed as type 2 diabetes. One in three US adults is at risk for type 2 diabetes, due to the substantial volume of people diagnosed with DM, there is a need for healthcare providers and researchers to help better understand the causes attributed to DM to reduce or prevent the occurrence of future cases. Prediabetes is defined by the American Diabetes Association (2016) as blood glucose levels above the normal average but not high enough to be diagnosed with Diabetes Mellitus. Chronic high levels of blood glucose may lead to many health complications including diabetes. Understanding variables that may increase the risk of prediabetes or diabetes may potentially reduce future cases and lead to a healthier society. There is consensus in the literature explaining the relationship of elevated glucose with the risk of poor body composition, age, sedentary behavior and high carbohydrate diets however caffeine consumption and risk for diabetes has varied. Research has demonstrated that caffeine consumption has an effect on glycemic control but according to the ADA (2017) conflicting findings among numerous caffeine research studies exist. Some indicate that drinking coffee may prevent type 2 diabetes while other studies reported that coffee intake could elevate blood glucose. The purpose of this study was to investigate the effect of chronic caffeine ingestion on glycemic mechanics in non-diabetic adults by using Chi-square Automatic Interaction Detection (CHAID) vii decision tree to classify prediabetes and diabetes based on A1C criteria using a sample derived from the National Health and Nutrition Examination Survey (NHANES) 2013- 2014 data. The study sample was derived from 3928 male and females’ participants between 18 to 59 years of age. The CHAID growth criteria was set as 60 cases parent node and 30 cases for child node with significance for a split and merge set at α = 0.05 and maximum tree depth set at the default of 3 levels. Results from the data showed the risk for diabetes or prediabetes was almost five times (4.57) higher with those with high carbohydrate intake compared to those with low carbohydrate intake. Results showed the risk of prediabetes or diabetes was 1.54 times higher in males compared to females and participant’s age increased the risk with 50.1% risk for people who are older than 51 years of age compared to 6.8% risk for whose less than or equal to 27 years of age. Daily habitual caffeine consumption greater than 92 mg/day combined with low physical activity (less than 30 minutes per day of exercise) were 4.17 times more likely to have diabetes or pre-diabetes based on A1C criteria compared to those who were physically active (more than 30 minutes per day of exercise). Overall, non-diabetic adults consuming habitual caffeine consumption combined with regular physical activity had the lowest risk for elevated A1C and being diagnosed with prediabetes or diabetes. The findings provide a unique understanding to the potential relationship between caffeine and physical activity leading to a protective effect on glycemic mechanics in non- diabetic adults. viii ACKNOWLEDGEMENTS I would like to thank the faculty and staff of the School of Sport Science and Wellness Education at The University of Akron for their support throughout my educational career. A special thank you to my academic advisor and thesis committee chair Dr. Ronald Otterstetter, for his advice from the first day he met me at the university. Dr. O always helped me whenever I ran into trouble. Thank you for all you have done to make my Master of Science in Exercise Physiology a positive and pleasant experience. I would also like to acknowledge my advisor, Brain Miller, for his guidance and patience through the thesis process. Thank you also for enriching my knowledge and providing me with opportunities to pursue research using NHANES data. I would also like to express thanks to Dr. Laura A. Richardson, for dedicating her time to be on my committee and sharing her expertise. Dr. Mark Fridline provided his guidance and help with statistical interpretations and I am grateful for his time with data analysis. Finally, I must express my very profound gratitude to my parents, my husband, my sisters, and my friends for providing me with unfailing support and continuous encouragement throughout my years of study and through the process of researching and writing this thesis. Also, I would also like to acknowledge my government that provides me with a full scholarship to continue my studying in the U.S. This accomplishment would not have been possible without them. Thank you. ix CHAPTER Ⅰ INTRODUCTION The total number of diabetes mellitus (DM) is expected to
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