***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: AIM To explore incident cases of diagnosed diabetes over 35 years of follow-up in relation to self-perceived stress at baseline . METHODS This was a population -based r and om sample of 7251 men derived from the Primary Prevention Trial Study , aged 47 - 56 years at baseline and without prior history of diabetes , coronary heart disease and stroke . Incident diabetes was identified from hospital discharge and death registries as principal or secondary diagnosis . Cox proportional hazards regression was used to evaluate the potential association between stress and diabetes . RESULTS During a 35-year follow-up , a total of 899 men were identified with diabetes . The crude incidence was 5.2 per 1000 persons-years . At baseline , 15.5 % men reported permanent stress related to conditions at work or home . After adjusting for age and competing risk of death , the estimated 35-year conditional probability of diabetes in men with permanent stress was 42.6 % , compared with 31.0 % for those with periodic stress and 31.2 % with no stress . In age-adjusted Cox regression analysis , men with permanent stress had a higher risk of diabetes [ hazard ratio 1.52 ( 95 % CI 1.26 - 1.82 ) ] compared with men with no ( referent ) or periodic stress [ hazard ratio 1.09 ( 95 % CI 0.94 - 1.27 ) ] . The association between stress and diabetes was slightly attenuated but remained significant after adjustment for age , socio-economic status , physical inactivity , BMI , systolic blood pressure and use of anti-hypertensive medication [ hazard ratio 1.45 ( 95 % CI 1.20 - 1.75 ) ] . When examining principal diagnosis of diabetes cases separately from secondary diagnoses cases , the excess risk of diabetes associated with permanent stress remained significant both in age ( only ) and multivariable adjusted models . CONCLUSION  Self-perceived permanent stress  is an important long-term predictor of diagnosed diabetes , independently of socio-economic status , BMI and other conventional Type 2 diabetes risk factors A new cohort study links work-related stress to an increased risk of developing type 2 diabetes mellitus ( T2DM ) in women , but the findings are less clear in men . R and omized controlled studies are now needed to determine whether management of stress could be used to reduce the risk of developing T2DM BACKGROUND Social inequalities in the incidence of type 2 diabetes and the relation of health behaviors and psychosocial factors to the incidence of type 2 diabetes are not well established . METHODS Prospect i ve occupational cohort study of 10 308 civil servants aged 35 to 55 years at baseline in phase 1 ( 1985 - 1988 ) . Diagnosis of diabetes was ascertained by question naire at baseline and follow-up at phases 2 ( 1989 ) , 3 ( 1992 - 1993 ) , 4 ( 1995 ) , and 5 ( 1997 - 1999 ) and glucose tolerance tests in phases 3 and 5 . RESULTS Participants working in the lower employment grade s had a higher incidence of diabetes than those in higher employment grade s ( men : odds ratio [ OR ] , 2.9 ; 95 % confidence interval [ CI ] , 1.9 - 4.4 ; women : OR , 1.7 [ 95 % CI , 0.8 - 3.7 ] ) . Body mass index and other risk factors considered traditional for type 2 diabetes were found to be so in this cohort . In men , of the psychosocial risk factors examined , only effort-reward imbalance was related to incidence of diabetes ( OR , 1.7 [ 95 % CI , 1.0 - 2.8 ] ) . The General Health Question naire depression subscale was related to incidence of diabetes and impaired glucose tolerance ( OR , 1.25 [ 95 % CI , 1.0 - 1.6 ] ) . These associations remained after adjustment for other confounding factors . In men only , social difference in incidence of diabetes was reduced but still significant after adjustment for conventional risk factors . CONCLUSIONS An inverse relationship exists between social position and incidence of diabetes that is partly explained by health behaviors and other risk factors . Effort-reward imbalance , which is reportedly associated with coronary heart disease , is also associated with type 2 diabetes Positive energy balance is the major cause of obesity , and chronic stress may be a contributory factor . The authors examined cumulative work stress , using the Job Strain Question naire on four occasions , as a predictor of obesity in a prospect i ve 19-year study of 6,895 men and 3,413 women ( aged 35 - 55 years ) in the Whitehall II cohort in London , United Kingdom ( baseline : 1985 - 1988 ) . A dose-response relation was found between work stress and risk of general obesity ( body mass index > or = 30 kg/m(2 ) ) and central obesity ( waist circumference > 102 cm in men , > 88 cm in women ) that was largely independent of covariates . The imputed odds ratios of body mass index obesity for one , two , and three or more reports of work stress adjusted for age , sex , and social position were 1.17 , 1.24 , and 1.73 ( trend p < 0.01 ) , respectively . For waist obesity , the corresponding findings were 1.17 , 1.41 , and 1.61 ( trend p < 0.01 ) . Work stress effect was modestly attenuated after exclusion of obese individuals at baseline and further adjustments for smoking ; intakes of dietary fiber , fruits and vegetables , and alcohol ; and levels of physical activity during follow-up . This study provides prospect i ve , population -based evidence that chronic work stress predicts general and central obesity OBJECTIVES To determine whether men and women with repeated ERI exposure have increased  BP means or higher hypertension incidence over a 3-year follow-up . To examine the potential modifying effect of age and overcommitment . METHODS The study cohort was composed of 1,595 white-collar workers ( 629 men and 966 women ) assessed at baseline and 3-year follow-up .  Ambulatory BP measures  were taken every 15 min during a working day . ERI at work was self-reported using vali date d scales . BP means at follow-up and cumulative incidence of hypertension were respectively modeled with analyses of covariance ( ANCOVA ) and log-binomial regression . RESULTS Among men , no association was observed between repeated ERI exposure and BP . Among women , age had a modifying effect . Women < 45 years old exposed to ERI at both times had significantly higher BP means at follow-up ( 122.2/78.9 mmHg ) than those unexposed ( 120.4/77.4 mmHg ) . In women ≥45 years old , the cumulative incidence of hypertension was 2.78 ( 95 % CI : 1.26 - 6.10 ) times higher among those exposed to ERI at both times . Men and women in the higher tertile of overcommitment had higher BP means ( men : 128.9/82.2 mmHg , women : 121.9/78.0 mmHg ) than those in the lower tertile ( men : 127.2/81.3 mmHg , women : 120.6/77.0 mmHg ) . CONCLUSION This prospect i ve study showed that , among women , repeated ERI exposure led to a significant age-specific increase in BP means and a major age-specific increase in hypertension incidence . These results suggest that primary intervention aim ed at reducing ERI may contribute to lower BP and prevent hypertension in women OBJECTIVES We evaluated whether cumulative exposure to  job strain increases blood pressure . METHODS A prospect i ve study of 8395 white-collar workers was initiated during 1991 to 1993 . At follow-up , 7.5 years later , 84 % of the participants were reassessed to estimate cumulative exposure to job strain . RESULTS Compared with men who had never been exposed , men with cumulative exposure and those who became exposed during follow-up showed significant systolic blood pressure increments of 1.8 mm Hg ( 95 % confidence interval [CI]=0.1 , 3.5 ) and 1.5 mm Hg ( 95 % CI=0.2 , 2.8 ) , respectively , and relative risks of blood pressure increases in the highest quintile group of 1.33 ( 95 % CI = 1.01 , 1.76 ) and 1.40 ( 95 % CI = 1.14 , 1.73 ) . Effect magnitudes were smaller among women . Effects tended to be more pronounced among men and women with low levels of social support at work . CONCLUSIONS Among these white-collar workers , exposure to cumulative job strain had a modest but significant effect on systolic blood pressure among men . The risk was of comparable magnitude to that observed for age and sedentary behavior . Men and women with low levels of social support at work appeared to be at higher risk for increases in blood pressure OBJECTIVES We investigated whether exposure to  negative aspects of close relationships  was associated with subsequent increase in body mass index ( BMI ) and waist circumference . METHODS Data came from a prospect i ve cohort study ( Whitehall II ) of 9425 civil servants aged 35 to 55 years at baseline ( phase 1 : 1985 - 1988 ) . We assessed negative aspects of close relationships with the Close Persons Question naire ( range 0 - 12 ) at phases 1 and 2 ( 1989 - 1990 ) . We measured BMI and waist circumference  at phases 3 ( 1991 - 1994 ) and 5 ( 1997 - 1999 ) . Covariates at phase 1 included gender , age , marital status , ethnicity , BMI , employment grade , smoking , physical activity , fruit and vegetable consumption , and common mental disorder . RESULTS After adjustment for sociodemographic characteristics and health behaviors , participants with higher exposure to negative aspects of close relationships had a higher likelihood of a 10 % or greater increase in BMI and waist circumference ( odds ratios per 1-unit increase 1.08 [ 95 % confidence interval ( CI ) = 1.02 , 1.14 ; P = .007 ] and 1.09 [ CI = 1.04 , 1.14 ; P ≤ .001 ] , respectively ) as well as a transition from the overweight ( 25 ≤ BMI < 30 ) to the obese ( BMI ≥ 0 ) category . CONCLUSIONS Adverse social relationships may contribute to weight gain Background Review s have shown that depression is a risk factor for the development of  type 2 diabetes .  However , there is limited evidence for general psychological distress to be associated with incident diabetes . The aim of the present study was to test whether persons who report higher levels of psychological distress are at increased risk to develop type 2 diabetes during 18 years follow up , adjusted for confounders . Methods A prospect i ve analysis using data from 9,514 participants ( 41 years , SD=14 ; 44 % men ) of the British Household Panel Survey . The General Health Question naire 12 item version was used to assess general psychological distress , diabetes was measured by means of self-report . Cox proportional hazards regression models were used to calculate the multivariate-adjusted hazard ratio ( HR ) of incident diabetes during 18 years follow up , comparing participants with low versus high psychological distress at baseline ( 1991 ) . Results A total of 472 participants developed diabetes 18 year follow up . Those with a high level of psychological distress had a 33 % higher hazard of developing diabetes ( HR=1.33 , 95 % CI 1.10–1.61 ) , relative to those with a low level of psychological distress , adjusted for age , sex , education level and household income . After further adjustment for differences in level of energy , health status , health problems and activity level , higher psychological distress was no longer associated with incident diabetes ( HR=1.10 , 95 % CI 0.91 - 1.34 ) . Conclusions Higher levels of psychological distress are a risk factor for the development of diabetes during an 18 year follow up period . This association may be potentially mediated by low energy level and impaired health status Two studies investigate the effect of stress on  food choice .  Experiment 1 demonstrates experimentally that stress causes changes in food choice away from healthy low fat foods ( grapes ) to less healthy high fat foods ( M&Ms ) , confirming previous survey research . Experiment 2 , a survey study , finds that more females than males report increasing food consumption when stressed . A much larger percentage of those who report increasing their food consumption when stressed ( 71 % ) are restrained eaters ( i.e. , dieters ) than are people who undereat or who do not change the amount they eat when stressed ( 35 % ) . The foods that they report overeating when stressed are foods they normally avoid for weight-loss or health reasons ( i.e. , highly caloric high fat snack foods ) . They report eating these foods to feel better . Both studies show that stress not only increases consumption in certain individuals but also shifts their food choice from lower fat to higher fat foods OBJECTIVE To investigate the prospect i ve influence of work stress on type 2 diabetes ( T2D ) . RESEARCH DESIGN AND METHODS This population -based cohort included 3,2 
    Output:
    
Regarding the four elements of MES : i ) weight gain : the prospect i ve studies supported etiological roles for relationship stress , perceived stress , and distress , while the studies on work-related stress ( WS ) showed conflicting results ; ii ) dyslipidemi : too few studies on psychosocial stress as a risk factor for dyslipidemia were available to draw a conclusion ; however , a trend toward a positive association was present ; iii ) type 2 diabetes mellitus ( DM2 ) : prospect i ve studies supported perceived stress and distress as risk factors for the development of DM2 among men , but not among women , while WS was generally not supported as a risk factor among neither men nor women ; iv ) hypertension : marital stress and perceived stress might have an influence on blood pressure ( BP ) , while no association was found regarding distress .
Evaluating WS the results were equivocal and indicated that different types of WS affected the BP differently between men and women .
In conclusion , a longitudinal association between chronic psychosocial stress and the development of MES seems present .