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Eastwood SV, Hemani G, Watkins SH, Scally A, Davey Smith G, Chaturvedi N. Ancestry, ethnicity, and race: explaining inequalities in cardiometabolic disease. Trends Mol Med 2024:S1471-4914(24)00090-X. [PMID: 38677980 DOI: 10.1016/j.molmed.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/30/2024] [Accepted: 04/03/2024] [Indexed: 04/29/2024]
Abstract
Population differences in cardiometabolic disease remain unexplained. Misleading assumptions over genetic explanations are partly due to terminology used to distinguish populations, specifically ancestry, race, and ethnicity. These terms differentially implicate environmental and biological causal pathways, which should inform their use. Genetic variation alone accounts for a limited fraction of population differences in cardiometabolic disease. Research effort should focus on societally driven, lifelong environmental determinants of population differences in disease. Rather than pursuing population stratifiers to personalize medicine, we advocate removing socioeconomic barriers to receipt of and adherence to healthcare interventions, which will have markedly greater impact on improving cardiometabolic outcomes. This requires multidisciplinary collaboration and public and policymaker engagement to address inequalities driven by society rather than biology per se.
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Affiliation(s)
- Sophie V Eastwood
- MRC Unit for Lifelong Health and Ageing at UCL Population Sciences and Experimental Medicine, Institute of Cardiovascular Sciences Faculty of Population Health Sciences, University College London, London, UK
| | - Gibran Hemani
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah H Watkins
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Aylwyn Scally
- Department of Genetics, University of Cambridge, Downing Street, Cambridge, UK
| | - George Davey Smith
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nishi Chaturvedi
- MRC Unit for Lifelong Health and Ageing at UCL Population Sciences and Experimental Medicine, Institute of Cardiovascular Sciences Faculty of Population Health Sciences, University College London, London, UK.
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Huh Y, Park HS. Associations of overweight and obesity with cardiometabolic risk factor clusters among Korean adolescents. Sci Rep 2024; 14:3581. [PMID: 38351083 PMCID: PMC10864260 DOI: 10.1038/s41598-024-53698-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 02/03/2024] [Indexed: 02/16/2024] Open
Abstract
This study investigated the association between overweight, obesity, and cardiometabolic risk factor clusters in Korean adolescents. We included 2182 participants (1161 boys and 1021 girls) aged 12-18 years from the Korea National Health and Nutrition Examination Survey (2016-2021). Cardiometabolic risk factors include hypertension, high low-density lipoprotein cholesterol (LDL-C) level, low high-density lipoprotein cholesterol (HDL-C) level, hypertriglyceridemia, high fasting plasma glucose level, elevated alanine aminotransferase level, and hyperuricemia. The average age was 15.1 ± 0.1 years in both boys and girls. The proportion of subjects with ≥ 1, ≥ 2, and ≥ 3 cardiometabolic risk factors was 76.5%, 49.8%, and 22.7% in obese adolescents, and 60.5%, 24.0%, and 9.1%, in overweight adolescents, respectively. Compared to adolescents with underweight/normal weight, the odds ratios (ORs) and 95% confidence intervals for the clustering of cardiometabolic risk factors were at 2.76 (1.74-4.38) for ≥ 1; 3.75 (2.11-6.66) for ≥ 2; and 4.75 (1.70-13.25) for ≥ 3 factors in obese adolescents and 1.88 (1.26-2.81) for ≥ 1 factor in overweight adolescents. Overweight and obese adolescents exhibited high cardiometabolic risk clustering. Prevention and management of overweight/obesity in Korean adolescents are emerging to mitigate health risk associated with this condition.
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Affiliation(s)
- Youn Huh
- Department of Family Medicine, Uijeongbu Eulji Medical Center, Eulji University, Gyeonngi-do, Republic of Korea
| | - Hye Soon Park
- Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
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3
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Su D, Yang H, Chen Z, Kong Y, Na X, Lin Q, Zhao A, Zheng Y, Ma Y, Li X, Li Z. Ethnicity-specific blood pressure thresholds based on cardiovascular and renal complications: a prospective study in the UK Biobank. BMC Med 2024; 22:54. [PMID: 38317131 PMCID: PMC10845677 DOI: 10.1186/s12916-024-03259-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 01/15/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND The appropriateness of hypertension thresholds for triggering action to prevent cardiovascular and renal complications among non-White populations in the UK is subject to question. Our objective was to establish ethnicity-specific systolic blood pressure (SBP) cutoffs for ethnic minority populations and assess the efficacy of these ethnicity-specific cutoffs in predicting adverse outcomes. METHODS We analyzed data from UK Biobank, which included 444,418 participants from White, South Asian, Black Caribbean, and Black African populations with no history of cardiorenal complications. We fitted Poisson regression models with continuous SBP and ethnic groups, using Whites as the referent category, for the composite outcome of atherosclerotic cardiovascular disease, heart failure, and chronic kidney disease. We determined ethnicity-specific thresholds equivalent to the risks observed in Whites at SBP levels of 120, 130, and 140 mm Hg. We adjusted models for clinical characteristics, sociodemographic factors, and behavioral factors. The performance of ethnicity-specific thresholds for predicting adverse outcomes and associated population-attributable fraction (PAF) was assessed in ethnic minority groups. RESULTS After a median follow-up of 12.5 years (interquartile range, 11.7-13.2), 32,662 (7.4%) participants had incident composite outcomes. At any given SBP, the predicted incidence rate of the composite outcome was the highest for South Asians, followed by White, Black Caribbean, and Black African. For an equivalent risk of outcomes observed in the White population at an SBP level of 140 mm Hg, the SBP threshold was lower for South Asians (123 mm Hg) and higher for Black Caribbean (156 mm Hg) and Black African (165 mm Hg). Furthermore, hypertension defined by ethnicity-specific thresholds was a stronger predictor and resulted in a larger PAF for composite outcomes in South Asians (21.5% [95% CI, 2.4,36.9] vs. 11.3% [95% CI, 2.6,19.1]) and Black Africans (7.1% [95% CI, 0.2,14.0] vs. 5.7 [95% CI, -16.2,23.5]) compared to hypertension defined by guideline-recommended thresholds. CONCLUSIONS Guideline-recommended blood pressure thresholds may overestimate risks for the Black population and underestimate risks for South Asians. Using ethnicity-specific SBP thresholds may improve risk estimation and optimize hypertension management toward the goal of eliminating ethnic disparities in cardiorenal complications.
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Affiliation(s)
- Donghan Su
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Huanhuan Yang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Zekun Chen
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Yuhao Kong
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Xiaona Na
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Queran Lin
- Clinical Research Design Division, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ai Zhao
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Yan Zheng
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, China
| | - Yanan Ma
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Shenyang, China
| | - Xiaoyu Li
- Department of Sociology, Tsinghua University, Beijing, China
| | - Zhihui Li
- Vanke School of Public Health, Tsinghua University, Beijing, China.
- Institute for Healthy China, Tsinghua University, Beijing, China.
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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Kadowaki T, Matsumoto N, Matsuo R, Mitsuhashi T, Sasaki A, Takao S, Yorifuji T. Obesity, overweight, and severe prognosis in COVID-19 patients in Japan. J Infect Chemother 2023; 29:1109-1113. [PMID: 37558090 DOI: 10.1016/j.jiac.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/08/2023] [Accepted: 08/05/2023] [Indexed: 08/11/2023]
Abstract
INTRODUCTION Obesity (i.e., body mass index [BMI] of 30 kg/m2 or more) is one of the risk factors for severe COVID-19, but the findings may not be directly applicable to Asians, who have a different cutoff point for defining obesity. We thus examined the association between obesity/overweight (BMI of 25 kg/m2 or more and less than 30 kg/m2) and the risk of COVID-19 severity. METHODS The study population included COVID-19 patients who had been enrolled in the registry of the Okayama City Public Health Center in Okayama, Japan, between March 2020 and June 2022. We included 27 820 patients who had information on BMI and prognosis, and we conducted Poisson regression analysis with robust error variance to estimate risk ratios (RRs) with 95% confidence intervals (CIs) for severe outcomes. RESULTS Obesity and overweight were associated with the increased risk of severe COVID-19 in all age categories. The RRs (95% CI) for COVID-19 induced respiratory failure compared to the normal weight category were 1.57 (1.31-1.88) for overweight and 2.45 (1.90-3.15) for obesity. CONCLUSIONS Both obesity and overweight were associated with increased risk of severe COVID-19. This study suggests the importance of the overweight category to predict the risk of severe COVID-19 in Asians.
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Affiliation(s)
- Tomoka Kadowaki
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan.
| | - Naomi Matsumoto
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Rumi Matsuo
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Toshiharu Mitsuhashi
- Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan
| | - Ayako Sasaki
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Soshi Takao
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Takashi Yorifuji
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
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Zhu Z, Liu D, Chen R, Hu W, Liao H, Kiburg K, Ha J, He S, Shang X, Huang Y, Wang W, Yu H, Yang X, He M. The Association of Retinal age gap with metabolic syndrome and inflammation. J Diabetes 2023; 15:237-245. [PMID: 36919192 PMCID: PMC10036256 DOI: 10.1111/1753-0407.13364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 12/06/2022] [Accepted: 01/14/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) is a clustering of cardiometabolic components, posing tremendous burdens in the aging society. Retinal age gap has been proposed as a robust biomarker associated with mortality and Parkinson's disease. Although MetS and chronic inflammation could accelerate the aging process and increase the risk of mortality, the association of the retinal age gap with MetS and inflammation has not been examined yet. METHODS Retinal age gap (retina-predicted age minus chronological age) was calculated using a deep learning model. MetS was defined as the presence of three or more of the following: central obesity, hypertension, dyslipidemia, hypertriglyceridemia, and hyperglycemia. Inflammation index was defined as a high-sensitivity C-reactive protein level above 3.0 mg/L. Logistic regression models were used to examine the associations of retinal age gaps with MetS and inflammation. RESULTS We found that retinal age gap was significantly associated with MetS and inflammation. Specifically, compared to participants with retinal age gaps in the lowest quartile, the risk of MetS was significantly increased by 10% and 14% for participants with retinal age gaps in the third and fourth quartile (odds ratio [OR]:1.10; 95% confidence interval [CI], 1.01,1.21;, p = .030; OR: 1.14, 95% CI, 1.03,1.26; p = .012, respectively). Similar trends were identified for the risk of inflammation and combined MetS and inflammation. CONCLUSION We found that retinal age gaps were significantly associated with MetS as well as inflammation. Given the noninvasive and cost-effective nature and the efficacy of the retinal age gap, it has great potential to be used as a screening tool for MetS in large populations.
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Affiliation(s)
- Zhuoting Zhu
- Department of OphthalmologyGuangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical UniversityGuangzhouChina
- Centre for Eye Research Australia; OphthalmologyUniversity of MelbourneMelbourneAustralia
- Ophthalmology, Department of SurgeryUniversity of MelbourneMelbourneAustralia
| | - Dan Liu
- Population Health SciencesGerman Centre for Neurodegenerative Diseases (DZNE)BonnGermany
| | - Ruiye Chen
- Centre for Eye Research Australia; OphthalmologyUniversity of MelbourneMelbourneAustralia
- Ophthalmology, Department of SurgeryUniversity of MelbourneMelbourneAustralia
| | - Wenyi Hu
- Centre for Eye Research Australia; OphthalmologyUniversity of MelbourneMelbourneAustralia
- Ophthalmology, Department of SurgeryUniversity of MelbourneMelbourneAustralia
| | - Huan Liao
- Population Health SciencesGerman Centre for Neurodegenerative Diseases (DZNE)BonnGermany
| | - Katerina Kiburg
- Centre for Eye Research Australia; OphthalmologyUniversity of MelbourneMelbourneAustralia
| | - Jason Ha
- Centre for Eye Research Australia; OphthalmologyUniversity of MelbourneMelbourneAustralia
| | - Shuang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic CenterSun Yat‐sen UniversityGuangzhouChina
| | - Xianwen Shang
- Centre for Eye Research Australia; OphthalmologyUniversity of MelbourneMelbourneAustralia
- Ophthalmology, Department of SurgeryUniversity of MelbourneMelbourneAustralia
| | - Yu Huang
- Department of OphthalmologyGuangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical UniversityGuangzhouChina
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic CenterSun Yat‐sen UniversityGuangzhouChina
| | - Honghua Yu
- Department of OphthalmologyGuangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical UniversityGuangzhouChina
| | - Xiaohong Yang
- Department of OphthalmologyGuangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical UniversityGuangzhouChina
| | - Mingguang He
- Department of OphthalmologyGuangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical UniversityGuangzhouChina
- Centre for Eye Research Australia; OphthalmologyUniversity of MelbourneMelbourneAustralia
- Ophthalmology, Department of SurgeryUniversity of MelbourneMelbourneAustralia
- Population Health SciencesGerman Centre for Neurodegenerative Diseases (DZNE)BonnGermany
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Abidin NZ. Obesity and Musculoskeletal Health of Young and Older Malaysian Women: A Cross-Sectional Study. Malays J Med Sci 2023; 30:137-151. [PMID: 36875189 PMCID: PMC9984110 DOI: 10.21315/mjms2023.30.1.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 07/01/2022] [Indexed: 03/05/2023] Open
Abstract
Background Asian women are more susceptible to musculoskeletal disorders compared to their Caucasian counterparts, and employed women are substantially more prone to musculoskeletal disorders compared to men. Data on musculoskeletal health in Malaysian women are lacking. The study's goal was to evaluate the body composition and functional performance of older and younger Malaysian women for obesity and musculoskeletal health problems. Methods The study included 141 post-menopausal Malaysian women and 118 young Malaysian women between 18 years old and 32 years old of age. Body composition, bone density, handgrip strength and physical performance were assessed using bio-electrical impedance analyser, calcaneal quantitative ultrasound, hand dynamometer and modified short physical performance battery test, respectively. Results There was a higher prevalence of 'low muscle mass' among the younger age group compared to their older counterparts (48 young women [40.0%] versus 44 post-menopausal women [31.2%]). Conversely, there was a higher prevalence of 'obesity' and 'low bone density' among the older age group compared to their younger counterparts. Mean broadband ultrasound attenuation (BUA) for both age groups was ≥ 70.0 dB/MHz. The majority of post-menopausal women had a 'minor functional decline' (40.6%), followed by moderate (28.1%), major (22.7%), severe (6.3%) and the lowest percentage for 'no decline' (2.3%). Conclusion There was a high prevalence of obesity with poor musculoskeletal health in older Malaysian women, which may lead to frailty and higher incidences of falls and fractures at an advanced age. The screening of musculoskeletal conditions among Malaysian women may aid in early detection of abnormalities and timely intervention.
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Affiliation(s)
- Nurdiana Zainol Abidin
- Department of Community Health, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Pulau Pinang, Malaysia.,School of Biosciences, Faculty of Science and Engineering, University of Nottingham Malaysia, Selangor, Malaysia
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Li Z, Daniel S, Fujioka K, Umashanker D. Obesity among Asian American people in the United States: A review. Obesity (Silver Spring) 2023; 31:316-328. [PMID: 36695056 PMCID: PMC10108164 DOI: 10.1002/oby.23639] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/10/2022] [Accepted: 10/27/2022] [Indexed: 01/26/2023]
Abstract
Standard measures of obesity, i.e., body weight and BMI, suggest that Asian American people have a lower obesity prevalence than other racial groups in the United States. However, Asian American people face a unique challenge in their pattern of adiposity with central obesity, which raises the risk for multiple comorbidities, such as type 2 diabetes, metabolic syndrome, and cardiovascular disease, at a lower BMI compared with other populations. Several organizations recommend lower BMI cutoffs for obesity in Asian people (BMI ≥25.0 or ≥27.5 kg/m2 ) instead of the standard ≥30.0 kg/m2 threshold. The risks of obesity and related comorbidities in this population are further influenced by diet, physical activity, perceptions of health, and access to information and therapies. Asian-specific parameters for assessing obesity should become a standard part of clinical practice. Asian American people should equally be offered subgroup-specific tailored interventions owing to heterogeneity of this population. Access to medications and surgery should be improved, in part by updating US indications for therapies to reflect race-specific obesity thresholds and through inclusion of Asian American people of all subtypes with lower BMI values in clinical trials.
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Affiliation(s)
- Zhaoping Li
- Center for Human Nutrition, UCLA, Los Angeles, California, USA
| | | | - Ken Fujioka
- Scripps Clinic Del Mar, San Diego, California, USA
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Forouhi NG. Nutrition and Type 2 Diabetes: Computational Optimization Modeling to Expand the Evidence Base for South Asians. Diabetes Care 2022; 45:2811-2813. [PMID: 36455116 DOI: 10.2337/dci22-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
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Abstract
It is well established from clinical trials that behavioural interventions can halve the risk of progression from prediabetes to type 2 diabetes but translating this evidence of efficacy into effective real-world interventions at scale is an ongoing challenge. A common suggestion is that future preventive interventions need to be more personalised in order to enhance effectiveness. This review evaluates the degree to which existing interventions are already personalised and outlines how greater personalisation could be achieved through better identification of those at high risk, division of type 2 diabetes into specific subgroups and, above all, more individualisation of the behavioural targets for preventive action. Approaches using more dynamic real-time data are in their scientific infancy. Although these approaches are promising they need longer-term evaluation against clinical outcomes. Whatever personalised preventive approaches for type 2 diabetes are developed in the future, they will need to be complementary to existing individual-level interventions that are being rolled out and that are demonstrably effective. They will also need to ideally synergise with, and at the very least not detract attention from, efforts to develop and implement strategies that impact on type 2 diabetes risk at the societal level.
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Affiliation(s)
- Nicholas J Wareham
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge Clinical School, Cambridge, UK.
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Elliott HR, Burrows K, Min JL, Tillin T, Mason D, Wright J, Santorelli G, Davey Smith G, Lawlor DA, Hughes AD, Chaturvedi N, Relton CL. Characterisation of ethnic differences in DNA methylation between UK-resident South Asians and Europeans. Clin Epigenetics 2022; 14:130. [PMID: 36243740 PMCID: PMC9571473 DOI: 10.1186/s13148-022-01351-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/20/2022] [Indexed: 11/10/2022] Open
Abstract
Ethnic differences in non-communicable disease risk have been described between individuals of South Asian and European ethnicity that are only partially explained by genetics and other known risk factors. DNA methylation is one underexplored mechanism that may explain differences in disease risk. Currently, there is little knowledge of how DNA methylation varies between South Asian and European ethnicities. This study characterised differences in blood DNA methylation between individuals of self-reported European and South Asian ethnicity from two UK-based cohorts: Southall and Brent Revisited and Born in Bradford. DNA methylation differences between ethnicities were widespread throughout the genome (n = 16,433 CpG sites, 3.4% sites tested). Specifically, 76% of associations were attributable to ethnic differences in cell composition with fewer effects attributable to smoking and genetic variation. Ethnicity-associated CpG sites were enriched for EWAS Catalog phenotypes including metabolites. This work highlights the need to consider ethnic diversity in epigenetic research.
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Affiliation(s)
- Hannah R. Elliott
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Kimberley Burrows
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Josine L. Min
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Therese Tillin
- Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, University College London, London, UK
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Dan Mason
- Bradford Institute for Health Research, Bradford, UK
| | - John Wright
- Bradford Institute for Health Research, Bradford, UK
| | | | - George Davey Smith
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Deborah A. Lawlor
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Alun D. Hughes
- Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, University College London, London, UK
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Nishi Chaturvedi
- Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, University College London, London, UK
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Caroline L. Relton
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Horlyck-Romanovsky MF, Farag M, Bhat S, Khosla L, McNeel TS, Williams F. Black New Yorkers with Type 2 Diabetes: Afro-Caribbean Immigrants Have Lower BMI and Lower Waist Circumference than African Americans. J Racial Ethn Health Disparities 2022:10.1007/s40615-022-01375-7. [PMID: 35913542 PMCID: PMC9889567 DOI: 10.1007/s40615-022-01375-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 07/04/2022] [Accepted: 07/15/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Using the 2013/2014 New York City (NYC) Health and Nutrition Examination Survey (NYCHANES) data, this exploratory study examined whether (a) type 2 diabetes (diabetes) prevalence differed between NYC Afro-Caribbeans and African Americans; (b) anthropometric, biochemical, and sociodemographic diabetes profiles differed between and within groups; and (c) diabetes odds differed between and within groups. METHODS Diabetes was defined as prior diagnosis, HbA1c ≥ 6.5% (7.8 mmol/L), or fasting glucose ≥ 126 mg/dL. Weighted logistic regression estimated diabetes odds by nativity and either waist circumference (WC) (cm) or BMI (kg/m2). All regression models controlled for age, hypertension, gender, education, income, marital status, physical activity, and smoking. RESULTS Among Afro-Caribbeans (n = 81, 65% female, age (mean ± SE) 49 ± 2 years, BMI 29.2 ± 0.7 kg/m2) and African Americans (n = 118, 50% female, age 47 ± 2 years, BMI 30.3 ± 0.9 kg/m2), Afro-Caribbeans with diabetes had lower BMI (29.9 ± 0.8 kg/m2 vs. 34.6 ± 1.7 kg/m2, P = 0.01) and lower WC (102 ± 2 cm vs. 114 ± 3 cm, P = 0.002) than African Americans with diabetes. Afro-Caribbeans with diabetes had lower prevalence of obesity (33.2% vs. 74.7%) and higher prevalence of overweight (57.2% vs. 13.5%) (P = 0.02) than African Americans with diabetes. Odds of diabetes did not differ between Afro-Caribbeans and African Americans. In models predicting the effect of WC, diabetes odds increased with WC (OR = 1.07 (95% CI 1.02, 1.11), P = 0.003) and age (OR = 1.09 (95% CI 1.03-1.15), P = 0.003) for African Americans only. In models predicting the effect of BMI, diabetes odds increased for Afro-Caribbeans with age (OR = 1.06 (1.01, 1.11)*, P = 0.04) and hypertension (OR = 5.62 (95% CI 1.04, 30.42), P = 0.045), whereas for African Americans, only age predicted higher diabetes odds (OR = 1.08 (95% CI 1.03, 1.14), P = 0.003). CONCLUSIONS In NYC, Afro-Caribbeans with diabetes have lower BMI and lower WC than African Americans with diabetes, but odds of diabetes do not differ. Combining African-descent populations into one group obscures clinical differences and generalizes diabetes risk.
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Affiliation(s)
- Margrethe F. Horlyck-Romanovsky
- Department of Health and Nutrition Sciences, Brooklyn College, City University of New York, Brooklyn, NY, USA,Center for Health Promotion, Brooklyn College, City University of New York, New York, NY, USA
| | - Maria Farag
- Department of Health and Nutrition Sciences, Brooklyn College, City University of New York, Brooklyn, NY, USA
| | - Sonali Bhat
- College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Lakshay Khosla
- College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | | | - Faustine Williams
- Division of Intramural Research, National Institute On Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA.
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The Morphology of Coronary Artery Disease in South Asians versus White Caucasians and its Implications. Can J Cardiol 2022; 38:1570-1579. [PMID: 35568268 DOI: 10.1016/j.cjca.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 04/27/2022] [Accepted: 05/05/2022] [Indexed: 01/09/2023] Open
Abstract
South Asians (SAs) experience a higher prevalence and earlier onset of coronary artery disease and have worse outcomes relative to White Caucasians (WCs) following invasive revascularization procedures, a mainstay of coronary artery disease (CAD) management. We sought to review the differences in the CAD pattern and risk factors between SA and WC patients and discuss their potential impact on the development of coronary disease, acute coronary syndrome and revascularization outcomes. SAs have a more diffuse pattern with multi-vessel involvement compared to WCs. However, less is known about other morphological characteristics such as calcification of atherosclerotic plaque and coronary diameter in SA populations. Despite a similar coronary calcification burden, higher non-calcified plaque composition, elevated thrombosis and inflammatory markers likely contribute to the disease pattern. While the current evidence on the role of coronary vessel size remains inconsistent, smaller coronary diameters in SAs could play a potential role in the higher disease prevalence. This is especially important given the impact of coronary artery diameter on revascularization outcomes. In conclusion, SAs have a unique CAD risk profile comprised of traditional and novel risk factors. Our findings highlight the need for additional awareness of healthcare professionals of this specific risk profile and potential therapeutic targets, as well as the need for further research in this vulnerable population.
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Iyen B, Vinogradova Y, Akyea RK, Weng S, Qureshi N, Kai J. Ethnic disparities in mortality among overweight or obese adults with newly diagnosed type 2 diabetes: a population-based cohort study. J Endocrinol Invest 2022; 45:1011-1020. [PMID: 35025081 PMCID: PMC8995280 DOI: 10.1007/s40618-021-01736-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/23/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Ethnic variation in risk of type 2 diabetes is well established, but its impact on mortality is less well understood. This study investigated the risk of all-cause and cardiovascular mortality associated with newly diagnosed type 2 diabetes in White, Asian and Black adults who were overweight or obese. METHODS This population-based cohort study used primary care records from the UK Clinical Practice Research Datalink, linked with secondary care and death registry records. A total of 193,528 obese or overweight adults (BMI of 25 or greater), with ethnicity records and no pre-existing type 2 diabetes were identified between 01 January 1995 and 20 April 2018. Multivariable Cox proportional hazards regression estimated hazards ratios (HR) for incident type 2 diabetes in different ethnic groups. Adjusted hazards ratios for all-cause and cardiovascular mortality were determined in individuals with newly diagnosed type 2 diabetes. RESULTS During follow-up (median 9.8 years), the overall incidence rate of type 2 diabetes (per 1,000 person-years) was 20.10 (95% CI 19.90-20.30). Compared to Whites, type 2 diabetes risk was 2.2-fold higher in Asians (HR 2.19 (2.07-2.32)) and 30% higher in Blacks (HR 1.34 (1.23-1.46)). In individuals with newly diagnosed type 2 diabetes, the rates (per 1,000 person-years) of all-cause mortality and cardiovascular mortality were 24.34 (23.73-24.92) and 4.78 (4.51-5.06), respectively. Adjusted hazards ratios for mortality were significantly lower in Asians (HR 0.70 (0.55-0.90)) and Blacks (HR 0.71 (0.51-0.98)) compared to Whites, and these differences in mortality risk were not explained by differences in severity of hyperglycaemia. CONCLUSIONS/INTERPRETATION Type 2 diabetes risk in overweight and obese adults is greater in Asian and Black compared to White ethnic populations, but mortality is significantly higher in the latter. Greater attention to optimising screening, disease and risk management appropriate to all communities with type 2 diabetes is needed.
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Affiliation(s)
- B Iyen
- Primary Care Stratified Medicine, Population Health and Lifespan Sciences, University of Nottingham, Nottingham, UK.
| | - Y Vinogradova
- Primary Care Stratified Medicine, Population Health and Lifespan Sciences, University of Nottingham, Nottingham, UK
| | - R K Akyea
- Primary Care Stratified Medicine, Population Health and Lifespan Sciences, University of Nottingham, Nottingham, UK
| | - S Weng
- Primary Care Stratified Medicine, Population Health and Lifespan Sciences, University of Nottingham, Nottingham, UK
| | - N Qureshi
- Primary Care Stratified Medicine, Population Health and Lifespan Sciences, University of Nottingham, Nottingham, UK
| | - J Kai
- Primary Care Stratified Medicine, Population Health and Lifespan Sciences, University of Nottingham, Nottingham, UK
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Anthropometric cut-points for discriminating diabetes and the metabolic syndrome among Arabs and Asians: the Kuwait Diabetes Epidemiology Program. Br J Nutr 2022; 127:92-102. [PMID: 33658089 DOI: 10.1017/s0007114521000751] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This study aimed to determine anthropometric cut-points for screening diabetes and the metabolic syndrome (MetS) in Arab and South Asian ethnic groups in Kuwait and to compare the prevalence of the MetS based on the ethnic-specific waist circumference (WC) cut-point and the International Diabetes Federation (IDF) and American Heart Association/National Heart, Lung, and Blood Institute WC criteria. The national population-based survey data set of diabetes and obesity in Kuwait adults aged 18-60 years was analysed. Age-adjusted logistic regression and receiver operating characteristic (ROC) analyses were conducted to evaluate for 3589 individuals the utility of WC, waist:height ratio (WHtR) and BMI to discriminate both diabetes and ≥3 CVD risk factors. Areas under the ROC curve were similar for WC, WHtR and BMI. In Arab men, WC, WHtR and BMI cut-offs for diabetes were 106 cm, 0·55 and 28 kg/m2 and for ≥3 CVD risk factors, 97 cm, 0·55 and 28 kg/m2, respectively. In Arab women, cut-offs for diabetes were 107 cm, 0·65 and 33 kg/m2 and for ≥3 CVD risk factors, 93 cm, 0·60 and 30 kg/m2, respectively. WC cut-offs were higher for South Asian women than men. IDF-based WC cut-offs corresponded to a higher prevalence of the MetS across sex and ethnic groups, compared with Kuwait-specific cut-offs. Any of the assessed anthropometric indices can be used in screening of diabetes and ≥3 CVD risk factors in Kuwaiti Arab and Asian populations. ROC values were similar. The WC threshold for screening the MetS in Kuwaiti Arabs and South Asians is higher for women.
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Wade AN, Hambleton IR, Hennis AJM, Howitt C, Jeyaseelan SM, Ojeh NO, Rose AMC, Unwin N. Anthropometric cut-offs to identify hyperglycemia in an Afro-Caribbean population: a cross-sectional population-based study from Barbados. BMJ Open Diabetes Res Care 2021; 9:9/1/e002246. [PMID: 34400464 PMCID: PMC8370513 DOI: 10.1136/bmjdrc-2021-002246] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 07/27/2021] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Body mass index (BMI) and waist circumference (WC) cut-offs associated with hyperglycemia may differ by ethnicity. We investigated the optimal BMI and WC cut-offs for identifying hyperglycemia in the predominantly Afro-Caribbean population of Barbados. RESEARCH DESIGN AND METHODS A cross-sectional study of 865 individuals aged ≥25 years without known diabetes or cardiovascular disease was conducted. Hyperglycemia was defined as fasting plasma glucose ≥5.6 mmol/L or hemoglobin A1c ≥5.7% (39 mmol/mol). The Youden index was used to identify the optimal cut-offs from the receiver operating characteristic (ROC) curves. Further ROC analysis and multivariable log binomial regression were used to compare standard and data-derived cut-offs. RESULTS The prevalence of hyperglycemia was 58.9% (95% CI 54.7% to 63.0%). In women, optimal BMI and WC cut-offs (27 kg/m2 and 87 cm, respectively) performed similarly to standard cut-offs. In men, sensitivities of the optimal cut-offs of BMI ≥24 kg/m2 (72.0%) and WC ≥86 cm (74.0%) were higher than those for standard BMI and WC obesity cut-offs (30.0% and 25%-46%, respectively), although with lower specificity. Hyperglycemia was 70% higher in men above the data-derived WC cut-off (prevalence ratio 95% CI 1.2 to 2.3). CONCLUSIONS While BMI and WC cut-offs in Afro-Caribbean women approximate international standards, our findings, consistent with other studies, suggest lowering cut-offs in men may be warranted to improve detection of hyperglycemia. Our findings do, however, require replication in a new data set.
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Affiliation(s)
- Alisha N Wade
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | - Ian R Hambleton
- The University of the West Indies George Alleyne Chronic Disease Research Centre, Bridgetown, Barbados
| | - Anselm J M Hennis
- The University of the West Indies George Alleyne Chronic Disease Research Centre, Bridgetown, Barbados
| | - Christina Howitt
- The University of the West Indies George Alleyne Chronic Disease Research Centre, Bridgetown, Barbados
| | - Selvi M Jeyaseelan
- Faculty of Medical Sciences, The University of the West Indies Cave Hill Campus, Bridgetown, Barbados
| | - Nkemcho O Ojeh
- Faculty of Medical Sciences, The University of the West Indies Cave Hill Campus, Bridgetown, Barbados
| | - Angela M C Rose
- The University of the West Indies George Alleyne Chronic Disease Research Centre, Bridgetown, Barbados
- Epidemiology Department, Epiconcept SAS, Paris, France
| | - Nigel Unwin
- The University of the West Indies George Alleyne Chronic Disease Research Centre, Bridgetown, Barbados
- European Centre for Environment and Human Health, University of Exeter Medical School, Exeter, UK
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
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Yates T, Zaccardi F, Islam N, Razieh C, Gillies CL, Lawson CA, Chudasama Y, Rowlands A, Davies MJ, Docherty AB, Openshaw PJM, Baillie JK, Semple MG, Khunti K. Obesity, Ethnicity, and Risk of Critical Care, Mechanical Ventilation, and Mortality in Patients Admitted to Hospital with COVID-19: Analysis of the ISARIC CCP-UK Cohort. Obesity (Silver Spring) 2021; 29:1223-1230. [PMID: 33755331 PMCID: PMC8251439 DOI: 10.1002/oby.23178] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/05/2021] [Accepted: 03/17/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the association of obesity with in-hospital coronavirus disease 2019 (COVID-19) outcomes in different ethnic groups. METHODS Patients admitted to hospital with COVID-19 in the United Kingdom through the Clinical Characterisation Protocol UK (CCP-UK) developed by the International Severe Acute Respiratory and emerging Infections Consortium (ISARIC) were included from February 6 to October 12, 2020. Ethnicity was classified as White, South Asian, Black, and other minority ethnic groups. Outcomes were admission to critical care, mechanical ventilation, and in-hospital mortality, adjusted for age, sex, and chronic diseases. RESULTS Of the participants included, 54,254 (age = 76 years; 45.0% women) were White, 3,728 (57 years; 41.1% women) were South Asian, 2,523 (58 years; 44.9% women) were Black, and 5,427 (61 years; 40.8% women) were other ethnicities. Obesity was associated with all outcomes in all ethnic groups, with associations strongest for black ethnicities. When stratified by ethnicity and obesity status, the odds ratios for admission to critical care, mechanical ventilation, and mortality in black ethnicities with obesity were 3.91 (3.13-4.88), 5.03 (3.94-6.63), and 1.93 (1.49-2.51), respectively, compared with White ethnicities without obesity. CONCLUSIONS Obesity was associated with an elevated risk of in-hospital COVID-19 outcomes in all ethnic groups, with associations strongest in Black ethnicities.
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Affiliation(s)
- Thomas Yates
- Diabetes Research CentreUniversity of LeicesterLeicester General HospitalLeicesterUK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC)University Hospitals of Leicester NHS Trust and University of LeicesterLeicesterUK
| | - Francesco Zaccardi
- Diabetes Research CentreUniversity of LeicesterLeicester General HospitalLeicesterUK
- Leicester Real World Evidence UnitDiabetes Research CentreUniversity of LeicesterLeicesterUK
| | - Nazrul Islam
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU)Nuffield Department of Population HealthUniversity of OxfordOxfordUK
- Medical Research Council Epidemiology UnitUniversity of CambridgeCambridgeUK
| | - Cameron Razieh
- Diabetes Research CentreUniversity of LeicesterLeicester General HospitalLeicesterUK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC)University Hospitals of Leicester NHS Trust and University of LeicesterLeicesterUK
| | - Clare L. Gillies
- Diabetes Research CentreUniversity of LeicesterLeicester General HospitalLeicesterUK
- Leicester Real World Evidence UnitDiabetes Research CentreUniversity of LeicesterLeicesterUK
| | - Claire A. Lawson
- Diabetes Research CentreUniversity of LeicesterLeicester General HospitalLeicesterUK
| | - Yogini Chudasama
- Leicester Real World Evidence UnitDiabetes Research CentreUniversity of LeicesterLeicesterUK
| | - Alex Rowlands
- Diabetes Research CentreUniversity of LeicesterLeicester General HospitalLeicesterUK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC)University Hospitals of Leicester NHS Trust and University of LeicesterLeicesterUK
| | - Melanie J. Davies
- Diabetes Research CentreUniversity of LeicesterLeicester General HospitalLeicesterUK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC)University Hospitals of Leicester NHS Trust and University of LeicesterLeicesterUK
| | - Annemarie B. Docherty
- Centre for Medical InformaticsUsher InstituteUniversity of EdinburghEdinburghUK
- Intensive Care UnitRoyal Infirmary EdinburghEdinburghUK
| | | | | | - Malcolm G. Semple
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections and Institute of Translational Medicine, Faculty of Health and Life SciencesUniversity of LiverpoolLiverpoolUK
- Respiratory MedicineAlder Hey Children’s HospitalInstitute in The ParkUniversity of LiverpoolAlder Hey Children’s HospitalLiverpoolUK
| | | | - Kamlesh Khunti
- Diabetes Research CentreUniversity of LeicesterLeicester General HospitalLeicesterUK
- Leicester Real World Evidence UnitDiabetes Research CentreUniversity of LeicesterLeicesterUK
- NIHR Applied Research Collaboration – East Midlands (ARC‐EM)University Hospitals of Leicester NHS Trust and University of LeicesterLeicesterUK
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Caleyachetty R, Barber TM, Mohammed NI, Cappuccio FP, Hardy R, Mathur R, Banerjee A, Gill P. Ethnicity-specific BMI cutoffs for obesity based on type 2 diabetes risk in England: a population-based cohort study. Lancet Diabetes Endocrinol 2021; 9:419-426. [PMID: 33989535 PMCID: PMC8208895 DOI: 10.1016/s2213-8587(21)00088-7] [Citation(s) in RCA: 126] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND National and global recommendations for BMI cutoffs to trigger action to prevent obesity-related complications like type 2 diabetes among non-White populations are questionable. We aimed to prospectively identify ethnicity-specific BMI cutoffs for obesity based on the risk of type 2 diabetes that are risk-equivalent to the BMI cutoff for obesity among White populations (≥30 kg/m2). METHODS In this population-based cohort study, we used electronic health records across primary care (Clinical Practice Research Datalink) linked to secondary care records (Hospital Episodes Statistics) from a network of general practitioner practices in England. Eligible participants were aged 18 years or older, without any past or current diagnosis of type 2 diabetes, had a BMI of 15·0-50·0 kg/m2 and complete ethnicity data, were registered with a general practitioner practice in England at any point between Sept 1, 1990, and Dec 1, 2018, and had at least 1 year of follow-up data. Patients with type 2 diabetes were identified by use of a CALIBER phenotyping algorithm. Self-reported ethnicity was collapsed into five main categories. Age-adjusted and sex-adjusted negative binomial regression models, with fractional polynomials for BMI, were fitted with incident type 2 diabetes and ethnicity data. FINDINGS 1 472 819 people were included in our study, of whom 1 333 816 (90·6%) were White, 75 956 (5·2%) were south Asian, 49 349 (3·4%) were Black, 10 934 (0·7%) were Chinese, and 2764 (0·2%) were Arab. After a median follow-up of 6·5 years (IQR 3·2-11·2), 97 823 (6·6%) of 1 472 819 individuals were diagnosed with type 2 diabetes. For the equivalent age-adjusted and sex-adjusted incidence of type 2 diabetes at a BMI of 30·0 kg/m2 in White populations, the BMI cutoffs were 23·9 kg/m2 (95% CI 23·6-24·0) in south Asian populations, 28·1 kg/m2 (28·0-28·4) in Black populations, 26·9 kg/m2 (26·7-27·2) in Chinese populations, and 26·6 kg/m2 (26·5-27·0) in Arab populations. INTERPRETATION Revisions of ethnicity-specific BMI cutoffs are needed to ensure that minority ethnic populations are provided with appropriate clinical surveillance to optimise the prevention, early diagnosis, and timely management of type 2 diabetes. FUNDING National Institute for Health Research.
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Affiliation(s)
- Rishi Caleyachetty
- Nuffield Department of Population Health, University of Oxford, Oxford, UK; Warwick Medical School, University of Warwick, Coventry, UK.
| | - Thomas M Barber
- Warwick Medical School, University of Warwick, Coventry, UK; Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | | | - Rebecca Hardy
- Social Research Institute, University College London, London, UK
| | - Rohini Mathur
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, UK
| | - Paramjit Gill
- Warwick Medical School, University of Warwick, Coventry, UK
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Sanchez S, Teelucksingh S, Ali R, Bailey H, Legall G. Quality of Life and Health Status Among Patients Receiving Renal Replacement Therapy in Trinidad and Tobago, West Indies. Int J Nephrol Renovasc Dis 2021; 14:173-192. [PMID: 34135618 PMCID: PMC8199923 DOI: 10.2147/ijnrd.s302157] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 04/24/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The determinants of quality of life for patients on renal replacement therapy vary across the world. The aim of this study is to determine the quality of life of patients on renal replacement therapy in Trinidad and Tobago and predictors thereof. PATIENTS AND METHODS This cross-sectional study took place over a 1-year period. Data were obtained from 530 out of 1383 patients meeting inclusion criteria (100 transplants, 80 peritoneal dialyses, 350 hemodialyses) using the survey instruments. Stratified random sampling with proportional allocation was used to select patients at hemodialysis centres. The Kidney Disease Quality of Life questionnaire (KDQOL-36), EuroQol and demographic questionnaires were administered via face-to-face interviews. SPSS24, STATA14 and MINITAB18 were used for descriptive and inferential data analysis. RESULTS Of the 530 patients, 52.5% were male, 37.5% were in the 56-65 years age group and 51.3% were of Indo-Trinbagonian descent. Hypertension (25.5%) and type 2 diabetes mellitus (62.0%) were reported as the main causes of kidney disease in the dialysis group. In the transplant category, chronic glomerulonephritis (45%) was the main aetiology of kidney disease. The KDQOL-36 domain scores and significantly associated variables included modality of renal replacement, Charlson's Comorbidity Index, ethnicity, income and employment status. Transplant patients had higher mean subcomponent Kidney Disease Quality of Life scores and performed better in the EuroQol than patients on dialysis. Patients on peritoneal dialysis had a better quality of life than hemodialysis patients. Among patients on hemodialysis, an arteriovenous fistula significantly impacted their quality of life. CONCLUSION Renal transplant recipients enjoy the best quality of life and health state among patients on renal replacement therapy in Trinidad and Tobago. Increasing patients' access to renal transplantation or peritoneal dialysis will markedly improve health status for the number of years of renal replacement therapy.
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Affiliation(s)
- Sharlene Sanchez
- Department of Medicine, North Central Regional Health Authority, Arima General Hospital, Arima, Trinidad and Tobago, West Indies
| | - Surujpal Teelucksingh
- Department of Clinical Medical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago, West Indies
| | - Ronan Ali
- Department of Clinical Medical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago, West Indies
| | - Henry Bailey
- Department of Economics, University of the West Indies, St Augustine, Trinidad and Tobago, West Indies
| | - George Legall
- Department of Natural Sciences, University of the West Indies, St Augustine, Trinidad and Tobago, West Indies
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Jones S, Tillin T, Park C, Williams S, Rapala A, Al Saikhan L, Eastwood SV, Richards M, Hughes AD, Chaturvedi N. Cohort Profile Update: Southall and Brent Revisited (SABRE) study: a UK population-based comparison of cardiovascular disease and diabetes in people of European, South Asian and African Caribbean heritage. Int J Epidemiol 2021; 49:1441-1442e. [PMID: 33049759 PMCID: PMC7746410 DOI: 10.1093/ije/dyaa135] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 07/07/2020] [Indexed: 12/15/2022] Open
Affiliation(s)
- Siana Jones
- MRC Unit for Lifelong Health & Ageing at UCL, Department of Population Science & Experimental Medicine, Institute for Cardiovascular Science, UCL, London, UK
| | - Therese Tillin
- MRC Unit for Lifelong Health & Ageing at UCL, Department of Population Science & Experimental Medicine, Institute for Cardiovascular Science, UCL, London, UK
| | - Chloe Park
- MRC Unit for Lifelong Health & Ageing at UCL, Department of Population Science & Experimental Medicine, Institute for Cardiovascular Science, UCL, London, UK
| | - Suzanne Williams
- MRC Unit for Lifelong Health & Ageing at UCL, Department of Population Science & Experimental Medicine, Institute for Cardiovascular Science, UCL, London, UK
| | - Alicja Rapala
- MRC Unit for Lifelong Health & Ageing at UCL, Department of Population Science & Experimental Medicine, Institute for Cardiovascular Science, UCL, London, UK
| | - Lamia Al Saikhan
- MRC Unit for Lifelong Health & Ageing at UCL, Department of Population Science & Experimental Medicine, Institute for Cardiovascular Science, UCL, London, UK.,Department of Cardiac Technology, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Sophie V Eastwood
- MRC Unit for Lifelong Health & Ageing at UCL, Department of Population Science & Experimental Medicine, Institute for Cardiovascular Science, UCL, London, UK
| | - Marcus Richards
- MRC Unit for Lifelong Health & Ageing at UCL, Department of Population Science & Experimental Medicine, Institute for Cardiovascular Science, UCL, London, UK
| | - Alun D Hughes
- MRC Unit for Lifelong Health & Ageing at UCL, Department of Population Science & Experimental Medicine, Institute for Cardiovascular Science, UCL, London, UK
| | - Nishi Chaturvedi
- MRC Unit for Lifelong Health & Ageing at UCL, Department of Population Science & Experimental Medicine, Institute for Cardiovascular Science, UCL, London, UK
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Tudor K, Tearne S, Jebb SA, Lewis A, Adab P, Begh R, Jolly K, Daley A, Farley A, Lycett D, Nickless A, Aveyard P. Gender differences in response to an opportunistic brief intervention for obesity in primary care: Data from the BWeL trial. Clin Obes 2021; 11:e12418. [PMID: 33026192 DOI: 10.1111/cob.12418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/11/2020] [Accepted: 09/02/2020] [Indexed: 11/30/2022]
Abstract
Weight loss programmes appeal mainly to women, prompting calls for gender-specific programmes. In the United Kingdom, general practitioners (GPs) refer nine times as many women as men to community weight loss programmes. GPs endorsement and offering programmes systematically could reduce this imbalance. In this trial, consecutively attending patients in primary care with obesity were invited and 1882 were enrolled and randomized to one of two opportunistic 30-second interventions to support weight loss given by GPs in consultations unrelated to weight. In the support arm, clinicians endorsed and offered referral to a weight loss programme and, in the advice arm, advised that weight loss would improve health. Generalized linear mixed effects models examined whether gender moderated the intervention. Men took effective weight loss action less often in both arms (support: 41.6% vs 60.7%; advice: 12.1% vs 18.3%; odds ratio (OR) = 0.38, 95% confidence interval (CI), 0.27, 0.52, P < .001) but there was no evidence that the relative effect differed by gender (interaction P = .32). In the support arm, men accepted referral and attended referral less often, 69.3% vs 82.4%; OR = 0.48, 95% CI, 0.35, 0.66, P < .001 and 30.4% vs 47.6%; OR = 0.48, 95% CI, 0.36, 0.63, P < .001, respectively. Nevertheless, the gender balance in attending weight loss programmes closed to 1.6:1. Men and women attended the same number of sessions (9.7 vs 9.1 sessions, P = .16) and there was no evidence weight loss differed by gender (6.05 kg men vs 4.37 kg women, P = .39). Clinician-delivered opportunistic 30-second interventions benefits men and women equally and reduce most of the gender imbalance in attending weight loss programmes.
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Affiliation(s)
- Kate Tudor
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, UK
| | - Sarah Tearne
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, UK
| | - Amanda Lewis
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Peymane Adab
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Rachna Begh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Amanda Daley
- School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, UK
| | - Amanda Farley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Deborah Lycett
- Faculty Research Centre for Advances in Behavioural Science, Coventry University, Coventry, UK
| | | | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, UK
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Okuda M, Fujiwara A, Sasaki S. Added and Free Sugars Intake and Metabolic Biomarkers in Japanese Adolescents. Nutrients 2020; 12:nu12072046. [PMID: 32660122 PMCID: PMC7400823 DOI: 10.3390/nu12072046] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 02/07/2023] Open
Abstract
Reduction in the intakes of added and free sugars is a recommendation to lower cardiometabolic risks. Sugars intake is considered lowest in the Asian-Pacific region, particularly Japan. We examined the association between sugars intake and cardiometabolic risks in Japanese adolescents. We included 3242 students (mean age, 13.56 years) living in Shunan City, Japan, between 2006 and 2010. Sugars intake was estimated using the brief-type self-administered diet history questionnaire. Anthropometrics, serum lipids, fasting plasma glucose, and blood pressure were measured. Metabolic syndrome was determined by the combination of overweight and other risks. Intakes of added and free sugars were 7.6–7.9%E and 8.4–8.8%E of the total energy intake (%E), respectively. Categories based on quintiles of added or free sugars intakes were associated with fasting glucose, systolic blood pressure, and the z-score of metabolic syndrome (Ptrend ≤ 0.025). Other than the association between added sugars ≥10%E and high glucose (odds ratio 1.51, 95% confidence interval 1.04–2.19, p = 0.031), non-significantly high intakes of added or free sugars for risks occurred. Association was observed between added or free sugars intake and cardiometabolic biomarkers in Japanese adolescents, and added sugars intake <10%E could prevent glucose intolerance but not metabolic syndrome.
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Affiliation(s)
- Masayuki Okuda
- Graduate School of Sciences and Technology for Innovation, Yamaguchi University, 1-1-1 Minami-Kogushi, Ube 755-8505, Japan
- Correspondence: ; Tel.: +81-836-22-2231
| | - Aya Fujiwara
- Department of Nutritional Epidemiology and Shokuiku, National Institute of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8636, Japan;
- Department of Social and Preventive Epidemiology, Graduate School of Medicine, and School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan;
| | - Satoshi Sasaki
- Department of Social and Preventive Epidemiology, Graduate School of Medicine, and School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan;
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Affiliation(s)
- Amedeo Lonardo
- Operating Unit of Internal Medicine, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy.
- Operating Unit Metabolic Syndrome, Ospedale Civile di Baggiovara, Pietro Giardini, 1355 - 41126, 41126, Modena, Italy.
| | - Giovanni Targher
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
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Tudor K, Jebb SA, Manoharan I, Aveyard P. Brief interventions for obesity when patients are asked to pay for weight loss treatment: an observational study in primary care with an embedded randomised trial. Br J Gen Pract 2020; 70:e348-e355. [PMID: 32094219 PMCID: PMC7041639 DOI: 10.3399/bjgp20x708797] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 11/01/2019] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND A brief intervention whereby GPs opportunistically facilitate an NHS-funded referral to a weight loss programme is clinically and cost-effective. AIM To test the acceptability of a brief intervention and attendance at a weight loss programme when GPs facilitate a referral that requires patients to pay for the service. DESIGN AND SETTING An observational study of the effect of a GP encouraging attendance at a weight loss programme requiring self-payment in the West Midlands from 16 October 2018 to 30 November 2018, to compare with a previous trial in England in which the service was NHS-funded. METHOD Sixty patients with obesity who consecutively attended primary care appointments received an opportunistic brief intervention by a GP to endorse and offer a referral to a weight loss programme at the patient's own expense. Participants were randomised to GPs who either stated the weekly monetary cost of the programme (basic cost) or who compared the weekly cost to an everyday discretionary item (cost comparison). Participants were subsequently asked to report whether they had attended a weight loss programme. RESULTS Overall, 47% of participants (n = 28) accepted the referral; 50% (n = 15) in the basic cost group and 43% (n = 13) in the cost comparison group. This was significantly less than in a previous study when the programme was NHS-funded (77%, n = 722/940; P<0.0001). Most participants reported the intervention to be helpful/very helpful and appropriate/very appropriate (78%, n = 46/59 and 85%, n = 50/59, respectively) but scores were significantly lower than when the programme was NHS-funded (92% n = 851/922 and 88% n = 813/922, respectively; P = 0.004). One person (2%) attended the weight loss programme, which is significantly lower than the 40% of participants who attended when the programme was NHS-funded (P<0.0001). CONCLUSION GP referral to a weight loss programme that requires patients to pay rather than offering an NHS-funded programme is acceptable; however, it results in almost no attendance.
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Affiliation(s)
- Kate Tudor
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford; National Institute for Health Research Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford; National Institute for Health Research Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford
| | - Indrani Manoharan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford; National Institute for Health Research Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford
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Foley K, McNaughton D, Ward P. Monitoring the 'diabetes epidemic': A framing analysis of United Kingdom print news 1993-2013. PLoS One 2020; 15:e0225794. [PMID: 31951616 PMCID: PMC6968867 DOI: 10.1371/journal.pone.0225794] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/12/2019] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION The view that we are in the midst of a global diabetes epidemic has gained considerable ground in recent years and is often linked to the prior 'obesity epidemic'. This research explored how the diabetes epidemic was represented in United Kingdom (UK) news over the same time period that the obesity epidemic was widely reported. The research was motivated by a sociological interest in how postmodern 'epidemics' synergise with each other amidst broader political, economic, moral and sociocultural discourses. METHOD We analysed three time-bound samples of UK news articles about diabetes: 1993 (n = 19), 2001 (n = 119) and 2013 (n = 324). Until now, UK media has had the least attention regarding portrayal of diabetes. We adopted an empathically neutral approach and used a dual method approach of inductive thematic analysis and deductive framing analysis. The two methods were triangulated to produce the findings. RESULTS Framing of diabetes moved from medical in 1993 to behavioural in 2001, then societal in 2013. By 2001 obesity was conceptualised as causal to diabetes, rather than a risk factor. Between 2001 and 2013 portrayals of the modifiable risk factors for diabetes (i.e. diet, exercise and weight) became increasingly technical. Other risk factors like age, family history and genetics faded during 2001 and 2013, while race, ethnicity and culture were positioned as states of 'high risk' for diabetes. The notion of an 'epidemic' of diabetes 'powered up' these concerns from an individual problem to a societal threat in the context of obesity as a well-known health risk. DISCUSSION AND CONCLUSION Portraying diabetes and the diabetes epidemic as anticipated consequences of obesity enlivens the heightened awareness to future risks in everyday life brought about during the obesity epidemic. The freeform adoption of the 'epidemic' term in contemporary health discourse appears to foster individual and societal dependence on biomedicine, giving it political, economic and divisive utility.
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Affiliation(s)
- Kristen Foley
- Discipline of Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Darlene McNaughton
- Discipline of Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Paul Ward
- Discipline of Public Health, Flinders University, Adelaide, South Australia, Australia
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Khaghanzadeh N, Naderi N, Pournasrollah N, Farahbakhsh E, Kheirandish M, Samiei A. TLR4 Polymorphisms (896A>G and 1196C>T) Affect the Predisposition to Diabetic Nephropathy in Type 2 Diabetes Mellitus. Diabetes Metab Syndr Obes 2020; 13:1015-1021. [PMID: 32308451 PMCID: PMC7138628 DOI: 10.2147/dmso.s238942] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 03/23/2020] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Type 2 diabetes mellitus (T2DM) is a disease with a steadily increasing incidence throughout the world. Some molecules regulating the innate immune responses such as toll-like receptor 4 (TLR4) have shown to be involved in late diabetic complications. This study aimed to investigate the association of TLR4 gene polymorphisms with clinicopathological aspects of T2DM in the Iranian population. PATIENTS AND METHODS Two TLR4 896A>G and 1196C>T polymorphisms were assessed in 100 T2DM patients and 100 healthy controls using sequence-specific primers PCR. Demographic, anthropometric, and biochemical parameters were obtained from the participants. RESULTS After logistic regression, in 1196C>T, a significant association was shown between diabetic nephropathy (DN) and CT genotype (P= 0.04, OR= 4.35, CI= (1.04-18.1)). TG level has increased significantly in both T2DM and control subjects with CT genotype (P= 0.027, OR= 1.005, 95% CI= (1.001-1.01)). For 896A>G variant, a significant association was also detected between AG genotype and increased oral glucose tolerance test (OGTT) level (P= 0.048, OR= 1.003, 95% CI= (1.00-1.005)). CONCLUSION Although minor alleles of 1196C>T and 896A>G variants have not directly been associated with type 2 diabetes, by involving in the dysregulation of serum TG and blood sugar levels, they might increase the risk of DN.
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Affiliation(s)
- Narges Khaghanzadeh
- Molecular Medicine Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Nadereh Naderi
- Molecular Medicine Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Nazanin Pournasrollah
- Molecular Medicine Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Elahe Farahbakhsh
- Molecular Medicine Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Masoumeh Kheirandish
- Endocrinology and Metabolism Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Afshin Samiei
- Molecular Medicine Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
- Department of Immunology, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
- Correspondence: Afshin Samiei Department of Immunology, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas7919693116, IranTel +98 76 337103070Fax +98 76 33710371 Email
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Paiman EHM, van Eyk HJ, Bizino MB, Dekkers IA, de Heer P, Smit JWA, Jazet IM, Lamb HJ. Phenotyping diabetic cardiomyopathy in Europeans and South Asians. Cardiovasc Diabetol 2019; 18:133. [PMID: 31604432 PMCID: PMC6788052 DOI: 10.1186/s12933-019-0940-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 10/01/2019] [Indexed: 01/07/2023] Open
Abstract
Background The pathogenesis and cardiovascular impact of type 2 diabetes (T2D) may be different in South Asians compared with other ethnic groups. The phenotypic characterization of diabetic cardiomyopathy remains debated and little is known regarding differences in T2D-related cardiovascular remodeling across ethnicities. We aimed to characterize the differences in left ventricular (LV) diastolic and systolic function, LV structure, myocardial tissue characteristics and aortic stiffness between T2D patients and controls and to assess the differences in T2D-related cardiovascular remodeling between South Asians and Europeans. Methods T2D patients and controls of South Asian and European descent underwent 3 Tesla cardiovascular magnetic resonance imaging (CMR) and cardiac proton-magnetic resonance spectroscopy (1H-MRS). Differences in cardiovascular parameters between T2D patients and controls were examined using ANCOVA and were reported as mean (95% CI). Ethnic group comparisons in the association of T2D with cardiovascular remodeling were made by adding the interaction term between ethnicity and diabetes status to the model. Results A total of 131 individuals were included (54 South Asians [50.1 ± 8.7 years, 33% men, 33 patients vs. 21 controls) and 77 Europeans (58.8 ± 7.0 years, 56% men, 48 patients vs. 29 controls)]. The ratio of the transmitral early and late peak filling rate (E/A) was lower in T2D patients compared with controls, in South Asians [− 0.20 (− 0.36; − 0.03), P = 0.021] and Europeans [− 0.20 (− 0.36; − 0.04), P = 0.017], whereas global longitudinal strain and aortic pulse wave velocity were similar. South Asian T2D patients had a higher LV mass [+ 22 g (15; 30), P < 0.001] (P for interaction by ethnicity = 0.005) with a lower extracellular volume fraction [− 1.9% (− 3.4; − 0.4), P = 0.013] (P for interaction = 0.114), whilst European T2D patients had a higher myocardial triglyceride content [+ 0.59% (0.35; 0.84), P = 0.001] (P for interaction = 0.002) than their control group. Conclusions Diabetic cardiomyopathy was characterized by impaired LV diastolic function in South Asians and Europeans. Increased LV mass was solely observed among South Asian T2D patients, whereas differences in myocardial triglyceride content between T2D patients and controls were only present in the European cohort. The diabetic cardiomyopathy phenotype may differ between subsets of T2D patients, for example across ethnicities, and tailored strategies for T2D management may be required.
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Affiliation(s)
- Elisabeth H M Paiman
- Dept. Radiology, Leiden University Medical Center, P.O. Box 9600, Postal Zone C2-S, 2300 RC, Leiden, The Netherlands.
| | - Huub J van Eyk
- Dept. Internal Medicine, Leiden University Medical Center, P.O. Box 9600, Postal Zone C7-Q, 2300 RC, Leiden, The Netherlands
| | - Maurice B Bizino
- Dept. Internal Medicine, Leiden University Medical Center, P.O. Box 9600, Postal Zone C7-Q, 2300 RC, Leiden, The Netherlands
| | - Ilona A Dekkers
- Dept. Radiology, Leiden University Medical Center, P.O. Box 9600, Postal Zone C2-S, 2300 RC, Leiden, The Netherlands
| | - Paul de Heer
- Dept. Radiology, Leiden University Medical Center, P.O. Box 9600, Postal Zone C2-S, 2300 RC, Leiden, The Netherlands
| | - Johannes W A Smit
- Dept. Internal Medicine, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Ingrid M Jazet
- Dept. Internal Medicine, Leiden University Medical Center, P.O. Box 9600, Postal Zone C7-Q, 2300 RC, Leiden, The Netherlands
| | - Hildo J Lamb
- Dept. Radiology, Leiden University Medical Center, P.O. Box 9600, Postal Zone C2-S, 2300 RC, Leiden, The Netherlands
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Abstract
Type 2 diabetes is a major UK public health priority. Among minority ethnic communities, the prevalence is alarmingly high, approximately three to five times higher than in the white British population. Particularly striking is the earlier onset of Type 2 diabetes, which occurs some 10-12 years younger, with a significant proportion of cases being diagnosed before the age of 40 years. This review focuses on the UK context and Type 2 diabetes in adult populations, exploring the available evidence regarding the complex interplay of biological, lifestyle, social, clinical and healthcare system factors that are known to drive these disparities.
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Affiliation(s)
- L M Goff
- Diabetes Research Group, Departments of Diabetes and Nutritional Sciences, King's College London, London, UK
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Pomeroy E, Mushrif-Tripathy V, Cole TJ, Wells JCK, Stock JT. Ancient origins of low lean mass among South Asians and implications for modern type 2 diabetes susceptibility. Sci Rep 2019; 9:10515. [PMID: 31324875 PMCID: PMC6642207 DOI: 10.1038/s41598-019-46960-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 07/05/2019] [Indexed: 12/21/2022] Open
Abstract
Living South Asians have low lean tissue mass relative to height, which contributes to their elevated type 2 diabetes susceptibility, particularly when accompanied by obesity. While ongoing lifestyle transitions account for rising obesity, the origins of low lean mass remain unclear. We analysed proxies for lean mass and stature among South Asian skeletons spanning the last 11,000 years (n = 197) to investigate the origins of South Asian low lean mass. Compared with a worldwide sample (n = 2,003), South Asian skeletons indicate low lean mass. Stature-adjusted lean mass increased significantly over time in South Asia, but to a very minor extent (0.04 z-score units per 1,000 years, adjusted R2 = 0.01). In contrast stature decreased sharply when agriculture was adopted. Our results indicate that low lean mass has characterised South Asians since at least the early Holocene and may represent long-term climatic adaptation or neutral variation. This phenotype is therefore unlikely to change extensively in the short term, so other strategies to address increasing non-communicable disease rates must be pursued.
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Affiliation(s)
- Emma Pomeroy
- Department of Archaeology, University of Cambridge, Downing Street, Cambridge, CB2 3DZ, UK.
| | - Veena Mushrif-Tripathy
- Department of Archaeology, Deccan College Postgraduate and Research Institute, Yerwada, Pune, 411 006, India
| | - Tim J Cole
- UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
| | - Jonathan C K Wells
- UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
| | - Jay T Stock
- ADaPt Project, PAVE Research Group, Department of Archaeology, University of Cambridge, Pembroke Street, Cambridge, CB2 3DZ, UK
- Department of Anthropology, University of Western Ontario, London, Ontario, N6A 5C2, Canada
- Department of Archaeology, Max Planck Institute for the Science of Human History, Kahlaische Strasse 10, Jena, Germany, Jena, Germany
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Ethnic distinctions in the pathophysiology of type 2 diabetes: a focus on black African-Caribbean populations. Proc Nutr Soc 2019; 79:184-193. [PMID: 31307560 DOI: 10.1017/s0029665119001034] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Type 2 diabetes (T2D) is a global public health priority, particularly for populations of black African-Caribbean ethnicity, who suffer disproportionately high rates of the disease. While the mechanisms underlying the development of T2D are well documented, there is growing evidence describing distinctions among black African-Caribbean populations. In the present paper, we review the evidence describing the impact of black African-Caribbean ethnicity on T2D pathophysiology. Ethnic differences were first recognised through evidence that metabolic syndrome diagnostic criteria fail to detect T2D risk in black populations due to less central obesity and dyslipidaemia. Subsequently more detailed investigations have recognised other mechanistic differences, particularly lower visceral and hepatic fat accumulation and a distinctly hyperinsulinaemic response to glucose stimulation. While epidemiological studies have reported exaggerated insulin resistance in black populations, more detailed and direct measures of insulin sensitivity have provided evidence that insulin sensitivity is not markedly different to other ethnic groups and does not explain the hyperinsulinaemia that is exhibited. These findings lead us to hypothesise that ectopic fat does not play a pivotal role in driving insulin resistance in black populations. Furthermore, we hypothesise that hyperinsulinaemia is driven by lower rates of hepatic insulin clearance rather than heightened insulin resistance and is a primary defect rather than occurring in compensation for insulin resistance. These hypotheses are being investigated in our ongoing South London Diabetes and Ethnicity Phenotyping study, which will enable a more detailed understanding of ethnic distinctions in the pathophysiology of T2D between men of black African and white European ethnicity.
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Kloecker DE, Zaccardi F, Baldry E, Davies MJ, Khunti K, Webb DR. Efficacy of low- and very-low-energy diets in people with type 2 diabetes mellitus: A systematic review and meta-analysis of interventional studies. Diabetes Obes Metab 2019; 21:1695-1705. [PMID: 30924575 DOI: 10.1111/dom.13727] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/11/2019] [Accepted: 03/26/2019] [Indexed: 12/29/2022]
Abstract
AIMS To review systematically and quantify the weight loss achieved through low- (LEDs) and very-low-energy diets (VLEDs) in people with type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS Studies reporting the effects of diet-only interventions of up to 1600 kcal/d in people with T2DM were searched in MEDLINE, EMBASE and CINAHL up to July 2018. Changes in the primary (body weight and body mass index [BMI]) and secondary outcomes (glycated haemoglobin, blood lipids) according to energy restriction and duration of diet were modelled using restricted cubic splines. RESULTS Forty-four studies (3817 participants) were included. The overall quality of the evidence was moderate and limited to short-term interventions up to 4 months. Baseline mean weight and BMI were 92.1 kg and 36.6 kg/m2 . VLEDs of 400 kcal/d led to 5.4% weight loss at 2 weeks, increasing to 17.9% at 3 months. More modest reductions of 7.3% were observed on LEDs of 1200 kcal/d and 2.0% on 1600 kcal/d after 3 months. No clear patterns emerged for secondary outcomes. Publication bias was significant for primary outcomes. CONCLUSIONS Through modelling, we were able to describe effective dietary deficit strategies to achieve weight reduction up to 4 months in people with T2DM. High-quality studies are required to further support clinical practice with evidence-based dietary interventions.
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Affiliation(s)
- David E Kloecker
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Francesco Zaccardi
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Emma Baldry
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK
- National Institute for Health Research, Biomedical Research Centre, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK
- National Institute for Health Research, Collaboration for Leadership in Applied Health Research and Care East Midlands, Leicester General Hospital, Leicester, UK
| | - David R Webb
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK
- National Institute for Health Research, Biomedical Research Centre, Leicester, UK
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Matsha TE, Ismail S, Speelman A, Hon GM, Davids S, Erasmus RT, Kengne AP. Visceral and subcutaneous adipose tissue association with metabolic syndrome and its components in a South African population. Clin Nutr ESPEN 2019; 32:76-81. [PMID: 31221294 DOI: 10.1016/j.clnesp.2019.04.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 03/28/2019] [Accepted: 04/29/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS A number of studies concur that visceral abdominal tissue (VAT) is a metabolic organ that mostly contributes to the metabolic consequences of obesity, however reports regarding subcutaneous adipose tissue (SAT) are controversial. We aimed to investigate the association between computed tomography measured visceral and subcutaneous adipose tissue and metabolic syndrome as well as its individual components. METHODS Computed tomography at level L4/L5 intervertebral disc space was performed in 401 mixed ancestry individuals from the Bellville South community of Cape Town. Data collections included OGTT, anthropometric, blood pressure, lipids, insulin cotinine, and alcohol consumption history. RESULTS Both VAT and SAT were increased in subjects with metabolic syndrome (p < 0.0001). In logistic regression, adjusted for age, gender, BMI, smoking, alcohol use, hypertension, diabetes and dyslipidaemia treatment (for women also adjusted for menopausal age) increasing quartiles of VAT were associated with metabolic syndrome {odds ratio (95% confidence interval) ≥ 4.14 (1.92-8.93), p < 0.001} and any type of hyperglycaemia (≥4.45 (1.89-10.47), p ≤ 0.001) whilst decreasing quartiles of SAT were associated with metabolic syndrome, p ≤ 0.037. In gender specific multivariate linear regression models, increased SAT levels were associated with 2-h plasma glucose, insulin levels and triglycerides in men, β ≥ 0.999, p ≤ 0.01. CONCLUSIONS Our study shows that increased VAT and decreased SAT are associated with metabolic syndrome in women, but in men increased SAT has deleterious effects to metabolic syndrome components. Therefore, in men increased SAT may like VAT increase the risk of diabetes development.
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Affiliation(s)
- Tandi E Matsha
- SAMRC/CPUT/Cardiometabolic Health Research Unit, Department of Biomedical Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa.
| | - Saaiga Ismail
- SAMRC/CPUT/Cardiometabolic Health Research Unit, Department of Biomedical Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa; MITS, Faculty of Health and Wellness Science, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Aladdin Speelman
- SAMRC/CPUT/Cardiometabolic Health Research Unit, Department of Biomedical Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa; MITS, Faculty of Health and Wellness Science, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Gloudina M Hon
- SAMRC/CPUT/Cardiometabolic Health Research Unit, Department of Biomedical Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Saarah Davids
- SAMRC/CPUT/Cardiometabolic Health Research Unit, Department of Biomedical Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Rajiv T Erasmus
- Division of Chemical Pathology, Faculty of Health Sciences, National Health Laboratory Service (NHLS) and University of Stellenbosch, Cape Town, South Africa
| | - Andre P Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa; Department of Medicine, University of Cape Town, Cape Town, South Africa
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Skogberg N, Laatikainen T, Lilja E, Lundqvist A, Härkänen T, Koponen P. The association between anthropometric measures and glycated haemoglobin (HbA1c) is different in Russian, Somali and Kurdish origin migrants compared with the general population in Finland: a cross-sectional population-based study. BMC Public Health 2019; 19:391. [PMID: 30971258 PMCID: PMC6458679 DOI: 10.1186/s12889-019-6698-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 03/25/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Persons of African and Middle-Eastern origin living in European countries have a high prevalence of type 2 diabetes, accompanied by high prevalence of obesity among women but not always among men. The aim of this study was to examine whether there are differences in the association between anthropometric measures and glucose levels measured with glycated haemoglobin and fasting blood glucose among persons of migrant origin in Finland. METHODS Cross-sectional population-based data of the 30-64 year-old participants in the health examination of the Migrant Health and Wellbeing Study was used, selecting persons without diabetes (Russian origin n = 293, Somali origin n = 184, Kurdish origin n = 275). The reference group were non-diabetic participants in the Health 2011 Survey (n = 653), representative of the general Finnish population. Anthropometric measures included body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR) and waist-to-hip ratio (WHR, available for Maamu Study participants only). RESULTS Depending on whether continuous or categorical anthropometric measures were used, age, sex and anthropometrics explained 13-18% of variation in HbA1c among persons of Russian origin, 5-10% among persons of Somali origin, 1-3% among persons of Kurdish origin and 11-13% among the general population. Also depending on whether continuous or categorical anthropometric measures were used, age, sex and anthropometrics explained 13-19% of variation in fasting blood glucose among persons of Russian origin, 15-20% among persons of Somali origin, 13-17% among persons of Kurdish origin and 16-17% among the general population. With exception for BMI, strength of the association between continuous anthropometric measures and HbA1c was significantly lower among persons of Kurdish origin compared with the general Finnish population (p = 0.044 for WC and p = 0.040 for WHtR). CONCLUSIONS A low degree of association between anthropometric measures and HbA1c was observed among persons of Kurdish origin. Findings of this study suggest caution is warranted when using HbA1c as a screening tool for glucose impairment among persons without diabetes in populations of diverse origin.
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Affiliation(s)
- Natalia Skogberg
- Department of Welfare, National Institute for Health and Welfare, Mannerheimintie 166, PL 30, 00271, Helsinki, Finland.
| | - Tiina Laatikainen
- Department of Public Health Solutions, National Institute for Health and Welfare, Mannerheimintie 166, PL 30, 00271, Helsinki, Finland.,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, PL 1627, 70211, Kuopio, Finland.,Joint municipal authority for North Karelia social and health services, Tikkamäentie 16, 80210, Joensuu, Finland
| | - Eero Lilja
- Department of Welfare, National Institute for Health and Welfare, Mannerheimintie 166, PL 30, 00271, Helsinki, Finland
| | - Annamari Lundqvist
- Department of Public Health Solutions, National Institute for Health and Welfare, Mannerheimintie 166, PL 30, 00271, Helsinki, Finland
| | - Tommi Härkänen
- Department of Public Health Solutions, National Institute for Health and Welfare, Mannerheimintie 166, PL 30, 00271, Helsinki, Finland
| | - Päivikki Koponen
- Department of Public Health Solutions, National Institute for Health and Welfare, Mannerheimintie 166, PL 30, 00271, Helsinki, Finland
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Mascarenhas M, Kulkarni M, Balen A. Can the ethnic differences in IVF cycle outcome be influenced by the impact of BMI? HUM FERTIL 2019; 23:275-281. [DOI: 10.1080/14647273.2018.1563915] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
| | - Mugdha Kulkarni
- Leeds Fertility, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Adam Balen
- Leeds Fertility, Leeds Teaching Hospital NHS Trust, Leeds, UK
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Owusu Adjah ES, Ray KK, Paul SK. Ethnicity-specific association of BMI levels at diagnosis of type 2 diabetes with cardiovascular disease and all-cause mortality risk. Acta Diabetol 2019; 56:87-96. [PMID: 30167871 DOI: 10.1007/s00592-018-1219-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 08/20/2018] [Indexed: 01/19/2023]
Abstract
AIM To evaluate the risk of CVD and all-cause mortality at different BMI levels in conjunction with weight change prior to diagnosis of T2DM in a multi-ethnic population. METHODS Longitudinal study of 51,455 patients with T2DM and without a history of comorbid diseases at diagnosis. Weight changes prior to diagnosis of T2DM were evaluated, and the risk of CVD and all-cause mortality at different BMI levels among three ethnic groups estimated using treatment effects model. RESULTS White Europeans (WE), African-Caribbeans (AC), and South Asians (SA) were mean 52, 49, and 47 years with a mean BMI of 33.0, 32.0, and 30.0 kg/m2 at diagnosis, respectively. Among WE, normal weight patients developed CVD significantly earlier by 0.5 years (95% CI 0.1, 0.9 years; p = 0.018) compared to obese patients. Furthermore, those with normal body weight at diagnosis were significantly more likely to die earlier by 0.6 years (95% CI 0.03, 1.2 years; p = 0.037) among WE and by 2.5 years (95% CI 0.3, 4.6 years; p = 0.023) among SA compared to their respective obese patients. However, BMI at diagnosis was not associated with increased risk of CVD and death among AC. CONCLUSIONS This study suggests a paradoxical association of BMI with cardiovascular and mortality risks in different ethnic groups, which may partially be driven by different cardiovascular and glycaemic risk profiles at diagnosis.
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Affiliation(s)
- Ebenezer S Owusu Adjah
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Kausik K Ray
- Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Sanjoy K Paul
- Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Australia.
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Hudda MT, Donin AS, Owen CG, Rudnicka AR, Sattar N, Cook DG, Whincup PH, Nightingale CM. Exploring the use of adjusted body mass index thresholds based on equivalent insulin resistance for defining overweight and obesity in UK South Asian children. Int J Obes (Lond) 2018; 43:1440-1443. [PMID: 30546135 PMCID: PMC6451638 DOI: 10.1038/s41366-018-0279-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 10/12/2018] [Accepted: 11/04/2018] [Indexed: 11/09/2022]
Abstract
Background Body mass index (BMI) overweight/obesity thresholds in South Asian (SA) adults, at equivalent type-2 diabetes risk are lower than for white Europeans (WE). We aimed to define adjusted overweight/obesity thresholds for UK–SA children based on equivalent insulin resistance (HOMA-IR) to WE children. Methods In 1138 WE and 1292 SA children aged 9.0–10.9 years, multi-level regression models quantified associations between BMI and HOMA-IR by ethnic group. HOMA-IR levels for WE children were calculated at established overweight/obesity thresholds (at 9.5 years and 10.5 years), based on UK90 BMI cut-offs. Quantified associations in SA children were then used to estimate adjusted SA weight-status thresholds at the calculated HOMA-IR levels. Results At 9.5 years, current WE BMI overweight and obesity thresholds were 19.2 kg/m2, 21.3 kg/m2 (boys) and 20.0 kg/m2, 22.5 kg/m2 (girls). At equivalent HOMA-IR, SA overweight and obesity thresholds were lower by 2.9 kg/m2 (95% CI: 2.5–3.3 kg/m2) and 3.2 kg/m2 (95% CI: 2.7–3.6 kg/m2) in boys and 3.0 kg/m2 (95% CI: 2.6–3.4 kg/m2) and 3.3 kg/m2 (95% CI: 2.8–3.8 kg/m2) in girls, respectively. At these lower thresholds, overweight/obesity prevalences in SA children were approximately doubled (boys: 61%, girls: 56%). Patterns at 10.5 years were similar. Conclusions SA adjusted overweight/obesity thresholds based on equivalent IR were markedly lower than BMI thresholds for WE children, and defined more than half of SA children as overweight/obese.
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Affiliation(s)
- Mohammed T Hudda
- Population Health Research Institute, St George's, University of London, London, UK.
| | - Angela S Donin
- Population Health Research Institute, St George's, University of London, London, UK
| | - Christopher G Owen
- Population Health Research Institute, St George's, University of London, London, UK
| | - Alicja R Rudnicka
- Population Health Research Institute, St George's, University of London, London, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland, UK
| | - Derek G Cook
- Population Health Research Institute, St George's, University of London, London, UK
| | - Peter H Whincup
- Population Health Research Institute, St George's, University of London, London, UK.
| | - Claire M Nightingale
- Population Health Research Institute, St George's, University of London, London, UK.
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Taylor R, Lin S, Linhart C, Morrell S. Overview of trends in cardiovascular and diabetes risk factors in Fiji. Ann Hum Biol 2018; 45:188-201. [PMID: 29877150 DOI: 10.1080/03014460.2018.1465122] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
CONTEXT Fiji has undergone an epidemiological transition, characterised by declining infectious disease and childhood mortality, that has been offset by rising cardiovascular disease mortality. Other Pacific Island states are in a comparable situation. OBJECTIVE With a focus on Fiji, this study reviews and contextualises research performed by the authors and others that examines cardiovascular disease (CVD) and type 2 diabetes (T2DM) and their risk factors in Pacific Island states. METHODS This overview covers evidence for the causes and consequences of CVD risk factors and the epidemiological transition and reflects on biological and evolutionary hypotheses. It is based on studies the authors carried out that synthesised disparate population-based CVD risk factor surveys conducted in Fiji over 1980-2012. RESULTS Prevalences of obesity, T2DM and hypertension continue to increase in the Fiji population. Tobacco smoking prevalence has decreased, but remains relatively high in men compared to many developed countries. T2DM and hypertension trends, and CVD consequences related to diet, exercise and tobacco smoking, have placed the Fiji population in a variant of the epidemiological transition manifesting as a plateau in life expectancy similar to that of numerous developed countries during the mid-20th century. CONCLUSION There is evidence that risk factors and consequent CVD mortality can be reduced in populations. Obesity and T2DM reductions have been observed only in populations surviving in dire circumstances. Interventions to lower the prevalence of CVD and T2DM risk factors in the Fiji population require multi-faceted approaches, with continual monitoring and evaluation for their impact on these risk factors and morbidity and mortality outcomes.
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Affiliation(s)
- R Taylor
- a School of Public Health and Community Medicine , University of NSW , Sydney , Australia
| | - S Lin
- a School of Public Health and Community Medicine , University of NSW , Sydney , Australia
| | - C Linhart
- a School of Public Health and Community Medicine , University of NSW , Sydney , Australia
| | - S Morrell
- a School of Public Health and Community Medicine , University of NSW , Sydney , Australia
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McCurley JL, Penedo F, Roesch SC, Isasi CR, Carnethon M, Sotres-Alvarez D, Schneiderman N, Gonzalez P, Chirinos DA, Camacho A, Teng Y, Gallo LC. Psychosocial Factors in the Relationship between Socioeconomic Status and Cardiometabolic Risk: the HCHS/SOL Sociocultural Ancillary Study. Ann Behav Med 2018; 51:477-488. [PMID: 28130624 DOI: 10.1007/s12160-016-9871-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND U.S. Hispanics/Latinos display a high prevalence of metabolic syndrome (MetSyn), a group of co-occurring cardiometabolic risk factors (abdominal obesity, impaired fasting glucose, dyslipidemia, elevated blood pressure) associated with higher cardiovascular disease and mortality risk. Low socioeconomic status (SES) is associated with higher risk for MetSyn in Hispanics/Latinos, and psychosocial factors may play a role in this relationship. PURPOSE This cross-sectional study examined psychosocial factors in the association of SES and MetSyn components in 4,996 Hispanic/Latino adults from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study. METHODS MetSyn components were measured at the baseline examination. Participants completed interviews to determine psychosocial risks (e.g., depression) and resources (e.g., social support) within 9 months of baseline (< 4 months in 72.6% of participants). Confirmatory factor analysis (CFA) and structural equation modeling (SEM) were used to identify latent constructs and examine associations. RESULTS Participant mean age was 41.7 years (SE = 0.4) and 62.7% were female. CFA identified single latent factors for SES and psychosocial indicators, and three factors for MetSyn [blood pressure, lipids, metabolic factors]. SEMs showed that lower SES was related to MetSyn factors indirectly through higher psychosocial risk/lower resources (Y-Bχ2 (df = 420) = 4412.90, p < .05, RMSEA = .042, SRMR = .051). A statistically significant effect consistent with mediation was found from lower SES to higher metabolic risk (glucose/waist circumference) via psychosocial risk/resource variables (Mackinnon's 95% asymmetric CI = -0.13 to -0.02). CONCLUSIONS SES is related to metabolic variables indirectly through psychosocial factors in U.S. Hispanics/Latinos of diverse ancestries.
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Affiliation(s)
- Jessica L McCurley
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA
| | - Frank Penedo
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Scott C Roesch
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Carmen R Isasi
- Deptartment of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mercedes Carnethon
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Daniela Sotres-Alvarez
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Neil Schneiderman
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Patricia Gonzalez
- Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - Diana A Chirinos
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Alvaro Camacho
- Departments of Psychiatry and Family Medicine and Public Health, University of California, San Diego, San Diego, CA, USA
| | - Yanping Teng
- Department of Biostatistics, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, CA, USA. .,South Bay Latino Research Center, 450 4th Ave, Suite 304, Chula Vista, CA, 91910, USA.
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Pomeroy E, Mushrif-Tripathy V, Kulkarni B, Kinra S, Stock JT, Cole TJ, Shirley MK, Wells JCK. Estimating body mass and composition from proximal femur dimensions using dual energy x-ray absorptiometry. ARCHAEOLOGICAL AND ANTHROPOLOGICAL SCIENCES 2018; 11:2167-2179. [PMID: 31565085 PMCID: PMC6743672 DOI: 10.1007/s12520-018-0665-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 06/04/2018] [Indexed: 06/10/2023]
Abstract
Body mass prediction from the skeleton most commonly employs femoral head diameter (FHD). However, theoretical predictions and empirical data suggest the relationship between mass and FHD is strongest in young adults, that bone dimensions reflect lean mass better than body or fat mass and that other femoral measurements may be superior. Here, we generate prediction equations for body mass and its components using femoral head, neck and proximal shaft diameters and body composition data derived from dual-energy x-ray absorptiometry (DXA) scans of young adults (n = 155, 77 females and 78 males, mean age 22.7 ± 1.3 years) from the Andhra Pradesh Children and Parents Study, Hyderabad, India. Sex-specific regression of log-transformed data on femoral measurements predicted lean mass with smaller standard errors of estimate (SEEs) than body mass (12-14% and 16-17% respectively), while none of the femoral measurements were significant predictors of fat mass. Subtrochanteric mediolateral shaft diameter gave lower SEEs for lean mass in both sexes and for body mass in males than FHD, while FHD was a better predictor of body mass in women. Our results provide further evidence that lean mass is more closely related to proximal femur dimensions than body or fat mass and that proximal shaft diameter is a better predictor than FHD of lean but not always body mass. The mechanisms underlying these relationships have implications for selecting the most appropriate measurement and reference sample for estimating body or lean mass, which also depend on the question under investigation.
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Affiliation(s)
- Emma Pomeroy
- School of Natural Sciences and Psychology, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF UK
| | | | | | - Sanjay Kinra
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Jay T. Stock
- ADaPt Project, PAVE Research Group, Department of Archaeology and Anthropology, University of Cambridge, Cambridge, UK
| | - Tim J. Cole
- UCL Great Ormond Street Institute of Child Health, UCL, London, UK
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Forouhi NG, Misra A, Mohan V, Taylor R, Yancy W. Dietary and nutritional approaches for prevention and management of type 2 diabetes. BMJ 2018; 361:k2234. [PMID: 29898883 PMCID: PMC5998736 DOI: 10.1136/bmj.k2234] [Citation(s) in RCA: 215] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Nita G Forouhi
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Anoop Misra
- Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, and National Diabetes, Obesity and Cholesterol Foundation, New Delhi, India
| | - Viswanathan Mohan
- Dr Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India
| | - Roy Taylor
- Magnetic Resonance Centre, Institute of Cellular Medicine, Newcastle University, Newcastle, UK
| | - William Yancy
- Duke University Diet and Fitness Center, Durham, North Carolina, USA
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Center for Health Services Research in Primary Care, Department of Veterans Affairs, Durham, North Carolina, USA
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Ding T, Hardiman PJ, Petersen I, Baio G. Incidence and prevalence of diabetes and cost of illness analysis of polycystic ovary syndrome: a Bayesian modelling study. Hum Reprod 2018; 33:1299-1306. [DOI: 10.1093/humrep/dey093] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 04/03/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Tao Ding
- Department of Statistical Science, University College London, 1-19 Torrington Place, London, UK
| | - Paul J Hardiman
- Institute for Women's Health, University College London Medical School, Royal Free Campus, Rowland Hill Street, London, UK
| | - Irene Petersen
- Department of Primary Care and Population Health, University College London, Upper 3rd Floor, Royal Free Campus, Rowland Hill Street, London, UK
| | - Gianluca Baio
- Department of Statistical Science, University College London, 1-19 Torrington Place, London, UK
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Sulaiman N, Elbadawi S, Hussein A, Abusnana S, Madani A, Mairghani M, Alawadi F, Sulaiman A, Zimmet P, Huse O, Shaw J, Peeters A. Prevalence of overweight and obesity in United Arab Emirates Expatriates: the UAE National Diabetes and Lifestyle Study. Diabetol Metab Syndr 2017; 9:88. [PMID: 29118852 PMCID: PMC5667520 DOI: 10.1186/s13098-017-0287-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 10/21/2017] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To describe current prevalence of obesity and related non-communicable diseases (NCDs) in expatriates living in the United Arab Emirates (UAE). METHODS We used data from the cross-sectional UAE National Diabetes and Lifestyle Study (UAEDIAB), which surveyed adult expatriates living in the UAE for at least 4 years. We report crude prevalence of overweight and obesity, indicated by gender and ethnicity-specific body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) cut-offs, by lifestyle and biomedical characteristics, as well as age and sex-adjusted odds ratios. RESULTS Out of a total of 3064 recruited expatriates (response rate 68%), 2724 had completed all stages of the UAEDIAB study. Expatriates were; 81% men, mean age 38 years (range 18-80), 71% South East Asians, and 36% university graduates. In this sample, the prevalence of overweight and obesity, by BMI, were 43.0 and 32.3%, respectively. 52.4 and 56.5% of participants were at a substantially increased risk according to WC and WHR, respectively. The prevalence of diabetes, hypertension and hypercholesterolemia were 15.5, 31.8, and 51.7%, respectively, with the prevalence of each being higher in those with obesity. CONCLUSION Prevalence of obesity and associated NCDs are extremely high in UAE expatriates. Without comprehensive prevention and management, levels of disease will continue to increase and productivity will fall.
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Affiliation(s)
- Nabil Sulaiman
- Department of Family and Community Medicine, College of Medicine, University of Sharjah, P.O. Box 27272, Sharjah, UAE
| | | | - Amal Hussein
- Department of Family and Community Medicine, College of Medicine, University of Sharjah, P.O. Box 27272, Sharjah, UAE
| | | | | | | | | | - Ahmad Sulaiman
- College of Medicine, University of New South Wales (UNSW), Sydney, Australia
| | | | - Oliver Huse
- School of Health and Social Development, Deakin University, Geelong, VIC Australia
| | | | - Anna Peeters
- School of Health and Social Development, Deakin University, Geelong, VIC Australia
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Emadian A, England CY, Thompson JL. Dietary intake and factors influencing eating behaviours in overweight and obese South Asian men living in the UK: mixed method study. BMJ Open 2017; 7:e016919. [PMID: 28729327 PMCID: PMC5541587 DOI: 10.1136/bmjopen-2017-016919] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE It is widely recognised that South Asian men living in the UK are more likely to develop type 2 diabetes mellitus (T2DM) than their white British counterparts. Despite this, limited data have been published quantifying current dietary intake patterns and qualitatively exploring eating behaviours in this population. The objectives of this study were to (1) assess diet, (2) explore perceptions of T2DM, (3) investigate factors influencing eating behaviours in overweight/obese South Asian men and (4) determine the suitability of the UK Diet and Diabetes Questionnaire (UKDDQ) for use in this population. SETTING Community-based setting in the Greater London, UK area. PARTICIPANTS South Asian men aged 18-64 years, with a body mass index of over 23.0 kg/m2, not previously diagnosed with T2DM. METHODS A cross-sectional mixed-methods design, including assessment of dietary intake using UKDDQ (n=63), followed by semistructured interviews in a purposive sample (n=36). RESULTS UKDDQ scores indicated 54% of participants had a 'healthy' diet with a mean sample score of 3.44±0.43 out of a maximum of 5. Oily fish consumption was low (1.84±1.85). Body weight was positively associated with a high-added sugar subscore (r=0.253, p=0.047), with 69.8% of the men having 'unhealthy' intakes of sugar-sweetened beverages. Cultural commitments (eg, extended family and faith events), motivation and time were identified as key barriers to dietary change, with family support an important facilitator to making healthy dietary changes. Participants stated that UKDDQ was suitable for assessing diets of South Asians and made suggestions for tailoring questions related to rice consumption, providing examples of Indian sweets, and including ghee as a fat source. CONCLUSION Many of the areas of dietary improvement and factors affecting eating behaviours identified in this study are similar to those observed in the general UK population. Consumption of sugar-sweetened beverages in particular was high; given the association between their consumption and the risk of T2DM, this should be an area of primary focus for healthcare professionals. Nevertheless, there are sociocultural factors unique to this population that need to be considered when designing culturally specific programs to reduce the development of T2DM in this high-risk population.
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Affiliation(s)
- Amir Emadian
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Clare Y England
- Centre for Exercise, Nutrition and Health Sciences, University of Bristol, Bristol, UK
- Bristol Biomedical Research Unit in Nutrition, Diet and Lifestyle, National Institute for Health Research, University Hospitals Bristol Education and Research Centre, Bristol, UK
| | - Janice L Thompson
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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Paul SK, Owusu Adjah ES, Samanta M, Patel K, Bellary S, Hanif W, Khunti K. Comparison of body mass index at diagnosis of diabetes in a multi-ethnic population: A case-control study with matched non-diabetic controls. Diabetes Obes Metab 2017; 19:1014-1023. [PMID: 28211609 DOI: 10.1111/dom.12915] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 02/02/2017] [Accepted: 02/04/2017] [Indexed: 01/05/2023]
Abstract
AIMS To investigate the probability of developing type 2 diabetes mellitus (T2DM) at different body mass index levels compared to matched non-diabetic controls in a multi-ethnic population. MATERIALS AND METHODS This was a case-control study of 90 367 patients with incident diabetes and 362 548 age-sex-ethnicity matched controls from UK primary care. The probability of developing T2DM was estimated. RESULTS Case and control patients were 56 years old at index and 56% were male. Patients with T2DM had significantly higher mean BMI levels by about 5 kg/m2 at diagnosis (32.2 kg/m2 ) compared to the matched controls (27.4 kg/m2 ). White Europeans (n = 79 270), African-Caribbeans (n = 4115) and South Asians (n = 7252) were 58, 48 and 46 years old with a mean BMI of 32.5, 31.1 and 29.2 kg/m2 , respectively, at diagnosis. More South Asians developed T2DM at BMI below 30 kg/m2 (38%) than White Europeans (26%) and African-Caribbeans (29%) (all P < .01). Within the 18 to 70-year age range, South Asian males and females had a significantly higher probability of developing diabetes in the continuously measured BMI range of 18 to 30 kg/m2 , compared to White Europeans and African-Caribbeans. Across all age groups <70 years, South Asians and African-Caribbeans had a significantly higher probability of developing T2DM in the normal weight and overweight categories, compared to White Europeans. However, this risk pattern of developing diabetes was reversed amongst the obese in all age groups. CONCLUSION Risk patterns of developing diabetes at different levels of obesity varies among ethnic groups across all ages, while South Asians and African-Caribbeans carry the highest risk at a younger age and at lower adiposity burden.
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Affiliation(s)
- Sanjoy K Paul
- Clinical Trials and Biostatistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Australia
- Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Australia
| | - Ebenezer S Owusu Adjah
- Clinical Trials and Biostatistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Australia
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - Mayukh Samanta
- Clinical Trials and Biostatistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Kiran Patel
- University of Warwick, Warwick, UK
- Heart of England NHS Trust, Birmingham, UK
| | - Srikanth Bellary
- Aston Research Centre for Healthy Ageing, Aston University, Birmingham, UK
| | - Wasim Hanif
- Department of Diabetes, University Hospital Birmingham, Birmingham, UK
| | - Kamlesh Khunti
- Department of Health Sciences, University of Leicester, Leicester, Birmingham, UK
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Body mass index adjustments to increase the validity of body fatness assessment in UK Black African and South Asian children. Int J Obes (Lond) 2017; 41:1048-1055. [PMID: 28325931 PMCID: PMC5500188 DOI: 10.1038/ijo.2017.75] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 12/20/2016] [Accepted: 02/19/2017] [Indexed: 11/18/2022]
Abstract
Background/Objectives: Body mass index (BMI) (weight per height2) is the most widely used marker of childhood obesity and total body fatness (BF). However, its validity is limited, especially in children of South Asian and Black African origins. We aimed to quantify BMI adjustments needed for UK children of Black African and South Asian origins so that adjusted BMI related to BF in the same way as for White European children. Methods: We used data from four recent UK studies that made deuterium dilution BF measurements in UK children of White European, South Asian and Black African origins. A height-standardized fat mass index (FMI) was derived to represent BF. Linear regression models were then fitted, separately for boys and girls, to quantify ethnic differences in BMI–FMI relationships and to provide ethnic-specific BMI adjustments. Results: We restricted analyses to 4–12 year olds, to whom a single consistent FMI (fat mass per height5) could be applied. BMI consistently underestimated BF in South Asians, requiring positive BMI adjustments of +1.12 kg m−2 (95% confidence interval (CI): 0.83, 1.41 kg m−2; P<0.0001) for boys and +1.07 kg m−2 (95% CI: 0.74, 1.39 kg m−2; P<0.0001) for girls of all age groups and FMI levels. BMI overestimated BF in Black Africans, requiring negative BMI adjustments for Black African children. However, these were complex because there were statistically significant interactions between Black African ethnicity and FMI (P=0.004 boys; P=0.003 girls) and also between FMI and age group (P<0.0001 for boys and girls). BMI adjustments therefore varied by age group and FMI level (and indirectly BMI); the largest adjustments were in younger children with higher unadjusted BMI and the smallest in older children with lower unadjusted BMI. Conclusions: BMI underestimated BF in South Asians and overestimated BF in Black Africans. Ethnic-specific adjustments, increasing BMI in South Asians and reducing BMI in Black Africans, can improve the accuracy of BF assessment in these children.
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Hardy DS, Stallings DT, Garvin JT, Gachupin FC, Xu H, Racette SB. Anthropometric discriminators of type 2 diabetes among White and Black American adults. J Diabetes 2017; 9:296-307. [PMID: 27106521 PMCID: PMC5079832 DOI: 10.1111/1753-0407.12416] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 03/30/2016] [Accepted: 04/15/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The aim of the present study was to determine the best anthropometric discriminators of type 2 diabetes mellitus (T2DM) among White and Black males and females in a large US sample. METHODS We used Atherosclerosis Risk in Communities study baseline data (1987-89) from 15 242 participants (1827 with T2DM) aged 45-65 years. Anthropometric measures included a body shape index (ABSI), body adiposity index (BAI), body mass index, waist circumference (WC), waist: height ratio (WHtR), and waist: hip ratio (WHR). All anthropometric measures were standardized to Z-scores. Using logistic regression, odds ratios for T2DM were adjusted for age, physical activity, and family history of T2DM. The Akaike information criterion and receiver operating characteristic C-statistic were used to select the best-fit models. RESULTS Body mass index, WC, WHtR, and WHR were comparable discriminators of T2DM among White and Black males, and were superior to ABSI and BAI in predicting T2DM (P < 0.0001). Waist circumference, WHtR, and WHR were the best discriminators among White females, whereas WHR was the best discriminator among Black females. The ABSI was the poorest discriminator of T2DM for all race-gender groups except Black females. Anthropometric values distinguishing T2DM cases from non-cases were lower for Black than White adults. CONCLUSIONS Anthropometric measures that included WC, either alone or relative to height (WHtR) or hip circumference (WHR), were the strongest discriminators of T2DM across race-gender groups. Body mass index was a comparable discriminator to WC, WHtR, and WHR among males, but not females.
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Affiliation(s)
- Dale S. Hardy
- Institute of Public and Preventive Health, Augusta University, Augusta, Georgia
- Correspondence, Dale S. Hardy, Institute of Public and Preventive Health, CJ-2325, Augusta University, 1120 15th Street, Augusta, GA 30912-0850, Phone: (706) 721-8794,
| | | | - Jane T. Garvin
- College of Nursing, Augusta University, Augusta, Georgia
| | - Francine C. Gachupin
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Hongyan Xu
- Department of Biostatistics and Epidemiology, Augusta University, Augusta, Georgia
| | - Susan B. Racette
- Program in Physical Therapy and Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
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Gobardhan SN, Dimitriu-Leen AC, van Rosendael AR, van Zwet EW, Roos CJ, Oemrawsingh PV, Kharagjitsingh AV, Jukema JW, Delgado V, Schalij MJ, Bax JJ, Scholte AJ. Prevalence by Computed Tomographic Angiography of Coronary Plaques in South Asian and White Patients With Type 2 Diabetes Mellitus at Low and High Risk Using Four Cardiovascular Risk Scores (UKPDS, FRS, ASCVD, and JBS3). Am J Cardiol 2017; 119:705-711. [PMID: 28024655 DOI: 10.1016/j.amjcard.2016.11.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 11/11/2016] [Accepted: 11/11/2016] [Indexed: 01/17/2023]
Abstract
The aim of this study was to explore the association between various cardiovascular (CV) risk scores and coronary atherosclerotic burden on coronary computed tomography angiography (CTA) in South Asians with type 2 diabetes mellitus and matched whites. Asymptomatic type 2 diabetic South Asians and whites were matched for age, gender, body mass index, hypertension, and hypercholesterolemia. Ten-year CV risk was estimated using different risk scores (United Kingdom Prospective Diabetes Study [UKPDS], Framingham Risk Score [FRS], AtheroSclerotic CardioVascular Disease [ASCVD], and Joint British Societies for the prevention of CVD [JBS3]) and categorized into low- and high-risk groups. The presence of coronary artery calcium (CAC) and obstructive coronary artery disease (CAD; ≥50% stenosis) was assessed using coronary CTA. Finally, the relation between coronary atherosclerosis on CTA and the low- and high-risk groups was compared. UKPDS, FRS, and ASCVD showed no differences in estimated CV risk between 159 South Asians and 159 matched whites. JBS3 showed a significant greater absolute CV risk in South Asians (18.4% vs 14.2%, p <0.01). Higher presence of CAC score >0 (69% vs 55%, p <0.05) and obstructive CAD (39% vs 27%, p <0.05) was observed in South Asians. South Asians categorized as high risk, using UKPDS, FRS, and ASCVD, showed more CAC and CAD compared than whites. JBS3 showed no differences. In conclusion, asymptomatic South Asians with type 2 diabetes mellitus more frequently showed CAC and obstructive CAD than matched whites in the population categorized as high-risk patients using UKPDS, FRS, and ASCVD as risk estimators. However, JBS3 seems to correlate best to CAC and CAD in both ethnicity groups compared with the other risk scores.
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Rønn PF, Andersen GS, Lauritzen T, Christensen DL, Aadahl M, Carstensen B, Jørgensen ME. Ethnic differences in anthropometric measures and abdominal fat distribution: a cross-sectional pooled study in Inuit, Africans and Europeans. J Epidemiol Community Health 2017; 71:536-543. [DOI: 10.1136/jech-2016-207813] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 12/13/2016] [Accepted: 12/16/2016] [Indexed: 01/27/2023]
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What have human experimental overfeeding studies taught us about adipose tissue expansion and susceptibility to obesity and metabolic complications? Int J Obes (Lond) 2017; 41:853-865. [PMID: 28077863 DOI: 10.1038/ijo.2017.4] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 12/08/2016] [Accepted: 12/18/2016] [Indexed: 02/07/2023]
Abstract
Overfeeding experiments, in which we impose short-term positive energy balance, help unravel the cellular, physiological and behavioural adaptations to nutrient excess. These studies mimic longer-term mismatched energy expenditure and intake. There is considerable inter-individual heterogeneity in the magnitude of weight gain when exposed to similar relative caloric excess reflecting variable activation of compensatory adaptive mechanisms. Significantly, given similar relative weight gain, individuals may be protected from/predisposed to metabolic complications (insulin resistance, dyslipidaemia, hypertension), non-alcoholic fatty liver disease and cardiovascular disease. Similar mechanistic considerations underpinning the heterogeneity of overfeeding responses are pertinent in understanding emerging metabolic phenotypes, for example, metabolically unhealthy normal weight and metabolically healthy obesity. Intrinsic and extrinsic factors modulate individuals' overfeeding response: intrinsic factors include gender/hormonal status, genetic/ethnic background, baseline metabolic health and cardiorespiratory fitness; extrinsic factors include macronutrient (fat vs carbohydrate) content, fat/carbohydrate composition and overfeeding pattern. Subcutaneous adipose tissue (SAT) analysis, coupled with metabolic assessment, with overfeeding have revealed how SAT remodels to accommodate excess nutrients. SAT remodelling occurs either by hyperplasia (increased adipocyte number) or by hypertrophy (increased adipocyte size). Biological responses of SAT also govern the extent of ectopic (visceral/liver) triglyceride deposition. Body composition analysis by DEXA/MRI (dual energy X-ray absorptiometry/magnetic resonance imaging) have determined the relative expansion of SAT (including abdominal/gluteofemoral SAT) vs ectopic fat with overfeeding. Such studies have contributed to the adipose expandability hypothesis whereby SAT has a finite capacity to expand (governed by intrinsic biological characteristics), and once capacity is exceeded ectopic triglyceride deposition occurs. The potential for SAT expandability confers protection from/predisposes to the adverse metabolic responses to overfeeding. The concept of a personal fat threshold suggests a large inter-individual variation in SAT capacity with ectopic depot expansion/metabolic decompensation once one's own threshold is exceeded. This review summarises insight gained from overfeeding studies regarding susceptibility to obesity and related complications with nutrient excess.
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Aveyard P, Lewis A, Tearne S, Hood K, Christian-Brown A, Adab P, Begh R, Jolly K, Daley A, Farley A, Lycett D, Nickless A, Yu LM, Retat L, Webber L, Pimpin L, Jebb SA. Screening and brief intervention for obesity in primary care: a parallel, two-arm, randomised trial. Lancet 2016; 388:2492-2500. [PMID: 27789061 PMCID: PMC5121130 DOI: 10.1016/s0140-6736(16)31893-1] [Citation(s) in RCA: 183] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 10/04/2016] [Accepted: 10/06/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND Obesity is a common cause of non-communicable disease. Guidelines recommend that physicians screen and offer brief advice to motivate weight loss through referral to behavioural weight loss programmes. However, physicians rarely intervene and no trials have been done on the subject. We did this trial to establish whether physician brief intervention is acceptable and effective for reducing bodyweight in patients with obesity. METHODS In this parallel, two-arm, randomised trial, patients who consulted 137 primary care physicians in England were screened for obesity. Individuals could be enrolled if they were aged at least 18 years, had a body-mass index of at least 30 kg/m2 (or at least 25 kg/m2 if of Asian ethnicity), and had a raised body fat percentage. At the end of the consultation, the physician randomly assigned participants (1:1) to one of two 30 s interventions. Randomisation was done via preprepared randomisation cards labelled with a code representing the allocation, which were placed in opaque sealed envelopes and given to physicians to open at the time of treatment assignment. In the active intervention, the physician offered referral to a weight management group (12 sessions of 1 h each, once per week) and, if the referral was accepted, the physician ensured the patient made an appointment and offered follow-up. In the control intervention, the physician advised the patient that their health would benefit from weight loss. The primary outcome was weight change at 12 months in the intention-to-treat population, which was assessed blinded to treatment allocation. We also assessed asked patients' about their feelings on discussing their weight when they have visited their general practitioner for other reasons. Given the nature of the intervention, we did not anticipate any adverse events in the usual sense, so safety outcomes were not assessed. This trial is registered with the ISRCTN Registry, number ISRCTN26563137. FINDINGS Between June 4, 2013, and Dec 23, 2014, we screened 8403 patients, of whom 2728 (32%) were obese. Of these obese patients, 2256 (83%) agreed to participate and 1882 were eligible, enrolled, and included in the intention-to-treat analysis, with 940 individuals in the support group and 942 individuals in the advice group. 722 (77%) individuals assigned to the support intervention agreed to attend the weight management group and 379 (40%) of these individuals attended, compared with 82 (9%) participants who were allocated the advice intervention. In the entire study population, mean weight change at 12 months was 2·43 kg with the support intervention and 1·04 kg with the advice intervention, giving an adjusted difference of 1·43 kg (95% CI 0·89-1·97). The reactions of the patients to the general practitioners' brief interventions did not differ significantly between the study groups in terms of appropriateness (adjusted odds ratio 0·89, 95% CI 0·75-1·07, p=0·21) or helpfulness (1·05, 0·89-1·26, p=0·54); overall, four (<1%) patients thought their intervention was inappropriate and unhelpful and 1530 (81%) patients thought it was appropriate and helpful. INTERPRETATION A behaviourally-informed, very brief, physician-delivered opportunistic intervention is acceptable to patients and an effective way to reduce population mean weight. FUNDING The UK National Prevention Research Initiative.
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Affiliation(s)
- Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK.
| | - Amanda Lewis
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Sarah Tearne
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
| | - Kathryn Hood
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
| | - Anna Christian-Brown
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
| | - Peymane Adab
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Rachna Begh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Amanda Daley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Amanda Farley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Deborah Lycett
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Alecia Nickless
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
| | - Ly-Mee Yu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
| | | | | | | | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
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Hruschka DJ, Hadley C. How much do universal anthropometric standards bias the global monitoring of obesity and undernutrition? Obes Rev 2016; 17:1030-1039. [PMID: 27383689 DOI: 10.1111/obr.12449] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 06/06/2016] [Accepted: 06/06/2016] [Indexed: 12/15/2022]
Abstract
Each year, hundreds of articles in population health and nutrition, many in high-profile journals, use standard cutoffs based on weight and height as assessments of obesity and undernutrition. These global efforts to monitor overweight and underweight often rest on the assumption that ethnic differences in underlying body form are sufficiently small to permit universal anthropometric cutoffs for comparing excess and insufficient body fat across populations. However, a century of work in human biological variation suggests that human populations can vary dramatically in underlying body form in a way that may require population-sensitive cutoffs for monitoring. Here, we describe recently developed methods that can provide population-sensitive assessments of both excess and insufficient energy reserves in a wide range of countries. We use this approach to illustrate how worldwide variation in human body form is far more widespread than previously thought, and that it can occur at several geographic scales, including the level of world regions, countries and populations within countries. The findings also suggest that using standard cutoffs that ignore this variation can underestimate current obesity levels in adults by more than 400-500 million while also incorrectly prioritizing high-risk areas for undernutrition in children in key regions around the world.
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Affiliation(s)
- D J Hruschka
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, USA.
| | - C Hadley
- Anthropology Department, Emory University, Decatur, GA, USA
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