Prevalence and correlates of the insulin resistance syndrome among Native Americans. The Inter-Tribal Heart Project

Gut microbiota composition explains more variance in the host cardiometabolic risk than genetic ancestry

Cardiometabolic affections greatly contribute to the global burden of disease. The susceptibility to obesity, cardiovascular disease, and type-2 diabetes, conditions that add to the cardiometabolic syndrome (CMS), was associated with the ancestral genetic composition and gut microbiota. Studies explicitly testing associations between genetic ancestry and gut microbes are growing. We here examined whether the host genetic ancestry was associated with gut microbiota composition, and distinguished the effects of genetic ancestry and non-genetic factors on human cardiometabolic health. We performed a cross-sectional study with 441 community-dwelling Colombian mestizos from five cities spanning the Andes, Pacific, and Caribbean coasts. We characterized the host genetic ancestry by genotyping 40 ancestry informative markers; characterized gut microbiota through 16S rRNA gene sequencing; assessed diet intake, physical activity, cigarette, and medicament consumption; and measured cardiometabolic outcomes that allowed calculating a CMS risk scale. On average, each individual of our cohort was 67 ± 6% European, 21 ± 5% Native American and 12 ± 5% African. Multivariable-adjusted generalized linear models showed that individuals with higher Native American and African ancestries had increased fasting insulin, body mass index and CMS risk, as assessed by the CMS risk scale. Furthermore, we identified 21 OTUs associated to the host genetic ancestry and 20 to cardiometabolic health. While we highlight novel associations between genetic ancestry and gut microbiota, we found that the effect of intestinal microbes was more likely to explain the variance in CMS risk scale than the contributions of European, Native American and African genetic backgrounds.

[Conicity index as a predictor of changes in the lipid profile of adolescents in a city in Northeast Brazil]

The objective was to evaluate the conicity index (C Index) as a predictor of changes in the lipid profile of adolescents and to establish its cutoff points. This was a cross-sectional study in 774 adolescents of both sexes (55% girls), 10 to 14 years of age. C Index was calculated according to the formula proposed by Valdez, considering body mass, height, and waist circumference (WC). Changes in the adolescents' lipid profile were defined according to one of the following conditions: elevated levels of total cholesterol, low-density lipoprotein (LDL), and triglycerides and low levels of high-density lipoprotein (HDL). The predictive power of the conicity index for altered lipid profile and its cutoff points were determined by Receiver Operating Characteristic (ROC) curves. The C Index was a good predictor of lipid alterations in adolescents, emphasizing triglycerides in boys 10 to 11 years of age (ROC = 0.67; 95%CI: 0.50-0.85) and 12 to 14 (ROC = 0.69; 95%CI: 0.59-0.80), and in girls 10 to 11 years (ROC = 0.65; 95%CI: 0.50-0.79); and LDL in girls 10 to 11 years (ROC = 0.70; 95%CI: 0.59-0.80) and boys (ROC = 0.65; 95%CI: 0.55-0.75) and girls (ROC = 0.62; 95%CI: 0.50-0.75) 12 to 14 years. The cutoff points for the C Index varied from 1.12 to 1.16 between boys and girls. The C Index can be used to predict lipid alterations, and its cutoff points can be used to screen adolescents for risk of alterations in lipid profile.

Burden of diabetes mellitus and prediabetes in tribal population of India: a systematic review

OBJECTIVE

To estimate the burden of diabetes mellitus and pre-diabetes in tribal populations of India.

METHODS

The authors reviewed studies from 2000 to 2011 that documented the prevalence of diabetes mellitus in various tribal populations of India. The search was performed using electronic and manual methods. Meta-analysis of data on point prevalence was performed.

RESULTS

A total of seven studies were retrieved. The prevalence of diabetes mellitus ranged from 0.7% to 10.1%. The final estimate of diabetes prevalence obtained after pooling of data from individual studies, was 5.9% (95% CI; 3.1-9.5%). The prevalence for impaired fasting glucose (IFG) varied from 5.1% to 13.5% and impaired glucose tolerance (IGT), from 6.6% to 12.9%.

CONCLUSION

Chronic disease research in tribal populations is limited. The reported prevalence of IFG/IGT was higher than the prevalence of diabetes and this observation could be suggestive of a potential increase in diabetes in the coming years. Given that lifestyle changes have occurred in the tribal populations, there is a need to synthesize evidence(s) relating to diabetes and other chronic diseases in these marginalized populations and inform policy makers.

Cardiometabolic risk, knowledge, risk perception, and self-efficacy among American Indian women with previous gestational diabetes

OBJECTIVE

To describe cardiometabolic risk among a sample of American Indian women with previous gestational diabetes and describe the women's knowledge, risk perception for type 2 diabetes and cardiovascular disease, and self-efficacy beliefs related to preventing these diseases.

DESIGN

Mixed methods, cross-sectional, exploratory, descriptive.

SETTING

Four campuses within one American Indian tribal health care system in a southwestern state.

PARTICIPANTS

A purposeful sample of 22 self-identified American Indian women with a history of gestational diabetes.

METHODS

Qualitative interview data were subjected to content analysis, and descriptive statistics were used to analyze quantitative questionnaire data and biophysiologic data.

RESULTS

The majority of participants (13 of 21) were classified as having metabolic syndrome, and 13 of 18 women were found to be insulin resistant. In general, the women had high levels of knowledge related to type 2 diabetes and cardiovascular disease and high risk perception, but low self-efficacy related to preventing cardiometabolic disease. The overarching theme from the in-depth interviews, struggling to change lifestyle behaviors while doubting prevention is possible, encompassed four categories that provided further illumination into participants' risk perceptions and self-efficacy beliefs: concerns, control, beliefs/attitudes, and prevention.

CONCLUSIONS

High levels of knowledge and risk perception do not necessarily promote increased self-efficacy to prevent cardiometabolic disease among American Indian women with previous gestational diabetes. Findings indicate the need to further explore women's self-efficacy beliefs in the context of American Indian culture prior to developing interventions aimed at increasing self-efficacy to prevent or delay type 2 diabetes and cardiovascular disease. Women with previous gestational diabetes are at increased risk for developing cardiovascular disease, independent of a diagnosis of type 2 diabetes.

Insulin resistance in the middle-aged women with "Tigerish Back and Bearish Waist"

The objective of this study was to elucidate the role of fat distribution in predicting insulin resistance in peri- or post-menopausal women. The results demonstrated that insulin resistance increases with waist circumference and subscapular skinfold thickness but decreases with higher thigh circumflex in the peri- and post-menopausal women.

Prevalence of metabolic syndrome in an adult urban population of the west of Iran

Objectives. We determine the prevalence of the metabolic syndrome in an urban population of Zanjan, a province located to the west of Tehran. Methods. Randomly selected adults >20 years were studied using stratified sampling. Target study sample was 2941 (1396 males and 1545 females). Metabolic syndrome was diagnosed using Adult Treatment Panel-III (ATP-III) guidelines when any three of the following were present: central obesity, raised triglycerides ≥150 mg/dl, low high-density lipoprotein (HDL) cholesterol, blood pressure ≥ 130/ ≥ 85 mm Hg, and diabetes or fasting plasma glucose (FPG) ≥ 100 mg/dl. Results. Metabolic syndrome was present in 697 (23.7%) subjects (CI 95%:22%–25%, P = .001), prevalence was 23.1% in men and 24.4% in women (P : .4). The prevalence increased from 7.5% in the population younger than 30 y to 45.6% in ages more than 50 years. Low HDL was the most common metabolic abnormality in both sexes. Most of those with metabolic syndrome had three components of the syndrome (75.6%), 170 subjects (24.4%) had four and none had five components simultaneously. The prevalence of obesity (BMI ≥ 30 kg/m²), hypercholesterolemia (≥200 mg/dl) and high LDL cholesterol (≥130 mg/dl) was greater in the metabolic syndrome group than normal subjects (P = .00). Conclusions. There is a high prevalence of metabolic syndrome in this urban population of the northern west of Iran. Focus of cardiovascular prevention should be undertaken in this area.

Indigenous health: update on the impact of diabetes and chronic kidney disease

PURPOSE OF REVIEW

With respect to chronic diseases such as diabetes and its complications, indigenous populations are known to suffer from poor health outcomes in comparison with whites. The purpose of this review is to highlight recent epidemiologic and intervention studies that have occurred in the areas of diabetes and renal disease among indigenous populations.

RECENT FINDINGS

The burden of diabetes is increasing among younger indigenous groups with epidemic levels of end-stage kidney disease. As dialysis therapy has contributed to prolong life among indigenous patients, cardiovascular disease has now become the leading cause of mortality in these populations. Clear preventive intervention strategies to improve rates of progression to end-stage kidney disease are not prevalent nor are they emerging over time. Access to kidney transplantation is also reduced among indigenous populations in Australia, New Zealand, the USA and Canada. Reasons for this disparity are unclear but likely multifactorial.

SUMMARY

Diabetes and its complications have produced a health crisis among indigenous populations. The impact on healthcare systems in countries where these indigenous populations reside will be substantial unless significant efforts are made to improve diabetic renal disease outcomes in the near future.

Cardiovascular risk factors among Native American women Inter-Tribal Heart Project participants

OBJECTIVE

To examine cardiovascular disease risk factors among adult Native American women Inter-Tribal Heart Project participants.

DESIGN

A secondary analysis used controllable risk factors identified by the American Heart Association as the framework to examine cardiovascular disease risk factors in this population.

SETTING

Three Native American Reservations in Minnesota and Wisconsin.

PARTICIPANTS

866 adult Native American women who participated in the Inter-Tribal Heart Project cardiovascular health research study.

MAIN OUTCOME MEASURES

Descriptive, correlational, bivariate, and multivariate analysis provided findings on cardiovascular disease risk factors in this population.

RESULTS

Cardiovascular disease risk factors are high among this population. For every additional risk factor, the odds of self-reported cardiovascular disease increases 1.2 times (95% confidence interval: 1.1-1.3). Participants who self-reported cardiovascular disease were older, less educated, employed less, and reported more Indian ancestry (higher blood quantum) and had higher prevalence rates of diabetes, higher systolic blood pressure, and body mass index in comparison to women who self-reported an absence of cardiovascular disease.

CONCLUSIONS

A key to decreasing cardiovascular disease lies in preventing and controlling cardiovascular disease risk factors with concerted efforts specific to the culture and life ways of the Native American woman.

Omega-3 fatty acids improve glucose tolerance and components of the metabolic syndrome in Alaskan Eskimos: the Alaska Siberia project

OBJECTIVES

To test the hypothesis that the unusually low prevalences of insulin resistance (IR), metabolic syndrome (MS) and diabetes (DM) in Alaskan Eskimos, compared to American Indians, is related to the traditional Eskimo diet, high in C20-C22 omega-3 fatty acids (FAs). To determine if the relatively low blood pressures, low serum triglycerides and high HDL cholesterol levels in Eskimos result from high omega-3 FA consumption.

STUDY DESIGN

Cross-sectional study.

METHODS

We measured plasma FA concentrations in 447 Norton Sound Eskimos (35-74 years of age) and screened for DM, CHD and associated risk factors. A dietary assessment (24-hr recall) was obtained for comparison the day before the blood sampling.

RESULTS

Plasma omega-3 FA concentrations were highly correlated with dietary omega-3 FAs and HDL levels and inversely correlated with plasma levels of insulin, 2-h insulin (OGTT), HOMI-IR, 2-h glucose (OGTT), triglyceride levels and diastolic blood pressure.

CONCLUSIONS

High consumption of omega-3 FAs positively affects components of the MS, insulin sensitivity and glucose tolerance. This finding suggests that high consumption of C20-C22 omega-3 FAs protects against the development of the MS and glucose intolerance.

Prevalence and risk factors associated with the metabolic syndrome and dyslipidemia in White, Black, Amerindian and Mixed Hispanics in Zulia State, Venezuela

Studies have highlighted the association between insulin resistance (IR) and several cardiovascular (CV) risk factors, including hypertension (HTN), obesity, dyslipidemia (i.e. high triglyceride and low HDL-cholesterol) and glucose intolerance, in a cluster known as the metabolic syndrome (MS). There are few data on the frequency of the MS and dyslipidemia in developing countries, and none in South America. To estimate the prevalence of the MS and its components in Zulia State, Venezuela, and to establish associated demographic and clinical factors, we evaluated 3108 Hispanic men and women aged 20 years or older from a cross-sectional survey of a random representative sample from each health district in Zulia State, Venezuela (1999-2001). Prevalence of the MS and dyslipidemia was defined according to the National Cholesterol Education Program (NCEP)/Adult Treatment Panel III (ATP III) criteria. The age-adjusted prevalence of MS and dyslipidemia was 31.2% and 24.1%, respectively, with higher rates in men than in women. Prevalence rates increased with age and with the degree of obesity. MS prevalence was lower in Amerindian (17.%) compared to Black (27.2%), White (33.3%) and Mixed (37.4%) men, but no differences were found among women. Overall, low HDL-cholesterol (65.3%), abdominal obesity (42.9%) and HTN (38.1%) were the most frequent MS components. After adjusting for age, sex and race groups, family history of diabetes, obesity and HTN were associated with the MS. Sedentary lifestyle also increased the risk of MS, event after adjusting for the same covariates, obesity and the degree of IR. These results suggest that MS is found in approximately one-third of the Venezuelan adult population in Zulia State, with higher prevalence in men related to the presence of dyslipidemia. Lifestyle interventions in MS subjects are needed in Venezuela to halt the burden of CV disease and diabetes.

Differences in food habits and cardiovascular disease risk factors among Native Americans with and without diabetes: the Inter-Tribal Heart Project

OBJECTIVE

To examine differences in food habits among Native Americans with and without diabetes.

DESIGN

A cross-sectional epidemiological study in which participants underwent a physical examination and answered an extensive interviewer-administered questionnaire to assess differences in food servings, preparation and eating habits.

SETTING/PARTICIPANTS

Participants aged >/=25 years were randomly selected from three reservations in Minnesota and Wisconsin. There were 990 persons without diabetes, 294 with a prior diagnosis of diabetes, and 80 with fasting glucose >125 mg dl(-1) but no prior diabetes diagnosis.

RESULTS

Persons with prior diabetes diagnosis were less likely than those without diabetes to report eating fast-food meals two or more times per week, eat visible fat on meat or the skin on poultry, eat fried chicken or fried fish, to add fat to cooked vegetables and drink whole milk. Persons with previously undiagnosed diabetes were more likely than previously diagnosed persons to report eating fast-food meals two or more times per week, eat visible fat on meat and the skin on poultry, drink whole milk and eat fried fish, but were less likely to drink low-fat milk. Previously undiagnosed persons were more likely than either diagnosed persons or persons without diabetes to consume lard from cooked foods and use it when cooking.

CONCLUSION

Persons with diagnosed diabetes showed healthier eating patterns than those without diabetes, while undiagnosed persons showed some less favourable patterns. Because virtually all persons with diabetes in these communities receive nutrition education, the results suggest that nutrition education programmes for diabetics may be associated with healthier eating patterns.

Sensibilidade e especificidade do índice de conicidade como discriminador do risco coronariano de adultos em Salvador, Brasil

OBJETIVO: No início da década de 90, foi proposto o índice de conicidade para avaliação da distribuição da gordura corporal, com base nas medidas de peso, estatura e circunferência da cintura. Este estudo teve como objetivo selecionar através da sensibilidade e especificidade os melhores pontos de corte para o índice de conicidade como discriminador de risco coronariano elevado. MÉTODOS: Estudo de corte transversal, com amostra composta por 968 adultos de 30-74 anos de idade, sendo 391 (40,4%) do sexo masculino. A análise foi feita por curva Receiver Operating Characteristic (ROC) para identificar a sensibilidade e especificidade do melhor ponto de corte do índice de conicidade como discriminador de risco coronariano elevado. Verificou-se também a significância estatística da área sob a curva ROC entre o índice de conicidade e risco coronariano elevado. Foi utilizado intervalo de confiança (IC) a 95%. RESULTADOS: A área total sob a curva ROC entre o índice de conicidade e risco coronariano foi de 0,80, IC 95% (0,74-0,85) para homens e 0,75, IC 95% (0,70-0,80) para mulheres. Os melhores pontos de corte para discriminar o risco coronariano elevado foram, para homens e mulheres, respectivamente, 1,25 (sensibilidade de 73,91% e especificidade de 74,92%) e 1,18 (sensibilidade de 73.39% e especificidade de 61,15%). CONCLUSÕES: Os resultados encontrados neste estudo sugerem que o índice de conicidade deve ser comparado aos demais indicadores antropométricos de obesidade e pode vir a ser utilizado para discriminar risco coronariano elevado.

Diabetes and impaired fasting glycemia in the tribes of Khagrachari hill tracts of Bangladesh

OBJECTIVE

To determine the prevalence of type 2 diabetes and impaired fasting glycemia (IFG) in a tribal population of Bangladesh.

RESEARCH DESIGN AND METHODS

A cluster sampling of 1,287 tribal subjects of age > or =20 years was investigated. They live in a hilly area of Khagrachari in the far northeast of Bangladesh. Fasting plasma glucose, blood pressure, height, weight, waist girth, and hip girth were measured. Lipid fractions were also estimated. We used the 1997 American Diabetes Association diagnostic criteria.

RESULTS

The crude prevalence of type 2 diabetes was 6.6% and IFG was 8.5%. The age-standardized (20-70 years) prevalence of type 2 diabetes (95% CI) was 6.4% (4.96-7.87) and of IFG was 8.4% (6.48-10.37). Both tribesmen and women had equal risk for diabetes and IFG. Compared with the lower-income group, the participants with higher income had a significantly higher prevalence of type 2 diabetes (18.8 vs. 3.1%, P < 0.001) and IFG (17.2 vs. 4.3%, P < 0.001). Using logistic regression, we found that increased age, high-income group, and increased central obesity were the important risk factors of diabetes.

CONCLUSIONS

The prevalence of diabetes in the tribal population was higher than that of the nontribal population of Bangladesh. Older age, higher central obesity, and higher income were proven significant risk factors of diabetes. High prevalence of diabetes among these tribes indicates that the prevalence of diabetes and its complications will continue to increase. Evidently, health professionals and planners should initiate diabetes care in these tribal communities.

Prevalence of metabolic syndrome in an urban population: Tehran Lipid and Glucose Study

The aim of the present investigation was to determine the prevalence of the metabolic syndrome among 103,68 of the adults (4,397 men and 5,971 women) aged 20 years and over, participating in the Tehran Lipid and Glucose Study. The metabolic syndrome was defined by the presence of three or more of the following components: abdominal obesity, hypertriglyceridemia, low HDL-C, high blood pressure, and high fasting glucose. The unadjusted prevalence of metabolic syndrome in the study population was 30.1% (CI 95%: 29.2-31.0) and age-standardized prevalence was 33.7% (CI 95%: 32.8-34.6). The prevalence increased with age in both sexes. The metabolic syndrome was more commonly seen in women than in men (42% vs. 24%, P<0.001). Low HDL-C was the most common metabolic abnormality in both sexes. Except for high FPG, all abnormalities were more common in women than in men (P<0.001). Most of those with metabolic syndrome had three components of the syndrome (58%), 33% had four, and 9% had five components. This report on the metabolic syndrome from Iran shows a high prevalence of this disorder. Efforts on promoting healthy diets, physical activity, and blood pressure control must be undertaken.

The metabolic syndrome: prevalence and associated risk factor findings in the US population from the Third National Health and Nutrition Examination Survey, 1988-1994

BACKGROUND

The metabolic syndrome is an important cluster of coronary heart disease risk factors with common insulin resistance. The extent to which the metabolic syndrome is associated with demographic and potentially modifiable lifestyle factors in the US population is unknown.

METHODS

Metabolic syndrome-associated factors and prevalence, as defined by Adult Treatment Panel III criteria, were evaluated in a representative US sample of 3305 black, 3477 Mexican American, and 5581 white men and nonpregnant or lactating women aged 20 years and older who participated in the cross-sectional Third National Health and Nutrition Examination Survey.

RESULTS

The metabolic syndrome was present in 22.8% and 22.6% of US men and women, respectively (P =.86). The age-specific prevalence was highest in Mexican Americans and lowest in blacks of both sexes. Ethnic differences persisted even after adjusting for age, body mass index, and socioeconomic status. The metabolic syndrome was present in 4.6%, 22.4%, and 59.6% of normal-weight, overweight, and obese men, respectively, and a similar distribution was observed in women. Older age, postmenopausal status, Mexican American ethnicity, higher body mass index, current smoking, low household income, high carbohydrate intake, no alcohol consumption, and physical inactivity were associated with increased odds of the metabolic syndrome.

CONCLUSIONS

The metabolic syndrome is present in more than 20% of the US adult population; varies substantially by ethnicity even after adjusting for body mass index, age, socioeconomic status, and other predictor variables; and is associated with several potentially modifiable lifestyle factors. Identification and clinical management of this high-risk group is an important aspect of coronary heart disease prevention.

The effect of fiber-rich carbohydrates on features of Syndrome X

There has been much debate among nutritionists and scientists regarding the optimal dietary approach for the treatment of the Insulin Resistance Syndrome, also called Syndrome X. This condition, which may affect as many as 47 million individuals in the United States, significantly increases risk of coronary heart disease and stroke. Major health organizations have historically recommended high-carbohydrate, low-fat (HCLF) diets to reduce chronic disease risk. However, there is evidence that a high intake of carbohydrates may adversely affect one or more of the abnormalities associated with this syndrome. Studies in this area have often had limitations. For example, some studies showing adverse effects of an HCLF diet have not taken into account the dietary fiber content of the diet. This article describes abnormalities often associated with Syndrome X, reviews the beneficial effects of fiber-rich carbohydrates, discusses the effect of fiber-rich carbohydrates on features of this syndrome, and concludes with applications of these findings for those involved in treating individuals with features of this disorder. This review indicates that an HCLF dietary pattern such as that used in the DASH trial, with a level of dietary fiber consistent with the recommendations of the American Dietetic Association (eg, 20-35g/day), containing from 3 to 10 g soluble fiber/day, may be beneficial for treating those with Syndrome X.

Factor analysis of ethnic variation in the multiple metabolic (insulin resistance) syndrome in three Canadian populations

This study describes and compares the pattern of risk factor clustering in multiple metabolic (insulin resistance) syndrome (MMS) in three Canadian ethnic groups (Indians, Inuit, non-Aboriginal Canadians). Three cross-sectional, population-based sample surveys in three contiguous regions of Canada were conducted during the late 1980s and early 1990s (Ontario, Manitoba, Northwest Territories). The combined dataset consists of 873 Cree-Ojibwa Indians from northern Ontario and Manitoba, 387 Inuit from the Northwest Territories, and 2,670 non-Aboriginal Canadians (predominantly of European origin) in the province of Manitoba. The samples are representative of the noninstitutionalized, adult population of their respective catchment areas. Factor analysis transformed 10 anthropometric and metabolic variables into three uncorrelated factors. Three factors, which together account for 64.3% of the variance, can be identified: an "obesity factor" (factor loadings for weight, height, waist and hip girth, and HDL-cholesterol); a "blood pressure factor" (factor loadings for mean systolic and diastolic BP and total cholesterol); and a "lipid/glucose factor" (factor loadings for triglycerides, total cholesterol, HDL, and fasting plasma glucose). Fasting insulin is available for only a subset of the data and separate analysis shows that it groups with glucose. Factor scores generated by the factor analysis differ according to ethnic group, diabetes status, and sex on multivariate analysis of variance. Indians have the highest scores for all three factors. Inuit have the lowest obesity scores and are not significantly different from non-Aboriginal people with regard to the other two factors. MMS is prevalent in diverse ethnic groups but varies in the pattern of phenotypic expression, with some components more prominent in some groups.

Prevalence of insulin resistance syndrome in southwestern France and its relationship with inflammatory and hemostatic markers

OBJECTIVE

To assess the prevalence and relationships of insulin resistance syndrome (IRS) with inflammatory and hemostatic markers in a representative sample of the population of Southwestern France aged 35-64 years.

RESEARCH DESIGN AND METHODS

In this cross-sectional study, data were collected from 597 men and 556 women and were assessed regarding BMI, blood pressure, total and HDL cholesterol levels, triglyceride level, glucose level, plasma insulin level, white blood cell count, fibrinogen level, factor VII level, von Willebrand factor, C-reactive protein level, soluble intercellular adhesion molecule, soluble vascular cell adhesion molecule-1, and soluble CD(14). Insulin resistance was defined by homeostasis model assessment > or =3.8.

RESULTS

Prevalence of IRS was higher in men than in women (23 vs. 12%, respectively; P < 0.001) and increased with age in both sexes (9, 24, and 34% for age groups 35-44, 45-54, and 55-64 years, respectively, for men and 4, 10, and 21% for women). After adjusting for age, alcohol consumption, tobacco smoking, and also for menopause in women, subjects (men and women) with IRS had significantly higher white blood cell count, factor VII levels, coagulating factor VII levels, and C-reactive protein levels than the other subjects. In men, further increases in soluble intercellular adhesion molecule and soluble vascular cell adhesion molecule-1 were noted, whereas in women, the differences were borderline significant. Conversely, no differences were found in fibrinogen, von Willebrand factor, and soluble CD(14) in both sexes.

CONCLUSIONS

IRS is relatively common in residents of Southwestern France and is related to a deleterious increase in hemostatic and inflammatory parameters.

Cardiovascular disease risk factors and n-3 fatty acid status in the adult population of James Bay Cree

BACKGROUND

Canadian native populations, which traditionally consume large amounts of fish, have lower rates of mortality from heart disease than do Canadian nonnative populations, which have low fish intakes. Fish oils rich in n-3 fatty acids may have a protective effect against cardiovascular disease (CVD) risk factors.

OBJECTIVES

The purposes were to examine the profile of plasma phospholipid concentrations of the n-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) among James Bay Cree and to verify the relation between these concentrations and CVD risk factors.

DESIGN

The study population consisted of 917 subjects aged 18-74 y who participated in the 1991 Santé Québec Health Survey. Data were obtained through home interviews and clinic visits. Plasma samples were analyzed for phospholipid fatty acid composition.

RESULTS

The mean fish consumption on the day before the survey was 60 g among the adult Cree population. Expressed as a percentage of total fatty acids, relative concentrations of EPA and DHA were 0.65% and 2.80%, respectively. n-3 Fatty acids were higher among coastal residents than among inland residents. A positive association was observed between plasma HDL and n-3 fatty acids. EPA and EPA+DHA were inversely associated with triacylglycerols. Among subjects aged 50-74 y, an inverse association between EPA and EPA:AA and total:HDL cholesterol was observed.

CONCLUSIONS

n-3 Fatty acids may favorably influence some CVD risk factors. The Cree population must be encouraged to maintain their traditional fish-based diet, which may be one of the factors protecting them against mortality from CVD.

Association of the insulin resistance syndrome and microalbuminuria among nondiabetic native Americans. The Inter-Tribal Heart Project

This study investigated the association between microalbuminuria and the insulin resistance syndrome (IRS) among nondiabetic Native Americans. In a cross-sectional survey, age-stratified random samples were drawn from the Indian Health Service clinic lists for one Menominee and two Chippewa reservations. Information was collected from physical examinations, personal interviews, and blood and urine samples. The urinary albumin:creatinine ratio (ACR) was measured using a random spot urine sample. The IRS was defined by the number of composite traits: hypertension, impaired fasting glucose (IFG), high fasting insulin, low HDL cholesterol, and hypertriglyceridemia. Among the 934 eligible nondiabetic participants, 15.2% exhibited microalbuminuria. The prevalence of one, two, and three or more traits was 27.0, 16.6, and 7.4%, respectively. After controlling for age, sex, smoking, body mass index, education, and family histories of diabetes and kidney disease, the odds ratio (OR) for microalbuminuria was 1.8 (95% confidence interval [CI], 1.1 to 2.8) for one IRS trait, 1.8 (95% CI, 1.0 to 3.2) for two traits, and 2.3 (95% CI, 1.1 to 4.9) for three or more traits (versus no traits). The pattern of association appeared weaker among women compared with men. Of the individual IRS traits, only hypertension and IFG were associated with microalbuminuria. Among these nondiabetic Native Americans, the IRS was associated with a twofold increased prevalence of microalbuminuria. Health promotion efforts should focus on lowering the prevalence of hypertension, as well as glucose intolerance and obesity, in this population at high risk for renal and cardiovascular disease.

The epidemiology of atherosclerosis and its risk factors among Native Americans

In the past, the rates of risk factors for atherosclerosis and cardiovascular disease (CVD) as well as the manifestations of coronary heart disease, stroke, and peripheral vascular disease in Native Americans have been relatively low compared to the general United States population. However, over the past several decades the rates of these CVD-associated risk factors have markedly increased with the concomitant development of a significant and alarming rise in the manifestations of atherosclerosis.

n-3 Fatty acids and cardiovascular disease risk factors among the Inuit of Nunavik

BACKGROUND

Inuit traditionally consume large amounts of marine foods rich in n-3 fatty acids. Evidence exists that n-3 fatty acids have beneficial effects on key risk factors for cardiovascular disease.

OBJECTIVE

Our goal was to verify the relation between plasma phospholipid concentrations of the n-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) and various cardiovascular disease risk factors among the Inuit of Nunavik, Canada.

DESIGN

The study population consisted of 426 Inuit aged 18-74 y who participated in a 1992 health survey. Data were obtained through home interviews and clinical visits. Plasma samples were analyzed for phospholipid fatty acid composition.

RESULTS

Expressed as the percentage of total fatty acids, geometric mean concentrations of EPA, DHA, and their combination in plasma phospholipids were 1.99%, 4.52%, and 6.83%, respectively. n-3 Fatty acids were positively associated with HDL-cholesterol concentrations and inversely associated with triacylglycerol concentrations and the ratio of total to HDL cholesterol. In contrast, concentrations of total cholesterol, LDL cholesterol, and plasma glucose increased as n-3 fatty acid concentrations increased. There were no significant associations between n-3 fatty acids and diastolic and systolic blood pressure and plasma insulin.

CONCLUSIONS

Consumption of marine products, the main source of EPA and DHA, appears to beneficially affect some cardiovascular disease risk factors. The traditional Inuit diet, which is rich in n-3 fatty acids, is probably responsible for the low mortality rate from ischemic heart disease in this population.

[Prevalence of risk factors for cardiovascular disease in the Guaraní-Mbyá population of the State of Rio de Janeiro]

Social change has been involved in the unequal distribution patterns of chronic diseases in several populations. Among Indian communities experiencing life pattern changes, international studies have reported increased prevalence of hypertension and other cardiovascular risk factors. Such increased prevalence was ascertained in a survey conducted in 1999 in selected Guaraní-Mbyá communities (Sapukai, Paraty-Mirim, and Araponga) in the State of Rio de Janeiro, Brazil. A population census was carried out and interviews and clinical and biochemical evaluations were conducted with 80 men and 71 women. Observed prevalence of selected risk factors in the overall sample, including men and women, was as follows for the three communities: hypertension (4.8%, 2.6%, 7.4%); overweight (26.7%, 19.5%, 34.8%); total cholesterol levels (2.8%, 2.7%, 2.9%), and increased triglyceride levels (12.6%, 9.5%, 15.9%). All prevalence rates were higher among women and at older ages. The results suggest that the Guaraní communities have a moderate risk of chronic diseases and that measures to reduce these risk factors should be adopted.

Visceral obesity and metabolic syndrome

There is increasing evidence for the existence of a condition consisting of a cluster of metabolic disorders which include insulin resistance, alterations in glucose and lipid metabolism, increased blood pressure and visceral obesity. The metabolic syndrome is now the favoured definition of the cluster. Each single component of the cluster increases the cardiovascular risk, but the combination of factors is much more important. Insulin resistance is the most frequently associated factor to the singular components of the syndrome: most authors believe that it may be the common aetiological factor. However, visceral obesity seems to be the main driving factor by means of the increased production of free fatty acids whose activity, in turn, might interfere with the action of insulin. Some questions exist about the syndrome because of the frequent lack in the cluster of one of the factors. This does not mean that the missing factor does not belong to the syndrome, but only that it is not yet clinically evident. Weight gain has been shown to be a strong predictor of the metabolic syndrome. This aspect gives strength to treatment and prevention because it means that losing weight or stopping weight increase might reduce the risk of a future appearance of a factor that is still not evident. Interventions to treat visceral obesity by means of losing weight seem to be the most efficacious way to treat the metabolic syndrome thus improving the most widespread cardiovascular risk factor in western countries.