1
|
Yu D, Cai Y, Osuagwu UL, Pickering K, Baker J, Cutfield R, Orr-Walker BJ, Sundborn G, Wang Z, Zhao Z, Simmons D. All-cause, premature, and cardiovascular death attributable to socioeconomic and ethnic disparities among New Zealanders with type 1 diabetes 1994-2019: a multi-linked population-based cohort study. BMC Public Health 2024; 24:298. [PMID: 38273238 PMCID: PMC10811898 DOI: 10.1186/s12889-023-17326-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 11/24/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND New Zealand (NZ) research into type 1 diabetes mellitus (T1DM) mortality can inform policy and future research. In this study we aimed to quantify the magnitude to which ethnicity and socioeconomic disparities influenced mortality at the population level among people with Type 1 diabetes (T1DM) in Auckland, New Zealand (NZ). METHODS The cohort data were derived from the primary care diabetes audit program the Diabetes Care Support Service (DCSS), and linked with national primary care, pharmaceutical claims, hospitalisation, and death registration databases. People with T1DM enrolled in DCSS between 1994-2018 were included. All-cause, premature, and cardiovascular mortalities were estimated by Poisson regression models with adjustment for population-level confounders. The mortality rates ratio (MRR) was standardized against the DCSS type 2 diabetes population. Mortality rates were compared by ethnic group (NZ European (NZE) and non-NZE) and socioeconomic deprivation quintile. The population attributable fraction (PAF) was estimated for ethnic and socioeconomic disparities by Cox regression adjusting for demographic, lifestyle, and clinical covariates. The adjusted slope index inequality (SII) and relative index of inequality (RII) were used to measure the socioeconomic disparity in mortalities. RESULTS Overall, 2395 people with T1DM (median age 34.6 years; 45% female; 69% NZE) were enrolled, among whom the all-cause, premature and CVD mortalities were 6.69 (95% confidence interval: 5.93-7.53), 3.30 (2.77-3.90) and 1.77 (1.39-2.23) per 1,000 person-years over 25 years. The overall MRR was 0.39 (0.34-0.45), 0.65 (0.52-0.80), and 0.31 (0.24-0.41) for all-cause, premature and CVD mortality, respectively. PAF attributable to ethnicity disparity was not significantly different for mortality. The adjusted PAF indicated that 25.74 (0.84-44.39)% of all-cause mortality, 25.88 (0.69-44.69)% of premature mortality, 55.89 (1.20-80.31)% of CVD mortality could be attributed to socioeconomic inequality. The SII was 8.04 (6.30-9.78), 4.81 (3.60-6.02), 2.70 (1.82-3.59) per 1,000 person-years and RII was 2.20 (1.94-2.46), 2.46 (2.09-2.82), and 2.53 (2.03-3.03) for all-cause, premature and CVD mortality, respectively. CONCLUSIONS Our results suggest that socioeconomic disparities were responsible for a substantial proportion of all-cause, premature and CVD mortality in people with T1DM in Auckland, NZ. Reducing socioeconomic barriers to management and self-management would likely improve clinical outcomes.
Collapse
Affiliation(s)
- Dahai Yu
- Department of Nephrology, the First Affiliated Hospital Zhengzhou University, Zhengzhou, 450052, China
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, ST5 5BG, UK
| | - Yamei Cai
- Department of Nephrology, the First Affiliated Hospital Zhengzhou University, Zhengzhou, 450052, China
| | - Uchechukwu Levi Osuagwu
- School of Medicine, Western Sydney University, Locked Bag 1797, Campbelltown, NSW 2751, Australia
| | | | - John Baker
- Diabetes Foundation Aotearoa, Otara, New Zealand
- Department of Diabetes and Endocrinology, Counties Manukau Health, Auckland, New Zealand
| | - Richard Cutfield
- Diabetes Foundation Aotearoa, Otara, New Zealand
- Department of Diabetes and Endocrinology, Waitemata District Health Board, Auckland, New Zealand
| | - Brandon J Orr-Walker
- Diabetes Foundation Aotearoa, Otara, New Zealand
- Department of Diabetes and Endocrinology, Counties Manukau Health, Auckland, New Zealand
| | - Gerhard Sundborn
- Section of Pacific Health, the University of Auckland, Auckland, New Zealand
| | - Zheng Wang
- Department of Nephrology, the First Affiliated Hospital Zhengzhou University, Zhengzhou, 450052, China
| | - Zhanzheng Zhao
- Department of Nephrology, the First Affiliated Hospital Zhengzhou University, Zhengzhou, 450052, China.
| | - David Simmons
- Department of Nephrology, the First Affiliated Hospital Zhengzhou University, Zhengzhou, 450052, China.
- School of Medicine, Western Sydney University, Locked Bag 1797, Campbelltown, NSW 2751, Australia.
- Diabetes Foundation Aotearoa, Otara, New Zealand.
| |
Collapse
|
2
|
Thornley S, Sundborn G, Engelman D, Roskvist R, Pasay C, Marshall R, Long W, Dugu N, Hopoi N, Moritsuka S, McCarthy J, Morris AJ. Children's scabies survey indicates high prevalence and misdiagnosis in Auckland educational institutions. J Paediatr Child Health 2023; 59:1296-1303. [PMID: 37920140 DOI: 10.1111/jpc.16512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 10/16/2023] [Accepted: 10/19/2023] [Indexed: 11/04/2023]
Abstract
AIM Here, we present results of a survey of scabies prevalence in childcare centres and primary schools in Auckland. METHODS Children whose parents agreed to take part in participating centres in the Auckland region were examined for scabies by general practitioners and given questionnaires of relevant symptoms. Diagnoses of clinical or suspected scabies were made according to the International Alliance for the Control of Scabies (IACS) criteria. The survey was a stratified random sample of schools and early childcare centres. A quantitative polymerase chain reaction (PCR) test was also used to complement the IACS criteria. RESULTS A total of 181 children were examined, with 145 children with history information, 16 of whom (11.0%) met the criteria for 'clinical' or 'suspected' scabies. Weighted analysis, accounting for the survey design, indicated that the prevalence of scabies in early childcare centres was 13.2% (95% CI: 4.3 to 22.1), with no school-aged children fulfilling these criteria. A higher proportion had clinical signs of scabies with 23 (12.7%) having typical scabies lesions and a further 43 (23.8%) had atypical lesions. A total of 64 PCR tests were taken and 15 (23%) were positive. None of these cases were receiving treatment for scabies. Five were undergoing topical skin treatment: three with topical steroid and two with calamine lotion. CONCLUSIONS The prevalence of children with scabies is high in early childcare centres in Auckland. Misdiagnosis is suggested by several PCR positive cases being treated by topical agents used to treat other skin conditions.
Collapse
Affiliation(s)
- Simon Thornley
- Section of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Gerhard Sundborn
- Section of Pacific Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Daniel Engelman
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Rachel Roskvist
- Department of Primary Care, The University of Auckland, Auckland, New Zealand
| | - Cielo Pasay
- QIMR Berghoffer Medical Research Institute, Brisbane, Queensland, Australia
| | - Roger Marshall
- Section of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Wei Long
- Auckland Family Medical Centre, Auckland, New Zealand
| | - Noela Dugu
- Conifer Gardens Medical Centre, Auckland, New Zealand
| | | | - Shunsuke Moritsuka
- Section of Pacific Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - James McCarthy
- Doherty Institute, The University of Melbourne, Melbourne, Victoria, Australia
| | - Arthur J Morris
- LabPLUS, Auckland District Health Board, Auckland, New Zealand
| |
Collapse
|
3
|
Yu D, Qu B, Osuagwu UL, Pickering K, Baker J, Cutfield R, Cai Y, Orr‐Walker BJ, Sundborn G, Zhao Z, Simmons D. Association Between Onset of Type 2 Diabetes and Risk of Atrial Fibrillation in New Zealanders With Impaired Glucose Tolerance Over 25 Years. J Am Heart Assoc 2023; 12:e030159. [PMID: 37702092 PMCID: PMC10547295 DOI: 10.1161/jaha.123.030159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/08/2023] [Indexed: 09/14/2023]
Abstract
Background The association between the onset of type 2 diabetes (T2D) and atrial fibrillation (AF) risk in individuals with impaired glucose tolerance (IGT) remains unclear. This study aimed to investigate the relationship between the incident onset of T2D and 5- and 10-year (after the landmark period) risks of AF in people with IGT identified in South and West Auckland primary care settings between 1994 and 2019. Methods and Results We compared AF risk in patients with IGT with and without newly diagnosed T2D within a 1- to 5-year exposure window. Tapered matching and landmark analysis (to address immortal bias) were used to control for confounding variables. The cohorts incorporated 785 patients who had T2D newly diagnosed within 5 years from enrollment (landmark date) and 15 079 patients without a T2D diagnosis. Patients progressing to T2D exhibited significantly higher 5-year (after the landmark period) AF risk (hazard ratio [HR], 1.34 [95% CI, 1.10-1.63]) and 10-year (after the landmark period) AF risk (HR, 1.28 [95% CI, 1.02-1.62]) compared with those without incident T2D. The association was more pronounced among men, older patients, socioeconomically deprived individuals, current smokers, those with higher metabolic measures, and lower renal function. New Zealand European ethnicity was associated with a lower 5- and 10-year risk of AF. Conclusions This study found a mediating effect of T2D on the risk of AF in a population with IGT in New Zealand. The development of risk scores and future replication studies can help identify and guide management of individuals with IGT at the highest risk of AF following incident T2D.
Collapse
Affiliation(s)
- Dahai Yu
- Department of Nephrology, The First Affiliated HospitalZhengzhou UniversityZhengzhouChina
- Primary Care Centre Versus Arthritis, School of MedicineKeele UniversityKeeleUnited Kingdom
| | - Bingjie Qu
- Department of Nephrology, The First Affiliated HospitalZhengzhou UniversityZhengzhouChina
| | - Uchechukwu Levi Osuagwu
- Translational Health Research Institute (THRI)Western Sydney University, CampbelltownSydneyAustralia
- School of MedicineWestern Sydney University, CampbelltownSydneyAustralia
| | | | - John Baker
- Diabetes Foundation AotearoaOtaraNew Zealand
- Department of Diabetes and EndocrinologyCounties Manukau HealthAucklandNew Zealand
| | - Richard Cutfield
- Diabetes Foundation AotearoaOtaraNew Zealand
- Department of Diabetes and EndocrinologyWaitemata District Health BoardAucklandNew Zealand
| | - Yamei Cai
- Department of Nephrology, The First Affiliated HospitalZhengzhou UniversityZhengzhouChina
| | - Brandon J. Orr‐Walker
- Diabetes Foundation AotearoaOtaraNew Zealand
- Department of Diabetes and EndocrinologyCounties Manukau HealthAucklandNew Zealand
| | - Gerhard Sundborn
- Section of Pacific HealthThe University of AucklandAucklandNew Zealand
| | - Zhanzheng Zhao
- Department of Nephrology, The First Affiliated HospitalZhengzhou UniversityZhengzhouChina
| | - David Simmons
- Department of Nephrology, The First Affiliated HospitalZhengzhou UniversityZhengzhouChina
- Translational Health Research Institute (THRI)Western Sydney University, CampbelltownSydneyAustralia
- School of MedicineWestern Sydney University, CampbelltownSydneyAustralia
| |
Collapse
|
4
|
Yu D, Qu B, Osuagwu UL, Pickering K, Baker J, MBChB RC, Cai Y, Orr-Walker BJ, Sundborn G, Zhao Z, Simmons D. Effect of onset of type 2 diabetes on risks of cardiovascular disease and heart failure among new Zealanders with impaired glucose tolerance over 25 years: tapered-matched landmark analysis. Cardiovasc Diabetol 2023; 22:163. [PMID: 37391762 PMCID: PMC10314599 DOI: 10.1186/s12933-023-01871-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/29/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND This study aimed to examine the association between the incident onset of T2DM and 5- and 10-year risks of CVD and HF in people with IGT identified in primary care in South and West Auckland, New Zealand (NZ) between 1994 and 2019. METHODS We compared CVD and HF risks in patients with IGT and with/without T2D newly diagnosed within the exposure window (1-5 years). Tapered matching and landmark analysis (to account for immortal bias) were used to control for potential effects of known confounders. RESULTS Among 26,794 patients enrolled with IGT, 845 had T2D newly diagnosed within 5 years from enrolment (landmark date) and 15,452 did not have T2D diagnosed. Patients progressing to T2D (vs. those not progressing) had a similar 5-year risk for CVD (hazard ratio 1.19; 95% CI 0.61-2.32) but significantly higher 10-year risk of CVD (2.45(1.40-4.29)), 5-year risk of HF (1.94(1.20-3.12)) and 10-year risk of HF (2.84(1.83-4.39). The association between the onset of T2D and risk of 10-year risk of CVD, 5-year and 10-year risk of HF was more likely among men, the socioeconomically deprived, those currently smoking, patients with higher metabolic measures and/or those with lower renal function. Patients of NZ European ethnicity had a lower 10-year risk of CVD. CONCLUSIONS The study suggests that the diagnosis of T2D mediates the risk of CVD and HF in people with IGT. The development of risk scores to identify and better manage individuals with IGT at high risk of T2D is warranted.
Collapse
Affiliation(s)
- Dahai Yu
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450052, China
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, ST5 5BG, UK
| | - Bingjie Qu
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450052, China
| | - Uchechukwu Levi Osuagwu
- Translational Health Research Institute (THRI), Western Sydney University, Campbelltown, Sydney, NSW, 2560, Australia
- School of Medicine, Western Sydney University, Campbelltown, Sydney, NSW, 2751, Australia
| | | | - John Baker
- Diabetes Foundation Aotearoa, Otara, New Zealand
- Department of Diabetes and Endocrinology, Counties Manukau Health, Auckland, New Zealand
| | - Richard Cutfield MBChB
- Diabetes Foundation Aotearoa, Otara, New Zealand
- Department of Diabetes and Endocrinology, Waitemata District Health Board, Auckland, New Zealand
| | - Yamei Cai
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450052, China
| | - Brandon J Orr-Walker
- Diabetes Foundation Aotearoa, Otara, New Zealand
- Department of Diabetes and Endocrinology, Counties Manukau Health, Auckland, New Zealand
| | - Gerhard Sundborn
- Section of Pacific Health, the University of Auckland, Auckland, New Zealand
| | - Zhanzheng Zhao
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450052, China.
| | - David Simmons
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450052, China.
- Translational Health Research Institute (THRI), Western Sydney University, Campbelltown, Sydney, NSW, 2560, Australia.
- School of Medicine, Western Sydney University, Campbelltown, Sydney, NSW, 2751, Australia.
- Macarthur Clinical School, School of Medicine, Western Sydney University, Locked Bag 1797, Campbelltown, NSW, 2751, Australia.
| |
Collapse
|
5
|
Maddison R, Hargreaves EA, Jiang Y, Calder AJ, Wyke S, Gray CM, Hunt K, Lubans DR, Eyles H, Draper N, Heke I, Kara S, Sundborn G, Arandjus C, Gao L, Lee P, Lim M, Marsh S. Rugby Fans in Training New Zealand (RUFIT NZ): a randomized controlled trial to assess the effectiveness of a healthy lifestyle program for overweight men delivered through professional rugby clubs. Int J Behav Nutr Phys Act 2023; 20:37. [PMID: 36978139 PMCID: PMC10043512 DOI: 10.1186/s12966-022-01395-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 12/03/2022] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND A healthy lifestyle program that appeals to, and supports, overweight and obese New Zealand (NZ) European, Māori (indigenous) and Pasifika men to achieve weight loss is urgently needed. A pilot program inspired by the successful Football Fans in Training program but delivered via professional rugby clubs in NZ (n = 96) was shown to be effective in weight loss, adherence to healthy lifestyle behaviors, and cardiorespiratory fitness in overweight and obese men. A full effectiveness trial is now needed. AIMS To determine the effectiveness and cost effectiveness of Rugby Fans In Training-NZ (RUFIT-NZ) on weight loss, fitness, blood pressure, lifestyle change, and health related quality of life (HRQoL) at 12- and 52-weeks. METHODS We conducted a pragmatic, two-arm, multi-center, randomized controlled trial in NZ with 378 (target 308) overweight and obese men aged 30-65 years, randomized to an intervention group or wait-list control group. The 12-week RUFIT-NZ program was a gender-sensitised, healthy lifestyle intervention delivered through professional rugby clubs. Each intervention session included: i) a 1-h workshop-based education component focused on nutrition, physical activity, sleep, sedentary behavior, and learning evidence-based behavior change strategies for sustaining a healthier lifestyle; and 2) a 1-h group-based, but individually tailored, exercise training session. The control group were offered RUFIT-NZ after 52-weeks. The primary outcome was change in body weight from baseline to 52-weeks. Secondary outcomes included change in body weight at 12-weeks, waist circumference, blood pressure, fitness (cardiorespiratory and musculoskeletal), lifestyle behaviors (leisure-time physical activity, sleep, smoking status, and alcohol and dietary quality), and health-related quality of life at 12- and 52-weeks. RESULTS Our final analysis included 200 participants (intervention n = 103; control n = 97) who were able to complete the RUFIT-NZ intervention prior to COVID-19 restrictions. At 52-weeks, the adjusted mean group difference in weight change (primary outcome) was -2.77 kg (95% CI -4.92 to -0.61), which favored the intervention group. The intervention also resulted in favorable significant differences in weight change and fruit and vegetable consumption at 12-weeks; and waist circumference, fitness outcomes, physical activity levels, and health-related quality of life at both 12 and 52 weeks. No significant intervention effects were observed for blood pressure, or sleep. Incremental cost-effective ratios estimated were $259 per kg lost, or $40,269 per quality adjusted life year (QALY) gained. CONCLUSION RUFIT-NZ resulted in sustained positive changes in weight, waist circumference, physical fitness, self-reported physical activity, selected dietary outcomes, and health-related quality of life in overweight/obese men. As such, the program should be recommended for sustained delivery beyond this trial, involving other rugby clubs across NZ. TRIAL REGISTRATION Australia New Zealand Clinical Trials Registry, ACTRN12619000069156. Registered 18 January 2019, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376740 Universal Trial Number, U1111-1245-0645.
Collapse
Affiliation(s)
- Ralph Maddison
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand.
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia.
| | - Elaine Anne Hargreaves
- School of Physical Education, Sport & Exercise Sciences, University of Otago, Dunedin, New Zealand
| | - Yannan Jiang
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
- Department of Statistics, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Amanda Jane Calder
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Sally Wyke
- Institute of Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, Scotland
| | - Cindy M Gray
- Institute of Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, Scotland
| | - Kate Hunt
- Institute for Social Marketing and Health, Faculty of Health and Sports Sciences, University of Stirling, Stirling, Scotland
| | - David Revalds Lubans
- School of Education, Centre for Active Living and Learning, University of Newcastle, Hunter Medical Research Institute, Newcastle, Australia
| | - Helen Eyles
- Department of Epidemiology and Biostatistics, National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Nick Draper
- Faculty of Health, SHARRC, University of Canterbury, Christchurch, New Zealand
| | | | - Stephen Kara
- Axis Sport Medicine Clinic, Auckland, New Zealand
| | - Gerhard Sundborn
- Department of Pacific Health, University of Auckland, Auckland, New Zealand
| | - Claire Arandjus
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Lan Gao
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
| | - Peter Lee
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
| | - Megumi Lim
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
| | - Samantha Marsh
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| |
Collapse
|
6
|
Sundborn G, Lesa F, King G, Vennell K, Kozak H, Pickering K, Baker J. Empagliflozin and dulaglutide: community awareness project promotes improved access to newly funded medications for Pacific patients with type 2 diabetes. N Z Med J 2023; 136:66-74. [PMID: 36958323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
AIM The aims of our awareness campaign were to increase the number of inquiries by patients to doctors for two new diabetes drugs funded by Pharmac on 1 February 2021 and 1 September 2021 respectively, to increase the number of applications for special authority, and to trial a "grass roots" community dissemination of information that appeals to explicit individual benefit from the new medicines. The campaign used an approach tailored primarily to the Pasifika community. METHODS The campaign ran from April 2021 to July 2021 and targeted Counties Manukau communities using a talanoa approach by primarily by sharing key messages informally through social networks face-to-face by word-of-mouth. The key messages about the new medicines were shared orally with local organisations, family, friends, influential community leaders and colleagues such as justices of peace, kapa haka leaders, committee representatives from local schools, sports, cultural and hobby clubs. A printed pamphlet translated in Māori, Samoan, Tongan and English with the key messages was also distributed widely. The campaign notified 102 primary care practices, used Pacific equity teams to disseminate the information, promoted the message on Māori and Pasifika radio stations, and engaged a public relations company who contacted the South Auckland Community Trust, councillors, community boards and local churches. This approach was intended to spread the message through the community to reach people with type 2 diabetes and/or their families to prompt them to contact their doctor and see if they are eligible. To gauge how effective the campaign was, we gathered data from Pharmac that quantified new prescriptions for the new medicines by location and ethnicity. RESULTS An estimated 45,000 people were exposed to our campaign materials or were told about the new medicines by people they knew. These estimations were conservatively based on the known membership, listenership, and reach of the various delivery arms by which this campaign was delivered. These data show Pacific patients, the focus of about 64% of our project work, were 40% more likely to apply and receive a prescription for empagliflozin in Counties Manukau than anywhere else in the country. CONCLUSION Direct-to-consumer marketing is an effective way of increasing health awareness and uptake of newly funded diabetes medicine amongst Pacific patients with type 2 diabetes.
Collapse
Affiliation(s)
- Gerhard Sundborn
- Senior Lecturer, Section of Pacific Health School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland
| | - Fale Lesa
- Board Member, Diabetes Foundation Aotearoa
| | | | | | | | | | - John Baker
- Clinical Director, Middlemore Clinical Trials, Auckland
| |
Collapse
|
7
|
Satokar VV, Derraik JGB, Harwood M, Okesene-Gafa K, Beck K, Cameron-Smith D, Garg ML, O'Sullivan JM, Sundborn G, Pundir S, Mason RP, Cutfield WS, Albert BB. Fish oil supplementation during pregnancy and postpartum in mothers with overweight and obesity to improve body composition and metabolic health during infancy: A double-blind randomized controlled trial. Am J Clin Nutr 2023; 117:883-895. [PMID: 36781129 DOI: 10.1016/j.ajcnut.2023.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 02/01/2023] [Accepted: 02/08/2023] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND Maternal obesity during pregnancy is associated with an increased risk of obesity and metabolic disease in the offspring. Supplementation with fish oil (FO), which is insulin sensitizing, during pregnancy in mothers with overweight or obesity may prevent the development of greater adiposity and metabolic dysfunction in their children. OBJECTIVES To determine the effects of FO supplementation throughout the second half of pregnancy and lactation in mothers with overweight or obesity on infant body composition and metabolism. METHODS A double-blind randomized controlled trial of 6 g FO (3.55 g/d of n-3 PUFAs) compared with olive oil (control) from mid-pregnancy until 3 mo postpartum. Eligible women had singleton pregnancies at 12-20 wk of gestation, and BMI ≥ 25 kg/m2. The primary outcome was the infant body fat percentage (DXA scans) at 2 wk of age. Secondary outcomes included maternal metabolic markers during pregnancy, infant anthropometry at 2 wk and 3 mo of age, and metabolic markers at 3 mo. RESULTS A total of 129 mothers were randomized, and 98 infants had a DXA scan at 2 wk. PRIMARY OUTCOME Imputed and nonimputed analyses showed no effects of FO supplementation on infant body fat percentage at age 2 wk. SECONDARY OUTCOMES There were no treatment effects on infant outcomes at 2 wk, but FO infants had a higher BMI z-score (P = 0.025) and ponderal index (P = 0.017) at age 3 mo. FO supplementation lowered maternal triglycerides by 17% at 30 wk of pregnancy (P = 0.0002) and infant triglycerides by 21% at 3 mo of age (P = 0.016) but did not affect maternal or infant insulin resistance. The rate of emergency cesarean section was lower with FO supplementation [aRR = 0.38 (95%CI 0.16, 0.90); P = 0.027]. CONCLUSIONS FO supplementation of mothers with overweight or obesity during pregnancy did not impact infant body composition. There is a need to follow up the offspring to determine whether the observed metabolic effects persist. CLINICAL TRIAL REGISTRY NUMBER This study was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12617001078347p). In addition, the Universal Trial Number, WHO, was obtained (U1111-1199-5860).
Collapse
Affiliation(s)
- Vidit V Satokar
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - José G B Derraik
- Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Environmental - Occupational Health Sciences and Non-Communicable Diseases Research Group, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Matire Harwood
- Department of General Practice and Primary Care, University of Auckland, Auckland, New Zealand
| | - Karaponi Okesene-Gafa
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Kathryn Beck
- School of Sport Exercise and Nutrition, College of Health, Massey University, Auckland, New Zealand
| | - David Cameron-Smith
- Liggins Institute, University of Auckland, Auckland, New Zealand; College of Engineering, Science and Environment, University of Newcastle, New South Wales, Australia; School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, New South Wales, Australia
| | - Manohar L Garg
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, New South Wales, Australia
| | | | - Gerhard Sundborn
- Department of Pacific Health, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Shikha Pundir
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - R Preston Mason
- Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Wayne S Cutfield
- Liggins Institute, University of Auckland, Auckland, New Zealand; A Better Start - National Science Challenge, University of Auckland, New Zealand
| | - Benjamin B Albert
- Liggins Institute, University of Auckland, Auckland, New Zealand; A Better Start - National Science Challenge, University of Auckland, New Zealand.
| |
Collapse
|
8
|
Yu D, Osuagwu UL, Pickering K, Baker J, Cutfield R, Wang Z, Cai Y, Orr-Walker BJ, Sundborn G, Zhao Z, Simmons D. Adverse Clinical Outcomes Attributable to Socioeconomic and Ethnic Disparities Among People with Type 2 Diabetes in New Zealand Between 1994-2018: A Multiple Linked Cohort Study. Clin Epidemiol 2023; 15:511-523. [PMID: 37153075 PMCID: PMC10162107 DOI: 10.2147/clep.s402307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/17/2023] [Indexed: 05/09/2023] Open
Abstract
Purpose The study aimed to examine the separate population-level contributions of the ethnic and socioeconomic disparities among people with type 2 diabetes mellitus (T2DM) and residence in New Zealand (NZ). Patients and Methods A prospective cohort enrolled T2DM patients from 01/01/1994 into the Diabetes Care Support Service, a primary care audit program in Auckland, NZ. The cohort was linked to national registry databases (socioeconomic status, pharmaceutical claim, hospitalization, and death registration). Each cohort member was followed up till death or the study end time (31/12/2019), whichever came first. Incident clinical events (stroke, myocardial infarction (MI), heart failure (HF), end-stage renal disease (ESRD), and premature mortality (PM)) were used as outcomes. The attributable fractions (AFs) were estimated for the whole population and for specific population with NZ Europeans (NZE) and/or least deprived population as reference, both unadjusted and with adjustment for covariables by Cox Regression models. Results Among 36,267 patients, adjusted population AFs indicated 6.6(-30.8-33.3)% of PM, 17.1(5.8-27.0)% of MI, 35.3(22.6-46.0)% of stroke, 14.3(3.2-24.2)% of HF, and 15.9(6.7-24.2)% of ESRD could be attributed to deprivation; while 14.3(3.3-25.4)% of PM, -3.3(-8.3-1.5)% of MI, -0.5(-6.7-5.3)% of stroke, 4.7(0.3-8.8)% of HF, 13.3(9.9-16.6)% of ESRD could be attributed to ethnicity. Deprivation contributed a significant AF to stroke, while ethnicity was important for ESRD. Gradient of AF for deprivation indicated NZE and Asians were most affected by deprivation across outcomes. Conversely, Māori, with the highest AFs for ethnicity of PM and ESRD, were unaffected by deprivation. At same deprivations, the AFs of MI and stroke were greatest among NZE compared with other ethnic groups; the AF of ESRD was greatest among Māori and Pasifika. Conclusion Both socioeconomic deprivation and ethnicity are strongly associated with outcomes in patients with T2DM in NZ, although the extent of the deprivation gradient is greatest among NZE and Asians, and least among Māori.
Collapse
Affiliation(s)
- Dahai Yu
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450052, People’s Republic of China
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Uchechukwu Levi Osuagwu
- Translational Health Research Institute (THRI), Western Sydney University, Sydney, NSW, Australia
- School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | | | - John Baker
- Diabetes Foundation Aotearoa, Auckland, New Zealand
- Department of Diabetes and Endocrinology, Counties Manukau Health, Auckland, New Zealand
| | - Richard Cutfield
- Diabetes Foundation Aotearoa, Auckland, New Zealand
- Department of Diabetes and Endocrinology, Waitemata District Health Board, Auckland, New Zealand
| | - Zheng Wang
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450052, People’s Republic of China
| | - Yamei Cai
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450052, People’s Republic of China
| | - Brandon J Orr-Walker
- Diabetes Foundation Aotearoa, Auckland, New Zealand
- Department of Diabetes and Endocrinology, Counties Manukau Health, Auckland, New Zealand
| | - Gerhard Sundborn
- Section of Pacific Health, The University of Auckland, Auckland, New Zealand
| | - Zhanzheng Zhao
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450052, People’s Republic of China
| | - David Simmons
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450052, People’s Republic of China
- Translational Health Research Institute (THRI), Western Sydney University, Sydney, NSW, Australia
- School of Medicine, Western Sydney University, Sydney, NSW, Australia
- Correspondence: David Simmons; Zhanzheng Zhao, Department of Nephrology, The First Affiliated Hospital Zhengzhou University, Zhengzhou, 450052, People’s Republic of China, Tel +61 2 4620 3899; +86 139 3852 5666, Fax +61 2 4620 3890; +86 371 6698 8753, Email ;
| |
Collapse
|
9
|
Yu D, Wang Z, Cai Y, Osuagwu UL, Pickering K, Baker J, Cutfield R, Orr-Walker BJ, Sundborn G, Jayanatha K, Zhao Z, Simmons D. Ethnic differences in 25-year risk of incident chronic kidney disease among people with type 2 diabetes in New Zealand. BMJ Open Diabetes Res Care 2022; 10:10/6/e003077. [PMID: 36521879 PMCID: PMC9756147 DOI: 10.1136/bmjdrc-2022-003077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 10/14/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Insights into ethnic differences in the natural history of chronic kidney disease (CKD) among people with type 2 diabetes mellitus (T2DM) might inform clinical strategies to address disparities in hospitalization and mortality. Risks of CKD II-V stages over a 25-year period between New Zealand Europeans (NZEs), Māori and Pasifika, and with T2DM in Auckland, New Zealand (NZ) were compared. RESEARCH DESIGN AND METHODS As a primary care audit program in Auckland, the Diabetes Care Support Service was linked with national registration databases. People with existing CKD II-V were ruled out. To balance potential confounders, we applied a tapered matching method . 'Quasi-trial'-matched cohorts were set up separately between Māori and NZE and between Pasifika and NZE. Ethnic population differences in risk of any and each stage of CKD over 1994-2018 were examined by weighted Cox regression model. RESULTS The HRs for developing any CKD, CKD stages II-V for Māori (n=2215) versus NZE (n=2028) were 1.18 (95% CI 0.99 to 1.41), 1.10 (95% CI 0.91 to 1.32), 1.70 (95% CI 1.19 to 2.43), 3.93 (95% CI 2.16 to 7.14), and 3.74 (95% CI 1.74 to 8.05), respectively. Compared with NZE (n=2474), the HRs for developing any CKD, CKD stages II-V for Pasifika (n=3101) were 1.31 (95% CI 1.09 to 1.57), 1.26 (95% CI 1.05 to 1.52), 1.71 (95% CI 1.14 to 2.57), 3.75 (95% CI 1.40 to 10.05), and 4.96 (95% CI 1.56 to 15.75), respectively. CONCLUSIONS Among people with T2DM in NZ, significant ethnic differences exist in the risk of progressing to each stage of CKD (stage V in particular). Mechanism studies underlying these differences, as well as the need for identification of biomarkers to predict the early onset renal lesion, are warranted.
Collapse
Affiliation(s)
- Dahai Yu
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, People's Republic of China
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Zheng Wang
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Yamei Cai
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, People's Republic of China
| | | | | | - John Baker
- Diabetes Foundation Aotearoa, Otara, New Zealand
- Department of Diabetes and Endocrinology, Counties Manukau Health, Auckland, New Zealand
| | - Richard Cutfield
- Diabetes Foundation Aotearoa, Otara, New Zealand
- Department of Diabetes and Endocrinology, Waitemata District Health Board, Auckland, New Zealand
| | - Brandon J Orr-Walker
- Diabetes Foundation Aotearoa, Otara, New Zealand
- Department of Diabetes and Endocrinology, Counties Manukau Health, Auckland, New Zealand
| | - Gerhard Sundborn
- Section of Pacific Health, the University of Auckland, Auckland, New Zealand
| | - Kalpa Jayanatha
- Department of Renal Medicine, Counties Manukau Health, Auckland, New Zealand
- Faculty of Medical and Health Sciences, the University of Auckland, Auckland, New Zealand
| | - Zhanzheng Zhao
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, People's Republic of China
| | - David Simmons
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, People's Republic of China
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| |
Collapse
|
10
|
Thornley S, Sundborn G, Engelman D, Roskvist R, Heather M, Pasay CJ, Marshall R, McCarthy J. High prevalence of scabies in Auckland pre-schools. N Z Med J 2022; 135:12-17. [PMID: 35999795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
AIM Scabies is a difficult disease to diagnose and its prevalence not well established. A strong association between scabies and more serious illnesses in children, for instance acute rheumatic fever, suggests greater understanding of scabies prevalence is warranted. Here, we present initial findings of a study of childcare centres, to estimate the prevalence of scabies in the Auckland community. METHODS Children in three childcare centres from socio-economically challenged areas were examined for scabies. Diagnoses were made according to the International Alliance for the Control of Scabies (IACS) criteria, whose "clinical" or "suspected" definition consists of examination findings of papules: either "typical" or "atypical" distribution, along with history features of itch and contact with likely other cases. A quantitative polymerase chain reaction (qPCR) test was also used. RESULTS A total of 67 children were examined, with over half (n=38 or 56.7%) showing signs of typical (14; 20.9%) or atypical (24; 35.8%) scabies lesions. History information was available for 50 children. Of these, nine (18%) met the criteria for "clinical" or "suspected" scabies. Of 27 qPCR tests performed nine (33%) tested positive. CONCLUSION The prevalence of scabies is high in early childcare centres in socio-economically challenged areas of Auckland.
Collapse
Affiliation(s)
- Simon Thornley
- Senior Lecturer, Section of Epidemiology and Biostatistics, The University of Auckland, Auckland, New Zealand
| | - Gerhard Sundborn
- Senior Lecturer, Section of Pacific Health, The University of Auckland, Auckland, New Zealand
| | - Daniel Engelman
- Team Leader/Clinician Scientist Fellow, Murdoch Children's Research Institute, Melbourne, Australia
| | - Rachel Roskvist
- Senior Lecturer and General Practitioner, Department of Primary Care, The University of Auckland, Auckland, New Zealand
| | - Maryann Heather
- Senior Lecturer, Section of Pacific Health, The University of Auckland, Auckland, New Zealand
| | - Cielo J Pasay
- Research Officer, QIMR Berghoffer Medical Research Institute, Brisbane, Queensland, Australia
| | - Roger Marshall
- Emeritus Professor of Biostatistics, Section of Epidemiology and Biostatistics, The University of Auckland, Auckland, New Zealand
| | - James McCarthy
- Professor of Medicine, Doherty Institute, The University of Melbourne, Melbourne, Australia
| |
Collapse
|
11
|
Yu D, Cai Y, Levi Osuagwu U, Pickering K, Baker J, Cutfield R, McKree Jansen R, Orr-Walker BJ, Sundborn G, Zhao Z, Simmons D. Ethnic differences in metabolic achievement between Māori, Pacific, and European New Zealanders with type 2 diabetes. Diabetes Res Clin Pract 2022; 189:109910. [PMID: 35537520 DOI: 10.1016/j.diabres.2022.109910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 03/07/2022] [Accepted: 05/03/2022] [Indexed: 11/25/2022]
Abstract
AIMS To compare variations in metabolic target achievement by ethnicity (Europeans, Māori and Pasifika) among patients with type 2 diabetes (T2DM) in Auckland, New Zealand (NZ) between 1994 and 2013. METHODS 32,237 patients were enrolled. Adjusted marginal difference (European as reference) of systolic blood pressure (SBP), body mass index (BMI), HbA1c and total cholesterol, alongside the proportion achieving metabolic targets were estimated using multivariable mixed effect models at baseline, 1-, 2-, 3-, 4-, and 5-years, adjusted for covariates. RESULTS Compared with Europeans, Māori and Pasifika had continuously, significantly higher HbA1c (by 0.3% (+3.5 mmol/mol) and 0.6% (+6.8 mmol/mol) respectively and BMI (+1.5 and +0.3 kg/m2 respectively) but lower SBP (-1.8 and -3.4 mmHg respectively) and TG (-0.03 and -0.34 mmol/L respectively), and insignificantly TC (+0.004 and +0.01 respectively), by 5-years of follow-up. While 49% Europeans were within target HbA1c, this was achieved by only 30% Māori and 27% Pasifika. Conversely, 41% Europeans, 46% Māori and 59% Pasifika achieved the SBP target (all P < 0.0001). CONCLUSIONS Managing hyperglycemia appears to be more challenging than treating hypertension and dyslipidemia among Māori and Pasifika. New anti-hyperglycemia treatments, addressing health literacy, socioeconomic and any cultural barriers to management and self-management are urgently needed to reduce these disparities.
Collapse
Affiliation(s)
- Dahai Yu
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China; Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele ST5 5BG, UK
| | - Yamei Cai
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
| | - Uchechukwu Levi Osuagwu
- Macarthur Clinical School, Western Sydney University, Campbelltown, Sydney NSW 2751, Australia
| | | | - John Baker
- Diabetes Foundation Aotearoa, Otara, New Zealand; Department of Diabetes and Endocrinology, Counties Manukau Health, South Auckland, New Zealand
| | - Richard Cutfield
- Diabetes Foundation Aotearoa, Otara, New Zealand; Department of Diabetes and Endocrinology, Waitemata District Health Board, Auckland, New Zealand
| | | | - Brandon J Orr-Walker
- Diabetes Foundation Aotearoa, Otara, New Zealand; Department of Diabetes and Endocrinology, Counties Manukau Health, South Auckland, New Zealand
| | - Gerhard Sundborn
- Section of Epidemiology and Biostatistics, the University of Auckland, Auckland, New Zealand
| | - Zhanzheng Zhao
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China.
| | - David Simmons
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China; Macarthur Clinical School, Western Sydney University, Campbelltown, Sydney NSW 2751, Australia.
| |
Collapse
|
12
|
Sundborn G, Thornley S, Veatupu L, Lang B. If soft drink companies can do it, why can't government? Sugary drink sales policies in schools must be tightened. Aust N Z J Public Health 2022; 46:415-416. [PMID: 35174944 DOI: 10.1111/1753-6405.13218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Gerhard Sundborn
- Department of Pacific Health, University of Auckland, New Zealand
| | - Simon Thornley
- Section of Epidemiology and Biostatistics, University of Auckland, New Zealand
| | - Loma Veatupu
- Department of Pacific Health, University of Auckland, New Zealand
| | - Bodo Lang
- Marketing Department, University of Auckland, New Zealand
| |
Collapse
|
13
|
Yu D, Wang Z, Cai Y, McBride K, Osuagwu UL, Pickering K, Baker J, Cutfield R, Orr-Walker BJ, Sundborn G, Jameson MB, Zhao Z, Simmons D. Ethnic Differences in Cancer Rates Among Adults With Type 2 Diabetes in New Zealand From 1994 to 2018. JAMA Netw Open 2022; 5:e2147171. [PMID: 35129595 PMCID: PMC8822383 DOI: 10.1001/jamanetworkopen.2021.47171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE People with type 2 diabetes have greater risk for some site-specific cancers, and risks of cancers differ among racial and ethnic groups in the general population of Aotearoa New Zealand. The extent of ethnic disparities in cancer risks among people with type 2 diabetes in New Zealand is unclear. OBJECTIVE To compare the risks of 21 common adult cancers among Māori, Pasifika, and New Zealand European individuals with type 2 diabetes in New Zealand from 1994 to 2018. DESIGN, SETTING, AND PARTICIPANTS This population-based, matched cohort study used data from the primary care audit program in Auckland, New Zealand, linked with national cancer, death, and hospitalization registration databases, collected from January 1, 1994, to July 31, 2018, with follow-up data obtained through December 31, 2019. Using a tapered matching method to balance potential confounders (sociodemographic characteristics, lifestyle, anthropometric and clinical measurements, treatments [antidiabetes, antihypertensive, lipid-lowering, and anticoagulant], period effects, and recorded duration of diabetes), comparative cohorts were formed between New Zealand European and Māori and New Zealand European and Pasifika individuals aged 18 years or older with type 2 diabetes. Sex-specific matched cohorts were formed for sex-specific cancers. EXPOSURES Māori, Pasifika, and New Zealand European (reference group) ethnicity. MAIN OUTCOMES AND MEASURES The incidence rates of 21 common cancers recorded in nationally linked databases between 1994 and 2018 were the main outcomes. Weighted Cox proportional hazards regression was used to assess ethnic differences in risk of each cancer. RESULTS A total of 33 524 adults were included: 15 469 New Zealand European (mean [SD] age, 61.6 [13.2] years; 8522 [55.1%] male), 6656 Māori (mean [SD] age, 51.2 [12.4] years; 3345 [50.3%] female), and 11 399 Pasifika (mean [SD] age, 52.8 [12.7] years; 5994 [52.6%] female) individuals. In the matched New Zealand European and Māori cohort (New Zealand European: 8361 individuals; mean [SD] age, 58.9 [12.9] years; 4595 [55.0%] male; Māori: 5039 individuals; mean [SD] age, 51.4 [12.3] years; 2542 [50.5%] male), significant differences between New Zealand European and Māori individuals were identified in the risk for 7 cancers. Compared with New Zealand European individuals, the hazard ratios (HRs) among Māori individuals were 15.36 (95% CI, 4.50-52.34) for thyroid cancer, 7.94 (95% CI, 1.57-40.24) for gallbladder cancer, 4.81 (95% CI, 1.08-21.42) for cervical cancer (females only), 1.97 (95% CI, 1.30-2.99) for lung cancer, 1.81 (95% CI, 1.08-3.03) for liver cancer, 0.56 (95% CI, 0.35-0.90) for colon cancer, and 0.11 (95% CI, 0.04-0.27) for malignant melanoma. In the matched New Zealand European and Pasifika cohort (New Zealand European: 9340 individuals; mean [SD] age, 60.6 [13.1] years; 4885 [52.3%] male; Pasifika: 8828 individuals; mean [SD] age, 53.1 [12.6] years; 4612 [52.2%] female), significant differences between New Zealand European and Pasifika individuals were identified for 6 cancers. Compared with New Zealand European individuals, HRs among Pasifika individuals were 25.10 (95% CI, 3.14-200.63) for gallbladder cancer, 4.47 (95% CI, 1.25-16.03) for thyroid cancer, 0.48 (95% CI, 0.30-0.78) for colon cancer, 0.21 (95% CI, 0.09-0.48) for rectal cancer, 0.21 (95% CI, 0.07-0.65) for malignant melanoma, and 0.01 (95% CI, 0.01-0.10) for bladder cancer. CONCLUSIONS AND RELEVANCE In this cohort study, differences in the risk of 21 common cancers were found between New Zealand European, Māori, and Pasifika groups of adults with type 2 diabetes in New Zealand from 1994 to 2018. Research into the mechanisms underlying these differences as well as additional screening strategies (eg, for thyroid and gallbladder cancers) appear to be warranted.
Collapse
Affiliation(s)
- Dahai Yu
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, United Kingdom
| | - Zheng Wang
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Yamei Cai
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Kate McBride
- School of Medicine, Western Sydney University, Campbelltown, Sydney, New South Wales, Australia
| | - Uchechukwu Levi Osuagwu
- School of Medicine, Western Sydney University, Campbelltown, Sydney, New South Wales, Australia
| | | | - John Baker
- Diabetes Foundation Aotearoa, Otara, New Zealand
- Department of Diabetes and Endocrinology, Counties Manukau Health, South Auckland, New Zealand
| | - Richard Cutfield
- Diabetes Foundation Aotearoa, Otara, New Zealand
- Department of Diabetes and Endocrinology, Waitemata District Health Board, Auckland, New Zealand
| | - Brandon J. Orr-Walker
- Diabetes Foundation Aotearoa, Otara, New Zealand
- Department of Diabetes and Endocrinology, Counties Manukau Health, South Auckland, New Zealand
| | - Gerhard Sundborn
- Section of Pacific Health, The University of Auckland, Auckland, New Zealand
| | - Michael B. Jameson
- Oncology Department, Waikato Hospital, Hamilton, New Zealand
- Waikato Clinical Campus, The University of Auckland, Hamilton, New Zealand
| | - Zhanzheng Zhao
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - David Simmons
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
- School of Medicine, Western Sydney University, Campbelltown, Sydney, New South Wales, Australia
| |
Collapse
|
14
|
Thornley S, Grant C, Sundborn G. Higher Rates of Hospital Treatment for Parasuicide are Temporally Associated with Covid-19 Lockdowns in New Zealand Children. J Paediatr Child Health 2021; 57:2038-2039. [PMID: 34523776 PMCID: PMC8661839 DOI: 10.1111/jpc.15736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Simon Thornley
- Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
| | - Cameron Grant
- Department of Paediatrics, Child and Youth Health, School of Medicine, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
| | - Gerhard Sundborn
- Section of Pacific Health, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
| |
Collapse
|
15
|
Yu D, Cai Y, Osuagwu UL, Pickering K, Baker J, Cutfield R, Jansen RM, Orr-Walker BJ, Sundborn G, Zhao Z, Simmons D. Metabolic Profiles of Maori, Pacific, and European New Zealanders With Type 2 Diabetes Over 25 Years. Diabetes Care 2021; 44:dc211255. [PMID: 34362817 DOI: 10.2337/dc21-1255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/14/2021] [Indexed: 02/03/2023]
Affiliation(s)
- Dahai Yu
- Department of Nephrology, First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, U.K
| | - Yamei Cai
- Department of Nephrology, First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | | | | | - John Baker
- Diabetes Foundation Aotearoa, Otara, New Zealand
- Department of Diabetes and Endocrinology, Counties Manukau Health, South Auckland, New Zealand
| | - Richard Cutfield
- Diabetes Foundation Aotearoa, Otara, New Zealand
- Department of Diabetes and Endocrinology, Waitemata District Health Board, Auckland, New Zealand
| | | | - Brandon J Orr-Walker
- Diabetes Foundation Aotearoa, Otara, New Zealand
- Department of Diabetes and Endocrinology, Counties Manukau Health, South Auckland, New Zealand
| | - Gerhard Sundborn
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Zhanzheng Zhao
- Department of Nephrology, First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - David Simmons
- Department of Nephrology, First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
- Macarthur Clinical School, Western Sydney University, Campbelltown, Sydney, Australia
| |
Collapse
|
16
|
Sundborn G, Thornley S, Grey C, Gentles D, Jackson RT, Swinburn B, Veatupu L, Lang B. Gamification and Sugar: A School-Based Pilot Study of Social Marketing and Gamification Approaches to Reduce Sugary Drink Intake in Pasifika School Students. Asia Pac J Public Health 2021; 33:727-733. [PMID: 34218679 DOI: 10.1177/10105395211030133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to investigate a social marketing-gamification intervention to reduce sugary drink intake drawing on popular culture of Pasifika secondary school students in Auckland, New Zealand. Students aged 11 to 14 years from one coeducational high school participated in the 11-week pilot study. The 9-week intervention was undertaken in assemblies and classrooms. Baseline and follow-up measures were completed by 227 and 220 students, respectively, of 298 enrolled students. Retention of the "3-6-9" teaching related to maximum daily sugar intake increased from 9% at baseline to 97% at follow-up (P < .0001). Significant increases were observed of students who correctly answered sugar content of drinks. Overall consumption of sugary drink decreased at follow-up by 0.46 glasses per day. The main conclusion from this study was that this school-based gamification educational package to convey messages about sugar content of drinks using popular modes of engagement is a promising intervention that was acceptable and well supported by school staff and students.
Collapse
Affiliation(s)
| | | | - Corina Grey
- Auckland District Health Board, Auckland, New Zealand
| | | | | | | | | | - Bodo Lang
- University of Auckland, Auckland, New Zealand
| |
Collapse
|
17
|
Sundborn G, Thornley S, Jackson M, Morris G, Blackham M, Schofield G, Doehring R, Goedeke R, Chaudhuri A. Chasing elimination through lockdowns is stamping out livelihoods and lives [includes Addendum]. J Prim Health Care 2020; 12:298-301. [PMID: 33349316 DOI: 10.1071/hc20132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 12/05/2020] [Indexed: 11/23/2022] Open
Affiliation(s)
- Gerhard Sundborn
- Faculty of Medical and Health Sciences, The University of Auckland, 85 Park Road, Grafton, Auckland 1023, New Zealand; and Corresponding author.
| | - Simon Thornley
- Faculty of Medical and Health Sciences, The University of Auckland, 85 Park Road, Grafton, Auckland 1023, New Zealand
| | - Michael Jackson
- School of Biological Sciences, University of Canterbury, Private Bag 4800, Christchurch 8140, New Zealand
| | - Grant Morris
- Faculty of Law, Victoria University of Wellington, GB 324, Government Buildings, 55 Lambton Lambton Quay, Pipitea, Wellington 6011, New Zealand
| | - Mark Blackham
- Blackland PR, Level 12, City Chambers, 142 Featherston Street, Wellington Central, Wellington 6011, New Zealand
| | - Grant Schofield
- Human Potential Centre/Centre for Physical Activity and Nutrition, Faculty of Health & Environmental Sciences, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | | | - Ronald Goedeke
- Private Practice, 72a Apollo Drive, Albany, Auckland 0632, New Zealand
| | - Ananish Chaudhuri
- Business School, The University of Auckland, Owen G Glenn Building, 12 Grafton Road, Auckland CBD, Auckland 1010, New Zealand
| |
Collapse
|
18
|
Thornley S, Jackson MD, Sundborn G. Danish mask study: masks, media, fact checkers, and the interpretation of scientific evidence. BMJ 2020; 371:m4919. [PMID: 33361085 DOI: 10.1136/bmj.m4919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Simon Thornley
- Section of Epidemiology and Biostatistics, University of Auckland, Building 507, 22-30 Park Road, Grafton, Auckland 1142, New Zealand
| | - Michael D Jackson
- School of Biological Sciences, University of Canterbury, Christchurch, New Zealand
| | - Gerhard Sundborn
- Section of Pacific Health, University of Auckland, Auckland, New Zealand
| |
Collapse
|
19
|
Satokar VV, Cutfield WS, Derraik JGB, Harwood M, Okasene-Gafa K, Beck K, Cameron-Smith D, O'Sullivan JM, Sundborn G, Pundir S, Mason RP, Albert BB. Double-blind RCT of fish oil supplementation in pregnancy and lactation to improve the metabolic health in children of mothers with overweight or obesity during pregnancy: study protocol. BMJ Open 2020; 10:e041015. [PMID: 33323442 PMCID: PMC7745511 DOI: 10.1136/bmjopen-2020-041015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Maternal obesity during pregnancy is associated with adverse changes in body composition and metabolism in the offspring. We hypothesise that supplementation during pregnancy of overweight and obese women may help prevent the development of greater adiposity and metabolic dysfunction in children. Previous clinical trials investigating fish oil supplementation in pregnancy on metabolic outcomes and body composition of the children have not focused on the pregnancies of overweight or obese women. METHODS AND ANALYSIS A double-blind randomised controlled trial of fish oil (providing 3 g/day of n-3 polyunsaturated fatty acids) versus an equal volume of olive oil (control) taken daily from recruitment until birth, and in breastfeeding mothers, further continued for 3 months post partum. Eligible women will have a singleton pregnancy at 12-20 weeks' gestation and be aged 18-40 years with body mass index ≥25 kg/m2 at baseline. We aim to recruit a minimum of 128 participants to be randomised 1:1. Clinical assessments will be performed at baseline and 30 weeks of pregnancy, including anthropometric measurements, fasting metabolic markers, measures of anxiety, physical activity, quality of life and dietary intake. Subsequent assessments will be performed when the infant is 2 weeks, 3 months and 12 months of age for anthropometry, body composition (dual-energy X-ray absorptiometry (DXA)) and blood sampling. The primary outcome of the study is a between-group difference in infant percentage body fatness, assessed by DXA, at 2 weeks of age. Secondary outcomes will include differences in anthropometric measures at each time point, percentage body fat at 3 and 12 months and homeostatic model assessment of insulin resistance at 3 months. Statistical analysis will be carried out on the principle of intention to treat. ETHICS AND DISSEMINATION This trial was approved by the Northern A Health and Disabilities Ethics Committee, New Zealand Ministry of Health (17/NTA/154). Results will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER ACTRN12617001078347p; Pre-results.
Collapse
Affiliation(s)
- Vidit V Satokar
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Wayne S Cutfield
- Liggins Institute, University of Auckland, Auckland, New Zealand
- A Better Start - National Science Challenge, University of Auckland, Auckland, New Zealand
| | - José G B Derraik
- Liggins Institute, University of Auckland, Auckland, New Zealand
- A Better Start - National Science Challenge, University of Auckland, Auckland, New Zealand
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Endocrinology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Matire Harwood
- National Hauora Coalition, Auckland, New Zealand
- Te Kupenga Hauora Māori Teaching, University of Auckland, Auckland, New Zealand
| | - Karaponi Okasene-Gafa
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Kathryn Beck
- School of Sport Exercise and Nutrition, Massey University, Auckland, New Zealand
| | - David Cameron-Smith
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | | | - Gerhard Sundborn
- Department of Pacific Health, University of Auckland, Auckland, New Zealand
| | - Shikha Pundir
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - R Preston Mason
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Benjamin B Albert
- Liggins Institute, University of Auckland, Auckland, New Zealand
- A Better Start - National Science Challenge, University of Auckland, Auckland, New Zealand
| |
Collapse
|
20
|
Jansen RM, Sundborn G, Cutfield R, Yu D, Simmons D. Ethnic inequity in diabetes outcomes-inaction in the face of need. N Z Med J 2020; 133:8-10. [PMID: 33223543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
| | - Gerhard Sundborn
- Diabetes Foundation Aotearoa, Otara; Department of Pacific Health, School of Population Health, University of Auckland, Auckland
| | - Rick Cutfield
- Department of Diabetes and Endocrinology, Waitemata District Health Board, Auckland; Diabetes Care Support Service, Diabetes Foundation Aotearoa, Otara
| | - Dahai Yu
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele ST5 5BG, UK
| | - David Simmons
- Macarthur Clinical School, Western Sydney University, Campbelltown, Sydney NSW 2751, Australia
| |
Collapse
|
21
|
Affiliation(s)
- Andrew Lee
- School of Health and Related Research, Sheffield University, UK
| | - Simon Thornley
- Section of Epidemiology and Biostatistics, University of Auckland, New Zealand
| | | | | |
Collapse
|
22
|
Thornley S, King R, Marshall R, Oakley A, Sundborn G, Harrower J, Reynolds E, Arbuckle M, Johnson RJ. How strong is the relationship between scabies and acute rheumatic fever? An analysis of neighbourhood factors. J Paediatr Child Health 2020; 56:600-606. [PMID: 31774599 DOI: 10.1111/jpc.14697] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 10/24/2019] [Accepted: 11/03/2019] [Indexed: 01/06/2023]
Abstract
AIM Recent studies have linked scabies with acute rheumatic fever (ARF). We explored the relationship, by neighbourhood, between permethrin dispensing as an indicator of scabies prevalence and ARF cases over the same period. METHODS Incident cases of ARF notified to public health between September 2015 and June 2018 and the annual incidence of prescribing by neighbourhood over the same period were analysed. Evidence of an association between permethrin and ARF was obtained by carrying out Poisson regression of the rate of ARF in terms of permethrin rate at the census area unit level, with adjustment for ethnicity and socio-economic deprivation. RESULTS A total of 413 neighbourhoods were included. The incidence of ARF varied between 0 and 102 per 100 000 people per year (mean 4.3). In contrast, the annual incidence of dispensing of permethrin varied between 0 and 3201 per 100 000 people per year (mean 771). A strong association was observed between the two variables. In an adjusted quasi-Poisson model, permethrin-dispensing rates were strongly associated with ARF incidence, with a change from the 16th to the 84th centile associated with a 16.5-fold increase in incidence (95% confidence interval: 3.82-71.6). CONCLUSIONS Permethrin prescribing as an indicator of scabies is strongly associated with the incidence of ARF. Considered together with other studies, this evidence suggests that improving scabies control may reduce the burden of ARF in New Zealand.
Collapse
Affiliation(s)
- Simon Thornley
- Greenlane Clinical Centre, Auckland Regional Public Health Service, Auckland, New Zealand.,Section of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Ron King
- Greenlane Clinical Centre, Auckland Regional Public Health Service, Auckland, New Zealand
| | - Roger Marshall
- Section of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Amanda Oakley
- Waikato Clinical Campus, Waikato Hospital, The University of Auckland, Hamilton, New Zealand
| | - Gerhard Sundborn
- Section of Pacific Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Jay Harrower
- Greenlane Clinical Centre, Auckland Regional Public Health Service, Auckland, New Zealand
| | - Edwin Reynolds
- Greenlane Clinical Centre, Auckland Regional Public Health Service, Auckland, New Zealand
| | - Mark Arbuckle
- Ōtara Christian and Family Health Centre, Auckland, New Zealand
| | - Richard J Johnson
- Division of Renal Diseases and Hypertension, University of Colorado, Aurora, Colorado, United States
| |
Collapse
|
23
|
Maddison R, Hargreaves EA, Jiang Y, Calder AJ, Wyke S, Gray CM, Hunt K, Lubans D, Eyles H, Draper N, Heke I, Kara S, Sundborn G, Arandjus C, Jenkins M, Marsh S. Rugby Fans in Training New Zealand (RUFIT-NZ): protocol for a randomized controlled trial to assess the effectiveness and cost-effectiveness of a healthy lifestyle program for overweight men delivered through professional rugby clubs in New Zealand. Trials 2020; 21:139. [PMID: 32019609 PMCID: PMC7001306 DOI: 10.1186/s13063-019-4038-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 12/29/2019] [Indexed: 11/18/2022] Open
Abstract
Background A healthy lifestyle program that appeals to, and supports, obese New Zealand (NZ) European, Māori (indigenous) and Pasifika men to achieve weight loss is urgently needed. In Scotland, Football Fans in Training (FFIT), a weight management and healthy lifestyle program for overweight and obese men aged 35–65 years , delivered by community coaching staff at professional football clubs, has been shown to be beneficial and cost-effective. A pilot program inspired by FFIT but delivered by professional rugby clubs in NZ (n = 96) was shown to be effective in weight loss, improved physiological outcomes, and adherence to healthy lifestyle behaviors in overweight and obese men. The objective of this trial is to determine the effectiveness and cost-effectiveness of the Rugby Fans in Training New Zealand (RUFIT-NZ) program. Methods A pragmatic, two-arm, multi-center, randomized controlled trial involving 308 overweight and obese men aged 30–65 years, randomized to either an intervention group (n = 154) or a wait-list control group (n = 154). The intervention-group participated in the 12-week RUFIT-NZ program, a gender-sensitized, healthy lifestyle intervention adapted to the environment and cultural diversity of NZ and delivered through professional rugby clubs. Participants in the intervention group undergo physical training sessions, in addition to workshop-based sessions to learn about nutrition, physical activity, sleep, sedentary behavior, and a range of behavior-change strategies for sustaining a healthier lifestyle. The control group receives the program after 52 weeks. The primary outcome is change in body weight from baseline to 52 weeks. Secondary outcomes include change in body weight at 12 weeks; waist circumference, blood pressure, fitness, and lifestyle behaviors at 12 and 52 weeks; and cost-effectiveness. A process evaluation informed by the RE-AIM framework will evaluate potential implementation of RUFIT-NZ as an ongoing program in NZ after the trial. Discussion This trial will investigate the effectiveness and cost-effectiveness of the RUFIT-NZ program in overweight and obese NZ men. Trial registration Australia New Zealand Clinical Trials Registry, ACTRN12619000069156. Registered on 18 January 2019, according to the World Health Organization Trial Registration Data Set. Universal Trial Number, U1111-1245-0645.
Collapse
Affiliation(s)
- Ralph Maddison
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand. .,Institute for Physical Activity and Nutrition, Deakin University, Melbourne, VIC, Australia.
| | - Elaine Anne Hargreaves
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
| | - Yannan Jiang
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Amanda Jane Calder
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Sally Wyke
- Institute for Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, Scotland
| | - Cindy M Gray
- Institute for Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, Scotland
| | - Kate Hunt
- Institute for Social Marketing, Faculty of Health and Sports Sciences, University of Stirling, Stirling, UK
| | - David Lubans
- School of Education, Priority Research Centre for Physical Activity and Nutrition University of Newcastle, Newcastle, NSW, Australia
| | - Helen Eyles
- National Institute for Health Innovation and Department of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Nick Draper
- School of Health Sciences, University of Canterbury, Christchurch, New Zealand
| | | | - Stephen Kara
- Axis Sport Medicine Clinic, Auckland, New Zealand
| | - Gerhard Sundborn
- Department of Pacific Health, University of Auckland, Auckland, New Zealand
| | - Claire Arandjus
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Matthew Jenkins
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
| | - Samantha Marsh
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| |
Collapse
|
24
|
Sundborn G, Thornley S, Merriman TR, Lang B, King C, Lanaspa MA, Johnson RJ. Are Liquid Sugars Different from Solid Sugar in Their Ability to Cause Metabolic Syndrome? Obesity (Silver Spring) 2019; 27:879-887. [PMID: 31054268 DOI: 10.1002/oby.22472] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 01/29/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Intake of sugary drinks, especially soft drinks, carries increased risk for obesity and diabetes. This article reviews whether sugary drinks carry different risks for metabolic syndrome compared with foods that contain natural or added sugars. METHODS A narrative review was performed to evaluate differences between liquid and solid sugars in their ability to induce metabolic syndrome and to discuss potential mechanisms to account for the differences. RESULTS Epidemiological studies support liquid added sugars, such as soft drinks, as carrying greater risk for development of metabolic syndrome compared with solid sugar. Some studies suggest that fruit juice may also confer relatively higher risk for weight gain and insulin resistance compared with natural fruits. Experimental evidence suggests this may be due to differences in how fructose is metabolized. Fructose induces metabolic disease by reducing the energy levels in liver cells, mediated by the concentration of fructose to which the cells are exposed. The concentration relates to the quantity and speed at which fructose is ingested, absorbed, and metabolized. CONCLUSIONS Although reduced intake of added sugars (sucrose and high-fructose corn syrup) remains a general recommendation, there is evidence that sugary soft drinks may provide greater health risks relative to sugar-containing foods.
Collapse
Affiliation(s)
- Gerhard Sundborn
- Department of Pacific Health, The University of Auckland, Auckland, New Zealand
| | - Simon Thornley
- Auckland Regional Public Health Service, Auckland, New Zealand
| | - Tony R Merriman
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Bodo Lang
- Department of Marketing, Business School, The University of Auckland, Auckland, New Zealand
| | - Christopher King
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Miguel A Lanaspa
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Richard J Johnson
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| |
Collapse
|
25
|
Maddison R, Hargreaves EA, Wyke S, Gray CM, Hunt K, Heke JI, Kara S, Ni Mhurchu C, Jull A, Jiang Y, Sundborn G, Marsh S. Rugby Fans in Training New Zealand (RUFIT-NZ): a pilot randomized controlled trial of a healthy lifestyle program for overweight men delivered through professional rugby clubs in New Zealand. BMC Public Health 2019; 19:166. [PMID: 30736781 PMCID: PMC6368698 DOI: 10.1186/s12889-019-6472-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 01/23/2019] [Indexed: 12/05/2022] Open
Abstract
Background Healthy lifestyle programs that are designed specifically to appeal to and support men to improve lifestyle behaviors and lose weight are needed. The Rugby Fans in Training-New Zealand (RUFIT-NZ) program is delivered by professional rugby clubs and inspired by the successful Football Fans In Training program (FFIT), a gender sensitized weight loss program for obese middle-aged men delivered by professional football clubs in Scotland. RUFIT-NZ required development and evaluation for feasibility. Methods To develop the intervention we reviewed content from the FFIT program and evidence-based physical activity, dietary and weight management guidelines, and undertook a series of focus groups and key informant interviews. We then evaluated the feasibility of the intervention in a two-arm, parallel, pilot randomized controlled trial in New Zealand. Ninety-six participants were randomized to either the 12-week RUFIT-NZ intervention (N = 49) or a control group (N = 47). The intervention was delivered through professional rugby clubs and involved physical activity training and classroom sessions on healthy lifestyle behaviors. Pilot trial outcomes included body weight, heart rate, blood pressure, cardiorespiratory fitness, and lifestyle behaviors. Feasibility was assessed by recruitment and retention rates, and acceptability of the intervention. Results At 12 weeks the mean difference in body weight was 2.5 kg (95% CI -0.4 to 5.4), which favored the intervention. Statistically significant differences in favor of the intervention group were also observed for waist circumference, resting heart rate, diastolic blood pressure, cardiorespiratory fitness, and the proportion of participants that were adherent to 3 or more healthy lifestyle behaviors. The intervention was considered feasible to test in a full trial given the good recruitment and retention rates, and positive feedback from participants. Conclusions A pilot study of a healthy lifestyle intervention delivered via professional rugby clubs in New Zealand demonstrated positive effects on weight and physiological outcomes, as well as adherence to lifestyle behaviors. Feasibility issues in terms of recruitment, retention, and participant acceptability were assessed and findings will be used to inform the design of a definitive trial. Trial registration The trial was prospectively registered with the Australian New Zealand Clinical Trials Registry ACTRN12616000137493, 05/12/2016.
Collapse
Affiliation(s)
- Ralph Maddison
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, Melbourne, Vic, 3125, Australia.
| | - Elaine Anne Hargreaves
- School of Physical Education, Sport & Exercise Sciences, University of Otago, Dunedin, New Zealand
| | - Sally Wyke
- Institute of Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Cindy M Gray
- Institute of Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Kate Hunt
- Institute for Social Marketing, Faculty of Health and Sports Sciences, University of Stirling, Stirling, UK
| | | | - Stephen Kara
- Axis Sports Medicine Clinic, Auckland, New Zealand
| | - Cliona Ni Mhurchu
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Andrew Jull
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Yannan Jiang
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Gerhard Sundborn
- Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Samantha Marsh
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| |
Collapse
|
26
|
Purdy SC, Taylor S, Schluter PJ, Tautolo ES, Iusitini L, Ahmad Z, Sundborn G, Paterson J. Hearing and ear status of Pacific children aged 11 years living in New Zealand: the Pacific Islands families hearing study. Int J Audiol 2018; 58:77-86. [PMID: 30261774 DOI: 10.1080/14992027.2018.1506170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE This study aimed to determine the prevalence of hearing loss and ear problems in Pacific children, and investigate current and past demographic, health and social factors potentially associated with hearing and ear problems. DESIGN A cross-sectional observational study design nested within a birth cohort was employed. STUDY SAMPLE Nine-hundred-twenty Pacific children aged 11 years were audiologically assessed. Using average hearing thresholds at 500, 1k and 2k Hz, 162 (18%) right and 197 (21%) left ears had ≥20 dB hearing loss. Hearing loss was mild (20-39 dB) in most cases; 2% of ears had moderate to moderate-severe (40-69 dB) hearing loss. However, only 101 (11%) children had normal peripheral hearing defined by passing hearing threshold, tympanogram and distortion product otoacoustic emission assessments. Those with confirmed middle ear disease at age 2 years had significantly increased odds of a non-Type A tympanogram (adjusted odds ratio: 2.00; 95% confidence interval: 1.56, 2.50) when re-assessed at age 11 years. CONCLUSIONS Hearing loss, abnormal tympanograms, and auditory processing difficulties were present in many Pacific children. Interventions are also urgently needed to mitigate the effect of the longstanding ear disease likely to be present for many Pacific children.
Collapse
Affiliation(s)
- Suzanne C Purdy
- a School of Psychology , University of Auckland , Auckland , New Zealand
| | - Steve Taylor
- b Department of Biostatistics and Epidemiology , Auckland University of Technology , Auckland , New Zealand
| | - Philip J Schluter
- c School of Health Sciences , University of Canterbury - Te Whare Wānanga o Waitaha , Christchurch , New Zealand.,d School of Clinical Medicine, Primary Care Clinical Unit , The University of Queensland , Brisbane , Australia
| | - El-Shadan Tautolo
- e Centre for Pacific Health and Development Research , Auckland University of Technology , Auckland , New Zealand
| | - Leon Iusitini
- e Centre for Pacific Health and Development Research , Auckland University of Technology , Auckland , New Zealand
| | - Zahoor Ahmad
- f Ear, Nose & Throat (ENT) - Otorhinolaryngology, Manukau SuperClinic , Counties Manukau District Health Board, Ear , Auckland , New Zealand
| | - Gerhard Sundborn
- g School of Population Health , University of Auckland , Auckland , New Zealand
| | - Janis Paterson
- e Centre for Pacific Health and Development Research , Auckland University of Technology , Auckland , New Zealand
| |
Collapse
|
27
|
Thornley S, Sundborn G, Arbuckle M, Loring B, Heather M, Reynolds E. Is impetigo a missed opportunity for scabies treatment? N Z Med J 2018; 131:78-81. [PMID: 30161116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Simon Thornley
- Senior Lecturer, The University of Auckland, Auckland; Senior Research Fellow, Auckland University of Technology, Auckland; Epidemiologist, Communicable Diseases, Auckland Regional Public Health Service, Auckland
| | - Gerhard Sundborn
- Senior Lecturer, Section of Pacific Health, The University of Auckland, Auckland
| | - Mark Arbuckle
- General Practitioner, Otara Family and Christian Health Centre, Otara, Auckland
| | | | - Maryann Heather
- General Practitioner, South Seas Healthcare, Auckland; Honarary Academic, Section of Pacific Health, The University of Auckland, Auckland
| | - Edwin Reynolds
- Medical Officer, Auckland Regional Public Health Service, Greenlane Clinical Centre, Greenlane West, Auckland
| |
Collapse
|
28
|
Grey C, Jackson R, Wells S, Wu B, Poppe K, Harwood M, Sundborn G, Kerr AJ. Trends in ischaemic heart disease: patterns of hospitalisation and mortality rates differ by ethnicity (ANZACS-QI 21). N Z Med J 2018; 131:21-31. [PMID: 30001303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
AIM To examine trends in ischaemic heart disease (IHD) events by ethnicity. METHODS All IHD deaths and hospitalisations from 2006-2015 were identified using individual-linkage of national hospitalisation and mortality data. Age-standardised IHD rates and average annual age-adjusted percent changes were estimated by ethnic group. Ratios of non-fatal to fatal events were calculated by dividing age-standardised hospitalisation by death rates. RESULTS IHD mortality rates declined by 3.1-5.4% per year for most groups, except Pacific women, who experienced a non-significant decline of 1.3% per year. IHD hospitalisation rates declined significantly by 3.6-8.8% per year in all groups. IHD mortality rates were highest in Māori and Pacific people, but hospitalisation rates highest in Indians. Indians also had the highest ratio of hospitalisations to deaths. For every person who died from IHD in 2014/15, 7-8 Indians, but only 3-4 Māori or Pacific people, were hospitalised with IHD. CONCLUSION Fatal and non-fatal IHD rates are declining in all groups, but Māori and Pacific people have disproportionately high rates of IHD mortality. The much lower ratio of IHD hospitalisations to deaths among Māori and Pacific people compared to others suggests there are still important barriers to preventive interventions and acute care for Māori and Pacific men and women.
Collapse
Affiliation(s)
- Corina Grey
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland
| | - Rod Jackson
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland
| | - Susan Wells
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland
| | - Billy Wu
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland
| | - Katrina Poppe
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland
| | - Matire Harwood
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland
| | | | - Andrew J Kerr
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland; Counties Manukau District Health Board, Otahuhu, Auckland
| |
Collapse
|
29
|
Thornley S, Marshall R, Jarrett P, Sundborn G, Reynolds E, Schofield G. Scabies is strongly associated with acute rheumatic fever in a cohort study of Auckland children. J Paediatr Child Health 2018; 54:625-632. [PMID: 29442387 DOI: 10.1111/jpc.13851] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 11/01/2017] [Accepted: 12/14/2017] [Indexed: 11/30/2022]
Abstract
AIM This study sought to determine whether scabies infection is associated with acute rheumatic fever (ARF) or chronic rheumatic heart disease (CRHD). METHODS A cohort study was undertaken using health records of children aged 3-12 years attending an oral health service for the first time. Subjects were then linked to hospital diagnoses of scabies and ARF or CRHD. RESULTS A total of 213 957 children free of rheumatic heart disease at baseline were available for analysis. During a mean follow-up time of 5.1 years, 440 children were diagnosed with ARF or CRHD in hospital records. Children diagnosed with scabies during follow-up were 23 times more likely to develop ARF or CRHD, compared with children who had no scabies diagnosis. After adjustment for confounders in a Cox model, the association reduced but remained strong (adjusted hazard ratio: 8.98; 95% confidence interval: 6.33-20.2). In an analysis restricted to children hospitalised at least once during follow-up, the adjusted hazard ratio for the same comparison was 3.43 (95% confidence interval: 1.85-6.37). CONCLUSIONS A recent diagnosis of scabies from hospital records is strongly associated with a subsequent diagnosis of ARF. Further investigation of the role that scabies infestation may play in the aetiology of ARF is warranted.
Collapse
Affiliation(s)
- Simon Thornley
- Communicable Diseases and Disease Investigation, Auckland Regional Public Health Service, Auckland, New Zealand.,Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Roger Marshall
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Paul Jarrett
- Department of Medicine, Counties Manukau District Health Board, Middlemore Hospital, Auckland, New Zealand.,Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Gerhard Sundborn
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Edwin Reynolds
- Communicable Diseases and Disease Investigation, Auckland Regional Public Health Service, Auckland, New Zealand
| | - Grant Schofield
- Human Potential Centre, Millennium Institute, Auckland University of Technology, Auckland, New Zealand
| |
Collapse
|
30
|
Sundborn G, Thornley S, Beaglehole R, Bezzant N. Policy brief: a sugary drink tax for New Zealand and 10,000-strong petition snubbed by Minister of Health and National Government. N Z Med J 2017; 130:114-116. [PMID: 28934776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Gerhard Sundborn
- Epidemiology and Biostatistics, University of Auckland, Auckland
| | | | | | | |
Collapse
|
31
|
Volkova E, Michie J, Corrigan C, Sundborn G, Eyles H, Jiang Y, Mhurchu CN. Effectiveness of recruitment to a smartphone-delivered nutrition intervention in New Zealand: analysis of a randomised controlled trial. BMJ Open 2017; 7:e016198. [PMID: 28674144 PMCID: PMC5734449 DOI: 10.1136/bmjopen-2017-016198] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Delivery of interventions via smartphone is a relatively new initiative in public health, and limited evidence exists regarding optimal strategies for recruitment. We describe the effectiveness of approaches used to recruit participants to a smartphone-enabled nutrition intervention trial. METHODS Internet and social media advertising, mainstream media advertising and research team networks were used to recruit New Zealand adults to a fully automated smartphone-delivered nutrition labelling trial (no face-to-face visits were required). Recruitment of Māori and Pacific participants was a key focus and ethically relevant recruitment materials and approaches were used where possible. The effectiveness of recruitment strategies was evaluated using Google Analytics, monitoring of study website registrations and randomisations, and self-reported participant data. The cost of the various strategies and associations with participant demographics were assessed. RESULTS Over a period of 13 months, there were 2448 registrations on the study website, and 1357 eligible individuals were randomised into the study (55%). Facebook campaigns were the most successful recruitment strategy overall (43% of all randomised participants) and for all ethnic groups (Māori 44%, Pacific 44% and other 43%). Significant associations were observed between recruitment strategy and age (p<0.001), household size (p<0.001), ethnicity (p<0.001), gender (p=0.005) and interest in healthy eating (p=0.022). Facebook campaigns resulted in the highest absolute numbers of study registrations and randomisations (966 and 584, respectively). Network strategies and Facebook campaigns cost least per randomised participant (NZ$4 and NZ$5, respectively), whereas radio advertising costs most (NZ$179 per participant). CONCLUSION Internet and social media advertising were the most effective and least costly approaches to recruiting participants to a smartphone-delivered trial. These approaches also reached diverse ethnic groups. However, more culturally appropriate recruitment strategies are likely to be necessary in studies where large numbers of participants from specific ethnic groups are sought. TRIAL REGISTRATION ACTRN12614000644662; Post-results.
Collapse
Affiliation(s)
- Ekaterina Volkova
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Jo Michie
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | | | - Gerhard Sundborn
- Department of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Helen Eyles
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Yannan Jiang
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Cliona Ni Mhurchu
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| |
Collapse
|
32
|
Sundborn G, Thornley SJ, Malcolm J, Zinn C, Lang B, Johnson R. New Zealand infants weaned onto a high sugar diet from four months old: better health or better business? Part II. N Z Med J 2017; 130:86-88. [PMID: 28617794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
| | | | | | | | - Bodo Lang
- Department of Marketing, Business School, University of Auckland
| | - Richard Johnson
- Division of Renal Diseases and Hypertension, University of Colorado, Colorado, USA
| |
Collapse
|
33
|
Thornley S, Marshall R, Reynolds G, Koopu P, Sundborn G, Schofield G. Low sugar nutrition policies and dental caries: A study of primary schools in South Auckland. J Paediatr Child Health 2017; 53:494-499. [PMID: 28073166 DOI: 10.1111/jpc.13449] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 10/04/2016] [Accepted: 10/31/2016] [Indexed: 11/28/2022]
Abstract
AIM The study assessed whether a healthy food policy implemented in one school, Yendarra Primary, situated in a socio-economically deprived area of South Auckland, had improved student oral health by comparing dental caries levels with students of similar schools in the same region with no such policy. METHODS Records of caries of the primary and adult teeth were obtained between 2007 and 2014 for children attending Yendarra, and were compared to those of eight other public schools in the area, with a similar demographic profile. Children were selected between the ages of 8 and 11 years. Linear regression models were used to estimate the strength of association between attending Yendarra school and dental caries. RESULTS During the study period, 3813 records were obtained of children who attended dental examinations and the schools of interest. In a linear model, mean number of carious primary and adult teeth were 0.37 lower (95% confidence interval: 0.09-0.65) in Yendarra school children, compared to those in other schools, after adjustment for confounders. Pacific students had higher numbers of carious teeth (adjusted β coefficient: 0.25; 95% confidence interval: 0.03-0.46) than Māori. CONCLUSION This nutrition policy, implemented in a school in the poorest region of South Auckland, which restricted sugary food and drink availability, was associated with a marked positive effect on the oral health of students, compared to students in surrounding schools. We recommend that such policies are a useful means of improving child oral health.
Collapse
Affiliation(s)
- Simon Thornley
- Health Intelligence, Auckland Regional Public Health Service, Auckland, New Zealand
| | - Roger Marshall
- Section of Epidemiology and Biostatistics, The University of Auckland, Auckland, New Zealand
| | - Gary Reynolds
- Health Intelligence, Auckland Regional Public Health Service, Auckland, New Zealand
| | - Pauline Koopu
- Paediatric Services, Oral Health Department, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
| | - Gerhard Sundborn
- Section of Epidemiology and Biostatistics, The University of Auckland, Auckland, New Zealand
| | - Grant Schofield
- Millenium Institute, Human Potential Centre, Auckland University of Technology, Auckland, New Zealand
| |
Collapse
|
34
|
Thornley S, Marshall RJ, Bach K, Koopu P, Reynolds G, Sundborn G, Ei WLSS. Sugar, dental caries and the incidence of acute rheumatic fever: a cohort study of Māori and Pacific children. J Epidemiol Community Health 2016; 71:364-370. [DOI: 10.1136/jech-2016-208219] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 10/04/2016] [Accepted: 10/26/2016] [Indexed: 11/03/2022]
|
35
|
Sundborn G, Thornley S, Lang B, Beaglehole R. New Zealand's growing thirst for a sugar-sweetened beverage tax. N Z Med J 2015; 128:80-82. [PMID: 26411854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Gerhard Sundborn
- Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand.
| | | | | | | |
Collapse
|
36
|
Sundborn G. Gestational diabetes in the Cook Islands: universal screening needed on 'booking'. N Z Med J 2015; 128:8-9. [PMID: 25899487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Gerhard Sundborn
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
| |
Collapse
|
37
|
Sundborn G, Thornley S, Te Morenga L, Merriman T. FIZZ Sugary Drink Free Pacific by 2030--Symposium Declaration. N Z Med J 2014; 127:98-101. [PMID: 24806253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Gerhard Sundborn
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand.
| | | | | | | |
Collapse
|
38
|
Sundborn G, Utter J, Teevale T, Metcalf P, Jackson R. Carbonated beverages consumption among New Zealand youth and associations with BMI and waist circumference. Pac Health Dialog 2014; 20:81-86. [PMID: 25929001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM The primary aim of this study was to describe the carbonated beverage (soft drink) consumption patterns of New Zealand (NZ) youth and to investigate the influence that home availability of soft drinks had on their consumption. A secondary aim was to determine if there was an association between soft drink consumption and body mass index (BMI) or waist circumference. METHODS Data from Youth '07, a nationally representative survey of the health and well-being of NZ youth, including 8,697 NZ students aged 13 to 17 years, were analysed. RESULTS The relevant data was available for 8697 students of whom 4633 identified as NZ European. 1621 Māori, 1.098 Asian, 834 Pacific, and 504 Other. Twenty nine percent (29%) were categorised as high consumers of soft drinks (>4 times a week), 45.4% were moderate consumers (1-3 times a week), and 25.6% were low consumers (had not consumed soft drinks in the past week). Male gender, Pacific ethnicity, and high deprivation were all significantly associated with being in the high consumer group. Fifty eight percent (58%) of children who reported that soft drinks were 'usually' available at home were in the high consumption group, compared to 15.1% of children who reported that these drinks were never available at home. After adjusting for possible confounders, waist circumference was significantly associated with soft drink consumption (p<0.05), however, BMI was not. Mean soft drink consumption for boys was 3.5 times per week and was 2.0 for girls. CONCLUSION This study provides detailed information on soft drink consumption patterns of NZ youth and highlights factors associated with high consumption. Moderating the availability of soft drinks in the home is likely to significantly reduce their consumption among NZ youth.
Collapse
|
39
|
Metcalf PA, Scragg RRK, Sundborn G, Jackson R. Dietary intakes of Pacific ethnic groups and European people. Pac Health Dialog 2014; 20:73-80. [PMID: 25929000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To compare dietary intakes, food servings, and cooking practices of Pacific ethnic groups with New Zealand Europeans. METHODS Daily nutrient intakes were calculated from a self-administered food frequency questionnaire from a cross-sectional health screening study. Participants were Pacific (n=954) and New Zealand European (n=1.745) people aged 35 to 74 years. RESULTS Total energy intakes in Samoan and Niuean men were higher than European men, while for women, total energy intakes were significantly higher in all Pacific ethnic groups compared to New Zealand European women. Pacific men and women had lower alcohol and calcium intakes compared to New Zealand Europeans, and Pacific men had higher protein and cholesterol intakes. Pacific adults reported eating more servings of fish, chicken and bread, fewer servings of cheese and breakfast cereal per month, and boiled their meat more often than European adults. CONCLUSIONS Substantial differences in dietary habits and cooking practices exist between European and the different Pacific adult groups mainly related to the frequency of consumption of certain food/nutrient groups and greater serving sizes in Pacific compared to New Zealand European adults. Implications Strategies targeting serving sizes and frequency of consumption of specific food groups may help address the major ethnic disparities in nutrition-related health problems in New Zealand.
Collapse
|
40
|
Thornley S, Sundborn G, Schmidt-Uili SM. Rheumatic fever in New Zealand: what are the teeth trying to tell us? Pac Health Dialog 2014; 20:7-10. [PMID: 25928989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Rheumatic fever remains an important disease of childhood in New Zealand, despite increasing access and awareness of the need for preventive antibiotic treatment. Mãori and Pacific children have an incidence rate about 30 times and 70 times higher than European children, from annual notification data (77.7 per 100,000 for Pacific, 30.4 per 100,000 for Mãori, and 1 per 100,000 for European). In the early 20th century, a Canadian dentist, Weston A. Price, noted that 95% of children who presented with acute rheumatic fever also had advanced dental caries. Oral health surveys show that Mãori and Pacific children are disproportionately affected by dental caries compared to European. Excess dietary sugar intake is widely recognised to cause dental decay and also provides energy to some species of bacteria implicated in the pathogenesis of dental decay and rheumatic fever. We suggest that a case-control study be conducted to evaluate the evidence for an association between sugar intake, dental decay and incidence of disease.
Collapse
|
41
|
Sundborn G, Gentles D, Metcalf P. Carbonated beverage consumption in New Zealand adults. Pac Health Dialog 2014; 20:87-88. [PMID: 25929002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
|
42
|
Thornley S, Sundborn G. The story of FiZZ: an advocacy group to end the sale of sugar sweetened beverages in New Zealand. Pac Health Dialog 2014; 20:95-97. [PMID: 25929004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
FIZZ (which stands for fighting sugar in soft-drinks) is a new advocacy group started to reduce population consumption of sugar-sweetened soft drinks in New Zealand. The vision of FIZZ is for New Zealand to be sugary drink free by 2025. This means that sugar sweetened beverages will comprise < or = 5% of the total beverage market, and sugar free drinks will be the norm. In this paper, we outline the story of FIZZ: to reiterate why we believe the group is needed, reflect on what the group has achieved to date, consider what it aims to accomplish, and outline what methods it will seek to achieve these aims. Put simply, we believe that the epidemiological evidence that sugar intake, particularly in liquid form, causes poor physical and mental health is overwhelming. Swapping sugar sweetened drinks for sugar free alternatives, water or milk, is, in our view, an urgently needed and important step which is likely to reduce the epidemic of unhealthy weight (obesity) and its sequelae. The nutrition environment in New Zealand is now out of step with scientific evidence, with virtually unrestricted access to, and sales and marketing of, sugary drinks to both children and adults. FIZZ is seeking the implementation of local and nationwide policy, similar to those implemented for tobacco, to limit advertising, restrict marketing, raise purchase prices and ultimately curb the sales of sugary drinks in New Zealand. FIZZ is also working in communities to raise people's awareness of the harms sugary drinks pose to health. We at FIZZ also acknowledge that the beverage industry may play an important role in accomplishing this vision, and have established that there is common ground upon which FIZZ and industry can engage to reduce the sugary drink intake.
Collapse
|
43
|
Johnson RJ, Lanaspa MA, Sanchez-Lozada LG, Rivard CJ, Bjornstad PS, Merriman T, Sundborn G. Fat storage syndrome in Pacific peoples: a combination of environment and genetics? Pac Health Dialog 2014; 20:11-16. [PMID: 25928990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Pacific people (especially Micronesian and Polynesian) have some of the highest rates of obesity and diabetes in the world that largely developed since the introduction of western culture and diet. Recent studies suggest that much of the risk relates to the excessive intake of sugar (sucrose) and carbohydrates, leading to a type of fat storage syndrome (metabolic syndrome). Here we discuss some of the environmental. genetic and epigenetic reasons why this group might be especially prone to developing obesity and diabetes compared to other ethnic groups. Indirect evidence suggests that the higher endogenous uric acid levels in the Polynesian-Micronesian population may represent a predisposing factor for the development of obesity and diabetes in the context of Western diets and lifestyles. Pacific people may be an ideal group to study the role of "thrifty genes" in the pathogenesis of the current obesity epidemic.
Collapse
|
44
|
Sundborn G, Ni Mhurchu C, Ness C, Latu H, Jackson R. Kelston Beverages Pilot Study: Rationale, design and implementation of a community and school based intervention to reduce sugary drink consumption among children and youth. Pac Health Dialog 2014; 20:89-94. [PMID: 25929003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The Kelston Beverages Study was designed to increase awareness of the sugar content of sugary drinks, the poor health consequences that high intake of these drinks have, and inform on ways to reduce intake of students. The aims of this pilot study were to refine interventions and processes designed to raise awareness of the harms that sugar sweetened beverages (SSBs) have on health, and to reduce their consumption among the youth of a small West Auckland suburb. There were three arms to this interventional study, one in schools, another in community organisations (churches, sports clubs and community groups), and the final arm is in the local retail sector. The school arm was the most extensive component and initially involved a survey of children's knowledge and consumption of sugar sweetened beverages (SSBs) using a brief questionnaire. The study evaluated any SSB policies in schools and for schools that did not have policies, opportunities were scoped to develop and implement them; a canteen AUDIT focussed particularly on beverages was carried out; and finally a student partnered social marketing exercise was undertaken that comprised 2 competitions, one to design a poster, and another to write and perform a rap. Children were re-surveyed at the completion of the intervention (7 months later) to determine change in knowledge and self-reported consumption of SSBs. Both the community organisations and retail arms of this study focussed on raising awareness into the harmful effects of SSBs and establishing healthy beverage policy in the respective organisations. Promising results with regards to acceptability, feasibility, and recruitment as well as valuable learnings with regard to process support the development of a proposal to conduct a cluster randomised trial of the interventions successfully tested in this pilot study.
Collapse
|
45
|
Thornley S, Sundborn G. The case to ban sugary food and drink from schools: these products are addictive, and kids will learn best without them. Pac Health Dialog 2014; 20:17-21. [PMID: 25928991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In New Zealand, schools have been a battleground as a setting to address the obesity epidemic, with successive governments enforcing, and then repealing laws to ban junk food from canteen menus. Just what is considered 'junk food' remains controversial, but recently sugar sweetened beverages have become a target of public health groups. The adverse health consequences of their intake have been the principal arguments to reduce their availability. Here, we argue that the advantages of reducing intake of sugar in schools are very likely to lead to educational and other social benefits. Indices of sugar intake have been associated with aggressive behaviour, attention deficit, dysphoria and suicidal thoughts in cross-sectional studies. Longitudinal studies have also linked soft drink intake with impaired cognitive development. We believe that banning sugary drinks from schools will assist teachers and students to better achieve their learning goals, with a side effect of improving their health status.
Collapse
|
46
|
Sundborn G, Merriman TR, Thornley S, Metcalf P, Jackson R. An 'end-game' for sugar sweetened beverages? Pac Health Dialog 2014; 20:22-30. [PMID: 25928992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The epidemic of unhealthy weight is now in its third decade. The multitude of initiatives designed to address this issue (globally) have predominantly been ineffective as the prevalence of unhealthy weight has continued to rise. Public health professionals have proposed an 'endgame' for tobacco smoking in New Zealand by 2025, which has received widespread support. Similarly, here, to control the prevalence of unhealthy weight, we consider whether a similar approach to tobacco is justified to restrict the intake of sweetened beverages. APPROACH This paper reviews the evidence relating sugar sweetened beverages to unhealthy weight and adverse health effects. Current initiatives aimed at reducing sugar sweetened beverage consumption both internationally and in New Zealand are reviewed. FINDINGS Epidemiological evidence consistently links sugar-sweetened drink intake with unhealthy weight and other risk factors for cardiovascular disease, such as diabetes, gout, and raised blood pressure. Food disappearance data suggests that sugar intake continues to increase in New Zealand, and that a subtle addiction to sugar may underlie this trend. A number of successful initiatives to reduce sugary drink intake are described. IMPLICATION/CONCLUSION: We argue that an 'endgame' to the consumption of sugar-sweetened beverages be supported as a means to address the issue of unhealthy weight at a population level. Finally, a preliminary draft endgame plan is presented for consideration, dialogue and debate.
Collapse
|
47
|
Sundborn G. Malohani, bula vinaka, fakalofa lahi atu, kia orana, talofa lava, malo e lelei, greetings. Pac Health Dialog 2014; 20:5-6. [PMID: 25928988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
|
48
|
Sundborn G, Thornley S, Jackson R. Coke's anti-obesity campaign: a FIZZ or not? N Z Med J 2013; 126:106-108. [PMID: 24045360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
|
49
|
Sundborn G, Thornley S, Jackson R. FIZZ: a new advocacy group to FIght Sugar in Soft-drinks. N Z Med J 2013; 126:107-108. [PMID: 23799395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
|
50
|
Mehta S, Wells S, Grey C, Riddell T, Kerr A, Marshall R, Ameratunga S, Harrison J, Kenealy T, Bramley D, Chan WC, Thornley S, Sundborn G, Jackson R. Initiation and maintenance of cardiovascular medications following cardiovascular risk assessment in a large primary care cohort: PREDICT CVD-16. Eur J Prev Cardiol 2012; 21:192-202. [DOI: 10.1177/2047487312462150] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Sue Wells
- University of Auckland, Auckland, New Zealand
| | - Corina Grey
- University of Auckland, Auckland, New Zealand
| | | | - Andrew Kerr
- Counties Manukau District Health Board, Auckland, New Zealand
| | | | | | | | - Tim Kenealy
- University of Auckland, Auckland, New Zealand
| | - Dale Bramley
- Waitemata District Health Board, Auckland, New Zealand
| | - Wing Cheuk Chan
- Counties Manukau District Health Board, Auckland, New Zealand
| | | | | | - Rod Jackson
- University of Auckland, Auckland, New Zealand
| |
Collapse
|