1
|
Cruickshank JK. Age-dependent association of central blood pressure with cardiovascular outcomes: a cohort study involving 34 289 participants using the UK biobank. J Hypertens 2024; 42:768. [PMID: 38573218 DOI: 10.1097/hjh.0000000000003701] [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] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
|
2
|
Kaduka L, Olale J, Karamanos A, Mutai J, Coultas C, Ahmed I, L'Esperance V, Read U, Dazzan P, Cruickshank JK, Muniu E, Harding S. Contextually appropriate communication strategies for COVID-19 prevention in Kenya border regions: evidence from a mixed methods observational study in Busia and Mandera counties. BMJ Open 2023; 13:e062686. [PMID: 37192800 PMCID: PMC10192579 DOI: 10.1136/bmjopen-2022-062686] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/11/2022] [Accepted: 05/02/2023] [Indexed: 05/18/2023] Open
Abstract
OBJECTIVES Kenya has long and porous borders with its neighbouring countries. These regions, predominantly inhabited by highly mobile rural communities with strong cross-border cultural ties, present major challenges in managing movement of people and COVID-19 preventive measures. Our study sought to assess knowledge of COVID-19 prevention behaviours, how these varied by socioeconomic (SEC) factors and the challenges of engagement and implementation, in two border counties of Kenya. METHODS We conducted a mixed methods study using a household e-survey (Busia, N=294; Mandera, N=288; 57% females, 43% males), and qualitative telephone interviews (N=73: Busia 55; Mandera 18) with policy actors, healthcare workers, truckers and traders, and community members. Interviews were transcribed, English translated and analysed using the framework method. Associations between SEC (wealth quintiles, educational level) and knowledge of COVID-19 preventive behaviours were explored using Poisson regression. RESULTS Participants were mostly educated to primary school level (54.4% Busia, 61.6% Mandera). Knowledge of COVID-19 prevention varied by behaviour: hand washing-86.5%, use of hand sanitiser-74.8%, wearing a face mask-63.1%, covering the mouth when sneezing or coughing-56.3% and social distancing-40.1%. Differences in knowledge by area, educational level and the wealth index were marked, greatest for Mandera, the less educated and the poor. Interviews with stakeholders revealed challenges in health messaging, psychosocial and socioeconomic factors, lack of preparedness for truck border crossings, language barrier, denial and livelihood insecurity as key challenges to engagement with and implementation of COVID-19 prevention behaviours in the border regions. CONCLUSION The influence of SEC disparities and border dynamics on knowledge and engagement with COVID-19 prevention behaviours calls for contextually appropriate risk communication strategies that are cognisant of community needs and local patterns of information flow. Coordinating response measures across border points is crucial in winning communities' trust and maintaining essential economic and social activities.
Collapse
Affiliation(s)
- Lydia Kaduka
- Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
- Faculty of Life Sciences & Medicine, School of Life Course Science, King's College London, London, UK
| | - Joanna Olale
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Alexis Karamanos
- Faculty of Life Sciences & Medicine, School of Life Course Science, King's College London, London, UK
| | - Joseph Mutai
- Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Clare Coultas
- School of Medical Education, King's College London, London, UK
| | - Ismail Ahmed
- Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Veline L'Esperance
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Ursula Read
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Paola Dazzan
- Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - John Kennedy Cruickshank
- Faculty of Life Sciences & Medicine, School of Life Course Science, King's College London, London, UK
| | - Erastus Muniu
- Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Seeromanie Harding
- Faculty of Life Sciences & Medicine, School of Life Course Science, King's College London, London, UK
| |
Collapse
|
3
|
Tandon S, Grande AJ, Karamanos A, Cruickshank JK, Roever L, Mudway IS, Kelly FJ, Ayis S, Harding S. Association of Ambient Air Pollution with Blood Pressure in Adolescence: A Systematic-review and Meta-analysis. Curr Probl Cardiol 2023; 48:101460. [PMID: 36265590 DOI: 10.1016/j.cpcardiol.2022.101460] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 10/13/2022] [Indexed: 01/04/2023]
Abstract
We systematically reviewed the association of ambient air pollution with blood pressure (BP) as a primary outcome in adolescents (10-19 years). Five databases (Ovid Medline, Ovid Embase, Web of Science, The Cochrane Library, and LILACS) were searched for relevant articles published up to August 2022. Meta-analyses were conducted using STATA v17 (Protocol - OSF Registries https://doi.org/10.17605/OSF.IO/96G5Q). Eight studies (5 cohort, 3 cross-sectional) with approximately 15,000 adolescents were included. Data from 6 studies were suitable for inclusion in the meta-analyses. In sub-group analyses, non-significant positive associations were observed for cohort studies assessing long-term exposure to PM10, PM2.5, and NO2 on systolic and diastolic BP. At age 12 years old (3702 adolescents), we found significant positive associations for long-term exposure to PM2.5(β=5.33 (1.56, 9.09) mmHg) and PM10 (β=2.47 (0.10, 4.85) mmHg) on diastolic BP. Significant positive associations were observed (3,592 adolescents) for long-term exposure to PM10(β=0.34 (0.19, 0.50) mmHg) and NO2 on diastolic BP (β=0.40 (0.09, 0.71) mmHg), and PM10 on systolic BP (β=0.48 (0.19, 0.77) mmHg). The overall quality of evidence analysed was graded as "low/very low." Insufficient data for short-term exposures to PM2.5, PM10, NO2, CO on BP led to their exclusion from the meta-analysis. Inconsistent associations were reported for gender-stratified results. The evidence, though of low-quality and limited, indicated that ambient air pollution was positively associated with adolescent BP. Future studies need improved measures of air pollutant exposures, consideration of gender and socio-economic circumstances on the observed pollution effects, as well as adjustment for other potential confounding factors.
Collapse
Affiliation(s)
- Saniya Tandon
- School of Life Course and Population Health, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Antonio Jose Grande
- School of Life Course and Population Health, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Curso de Medicina, Universidade Estadual do Mato Grosso do Sul, Campo Grande, Brazil
| | - Alexis Karamanos
- School of Life Course and Population Health, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - John Kennedy Cruickshank
- School of Life Course and Population Health, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Leonardo Roever
- Department of Clinical Research, Federal University of Uberlandia, Uberlândia, Brazil
| | - Ian Stanley Mudway
- MRC Centre for Environment and Health, Imperial College London, London, United Kingdom; NIHR Health Protection Research Unit in Environmental Exposures and Health, Imperial College London, United Kingdom
| | - Frank James Kelly
- MRC Centre for Environment and Health, Imperial College London, London, United Kingdom; NIHR Health Protection Research Unit in Environmental Exposures and Health, Imperial College London, United Kingdom
| | - Salma Ayis
- School of Life Course and Population Health, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Seeromanie Harding
- School of Life Course and Population Health, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom.
| |
Collapse
|
4
|
Kirkham FA, Mills C, Fantin F, Tatsuno I, Nagayama D, Giani A, Zamboni M, Shirai K, Cruickshank JK, Rajkumar C. Are you as old as your arteries? Comparing arterial aging in Japanese and European patient groups using cardio-ankle vascular index. J Hypertens 2022; 40:1758-1767. [PMID: 35943103 DOI: 10.1097/hjh.0000000000003214] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Most comparisons of arterial stiffness between ethnic groups focus on pulse wave velocity. This study used the cardio-ankle vascular index (CAVI) in European compared to Japanese individuals to investigate how cardiovascular risk factors affect arterial aging across geographic regions. METHODS Four hundred and ninety-four European and 1044 Japanese individuals underwent measurements of CAVI, blood pressure and information on cardiovascular risk factors. Both datasets included individuals with 0-5 cardiovascular risk factors. RESULTS Average CAVI was higher in the Japanese than the European group in every age category, with significant differences up to 75 years for males and 85 for females. The correlation of CAVI with age, controlled for cardiovascular risk factors, was slightly higher in Japanese females (r = 0.594 vs. Europeans r = 0.542) but much higher in European males (r = 0.710 vs. Japanese r = 0.511). There was a significant correlation between CAVI and total cardiovascular risk factors in the Japanese (r = 0.141, P < 0.001) but not the European group. On linear regression, average CAVI was significantly dependent on age, sex, diabetes, BMI, SBP and geographic region. When divided into 'healthy' vs. 'high risk', the healthy group had a steeper correlation with age for Europeans (r = 0.644 vs. Japanese r = 0.472, Fisher's Z P < 0.001), whereas in the high-risk group, both geographic regions had similar correlations. CONCLUSION Japanese patient groups had higher arterial stiffness than Europeans, as measured by CAVI, controlling for cardiovascular risk factors. Europeans had greater increases in arterial stiffness with age in healthy individuals, particularly for males. However, cardiovascular risk factors had a greater impact on the Japanese group.
Collapse
Affiliation(s)
| | | | - Francesco Fantin
- Department of Medicine, Section of Geriatric Medicine, University of Verona, Verona, Italy
| | - Ichiro Tatsuno
- Chiba Prefectural University of Health Sciences, Chiba
- Toho University Medical Center, Sakura Hospital, Sakura
| | - Daiji Nagayama
- Nagayama Clinic, Nagayama
- Toho University Medical Center, Sakura Hospital, Sakura
| | - Anna Giani
- Department of Medicine, Section of Geriatric Medicine, University of Verona, Verona, Italy
| | - Mauro Zamboni
- Department of Medicine, Section of Geriatric Medicine, University of Verona, Verona, Italy
| | | | | | - Chakravarthi Rajkumar
- University Hospitals Sussex, NHS Foundation Trust
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| |
Collapse
|
5
|
Williamson W, Lewandowski AJ, Huckstep OJ, Lapidaire W, Ooms A, Tan C, Mohamed A, Alsharqi M, Bertagnolli M, Woodward W, Dockerill C, McCourt A, Kenworthy Y, Burchert H, Doherty A, Newton J, Hanssen H, Cruickshank JK, McManus R, Holmes J, Ji C, Love S, Frangou E, Everett C, Hillsdon M, Dawes H, Foster C, Leeson P. Effect of moderate to high intensity aerobic exercise on blood pressure in young adults: The TEPHRA open, two-arm, parallel superiority randomized clinical trial. EClinicalMedicine 2022; 48:101445. [PMID: 35706495 PMCID: PMC9112102 DOI: 10.1016/j.eclinm.2022.101445] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 04/20/2022] [Accepted: 04/22/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Exercise is advised for young adults with elevated blood pressure, but no trials have investigated efficacy at this age. We aimed to determine whether aerobic exercise, self-monitoring and motivational coaching lowers blood pressure in this group. METHODS The study was a single-centre, open, two-arm, parallel superiority randomized clinical trial with open community-based recruitment of physically-inactive 18-35 year old adults with awake 24 h blood pressure 115/75mmHg-159/99 mmHg and BMI<35 kg/m2. The study took place in the Cardiovascular Clinical Research Facility, John Radcliffe Hospital, Oxford, UK. Participants were randomized (1:1) with minimisation factors sex, age (<24, 24-29, 30-35 years) and gestational age at birth (<32, 32-37, >37 weeks) to the intervention group, who received 16-weeks aerobic exercise training (three aerobic training sessions per week of 60 min per session at 60-80% peak heart rate, physical activity self-monitoring with encouragement to do 10,000 steps per day and motivational coaching to maintain physical activity upon completion of the intervention. The control group were sign-posted to educational materials on hypertension and recommended lifestyle behaviours. Investigators performing statistical analyses were blinded to group allocation. The primary outcome was 24 h awake ambulatory blood pressure (systolic and diastolic) change from baseline to 16-weeks on an intention-to-treat basis. Clinicaltrials.gov registered on March 30, 2016 (NCT02723552). FINDINGS Enrolment occurred between 30/06/2016-26/10/2018. Amongst the 203 randomized young adults (n = 102 in the intervention group; n = 101 in the control group), 178 (88%; n = 76 intervention group, n = 84 control group) completed 16-week follow-up and 160 (79%; n = 68 intervention group, n = 69 control group) completed 52-weeks follow-up. There were no group differences in awake systolic (0·0 mmHg [95%CI, -2·9 to 2·8]; P = 0·98) or awake diastolic ambulatory blood pressure (0·6 mmHg [95%CI, -1·4. to 2·6]; P = 0·58). Aerobic training increased peak oxygen uptake (2·8 ml/kg/min [95%CI, 1·6 to 4·0]) and peak wattage (14·2watts [95%CI, 7·6 to 20·9]) at 16-weeks. There were no intervention effects at 52-weeks follow-up. INTEPRETATION These results do not support the exclusive use of moderate to high intensity aerobic exercise training for blood pressure control in young adults. FUNDING Wellcome Trust, British Heart Foundation, National Institute for Health Research, Oxford Biomedical Research Centre.
Collapse
Affiliation(s)
- Wilby Williamson
- Radcliffe Department of Medicine, Oxford Cardiovascular Clinical Research Facility Division of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Adam James Lewandowski
- Radcliffe Department of Medicine, Oxford Cardiovascular Clinical Research Facility Division of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
- Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Odaro John Huckstep
- Radcliffe Department of Medicine, Oxford Cardiovascular Clinical Research Facility Division of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
- Department of Biology, United States Air Force Academy, CO, USA
| | - Winok Lapidaire
- Radcliffe Department of Medicine, Oxford Cardiovascular Clinical Research Facility Division of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
| | - Alexander Ooms
- Nuffield Department of Orthopaedics, Centre for Statistics in Medicine, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
| | - Cheryl Tan
- Radcliffe Department of Medicine, Oxford Cardiovascular Clinical Research Facility Division of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
| | - Afifah Mohamed
- Radcliffe Department of Medicine, Oxford Cardiovascular Clinical Research Facility Division of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
- Department of Diagnostic Imaging & Applied Health Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Maryam Alsharqi
- Radcliffe Department of Medicine, Oxford Cardiovascular Clinical Research Facility Division of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
| | - Mariane Bertagnolli
- Radcliffe Department of Medicine, Oxford Cardiovascular Clinical Research Facility Division of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
- Hôpital du Sacré-Cœur de Montréal Research Center (CIUSSS Nord-de-l’Île-de-Montréal), School of Physical and Occupational Therapy, McGill University, Montréal, Canada
| | - William Woodward
- Radcliffe Department of Medicine, Oxford Cardiovascular Clinical Research Facility Division of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
| | - Cameron Dockerill
- Radcliffe Department of Medicine, Oxford Cardiovascular Clinical Research Facility Division of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
| | - Annabelle McCourt
- Radcliffe Department of Medicine, Oxford Cardiovascular Clinical Research Facility Division of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
| | - Yvonne Kenworthy
- Radcliffe Department of Medicine, Oxford Cardiovascular Clinical Research Facility Division of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
| | - Holger Burchert
- Radcliffe Department of Medicine, Oxford Cardiovascular Clinical Research Facility Division of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
| | - Aiden Doherty
- Nuffield Department of Population Health, BHF Centre of Research Excellence, University of Oxford, UK
| | - Julia Newton
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
| | - Henner Hanssen
- Department of Sport, Exercise and Health, University of Basel, Switzerland
| | | | - Richard McManus
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
| | - Jane Holmes
- Nuffield Department of Orthopaedics, Centre for Statistics in Medicine, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
| | - Chen Ji
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
| | - Sharon Love
- MRC Clinical Trials Unit, University College London, London, UK
| | - Elena Frangou
- MRC Clinical Trials Unit, University College London, London, UK
| | - Colin Everett
- Clinical Trials Research Unit, University of Leeds, Leeds, West Yorkshire, UK
| | | | - Helen Dawes
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Charlie Foster
- School of Policy Studies, University of Bristol, Bristol, UK
| | - Paul Leeson
- Radcliffe Department of Medicine, Oxford Cardiovascular Clinical Research Facility Division of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
- Corresponding author.
| |
Collapse
|
6
|
Grande AJ, Elia C, Peixoto C, Jardim PDTC, Dazzan P, Veras AB, Cruickshank JK, da Rosa MI, Harding S. Mental health interventions for suicide prevention among indigenous adolescents: a systematic review. SAO PAULO MED J 2022; 140:486-498. [PMID: 35508004 PMCID: PMC9671239 DOI: 10.1590/1516-3180.2021.0292.r1.22102021] [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: 04/19/2021] [Revised: 07/12/2021] [Accepted: 10/22/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The legacies of colonization and of policies of forced assimilation continue to be a cause of intergenerational trauma, manifested through feelings of marginality, depression, anxiety and confusion, which place indigenous peoples at increased risk of suicide. OBJECTIVES To assess the quality, content, delivery and effectiveness of interventions for preventing suicides among indigenous adolescents. DESIGN AND SETTING Systematic review conducted with Cochrane methodology, Campo Grande, Mato Grosso do Sul, Brazil. METHODS The Cochrane library, MEDLINE, EMBASE, CINAHL, LILACS and PsycINFO databases were searched for studies published up to February 2021. The following inclusion criteria were used: published in any language; interventions that aimed to prevent suicides among indigenous adolescents; randomized or non-randomized study with a control or comparative group; and validated measurements of mental health problems. RESULTS Two studies were identified: one on adolescents in the remote Yup'ik community in south-western Alaska, and the other on Zuni adolescents in New Mexico. Both studies showed evidence of effectiveness in interventions for reducing some of the risk factors and increasing some of the protective factors associated with suicide. High levels of community engagement and culture-centeredness were key anchors of both studies, which ensured that the intervention content, delivery and outcome measurements aligned with the beliefs and practices of the communities. Both studies were judged to have a moderate risk of bias, with biases in sample selection, attrition and inadequate reporting of results. CONCLUSIONS The current evidence base is small but signaled the value of culturally appropriate interventions for prevention of suicide among indigenous adolescents. REGISTRATION DETAILS The study protocol is registered in the international prospective register of systematic reviews (PROSPERO); no. CRD42019141754.
Collapse
Affiliation(s)
- Antonio Jose Grande
- PhD. Physical Educator and Adjunct Professor, Medical Course, Universidade Estadual de Mato Grosso do Sul (UEMS), Campo Grande (MS), Brazil.
| | - Christelle Elia
- MSc. Dietitian and Research Assistant, Department of Nutrition, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, Franklin Wilkins Building, London, United Kingdom.
| | - Clayton Peixoto
- PhD. Psychologist and Adjunct Professor, Medical Course, Universidade Estadual de Mato Grosso do Sul (UEMS), Campo Grande (MS), Brazil.
| | - Paulo de Tarso Coelho Jardim
- PhD. Dentist and Adjunct Professor, Medical Course, Universidade Estadual de Mato Grosso do Sul (UEMS), Campo Grande (MS), Brazil.
| | - Paola Dazzan
- PhD. Physician and Professor, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, Denmark Hill Campus, London, United Kingdom.
| | - Andre Barciela Veras
- PhD. Physician and Adjunct Professor, Medical Course, Universidade Estadual de Mato Grosso do Sul (UEMS), Campo Grande (MS), Brazil.
| | - John Kennedy Cruickshank
- MBChB, MD. Physician and Professor of Cardiovascular Medicine & Diabetes, Department of Nutrition, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, Franklin Wilkins Building, London, United Kingdom.
| | - Maria Inês da Rosa
- PhD. Physician and Professor, Translational Psychiatry Laboratory, Postgraduate Program in Health Sciences, Universidade do Extremo Sul Catarinense (UNESC), Criciúma (SC), Brazil.
| | - Seeromanie Harding
- PhD. Professor of Social Epidemiology, Department of Population Health Sciences, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, Franklin Wilkins Building, London, United Kingdom.
| |
Collapse
|
7
|
Karamanos A, Mudway I, Kelly F, Beevers SD, Dajnak D, Elia C, Cruickshank JK, Lu Y, Tandon S, Enayat E, Dazzan P, Maynard M, Harding S. Air pollution and trajectories of adolescent conduct problems: the roles of ethnicity and racism; evidence from the DASH longitudinal study. Soc Psychiatry Psychiatr Epidemiol 2021; 56:2029-2039. [PMID: 33929549 PMCID: PMC8519907 DOI: 10.1007/s00127-021-02097-7] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 04/23/2021] [Indexed: 01/19/2023]
Abstract
PURPOSE No known UK empirical research has investigated prospective associations between ambient air pollutants and conduct problems in adolescence. Ethnic minority children are disproportionately exposed to structural factors that could moderate any observed relationships. This prospective study examined whether exposure to PM2.5 and NO2 concentrations is associated with conduct problems in adolescence, and whether racism or ethnicity moderate such associations. METHODS Longitudinal associations between annual mean estimated PM2.5 and NO2 concentrations at the residential address and trajectories of conduct problems, and the potential influence of racism and ethnicity were examined school-based sample of 4775 participants (2002-2003 to 2005-2006) in London, using growth curve models. RESULTS Overall, in the fully adjusted model, exposure to lower concentrations of PM2.5 and NO2 was associated with a decrease in conduct problems during adolescence, while exposure to higher concentrations was associated with a flattened trajectory of conduct symptoms. Racism amplified the effect of PM2.5 (β = 0.05 (95% CI 0.01 to 0.10, p < 0.01)) on adolescent trajectories of conduct problems over time. At higher concentrations of PM2.5, there was a divergence of trajectories of adolescent conduct problems between ethnic minority groups, with White British and Black Caribbean adolescents experiencing an increase in conduct problems over time. CONCLUSION These findings suggest that the intersections between air pollution, ethnicity, and racism are important influences on the development of conduct problems in adolescence.
Collapse
Affiliation(s)
- A Karamanos
- Department of Nutritional Sciences, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, 57 Waterloo Road, London, SE1 8WA, UK.
| | - I Mudway
- MRC Centre for Environment and Health, Imperial College London, London, UK
- NIHR Health Protection Research Unit in Environmental Exposures and Health, Imperial College London, London, UK
| | - F Kelly
- MRC Centre for Environment and Health, Imperial College London, London, UK
- NIHR Health Protection Research Unit in Environmental Exposures and Health, Imperial College London, London, UK
| | - S D Beevers
- MRC Centre for Environment and Health, Imperial College London, London, UK
- NIHR Health Protection Research Unit in Environmental Exposures and Health, Imperial College London, London, UK
| | - D Dajnak
- MRC Centre for Environment and Health, Imperial College London, London, UK
- NIHR Health Protection Research Unit in Environmental Exposures and Health, Imperial College London, London, UK
| | - C Elia
- Department of Nutritional Sciences, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, 57 Waterloo Road, London, SE1 8WA, UK
| | - J K Cruickshank
- Department of Nutritional Sciences, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, 57 Waterloo Road, London, SE1 8WA, UK
| | - Y Lu
- Department of Nutritional Sciences, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, 57 Waterloo Road, London, SE1 8WA, UK
| | - S Tandon
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - E Enayat
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - P Dazzan
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - M Maynard
- School of Clinical and Applied Sciences, Leeds Beckett University, London, UK
| | - S Harding
- Department of Nutritional Sciences, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, 57 Waterloo Road, London, SE1 8WA, UK
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| |
Collapse
|
8
|
Joy G, Crane JD, Lau C, Augusto J, Brown LAE, Chowdhary A, Kotecha T, Plein S, Fontana M, Moon JC, Kellman P, Xue H, Cruickshank JK, Mcgowan BM, Manisty C. Impact of obesity on myocardial microvasculature assessed using fully-automated inline myocardial perfusion mapping CMR. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Guy"s and St Thomas" Charity University College London Hospitals Biomedical Research Centre
Background
Obesity and cardiovascular disease are associated, but the relationship is poorly understood. Myocardial perfusion, metabolic derangement and lipotoxicity appear adversely associated in many scenarios (myocardial injury, diastolic dysfunction, diabetes). Altered perfusion (by PET) predicts outcome, and it is hypothesised that perfusion derangement is part of causality for cardiac disease and adverse outcomes.
Purpose
To assess the presence and pattern of myocardial microvascular dysfunction in patients with obesity (scheduled for bariatric surgery) using stress quantitative perfusion mapping.
Methods
38 subjects with obesity planned to undergo bariatric surgery and 38 age and sex matched healthy volunteers (no diabetes, no hypertension) underwent anthropometry, biochemistry and CMR at 1.5T (Siemens) with cine imaging, stress (adenosine 140-210 mcg/kg/min) and rest fully-automated quantitative perfusion mapping.
Results
Bariatric patients had a higher BMI (44 ± 6.4 vs 26.5 ± 4kg/m2 p = 0.001); 58%(22) were diabetic and 58%(22) had hypertension. Bariatric patients had higher absolute but lower indexed end-diastolic volumes, and overall higher ejection fractions (+5%) (see Table). Rest myocardial blood flow (MBF) in bariatric patients was the same (1.00 ± 0.3 vs 0.88 ± 0.24 p = 0.052), but stress perfusion results were significantly lower both for stress MBF (2.35 ± 0.69 vs 2.93 ± 0.76ml/g/min p = 0.001) and myocardial perfusion reserve (MPR 2.48 ± 0.82 vs 3.4 ± 0.81ml/g/min p = 0.0001). Although this was transmural, the endocardial stress MBF was particularly negatively affected in the bariatric cohort compared to controls (endocardial MBF 2.16 ± 0.65 vs 2.82 ± 0.73ml/g/min, p = 0.0001 vs epicardial MBF: 2.52 ± 0.76 vs 3.06 ± 0.79 p = 0.003), meaning there was an increased endo-epicardial stress MBF gradient in bariatric patients (0.87 ± 0.12 vs 0.92 ± 0.07 p = 0.03).
Conclusion
Compared to healthy controls, patients with obesity have abnormal myocardial stress perfusion with reduced global perfusion, perfusion reserve and an increased transmyocardial perfusion gradient.
Table - myocardial perfusion parameters Category Bariatric patients n = 38 Controls n = 38 p value Age (years) 48 ± 11 45 ± 13 0.25 n male (%) 12 (32%) 10 (36%) 0.32 LVEDV (ml) 168 ± 37 149 ± 31 0.017 LVEDVi (ml/m2) 70.4 ± 12.3 78.8 ± 12.1 0.004 LV Mass (g) 116 ± 31 99 ± 28 0.019 EF (%) 70 ± 8 65 ± 5 0.002 LVEDV - left ventricular end-diastolic volume, EF - ejection fraction
Collapse
Affiliation(s)
- G Joy
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - JD Crane
- King"s College London, Department of Diabetes and Nutritional Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - C Lau
- Queen Mary University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - J Augusto
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - LAE Brown
- University of Leeds, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - A Chowdhary
- University of Leeds, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - T Kotecha
- Royal Free Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - S Plein
- University of Leeds, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - M Fontana
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - JC Moon
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - P Kellman
- National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, United States of America
| | - H Xue
- National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, United States of America
| | - JK Cruickshank
- King"s College London, Department of Diabetes and Nutritional Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - BM Mcgowan
- King"s College London, Department of Diabetes and Nutritional Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - C Manisty
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| |
Collapse
|
9
|
Grande AJ, Elia C, Peixoto C, Jardim PDTC, Dazzan P, Veras AB, Cruickshank JK, Harding S. Mental health interventions for suicide prevention among indigenous adolescents: a systematic review protocol. BMJ Open 2020; 10:e034055. [PMID: 32423928 PMCID: PMC7239512 DOI: 10.1136/bmjopen-2019-034055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 03/10/2020] [Accepted: 04/16/2020] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION There are more than 370 million indigenous people from 5000 cultures living in 90 countries worldwide. Although they make up 5% of the global population, they account for 15% of the extreme poor. Youth suicide is the second leading cause of mortality among 15-29 years old and disproportionately affects indigenous youth. This research protocol pertains to a systematic review of studies that use a comparator/control group to evaluate the effectiveness of suicide interventions targeting indigenous adolescents (aged 10-19 years). METHODS AND ANALYSIS We will conduct a systematic search on MEDLINE, EMBASE, CINAHL, LILACS and PsycINFO from inception to September 2019 to identify articles that compare mental health interventions for suicide prevention among indigenous adolescents. Two reviewers will independently determine the eligibility of each study. Studies will be assessed for methodological quality using the risk of bias tool to assess non-randomised studies of interventions. We will conduct a meta-analysis if possible and use established statistical methods to identify and control for heterogeneity where appropriate. ETHICS AND DISSEMINATION This systematic review will use published data and does not require ethics approval. However, this review is in preparation of a feasibility study that will examine how best to support the physical and mental health of indigenous adolescents in Brazil. Ethics approval for the feasibility study was obtained from National Research Ethics Commission. Findings will be disseminated through a peer-reviewed publication and will be made available to key decision-makers with authority for indigenous health and other relevant stakeholders. PROSPERO REGISTRATION NUMBER CRD42019141754.
Collapse
Affiliation(s)
- Antonio José Grande
- State University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Christelle Elia
- King's College London Faculty of Life Sciences and Medicine, London, UK
| | - Clayton Peixoto
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Paola Dazzan
- King's College London Faculty of Life Sciences and Medicine, London, UK
| | - Andre Barciela Veras
- State University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | | | | |
Collapse
|
10
|
Banerjee M, Shaw L, Charlton-Menys V, Pemberton P, Malik RA, Cruickshank JK, Austin CE. Modulation of Small Artery Function by Insulin in Young Women: Role of Adiposity. Endocr Metab Immune Disord Drug Targets 2020; 20:1244-1252. [PMID: 32342823 DOI: 10.2174/1871530320666200428111924] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 11/11/2019] [Accepted: 12/03/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Vascular dysfunction is common in obesity. Insulin can directly modulate arterial function, but its role is unclear in obesity. We examined the influence of adiposity on direct effects of insulin on human artery responses. METHODS 22 healthy women were stratified by median BMI into lower (LA) (n=11) and higher adiposity (HA) (n=11). Small arteries from gluteal biopsies were tested for contractile responses to Noradrenaline (NA), the endothelium-dependent dilator Carbachol and the endothelium-independent dilator sodium nitroprusside were examined before and after incubation with 100 mU/ml human insulin. RESULTS Contractile responses were similar in the two groups. Insulin reduced NA-induced contraction in HA [3.5 (2.4-4.6) vs. 2.4 (1.4-3.4) mN/mm: p=0.004] but not those from LA [4.1 (2.8-5.3) vs. 3.7 (2.5-5.0) mN/mm: p=0.33]. Endothelium-dependent dilation (EDD) was significantly reduced in arteries from women in the HA (34.7 (18.8-50.6%)) compared to those from women in the LA (62.3 (46.2- 78.4); p=0.013). Insulin improved EDD (change in maximal dilation before/after insulin (%)) in arteries from the HA (37.7 (18.0 to 57.3) but not the LA (6.3 (-6.5 to 19.1), p=0.007. CONCLUSION Reduced EDD evident in arteries from HA subjects improve by incubating in insulin. Hyperinsulinaemia may be necessary in maintaining endothelial function in obesity.
Collapse
Affiliation(s)
- Moulinath Banerjee
- Centre for Endocrinology & Diabetes Research Group, University of Manchester, Manchester M13 9NT, United Kingdom,Bolton Foundation NHS Trust, BL4 0JR, United Kingdom
| | - Linda Shaw
- Cardiovascular Research Group, University of Manchester, Manchester M13 9NT, United Kingdom
| | | | - Phillip Pemberton
- Department of Clinical Biochemistry, Central Manchester University Hospitals NHS Foundation Trust, Manchester, M13 9NL, United Kingdom
| | - Rayaz Ahmed Malik
- Centre for Endocrinology & Diabetes Research Group, University of Manchester, Manchester M13 9NT, United Kingdom,Department of Endocrinology, Weil Cornell Medicine, Ar-Rayyan, Qatar
| | - John Kennedy Cruickshank
- Cardiovascular Research Group, University of Manchester, Manchester M13 9NT, United Kingdom,Department of Cardiovascular Medicine & Nutrition, King's College, London, SE1 8WA, United Kingdom
| | - Clare Elizabeth Austin
- Cardiovascular Research Group, University of Manchester, Manchester M13 9NT, United Kingdom,Faculty of Health and Social care, Edgehill University, United Kingdom
| |
Collapse
|
11
|
Webster LM, Myers JE, Nelson-Piercy C, Mills C, Watt-Coote I, Khalil A, Seed PT, Cruickshank JK, Chappell LC. Longitudinal changes in vascular function parameters in pregnant women with chronic hypertension and association with adverse outcome: a cohort study. Ultrasound Obstet Gynecol 2019; 53:638-648. [PMID: 29380922 DOI: 10.1002/uog.19021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 12/14/2017] [Accepted: 01/19/2018] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Raised vascular function measures are associated with adverse maternal and perinatal outcomes in low-risk pregnancy. This study aimed to evaluate the association between longitudinal vascular function parameters and adverse outcome in pregnant women with chronic hypertension, and to assess whether these measures vary according to baseline parameters such as black ethnicity. METHODS This was a nested cohort study of women with chronic hypertension and a singleton pregnancy recruited to the PANDA (Pregnancy And chronic hypertension: NifeDipine vs lAbetalol as antihypertensive treatment) study at one of three UK maternity units. Women had serial pulse-wave analyses performed using the Arteriograph®, while in a sitting position, from 12 weeks' gestation onwards. Statistical analysis was performed using random-effects logistic regression models. Longitudinal vascular parameters were compared between women who developed superimposed pre-eclampsia (SPE) and those who did not, between women who delivered a small-for-gestational-age (SGA) infant (birth weight < 10th centile) and those who delivered an infant with birth weight ≥ 10th centile and between women of black ethnicity and those of non-black ethnicity. RESULTS The cohort included 97 women with chronic hypertension and a singleton pregnancy, of whom 90% (n = 87) were randomized to antihypertensive treatment and 57% (n = 55) were of black ethnicity, with up to six (mean, three) longitudinal vascular function assessments. SPE was diagnosed in 18% (n = 17) of women and 30% (n = 29) of infants were SGA. In women who developed subsequent SPE, compared with those who did not, mean brachial systolic blood pressure (SBP) (148 mmHg vs 139 mmHg; P = 0.002), mean diastolic blood pressure (DBP) (87 mmHg vs 82 mmHg; P = 0.01), mean central aortic pressure (139 mmHg vs 128 mmHg; P = 0.001) and mean augmentation index (AIx-75) (29% vs 22%; P = 0.01) were significantly higher across gestation. In women who delivered a SGA infant compared to those who delivered an infant with birth weight ≥ 10th centile, mean brachial SBP (146 mmHg vs 138 mmHg; P = 0.001), mean DBP (86 mmHg vs 82 mmHg; P = 0.01), mean central aortic pressure (137 mmHg vs 127 mmHg; P < 0.0001) and mean pulse-wave velocity (9.1 m/s vs 8.5 m/s; P = 0.02) were higher across gestation. No longitudinal differences were found in vascular function parameters in women of black ethnicity compared with those of non-black ethnicity. CONCLUSION There were persistent differences in vascular function parameters and brachial blood pressure throughout pregnancy in women with chronic hypertension who later developed adverse maternal or perinatal outcome. Further investigation into the possible clinical use of these findings is warranted. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- L M Webster
- Women's Health Academic Centre, King's College London, St Thomas' Hospital, London, UK
| | - J E Myers
- Maternal & Fetal Health Research Centre, University of Manchester, Manchester Academic Health Science Centre, Central Manchester Foundation Trust, Manchester, UK
| | - C Nelson-Piercy
- Women's Health Academic Centre, King's College London, St Thomas' Hospital, London, UK
| | - C Mills
- King's College London, Division of Life Course Sciences, Department of Nutritional Sciences, London, UK
| | - I Watt-Coote
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - P T Seed
- Women's Health Academic Centre, King's College London, St Thomas' Hospital, London, UK
| | - J K Cruickshank
- King's College London, Division of Life Course Sciences, Department of Nutritional Sciences, London, UK
| | - L C Chappell
- Women's Health Academic Centre, King's College London, St Thomas' Hospital, London, UK
| |
Collapse
|
12
|
Herbert A, Cruickshank JK, Laurent S, Boutouyrie P. Establishing reference values for central blood pressure and its amplification in a general healthy population and according to cardiovascular risk factors. Eur Heart J 2014; 35:3122-33. [PMID: 25112663 DOI: 10.1093/eurheartj/ehu293] [Citation(s) in RCA: 188] [Impact Index Per Article: 18.8] [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] [Indexed: 02/07/2023] Open
Abstract
AIMS Estimated central systolic blood pressure (cSBP) and amplification (Brachial SBP-cSBP) are non-invasive measures potentially prognostic of cardiovascular (CV) disease. No worldwide, multiple-device reference values are available. We aimed to establish reference values for a worldwide general population standardizing between the different available methods of measurement. How these values were significantly altered by cardiovascular risk factors (CVRFs) was then investigated. METHODS AND RESULTS Existing data from population surveys and clinical trials were combined, whether published or not. Reference values of cSBP and amplification were calculated as percentiles for 'Normal' (no CVRFs) and 'Reference' (any CVRFs) populations. We included 45,436 subjects out of 82,930 that were gathered from 77 studies of 53 centres. Included subjects were apparently healthy, not treated for hypertension or dyslipidaemia, and free from overt CV disease and diabetes. Values of cSBP and amplification were stratified by brachial blood pressure categories and age decade in turn, both being stratified by sex. Amplification decreased with age and more so in males than in females. Sex was the most powerful factor associated with amplification with 6.6 mmHg (5.8-7.4) higher amplification in males than in females. Amplification was marginally but significantly influenced by CVRFs, with smoking and dyslipidaemia decreasing amplification, but increased with increasing levels of blood glucose. CONCLUSION Typical values of cSBP and amplification in a healthy population and a population free of traditional CVRFs are now available according to age, sex, and brachial BP, providing values included from different devices with a wide geographical representation. Amplification is significantly influenced by CVRFs, but differently in men and women.
Collapse
Affiliation(s)
- Annie Herbert
- Department of Pharmacology and INSERM U970, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, 56 rue Leblanc, Paris 75015, France Research & Development Department, Pennine Acute Hospitals NHS Trust, Crumpsall, Manchester, UK
| | - John Kennedy Cruickshank
- Diabetes, Cardiovascular Medicine & Nutrition, King's College University of London & King's Health Partners, London, UK
| | - Stéphane Laurent
- Department of Pharmacology and INSERM U970, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, 56 rue Leblanc, Paris 75015, France
| | - Pierre Boutouyrie
- Department of Pharmacology and INSERM U970, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, 56 rue Leblanc, Paris 75015, France
| | | |
Collapse
|
13
|
Anderson SG, Hutchings DC, Heald AH, Anderson CD, Sanders TAB, Cruickshank JK. Haemostatic factors, lipoproteins and long-term mortality in a multi-ethnic population of Gujarati, African-Caribbean and European origin. Atherosclerosis 2014; 236:62-72. [PMID: 25014036 DOI: 10.1016/j.atherosclerosis.2014.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 08/23/2013] [Revised: 05/14/2014] [Accepted: 06/07/2014] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To examine the relations between haemostatic factors and lipoproteins with mortality in British Europeans, African-Caribbeans (AfC) and Gujarati Indians. METHODS A prospective cohort study of 331 subjects (40-79 years), followed-up over 26 years for mortality. Apolipoprotein-A1 (Apo-A1), apolipoprotein-B (Apo-B), factor VII coagulant activity (FVIIc), fibrinogen and von Willebrand Factor (vWF) were measured at baseline in 118 Europeans, 100 AfC and 113 Gujaratis. Aortic pulse wave velocity (aPWV) was measured in 174 participants. RESULTS 147 (44.4%) subjects died during a median of 24 years follow-up with 69 cardiovascular deaths. Women at baseline had higher, and AfC males the lowest FVIIc and Apo-A1 levels. Baseline age-sex and ethnicity adjusted FVIIc levels were higher in those who died (131.0 vs. 117.4%; P = 0.048). In similarly adjusted partial correlations, Apo-A1 was inversely related to arterial stiffness (ρ = -0.23, P = 0.04). Over the 26 years follow-up, participants below the median (i.e. with lower concentration) of FVIIc, Fibrinogen, Apo-B and vWF had better survival rates than those with higher concentrations; those with higher concentrations of Apo-A1 had better survival. In Cox multivariable regression analyses including sex, ethnicity and aPWV, independently increased risk of all-cause mortality came only from SBP (per 5 mmHg); P = 0.011), age (per year); P < 0.0001 and FVIIc at 7% (per 10-unit; HR 1.07 (1.02, 1.12); P = 0.008. Separately, Apo-A1 (HR 0.12 (0.02, 0.75; P = 0.029) was independently associated with a very significant 88% reduction in all-cause mortality. CONCLUSIONS Despite a relatively small sample size, long-term follow-up suggests an independent effect of the prothrombotic state (via FVIIc) and apo-A1 (a constituent of HDL) on mortality.
Collapse
Affiliation(s)
- S G Anderson
- Institute of Cardiovascular Sciences, Core Technology Facility (3rd Floor), University of Manchester, 46 Grafton Street, Manchester M13 9NT, UK.
| | - D C Hutchings
- Institute of Cardiovascular Sciences, Core Technology Facility (3rd Floor), University of Manchester, 46 Grafton Street, Manchester M13 9NT, UK
| | - A H Heald
- Institute of Cardiovascular Sciences, Core Technology Facility (3rd Floor), University of Manchester, 46 Grafton Street, Manchester M13 9NT, UK
| | - C D Anderson
- Institute of Cardiovascular Sciences, Core Technology Facility (3rd Floor), University of Manchester, 46 Grafton Street, Manchester M13 9NT, UK
| | - T A B Sanders
- Diabetes, Cardiovascular Medicine & Nutrition, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London SE1 9NH, UK
| | - J K Cruickshank
- Diabetes, Cardiovascular Medicine & Nutrition, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London SE1 9NH, UK
| |
Collapse
|
14
|
Weber T, Wassertheurer S, Hametner B, Herbert A, Boutouyrie P, Laurent S, Cruickshank JK. Reference values for central blood pressure. J Am Coll Cardiol 2014; 63:2299. [PMID: 24613335 DOI: 10.1016/j.jacc.2013.12.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 12/03/2013] [Indexed: 11/30/2022]
|
15
|
Alam U, Chan AWS, Buazon A, Van Zeller C, Berry JL, Jugdey RS, Asghar O, Cruickshank JK, Petropoulos IN, Malik RA. Differential effects of different vitamin D replacement strategies in patients with diabetes. J Diabetes Complications 2014; 28:66-70. [PMID: 24139562 DOI: 10.1016/j.jdiacomp.2013.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [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: 04/14/2013] [Revised: 08/02/2013] [Accepted: 09/06/2013] [Indexed: 01/28/2023]
Abstract
BACKGROUND The optimal treatment regimen for correcting vitamin D insufficiency in diabetic patients has not been established. METHODS Two hundred and forty four adult diabetic patients with vitamin D insufficiency were enrolled to receive: Ergocalciferol (D2) 50,000 IU daily over 10 days (500,000 IU) followed by Calcichew D3 (calcium carbonate/Cholecalciferol) BID (~24,000 IU cholecalciferol/month) (ECC) (n=53); Cholecalciferol (D3) 40,000 IU daily over 10 days (400,000 IU) followed by Calcichew D3 BID (~24,000 IU cholecalciferol/month) (CCC) (n=94) or Cholecalciferol 40,000 IU daily over 10 days (400,000 IU) followed by Cholecalciferol 40,000 IU monthly (CC) (n=97). The 25(OH)D, HbA1c, lipids, blood pressure and eGFR were assessed at baseline and after a mean follow up of 8.0±4.0 months. RESULTS Treatment increased 25(OH)D concentrations significantly in ECC (17.4±13.8 vs 29.9±9.6 ng/ml, P<0.0001), CCC (14.2±6.6 vs 30.9±13.1 ng/ml, p<0.0001) and CC (13.5±8.4 vs 33.9±14.4 ng/ml, P<0.0001). The relative increase in 25(OH)D was significantly lower with ECC compared to CC (+14.6±12.2 vs +20.6±15.0, P=0.01) and the majority of subjects in the ECC group (63%) remained vitamin D deficient (25(OH)D <30 ng/ml) compared to CCC (46%) and CC (36%) (P=0.0005). CONCLUSION This study demonstrates that relatively aggressive treatment regimens of both vitamin D2 and D3 increase 25(OH)D concentrations in diabetic patients, but the ability to raise 25(OH)D status to 'sufficient' levels is inadequate in a large proportion of individuals.
Collapse
Affiliation(s)
- Uazman Alam
- Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester and the Central Manchester University Hospitals Foundation Trust, Manchester, UK
| | | | - April Buazon
- Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester and the Central Manchester University Hospitals Foundation Trust, Manchester, UK
| | - Cristiano Van Zeller
- Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester and the Central Manchester University Hospitals Foundation Trust, Manchester, UK
| | - Jacqueline L Berry
- Vitamin D Research Group, School of Biomedicine, University of Manchester, UK
| | | | - Omar Asghar
- Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester and the Central Manchester University Hospitals Foundation Trust, Manchester, UK
| | - John Kennedy Cruickshank
- Department of Diabetes and Nutritional Sciences, King's College and St Thomas' and Guy's Hospitals, UK
| | - Ioannis N Petropoulos
- Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester and the Central Manchester University Hospitals Foundation Trust, Manchester, UK
| | - Rayaz A Malik
- Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester and the Central Manchester University Hospitals Foundation Trust, Manchester, UK.
| |
Collapse
|
16
|
Abstract
OBJECTIVES Perinatal depression has been found to be a strong and independent risk factor for poor child growth and development in low-income South Asian populations. The authors aimed to study if there was a similar association in first and second-generation British women of Pakistani origin. DESIGN A prospective cohort study. SETTING The study was conducted in the North-West of England, in areas with high density of Pakistani-origin population. The subjects were recruited from Central Manchester Hospital in the City of Manchester and East Lancashire Hospital in Lancashire. PARTICIPANTS 704 physically healthy women were assessed in two phases (screening and detailed assessment of high scorers and a proportion of low scorers) during the third trimester of pregnancy to obtain at birth a cohort of 63 infants of depressed mothers and 173 infants of psychologically well mothers. PRIMARY AND SECONDARY OUTCOME MEASURES All infants were weighed and measured at birth and 6 months, and their development was assessed using the Bayley Scales of Infant Development-Third Edition. RESULTS There was no difference in the birth weight or weight and height at 6 months of infants of depressed mothers versus infants of psychologically well mothers. The only significant difference between the two groups was in the infants' adaptive behaviour; infants of depressed mothers scored significantly lower than those of psychologically well mothers (mean difference 4.6, t=2.81, df 195, p=0.006). The associations remained significant after adjustment for socio-demographic factors by multivariate analyses. CONCLUSIONS Prenatal depression is not associated with impaired growth in this sample of British Pakistani women. There is, however, an association of prenatal depression with parent-reported problems in the infants' adaptive behaviour. Further research is needed to understand various pathways through which maternal depression affects infant outcomes in low- and high-income settings.
Collapse
Affiliation(s)
- Nusrat Husain
- Psychiatry Research Group, School of Community Based Medicine, University of Manchester, Manchester, UK
- Culture and International Mental Health Research Group, Lancashire Care NHS Foundation Trust, Lancashire, UK
| | | | - Barbara Tomenson
- Psychiatry Research Group, School of Community Based Medicine, University of Manchester, Manchester, UK
| | - Sarah Khan
- Central Manchester Foundation Trust, Manchester, UK
| | - Atif Rahman
- Institute of Psychology, Health & Society, University of Liverpool, Liverpool, UK
| |
Collapse
|
17
|
Paisley AN, Banerjee M, Rezai M, Schofield RE, Balakrishnannair S, Herbert A, Lawrance JAL, Trainer PJ, Cruickshank JK. Changes in arterial stiffness but not carotid intimal thickness in acromegaly. J Clin Endocrinol Metab 2011; 96:1486-92. [PMID: 21346071 DOI: 10.1210/jc.2010-2225] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [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] [Indexed: 02/10/2023]
Abstract
CONTEXT Acromegaly increases cardiovascular morbidity. We tested the hypothesis that increased arterial stiffness together with left ventricular hypertrophy may be a contributory factor. PATIENTS AND DESIGN Fifty-six patients (40 males, 54 ± 13 yr; 25 active disease, 31 in remission) and 46 healthy controls (30 males, 52 ± 13 yr) underwent measurements of aortic pulse wave velocity (PWV), carotid Doppler (IMT), echocardiography, and cardiovascular risk factors. RESULTS Mean serum IGF-I was 323 ± 286 ng/ml (sd score 1.8 ± 1.9) in all patients. Age, body mass index, diastolic blood pressure (BP), and lipid levels were similar comparing patients and controls. Systolic BP (130.8 ± 19.9 vs. 122 ± 14 mm Hg controls, P < 0.01) and PWV (11.7 ± 3.8 vs. 9.7 ± 2.8 m/sec, 95% confidence interval -3.4 to -0.7, P <0.01) were higher in patients than controls. Regression analysis revealed age, presence of acromegaly, systolic BP, and body mass index, inversely, as significantly and independently associated with PWV. No difference in carotid IMT was seen (0.8 ± 0.2 patients vs. 0.7 ± 0.2 mm controls, P = 0.5) or between active/controlled disease. In the subset of participants with echocardiography (n = 32), left ventricular mass was higher by a mean of 38.2 g (95% confidence interval -80.9 to +4.6, P = 0.08). CONCLUSION In summary, patients with acromegaly had independently and significantly increased aortic PWV as evidence of arterial stiffening but unaltered carotid IMT compared with controls, also influenced by age and systolic BP. Premature cardiovascular disease in patients with acromegaly is likely related to pressure-related arterial and left ventricular stiffening rather than atherosclerotic disease.
Collapse
Affiliation(s)
- A N Paisley
- Department of Endocrinology, The Christie National Health Service Foundation Trust, Manchester M20 4BX, United Kingdom.
| | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Rutter MK, Prais HR, Charlton-Menys V, Gittins M, Roberts C, Davies RR, Moorhouse A, Jinadev P, France M, Wiles PG, Gibson JM, Dean J, Kalra PA, Cruickshank JK, Durrington PN. Protection Against Nephropathy in Diabetes with Atorvastatin (PANDA): a randomized double-blind placebo-controlled trial of high- vs. low-dose atorvastatin(1). Diabet Med 2011; 28:100-8. [PMID: 21166851 DOI: 10.1111/j.1464-5491.2010.03139.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [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] [Indexed: 11/27/2022]
Abstract
AIMS To compare the renal effects of low- vs. high-dose atorvastatin in patients with Type 2 diabetes mellitus and optimally managed early renal disease. METHODS We compared the 2-year progression of nephropathy in a double-blind randomized controlled trial of atorvastatin 80 mg/day (n = 60) vs. 10 mg/day (n = 59) in patients with Type 2 diabetes with microalbuminuria or proteinuria [mean (sd): age 64 years (10 years); HbA(1c) 7.7% (1.3%), 61 mmol/mol (10 mmol/mol); blood pressure 131/73 mmHg; renin-angiotensin system blocker use > 80%; dual blockade > 67%] recruited from diabetes clinics in Greater Manchester. RESULTS Over (mean) 2.1 years of follow-up, the Modification of Diet in Renal Disease estimated glomerular filtration rate declined by 3 ml min(-1) 1.73 m(-2) in the combined group. The mean (95% CI) between-group difference during follow-up was not significant [2.2 ml min(-1) 1.73 m(-2) (-1.1 to 5.4 ml min(-1) 1.73: m(-2) ), P = 0.20] after adjusting for baseline differences in renal function; positive difference favours 80 mg dose. Similarly, there was no significant difference in creatinine clearance by Cockcroft and Gault [2.5 ml/min (-2.4 to 7.3 ml/min), P = 0.32]; serum creatinine/24-h urine collections [4.0 ml/min (-4.8 to 12.7 ml/min), P = 0.38]; cystatin C (P = 0.69); or 24-h urine protein or albumin excretion (P = 0.92; P = 0.93). We recorded no significant between-group differences in deaths or adverse events. CONCLUSIONS In patients with Type 2 diabetes with early renal disease, we found no statistical difference in renal function between those taking high- or low-dose atorvastatin over 2 years. We cannot exclude a beneficial effect of < 1.6 ml min(-1) 1.73 m(-2) year(-1) on Modification of Diet in Renal Disease estimated glomerular filtration rate, or if blood pressure management or if renin-angiotensin system blocker use had not been optimized.
Collapse
Affiliation(s)
- M K Rutter
- Cardiovascular Medicine Research Group, School of Biomedicine, University of Manchester, Manchester, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
|
20
|
Patel JV, Caslake MJ, Vyas A, Cruickshank JK, Prabhakaran D, Bhatnagar D, Reddy KS, Lip GYH, Mackness MI, Hughes EA, Durrington PN. Triglycerides and small dense low density lipoprotein in the discrimination of coronary heart disease risk in South Asian populations. Atherosclerosis 2009; 209:579-84. [PMID: 19922937 DOI: 10.1016/j.atherosclerosis.2009.10.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Revised: 09/17/2009] [Accepted: 10/05/2009] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Coronary heart disease (CHD) is exceptionally prevalent amongst globally dispersed migrant groups originating from the Indian subcontinent, but the contribution of dyslipidaemia to their increased risk remains poorly defined. METHODS Fasting lipids and lipoproteins, apolipoproteins (Apo), low density lipoprotein (LDL) diameter and oxidised LDL were measured amongst rural Indians in India (n=294) and their migrant contemporaries in the UK (n=242). The performance of qualitative and quantitative measures of lipid metabolism were compared in the discrimination of WHO defined metabolic risk and raised Framingham CHD risk scores (>15%) using Receiver Operating Characteristic (ROC) curves. RESULTS LDL diameter was correlated with triglycerides (R(2)=0.12, P<0.001) and with high density lipoprotein (HDL) cholesterol levels (R(2)=0.15, P<0.001) in both groups. Migrants had less small dense LDL (95% CI: 12.5-14.2%) vs. rural Indians (15.7-17.2, P<0.05). On ROC analysis, triglycerides were the only consistent discriminators of metabolic and CHD risk scores (all P< or =0.001). Apo B was also a strong indicator of raised CHD risk scores. Irrespective of site, individuals with raised triglycerides also had higher total cholesterol and Apo B, denser LDL, lower HDL and more oxidised LDL (all P< or =0.01). DISCUSSION Fasting triglycerides reflect both qualitative and quantitative aspects of lipid metabolism, and are a comprehensive discriminator of CHD risk in this South Asian population.
Collapse
Affiliation(s)
- J V Patel
- Clinical Epidemiology & Cardiovascular Medicine Group, University Department of Medicine, University of Manchester, UK.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Beulens JWJ, Patel A, Vingerling JR, Cruickshank JK, Hughes AD, Stanton A, Lu J, McG Thom SA, Grobbee DE, Stolk RP. Effects of blood pressure lowering and intensive glucose control on the incidence and progression of retinopathy in patients with type 2 diabetes mellitus: a randomised controlled trial. Diabetologia 2009; 52:2027-36. [PMID: 19633827 DOI: 10.1007/s00125-009-1457-x] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.1] [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: 02/13/2009] [Accepted: 06/22/2009] [Indexed: 10/20/2022]
Abstract
AIMS/HYPOTHESIS The aim of the present study was to investigate the effect of blood pressure lowering and intensive glucose control on the incidence and progression of retinopathy in type 2 diabetic patients. METHODS The Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) Retinal Measurements study, a substudy of ADVANCE, is a randomised (using a central, computer-based procedure) controlled 2 x 2 factorial trial comprising a double-blind comparison of blood pressure lowering with perindopril-indapamide vs placebo, and an open comparison of standard vs intensive glucose control targeting a HbA(1c) of < or = 6.5% in 1,602 diabetic patients from ADVANCE centres with access to retinal cameras conducted from 2001 to 2008. At baseline and the final visit, seven-field stereoscopic retinal photographs were taken and graded by blinded readers (gradeable baseline and final photographs from 1,241 patients). Progression of > or =2 steps in the Early Treatment of Diabetic Retinopathy Study classification (using the eye with worst grading) was the primary outcome. RESULTS Retinopathy progressed in 59 (4.8%) patients and developed in 128 (10.3%) patients over 4.1 years. Fewer patients on blood pressure-lowering treatment (n = 623) experienced incidence or progression of retinopathy compared with patients on placebo (n = 618), but the difference was not significant (OR 0.78; 95% CI 0.57-1.06; p = 0.12). Blood pressure-lowering treatment reduced the occurrence of macular oedema (OR 0.50; 95% CI 0.29-0.88; p = 0.016) and arteriovenous nicking compared with placebo (OR 0.60; 95% CI 0.38-0.94; p = 0.025). Compared with standard glucose control (n = 611), intensive glucose control (n = 630) did not reduce (p = 0.27) the incidence and progression of retinopathy (OR 0.84; 95% CI 0.61-1.15). Lower, borderline significant risks of microaneurysms, hard exudates and macular oedema were observed with intensive glucose control, adjusted for baseline retinal haemorrhages. These effects of the two treatments were independent and additive. Adverse events in the ADVANCE study are reported elsewhere. CONCLUSIONS/INTERPRETATION Blood pressure lowering or intensive glucose control did not significantly reduce the incidence and progression of retinopathy, although consistent trends towards a benefit were observed, with significant reductions in some lesions observed with both interventions. TRIAL REGISTRATION ClinicalTrials.gov ID no. NCT00145925. FUNDING Grants from Servier and the National Health and Medical Research Council of Australia.
Collapse
Affiliation(s)
- J W J Beulens
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, GA, the Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Oldroyd JC, Heald A, Bansal N, Vyas A, Siddals K, Gibson M, Clayton P, Cruickshank JK. Inflammatory markers and growth in South Asian and European origin infants in Britain: the Manchester Children's Growth and Vascular Health Study. Atherosclerosis 2009; 207:227-31. [PMID: 19439300 DOI: 10.1016/j.atherosclerosis.2009.03.045] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2009] [Revised: 03/15/2009] [Accepted: 03/30/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Given the high risk of cardiovascular disease in South Asians and the importance of inflammation in coronary heart disease we tested the hypothesis that circulating C-reactive protein (CRP) and interleukin 6 (IL-6) would be higher in healthy British born infants of South Asian origin than in infants of European origin in the first 2 years of life. STUDY DESIGN AND SETTING Infants of South Asian (n=74) and European (n=129) origin were followed prospectively from birth. Anthropometry and fasting CRP and IL-6 concentrations were measured at one or more of 3, 6, 12 and 24 months of age. RESULTS South Asian infants had a significantly lower circulating CRP compared with European infants (beta=0.63, 95% CI 0.41-0.98 mg/l, P=0.040). There was no significant change in CRP from birth to 2 years in either ethnic group so that neither infant weight nor weight gain were associated with CRP during follow-up. IL-6 concentrations were low or undetectable during follow-up in all participants. CONCLUSION In our cohort, South Asian origin infants had significantly lower markers of inflammation compared with European infants. Infant growth to age 2 years was not associated with CRP or IL-6. Inflammatory markers are not useful indices of CVD risk at this age, with such markers not being elevated as expected in South Asian infants. The timing of the rise of such markers to the levels found in adult South Asian populations needs longer prospective study.
Collapse
Affiliation(s)
- J C Oldroyd
- Cardiovascular Research Group, School of Clinical & Laboratory Sciences, Core Technology Facility, University of Manchester, 46 Grafton Street, Manchester, UK.
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Cruickshank JK. Day or night blood pressures for prognosis. Lancet 2008; 371:113-4; author reply 114-5. [PMID: 18191677 DOI: 10.1016/s0140-6736(08)60096-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
24
|
Heald AH, Patel J, Anderson SG, Vyas A, Rudenski A, Hughes E, Panja NC, Ullah A, Prabhakaran D, Reddy S, Durrington P, Gibson JM, Laing I, Bhatnagar D, Cruickshank JK. Migration is associated with lower total, but not free testosterone levels in South Asian men. Clin Endocrinol (Oxf) 2007; 67:651-5. [PMID: 17900299 DOI: 10.1111/j.1365-2265.2007.02856.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [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] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Serum testosterone measurement is an integral part of the endocrine assessment of men. Little is known about its variation in relation to migration. We examined within a South Asian group the effect of migration to the UK on androgen levels. DESIGN Circulating testosterone and SHBG concentrations were measured in 97 Gujarati men resident in India and in 79 men from the same villages of origin living in Birmingham, UK. Free testosterone was calculated by Vermeulen's method. Insulin sensitivity (HOMA-S) was determined from paired fasting plasma intact insulin and glucose values. RESULTS Circulating testosterone was significantly lower in UK Gujarati men (17.2 nmol/l [15.7-18.7]) vs. Indian Gujarati men (21.7 [20.0-23.5]) (P = 0.0002) (age-adjusted median [95% CI]). There was no difference by migration status in circulating free testosterone. Sex hormone binding globulin (SHBG) levels were lower in UK migrants (16.8 nmol/l [15.5-18.1]) than in nonmigrants (21.9 nmol/l [20.5-23.3]) (P < 0.0001). Testosterone level correlated positively with insulin sensitivity (HOMA-S) (rho 0.16, P = 0.04). In multivariate analysis, total testosterone was independently and positively associated with logSHBG (normalized beta (beta) = 0.29, P = 0.002) and independently and negatively with waist circumference (beta = -0.19, P = 0.04), in a model also including height, age, migration status, leptin and fasting insulin. CONCLUSION Lower circulating testosterone in UK Gujarati men and its association with markers of insulin sensitivity suggest a profound influence of body composition change with migration on testosterone levels. The lower SHBG in this group restores parity in free testosterone. Account should be taken of SHBG in interpreting testosterone levels in men, as well as in women.
Collapse
Affiliation(s)
- A H Heald
- Department of Endocrinology, University of Manchester, Salford NHS Trust, Salford, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Abstract
BACKGROUND While initial dietary management immediately after formal diagnosis is an 'accepted' cornerstone of treatment of type 2 diabetes mellitus, a formal and systematic overview of its efficacy and method of delivery is not currently available. OBJECTIVES To assess the effects of type and frequency of different types of dietary advice for adults with type 2 diabetes. SEARCH STRATEGY We carried out a comprehensive search of The Cochrane Library, MEDLINE, EMBASE, CINAHL, AMED, bibliographies and contacted relevant experts. SELECTION CRITERIA All randomised controlled trials, of six months or longer, in which dietary advice was the main intervention. DATA COLLECTION AND ANALYSIS The lead investigator performed all data extraction and quality scoring with duplication being carried out by one of the other six investigators independently with discrepancies resolved by discussion and consensus. Authors were contacted for missing data. MAIN RESULTS Thirty-six articles reporting a total of eighteen trials following 1467 participants were included. Dietary approaches assessed in this review were low-fat/high-carbohydrate diets, high-fat/low-carbohydrate diets, low-calorie (1000 kcal per day) and very-low-calorie (500 kcal per day) diets and modified fat diets. Two trials compared the American Diabetes Association exchange diet with a standard reduced fat diet and five studies assessed low-fat diets versus moderate fat or low-carbohydrate diets. Two studies assessed the effect of a very-low-calorie diet versus a low-calorie diet. Six studies compared dietary advice with dietary advice plus exercise and three other studies assessed dietary advice versus dietary advice plus behavioural approaches. The studies all measured weight and measures of glycaemic control although not all studies reported these in the articles published. Other outcomes which were measured in these studies included mortality, blood pressure, serum cholesterol (including LDL and HDL cholesterol), serum triglycerides, maximal exercise capacity and compliance. The results suggest that adoption of regular exercise is a good way to promote better glycaemic control in type 2 diabetic patients, however all of these studies were at high risk of bias. AUTHORS' CONCLUSIONS There are no high quality data on the efficacy of the dietary treatment of type 2 diabetes, however the data available indicate that the adoption of exercise appears to improve glycated haemoglobin at six and twelve months in people with type 2 diabetes. There is an urgent need for well-designed studies which examine a range of interventions, at various points during follow-up, although there is a promising study currently underway.
Collapse
Affiliation(s)
- L Nield
- University of Teesside, Parkside West Offices, Middlesbrough, U K, TS1 3BA.
| | | | | | | | | | | | | |
Collapse
|
26
|
Jackson M, Walker S, Cruickshank JK, Sharma S, Cade J, Mbanya JC, Younger N, Forrester TF, Wilks R. Diet and overweight and obesity in populations of African origin: Cameroon, Jamaica and the UK. Public Health Nutr 2007; 10:122-30. [PMID: 17261220 DOI: 10.1017/s1368980007246762] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To determine the relationship of diet to overweight and obesity among populations of African origin. DESIGN AND SETTING Cross-sectional data were obtained from adults aged 25-74 years in rural Cameroon (n = 686), urban Cameroon (n = 975), Jamaica (n = 924) and Afro-Caribbeans in the UK (n = 257). Dietary data were collected using food-frequency questionnaires specifically designed for each site. Body mass index (BMI) was used as a measure of overweight. RESULTS The expected gradient in the distribution of overweight across sites was seen in females (rural Cameroon, 9.5%; urban Cameroon, 47.1%; Jamaica, 63.8%; UK, 71.6%); however, among males overweight was less prevalent in Jamaica (22.0%) than urban Cameroon (36.3%). In developing countries increased risks of overweight (BMI > or = 25 kg m(-2) were influenced by higher energy (urban Cameroonian men) and protein (Jamaican women) intakes. No dietary variables were associated with obesity (BMI > or = 30 kg m(-2) in Cameroon or Jamaica. In the UK, energy intakes were inversely related with overweight whereas increased risks of being overweight were associated with higher protein (men) and fat (women) intakes. Similarly, whereas higher protein and fat intakes in UK men and women were associated with obesity, carbohydrate intakes were associated with decreased risks of obesity in men. CONCLUSIONS Diet and overweight were associated in the UK but few dietary variables were related to overweight in Jamaica and the Cameroon. These findings suggest that associations between diet and overweight/obesity are not generalisable among populations.
Collapse
Affiliation(s)
- M Jackson
- Department of Community Health and Psychiatry, University of the West Indies, Mona Campus, Kingston 7, Jamaica.
| | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Heald AH, Anderson SG, Patel J, Rudenski A, Vyas A, Yates A, Hughes E, Prabharakan D, Reddy S, Durrington P, Gibson JM, Bhatnagar D, Cruickshank JK, Laing I. Change in pancreatic B-cell function (HOMA-B) varies in different populations with similar genetic backgrounds but different environments. Diabet Med 2007; 24:145-53. [PMID: 17257276 DOI: 10.1111/j.1464-5491.2007.02032.x] [Citation(s) in RCA: 8] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To determine whether pancreatic B-cell function varies in different populations with similar genetic backgrounds but different environments. RESEARCH DESIGN/METHODS We compared a specific migrant Gujarati community in the UK (n = 205) with people still resident in the same villages of origin in Gujarat, India (n = 246). Pancreatic B-cell function (HOMA-B) was determined and the influence of age, migration and other factors was explored. RESULTS As anticipated, there was an age-related decline in log(HOMA-B) in both groups. However, the age-related fall in log(HOMA-B) was more pronounced in the UK than in Gujarat (normalized beta-0.29 vs. -0.14, P for difference = 0.03). The decline of HOMA-B with age persisted after adjustment for body mass index (UK beta = -0.31; Gujarat beta = -0.16, P = 0.015, P < 0.001). There was no significant change in insulin sensitivity (HOMA-S) with age at either site, although insulin sensitivity was lower in the UK. Fasting non-estrified fatty acid (NEFA) levels rose with age in the UK but not in Gujarat (P = 0.003 for difference in gradients). In multiple linear regression analysis, lower log(HOMA-B) was independently associated with higher fasting log(NEFA) levels; normalized beta = -0.24, P < 0.001, age; beta = -0.16, P = 0.005, higher log(insulin-like growth factor binding protein-1); beta = -0.19, P = 0.007 and lower body mass index; beta = 0.26, P = 0.001. This model accounted for 25% of the variability in HOMA-B. CONCLUSIONS HOMA-B as a measure of B-cell function declines more rapidly with age in the migrant UK group than in Gujarat. This may be a direct consequence of chronically higher NEFA exposure in the UK group.
Collapse
Affiliation(s)
- A H Heald
- Department of Diabetes & Endocrinology, Univerity of Manchester, Salford NHS Trust, Hope Hospital, Salford, Greater Manchester, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Heald AH, Sharma R, Anderson SG, Vyas A, Siddals K, Patel J, Bhatnagar D, Prabharkaran D, Rudenski A, Hughes E, Durrington P, Gibson JM, Cruickshank JK. Dietary intake and the insulin-like growth factor system: effects of migration in two related populations in India and Britain with markedly different dietary intake. Public Health Nutr 2007; 8:620-7. [PMID: 16236191 DOI: 10.1079/phn2005729] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AbstractBackgroundThe insulin-like growth factor (IGF) system is implicated in the pathogenesis of diabetes and cardiovascular disease.ObjectiveWe report the effects of total energy intake on the IGF system in two populations with markedly different dietary macronutrient intake and cardiovascular event rate.Design, subjects and settingDietary macronutrient intake was measured in a specific Gujarati migrant community in Sandwell, UK (n = 205) compared with people still resident in the same villages of origin in India (n = 246). Fasting IGF-I, IGF-binding protein (IGFBP)-1 and IGFBP-3, insulin and glucose (0 and 2-hour) were measured.ResultsTotal energy and total fat intake were higher in UK migrants, as were IGFBP-3 and IGF-I (mean (95% confidence interval): 145.9 (138.1–153.6) vs. 100.9 (94.6–107.3) ng ml-1; F = 76.6, P < 0.001). IGFBP-1 was lower in UK migrants (29.5 (25.9–33.0) vs. 56.5 (50.6–62.5) μg l-1; F = 48.4, P < 0.001). At both sites, IGF-I correlated positively with total energy (Spearman's ρ = 0.45, P < 0.001) and total fat (ρ = 0.44, P < 0.001) as did IGFBP-3 with total energy (ρ = 0.21, P < 0.05) and fat (ρ = 0.26, P < 0.001). Conversely, in Indian Gujaratis, IGFBP-1 fell with increasing total energy (ρ = -0.27, P < 0.001) and fat intake (ρ = -0.26, P < 0.01) but not in UK Gujaratis. Multiple linear regression modelling showed that increasing quartiles of fat intake were associated with higher IGF-I (β = 0.42, P = 0.007) independent of age, body mass index, plasma insulin, fatty acids and 2-hour glucose.ConclusionIn these genetically similar groups, migration to the UK and adoption of a different diet is associated with marked changes in the IGF system, suggesting that environmental factors profoundly modulate serum concentrations and actions of IGFs.
Collapse
Affiliation(s)
- A H Heald
- University of Manchester, Salford Royal Hospitals University Trust, Hope Hospital, Stott Lane, Salford, Greater Manchester M6 8HD, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Banerjee M, Cruickshank JK. Pregnancy as the prodrome to vascular dysfunction and cardiovascular risk. ACTA ACUST UNITED AC 2006; 3:596-603. [PMID: 17063164 DOI: 10.1038/ncpcardio0683] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2006] [Accepted: 06/30/2006] [Indexed: 11/08/2022]
Abstract
In previously apparently healthy women, glucose intolerance and high blood pressure during pregnancy are common and frequently occur together. This article reviews the role of these gestational disorders as markers of vascular dysfunction and its pathophysiology. Mechanisms include alterations to function of large arteries and resistance vessels and to capillary blood flow. Much of the vessel pathology is seen in both gestational diabetes and hypertension. In women who have had transient diabetes during pregnancy and later redeveloped overt diabetes, cardiovascular risk is already elevated nearly fourfold before diagnosis, which is almost as high as the average risk after a clinical diagnosis of diabetes is made. This key finding suggests that vascular risk in such women is at least partly independent of overt hyperglycemia.
Collapse
Affiliation(s)
- M Banerjee
- Division of Cardiovascular & Endocrine Sciences, Core Technology Facility (3rd Floor), University of Manchester, Manchester M13 9NT, UK
| | | |
Collapse
|
30
|
Heald AH, Anderson SG, Ivison F, Riste L, Laing I, Cruickshank JK, Gibson JM. Low sex hormone binding globulin is a potential marker for the metabolic syndrome in different ethnic groups. Exp Clin Endocrinol Diabetes 2006; 113:522-8. [PMID: 16235154 DOI: 10.1055/s-2005-865807] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [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] [Indexed: 10/25/2022]
Abstract
Hepatic sex-hormone binding globulin (SHBG) production is down-regulated by insulin and low levels reflect insulin resistance. Because insulin resistance is closely related to the development of cardiovascular disease in different ethnic groups we examined ethnic variation in SHBG across populations with different baseline cardiovascular risk and metabolic syndrome prevalence. Participants were population-based, of European (n = 142), Pakistani (n = 130), and African-Caribbean (AfC) origin (n = 193). SHBG, fasting lipids, and glucose concentrations plus insulin sensitivity (HOMA-S) were determined. Age adjusted SHBG was significantly lower in both Pakistani men and women. Circulating SHBG levels were lower in those with impaired vs. normal glucose homeostasis. SHBG correlated positively with HOMA-S (rho = 0.28, p < 0.001), and negatively with WHR (rho = - 0.38, p < 0.001), BMI (r = - 0.30, p < 0.001), and diastolic blood pressure (rho = - 0.14, p < 0.01) across all ethnic groups. In multivariate logistic regression analysis a low SHBG increased the likelihood of the metabolic syndrome (odds ratio [OR] = 0.42 [0.21 - 0.82], p = 0.01) as did higher fasting NEFA (OR 1.47 [1.04 - 2.08], p = 0.03), low IGFBP-1 concentrations (OR 0.6 [0.44 - 0.81], p = 0.001), age (OR 1.05 [1.02 - 1.09], p = 0.003), and Pakistani ethnicity (p = 0.001) in a model which also contained gender, lnCRP, IGF-I, and IGF-II. As ethnic differences in SHBG level closely parallel differences in insulin resistance. Its measurement may be useful in identifying individuals at particular risk of the metabolic syndrome, for early intervention.
Collapse
Affiliation(s)
- A H Heald
- Department of Endocrinology, University of Manchester, Salford NHS Trust, Salford, UK.
| | | | | | | | | | | | | |
Collapse
|
31
|
Cruickshank JK, Mzayek F, Liu L, Kieltyka L, Sherwin R, Webber LS, Srinavasan SR, Berenson GS. Origins of the "black/white" difference in blood pressure: roles of birth weight, postnatal growth, early blood pressure, and adolescent body size: the Bogalusa heart study. Circulation 2005; 111:1932-7. [PMID: 15837946 DOI: 10.1161/01.cir.0000161960.78745.33] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.0] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND The determinants of differences in blood pressure that emerge in adolescence between black Americans of predominantly African descent and white Americans of predominantly European descent are unknown. One hypothesis is related to intrauterine and early childhood growth. The role of early blood pressure itself is also unclear. We tested whether differences in birth weight and in carefully standardized subsequent measures of weight, height, and blood pressure from 0 to 4 or 5 years were related to black/white differences in blood pressure in adolescence. METHODS AND RESULTS Two Bogalusa cohorts who had complete follow-up data on birth weights and early childhood and adolescent anthropometric and blood pressure measures were pooled. One hundred eighty-five children (48 black and 47 white boys and 41 black and 49 white girls) were followed up and studied after 15 to 17 years. Birth weights were a mean 443 and 282 g lower in black boys and girls, respectively, than in whites (P<0.001). Blood pressures in adolescence were 3.4/1.9 and 1.7/0.6 mm Hg higher, respectively, and tracked from early childhood. In regression analyses, birth weight accounted for the ethnic difference in adolescent blood pressure, which was also independently predicted, in decreasing impact order, by adolescent height, adolescent body mass index, and systolic blood pressure at 4 to 5 years and inversely by growth from 0 to 4 to 5 years. CONCLUSIONS If these results can be replicated in larger and independent samples, they suggest that efforts to improve intrauterine growth in black infants as well as lessen weight gain in adolescence might substantially reduce excess high blood pressure/hypertension in this ethnic group.
Collapse
Affiliation(s)
- J K Cruickshank
- Tulane Center for Cardiovascular Health, Tulane University Medical Center School of Public Health, New Orleans, LA, USA.
| | | | | | | | | | | | | | | |
Collapse
|
32
|
Heald AH, Anderson SG, Vyas A, Siddals K, Patel J, Yates AP, Bhatnagar D, Prabhakaran D, Hughes E, Rudenski A, Durrington P, Gibson JM, Cruickshank JK. Marked differences in the IGF system that are associated with migration in comparable populations of Gujaratis living in Sandwell, UK, and Gujarat, India. Diabetologia 2005; 48:1756-65. [PMID: 16041536 DOI: 10.1007/s00125-005-1871-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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: 09/01/2004] [Accepted: 11/25/2004] [Indexed: 01/28/2023]
Abstract
AIMS/HYPOTHESES We previously reported independent links between the IGF system and the development of impaired glucose tolerance and cardiovascular risk. This study tests the hypothesis that the lifestyle change which accompanies population migration, with attendant increases in cardiovascular risk, is reflected by changes in the IGF system. MATERIALS AND METHODS We compared a specific Gujarati community in Sandwell, UK (n=205), with people still resident in the same villages of origin near Navsari, India (n=246). We performed anthropometry and measured fasting plasma insulin, IGF-I, insulin-like growth factor binding protein (IGFBP)-1 and IGFBP-3. RESULTS Daily calorie intake, BMI and WHR were significantly higher in UK Gujaratis than in Indian Gujaratis. IGFBP-1 was significantly lower in UK migrants (mean 29.5 [95% CI 25.9-33.0] vs 56.5 [50.6-62.5] microg/l; F=48.4, p<0.001). Conversely, fasting insulin, IGFBP-3 and IGF-I were all higher in UK Gujaratis (mean IGF-I 145.9 [138.1-153.6]ng/ml in UK Gujaratis and 100.9 [94.6-107.3] ng/ml in Navsari Gujaratis; F=76.6, p<0.001). These differences were still apparent when adjustment was made for BMI by location for IGF-I (F=57.4, p<0.001) and IGFBP-3 (F=5.7, p=0.02), but were no longer apparent for IGFBP-1 and insulin. At the population level, the decrease in IGFBP-1 for a given increase in insulin was significantly smaller in UK Gujaratis, suggesting greater hepatic insulin resistance in this group. CONCLUSIONS/INTERPRETATION Environmental factors have profound effects on circulating IGF system components and on the relationship between IGFBP-1, IGF-I and related metabolic variables. This may have long-term implications for the development of worsening glucose tolerance and cardiovascular disease.
Collapse
Affiliation(s)
- A H Heald
- Department of Diabetes and Endocrinology, Salford Royal Hospitals University Trust, Hope Hospital, University of Manchester, Stott Lane, Salford, Greater Manchester, M6 8HD, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Patel JV, Vyas A, Cruickshank JK, Prabhakaran D, Hughes E, Reddy KS, Mackness MI, Bhatnagar D, Durrington PN. Impact of migration on coronary heart disease risk factors: comparison of Gujaratis in Britain and their contemporaries in villages of origin in India. Atherosclerosis 2005; 185:297-306. [PMID: 16005463 DOI: 10.1016/j.atherosclerosis.2005.06.005] [Citation(s) in RCA: 147] [Impact Index Per Article: 7.7] [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: 01/24/2005] [Revised: 05/27/2005] [Accepted: 06/02/2005] [Indexed: 02/07/2023]
Abstract
The causes of the excess coronary heart disease (CHD) risk in South Asian migrants from the Indian subcontinent remain unclear. Comparisons of CHD risk factors amongst South Asian migrants living in Britain with those of the general UK population provide only a partial explanation. We compared Gujaratis in Britain with similar, non-migrant Gujaratis in India, to test the hypothesis that differences in CHD risk factors associated with migration would be more informative. Randomly sampled Gujaratis aged 25-79 years living in Sandwell (n = 242) were compared with age-, gender- and caste-matched contemporaries remaining in their villages of origin in Navsari, India (n = 295). Lifestyle indices, food intake and physical activity, were assessed with standardised questionnaires and energy expenditure and metabolic parameters measured. British Gujaratis had higher, mean body mass indices by 6 (4.5-7.4) kg/m(2) mean (95% CI), and greater dietary energy intake, fat intake, blood pressure, fasting serum cholesterol, apolipoprotein B, triglycerides, non-esterified fatty acid (NEFA) and C-reative protein concentrations than Gujaratis in India. Dietary folate and serum folate and Vitamin B(12) were lower and plasma homocysteine was higher in India. Smoking was less prevalent and high-density lipoprotein cholesterol tended to be higher in Britain. Diabetes prevalence was high in both populations and impaired fasting or 2 h post-glucose challenge plasma glucose was even more prevalent in Gujarat. In India, however, where insulin secretion and NEFA were lower diabetes and impaired glucose tolerance were less frequently accompanied by excess metabolic CVD risk factors. In conclusion, exposure to increased fat intake and obesity related to migration is likely to explain the disproportionate combination of established and emerging CHD risk factors prevalent in Gujaratis in Britain. Strategies to improve nutrition and to identify and treat cardiovascular risk factors such as dyslipidaemia and hypertension are urgently required.
Collapse
Affiliation(s)
- J V Patel
- University Department of Medicine, University of Manchester, Division of Cardiovascular and Endocrine Science, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
| | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Harding S, Rosato MG, Cruickshank JK. Lack of change in birthweights of infants by generational status among Indian, Pakistani, Bangladeshi, Black Caribbean, and Black African mothers in a British cohort study. Int J Epidemiol 2004; 33:1279-85. [PMID: 15155695 DOI: 10.1093/ije/dyh186] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIM To test the hypothesis that an intergenerational increase would occur in birthweights of babies born to UK-born compared with overseas-born (migrant) minority women. METHOD Live singleton births to mothers present at the 1991 Census in a national longitudinal study were classified by mother's country of birth and ethnic origin as reported in the census. During 1983-2000, 52,554 White, 1788 Indian, 1538 Pakistani, 995 Bangladeshi, 300 Black Caribbean, and 299 Black African live singleton births were identified. Mean birthweights were adjusted for maternal age, socio-economic circumstances, gender, year of birth, and birth order. RESULTS Adjusted mean birthweights were: 3400 g (95% CI: 3395, 3405) for infants of UK-born White mothers; 3033 g (95% CI: 2980, 3087) of UK-born Indian mothers and 3066 g (95% CI: 3034, 3097) of migrant Indian mothers; 3110 g (95% CI: 3049, 3172) of UK-born Pakistani mothers and 3123 g (95% CI: 3087, 3159) of migrant Pakistani mothers; 3026 g (95% CI: 2922, 3130) of UK-born Bangladeshi mothers and 3110 g (95% CI: 3076, 3145) of migrant Bangladeshi mothers; 3268 g (95% CI: 3177, 3359) of UK-born Black Caribbean mothers and 3238 g (95% CI: 3089, 3388) of migrant Black Caribbean mothers; and 3167 g (95% CI: 3004, 3330) of UK-born Black African mothers and 3302 g (95% CI: 3208, 3395) of migrant Black African mothers. The proportions of low birthweight infants (<2500 g), generally greater among migrant mothers than White UK-born mothers, were similar by generational status within the ethnic groups. CONCLUSION There are no significant differences in mean birthweights of infants by generational status among mothers from these main ethnic minority groups in the UK.
Collapse
Affiliation(s)
- S Harding
- MRC Social and Public Health Sciences Unit, University of Glasgow, 4 Lilybank Gardens, Glasgow G12 8RZ, UK.
| | | | | |
Collapse
|
35
|
Vyas A, Haidery AZ, Wiles PG, Gill S, Roberts C, Cruickshank JK. A pilot randomized trial in primary care to investigate and improve knowledge, awareness and self-management among South Asians with diabetes in Manchester. Diabet Med 2003; 20:1022-6. [PMID: 14632704 DOI: 10.1046/j.1464-5491.2003.01082.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [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] [Indexed: 11/20/2022]
Abstract
AIMS To investigate whether a secondary-primary care partnership education package could improve understanding of diabetes care among South Asians. METHODS In a pilot randomized controlled trial, in the setting of eight general practices randomized to intervention or control, patients were invited to four or more rotating visits per year by one of a diabetes specialist nurse, dietician or chiropodist working with general practice staff. Participants were from lists of South Asian patients with known Type 2 diabetes in each (general) practice. RESULTS Patients and practice scores at baseline and 1-year follow-up, from an interview using a questionnaire on knowledge, awareness and self-management of diabetes. Responses were developed into educational packages used during intervention. Of the 411 patients listed at baseline only 211 were traced for interview (refusal only 4%). Mean age was 55.4 years, age of diabetes onset 47.1 years. Fourteen percent were employed and 35% were able to communicate in English fluently. Only 118 could be traced and interviewed at 1 year, although there was no significant difference in demography between those who completed the study and those who did not. Despite a mean of four visits/patient, intervention had no impact on scores for diabetes knowledge, or awareness [score change 0.14, 95% confidence interval (CI) -0.20, 0.49] or self-management (-0.05, 95% CI -0.48, 0.39) between baseline and 1 year. CONCLUSIONS This form of secondary/primary care support did not transfer information effectively, and we suspect similar problems would arise in other similar communities. Different methods of clinician/patient information exchange need to be developed for diabetes in this South Asian group.
Collapse
Affiliation(s)
- A Vyas
- Clinical Epidemiology & Biostatistics Group, University of Manchester Medical School and Manchester Diabetes Centre/Royal Infirmary, UK.
| | | | | | | | | | | |
Collapse
|
36
|
Heald AH, Cade JE, Cruickshank JK, Anderson S, White A, Gibson JM. The influence of dietary intake on the insulin-like growth factor (IGF) system across three ethnic groups: a population-based study. Public Health Nutr 2003; 6:175-80. [PMID: 12675960 DOI: 10.1079/phn2002414] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The insulin-like growth factor (IGF) system has been implicated in the aetiopathogenesis of cancer, cardiovascular disease and diabetes. Since dietary factors and ethnicity are considered contributory to the development of these diseases, we examined the IGF system in relation to nutritional intake by ethnic group. DESIGN, SUBJECTS AND SETTING Dietary intake in 257 subjects of White European, African-Caribbean and Pakistani ethnic origin living in Manchester, UK was assessed using ethnic-group-specific food-frequency questionnaires to assess habitual nutrient intake over the previous 12 months. Fasting IGF-I, IGF-II and IGF-binding protein-1 (IGFBP-1) concentrations were determined and their relationship to specific dietary constituents was analysed. RESULTS Analysis by quintiles of nutrient intake showed a significant increase in circulating IGF-I concentration with increasing dietary fat intake (F for trend=3.9, ), saturated fat intake and for protein intake There was also a significant increase in IGF-II by quintiles of dietary protein intake There was a trend for increasing IGF-I with increasing energy intake. The relationships between circulating concentration of IGFBP-1, an acute regulator of IGF action, and fat/protein intake were opposite to those for IGF-I and IGF-II. Multiple linear regression modelling showed that people of Pakistani origin and older subjects had lower levels of IGF-I (Pakistani origin vs. others, ) (age, for both). There was an independent inverse relationship between IGF-I and dietary carbohydrate intake CONCLUSIONS This study provides evidence for a dietary contribution to regulation of the IGF system, although the effects of ethnicity on circulating IGF levels remain dominant. We propose that the IGF system's influences on cancer risk in specific ethnic groups are potentially modifiable by dietary intervention.
Collapse
Affiliation(s)
- A H Heald
- Department of Diabetes, University of Manchester, Salford Royal Hospitals University Trust, Hope Hospital, Stott Lane, Greater Manchester M6 8HD.
| | | | | | | | | | | |
Collapse
|
37
|
Jackson M, Walker S, Forrester T, Cruickshank JK, Wilks R. Social and dietary determinants of body mass index of adult Jamaicans of African origin. Eur J Clin Nutr 2003; 57:621-7. [PMID: 12700626 DOI: 10.1038/sj.ejcn.1601584] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2002] [Revised: 06/11/2002] [Accepted: 07/03/2002] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To determine the relationships between body mass index (BMI) and diet, social and behavioural factors among adult Jamaicans of African origin. DESIGN Cross-sectional. SETTING Urban communities in Jamaica, West Indies. SUBJECTS Three-hundred and sixty-three males and 561 females of African origin, aged 25-74 y. RESULTS Women had higher mean BMIs (27.5+/-6.4 kg/m(2)) than men (23.4+/-4.3 kg/m(2)); 30.7% of women compared with 6.7% of men were obese. There was a tendency for obese men to have higher percentage of intakes from fat and less from carbohydrate, and women reported diets in which the percentage contribution of protein increased significantly with increasing BMI. In multivariate analyses, BMI was not explained by energy but was associated with protein intakes in females only. Predictors of relative weight were inversely related. Social (marital status) and behavioural (cigarette smoking) factors predicted BMI in both genders; older age in men and increased fibre intakes in women were associated with lower BMI. CONCLUSIONS Social and behavioural factors are important determinants of body weight. Further investigations are needed which consider factors such as physical activity, genetic and other environmental variables as predictors of relative weight.
Collapse
Affiliation(s)
- M Jackson
- Department of Community Health and Psychiatry, University of the West Indies, Kingston, Jamaica, West Indies.
| | | | | | | | | |
Collapse
|
38
|
Brown MJ, Cruickshank JK, Dominiczak AF, MacGregor GA, Poulter NR, Russell GI, Thom S, Williams B. Better blood pressure control: how to combine drugs. J Hum Hypertens 2003; 17:81-6. [PMID: 12574784 DOI: 10.1038/sj.jhh.1001511] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Prospective comparisons of different drug classes have shown that differences in blood pressure control, rather than differences between drug classes, have the over-riding influence on overall outcome. The same studies have also reinforced the need, in the majority of patients, to use combinations of drugs in order to achieve the target of <140/85 mmHg. By contrast, most patients in routine practice receive single agents and consequently fail to achieve target blood pressure. This failure reflects in part the emphasis in individual studies and subsequent guidelines on comparison of individual drugs. In this article we show how the consistency of both theory and a broad range of evidence permits a didactic approach to combination therapy. Our advice is based on the growing recognition that essential hypertension and its treatment fall into two main categories. Younger Caucasians usually have renin-dependent hypertension that responds well to angiotensin-converting-enzyme inhibition or angiotensin receptor blockade (A) or ss blockade (B). Most other patients have low-renin hypertension that responds better to calcium channel blockade (C) or diuretics (D). These latter drugs activate the renin system rendering patients responsive to the addition of renin suppressive therapy. Coincidence of the initials of these main drug classes with the first four letters of the alphabet permits an AB/CD rule, according to which recommended combinations are one drug from each of the "AB" and "CD" categories of drugs. However, the diabetogenic potential of the older "B" and "D" classes leads us to advise against combining "B" and "D" in older patients, and to recommend "A" + "C" + "D" as standard triple therapy for resistant hypertension.
Collapse
Affiliation(s)
- M J Brown
- University of Cambridge, Level 6, ACCI, Box 110 Addenbrookes Hospital, Cambridge CB2 2QQ, UK.
| | | | | | | | | | | | | | | |
Collapse
|
39
|
|
40
|
|
41
|
Sharma S, Cade J, Landman J, Cruickshank JK. Assessing the diet of the British African-Caribbean population: frequency of consumption of foods and food portion sizes. Int J Food Sci Nutr 2002; 53:439-44. [PMID: 12396469 DOI: 10.1080/0963748021000044787] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
There is a very high prevalence of diet related disorders in the British African-Caribbean population but very few studies have determined associations between diet and disease within this community. There are virtually no published data on the frequency of foods consumed by this population or on the usual portion sizes which are necessary not only for nutritional epidemiological studies but also for treating diet related conditions such as diabetes. Here we present the frequency of foods consumed, assessed by a quantitative FFQ specifically developed for this sample, and the usual portion size reported by 210 randomly selected adult men and women. Frequency of consumption of foods and food portion sizes reported differed greatly from those consumed by the majority White population. This paper highlights the need to collect valid food consumption data for specific ethnic groups rather than using data available from another population, which is inappropriate. Such data will enable more precise dietary assessment and will further our understanding of the role of diet in the aetiology and prevention of diet-related diseases.
Collapse
Affiliation(s)
- S Sharma
- Cancer Etiology Program, Epidemiology Program, Cancer Research Center Hawaii, 1236 Lauhala Street, Honolulu 96813, USA
| | | | | | | |
Collapse
|
42
|
Jude EB, Anderson SG, Cruickshank JK, Srivatsa A, Tentolouris N, Chandrasekaran R, Gokal R, Boulton AJM. Natural history and prognostic factors of diabetic nephropathy in type 2 diabetes. QJM 2002; 95:371-7. [PMID: 12037245 DOI: 10.1093/qjmed/95.6.371] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [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] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The causes and mechanisms of increased mortality of patients with diabetic nephropathy are unclear, and its natural history is poorly understood. AIM To evaluate risk factors for mortality in type 2 diabetic patients with nephropathy. DESIGN Retrospective study of clinical and biochemical parameters in diabetic nephropathic patients and controls sampled from a secondary care register. METHODS We studied 170 type 2 diabetic patients (from 1987 to 1995) with nephropathy (proteinuria >0.5 g/24 h) and 170 non-nephropathic patients. Follow-up was until death or December 1997. Details of demographics, clinical and treatment history were obtained from medical records. RESULTS Mean follow-up was 5.3 years. Of the patients with nephropathy at baseline, 63 (37%) died compared with 14 (8%) non-nephropathic patients (chi(2)=53.8, p<0.0001). Age- and sex-adjusted all-cause mortality rates were 8.1 (6.4, 9.8) and 1.4 (0.5, 2.2) deaths per 100 person-years, respectively (rate ratio 5.8). Forty-four patients (57%) died from cardiovascular causes (rate ratio 5.4). Mortality was directly proportional to degree of proteinuria: 0.5-2 g/24 h, 4.6 (2.9-7.1); >2 g/24 h, 9.9 (7.3-13.5) per 100 patient-years. A 36% (5-78%) excess risk of mortality was observed for each log unit increase in proteinuria. Multivariate Cox regression analyses confirmed a five-fold excess risk for all-cause and cardiovascular mortality in patients with nephropathy compared with those without. This was independent of other risk factors including baseline age [5% (1-8%)/year], creatinine [2.5 (1.12-5.6)/10 micromol/l] and glycaemic control (HbA(1c)) [15% (1-31%) per 1% rise]. CONCLUSIONS Proteinuria is a potentially preventable and reversible risk factor associated with high mortality in type 2 diabetic patients. Prevention of the development of overt nephropathy and improvement in diabetes control may reduce mortality in these patients.
Collapse
Affiliation(s)
- E B Jude
- Department of Medicine, Manchester Royal Infirmary, Manchester University, Manchester, UK.
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Cruickshank JK. Ethnic health, "ecological balance," the environment, and genes. Ethn Dis 2002; 11:378-84. [PMID: 11572403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
|
44
|
Sharma S, Cruickshank JK. Cultural differences in assessing dietary intake and providing relevant dietary information to British African-Caribbean populations. J Hum Nutr Diet 2001; 14:449-56. [PMID: 11906587 DOI: 10.1046/j.1365-277x.2001.00319.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Diet can play a key role in the management of disorders such as obesity, diabetes and hypertension, conditions highly prevalent in the British African Caribbean population. In this paper, information not previously available is provided on the dietary habits and foods consumed by a British African-Caribbean population representative of the local community. Food frequency questionnaires were obtained from 255 randomly selected subjects in Manchester (78% of Jamaican origin), the nutrient intake results of which are available elsewhere. Here, suggestions are given to ensure that complete and valid dietary assessments (by diet history) are obtained, and the need for the approach to be somewhat different to that used in the White European population, highlighted with examples. Suggestions have also been listed for methods of dietary modification for obesity, diabetes and hypertension, taking into account differences in cultural understanding and food practices. People of Caribbean origin are not from just one territory: food habits and cultural context play an important role in every island, with clear differences between each which persist in first and later generations in Britain. In this paper, we attempt to integrate experience of learning from patients themselves during consultations and from participants in this study, with direct quantitative data on types of foods and their frequency in the local African-Caribbean diet.
Collapse
Affiliation(s)
- S Sharma
- Clinical Epidemiology Group, University of Manchester Medical School, Manchester M13 9PT, UK.
| | | |
Collapse
|
45
|
Jackson M, Walker S, Cade J, Forrester T, Cruickshank JK, Wilks R. Reproducibility and validity of a quantitative food-frequency questionnaire among Jamaicans of African origin. Public Health Nutr 2001; 4:971-80. [PMID: 11784410 DOI: 10.1079/phn2001166] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND An interviewer-administered quantitative food-frequency questionnaire (FFQ) was developed to determine the energy and nutrient intakes of adult Jamaicans of African origin as part of a study of the epidemiology of diabetes and hypertension. METHODS Reproducibility of the questionnaire was investigated in 123 participants aged 25-74 years. The relative validity of the FFQ was assessed against twelve 24-hour recalls administered over 12 months in 73 of the participants. In addition, energy intakes (EI) were compared with estimated basal metabolic rates (BMR). RESULTS Reproducibility correlation coefficients (Pearson and intraclass) varied between 0.42 for retinol and 0.71 for carbohydrate, with most values falling between 0.50 and 0.60. When compared with repeated 24-hour recalls, the FFQ estimated slightly higher energy (mean 6%) and macronutrient intakes (mean 2-14%), and was within 5% when expressed as a percentage of energy intake. Micronutrients were higher by 1.19 (calcium) to 1.61 times (vitamin C). Unadjusted correlations between the FFQ and the reference method ranged from 0.20 for beta-carotene to 0.86 for alcohol. Cross-classification of nutrients into quartiles showed that 46-48% of participants in the lowest and highest quartiles were jointly classified by both methods. Misclassifications were low for most nutrients with one or two persons misclassified at the extreme quartiles. EI/BMR ratios suggested light to moderate activity levels appropriate for an urban population in a developing country. CONCLUSIONS The FFQ showed reasonable reproducibility and validity and is suitable for estimating the habitual intakes of energy and macronutrients, but was poor for some micronutrients (retinol and beta-carotene).
Collapse
Affiliation(s)
- M Jackson
- Tropical Medicine Research Institute, University of the West Indies, Mona, Kingston 7, Jamaica, WI.
| | | | | | | | | | | |
Collapse
|
46
|
Cruickshank JK, Heald AH, Anderson S, Cade JE, Sampayo J, Riste LK, Greenhalgh A, Taylor W, Fraser W, White A, Gibson JM. Epidemiology of the insulin-like growth factor system in three ethnic groups. Am J Epidemiol 2001; 154:504-13. [PMID: 11549555 DOI: 10.1093/aje/154.6.504] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The insulin-like growth factor (IGF) system, comprising insulin-like growth factor I (IGF-I), insulin-like growth factor II (IGF-II), and their binding proteins (IGFBPs), is linked to cell growth, the development of cardiovascular disease, and several cancers. Little is known about its epidemiology. The authors studied relations of the IGF system to anthropometric and metabolic variables in three population-based ethnic groups in Manchester, England, in 1994-1998 with differing disease risks: African Caribbean (n = 193), Pakistani (n = 130), and local Europeans(n = 142). Standardized anthropometry, glucose tolerance tests, and serum assays were performed. Body mass indices (BMIs) were high in all groups. IGF-I levels were highest in normoglycemic African Caribbeans and declined with age (r = -0.28). IGF-II levels were greatest in Europeans. IGFBP-1 concentrations increased with age in Pakistanis (r = 0.20) and Europeans (r = 0.29), but not in African Caribbeans (r = 0.06), and were inversely related to BMI (r = -0.37). Age- and sex-adjusted IGFBP-1 was inversely related to fasting insulin and proinsulin in all groups; participants with newly detected diabetes were relatively insulinopenic but had higher IGFBP-1 concentrations. Nonesterified (free) fatty acid (NEFA) concentrations increased with declining glucose tolerance. In multiple regression analysis, IGFBP-1 was independently and negatively related to fasting insulin, BMI, and African-Caribbean compared with European ethnicity but positively related to age, fasting glucose, and NEFA. IGF-I was inversely related only to age, NEFA, and Pakistani ethnicity. IGF-II showed a strong ethnic difference but was unrelated to other variables. These data indicate considerable potential for exploring disease-IGF system relations in population samples.
Collapse
Affiliation(s)
- J K Cruickshank
- Clinical Epidemiology Group, Unit of Chronic Disease Epidemiology, University of Manchester Medical School, Manchester, England.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Cruickshank JK. Glycaemia and vascular effects of type 2 diabetes. UKPDS is not a cohort study and analysis is misleading. BMJ 2001; 322:1246; author reply 1247. [PMID: 11388184] [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: 02/20/2023]
|
48
|
Abstract
OBJECTIVES To identify lessons from and gaps in research on diet-disease links among former migrants in the United Kingdom (UK). RESULTS Migrant status and self-identified ethnicity do not match so these terms mask differences in social, nutritional and health status within and between population groups. Some former migrants differ in causes of death from the general population, e.g.: fewer coronary heart disease deaths among Caribbean-born; fewer cancer deaths among Caribbean, South Asian- and East African-born adults. Irish- and Scottish-born have higher mortality from all causes. Experience of risk factors differ also, e.g.: higher prevalences of hypertension and diabetes in Caribbean- and South Asian-born adults than representative samples of the general population; obesity and raised waist-hip circumference ratios in South Asian, African-Caribbean and some Irish-born adults. Former migrants experience long-term disadvantage, associated with more self-defined illness and lower reported physical activity. Nutrient intake data from the few, recent, small-scale studies must be interpreted with caution due to methodological diversity. However, second generation offspring of former migrants appear to adopt British dietary patterns, increasing fat and reducing vegetable, fruit and pulse consumption compared with first generation migrants. CONCLUSIONS There is insufficient evidence on why some former migrants but not others experience lower specific mortality than the general population. Dietary intake variations provide important clues particularly when examined by age and migration status. Majority ethnic and younger migrant groups could raise and sustain high fruit and vegetable intakes but lower proportions of fat, by adopting many dietary practices from older migrants. Objective measures of physical activity and longitudinal studies of diets among different ethnic groups are needed to explain diversity in health outcomes and provide for evidence-based action.
Collapse
Affiliation(s)
- J Landman
- Queen Margaret University College, Edinburgh, UK.
| | | |
Collapse
|
49
|
Heald AH, Cruickshank JK, Riste LK, Cade JE, Anderson S, Greenhalgh A, Sampayo J, Taylor W, Fraser W, White A, Gibson JM. Close relation of fasting insulin-like growth factor binding protein-1 (IGFBP-1) with glucose tolerance and cardiovascular risk in two populations. Diabetologia 2001; 44:333-9. [PMID: 11317665 DOI: 10.1007/s001250051623] [Citation(s) in RCA: 147] [Impact Index Per Article: 6.4] [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] [Indexed: 10/27/2022]
Abstract
AIMS/HYPOTHESIS Insulin resistance/hyperinsulinaemia is implicated in the development of cardiovascular disease and diabetes but its role and causal pathways are not clear. We tested the hypothesis that the insulin-like growth factor system is independently associated with cardiovascular risk within susceptible populations based on previous reports of the links between low circulating insulin-like growth factor binding protein-1 concentrations and increased macrovascular disease in Type II (non-insulin-dependent) diabetes mellitus. METHODS In a population-based study 272 subjects (142 subjects of European and 130 Pakistani of origin) underwent a 75 g oral glucose tolerance test and standardised anthropometry. Fasting concentrations of insulin-like growth factor binding protein-1 (IGFBP-1), insulin-like growth factor-I (IGF-I), insulin-like growth factor-II (IGF-II), intact insulin and lipids were measured and were related to 2-h glucose tolerance test status. Insulin sensitivity was calculated using the homeostasis model assessment (HOMA). RESULTS Insulin-like growth factor binding protein-1 was significantly lower in subjects with impaired glucose tolerance when compared with normal glucose tolerance in both ethnic groups (Europeans F = 6.7, p = 0.002 and Pakistanis F = 4.4, p = 0.01). Multiple linear regression modelling showed that insulin-like growth factor binding protein-1 was independently associated with 2-h glucose (beta = 0.16, p = 0.009) and logistic regression indicated a 40% reduction in risk of impaired glucose tolerance for every 2.7 ng/ml increase in the insulin-like growth factor binding protein-1 concentration [odds ratio 0.6 (CI = 0.49-0.71), p = 0.001)]. In addition, insulin-like growth factor binding protein-1 was significantly correlated negatively with several established cardiovascular factors, and positively with insulin sensitivity. CONCLUSIONS/INTERPRETATION Insulin-like growth factor binding protein-1 is closely related to risk factors for diabetes and cardiovascular disease in people of European and Pakistani origin. It has potential use as a marker of (hepatic) insulin resistance in clinical intervention studies and further implicates the insulin-like growth factor system in the development of macrovascular disease.
Collapse
Affiliation(s)
- A H Heald
- Endocrine Sciences Research Group, Faculty of Medicine and School of Biological Sciences, University of Manchester, Manchester, UK
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Cruickshank JK, Mbanya JC, Wilks R, Balkau B, McFarlane-Anderson N, Forrester T. Sick genes, sick individuals or sick populations with chronic disease? The emergence of diabetes and high blood pressure in African-origin populations. Int J Epidemiol 2001; 30:111-7. [PMID: 11171870 DOI: 10.1093/ije/30.1.111] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIM AND METHODS To discuss evidence for and against genetic 'causes' of type 2 diabetes, illustrated by standardized study of glucose intolerance and high blood pressure in four representative African origin populations. Comparison of two genetically closer sites: rural (site 1) and urban Cameroon (2); then Jamaica (3) and Caribbean migrants to Britain (80% from Jamaica-4). BACKGROUND Alternatives to the reductionist search for genetic 'causes' of chronic disease include Rose's concept that populations give rise to 'sick' individuals. Twin studies offer little support to genetic hypotheses because monozygotic twins share more than genes in utero and suffer from ascertainment bias. Non-genetic intergenerational mechanisms include amniotic fluid growth factors and maternal exposures. Type 2 diabetes and hypertension incidence accelerate in low-risk European populations from body mass > or =23 kg/m2, well within 'desirable' limits. Transition from subsistence agriculture in West Africa occurred this century and from western hemisphere slavery only six generations ago, with slow escape from intergenerational poverty since. RESULTS 'Caseness' increased clearly within and between genetically similar populations: age-adjusted diabetes rates were 0.8, 2.4, 8.5 and 16.4% for sites 1-4, respectively; for 'hypertension', rates were 7, 16, 21 and 34%, with small shifts in risk factors. Body mass index rose similarly. CONCLUSION Energy imbalance and intergenerational socioeconomic influences are much more likely causes of diabetes (and most chronic disease) than ethnic/genetic variation, which does occur, poorly related to phenotype. The newer method of 'proteomics' holds promise for identifying environmental triggers influencing gene products. Even in lower prevalence 'westernized' societies, genetic screening per se for diabetes/chronic disease is likely to be imprecise and inefficient hence unreliable and expensive.
Collapse
Affiliation(s)
- J K Cruickshank
- Clinical Epidemiology Unit, University of Manchester Medical School, Manchester M13 9PT, UK.
| | | | | | | | | | | |
Collapse
|