A cross-sectional study on the concordance between vaginal HPV DNA detection and type-specific antibodies in a multi-ethnic cohort of women from Amsterdam, the Netherlands - the HELIUS study

Background

Acquisition of genital human papillomavirus (HPV) infection is common among the young, sexually active population. Genital HPV infections do not always lead to seroconversion. We aimed to assess the association between cervico-vaginal high risk (hr) HPV DNA and type-specific antibodies in an ethnically diverse cohort of young women.

Methods

Women of Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Moroccan and Turkish origin participating in a large-scale multi-ethnic population-based cohort (the HELIUS study) provided vaginal self-samples and blood samples, and completed a questionnaire regarding demographics, lifestyle and sexual health. Vaginal swabs were tested for HPV using the highly sensitive SPF10-PCR DEIA/LiPA25 system (version1). Serum samples were tested for type-specific L1 antibodies against 7 hrHPV types (16,18,31,33,45,52,58) with multiplex serology. We assessed the association between vaginal HPV DNA and type-specific seropositivity with logistic and linear regression, using generalized estimating equations (GEE). We determined whether this association varies by ethnicity by adding an interaction term.

Results

We selected 532 women who completed the questionnaire, provided a vaginal swab and a blood sample. Their median age was 27 years (interquartile range 24–31 years). Prevalence of DNA of any of the 7 hrHPV was 22 %; HPV-52 was most common. Prevalence of antibodies against one or more hrHPV types was 24 %; HPV-16 seropositivity was most common. In multivariable logistic regression analysis using GEE, adjusting for other determinants, vaginal HPV DNA detection was associated with type-specific HPV seropositivity (OR 1.53, 95 % CI 1.06-2.20). In multivariable linear regression analysis using GEE, the geometric mean of type-specific antibody reactivity was 1.15 (95 % CI 1.04-1.27) times higher in women positive for HPV DNA compared to HPV DNA-negative women. There was little evidence that ethnicity modified the association between HPV DNA, and type-specific seropositivity, or with antibody reactivities (p = 0.47 and p = 0.57, respectively).

Conclusions

In this multi-ethnic group of young women in Amsterdam, cervico-vaginal hrHPV DNA detection was an independent determinant of type-specific HPV seropositivity.

Trans-ethnic Meta-analysis and Functional Annotation Illuminates the Genetic Architecture of Fasting Glucose and Insulin

Knowledge of the genetic basis of the type 2 diabetes (T2D)-related quantitative traits fasting glucose (FG) and insulin (FI) in African ancestry (AA) individuals has been limited. In non-diabetic subjects of AA (n = 20,209) and European ancestry (EA; n = 57,292), we performed trans-ethnic (AA+EA) fine-mapping of 54 established EA FG or FI loci with detailed functional annotation, assessed their relevance in AA individuals, and sought previously undescribed loci through trans-ethnic (AA+EA) meta-analysis. We narrowed credible sets of variants driving association signals for 22/54 EA-associated loci; 18/22 credible sets overlapped with active islet-specific enhancers or transcription factor (TF) binding sites, and 21/22 contained at least one TF motif. Of the 54 EA-associated loci, 23 were shared between EA and AA. Replication with an additional 10,096 AA individuals identified two previously undescribed FI loci, chrX FAM133A (rs213676) and chr5 PELO (rs6450057). Trans-ethnic analyses with regulatory annotation illuminate the genetic architecture of glycemic traits and suggest gene regulation as a target to advance precision medicine for T2D. Our approach to utilize state-of-the-art functional annotation and implement trans-ethnic association analysis for discovery and fine-mapping offers a framework for further follow-up and characterization of GWAS signals of complex trait loci.

Vaginal high-risk human papillomavirus infection in a cross-sectional study among women of six different ethnicities in Amsterdam, the Netherlands: the HELIUS study

OBJECTIVE

In the Netherlands the incidence of cervical cancer is higher among ethnic minority populations compared with the general Dutch population. We investigated the prevalence of, and risk factors associated with, vaginal high-risk human papillomavirus (hrHPV) infection in women of six different ethnicities living in Amsterdam.

METHODS

For this cross-sectional study we selected women aged 18-34 years old of six ethnicities from the large-scale multiethnic HEalthy LIfe in an Urban Setting study. Self-collected vaginal swabs were tested for HPV DNA and genotyped using a highly sensitive PCR and reverse line blot assay (short PCR fragment (SPF)10-PCR DNA enzyme immunoassay/LiPA25-system version-1, delft diagnostic laboratory (DDL)). Participants completed a questionnaire regarding demographics and sexual behaviour. Logistic regression using generalised estimating equations was used to assess risk factors of hrHPV, and to investigate whether prevalence of hrHPV differed among ethnicities.

RESULTS

The study population consisted of 592 women with a median age of 27 (IQR: 23-31) years. Dutch and African Surinamese women reported the highest sexual risk behaviour. HrHPV prevalence was highest in the Dutch (40%) followed by the African Surinamese (32%), Turkish (29%), Ghanaian (26%), Moroccan (26%) and South-Asian Surinamese (18%). When correcting for sexual risk behaviour, the odds to be hrHPV-positive were similar for all non-Dutch groups when compared with that of the Dutch group.

CONCLUSIONS

We found an overall higher hrHPV prevalence and higher sexual risk behaviour in the native Dutch population. Further research is needed to unravel the complex problem concerning cervical cancer disparities, such as differences in participation in the cervical cancer screening programme, or differences in clearance and persistence of hrHPV.

Relationship between sleep duration and arterial stiffness in a multi-ethnic population: The HELIUS study

We examined the relationship between sleep duration and arterial stiffness among a multi-ethnic cohort, and whether the associations differed among ethnic minority groups in the Netherlands. Data were derived from 10 994 participants (aged 18-71 years) of the Healthy Life in an Urban Setting (HELIUS) study. Self-reported sleep duration was categorized into: short (<7 h/night), healthy (7-8 h/night) and long (≥9 h/night). Arterial stiffness was assessed by duplicate pulse-wave velocity (PWV in m/s) measurements using the Arteriograph system. The association of sleep duration with PWV was analysed using linear regression (β) with 95% confidence interval (CI). Results showed that neither short nor long sleep was related to PWV in all ethnic groups, except for long sleep in Dutch men which was associated with higher PWV (indicating stiffer arteries) after adjustment for potential confounders (β = 0.67, 95%CI, 0.23-1.11). Our study showed no convincing evidence that sleep duration was related to arterial stiffness among various ethnic groups. The link between sleep duration and cardiovascular outcomes does not seem to operate through arterial stiffness. Further research is needed to consolidate these findings.

Prevalence of depressive symptoms among patients with a chronic nonspecific lung disease in five ethnic minority groups

OBJECTIVE

Earlier studies found chronic nonspecific lung disease (CNSLD) to be associated with depressive symptoms. We aimed to assess whether the association between CNSLD and depressive symptoms varies between ethnic groups.

METHODS

We used questionnaire data from 10916 participants of the HELIUS study in Amsterdam from six different ethnic groups. We applied logistic regression analysis to determine the association between CNSLD and depressive symptoms and interaction terms to test whether this association varied between ethnic groups.

RESULTS

CNSLD prevalence was higher among South-Asian Surinamese, Turkish and Moroccans (10.1% to 12.5%) than African Surinamese, Dutch and Ghanaians (4.8% to 6.3%). The prevalence of depressive symptoms was higher among participants with CNSLD (28.4% vs. 13.7%). This association was not significantly different between ethnic groups. The absolute prevalence of depressive symptoms was higher among the CNSLD patients from ethnic minority groups (19.2 % to 35.6%) as compared with the Dutch-origin majority group (11.2%).

CONCLUSIONS

CNSLD is associated with a high risk of depressive symptoms, especially among the five ethnic minority groups. These results imply a need to monitor the mental health of CNSLD patients in particular when a patient is from an ethnic minority group.

Prevalence of type 2 diabetes and its association with measures of body composition among African residents in the Netherlands--The HELIUS study

AIMS

To compare type 2 diabetes prevalence among three ethnic groups resident in the Netherlands: Ghanaians, African Surinamese and Dutch origin. Secondly, to determine the contribution of measures of body composition to ethnic differences in type 2 diabetes.

METHODS

Baseline data from Ghanaian (n=1873), African Surinamese (n=2189) and Dutch (n=2151) origin participants of the HELIUS study (aged 18-70 years) were analyzed. Type 2 diabetes was determined according to the WHO criteria. Logistic regression tested ethnic differences in type 2 diabetes and the contribution of body fat percentage and waist-to-hip ratio.

RESULTS

Among men, type 2 diabetes prevalence was higher in Ghanaians (14.9%) than in African Surinamese (10.4%) and Dutch (5.0%). Among women, type 2 diabetes prevalence in Ghanaian (11.1%) was higher than in Dutch (2.3%), but similar to African Surinamese (11.5%). After adjusting for age, body fat percentage and waist-to-hip ratio, the odds ratios for having type 2 diabetes were 1.55 (95% CI: 1.12-2.15) for Ghanaian men compared with African Surinamese and 4.19 (95% CI: 2.86-6.12) compared with Dutch. Among women these odds ratios were 0.94 (95% CI: 0.70-1.26) and 4.78 (95% CI: 2.82-8.11).

CONCLUSIONS

The higher prevalence of type 2 diabetes among Ghanaian compared with African Surinamese men suggests a need to distinguish between African descent populations when assessing their type 2 diabetes risk. The higher odds for type 2 diabetes among Ghanaians cannot be attributed to differences in body composition. Further research on the contribution of lifestyle factors as well as genetic and epigenetic factors is needed to identify the reasons for the observed disparities.

The Association of Handgrip Strength and Type 2 Diabetes Mellitus in Six Ethnic Groups: An Analysis of the HELIUS Study

We investigated whether ethnic differences in handgrip strength, a marker of poor muscle strength and quality, is a potential cause of ethnic disparities in type 2 diabetes mellitus. We included 2086 Dutch, 2216 South Asian Surinamese, 2084 African Surinamese, 1786 Ghanaian, 2223 Turkish and 2199 Moroccan origin participants from the HELIUS study. We analyzed ethnic differences in handgrip strength, and its association with type 2 diabetes mellitus using logistic regression analyses adjusted for socio-demographic factors, body composition and lifestyle factors. Additionally, we investigated whether handgrip strength explained the ethnic differences in type 2 diabetes mellitus. We found that handgrip strength differed significantly across ethnic groups. After full adjustment, we found an inverse association with type 2 diabetes mellitus (OR 0.95; 95% CI 0.92-0.97) that did not differ substantially between ethnic groups, men and among women, and lean and overweight individuals. The association was not affected by the measure used to define type 2 diabetes mellitus, but was attenuated by exclusion of people with known diabetes. The ethnic differences in type 2 diabetes mellitus were not explained by handgrip strength (e.g. the OR for the South Asian Surinamese vs. Dutch changed from 5.03; 3.69-6.68 to 4.87; 3.57-6.65). In conclusion, we found large ethnic differences in handgrip strength and a consistent association of low handgrip strength with prevalent type 2 diabetes mellitus. This suggests that handgrip strength may be investigated as a target for intervention or a marker to identify people at risk of type 2 diabetes mellitus.

Do unfavourable working conditions explain mental health inequalities between ethnic groups? Cross-sectional data of the HELIUS study

Background

Ethnic inequalities in mental health have been found in many high-income countries. The purpose of this study is to test whether mental health inequalities between ethnic groups are mediated by exposure to unfavourable working conditions.

Methods

Workers (n = 6278) were selected from baseline data of the multi-ethnic HELIUS study. Measures included two indices of unfavourable working conditions (lack of recovery opportunities, and perceived work stress), and two mental health outcomes (generic mental health: MCS-12 and depressive symptoms: PHQ-9). Mediation of the relationships between ethnicity and mental health by unfavourable working conditions was tested using the bias-corrected bootstrap confidence intervals technique. Linear models with and without the mediators included, and adjusted for gender and age. Attenuation was calculated as the change in B between the models with and without mediators.

Results

The sample comprised Dutch (1355), African Surinamese (1290), South-Asian Surinamese (1121), Turkish (1090), Ghanaian (729), and Moroccan (693) workers. After controlling for age and gender, all ethnic minorities had a higher risk of mental health problems as compared to the Dutch host population, with the exception of Ghanaians in the case of depressive symptoms, and African Surinamese workers with regard to both outcomes. The Turkish group stands out with the lowest mental health on both mental health indices, followed by Moroccan and South-Asian Surinamese workers. A lack of recovery opportunities mediated the relationship between ethnic group and a higher risk of mental health problems. Perceived work stress did not contribute to the explanation of ethnic inequalities.

Conclusions

The higher risk of mental health problems in ethnic minority groups can be partly accounted for by a lack of recovery opportunities at work, but not by perceived work stress. This may imply that workplace prevention targeting recovery opportunities have the potential to reduce ethnic inequalities, but ethnic-specific experiences at the workplace need to be further explored.

Comparable Dietary Patterns Describe Dietary Behavior across Ethnic Groups in the Netherlands, but Different Elements in the Diet Are Associated with Glycated Hemoglobin and Fasting Glucose Concentrations

BACKGROUND

Ethnic minority populations in Western societies suffer from a disproportionate burden of type 2 diabetes (T2D). Insight into the role of dietary patterns in T2D may assist public health nutrition efforts in addressing these health disparities.

OBJECTIVE

We explored the association between dietary patterns and biomarkers of T2D in 5 ethnic groups living in Amsterdam, Netherlands.

METHODS

A total of 3776 men and women aged 18-70 y of Dutch, South Asian Surinamese, African-Surinamese, Turkish, and Moroccan origin from the HELIUS (HEalthy LIfe in an Urban Setting) study were included. Diet was assessed by using a food-frequency questionnaire, and dietary patterns were derived separately per ethnic group. First, food group-based dietary patterns were derived by using principal components analysis and the association with glycated hemoglobin (HbA1c) and plasma fasting glucose was assessed by using multivariable linear regression. Second, biomarker-driven dietary patterns based on HbA1c and fasting glucose concentrations were derived by applying reduced rank regression.

RESULTS

Two comparable food group-based dietary patterns were identified in each ethnic group: a "meat and snack" pattern and a "vegetable" pattern. The meat-and-snack pattern derived within the Dutch origin population was significantly associated with HbA1c (β = 0.09; 95% CI: 0.00, 0.19) and fasting glucose (β = 0.18; 95% CI: 0.09, 0.26) concentrations. A biomarker-derived pattern characterized by red and processed meat was observed among Dutch-origin participants; however, among ethnic minority groups, this pattern was characterized by other foods including ethnicity-specific foods (e.g., roti, couscous).

CONCLUSIONS

Although similar food group dietary patterns were derived within 5 ethnic groups, the association of the meat-and-snack pattern with fasting glucose concentrations differed by ethnicity. Taken together with the finding of ethnic differences in biomarker-driven dietary patterns, our results imply that addressing T2D risk in multiethnic populations requires ethnicity-specific approaches.

Socio-economic status and ethnicity are independently associated with dietary patterns: the HELIUS-Dietary Patterns study

Background

Differences in dietary patterns between ethnic groups have often been observed. These differences may partially be a reflection of differences in socio-economic status (SES) or may be the result of differences in the direction and strength of the association between SES and diet.

Objective

We aimed to examine ethnic differences in dietary patterns and the role of socio-economic indicators on dietary patterns within a multi-ethnic population.

Design

Cross-sectional multi-ethnic population-based study.

Setting

Amsterdam, the Netherlands.

Subjects

Principal component analysis was used to identify dietary patterns among Dutch (n=1,254), South Asian Surinamese (n=425), and African Surinamese (n=784) participants. Levels of education and occupation were used to indicate SES. Linear regression analysis was used to examine the association between ethnicity and dietary pattern scores first and then between socio-economic indicators and dietary patterns within and between ethnic groups.

Results

‘Noodle/rice dishes and white meat’, ‘red meat, snacks, and sweets’ and ‘vegetables, fruit and nuts’ patterns were identified. Compared to the Dutch origin participants, Surinamese more closely adhered to the ‘noodle/rice dishes and white meat’ pattern which was characterized by foods consumed in a ‘traditional Surinamese diet’. Closer adherence to the other two patterns was observed among Dutch compared to Surinamese origin participants. Ethnic differences in dietary patterns persisted within strata of education and occupation. Surinamese showed greater adherence to a ‘traditional’ pattern independent of SES. Among Dutch participants, a clear socio-economic gradient in all dietary patterns was observed. Such a gradient was only present among Surinamese dietary oatterns to the ‘vegetables, fruit and nuts’ pattern.

Conclusions

We found a selective change in the adherence to dietary patterns among Surinamese origin participants, presumably a move towards more vegetables and fruits with higher SES but continued fidelity to the traditional diet.

Ethnic differences in arterial stiffness the Helius study

OBJECTIVE

Well-known ethnic differences in cardiovascular risk exist, which may be explained by ethnic differences in arterial stiffness. Our aim was to assess ethnic differences in arterial stiffness, to explore whether these differences are accounted for by conventional cardiovascular risk factors, and study whether they differ across age.

METHODS

Cross-sectional data of 1797 Dutch, 1846 South-Asian Surinamese, 1840 African Surinamese, and 1673 Ghanaian participants of the observational HELIUS study (aged 18-70 years) were used. Arterial stiffness was assessed by duplicate pulse wave velocity (PWV) measurements using the Arteriograph system.

RESULTS

Linear regression showed that South-Asian Surinamese had higher PWVs as compared with Dutch (age-adjusted mean difference (95% CI) was 0.55 (0.39-0.70) m/s in men and 0.82 (0.63-1.01) m/s in women). These differences were largely, but not completely, explained by conventional risk factors (particularly age and MAP). These ethnic differences were not found at young age (<35 years). African Surinamese and Ghanaians had higher PWVs as compared with Dutch across the entire age range (ranging from 0.22 (0.06-0.39) m/s in African Surinamese men to 1.07 (0.89-1.26) m/s in Ghanaian women), but these differences disappeared or reversed after adjustment for risk factors.

CONCLUSIONS

PWV levels paralleled the well-known ethnic differences in cardiovascular risk. After adjustment for cardiovascular risk factors, however, these ethnic differences in PWV largely disappear. Together with the absence of ethnic differences in PWV at young age, our results support the hypothesis that higher PWV in South-Asian and African ethnic groups develops due to higher exposure to cardiovascular risk factors.

Hypertension control in a large multi-ethnic cohort in Amsterdam, The Netherlands: the HELIUS study

OBJECTIVE

Hypertension is a major problem among European ethnic minority groups. We assessed the current situation of hypertension prevalence and its management among a multi-ethnic population in Amsterdam, The Netherlands.

METHODS

Data from the HELIUS study were used including 12,974 participants (1871 Ghanaian, 2184 African Surinamese, 2278 South-Asian Surinamese, 2277 Turkish, 2222 Moroccan and 2142 Dutch origin people), aged 18-70 years. Comparisons among groups were made using proportions and age-adjusted prevalence ratios (PRs).

RESULTS

Hypertension prevalence ranged from 24% and 16% in Moroccan men and women to 52% and 62% in Ghanaian men and women. Except for Moroccan women, age-adjusted PR of hypertension was higher in all the ethnic minority groups than in Dutch. Among hypertensives, ethnic minority groups generally had higher levels of hypertension awareness and BP lowering treatment than Dutch. Moreover, prevalence rates for the prescription of more than one BP lowering drug were generally higher in African and South-Asian origin groups compared with Dutch origin people. By contrast, BP control levels were lower in all the ethnic groups than in Dutch, with control rates being significantly lower in Ghanaian men (26%, PR=0.49; 95% CI, 0.37-0.66) and women (45%, PR=0.64; 0.52-0.77), African-Surinamese men (30%, PR=0.61; 0.46-0.81) and women (45%, PR=0.72; 0.51-0.77), and South-Asian Surinamese men (43%, PR=0.77; 0.61-0.97) and women (47%, PR=0.76; 0.63-0.92) compared with Dutch men (53%) and women (61%).

CONCLUSION

Our findings indicate poor BP control in ethnic minority groups despite the high treatment levels. More work is needed to unravel the potential factors contributing to the poor control in order to improve BP control in ethnic minority groups, particularly among African and South-Asian origin groups.

Healthcare consumption by ethnic minority people in their country of origin

BACKGROUND

Studies from the USA, New Zealand and Denmark suggest that many ethnic minority citizens obtain healthcare in their country of origin. Their reasons for doing so and the possible consequences remain unclear.

METHODS

We used data from the Healthy Life in an Urban Setting study to investigate the magnitude, types, self-reported reasons and determinants of past-year healthcare consumption in the country of origin by ethnic minority people living in the Netherlands. Individuals of African Surinamese (n = 2059), South-Asian Surinamese (n = 1915), Ghanaian (n = 1426), Moroccan (n = 1516) and Turkish (n = 2245) origin were included (recruited 2011-2013). We performed descriptive and stepwise logistic regression analyses.

RESULTS

Respondents of Turkish origin reported the highest healthcare utilization in the country of origin (21.3%) compared with Moroccan (9.8%), Ghanaian (6.6%), African Surinamese (4.8%) and South-Asian Surinamese (3.0%) respondents. The main services used were outpatient clinics, pharmacies and health centres. The chief reported motivations were healthcare for illness, dissatisfaction with care in the residence country and seeking second opinions. Physical health status, cultural distance to the Dutch healthcare system and Turkish origin were all independently associated with healthcare use in countries of origin.

CONCLUSION

Both health status and attitudes towards services in the countries of residence and origin are significantly associated with cross-border healthcare use. Further research is needed to clarify the reasons for the relatively high rates shown by Turkish respondents and to explore the consequences for health and for healthcare utilization in the country of residence.

Ethnic disparities in the association of impaired fasting glucose with the 10-year cumulative incidence of type 2 diabetes

AIMS

Evidence of ethnic disparities in the conversion of prediabetes to type 2 diabetes is scarce. We studied the association of impaired fasting glucose (IFG) and fasting plasma glucose (FPG) with the 10-year cumulative incidence of type 2 diabetes in three ethnic groups.

METHODS

We analyzed data for 90 South-Asian Surinamese, 190 African-Surinamese, and 176 ethnic Dutch that were collected in the periods 2001-2003 and 2011-2012. We excluded those with type 2 diabetes or missing FPG data. We defined baseline IFG as FPG of 5.7-6.9 mmol/L. We defined type 2 diabetes at follow-up as FPG ≥ 7.0 mmol/L, HbA1c ≥ 48 mmol/mol (6.5%), or self-reported type 2 diabetes.

RESULTS

10-Year cumulative incidences of type 2 diabetes were: South-Asian Surinamese, 18.9%; African-Surinamese, 13.7%; ethnic Dutch, 4.5% (p<0.05). The adjusted association of baseline IFG and FPG with the 10-year cumulative incidence of type 2 diabetes was stronger for South-Asian Surinamese than for African-Surinamese and ethnic Dutch. The IFG (compared to normoglycaemia) ORs were 11.1 [3.0-40.8] for South-Asian Surinamese, 5.1 [2.0-13.3] for African-Surinamese, and 2.2 [0.5-10.1] for ethnic Dutch.

CONCLUSIONS

The 10-year cumulative incidence of type 2 diabetes was higher and associations with baseline IFG and FPG were stronger among South-Asian Surinamese and African-Surinamese than among ethnic Dutch. Our findings confirm the high risk of type 2 diabetes in South-Asians and suggest more rapid conversion in populations of South-Asian origin and (to a lesser extent) African origin than European origin.

Dietary patterns within a population are more reproducible than those of individuals

Insight into the stability of dietary behavior over time is important, because only a single measurement of diet is often available to study the association between eating behavior and the occurrence of chronic diseases many years after baseline data collection. Little is known about changes in dietary patterns over time. The current study examined the (internal) stability and reproducibility of dietary patterns and the transition of individuals between patterns over time from 3 surveys within one study population by using cluster analysis. The dietary intake of participants in the Doetinchem Cohort Study in 6113, 4916, and 4520 adults in 1993-1997, 1998-2002, and 2003-2007, respectively, was measured using a validated food-frequency questionnaire. Stability and reproducibility of dietary patterns were studied by examining the optimal number of clusters per survey by comparing the contribution of food groups to total energy intake within the clusters over time and by studying transitions of individuals between clusters over time. A low-fiber bread pattern and a high-fiber bread pattern were identified in all 3 surveys. Over time, dietary patterns were comparable in terms of foods contributing most to total energy intake, suggesting good reproducibility. Nevertheless, only 41.8% of the participants were consistently assigned to the same dietary pattern for all 3 surveys. This implies that, over time, similar dietary patterns were found at the group level, but that ignoring individual transitions between dietary patterns during follow-up may lead to misclassification of a large proportion of the study population.