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Wentzel A, Patterson AC, Duhuze Karera MG, Waldman ZC, Schenk BR, DuBose CW, Sumner AE, Horlyck-Romanovsky MF. Non-invasive type 2 diabetes risk scores do not identify diabetes when the cause is β-cell failure: The Africans in America study. Front Public Health 2022; 10:941086. [PMID: 36211668 PMCID: PMC9537602 DOI: 10.3389/fpubh.2022.941086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/19/2022] [Indexed: 01/25/2023] Open
Abstract
Background Emerging data suggests that in sub-Saharan Africa β-cell-failure in the absence of obesity is a frequent cause of type 2 diabetes (diabetes). Traditional diabetes risk scores assume that obesity-linked insulin resistance is the primary cause of diabetes. Hence, it is unknown whether diabetes risk scores detect undiagnosed diabetes when the cause is β-cell-failure. Aims In 528 African-born Blacks living in the United States [age 38 ± 10 (Mean ± SE); 64% male; BMI 28 ± 5 kg/m2] we determined the: (1) prevalence of previously undiagnosed diabetes, (2) prevalence of diabetes due to β-cell-failure vs. insulin resistance; and (3) the ability of six diabetes risk scores [Cambridge, Finnish Diabetes Risk Score (FINDRISC), Kuwaiti, Omani, Rotterdam, and SUNSET] to detect previously undiagnosed diabetes due to either β-cell-failure or insulin resistance. Methods Diabetes was diagnosed by glucose criteria of the OGTT and/or HbA1c ≥ 6.5%. Insulin resistance was defined by the lowest quartile of the Matsuda index (≤ 2.04). Diabetes due to β-cell-failure required diagnosis of diabetes in the absence of insulin resistance. Demographics, body mass index (BMI), waist circumference, visceral adipose tissue (VAT), family medical history, smoking status, blood pressure, antihypertensive medication, and blood lipid profiles were obtained. Area under the Receiver Operator Characteristics Curve (AROC) estimated sensitivity and specificity of each continuous score. AROC criteria were: Outstanding: >0.90; Excellent: 0.80-0.89; Acceptable: 0.70-0.79; Poor: 0.50-0.69; and No Discrimination: 0.50. Results Prevalence of diabetes was 9% (46/528). Of the diabetes cases, β-cell-failure occurred in 43% (20/46) and insulin resistance in 57% (26/46). The β-cell-failure group had lower BMI (27 ± 4 vs. 31 ± 5 kg/m2 P < 0.001), lower waist circumference (91 ± 10 vs. 101 ± 10cm P < 0.001) and lower VAT (119 ± 65 vs. 183 ± 63 cm3, P < 0.001). Scores had indiscriminate or poor detection of diabetes due to β-cell-failure (FINDRISC AROC = 0.49 to Cambridge AROC = 0.62). Scores showed poor to excellent detection of diabetes due to insulin resistance, (Cambridge AROC = 0.69, to Kuwaiti AROC = 0.81). Conclusions At a prevalence of 43%, β-cell-failure accounted for nearly half of the cases of diabetes. All six diabetes risk scores failed to detect previously undiagnosed diabetes due to β-cell-failure while effectively identifying diabetes when the etiology was insulin resistance. Diabetes risk scores which correctly classify diabetes due to β-cell-failure are urgently needed.
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Affiliation(s)
- Annemarie Wentzel
- Section on Ethnicity and Health, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States,Hypertension in Africa Research Team, North-West University, Potchefstroom, South Africa,South African Medical Research Council, Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa,*Correspondence: Annemarie Wentzel
| | - Arielle C. Patterson
- Section on Ethnicity and Health, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States
| | - M. Grace Duhuze Karera
- Section on Ethnicity and Health, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States,National Institute of Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, United States,Institute of Global Health Equity Research, University of Global Health Equity, Kigali, Rwanda
| | - Zoe C. Waldman
- Section on Ethnicity and Health, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Blayne R. Schenk
- Section on Ethnicity and Health, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Christopher W. DuBose
- Section on Ethnicity and Health, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Anne E. Sumner
- Section on Ethnicity and Health, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States,National Institute of Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, United States
| | - Margrethe F. Horlyck-Romanovsky
- Section on Ethnicity and Health, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States,Department of Health and Nutrition Sciences, Brooklyn College, City University of New York, New York, NY, United States,Margrethe F. Horlyck-Romanovsky
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Meeks KAC, Adeyemo A, Agyemang C. Beta-cell dysfunction and insulin resistance in relation to abnormal glucose tolerance in African populations: can we afford to ignore the diversity within African populations? BMJ Open Diabetes Res Care 2022; 10:10/1/e002685. [PMID: 35210285 PMCID: PMC8883230 DOI: 10.1136/bmjdrc-2021-002685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/05/2022] [Indexed: 11/21/2022] Open
Affiliation(s)
- Karlijn A C Meeks
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
- Department of Public and Occupational Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Adebowale Adeyemo
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Charles Agyemang
- Department of Public and Occupational Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
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Kastberg SE, Lund HS, de Lucia-Rolfe E, Kaduka LU, Boit MK, Corpeleijn E, Friis H, Bernard S, Paquette M, Baas A, Rasmussen JJ, Christensen DL. Hepatic steatosis is associated with anthropometry, cardio-metabolic disease risk, sex, age and urbanisation, but not with ethnicity in adult Kenyans. Trop Med Int Health 2021; 27:49-57. [PMID: 34704339 PMCID: PMC7614816 DOI: 10.1111/tmi.13696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE We aimed to determine the associations of non-alcoholic fatty liver disease (NAFLD) with cardio-metabolic risk factors for diabetes in adult Kenyans. METHODS A cross-sectional study was undertaken among rural and urban Kenyans of different ethnic origin. Ultrasonography scanning (USS) methods were used for the assessment of hepatic fat accumulation for NAFLD assessment and abdominal fat distribution, and simple anthropometry measurements were performed. All participants underwent a 2-h oral glucose tolerance test, and biochemical, haemodynamic and lifestyle data were obtained. Multivariate logistic regression analyses were used to assess sex, age, residency and ethnic differences in the association between NAFLD and various metabolic parameters. RESULTS In total, 743 individuals (59.1% women) with a mean age of 38.0 (range 18-68) years participated in the study. Overall, 118 individuals (15.9%) had NAFLD, of whom 94.1% had mild steatosis. Age >40 years was significantly associated with having NAFLD compared with <30 years of age with no difference found in NAFLD between ethnic groups (Luo, Kamba, Maasai). All body composition and clinical measurements were associated with NAFLD (p < 0.045 for OR). CONCLUSION Finding lower odds for NAFLD in men was unexpected, as was the lack of differences in NAFLD among the ethnic groups, while higher odds for NAFLD with increasing age and in urban vs. rural populations was expected. Especially the sex-specific results warrant further studies in black African populations on biology of body composition for having NAFLD, and whether this translates into insulin resistance and higher risk of diabetes and consequently cardiovascular disease in black African women.
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Affiliation(s)
- Sophie E Kastberg
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Helene S Lund
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Emanuella de Lucia-Rolfe
- NIHR Cambridge Biomedical Research Centre-Diet, Anthropometry and Physical Activity Group, MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Lydia U Kaduka
- Centre for Public Health Research, KEMRI, Nairobi, Kenya
| | - Michael K Boit
- Department of Physical, Exercise and Sport Science, Kenyatta University, Nairobi, Kenya
| | - Eva Corpeleijn
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Sophie Bernard
- Lipids, Nutrition and Cardiovascular Prevention Clinic of the Montreal Clinical Research Institute, Montreal, Canada
| | - Martine Paquette
- Lipids, Nutrition and Cardiovascular Prevention Clinic of the Montreal Clinical Research Institute, Montreal, Canada
| | - Alexis Baas
- Lipids, Nutrition and Cardiovascular Prevention Clinic of the Montreal Clinical Research Institute, Montreal, Canada.,Department of Medicine, Divisions of Experimental Medicine and Medical Biochemistry, McGill University, Montreal, Canada
| | - Jon J Rasmussen
- Department of Endocrinology, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Dirk L Christensen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Ishimwe MCS, Wentzel A, Shoup EM, Osei-Tutu NH, Hormenu T, Patterson AC, Bagheri H, DuBose CW, Mabundo LS, Ha J, Sherman A, Sumner AE. Beta-cell failure rather than insulin resistance is the major cause of abnormal glucose tolerance in Africans: insight from the Africans in America study. BMJ Open Diabetes Res Care 2021; 9:9/1/e002447. [PMID: 34531244 PMCID: PMC8449936 DOI: 10.1136/bmjdrc-2021-002447] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/26/2021] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Uncertainties exist on whether the main determinant of abnormal glucose tolerance (Abnl-GT) in Africans is β-cell failure or insulin resistance (IR). Therefore, we determined the prevalence, phenotype and characteristics of Abnl-GT due to β-cell failure versus IR in 486 African-born blacks (male: 64%, age: 38±10 years (mean±SD)) living in America. RESEARCH DESIGN AND METHODS Oral glucose tolerance test were performed. Abnl-GT is a term which includes both diabetes and prediabetes and was defined as fasting plasma glucose (FPG) ≥5.6 mmol/L and/or 2-hour glucose ≥7.8 mmol/L. IR was defined by the lowest quartile of the Matsuda Index (≤2.98) and retested using the upper quartile of homeostatic model assessment of insulin resistance (HOMA-IR) (≥2.07). Abnl-GT-IR required both Abnl-GT and IR. Abnl-GT-β-cell failure was defined as Abnl-GT without IR. Beta-cell compensation was assessed by the Disposition Index (DI). Fasting lipids were measured. Visceral adipose tissue (VAT) volume was obtained with abdominal CT scan. RESULTS The prevalence of Abnl-GT was 37% (182/486). For participants with Abnl-GT, IR occurred in 38% (69/182) and β-cell failure in 62% (113/182). Compared with Africans with Abnl-GT-IR, Africans with Abnl-GT-β-cell failure had lower body mass index (BMI) (30.8±4.3 vs 27.4±4.0 kg/m2), a lower prevalence of obesity (52% vs 19%), less VAT (163±72 vs 107±63 cm2), lower triglyceride (1.21±0.60 vs 0.85±0.42 mmol/L) and lower FPG (5.9±1.4 vs 5.3±0.6 mmol/L) and 2-hour glucose concentrations (10.0±3.1 vs 9.0±1.9 mmol/L) (all p<0.001) and higher DI, high-density lipoprotein (HDL), low-density lipoprotein particle size and HDL particle size (all p<0.01). Analyses with Matsuda Index and HOMA-IR yielded similar results. Potential confounders such as income, education, alcohol and fiber intake did not differ by group. CONCLUSIONS Beta-cell failure occurred in two-thirds of participants with Abnl-GT and may be a more frequent determinant of Abnl-GT in Africans than IR. As BMI category, degree of glycemia and lipid profile appeared more favorable when Abnl-GT was due to β-cell failure rather than IR, the clinical course and optimal interventions may differ. TRIAL REGISTRATION NUMBER NCT00001853.
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Affiliation(s)
| | | | - Elyssa M Shoup
- NIDDK, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Thomas Hormenu
- NIDDK, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Hadi Bagheri
- Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | | | | | - Joon Ha
- NIDDK, National Institutes of Health, Bethesda, Maryland, USA
| | - Arthur Sherman
- NIDDK, National Institutes of Health, Bethesda, Maryland, USA
| | - Anne E Sumner
- NIDDK, National Institutes of Health, Bethesda, Maryland, USA
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Otieno FC, Mikhail T, Acharya K, Muga J, Ngugi N, Njenga E. Suboptimal glycemic control and prevalence of diabetes-related complications in Kenyan population with diabetes: cohort analysis of the seventh wave of the International Diabetes Management Practices Study (IDMPS). ENDOCRINE AND METABOLIC SCIENCE 2021. [DOI: 10.1016/j.endmts.2021.100093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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6
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Meeks KAC, Bentley AR, Adeyemo AA, Rotimi CN. Evolutionary forces in diabetes and hypertension pathogenesis in Africans. Hum Mol Genet 2021; 30:R110-R118. [PMID: 33734377 DOI: 10.1093/hmg/ddaa238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/16/2020] [Accepted: 10/22/2020] [Indexed: 11/12/2022] Open
Abstract
Rates of type 2 diabetes (T2D) and hypertension are increasing rapidly in urbanizing sub-Saharan Africa (SSA). While lifestyle factors drive the increases in T2D and hypertension prevalence, evidence across populations shows that genetic variation, which is driven by evolutionary forces including a natural selection that shaped the human genome, also plays a role. Here we report the evidence for the effect of selection in African genomes on mechanisms underlying T2D and hypertension, including energy metabolism, adipose tissue biology, insulin action and salt retention. Selection effects found for variants in genes PPARA and TCF7L2 may have enabled Africans to respond to nutritional challenges by altering carbohydrate and lipid metabolism. Likewise, African-ancestry-specific characteristics of adipose tissue biology (low visceral adipose tissue [VAT], high intermuscular adipose tissue and a strong association between VAT and adiponectin) may have been selected for in response to nutritional and infectious disease challenges in the African environment. Evidence for selection effects on insulin action, including insulin resistance and secretion, has been found for several genes including MPHOSPH9, TMEM127, ZRANB3 and MC3R. These effects may have been historically adaptive in critical conditions, such as famine and inflammation. A strong correlation between hypertension susceptibility variants and latitude supports the hypothesis of selection for salt retention mechanisms in warm, humid climates. Nevertheless, adaptive genomics studies in African populations are scarce. More work is needed, particularly genomics studies covering the wide diversity of African populations in SSA and Africans in diaspora, as well as further functional assessment of established risk loci.
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Affiliation(s)
- Karlijn A C Meeks
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Amy R Bentley
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Adebowale A Adeyemo
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Charles N Rotimi
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
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7
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Rønn PF, Andersen GS, Lauritzen T, Christensen DL, Aadahl M, Carstensen B, Grarup N, Jørgensen ME. Abdominal visceral and subcutaneous adipose tissue and associations with cardiometabolic risk in Inuit, Africans and Europeans: a cross-sectional study. BMJ Open 2020; 10:e038071. [PMID: 32928857 PMCID: PMC7490939 DOI: 10.1136/bmjopen-2020-038071] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Abdominal fat has been identified as a risk marker of cardiometabolic disease independent of overall adiposity. However, it is not clear whether there are ethnic disparities in this risk. We investigated the associations of visceral adipose tissue (VAT) and abdominal subcutaneous adipose tissue (SAT) with cardiometabolic risk factors in three ethnic diverse populations of Inuit, Africans and Europeans. DESIGN Cross-sectional pooled study. SETTING Greenland, Kenya and Denmark. METHODS A total of 5113 participants (2933 Inuit, 1397 Africans and 783 Europeans) from three studies in Greenland, Kenya and Denmark were included. Measurements included abdominal fat distribution assessed by ultrasound, oral glucose tolerance test, hepatic insulin resistance, blood pressure and lipids. The associations were analysed using multiple linear regressions. RESULTS Across ethnic group and gender, an increase in VAT of 1 SD was associated with higher levels of hepatic insulin resistance (ranging from 14% to 28%), triglycerides (8% to 16%) and lower high-density lipoprotein cholesterol (HDL-C, -1.0 to -0.05 mmol/L) independent of body mass index. VAT showed positive associations with most of the other cardiometabolic risk factors in Inuit and Europeans, but not in Africans. In contrast, SAT was mainly associated with the outcomes in Inuit and Africans. Of notice was that higher SAT was associated with higher HDL-C in African men (0.11 mmol/L, 95% CI: 0.03 to 0.18) and with lower HDL-C in Inuit (-0.07 mmol/L, 95% CI: -0.12 to -0.02), but not in European men (-0.02 mmol/L, 95% CI: -0.09 to 0.05). Generally weaker associations were observed for women. Furthermore, the absolute levels of several of the cardiometabolic outcomes differed between the ethnic groups. CONCLUSIONS VAT and SAT were associated with several of the cardiometabolic risk factors beyond overall adiposity. Some of these associations were specific to ethnicity, suggesting that ethnicity plays a role in the pathway from abdominal fat to selected cardiometabolic risk factors.
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Affiliation(s)
- Pernille Falberg Rønn
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Public Health, Centre for Arctic Health, Aarhus University, Aarhus, Denmark
| | | | - Torsten Lauritzen
- Department of Public Health, General Practice, Aarhus University, Aarhus, Denmark
| | - Dirk Lund Christensen
- Department of Public Health, Global Health Section, University of Copenhagen, Copenhagen, Denmark
| | - Mette Aadahl
- Center for Clinical Research and Prevention, Frederiksberg and Bispebjerg Hospital, Frederiksberg, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bendix Carstensen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Niels Grarup
- Novo Nordisk Foundation, Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Kobenhavn, Denmark
| | - Marit Eika Jørgensen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- Greenland University, Nuuk, Greenland
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Lajeunesse-Trempe F, Dufour R, du Souich P, Paquette M, Kaduka LU, Christensen DL. Anthropometric measures and their association with risk factors for cardio-metabolic diseases in Kenyan adults. Ann Hum Biol 2019; 45:486-495. [PMID: 30608195 DOI: 10.1080/03014460.2018.1562568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The prevalence of cardio-metabolic diseases (CMD) is drastically increasing worldwide. Anthropometric measures of fat accumulation are correlated with CMD and Metabolic Syndrome (MS), but few studies have addressed this association in sub-Saharan African populations. AIM To investigate the association between anthropometric features, MS and other CMD risk factors in a population from Kenya. SUBJECTS AND METHODS In this cross-sectional study including 1405 Kenyans, anthropometric measurements including visceral adipose tissue (VAT) and abdominal subcutaneous adipose tissue (SAT) were carried out. Fasting blood glucose and standard oral glucose tolerance test, fasting serum insulin and plasma lipids were analysed. Homeostatic model assessment of insulin resistance was calculated. Systolic and diastolic blood pressures were measured. RESULTS CMD risk factors and MS were associated with all anthropometric features, except for high-density lipoprotein cholesterol levels (p < 0.05). The strongest association between MS and anthropometrics was seen with SAT (β = 1.45 ± 0.32 in men and 0.88 ± 0.14 in women, both p < 0.05). CONCLUSIONS Anthropometric measures, especially features of central obesity such as VAT and SAT, are relevant indicators of cardio-metabolic health in Kenyan populations. SAT is the strongest predictor of MS. These results highlight the need for further research on the pathological implication of VAT and SAT, in order to understand patterns of fat distribution and cardio-metabolic health among different ethnic groups.
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Affiliation(s)
- F Lajeunesse-Trempe
- a Faculty of Medicine , University of Montreal , Montreal , Canada.,b Nutrition, Metabolism and Atherosclerosis Clinic , Montreal Clinical Research Institute, affiliated with University of Montreal , Montreal , Canada
| | - R Dufour
- b Nutrition, Metabolism and Atherosclerosis Clinic , Montreal Clinical Research Institute, affiliated with University of Montreal , Montreal , Canada.,c Department of Nutrition , University of Montreal , Montreal , Canada
| | - P du Souich
- b Nutrition, Metabolism and Atherosclerosis Clinic , Montreal Clinical Research Institute, affiliated with University of Montreal , Montreal , Canada.,d Department of Pharmacology and Physiology, Faculty of Medicine , University of Montreal , Montreal , Canada
| | - M Paquette
- b Nutrition, Metabolism and Atherosclerosis Clinic , Montreal Clinical Research Institute, affiliated with University of Montreal , Montreal , Canada
| | - L U Kaduka
- e Centre for Public Health Research , KEMRI , Nairobi , Kenya
| | - D L Christensen
- f Department of Public Health , University of Copenhagen , Copenhagen , Denmark
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Lee JC, Westgate K, Boit MK, Mwaniki DL, Kiplamai FK, Friis H, Tetens I, Christensen DL, Brage S. Physical activity energy expenditure and cardiometabolic health in three rural Kenyan populations. Am J Hum Biol 2018; 31:e23199. [PMID: 30537282 PMCID: PMC6435188 DOI: 10.1002/ajhb.23199] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 09/17/2018] [Accepted: 10/18/2018] [Indexed: 11/12/2022] Open
Abstract
Objectives Physical activity is beneficial for metabolic health but the extent to which this may differ by ethnicity is still unclear. Here, the objective was to characterize the association between physical activity energy expenditure (PAEE) and cardiometabolic risk among the Luo, Kamba, and Maasai ethnic groups of rural Kenya. Methods In a cross‐sectional study of 1084 rural Kenyans, free‐living PAEE was objectively measured using individually‐calibrated heart rate and movement sensing. A clustered metabolic syndrome risk score (zMS) was developed by averaging the sex‐specific z‐scores of five risk components measuring central adiposity, blood pressure, lipid levels, glucose tolerance, and insulin resistance. Results zMS was 0.08 (−0.09; −0.06) SD lower for every 10 kJ/kg/day difference in PAEE after adjustment for age and sex; this association was modified by ethnicity (interaction with PAEE P < 0.05). When adjusted for adiposity, each 10 kJ/kg/day difference in PAEE was predicted to lower zMS by 0.04 (−0.05, −0.03) SD, without evidence of interaction by ethnicity. The Maasai were predicted to have higher cardiometabolic risk than the Kamba and Luo at every quintile of PAEE, with a strong dose‐dependent decreasing trend among all ethnicities. Conclusion Free‐living PAEE is strongly inversely associated with cardiometabolic risk in rural Kenyans. Differences between ethnic groups in this association were observed but were explained by differences in central adiposity. Therefore, targeted interventions to increase PAEE are more likely to be effective in subgroups with high central adiposity, such as Maasai with low levels of PAEE.
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Affiliation(s)
- Jerry C Lee
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.,School of Medicine, Duke University, Durham, North Carolina.,MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Kate Westgate
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Michael K Boit
- Department of Recreation Management and Exercise Science, Kenyatta University, Nairobi, Kenya
| | | | - Festus K Kiplamai
- Department of Recreation Management and Exercise Science, Kenyatta University, Nairobi, Kenya
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Inge Tetens
- National Food Institute, Technical University of Denmark, Soeborg, Denmark
| | - Dirk L Christensen
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Soren Brage
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
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Goedecke JH, Mtintsilana A, Dlamini SN, Kengne AP. Type 2 diabetes mellitus in African women. Diabetes Res Clin Pract 2017; 123:87-96. [PMID: 28006698 DOI: 10.1016/j.diabres.2016.11.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 11/28/2016] [Indexed: 02/08/2023]
Abstract
Compared to global estimates, Sub-Saharan Africa (SSA) has the highest projected rates of increase in type 2 diabetes (T2D) over the next 25years. This is attributed to the ageing population, increasing urbanisation and the associated lifestyle changes. Although the prevalence does not differ by gender, deaths attributable to T2D in SSA are greater in women, likely due to differences in beliefs and access to care. Women in SSA also have greater risk factor burden for T2D than men, in particular obesity, which is explained in part by sociocultural factors. The pathogenesis of diabetes differs between African and Caucasian women, with implications for risk assessment. African women are more insulin resistant than their Caucasian counterparts, despite a more 'favourable' body fat distribution. Notably, women in SSA face the dual burden of T2D and HIV/AIDS. HIV positive women in SSA are typically young and obese, with the latter being exacerbated by anti-retroviral therapy (ART). Cultural perceptions regarding weight loss and limited financial resources are the major limitations to the management of T2D. Hence prevention is vital. However, there is a paucity of studies examining the effectiveness and sustainability of interventions to reduce T2D in SSA.
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Affiliation(s)
- Julia H Goedecke
- Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.
| | - Asanda Mtintsilana
- Medical Research Council/University of Witwatersrand, Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Siphiwe N Dlamini
- Medical Research Council/University of Witwatersrand, Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Andre Pascal Kengne
- Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
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Liu J, Liu J, Li H, Liu L, Zheng J, Huang Z, Cao X, Xiao H, Li Y. Higher Ratio of Abdominal Subcutaneous to Visceral Adipose Tissue Related with Preservation of Islet β-Cell Function in Healthy Individuals. Int J Endocrinol 2017; 2017:6180904. [PMID: 29445396 PMCID: PMC5763169 DOI: 10.1155/2017/6180904] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 10/30/2017] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To investigate the relationship between abdominal adipose tissue distribution, β-cell function, and insulin sensitivity (IS) in a Chinese population. METHODS One hundred and eighty-eight healthy subjects (healthy group), 239 with normal glucose, and 1~4 abnormal metabolic traits (metabolic dysfunction group, MD group) and 125 with hyperglycemia (hyperglycemia group) were studied. HOMA-IR, HOMA-B, Matsuda index, early- (I0-30/G0-30) and late-phase (I30-120/G30-120) insulin responses and the corresponding disposition indexes (DI) were calculated. The area of abdominal subcutaneous adipose tissue (ASAT) and visceral adipose tissue (VAT) was measured and the ratio of ASAT to VAT (SVR) was calculated. RESULTS SVR was correlated positively with Matsuda index in healthy, MD, and hyperglycemia groups, and inversely with HOMA-IR. SVR positively related with both early- and late-phase DI in the healthy group only. In the healthy group, the hyperbolas of I0-30/G0-30 and I30-120/G30-120 versus Matsuda index in the highest quarter of SVR were significantly right shifted compared to those in the lowest (both P < 0.05). CONCLUSIONS In healthy adults, higher SVR was a protective factor for β-cell function and IS, while in those with glucometabolic abnormality, higher SVR contributed to a relative better IS, indicating SVR is possible to be an early predicator of type 2 diabetes development.
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Affiliation(s)
- Juan Liu
- Endocrinology Department, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Jianbin Liu
- Centre for Eye Research Australia, Faculty of Medicine, Dentistry and Health Science, The University of Melbourne, East Melbourne, VIC 3002, Australia
- Box Hill Hospital Eastern Health, Box Hill, VIC 3128, Australia
| | - Hai Li
- Endocrinology Department, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Liehua Liu
- Endocrinology Department, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Jing Zheng
- Endocrinology Department, The Affiliated Hospital of Guizhou Medical University, Guangyang 550000, China
| | - Zhimin Huang
- Endocrinology Department, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Xiaopei Cao
- Endocrinology Department, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Haipeng Xiao
- Endocrinology Department, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Yanbing Li
- Endocrinology Department, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
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Morano S, Romagnoli E, Filardi T, Nieddu L, Mandosi E, Fallarino M, Turinese I, Dagostino MP, Lenzi A, Carnevale V. Short-term effects of glucagon-like peptide 1 (GLP-1) receptor agonists on fat distribution in patients with type 2 diabetes mellitus: an ultrasonography study. Acta Diabetol 2015; 52:727-32. [PMID: 25577244 DOI: 10.1007/s00592-014-0710-z] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 12/26/2014] [Indexed: 01/22/2023]
Abstract
AIMS Glucagon-like peptide 1 receptor agonists (GLP-1 RA) induce weight loss and reduction in adipose tissue, but the effects of GLP-1 RA on the distribution of fat deposits have been poorly investigated. METHODS In 25 patients with type 2 diabetes (16 females and 9 males, mean age 63.5 ± 8.8 years), treated with GLP-1 RA (exenatide, n. 12; liraglutide, n.13), both before and 3 months after starting treatment, an abdominal ultrasonographic scan, with Doppler of renal arteries, and echocardiography were performed. Subcutaneous fat width (peri-umbilical and sub-xiphoid), deep fat deposits (pre-aortic, peri-renal, and epicardial), and renal resistive index (RI) were evaluated. RESULTS GLP-1 RA induced highly significant (p < 0.001) decrease in BMI and in fat thickness at all the assessed sites, without differences between exenatide and liraglutide treatment. A slight decrease in RI (p = 0.055) was also found. The percent changes of fat thickness was different between sites (p < 0.025), and the changes in subcutaneous deposits showed no significant correlation (p = 0.064) with those of deep fat deposits. CONCLUSIONS A short course of treatment with GLP-1 RA, besides weight loss, induces a redistribution of adipose tissue deposits, possibly contributing to a better cardiovascular risk profile in patients with type 2 diabetes mellitus.
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Affiliation(s)
- Susanna Morano
- Department of Experimental Medicine, Policlinico Umberto I, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy,
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13
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Christensen DL, Faurholt-Jepsen D, Birkegaard L, Mwaniki DL, Boit MK, Kilonzo B, Brage S, Friis H, Tetens I, Borch-Johnsen K, Vistisen D. Cardiovascular risk factors in rural Kenyans are associated with differential age gradients, but not modified by sex or ethnicity. Ann Hum Biol 2015; 43:42-9. [PMID: 26073640 DOI: 10.3109/03014460.2015.1013987] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The relationship between metabolic disease and the non-modifiable risk factors sex, age and ethnicity in Africans is not well-established. AIM This study aimed to describe sex, age and ethnicity differences in blood pressure (BP) and lipid status in rural Kenyans. SUBJECTS AND METHODS A cross-sectional study was undertaken among rural Kenyans. BP and pulse rate (PR) were measured while sitting and fasting blood samples were taken for analysis of standard lipid profile. Standard anthropometric measurements were collected. Physical activity energy expenditure was obtained objectively and lifestyle data were obtained using questionnaires. RESULTS In total, 1139 individuals (61.0% women) participated aged 17-68 years. Age was positively associated with BP and plasma cholesterol levels. Sitting PR was negatively associated with age in women only (sex-interaction p < 0.001). Ethnicity did not modify any of the age-associations with haemodynamic or lipid outcomes. Differences in intercept between women and men were found in all parameters except for diastolic BP (p = 0.154), with men having lower HDL-C but higher values in all other cardiovascular risk factors. CONCLUSION BP and plasma cholesterol levels increase with age at a similar gradient in men and women, but absolute levels of the majority of the risk factors were higher in men.
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Affiliation(s)
- Dirk L Christensen
- a Department of Public Health , University of Copenhagen , Copenhagen , Denmark .,b Steno Diabetes Center , Gentofte , Denmark
| | - Daniel Faurholt-Jepsen
- c Department of Nutrition, Exercise and Sports , University of Copenhagen , Frederiksberg , Denmark .,d Department of Infectious Diseases , National University Hospital (Rigshospitalet) , Copenhagen , Denmark
| | - Louise Birkegaard
- a Department of Public Health , University of Copenhagen , Copenhagen , Denmark
| | | | - Michael K Boit
- f Department of Recreation Management and Exercise Science , Kenyatta University , Nairobi , Kenya
| | | | - Søren Brage
- g Medical Research Council Epidemiology Unit, University of Cambridge , Cambridge , UK
| | - Henrik Friis
- c Department of Nutrition, Exercise and Sports , University of Copenhagen , Frederiksberg , Denmark
| | - Inge Tetens
- h National Food Institute, Technical University of Denmark , Søborg , Denmark , and
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