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Anisman H, Doubad D, Asokumar A, Matheson K. Psychosocial and neurobiological aspects of the worldwide refugee crisis: From vulnerability to resilience. Neurosci Biobehav Rev 2024; 165:105859. [PMID: 39159733 DOI: 10.1016/j.neubiorev.2024.105859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 08/06/2024] [Accepted: 08/15/2024] [Indexed: 08/21/2024]
Abstract
Anisman, H., Doubad, D., Asokumar, A. & Matheson, K. Psychosocial and neurobiological aspects of the worldwide refugee crisis: From vulnerability to resilience. NEUROSCI BIOBEHAV REV, XXXX. Immigration occurs between countries either to obtain employment, for family reunification or to escape violence and other life-threatening conditions. Refugees and asylum seekers are often obligated to overcome a uniquely challenging set of circumstances prior to and during migration. Settlement following immigration may pose yet another set of stressors related to acculturation to the host country, as well as financial insecurity, discrimination, language barriers, and social isolation. Here we discuss the multiple consequences of immigration experiences, focusing on the health disturbances that frequently develop in adults and children. Aside from the psychosocial influences, immigration-related challenges may cause hormonal, inflammatory immune, and microbiota changes that favor psychological and physical illnesses. Some biological alterations are subject to modification by epigenetic changes, which have implications for intergenerational trauma transmission, as might disruptions in parenting behaviors and family dysfunction. Despite the hardships experienced, many immigrants and their families exhibit positive psychological adjustment after resettlement. We provide information to diminish the impacts associated with immigration and offer strength-based approaches that may foster resilience.
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Affiliation(s)
- H Anisman
- Carleton University, Department of Neuroscience, Ottawa, Ontario K1S 5B6, Canada.
| | - D Doubad
- Carleton University, Department of Neuroscience, Ottawa, Ontario K1S 5B6, Canada
| | - A Asokumar
- Carleton University, Department of Neuroscience, Ottawa, Ontario K1S 5B6, Canada
| | - K Matheson
- Carleton University, Department of Neuroscience, Ottawa, Ontario K1S 5B6, Canada
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Akingbule O, Teran-Garcia M, Alston R. Exploring the dietary practices and perceptions of African immigrants in Illinois- a qualitative study of immigrants from Nigeria and Congo. ETHNICITY & HEALTH 2024; 29:353-370. [PMID: 38515253 DOI: 10.1080/13557858.2024.2311418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 01/23/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVE Previous studies suggest an increased prevalence of diet-related chronic diseases among African immigrants with increased length of stay in the U.S. The objective of the current study is to understand the dietary practices and perceptions of recent African immigrant families. DESIGN Focus group sessions were conducted with Nigerian and Congolese immigrant parents residing in Illinois. Participants were recruited using convenience sampling methods and focus group sessions were conducted via videoconference. Participants discussed dietary practices, meal preparation, and family mealtimes for their families. They also discussed experiences with eating different kinds of foods since arrival in the U.S. Verbatim transcription of focus group sessions were completed and deductive thematic analysis of transcribed data was conducted using NVivo (QSR International Pty Ltd. [2020] NVivo [version 12]). RESULTS Twenty African immigrant parents (Mean age: 42 years, Female: 95%) residing in Northern and Central Illinois participated in a total of five focus group sessions. Seven themes were derived from the analysis. Participants had a positive attitude toward healthy diet and had a high level of interest in receiving educational resources to make healthier food choices. Participants preferred and mostly consumed foods they were familiar with before migration. A majority of the participants perceived 'American foods' as unhealthy, characterizing them as containing a high amount of sugar and salt. Parents reported that their school-aged children often preferred a western diet over traditional African meals. CONCLUSION This study helps to understand unique diet-related practices and perceptions of recent Nigerian and Congolese African immigrants in Illinois. Findings could help to inform cultural adaptation of evidence-based nutrition education programs for these groups of African immigrants.
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Affiliation(s)
- Oluwatosin Akingbule
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Margarita Teran-Garcia
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Champaign, IL, USA
- Department of Biomedical and Translational Sciences, Carle Illinois College of Medicine, Urbana-Champaign, Champaign, IL, USA
- University of Illinois Extension, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Reginald Alston
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
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Doan SN, Davis AS, Lazarus M, Poudel A, Tran P, Clark N, Fuller-Rowell TE. Belonging Exacerbates the Relations Between Racial Climate Stress and Physiological Dysregulation. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01740-0. [PMID: 37676634 DOI: 10.1007/s40615-023-01740-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/24/2023] [Accepted: 07/27/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVE Belonging is often considered a buffer against the physical and emotional consequences of discrimination and racial climate stress Youth Soc. 48(5):649-72, 2016. However, recent research suggests that feelings of belonging toward an institution can be detrimental when an individual feels discriminated against by the same institution to which one feels a sense of connection J Behav Med. 44(4):571-8, 2021. Therefore, the present study aimed to investigate the moderating role of institutional belonging in the relationship between racial climate stress and health, as indexed by allostatic load (AL), a multi-system indicator of physiological dysregulation. METHODS In a sample of Black and White college students (N = 150; White = 82; Black = 68), self-reported racial climate stress, institutional belonging, and various demographic variables were collected. An AL composite was also collected, comprised of six biological measures of the SAM system, HPA axis, cardiovascular system, and metabolic system. Multiple regression analyses were conducted to explore the relationships between these variables. RESULTS Results demonstrated no main effect of racial climate stress on AL but did show a significant interaction between racial climate stress and belonging, such that the positive relationship between racial climate stress and AL was significant only for those who also felt high levels of institutional belonging (β int = .05, p = .006, 95% CI = 0.01 - 0.08). CONCLUSIONS Feeling a sense of belonging may have negative physiological consequences for those who experience racial climate stress in a college setting.
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Affiliation(s)
- Stacey N Doan
- Claremont McKenna College, Department of Psychological Science, Claremont, CA, 91711, USA.
- City of Hope National Medical Center, Department of Population Sciences, Duarte, CA, USA.
| | - Alicia S Davis
- Claremont McKenna College, Department of Psychological Science, Claremont, CA, 91711, USA
| | - Molly Lazarus
- Claremont McKenna College, Department of Psychological Science, Claremont, CA, 91711, USA
| | - Akriti Poudel
- Claremont McKenna College, Department of Psychological Science, Claremont, CA, 91711, USA
| | - Phil Tran
- Claremont McKenna College, Department of Psychological Science, Claremont, CA, 91711, USA
| | - Natalie Clark
- Claremont McKenna College, Department of Psychological Science, Claremont, CA, 91711, USA
| | - Thomas E Fuller-Rowell
- Auburn University, College of Human Sciences, Human Development and Family Science Duarte, Auburn, CA, USA
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Bashir T, Obeng-Gyasi E. Combined Effects of Multiple Per- and Polyfluoroalkyl Substances Exposure on Allostatic Load Using Bayesian Kernel Machine Regression. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105808. [PMID: 37239535 DOI: 10.3390/ijerph20105808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/01/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023]
Abstract
This study aims to investigate the combined effects of per- and polyfluoroalkyl substances (PFAS) on allostatic load, an index of chronic stress that is linked to several chronic diseases, including cardiovascular disease and cancer. Using data from the National Health and Nutrition Examination Survey (NHANES) 2007-2014, this study examines the relationship between six PFAS variables (PFDE, PFNA, PFOS, PFUA, PFOA, and PFHS) and allostatic load using Bayesian Kernel Machine Regression (BKMR) analysis. The study also investigates the impact of individual and combined PFAS exposure on allostatic load using various exposure-response relationships, such as univariate, bivariate, or multivariate models. The analysis reveals that the combined exposure to PFDE, PFNA, and PFUA had the most significant positive trend with allostatic load when it was modeled as a binary variable, while PFDE, PFOS, and PFNA had the most significant positive trend with allostatic load when modeled as a continuous variable. These findings provide valuable insight into the consequences of cumulative exposure to multiple PFAS on allostatic load, which can help public health practitioners identify the dangers associated with potential combined exposure to select PFAS of interest. In summary, this study highlights the critical role of PFAS exposure in chronic stress-related diseases and emphasizes the need for effective strategies to minimize exposure to these chemicals to reduce the risk of chronic diseases. It underscores the importance of considering the combined effects of PFAS when assessing their impact on human health and offers valuable information for policymakers and regulators to develop strategies to protect public health.
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Affiliation(s)
- Tahir Bashir
- Department of Built Environment, North Carolina A&T State University, Greensboro, NC 27411, USA
- Environmental Health and Disease Laboratory, North Carolina A&T State University, Greensboro, NC 27411, USA
| | - Emmanuel Obeng-Gyasi
- Department of Built Environment, North Carolina A&T State University, Greensboro, NC 27411, USA
- Environmental Health and Disease Laboratory, North Carolina A&T State University, Greensboro, NC 27411, USA
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Bashir T, Obeng-Gyasi E. The Association of Combined Per- and Polyfluoroalkyl Substances and Metals with Allostatic Load Using Bayesian Kernel Machine Regression. Diseases 2023; 11:diseases11010052. [PMID: 36975601 PMCID: PMC10047702 DOI: 10.3390/diseases11010052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/01/2023] [Accepted: 03/19/2023] [Indexed: 03/29/2023] Open
Abstract
Background/Objective: This study aimed to investigate the effect of exposure to per- and polyfluoroalkyl substances (PFAS), a class of organic compounds utilized in commercial and industrial applications, on allostatic load (AL), a measure of chronic stress. PFAS, such as perfluorodecanoic acid (PFDE), perfluorononanoic acid (PFNA), perfluorooctane sulfonic acid (PFOS), perfluoroundecanoic acid (PFUA), perfluorooctanoic acid (PFOA), and perfluorohexane sulfonic acid (PFHS), and metals, such as mercury (Hg), barium (Ba), cadmium (Cd), cobalt (Co), cesium (Cs), molybdenum (Mo), lead (Pb), antimony (Sb), thallium (TI), tungsten (W), and uranium (U) were investigated. This research was performed to explore the effects of combined exposure to PFAS and metals on AL, which may be a disease mediator. Methods: Data from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2014 were used to conduct this study on persons aged 20 years and older. A cumulative index of 10 biomarkers from the cardiovascular, inflammatory, and metabolic systems was used to calculate AL out of 10. If the overall index was ≥ 3, an individual was considered to be chronically stressed (in a state of AL). In order to assess the dose-response connections between mixtures and outcomes and to limit the effects of multicollinearity and other potential interaction effects between exposures, Bayesian kernel machine regression (BKMR) was used. Results: The most significant positive trend between mixed PFAS and metal exposure and AL was revealed by combined exposure to cesium, molybdenum, PFHS, PFNA, and mercury (posterior inclusion probabilities, PIP = 1, 1, 0.854, 0.824, and 0.807, respectively). Conclusions: Combined exposure to metals and PFAS increases the likelihood of being in a state of AL.
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Affiliation(s)
- Tahir Bashir
- Department of Built Environment, North Carolina A&T State University, Greensboro, NC 27411, USA
- Environmental Health and Disease Laboratory, North Carolina A&T State University, Greensboro, NC 27411, USA
| | - Emmanuel Obeng-Gyasi
- Department of Built Environment, North Carolina A&T State University, Greensboro, NC 27411, USA
- Environmental Health and Disease Laboratory, North Carolina A&T State University, Greensboro, NC 27411, USA
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Bashir T, Asiseh F, Jefferson-Moore K, Obeng-Gyasi E. The Association of Per- and Polyfluoroalkyl Substances Serum Levels and Allostatic Load by Country of Birth and the Length of Time in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9438. [PMID: 35954796 PMCID: PMC9367790 DOI: 10.3390/ijerph19159438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/29/2022] [Accepted: 07/29/2022] [Indexed: 11/17/2022]
Abstract
Objectives: The aim of this study was to examine the association of per- and polyfluoroalkyl (PFAS) concentrations and allostatic load (AL) by the county of birth and the length of time in the United States of America (U.S.), in a representative sample of U.S. adults. Methods: Data from the 2007−2014 National Health and Nutrition Examination Survey (NHANES) were used in this cross-sectional study on the U.S. adults aged 20 and older. The analysis was stratified by the length of time in the U.S. and by the county of birth. In all, the sample contained those who were US-born (n = 10,264), Mexico-born (n = 4018), other Spanish speaking country-born (n = 2989), and other not−Hispanic speaking country-born (n = 3911). Poisson models were used to assess the differences in AL and PFAS levels depending on country of birth and length of time in the U.S. Results: Estimates indicated that those born in Other non−Spanish speaking counties had the highest PFAS levels among the country of birth category in the database. Regarding length of time in the U.S., those born in Mexico had low PFAS levels when their length of time in the U.S. was short. The Mexico-born category presented the most at-risk high serum PFAS levels, with AL levels increasing by length of time in the U.S. (p-value < 0.001). Conclusion: This study found that PFAS concentrations increased by the length of time residing in the U.S. Those born in other non−Hispanic counties had the highest PFAS levels among all the categories. In general, AL and PFAS levels are mostly associated with the length of time in the U.S., with foreign-born individuals having increased levels of both the longer they stay.
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Affiliation(s)
- Tahir Bashir
- Department of Built Environment, North Carolina Agricultural and Technical State University, Greensboro, NC 27411, USA;
- Environmental Health and Disease Laboratory, North Carolina Agricultural and Technical State University, Greensboro, NC 27411, USA
| | - Fafanyo Asiseh
- Department of Economics, Deese College of Business and Economics, North Carolina Agricultural and Technical State University, Greensboro, NC 27411, USA;
| | - Kenrett Jefferson-Moore
- Department of Agribusiness, Applied Economics and Agriscience Education, North Carolina Agricultural and Technical State University, Greensboro, NC 27411, USA;
| | - Emmanuel Obeng-Gyasi
- Department of Built Environment, North Carolina Agricultural and Technical State University, Greensboro, NC 27411, USA;
- Environmental Health and Disease Laboratory, North Carolina Agricultural and Technical State University, Greensboro, NC 27411, USA
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Waldman ZC, Schenk BR, Duhuze Karera MG, Patterson AC, Hormenu T, Mabundo LS, DuBose CW, Jagannathan R, Whitesell PL, Wentzel A, Horlyck-Romanovsky MF, Sumner AE. Sleep and Economic Status Are Linked to Daily Life Stress in African-Born Blacks Living in America. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052562. [PMID: 35270258 PMCID: PMC8909882 DOI: 10.3390/ijerph19052562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/08/2022] [Accepted: 02/17/2022] [Indexed: 02/01/2023]
Abstract
To identify determinants of daily life stress in Africans in America, 156 African-born Blacks (Age: 40 ± 10 years (mean ± SD), range 22–65 years) who came to the United States as adults (age ≥ 18 years) were asked about stress, sleep, behavior and socioeconomic status. Daily life stress and sleep quality were assessed with the Perceived Stress Scale (PSS) and Pittsburgh Sleep Quality Index (PSQI), respectively. High-stress was defined by the threshold of the upper quartile of population distribution of PSS (≥16) and low-stress as PSS < 16. Poor sleep quality required PSQI > 5. Low income was defined as <40 k yearly. In the high and low-stress groups, PSS were: 21 ± 4 versus 9 ± 4, p < 0.001 and PSQI were: 6 ± 3 versus 4 ± 3, p < 0.001, respectively. PSS and PSQI were correlated (r = 0.38, p < 0.001). The odds of high-stress were higher among those with poor sleep quality (OR 5.11, 95% CI: 2.07, 12.62), low income (OR 5.03, 95% CI: 1.75, 14.47), and no health insurance (OR 3.01, 95% CI: 1.19, 8.56). Overall, in African-born Blacks living in America, daily life stress appears to be linked to poor quality sleep and exacerbated by low income and lack of health insurance.
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Affiliation(s)
- Zoe C. Waldman
- Section on Ethnicity and Health, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD 20892, USA; (Z.C.W.); (B.R.S.); (M.G.D.K.); (A.C.P.); (T.H.); (L.S.M.); (C.W.D.); (A.W.); (M.F.H.-R.)
| | - Blayne R. Schenk
- Section on Ethnicity and Health, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD 20892, USA; (Z.C.W.); (B.R.S.); (M.G.D.K.); (A.C.P.); (T.H.); (L.S.M.); (C.W.D.); (A.W.); (M.F.H.-R.)
| | - Marie Grace Duhuze Karera
- Section on Ethnicity and Health, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD 20892, USA; (Z.C.W.); (B.R.S.); (M.G.D.K.); (A.C.P.); (T.H.); (L.S.M.); (C.W.D.); (A.W.); (M.F.H.-R.)
- National Institute of Minority Health and Health Disparities, Bethesda, MD 20892, USA
- Institute of Global Health Equity Research, University of Global Health Equity, Kigali 6955, Rwanda
| | - Arielle C. Patterson
- Section on Ethnicity and Health, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD 20892, USA; (Z.C.W.); (B.R.S.); (M.G.D.K.); (A.C.P.); (T.H.); (L.S.M.); (C.W.D.); (A.W.); (M.F.H.-R.)
| | - Thomas Hormenu
- Section on Ethnicity and Health, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD 20892, USA; (Z.C.W.); (B.R.S.); (M.G.D.K.); (A.C.P.); (T.H.); (L.S.M.); (C.W.D.); (A.W.); (M.F.H.-R.)
- Department of Health, Physical Education, University of Cape Coast, Cape Coast P.O. Box 5007, Ghana
| | - Lilian S. Mabundo
- Section on Ethnicity and Health, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD 20892, USA; (Z.C.W.); (B.R.S.); (M.G.D.K.); (A.C.P.); (T.H.); (L.S.M.); (C.W.D.); (A.W.); (M.F.H.-R.)
| | - Christopher W. DuBose
- Section on Ethnicity and Health, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD 20892, USA; (Z.C.W.); (B.R.S.); (M.G.D.K.); (A.C.P.); (T.H.); (L.S.M.); (C.W.D.); (A.W.); (M.F.H.-R.)
| | - Ram Jagannathan
- Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA;
| | - Peter L. Whitesell
- Howard University Hospital Sleep Disorders Center, Howard University, 2041 Georgia Ave, NW, Washington, DC 20060, USA;
| | - Annemarie Wentzel
- Section on Ethnicity and Health, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD 20892, USA; (Z.C.W.); (B.R.S.); (M.G.D.K.); (A.C.P.); (T.H.); (L.S.M.); (C.W.D.); (A.W.); (M.F.H.-R.)
| | - Margrethe F. Horlyck-Romanovsky
- Section on Ethnicity and Health, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD 20892, USA; (Z.C.W.); (B.R.S.); (M.G.D.K.); (A.C.P.); (T.H.); (L.S.M.); (C.W.D.); (A.W.); (M.F.H.-R.)
- Department of Health and Nutrition Sciences, Brooklyn College, City University of New York, New York, NY 11210, USA
| | - Anne E. Sumner
- Section on Ethnicity and Health, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD 20892, USA; (Z.C.W.); (B.R.S.); (M.G.D.K.); (A.C.P.); (T.H.); (L.S.M.); (C.W.D.); (A.W.); (M.F.H.-R.)
- National Institute of Minority Health and Health Disparities, Bethesda, MD 20892, USA
- Correspondence:
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Dias J, Echeverria S, Mayer V, Janevic T. Diabetes Risk and Control in Multi-ethnic US Immigrant Populations. Curr Diab Rep 2020; 20:73. [PMID: 33216289 DOI: 10.1007/s11892-020-01358-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW The goal of this review is to assess current evidence on diabetes risk and control among adult immigrants in the USA. RECENT FINDINGS Patterns of diabetes risk in US immigrants may reflect global diabetes trends. Asian, Black, and Latinx immigrants all see a diabetes disadvantage relative to US-born Whites. Diabetes risk in Asian immigrants also surpasses US-born Asians. Relative diabetes risk among all groups increases with time in the USA. Research to explain patterns in diabetes risk and control among immigrants has broadened from lifestyle factors to include multi-level, life course influences on trajectories of risk. Some determinants are shared across groups, such as structural racism, healthcare access, and migration stress, whereas others such as diet are embedded in sending country culture. Current literature on diabetes in immigrant populations suggests a need to shift towards a transnational lens and macro-level social determinants of health framework to understand diabetes risk and potential prevention factors.
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Affiliation(s)
- Jennifer Dias
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sandra Echeverria
- Department of Public Health Education, School of Health and Human Sciences, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Victoria Mayer
- General Internal Medicine, Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Teresa Janevic
- Obstetrics, Gynecology, and Reproductive Science, Population Health Science & Policy, Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Mugeni R, Hormenu T, Hobabagabo A, Shoup EM, DuBose CW, Sumner AE, Horlyck-Romanovsky MF. Identifying Africans with undiagnosed diabetes: Fasting plasma glucose is similar to the hemoglobin A1C updated Atherosclerosis Risk in Communities diabetes prediction equation. Prim Care Diabetes 2020; 14:501-507. [PMID: 32173292 DOI: 10.1016/j.pcd.2020.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/24/2020] [Indexed: 12/15/2022]
Abstract
AIMS Seventy percent of Africans living with diabetes are undiagnosed. Identifying who should be referred for testing is critical. Therefore we evaluated the ability of the Atherosclerosis Risk in Communities (ARIC) diabetes prediction equation with A1C added (ARIC + A1C) to identify diabetes in 451 African-born blacks living in America (66% male; age 38 ± 10y (mean ± SD); BMI 27.5 ± 4.4 kg/m2). METHODS All participants denied a history of diabetes. OGTTs were performed. Diabetes diagnosis required 2-h glucose ≥200 mg/dL. The five non-invasive (Age, parent history of diabetes, waist circumference, height, systolic blood pressure) and four invasive variables (Fasting glucose (FPG), A1C, triglycerides (TG), HDL) were obtained. Four models were tested: Model-1: Full ARIC + A1C equation; Model-2: All five non-invasive variables with one invasive variable excluded at a time; Model-3: All five non-invasive variables with one invasive variable included at a time; Model-4: Each invasive variable singly. Area under the receiver operator characteristic curve (AROC) predicted diabetes. Youden Index identified optimal cut-points. RESULTS Diabetes occurred in 7% (30/451). Model-1, the full ARIC + A1C equation, AROC = 0.83. Model-2: With FPG excluded, AROC = 0.77 (P = 0.038), but when A1C, HDL or TG were excluded AROC remained unchanged. Model-3 with all non-invasive variables and FPG alone, AROC=0.87; but with A1C, TG or HDL included AROC declined to ≤0.76. Model-4: FPG as a single predictor, AROC = 0.87. A1C, TG, or HDL as single predictors all had AROC ≤ 0.74. Optimal cut-point for FPG was 100 mg/dL. CONCLUSIONS To detect diabetes, FPG performed as well as the nine-variable updated ARIC + A1C equation.
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Affiliation(s)
- Regine Mugeni
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, United States; National Institute of Minority Health and Health Disparities (NIMHD), National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, United States
| | - Thomas Hormenu
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, United States
| | - Arsène Hobabagabo
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, United States; National Institute of Minority Health and Health Disparities (NIMHD), National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, United States
| | - Elyssa M Shoup
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, United States
| | - Christopher W DuBose
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, United States
| | - Anne E Sumner
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, United States; National Institute of Minority Health and Health Disparities (NIMHD), National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, United States
| | - Margrethe F Horlyck-Romanovsky
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, United States; City University of New York, Brooklyn College, 2900 Bedford Avenue, Brooklyn, NY, United States.
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Stress Measured by Allostatic Load Varies by Reason for Immigration, Age at Immigration, and Number of Children: The Africans in America Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124533. [PMID: 32599711 PMCID: PMC7345091 DOI: 10.3390/ijerph17124533] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 06/17/2020] [Accepted: 06/20/2020] [Indexed: 12/18/2022]
Abstract
Stress leads to physiologic dysfunction and cardiometabolic disease. Allostatic load score (ALS) measures stress-induced cardiovascular, metabolic, and inflammatory biomarkers. We estimated the odds of high ALS by reason for and age at immigration, duration of American residence, number of children, and socioeconomic status in 193 African immigrants (male: 65%, age 41 ± 10 y (mean ± Standard Deviation (SD)), range 22–65 y). ALS was calculated with High-ALS defined as ALS ≥ 3.0 and Low-ALS defined as ALS < 3.0. Oral glucose tolerance tests (OGTT) were performed, the cardiovascular disease (CVD) risk estimated, and TNF-α, an inflammatory cytokine, measured. Logistic regression was used to estimate odds of High-ALS. In the High- and Low-ALS groups, ALS were 4.0 ± 1.2 vs. 1.3 ± 0.7, diabetes prevalence: 14% vs. 4%, CVD risk: 23% vs. 8%, TNF-α levels: 15 ± 9 vs. 11 ± 6 pg/mL, respectively (all p ≤ 0.01). Immigrants were more likely to be in the High-ALS group if their reason for immigration was work or asylum/refugee (OR 2.18, p = 0.013), their age at immigration was ≥30 y (OR 3.28, p < 0.001), their duration of residence in United States was ≥10 y (OR 3.16, p = 0.001), or their number of children was ≥3 (OR 2.67, p = 0.019). Education, income, health insurance, marital status, and gender did not affect High-ALS odds. Factors adversely influencing allostatic load and cardiometabolic health in African immigrants were age at and reason for immigration, duration of residence in America, and number of children.
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Courville AB, Yang SB, Andrus S, Hayat N, Kuemmerle A, Leahy E, Briker S, Zambell K, Chung S, Sumner AE. Body adiposity measured by bioelectrical impedance is an alternative to dual-energy x-ray absorptiometry in black Africans: The Africans in America Study. Nutrition 2020; 74:110733. [PMID: 32179385 DOI: 10.1016/j.nut.2020.110733] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 01/02/2020] [Accepted: 01/09/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The prevalence of cardiometabolic disease has risen in Africa and parallels the obesity epidemic. To assess cardiometabolic risk, body composition measurements by dual-energy X-ray absorptiometry (DXA) are ideal. In communities with limited resources, alternative measures may be useful but have not been compared extensively in black Africans. Therefore, the aim of this study was to identify alternative methods of body composition assessment, such as body adiposity index (BAI) and bioelectrical impedance analysis (BIA), for use in African-born blacks. METHODS This was a cross-sectional study with African-born blacks. BAI and five BIA predictive equations (using variations of height, weight, age, sex, and impedance) were compared with DXA to estimate percent fat. Participants were 266 African-born blacks (39 ± 10 y, body mass index 28 ± 4 kg/m2, and 68% men) living in metropolitan Washington DC. Equivalence (90% confidence interval, -3 to 3), concordance, and Bland-Altman analyses (bias <2%, R2 closest to zero) compared BAI or BIA predictive equations to DXA as the criterion method. RESULTS DXA percent fat was 27.2% ± 5.5% and 40.3% ± 6.9% in men and women, respectively. BAI underestimated percent fat in men (bias: 1.88 ± 4.71, R2 = 0.25, P < 0.001) and women (bias: 6.47 ± 4.94, R2 = 0.08, P = 0.01). Of the five BIA predictive equations, the equation reported by Sun et al. had the best agreement with DXA percent fat for men (bias: -0.91 ± 3.67, R2 = 0.02, P = 0.05) and women (bias: -0.92 ± 4.02, R2 = 0.003, P = 0.58). Percent fat from the Sun et al. equation best agreed with DXA percent fat. CONCLUSION BIA with the Sun et al. predictive equation was the best alternative to DXA for body fat assessment in African-born blacks.
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Affiliation(s)
- Amber B Courville
- National Institutes of Health, Clinical Center, Nutrition Department, Bethesda, Maryland, USA.
| | - Shanna B Yang
- National Institutes of Health, Clinical Center, Nutrition Department, Bethesda, Maryland, USA
| | - Sarah Andrus
- National Institutes of Health, Clinical Center, Nutrition Department, Bethesda, Maryland, USA
| | - Nosheen Hayat
- National Institutes of Health, Clinical Center, Nutrition Department, Bethesda, Maryland, USA
| | - Anneliese Kuemmerle
- National Institutes of Health, Clinical Center, Nutrition Department, Bethesda, Maryland, USA
| | - Elizabeth Leahy
- National Institutes of Health, Clinical Center, Nutrition Department, Bethesda, Maryland, USA
| | - Sara Briker
- National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Kirsten Zambell
- National Institutes of Health, Clinical Center, Nutrition Department, Bethesda, Maryland, USA
| | - Stephanie Chung
- National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Anne E Sumner
- National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA; National Institutes of Health, National Institute of Minority Health, Bethesda, Maryland, USA
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Horlyck-Romanovsky MF, Fuster M, Echeverria SE, Wyka K, Leung MM, Sumner AE, Huang TTK. Black Immigrants from Africa and the Caribbean Have Similar Rates of Diabetes but Africans Are Less Obese: the New York City Community Health Survey 2009-2013. J Racial Ethn Health Disparities 2019; 6:635-645. [PMID: 30725381 DOI: 10.1007/s40615-019-00562-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/17/2019] [Accepted: 01/17/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study was designed to determine (a) whether the prevalence and odds of either obesity or diabetes differed in foreign-born black Africans and Caribbeans living in New York City (NYC) and (b) whether time in the United States (US) affected odds of either outcome. METHODS Data were obtained from NYC Community Health Survey 2009-13 for 380 African-born blacks and 2689 Caribbean-born blacks. Weighted logistic regression estimated odds of obesity and diabetes, adjusting for age, sex, education, income, marital status, children < 18, BMI (diabetes models only), and time in the US. RESULTS Obesity prevalence in Africans (60.2%, male; age, 46.0 ± 13.5 years, (mean ± SD); BMI, 27.3 ± 5.6 kg/m2) was 16.7 and 30.2% in Caribbeans (39.3%, male; age, 49.7 ± 14.7 years; BMI, 28.0 ± 5.8 kg/m2). Prevalence of diabetes was 10.5% in Africans and 14.7% in Caribbeans. Africans had lower adjusted odds of obesity (aOR = 0.60 (95% CI, 0.40-0.90); P = 0.015), but there was no difference in diabetes odds between groups. Obesity odds were higher in African (aOR = 2.35 (95% CI, 1.16-4.78); P = 0.018) and Caribbean women (aOR = 2.20 (95% CI, 1.63-2.98); P < 0.001) than their male counterparts. Odds of diabetes did not differ between sexes in either group. Time in the US did not affect odds of either obesity or diabetes. CONCLUSIONS Africans living in NYC are less obese than Caribbeans, but odds of diabetes do not differ. Time in the US does not affect odds of either obesity or diabetes. Hence, BMI and diabetes risk profiles in blacks differ by region of origin and combining foreign-born blacks into one group masks important differences.
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Affiliation(s)
- Margrethe F Horlyck-Romanovsky
- Graduate School of Public Health and Health Policy, Center for Systems and Community Design, City University of New York, New York, NY, USA.
- Graduate School of Public Health and Health Policy, Department of Community Health and Social Science, City University of New York, New York, NY, USA.
| | - Melissa Fuster
- Brooklyn College, Department of Health and Nutrition Sciences, City University of New York, Brooklyn, NY, USA
| | - Sandra E Echeverria
- Graduate School of Public Health and Health Policy, Department of Community Health and Social Science, City University of New York, New York, NY, USA
| | - Katarzyna Wyka
- Graduate School of Public Health and Health Policy, Center for Systems and Community Design, City University of New York, New York, NY, USA
- Graduate School of Public Health and Health Policy, Department of Epidemiology and Biostatistics, City University of New York, New York, NY, USA
| | - May May Leung
- Hunter College, Nutrition Program, City University of New York, New York, NY, USA
| | - Anne E Sumner
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, USA
- National Institute of Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Terry T-K Huang
- Graduate School of Public Health and Health Policy, Center for Systems and Community Design, City University of New York, New York, NY, USA
- Graduate School of Public Health and Health Policy, Department of Community Health and Social Science, City University of New York, New York, NY, USA
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Briker SM, Aduwo JY, Mugeni R, Horlyck-Romanovsky MF, DuBose CW, Mabundo LS, Hormenu T, Chung ST, Ha J, Sherman A, Sumner AE. A1C Underperforms as a Diagnostic Test in Africans Even in the Absence of Nutritional Deficiencies, Anemia and Hemoglobinopathies: Insight From the Africans in America Study. Front Endocrinol (Lausanne) 2019; 10:533. [PMID: 31447780 PMCID: PMC6692432 DOI: 10.3389/fendo.2019.00533] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/18/2019] [Indexed: 12/16/2022] Open
Abstract
Introduction: To improve detection of undiagnosed diabetes in Africa, there is movement to replace the OGTT with A1C. The performance of A1C in the absence of hemoglobin-related micronutrient deficiencies, anemia and heterozygous hemoglobinopathies is unknown. Therefore, we determined in 441 African-born blacks living in America [male: 65% (281/441), age: 38 ± 10 y (mean ± SD), BMI: 27.5 ± 4.4 kg/m2] (1) nutritional and hematologic profiles and (2) glucose tolerance categorization by OGTT and A1C. Methods: Hematologic and nutritional status were assessed. Hemoglobin <11 g/dL occurred in 3% (11/441) of patients and led to exclusion. A1C and OGTT were performed in the remaining 430 participants. ADA thresholds for A1C and OGTT were used. Diagnosis by A1C required meeting either A1C-alone or A1C&OGTT criteria. Diagnosis by OGTT-alone required detection by OGTT and not A1C. Results: Hemoglobin, mean corpuscular volume and red blood cell distribution width were 14.0 ± 1.3 g/dL, 85.5 ± 5.3 fL, and 13.2 ± 1.2% respectively. B12, folate, and iron deficiency occurred in 1% (5/430), 0% (0/430), and 4% (12/310), respectively. Heterozygous hemoglobinopathy prevalence was 18% (78/430). Overall, diabetes prevalence was 7% (32/430). A1C detected diabetes in 32% (10/32) but OGTT-alone detected 68% (22/32). Overall prediabetes prevalence was 41% (178/430). A1C detected 57% (102/178) but OGTT-alone identified 43% (76/178). After excluding individuals with heterozygous hemoglobinopathies, the rate of missed diagnosis by A1C of abnormal glucose tolerance did not change (OR: 0.99, 95% CI: 0.61, 1.62). Conclusions: In nutritionally replete Africans without anemia or heterozygous hemoglobinopathy, if only A1C is used, ~60% with diabetes and ~40% with prediabetes would be undiagnosed. Clinical Trial Registration:: www.ClinicalTrials.gov, Identifier: NCT00001853.
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Affiliation(s)
- Sara M. Briker
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Jessica Y. Aduwo
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Regine Mugeni
- 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
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Christopher W. DuBose
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Lilian S. Mabundo
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Thomas Hormenu
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Stephanie T. Chung
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Joon Ha
- Laboratory of Biological Modeling Medicine, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Arthur Sherman
- Laboratory of Biological Modeling Medicine, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Anne E. Sumner
- 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
- *Correspondence: Anne E. Sumner
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Kabakambira JD, Baker RL, Briker SM, Courville AB, Mabundo LS, DuBose CW, Chung ST, Eckel RH, Sumner AE. Do current guidelines for waist circumference apply to black Africans? Prediction of insulin resistance by waist circumference among Africans living in America. BMJ Glob Health 2018; 3:e001057. [PMID: 30364383 PMCID: PMC6195140 DOI: 10.1136/bmjgh-2018-001057] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/19/2018] [Accepted: 08/20/2018] [Indexed: 02/06/2023] Open
Abstract
Background To lower the risk of diabetes and heart disease in Africa, identification of African-centred thresholds for inexpensive biomarkers of insulin resistance (IR) is essential. The waist circumference (WC) thresholds that predicts IR in African men and women have not been established, but investigations recently conducted in Africa using indirect measures of IR suggest IR is predicted by WC of 80–95 cm in men and 90–99 cm in women. These WC cannot be used for guidelines until validated by direct measurements of IR and visceral adipose tissue (VAT). Therefore, we determined in a group of African-born black people living in America (A) the WC, which predicts IR and (B) the influence of abdominal fat distribution on IR. Methods The 375 participants (age 38±10 years (mean±SD), 67% men) had IR determined by HOMA-IR and Matsuda index. VAT and subcutaneous adipose tissue (SAT) were measured by abdominal CT scans. Optimal WC for the prediction of IR was determined in sex-specific analyses by area under the receiver operating characteristic (AUC-ROC) and Youden index. Results Women had more SAT (203±114 vs 128±74 cm2) and less VAT than men (63±48 vs 117±72 cm2, p<0.001). Optimal WC for prediction of IR in men and women were: 91 cm (AUC-ROC: 0.80±0.03 (mean±SE)) and 96 cm (AUC-ROC: 0.81±0.08), respectively. Regression analyses revealed a significant sex–VAT interaction (p<0.001). Therefore, for every unit increase in VAT, women had a 0.94 higher unit increase in SAT and 0.07 higher unit increase in WC than men. Conclusion Working with a group of African-born black people living in America, we accessed technology, which validated observations made in Africa. Higher SAT at every level of VAT explained why the WC that predicted IR was higher in women (96 cm) than men (91 cm). For Africans to benefit from WC measurements, convening a panel of experts to develop evidence-based African-centred WC guidelines may be the way forward.
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Affiliation(s)
- J Damascene Kabakambira
- Section on Ethnicity and Health, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, Bethesda, Maryland, USA.,National Institute of Minority Health and Health Disparities, Bethesda, Maryland, USA
| | - Rafeal L Baker
- Section on Ethnicity and Health, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Sara M Briker
- Section on Ethnicity and Health, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Amber B Courville
- Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Lilian S Mabundo
- Section on Ethnicity and Health, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Christopher W DuBose
- Section on Ethnicity and Health, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Stephanie T Chung
- Section on Ethnicity and Health, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Robert H Eckel
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Anne E Sumner
- Section on Ethnicity and Health, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, Bethesda, Maryland, USA.,National Institute of Minority Health and Health Disparities, Bethesda, Maryland, USA
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