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Simchoni M, Hamiel U, Pinhas-Hamiel O, Zucker I, Cukierman-Yaffe T, Lutski M, Derazne E, Beer Z, Behar D, Keinan-Boker L, Mosenzon O, Tzur D, Afek A, Tirosh A, Raz I, Twig G. Adolescent BMI and early-onset type 2 diabetes among Ethiopian immigrants and their descendants: a nationwide study. Cardiovasc Diabetol 2020; 19:168. [PMID: 33023586 PMCID: PMC7542395 DOI: 10.1186/s12933-020-01143-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/27/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND We assessed in a nationwide cohort the association between adolescent BMI and early-onset (< 40 years) type 2 diabetes among Israelis of Ethiopian origin. METHODS Normoglycemic adolescents (range 16-20 years old), including 93,806 native Israelis (≥ 3rd generation in Israel) and 27,684 Israelis of Ethiopian origin, were medically assessed for military service between 1996 and 2011. Weight and height were measured. Data were linked to the Israeli National Diabetes Registry. Incident type 2 diabetes by December 31, 2016 was the outcome. Cox regression models stratified by sex and BMI categories were applied. RESULTS 226 (0.29%) men and 79 (0.18%) women developed diabetes during 992,980 and 530,814 person-years follow-up, respectively, at a mean age of 30.4 and 27.4 years, respectively. Among native Israeli men with normal and high (overweight and obese) BMI, diabetes incidence was 9.5 and 62.0 (per 105 person-years), respectively. The respective incidences were 46.9 and 112.3 among men of Ethiopian origin. After adjustment for sociodemographic confounders, the hazard ratios for type 2 diabetes among Ethiopian men with normal and high BMI were 3.4 (2.3-5.1) and 15.8 (8.3-30.3) respectively, compared to third-generation Israelis with normal BMI. When this analysis was limited to Israeli-born Ethiopian men, the hazard ratios were 4.4 (1.7-11.4) and 29.1 (12.9-70.6), respectively. Results persisted when immigrants of other white Caucasian origin were the reference; and among women with normal, but not high, BMI. CONCLUSIONS Ethiopian origin is a risk factor for early-onset type 2 diabetes among young men at any BMI, and may require selective interventions.
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Affiliation(s)
- Maya Simchoni
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Uri Hamiel
- Genetic Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orit Pinhas-Hamiel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatric Endocrinology, Safra Children Hospital, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Inbar Zucker
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel
| | - Tali Cukierman-Yaffe
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Miri Lutski
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel
| | - Estela Derazne
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zivan Beer
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | | | - Lital Keinan-Boker
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel
| | - Ofri Mosenzon
- The Diabetes Unit, Department of Internal Medicine, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Dorit Tzur
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Arnon Afek
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Central Management, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Amir Tirosh
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Itamar Raz
- The Diabetes Unit, Department of Internal Medicine, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Gilad Twig
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel.
- Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Peled A, Gordon B, Twig G, Grossman E, Matani D, Derazne E, Afek A. Hypertension and childhood migration: a nationwide study of 2.7 million adolescents. J Hypertens 2019; 37:702-709. [PMID: 30817450 DOI: 10.1097/hjh.0000000000001957] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Immigration studies can shed light on hypertension development and reveal high-risk populations. To this end, we investigated the association between age at immigration and hypertension occurrence at adolescence among immigrants to Israel. METHODS We analyzed cross-sectional data on 2 681 294 adolescents assessed for mandatory military service at approximately 17 years of age between 1967 and 2016. The study population constituted of 410 488 immigrants with origins in Ethiopia, Middle East and North Africa, Former USSR and Western Countries. Age at immigration was categorized into 0-5, 6-11 and 12-19 years. Odds ratios (ORs) for hypertension were calculated according to age at immigration with Israel-born participants as controls. Models were made to account for possible confounders. Additionally, the study population was stratified by country of origin and each immigrant group referenced to Israel-born participants of the same origin. RESULTS In the fully-adjusted model, immigrants arriving until age 11 years had comparable ORs for hypertension to the Israeli-born reference group, whereas recent immigrants, arriving at age 12-19 years had a marked lower OR of 0.30 (95% CI 0.27-0.33; P < 0.001). The lower hypertension odds among recent immigrants persisted in all models and when the study sample was stratified by sex and origin, with all but those of Western origin showing a graded decrease with increasing age at migration categories. CONCLUSION Immigrants arriving earlier in childhood lose their protection against hypertension at adolescence relative to the Israeli-born, likely because of lifestyle acculturation. Prevention programs are needed, beginning upon arrival and placing emphasis on nutritional and physical activity habits.
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Affiliation(s)
- Alon Peled
- Sackler Faculty of Medicine, Tel Aviv University
| | - Barak Gordon
- Sackler Faculty of Medicine, Tel Aviv University
- Medical Corps, Israeli Defense Forces
| | - Gilad Twig
- Sackler Faculty of Medicine, Tel Aviv University
- Medical Corps, Israeli Defense Forces
- Department of Medicine
- Talpiot Medical Leadership Program, Sheba Medical Center
| | - Ehud Grossman
- Sackler Faculty of Medicine, Tel Aviv University
- Department of Internal Medicine D and Hypertension Unit, The Chaim Sheba Medical Center
| | | | - Estela Derazne
- Sackler Faculty of Medicine, Tel Aviv University
- Medical Corps, Israeli Defense Forces
| | - Arnon Afek
- Sackler Faculty of Medicine, Tel Aviv University
- Central Management, Chaim Sheba Medical Center, Tel Hashomer, Israel
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Peled A, Gordon B, Twig G, Mendlovic J, Derazne E, Lisnyansky M, Raz I, Afek A. Immigration to Israel during childhood is associated with diabetes at adolescence: a study of 2.7 million adolescents. Diabetologia 2017; 60:2226-2230. [PMID: 28821907 DOI: 10.1007/s00125-017-4399-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 07/06/2017] [Indexed: 10/19/2022]
Abstract
AIMS/HYPOTHESIS Immigration studies can shed light on diabetes pathogenesis and risk factors. To this end, we investigated the association between age at immigration and diabetes occurrence at adolescence among immigrants to Israel. METHODS We analysed cross-sectional data on 2,721,767 Jewish adolescents assessed for mandatory military service at approximately 17 years of age between 1967 and 2014. The study population comprised 430,176 immigrants with origins in Ethiopia, former USSR, Middle East and North Africa (ME/NA) and western countries. ORs for diabetes were calculated for men and women, grouped according to age at immigration, with Israel-born participants as controls. Unadjusted and fully adjusted models were made to account for possible confounders. Additionally, the study population was stratified by origin and each immigrant group was referenced to Israel-born participants of the same origin. RESULTS There was a graded decrease in OR for diabetes across the study groups in the fully adjusted model. Immigrants arriving at age 0-5 years had comparable OR for diabetes to the Israeli-born reference group; those arriving at age 6-11 years had an OR of 0.82 (95% CI 0.70, 0.97; p = 0.017) and recent immigrants, arriving at age 12-19 years, had the lowest OR of 0.65 (95% CI 0.54, 0.77; p < 0.0001). When age at immigration was treated as a continuous variable, there was an adjusted risk for occurrence of diabetes of 0.97 (95% CI 0.96, 0.99; p = 0.001) for every year increment. The lower risk for diabetes among recent immigrants persisted in the unadjusted model and persisted when the study sample was stratified by sex and origin, except for immigrants arriving from ME/NA. Notably, Ethiopians born in Israel had a sixfold higher diabetes crude prevalence than Ethiopian immigrants arriving after the age of 5 years. CONCLUSIONS/INTERPRETATION Immigrants of different ethnic groups arriving earlier in childhood lose their protection against diabetes at adolescence, relative to children born in Israel. This is perhaps due to environmental and lifestyle changes, especially those beginning at an early age.
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Affiliation(s)
- Alon Peled
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- , Leshem 37, Rishon Lezion, Israel.
| | - Barak Gordon
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Medical Corps, Israeli Defense Forces, Tel Hashomer Base, Tel Hashomer, Israel
| | - Gilad Twig
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Medical Corps, Israeli Defense Forces, Tel Hashomer Base, Tel Hashomer, Israel
- Department of Medicine, Sheba Medical Center, Tel Hashomer, Israel
- Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Israel
- Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Israel
| | - Joseph Mendlovic
- Ministry of Health, Jerusalem, Israel
- Shaare Zedek Medical Center, Jerusalem, Israel
| | - Estela Derazne
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Medical Corps, Israeli Defense Forces, Tel Hashomer Base, Tel Hashomer, Israel
| | | | - Itamar Raz
- Diabetes Research Center, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Arnon Afek
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Ministry of Health, Jerusalem, Israel
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Machluf Y, Tal O, Navon A, Chaiter Y. From Population Databases to Research and Informed Health Decisions and Policy. Front Public Health 2017; 5:230. [PMID: 28983476 PMCID: PMC5613084 DOI: 10.3389/fpubh.2017.00230] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 08/15/2017] [Indexed: 12/21/2022] Open
Abstract
Background In the era of big data, the medical community is inspired to maximize the utilization and processing of the rapidly expanding medical datasets for clinical-related and policy-driven research. This requires a medical database that can be aggregated, interpreted, and integrated at both the individual and population levels. Policymakers seek data as a lever for wise, evidence-based decision-making and information-driven policy. Yet, bridging the gap between data collection, research, and policymaking, is a major challenge. The model To bridge this gap, we propose a four-step model: (A) creating a conjoined task force of all relevant parties to declare a national program to promote collaborations; (B) promoting a national digital records project, or at least a network of synchronized and integrated databases, in an accessible transparent manner; (C) creating an interoperative national research environment to enable the analysis of the organized and integrated data and to generate evidence; and (D) utilizing the evidence to improve decision-making, to support a wisely chosen national policy. For the latter purpose, we also developed a novel multidimensional set of criteria to illuminate insights and estimate the risk for future morbidity based on current medical conditions. Conclusion Used by policymakers, providers of health plans, caregivers, and health organizations, we presume this model will assist transforming evidence generation to support the design of health policy and programs, as well as improved decision-making about health and health care, at all levels: individual, communal, organizational, and national.
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Affiliation(s)
| | - Orna Tal
- The Israeli Center for Emerging Technologies (ICET) in Hospitals and Hospital-Based Health Technology Assessment (HB-HTA), Assaf Harofeh Medical Center, Zerifin, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Israeli Center for Technology Assessment in Health Care (ICTAHC), The Gertner Institute for Epidemiology and Health Policy, Tel Aviv, Israel
| | - Amir Navon
- The School of Social Sciences and Humanities, Kinneret College, Sea of Galilee, Jordan Valley, Israel
| | - Yoram Chaiter
- The Israeli Center for Emerging Technologies (ICET) in Hospitals and Hospital-Based Health Technology Assessment (HB-HTA), Assaf Harofeh Medical Center, Zerifin, Israel
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