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Hu L, Wyatt LC, Mohsin F, Lim S, Zanowiak J, Mammen S, Hussain S, Ali SH, Onakomaiya D, Belli HM, Aifah A, Islam NS. Characterizing Technology Use and Preferences for Health Communication in South Asian Immigrants With Prediabetes or Diabetes: Cross-Sectional Descriptive Study. JMIR Form Res 2024; 8:e52687. [PMID: 38669062 PMCID: PMC11087851 DOI: 10.2196/52687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Type 2 diabetes disproportionately affects South Asian subgroups. Lifestyle prevention programs help prevent and manage diabetes; however, there is a need to tailor these programs for mobile health (mHealth). OBJECTIVE This study examined technology access, current use, and preferences for health communication among South Asian immigrants diagnosed with or at risk for diabetes, overall and by sex. We examined factors associated with interest in receiving diabetes information by (1) text message, (2) online (videos, voice notes, online forums), and (3) none or skipped, adjusting for sociodemographic characteristics and technology access. METHODS We used baseline data collected in 2019-2021 from two clinical trials among South Asian immigrants in New York City (NYC), with one trial focused on diabetes prevention and the other focused on diabetes management. Descriptive statistics were used to examine overall and sex-stratified impacts of sociodemographics on technology use. Overall logistic regression was used to examine the preference for diabetes information by text message, online (videos, voice notes, or forums), and no interest/skipped response. RESULTS The overall sample (N=816) had a mean age of 51.8 years (SD 11.0), and was mostly female (462/816, 56.6%), married (756/816, 92.6%), with below high school education (476/816, 58.3%) and limited English proficiency (731/816, 89.6%). Most participants had a smartphone (611/816, 74.9%) and reported interest in receiving diabetes information via text message (609/816, 74.6%). Compared to male participants, female participants were significantly less likely to own smartphones (317/462, 68.6% vs 294/354, 83.1%) or use social media apps (Viber: 102/462, 22.1% vs 111/354, 31.4%; WhatsApp: 279/462, 60.4% vs 255/354, 72.0%; Facebook: Messenger 72/462, 15.6% vs 150/354, 42.4%). A preference for receiving diabetes information via text messaging was associated with male sex (adjusted odds ratio [AOR] 1.63, 95% CI 1.01-2.55; P=.04), current unemployment (AOR 1.62, 95% CI 1.03-2.53; P=.04), above high school education (AOR 2.17, 95% CI 1.41-3.32; P<.001), and owning a smart device (AOR 3.35, 95% CI 2.17-5.18; P<.001). A preference for videos, voice notes, or online forums was associated with male sex (AOR 2.38, 95% CI 1.59-3.57; P<.001) and ownership of a smart device (AOR 5.19, 95% CI 2.83-9.51; P<.001). No interest/skipping the question was associated with female sex (AOR 2.66, 95% CI 1.55-4.56; P<.001), high school education or below (AOR 2.02, 95% CI 1.22-3.36; P=.01), not being married (AOR 2.26, 95% CI 1.13-4.52; P=.02), current employment (AOR 1.96, 95% CI 1.18-3.29; P=.01), and not owning a smart device (AOR 2.06, 95% CI 2.06-5.44; P<.001). CONCLUSIONS Technology access and social media usage were moderately high in primarily low-income South Asian immigrants in NYC with prediabetes or diabetes. Sex, education, marital status, and employment were associated with interest in mHealth interventions. Additional support to South Asian women may be required when designing and developing mHealth interventions. TRIAL REGISTRATION ClinicalTrials.gov NCT03333044; https://classic.clinicaltrials.gov/ct2/show/NCT03333044, ClinicalTrials.gov NCT03188094; https://classic.clinicaltrials.gov/ct2/show/NCT03188094. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s13063-019-3711-y.
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Affiliation(s)
- Lu Hu
- Department of Population Health, Center for Healthful Behavior Change, Institute for Excellence in Health Equity, New York University Grossman School of Medicine, New York, NY, United States
| | - Laura C Wyatt
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Farhan Mohsin
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Sahnah Lim
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Jennifer Zanowiak
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Shinu Mammen
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Sarah Hussain
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Shahmir H Ali
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, United States
| | - Deborah Onakomaiya
- Vilcek Institute of Graduate Biomedical Sciences, New York University Grossman School of Medicine, New York, NY, United States
| | - Hayley M Belli
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Angela Aifah
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Nadia S Islam
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
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van der Velden AIM, IJpelaar DHT, Chandie Shaw PK, Pijl H, Vink H, van der Vlag J, Rabelink TJ, van den Berg BM. Role of dietary interventions on microvascular health in South-Asian Surinamese people with type 2 diabetes in the Netherlands: A randomized controlled trial. Nutr Diabetes 2024; 14:17. [PMID: 38600065 PMCID: PMC11006941 DOI: 10.1038/s41387-024-00275-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 03/25/2024] [Accepted: 04/03/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND/OBJECTIVES We investigated whether dietary interventions, i.e. a fasting mimicking diet (FMD, Prolon®) or glycocalyx mimetic supplementation (EndocalyxTM) could stabilize microvascular function in Surinamese South-Asian patients with type 2 diabetes (SA-T2DM) in the Netherlands, a patient population more prone to develop vascular complications. SUBJECTS/METHODS A randomized, placebo controlled, 3-arm intervention study was conducted in 56 SA-T2DM patients between 18 and 75 years old, for 3 consecutive months, with one additional follow up measurement 3 months after the last intervention. Sublingual microcirculation was assessed with SDF-imaging coupled to the GlycoCheckTM software, detecting red blood cell velocity, capillary density, static and dynamic perfused boundary region (PBR), and the overall microvascular health score (MVHS). Linear mixed models and interaction analysis were used to investigate the effects the interventions had on microvascular function. RESULTS Despite a temporal improvement in BMI and HbA1c after FMD the major treatment effect on microvascular health was worsening for RBC-velocity independent PBRdynamic, especially at follow-up. Glycocalyx supplementation, however, reduced urinary MCP-1 presence and improved both PBRdynamic and MVHSdynamic, which persisted at follow-up. CONCLUSIONS We showed that despite temporal beneficial changes in BMI and HbA1c after FMD, this intervention is not able to preserve microvascular endothelial health in Dutch South-Asian patients with T2DM. In contrast, glycocalyx mimetics preserves the microvascular endothelial health and reduces the inflammatory cytokine MCP-1. CLINICAL STUDY REGISTRATION NCT03889236.
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Affiliation(s)
- Anouk I M van der Velden
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
- Einthoven Laboratory of Vascular and Regenerative Medicine, LUMC, Leiden, The Netherlands
| | - Daphne H T IJpelaar
- Department of Internal Medicine and Nephrology, Green Heart Hospital, Gouda, The Netherlands
| | - Prataap K Chandie Shaw
- Department of Internal Medicine and Nephrology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Hanno Pijl
- Einthoven Laboratory of Vascular and Regenerative Medicine, LUMC, Leiden, The Netherlands
- Department of Internal Medicine (Endocrinology), LUMC, Leiden, The Netherlands
| | - Hans Vink
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
- MicroVascular Health Solutions LLC, Alpine, Utah, USA
| | - Johan van der Vlag
- Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ton J Rabelink
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
- Einthoven Laboratory of Vascular and Regenerative Medicine, LUMC, Leiden, The Netherlands
| | - Bernard M van den Berg
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands.
- Einthoven Laboratory of Vascular and Regenerative Medicine, LUMC, Leiden, The Netherlands.
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Diaz-Thomas AM, Golden SH, Dabelea DM, Grimberg A, Magge SN, Safer JD, Shumer DE, Stanford FC. Endocrine Health and Health Care Disparities in the Pediatric and Sexual and Gender Minority Populations: An Endocrine Society Scientific Statement. J Clin Endocrinol Metab 2023; 108:1533-1584. [PMID: 37191578 PMCID: PMC10653187 DOI: 10.1210/clinem/dgad124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Indexed: 05/17/2023]
Abstract
Endocrine care of pediatric and adult patients continues to be plagued by health and health care disparities that are perpetuated by the basic structures of our health systems and research modalities, as well as policies that impact access to care and social determinants of health. This scientific statement expands the Society's 2012 statement by focusing on endocrine disease disparities in the pediatric population and sexual and gender minority populations. These include pediatric and adult lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA) persons. The writing group focused on highly prevalent conditions-growth disorders, puberty, metabolic bone disease, type 1 (T1D) and type 2 (T2D) diabetes mellitus, prediabetes, and obesity. Several important findings emerged. Compared with females and non-White children, non-Hispanic White males are more likely to come to medical attention for short stature. Racially and ethnically diverse populations and males are underrepresented in studies of pubertal development and attainment of peak bone mass, with current norms based on European populations. Like adults, racial and ethnic minority youth suffer a higher burden of disease from obesity, T1D and T2D, and have less access to diabetes treatment technologies and bariatric surgery. LGBTQIA youth and adults also face discrimination and multiple barriers to endocrine care due to pathologizing sexual orientation and gender identity, lack of culturally competent care providers, and policies. Multilevel interventions to address these disparities are required. Inclusion of racial, ethnic, and LGBTQIA populations in longitudinal life course studies is needed to assess growth, puberty, and attainment of peak bone mass. Growth and development charts may need to be adapted to non-European populations. In addition, extension of these studies will be required to understand the clinical and physiologic consequences of interventions to address abnormal development in these populations. Health policies should be recrafted to remove barriers in care for children with obesity and/or diabetes and for LGBTQIA children and adults to facilitate comprehensive access to care, therapeutics, and technological advances. Public health interventions encompassing collection of accurate demographic and social needs data, including the intersection of social determinants of health with health outcomes, and enactment of population health level interventions will be essential tools.
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Affiliation(s)
- Alicia M Diaz-Thomas
- Department of Pediatrics, Division of Endocrinology, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Sherita Hill Golden
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Dana M Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Adda Grimberg
- Department of Pediatrics, Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Sheela N Magge
- Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Joshua D Safer
- Department of Medicine, Division of Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY 10001, USA
| | - Daniel E Shumer
- Department of Pediatric Endocrinology, C.S. Mott Children's Hospital, University of Michigan School of Medicine, Ann Arbor, MI 48109, USA
| | - Fatima Cody Stanford
- Massachusetts General Hospital, Department of Medicine-Division of Endocrinology-Neuroendocrine, Department of Pediatrics-Division of Endocrinology, Nutrition Obesity Research Center at Harvard (NORCH), Boston, MA 02114, USA
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Deshpande A, Shah NS, Kandula NR. Obesity and Cardiovascular Risk among South Asian Americans. CURRENT CARDIOVASCULAR RISK REPORTS 2023; 17:73-82. [PMID: 37009309 PMCID: PMC10063226 DOI: 10.1007/s12170-023-00714-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2022] [Indexed: 02/05/2023]
Abstract
Purpose of review South Asian Americans experience higher cardiometabolic risk and disproportionately high rates of cardiovascular disease (CVD) compared to other racial and ethnic groups in the United States. The purpose of this review is to summarize recent evidence about the role of obesity in CVD risk in South Asian Americans and identify key evidence gaps and future directions for research and interventions for obesity in this group. Recent findings South Asian Americans are predisposed to abdominal obesity and have a higher distribution of visceral fat, intermuscular fat, and intrahepatic fat compared to adults of other race and ethnic groups. In this population, the risk for cardiometabolic disease appears to be elevated even at a normal body mass index. Social, cultural, religious, interpersonal, and environmental factors are related to obesity and obesity-related behaviors among South Asian Americans. Summary There is a relatively high prevalence of obesity in South Asian-origin populations in the United States, who have unique socio-cultural determinants of overweight and obesity. Future research should clarify why the risk for metabolic disease and CVD is elevated at normal BMI in the South Asian American population, and environmental and other structural factors that may influence obesity in this group. Interventions must be adapted to the social and cultural context of South Asian Americans to improve effectiveness and implementation.
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Affiliation(s)
| | - Nilay S. Shah
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Medicine (Cardiology), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Namratha R. Kandula
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Medicine (General Internal Medicine), Northwestern University Feinberg School of Medicine, Chicago, IL
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Mahadevan M, Bose M, Gawron KM, Blumberg R. Metabolic Syndrome and Chronic Disease Risk in South Asian Immigrants: A Review of Prevalence, Factors, and Interventions. Healthcare (Basel) 2023; 11:healthcare11050720. [PMID: 36900725 PMCID: PMC10000781 DOI: 10.3390/healthcare11050720] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/21/2023] [Accepted: 02/26/2023] [Indexed: 03/05/2023] Open
Abstract
South Asians (SAs) are among the fastest-growing ethnic groups in the U.S. Metabolic syndrome (MetS) is a condition that is characterized by multiple health factors that increase the risk for chronic diseases, such as cardiovascular disease (CVD) and diabetes. MetS prevalence among SA immigrants ranges from 27-47% in multiple cross-sectional studies using different diagnostic criteria, which is generally higher compared to other populations in the receiving country. Both genetic and environmental factors are attributed to this increased prevalence. Limited intervention studies have shown effective management of MetS conditions within the SA population. This review reports MetS prevalence in SAs residing in non-native countries, identifies contributing factors, and discusses ways to develop effective community-based strategies for health promotion targeting MetS among SA immigrants. There is a need for more consistently evaluated longitudinal studies to facilitate the development of directed public health policy and education to address chronic diseases in the SA immigrant community.
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Affiliation(s)
- Meena Mahadevan
- Department of Nutrition and Food Studies, Montclair State University, Montclair, NJ 07043, USA
- Correspondence: ; Tel.: +1-973-655-7574
| | - Mousumi Bose
- Department of Nutrition and Food Studies, Montclair State University, Montclair, NJ 07043, USA
| | | | - Renata Blumberg
- Department of Nutrition and Food Studies, Montclair State University, Montclair, NJ 07043, USA
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Misra R, Madhavan SS, Dhumal T, Sambamoorthi U. Prevalence and factors associated with diagnosed diabetes mellitus among Asian Indian adults in the United States. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001551. [PMID: 36963049 PMCID: PMC10021922 DOI: 10.1371/journal.pgph.0001551] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/10/2023] [Indexed: 02/05/2023]
Abstract
Higher prevalence of diabetes mellitus (DM) has been documented among South Asians living in the United States. However, combining the south Asian subgroups into one category masks the heterogeneity in the diagnosed DM, after controlling for known protective and risk factors. We assessed the association of Asian Indian ethnicity to diagnosed DM using a nationally representative sample of 1,986 Asian Indian adults in the US compared to 109,072 Non-Hispanic Whites (NHWs) using disaggregated data from the National Health Interview Survey (2012-2016) (NHIS). 2010 US census figures were used for age-sex standardization. Age-sex adjusted prevalence of DM was 8.3% in Asian Indians as compared to 5.8% in NHW. In adjusted multivariable logistic regression models, Asian Indians had higher odds ratios of reporting diagnosed DM compared to NHWs (AOR = 1.39, 95% CI: 1.12, 1.71). This association remained strong and significant even after controlling for other risk factors in the model (AOR = 1.47, 95% CI: 1.16, 1.85). Results suggest a favorable socio-economic profile of Asian Indians was not protective on diagnosed DM. In addition, they were more likely to have diagnosed DM due to higher prevalence of obesity despite healthier behaviors of smoking and exercise.
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Affiliation(s)
- Ranjita Misra
- Department of Social and Behavioral Sciences, School of Public Health, West Virginia University, Morgantown, West Virginia, United States of America
| | - Suresh S Madhavan
- College of Pharmacy, University of North Texas System, Denton, Texas, United States of America
| | - Trupti Dhumal
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, West Virginia, United States of America
| | - Usha Sambamoorthi
- College of Pharmacy, University of North Texas System, Denton, Texas, United States of America
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Iliodromiti S, McLaren J, Ghouri N, Miller MR, Dahlqvist Leinhard O, Linge J, Ballantyne S, Platt J, Foster J, Hanvey S, Gujral UP, Kanaya A, Sattar N, Lumsden MA, Gill JMR. Liver, visceral and subcutaneous fat in men and women of South Asian and white European descent: a systematic review and meta-analysis of new and published data. Diabetologia 2023; 66:44-56. [PMID: 36224274 PMCID: PMC9729139 DOI: 10.1007/s00125-022-05803-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 05/31/2022] [Indexed: 12/14/2022]
Abstract
AIMS/HYPOTHESIS South Asians have a two- to fivefold higher risk of developing type 2 diabetes than those of white European descent. Greater central adiposity and storage of fat in deeper or ectopic depots are potential contributing mechanisms. We collated existing and new data on the amount of subcutaneous (SAT), visceral (VAT) and liver fat in adults of South Asian and white European descent to provide a robust assessment of potential ethnic differences in these factors. METHODS We performed a systematic review of the Embase and PubMed databases from inception to August 2021. Unpublished imaging data were also included. The weighted standardised mean difference (SMD) for each adiposity measure was estimated using random-effects models. The quality of the studies was assessed using the ROBINS-E tool for risk of bias and overall certainty of the evidence was assessed using the GRADE approach. The study was pre-registered with the OSF Registries ( https://osf.io/w5bf9 ). RESULTS We summarised imaging data on SAT, VAT and liver fat from eight published and three previously unpublished datasets, including a total of 1156 South Asian and 2891 white European men, and 697 South Asian and 2271 white European women. Despite South Asian men having a mean BMI approximately 0.5-0.7 kg/m2 lower than white European men (depending on the comparison), nine studies showed 0.34 SMD (95% CI 0.12, 0.55; I2=83%) more SAT and seven studies showed 0.56 SMD (95% CI 0.14, 0.98; I2=93%) more liver fat, but nine studies had similar VAT (-0.03 SMD; 95% CI -0.24, 0.19; I2=85%) compared with their white European counterparts. South Asian women had an approximately 0.9 kg/m2 lower BMI but 0.31 SMD (95% CI 0.14, 0.48; I2=53%) more liver fat than their white European counterparts in five studies. Subcutaneous fat levels (0.03 SMD; 95% CI -0.17, 0.23; I2=72%) and VAT levels (0.04 SMD; 95% CI -0.16, 0.24; I2=71%) did not differ significantly between ethnic groups in eight studies of women. CONCLUSIONS/INTERPRETATION South Asian men and women appear to store more ectopic fat in the liver compared with their white European counterparts with similar BMI levels. Given the emerging understanding of the importance of liver fat in diabetes pathogenesis, these findings help explain the greater diabetes risks in South Asians. FUNDING There was no primary direct funding for undertaking the systematic review and meta-analysis.
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Affiliation(s)
- Stamatina Iliodromiti
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
- School of Medicine, University of Glasgow, Glasgow, UK.
| | - James McLaren
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.
| | - Nazim Ghouri
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Melissa R Miller
- Worldwide Research Development and Medical, Pfizer, Cambridge, MA, USA
| | - Olof Dahlqvist Leinhard
- AMRA Medical AB, Linköping, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | | | | | - Jonathan Platt
- Department of Radiology, Greater Glasgow and Clyde NHS, Glasgow, UK
| | - John Foster
- Department of Clinical Physics and Bioengineering, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Scott Hanvey
- Radiotherapy Physics, Derriford Hospital, Plymouth, UK
| | - Unjali P Gujral
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Alka Kanaya
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | | | - Jason M R Gill
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
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There is urgent need to treat atherosclerotic cardiovascular disease risk earlier, more intensively, and with greater precision: A review of current practice and recommendations for improved effectiveness. Am J Prev Cardiol 2022; 12:100371. [PMID: 36124049 PMCID: PMC9482082 DOI: 10.1016/j.ajpc.2022.100371] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/10/2022] [Accepted: 08/05/2022] [Indexed: 12/12/2022] Open
Abstract
Atherosclerotic cardiovascular disease (ASCVD) is epidemic throughout the world and is etiologic for such acute cardiovascular events as myocardial infarction, ischemic stroke, unstable angina, and death. ASCVD also impacts risk for dementia, chronic kidney disease peripheral arterial disease and mobility, impaired sexual response, and a host of other visceral impairments that adversely impact the quality and rate of progression of aging. The relationship between low-density lipoprotein cholesterol (LDL-C) and risk for ASCVD is one of the most highly established and investigated issues in the entirety of modern medicine. Elevated LDL-C is a necessary condition for atherogenesis induction. Basic scientific investigation, prospective longitudinal cohorts, and randomized clinical trials have all validated this association. Yet despite the enormous number of clinical trials which support the need for reducing the burden of atherogenic lipoprotein in blood, the percentage of high and very high-risk patients who achieve risk stratified LDL-C target reductions is low and has remained low for the last thirty years. Atherosclerosis is a preventable disease. As clinicians, the time has come for us to take primordial and primary prevention more serously. Despite a plethora of therapeutic approaches, the large majority of patients at risk for ASCVD are poorly or inadequately treated, leaving them vulnerable to disease progression, acute cardiovascular events, and poor aging due to loss of function in multiple visceral organs. Herein we discuss the need to greatly intensify efforts to reduce risk, decrease disease burden, and provide more comprehensive and earlier risk assessment to optimally prevent ASCVD and its complications. Evidence is presented to support that treatment should aim for far lower goals in cholesterol management, should take into account many more factors than commonly employed today and should begin significantly earlier in life.
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Nisar M, Uddin R, Kolbe-Alexander T, Khan A. The prevalence of chronic diseases in international immigrants: a systematic review and meta-analysis. Scand J Public Health 2022:14034948221116219. [DOI: 10.1177/14034948221116219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Aims: The purpose of this study is systematically to review and synthesise available prevalence data of major chronic diseases in international immigrants. Methods: Four electronic databases were searched to retrieve peer-reviewed original articles published in English between January 2000 and December 2020. Cross-sectional, cohort, or longitudinal studies that reported the prevalence of cardiovascular disease, any type of cancer, chronic obstructive pulmonary disease, and type 2 diabetes among immigrant adults were included. We calculated pooled prevalence using random-effects meta-analyses. Results: Of 13,363 articles retrieved, 24 met the eligibility criteria. The pooled prevalence of diabetes was 9.0% (95% confidence interval (CI) 7.6–10.4) with a higher prevalence in North American countries 11.1% (95% CI 8.0–14.1) than in the other destination countries: 6.6% (95% CI 5.1–8.1) including Italy, Sweden, The Netherlands, Australia, and Israel. The pooled prevalence of cardiovascular diseases and respiratory diseases was 7.7% (95% CI 5.7–9.6) and 6.5% (95% CI 2.3–10.7), respectively. Only two articles reported the prevalence of cancers (2.7% and 3.8%). We found high heterogeneity among all studies regardless of the disease. Conclusions: The prevalence of diabetes was higher than other chronic diseases in international immigrants. There is a strong need to enhance health information systems to understand the magnitude of chronic diseases among different immigrant subgroups.
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Affiliation(s)
- Mehwish Nisar
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Riaz Uddin
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Australia
| | - Tracy Kolbe-Alexander
- School of Health and Wellbeing, University of Southern Queensland, Ipswich, Australia
| | - Asaduzzaman Khan
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Vicks WS, Lo JC, Guo L, Rana JS, Zhang S, Ramalingam ND, Gordon NP. Prevalence of prediabetes and diabetes vary by ethnicity among U.S. Asian adults at healthy weight, overweight, and obesity ranges: an electronic health record study. BMC Public Health 2022; 22:1954. [PMID: 36273116 PMCID: PMC9587616 DOI: 10.1186/s12889-022-14362-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 09/28/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Asian adults develop Type 2 diabetes at a lower body mass index (BMI) compared to other racial/ethnic groups. We examined the variation in prevalence of prediabetes and diabetes among Asian ethnic groups within weight strata by comparing middle-aged Chinese, Filipino, South Asian, and White adults receiving care in the same integrated healthcare delivery system. METHODS Our retrospective cross-sectional U.S. study examined data from 283,110 (non-Hispanic) White, 33,263 Chinese, 38,766 Filipino, and 17,959 South Asian adults aged 45-64 years who were members of a Northern California health plan in 2016 and had measured height and weight. Prediabetes and diabetes were classified based on laboratory data, clinical diagnoses, or diabetes pharmacotherapy. Age-standardized prevalence of prediabetes and diabetes were compared by race/ethnicity within healthy weight, overweight, and obesity categories, using standard BMI thresholds for White adults (18.5 to < 25, 25 to < 30, ≥ 30 kg/m2) and lower BMI thresholds for Asian adults (18.5 to < 23, 23 to < 27.5, ≥ 27.5 kg/m2). Prevalence ratios (PRs) were used to compare the prevalence of diabetes and prediabetes for Asian groups to White adults in each weight category, adjusted for age and BMI. RESULTS Across all weight categories, diabetes prevalence was higher for Asian than White adults, and among Asian groups it was highest for Filipino and South Asian adults. Compared to White, PRs for South Asian men/women at healthy BMI were 1.8/2.8 for prediabetes and 5.9/8.0 for diabetes, respectively. The PRs for Filipino men/women at healthy BMI were 1.8/2.6 for prediabetes and 5.0/7.5 for diabetes, respectively. For Chinese men/women at healthy BMI, the PRs for prediabetes (2.1/2.9) were similar to Filipino and South Asian, but the PRs for diabetes were lower (2.1/3.4). CONCLUSION Chinese, Filipino, and South Asian adults have higher prevalence of prediabetes and diabetes than White adults in all weight categories, despite using lower BMI thresholds for weight classification in Asian groups. Within Asian ethnic groups, Filipino and South Asian adults had considerably higher diabetes prevalence than Chinese adults. Our data emphasize the disproportionate metabolic risk among middle-aged Asian adults and underscore the need for diabetes screening among high-risk Asian groups at healthy BMI levels.
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Affiliation(s)
- William S Vicks
- Department of Medicine, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
| | - Joan C Lo
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
- The Permanente Medical Group, Oakland, CA, USA
| | - Lynn Guo
- Albany Medical College, Albany, NY, USA
| | - Jamal S Rana
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
- The Permanente Medical Group, Oakland, CA, USA
- Department of Cardiology, Kaiser Permanente East Bay, Oakland, CA, USA
| | - Sherry Zhang
- Department of Medicine, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
| | - Nirmala D Ramalingam
- Graduate Medical Education, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
| | - Nancy P Gordon
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA.
- The Permanente Medical Group, Oakland, CA, USA.
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11
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Rahmati M, Saei Ghare Naz M, Azizi F, Ramezani Tehrani F. Pregnancy loss and subsequent risk of prediabetes, diabetes and metabolic syndrome in couples: Tehran lipid and glucose study. Lab Invest 2022; 20:372. [PMID: 35982490 PMCID: PMC9389652 DOI: 10.1186/s12967-022-03578-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 08/07/2022] [Indexed: 12/15/2022]
Abstract
Background There is limited evidence regarding the impact of pregnancy loss on the subsequent risk of metabolic disorders. We aimed to investigate whether history of pregnancy loss is associated with the subsequent risk of prediabetes (pre-DM), diabetes (DM), and metabolic syndrome (METs) among couples. Method In this population-based cohort study, 2765 couples with and without history of pregnancy loss and free of DM, pre-DM, and METs at baseline were included and followed for incidents of DM, pre-DM, and METs by 3-year intervals visits from 1999 to 2018. Detailed data of variables was collected using standard questionnaires, interviews, clinical and laboratory assessments. A modified Poisson regression for binary outcome data with a log link function and robust error variance was used to estimate relative risks (RRs) in couples with and without history of pregnancy loss. Both unadjusted and adjusted models were fitted, and effect measures were calculated. Result During a median follow-up of 15 years, females with history of pregnancy loss were experienced more pre-DM (50% vs. 45.5%), DM (28.9% vs. 21.3%), and METs (70% vs. 60.1%) than females without such history. Moreover, history of pregnancy loss increased the risk of METs by 8% among females. The incidence of DM in males with history of pregnancy loss in their spouses was higher than in males without it (28.8% vs. 23.5%). Among males, having a spouse with history of pregnancy loss was positively associated with the risk of pre-DM (RR = 1.12; 95%CI: 1.02, 1.23, p = 0.02); furthermore, they were more prone to the risk of METs than females with a history of pregnancy loss (RR = 1.13; 95%CI: 1.07, 1.20, p < 0.001). Conclusion Although pregnancy loss is a female-specific factor, may foreshadow the subsequent METs, our study identified a higher risk of subsequent pre-DM and METs in males with history of pregnancy loss in their spouses. Pregnancy loss could be considered a possible future risk factor for metabolic disorders in couples.
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Affiliation(s)
- Maryam Rahmati
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid, Beheshti University of Medical Sciences, Tehran, Iran
| | - Marzieh Saei Ghare Naz
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid, Beheshti University of Medical Sciences, Tehran, Iran.
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid, Beheshti University of Medical Sciences, Tehran, Iran
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12
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Jamil A, Jonkman LJ, Miller M, Jennings L, Connor SE. Medication adherence and health beliefs among South Asian immigrants with diabetes in the United States: A qualitative study. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Amna Jamil
- UPMC Presbyterian‐Shadyside Pittsburgh Pennsylvania USA
| | - Lauren J. Jonkman
- Department of Pharmacy & Therapeutics University of Pittsburgh School of Pharmacy Pittsburgh Pennsylvania USA
| | - Michelle Miller
- University of Pittsburgh School of Pharmacy Pittsburgh Pennsylvania USA
| | - Luke Jennings
- University of Pittsburgh School of Pharmacy Pittsburgh Pennsylvania USA
| | - Sharon E. Connor
- Department of Pharmacy & Therapeutics University of Pittsburgh School of Pharmacy Pittsburgh Pennsylvania USA
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13
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Siddiqui ZA, Sambamoorthi U. Psychological Distress Among Asian Indians and Non-Hispanic Whites in the United States. Health Equity 2022; 6:516-526. [PMID: 36186615 PMCID: PMC9518809 DOI: 10.1089/heq.2021.0159] [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] [Accepted: 05/31/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction The prevalence of psychological distress (PD) among Asian Indians is unknown. This study estimated and compared moderate-serious PD in Asian Indians and non-Hispanic Whites (NHWs) in the United States. Methods We used a cross-sectional design using the National Health Interview Survey (2012-2017). Adult (age >18 years) NHWs and Asian Indians (N=2,218) were included. PD was measured using the six-item Kessler (K6) scale. We used multivariable logistic regression to determine the association of Asian Indian ethnicity with PD. Results In the analysis, 19.9% of NHWs and 11.0% of Asian Indians reported moderate-serious PD. Asian Indians were less likely to report PD in both unadjusted (unadjusted odds ratio=0.50; 95% confidence interval [CI]=0.42-0.58) and fully adjusted (adjusted odds ratio=0.7; 95% CI 0.59-0.82) models. Conclusions Asian Indians had a lower prevalence of PD than NHWs, likely due to multiple protective factors such as high socioeconomic status and lower multimorbidity.
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Affiliation(s)
- Zasim Azhar Siddiqui
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Robert C. Byrd Health Sciences Center, Morgantown, West Virginia, USA
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Robert C. Byrd Health Sciences Center, Morgantown, West Virginia, USA
- Department of Pharmacotherapy, College of Pharmacy, Texas Center for Health Disparities, University of North Texas Health Science Center, Fort Worth, Texas, USA
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14
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Dod R, Rajendran A, Kathrotia M, Clarke A, Dodani S. Cardiovascular Disease in South Asian Immigrants: a Review of Dysfunctional HDL as a Potential Marker. J Racial Ethn Health Disparities 2022; 10:1194-1200. [PMID: 35449485 PMCID: PMC9022895 DOI: 10.1007/s40615-022-01306-6] [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: 02/09/2022] [Revised: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 11/24/2022]
Abstract
South Asians (SAs) account for a quarter of the world's population and are one of the fastest-growing immigrant groups in the United States (US). South Asian Immigrants (SAIs) are disproportionately more at risk of developing cardiovascular disease (CVD) than other ethnic/racial groups. Atherosclerosis is a chronic inflammatory disorder and is the major cause of CVD. Traditional CVD risk factors, though important, do not fully explain the elevated risk of CVD in SAIs. High-density lipoproteins (HDLs) are heterogeneous lipoproteins that modify their composition and functionality depending on physiological or pathological conditions. With its cholesterol efflux, anti-inflammatory, and antioxidant functions, HDL is traditionally considered a protective factor for CVD. However, its functions can be compromised under pathological conditions, such as chronic inflammation, making it dysfunctional (Dys-HDL). SAIs have a high prevalence of type 2 diabetes and metabolic syndrome, which may further promote Dys-HDL. This review explores the potential association between Dys-HDL and CVD in SAIs and presents current literature discussing the role of Dys-HDL in CVD.
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Affiliation(s)
- Rohan Dod
- School of Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Aishwarya Rajendran
- EVMS - Sentara Healthcare Analytics and Delivery Science Institute, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Mayuri Kathrotia
- School of Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Amanda Clarke
- EVMS - Sentara Healthcare Analytics and Delivery Science Institute, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Sunita Dodani
- School of Medicine, Eastern Virginia Medical School, Norfolk, VA, USA. .,EVMS - Sentara Healthcare Analytics and Delivery Science Institute, Eastern Virginia Medical School, Norfolk, VA, USA.
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15
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Overview of the Composition of Whole Grains’ Phenolic Acids and Dietary Fibre and Their Effect on Chronic Non-Communicable Diseases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19053042. [PMID: 35270737 PMCID: PMC8910396 DOI: 10.3390/ijerph19053042] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/22/2022] [Accepted: 02/26/2022] [Indexed: 02/01/2023]
Abstract
Chronic non-communicable diseases are the major cause of death globally. Whole grains are recommended in dietary guidelines worldwide due to increasing evidence that their consumption can improve health beyond just providing energy and nutrients. Epidemiological studies have suggested that the incorporation of whole grains, as part of a healthy diet, plays a key role in reducing one’s risk for cardiovascular diseases (CVDs), obesity, type 2 diabetes (T2D) and cancer. Phenolic acids and dietary fibre are important components found in whole grains that are largely responsible for these health advantages. Both phenolic acids and dietary fibre, which are predominantly present in the bran layer, are abundant in whole-grain cereals and pseudo-cereals. Several studies indicate that whole grain dietary fibre and phenolic acids are linked to health regulation. The main focus of this study is two-fold. First, we provide an overview of phenolic acids and dietary fibres found in whole grains (wheat, barley, oats, rice and buckwheat). Second, we review existing literature on the linkages between the consumption of whole grains and the development of the following chronic non-communicable diseases: CVDs, obesity, T2D and cancer. Altogether, scientific evidence that the intake of whole grains reduces the risk of certain chronic non-communicable disease is encouraging but not convincing. Based on previous studies, the current review encourages further research to cover the gap between the emerging science of whole grains and human health.
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16
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Prasad GVR, Bhamidi V. Managing cardiovascular disease risk in South Asian kidney transplant recipients. World J Transplant 2021; 11:147-160. [PMID: 34164291 PMCID: PMC8218347 DOI: 10.5500/wjt.v11.i6.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/12/2021] [Accepted: 05/22/2021] [Indexed: 02/06/2023] Open
Abstract
South Asians (SA) are at higher cardiovascular risk than other ethnic groups, and SA kidney transplant recipients (SA KTR) are no exception. SA KTR experience increased major adverse cardiovascular events both early and late post-transplantation. Cardiovascular risk management should therefore begin well before transplantation. SA candidates may require aggressive screening for pre-transplant cardiovascular disease (CVD) due to their ethnicity and comorbidities. Recording SA ethnicity during the pre-transplant evaluation may enable programs to better assess cardiovascular risk, thus allowing for earlier targeted peri- and post-transplant intervention to improve cardiovascular outcomes. Diabetes remains the most prominent post-transplant cardiovascular risk factor in SA KTR. Diabetes also clusters with other metabolic syndrome components including lower high-density lipoprotein cholesterol, higher triglycerides, hypertension, and central obesity in this population. Dyslipidemia, metabolic syndrome, and obesity are all significant CVD risk factors in SA KTR, and contribute to increased insulin resistance. Novel biomarkers such as adiponectin, apolipoprotein B, and lipoprotein (a) may be especially important to study in SA KTR. Focused interventions to improve health behaviors involving diet and exercise may especially benefit SA KTR. However, there are few interventional clinical trials specific to the SA population, and none are specific to SA KTR. In all cases, understanding the nuances of managing SA KTR as a distinct post-transplant group, while still screening for and managing each CVD risk factor individually in all patients may help improve the long-term success of all kidney transplant programs catering to multi-ethnic populations.
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Affiliation(s)
- G V Ramesh Prasad
- Kidney Transplant Program, St. Michael's Hospital, Toronto M5C 2T2, ON, Canada
| | - Vaishnavi Bhamidi
- Kidney Transplant Program, St. Michael's Hospital, Toronto M5C 2T2, ON, Canada
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Kalra D, Vijayaraghavan K, Sikand G, Desai NR, Joshi PH, Mehta A, Karmally W, Vani A, Sitafalwalla SJ, Puri R, Duell PB, Brown A. Prevention of atherosclerotic cardiovascular disease in South Asians in the US: A clinical perspective from the National Lipid Association. J Clin Lipidol 2021; 15:402-422. [PMID: 33846108 DOI: 10.1016/j.jacl.2021.03.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/20/2021] [Indexed: 12/24/2022]
Abstract
It is now well recognized that South Asians living in the US (SAUS) have a higher prevalence of atherosclerotic cardiovascular disease (ASCVD) that begins earlier and is more aggressive than age-matched people of other ethnicities. SA ancestry is now recognized as a risk enhancer in the US cholesterol treatment guidelines. The pathophysiology of this is not fully understood but may relate to insulin resistance, genetic and dietary factors, lack of physical exercise, visceral adiposity and other, yet undiscovered biologic mechanisms. In this expert consensus document, we review the epidemiology of ASCVD in this population, enumerate the challenges faced in tackling this problem, provide strategies for early screening and education of the community and their healthcare providers, and offer practical prevention strategies and culturally-tailored dietary advice to lower the rates of ASCVD in this cohort.
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Affiliation(s)
- Dinesh Kalra
- Division of Cardiology, Rush University Medical Center, 1620W. Harrison St, Kellogg Suite 320, Chicago, IL 60612, United States.
| | | | - Geeta Sikand
- University of California Irvine School of Medicine, Irvine, CA, United States
| | - Nihar R Desai
- Yale School of Medicine, New Haven, CT, United States
| | - Parag H Joshi
- University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Anurag Mehta
- Emory University School of Medicine, Atlanta, GA, United States
| | - Wahida Karmally
- Columbia University Irving Medical Center, New York, NY, United States
| | - Anish Vani
- New York University Langone Health, New York, NY, United States
| | | | - Raman Puri
- Lipid Association of India, New Delhi, India
| | - P Barton Duell
- Oregon Health and Science University, Portland, OR, United States
| | - Alan Brown
- Advocate Lutheran General Hospital, Park Ridge, IL, United States
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18
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Group Dance and Motivational Coaching for Walking: A Physical Activity Program for South Asian Indian Immigrant Women Residing in the United States. J Phys Act Health 2021; 18:262-271. [PMID: 33540381 DOI: 10.1123/jpah.2019-0316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 01/05/2020] [Accepted: 11/20/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND South Asian Indian immigrants residing in the United States are at high risk of cardiovascular disease (prevalence ≥35%), diabetes (prevalence 45.4%), and stroke (prevalence 26.5%). This study examined the effect of culturally relevant physical activity interventions on the improvement of physiological measures and average daily steps in at-risk midlife South Asian Indian immigrant women. METHODS In this 2-arm interventional research design, the dance (n = 25) and the motivational phone calls group (n = 25), attended social cognitive theory-based motivational workshops every 2 weeks for the first 12 weeks. Data for weight, waist circumference, blood pressure, blood sugar, cholesterol level, and 12-lead electrocardiogram were collected at the baseline, 12 weeks, and 24 weeks. RESULTS Significant differences were seen in body weight (F2,94 = 4.826, P = .024; ηp2=.093), waist circumference (F2,92 = 7.496, P = .001; ηp2=.140), systolic blood pressure (F2,94 = 19.865, P = .000; ηp2=.2970), triglyceride (F2,94 = 11.111, P = .000; ηp2=.191), cholesterol (F2,94 = 8.925, P = .001; ηp2=.160), blood sugar level (F2,94 = 8.851, P = .000; ηp2=.158), and average daily steps across both intervention groups over time (F2,96 = 30.94, P = .000; ηp2=.392). CONCLUSION Culturally relevant motivational workshops with Indian dance and walking are an innovative approach to increasing lifestyle physical activity among South Asian Indian immigrant women.
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19
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Wolf RM, Nagpal M, Magge SN. Diabetes and cardiometabolic risk in South Asian youth: A review. Pediatr Diabetes 2021; 22:52-66. [PMID: 32666595 PMCID: PMC8191592 DOI: 10.1111/pedi.13078] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/22/2020] [Accepted: 06/02/2020] [Indexed: 12/15/2022] Open
Abstract
South Asians are at increased risk for developing type 2 diabetes and cardiovascular disease at lower body mass index compared to other ancestral groups. Many factors contribute to this increased risk, including genetics, maternal-fetal factors, diet, fitness, body composition, and unique pathophysiology. Increased cardiometabolic risk is also seen at younger ages in South Asian individuals as compared to their White counterparts. This risk persists in migrant communities outside of South Asia. With the growing prevalence of obesity, diabetes, and cardiovascular disease in the South Asian population, it is imperative that we had better understand the mechanisms underlying this increased risk and implement strategies to address this growing public health problem during childhood and adolescence.
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Affiliation(s)
- Risa M Wolf
- Department of Pediatrics, Division of Endocrinology and Diabetes, Johns Hopkins University School of Medicine
| | - Mohika Nagpal
- Department of Pediatrics, Division of Endocrinology and Diabetes, Johns Hopkins University School of Medicine
| | - Sheela N. Magge
- Department of Pediatrics, Division of Endocrinology and Diabetes, Johns Hopkins University School of Medicine
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20
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Feldman JM, Conderino S, Islam NS, Thorpe LE. Subgroup Variation and Neighborhood Social Gradients-an Analysis of Hypertension and Diabetes Among Asian Patients (New York City, 2014-2017). J Racial Ethn Health Disparities 2021; 8:256-263. [PMID: 32488823 PMCID: PMC7708414 DOI: 10.1007/s40615-020-00779-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 05/19/2020] [Accepted: 05/22/2020] [Indexed: 10/24/2022]
Abstract
Diabetes and hypertension are socially patterned by individual race/ethnicity and by neighborhood economic context, but distributions among Asian subgroups are undercharacterized. We examined variation in prevalence for both conditions, comparing between US Asian subgroups, including within South Asian nationalities, and comparing within subgroups by neighborhood economic context. We obtained data on a non-probability sample of 633,664 patients ages 18-64 in New York City, NY, USA (2014-2017); 30,138 belonged to one of seven Asian subgroups (Asian Indian, Bangladeshi, Pakistani, Chinese, Korean, Japanese, and Filipino). We used electronic health records to classify disease status. We characterized census tract economic context using the Index of Concentration at the Extremes and estimated prevalence differences using multilevel models. Among Asian men, hypertension prevalence was highest for Filipinos. Among Asian women, hypertension prevalence was highest for Filipinas and Bangladeshis. Diabetes prevalence was highest among Pakistanis and Bangladeshis of both genders, exceeding all other Asian and non-Asian groups. There was consistent evidence of an economic gradient for both conditions, whereby persons residing in the most privileged neighborhood tertile had the lowest disease prevalence. The economic gradient was particularly strong for diabetes among Pakistanis, whose prevalence in the most deprived tertile exceeded that of the most privileged by 9 percentage points (95% CI 3, 14). Only Koreans departed from the trend, experiencing the highest diabetes prevalence in the most privileged tertile. US Asian subgroups largely demonstrate similar neighborhood economic gradients as other groups. Disaggregating Asian subgroups, including within South Asian nationalities, reveals important heterogeneity in prevalence.
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Affiliation(s)
- Justin M Feldman
- Department of Population Health, NYU School of Medicine, 180 Madison Ave., 5th Floor, New York, NY, 10016, USA.
| | - Sarah Conderino
- Department of Population Health, NYU School of Medicine, 180 Madison Ave., 5th Floor, New York, NY, 10016, USA
| | - Nadia S Islam
- Department of Population Health, NYU School of Medicine, 180 Madison Ave., 5th Floor, New York, NY, 10016, USA
| | - Lorna E Thorpe
- Department of Population Health, NYU School of Medicine, 180 Madison Ave., 5th Floor, New York, NY, 10016, USA
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21
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Zhu L, Spence C, Yang WJ, Ma GX. The IDF Definition Is Better Suited for Screening Metabolic Syndrome and Estimating Risks of Diabetes in Asian American Adults: Evidence from NHANES 2011-2016. J Clin Med 2020; 9:jcm9123871. [PMID: 33260754 PMCID: PMC7759813 DOI: 10.3390/jcm9123871] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE extensive effort has been made to better define metabolic syndrome (MetS). Whether current definitions accurately diagnose MetS and predict risk of cardiovascular disease (CVD) or diabetes in diverse ethnic groups remains largely unknown. The objective of this study was to compare the prevalence of MetS and risk of CVD and diabetes among Asian American adults using two MetS definitions, one proposed by the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III) and one by the International Diabetes Federation (IDF). METHODS we obtained a nationally representative sample of 2121 Asian American adults in the noninstitutionalized civilian population of the United States from the National Health and Nutrition Examination Survey (2011-2016). We computed age-adjusted, gender-specific MetS prevalence and each MetS component using ATP III and IDF definitions. RESULTS based on the IDF definition, MetS prevalence was 39.26% among Asian American men and 39.66% among Asian American women included in the study sample. Based on the ATP III definition, MetS prevalence in our sample was 39.38% among men and 36.11% among women. We found good concordance between the IDF and the ATP III definitions in identifying MetS in Asian American adults. Those with MetS defined only by the IDF definition had significantly higher body mass index (BMI) and waist circumference than those with MetS defined only by the ATP III definition. The IDF definition also better predicted elevated fasting insulin. CONCLUSIONS the IDF definition is more pertinent than the ATP III definition for screening and estimating risk of CVD and diabetes in Asian American adults. Future studies should examine differences in MetS prevalence across Asian ethnic groups to facilitate the development of culturally tailored strategies improve MetS prevention and detection in Asian Americans.
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Affiliation(s)
- Lin Zhu
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; (W.J.Y.); (G.X.M.)
- Correspondence: ; Tel.: +1-215-707-4039
| | - Cody Spence
- Department of Sociology, College of Liberal Art, Temple University, Philadelphia, PA 19122, USA;
| | - Wei Jenny Yang
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; (W.J.Y.); (G.X.M.)
| | - Grace X. Ma
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; (W.J.Y.); (G.X.M.)
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Alkandari A, Alarouj M, Elkum N, Sharma P, Devarajan S, Abu-Farha M, Al-Mulla F, Tuomilehto J, Bennakhi A. Adult Diabetes and Prediabetes Prevalence in Kuwait: Data from the Cross-Sectional Kuwait Diabetes Epidemiology Program. J Clin Med 2020; 9:E3420. [PMID: 33113867 PMCID: PMC7694112 DOI: 10.3390/jcm9113420] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/13/2020] [Accepted: 10/22/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND This study aimed to estimate the prevalence of diabetes and prediabetes in adults in Kuwait. METHODS The Kuwait Diabetes Epidemiology Program was a nationally representative, cross-sectional study of diabetes and obesity in Kuwait conducted between 2011 and 2014. The survey sampled 4937 adults in Kuwait aged 20 years or more and recorded participants' demographics, behaviours, medical history, physical measurements and blood biochemical measurements. Prediabetes was defined as fasting plasma glucose between 6.1 and 6.9 mmol/L or HbA1c between 6 and 6.4% (42-47 mmol/mol). Diabetes was defined as self-reported history with prescribed glucose-lowering medication or FPG ≥7mmol/L or HbA1c level ≥6.5% (≥48 mmol/mol). RESULTS The overall adjusted prevalence of diabetes was 19.1%. The overall adjusted prevalence of prediabetes was 13.5%. Diabetes prevalence was 5.4%, 14.2%, 38.7% and 64.8% in adults aged 20-29, 30-44, 45-59 and 60 years or more, respectively. Diabetes prevalence was 22.4% in men and 14.4% in women. Prediabetes prevalence was 14.8% in men and 11.5% in women. In Kuwaitis, diabetes and prediabetes prevalence was 21.8% and 11.1%, respectively, while prevalence in non-Kuwaitis was 18.2% for diabetes and 14.3% for prediabetes. CONCLUSION These findings illustrate the severe public health challenge posed by diabetes in Kuwait.
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Affiliation(s)
- Abdullah Alkandari
- Dasman Diabetes Institute, Kuwait City 15462, Kuwait; (M.A.); (P.S.); (S.D.); (M.A.-F.); (F.A.-M.); (A.B.)
| | - Monira Alarouj
- Dasman Diabetes Institute, Kuwait City 15462, Kuwait; (M.A.); (P.S.); (S.D.); (M.A.-F.); (F.A.-M.); (A.B.)
| | - Naser Elkum
- Sidra Medical and Research Center, Doha 26999, Qatar;
| | - Prem Sharma
- Dasman Diabetes Institute, Kuwait City 15462, Kuwait; (M.A.); (P.S.); (S.D.); (M.A.-F.); (F.A.-M.); (A.B.)
| | - Sriraman Devarajan
- Dasman Diabetes Institute, Kuwait City 15462, Kuwait; (M.A.); (P.S.); (S.D.); (M.A.-F.); (F.A.-M.); (A.B.)
| | - Mohamed Abu-Farha
- Dasman Diabetes Institute, Kuwait City 15462, Kuwait; (M.A.); (P.S.); (S.D.); (M.A.-F.); (F.A.-M.); (A.B.)
| | - Fahd Al-Mulla
- Dasman Diabetes Institute, Kuwait City 15462, Kuwait; (M.A.); (P.S.); (S.D.); (M.A.-F.); (F.A.-M.); (A.B.)
| | - Jaakko Tuomilehto
- Public Health Prevention Unit, Finnish Institute for Health and Welfare, FI-00271 Helsinki, Finland;
| | - Abdullah Bennakhi
- Dasman Diabetes Institute, Kuwait City 15462, Kuwait; (M.A.); (P.S.); (S.D.); (M.A.-F.); (F.A.-M.); (A.B.)
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Prevalence of Multimorbidity among Asian Indian, Chinese, and Non-Hispanic White Adults in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17093336. [PMID: 32403412 PMCID: PMC7246600 DOI: 10.3390/ijerph17093336] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/04/2020] [Accepted: 05/08/2020] [Indexed: 11/23/2022]
Abstract
Asian Americans are the fastest-growing minority group in the United States, yet little is known about their multimorbidity. This study examined the association of Asian Indians, Chinese and non-Hispanic whites (NHWs) to multimorbidity, defined as the concurrent presence of two or more chronic conditions in the same individual. We used a cross-sectional design with data from the National Health Interview Survey (2012–2017) of Asian Indians, Chinese, and NHWs (N = 132,666). Logistic regressions were used to examine the adjusted association of race/ethnicity to multimorbidity. There were 1.9% Asian Indians, 1.8% Chinese, and 96.3% NHWs. In unadjusted analyses (p < 0.001), 17.1% Asian Indians, 17.9% Chinese, and 39.0% NHWs had multimorbidity. Among the dyads, high cholesterol and hypertension were the most common combination of chronic conditions among Asian Indians (32.4%), Chinese (41.0%), and NHWs (20.6%). Asian Indians (AOR = 0.73, 95% CI = (0.61, 0.89)) and Chinese (AOR = 0.63, 95% CI = (0.53, 0.75)) were less likely to have multimorbidity compared to NHWs, after controlling for age, sex, and other risk factors. However, Asian Indians and Chinese were more likely to have high cholesterol and hypertension, risk factors for diabetes and heart disease.
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Vimaleswaran KS. A nutrigenetics approach to study the impact of genetic and lifestyle factors on cardiometabolic traits in various ethnic groups: findings from the GeNuIne Collaboration. Proc Nutr Soc 2020; 79:194-204. [PMID: 32000867 DOI: 10.1017/s0029665119001186] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Several studies on gene-diet interactions (nutrigenetics) have been performed in western populations; however, there are only a few studies to date in lower middle-income countries (LMIC). A large-scale collaborative project called gene-nutrient interactions (GeNuIne) Collaboration, the main objective of which is to investigate the effect of GeNuIne on cardiometabolic traits using population-based studies from various ethnic groups, has been initiated at the University of Reading, UK. While South Asians with higher genetic risk score (GRS) showed a higher risk of obesity in response to a high-carbohydrate diet, South East and Western Asian populations with higher GRS showed an increased risk of central obesity in response to a high-protein diet. The paper also provides a summary of other gene-diet interaction analyses that were performed in LMIC as part of this collaborative project and gives an overview of how these nutrigenetic findings can be translated to personalised and public health approaches for the prevention of cardiometabolic diseases such as obesity, type 2 diabetes and CVD.
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Affiliation(s)
- Karani S Vimaleswaran
- Department of Food and Nutritional Sciences, Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research, University of Reading, Reading, UK
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Al-Sofiani ME, Langan S, Kanaya AM, Kandula NR, Needham BL, Kim C, Vaidya D, Golden SH, Gudzune KA, Lee CJ. The relationship of acculturation to cardiovascular disease risk factors among U.S. South Asians: Findings from the MASALA study. Diabetes Res Clin Pract 2020; 161:108052. [PMID: 32113027 PMCID: PMC7445080 DOI: 10.1016/j.diabres.2020.108052] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 01/23/2020] [Accepted: 01/31/2020] [Indexed: 12/22/2022]
Abstract
AIM We investigated the association between acculturation strategies and cardiometabolic risk among South Asian (SA) immigrants in the US. METHODS In this cross-sectional analysis of data from 849 SA participants in the Mediators of Atherosclerosis in SAs Living in America (MASALA), we performed multidimensional measures of acculturation to categorize the participants into three acculturation classes: separation (preference for SA culture), assimilation (preference for US culture), and integration (similar preference for both cultures). Differences in glycemic indices, blood pressure, lipid parameters and body composition by acculturation strategy were examined. RESULTS Women in the integration class had the lowest prevalence of diabetes (16.4%), prediabetes (29.7%), fasting and 2-h glucose compared to women in the separation class with the highest prevalence of diabetes (29.3%), prediabetes (31.5%), fasting and 2-h glucose and 2-hr insulin (all p < 0.05). Women in the assimilation class had significantly lower triglycerides, BMI, and waist circumference and higher HDL compared to women in the separation class after adjusting for age, study site, and years in the US. After additionally accounting for socioeconomic/lifestyle factors, women in the assimilation class had significantly lower triglyceride and higher HDL levels compared to women in the separation class (p < 0.01). There was no significant association between acculturation strategies and cardiometabolic risk in SA men. CONCLUSION SA women who employed an assimilation or integration strategy had a more favorable cardiometabolic profile compared to women using a separation strategy. Future research should investigate the behavioral and psychosocial pathways linking acculturation strategies with cardiometabolic health to inform preventive interventions among SAs living in America.
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Affiliation(s)
- Mohammed E Al-Sofiani
- Division of Endocrinology, Diabetes & Metabolism, King Saud University, Riyadh, Saudi Arabia; Division of Endocrinology, College of Medicine, The Johns Hopkins University, Baltimore, MD, United States; Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Susan Langan
- Division of Endocrinology, College of Medicine, The Johns Hopkins University, Baltimore, MD, United States
| | - Alka M Kanaya
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Namratha R Kandula
- Feinberg School of Medicine, Division of General Internal Medicine, Northwestern University, Chicago, IL, United States
| | - Belinda L Needham
- Department of Epidemiology and Center for Social Epidemiology and Population Health, University of Michigan, Ann Arbor, MI, United States
| | - Catherine Kim
- Departments of Medicine, Obstetrics & Gynecology, and Epidemiology, University of Michigan, Ann Arbor, MI, United States
| | - Dhananjay Vaidya
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Sherita H Golden
- Division of Endocrinology, College of Medicine, The Johns Hopkins University, Baltimore, MD, United States; The Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University, Baltimore, MD, United States
| | - Kimberly A Gudzune
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, United States; The Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University, Baltimore, MD, United States
| | - Clare J Lee
- Division of Endocrinology, College of Medicine, The Johns Hopkins University, Baltimore, MD, United States.
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Gill G, Lancki N, Randhawa M, Mann SK, Arechiga A, Smith RD, Soret S, Kanaya AM, Kandula N. Linkage between Neighborhood Social Cohesion and BMI of South Asians in the Masala Study. J Obes 2020; 2020:7937530. [PMID: 31998534 PMCID: PMC6969985 DOI: 10.1155/2020/7937530] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/11/2019] [Accepted: 08/20/2019] [Indexed: 11/17/2022] Open
Abstract
UNLABELLED Introduction. South Asians in the United States have a high prevalence of obesity and an elevated risk for cardiometabolic diseases. Yet, little is known about how aspects of neighborhood environment influence cardiometabolic risk factors such as body mass index (BMI) in this rapidly growing population. We aimed to investigate the association between perceived neighborhood social cohesion and BMI among South Asians. METHODS We utilized cross-sectional data from the MASALA study, a prospective community-based cohort of 906 South Asian men and women from the San Francisco Bay area and the greater Chicago area. Multivariable linear regression models, stratified by sex, were used to examine the association between perceived level of neighborhood social cohesion and individual BMI after adjusting for sociodemographics. RESULTS Participants were 54% male, with an average age of 55 years, 88% had at least a bachelor's degree, and the average BMI was 26.0 kg/m2. South Asian women living in neighborhoods with the lowest social cohesion had a significantly higher BMI than women living in neighborhoods with the highest cohesion (β coefficient = 1.48, 95% CI 0.46-2.51, p=0.02); however, the association was not statistically significant after adjusting for sociodemographic factors (β coefficient = 1.48, 95% CI 0.46-2.51, p=0.02); however, the association was not statistically significant after adjusting for sociodemographic factors (. CONCLUSION Perceived neighborhood social cohesion was not significantly associated with BMI among South Asians in our study sample. Further research is recommended to explore whether other neighborhood characteristics may be associated with BMI and other health outcomes in South Asians and the mechanisms through which neighborhood may influence health.
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Affiliation(s)
- Gagandeep Gill
- School of Public Health, Loma Linda University, Loma Linda, CA, USA
| | - Nicola Lancki
- Northwestern University Feinberg School of Medicine, Departments of Medicine and Preventive Medicine, Chicago, IL, USA
| | | | - Semran K. Mann
- School of Behavioral Health, Loma Linda University, Loma Linda, CA, USA
| | - Adam Arechiga
- School of Behavioral Health, Loma Linda University, Loma Linda, CA, USA
| | - Robin D. Smith
- School of Public Health, Loma Linda University, Loma Linda, CA, USA
| | - Samuel Soret
- School of Public Health, Loma Linda University, Loma Linda, CA, USA
| | | | - Namratha Kandula
- Northwestern University Feinberg School of Medicine, Departments of Medicine and Preventive Medicine, Chicago, IL, USA
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Yu Y, Paul K, Arah OA, Mayeda ER, Wu J, Lee E, Shih IF, Su J, Jerrett M, Haan M, Ritz B. Air pollution, noise exposure, and metabolic syndrome - A cohort study in elderly Mexican-Americans in Sacramento area. ENVIRONMENT INTERNATIONAL 2020; 134:105269. [PMID: 31778933 PMCID: PMC6953612 DOI: 10.1016/j.envint.2019.105269] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 08/30/2019] [Accepted: 10/14/2019] [Indexed: 05/25/2023]
Abstract
BACKGROUND Previous studies suggested that air pollutants may increase the incidence of metabolic syndrome, but the potential impact from traffic sources is not well-understood. This study aimed to investigate associations between traffic-related nitrogen oxides (NOx) or noise pollution and risk of incident metabolic syndrome and its components in an elderly Mexican-American population. METHODS A total of 1,554 Mexican-American participants of the Sacramento Area Latino Study on Aging (SALSA) cohort were followed from 1998 to 2007. We used anthropometric measures and biomarkers to define metabolic syndrome according to the recommendations of the Third Adult Treatment Panel of the National Cholesterol Education Program (NCEP ATP III). Based on participants' residential addresses at baseline, estimates of local traffic-related NOx were generated using the California Line Source Dispersion Model version 4 (CALINE4), and of noise employing the SoundPLAN software package. We used Cox regression models with calendar time as the underlying time scale to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations of air pollution or noise with metabolic syndrome or its components. RESULTS Each per unit increase of traffic-related NOx (2.29 parts per billion (ppb)) was associated with a 15% (HR = 1.15, 95% CI: 1.04-1.28) lower level of high-density lipoprotein cholesterol (HDL-cholesterol), and each 11.6 decibels (dB) increase in noise increased the risk of developing metabolic syndrome by 17% (HR = 1.17, 95% CI: 1.01-1.35). CONCLUSION Policies aiming to reduce traffic-related air pollution and noise might mitigate the risk of metabolic syndrome and its components in vulnerable populations.
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Affiliation(s)
- Yu Yu
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Kimberly Paul
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Onyebuchi A Arah
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA; Department of Statistics, UCLA College of Letters and Science, Los Angeles, CA, USA
| | - Elizabeth Rose Mayeda
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Jun Wu
- Program in Public Health, Susan and Henry Samueli College of Health Sciences, UCI, Irvine, USA
| | - Eunice Lee
- Division of Environmental Health Science, UCB School of Public Health, Berkeley, CA, USA
| | - I-Fan Shih
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Jason Su
- Division of Environmental Health Science, UCB School of Public Health, Berkeley, CA, USA
| | - Michael Jerrett
- Department of Environmental Health Science, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Mary Haan
- Department of Epidemiology & Biostatistics, UCSF, San Francisco, CA, USA
| | - Beate Ritz
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA; Department of Environmental Health Science, UCLA Fielding School of Public Health, Los Angeles, CA, USA; Department of Neurology, David Geffen School of Medicine, Los Angeles, CA, USA.
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Mathew Joseph N, Misra R, Wang J. Mediating Role of Acculturation and Lifestyle Behaviors on Cardiometabolic Risk Among a National Sample of U.S. Asian Indians. J Immigr Minor Health 2019; 22:727-735. [PMID: 31485817 DOI: 10.1007/s10903-019-00930-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Asian Indians are the third largest and fastest growing Asian subgroup in the U.S. and have high risks for diabetes and cardiovascular disease. This study explored the mediating role of lifestyle behaviors on the relationship between acculturation and cardiometabolic risk factors among Asian Indians using the Diabetes in Indian Americans national study. The cross-sectional study sample comprised 1038 randomly selected adult Asian Indians in seven U.S. sites. Acculturation was assessed using the Acculturation Scale for Southeast Asians. Diet and lifestyle behaviors were measured using the Health-Promoting Lifestyle Profile II subscales. Path analyses with bootstrap methods were conducted. Dietary behavior significantly mediated the relationship between acculturation and HbA1C (β = 0.004, p = 0.047), and physical activity mediated the relationship between acculturation and HDL (β = 0.08, p = 0.011). Other mediation models were not significant (p > 0.05). Mediating factors besides lifestyle behaviors should be explored in future studies.
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Affiliation(s)
- Nitha Mathew Joseph
- Department of Undergraduate Studies, Cizik School of Nursing, The University of Texas Health Science Center at Houston, 6901 Bertner Ave, Houston, TX, 77030, USA.
| | - Ranjita Misra
- Department of Social and Behavioral Sciences, Robert C. Byrd Health Sciences Center, School of Public Health, West Virginia University, Morgantown, WV, 26506-9190, USA
| | - Jing Wang
- School of Nursing, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., MC 7950, San Antonio, TX, 78229, USA
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Fazli GS, Moineddin R, Bierman AS, Booth GL. Ethnic differences in prediabetes incidence among immigrants to Canada: a population-based cohort study. BMC Med 2019; 17:100. [PMID: 31122233 PMCID: PMC6533737 DOI: 10.1186/s12916-019-1337-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 04/30/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Prediabetes appears to be increasing worldwide. This study examined the incidence of prediabetes among immigrants to Canada of different ethnic origins and the age at which ethnic differences emerged. METHODS We assembled a cohort of Ontario adults (≥ 20 years) with normoglycemia based on glucose testing performed between 2002 and 2011 through a single commercial laboratory database (N = 1,772,180). Immigration data were used to assign ethnicity based on country of origin, mother tongue, and surname. Individuals were followed until December 2013 for the development of prediabetes, defined using either the World Health Organization/Diabetes Canada (WHO/DC) or American Diabetes Association (ADA) thresholds. Multivariate competing risk regression models were derived to examine the effect of ethnicity and immigration status on prediabetes incidence. RESULTS After a median follow-up of 8.0 years, 337,608 individuals developed prediabetes. Using definitions based on WHO/DC, the adjusted cumulative incidence of prediabetes was 40% (HR 1.40, CI 1.38-1.41) higher for immigrants relative to long-term Canadian residents (21.2% vs 16.0%, p < 0.001) and nearly twofold higher among South Asian than Western European immigrants (23.6%; HR 1.95, CI1.87-2.03 vs 13.1%; referent). Cumulative incidence rates based on ADA thresholds were considerably higher (47.1% and 32.3% among South Asians and Western Europeans, respectively). Ethnic differences emerged at young ages. South Asians aged 20-34 years had a similar prediabetes incidence as Europeans who were 15 years older (35-49 years), regardless of which prediabetes definition was used (WHO/DC 14.4% vs 15.7%; ADA 38.0% vs 33.0%). CONCLUSION Prediabetes incidence was substantially higher among non-European immigrants to Canada, highlighting the need for early prevention strategies in these populations.
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Affiliation(s)
- Ghazal S. Fazli
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, Toronto, Ontario M5C 1N8 Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, 155 College Street Health Science Building, Toronto, Ontario M5T 3M7 Canada
| | - Rahim Moineddin
- Institute for Clinical Evaluative Sciences, G1 06, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5 Canada
- Department of Family and Community Medicine, University of Toronto, 263 McCaul Street, Toronto, Ontario M5T 1W7 Canada
| | - Arlene S. Bierman
- Institute of Health Policy Management and Evaluation, University of Toronto, 155 College Street Health Science Building, Toronto, Ontario M5T 3M7 Canada
| | - Gillian L. Booth
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, Toronto, Ontario M5C 1N8 Canada
- Institute for Clinical Evaluative Sciences, G1 06, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5 Canada
- Department of Medicine, University of Toronto, 1 Kings College Circle, Toronto, Ontario M5S 1A8 Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, 155 College Street Health Science Building, Toronto, Ontario M5T 3M7 Canada
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Culturally Tailored Self-Management Interventions for South Asians With Type 2 Diabetes: A Systematic Review. Can J Diabetes 2019; 43:445-452. [PMID: 31375180 DOI: 10.1016/j.jcjd.2019.04.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 04/04/2019] [Accepted: 04/30/2019] [Indexed: 01/18/2023]
Abstract
Diabetes mellitus is one of the most common chronic diseases worldwide and a leading cause of morbidity and mortality. A high prevalence of type 2 diabetes mellitus has been noted among the South Asian population, in general, and migrant South Asians. Self-management is considered a proponent to the management of diabetes. Although empirical evidence supports such interventions, little is known regarding the cultural congruency of such interventions for diverse cultural and ethnic groups, particularly South Asians. Our purpose was to determine the effectiveness of diabetes self-management education (DSME) and diabetes self-management support (DSMS), interventions on migrant South Asian's glycated hemoglobin (A1C) levels and whether DSME and DSMS interventions are culturally tailored to the migrant South Asian population. In this study, a systematic review, with narrative synthesis, was conducted. Data were extracted on the study, participant, and intervention characteristics and the cultural congruity using Leininger's sunrise model. Four studies meeting the inclusion criteria were included. Overall, most (75%) of the DSME and DSMS interventions were not effective in reducing A1C levels. Specific to cultural congruity of the interventions, all studies delivered the intervention based on the participant's preferred language and incorporated culturally sensitive dietary information primarily by persons of the same cultural and ethnic background. However, little information was presented on the provision and integration of culturally congruent care. Findings highlight the importance of rethinking the way in which South Asians are labelled as a homogenous group and accounting for such differences when adapting and designing culturally tailored DSME and or DSMS interventions in clinical practice.
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Abstract
PURPOSE OF REVIEW Diabetes mellitus (DM) has become a rising epidemic in the last century, more pressing in the last few decades with the exponential rise of obesity, and has become one of the leading causes of death worldwide. RECENT FINDINGS Genetic variants have also been a new field of epidemiology research to determine the underlying genetic component of those risk factors and the association of DM with CVD. In light of its significant prevalence, patients remain unaware of their disease progression that arises from genetic and metabolic risk factors. As compared to non-diabetics, those with type 2 DM carry a higher mortality risk from cardiovascular disease (CVD) across different ethnicity groups and sex. The most common cardiovascular manifestations in those with DM include heart failure, peripheral arterial disease, and coronary heart disease. Although DM does predispose patients to CVD, it in fact is not a risk equivalent, but carries significant heterogeneity in risk for CVD.
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Affiliation(s)
- Diana Glovaci
- Department of Medicine, Heart Disease Prevention Program, Division of Cardiology, University of California, C240 Medical Sciences, Irvine, CA, 92697, USA.
| | - Wenjun Fan
- Department of Medicine, Heart Disease Prevention Program, Division of Cardiology, University of California, C240 Medical Sciences, Irvine, CA, 92697, USA
| | - Nathan D Wong
- Department of Medicine, Heart Disease Prevention Program, Division of Cardiology, University of California, C240 Medical Sciences, Irvine, CA, 92697, USA
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Engelman M, Ye LZ. The Immigrant Health Differential in the Context of Racial and Ethnic Disparities: The Case of Diabetes. ADVANCES IN MEDICAL SOCIOLOGY 2019; 19:147-171. [PMID: 31057317 PMCID: PMC6494443 DOI: 10.1108/s1057-629020190000019008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE Social and economic disparities between racial/ethnic groups are a feature of the American context into which immigrants are incorporated, and a key determinant of population health. We ask whether racial/ethnic disparities in diabetes vary by nativity and whether native-immigrant disparities in diabetes vary by race and over time in the United States. METHODS Using the 2000-2015 National Health Interview Survey, we estimate logistic regressions to examine the interaction of race/ethnicity, nativity, and duration in the U.S. in shaping diabetes patterns. RESULTS Relative to their native-born co-ethnics, foreign-born Asian adults experience a significant diabetes disadvantage, while foreign-born Hispanic, Black, and White adults experience a significant advantage. Adjusting for obesity, education, and other covariates eliminates the foreign-born advantage for Black and White adults, but it persists for Hispanic adults. The same adjustment accentuates the disadvantage for foreign-born Asian adults. For Black and Hispanic adults, the protective foreign-born effect erodes as duration in the U.S. increases. For foreign-born Asian adults, the immigrant disadvantage appears to grow with duration in the U.S. Relative to native-born White adults, all non-white groups regardless of nativity see a diabetes disadvantage because the racial/ethnic disadvantage either countervails a foreign-born advantage or amplifies a foreign-born disadvantage. DISCUSSION Racial/ethnic differentials in diabetes are considerable, and are influenced by each group's nativity composition. Obesity and (for the foreign-born) time in the U.S. influence these disparities, but do not explain them. These findings underscore the importance of unmeasured, systemic determinants of health in America's race-conscious society.
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Affiliation(s)
- Michal Engelman
- Department of Sociology, Center for Demography and Ecology, University of Wisconsin-Madison
| | - Leafia Zi Ye
- Department of Sociology, Center for Demography and Ecology, University of Wisconsin-Madison
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Palaniappan L, Garg A, Enas E, Lewis H, Bari S, Gulati M, Flores C, Mathur A, Molina C, Narula J, Rahman S, Leng J, Gany F. South Asian Cardiovascular Disease & Cancer Risk: Genetics & Pathophysiology. J Community Health 2018; 43:1100-1114. [PMID: 29948525 PMCID: PMC6777562 DOI: 10.1007/s10900-018-0527-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
South Asians (SAs) are at heightened risk for cardiovascular disease as compared to other ethnic groups, facing premature and more severe coronary artery disease, and decreased insulin sensitivity. This disease burden can only be partially explained by conventional risk factors, suggesting the need for a specific cardiovascular risk profile for SAs. Current research, as explored through a comprehensive literature review, suggests the existence of population specific genetic risk factors such as lipoprotein(a), as well as population specific gene modulating factors. This review catalogues the available research on cardiovascular disease and genetics, anthropometry, and pathophysiology, and cancer genetics among SAs, with a geographical focus on the U.S. A tailored risk profile will hinge upon population customized classification and treatment guidelines, informed by continued research.
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Affiliation(s)
| | - Arun Garg
- Laboratory Medicine and Pathology, Fraser Health Authority, New Westminster, BC, Canada
| | - Enas Enas
- Coronary Artery Disease among Asian Indians (CADI) Research Foundation, Lisle, IL, USA
| | - Henrietta Lewis
- Rollins School of Public Health, Global Epidemiology, Emory University, Atlanta, GA, USA
| | | | - Martha Gulati
- Division of Cardiology, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Cristina Flores
- The Warren Alpert Medical School, The Brown Human Rights Asylum Clinic (BHRAC), Brown University, Providence, RI, USA
| | - Ashish Mathur
- South Asian Heart Center, El Camino Hospital, Mountain View, CA, USA
| | - Cesar Molina
- South Asian Heart Center, El Camino Hospital, Mountain View, CA, USA
| | | | - Shahid Rahman
- I-Say, Bangladeshi American Youth Association, Teach & Travel, New York, NY, USA
| | - Jennifer Leng
- Immigrant Health and Cancer Disparities Center, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
| | - Francesca Gany
- Immigrant Health and Cancer Disparities Center, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA.
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
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Iguacel I, Michels N, Ahrens W, Bammann K, Eiben G, Fernández-Alvira JM, Mårild S, Molnár D, Reisch L, Russo P, Tornaritis M, Veidebaum T, Wolters M, Moreno LA, Börnhorst C. Prospective associations between socioeconomically disadvantaged groups and metabolic syndrome risk in European children. Results from the IDEFICS study. Int J Cardiol 2018; 272:333-340. [PMID: 30017513 DOI: 10.1016/j.ijcard.2018.07.053] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/28/2018] [Accepted: 07/09/2018] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Socioeconomic disadvantages during childhood are hypothesised to have negative implications for health. We aimed to investigate the association between socioeconomic disadvantages and children's total metabolic syndrome (MetS) score at baseline and follow-up and the extent to which socioeconomic disadvantages over time and the accumulation of these socioeconomic disadvantages can affect children's MetS risk. METHODS The two-year longitudinal IDEFICS study included 2401 European children (aged 2.0-9.9) with complete information of the 16,229 participating at baseline. Sociodemographic variables, psychosocial factors and lifestyle were proxy-reported via questionnaires. Socioeconomically disadvantaged groups included children from families with low income, low education, migrant origin, unemployed parents, parents who lacked a social network, and from non-traditional families. MetS risk score was calculated as the sum of z-scores of waist circumference, blood pressure, lipids and insulin resistance. Linear mixed-effects models were used to study the association between social disadvantages and MetS risk. Models were adjusted for sex, age, well-being and lifestyle (fruit and vegetables consumption, physical activity, screen time). RESULTS At both time points, children from low-income families (0.20 [0.03-0.37]); (β estimate and 99% confidence interval), children from non-traditional families (0.14 [0.02-0.26]), children whose parents were unemployed (0.31 [0.05-0.57]) and children who accumulated >3 disadvantages (0.21 [0.04-0.37]) showed a higher MetS score compared to non-socioeconomically disadvantaged groups. CONCLUSION Children from socioeconomically disadvantaged families are at high metabolic risk independently of diet, physical activity, sedentary behaviours and well-being. Interventions focusing on these socioeconomically disadvantaged groups should be developed to tackle health disparities.
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Affiliation(s)
- Isabel Iguacel
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, Faculty of Health Sciences, University of Zaragoza, Edificio del SAI, C/Pedro Cerbuna s/n, 50009 Zaragoza, Spain; Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain; Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain; Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Zaragoza, Spain.
| | | | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany; Institute of Statistics, University of Bremen, Bremen, Germany
| | - Karin Bammann
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany; Institute for Public Health and Nursing Sciences (IPP), University of Bremen, Bremen, Germany
| | - Gabriele Eiben
- Section for Epidemiology and Social Medicine (EPSO), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Biomedicine and Public Health, School of Health and Education, University of Skövde, Skövde, Sweden
| | - Juan M Fernández-Alvira
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, Faculty of Health Sciences, University of Zaragoza, Edificio del SAI, C/Pedro Cerbuna s/n, 50009 Zaragoza, Spain; Fundación Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | - Staffan Mårild
- Section for Epidemiology and Social Medicine (EPSO), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Dénes Molnár
- Department of Paediatrics, University of Pécs, Pécs, Hungary
| | | | - Paola Russo
- Institute of Food Sciences, National Research Council, Avellino, Italy
| | | | - Toomas Veidebaum
- Department of Chronic Diseases, National Institute for Health Development, Tallinn, Estonia
| | - Maike Wolters
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Luis A Moreno
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, Faculty of Health Sciences, University of Zaragoza, Edificio del SAI, C/Pedro Cerbuna s/n, 50009 Zaragoza, Spain; Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain; Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain; Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Zaragoza, Spain
| | - Claudia Börnhorst
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
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Banerjee AT, Shah BR. Differences in prevalence of diabetes among immigrants to Canada from South Asian countries. Diabet Med 2018; 35:937-943. [PMID: 29663510 DOI: 10.1111/dme.13647] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/09/2018] [Indexed: 12/23/2022]
Abstract
AIMS The prevalence of diabetes is high in South Asians migrants. However, most previous research has studied South Asians as a collective whole. The aim of this study was to examine diabetes prevalence among immigrants from five South Asian countries living in Ontario, Canada. METHODS Population-based health care and immigration databases were used to compare crude and adjusted diabetes prevalence on 1 January 2012 between immigrants to Ontario from different South Asians countries and the non-immigrant population. The prevalence of diabetes was also stratified by various sociodemographic factors. RESULTS There were 431 765 first-generation South Asian immigrants; 68 440 (crude prevalence of 15.9%) of whom had a diagnosis of diabetes. After standardization for age, sex and income, diabetes prevalence was highest among South Asians from Sri Lanka (26.8%) followed by Bangladesh (22.2%), Pakistan (19.6%), India (18.3%) and Nepal (16.5%) in comparison with the non-immigrant population (11.6%). Increased prevalence was evident among men compared with women in each country of South Asia. Sociodemographic indicators including income, education, English proficiency and refugee status were associated with increased prevalence of diabetes in specific populations from South Asia. CONCLUSION Striking differences in the prevalence of diabetes are evident among immigrants from different countries of South Asia. Awareness of the heterogeneity will help in recognizing priorities for the delivery of primary care for specific South Asian migrant populations with a range of settlement needs that also encompass social determinants of health.
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Affiliation(s)
- A T Banerjee
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - B R Shah
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Cardiovascular Risk in South America Compared to Other Countries. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2018. [DOI: 10.1007/s40138-018-0154-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Venkatesh S, Weatherspoon LJ. Reliability and Validity of an Asian Indian Dietary Acculturation Measure (AIDAM). HEALTH EDUCATION & BEHAVIOR 2018; 45:908-917. [PMID: 29848138 DOI: 10.1177/1090198118775479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Dietary acculturation (adopting the eating patterns/practices of the host environment) of individuals who relocate to another country could be a risk factor for diet-related chronic diseases. A reliable and validated measure for the assessment of dietary acculturation may facilitate understanding of the relationship between dietary acculturation and diet-related chronic diseases in various nonnative populations. We aimed to determine the reliability and validity of a culturally sensitive Asian Indian Dietary Acculturation Measure (AIDAM) for Asian Indians. A cross-sectional survey was administered via Qualtrics Research Suite to 191 Asian Indian adults in the United States. The web survey consisted of AIDAM, a food frequency questionnaire consisting of Asian Indian (AI-FFQ) and non-Indian (NI-FFQ) foods and participant sociodemographic questions. Reliability and validity were examined through a polytomous Rasch model. Except for one item that was excluded due to misfit, 50 items were stable. The root mean square error was .08 for all the items, and the item and person reliabilities were .98 and .88, respectively. AIDAM was positively related to NI-FFQ ( r = .265) and negatively related to AI-FFQ ( r = -.432) based on correlations and linear regressions ( p < .001). Our preliminary analysis showed the AIDAM to have good reliability and validity when tested with a sample of Asian Indians in the United States. Further large studies with Asian Indians using AIDAM are needed to support our findings. This tool can be used by health professionals and researchers to determine the level of dietary acculturation as well as diet quality implications when assessing risk for diet-related diseases.
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Venkatesh S, Weatherspoon LJ. Food Behaviors and Dietary Acculturation of Asian Indians in the US. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2018; 50:529-535. [PMID: 29246566 DOI: 10.1016/j.jneb.2017.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 10/17/2017] [Accepted: 10/29/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To examine food behaviors and dietary acculturation of Asian Indians in the US. DESIGN Qualitative focus group discussions. SETTING Public library and university. PARTICIPANTS Thirty Asian Indian adults in a US Midwestern state. MAIN OUTCOME MEASURES Participant perceptions of food behaviors and 24-hour modified weekday and weekend dietary recalls. ANALYSIS Eight focus group transcripts and participant dietary recalls were independently analyzed by 2 Asian Indian moderators using the constant comparison method. RESULTS The sample (n = 16 males and 14 females) consisted of a variable group of Asian Indians from different generations, religions, and places of origin in India. Key themes associated with modification of traditional behaviors were social independence, social network influences, increased health awareness, cost and quality of Asian Indian foods, and time constraints and convenience. CONCLUSIONS AND IMPLICATIONS This study elucidated dietary behaviors and factors that contribute to dietary acculturation of Asian Indians, which are important considerations for health professionals. These findings inform researchers regarding the development of culturally appropriate dietary assessment measures targeted at Asian Indian individuals.
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Metabolic Syndrome Among Asian Indians in the United States. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2018; 25:45-52. [PMID: 29461333 DOI: 10.1097/phh.0000000000000738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Metabolic syndrome (MetS), a clustering of cardiometabolic risk factors of type 2 diabetes and cardiovascular disease, disproportionately affects Asian Indians (AIs). We examined prevalence of MetS using 3 ethnicity-specific MetS criteria among immigrant AIs in the United States. We also examined associations between MetS and health promotion behaviors. OBJECTIVE To present MetS prevalence estimates by the 3 ethnicity-specific criteria and investigate differences in health promotion behaviors among AIs with and without MetS to highlight the critical need for lifestyle modification strategies for this population. DESIGN We analyzed data from a national cross-sectional study of 1037 AIs in the United States (2004-2006). We used the consensus criteria, International Diabetes Federation criteria, and modified criteria to estimate MetS prevalence. The Health Promotion Lifestyle Profile II scale measured health promotion behaviors. Bioclinical data (fasting blood glucose, triglyceride levels) were collected. Directed acyclic graphs and Likelihood Ratio Test assisted with model selection. Multiple imputation inference incorporated uncertainty due to missing data and made use of all available data. Adjusted multivariable logistic regression analysis tested for associations. RESULTS Out of all participants, 40.3% met the consensus criteria, 34.8% met the International Diabetes Federation criteria, and 52.5% met the modified criteria. We found no statistically significant associations between engagement in health promotion measures and the prevalence of MetS and its criteria. CONCLUSION Our study confirmed the high prevalence of MetS in the immigrant AI population in the United States. Our results showed that AIs with MetS did not exhibit an increased level of engagement in health promotion behaviors. We recommend continued refining of criteria for diagnosis and culturally suitable, age-appropriate strategies to increase engagement in healthier lifestyles among this high-risk population.
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Jayaweera K, Aschan L, Pannala G, Adikari A, Glozier N, Ismail K, Pariante CM, Rijsdijk F, Siribaddana S, Zavos HMS, Zunszain PA, Sumathipala A, Hotopf M. The Colombo Twin and Singleton Follow-up Study: a population based twin study of psychiatric disorders and metabolic syndrome in Sri Lanka. BMC Public Health 2018; 18:145. [PMID: 29343229 PMCID: PMC5773033 DOI: 10.1186/s12889-017-4992-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 12/12/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The disease burden related to mental disorders and metabolic syndrome is growing in low-and middle-income countries (LMIC). The Colombo Twin and Singleton Study (COTASS) is a population-based sample of twins and singletons in Colombo, Sri Lanka. Here we present prevalence estimates for metabolic syndrome (metS) and mental disorders from a follow-up (COTASS-2) of the original study (COTASS-1), which was a mental health survey. METHODS In COTASS-2, participants completed structured interviews, anthropometric measures and provided fasting blood and urine samples. Depressive disorder, depressive symptoms, anxiety symptoms, post-traumatic stress disorder (PTSD) and hazardous alcohol use were ascertained with structured psychiatric screens (Composite International Diagnostic Interview (CIDI), Beck Depression Inventory (BDI-II), Generalised Anxiety Disorder Questionnaire (GAD-7), PTSD Checklist - Civilian Version (PCL-C), and Alcohol Use Disorders Identification Test (AUDIT)). We defined metS according to the International Diabetes Federation (IDF) criteria and the revised National Cholesterol Education Programme Adult Treatment Panel (NCEP ATP III) criteria. We estimated the prevalence of psychiatric disorders and metS and metS components, and associations with gender, education and age. RESULTS Two thousand nine hundred thirty-four twins and 1035 singletons were followed up from COTASS-1 (83.4 and 61.8% participation rate, respectively). Prevalence estimates for depressive disorder (CIDI), depressive symptoms (BDI ≥ 16), anxiety symptoms (GAD-7 ≥ 10) and PTSD (PCL-C DSM criteria) were 3.8, 5.9, 3.6, and 4.5% respectively for twins and 3.9, 9.8, 5.1 and 5.4% for singletons. 28.1 and 30.9% of male twins and singletons respectively reported hazardous alcohol use. Approximately one third met the metS criteria (IDF: 27.4% twins, 44.6% singletons; NCEP ATP III: 30.6% twins, 48.6% singletons). The most prevalent components were central obesity (59.2% twins, 71.2% singletons) and raised fasting blood glucose or diabetes (38.2% twins, 56.7% singletons). CONCLUSION MetS was highly prevalent in twins, and especially high in singletons, whereas the prevalence of mental disorders was low, but consistent with local estimates. The high levels of raised fasting plasma glucose and central obesity were particularly concerning, and warrant national diabetes prevention programmes.
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Affiliation(s)
| | - Lisa Aschan
- Psychological Medicine Department, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK
- NIHR Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust, King’s College London, London, UK
| | - Gayani Pannala
- Institute for Research and Development, Colombo, Sri Lanka
| | | | | | - Khalida Ismail
- Psychological Medicine Department, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK
- NIHR Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust, King’s College London, London, UK
| | - Carmine M. Pariante
- Stress, Psychiatry and Immunology Laboratory, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Fruhling Rijsdijk
- Social Genetic and Developmental Research Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | | | - Helena M. S. Zavos
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Patricia A. Zunszain
- Stress, Psychiatry and Immunology Laboratory, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Athula Sumathipala
- Institute for Research and Development, Colombo, Sri Lanka
- Research Institute for Primary Care & Health Sciences, Faculty of Medicine & Health Sciences, Keele University, Keele, UK
| | - Matthew Hotopf
- Psychological Medicine Department, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK
- NIHR Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust, King’s College London, London, UK
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Psychosocial Factors Associated with Subclinical Atherosclerosis in South Asians: The MASALA Study. J Immigr Minor Health 2018; 18:1317-1327. [PMID: 26897179 DOI: 10.1007/s10903-016-0367-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
South Asians have the highest rates of premature atherosclerotic cardiovascular disease amongst all ethnic groups in the world; however this risk cannot be fully explained by traditional risk factors. Participants from the Mediators of Atherosclerosis in South Asians Living in America Study were included in this cross-sectional analysis. The purpose of this study was to investigate the association of psychosocial factors (including anger, anxiety, depressive symptoms, current and chronic stress, and everyday hassles) with carotid intima-media thickness (CIMT). Three multivariate models were examined to evaluate the association between the psychosocial factors and CIMT. Findings suggest that the impact of psychosocial factors on subclinical atherosclerosis is differential for South Asian men and women. For men, anxiety and depression were associated; while for women, stress was associated with common carotid intima media thickness, independent of traditional CVD risk factors, diet and physical activity.
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Sapkota RP, Upadhyaya T, Gurung G, Parker M, Raman R, Pardhan S. Need to improve awareness and treatment compliance in high-risk patients for diabetic complications in Nepal. BMJ Open Diabetes Res Care 2018; 6:e000525. [PMID: 29755757 PMCID: PMC5942410 DOI: 10.1136/bmjdrc-2018-000525] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/23/2018] [Accepted: 04/19/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE/INTRODUCTION It is known that knowledge, awareness, and practice influence diabetic control. We compared factors pertaining to healthy lifestyle (exercising, avoiding smoking), self-help (attending appointments, following treatment regimens), and diabetic awareness in high-risk patients for diabetic complications, specifically, those on insulin versus non-insulin treatment, and also those with a longer diabetic duration (≥5 years) versus a shorter duration. METHODS 200 consecutive patients with type 2 diabetes (52.0±11.6 years) attending diabetic clinic at a referral hospital in Nepal were recruited. A structured questionnaire explored non-clinical parameters including age, gender, diabetic duration, awareness about diabetes control, self-help, and lifestyle. Clinical data were also measured: HbA1c, fasting blood sugar (FBS), blood pressure, and treatment type (insulin, diet/tablet). RESULTS A significantly higher proportion of patients on insulin (vs non-insulin) or with diabetic duration ≥5 years (vs <5 years) self-reported not doing regular exercise, forgetting to take medicine, and not knowing whether their diabetes was controlled (p≤0.005). HbA1c/FBS levels were significantly higher for patients on insulin or with a longer diabetic duration (p≤0.001). 92% of those on insulin (vs 31% on non-insulin) and 91% with diabetic duration ≥5 years (vs 28% of <5 years) self-reported to seeking medical help due to episodes of uncontrolled blood sugar in the last year (p<0.001). CONCLUSION Poor self-help/lifestyle and reduced knowledge/awareness about diabetic control was found in patients on insulin or with longer diabetic duration. This is a worrying finding as these patients are already at high risk for developing diabetic complications. The findings highlight need for targeting this more vulnerable group and provide more support/diabetic educational tools.
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Affiliation(s)
- Raju P Sapkota
- Vision & Eye Research Unit (VERU), School of Medicine, Anglia Ruskin University, Cambridge, UK
| | - Tirthalal Upadhyaya
- Department of Internal Medicine, Gandaki Medical College Teaching Hospital, Pokhara, Nepal
| | - Govind Gurung
- Department of Ophthalmology, Gandaki Medical College Teaching Hospital, Pokhara, Nepal
| | - Mike Parker
- Clinical Trial Unit, Postgraduate Medical Institute, Anglia Ruskin University, Cambridge, UK
| | - Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Shahina Pardhan
- Vision & Eye Research Unit (VERU), School of Medicine, Anglia Ruskin University, Cambridge, UK
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Misra R, Balagopal P, Raj S, Patel TG. Vegetarian Diet and Cardiometabolic Risk among Asian Indians in the United States. J Diabetes Res 2018; 2018:1675369. [PMID: 29670913 PMCID: PMC5835256 DOI: 10.1155/2018/1675369] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 11/22/2017] [Indexed: 02/07/2023] Open
Abstract
Research studies have shown that plant-based diets confer cardiovascular and metabolic health benefits. Asian Indians (AIs) in the US (who have often followed plant-based diets) have elevated risk for chronic diseases such as diabetes, metabolic syndrome, and obesity suggesting ethnic vulnerability that imply genetic and/or lifestyle causative links. This study explored the association between this ethnic group and diabetes, obesity, and metabolic syndrome after controlling for demographics, acculturation, family history of diabetes, and lifestyle and clinical risk factors. The sample comprised of 1038 randomly selected adult AIs in seven US sites. Prevalence and metabolic syndrome was estimated, and obesity was calculated using the WHO Asian criteria. Multivariate analysis included multinomial logistic regression. The mean age and length of residency in the US were 47 and 18.5 years, respectively. The majority of respondents were vegetarians (62%) and educated. A vegetarian lifestyle was associated with females, food label users, respondents with poor/fair current health status, less acculturated, and those who reported their diet had not changed after coming to the US. Vegetarian status was a protective factor and lowered the risk for diabetes but not for metabolic syndrome and obesity in the regression model. Results provide a firm basis for educational programs.
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Affiliation(s)
- Ranjita Misra
- WVU Public Health Training Center, 3313A, Robert C. Byrd Health Science Center, West Virginia University, Morgantown, WV 26506-9190, USA
| | - Padmini Balagopal
- Clinical Nutritionist, Early Intervention, 1901 JFK Blvd, Philadelphia, PA 19103, USA
| | - Sudha Raj
- Department of Public Health, Food Studies and Nutrition, 562 Falk College, Syracuse, NY 13244, USA
| | - Thakor G. Patel
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Lopez PM, Zanowiak J, Goldfeld K, Wyka K, Masoud A, Beane S, Kumar R, Laughlin P, Trinh-Shevrin C, Thorpe L, Islam N. Protocol for project IMPACT (improving millions hearts for provider and community transformation): a quasi-experimental evaluation of an integrated electronic health record and community health worker intervention study to improve hypertension management among South Asian patients. BMC Health Serv Res 2017; 17:810. [PMID: 29207983 PMCID: PMC5717844 DOI: 10.1186/s12913-017-2767-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 11/24/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The Million Hearts® initiative aims to prevent heart disease and stroke in the United States by mobilizing public and private sectors around a core set of objectives, with particular attention on improving blood pressure control. South Asians in particular have disproportionately high rates of hypertension and face numerous cultural, linguistic, and social barriers to accessing healthcare. Interventions utilizing Health information technology (HIT) and community health worker (CHW)-led patient coaching have each been demonstrated to be effective at advancing Million Hearts® goals, yet few studies have investigated the potential impact of integrating these strategies into a clinical-community linkage initiative. Building upon this initiative, we present the protocol and preliminary results of a research study, Project IMPACT, designed to fill this gap in knowledge. METHODS Project IMPACT is a stepped wedge quasi-experimental study designed to test the feasibility, adoption, and impact of integrating CHW-led health coaching with electronic health record (EHR)-based interventions to improve hypertension control among South Asian patients in New York City primary care practices. EHR intervention components include the training and implementation of hypertension-specific registry reports, alerts, and order sets. Fidelity to the EHR intervention is assessed by collecting the type, frequency, and utilization of intervention components for each practice. CHW intervention components consist of health coaching sessions on hypertension and related risk factors for uncontrolled hypertensive patients. The outcome, hypertension control (<140 mmHg systolic blood pressure (BP) and <90 mmHg diastolic BP), is collected at the aggregate- and individual-level for all 16 clinical practices enrolled. DISCUSSION Project IMPACT builds upon the evidence base of the effectiveness of CHW and Million Hearts® initiatives and proposes a unique integration of provider-based EHR and community-based CHW interventions. The project informs the effectiveness of these interventions in team-based care approaches, thereby, helping to develop relevant sustainability strategies for improving hypertension control among targeted racial/ethnic minority populations at small primary care practices. TRIAL REGISTRATION This study protocol has been approved and is made available on Clinicaltrials.gov by NCT03159533 as of May 17, 2017.
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Affiliation(s)
- Priscilla M. Lopez
- Department of Population Health, NYU School of Medicine, New York, USA
- NYU-CUNY Prevention Research Center, New York, USA
| | - Jennifer Zanowiak
- Department of Population Health, NYU School of Medicine, New York, USA
- NYU-CUNY Prevention Research Center, New York, USA
| | - Keith Goldfeld
- Department of Population Health, NYU School of Medicine, New York, USA
| | - Katarzyna Wyka
- CUNY Graduate School of Public Health and Health Policy, New York, USA
| | | | | | | | | | - Chau Trinh-Shevrin
- Department of Population Health, NYU School of Medicine, New York, USA
- NYU-CUNY Prevention Research Center, New York, USA
| | - Lorna Thorpe
- Department of Population Health, NYU School of Medicine, New York, USA
- NYU-CUNY Prevention Research Center, New York, USA
| | - Nadia Islam
- Department of Population Health, NYU School of Medicine, New York, USA
- NYU-CUNY Prevention Research Center, New York, USA
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Deol R, Lee KA, Kandula NR, Kanaya AM. Risk of Obstructive Sleep Apnoea is Associated with Glycaemia Status in South Asian Men and Women in the United States. ACTA ACUST UNITED AC 2017; 9:1-6. [PMID: 29354780 DOI: 10.1016/j.obmed.2017.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Aims To examine the association between glycaemia status and the risk for obstructive sleep apnoea (OSA) in a cohort of South Asians living in the United States. Methods A secondary analysis of a community based cohort of 899 participants from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study. The Berlin Questionnaire was used to screen for OSA. Results Almost one in four (24%) South Asians was at high risk for OSA. Compared to the normal glucose tolerance group (18%), high risk of OSA was significantly more likely in the prediabetes (24%) and diabetes (32%) groups (p = .007). More men (28%) than women (18%) were at high risk of OSA. Risk for OSA was also associated with higher haemoglobin A1c values, hypertension, large waist circumference, and BMI > 27.5 kg/m2. In a multivariate regression analysis, sleep disordered breathing (SDB) remained significantly associated with higher haemoglobin A1c values, even after controlling for waist circumference and other demographic and clinical factors. Conclusions The risk for SDB and OSA was high among South Asian men and women. Given the association between dysglycaemia and risk for OSA, these health issues require simultaneous clinical assessment. Future studies using objective sleep measures such as polysomnography are warranted in the diagnosis and treatment of OSA in the South Asian adult population already at high risk for dysglycaemia.
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Affiliation(s)
- Rupinder Deol
- Department of Family Health Care Nursing, University of California, San Francisco, San Francisco, CA 94143
| | - Kathryn A Lee
- Department of Family Health Care Nursing, University of California, San Francisco, San Francisco, CA 94143
| | - Namratha R Kandula
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611
| | - Alka M Kanaya
- Epidemiology & Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA 94115
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Interaction between TCF7L2 polymorphism and dietary fat intake on high density lipoprotein cholesterol. PLoS One 2017; 12:e0188382. [PMID: 29182660 PMCID: PMC5705148 DOI: 10.1371/journal.pone.0188382] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 10/18/2017] [Indexed: 12/25/2022] Open
Abstract
Recent evidence suggests that lifestyle factors influence the association between the Melanocortin 4 receptor (MC4R) and Transcription Factor 7-Like 2 (TCF7L2) gene variants and cardio-metabolic traits in several populations; however, the available research is limited among the Asian Indian population. Hence, the present study examined whether the association between the MC4R single nucleotide polymorphism (SNP) (rs17782313) and two SNPs of the TCF7L2 gene (rs12255372 and rs7903146) and cardio-metabolic traits is modified by dietary factors and physical activity. This cross sectional study included a random sample of normal glucose tolerant (NGT) (n = 821) and participants with type 2 diabetes (T2D) (n = 861) recruited from the urban part of the Chennai Urban Rural Epidemiology Study (CURES). A validated food frequency questionnaire (FFQ) was used for dietary assessment and self-reported physical activity measures were collected. The threshold for significance was set at P = 0.00023 based on Bonferroni correction for multiple testing [(0.05/210 (3 SNPs x 14 outcomes x 5 lifestyle factors)]. After Bonferroni correction, there was a significant interaction between the TCF7L2 rs12255372 SNP and fat intake (g/day) (Pinteraction = 0.0001) on high-density lipoprotein cholesterol (HDL-C), where the ‘T’ allele carriers in the lowest tertile of total fat intake had higher HDL-C (P = 0.008) and those in the highest tertile (P = 0.017) had lower HDL-C compared to the GG homozygotes. In a secondary analysis of SNPs with the subtypes of fat, there was also a significant interaction between the SNP rs12255372 and polyunsaturated fatty acids (PUFA, g/day) (Pinteraction<0.0001) on HDL-C, where the minor allele carriers had higher HDL-C in the lowest PUFA tertile (P = 0.024) and those in the highest PUFA tertile had lower HDL-C (P = 0.028) than GG homozygotes. In addition, a significant interaction was also seen between TCF7L2 SNP rs12255372 and fibre intake (g/day) on HDL-C (Pinteraction<0.0001). None of the other interactions between the SNPs and lifestyle factors were statistically significant after correction for multiple testing. Our findings indicate that the association between TCF7L2 SNP rs12255372 and HDL-C may be modified by dietary fat intake in this Asian Indian population.
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Prakaschandra R, Naidoo DP. Increased waist circumference is the main driver for the development of the metabolic syndrome in South African Asian Indians. Diabetes Metab Syndr 2017; 11 Suppl 1:S81-S85. [PMID: 28024832 DOI: 10.1016/j.dsx.2016.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 12/12/2016] [Indexed: 10/20/2022]
Abstract
UNLABELLED There is no current evidence available on the prevalence of metabolic syndrome (MetS) in South African Asian Indians, who are at high risk for cardiovascular disease. The aim of our study was to determine the prevalence of the MetS in this group, between males and females, as well as in the different age-groups, using the harmonised criteria and determined the main components driving the development of MetS. DESIGN AND METHODS This cross-sectional study recruited randomly selected community participants between the ages of 15 and 65 years, in the community of Phoenix, in KwaZulu-Natal. All subjects had anthropometric variables and blood pressure measured, as well as blood drawn for blood glucose and lipids after overnight fasting. The MetS was determined using the harmonised criteria. RESULTS There were 1378 subjects sampled, mean age 45.5±13years and 1001 (72.6%) women. The age standardised prevalence for MetS was 39.9% and significantly higher (p<0.001) in women (49.9% versus 35.0% in men). The MetS was identified in 6.9% of young adults (15-24 years), with a four-fold increase in the 25-34year olds, and 60.1% in the 55-64year old group. Clustering of MetS components was present in all age-groups, but increased with advancing age. The independent contributors to the MetS were increased waist circumference, raised triglycerides and obesity. This study highlights the high prevalence of MetS in this ethnic group and the emergence of MetS in our younger subjects. Urgent population-based awareness campaigns, focussing on correcting unhealthy lifestyle behaviours should begin in childhood.
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Affiliation(s)
- Rosaley Prakaschandra
- Department of Biomedical and Clinical Technology, Durban University of Technology, South Africa.
| | - Datshana P Naidoo
- Department of Cardiology, University of KwaZulu-Natal, South Africa.
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Daniel M, Abendroth M, Erlen JA. Barriers and Motives to PA in South Asian Indian Immigrant Women. West J Nurs Res 2017; 40:1339-1356. [PMID: 28281387 DOI: 10.1177/0193945917697218] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The high prevalence of chronic illnesses in South Asian Indian immigrant women underscores the need for identifying factors that could influence their PA. The purpose of this qualitative study was to examine the perspectives of South Asian Indian immigrant women related to barriers to and motives for lifestyle PA within the PA Framework for South Asian Indian Immigrants. Forty women participated in focus groups that were conducted in English and Hindi. Focus group questions were open-ended and semistructured. Transcribed and de-identified audiotaped sessions were coded and analyzed using Atlas.ti software. Role expectation was a core theme for barriers with four subthemes: lack of time, loss of interest, diminished social support, and environmental constraints. Self-motivation was a core theme for motives with three subthemes: optimal physical and psychological health, emphasis on external beauty, and strong social support. Future PA interventions need to target these culturally sensitive factors.
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Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, de Ferranti SD, Floyd J, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Mackey RH, Matsushita K, Mozaffarian D, Mussolino ME, Nasir K, Neumar RW, Palaniappan L, Pandey DK, Thiagarajan RR, Reeves MJ, Ritchey M, Rodriguez CJ, Roth GA, Rosamond WD, Sasson C, Towfighi A, Tsao CW, Turner MB, Virani SS, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation 2017; 135:e146-e603. [PMID: 28122885 PMCID: PMC5408160 DOI: 10.1161/cir.0000000000000485] [Citation(s) in RCA: 6152] [Impact Index Per Article: 878.9] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Fan W. Epidemiology in diabetes mellitus and cardiovascular disease. Cardiovasc Endocrinol 2017; 6:8-16. [PMID: 31646113 PMCID: PMC6768526 DOI: 10.1097/xce.0000000000000116] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 01/17/2017] [Indexed: 12/13/2022] Open
Abstract
As one of the leading causes of death in the USA, diabetes mellitus (DM) has become an epidemic over the past few decades. Despite the high prevalence of diagnosed DM, close to half of all people with DM are unaware of their disease. The risk of type 2 DM is determined by interplay of genetic and metabolic factors. Patients with type 2 DM have a higher risk of death from cardiovascular causes compared with their nondiabetic counterparts, and the mortality rate of DM associated cardiovascular disease is different among ethnicity groups and sex groups. Because of its adverse effect on people's health, DM also imposes an economic burden on individuals and households affected, as well as on the healthcare system. Current guidelines for cardiovascular disease prevention have focused on lifestyle management, blood pressure control, lipid control, blood glucose control, antiplatelet agent use, and tobacco use cessation.
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Affiliation(s)
- Wenjun Fan
- Department of Medicine, Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, California, USA
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