Metabolic syndrome and cardiometabolic risk factors among indigenous Malaysians

Yang AC, Zeng JL, Yang YY, Lo YT, Chang YH, Pai TH. Metabolic Syndrome-Related Knowledge, Attitudes, and Behavior among Indigenous Communities in Taiwan: A Cross-Sectional Study

BACKGROUND

Metabolic syndrome is characterized by cardiovascular and chronic disease risk factors that cause health problems. Inequalities in medical resources and information present a challenge in this context. Indigenous communities may be unaware of their risk for metabolic syndrome.

AIMS

This study explored factors associated with metabolic syndrome-related knowledge, attitudes, and behaviors among Taiwanese indigenous communities.

METHODS

For this descriptive cross-sectional survey, we collected anthropometric data and used a self-administered questionnaire between 1 July 2016, to 31 July 2017, from a convenience sample of an indigenous tribe in eastern Taiwan. The response rate was 92%.

RESULTS

The prevalence of metabolic syndrome was as high as 71%, and the average correct knowledge rate was 39.1%. The participants' self-management attitudes were mainly negative, and the self-management behaviors were low in this population. Stepwise regression analysis showed that knowledge, attitude, age, perception of physical condition, and body mass index, which accounted for 65% of the total variance, were the most predictive variables for self-management behaviors.

CONCLUSIONS

This is the first study to report the relationship between metabolic syndrome knowledge, attitudes, and behaviors in an indigenous population. There is an urgent need to develop safety-based MetS health education programs that can provide access to the right information and enhance self-management approaches to lessen the growing burden of MetS in indigenous communities.

Orang Asli Health and Lifeways Project (OA HeLP): a cross-sectional cohort study protocol

INTRODUCTION

Non-communicable disease (NCD) risk is influenced by environmental factors that are highly variable worldwide, yet prior research has focused mainly on high-income countries where most people are exposed to relatively homogeneous and static environments. Understanding the scope and complexity of environmental influences on NCD risk around the globe requires more data from people living in diverse and changing environments. Our project will investigate the prevalence and environmental causes of NCDs among the indigenous peoples of Peninsular Malaysia, known collectively as the Orang Asli, who are currently undergoing varying degrees of lifestyle and sociocultural changes that are predicted to increase vulnerability to NCDs, particularly metabolic disorders and musculoskeletal degenerative diseases.

METHODS AND ANALYSIS

Biospecimen sampling and screening for a suite of NCDs (eg, cardiovascular disease, type II diabetes, osteoarthritis and osteoporosis), combined with detailed ethnographic work to assess key lifestyle and sociocultural variables (eg, diet, physical activity and wealth), will take place in Orang Asli communities spanning a gradient from remote, traditional villages to acculturated, market-integrated urban areas. Analyses will first test for relationships between environmental variables, NCD risk factors and NCD occurrence to investigate how environmental changes are affecting NCD susceptibility among the Orang Asli. Second, we will examine potential molecular and physiological mechanisms (eg, epigenetics and systemic inflammation) that mediate environmental effects on health. Third, we will identify intrinsic (eg, age and sex) and extrinsic (eg, early-life experiences) factors that predispose certain people to NCDs in the face of environmental change to better understand which Orang Asli are at greatest risk of NCDs.

ETHICS AND DISSEMINATION

Approval was obtained from multiple ethical review boards including the Malaysian Ministry of Health. This study follows established principles for ethical biomedical research among vulnerable indigenous communities, including fostering collaboration, building cultural competency, enhancing transparency, supporting capacity building and disseminating research findings.

Association of obesity anthropometric indices with hypertension, diabetes mellitus and hypertriglyceridemia in apparently healthy adult Nigerian population

BACKGROUND

Hypertension, hyperglycemia and hypertriglyceridemia are chronic conditions associated with cardiometabolic diseases. Certain anthropometric indices are known to predict them.

AIM

To investigate the association of anthropometric indices with these chronic diseases and which anthropometric index predicts them best.

METHODS

In this study, 221 apparently healthy individuals who never received treatments for cardiovascular disease (CVD), diabetes or other chronic diseases participated. The age of the participants ranged from 20-75 years with mean age of 36.9 ± 11.4 years. The risk factors of these diseases namely systolic blood pressures (SBP) and diastolic blood pressures (DBP), fasting blood glucose (FBG) and triglycerides (TG) were determined for all the participants using standard clinical procedures. The obesity anthropometric indices, waist circumference, waist-to-height ratio, waist-to-hip ratio and body mass index as well as abdominal height (AH) and body surface index were determined. The association between each of them with the risk factors were determined by the Pearson correlation method.

RESULTS

From the results, it was found that AH showed superiority over the rest for SBP (r = 0.301, P < 0.01), DBP (r = 0.370, P < 0.01), FBG (r = 0.297, P < 0.01) and TG (r = 0.380, P < 0.01). Using the receiver operating characteristic curves, cut-off values of AH for SBP, DBP, FBG and TG were determined to be 24.75 cm, 24.75 cm, 25.25 cm and 24.75 cm respectively.

CONCLUSION

The indices of anthropometry used in this study correlated significantly with the studied CVD risk factors, with AH emerging as the most predictive.

The Oral, Gut Microbiota and Cardiometabolic Health of Indigenous Orang Asli Communities

The Orang Asli (OA) of Malaysia have been relatively understudied where little is known about their oral and gut microbiomes. As human health is closely intertwined with the human microbiome, this study first assessed the cardiometabolic health in four OA communities ranging from urban, rural to semi-nomadic hunter-gatherers. The urban Temuan suffered from poorer cardiometabolic health while rural OA communities were undergoing epidemiological transition. The oral microbiota of the OA were characterised by sequencing the V4 region of the 16S rRNA gene. The OA oral microbiota were unexpectedly homogenous, with comparably low alpha diversity across all four communities. The rural Jehai and Temiar PP oral microbiota were enriched for uncharacterised bacteria, exhibiting potential for discoveries. This finding also highlights the importance of including under-represented populations in large cohort studies. The Temuan oral microbiota were also elevated in opportunistic pathogens such as Corynebacterium, Prevotella, and Mogibacterium, suggesting possible oral dysbiosis in these urban settlers. The semi-nomadic Jehai gut microbiota had the highest alpha diversity, while urban Temuan exhibited the lowest. Rural OA gut microbiota were distinct from urban-like microbiota and were elevated in bacteria genera such as Prevotella 2, Prevotella 9, Lachnospiraceae ND3007, and Solobacterium. Urban Temuan microbiota were enriched in Odoribacter, Blautia, Parabacetroides, Bacteroides and Ruminococcacecae UCG-013. This study brings to light the current health trend of these indigenous people who have minimal access to healthcare and lays the groundwork for future, in-depth studies in these populations.

Risco cardiovascular aumentado e o papel da síndrome metabólica em idosos hipertensos

RESUMO Objetivo avaliar a síndrome metabólica e o risco cardiovascular de idosos hipertensos atendidos na atenção primária. Métodos estudo transversal realizado com 154 idosos hipertensos de uma Unidade Básica de Saúde do Distrito Federal. Um instrumento estruturado investigou o perfil dos idosos. Para a classificação da síndrome metabólica, consideraram-se os critérios propostos pela National Cholesterol Education Program – Adult Treatment Panel III. Para análise do risco cardiovascular, utilizou-se o escore de risco de Framingham. Foi realizada análise estatística e inferencial com a utilização da ANOVA, teste qui-quadrado e exato de Fisher, além da odds ratio e seu intervalo de confiança de 95% para estimar o risco cardiovascular entre os grupos. Resultados 64,9% dos idosos hipertensos eram obesos. Síndrome metabólica foi evidenciada em 70,8%. Observou-se que 27,2% apresentaram baixo, 46,8% moderado e 26,0% elevado risco cardiovascular, sendo que o sexo feminino e a idade avançada influenciaram negativamente o risco. Idosos com síndrome metabólica apresentaram 7,19 vezes mais chances de terem elevado risco cardiovascular. Considerações finais e implicações para a prática os idosos hipertensos apresentaram uma elevada prevalência de síndrome metabólica que aumentou significativamente o risco cardiovascular. Este resultado possibilita um melhor planejamento da assistência de enfermagem pelo enfermeiro da atenção primária à saúde.

Vitamin E Levels in Ethnic Communities in Malaysia and Its Relation to Glucose Tolerance, Insulin Resistance and Advanced Glycation End Products: A Cross-Sectional Study

Malaysian national morbidity surveys on diabetic prevalence have shown ethnical variation among prediabetic and diabetic populations. In our attempt to understand this variation, we studied the α-tocopherol, insulin resistance, β-cell function and receptor of advanced glycation end-products (RAGE) levels, as risk factors of type 2 diabetes, among the different ethnicities. In total, 299 subjects of Malay, Chinese, Indian and aboriginal Orang Asli (OA) heritage were recruited from urban and rural areas of Malaysia by stratified random sampling. Serum α-tocopherol concentrations were measured using high performance liquid chromatography (HPLC) and insulin concentrations were measured using enzyme-linked immunosorbent assay (ELISA). In subjects with pre-diabetes, OAs had the highest α-tocopherol level, followed by Chinese and Malays (0.8938, 0.8564 and 0.6948 respectively; p < 0.05). In diabetic subjects, Malays had significantly higher RAGE levels compared to Chinese and Indians (5579.31, 3473.40 and 3279.52 pg/mL respectively, p = 0.001). Low α-tocopherol level (OR = 3.021, p < 0.05) and high insulin resistance (OR = 2.423, p < 0.05) were linked strongly to the development of pre-diabetes. Low β-cell function (OR = 5.657, p < 0.001) and high RAGE level (OR = 3.244, p < 0.05) were linked strongly to the development of diabetes from pre-diabetes. These factors might be involved in the development of diabetes, along with genetic and environmental factors.