Comparison of general health status, myocardial infarction, obesity, diabetes, and fruit and vegetable intake between immigrant Pakistani population in the Netherlands and the local Amsterdam population

Empirical evidence of predictive adaptive response in humans: systematic review and meta-analysis of migrant populations

Meta-analysis is used to test a variant of a Developmental Origins of Adult Health and Disease (DOHaD)'s conjecture known as predictive adaptive response (PAR). According to it, individuals who are exposed to mismatches between adverse or constrained in utero conditions, on the one hand, and postnatal obesogenic environments, on the other, are at higher risk of developing adult chronic conditions, including obesity, type 2 diabetes (T2D), hypertension and cardiovascular disease. We argue that migrant populations from low and middle to high-income countries offer a unique opportunity to test the conjecture. A database was constructed from an exhaustive literature search of peer-reviewed papers published prior to May 2021 contained in PUBMED and SCOPUS using keywords related to migrants, DOHaD, and associated health outcomes. Random effects meta-regression models were estimated to assess the magnitude of effects associated with migrant groups on the prevalence rate of T2D and hypertension in adults and overweight/obesity in adults and children. Overall, we used 38 distinct studies and 78 estimates of diabetes, 59 estimates of hypertension, 102 estimates of overweight/obesity in adults, and 23 estimates of overweight/obesity in children. Our results show that adult migrants experience higher prevalence of T2D than populations at destination (PR 1.48; 95% CI 1.35-1.65) and origin (PR 1.80; 95% CI 1.40-2.34). Similarly, there is a significant excess of obesity prevalence in children migrants (PR 1.22; 95% CI 1.04-1.43) but not among adult migrants (PR 0.89; 95% CI 0.80-1.01). Although the total effect of migrant status on prevalence of hypertension is centered on zero, some migrant groups show increased risks. Finally, the size of estimated effects varies significantly by migrant groups according to place of destination. Despite limitations inherent to all meta-analyses and admitting that some of our findings may be accounted for alternative explanations, the present study shows empirical evidence consistent with selected PAR-like conjectures.

Characterizing non-communicable disease trends in undocumented migrants over a period of 10 years in Italy

Undocumented migrants represent a large part of the population in Countries of the European Union (EU) such as Italy. Their health burden is not fully understood and likely to be related mainly to chronic conditions. Information on their health needs and conditions may help to target public health interventions but is not found in national public health databases. We conducted a retrospective observational study of non-communicable disease (NCD) burden and management in undocumented migrants receiving medical care from Opera San Francesco, a non-governmental organization (NGO) in Milan, Italy. We analyzed the health records of 53,683 clients over a period of 10 years and collected data on demographics, diagnosis and pharmacological treatments prescribed. 17,292 (32.2%) of clients had one or more NCD diagnosis. The proportion of clients suffering from at least one NCD increased from 2011 to 2020. The risk of having an NCD was lower in men than women (RR = 0.88, 95% CI 0.86-0.89), increased with age (p for trend < 0.001) and changed with ethnicity. African and Asian migrants had a lower risk than Europeans of cardiovascular diseases (RR 0.62 CI 0.58-0.67, RR 0.85 CI 0.78-0.92 respectively) and mental health disorders (RR 0.66 CI 0.61-0.71, RR 0.60 CI 0.54-0.67 respectively), while the risk was higher in Latin American people (RR 1.07 CI 1.01-1.13, RR 1.18 CI 1.11-1.25). There was a higher risk of diabetes in those from Asia and Latin America (RR 1.68 CI 1.44-1.97, RR 1.39 CI 1.21-1.60). Overall, migrants from Latin America had the greatest risk of chronic disease and this was true for diabetes, cardiovascular diseases and mental health disorders. Undocumented migrants demonstrate a significantly different health burden of NCDs, which varies with ethnicity and background. Data from NGOs providing them with medical assistance should be included in structuring public health interventions aimed at the prevention and treatment of NCDs. This could help to better allocate resources and address their health needs.

Non-attitudinal and non-knowledge based factors constrain households from translating good nutritional knowledge and attitude to achieve the WHO recommended minimum intake level for fruits and vegetables in a developing country setting: evidence from Gulu district, Uganda

BACKGROUND

The high level of incidence of mortality attributed to non-communicable diseases such as cancer, diabetes and hypertension being experienced in developing countries requires concerted effort on investment in strategies that can reduce the risks of development of such diseases. Fruits and vegetables (FV) contain natural bioactive compounds, and if consumed at or above 400 g per day (RDMIL) as recommended by World Health Organization (WHO) is believed to contribute to reduced risk of development of such diseases. The objective of this study was to determine in a developing country set-up, the extent to which rural and urban households conform to RDMIL, the status of nutritional attitude (NA) and knowledge (NK) associated with consumption of FV, and to delineate non-attitudinal and non-knowledge-based factors (NANK) that hinder achievement of RDMIL.

METHOD

A cross-sectional survey of 400 randomly selected households and 16 focus group discussions (FGD) were conducted using Gulu district of Uganda as a microcosm for a developing country setting. Level of consumption of FV was assessed using 24-h dietary recall and compared to RDMIL as a fraction (%). The status of NK and NA were determined using sets of closed-ended questions anchored on a three-point Likert scale. Further quantitative statistical analyses were conducted using t-test, chi-square, Pearson's correlation and multiple linear regression. FGD provided data on NANK factors and were analysed using qualitative content analysis procedure.

RESULTS

Urban and rural inhabitants met up to 72.0 and 62.4% of the RMDIL, respectively, with absolute intake being higher among urban than rural households by 37.54 g. NK and NA were good but the intensity of NK was higher among urban respondents by 11%. RDMIL was positively correlated with NA while socio-demographic predictors of RDMIL varied with household location. FGD revealed that primary agricultural production constraints, market limitations, postharvest management limitations, health concerns, social discomfort and environmental policy restrictions were the major NANK factors that hindered achievement of the RDMIL.

CONCLUSIONS

These results indicate that NANK factors constrain households from translating good NA and NK to achieve the RMDIL.

Risk factors, awareness of disease and use of medications in a deprived population: differences between indigent natives and undocumented migrants in Italy

BACKGROUND

Undocumented migrants experience many health problems; a comparison with a suitable control group of natives living in the same socio-economic conditions is still lacking.

METHODS

Demographic data and data on risk factors, chronic conditions and dietary habits were obtained for 6933 adults (2950 Italians and 3983 undocumented migrants) receiving medical assistance from 40 non-governmental organizations all over the country.

RESULTS

Attributed to the fact that these were unselected groups, differences were found in their demographic features, the main ones being their marital status (singles: 50.5% among Italians and 42.8% among migrants; P < 0.001). Smokers were more frequent among Italians (45.3% versus 42.7% P = 0.03); the same happened with hypertension (40.5% versus 34.5% P < 0.001). Migrants were more often overweight (44.1% versus 40.5% P < 0.001) and reporting a chronic condition (20.2% versus 14.4% P < 0.001). Among those on medications (n = 1354), Italians were fewer (n = 425) and on different medications. Differences emerged also in dietary habits.

CONCLUSIONS

Differences in health conditions exist between native-borns and undocumented migrants, not because of a bias related to socio-economic conditions. Further studies are needed to design sustainable health policies and tailored prevention plans.

Cardiovascular disease risk factors in Spain: A comparison of native and immigrant populations

Cardiovascular disease (CDV) risk factors are highly prevalent among adults with low social class in Spain. However, little is known on how these factors are distributed in the immigrant population, a socio-economic disadvantaged population. Thus, this study aims to examine inequalities in CVD risk factors among immigrant and native populations. We conducted a cross-sectional study using data from the Spanish National Health Survey 2017 and used log-binomial regression to quantify the association of immigrant status on CVD risk factors among adults aged 25-64 years. The probabilities of having at least three CVD risk factors were higher for immigrants from Eastern Europe (PR: 1.25; 95% CI: 1.15-1.35) and lower for immigrants from Africa (PR: 0.79; 95% CI: 0.69-0.89) when compared with natives. The association of immigrant status and CVD risk factors varies with educational attainment (p-interaction = 0.001). Immigrants from Eastern Europe with low educational attainment have a higher probability of having at least three CVD risk factors compared with their native counterparts. In contrast, immigrants from Africa and Latin America with low educational attainment had a protective effect against having at least three CVD risk relative to natives. Health prevention and promotion strategies to reduce the burden of CVD taking should account for educational attainment given its differential effect among the immigrant population in Spain.

Current Pharmacological Treatment of Type 2 Diabetes Mellitus in Undocumented Migrants: Is It Appropriate for the Phenotype of the Disease?

Type 2 diabetes is increasingly recognized as a spectrum of metabolic disorders sharing chronic hyperglycaemia. In Europe, the continually growing number of migrants from developing countries could affect diabetes phenotypes. We evaluated a population of 426 Italians and 412 undocumented migrants. Using 17 variables (with the exclusion of ethnic origin) we performed a multiple component analysis to detect potential clusters, independently from ethnicity. We also compared the two groups to evaluate potential ethnicity associated differences. We found five clusters of patients with different disease phenotypes. Comparing Italians with undocumented migrants, we noted that the first had more often cardiovascular risk factors and neurologic involvement, while the latter had a higher frequency of diabetic ulcers and renal involvement. Metformin was used in a comparable percentage of patients in all clusters, but other antidiabetic treatments showed some differences. Italians were more often on insulin, due to a larger use of long acting insulin, and received a larger number of oral antidiabetics in combination. Pharmacological treatment of comorbidities showed some differences too. We suggest that type 2 diabetes should be considered as a spectrum of diseases with different phenotypes also in heterogeneous populations, and that this is not due only to ethnic differences.

Will undocumented migrants contribute to change epidemiology, presentation and pharmacologic treatment of diabetes in Western countries?

AIMS

Migrants from countries in which health and social conditions are unsatisfactory, and their offspring, are becoming a growing component of the western population. Available health data show that their morbidity is at least comparable to that of the host country population, with a significant contribution of chronic diseases as diabetes. The possibility that diabetes shows different features in undocumented migrants is the hypothesis that we tried to investigate in this study.

METHODS

We retrospectively analysed the data of 413 patients with type 2 diabetes mellitus (T2DM): 222 patients followed in a diabetes clinic at a University Hospital and 191 undocumented migrants cared for by a Charity in Milan, Italy.

RESULTS

We found that the onset of the disease was earlier in migrants; they showed a significant lower body mass index (BMI) and had lower socioeconomic conditions. They had a worse glycaemic control. The pattern of complications was also different between the two groups, with cardiovascular complications more frequent in Italians. Finally, also pharmacologic treatment differed significantly.

CONCLUSIONS

Age of onset, clinical manifestations and complications of T2DM in undocumented migrants and natives may show significant differences. This is important for both epidemiological and clinical reasons. If these preliminary observations are confirmed by larger studies, we can conclude that undocumented migrants should be screened for T2DM earlier than natives, and that therapies should be tailored to the specific features of their disease.

Fruit and Vegetable Consumption among Immigrants in Portugal: A Nationwide Cross-Sectional Study

This study aims to compare adequate fruit and vegetable (F&V) intake between immigrants and natives in Portugal, and to analyse factors associated with consumption of F&V among immigrants. Data from a population based cross-sectional study (2014) was used. The final sample comprised 17,410 participants (≥20 years old), of whom 7.4% were immigrants. Chi-squared tests and logistic regression models were conducted to investigate the association between adequate F&V intake, sociodemographic, anthropometric, and lifestyle characteristics. Adequate F&V intake was more prevalent among immigrants (21.1% (95% CI: 19.0–23.4)) than natives (18.5% (95% CI: 17.9–19.1)), (p = 0.000). Association between migrant status and adequate F&V intake was only evident for men: immigrants were less likely to achieve an adequate F&V intake (OR = 0.67, 95% CI = 0.66–0.68) when compared to Portuguese. Among immigrants, being female, older, with a higher education, and living in a low urbanisation area increased the odds of having F&V consumption closer to the recommendations. Adjusting for other factors, length of residence appears as a risk factor (15 or more years vs. 0–9 years: OR = 0.52, 95% CI = 0.50–0.53), (p = 0.000) for adequate F&V intake. Policies aiming to promote adequate F&V consumption should consider both populations groups, and gender-based strategies should address proper sociodemographic, anthropometric, and lifestyle determinants.

Gender and age related differences in the use of medicines for chronic diseases among undocumented migrants

Purpose

The purpose of this paper is to evaluate gender-related differences in the use of drugs for chronic diseases in undocumented migrants.

Design/methodology/approach

The authors analyzed the databases of two charitable organizations providing medical help and medicines to undocumented migrants. Data were available for 9,822 patients in the period 2014–2016. The authors grouped medicines according to the Anatomical Therapeutic Chemical (ATC) classification. We considered the ATC group as an indicator of a group of diseases.

Findings

Both males and females needed medicines for chronic diseases in a comparable manner. When we analyzed the age distribution, The authors noticed that males showed a tendency to begin to be affected at an earlier age; however, this cumulative difference was not statistically significant. But when we looked at six groups of drugs separately (cardiovascular, respiratory, anti-thrombotic, neurologic, psychiatric, anti-diabetic), the authors found that females always needed drugs for chronic diseases at a later age, always with a significant difference (p<0.0001 for cardiovascular, antithrombotic, antidiabetic and psychoactive drugs; p<0.002 for neurologic products; p<0.04 for drugs used in chronic respiratory conditions).

Research limitations/implications

This is a retrospective study based on the analysis of existing databases, but the peculiar features of this population (undocumented migrants) do not allow at the moment controlled studies.

Practical implications

Our observations could be important when planning public health strategies, especially in the field of prevention.

Originality/value

This is the first report of gender differences in the use of medicines for chronic diseases within a large sample of undocumented migrants.