Sleep History and Hypertension Burden in First-Generation Chinese Migrants Settled in Italy: The CHIinese In Prato Cross-Sectional Survey

Body-Size Perception among First-Generation Chinese Migrants in Italy

Body-size perception is an important factor in motivating people to lose weight. Study aim was to explore the perception of body image among first-generation Chinese migrants living in Italy. A sample of 1258 Chinese first-generation immigrants and of 285 native Italians living in Prato, Italy, underwent blood pressure measurements, blood tests (with measurement of glucose, cholesterol, and triglycerides), and anthropometric measurements. Body-size perception was investigated with Pulvers’ figure rating scale using logistic or linear multivariable regression adjusted for age, gender, BMI, education and years spent in Italy. Chinese migrants had lower BMI and discrepancy score (preferred minus current body size) than Italians (p < 0.05 for both). After a logistic regression analysis, the discrepancy score remained lower in the Chinese than in the Italian cohort independently from BMI and other confounders (OR 0.68; 95%CI 0.50 to 0.92). In the Chinese cohort, female gender, BMI and years spent in Italy were positive determinants of discrepancy score (desire to be thinner), while age showed negative impact (p < 0.05 for all). Overweight is an important risk factor for diabetes, a very prevalent condition among first-generation Chinese migrants. The present study offers useful information and suggests the need for prevention programs specifically addressed to men.

Gender differences in acculturation and cardiovascular disease risk-factor changes among Chinese immigrants in Italy: Evidence from a large population-based cohort

Background

In recent decades, the Chinese presence in Southern Europe has grown rapidly but no data is available on the influence that residing in Mediterranean countries has on Chinese immigrants. In this study, we aim to examine the association between acculturation and cardiovascular risk factors among first-generation Chinese immigrants in Italy.

Design

Population-based, cross-sectional study.

Methods

A sample of 2589 Chinese first-generation immigrants (1599 women and 990 men) living in Prato, Italy, underwent blood pressure measurement, blood tests (with measurement of glucose, cholesterol, and triglycerides), and anthropometric measurements. The influence of length of residence (dependent variable) on hypertension, type 2 diabetes, overweight/obesity, and hyperlipidemia (high cholesterol) (independent variables) was investigated with multivariable logistic regression adjusted for age, sex, education and urban/rural home area in China before migration.

Results

Mean age of Chinese participants was 47.2 ± 10.7 years and 61.7% were women. Immigrants residing in Italy for ≥20 years were more likely to be hypertensive [odd ratio (OR) 1.84; 95% confidence interval (CI) 1.33 to 2.59], or diabetic (1.91; 1.26 to 2.86) than those residing in Italy for <10 years. Differently, prevalence of hypercholesterolemia (total cholesterol≥240 mg/dl) was lower in immigrants residing in Italy for ≥20 years than in those with <10 years of residence (0.52; 0.32 to 0.83). The association between indicators of acculturation and cardiovascular risk factors appeared to differ by sex.

Conclusion

Acculturation of Chinese immigrants in Italy was associated with hypertension and type 2 diabetes whereas a favorable effect on hypercholesterolemia was observed.

Gender differences in the impact on physical activity and lifestyle in Italy during the lockdown, due to the COVID-19 pandemic

BACKGROUND AND AIMS

Italy responded to the Covid-19 pandemic early by forcing the entire population into a 2-month domestic confinement. The aim of this study was to assess gender differences in the impact of lockdown on physical activity and lifestyle habits.

METHODS AND RESULTS

A cross-sectional web-based survey was conducted in April 2020 on a general population sample residing in Italy. Participants completed validated questionnaires. Gender differences were assessed using a multivariable adjusted logistic regression model using gender as independent and exposures as dependent variables. Metabolic equivalents-hour/week was used to evaluate physical activity. A total of 2218 participants (761 men and 1457 women) agreed to participate in the study and completed the questionnaire. The survey found that women compared to men showed 1) a lower level of physical activity before the institution of lockdown, 2) a lower tendency to reduce physical activity levels during the lockdown, when gender differences in compliance with guideline recommendations for physical activity disappeared, 3) and a worsening of sleep and stool passage; men experienced an increase in alcohol consumption.

CONCLUSIONS

Women, who previously had a lower level of physical activity than men, showed a lower tendency to reduce it during lockdown, revealing greater resilience than men. However, the worsening in sleep, in stool passage, and a trend to weight increase revealed signs of psychological suffering after a protracted lockdown period.

Association Between Self-Reported Snoring and Metabolic Syndrome: A Systematic Review and Meta-Analysis

Background: Snoring is a common condition. Previous studies have reported the relationships between snoring and metabolic syndrome (MetS) and/or its five components: hypertension, hyperglycemia, low-high density lipoprotein (low-HDL), high-triglyceride level, and abdominal obesity. However, conclusions have been inconsistent, and there has been no comprehensive summary on this. Therefore, we performed a systematic review on the relationships between snoring and MetS, including each of MetS' components.

Methods: A systematic review and a meta-analysis were conducted following the Meta-analysis of Observational Studies in Epidemiology group and Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Electronic databases including PubMed, Embase, and the Cochrane Library were searched for publications from inception to 15 July 2020. The inverse-variance weighted method was used in the meta-analysis to calculate the pooled odds ratios (ORs) and their 95% confidence intervals (CIs) to determine the association between snoring and MetS (and its components) through a fixed or random effect model. A restricted cubic spline regression model and the linear regression model were used in a two-stage dose–response meta-analysis to evaluate the non-linear and the linear trends between snoring frequency and MetS and its components.

Results: A total of 40 studies with 966,652 participants were included in this study. The pooled ORs between snoring and MetS and its components, hypertension, hyperglycemia, low-HDL, high-triglyceride level, and abdominal obesity, were 1.61 (95% CI, 1.43–1.78), 1.23 (95% CI, 1.15–1.31), 1.05 (95% CI, 1.04–1.07), 1.09 (95% CI, 1.00–1.18), 1.08 (95% CI, 1.00–1.17), and 1.75 (95% CI, 1.46–2.05), respectively. Non-linear trends were detected in the five associations except for low-HDL. A linear trend was detected in the association of snoring with hypertension, hyperglycemia, low-HDL, or abdominal obesity, with ORs of 1.07 (95% CI, 1.01–1.13), 1.05 (95% CI, 1.02–1.08), 1.03 (95% CI, 1.02–1.04), and 1.17 (95% CI, 1.16–2.89), respectively.

Conclusion: Snoring was a risk factor of MetS, and a dose–response relationship existed between the two. Timely intervention in identifying snorers can minimize as much as possible the risk of metabolic syndrome in those who snore.

Sleep disorders in migrants and refugees: a systematic review with implications for personalized medical approach

Background

Sleep disorders are very common in migrants and refugees, often as a comorbid disorder to different somatic or psychiatric diagnoses and psychological disturbances such as metabolic syndrome, post-traumatic stress disorder, depression, and anxiety disorders.

Objectives

To review published prevalence rates as well as possible predictors for sleep disturbances in these vulnerable groups, including pre-migration stress, acculturation, and trauma before, during, and after migration, integration, and lifestyle in the host country with implications for predictive, preventive, and personalized medical approach (3PM).

Data sources

Electronic databases PubMed, PsycInfo, and Web of Knowledge were searched using (combined) search terms "migrant," "asylum seeker," "refugee," "sleep disturbances," "sleep disorder," "insomnia," and "sleep wake disorder."

Study eligibility criteria

Peer-reviewed studies from 2000 to 2018 reporting data on prevalence and/or predictors of any measure of sleep disturbance were included.

Participants

Studies on international migrants and refugees, as well as internally displaced populations, were included.

Methods

We conducted a systematic review on the topic of sleep disorders in migrant and refugee populations. Only published articles and reviews in peer-reviewed journals were included.

Results

We analyzed five studies on sleep disorders in migrants, five studies on adult refugees, and three on refugee children and adolescents. Prevalence of sleep disorders in migrants and refugees ranges between 39 and 99%. In migrant workers, stress related to integration and adaptation to the host society is connected to higher risks of snoring, metabolic diseases, and insomnia. Sleep disturbances in refugees are predicted by past war experience. Sleep difficulties in adult and child refugees are strongly correlated to trauma. Torture of parents and grandparents can predict sleep disorders in refugee children, while being accompanied by parents to the host country has a protective effect on children's sleep.

Conclusions and implications

Considering the differences in risk factors, vulnerability, and traumatic life events for different migrant populations, origins of sleep difficulties vary, depending on the migrant populations. Effects on sleep disturbances and sleep quality may be a result of integration in the host country, including changes of lifestyle, such as diet and working hours with implication for OSAS (obstructive sleep apnea) and insomnia. Compared with migrant populations, sleep disturbances in refugee populations are more correlated with mental health symptoms and disorders, especially PTSD (post-traumatic stress disorder), than with psychosocial problems. In juvenile refugee populations, psychological problems and disturbed sleep are associated with traumatic experiences during their journey to the host country. Findings highlight the need for expert recommendations for development of 3P approach stratified in the following: (1) prediction, including structured exploration of predisposing and precipitating factors that may trigger acute insomnia, screening of the according sleep disorders by validated translated questionnaires and sleep diaries, and a face-to-face or virtual setting and screening of OSAS; (2) target prevention by sleep health education for female and male refugees and migrant workers, including shift workers; and (3) personalized medical approach, including translated cognitive behavioral treatment for insomnia (CBT-I) and imagery rehearsal therapy for refugees and telehealth programs for improved CPAP adherence in migrants, with the goal to enable better sleep health quality and improved health economy.

Daily urinary sodium and potassium excretion in Chinese first-generation migrants in Italy

BACKGROUND

China has one of the highest salt intake levels in the world, and Chinese people form one of the largest foreign-born communities now living in Europe. The present study was performed to assess 24-hour urinary sodium and potassium excretion in Chinese migrants in Italy and to explore possible associations with hypertension, hypertension awareness, and length of residence in Italy.

METHODS

A cross-sectional evaluation was conducted on 319 first-generation Chinese migrants (154 women and 165 men) aged 18-70 years. Subjects were asked to do a 24-hour urine collection and the relationships of urinary sodium and potassium and arterial blood pressure, hypertension (BP ≥ 140/90 mmHg or anti-hypertensive drug use), hypertension awareness, and years of residence in Italy were investigated with linear or logistic regression analysis.

RESULTS

Sodium excretion was 145.2 mmol/day (95%CI 138.0-152.3) in men, and 134.7 (95%CI 127.6-141.8) in women corresponding to a dietary salt intake of 9.4 g/day (95%CI 9.0-9.9) and 8.8 (95%CI 8.3-9.2) respectively. Potassium excretion was 35.1 mmol/day (95%CI 33.6-36.5), with no significant difference by gender. At multivariable adjusted linear regression analysis body mass index, low education level, and hypertension were positive predictors of sodium urinary excretion; gender (women), and body mass index were positive predictors of potassium excretion. Sodium and potassium excretion were unaffected by hypertension awareness or years of residence in Italy.

CONCLUSIONS

Sodium excretion in Chinese workers is higher than recommended and in line with high salt intake in Italy. Potassium consumption remains low.

Comparison of type 2 diabetes prevalence in Chinese migrants vs Caucasians and new perspectives for screening of cerebrovascular disease in Chinese: A proof of concept study

AIMS

Type 2 diabetes (T2DM) is a recognized risk factor for intracranial stenosis (ICS) in China where ischemic stroke is a health priority. In Europe little information is available on T2DM prevalence among Chinese minority groups and vascular screening is commonly limited to extracranial vessels. Feasibility of community-based T2DM screening, differences in T2DM prevalence between Chinese migrants and Italians, and prevalence of ICS among Chinese patients with newly diagnosed T2DM were investigated.

METHODS

Chinese first generation migrants (n=1200) and native Italians (n=291) aged 35-59years were enrolled in a cross-sectional survey. Diagnosis of T2DM was based on fasting plasma glucose and/or current treatment with glucose-lowering drugs. Newly diagnosed Chinese patients were screened for ICS using Doppler ultrasound.

RESULTS

T2DM was more prevalent among Chinese (n=168, 14.0%) than Italians (n=21, 7.3%) (age- and gender adjusted OR 2.29; 95% C.L. 1.41-3.72). Prevalence of ICS among newly diagnosed Chinese was 18.2%. Nine out of the 17 patients with any ICS (52%) had >1 intracranial lesion.

CONCLUSIONS

T2DM screening within the Chinese community was feasible revealing prevalence twice as much as in the Italian cohort; the 18% prevalence of ICS in newly diagnosed Chinese patients stresses the need of implementing appropriate vascular screening strategies.

Prevalence, Awareness, Treatment, and Control of Hypertension among Chinese First-Generation Migrants and Italians in Prato, Italy: The CHIP Study

Data on health needs of Chinese living in the South of Europe are lacking. To compare prevalence, awareness, treatment, control, and risk factors for hypertension between Chinese migrants and Italian adults, a sample of 1200 first-generation Chinese migrants and 291 native Italians aged 35–59 years living in Prato (Italy) was recruited in a community-based participatory cross-sectional survey. Primary outcome measure was hypertension, diagnosed for blood pressure values ≥ 140/90 mmHg or current use of antihypertensive medications. Associations with exposures (including age, gender, body mass index, waist, education level, total cholesterol, and triglycerides) were examined using logistic regression. When compared with Italians, Chinese had higher hypertension prevalence (27.2% versus 21.3%, p < 0.01), with comparable levels of awareness (57.4% and 48.4%) but lower treatment rates (70.6% and 90.0%, resp.). In both ethnic groups age and parental history of hypertension were predictors of awareness and treatment, body mass index being predictor of hypertension diagnosis. In Chinese participants, where the optimum cut-off point for body mass index was ≥23.9 kg/m², the sensibility and specificity prediction for hypertension were 61.7% and 59.8%, respectively (area under the ROC curve = 0.629). Implementation of specific, culturally adapted health programs for the Chinese community is now needed.