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Hawley NL, Zarei P, Crouter SE, Desai MM, Pomer A, Rivara AC, Naseri T, Reupena MS, Viali S, Duckham RL, McGarvey ST. Accelerometer-Based Estimates of Physical Activity and Sedentary Time Among Samoan Adults. J Phys Act Health 2024; 21:636-644. [PMID: 38621669 DOI: 10.1123/jpah.2023-0590] [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] [Received: 10/09/2023] [Revised: 01/15/2024] [Accepted: 02/26/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND The prevalence of obesity-related cardiometabolic disease in Samoa is among the highest globally. While physical activity is a modifiable risk factor for obesity-related disease, little is known about physical activity levels among adult Samoans. Using wrist-worn accelerometer-based devices, this study aimed to characterize physical activity among Samoan adults. METHODS Samoan adults (n = 385; 55% female, mean [SD] age 52 [10] y) wore Actigraph GT3X+ devices for 7 to 10 days. General linear models were used to examine mean daily minutes of sedentary time, light physical activity, and moderate to vigorous physical activity by various participant characteristics. RESULTS Time spent in moderate to vigorous physical activity did not differ statistically between men (88 [5] min; 95% confidence interval [CI], 80-97) and women (78 [4] min; 95% CI, 70-86; P = .08). Women, however, spent more time than men in light physical activity: 380 (7) minutes (95% CI, 367-393) versus 344 (7) minutes (95% CI, 329-358; P < .001). While there were no differences in physical activity by census region, education, or occupation among women, men in urban areas spent significantly less time in moderate to vigorous physical activity than those in peri-urban and rural areas (P = .015). Women with class II/III obesity spent more time in sedentary activities than those with healthy weight or overweight/class I obesity (P = .048). CONCLUSIONS This study characterizes physical activity among Samoan adults and highlights variation by sex, urbanicity, and weight status. In providing initial device-measured estimates of physical activity in Samoa, this analysis establishes a baseline from which the success of future attempts to intervene on physical activity may be assessed.
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Affiliation(s)
- Nicola L Hawley
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Parmida Zarei
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
- University of Illinois College of Medicine, Chicago, IL, USA
| | - Scott E Crouter
- Department of Kinesiology, Recreation, and Sport Studies, The University of Tennessee, Knoxville, TN, USA
| | - Mayur M Desai
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Alysa Pomer
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Anna C Rivara
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | | | | | | | - Rachel L Duckham
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, Australia
- Clinical Leadership Effectiveness and Outcomes (CLEO), Digital Health Division, The Northern Hospital, Melbourne, VIC, Australia
| | - Stephen T McGarvey
- Department of Epidemiology and International Health Institute, Brown University School of Public Health, Providence, RI, USA
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Rivara AC, Russell EM, Carlson JC, Pomer A, Naseri T, Reupena MS, Manna SL, Viali S, Minster RL, Weeks DE, DeLany JP, Kershaw EE, McGarvey ST, Hawley NL. Associations between fasting glucose rate-of-change and the missense variant, rs373863828, in an adult Samoan cohort. PLoS One 2024; 19:e0302643. [PMID: 38829901 PMCID: PMC11146712 DOI: 10.1371/journal.pone.0302643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 04/09/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND The A allele of rs373863828 in CREB3 regulatory factor is associated with high Body Mass Index, but lower odds of type 2 diabetes. These associations have been replicated elsewhere, but to date all studies have been cross-sectional. Our aims were (1) to describe the development of type 2 diabetes and change in fasting glucose between 2010 and 2018 among a longitudinal cohort of adult Samoans without type 2 diabetes or who were not using diabetes medications at baseline, and (2) to examine associations between fasting glucose rate-of-change (mmol/L per year) and the A allele of rs373863828. METHODS We describe and test differences in fasting glucose, the development of type 2 diabetes, body mass index, age, smoking status, physical activity, urbanicity of residence, and household asset scores between 2010 and 2018 among a cohort of n = 401 adult Samoans, selected to have a ~2:2:1 ratio of GG:AG: AA rs373863828 genotypes. Multivariate linear regression was used to test whether fasting glucose rate-of-change was associated with rs373863828 genotype, and other baseline variables. RESULTS By 2018, fasting glucose and BMI significantly increased among all genotype groups, and a substantial portion of the sample developed type 2 diabetes mellitus. The A allele was associated with a lower fasting glucose rate-of-change (β = -0.05 mmol/L/year per allele, p = 0.058 among women; β = -0.004 mmol/L/year per allele, p = 0.863 among men), after accounting for baseline variables. Mean fasting glucose and mean BMI increased over an eight-year period and a substantial number of individuals developed type 2 diabetes by 2018. However, fasting glucose rate-of-change, and type 2 diabetes development was lower among females with AG and AA genotypes. CONCLUSIONS Further research is needed to understand the effect of the A allele on fasting glucose and type 2 diabetes development. Based on our observations that other risk factors increased over time, we advocate for the continued promotion for diabetes prevention and treatment programming, and the reduction of modifiable risk factors, in this setting.
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Affiliation(s)
- Anna C. Rivara
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Emily M. Russell
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Jenna C. Carlson
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Alysa Pomer
- Center of Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA, United States of America
| | - Take Naseri
- Family Health Clinic, Apia, Samoa
- Naseri & Associates Health Consultancy Firm, Apia, Samoa
| | | | - Samantha L. Manna
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
- Center for Craniofacial and Dental Genetics, Department of Oral and Craniofacial Sciences, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Satupaitea Viali
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, United States of America
- Oceania University of Medicine, Apia, Samoa
| | - Ryan L. Minster
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Daniel E. Weeks
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - James P. DeLany
- Advent Health Orlando, Translational Research Institute, Orlando, FL, United States of America
| | - Erin E. Kershaw
- Division of Endocrinology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Stephen T. McGarvey
- Department of Epidemiology, International Health Institute, School of Public Health, Brown University, Providence, RI, United States of America
- Department of Anthropology, Brown University, Providence, RI, United States of America
| | - Nicola L. Hawley
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, United States of America
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Niclou A, Vesi L, Arorae M, Naseri NC, Savusa KF, Naseri T, Young J, Rivara AC, Ocobock C. Indication of mixed glucose and fatty acid use by inferred brown adipose tissue activity in Samoans. Am J Hum Biol 2024; 36:e23998. [PMID: 37823535 PMCID: PMC10939975 DOI: 10.1002/ajhb.23998] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 09/11/2023] [Accepted: 09/21/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVES Despite the growing rates of global obesity and the known positive associations between brown adipose tissue (BAT) and cardiovascular health, little is known about the metabolic effects of BAT activity in Samoans, a population at high risk of obesity and type II diabetes. Here we assessed the potential effects of inferred BAT activity on metabolic health markers in Samoan adults exposed to mild cold. METHODS Using point-of-care finger prick technology we measured fasting glucose, total cholesterol, high-density lipoprotein (HDL), and low-density lipoprotein (LDL) levels before and after 30 min of cold exposure among 61 individuals (38 females, 23 males, ages 31-54) from 'Upolu Island, Samoa. Respiratory quotient was measured by indirect calorimetry to determine substrate metabolism at room temperature and cold exposure. RESULTS Fasting glucose levels decreased significantly (p < .001) after cold exposure while neither total cholesterol (p = .88), HDL (p = .312), nor LDL (p = .089) changed. Respiratory quotient decreased significantly (p = .009) between exposures, suggesting an increased preference for lipid metabolism as a response to cold. CONCLUSIONS The observed effects of inferred BAT activity on biomarkers suggest BAT activity utilizes both glucose and lipid-derived fatty acids as fuel for thermogenesis. Our work provides evidence for the beneficial metabolic effects of BAT and emphasizes the need for the population-specific development of metabolic treatments involving BAT to ensure the successful and equitable minimization of extreme consequences of obesity and metabolic health.
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Affiliation(s)
- Alexandra Niclou
- Pennington Biomedical Research Center, Baton Rouge, LA
- Department of Anthropology, University of Notre Dame, Notre Dame, IN
| | - Lupesina Vesi
- Obesity, Lifestyle and Genetic Adaptations (OLaGA) Study Group, Apia, Samoa
| | - Maria Arorae
- Obesity, Lifestyle and Genetic Adaptations (OLaGA) Study Group, Apia, Samoa
| | | | | | | | - Jessica Young
- Center for Social Science Research, University of Notre Dame, Notre Dame, IN
| | - Anna C. Rivara
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
| | - Cara Ocobock
- Department of Anthropology, University of Notre Dame, Notre Dame, IN
- Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN
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Kuek T. Type 2 Diabetes Prevalence, Control and Management within Fiji,Kiribati, Samoa, the Solomon Islands, Tonga, and Vanuatu: A ScopingReview with a Systematic Approach. Curr Diabetes Rev 2024; 20:e220124225914. [PMID: 38258764 DOI: 10.2174/0115733998260306231025151814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/25/2023] [Accepted: 09/15/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Type 2 diabetes (T2D) causes significant morbidity and is disproportionately prevalent in Pacific Island Countries (PICs). The socio-political demographics of PICs are rapidly changing, and health services must adapt to match the needs of their population. OBJECTIVES The objective of this study was to review the literature published within the last 15 years relating to T2D prevalence, control, and management, with a specific focus on targetable areas for future funding and research projects. METHODS This review was conducted using the PRISMA guidelines. Inclusion criteria were: discussion on T2D in the six PICs. Results were limited to those published between 1st January, 2006, and 27th July, 2023. RESULTS A total of 6,640 publications were retrieved, and 110 met the inclusion criteria. Nineteen additional studies were identified through hand-searching. T2D prevalence differed between countries but was predicted to increase in the coming decades, with projections of up to 31.2% by 2030 in Tonga. Factors associated with T2D varied between countries, including Indian-Fijian ethnicity in Fiji and tuberculosis in Kiribati. Control was generally poor, with high rates of undiagnosed diabetes and microvascular complications. Epidemiological data was limited in some cases, as was information describing the structure and function of diabetes services. CONCLUSION The prevalence, control, and management of T2D varied between Fiji, Kiribati, Samoa, the Solomon Islands, Tonga, and Vanuatu. Significant gaps remain in the data describing these domains; however, there are clearly targetable areas for future research and diabetes management programs.
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Affiliation(s)
- Timothy Kuek
- Interplast Australia and New Zealand, 250/290 Spring St, East Melbourne VIC, 3002, Australia
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Oyama S, Duckham RL, Pomer A, Rivara AC, Kershaw EE, Wood A, Fidow UT, Naseri T, Reupena MS, Viali S, McGarvey ST, Hawley NL. Association between age at menarche and cardiometabolic risk among Samoan adults. Am J Hum Biol 2024; 36:e23982. [PMID: 37668413 PMCID: PMC10845161 DOI: 10.1002/ajhb.23982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/19/2023] [Accepted: 08/15/2023] [Indexed: 09/06/2023] Open
Abstract
OBJECTIVES Recent studies suggest that early menarche may increase cardiometabolic morbidity and mortality. Yet few studies have examined this association in the Pacific Islands, where obesity prevalence is among the highest globally. We sought to examine associations between age at menarche and cardiometabolic risk in Samoa. METHODS Participants were from the Soifua Manuia study (n = 285, age 32-72 years) conducted in Samoa from 2017 to 2019. Logistic regressions were conducted to estimate odds of obesity, hypertension, diabetes, dyslipidemia, and metabolic syndrome per one-year increase in age at menarche. Linear regressions were conducted to examine associations between age at menarche and continuous measures of adiposity, blood pressure, insulin resistance, and serum lipids. RESULTS Median age at menarche was 14 years (IQR = 2). After controlling for relevant covariates, each one-year increase in age at menarche was associated with a 15% decrease (OR = 0.85, 95% CI: 0.72-1.01, p = .067) in odds of hypertension, but a 21% increase (OR = 1.21, 95% CI: 1.01-1.45, p = .044) in odds of diabetes and 18% increase (OR = 1.18, 95% CI: 0.98-1.42, p = .081) in odds of high total cholesterol. Each additional year in age at menarche was associated with a 1.60 ± 0.52 kg (p = .002) decrease in lean mass and 1.56 ± 0.51 kg (p = .003) decrease in fat-free mass. CONCLUSIONS Associations between age at menarche and cardiometabolic risk may be population-specific and are likely influenced by both current and historical nutritional and epidemiological contexts. Prospective studies are needed to clarify the role of childhood adiposity and other early life exposures on age at menarche and subsequent cardiometabolic risk.
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Affiliation(s)
- Sakurako Oyama
- Yale School of Medicine, New Haven, Connecticut, USA
- Department of Anthropology, Yale University, New Haven, Connecticut, USA
| | - Rachel L Duckham
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Burwood, Victoria, Australia
- Australian Institute for Musculoskeletal Sciences, Department of Medicine, Western Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Alysa Pomer
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Anna C Rivara
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Erin E Kershaw
- Division of Endocrinology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ashlee Wood
- Division of Endocrinology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ulai T Fidow
- Department of Obstetrics & Gynecology, Tupua Tamasese Meaole Hospital, Apia, Samoa
| | | | | | | | - Stephen T McGarvey
- International Health Institute, Department of Epidemiology, Department of Anthropology, Brown University, Providence, Rhode Island, USA
| | - Nicola L Hawley
- Department of Anthropology, Yale University, New Haven, Connecticut, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
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Rivara AC, Galárraga O, Selu M, Arorae M, Wang R, Faasalele-Savusa K, Rosen R, Hawley NL, Viali S. Identifying patient preferences for diabetes care: A protocol for implementing a discrete choice experiment in Samoa. PLoS One 2023; 18:e0295845. [PMID: 38134044 PMCID: PMC10745180 DOI: 10.1371/journal.pone.0295845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023] Open
Abstract
In Samoa, adult Type 2 diabetes prevalence has increased within the past 30 years. Patient preferences for care are factors known to influence treatment adherence and are associated with reduced disease progression and severity. However, patient preferences for diabetes care, generally, are understudied, and other patient-centered factors such as willingness-to-pay (WTP) for diabetes treatment have never been explored in this setting. Discrete Choice Experiments (DCE) are useful tools to elicit preferences and WTP for healthcare. DCEs present patients with hypothetical scenarios composed of a series of multi-alternative choice profiles made up of attributes and levels. Patients choose a profile based on which attributes and levels may be preferable for them, thereby quantifying and identifying locally relevant patient-centered preferences. This paper presents the protocol for the design, piloting, and implementation of a DCE identifying patient preferences for diabetes care, in Samoa. Using an exploratory sequential mixed methods design, formative data from a literature review and semi-structured interviews with n = 20 Samoan adults living with Type 2 diabetes was used to design a Best-Best DCE instrument. Experimental design procedures were used to reduce the number of choice-sets and balance the instrument. Following pilot testing, the DCE is being administered to n = 450 Samoan adults living with diabetes, along with associated questionnaires, and anthropometrics. Subsequently, we will also be assessing longitudinally how preferences for care change over time. Data will be analyzed using progressive mixed Rank Order Logit models. The results will identify which diabetes care attributes are important to patients (p < 0.05), examine associations between participant characteristics and preference, illuminate the trade-offs participants are willing to make, and the probability of uptake, and WTP for specific attributes and levels. The results from this study will provide integral data useful for designing and adapting efficacious diabetes intervention and treatment approaches in this setting.
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Affiliation(s)
- Anna C. Rivara
- Department of Epidemiology (Chronic Diseases), Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Omar Galárraga
- Department of Health Services Policy and Practice, and International Health Institute, School of Public Health, Brown University, Providence, Rhode Island, United States of America
| | - Melania Selu
- Obesity Lifestyle and Genetic Adaptations (OLaGA) Research Center, Apia, Samoa
| | - Maria Arorae
- Obesity Lifestyle and Genetic Adaptations (OLaGA) Research Center, Apia, Samoa
| | - Ruiyan Wang
- Department of Epidemiology (Chronic Diseases), Yale School of Public Health, New Haven, Connecticut, United States of America
| | | | - Rochelle Rosen
- Centers for Behavioral and Preventative Medicine, The Miriam Hospital, Providence, Rhode Island, United States of America
- Department of Behavioral and Social Sciences, Brown University, School of Public Health, Providence, Rhode Island, United States of America
| | - Nicola L. Hawley
- Department of Epidemiology (Chronic Diseases), Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Satupaitea Viali
- Department of Epidemiology (Chronic Diseases), Yale School of Public Health, New Haven, Connecticut, United States of America
- School of Medicine, National University of Samoa, Apia, Samoa
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Figueroa CA, Linhart CL, Dearie C, Fusimalohi LE, Kupu S, Morrell SL, Taylor RJ. Effects of inappropriate cause-of-death certification on mortality from cardiovascular disease and diabetes mellitus in Tonga. BMC Public Health 2023; 23:2381. [PMID: 38041110 PMCID: PMC10691179 DOI: 10.1186/s12889-023-17294-z] [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] [Received: 09/07/2023] [Accepted: 11/22/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) and diabetes mellitus are major health issues in Tonga and other Pacific countries, although mortality levels and trends are unclear. We assess the impacts of cause-of-death certification on coding of CVD and diabetes as underlying causes of death (UCoD). METHODS Tongan records containing cause-of-death data (2001-2018), including medical certificates of cause-of-death (MCCD), had UCoD assigned according to International Classification of Diseases 10th revision (ICD-10) coding rules. Deaths without recorded cause were included to ascertain total mortality. Diabetes and hypertension causes were reallocated from Part 1 of the MCCD (direct cause) to Part 2 (contributory cause) if potentially fatal complications were not recorded, and an alternative UCoD was assigned. Proportional mortality by cause based on the alternative UCoD were applied to total deaths then mortality rates calculated by age and sex using census/intercensal population estimates. CVD and diabetes mortality rates for unaltered and alternative UCoD were compared using Poisson regression. RESULTS Over 2001-18, in ages 35-59 years, alternative CVD mortality was higher than unaltered CVD mortality in men (p = 0.043) and women (p = 0.15); for 2010-18, alternative versus unaltered measures in men were 3.3/103 (95%CI: 3.0-3.7/103) versus 2.9/103 (95%CI: 2.6-3.2/103), and in women were 1.1/103 (95%CI: 0.9-1.3/103) versus 0.9/103 (95%CI: 0.8-1.1/103). Conversely, alternative diabetes mortality rates were significantly lower than the unaltered rates over 2001-18 in men (p < 0.0001) and women (p = 0.013); for 2010-18, these measures in men were 1.3/103 (95%CI: 1.1-1.5/103) versus 1.9/103 (95%CI: 1.6-2.2/103), and in women were 1.4/103 (95%CI: 1.2-1.7/103) versus 1.7/103 (95%CI: 1.5-2.0/103). Diabetes mortality rates increased significantly over 2001-18 in men (unaltered: p < 0.0001; alternative: p = 0.0007) and increased overall in women (unaltered: p = 0.0015; alternative: p = 0.014). CONCLUSIONS Diabetes reporting in Part 1 of the MCCD, without potentially fatal diabetes complications, has led to over-estimation of diabetes, and under-estimation of CVD, as UCoD in Tonga. This indicates the importance of controlling various modifiable risks for atherosclerotic CVD (including stroke) including hypertension, tobacco use, and saturated fat intake, besides obesity and diabetes. Accurate certification of diabetes as a direct cause of death (Part 1) or contributory factor (Part 2) is needed to ensure that valid UCoD are assigned. Examination of multiple cause-of-death data can improve understanding of the underlying causes of premature mortality to better inform health planning.
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Affiliation(s)
- Carah A Figueroa
- Statistics for Development Division, Pacific Community, Nouméa, New Caledonia.
| | - Christine L Linhart
- School of Population Health, University of New South Wales, UNSW, Sydney, Australia
| | - Catherine Dearie
- School of Population Health, University of New South Wales, UNSW, Sydney, Australia
| | | | | | - Stephen L Morrell
- School of Population Health, University of New South Wales, UNSW, Sydney, Australia
| | - Richard J Taylor
- School of Population Health, University of New South Wales, UNSW, Sydney, Australia
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Hailu Wondafrash A, Laifa Lima U, Abebe D, Negash KS. Incidence and Causes of Cellulitis Among Patients at Tupua Tamasese Meaole Hospital in Upolu, Samoa in 2019. Cureus 2023; 15:e48318. [PMID: 38058333 PMCID: PMC10697806 DOI: 10.7759/cureus.48318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 12/08/2023] Open
Abstract
OBJECTIVE To study the incidence and causes of cellulitis in patients who visited the only tertiary hospital in Samoa, i.e., Tupua Tamasese Meaole (TTM) Hospital, in 2019. METHOD Of the total of 14,198 patients who presented to TTM Hospital in 2019, a chart review of all 258 patients who presented with cellulitis was conducted. All charts with the final primary admitting diagnosis of cellulitis were extracted. No exclusion criteria were employed, and raw data were analyzed manually. RESULTS Of the 14,198 patients who sought care at TTM Hospital in 2019, 258 patients received care for cellulitis. This represents an incidence rate of 1.8%. Most patients were male (62.4%). Those in the age group of 41 to 80 years old accounted for 79.5% of the total. The leg (94.6%) was the major site of infection. Of those who had blood cultures drawn, 76.4% had negative results. Of the 56 patients with positive microbial growth, Staphylococcus and Streptococcus species accounted for a combined total of 71.4% of the cases. The mainstay of antibiotic treatment was flucloxacillin alone or in conjunction with other antibiotics (92.2%). Of the many comorbidities affecting patients, diabetes (44.2%) was the most prevalent. Hospital admission, ranging from three to 10 days was needed in 63.5% of patients. CONCLUSION The incidence rate of cellulitis at TTM in 2019 was 1.8%, which was marginally higher than noted in other parts of the world. Male patients and people over the age of 40 years are affected the most. The leg is affected the most mainly by Staphylococcus and Streptococcus species. Flucloxacillin is the main antibiotic used to treat cellulitis at the TTM Hospital. From the data analyses, it is inferred that a large proportion of patients who presented had moderate to severe cellulitis.
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Affiliation(s)
| | - Uila Laifa Lima
- Department of Medicine, Oceania University of Medicine, Apia, WSM
| | - Degu Abebe
- Department of Medicine, Oceania University of Medicine, Apia, WSM
| | - Kidus S Negash
- Department of Medicine, Hayat Medical College, Addis Ababa, ETH
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Tepai M, Nosa V, Herman J, May YY, Kiadarbandsari A, Sluyter J. Diabetes in the Cook Islands: a clinical audit. J Prim Health Care 2023; 15:176-183. [PMID: 37390040 DOI: 10.1071/hc21138] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/28/2023] [Indexed: 07/02/2023] Open
Abstract
Introduction The global burden of diabetes mellitus (diabetes) is significant and of increasing concern with more pregnant women being diagnosed with gestational diabetes mellitus (GDM). The Cook Islands face mounting pressures to address diabetes alongside competing population health needs and priorities. Cook Islands residents frequently travel to New Zealand to access health services. Inadequate information systems also make it difficult for countries to prioritise preventative measures for investment. In the absence of good data to inform effective diabetes preventative and treatment measures, people with diabetes are likely to progress to complications which will burden society and health systems in the Cook Islands and New Zealand. Aim To determine the prevalence of diabetes and prediabetes, and incidence of GDM, in the Cook Islands. Methods We analysed two Te Marae Ora Cook Islands Ministry of Health datasets, the Non-Communicable Diseases (NCD) register examining demographic data for the period 1967 to December 2018 and same for the GDM register from January 2009 to December 2018. Results Of the 1270 diabetes cases, 53% were female and half were aged 45-64 years. There were 54 pre-diabetes cases and 146 GDM. Of the 20 GDM cases who developed type 2 diabetes, 80% were diagnosed before the age of 40 years. Data quality was poor. Discussion The Cook Islands diabetes registers provide important data to inform priorities for diabetes-related preventative and treatment measures. A data analyst has been employed to ensure quality, regularly audited data and information systems.
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Affiliation(s)
- Machaela Tepai
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Vili Nosa
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Josephine Herman
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Yin Yin May
- Ministry of Health, PO Box 109, Avarua, Rarotonga, Cook Islands
| | - Atefeh Kiadarbandsari
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - John Sluyter
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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Heinsberg LW, Hawley NL, Duckham RL, Pomer A, Rivara AC, Naseri T, Reupena MS, Weeks DE, McGarvey ST, Minster RL. Validity of anthropometric equation-based estimators of fat mass in Samoan adults. Am J Hum Biol 2023; 35:e23838. [PMID: 36428275 PMCID: PMC10023273 DOI: 10.1002/ajhb.23838] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/28/2022] [Accepted: 11/03/2022] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION In 1999, a set of highly accurate Polynesian-specific equations to estimate adult body fat from non-invasive field measures of age, sex, height, and weight (Equation 1), age, sex, height, weight, and bioelectrical impedance analysis (BIA) resistance (Equation 2), and age, sex, height, weight, and the sum of two skinfold thicknesses (Equation 3) were published. The purpose of this study was to evaluate the performance of the equation-based estimators in a sample of Samoan adults recruited 20 years later between 2017 and 2019. METHODS Age, sex, height, weight, BIA resistance, skinfold thickness, and fat mass as measured using dual energy x-ray absorptiometry (DXA) were available for 432 Samoan adults (mean age 50.9 years, 56% female) seen in 2017/2019. We compared equation-derived fat mass and DXA-derived fat mass using scatterplots and Pearson correlation coefficients. We then updated the equation coefficient estimates in a training set (2/3 of the sample) and evaluated the performance of the updated equations in a testing set (the remaining 1/3 of the sample). RESULTS Equation-derived fat mass was strongly correlated with DXA-derived fat mass for Equation (1) (r2 = 0.95, n = 432), Equation (2) (r2 = 0.97, n = 425), and Equation (3) (r2 = 0.95, n = 426). Updating the equation coefficient estimates resulted in mostly similar coefficients and nearly identical testing set performance for Equation (1) (r2 = 0.96, n = 153), Equation (2) (r2 = 0.98, n = 150), and Equation (3) (r2 = 0.96, n = 150). CONCLUSIONS The Polynesian-specific body fat estimation equations remained stable despite changing social and environmental factors and marked increase in obesity prevalence in Samoa.
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Affiliation(s)
- Lacey W. Heinsberg
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nicola L. Hawley
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, CT, USA
| | - Rachel L. Duckham
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Burwood, VIC 3125, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), the University of Melbourne and Western Health, St. Albans, VIC 3021, Australia
| | - Alysa Pomer
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Anna C. Rivara
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, CT, USA
| | | | | | - Daniel E. Weeks
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Stephen T. McGarvey
- International Health Institute and Department of Epidemiology, School of Public Health, and Department of Anthropology, Brown University, Providence, Rhode Island, USA
| | - Ryan L. Minster
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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11
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Heinsberg LW, Carlson JC, Pomer A, Cade BE, Naseri T, Reupena MS, Weeks DE, McGarvey ST, Redline S, Hawley NL. Correlates of daytime sleepiness and insomnia among adults in Samoa. SLEEP EPIDEMIOLOGY 2022; 2:100042. [PMID: 36338277 PMCID: PMC9635619 DOI: 10.1016/j.sleepe.2022.100042] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Objective To describe daytime sleepiness and insomnia among adults in Samoa and identify modifiable factors associated with these measures. Design/setting Cross-sectional analysis of data from the Soifua Manuia ("Good Health") study (n = 519, 55.1% female); Upolu island, Samoa. Methods Daytime sleepiness and insomnia were assessed with the Epworth Sleepiness Scale (ESS) and the Women's Health Initiative Insomnia Rating Scale (WHIIRS), respectively. Detailed physical, sociodemographic, and behavioral factors were collected. Sleep measures were characterized using multiple linear regression with backwards elimination and a bootstrap stability investigation. Results Excessive daytime sleepiness (ESS>10) and insomnia (WHIIRS>10) were reported by 20% and 6.3% of the sample, respectively. ESS scores were higher in individuals reporting more physical activity (Estimate=1.88; 95% CI=1.12 to 2.75), higher material wealth (0.18; 0.09 to 0.28), and asthma (2.85; 1.25 to 4.51). ESS scores were lower in individuals residing in periurban versus urban regions (-1.43; -2.39 to -0.41), reporting no work versus day shift work (-2.26; -3.07 to -1.41), and reporting greater perceived stress (-0.14; -0.23 to -0.06). WHIIRS scores were lower in individuals reporting "other" shift work (split/irregular/on-call/rotating) versus day shift work (-1.96; -2.89 to -1.14) and those who perceived their village's wealth to be poor/average versus wealthy (-0.94; -1.50 to -0.34). Conclusions Participants had a generally higher prevalence of excessive daytime sleepiness, but lower prevalence of insomnia, compared with individuals from high-income countries. Factors associated with sleep health differed compared with prior studies, emphasizing potential cultural/environmental differences and the need for targeted interventions to improve sleep health in this setting.
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Affiliation(s)
- Lacey W. Heinsberg
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Corresponding author at: Department of Human Genetics, School of Public Health, University of Pittsburgh, Public Health 3102A, 130 De Soto Street, Pittsburgh, PA 15261. (L.W. Heinsberg)
| | - Jenna C. Carlson
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alysa Pomer
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Brian E. Cade
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | | | | | - Daniel E. Weeks
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Stephen T. McGarvey
- International Health Institute and Department of Epidemiology, School of Public Health, and Department of Anthropology, Brown University, Providence, Rhode Island, USA
| | - Susan Redline
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Nicola L. Hawley
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, Connecticut, USA
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12
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Fu H, Hawley NL, Carlson JC, Russell EM, Pomer A, Cheng H, Naseri T, Reupena MS, Deka R, Choy CC, McGarvey ST, Minster RL, Weeks DE. The missense variant, rs373863828, in CREBRF plays a role in longitudinal changes in body mass index in Samoans. Obes Res Clin Pract 2022; 16:220-227. [PMID: 35606300 DOI: 10.1016/j.orcp.2022.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/27/2022] [Accepted: 04/30/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE A missense variant, rs373863828, in CREBRF is associated with obesity in Polynesians. We investigate whether rs373863828 and other factors are associated with body mass index (BMI) rate-of-change between 2010 and 2017-19 in Samoans. METHODS We used sex-stratified models to test whether BMI rate-of-change was associated with rs373863828, baseline BMI, age, residence, physical activity, and household asset score in a cohort study of 480 Samoan adults measured in both 2010 (mean age 43.8 years) and 2017-19. RESULTS Mean BMI increased from 32.1 to 33.5 kg/m2 in males (n = 220, p = 1.3 ×10-8) and from 35.9 to 37.8 kg/m2 in females (n = 260, p = 1.2 ×10-13). In females, the A allele was associated with a higher rate-of-change (0.150 kg/m2/year/allele, p = 1.7 ×10-4). Across 10-year age groups, mean BMI rate-of-change was lower in older participants. The BMI rate of change differed by genotype: it was, in females with AA genotype, approximately half that seen in GG and AG participants. In females lower baseline household asset scores were associated with a higher rate-of-change (p = 0.002). CONCLUSIONS In Samoans, the minor A allele of rs373863828 is associated with an increased rate-of-change in BMI in females. On average, BMI of females with the AA genotype increased 0.30 kg/m2/year more than of those with the GG genotype.
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Affiliation(s)
- Haoyi Fu
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nicola L Hawley
- International Health Institute, Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA; Department of Epidemiology (Chronic Disease), School of Public Health, Yale University, New Haven, CT, USA
| | - Jenna C Carlson
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA; Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Emily M Russell
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alysa Pomer
- Department of Anthropology, Yale University, New Haven, CT, USA
| | - Hong Cheng
- Department of Environmental & Public Health Sciences, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Take Naseri
- International Health Institute, Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA; Ministry of Health, Apia, Samoa
| | | | - Ranjan Deka
- Department of Environmental & Public Health Sciences, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Courtney C Choy
- International Health Institute, Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA; Department of Epidemiology (Chronic Disease), School of Public Health, Yale University, New Haven, CT, USA
| | - Stephen T McGarvey
- International Health Institute, Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA; Department of Anthropology, Brown University, Providence, RI, USA
| | - Ryan L Minster
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Daniel E Weeks
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA; Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
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13
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Dembinsky M, Boodoosingh R, Fulu-Aiolupotea SM, Lima UL, Ekeroma A, Bugge C, Hagen S. Translating the Pelvic Organ Prolapse Score into Samoan using a modified back translation methodology. BMC Womens Health 2022; 22:93. [PMID: 35346163 PMCID: PMC8960078 DOI: 10.1186/s12905-022-01676-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 03/10/2022] [Indexed: 11/10/2022] Open
Abstract
Background Although Samoan women have a high prevalence of obesity and multiple parity which are risk factors of pelvic organ prolapse, there is no prevalence data on this condition.
Aims Translate the Pelvic Organ Prolapse-Symptoms Score (POP-SS) from English into Samoan, Materials and methods Standardised methods for translating questionnaires, individual face to face audio-recorded interviews in which women completed the POP-SS using a Think Aloud method, analysis using a Framework approach. Results The POP-SS was successfully translated in to Samoan, an additional information leaflet was developed to support women’s understanding of what prolapse is, 14 Samoan women were recruited of which 13 were interviewed and completed the POP-SS, results of POP-SS (scores), results of think aloud, results in terms of research experience. Conclusions A Samoan version of the POP-SS is now available for further evaluation of its psychometric properties prior to wider use. The team continue to collaborate on their work on establishing the prevalence of prolapse whilst building local research capacity. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01676-3.
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Affiliation(s)
- Melanie Dembinsky
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Ramona Boodoosingh
- School of Nursing and Health Science, National University of Samoa, Apia, Samoa
| | | | - Uila Laifa Lima
- School of Nursing and Health Science, National University of Samoa, Apia, Samoa
| | - Alec Ekeroma
- School of Nursing and Health Science, National University of Samoa, Apia, Samoa
| | - Carol Bugge
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Suzanne Hagen
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK.
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14
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Lameko V. Does Samoa Have Adequate Policies to Reduce Obesity and Obesity-Related Disease? Cureus 2022; 14:e23239. [PMID: 35449683 PMCID: PMC9012561 DOI: 10.7759/cureus.23239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 11/05/2022] Open
Abstract
In obesity, abnormal or excess body fat (adiposity) impairs health, increases the risk of long-term medical complications, and results in decreased lifespan. There are many long-term medical complications to consider, such as heart disease, cancer, stroke, type 2 diabetes mellitus, and non-alcoholic fatty liver disease, among others. These are all difficult and expensive conditions to treat in a small developing country like Samoa. The prevalence of obesity in Samoa has steadily increased since the 1960s, and today, 53% of Samoa’s adult population are obese. People living in the small island country of Samoa, with a total population of fewer than 200 thousand people, are one of the most obese people in the world today. Factors that have contributed to obesity over the previous four decades include urbanization, the dependence on a dietary transition from one based on fresh local food to highly processed imported food, poverty, as well as probable genetic predisposition. Efforts by the Samoa Ministry of Health and partners to reverse the trend of obesity have mainly relied on behavior change strategies since the 1970s, with no clinical evidence of success. This study critically reviews current policies and strategic plans in Samoa to reduce the obesity problem and proposes that because of the contributing structural factors, the health sector alone cannot achieve its objective without matching multi-sectorial government initiatives.
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15
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Hoffman SA, Desai SN, Sikorski MJ, Fatupaito G, Tupua S, Thomsen RE, Rambocus S, Nimarota-Brown S, Punimata LL, Sialeipata M, Tuilagi CF, Han J, Robins-Browne RM, Naseri TK, Levine MM. Point-of-Care Ultrasound by Nonexpert Operators Demonstrates High Sensitivity and Specificity in Detecting Gallstones: Data from the Samoa Typhoid Fever Control Program. Am J Trop Med Hyg 2022; 106:798-804. [PMID: 35008059 PMCID: PMC8922510 DOI: 10.4269/ajtmh.21-0973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/03/2021] [Indexed: 01/28/2023] Open
Abstract
Approximately 90% of chronic typhoid carriers with persistent Salmonella enterica serovar Typhi (S. Typhi) gallbladder infection have gallstones. In Samoa, where typhoid fever has been endemic for many decades, risk factors predisposing to the development of gallstones are increasing among adults. The Samoa Typhoid Fever Control Program dispatches a "Typhoid Epidemiologic SWAT Team" to perform a household investigation of every blood culture-confirmed case of acute typhoid fever. Investigations include screening household contacts to detect chronic carriers. Following limited training, two nonexpert ultrasound operators performed point-of-care ultrasound (POCUS) on 120 Samoan adults from August to September 2019 to explore the feasibility of POCUS to detect individuals with gallstones during household investigations and community screenings. POCUS scans from 120 Samoan adults in three cohorts (28 food handlers, two typhoid cases and their 18 household contacts, and 72 attendees at an ambulatory clinic) were reviewed by a board-certified radiologist who deemed 96/120 scans (80%) to be interpretable. Compared with the radiologist (gold standard), the nonexpert operators successfully detected 6/7 Samoans with gallstones (85.7% sensitivity) and correctly identified 85/89 without gallstones (95.5% specificity). The proportion (24/120) of uninterpretable scans from this pilot that used minimally trained clinicians (who are neither radiologists nor ultrasound technicians) indicates the need for additional training of POCUS operators. Nevertheless, this pilot feasibility study engenders optimism that in the Samoan setting nonexperts can be trained to use POCUS to diagnose cholelithiasis, thereby helping (along with stool cultures and Vi serology) to identify possible chronic S. Typhi carriers.
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Affiliation(s)
- Seth A. Hoffman
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland;,Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Sachin N. Desai
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland;,Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland;,Samoa Typhoid Fever Control Program, Ministry of Health, Government of Samoa, Apia, Samoa
| | - Michael J. Sikorski
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland;,Samoa Typhoid Fever Control Program, Ministry of Health, Government of Samoa, Apia, Samoa;,Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland;,Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Glenn Fatupaito
- Tupua Tamasese Meaole Hospital, Ministry of Health, Government of Samoa, Apia, Samoa
| | - Siaosi Tupua
- Samoa Typhoid Fever Control Program, Ministry of Health, Government of Samoa, Apia, Samoa
| | - Robert E. Thomsen
- Samoa Typhoid Fever Control Program, Ministry of Health, Government of Samoa, Apia, Samoa
| | - Savitra Rambocus
- Samoa Typhoid Fever Control Program, Ministry of Health, Government of Samoa, Apia, Samoa;,Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Susana Nimarota-Brown
- Samoa Typhoid Fever Control Program, Ministry of Health, Government of Samoa, Apia, Samoa
| | - Linatupu L. Punimata
- Samoa Typhoid Fever Control Program, Ministry of Health, Government of Samoa, Apia, Samoa
| | - Michelle Sialeipata
- Samoa Typhoid Fever Control Program, Ministry of Health, Government of Samoa, Apia, Samoa
| | - Chandler F. Tuilagi
- Tupua Tamasese Meaole Hospital, Ministry of Health, Government of Samoa, Apia, Samoa
| | - Jane Han
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland;,Samoa Typhoid Fever Control Program, Ministry of Health, Government of Samoa, Apia, Samoa
| | - Roy M. Robins-Browne
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia;,Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Australia
| | - Take K. Naseri
- Samoa Typhoid Fever Control Program, Ministry of Health, Government of Samoa, Apia, Samoa;,Tupua Tamasese Meaole Hospital, Ministry of Health, Government of Samoa, Apia, Samoa
| | - Myron M. Levine
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland;,Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland;,Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland;,Samoa Typhoid Fever Control Program, Ministry of Health, Government of Samoa, Apia, Samoa;,Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, Maryland;,Address correspondence to Myron M. Levine, Center for Vaccine Development and Global Health, 685 W. Baltimore St.—HSF 1 Room 480 Baltimore, MD 21201. E-mail:
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16
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Tafuna'i M, Turner RM, Richards R, Sopoaga F, Walker R. The prevalence of chronic kidney disease in Samoans living in Auckland, New Zealand. Nephrology (Carlton) 2022; 27:248-259. [PMID: 34698436 DOI: 10.1111/nep.13990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/11/2021] [Accepted: 10/20/2021] [Indexed: 11/27/2022]
Abstract
AIMS Pacific peoples have higher rates of chronic kidney disease (CKD) and are five times more likely to commence kidney replacement therapy compared with New Zealand (NZ) Europeans. As the majority live Auckland, this study looked at the prevalence of CKD in two Auckland Pacific Island health providers caring for a large proportion of Pacific peoples, of which almost 50% are Samoan, as well as NZ Europeans. METHODS De-identified information was requested on individuals who had two or more CKD tests (serum creatinine and urinary albumin creatinine ratios) more than 3 months apart. CKD prevalence across different demographic groups was determined. Logistic regression was used to look at associations of known risk factors and CKD. RESULTS Data from 25 127 patients was evaluated. Of the total sample, 7451 individuals identified as Samoans. The prevalence of CKD amongst all Samoans in this sample was 17.8% increasing to 36.3% in those Samoans that had been tested for CKD. The prevalence of CKD in this total sample was 13% increasing to 27.5% considering only those who had CKD testing. The odds of Samoans having CKD (adjOR: 1.9 [95%CI 1.7, 2.2]), all other Pacific Island ethnicities identified and NZ Maori (adjOR:1.5 [95%CI 1.3, 1.8]), were increased compared with non-Māori-non-Pacific (likelihood p value <.001). CONCLUSION We report the high prevalence of CKD (15.9%-33.4%) in Samoans living in New Zealand. This reveals an urgent need for further studies to develop strategies to prevent or reduce the development of kidney failure and premature death.
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Affiliation(s)
- Malama Tafuna'i
- National Kidney Foundation of Samoa, Apia, Samoa
- Centre for Pacific Health, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Robin M Turner
- Centre for Biostatistics, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Rosalina Richards
- Centre for Pacific Health, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Fa'afetai Sopoaga
- Centre for Pacific Health, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Robert Walker
- Department of Medicine, Otago Medical School, University of Otago, Dunedin, New Zealand
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17
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Rivara AC, Corley M, Choy CC, Duckham RL, Pomer A, Reupena MS, Viali S, Naseri T, Kershaw EE, Crouter S, McGarvey ST, Bribiescas RG, Valeggia C, Hawley NL. C-reactive protein in adult Samoans: Population variation and physiological correlates. Am J Hum Biol 2022; 34:e23646. [PMID: 34260111 PMCID: PMC8758804 DOI: 10.1002/ajhb.23646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/16/2021] [Accepted: 06/01/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES C-reactive protein (CRP) has been associated with adiposity and cardiometabolic disease risk in many populations but remains remarkably understudied in Pacific Islander populations. Here, we provide the first examination of correlates of CRP in adult Samoans (n = 108, ages 35-55 years) to test the hypotheses that CRP exhibits sex-dependent associations with measures of BMI, adiposity, and cardiometabolic disease risks. METHODS We analyzed associations between measures of adiposity (total fat mass, visceral fat mass, percent total body fat), body mass index (BMI), cardiometabolic risks, behaviors, demographics, and CRP. Unadjusted analyses of CRP were undertaken using Pearson's pairwise, and Spearman's rank correlations; one-way analysis of variance and Kruskal-Wallis tests assessed variables by CRP quartiles. Adjusted analyses of CRP correlates were examined using generalized linear regression. RESULTS Serum CRP ranged from 0.08 to 13.3 mg/L (median 1.4 mg/L) and varied significantly by sex t (108) = -2.47, p = .015. CRP was weakly to moderately associated with measures of adiposity and BMI (r and ρ ranged between 0.25 and 0.50, p < .05) and some cardiometabolic markers (including HbA1c, fasting insulin, and insulin resistance). CRP was significantly associated with percent body fat in women and men, adjusting for other variables. CONCLUSIONS These data are among the first to demonstrate CRP correlates in a sample of adult Samoans. CRP differed by sex and was associated with BMI, adiposity, and some cardiometabolic risk markers. These data align with findings in other populations.
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Affiliation(s)
- Anna C Rivara
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Margaret Corley
- Department of Anthropology, Yale University, New Haven, CT, USA
| | - Courtney C Choy
- Department of Epidemiology, International Health Institute, Brown School of Public Health, Brown University, Providence, RI, USA
| | - Rachel L Duckham
- Institute of Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Victoria, Australia,Department of General Practice, Monash University, Melbourne, Australia
| | - Alysa Pomer
- Department of Anthropology, Yale University, New Haven, CT, USA
| | | | | | | | - Erin E Kershaw
- Division of Endocrinology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Scott Crouter
- Department of Kinesiology, Recreation, and Sport Studies, The University of Tennessee Knoxville, Knoxville, TN, USA
| | - Stephen T McGarvey
- Department of Epidemiology, International Health Institute, Brown School of Public Health, Brown University, Providence, RI, USA
| | | | | | - Nicola L Hawley
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
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18
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Russell EM, Carlson JC, Krishnan M, Hawley NL, Sun G, Cheng H, Naseri T, Reupena MS, Viali S, Tuitele J, Major TJ, Miljkovic I, Merriman TR, Deka R, Weeks DE, McGarvey ST, Minster RL. CREBRF missense variant rs373863828 has both direct and indirect effects on type 2 diabetes and fasting glucose in Polynesian peoples living in Samoa and Aotearoa New Zealand. BMJ Open Diabetes Res Care 2022; 10:10/1/e002275. [PMID: 35144939 PMCID: PMC8845200 DOI: 10.1136/bmjdrc-2021-002275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 12/07/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The minor allele of a missense variant, rs373863828, in CREBRF is associated with higher body mass index (BMI), lower fasting glucose, and lower odds of type 2 diabetes. rs373863828 is common in Pacific Island populations (minor allele frequency (MAF) 0.096-0.259) but rare in non-Pacific Island populations (MAF <0.001). We examined the cross-sectional associations between BMI and rs373863828 in type 2 diabetes and fasting glucose with a large sample of adults of Polynesian ancestries from Samoa, American Samoa, and Aotearoa New Zealand, and estimated the direct and indirect (via BMI) effects of rs373863828 on type 2 diabetes and fasting glucose. RESEARCH DESIGN AND METHODS We regressed type 2 diabetes and fasting glucose on BMI and rs373863828 stratified by obesity, regressed type 2 diabetes and fasting glucose on BMI stratified by rs373863828 genotype, and assessed the effects of rs373863828 on type 2 diabetes and fasting glucose with path analysis. The regression analyses were completed separately in four samples that were recruited during different time periods between 1990 and 2010 and then the results were meta-analyzed. All samples were pooled for the path analysis. RESULTS Association of BMI with type 2 diabetes and fasting glucose may be greater in those without obesity (OR=7.77, p=0.015 and β=0.213, p=9.53×10-5, respectively) than in those with obesity (OR=5.01, p=1.12×10-9 and β=0.162, p=5.63×10-6, respectively). We did not observe evidence of differences in the association of BMI with type 2 diabetes or fasting glucose by genotype. In the path analysis, the minor allele has direct negative (lower odds of type 2 diabetes and fasting glucose) and indirect positive (higher odds of type 2 diabetes and fasting glucose) effects on type 2 diabetes risk and fasting glucose, with the indirect effects mediated through a direct positive effect of rs373863828 on BMI. CONCLUSIONS There may be a stronger effect of BMI on fasting glucose in Polynesian individuals without obesity than in those with obesity. Carrying the rs373863828 minor allele does not decouple higher BMI from higher odds of type 2 diabetes.
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Affiliation(s)
- Emily M Russell
- Department of Human Genetics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Jenna C Carlson
- Department of Human Genetics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Mohanraj Krishnan
- Department of Human Genetics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Nicola L Hawley
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Guangyun Sun
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Hong Cheng
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Take Naseri
- Ministry of Health, Government of Samoa, Apia, Samoa
| | | | | | - John Tuitele
- Department of Public Health, Lyndon B Johnson Tropical Medical Center, Faga'alu, American Samoa
| | - Tanya J Major
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Iva Miljkovic
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Tony R Merriman
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
- Division of Clinical Immunology and Rheumatology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ranjan Deka
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Daniel E Weeks
- Department of Human Genetics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Stephen T McGarvey
- International Health Institute and Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
- Department of Anthropology, Brown University, Providence, Rhode Island, USA
| | - Ryan L Minster
- Department of Human Genetics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
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Yu D, Zou M, Pan Q, Song Y, Li M, Zhang X, Zhou Y, Wang X, Guo L. Effects of liraglutide or lifestyle interventions combined with other antidiabetic drugs on abdominal fat distribution in people with obesity and type 2 diabetes mellitus evaluated by the energy spectrum ct: A prospective randomized controlled study. Front Endocrinol (Lausanne) 2022; 13:951570. [PMID: 36093105 PMCID: PMC9458907 DOI: 10.3389/fendo.2022.951570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/29/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To study the effects of liraglutide or lifestyle interventions combined with other antidiabetic drugs on glucose metabolism and abdominal fat distribution in patients with obesity and type 2 diabetes mellitus (T2DM). METHODS From April 30, 2020, to April 30, 2022, a prospective randomized controlled study was carried out at the Endocrinology Department of Beijing Hospital, the National Center of Gerontology. According to the in- and exclusion criteria and by the random table method, revisited T2DM patients were selected as the research subjects and were allocated into a Study group (taking liraglutide) and a Control group (underwent lifestyle interventions). All patients received continuous 12-weeks interventions to the endpoint, and the changes of value [Δ=(endpoint)-(baseline)] of physical measurements, blood tests, the energy spectrum CT examination results, and body composition analysis results were analyzed and compared. RESULTS A total of 85 people completed this study, and among them, 47 were in the Study group and 38 were in the Control group. Compared with the Control group, the changes of hemoglobin A1c (HbA1c) level (-0.78 ± 1.03% vs. -1.57 ± 2.00%, P=0.025), visceral fat area (0.91 ± 16.59 cm2 vs. -7.1 ± 10.17 cm2, P=0.011), and subcutaneous fat area of abdomen [0 (-18.75, 15.5) cm2 vs. -16.5 (-41.75, -2.25) cm2, P=0.014] were all greater in the Study group. The adverse events caused by liraglutide were mainly concentrated in the gastrointestinal system and all of them were minor adverse events. CONCLUSION Liraglutide can be the drug of choice for weight management and reduction of abdominal fat distribution in patients with obesity and T2DM.
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Affiliation(s)
- Dongni Yu
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Mingzhu Zou
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Qi Pan
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yan Song
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Miao Li
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Xianbo Zhang
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yan Zhou
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoxia Wang
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Lixin Guo
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Lixin Guo,
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20
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LaMonica LC, McGarvey ST, Rivara AC, Sweetman CA, Naseri T, Reupena MS, Kadiamada H, Kocher E, Rojas-Carroll A, DeLany JP, Hawley NL. Cascades of diabetes and hypertension care in Samoa: Identifying gaps in the diagnosis, treatment, and control continuum - a cross-sectional study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 18:100313. [PMID: 35024652 PMCID: PMC8669362 DOI: 10.1016/j.lanwpc.2021.100313] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/06/2021] [Accepted: 10/09/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Samoa is a Pacific Island country facing one of the highest burdens of non-communicable disease globally. METHODS In this study, we apply a cascade-of-care approach to understand gaps in the awareness, treatment, and control cascade of diabetes and hypertension in a cross-sectional, convenience sample of 703 young, high-risk Samoan adults (29.5-50.9 years). FINDINGS Non-communicable diseases were prevalent in the study sample: 19.5% (95% CI: 16.6%-22.7%) of participants had diabetes; 47.6% (95% CI: 43.7%-51.4%) presented with pre-diabetes or diabetes; 31.0% (95% CI: 27.5%-34.6%) had hypertension; and nearly 90% (95% CI: 86.7%-91.5%) had overweight or obesity. Among those with diabetes and hypertension, only 20.5% (95% CI: 13.9%-28.4%) and 11.8% (95% CI: 7.8%-16.9%) of participants were aware of their condition, respectively. Only 0.8% (95% CI: 0.0%-4.2%) of all participants with diabetes had achieved glycemic control; only 2.8% (95% CI: 1.1%-6.1%) of those with hypertension achieved control. INTERPRETATION We found a significant burden of diabetes and hypertension in Samoa, exceeding the recent prevalence estimates of other low- to middle-income countries by nearly two-fold. A severe unmet need in both detection and subsequent control and monitoring of these chronic conditions exists. Our results suggest that the initial diagnosis and surveillance stage in the cascade of care for chronic conditions should be a major focus of primary care efforts; national screening campaigns and programs that leverage village and district nurses to deliver community-based primary care may significantly impact gap closure in the NCD cascade. FUNDING This study was supported by the U.S. National Institutes of Health R01HL140570 (PIs: McGarvey and DeLany); AR was supported by NIH FIC D43TW010540; HK and AR-C were supported by the Minority Health and Health Disparities International Research Training (MHIRT) Program at Brown University, NIH Grant # 5T37MD008655.
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Affiliation(s)
- Lauren C. LaMonica
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Stephen T. McGarvey
- International Health Institute and Department of Epidemiology, School of Public Health, and Department of Anthropology, Brown University, Providence, Rhode Island, USA
| | - Anna C. Rivara
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Chlöe A. Sweetman
- Department of Anthropology, Guarini School of Graduate and Advanced Studies at Dartmouth College, Hanover, New Hampshire, USA
| | | | | | - Hemant Kadiamada
- International Health Institute and Department of Epidemiology, School of Public Health, and Department of Anthropology, Brown University, Providence, Rhode Island, USA
| | - Erica Kocher
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Alexa Rojas-Carroll
- International Health Institute and Department of Epidemiology, School of Public Health, and Department of Anthropology, Brown University, Providence, Rhode Island, USA
| | - James P. DeLany
- AdventHealth Orlando, Translational Research Institute, Orlando, FL, US
| | - Nicola L. Hawley
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
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21
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Moodley RM, D'Almeida SS, Lameko V, Ghimire S. Novel Relationship Between Hemoglobin A1c Levels and Foot Ulcer Development Among Patients With Type 2 Diabetes Mellitus Admitted at Tupua Tamasese Meaole Hospital. Cureus 2021; 13:e20054. [PMID: 34993030 PMCID: PMC8720040 DOI: 10.7759/cureus.20054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2021] [Indexed: 11/05/2022] Open
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22
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Neuendorf S, Neuendorf J, Yakub M. Origin, Impact, and Solutions for Lifestyle-Related Chronic Diseases in Samoa and American Samoa. Cureus 2021; 13:e17749. [PMID: 34659962 PMCID: PMC8493186 DOI: 10.7759/cureus.17749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2021] [Indexed: 12/12/2022] Open
Abstract
Samoa and American Samoa are two island groups in the South Pacific inundated with the physiological consequences of swift westernization of diet and lifestyle. These polities face the singular theme of lifestyle-related problems seen in other countries. This paper aims to discuss the current demographics in Samoa and American Samoa and examine the origin and impact of lifestyle-related chronic diseases within a subset of its populace. This review will highlight the prominent nutrition transition that these polities have undergone in their development and examine the pathogenesis and pathophysiology of lifestyle-related diseases, primarily type 2 diabetes and obesity, in the context of a prominent cultural shift. Samoa and American Samoa face a litany of public health concerns as a result of the rising prevalence of lifestyle-related chronic diseases and the persistent threat of obesity. Lifestyle medicine is proposed as the optimal treatment solution for the currently devastating disease states and is adapted to the vibrant agricultural resources and healing roots of the Samoan culture.
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Affiliation(s)
- Sable Neuendorf
- Medical Education, California University of Science and Medicine, Colton, USA
| | - Jadon Neuendorf
- Medical Education, California University of Science and Medicine, Colton, USA
| | - Mohsin Yakub
- Medical Education, California University of Science and Medicine, Colton, USA
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23
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D'Almeida SS, Moodley RM, Lameko V, Brown R. Prevalence of Sepsis Continuum in Patients With Type 2 Diabetes Mellitus at Tupua Tamasese Meaole Hospital in Samoa. Cureus 2021; 13:e17704. [PMID: 34650878 PMCID: PMC8489655 DOI: 10.7759/cureus.17704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2021] [Indexed: 11/05/2022] Open
Abstract
Background Individuals with longstanding type 2 diabetes mellitus (T2DM) have a significantly higher risk for infection caused by immune dysfunction, resulting in sepsis continuum (sepsis, severe sepsis, and septic shock) if not adequately addressed. In sepsis, organ dysfunction occurs because the host's response to infection is impaired, more so in severe sepsis. In septic shock, persistent hypotension happens, requiring vasopressors despite aggressive fluid management. The internal medicine (IM) ward plays a critical part in managing patients with sepsis. However, the prevalence of sepsis has been investigated extensively in an intensive care unit (ICU) setting instead of the IM ward. This study aimed to determine the prevalence rates of sepsis, severe sepsis, and septic shock in patients with T2DM admitted at an IM ward in Samoa. Methods This retrospective hospital record-based study was conducted over four months on 100 patients with T2DM admitted to the IM ward within the sepsis continuum. Participants were selected by convenience sampling, and the diagnosis was determined from the admission notes. Results The prevalence rates of sepsis, severe sepsis, and septic shock in patients with T2DM admitted to the IM ward were 80%, 12%, and 8%, respectively. Conclusion The most frequent presentation in individuals with T2DM who are within the sepsis continuum upon admission to the IM ward was sepsis, followed by severe sepsis and septic shock.
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Affiliation(s)
| | | | - Viali Lameko
- Internal Medicine, Oceania University of Medicine, Apia, WSM
| | - Randell Brown
- Research, Oceania University of Medicine, New York, USA
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24
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Ndwiga DW, McBride KA, Simmons D, Thompson R, Reath J, Abbott P, Alofivae-Doorbinia O, Patu P, Vaovasa AT, MacMillan F. Using Community Based Research Frameworks to Develop and Implement a Church-Based Program to Prevent Diabetes and Its Complications for Samoan Communities in South Western Sydney. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179385. [PMID: 34501974 PMCID: PMC8430533 DOI: 10.3390/ijerph18179385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/27/2021] [Accepted: 08/31/2021] [Indexed: 11/16/2022]
Abstract
Pasifika communities bear a disproportionate burden of diabetes compared to the general Australian population. Community-based participatory research (CBPR), which involves working in partnership with researchers and communities to address local health needs, has gained prominence as a model of working with underserved communities. This paper describes how Le Taeao Afua (LTA) Samoan diabetes prevention program was underpinned by two CBPR frameworks to develop a culturally tailored church-based lifestyle intervention to prevent diabetes and its complications in the Australian Samoan community. The name LTA, which means ‘a new dawn,’ was chosen by the community to signify a new dawn without diabetes in the Australian Samoan community. Strategies for engaging with the Australian Samoan community in South Western Sydney are discussed mapped to the key principles from the CBPR frameworks. In particular, this paper highlights the steps involved in building relationships with Samoan community leaders and the vital role of community activators and peer support facilitators in the success of delivering the program. Lessons learnt, such as the importance of church and maintaining a Samoan way of life in daily activities, and processes to build effective partnerships and maintain long-term relationships with the Australian Samoan community, are also discussed. Our paper, through providing a case example of how to apply CBPR frameworks, will help guide future community-based health promotion programs for underserved communities.
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Affiliation(s)
- Dorothy W. Ndwiga
- School of Health Sciences, Western Sydney University, Penrith 2751, Australia;
- Institute of Health and Management, Parramatta 2150, Australia
- Correspondence: (D.W.N.); (F.M.); Tel.: +61-2-4620-3464 (F.M.)
| | - Kate A. McBride
- School of Medicine, Western Sydney University, Penrith 2751, Australia; (K.A.M.); (D.S.); (R.T.); (J.R.); (P.A.)
- Diabetes Obesity Metabolism Translational Research Unit, Western Sydney University, Penrith 2751, Australia
- Translational Health Research Institute, Western Sydney University, Penrith 2751, Australia
| | - David Simmons
- School of Medicine, Western Sydney University, Penrith 2751, Australia; (K.A.M.); (D.S.); (R.T.); (J.R.); (P.A.)
- Diabetes Obesity Metabolism Translational Research Unit, Western Sydney University, Penrith 2751, Australia
- Translational Health Research Institute, Western Sydney University, Penrith 2751, Australia
| | - Ronda Thompson
- School of Medicine, Western Sydney University, Penrith 2751, Australia; (K.A.M.); (D.S.); (R.T.); (J.R.); (P.A.)
| | - Jennifer Reath
- School of Medicine, Western Sydney University, Penrith 2751, Australia; (K.A.M.); (D.S.); (R.T.); (J.R.); (P.A.)
- Diabetes Obesity Metabolism Translational Research Unit, Western Sydney University, Penrith 2751, Australia
- Translational Health Research Institute, Western Sydney University, Penrith 2751, Australia
| | - Penelope Abbott
- School of Medicine, Western Sydney University, Penrith 2751, Australia; (K.A.M.); (D.S.); (R.T.); (J.R.); (P.A.)
- Diabetes Obesity Metabolism Translational Research Unit, Western Sydney University, Penrith 2751, Australia
- Translational Health Research Institute, Western Sydney University, Penrith 2751, Australia
| | | | - Paniani Patu
- The Practice Blacktown NSW, Blacktown 2148, Australia;
| | - Annalise T. Vaovasa
- School of Health Sciences, Western Sydney University, Penrith 2751, Australia;
| | - Freya MacMillan
- School of Health Sciences, Western Sydney University, Penrith 2751, Australia;
- Diabetes Obesity Metabolism Translational Research Unit, Western Sydney University, Penrith 2751, Australia
- Translational Health Research Institute, Western Sydney University, Penrith 2751, Australia
- Correspondence: (D.W.N.); (F.M.); Tel.: +61-2-4620-3464 (F.M.)
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25
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Jiang JJ, Reupena SM, Naseri T, Swift RM, McGeary JE, McGarvey ST. Alcohol Consumption among Samoan Adults in 2010: Patterns, Correlates and Health Implications. Alcohol Alcohol 2020; 55:681-689. [PMID: 32666120 DOI: 10.1093/alcalc/agaa066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/12/2020] [Accepted: 06/12/2020] [Indexed: 11/12/2022] Open
Abstract
AIMS We aim to describe alcohol consumption and related problems from a nationwide survey in 2010 in Samoa in association with sociodemographic variables as part of an intervention development. METHODS The sample consisted of 3463 adults, 25-65 years of age. Participants self-reported alcohol consumption in the previous 12 months, patterns of drinking and alcohol-related psychosocial problems. Data about age, census region of residence, highest attained education level, employment, marital status, household assets score and current smoking status were gathered. RESULTS More than one-third of men, 36.1%, and 4.1% of women consumed alcohol in the past year. There were greater proportions of alcohol users among younger adults, <45 years, in both men and women. Among men, being unemployed and residing outside of rural Savai'i and smoking cigarettes were associated with current alcohol use. Among women, tertiary education and cigarette smoking were strongly associated with alcohol use. Among alcohol consumers, almost 75% of both men and women reported being drunk more than once in the prior month, and 58% of men and 81% of women drank heavily, consuming >4 drinks for women and >5 drinks for men at least once per episode in the prior week. More men than women, 51% versus 26%, felt that alcohol consumption had interfered with their daily life. CONCLUSION Our analyses identified correlates of alcohol consumption and associated problems that can help guide the development of targeted interventions for different sex and age groups to mitigate the social and physiological harms of alcohol misuse.
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Affiliation(s)
- Joy J Jiang
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetic, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.,International Health Institute & Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | | | - Take Naseri
- Ministry of Health, Government of Samoa, Apia, Samoa
| | - Robert M Swift
- Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA.,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Center for Alcohol and Addictions & Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - John E McGeary
- Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA.,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Stephen T McGarvey
- International Health Institute & Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA.,Department of Anthropology, Brown University, Providence, Rhode Island, USA
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26
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Heinsberg LW, Bui CN, Hartle JC, Sereika SM, Choy CC, Wang D, Soti-Ulberg C, Naseri T, Reupena MS, Duckham RL, Park JJ, Hawley NL, Deziel NC. Estimated Dietary Bisphenol-A Exposure and Adiposity in Samoan Mothers and Children. TOXICS 2020; 8:toxics8030067. [PMID: 32887300 PMCID: PMC7560430 DOI: 10.3390/toxics8030067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/25/2020] [Accepted: 08/27/2020] [Indexed: 12/14/2022]
Abstract
The Pacific Island nation of Samoa is marked by prevalent obesity and an increasing dependence on packaged foods likely to contain the endocrine disruptor bisphenol-A (BPA). We evaluated participant- and household-level characteristics associated with estimated dietary BPA exposure in Samoan mothers and their children and examined associations between dietary BPA exposure and body mass index (BMI) and abdominal circumference (AC). Dietary BPA exposure indices were estimated for 399 mother-child pairs by combining information from dietary questionnaires and relative concentrations of BPA measured in foods/beverages. We observed moderate to strong correlation between mother-child daily BPA indices (Spearman's rho = 0.7, p < 0.0001). In mothers, we observed lower daily BPA indices in those who were less physically active (p = 0.0004) and living in homes with higher income (p = 0.00001). In children, we observed lower daily BPA indices in those living in homes with higher income (p = 0.0003) and following a less modern dietary pattern (p = 0.002), and higher daily BPA indices in those who were less physically active (p = 0.02). No significant associations were observed between daily BPA indices and BMI or AC. Despite this, the application of the daily BPA index identified factors associated with dietary BPA exposure and warrants further examination in Samoa and other understudied populations.
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Affiliation(s)
- Lacey W. Heinsberg
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA
- Correspondence:
| | - Christina N.N. Bui
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT 06510, USA; (C.N.N.B.); (N.C.D.)
| | - Jennifer C. Hartle
- Department of Public Health and Recreation, College of Health and Human Sciences, San José State University, San José, CA 95192, USA;
| | - Susan M. Sereika
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, PA 15261, USA;
| | - Courtney C. Choy
- Department of Epidemiology, International Health Institute, School of Public Health, Brown University, Providence, RI 02912, USA;
| | - Dongqing Wang
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02120, USA;
| | | | - Take Naseri
- Ministry of Health, Apia, Samoa; (C.S.-U.); (T.N.)
| | | | - Rachel L. Duckham
- Institute for Physical Activity and Nutrition, Deakin University, Burwood Victoria 3125, Australia;
- Australian Institute for Musculoskeletal Science, The University of Melbourne and Western Health, St. Albans, Victoria 3021, Australia
| | - Jennifer J. Park
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT 06510, USA; (J.J.P.); (N.L.H.)
| | - Nicola L. Hawley
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT 06510, USA; (J.J.P.); (N.L.H.)
| | - Nicole C. Deziel
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT 06510, USA; (C.N.N.B.); (N.C.D.)
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Hawley NL, Pomer A, Rivara AC, Rosenthal SL, Duckham RL, Carlson JC, Naseri T, Reupena MS, Selu M, Lupematisila V, Unasa F, Vesi L, Fatu T, Unasa S, Faasalele-Savusa K, Wetzel AI, Soti-Ulberg C, Prescott AT, Siufaga G, Penaia C, To SB, LaMonica LC, Lameko V, Choy CC, Crouter SE, Redline S, Deka R, Kershaw EE, Urban Z, Minster RL, Weeks DE, McGarvey ST. Exploring the Paradoxical Relationship of a Creb 3 Regulatory Factor Missense Variant With Body Mass Index and Diabetes Among Samoans: Protocol for the Soifua Manuia (Good Health) Observational Cohort Study. JMIR Res Protoc 2020; 9:e17329. [PMID: 32706746 PMCID: PMC7413272 DOI: 10.2196/17329] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 02/24/2020] [Accepted: 03/02/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The prevalence of obesity and diabetes in Samoa, like many other Pacific Island nations, has reached epidemic proportions. Although the etiology of these conditions can be largely attributed to the rapidly changing economic and nutritional environment, a recently identified genetic variant, rs373863828 (CREB 3 regulatory factor, CREBRF: c.1370G>A p.[R457Q]) is associated with increased odds of obesity, but paradoxically, decreased odds of diabetes. OBJECTIVE The overarching goal of the Soifua Manuia (Good Health) study was to precisely characterize the association of the CREBRF variant with metabolic (body composition and glucose homeostasis) and behavioral traits (dietary intake, physical activity, sleep, and weight control behaviors) that influence energy homeostasis in 500 adults. METHODS A cohort of adult Samoans who participated in a genome-wide association study of adiposity in Samoa in 2010 was followed up, based on the presence or absence of the CREBRF variant, between August 2017 and March 2019. Over a period of 7-10 days, each participant completed the main study protocol, which consisted of anthropometric measurements (weight, height, circumferences, and skinfolds), body composition assessment (bioelectrical impedance and dual-energy x-ray absorptiometry), point-of-care glycated hemoglobin measurement, a fasting blood draw and oral glucose tolerance test, urine collection, blood pressure measurement, hand grip strength measurement, objective physical activity and sleep apnea monitoring, and questionnaire measures (eg, health interview, cigarette and alcohol use, food frequency questionnaire, socioeconomic position, stress, social support, food and water insecurity, sleep, body image, and dietary preferences). In January 2019, a subsample of the study participants (n=118) completed a buttock fat biopsy procedure to collect subcutaneous adipose tissue samples. RESULTS Enrollment of 519 participants was completed in March 2019. Data analyses are ongoing, with results expected in 2020 and 2021. CONCLUSIONS While the genetic variant rs373863828, in CREBRF, has the largest known effect size of any identified common obesity gene, very little is currently understood about the mechanisms by which it confers increased odds of obesity but paradoxically lowered odds of type 2 diabetes. The results of this study will provide insights into how the gene functions on a whole-body level, which could provide novel targets to prevent or treat obesity, diabetes, and associated metabolic disorders. This study represents the human arm of a comprehensive and integrated approach involving humans as well as preclinical models that will provide novel insights into metabolic disease. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/17329.
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Affiliation(s)
- Nicola L Hawley
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States
| | - Alysa Pomer
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States
| | - Anna C Rivara
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States
| | - Samantha L Rosenthal
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Rachel L Duckham
- Institute of Physical Activity and Nutrition, Deakin University, Geelong, Australia
- Australian Institute for Musculoskeletal Sciences, The University of Melbourne and Western Health, St Albans, Australia
| | - Jenna C Carlson
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | | | | | - Melania Selu
- Obesity, Lifestyle and Genetic Adaptations Study Group, Apia, Samoa
| | | | - Folla Unasa
- Obesity, Lifestyle and Genetic Adaptations Study Group, Apia, Samoa
| | - Lupesina Vesi
- Obesity, Lifestyle and Genetic Adaptations Study Group, Apia, Samoa
| | - Tracy Fatu
- Obesity, Lifestyle and Genetic Adaptations Study Group, Apia, Samoa
| | - Seipepa Unasa
- Obesity, Lifestyle and Genetic Adaptations Study Group, Apia, Samoa
| | | | - Abigail I Wetzel
- International Health Institute, Department of Epidemiology, School of Public Health, Brown University, Providence, RI, United States
| | | | - Angela T Prescott
- Department of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Gloria Siufaga
- Obesity, Lifestyle and Genetic Adaptations Study Group, Apia, Samoa
| | - Corina Penaia
- Asian Pacific Islander Forward Movement, Los Angeles, CA, United States
| | - Sophie B To
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, United States
| | - Lauren C LaMonica
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States
| | | | - Courtney C Choy
- International Health Institute, Department of Epidemiology, School of Public Health, Brown University, Providence, RI, United States
| | - Scott E Crouter
- Department of Kinesiology, Recreation, and Sport Studies, The University of Tennessee Knoxville, Knoxville, TN, United States
| | - Susan Redline
- Departments of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Ranjan Deka
- Department of Environmental Health, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Erin E Kershaw
- Division of Endocrinology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Zsolt Urban
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Ryan L Minster
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Daniel E Weeks
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Stephen T McGarvey
- International Health Institute, Department of Epidemiology, School of Public Health, Brown University, Providence, RI, United States
- Department of Anthropology, Brown University, Providence, RI, United States
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Osuagwu UL, Fuka F, Agho K, Khan A, Simmons D. Adverse Maternal Outcomes of Fijian Women with Gestational Diabetes Mellitus and the Associated Risk Factors. Reprod Sci 2020; 27:2029-2037. [PMID: 32548804 DOI: 10.1007/s43032-020-00222-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/25/2020] [Indexed: 11/30/2022]
Abstract
The purpose of this study is to determine the factors associated with adverse maternal outcomes in pregnancies complicated by gestational diabetes mellitus (GDM) in urban Fiji. This cross-sectional study used data from existing records of singleton pregnant women with GDM attending the Colonial War Memorial Hospital (CWMH) Suva Fiji between June 2013 and May 2014. Data retrieved included demographic data, antenatal and intrapartum care data, route of delivery, treatment modality, and maternal risk factors. The prevalence of GDM is 3.0%, n = 255/8698, and the most frequent maternal complications were induction of labor (66%), C-section (32%), and preeclampsia (19%), and 25% had babies with birthweight > 4 kg. Older women (≥ 36 years) and those treated with insulin were 5.2 times and 10.7 times, respectively, more likely to have labor induction during childbirth compared with younger women and those on dietary management. Family history of diabetes was associated with 2.4× and/or 2.5× higher odds of cesarean delivery and/or develop hypertension in pregnancy, respectively. Parity > 5 children and diagnoses of GDM after the first trimester reduced the odds of cesarean delivery. The odds of developing preeclampsia in GDM was 3.4 times higher (95% confidence interval (CI) of adjusted odds ratio (aOR): 1.03, 18.78) among obese women than normal-weight women, and married women were less likely to have babies with birthweight > 4 kg. The prevalence of and adverse outcomes among women with GDM attending antenatal public health care in Suva Fiji were higher than previously reported from the hospital. Older and multiparous women with GDM, those insulin treated, and with a strong family history and high body mass index (BMI) need special attention and better monitoring by health care personnel to reduce adverse outcomes during pregnancy.
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Affiliation(s)
- Uchechukwu L Osuagwu
- Diabetes, Obesity and Metabolism Translational Research Unit, Western Sydney University, Campbelltown, NSW, 2560, Australia.
| | - Falahola Fuka
- Ministry of Health, Vaoila Hospital, Tongatapu, Tonga
| | - Kingsley Agho
- School of Science and Health, Western Sydney University, Campbelltown, NSW, 2560, Australia.,African Vision Research Institute, University of KwaZulu-Natal Durban, Durban, South Africa
| | - Adnan Khan
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar.,Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - David Simmons
- Diabetes, Obesity and Metabolism Translational Research Unit, Western Sydney University, Campbelltown, NSW, 2560, Australia
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Choy CC, Hawley NL, Naseri T, Reupena MS, McGarvey ST. Associations between socioeconomic resources and adiposity traits in adults: Evidence from Samoa. SSM Popul Health 2020; 10:100556. [PMID: 32140541 PMCID: PMC7044745 DOI: 10.1016/j.ssmph.2020.100556] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/04/2020] [Accepted: 02/04/2020] [Indexed: 12/16/2022] Open
Abstract
In low- and middle-income countries, earlier in economic development, obesity tends to be more prevalent in high socioeconomic resource groups compared to low. Later in development, the distribution of obesity tends to show the opposite pattern, becoming more prevalent in those with low socioeconomic resources. This shift in obesity prevalence tends to occur between a gross national income per capita (GNI) of US$1,000 to $4,000 dollars. Whether a similar pattern occurs in Pacific Island countries has not been well documented. In Samoa, the GNI rose to US$3,200 dollars in 2010 at which time over 80% of adults were overweight or obese. We aimed to understand the association of socioeconomic resources, assessed by household assets, with adult body mass index (BMI) and abdominal circumference (AC) in Samoa. Data were from a genome-wide association study for obesity among 3,370 Samoans aged 24.5-<65 years in 2010. Household asset scores were calculated based on ownership of consumer durables, housing construction, and access to basic services. Sex-stratified multivariate linear regressions were used to assess adiposity trait differences by household asset ownership, after controlling for age, education, and household urbanicity. Higher asset ownership was associated with higher BMI and AC and the positive relationship remained robust after controlling for potential confounders. Despite significant economic growth preceding the year 2010 in Samoa, the obesity burden had not shifted to low socioeconomic groups in a similar way that has been observed in countries further along in the economic transition. The mechanism by which socioeconomic resources influence adiposity is complex and may be particularly complicated in Samoa by migrant remittances received both as cash and household assets. Social and physical environments may constrain the positive health behavior change necessary to reduce obesity even in the context of high socioeconomic position, a situation that requires further investigation.
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Affiliation(s)
- Courtney C. Choy
- Department of Epidemiology and International Health Institute, Brown University School of Public Health, Providence, RI, 02903, USA
| | - Nicola L. Hawley
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, 06510, USA
| | | | | | - Stephen T. McGarvey
- Department of Epidemiology and International Health Institute, Brown University School of Public Health, Providence, RI, 02903, USA
- Department of Anthropology, Brown University, Providence, RI, 02912, USA
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30
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Tanawattanacharoen VK, Choy CC, Anesi TJ, Naseri T, Soti-Ulberg C, Reupena MS, Hawley NL. Piloting a food photo sorting activity in Samoa to assess maternal beliefs and their role in child diet. MATERNAL AND CHILD NUTRITION 2020; 16:e12974. [PMID: 32056393 PMCID: PMC7296816 DOI: 10.1111/mcn.12974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 08/05/2019] [Accepted: 01/21/2020] [Indexed: 01/18/2023]
Abstract
Eating habits begin forming early in life when parental beliefs and behaviours often play a major role in shaping dietary intake. We aimed to assess maternal beliefs about the cost, social status, and nutritional value of foods in Samoa-a setting with an alarming burden of childhood obesity-and to determine how those beliefs may be related to child dietary intake. Samoan mothers (n = 44) sorted photographs of 26 foods commonly consumed in children in Samoa by cost, social status, and nutritional value (healthfulness). Responses were then assessed for their association with child dietary intake (reported using a food frequency questionnaire) using Pearson correlations. Mothers indicated that traditional Samoan foods were healthier, of higher social status, and lower cost compared with non-traditional/imported food items. Compared with nutritional experts and a market survey of food prices, mothers demonstrated strong nutritional (r = .87, 95% CI [0.68, 0.95], p < .001) and consumer (r = .84, 95% CI [0.68, 0.93], p < .001) knowledge. The perceived cost of food was more strongly associated (r = -.37, 95% CI [-0.66, 0.02], p = .06) with child dietary intake than either healthfulness or social status, with decreasing consumption reported with increasing food cost. Our findings contradicted the notion that the high social status of imported foods may be contributing to increased intake and rising prevalence of childhood obesity in this developing country setting. Despite their nutritional knowledge, Samoan mothers may need additional support in applying their knowledge/beliefs to provide a healthy child diet, including support for access to reasonably priced healthy foods.
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Affiliation(s)
| | - Courtney C Choy
- Department of Epidemiology, International Health Institute, School of Public Health, Brown University, Providence, Rhode, Island
| | | | - Take Naseri
- Department of Epidemiology, International Health Institute, School of Public Health, Brown University, Providence, Rhode, Island.,Samoa Ministry of Health, Apia, Samoa
| | | | | | - Nicola L Hawley
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut.,Yale Institute for Global Health, Yale University, New Haven, Connecticut
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To SB, Brewis AA, Pomer A, Naseri T, Reupena MS, McGarvey ST, Hawley NL. Changing body norms in the context of increasing body size: Samoa in 1995 and 2018. Am J Hum Biol 2020; 32:e23395. [PMID: 32017275 DOI: 10.1002/ajhb.23395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/17/2020] [Accepted: 01/20/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To understand how body size preferences changed in Samoa between 1995 and 2017 to 2019. METHODS Data were from adults aged from 31 to 59 years, who participated in two separate cross-sectional studies of obesity and cardiometabolic risk conducted in Samoa in 1995 and 2017 to 2019. Participants nominated line drawings representing their current size, ideal size, the most attractive and healthiest size, and the lower/upper limits of "normal" size. RESULTS In both sexes, body size preferences and perceived current average body size have increased, yet preference for bodies smaller than one's perceived current size has persisted. Furthermore, the range of body sizes that people considered "normal" has narrowed, suggesting decreased tolerance for extremes of body size. CONCLUSIONS These findings may have implications for mental and physical health outcomes, inform development of future health initiatives, and contribute to a deeper understanding of how body norms and weight-related public health efforts interface.
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Affiliation(s)
- Sophie B To
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Alexandra A Brewis
- School of Human Evolution and Social Change, Arizona State University, Tempe, Arizona
| | - Alysa Pomer
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | | | | | - Stephen T McGarvey
- International Health Institute, Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | - Nicola L Hawley
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
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32
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Zhang H, Qi D, Gu H, Wang T, Wu Y, Li J, Ni J, Liu J, Tu J, Ning X, Wang J. Trends in the prevalence, awareness, treatment and control of diabetes in rural areas of northern China from 1992 to 2011. J Diabetes Investig 2020; 11:241-249. [PMID: 31172682 PMCID: PMC6944834 DOI: 10.1111/jdi.13095] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 05/27/2019] [Accepted: 06/04/2019] [Indexed: 01/06/2023] Open
Abstract
AIMS/INTRODUCTION The worldwide prevalence of diabetes mellitus has been increasing over the past decades, particularly in developing countries. Because of the lack of information regarding changes in diabetes mellitus prevalence, awareness, treatment and control in rural China, we assessed these trends - overall and in the context of related health conditions - to explore the impact of these primary health issues on these rates in a poorly educated, rural population. MATERIALS AND METHODS Diabetes mellitus prevalence, awareness, treatment and control rates were compared between two surveys carried out in 1992 and 2011. The residents of three villages, aged 35-64 years, were recruited for this study. RESULTS In 1992, 1,091 individuals were interviewed and, in 2011, 2,338 individuals were interviewed. Between the two surveys, the overall diabetes mellitus prevalence in the study population was lower in 1992 than that in 2011 (P < 0.001); among men, the prevalence was 5.2-fold higher in 2011 than in 1992 (10.5 vs 1.7%) and nearly 4.3-fold higher (11.2 vs 2.1%) among women. Men aged 35-44 years, with >6 years of education, stage I hypertension and being overweight, had a higher prevalence of diabetes mellitus in 2011 than in 1992. Similarly, for the same time periods, there was also a higher diabetes mellitus prevalence among women aged 55-64 years, with 1-6 years of education, stage III hypertension and who were overweight. However, there were no significant changes in diabetes mellitus awareness, treatment or control in this population. CONCLUSIONS These results suggest that particular efforts must be made to enhance diabetes mellitus prevention, control and public awareness in rural communities in China.
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Affiliation(s)
- Hongyan Zhang
- Department of Endocrinology and MetabolismTianjin Medical University General HospitalTianjinChina
| | - Dongwang Qi
- Department of Endocrinology and MetabolismTianjin Medical University General HospitalTianjinChina
| | - Hongfei Gu
- Department of NeurologyTianjin Haibin People's HospitalTianjinChina
| | - Tao Wang
- Department of NeurologyTianjin Haibin People's HospitalTianjinChina
| | - Yanan Wu
- Department of NeurologyTianjin Medical University General HospitalTianjinChina
- Laboratory of EpidemiologyTianjin Neurological InstituteTianjinChina
- Key Laboratory of Post‐Neuroinjury Neuro‐Repair and Regeneration in Central Nervous SystemTianjin Neurological InstituteMinistry of Education and Tianjin CityTianjinChina
| | - Jingyan Li
- Department of Endocrinology and MetabolismTianjin Medical University General HospitalTianjinChina
| | - Jingxian Ni
- Department of NeurologyTianjin Medical University General HospitalTianjinChina
- Laboratory of EpidemiologyTianjin Neurological InstituteTianjinChina
- Key Laboratory of Post‐Neuroinjury Neuro‐Repair and Regeneration in Central Nervous SystemTianjin Neurological InstituteMinistry of Education and Tianjin CityTianjinChina
| | - Jie Liu
- Department of NeurologyTianjin Medical University General HospitalTianjinChina
- Laboratory of EpidemiologyTianjin Neurological InstituteTianjinChina
- Key Laboratory of Post‐Neuroinjury Neuro‐Repair and Regeneration in Central Nervous SystemTianjin Neurological InstituteMinistry of Education and Tianjin CityTianjinChina
| | - Jun Tu
- Department of NeurologyTianjin Medical University General HospitalTianjinChina
- Laboratory of EpidemiologyTianjin Neurological InstituteTianjinChina
- Key Laboratory of Post‐Neuroinjury Neuro‐Repair and Regeneration in Central Nervous SystemTianjin Neurological InstituteMinistry of Education and Tianjin CityTianjinChina
| | - Xianjia Ning
- Department of NeurologyTianjin Medical University General HospitalTianjinChina
- Laboratory of EpidemiologyTianjin Neurological InstituteTianjinChina
- Key Laboratory of Post‐Neuroinjury Neuro‐Repair and Regeneration in Central Nervous SystemTianjin Neurological InstituteMinistry of Education and Tianjin CityTianjinChina
| | - Jinghua Wang
- Department of NeurologyTianjin Medical University General HospitalTianjinChina
- Laboratory of EpidemiologyTianjin Neurological InstituteTianjinChina
- Key Laboratory of Post‐Neuroinjury Neuro‐Repair and Regeneration in Central Nervous SystemTianjin Neurological InstituteMinistry of Education and Tianjin CityTianjinChina
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Lynn CD, Howells M, Herdrich D, Ioane J, Hudson D, Fitiao STU. The evolutionary adaptation of body art: Tattooing as costly honest signaling of enhanced immune response in American Samoa. Am J Hum Biol 2019; 32:e23347. [DOI: 10.1002/ajhb.23347] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 10/03/2019] [Accepted: 10/04/2019] [Indexed: 12/15/2022] Open
Affiliation(s)
| | - Michaela Howells
- Department of AnthropologyUniversity of North Carolina Wilmington Wilmington North Carolina
| | - David Herdrich
- American Samoa Historic Preservation Office (ASHPO) American Samoa
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Ndwiga DW, McBride KA, Simmons D, MacMillan F. Diabetes, its risk factors and readiness to change lifestyle behaviours among Australian Samoans living in Sydney: Baseline data for church-wide interventions. Health Promot J Austr 2019; 31:268-278. [PMID: 31295377 DOI: 10.1002/hpja.276] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 07/05/2019] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To describe the current prevalence of type 2 diabetes (diabetes) and readiness to change diet and physical activity among Samoans associated with churches in Sydney. METHODS Residents aged ≥18 years attending four Samoan churches in Sydney were invited to participate in a church-wide lifestyle intervention. Participants completed questionnaires, anthropometric measurements, provided a non-fasting blood sample for HbA1c and random blood glucose (RBG) measurement, and performed a 6-minute walk test. Obesity was defined using a Pacific body mass index (BMI) threshold ≥32 kg/m2 and diabetes if HbA1c was ≥6.5%. RESULTS In total, 131/187 (70%) of Samoans (mean age of 44.1 ± 15 years; Female 52%) participated. Diabetes was present in 33% of the population which included 20% previously diagnosed diabetes, duration 13.4 ± 6.7 years, (HbA1c 8.3 ± 2.5% and RBG 10.2 ± 4.1 mmol/L) and 13% had undiagnosed diabetes (HbA1c 8.1 ± 2.7% and RBG 10.3 ± 4.7 mmol/L). The overall baseline prevalence of obesity, high blood pressure and meeting the physical activity recommendation of ≥150 min/wk were 77%, 44% and 38% respectively. Over 90% of participants were contemplating, if not already taking action towards healthier diet choices and increasing physical activity. CONCLUSIONS Prevalence of diabetes and its risk factors were high among Samoans in Sydney with a high proportion with undiagnosed diabetes. SO WHAT?: These findings highlight the need to prioritise the delivery of culturally appropriate interventions tailored to the needs of the Samoan community. The high level of healthy lifestyle contemplation suggests that the community would be receptive to such interventions.
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Affiliation(s)
- Dorothy W Ndwiga
- School of Science and Health, Western Sydney University, Sydney, NSW, Australia
| | - Kate A McBride
- School of Medicine, Western Sydney University, Sydney, NSW, Australia.,Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - David Simmons
- School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Freya MacMillan
- School of Science and Health, Western Sydney University, Sydney, NSW, Australia
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Misra A, Gopalan H, Jayawardena R, Hills AP, Soares M, Reza-Albarrán AA, Ramaiya KL. Diabetes in developing countries. J Diabetes 2019; 11:522-539. [PMID: 30864190 DOI: 10.1111/1753-0407.12913] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/27/2019] [Accepted: 03/08/2019] [Indexed: 12/24/2022] Open
Abstract
There has been a rapid escalation of type 2 diabetes (T2D) in developing countries, with varied prevalence according to rural vs urban habitat and degree of urbanization. Some ethnic groups (eg, South Asians, other Asians, and Africans), develop diabetes a decade earlier and at a lower body mass index than Whites, have prominent abdominal obesity, and accelerated the conversion from prediabetes to diabetes. The burden of complications, both macro- and microvascular, is substantial, but also varies according to populations. The syndemics of diabetes with HIV or tuberculosis are prevalent in many developing countries and predispose to each other. Screening for diabetes in large populations living in diverse habitats may not be cost-effective, but targeted high-risk screening may have a place. The cost of diagnostic tests and scarcity of health manpower pose substantial hurdles in the diagnosis and monitoring of patients. Efforts for prevention remain rudimentary in most developing countries. The quality of care is largely poor; hence, a substantial number of patients do not achieve treatment goals. This is further amplified by a delay in seeking treatment, "fatalistic attitudes", high cost and non-availability of drugs and insulins. To counter these numerous challenges, a renewed political commitment and mandate for health promotion and disease prevention are urgently needed. Several low-cost innovative approaches have been trialed with encouraging outcomes, including training and deployment of non-medical allied health professionals and the use of mobile phones and telemedicine to deliver simple health messages for the prevention and management of T2D.
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Affiliation(s)
- Anoop Misra
- National-Diabetes, Obesity and Cholesterol Foundation, Safdarjung Development Area, New Delhi, India
- Diabetes Foundation (India), New Delhi, India
- Fortis C-DOC Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, New Delhi, India
| | - Hema Gopalan
- National-Diabetes, Obesity and Cholesterol Foundation, Safdarjung Development Area, New Delhi, India
| | | | - Andrew P Hills
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Mario Soares
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Alfredo A Reza-Albarrán
- Endocrinology and Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Farrell P, Thow AM, Schuster S, Vizintin P, Negin J. Access to a Nutritious Diet in Samoa: Local Insights. Ecol Food Nutr 2019; 58:189-206. [PMID: 30957551 DOI: 10.1080/03670244.2019.1582528] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The adult obesity prevalence in Samoa is the third highest globally, and diet is a significant contributor. Our study aimed to explore the behavioral and demographic factors which influence diets in Samoa. The most important findings for strategic policy design were: i) cost was the most important reason for food choice, ii) participants reported high rates of consumption of sugary and fatty energy foods - along with high rates of food insecurity, and iii) the food frequency questionnaire findings from our small sample are in line with the existing evidence that the nutrition transition is underway in Samoa.
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Affiliation(s)
- Penny Farrell
- a Sydney School of Public Health , The University of Sydney , Sydney , Australia
| | - Anne Marie Thow
- b Menzies Centre for Health Policy , The University of Sydney , Sydney , Australia
| | - Suzie Schuster
- c Department of Education , National University of Samoa , Apia , Samoa
| | - Pavle Vizintin
- d National University of Samoa Chancellery, Le Papaigalagala Campus , To'omatagi , Samoa
| | - Joel Negin
- a Sydney School of Public Health , The University of Sydney , Sydney , Australia
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Abstract
PURPOSE OF REVIEW Diabetes mellitus prevalence is increasing throughout the world as a consequence of growing rates of obesity, metabolic syndrome, and westernization of lifestyle. It is currently unknown to what extent these trends affect the global burden of diabetic kidney disease (DKD). This review seeks to describe the global burden of DKD and how it has changed throughout time using recently released results of the Global Burden of Disease 2017 Study. RECENT FINDINGS DKD prevalence has remained fairly stable at the global level and among many world regions since 1990. At the global level, the proportion of DKD deaths relative to other types of CKD is increasing. Certain world regions still have very high rates of DKD, whereas other world regions have decreasing prevalence and mortality. Screening will likely play an important role in mitigating the growing burden within high-risk regions.
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Affiliation(s)
- Bernadette Thomas
- Department of Global Health, University of Washington, 325 9th Avenue (Box 359931), Seattle, WA, 98104, USA.
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Kelly P, Hoover K. Association between ethnicity and changes in weight, blood pressure, blood glucose and lipid levels after bariatric surgery: a systematic review protocol. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2019; 17:290-296. [PMID: 30875340 DOI: 10.11124/jbisrir-2017-003685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW QUESTION What is the association between ethnicity and changes in weight, blood pressure, blood glucose and lipid levels after bariatric surgery?
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Affiliation(s)
- Penny Kelly
- School of Nursing, University of Mississippi Medical Center, Jackson, USA
- Mississippi Centre of Evidence-Based Practice: a Joanna Briggs Institute Center of Excellence
| | - Kim Hoover
- School of Nursing, University of Mississippi Medical Center, Jackson, USA
- Mississippi Centre of Evidence-Based Practice: a Joanna Briggs Institute Center of Excellence
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Lin S, Rocha VM, Taylor R. Artefactual inflation of type 2 diabetes prevalence in
WHO STEP
surveys. Trop Med Int Health 2019; 24:477-483. [DOI: 10.1111/tmi.13213] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Sophia Lin
- University of New South Wales Sydney NSW Australia
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Pedersen ML. Diabetes care in the dispersed population of Greenland. A new model based on continued monitoring, analysis and adjustment of initiatives taken. Int J Circumpolar Health 2019; 78:1709257. [PMID: 31996108 PMCID: PMC7034430 DOI: 10.1080/22423982.2019.1709257] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/17/2019] [Accepted: 12/19/2019] [Indexed: 12/16/2022] Open
Abstract
Diabetes used to be a rare condition among Inuit in Greenland. However, research in recent decades has shown a high prevalence of undiagnosed diabetes. Addressing diabetes in the geographically dispersed population of Greenland presents a challenge to the health care system. In 2008, a new model of diabetes care was introduced in Greenland that included continual monitoring, analysis, and adjustment of initiatives taken. The overall aim of this review was to review the feasibility of the monitoring of an ongoing national diabetes care programme. After ten years of observation it was clear that monitoring of such a programme based on information in electronic medical records in Greenland was feasible. It was found that the majority of the population in Greenland was in contact with the health care system. Increased diagnostic activity resulted in an increased prevalence of diagnosed diabetes. The quality of diabetes care in Greenland and the testing effectiveness of gestational diabetes were improved. Microvascular complications were frequently observed among Greenlandic diabetic patients, except for retinopathy that was as an exception. In summary, this model may improve diabetes care and potentially care for other chronic conditions in Greenland, and may also be helpful in other remote settings where chronic disease care is difficult.Abbreviations: AD: Anno Domini; ADA: American Diabetes Association; BC: Before Christ; BMI: Body Mass Index; BP: Blood Pressure; CWB: Capillary Whole Blood; EMR: Electronic Medical Record; EASD: European Association for Study of Diabetes; GA: Gestational Age; GDM: Gestational Diabetes Mellitus; FIGO: The International Federation of Gynaecology and Obstetrics; HbA1c: Glycosylated haemoglobin; IDF: International Diabetes Federation; LDL: Low density lipoprotein; NDQIA: National Diabetes Quality Improvement Alliancel; NICE: National Institute for Health and Care Excellence; OECD: Organisation for Economic Co-operation and Development; OGTT: Oral Glucose Tolerance Test; QIH: Queen Ingrid Hospital; RCT: Randomised Controlled Tria;l T1D: Type 1 Diabetes; T2D: Type 2 Diabetes; UACR: Urine Albumin Creatinine Ratio; WHO: World Health Organisation.
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Affiliation(s)
- Michael Lynge Pedersen
- Greenland Center for Health Research, Institute Nursing and Health Science, University of Greenland, Nuuk, Greenland
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Chobot A, Górowska‐Kowolik K, Sokołowska M, Jarosz‐Chobot P. Obesity and diabetes-Not only a simple link between two epidemics. Diabetes Metab Res Rev 2018; 34:e3042. [PMID: 29931823 PMCID: PMC6220876 DOI: 10.1002/dmrr.3042] [Citation(s) in RCA: 162] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 05/17/2018] [Accepted: 06/13/2018] [Indexed: 12/13/2022]
Abstract
Diabetes (DM) as well as obesity, due to their increasing incidence, were recognized as epidemic by the World Health Organization. Obesity is involved not only in the aetiopathogenesis of the most common worldwide type of DM-type 2 diabetes-but also in the development of its complications. There is also increasing scientific evidence regarding the role of obesity and overweight in type 1 diabetes. Weight gain may be considered as a complication of insulin treatment but also reveals significant pathophysiological impact on various stages of the disease. Another very important aspect related to DM as well as obesity is the microbiome, which is highly variable. The function of the gut microflora, its interaction with the whole organism, and its role in the development of obesity and type 1 diabetes as well as type 2 diabetes are still not fully understood and subject of ongoing investigations. This review presents a summary of recently published results concerning the relation of obesity/overweight and DM as well as their associations with the microbiome.
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Affiliation(s)
- Agata Chobot
- Department of Pediatric Gastronterology and HepatologyClinical Hospital Nr 1ZabrzePoland
| | | | - Magdalena Sokołowska
- Department of PediatricsJohn Paul II Upper Silesian Child Health CentreKatowicePoland
| | - Przemysława Jarosz‐Chobot
- Department of Children's Diabetology, School of Medicine in KatowiceMedical University of SilesiaKatowicePoland
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Schramm JF, Seibert DC, Thompson MJM, Binder MM, King Young S, Deleon PH. Primary Care in American Samoa: How Nurse Practitioners Created a Bridge Across an Ocean. Mil Med 2018; 184:72-77. [DOI: 10.1093/milmed/usy219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/21/2018] [Accepted: 08/08/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jill F Schramm
- Uniformed Services University of the Health Sciences, Daniel K. Inouye Graduate School of Nursing, 4301 Jones Bridge Road, E1056, Bethesda, MD
| | - Diane C Seibert
- Uniformed Services University of the Health Sciences, Daniel K. Inouye Graduate School of Nursing, 4301 Jones Bridge Road, E1056, Bethesda, MD
| | - Maj Julie M Thompson
- Uniformed Services University of the Health Sciences, Daniel K. Inouye Graduate School of Nursing, 4301 Jones Bridge Road, E1056, Bethesda, MD
| | - Michelle M Binder
- Uniformed Services University of the Health Sciences, Daniel K. Inouye Graduate School of Nursing, 4301 Jones Bridge Road, E1056, Bethesda, MD
| | - Sandra King Young
- American Samoa Medicaid Agency, Office of the Governor, American Samoa Government, 301 3rd floor ASTC Building, PO Box 998383, Pago Pago, AS
| | - Patrick H Deleon
- Uniformed Services University of the Health Sciences, Daniel K. Inouye Graduate School of Nursing, 4301 Jones Bridge Road, E1056, Bethesda, MD
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Taylor R, Lin S, Linhart C, Morrell S. Overview of trends in cardiovascular and diabetes risk factors in Fiji. Ann Hum Biol 2018; 45:188-201. [PMID: 29877150 DOI: 10.1080/03014460.2018.1465122] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
CONTEXT Fiji has undergone an epidemiological transition, characterised by declining infectious disease and childhood mortality, that has been offset by rising cardiovascular disease mortality. Other Pacific Island states are in a comparable situation. OBJECTIVE With a focus on Fiji, this study reviews and contextualises research performed by the authors and others that examines cardiovascular disease (CVD) and type 2 diabetes (T2DM) and their risk factors in Pacific Island states. METHODS This overview covers evidence for the causes and consequences of CVD risk factors and the epidemiological transition and reflects on biological and evolutionary hypotheses. It is based on studies the authors carried out that synthesised disparate population-based CVD risk factor surveys conducted in Fiji over 1980-2012. RESULTS Prevalences of obesity, T2DM and hypertension continue to increase in the Fiji population. Tobacco smoking prevalence has decreased, but remains relatively high in men compared to many developed countries. T2DM and hypertension trends, and CVD consequences related to diet, exercise and tobacco smoking, have placed the Fiji population in a variant of the epidemiological transition manifesting as a plateau in life expectancy similar to that of numerous developed countries during the mid-20th century. CONCLUSION There is evidence that risk factors and consequent CVD mortality can be reduced in populations. Obesity and T2DM reductions have been observed only in populations surviving in dire circumstances. Interventions to lower the prevalence of CVD and T2DM risk factors in the Fiji population require multi-faceted approaches, with continual monitoring and evaluation for their impact on these risk factors and morbidity and mortality outcomes.
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Affiliation(s)
- R Taylor
- a School of Public Health and Community Medicine , University of NSW , Sydney , Australia
| | - S Lin
- a School of Public Health and Community Medicine , University of NSW , Sydney , Australia
| | - C Linhart
- a School of Public Health and Community Medicine , University of NSW , Sydney , Australia
| | - S Morrell
- a School of Public Health and Community Medicine , University of NSW , Sydney , Australia
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Linhart C, Naseri T, Lin S, Taylor R, Morrell S, McGarvey ST, Magliano DJ, Zimmet P. Continued increases in blood pressure over two decades in Samoa (1991-2013); around one-third of the increase explained by rising obesity levels. BMC Public Health 2018; 18:1122. [PMID: 30219049 PMCID: PMC6139166 DOI: 10.1186/s12889-018-6016-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 09/04/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND To analyse trends over the period 1991-2013 in systolic blood pressure (SBP), diastolic blood pressure (DBP) and the prevalence of hypertension in adults aged 25-64 years in Samoa; and to assess the contribution of rising obesity levels to period trends. METHODS Unit record data from seven population-based surveys (n = 10,881) conducted between 1991 and 2013 were included for analysis. Surveys were adjusted to the nearest previous census to improve national representativeness. Hypertension was defined as SBP ≥140 mmHg and/or DBP ≥90 mmHg and/or on medication for hypertension. Obesity was measured by body mass index (BMI). Poisson, linear and meta-regression were used to assess period trends. RESULTS Over 1991-2013 mean SBP and DBP (mmHg), and the prevalence of hypertension (%) increased in both sexes. Increases in hypertension were: from 18.3 to 33.9% (p < 0.001) in men (mean BP from 122/74 to 132/78); and from 14.3 to 26.4% (p < 0.001) in women (mean BP from 118/73 to 126/78). The estimate of the age-adjusted mean SBP and DBP over 1991-2013, and the relative risk for hypertension in 2013 compared to 1991, were attenuated after adjusting for BMI: by 22% (men) and 32% (women) for mean SBP; 37% (men) and 32% (women) for mean DBP; and 19% in both sexes for hypertension. CONCLUSIONS Significant increases have occurred in SBP/DBP and hypertension prevalence in both sexes in Samoa during 1991-2013, which would contribute significantly to premature mortality from cardiovascular disease. Obesity accounts for around one-third of the rising trend in blood pressure in the Samoan population. Strengthening of population control of hypertension through reduction in obesity and salt intake, and case detection and treatment through primary care, is required to reduce premature mortality from cardiovascular disease in Samoa.
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Affiliation(s)
- Christine Linhart
- Public and International Health, School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | | | - Sophia Lin
- Public and International Health, School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Richard Taylor
- Public and International Health, School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Stephen Morrell
- Public and International Health, School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Stephen T. McGarvey
- International Health Institute, Department of Epidemiology, Brown University School of Public Health, Providence, USA
| | | | - Paul Zimmet
- Baker IDI Heart & Diabetes Institute, Melbourne, Australia
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Sung KC, Lee MY, Kim YH, Huh JH, Kim JY, Wild SH, Byrne CD. Obesity and incidence of diabetes: Effect of absence of metabolic syndrome, insulin resistance, inflammation and fatty liver. Atherosclerosis 2018; 275:50-57. [PMID: 29860108 DOI: 10.1016/j.atherosclerosis.2018.05.042] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 04/24/2018] [Accepted: 05/22/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND AIMS Obesity is frequently associated with non-alcoholic fatty liver disease (NAFLD), insulin resistance (IR), inflammation and metabolic syndrome (MetS), all of which increase the risk of type 2 diabetes (T2DM). However, the role of these risk factors in mediating the effect of obesity remains unclear. We investigated the association between obesity and T2DM in the absence and presence of NAFLD, IR, inflammation and MetS components. METHODS 29,836 obese subjects without diabetes were studied in a Korean health screening program. Obesity was defined by the appropriate ethnic-specific body mass index (BMI) threshold ≥25 kg/m2. Hazard ratios (HRs and 95% confidence intervals, CIs) for incident T2DM were estimated for the group with no hypertension, dyslipidemia, impaired fasting glucose, fatty liver, IR, or inflammation (n = 1717), compared to the reference group, with one or more of these factors (n = 19,757). RESULTS Mean (SD) age at baseline was 37 (7) years and 1200 incident cases of diabetes occurred. Crude T2D incidence was 12.6/10,000 person-years in the group without metabolic abnormality and 143/10,000 person-years in the reference group. HR (95% CIs) for incident diabetes was 0.13 (0.06, 0.33) in the group without metabolic abnormality. CONCLUSIONS Obese subjects without components of the metabolic syndrome, IR, fatty liver and inflammation have an approximately 11-fold lower risk of incident type 2 diabetes than obese subjects who have these risk factors. These simple factors could be used to target limited resources in high risk obese subjects in the prevention of diabetes.
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Affiliation(s)
- Ki-Chul Sung
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Mi Yeon Lee
- Division of Biostatistics, Department of R&D Management, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young-Hwan Kim
- Department of Nuclear Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji-Hye Huh
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Jang-Young Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Sarah H Wild
- Centre for Population Health Sciences, Lothian Place University of Edinburgh, Edinburgh, Scotland, UK
| | - Christopher D Byrne
- Endocrinology and Metabolism Unit, IDS Building, Southampton General Hospital, University of Southampton, MP 887, Southampton, UK; Southampton National Institute for Health Research, Biomedical Research Centre, Southampton General Hospital, Southampton, UK.
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Maredia H, Hawley NL, Lambert-Messerlian G, Fidow U, Reupena MS, Naseri T, McGarvey S. Reproductive health, obesity, and cardiometabolic risk factors among Samoan women. Am J Hum Biol 2018; 30:e23106. [PMID: 29663637 PMCID: PMC5980683 DOI: 10.1002/ajhb.23106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 11/30/2017] [Accepted: 01/14/2018] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES Obesity leads to deleterious effects on not only cardiovascular health but also on the reproductive health of women. We estimate the prevalence of menstrual irregularity and of polycystic ovarian syndrome (PCOS) in Samoan women, among whom obesity prevalence is extremely high. We explore the association of these reproductive health conditions with adiposity, cardiometabolic risk factors, and androgen levels. METHODS A cross-sectional sample of Samoan women 25-39 years of age (n = 470) from a larger population-based genome-wide association study of adiposity and cardiometabolic disease was assessed for the prevalence of oligomenorrhea/amenorrhea (OM/AM) using a self-reported questionnaire. Serum androgens and anti-Müllerian hormone levels were assayed to determine hyperandrogenemia and presence of polycystic ovaries (PCO), respectively, using criterion values. PCOS was classified using NIH guidelines of having at least two of the three conditions: menstrual irregularity, hyperandrogenism, and PCO. We contrasted socio-demographic, reproductive health, and cardiometabolic risk factors between those with and without OM/AM and similarly for PCOS. RESULTS The prevalence of OM/AM was 7.4% (95% CI: 5.1, 9.8), and women with OM/AM had significantly higher central adiposity. PCOS was estimated at 6.8% (95% CI: 4.5, 9.1), and those with PCOS were younger but had higher overall and central adiposity measures, higher triglycerides, and higher prevalence of insulin resistance than women without PCOS. CONCLUSIONS The prevalence of menstrual irregularity and PCOS are less than hypothesized given the high levels of adiposity in this population. Nevertheless, Samoan women with menstrual irregularity and other features of PCOS have significantly poorer metabolic health.
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Affiliation(s)
- H. Maredia
- Departments of Pathology and Laboratory Medicine and Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, RI 02912, USA
- Department of Epidemiology and International Health Institute, Brown University School of Public Health, Providence, RI 02912, USA
| | - N. L. Hawley
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, 06520, USA
| | - G. Lambert-Messerlian
- Departments of Pathology and Laboratory Medicine and Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, RI 02912, USA
| | - U. Fidow
- Department of Obstetrics and Gynecology, Tupua Tamasese Meaole Hospital, National Health Service, Government of Samoa, Apia, Samoa
| | - M. S. Reupena
- Bureau of Statistics, Government of Samoa, Apia, Samoa
| | - T. Naseri
- Ministry of Health, Government of Samoa, Apia, Samoa
| | - S.T. McGarvey
- Department of Epidemiology and International Health Institute, Brown University School of Public Health, Providence, RI 02912, USA
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Thow AM, Reeve E, Naseri T, Martyn T, Bollars C. Food supply, nutrition and trade policy: reversal of an import ban on turkey tails. Bull World Health Organ 2017; 95:723-725. [PMID: 29147046 PMCID: PMC5689196 DOI: 10.2471/blt.17.192468] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 06/12/2017] [Accepted: 07/04/2017] [Indexed: 11/27/2022] Open
Affiliation(s)
- Anne Marie Thow
- Menzies Centre for Health Policy, D17 Charles Perkins Centre, University of Sydney, New South Wales, 2006, Australia
| | - Erica Reeve
- Centre for Population Health Research, Deakin University, Melbourne, Australia
| | | | - Tim Martyn
- Centre for Pacific Island Studies, University of the Sunshine Coast, Queensland, Australia
| | - Caroline Bollars
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
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Linhart C, Naseri T, Lin S, Taylor R, Morrell S, McGarvey ST, Magliano DJ, Zimmet P. Tobacco smoking trends in Samoa over four decades: can continued globalization rectify that which it has wrought? Global Health 2017; 13:31. [PMID: 28606163 PMCID: PMC5469026 DOI: 10.1186/s12992-017-0256-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 06/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The island country of Samoa (population 188,000 in 2011) forms part of Polynesia in the South Pacific. Over the past several decades Samoa has experienced exceptional modernization and globalization of many sectors of society, with noncommunicable diseases (NCD) now the leading cause of morbidity and mortality. The evolution of risk factor prevalence underpinning the increase in NCDs, however, has not been well described, including tobacco smoking which is related to cardiovascular disease, lung cancer, and chronic obstructive pulmonary disease. METHODS The present study examines tobacco smoking in relation to different forms and effects of globalization in Samoa using 7 population-based surveys (n = 9223) over 1978-2013. RESULTS The prevalence of daily tobacco smoking steadily decreased over 1978-2013 from 76% to 36% in men, and from 27% to 15% in women (p < 0.0001 both sexes). During 1991-2013, current tobacco smoking also steadily decreased from 64% to 40% in men (p < 0.0001), and from 21% to 17% in women (p < 0.05). Declines were similar in younger (25-44 years) and older (45-64 years) men and women. Colonial globalization facilitated the introduction and prolific spread of tobacco trade and consumption in the Pacific Islands from the sixteenth century, with many populations inexorably pulled into trade relations and links to the global economy. It has also been a different globalization which may have led to the decline in smoking prevalence in Samoa in recent decades, through global dissemination since the 1950s of information on the harmful effects of tobacco smoking derived from research studies in the USA and Europe. CONCLUSIONS Over the past 35 years tobacco smoking has steadily declined among Samoan adults; the only NCD risk factor to demonstrate marked declines during this period. By 2013 tobacco smoking in women had decreased to levels similar to Australia and New Zealand (ANZ), however in men smoking prevalence remained more than three times higher than ANZ. The impact on smoking prevalence of the variety of tobacco control interventions that have been implemented so far in Samoa need to be evaluated in order to determine the most effective initiatives that should be prioritized and strengthened.
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Affiliation(s)
- Christine Linhart
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | | | - Sophia Lin
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Richard Taylor
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Stephen Morrell
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Stephen T McGarvey
- International Health Institute, Department of Epidemiology, Brown University School of Public Health, Providence, USA
| | | | - Paul Zimmet
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
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Abstract
Introduction The purpose of this study was to determine the prevalence of diabetic retinopathy in Samoa by piloting a retinal photography screening programme. Methods We performed a cross-sectional study of patients with diabetes who presented to the Tupua Tamasese Meaole eye clinic in Apia, Samoa, between May 2011 and September 2011. Study approval was granted by the National Health Service Board of Samoa, the Monash University Human Research Ethics Committee, and the study adhered to the Tenets of the Declaration of Helsinki. Following informed consent, data collection included patient demographics [age, area of residence (rural or urban)], type of diabetes, length of time since diagnosis, most recent random blood sugar and blood pressure levels. The subjects had three 45-degree retinal photographs taken in each eye with the Canon CR6-45NM camera. All gradable photographs were assessed for the presence of diabetic retinopathy or macular oedema using the International Clinical Diabetic Retinopathy Severity Scale and the International Clinical Diabetic Macular Oedema Severity scale, respectively. Results Two hundred and fourteen eyes from 107 subjects were examined during the study period, all of whom had type 2 diabetes mellitus. Diabetic retinopathy was present in 53.3% (114/214) of eyes, with 14.5% having proliferative retinopathy and 7.5% with severe non-proliferative retinopathy. Also, 25.2% (54/214) had some evidence of macular oedema with 11.7% (25/214) requiring treatment. A statistically significant relationship existed between the length of time since diagnosis and the severity of both retinopathy (p < 0.001) and macular oedema (p = 0.031). Blood pressure more than 150/85 mmHg was associated with higher levels of diabetic retinopathy (p = 0.03) and macular oedema (p = 0.02). Conclusion A comprehensive diabetic retinopathy screening programme is much needed in Samoa given the high prevalence of diabetic eye disease.
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Lin S, Naseri T, Linhart C, Morrell S, Taylor R, McGarvey ST, Magliano DJ, Zimmet P. Trends in diabetes and obesity in Samoa over 35 years, 1978-2013. Diabet Med 2017; 34:654-661. [PMID: 27505623 PMCID: PMC5411261 DOI: 10.1111/dme.13197] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2016] [Indexed: 01/05/2023]
Abstract
AIMS Population surveys of Type 2 diabetes mellitus and obesity conducted in Samoa over three decades have used varying methodologies and definitions. This study standardizes measures, and trends of Type 2 diabetes mellitus and obesity for 1978-2013 are projected to 2020 for adults aged 25-64 years. METHODS Unit records from eight surveys (n = 12 516) were adjusted to the previous census for Division of residence, sex and age to improve national representativeness. Type 2 diabetes mellitus is defined as a fasting plasma glucose ≥ 7.0 mmol/l and/or on medication. Obesity is defined as BMI ≥ 30 kg/m2 . Random effects meta-regression was employed to assess time trends following logit transformation. Poisson regression from strata was used to assess the effects of mean BMI changes on Type 2 diabetes mellitus period trends. RESULTS Over 1978-2013, Type 2 diabetes mellitus prevalence increased from 1.2% to 19.6% in men (2.3% per 5 years), and from 2.2% to 19.5% in women (2.2% per 5 years). Obesity prevalence increased from 27.7% to 53.1% in men (3.6% per 5 years) and from 44.4% to 76.7% (4.5% per 5 years) in women. Type 2 diabetes mellitus and obesity prevalences increased in all age groups. From period trends, Type 2 diabetes mellitus prevalence in 2020 is projected to be 26% in men and women. Projected obesity prevalence is projected to be 59% in men and 81% in women. Type 2 diabetes mellitus period trends attributable to BMI increase are estimated as 31% (men) and 16% (women), after adjusting for age. CONCLUSION This is the first study to produce trends of Type 2 diabetes mellitus and obesity in Samoa based on standardized data from population surveys. Type 2 diabetes mellitus is equally prevalent in both sexes, and obesity is widespread. Type 2 diabetes mellitus prevalence in Samoa is likely to continue to increase in the near future.
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Affiliation(s)
- S. Lin
- School of Public Health and Community MedicineUniversity of New South WalesSydneyAustralia
| | | | - C. Linhart
- School of Public Health and Community MedicineUniversity of New South WalesSydneyAustralia
| | - S. Morrell
- School of Public Health and Community MedicineUniversity of New South WalesSydneyAustralia
| | - R. Taylor
- School of Public Health and Community MedicineUniversity of New South WalesSydneyAustralia
| | - S. T. McGarvey
- International Health InstituteBrown UniversityProvidenceRIUSA
| | - D. J. Magliano
- Baker IDI Heart and Diabetes InstituteMelbourneAustralia
| | - P. Zimmet
- Baker IDI Heart and Diabetes InstituteMelbourneAustralia
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