Social distribution of diabetes, hypertension and related risk factors in Barbados: a cross-sectional study

Comparing national device-based physical activity surveillance systems: a systematic review

BACKGROUND

Physical activity surveillance systems are important for public health monitoring but rely mostly on self-report measurement of physical activity. Integration of device-based measurements in such systems can improve population estimates, however this is still relatively uncommon in existing surveillance systems. This systematic review aims to create an overview of the methodology used in existing device-based national PA surveillance systems.

METHODS

Four literature databases (PubMed, Embase.com, SPORTDiscus and Web of Science) were searched, supplemented with backward tracking. Articles were included if they reported on population-based (inter)national surveillance systems measuring PA, sedentary time and/or adherence to PA guidelines. When available and in English, the methodological reports of the identified surveillance studies were also included for data extraction.

RESULTS

This systematic literature search followed the PRISMA guidelines and yielded 34 articles and an additional 18 methodological reports, reporting on 28 studies, which in turn reported on one or multiple waves of 15 different national and 1 international surveillance system. The included studies showed substantial variation between (waves of) systems in number of participants, response rates, population representativeness and recruitment. In contrast, the methods were similar on data reduction definitions (e.g. minimal number of valid days, non-wear time and necessary wear time for a valid day).

CONCLUSIONS

The results of this review indicate that few countries use device-based PA measurement in their surveillance system. The employed methodology is diverse, which hampers comparability between countries and calls for more standardized methods as well as standardized reporting on these methods. The results from this review can help inform the integration of device-based PA measurement in (inter)national surveillance systems.

Prevalence and correlates of alcohol use among the elderly in the Eastern Caribbean Health Outcomes Research Network (ECHORN) cohort study

BACKGROUND

Alcohol use is pervasive in the Caribbean; however, the prevalence and correlates of alcohol use and drinking problems in the elderly have not been extensively studied.

METHODS

Data were obtained from the Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study, a cohort study of Caribbean people from Puerto Rico, Barbados, Trinidad, and Tobago, and the U.S. Virgin Islands, collected between 2013 and 2018 (baseline study sample, ages 60+, n = 811). Descriptive statistics were used to compare the differences in drinking status (current vs. former vs. never), alcohol problems (Cut-down, Annoyed, Guilty, and Eye-opener (CAGE) scale score ≥2 vs. <2), and binge drinking days (0 days vs. 1-2 days vs. ≥3 days) across sample characteristics. Logistic regression analyses estimated the association of these alcohol measures with sociodemographic (e.g., sex), psychological (depression), and cultural (e.g., religion) correlates.

RESULTS

Thirty-six percent were 70 + years of age, 64 % were female, and 41 % had less than a high school education. Alcohol problems (≥2 CAGE score) was 21 %. Binge drinking ≥3 days was 30.6 %. Never attending religious services (vs. attending once a week or more) was associated with almost three times higher odds of alcohol problems (adjusted Odds Ratio: OR = 2.88, 95 % CI = 1.02, 8.15) four times higher odds of increasing binge drinking days (aOR = 4.04, 95 % CI = 1.11, 14.96). College education was protective against both the outcomes.

CONCLUSION

We provide current estimates of alcohol problems among elderly Eastern Caribbean people. Among the sociodemographic, psychological, and cultural correlates examined, religious attendance was significant. Replicate longitudinal studies using DSM-5 alcohol dependence are recommended.

Neighbourhood Walkability and Its Influence on Physical Activity and Cardiometabolic Disease: A Cross-Sectional Study in a Caribbean Small Island Developing State

Introduction Cities and neighborhoods may provide opportunities for population-level environmental interventions to reduce physical inactivity and cardiometabolic risk. In this study, we describe the association between neighborhood walkability, physical activity (PA), and cardiometabolic outcomes, by linking data from a nationally representative survey of adults (25 years and older) collected in 2012-2013 with spatial data on built environment features in Barbados. Methods We estimated a walkability index for 45 neighborhoods using objectively measured built environment features (residential density, street connectivity, and land use mix). We used the Recent Physical Activity Questionnaire to capture time spent in outdoor walking, active commuting, moderate-to-vigorous PA (MVPA), and total PA. Our primary cardiometabolic outcome was a predicted 10-year cardiovascular risk (CVD) score, estimated using the American College of Cardiology/American Heart Association pooled cohort equation. Our secondary cardiometabolic outcomes were hypertension and diabetes. We explored the effect of neighborhood walkability on PA and cardiometabolic outcomes using several multivariable regression models (tobit and linear and logistic multi-level mixed effects), with the model choice depending on the structure of the outcome.  Results The average time spent walking weekly for any purpose among participants was 75 minutes/week, time spent on active commuting was 15 minutes/week, and MVPA was 221 minutes/week. We estimated that the average 10-year CVD risk in the study population was 11.7% (95%CI 10.9-12.5). Our confounder-adjusted analyses showed positive linear relationships between neighborhood walkability and each PA outcome (p<0.05 in all cases), and a negative relationship between walkability and predicted 10-year CVD risk (p<0.001). Conclusion In our setting, adults residing in higher walkability neighborhoods spent more time engaged in PA, had a lower predicted 10-year CVD risk, and were less likely to have diabetes. Urban planners may consider shorter-term interventions, such as those on a microscale, which may provide additional ways to increase activity in a mostly fixed macroscale environment.

Risk factor contributions to socioeconomic inequality in cardiovascular risk in the Philippines: a cross-sectional study of nationally representative survey data

BACKGROUND

Primary prevention of cardiovascular diseases (CVD) increasingly relies on monitoring global CVD risk scores. Lack of evidence on socioeconomic inequality in these scores and the contributions that specific risk factors make to this inequality impedes effective targeting of CVD prevention. We aimed to address this evidence gap by measuring and decomposing socioeconomic inequality in CVD risk in the Philippines.

METHODS

We used data on 8462 individuals aged 40-74 years from the Philippines National Nutrition Survey and the laboratory-based Globorisk equation to predict 10-year risk of a CVD event from sex, age, systolic blood pressure, total cholesterol, high blood glucose, and smoking. We used a household wealth index to proxy socioeconomic status and measured socioeconomic inequality with a concentration index that we decomposed into contributions of the risk factors used to predict CVD risk. We measured socioeconomic inequalities in these risk factors and decomposed them into contributions of more distal risk factors: body mass index, fat share of energy intake, low physical activity, and drinking alcohol. We stratified by sex.

RESULTS

Wealthier individuals, particularly males, had greater exposure to all risk factors, with the exception of smoking, and had higher CVD risks. Total cholesterol and high blood glucose accounted for 58% and 34%, respectively, of the socioeconomic inequality in CVD risk among males. For females, the respective estimates were 63% and 69%. Systolic blood pressure accounted for 26% of the higher CVD risk of wealthier males but did not contribute to inequality among females. If smoking prevalence had not been higher among poorer individuals, then the inequality in CVD risk would have been 35% higher for males and 75% higher for females. Among distal risk factors, body mass index and fat intake contributed most to inequalities in total cholesterol, high blood sugar, and, for males, systolic blood pressure.

CONCLUSIONS

Wealthier Filipinos have higher predicted CVD risks and greater exposure to all risk factors, except smoking. There is need for a nuanced approach to CVD prevention that targets anti-smoking programmes on the poorer population while targeting diet and exercise interventions on the wealthier.

Prevalence of diabetes and its correlates among Iranian adults: Results of the first phase of Shahedieh cohort study

Background and Aims

The diabetes is one of the most common noncommunicable diseases, the prevalence of which is increasing worldwide. This study aimed to determine the prevalence, and correlates the factors of diabetes in the setting of Shahedieh cohort study in Yazd, Iran.

Method

The present study is a cross-sectional study conducted on the data of the initial stage of Shahdieh Yazd cohort. This study examined the data of 9747 participants aged from 30 to 73 years. The data included demographic, clinical, and blood test variables. Multivariable logistic regression was used to calculate the adjusted odds ratio (OR), and the risk factors of diabetes were studied. Meanwhile, population attributable risks for diabetes were estimated, and reported.

Results

The prevalence of diabetes was 17.9% (CI95%: 17.1-18.9); 20.5% in women, and 15.4% in men. Based on the results of multivariable logistic regression showed female sex (OR = 1.4, CI95%: 1.24-1.58), waist-hip ratio (OR = 1.4, CI95%: 1.24-1.58), high blood pressure (OR = 2.1, CI95%: 1.84-2.4), cardiovascular diseases (CVD) (OR = 1.52, CI95%: 1.28-1.82), stroke (OR = 1.91, CI95%: 1.24-2.94), age (OR = 1.81, CI95%: 1.67-1.96), hypercholesterolemia (OR = 1.79, CI95% triglyceride: 1.59-2.02), and low-density lipoprotein (LDL) (OR = 1.45, CI95%: 1.4-1.51), as risk factors for diabetes. Among the modifiable risk factors, high blood pressure(52.38%), waist-to-hip ratio (48.19%), the history of stroke (47.64%), hypercholesterolemia (44.13%), history of CVD (34.21%), and LDL ≥ 130 (31.03%) had the greatest population-attributable, respectively.

Conclusion

The results showed that some of the main determinants of diabetes are the modifiable risk factors. Therefore, implementing early detection, and screening programs for people at risk and preventive measures, such as lifestyle modification programs, and control of risk factors can prevent this disease.

Use of Cheminformatics to Determine Potential Drug Interactions between Popular Barbadian Botanical Medicines and Antihypertensive Drugs

Barbados has a rich traditional use of medicinal plants, especially among the older population who may have a chronic noncommunicable disease. This study aims to identify possible drug-herb interactions between popular herbal remedies used to manage elevated blood pressure and conventional antihypertensive drugs. In this study, in silico molecular docking experiments with AutoDock Vina (Scripps Research Institute, La Jolla, CA), a part of Yasara Structure software, version 20.12.24, were used to screen 30 potential phytochemicals for drug interactions from 11 popular plants in Barbados that are used for high blood pressure and could influence the pharmacology of the most prescribed antihypertensive drugs in Barbados. Thiazide and thiazide-like diuretics, calcium channel blockers (CCBs), angiotensin-converting enzyme inhibitors (ACE-I), and angiotensin receptor blockers (ARBs) are the most prescribed antihypertensive drugs. Twenty-seven phytochemicals show dissociation constants (K d) < 10 μM with pharmacological drug targets. Catharanthus roseus (L.) G. Don, Phyllanthus niruri L., Petroselinum crispum (Mill.) Fuss, and Lantana involucrata L. contain various compounds that show high binding affinities in all experiments. Possible interactions could affect renal excretion (thiazide-like diuretics), CYP metabolism (CCBs), absorption (ACE-I), hepatic CYP, and phase II metabolism (ARB). Oleanolic acid shows high binding affinities to almost all protein targets. This study also reveals potential candidates for the drug targets: T-type Cav3.3 (psychiatric diseases), PEPT1/2 (influencing bioavailability), and BK channel (epilepsy). Twenty-seven of 30 phytochemicals from C. roseus (L.) G. Don (Madagascar periwinkle), P. niruri L. (Seed under leaf), P. crispum Mill. Fuss (Parsley), and L. involucrata L. (Rock sage) have potential binding affinities with pharmacological targets of frequently prescribed antihypertensive drugs in Barbados and are likely to cause drug interactions. Compounds that are similar to naringin (e.g., astragalin, rutin, and quercitrin) and compounds that bind to OATP1, PEPT1/2, and enzymes involved in the metabolism of CCBs may be clinically relevant for further research. There should be greater awareness of potential drug-herb interactions, and further in vitro and in vivo studies are needed to unravel the exact effects on the pharmacology.

Peripheral Arterial Disease Prevalence in a Population-Based Sample of People with Diabetes on the Caribbean Island of Barbados

Background

Peripheral arterial disease (PAD) is a risk factor for amputation and systemic atherosclerotic disease. Barbados has a high diabetes prevalence, and 89% of diabetes-related hospital admissions are for foot problems. Foot examination is infrequent in Barbados primary care. The prevalence and potential risk factors for PAD in people with diabetes in Barbados were studied.

Methods

Multistage probability sampling was used to select a representative population sample of people ≥25 years of age with known diabetes or fasting blood glucose ≥7 mmol/L or HbA1c ≥6.5%. We administered the Edinburgh claudication questionnaire and assessed the ankle brachial pressure index (ABI) and Doppler waveform in both dorsalis pedis and posterior tibial arteries. Participants were classified into categories based on ABI as follows: PAD ≤0.90 in any leg; borderline 0.91 to 0.99 in one leg and the other not ≤0.90 or >0.4; normal 1.00 to 1.40 in both legs; and non-compressible >1.40 in one leg and the other not ≤0.9. Waveforms crossing the zero-flow baseline were categorised as normal. Multivariable logistic regression assessed the associations of potential risk factors with PAD.

Results

Of 236 participants (74% response rate, 33% male, median age 58.6 years), 51% had previously diagnosed diabetes. Of nine people with symptoms of definite or atypical claudication, four had PAD and one had non-compressible arteries. ABI prevalence (95% CI) was PAD 18.6% (13.8, 24.6), borderline 21.9% (16.6, 28.4), normal 55.5% (49.4, 61.5) and non-compressible 3.9% (1.6, 9.3). Increasing age and female gender were independently associated with PAD. Over 80% of normal legs (ABI 1.00 to 1.40) had normal posterior tibial and dorsalis pedis waveforms, while only 23% legs with PAD (ABI ≤0.90) had normal waveforms in both arteries (Kappa = 0.43).

Conclusion

Asymptomatic PAD is common in people with diabetes and requires ABI screening to detect it. Female gender is associated with PAD.

Self-care adherence and affective disorders in Barbadian adults with type 2 diabetes

Purpose

Diabetes management requires adherence to complicated self-care behaviors. Therefore, the emotional state of the individual living with diabetes, is likely to affect their ability to comply with recommendations. This study explored the relationship of self-care adherence to diabetes distress and depression in Barbadian adults with type 2 diabetes.

Methods

Adults aged 20 to 80 years, with type 2 diabetes, completed self-report questionnaires comprised of a profile section consisting of demographic and clinical characteristics; and standardized questionnaires comprising, The Diabetes Distress Scale (DDS), The Patient Health Questionnaire (PQH-9), and the Summary of Diabetes Self-care Activities Scale (SDSCA). Additionally biological measures (BP and HbA1c) were collected.

Results

For the 509 participants there were no differences in adherence for males (30.8%) and females (69.2%), high diabetes distress and depression were associated with low adherence. General diet was negatively associated with BP and HbA1c; while HbA1c was positively correlated with blood glucose testing.

Conclusion

Self-care non-adherence is more than a behavioral problem; it is a multidimensional phenomenon inclusive of demographic factors, condition or disease factors, psychological and social factors.

Assessing the effectiveness and implementation of a chronic disease self-management programme in faith-based organisations in Barbados: protocol for a cluster randomised parallel trial

INTRODUCTION

In the COVID-19 environment of reduced patient interaction with the healthcare system, evidenced-based self-care of chronic disease is vital. We will evaluate the effect of an online chronic disease self-management programme (CDSMP) plus medication adherence tools on systolic blood pressure (SBP) (primary aim) and, seek to understand the barriers and facilitators to implementation of this modified CDSMP in faith-based organisations (FBOs) (secondary aim).

METHODS

We will conduct an unblinded cluster randomised trial in FBOs throughout Barbados. Eligibility: Persons ages 35-70 years; a previous diagnosis of hypertension or currently on antihypertensive therapy and the occurrence of two or more blood pressure readings above 130 mm Hg (systolic) or 80 mm Hg (diastolic) on the day of recruitment. Persons not known to have hypertension but who have two or more blood pressure readings at or above 130 mm Hg (systolic) or 80 mm Hg (diastolic) on two recruitment days at least 1 week apart will also be eligible. The unit of randomisation is a church cluster which consists of 7-9 churches. We will perform block randomisation to assign 24 clusters to intervention or control. The intervention has three components: modified CDSMP workshops, distribution of medication pill boxes and use of social media (WhatsApp V.2.0) to encourage medication adherence. Controls will receive one didactic lecture only. We will determine the mean changes in SBP levels for the intervention group versus controls and compare differences in outcomes 6 months' post intervention using mixed effects regression models.

ETHICS AND DISSEMINATION

This project has received ethical approval from the Institutional Review Board of the University of the West Indies in Barbados. Dissemination will use peer-reviewed publications, policy briefs to government and guidelines to leaders of FBOs. We aim to increase the proportion of patients with controlled hypertension and inform implementation of self-management programmes in small populations.

TRAIL REGISTRATION NUMBER

NCT04437966.

Anthropometric cut-offs to identify hyperglycemia in an Afro-Caribbean population: a cross-sectional population-based study from Barbados

INTRODUCTION

Body mass index (BMI) and waist circumference (WC) cut-offs associated with hyperglycemia may differ by ethnicity. We investigated the optimal BMI and WC cut-offs for identifying hyperglycemia in the predominantly Afro-Caribbean population of Barbados.

RESEARCH DESIGN AND METHODS

A cross-sectional study of 865 individuals aged ≥25 years without known diabetes or cardiovascular disease was conducted. Hyperglycemia was defined as fasting plasma glucose ≥5.6 mmol/L or hemoglobin A_1c ≥5.7% (39 mmol/mol). The Youden index was used to identify the optimal cut-offs from the receiver operating characteristic (ROC) curves. Further ROC analysis and multivariable log binomial regression were used to compare standard and data-derived cut-offs.

RESULTS

The prevalence of hyperglycemia was 58.9% (95% CI 54.7% to 63.0%). In women, optimal BMI and WC cut-offs (27 kg/m² and 87 cm, respectively) performed similarly to standard cut-offs. In men, sensitivities of the optimal cut-offs of BMI ≥24 kg/m² (72.0%) and WC ≥86 cm (74.0%) were higher than those for standard BMI and WC obesity cut-offs (30.0% and 25%-46%, respectively), although with lower specificity. Hyperglycemia was 70% higher in men above the data-derived WC cut-off (prevalence ratio 95% CI 1.2 to 2.3).

CONCLUSIONS

While BMI and WC cut-offs in Afro-Caribbean women approximate international standards, our findings, consistent with other studies, suggest lowering cut-offs in men may be warranted to improve detection of hyperglycemia. Our findings do, however, require replication in a new data set.

Evidence of a health risk 'signalling effect' following the introduction of a sugar-sweetened beverage tax

Consuming sugar-sweetened beverages (SSBs) has been associated with increased rates of obesity and type 2 diabetes, making SSBs an increasingly popular target for taxation. In addition to changing prices, the introduction of an SSB tax may convey information about the health risks of SSBs (a signalling effect). If SSB taxation operates in part by producing a health risk signal, there may be important opportunities to amplify this effect. Our aim was to assess whether there is evidence of a risk signalling effect following the introduction of the Barbados SSB tax. We used process tracing to assess the existence of a signalling effect around sodas and sugar-sweetened juices (juice drinks). We used three data sources: 611 archived transcripts of local television news, 30 interviews with members of the public, and electronic point of sales data (46 months) from a major grocery store chain. We used directed content analysis to assess the qualitative data and an interrupted time series analysis to assess the quantitative data. We found evidence consistent with a risk signalling effect following the introduction of the SSB tax for sodas but not for juice drinks. Consistent with risk signalling theory, the findings suggest that consumers were aware of the tax, believed in a health rationale for the tax, understood that sodas were taxed and perceived that sodas and juice drinks were unhealthy. However consumers appear not to have understood that juice drinks were taxed, potentially reducing tax effectiveness from a health perspective. In addition, the tax may have incentivised companies to increase advertising around juice drinks (undermining any signalling effect) and to introduce low-cost SSB product lines. Policymakers can maximize the impact of risk signals by being clear about the definition of taxed SSBs, emphasizing the health rationale for introducing such a policy, and introducing co-interventions (e.g. marketing restrictions) that reduce opportunities for industry countersignals. These actions may amplify the impact of an SSB tax.

Ultra-processed food consumption in Barbados: evidence from a nationally representative, cross-sectional study

Our objective was to describe, for the first time in an English-speaking Caribbean country, the contribution of ultra-processed foods (UPFs) to nutrients linked to non-communicable disease. Using a cross-sectional study design, dietary data were collected from two non-consecutive 24-h dietary recalls. Recorded food items were then classified according to their degree of processing by the NOVA system. The present study took place in Barbados (2012-13). A representative population-based sample of 364 adult Barbadians (161 males and 203 females) aged 25-64 years participated in the study. UPFs represented 40⋅5 % (838 kcal/d; 95 % CI 791, 885) of mean energy intake. Sugar-sweetened beverages made the largest contribution to energy within the UPF category. Younger persons (25-44 years) consumed a significantly higher proportion of calories from UPF (NOVA group 4) compared with older persons (45-64 years). The mean energy shares of UPF ranged from 22⋅0 to 58⋅9 % for those in the lowest tertile to highest tertile. Within each tertile, the energy contribution was significantly higher in the younger age group (25-44 years) compared with the older (45-64 years). One-quarter of persons consume ≥50 % of their daily calories from UPF, this being significantly higher in younger persons. The ultra-processed diet fraction contained about six times the mean of free sugars and about 0⋅8 times the dietary fibre of the non-ultra-processed fraction (NOVA groups 1-3). Targeted interventions to decrease the consumption of UPF especially in younger persons is thus of high priority to improve the diet quality of Barbadians.

Prevalence and coprevalence of modifiable risk factors for upper digestive tract cancer among residents aged 40-69 years in Yangzhong city, China: a cross-sectional study

OBJECTIVES

To describe the prevalence of modifiable risk factors for upper digestive tract cancer (UDTC) and its coprevalence, and investigate relevant influencing factors of modifiable UDTC risk factors coprevalence among residents aged 40-69 years in Yangzhong city, China.

DESIGN

Cross-sectional study.

PARTICIPANTS

A total of 21 175 participants aged 40-69 years were enrolled in the study. 1962 subjects were excluded due to missing age, marital status or some other selected information. Eventually, 19 213 participants were available for the present analysis.

MAIN OUTCOMES MEASURES

Prevalence and coprevalence of eight modifiable UDTC risk factors (overweight or obesity, current smoking, excessive alcohol consumption, insufficient vegetables intake, insufficient fruit intake and the consumption of pickled, fried and hot food) were analysed.

RESULTS

The prevalence of overweight/obesity, current smoking, excessive alcohol consumption, insufficient vegetables intake, insufficient fruit intake and the consumption of pickled, fried and hot food in this study was 45.3%, 24.1%, 16.2%, 66.1%, 94.5%, 68.1%, 36.0% and 88.4%, respectively. Nearly all (99.9%) participants showed one or more UDTC risk factors, 98.6% of the participants showed at least two risk factors, 92.2% of the participants had at least three risk factors and 69.7% of the participants had four or more risk factors. Multivariate logistic regression analysis revealed that men, younger age, single, higher education, higher annual family income and smaller household size were more likely to present modifiable UDTC risk factors coprevalence.

CONCLUSIONS

The prevalence and coprevalence of modifiable UDTC risk factors are high among participants in Yangzhong city. Extra attention must be paid to these groups who are susceptible to risk factors coprevalence during screening progress. Relative departments also need to make significant public health programmes that aim to decrease modifiable UDTC risk factors coprevalence among residents aged 40-69 years from high-risk areas of UDTC.

Knowledge, attitudes and practices with regard to sugar sweetened beverages and taxation among people with type 2 diabetes mellitus in the Caribbean island of Barbados - A cross sectional survey in primary care

AIMS

Barbados implemented a 10% tax on sugar sweetened beverages (SSBs) in 2015. We aimed to determine knowledge, attitudes and practices towards SSB consumption and taxation among people with type 2 diabetes (T2D) attending public sector primary care clinics in Barbados.

METHODS

People with T2D attending public sector clinics completed a survey including the Beverage Intake Questionnaire (BEVQ-15). Waist circumference was measured.

RESULTS

Of 384 participants (34.6% male, median age 67 years, interquartile range 60-74 years, African descent 97.6%) 45.9% had diabetes diagnosed for >10 years, 30.7% used insulin, 31.8% had not seen a dietician since diabetes diagnosis, and 62.2% had abdominal obesity. Most (91.1%) thought that consuming SSB was unhealthy and 91% felt that reducing intake would be easy. Only 44.7% favoured the current 10% tax and 29.7% favoured a 20% tax. The median daily SSB consumption was 26.6ml (IQR 3.0-53.2). Responses did not differ by age, gender or abdominal obesity status (p>0.5). Weight loss was being attempted by 45.6% and 21.1% with and without abdominal obesity respectively (p<0.0001).

CONCLUSIONS

While most felt SSB consumption is harmful and the median reported consumption contributes few calories to the diet, a minority supported the current tax.

Electronic based reported anthropometry-A useful tool for interim monitoring of obesity prevalence in developing states

BACKGROUND

Wide participation in electronic surveys and reliable reporting of anthropometry can serve to reduce costs associated with monitoring of obesity among adolescents where resources are limited. We conducted a single school pilot study among Caribbean adolescents to assess use of electronic surveys and whether face to face encouragement could promote enrollment. In addition, we assessed students' ability to reliably report simple anthropometry.

METHODS

Students were provided with access to an electronic survey on anthropometry and food preferences regarding school-based food offerings. Responses to survey questions were presented as percentages. A sample of students also had their heights and weights measured after reporting these measures from memory. Intra-class correlation coefficients were used to assess reliability among measurers and Bland-Altman plots, consistency between student reported and recorded anthropometric measures and Support Vector Machine to assess robustness of anthropometry prediction models.

RESULTS

Response rate to the electronic survey was low (9%). Students were able to interpret questions; open-ended options were inappropriately used 13% of the time. Post survey qualitative responses indicated displeasure with use of school-associated e-mail addresses. Concerns with confidentiality were expressed as well as preference for completion of surveys during school time. Students reliably reported anthropometry most measures fell within the 95% CI of Bland-Altman plots. SVM classified with a prediction accuracy of 95%. Estimates of overweight from recorded and reported measures were similar.

CONCLUSIONS

Adolescents are able to report simple anthropometry, and this can be used to help with monitoring of growth and overweight. Although they are capable of competently completing electronic surveys, school-based email is an ineffective contact tool. In-person school-based contact and administration of surveys are preferred. Adolescents can reliably report simple anthropometry that can be utilized for estimation of overweight/obesity prevalence. This method can be widely applied.

Inducing remission of Type 2 diabetes in the Caribbean: findings from a mixed methods feasibility study of a low-calorie liquid diet-based intervention in Barbados

AIM

In a high proportion of people with recently diagnosed Type 2 diabetes, a short (2-3-month) low-calorie diet is able to restore normal glucose and insulin metabolism. The aim of this study was to determine the feasibility of this approach in Barbados.

METHODS

Twenty-five individuals with Type 2 diabetes diagnosed within past 6 years, not on insulin, BMI ≥ 27 kg/m² were recruited. Hypoglycaemic medication was stopped on commencement of the 8-week liquid (760 calorie) diet. Insulin response was assessed in meal tests at baseline, 8 weeks and 8 months. Semi-structured interviews, analysed thematically, explored participants' experiences. 'Responders' were those with fasting plasma glucose (FPG) < 7 mmol/l at 8 weeks.

RESULTS

Ten men and 15 women (mean age 48, range 26-68 years) participated. Mean (sd) BMI was 34.2 kg/m² (6.0); FPG 9.2 mmol/l (2.2). Mean weight loss at 8 weeks and 8 months was 10.1 kg [95% confidence interval (CI) 8.1, 12.0] and 8.2 kg (95% CI 5.8, 10.6); FPG was lower by 2.2 mmol/l (95% CI 1.2, 3.2) and 1.7 mmol/l (95% CI 0.8, 2.7) respectively. Nine of 11 (82%) of those who lost ≥ 10 kg were 'responders' compared with 6 of 14 (43%) who lost < 10 kg (P = 0.048). The 30-min insulin increment was higher in responders at baseline and follow-up (P ≤ 0.01). A food culture based on starchy foods and pressures to eat large amounts at social events were among the challenges identified by participants.

CONCLUSIONS

The feasibility of this approach to weight loss and diabetes remission in a predominantly black population in Barbados was demonstrated.

Food Sources and Dietary Quality in Small Island Developing States: Development of Methods and Policy Relevant Novel Survey Data from the Pacific and Caribbean

Small Island Developing States (SIDS) have high and increasing rates of diet-related diseases. This situation is associated with a loss of food sovereignty and an increasing reliance on nutritionally poor food imports. A policy goal, therefore, is to improve local diets through improved local production of nutritious foods. Our aim in this study was to develop methods and collect preliminary data on the relationships between where people source their food, their socio-demographic characteristics and dietary quality in Fiji and Saint Vincent and the Grenadines (SVG) in order to inform further work towards this policy goal. We developed a toolkit of methods to collect individual-level data, including measures of dietary intake, food sources, socio-demographic and health indicators. Individuals aged ≥15 years were eligible to participate. From purposively sampled urban and rural areas, we recruited 186 individuals from 95 households in Fiji, and 147 individuals from 86 households in SVG. Descriptive statistics and multiple linear regression were used to investigate associations. The mean dietary diversity score, out of 10, was 3.7 (SD1.4) in Fiji and 3.8 (SD1.5) in SVG. In both settings, purchasing was the most common way of sourcing food. However, 68% (Fiji) and 45% (SVG) of participants regularly (>weekly) consumed their own produce, and 5% (Fiji) and 33% (SVG) regularly consumed borrowed/exchanged/bartered food. In regression models, independent positive associations with dietary diversity (DD) were: borrowing/exchanging/bartering food (β = 0.73 (0.21, 1.25)); age (0.01 (0.00, 0.03)); and greater than primary education (0.44 (0.06, 0.82)). DD was negatively associated with small shop purchasing (-0.52 (95% CIs -0.91, -0.12)) and rural residence (-0.46 (-0.92, 0.00)). The findings highlight associations between dietary diversity and food sources and indicate avenues for further research to inform policy actions aimed at improving local food production and diet.

Spindle Cell Melanoma Presenting as an Ulcer in a Black Diabetic

Background. Melanoma in blacks is uncommon and exceedingly rare in association with a diabetic ulcer. We present a case of a spindle cell melanoma masquerading as a diabetic ulcer. Case Report. A 57-year-old overweight woman presented to The Maria Holder Diabetes Centre for the Caribbean with a nonhealing ulcer of the right heel after being treated by various primary care physicians over the preceding year. Her general and systematic examinations were unremarkable. There was a 1 × 1.5 cm ulcer with a necrotic base which bled easily on contact with no evidence of peripheral neuropathy nor arterial insufficiency. Microscopic examination of a biopsy of the lesion showed fascicles of spindle cells with plump nuclei and intracytoplasmic yellow-brown pigment. Immunohistochemistry confirmed a diagnosis of melanoma. Discussion. There should be a high index of suspicion of malignancy with nonhealing diabetic ulcer especially when coupled with short disease duration. This case highlights the importance of a biopsy and histological evaluation in ulcers presenting in recently diagnosed diabetics with no evidence of peripheral neuropathy or vascular disease. Melanoma should be considered in spindle cell lesions especially with pigment and residual nevus cells.

Using nutritional survey data to inform the design of sugar-sweetened beverage taxes in low-resource contexts: a cross-sectional analysis based on data from an adult Caribbean population

OBJECTIVE

Sugar-sweetened beverage (SSB) taxes have been implemented widely. We aimed to use a pre-existing nutritional survey data to inform SSB tax design by assessing: (1) baseline consumption of SSBs and SSB-derived free sugars, (2) the percentage of SSB-derived free sugars that would be covered by a tax and (3) the extent to which a tax would differentiate between high-sugar SSBs and low-sugar SSBs. We evaluated these three considerations using pre-existing nutritional survey data in a developing economy setting.

METHODS

We used data from a nationally representative cross-sectional survey in Barbados (2012-2013, prior to SSB tax implementation). Data were available on 334 adults (25-64 years) who completed two non-consecutive 24-hour dietary recalls. We estimated the prevalence of SSB consumption and its contribution to total energy intake, overall and stratified by taxable status. We assessed the percentage of SSB-derived free sugars subject to the tax and identified the consumption-weighted sugar concentration of SSBs, stratified by taxable status.

FINDINGS

Accounting for sampling probability, 88.8% of adults (95% CI 85.1 to 92.5) reported SSB consumption, with a geometric mean of 2.4 servings/day (±2 SD, 0.6, 9.2) among SSB consumers. Sixty percent (95% CI 54.6 to 65.4) of SSB-derived free sugars would be subject to the tax. The tax did not clearly differentiate between high-sugar beverages and low-sugar beverages.

CONCLUSION

Given high SSB consumption, targeting SSBs was a sensible strategy in this setting. A substantial percentage of free sugars from SSBs were not covered by the tax, reducing possible health benefits. The considerations proposed here may help policymakers to design more effective SSB taxes.

The influence of socio-environmental determinants on hypertension. A spatial analysis in Athens metropolitan area, Greece

INTRODUCTION

While epidemiological and pathophysiological aspects of hypertension are still being investigated, there is an increased global interest between hypertension and social health determinants and environmental factors that this study aims to examine.

METHODS

The sample size used in this work included 2,445 individuals, from Athens metropolitan area, who were randomly enrolled in ATTICA study, during 2001 to 2002. Principal component analysis (PCA), Poisson regression modeling and geographical analysis, based on Geographic Information Systems (GIS) technology, were applied.

RESULTS

Geographical analysis and thematic mapping revealed that the West municipalities of Athens had the lowest socio-environmental status. Three components were derived from PCA: high, low and mixed socio-environmental status. Poisson regression analysis showed that high socio-environmental status, educational and economic level were negatively correlated with hypertension in some sectors of Athens (p < 0.05, for all).

CONCLUSIONS

Through the use of geospatial surveillance the underlying epidemiology of hypertension, and those at greater risk, can be more precisely determined. This study underlines the need to account for environmental factors when developing public health policies and programs for effective hypertension prevention or reduction.

Egocentric Health Networks and Cardiovascular Risk Factors in the ECHORN Cohort Study

BACKGROUND

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the Caribbean region.

OBJECTIVE

This study explored the concept of a health network, relationships focused on health-related matters, and examined associations with CVD risk factors in the Eastern Caribbean.

DESIGN

The Eastern Caribbean Health Outcomes Research Network Cohort Study is an ongoing longitudinal cohort being conducted in the US Virgin Islands, Puerto Rico, Trinidad and Tobago, and Barbados.

PARTICIPANTS

Participants (n = 1989) were English or Spanish-speaking adults 40 years and older, who were residents of the island for at least 10 years, and who intended to live on-island for the next 5 years.

MAIN MEASURES

Logistic regression was used to examine associations between health network characteristics and CVD risk factors: physical activity, hypertension, and smoking. A baseline survey asked questions about health networks using name generator questions that assessed who participants spoke to about health matters, whose opinions on healthcare mattered, and who they would trust to make healthcare decisions on their behalf.

KEY RESULTS

Health networks were mainly comprised of family members and friends. Healthcare professionals comprised 7% of networks, mean network size was four, and 74% of health network contacts were perceived to be in "good" to "excellent" health. Persons with larger health networks had greater odds of being physically active compared with those with smaller networks (OR = 1.07, CI = 1.01-1.14).

CONCLUSIONS

Health networks may be useful to intervention efforts for CVD risk factor reduction. More studies are needed to examine health networks in Caribbean contexts and explore associations with other CVD risk factors.

Nutritional adequacy and dietary disparities in an adult Caribbean population of African descent with a high burden of diabetes and cardiovascular disease

The Caribbean island of Barbados has a high burden of diabetes and cardiovascular disease. Dietary habits were last described in 2005. A representative population-based sample (n = 363, aged 25-64 years) provided two nonconsecutive 24-hr dietary recalls in this cross-sectional study. Mean daily nutrient intakes were compared with the Dietary Guidelines for Americans. Subgroup differences by age, sex, and educational level were examined using logistic regression. High sugar intakes exist for both sexes with 24% (95% CIs 18.9, 30.0) consuming less than the recommended <10% of energy from added sugars (men 22%; 15.0, 31.6; women 26%; 18.9, 33.7). Sugar-sweetened beverages provide 43% (42.2%, 44.4%) of total sugar intake. Inadequate dietary fiber intakes (men 21 g, 18.2, 22.8; women 18 g, 16.7, 18.9) exist across all age groups. Inadequate micronutrient intake was found in women for calcium, folate, thiamine, zinc, and iron. Older persons (aged 45-64 years) were more likely to report adequacy of dietary fiber (OR = 2.7, 1.5, 4.8) and iron (OR = 3.0, 1.7, 5.3) than younger persons (aged 25-44). Older persons (aged 45-64 years) were less likely to have an adequate supply of riboflavin (OR = 0.4, 0.2, 0.6) than younger persons. Men were more likely to have adequate intakes of iron (OR = 13.0, 6.1, 28.2), folate (OR = 2.4, 1.3, 4.6), and thiamine (OR = 3.0, 1.5, 5.0) than women. Education was not associated with nutrient intake. The Barbadian diet is characterized by high sugar intakes and inadequate dietary fiber; a nutrient profile associated with an increased risk of obesity, type 2 diabetes, and related noncommunicable diseases.

The prevalence of peripheral neuropathy severe enough to cause a loss of protective sensation in a population-based sample of people with known and newly detected diabetes in Barbados: a cross-sectional study

AIMS

To determine the prevalence and potential risk factors for diabetic peripheral neuropathy with a loss of protective sensation in Barbados.

METHODS

A representative population sample aged > 25 years with previously diagnosed diabetes or a fasting blood glucose ≥ 7 mmol/l or HbA_1c ≥ 48 mmol/mol (6.5%) was tested by 10 g monofilament at four plantar sites per foot and a 28 Hz tuning fork and neurothesiometer at the hallux. Data were adjusted to the age structure of people with diabetes in Barbados. Multivariable logistic regression assessed associations with peripheral neuropathy with a loss of protective sensation.

RESULTS

Of 236 participants [74% response rate, 33% men, 91% black, median age 58.6 years, mean BMI 30.1 kg/m² , mean HbA_1c 54 mmol/mol (7.1%)], 51% had previously diagnosed diabetes. Foot examination demonstrated that 25.8% (95% CI 20.2 to 31.5) had at least one insensate site with monofilament testing, 14.8% (95% CI 10.2 to 19.4) had an abnormal tuning fork test and 10.9% (95% CI 6.9 to 14.9) had a vibration perception threshold > 25 V. Peripheral neuropathy with a loss of protective sensation prevalence was 28.5% (95% CI 22.7 to 34.4) as indicated by monofilament with ≥ 1 insensate site and/or vibration perception threshold > 25 V. With previously diagnosed diabetes the prevalence was 36.4% (95% CI 27.7 to 45.2) with 98.4% of cases identified by monofilament testing. Increasing age, previously diagnosed diabetes, male sex and abdominal obesity were independently associated with peripheral neuropathy with a loss of protective sensation.

CONCLUSIONS

Over a third of people with previously diagnosed diabetes had evidence of peripheral neuropathy with a loss of protective sensation. Monofilament testing alone may be adequate to rule out peripheral neuropathy with a loss of protective sensation. Monofilament and neurothesiometer stimuli are reproducible but dependent on participant response.

Social distribution of tobacco smoking, alcohol drinking and obesity in the French West Indies

BACKGROUND

Tobacco smoking, alcohol and obesity are important risk factors for a number of non-communicable diseases. The prevalence of these risk factors differ by socioeconomic group in most populations, but this socially stratified distribution may depend on the social and cultural context. Little information on this topic is currently available in the Caribbean. The aim of this study was to describe the distribution of tobacco smoking, alcohol drinking and obesity by several socioeconomic determinants in the French West Indies (FWI).

METHODS

We used data from a cross-sectional health survey conducted in Guadeloupe and Martinique in 2014 in a representative sample of the population aged 15-75 years (n = 4054). All analyses were stratified by gender, and encompassed sample weights, calculated to account for the sampling design and correct for non-response. For each risk factor, we calculated weighted prevalence by income, educational level, occupational class and having hot water at home. Poisson regression models were used to estimate age-adjusted prevalence ratios (PR) and 95% confidence intervals (CI).

RESULTS

Current smoking and harmful chronic alcohol use were more common in men than in women (PR = 1.80, 95% CI = 1.55-2.09; PR = 4.53, 95% CI = 3.38-6.09 respectively). On the other hand, the prevalence of obesity was higher in women than in men (PR = 0.67, 95% CI = 0.57-0.79). Higher education, higher occupational class and higher income were associated with lower prevalence of harmful alcohol drinking in men (PR = 0.43, 95% CI = 0.25-0.72; PR = 0.73, 95% CI = 0.53-1.01; PR = 0.72, 95% CI = 0.51-1.03 respectively), but not in women. For tobacco smoking, no variation by socioeconomic status was observed in men whereas the prevalence of current smoking was higher among women with higher occupational class (PR = 1.47, 95% CI = 1.13-1.91) and higher income (PR = 1.50, 95% CI = 1.11-2.03). In women, a lower prevalence of obesity was associated with a higher income (PR = 0.43, 95% CI = 0.33-0.56), a higher occupational class (PR = 0.63, 95% CI = 0.50-0.80), a higher educational level (PR = 0.36, 95% CI = 0.26-0.50) and having hot water at home (PR = 0.65, 95% CI = 0.54-0.80).

CONCLUSION

Women of high socio-economic status were significantly more likely to be smokers, whereas alcohol drinking in men and obesity in women were inversely associated with socioeconomic status.

Adverse risk factor trends limit gains in coronary heart disease mortality in Barbados: 1990-2012

Background

Although most countries face increasing population levels of obesity and diabetes their effect on coronary heart disease (CHD) mortality has not been often studied in small island developing states (SIDs) where obesity rates are among the highest in the world. We estimated the relative contributions of treatments and cardiovascular risk factors to the decline in CHD mortality from 1990 to 2012 in the Caribbean island, Barbados.

Methods

We used the IMPACT CHD mortality model to estimate the effect of increased coverage of effective medical/surgical treatments and changes in major CHD risk factors on mortality trends in 2012 compared with 1990. We calculated deaths prevented or postponed (DPPs) for each model risk factor and treatment group. We obtained data from WHO Mortality database, population denominators from the Barbados Statistical Service stratified by 10-year age group (ages 25–34 up to 85 plus), population-based risk factor surveys, Global Burden of Disease and Barbados’ national myocardial infarction registry. Monte Carlo probabilistic sensitivity analysis was performed.

Results

In 1990 the age-standardized CHD mortality rate was 109.5 per 100,000 falling to 55.3 in 2012. Implementation of effective treatment accounted for 56% DPPs (95% (Uncertainty Interval (UI) 46%, 68%), mostly due to the introduction of treatments immediately after acute myocardial infarction (AMI) (14%) and unstable angina (14%). Overall, risk factors contributed 19% DPPs (95% UI 6% to 34%) mostly attributed to decline in cholesterol (18% DPPs, 95% UI 12%, 26%). Adverse trends in diabetes: 14% additional deaths(ADs) 95% UI 8% to 21% ADs) and BMI (2% ADs 95%UI 0 to 5% ADs) limited potential for risk factor gains.

Conclusions

Given the significant negative impact of obesity/diabetes on mortality in this analysis, research that explores factors affecting implementation of evidenced-based preventive strategies is needed. The fact that most of the decline in CHD mortality in Barbados was due to treatment provides an example for SIDs about the advantages of universal access to care and treatment.

Youth Drug Use in Barbados and England: Correlates With Online Peer Influences

This study examined the relationship between susceptibility to drug-related online peer influence on Facebook and offline alcohol, tobacco, and marijuana use among emerging adults (18-24 years) enrolled at the university level in Barbados and England. A cross-national comparative, explanatory sequential mixed-methods design was employed with samples of students of African-Caribbean descent and European descent in Barbados and England, respectively. Quantitative data were collected using surveys from 241 students in Barbados and 186 in England. Qualitative focus groups were conducted with 23 Barbadian students and 16 English students. Spearman’s rank-order correlations were conducted to analyze quantitative data and a three-tiered categorization system was used to analyze the qualitative data. Significant positive relationships between students’ susceptibility to online peer influence (SOPI) and alcohol, tobacco, and marijuana use were found. Six qualitative themes emerged representing cross-national similarities, while three themes emerged highlighting some differences between the two contexts. We propose that the relationship between SOPI and offline drug use may be mediated by the interrelated factors of emerging-adult developmental characteristics and the online and offline social environments. We represent these findings diagrammatically to convey that developmental and environmental factors together can provide a holistic understanding of the interplay between online interactions and offline risk behaviors.

Association between socioeconomic status and prevalence of non-communicable diseases risk factors and comorbidities in Bangladesh: findings from a nationwide cross-sectional survey

OBJECTIVES

This study aimed to examine the prevalence and distribution in the comorbidity of non-communicable diseases (NCDs) among the adult population in Bangladesh by measures of socioeconomic status (SES).

DESIGN

This was a cross-sectional study.

SETTING

This study used Bangladesh Demographic and Health Survey 2011 data.

PARTICIPANTS

Total 8763 individuals aged ≥35 years were included.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome measures were diabetes mellitus (DM), hypertension (HTN) and overweight/obesity. The study further assesses factors (in particular SES) associated with these comorbidities (DM, HTN and overweight/obesity).

RESULTS

Of 8763 adults, 12% had DM, 27% HTN and 22% were overweight/obese (body mass index ≥23 kg/m2). Just over 1% of the sample had all three conditions, 3% had both DM and HTN, 3% DM and overweight/obesity and 7% HTN and overweight/obesity. DM, HTN and overweight/obesity were more prevalent those who had higher education, were non-manual workers, were in the richer to richest SES and lived in urban settings. Individuals in higher SES groups were also more likely to suffer from comorbidities. In the multivariable analysis, it was found that individual belonging to the richest wealth quintile had the highest odds of having HTN (adjusted OR (AOR) 1.49, 95% CI 1.29 to 1.72), DM (AOR 1.63, 95% CI 1.25 to 2.14) and overweight/obesity (AOR 4.3, 95% CI 3.32 to 5.57).

CONCLUSIONS

In contrast to more affluent countries, individuals with NCDs risk factors and comorbidities are more common in higher SES individuals. Public health approaches must consider this social patterning in tackling NCDs in the country.

Assessing the impact of the Barbados sugar-sweetened beverage tax on beverage sales: an observational study

Background

The World Health Organization has advocated for sugar-sweetened beverage (SSB) taxes as part of a broader non-communicable disease prevention strategy, and these taxes have been recently introduced in a wide range of settings. However, much is still unknown about how SSB taxes operate in various contexts and as a result of different tax designs. In 2015, the Government of Barbados implemented a 10% ad valorem (value-based) tax on SSBs. It has been hypothesized that this tax structure may inadvertently encourage consumers to switch to cheaper sugary drinks. We aimed to assess whether and to what extent there has been a change in sales of SSBs following implementation of the SSB tax.

Methods

We used electronic point of sale data from a major grocery store chain and applied an interrupted time series (ITS) design to assess grocery store SSB and non-SSB sales from January 2013 to October 2016. We controlled for the underlying time trend, seasonality, inflation, tourism and holidays. We conducted sensitivity analyses using a cross-country control (Trinidad and Tobago) and a within-country control (vinegar). We included a post-hoc stratification by price tertile to assess the extent to which consumers may switch to cheaper sugary drinks.

Results

We found that average weekly sales of SSBs decreased by 4.3% (95%CI 3.6 to 4.9%) compared to expected sales without a tax, primarily driven by a decrease in carbonated SSBs sales of 3.6% (95%CI 2.9 to 4.4%). Sales of non-SSBs increased by 5.2% (95%CI 4.5 to 5.9%), with bottled water sales increasing by an average of 7.5% (95%CI 6.5 to 8.3%). The sensitivity analyses were consistent with the uncontrolled results. After stratifying by price, we found evidence of substitution to cheaper SSBs.

Conclusions

This study suggests that the Barbados SSB tax was associated with decreased sales of SSBs in a major grocery store chain after controlling for underlying trends. This finding was robust to sensitivity analyses. We found evidence to suggest that consumers may have changed their behaviour in response to the tax by purchasing cheaper sugary drinks, in addition to substituting to untaxed products. This has important implications for the design of future SSB taxes.

Electronic supplementary material

The online version of this article (10.1186/s12966-019-0776-7) contains supplementary material, which is available to authorized users.

An updated systematic review and meta-analysis on the social determinants of diabetes and related risk factors in the Caribbean

OBJECTIVES

To conduct an analysis of the most recent data on diabetes and its risk factors by gender and other social determinants of health to understand why its prevalence is higher among women than men in the Caribbean; to inform policy agenda-setting for diabetes prevention and control in the Caribbean; and to identify gaps in the evidence that require further research.

METHODS

A previous systematic review of the literature describing studies conducted in the Caribbean that presented the distribution of diabetes, its outcomes, and risk factors, by one or more social determinants, was updated to include sources from 1 January 2007 - 31 December 2016. Surveys by the World Health Organization (WHO) were also included. Where data were sufficient, meta-analyses were undertaken.

RESULTS

A total of 8 326 manuscripts were identified. Of those, 282 were selected for full text review, and 114, for abstraction. In all, 36 papers, including WHO-related surveys, had sufficient information for meta-analysis. More women compared to men were obese (OR: 2.1; 95%CI = 1.65 - 2.69), physically inactive (OR: 2.18; 95%CI = 1.75 - 2.72), and had diabetes (OR: 1.48; 95%CI = 1.25 - 1.76). More men smoked (OR: 4.27; 95%CI = 3.18 - 5.74) and had inadequate fruit and vegetable intake (OR: 1.37; 95%CI = 1.21 - 1.57).

CONCLUSION

Thirty-six papers were added to the previously conducted systematic review; of those, 13 were added to the meta-analysis. Diabetes and its risk factors (primarily obesity and physical inactivity) continue to disproportionately affect women in the Caribbean. Smoking interventions should be targeted at men in this geographic area.

Regulatory measures to fight obesity in Small Island Developing States of the Caribbean and Pacific, 2015 - 2017

This report examines the experiences of Small Island Developing States in the Caribbean— Barbados, Dominica, Jamaica, and in the Pacific— Fiji, Nauru, and Tonga with specific governmental regulatory measures to reduce the risk of obesity and associated diet-related chronic noncommunicable diseases (NCDs), as well as the obstacles and opportunities encountered. Guided by the diet-related indicators of the World Health Organization (WHO) Noncommunicable Diseases Progress Monitor 2017, the authors reviewed legislation, country reports, articles, and the databases of WHO and the World Trade Organization to identify relevant regulatory measures and to establish the extent of implementation in the selected countries.

Obesity prevalence ranged from 25.9% in Dominica to 41.1% in Tonga. The principal diet-related measures implemented by the selected countries were fiscal measures, such as sugar-sweetened beverage taxes and import duties to encourage greater consumption of healthy foods. Governmental action was weakest in the area of restrictions on marketing of unhealthy foods.

If they are to reduce their current high rates of obesity and associated NCDs, Caribbean and Pacific states need to intensify implementation of diet-related regulatory measures, particularly in the area of marketing of unhealthy foods and beverages to children. Key implementation challenges include financial and staffing constraints and the need for increased political will to counter industry opposition and to allocate adequate financial resources to keep advancing this agenda.

Sodium and potassium excretion in an adult Caribbean population of African descent with a high burden of cardiovascular disease

Background

High sodium diets with inadequate potassium and high sodium-to-potassium ratios are a known determinant of hypertension and cardiovascular disease (CVD). The Caribbean island of Barbados has a high prevalence of hypertension and mortality from CVD. Our objectives were to estimate sodium and potassium excretion, to compare estimated levels with recommended intakes and to identify the main food sources of sodium in Barbadian adults.

Methods

A sub-sample (n = 364; 25–64 years) was randomly selected from the representative population-based Health of the Nation cross-sectional study (n = 1234), in 2012–13. A single 24-h urine sample was collected from each participant, following a strictly applied protocol designed to reject incomplete samples, for the measurement of sodium and potassium excretion (in mg), which were used as proxy estimates of dietary intake. In addition, sensitivity analyses based on estimated completeness of urine collection from urine creatinine values were undertaken. Multiple linear regression was used to examine differences in sodium and potassium excretion, and the sodium-to-potassium ratio, by age, sex and educational level. Two 24-h recalls were used to identify the main dietary sources of sodium. All analyses were weighted for the survey design.

Results

Mean sodium excretion was 2656 (2488–2824) mg/day, with 67% (62–73%) exceeding the World Health Organization (WHO) recommended limit of 2000 mg/d. Mean potassium excretion was 1469 (1395–1542) mg/d; < 0.5% met recommended minimum intake levels. Mean sodium-to-potassium ratio was 2.0 (1.9–2.1); not one participant had a ratio that met WHO recommendations. Higher potassium intake and lower sodium-to-potassium ratio were independently associated with age and tertiary education. Sensitivity analyses based on urine creatinine values did not notably alter these findings.

Conclusions

In this first nationally representative study with objective assessment of sodium and potassium excretion in a Caribbean population in over 20 years, levels of sodium intake were high, and potassium intake was low. Younger age and lower educational level were associated with the highest sodium-to-potassium ratios. These findings provide baseline values for planning future policy interventions for non-communicable disease prevention.

The proportion of dementia attributable to common modifiable lifestyle factors in Barbados

OBJECTIVE

To understand what number and proportion of dementia cases in Barbados are attributable to modifiable lifestyle factors and what effect a reduction in these risk factors would have on future dementia prevalence.

METHODS

This was an observational study using Levin's Attributable Risk formula, which assumes independence of risk factors, to calculate the population attributable risk (PAR) of dementia (all-cause) for six risk factors: midlife obesity, physical inactivity, smoking, low educational attainment, diabetes mellitus, and midlife hypertension in Barbados. A recently-published, modified formula was utilized to account for non-independence of risk factors using secondary data for Barbados. The number and proportion of dementia cases attributable to each risk factor and to all risk factors combined were computed, as was the effect that any reduction in these risk factors might have on future dementia prevalence.

RESULTS

Accounting for the fact that risk factors do not operate independently, 50.9% (1 526 cases) were attributable to the combined effect of the six risk factors under study. According to the analysis, if each risk factor were reduced by 5% - 20% per decade, dementia prevalence could be 3.3% - 31.8% lower by 2050.

CONCLUSION

Using a largely theoretical model, the six modifiable lifestyle factors were estimated to be attributable to 50.9% of dementia cases in Barbados. Since the risk factors have much in common, any intervention that targets one of them could significantly reduce future dementia prevalence.

Prevalence and phenotype of diabetes and prediabetes using fasting glucose vs HbA1c in a Caribbean population

BACKGROUND

Both fasting plasma glucose (FPG) and HbA1c are recommended for the diagnosis of diabetes and prediabetes by the American Diabetes Association (ADA), and for diabetes by the World Health Organization. The ADA guidance is influential on clinical practice in many developing countries, including in the Caribbean and Latin America. We aimed to compare the prevalence and characteristics of individuals identified as having diabetes and prediabetes by FPG and HbA1c in a predominantly African ancestry Caribbean population.

METHODS

A representative population-based sample of 1234 adults (≥25 years of age) resident in Barbados was recruited. Standard methods with appropriate quality control were used to collect data on height, weight, blood pressure, fasting lipids and history of diagnosed diabetes, and to measure fasting glucose and HbA1c. Those with previously diagnosed diabetes (n = 192) were excluded from the analyses. Diabetes was defined as: FPG ≥7.0 mmol/L or HbA1c ≥6.5%; prediabetes as: FPG ≥5.6 to <7mmol/L or HbA1c ≥5.7 to <6.5%.

RESULTS

Complete data were available on 939 participants without previously diagnosed diabetes. The prevalence of undiagnosed diabetes was higher, but not significantly so, by HbA1c (4.9%, 95% CI 3.5, 6.8) vs FPG (3.5%, 2.4, 5.1). Overall 79 individuals had diabetes by either measure, but only 21 on both. The prevalence of prediabetes was higher by HbA1c compared to FPG: 41.7% (37.9, 45.6) vs 15.0% (12.8, 17.5). Overall 558 individuals had prediabetes by either measure, but only 107 on both. HbA1c, but not FPG, was significantly higher in women than men; and FPG, but not HbA1c, was significantly associated with raised triglycerides and low HDL cholesterol.

CONCLUSION

The agreement between FPG and HbA1c defined hyperglycaemia is poor. In addition, there are some differences in the phenotype of those identified, and HbA1c gives a much higher prevalence of prediabetes. The routine use of HbA1c for screening and diagnosis in this population would have major implications for clinical and public health policies and resources. Given the lack of robust evidence, particularly for prediabetes, on whether intervention in the individuals identified would improve outcomes, this approach to screening and diagnosis cannot be currently recommended for this population.

Trends in beverage prices following the introduction of a tax on sugar-sweetened beverages in Barbados

A 10% excise tax on sugar sweetened beverages (SSBs) was implemented in Barbados in September 2015. A national evaluation has been established to assess the impact of the tax. We present a descriptive analysis of initial price changes following implementation of the SSB tax using price data provided by a major supermarket chain in Barbados over the period 2014-2016. We summarize trends in price changes for SSBs and non-SSBs before and after the tax using year-on-year mean price per liter. We find that prior to the tax, the year-on-year growth of SSB and non-SSB prices was very similar (approximately 1%). During the quarter in which the tax was implemented, the trends diverged, with SSB price growth increasing to 3% and that of non-SSBs decreasing slightly. The growth of SSB prices outpaced non-SSBs prices in each quarter thereafter, reaching 5.9% compared to <1% for non-SSBs. Future analyses will assess the trends in prices of SSBs and non-SSBs over a longer period and will integrate price data from additional sources to assess heterogeneity of post-tax price changes. A continued examination of the impact of the SSB tax in Barbados will expand the evidence base available to policymakers worldwide in considering SSB taxes as a lever for reducing the consumption of added sugar at the population level.

Socioeconomic Status and Cardiovascular Disease: an Update

PURPOSE OF REVIEW

The aim of this paper is to summarize the recent and relevant evidence linking socioeconomic status (SES) to cardiovascular disease (CVD) and cardiovascular risk factors (CVRFs).

RECENT FINDINGS

In high-income countries (HICs), the evidence continues to expand, with meta-analyses of large longitudinal cohort studies consistently confirming the inverse association between SES and several CVD and CVRFs. The evidence remains limited in low-income and middle-income countries (LMICs), where most of the evidence originates from cross-sectional studies of varying quality and external validity; the available evidence indicates that the association between SES and CVD and CVRFs depends on the socioeconomic development context and the stage in the demographic, epidemiological, and nutrition transition of the population. The recent evidence confirms that SES is strongly inversely associated with CVD and CVRFs in HICs. However, there remains a need for more research to better understand the way socioeconomic circumstances become embodied in early life and throughout the life course to affect cardiovascular risk in adult and later life. In LMICs, the evidence remains scarce; thus, there is an urgent need for large longitudinal studies to disaggregate CVD and CVRFs by socioeconomic indicators, particularly as these countries already suffer the greatest burden of CVD.

The Barbados Insulin Matters (BIM) study: Barriers to insulin therapy among a population-based sample of people with type 2 diabetes in the Caribbean island of Barbados

AIM

The purpose of this study was to document in people with type 2 diabetes (T2DM) in Barbados, attitudes and beliefs that may result in psychological insulin resistance.

METHODS

A representative, population-based, sample of 175 eligible people with T2DM 25 years of age and over was surveyed by telephone. The 20-item insulin treatment appraisal scale (ITAS) was administered (score range 20 to 100 for positive to negative perceptions).

RESULTS

117 people participated (67% response rate, 32% male, mean age 66 years, 90% Black, 22% on insulin). Of non-responders, 52 were not contactable and 6 were difficult to communicate with. Negative perceptions about insulin use included - meant a worsening of diabetes (68%), would worry family (63%), feared self-injection (58%), meant a failure in self-management (57%), injections were painful (54%), would be seen as being sicker (46%), increased hypoglycaemia risk (38%), required effort (34%), causes weight gain (27%), causes a deterioration in health (14%), and would have to give up enjoyable activities (10%). Positive perceptions were - helps good glycaemic control (78%), would prevent complications (61%) and improves health (58%). Mean total ITAS score (61.6, SD = 7.7) was lower for those on insulin compared to those not on insulin (53.7 vs. 63.8, p < 0.0001). Sex, age and diabetes diagnosis duration were not significant predictors of ITAS score.

CONCLUSIONS

Multiple factors related to patient beliefs and attitudes need to be considered and addressed when initiating insulin in order to minimise psychological insulin resistance and delay. Patients using insulin had less negative perceptions than those not on insulin.

Prevalence of arterial hypertension in the Krasnoyarsk Krai (Siberia, Russia)

Background

To estimate the prevalence, awareness, treatment and control of arterial hypertension among adult inhabitants of Krasnoyarsk Krai using the data from Russian multicenter epidemiological study ESSE-RF (Epidemiological Survey of cardiovascular diSEases in different regions of the Russian Federation).

Methods

The study included 1603 subjects 25 to 64 years old selected by means of systemic multistage stratified randomization among urban and rural inhabitants of Krasnoyarsk Krai recruited between February 2014 and June 2014. Office blood pressure (BP) was measured twice with “Omron” automated BP device on the right arm in the sitting position in presence of medical personnel. Arterial hypertension (HTN) was defined as systolic BP of at least 140 mmHg and/or diastolic BP of at least 90 mmHg or self-reported previous elevated BP registration or use of antihypertensive treatment. Treatment efficacy was defined as percentage of patients achieved the target BP level among those who received antihypertensive medications, and HTN control as percentage of people achieved the target BP level among all hypertensives.

Results

The gender distribution was 652 males (39.4%) and 951 females (60.6%). The average level of systolic BP was 133.4 ± 0.5 mmHg, diastolic BP – 82.9 ± 0.3 mmHg. The average prevalence of HTN was estimated at 49.4% and appeared to be higher than similar parameter based on the data of 10 regions from the ESSE-RF study (44%). The average prevalence of HTN was estimated at 56.3% in males and 43.7% in females. The HTN prevalence in rural community was significantly higher in comparison with urban community (63.4 ± 2.4 vs. 44.2 ± 1.5%, p < 0.01). The average rate of HTN awareness in Krasnoyarsk Krai was 77.9% (average Russian value from ESSE-RF study was 73.1%). The average use of antihypertensive treatment, its efficacy and HTN control in Krasnoyarsk Krai were estimated at 59.5%, 31.6% and 18.8%, respectively.

Conclusions

Estimated prevalence of HTN in Krasnoyarsk Krai is higher than the average Russian parameter. The average HTN prevalence among men is higher than in women. The rural inhabitants are more likely to have hypertension compared with urban inhabitants. Despite high levels of HTN awareness and antihypertensive medication intake, the antihypertensive treatment efficacy in Krasnoyarsk Krai appeared to be lower in comparison with average Russian ESSE-RF values.

Barbados Insulin Matters (BIM) study: Perceptions on insulin initiation by primary care doctors in the Caribbean island of Barbados

AIMS

With regards to insulin initiation in Barbados we explored primary care doctor (PCD) perception, healthcare system factors and predictors of PCD reluctance to initiate insulin.

METHODS

PCDs completed a questionnaire based on the theory of planned behaviour (TPB) and a reluctance to initiate insulin scale. Using linear regression, we explored the association between TPB domains and the reluctance to initiate insulin scale.

RESULTS

Of 161 PCDs, 70% responded (75 private and 37 public sector). The majority felt initiating insulin was uncomplicated (68%) and there was benefit if used before complications developed (68%), but would not use it until absolutely necessary (58%). More private than public sector PCDs (p<0.05) thought that the healthcare system allowed enough flexibility of time for education (68 vs 38%) and initiating insulin was easy (63 vs 35%), but less thought system changes would help initiating insulin (42 vs 70%). Reasons for reluctance to initiate insulin included patient nonadherence (83%) and reluctance (63%). Only the attitudes and belief domain of the TPB was associated with the reluctance to initiate insulin scale (p<0.001).

CONCLUSIONS

Interventions focusing on PCD attitudes and beliefs and restructuring services inclusive of the use of diabetes specialist nurses are required.

The Development of Public Policies to Address Non-communicable Diseases in the Caribbean Country of Barbados: The Importance of Problem Framing and Policy Entrepreneurs

BACKGROUND

Government policy measures have a key role to play in the prevention and control of non-communicable diseases (NCDs). The Caribbean, a middle-income region, has the highest per capita burden of NCDs in the Americas. Our aim was to examine policy development and implementation between the years 2000 and 2013 on NCD prevention and control in Barbados, and to investigate factors promoting, and hindering, success.

METHODS

A qualitative case study design was used involving a structured policy document review and semi-structured interviews with key informants, identified through stakeholder analysis and 'cascading.' Documents were abstracted into a standard form. Interviews were recorded, transcribed verbatim and underwent framework analysis, guided by the multiple streams framework (MSF). There were 25 key informants, from the Ministry of Health (MoH), other government Ministries, civil society organisations, and the private sector.

RESULTS

A significant policy window opened between 2005 and 2007 in which new posts to address NCDs were created in the MoH, and a government supported multi-sectoral national NCD commission was established. Factors contributing to this government commitment and funding included a high level of awareness, throughout society, of the NCD burden, including media coverage of local research findings; the availability of policy recommendations by international bodies that could be adopted locally, notably the framework convention on tobacco control (FCTC); and the activities of local highly respected policy entrepreneurs with access to senior politicians, who were able to bring together political concern for the problem with potential policy solutions. However, factors were also identified that hindered multi-sectoral policy development in several areas, including around nutrition, physical activity, and alcohol. These included a lack of consensus (valence) on the nature of the problem, often framed as being predominantly one of individuals needing to take responsibility for their health rather than requiring government-led environmental changes; lack of appropriate detailed policy guidance for local adaptation; conflicts with other political priorities, such as production and export of alcohol, and political reluctance to use legislative and fiscal measures.

CONCLUSION

The study's findings indicate mechanisms to promote and support NCD policy development in the Caribbean and similar settings.

A cross-sectional study of physical activity and sedentary behaviours in a Caribbean population: combining objective and questionnaire data to guide future interventions

Background

Current understanding of population physical activity (PA) levels and sedentary behaviour in developing countries is limited, and based primarily on self-report. We described PA levels using objective and self-report methods in a developing country population.

Methods

PA was assessed in a cross-sectional, representative sample of the population of Barbados (25–54 years), using a validated questionnaire (RPAQ) and individually calibrated combined heart rate and movement sensing monitors. The RPAQ collects information on recalled activity in 4 domains: home, work, transport, and leisure. Physical inactivity was defined according to World Health Organization (WHO) guidelines; sedentary lifestyle was defined as being sedentary for 8 h or more daily; PA overestimation was defined as perceiving activity to be sufficient, when classified as ‘inactive’ by objective measurement.

Results

According to objective estimates, 90.5 % (95 % CI: 83.3,94.7) of women and 58.9 % (48.4,68.7) of men did not accumulate sufficient activity to meet WHO minimum recommendations. Overall, 50.7 % (43.3,58.1) of the population was sedentary for 8 h or more each day, and 60.1 % (52.8,66.9) overestimated their activity levels. The prevalence of inactivity was underestimated by self-report in both genders by 28 percentage points (95 % CI: 18,38), but the accuracy of reporting differed by age group, education level, occupational grade, and overweight/obesity status. Low PA was greater in more socially privileged groups: higher educational level and higher occupational grade were both associated with less objectively measured PA and more sedentary time. Variation in domain-specific self-reported physical activity energy expenditure (PAEE) by educational attainment was observed: higher education level was associated with more leisure activity and less occupational activity. Occupational PA was the main driver of PAEE for women and men according to self-report, contributing 57 % (95 % CI: 52,61). The most popular leisure activities for both genders were walking and gardening.

Conclusions

The use of both objective and self-report methods to assess PA and sedentary behaviour provides important complementary information to guide public health programmes. Our results emphasize the urgent need to increase PA and reduce sedentary time in this developing country population. Women and those with higher social economic position are particularly at risk from low levels of physical activity.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3689-2) contains supplementary material, which is available to authorized users.

[Effect of N-3 polyunsaturated fatty acids on the modulation of T lymphocytes in vitro and redox status in obese women with hypertension]

OBJECTIVES

Deepen our knowledge of the immune system alterations associated with obesity-related hypertension and demonstrate that polyunsaturated fatty acids can enhance the proliferation and their profile oxidant/antioxidant and subsequently involved in the strategy prevention and treatment in obese hypertensives.

METHODS

T cells are isolated from the blood of the control and obese women with hypertension the University Hospital of Tlemcen (Algeria), these cells are incubated in the presence of a synthetic mixture of PUFA to 30μM (DHA/EPA/LA) and stimulated by mitogens for 48hours. The cells are counted and used to assess intracellular oxidative status. The biochemical parameters are determined by the use of plasma.

RESULTS

In obese women with hypertension, a significant increase in plasma levels of (glucose, uric acid, creatinine, urea, total cholesterol and triglycerides) compared to controls. In addition, decreased cell proliferation, basal or stimulated by Con A was observed in obese women with hypertension compared with controls. The mixture of PUFA to 30μM reduced lymphoproliferation as well in obese women with hypertension than in controls. The rates in malondialdéhyde (MDA) and protein carbonyl lymphocytes are elevated in hypertensive obese women. PUFA supplementation to 30μM seems correct this redox status in hypertensive obese since rates in protein carbonyl, are similar to those of controls.

CONCLUSION

The mixture of PUFA (n-3 and n-6) can modulate the activity of T lymphocyte proliferation and correct the intracellular redox status in hypertensive obese women.