Change in prevalence and severity of metabolic syndrome in the Sami and non-Sami population in rural Northern Norway using a repeated cross-sectional population-based study design: the SAMINOR Study

Ethnic differences in metabolic syndrome in high-income countries: A systematic review and meta-analysis

This review aimed to systematically quantify the differences in Metabolic Syndrome (MetS) prevalence across various ethnic groups in high-income countries by sex, and to evaluate the overall prevalence trends from 1996 to 2022. We conducted a systematic literature review using MEDLINE, Web of Science Core Collection, CINAHL, and the Cochrane Library, focusing on studies about MetS prevalence among ethnic groups in high-income countries. We pooled 23 studies that used NCEP-ATP III criteria and included 147,756 healthy participants aged 18 and above. We calculated pooled prevalence estimates and 95% confidence intervals (CI) using both fixed-effect and random-effect intercept logistic regression models. Data were analysed for 3 periods: 1996-2005, 2006-2009, and 2010-2021. The pooled prevalence of MetS in high-income countries, based on the NCEP-ATP III criteria, was 27.4% over the studied period, showing an increase from 24.2% in 1996-2005 to 31.9% in 2010-2021, with men and women having similar rates. When stratified by ethnicity and sex, ethnic minority women experienced the highest prevalence at 31.7%, while ethnic majority women had the lowest at 22.7%. Notably, MetS was more prevalent in ethnic minority women than men. Among ethnic minorities, women had a higher prevalence of MetS than men, and the difference was highest in Asians (about 15 percentage points). Among women, the prevalence of MetS was highest in Asians (41.2%) and lowest in Blacks/Africans (26.7%). Among men, it was highest in indigenous minority groups (34.3%) and lowest among in Blacks/Africans (19.8%). MetS is increasing at an alarming rate in high-income countries, particularly among ethnic minority women. The burden of MetS could be effectively reduced by tailoring interventions according to ethnic variations and risk profiles.

Sleep duration is associated with metabolic syndrome in adolescents and children: a systematic review and meta-analysis

STUDY OBJECTIVES

Studies on the associations between sleep duration and metabolic syndrome in adolescents and children have reported mixed results. To shed more light on this issue, we conducted this meta-analysis by synthesizing the results of previous studies.

METHODS

Studies were retrieved from PubMed, Ovid, Cochrane, and Embase from inception to October 2021. Fixed-effects models and random-effects models were used to analyze the effects of sleep time on metabolic syndrome in adolescents.

RESULTS

Data from 7 studies, including 13,305 adolescents and children, were meta-analyzed. Compared with the control group, short sleep durations were not associated with a high prevalence of metabolic syndrome in adolescents and children using a random-effects model (odds ratio = 0.92, 95% confidence interval = 0.48-1.37, I2 = 56.5%, P = .378). Using a fixed-effects model on long sleep duration, this association was statistically significant (odds ratio = 0.57, 95% confidence interval = 0.38-0.76, I2 = 0.0%, P < .001) as a protective factor compared with shorter sleep duration.

CONCLUSIONS

Long sleep duration, instead of short sleep duration, was significantly associated with a lower prevalence of metabolic syndrome among adolescents and children.

CITATION

Xu Y, Hua J, Wang J, Shen Y. Sleep duration is associated with metabolic syndrome in adolescents and children: a systematic review and meta-analysis. J Clin Sleep Med. 2023;19(10):1835-1843.

Association of C-reactive protein with future development of diabetes: a population-based 7-year cohort study among Norwegian adults aged 30 and older in the Tromsø Study 2007-2016

OBJECTIVES

The extent to which observed associations between high-sensitivity C-reactive protein (hs-CRP) and incident diabetes are explained by obesity and hypertension remains unclear. This study aimed to investigate the association of hs-CRP with developing diabetes in a Norwegian general population sample.

DESIGN

A cohort study using two population-based surveys of the Tromsø Study: the sixth survey Tromsø6 (2007-2008) as baseline and the seventh survey Tromsø7 (2015-2016) at follow-up.

SETTING

Tromsø municipality of Norway, a country with increasing proportion of older adults and a high prevalence of overweight, obesity and hypertension.

PARTICIPANTS

8067 women and men without diabetes, aged 30-87 years, at baseline Tromsø6 who subsequently also participated in Tromsø7.

OUTCOME MEASURES

Diabetes defined by self-reported diabetes, diabetes medication use and/or HbA1c≥6.5% (≥48 mmol/mol) was modelled by logistic regression for the association with baseline hs-CRP, either stratified into three quantiles or as continuous variable, adjusted for demographic factors, behavioural and cardiovascular risk factors, lipid-lowering medication use, and hypertension. Interactions by sex, body mass index (BMI), hypertension or abdominal obesity were assessed by adding interaction terms in the fully adjusted model.

RESULTS

There were 320 (4.0%) diabetes cases after 7 years. After multivariable adjustment including obesity and hypertension, individuals in the highest hs-CRP tertile 3 had 73% higher odds of developing diabetes (OR 1.73; p=0.004; 95% CI 1.20 to 2.49) when compared with the lowest tertile or 28% higher odds of incidence per one-log of hs-CRP increment (OR 1.28; p=0.003; 95% CI 1.09 to 1.50). There was no evidence for interaction between hs-CRP and sex, hypertension, BMI or abdominal obesity.

CONCLUSIONS

Raised hs-CRP was associated with future diabetes development in a Norwegian adult population sample. The CRP-diabetes association could not be fully explained by obesity or hypertension.

QTc Interval is Associated with Atrial Fibrillation in Individuals with Metabolic Syndrome Phenotype

Purpose

Manifestations of metabolic syndrome (MetS) carry risks for atrial fibrillation (AF). The study determined whether any electrocardiographic parameter can reflect increased AF risk in individuals with MetS.

Patients and Methods

From our University Hospital database, we examined the presence of AF and its correlation with MetS manifestations, renal function, lipid profiles, and electrocardiographic parameters (P wave duration, PR interval, QRS width, and QTc intervals). Between January 2008 and December 2015, data from 4479 adults (women 41.6% vs men 58.4%) were identified.

Results

The overall prevalence of AF was 12.4%, without sex differences (women, 12.8% vs men, 12.1%). Patients with AF were older (age 73.9 ± 11.8 vs non-AF 67 ± 13.5 years), with lower lipid levels (TG, total cholesterol, and LDL-cholesterol, all p < 0.0001), and at lower eGFR level (64.1 ± 30.9 vs non-AF 68.8 ± 41.4 mL/min/1.73m2, p < 0.0001). Besides, sex differences were present in all electrocardiographic parameters (all p < 0.05). Hypertension had the highest odds ratio (1.33; p = 0.026) for AF. Comparing AF to non-AF, the QTc of quartiles was significantly different (p < 0.0089). The shortest and longest QTc quartiles had an increased incidence of AF.

Conclusion

AF risk in patients with MetS phenotypes can be reflected by QTc quartiles.

Obesity measures, metabolic health and their association with 15-year all-cause and cardiovascular mortality in the SAMINOR 1 Survey: a population-based cohort study

Background

The mortality of metabolic-obesity phenotypes has been thoroughly studied, but it is not known if or how the association between mortality and body mass index (BMI), waist circumference or a body shape index (ABSI) differ in strata of cardiometabolic health status.

Methods

We linked data on 12,815 men and women aged 36–79 years from the SAMINOR 1 Survey with mortality data from the Norwegian Cause of Death Registry. We defined metabolically healthy and unhealthy as having zero and ≥ 1, respectively, of the following: MetS, pre-existing diabetes or cardiovascular disease (CVD), or prescribed drugs for high blood pressure, hyperglycaemia or dyslipidaemia. We defined general and abdominal obesity as BMI ≥ 30 kg/m² and waist circumference ≥ 88 cm (women) or 102 cm (men), respectively, and cross-classified these categories with metabolic status to create metabolically healthy non-obese and obese (MHNO and MHO) and metabolically unhealthy non-obese and obese (MUNO and MUO) phenotypes. We used Cox regression to estimate the hazard ratio (HR) for all-cause and CVD mortality for 1) the four phenotypes and 2) BMI, waist circumference and ABSI fitted with restricted cubic splines. We adjusted for age and lifestyle, and tested for interactions with sex and metabolic status (only continuous measures).

Results

The MHO phenotype was present in 7.8% of women and 5.8% of men. During a median follow-up of 15.3/15.2 years, 596/938 women/men had died, respectively. The MUNO and MUO groups had higher mortality than the MHNO group. Sex and phenotypes interacted with respect to CVD mortality: relative to the MHNO group, the MHO group had an adjusted HR (95% confidence interval) for CVD mortality of 1.05 (0.38–2.88) in women and 2.92 (1.71–5.01) in men. We found curvilinear associations between BMI/waist circumference and all-cause mortality irrespective of metabolic status. Corresponding relationships with CVD mortality were linear and the slope differed by sex and metabolic status. ABSI was linearly and positively associated with all-cause and CVD mortality in men.

Conclusion

The relationships between BMI, waist circumference or ABSI and mortality differed by sex, metabolic status and cause of death. Poor metabolic health substantially increases mortality regardless of obesity status.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12872-021-02288-9.

Physical activity in Sami and non-Sami populations in rural Northern Norway, the SAMINOR 2 Clinical Survey

Background

The Sami people is an indigenous minority population living in the northern parts of Norway and mainly in rural areas. We lack data of contemporary levels of physical activity (PA) in rural regions of Northern Norway and in the Sami population in particular. We aimed to describe the PA levels and investigate whether PA levels differs between Sami and non-Sami and between coastal and inland areas.

Methods

We used data from the second survey of the Population-based Study on Health and Living Conditions in Regions with Sami and Norwegian Populations – the SAMINOR 2 Clinical Survey (2012–2014) that includes the adult population in 10 municipalities in the counties Troms, Finnmark and Nordland. Participants self-reported on PA, ethnicity and modifiable lifestyle factors. Twelve thousand four hundred fifty-five individuals were invited with a response rate of 48.2% (n = 6004 participants). We tested differences using chi-square tests, two sample t-tests and linear regression models.

Results

Among 5628 participants, 41.1 and 40.9% of men and women, respectively, were defined as Sami. We found no ethnic differences in PA in men overall. However, Sami men living in Tana, and Nesseby reported higher PA compared to non-Sami men in the same area. For Sami women there was overall lower PA levels compared to non-Sami women, especially pronounced in Kautokeino/ Karasjok.

Conclusion

This study showed small differences in PA levels between Sami and non-Sami men. Sami women had lower PA levels compared to their non-Sami counterparts. It is important to identify whether there are differences in various ethnic populations, together with other predictors for PA in future planning of public health interventions.

Sami dietary habits and the risk of cardiometabolic disease: a systematic review

This systematic literary review investigates if an association between Sami dietary habits and cardiometabolic outcomes exists, and examines the dietary characteristics and cardiometabolic status of the Sami population. Included were all articles assessing Sami dietary habits and cardiometabolic disease or risk factors. Embase, Medline and SweMed were searched on 26 September 2019 and articles were screened for eligibility in October 2019. Data were extracted according to Moose Guidelines and the Newcastle Ottawa Scale (NOS) was used to assess risk of bias. The initial search generated 4,195 articles in total. Nine articles met all inclusion criteria. Two were cohort studies and seven were cross-sectional. Rating by NOS ranked from 2/7 to 8/9 stars. The studies were largely descriptive and only few had results regarding a direct association between Sami dietary habits and cardiometabolic outcomes. The findings demonstrated no association between consumption of certain Sami food items and blood-lipids or mortality from CVD/CHD. A higher intake of fat, protein, reindeer-meat and coffee and a slightly lower blood pressure and mortality from CVD/CHD was seen among Sami compared with non-Sami. The limited amount and descriptive nature of the eligible articles indicate that resaerch within the fielt is limited. Thus, additional longitudinal studies are suggested.

Coronary heart disease and stroke in the Sami and non-Sami populations in rural Northern and Mid Norway-the SAMINOR Study

BACKGROUND

Previous studies have suggested that Sami have a similar risk of myocardial infarction and a higher risk of stroke compared with non-Sami living in the same geographical area.

DESIGN

Participants in the SAMINOR 1 Survey (2003-2004) aged 30 and 36-79 years were followed to the 31 December 2016 for observation of fatal or non-fatal events of acute myocardial infarction (AMI), coronary heart disease (CHD), ischaemic stroke (IS), stroke and a composite endpoint (fatal or non-fatal AMI or stroke).

AIM

Compare the risk of AMI, CHD, IS, stroke and the composite endpoint in Sami and non-Sami populations, and identify intermediate factors if ethnic differences in risks are observed.

METHODS

Cox regression models.

RESULTS

The sex-adjusted and age-adjusted risks of AMI (HR for Sami versus non-Sami 0.99, 95% CI: 0.83 to 1.17), CHD (HR 1.03, 95% CI: 0.93 to 1.15) and of the composite endpoint (HR 1.09, 95% CI: 0.95 to 1.24) were similar in Sami and non-Sami populations. Sami ethnicity was, however, associated with increased risk of IS (HR 1.36, 95% CI: 1.10 to 1.68) and stroke (HR 1.31, 95% CI: 1.08 to 1.58). Height explained more of the excess risk observed in Sami than conventional risk factors.

CONCLUSIONS

The risk of IS and stroke were higher in Sami and height was identified as an important intermediate factor as it explained a considerable proportion of the ethnic differences in IS and stroke. The risk of AMI, CHD and the composite endpoint was similar in Sami and non-Sami populations.

How Neoliberalism Shapes Indigenous Oral Health Inequalities Globally: Examples from Five Countries

Evidence suggests that countries with neoliberal political and economic philosophical underpinnings have greater health inequalities compared to less neoliberal countries. But few studies examine how neoliberalism specifically impacts health inequalities involving highly vulnerable populations, such as Indigenous groups. Even fewer take this perspective from an oral health viewpoint. From a lens of indigenous groups in five countries (the United States, Canada, Australia, Aotearoa/New Zealand and Norway), this commentary provides critical insights of how neoliberalism, in domains including colonialism, racism, inter-generational trauma and health service provision, shapes oral health inequalities among Indigenous societies at a global level. We posit that all socially marginalised groups are disadvantaged under neoliberalism agendas, but that this is amplified among Indigenous groups because of ongoing legacies of colonialism, institutional racism and intergenerational trauma.

Relationships between metabolic markers and obesity measures in two populations that differ in stature-The SAMINOR Study

Background

The relationships between metabolic markers and obesity measures may differ by ethnicity, sex, and height. Questions have been posed whether these relationships differ by ethnicity in the population in Northern Norway, but this has not been explored yet.

Objectives

Investigate the relationships between metabolic markers and obesity measures in Sami and non‐Sami and explore the impact of stature.

Methods

In total, 13 921 men and women aged 30 and 36 to 79 years (22.0% Sami) from a population‐based cross‐sectional survey in Norway, the SAMINOR 1 Survey (2003‐2004, 57.2% attendance), were included. Relationships between triglycerides, high‐density lipoprotein cholesterol, glucose, systolic/diastolic blood pressure (BP), metabolic syndrome and diabetes mellitus as outcomes, and body mass index (BMI), waist circumference (WC), and waist‐to‐height ratio (WHtR), respectively, were modelled using fractional polynomial regression. Appropriate interaction analyses and adjustments were made.

Results

The non‐Sami were approximately 6 cm taller than the Sami. No interactions were found between ethnicity and obesity. At the same levels of WC, BMI, or WHtR, levels of lipids and BP differed marginally between Sami and non‐Sami, but these were eliminated by height adjustment, with one exception: At any given WC, BMI, or WHtR, Sami had approximately 1.4 mmHg (95% CI, −2.1 to −0.7) lower systolic BP than non‐Sami (P values < .001).

Conclusions

Height explained the marginal ethnic differences in metabolic markers at the same level of obesity, except for systolic BP, which was lower in Sami than in non‐Sami at any given BMI, WC, or WHtR.

A descriptive study of ten-year longitudinal changes in weight and waist circumference in the multi-ethnic rural Northern Norway. The SAMINOR Study, 2003-2014

The obesity epidemic is dynamic with varying secular trends and differences between countries and ethnic groups. The objective of this study was to describe the age- and sex-specific longitudinal changes in weight and waist circumference in a rural Norwegian population with a high proportion of the indigenous Sami population. Based on two population-based surveys, SAMINOR 1 (2003-2004) and SAMINOR 2 (2012-2014), we present longitudinal changes in weight and waist circumference according to age at baseline in the SAMINOR 1 Survey and sex during the 10-year period. The analyses included 1538 men and 1958 women aged 36 to 69 at baseline (birth year 1934 to 1967). Forty-one percent of the population were Sami. Both weight and waist circumference were measured. The mean weight increased 0.8 kg (95% confidence interval: 0.5, 1.1) in men and 0.3 kg (95% confidence interval: 0, 0.5) in women. In both men and women, younger individuals gained significantly more weight during the 10-year follow-up than older participants (p < 0.001). The mean weight showed a statistically significant increase in men aged 36-54 and women aged 36-49 at baseline and was statistically significantly reduced in men and women aged 60-69. The mean waist circumference increased by 6.3 cm (95% confidence interval: 6.0, 6.6) in men and 8.4 cm (95% confidence interval 8.1, 8.8) in women. The mean waist circumference increased statistically significantly from SAMINOR 1 to SAMINOR 2 in all age groups, and there was an inverse relationship between age at baseline and change in waist circumference (p < 0.001). Waist circumference increased more than can be explained by changes in weight and age during the 10-year period. The inverse relationships between age at baseline in SAMINOR 1 and the 10-year change in weight and waist circumference were found in both Sami and non-Sami participants. The findings underline the need for prevention of obesity, particularly in younger people, as it is difficult to achieve permanent weight loss.

Dietary patterns of adults and their associations with Sami ethnicity, sociodemographic factors, and lifestyle factors in a rural multiethnic population of northern Norway - the SAMINOR 2 clinical survey

Background

Few population-based studies have assessed dietary behaviors in the rural multiethnic population of Northern Norway. The present study determined dietary patterns and investigated their association with Sami ethnicity, sociodemographic factors, and lifestyle factors in a multiethnic population in rural Northern Norway.

Methods

This cross-sectional study included 4504 participants of the SAMINOR 2 Clinical Survey (2012–2014) aged 40–69 years. All participants completed a lifestyle and food frequency questionnaire. Dietary patterns were determined using principal component analysis. Associations between food patterns and ethnicity, sociodemographic factors, and lifestyle factors were examined by multiple linear regression.

Results

Six dietary patterns were identified that accounted for 28% of the variability in food intake in the study sample: ‘processed meat/westernized’, ‘fish/traditional’, ‘fruit/vegetables’, ‘reindeer/traditional’, ‘bread and sandwich spreads’, and ‘sweets and bakery goods’. The ‘reindeer/traditional’ pattern was most common among the inland Sami population. The ‘fish/traditional’ pattern was most common among costal multiethnic Sami and least common among inland Sami and among women independent of ethnicity. The ‘fish/traditional’ pattern was also positively associated with older age, high education level, small household size, and smoking. Adherence to the ‘processed meat/westernized’ pattern was lower among inland Sami than inland/coastal non-Sami; no ethnic differences in adherence to this pattern were found between costal multiethnic Sami and inland/coastal non-Sami. Unhealthy lifestyle factors, like low physical activity level and smoking, and younger age were mainly associated with the ‘processed meat/westernized’ pattern, whereas socioeconomic factors like low education, low gross annual household income, and large household size were related to the ‘sweets and bakery goods’ pattern. Male gender, low education level, and smoking were associated with the ‘bread and sandwich spreads’ pattern. The ‘fruit/vegetables’ pattern was characterized by healthy dietary choices and a health-conscious lifestyle, and was more common in women with a high education level and income.

Conclusions

Adherence to the six identified dietary patterns was characterized by different sociodemographic and lifestyle factors. Ethnicity, in combination with geographical region of residence, was associated with dietary behaviors. This study provides knowledge that will be useful in future studies on dietary patterns related to chronic diseases in the rural population of Northern Norway.

Weight underestimation linked to anxiety and depression in a cross-sectional study of overweight individuals in a Sami and non-Sami Norwegian population: the SAMINOR Study

OBJECTIVES

Underestimation of overweight/obesity may prevent weight loss attempts, resulting in further weight gain and maintenance of overweight. Mental health benefits may nevertheless surpass negative consequences. Our main objective was to study the association between underestimation of overweight/obesity and symptoms of anxiety and depression in Sami and non-Sami populations.

DESIGN

Population-based cross-sectional study.

SETTING

The SAMINOR 2 Clinical Study with participants from 10 municipalities in Northern Norway enrolled between 2012 and 2014.

PARTICIPANTS

The study included 3266 adults of multiethnic rural origin with overweight/obesity (body mass index (BMI) ≥25 kg/m²) whereof 1384 underestimated their weight (42%).

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary outcome measure was symptoms of anxiety and depression and secondary outcome measures were BMI and the demographic variables: sex, age, education and marital status.

RESULTS

A higher proportion of Sami men compared with non-Sami men were obese, and reported more symptoms of anxiety and depression. More men than women, and a higher proportion of Sami women compared with non-Sami women, underestimated their weight. Multivariable-adjusted analyses showed that women were less likely to underestimate their weight compared with men (OR 0.43, 95% CI 0.33 to 0.55 in Sami and OR 0.33, 95% CI 0.26 to 0.42 in non-Sami), higher BMI was protective against weight underestimation (OR 0.72, 95% CI 0.69 to 0.75 in Sami and OR 0.63, 95% CI 0.60 to 0.67 in non-Sami), slightly higher odds of weight underestimation were observed with increasing age in both ethnic groups (OR 1.03, 95% CI 1.01 to 1.05 in Sami and OR 1.02, 95% CI 1.00 to 1.03 in non-Sami), while higher education lowered the odds in non-Sami (OR 0.69, 95% CI 0.55 to 0.87). Weight underestimation was protectively associated with anxiety and depression in Sami men (OR 0.48, 95% CI 0.27 to 0.84) and in non-Sami women (OR 0.44, 95% CI 0.25 to 0.78) adjusted for age, BMI, education and marital status.

CONCLUSIONS

Independent of ethnicity, more men than women underestimated their weight. Underestimation of weight was protectively associated with anxiety and depression in Sami men and non-Sami women.