Acculturation, immigration status and cardiovascular risk factors among Portuguese immigrants to Luxembourg: findings from ORISCAV-LUX study

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

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

Adult first-generation immigrants and cardiovascular risk factors in the Veneto Region, Northeast Italy

Introduction

The health condition of immigrants traditionally follows a transition from a low disease occurrence to the epidemiological profile of the deprived groups in the host country. In the Europe, studies examining differences in biochemical and clinical outcomes among immigrants and natives are lacking. We examined differences in cardiovascular risk factors between first-generation immigrants and Italians, and how migration pattern variables could affect health outcomes.

Material and methods

We included participants between 20 and 69 years recruited from a Health Surveillance Program of the Veneto Region. Blood pressure (BP), total cholesterol (TC) and LDL cholesterol levels were measured. Immigrant status was defined by being born in a high migratory pressure country (HMPC) and subdivided by geographical macro-areas. We used generalized linear regression models to investigate differences between these outcomes among immigrants compared to native-born, adjusting for age, sex, education, BMI, alcohol consumption, smoking status, food consumption, salt consumption in the BP analysis and the laboratory in charge for cholesterol analysis. Within immigrant subjects, the results were stratified by variables of the migration pattern: age at immigration and length of residence in Italy.

Results

Thirty seven thousand three hundred and eighty subjects were included in the analysis, 8.6% were born in an HMPC. Heterogeneous results were seen by the macro-areas of origin and sex, with male immigrants from CE Europe (β = 8.77 mg/dl) and Asia (β = 6.56 mg/dl) showing higher levels of TC than native-born, while female immigrants from Northern Africa showed lower levels of TC (β = -8.64 mg/dl). BP levels were generally lower among immigrants. Immigrants residing in Italy for more than 20 years had lower levels of TC (β = -2.9 mg/dl) than native-born. In contrast, immigrants who arrived <20 years ago or arrived older than 18 years had higher levels of TC. This trend was confirmed for CE Europeans and was inverted for Northern Africans.

Conclusions

The large heterogeneity in the results depending on sex and macro-area of origin indicates the need for targeted intervention in each specific immigrant group. The results confirm that acculturation leads to a convergence toward the epidemiological profile of the host population that depends on the starting condition of the immigrant group.

International medical students' acculturation and self-rated health status in Hungary: a cross-sectional study

Background

Over the past few decades, the number of international students has increased dramatically. These students have to adjust to unfamiliar social, cultural, and educational environments. The concept of acculturation has been applied in multiple studies on various health outcomes. This study investigated the relationship between acculturation and self-rated health (SRH) among international medical students.

Methods

A cross-sectional study was conducted among international medical students at the University of Szeged, Hungary between April and October 2021. A total of 326 participants filled out questionnaires about sociodemographic characteristics, acculturation, and SRH. The modified Stephenson multigroup acculturation scale (SMAS) was used to assess the acculturation status; the scale defined acculturation as the degree of dominant society immersion (DSI, 12 items) and ethnic society immersion (ESI, 16 items). To measure SRH, participants were asked to rate their current general health and mental health. The data were analyzed by using descriptive statistics and the multiple logistic regression model.

Results

32.5% of the students reported having poor general and 49.7% poor mental health. We have found that acculturation was associated with SRH in multivariable logistic regression models controlling for sociodemographic characteristic. Bidimensional acculturation, such as ESI and DSI significantly influenced SRH as the likelihood of poor general health decreased (OR = 0.50; 95% CI = 0.31–0.81, P = 0.005), when the ESI was higher, whereas the likelihood of poor mental health decreased (OR = 0.52; 95% CI = 0.35–0.79, P = 0.002) if students had a greater DSI.

Conclusion

Both types of immersion can affect the students’ SRH. If the student could integrate better into their own ethnic group, their general health was better, and if they could strongly integrate into the Hungarian society, their mental health was more favorable. Acculturation measures should be promoted by academics and public health professionals in order to better understand their role in the behaviors, health outcomes, and health care use of medical international students. These findings will help professionals shape culturally sensitive prevention and counselling strategies for international student populations.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14334-y.

Comparative Study Regarding the Adherence to the Mediterranean Diet and the Eating Habits of Two Groups-The Romanian Children and Adolescents Living in Nord-West of Romania and Their Romanian Counterparts Living in Italy

Background: The Mediterranean diet (MD) is associated with significant health benefits, including prevention of noncommunicable diseases (NCDs). Given the important migratory flow from Romania to Italy in recent decades, this study seeks to evaluate the differences between the nutritional habits of Romanian children and adolescents in Romania compared with those of Romanian children who moved to Italy or were born in Italy from both Romanian parents. Method: To assess adherence to MD, parents of Romanian children in Romania (RCR) and Romanian children in Italy (RCI) answered questions from an adapted version of the KIDMED test. Results: The results show that the high KIDMED index among RCI is significantly higher than the same index among RCR (68.09 versus 17.76, p < 0.05). RCR obtained a higher KIDMED score on different items: they had a lower consumption of fast food and sweets but an increased consumption of nuts, yogurts, and cheese. Conclusions: RCI have a better adherence to MD, but, at the same time, they are more exposed to westernized diet and practice less physical activity. Nutrition education is an important tool for improving health outcome.

Mixed methods study protocol to explore acculturation, lifestyles and health of immigrants from the Community of Portuguese-Speaking Countries in two Iberian contexts: how to face uncertainties amidst the COVID-19 pandemic

INTRODUCTION

Studies which focus on the process of acculturation in the lifestyles, nutritional status and health of immigrants from the Community of Portuguese-Speaking Countries (CPLP) in the Iberian Peninsula are still scarce. This study aims to explore the influence of the acculturation process and dietary acculturation on the lifestyle and nutritional and health status of CPLP immigrants in Portugal and Spain, focusing on two Iberian contexts: Lisbon Metropolitan Area and the Basque Country.

METHODS AND ANALYSIS

A mixed methods sequential explanatory design, combining cross-sectional studies and semistructured interviews. Official data will also be analysed. Primary data will be collected through a questionnaire and assessment of nutritional status and body composition. The estimated samples sizes are 1061 adults (≥18 years old) in the Lisbon Metropolitan Area and 573 in the Basque Country. Time-location sampling will be used for the quantitative component and non-probabilistic sampling for the qualitative component. If safety conditions are not guaranteed due to the COVID-19 pandemic, online studies will be conducted. The semistructured interviews will complement the questionnaire data and extend knowledge about the process of acculturation of CPLP immigrants and their relationship with eating habits and physical activity. Thematic analysis will be used for qualitative data. Triangulation of data derived from different methods will be carried out. An integrative approach will be used to address potential discrepancies in findings and limitations inherent to the study design. As inter-method discrepancies may occur, triangulation protocol will be used, elaborating a 'convergence coding matrix' to display findings emerging from each component of the study.

ETHICS AND DISSEMINATION

Ethical approval was obtained through the IHMT Ethics Council (Doc No 20/2020), Portugal, and it was submitted to the Ethics Committee of the UPV/EHU (Doc No under revision), Spain.

Public health burden of pre-diabetes and diabetes in Luxembourg: finding from the 2013-2015 European Health Examination Survey

OBJECTIVE

The aim of this study was to determine the burden and risk factors of prediabetes and diabetes in the general adult population of Luxembourg.

DESIGN

Cross-sectional survey between 2013 and 2015.

SETTING

Data were collected as part of the European Health Examination Survey in Luxembourg (EHES-LUX).

PARTICIPANTS

1451 individuals were recruited in a random sample of the 25-64-year-old population of Luxembourg.

OUTCOMES

Diabetes was defined by a glycaemic biomarker (fasting plasma glucose (FPG) ≥7.0 mmol/L), self-reported medication and medical diagnosis; prediabetes by a glycaemic biomarker (FPG 5.6-6.9 mmol/L), no self-reported medication and no medical diagnosis. Undiagnosed diabetes was defined only from the glycaemic biomarker; the difference between total and undiagnosed diabetes was defined as diagnosed diabetes. Odds of diabetes and prediabetes as well as associated risk factors were estimated.

RESULTS

The weighted prevalence of prediabetes and diabetes was 25.6% and 6.5%, respectively. Nearly 4.8% (men: 5.8%; women: 3.8%) were diagnosed diabetes and 1.7% (men: 2.6%; women: 0.7%) were undiagnosed diabetes. The multivariable-adjusted OR (MVOR) for diabetes risk were: age 1.05 (95% CI 1.01 to 1.09), family history of diabetes 3.24 (1.95-5.38), abdominal obesity 2.63 (1.53-4.52), hypertension 3.18 (1.76-5.72), one-unit increase of triglycerides 1.16 (1.10-1.22) and total cholesterol 0.74 (0.64-0.86). The MVOR for prediabetes risk were: age 1.04 (95% CI 1.02 to 1.06), male sex 1.84 (1.30-2.60), moderate alcohol consumption 1.38 (1.01-1.89), family history of diabetes 1.52 (1.13-2.05), abdominal obesity 1.44 (1.06-1.97), second-generation immigrants 0.61 (0.39-0.95) and a one-unit increase of serum high-density lipoprotein cholesterol 0.70 (0.54-0.90).

CONCLUSIONS

In Luxembourg, an unexpectedly high number of adults may be affected by prediabetes and diabetes. Therefore, these conditions should be addressed as a public health priority for the country, requiring measures for enhanced detection and surveillance, which are currently lacking, especially in primary care settings.

Ethnic differences in overweight and obesity and the influence of acculturation on immigrant bodyweight: evidence from a national sample of Australian adults

Background

Despite growing international migration and documented ethnic differences in overweight and obesity in developed countries, no research has described the epidemiology of immigrant overweight and obesity at a national level in Australia, a country where immigrants comprise 28.1 % of the population. The aim of this study was to examine ethnic differences in body mass index (BMI) and overweight/obesity in Australia and the influence of acculturation on bodyweight among Australian immigrants.

Methods

Data from the national Household Income and Labour Dynamics in Australia (HILDA) survey were used to examine mean BMI and odds of overweight/obesity comparing immigrants (n = 2 997) with Australian born (n = 13 047). Among immigrants, acculturation differences were examined by length of residence in Australia and age at migration. Data were modelled in a staged approach using multilevel linear and logistic regression, controlling for demographic and socioeconomic variables.

Results

Relative to Australian born, men from North Africa/Middle East and Oceania regions had significantly higher BMIs, and men from North West Europe, North East Asia and Southern and Central Asia had significantly lower BMIs. Among women, the majority of foreign born groups had significantly lower BMIs compared with Australian born. Male and female immigrants living in Australia for 15 years or more had significantly higher BMIs and increased odds of being overweight/obese respectively, compared with immigrants living in Australia for less than 5 years. Male immigrants arriving as adolescents were twice more likely to be overweight/obese and had significantly higher BMIs than immigrants who arrived as adults. Male and female immigrants who arrived as children (≤11 years) had significantly higher odds of adult overweight/obesity and BMIs.

Conclusions

This study provides evidence of ethnic differences in overweight and obesity in Australia with male immigrants from North Africa/Middle East and Oceania regions being particularly vulnerable. In addition, this study suggests that greater acculturation may negatively impact immigrant bodyweight and recently arrived immigrants as well as those who arrive as children or adolescents may benefit from obesity prevention intervention. Public health policy targeted at and tailored to these immigrant cohorts will assist in the multi-pronged approach required to address the obesity epidemic.

Length of urban residence and obesity among within-country rural-to-urban Andean migrants

Objective

To evaluate the association between length of residence in an urban area and obesity among Peruvian rural-to-urban migrants.

Design

Cross-sectional database analysis of the migrant group from the PERU MIGRANT Study (2007). Exposure was length of urban residence, analysed as both a continuous (10-year units) and a categorical variable. Four skinfold site measurements (biceps, triceps, subscapular and suprailiac) were used to calculate body fat percentage and obesity (body fat percentage >25% males, >33% females). We used Poisson generalized linear models to estimate adjusted prevalence ratios and 95 % confidence intervals. Multicollinearity between age and length of urban residence was assessed using conditional numbers and correlation tests.

Setting

A peri-urban shantytown in the south of Lima, Peru.

Subjects

Rural-to-urban migrants (n 526) living in Lima.

Results

Multivariable analyses showed that for each 10-year unit increase in residence in an urban area, rural-to-urban migrants had, on average, a 12 % (95 % CI 6, 18 %) higher prevalence of obesity. This association was also present when length of urban residence was analysed in categories. Sensitivity analyses, conducted with non-migrant groups, showed no evidence of an association between 10-year age units and obesity in rural (P=0·159) or urban populations (P=0·078). High correlation and a large conditional number between age and length of urban residence were found, suggesting a strong collinearity between both variables.

Conclusions

Longer lengths of urban residence are related to increased obesity in rural-to-urban migrant populations; therefore, interventions to prevent obesity in urban areas may benefit from targeting migrant groups.

The impact of migration on body weight: a review

Immigrants may be more vulnerable to obesity as a result of the immigration process. The aim of this article is to summarize current knowledge about the impact of immigration on body mass index (BMI). A systematic review was performed in accordance with PRISMA guidelines through a database search of scientific articles (last updated in August 2014). Thirty-nine articles were included and assessed. Results varied according to ethnic background, country of origin and host country. A consistent positive association between BMI and time since immigration was found among Hispanic, European and African immigrants. Less than half of the studies observed a positive association among Asian immigrants. The quality of the majority of the studies assessed was poor, reflecting a need to improve methodology and concept definition. Immigration appears to have a deteriorative effect on BMI. Underlying causes may include changes in nutrition and physical activity, psychological and social factors, and genetic susceptibility and these aspects should be included as moderator variables in future studies.

Demographic and socioeconomic disparity in nutrition: application of a novel Correlated Component Regression approach

OBJECTIVES

This study aimed to examine the most important demographic and socioeconomic factors associated with diet quality, evaluated in terms of compliance with national dietary recommendations, selection of healthy and unhealthy food choices, energy density and food variety. We hypothesised that different demographic and socioeconomic factors may show disparate associations with diet quality.

STUDY DESIGN

A nationwide, cross-sectional, population-based study.

PARTICIPANTS

A total of 1352 apparently healthy and non-institutionalised subjects, aged 18-69 years, participated in the Observation of Cardiovascular Risk Factors in Luxembourg (ORISCAV-LUX) study in 2007-2008. The participants attended the nearest study centre after a telephone appointment, and were interviewed by trained research staff.

OUTCOME MEASURES

Diet quality as measured by 5 dietary indicators, namely, recommendation compliance index (RCI), recommended foods score (RFS), non-recommended foods score (non-RFS), energy density score (EDS), and dietary diversity score (DDS). The novel Correlated Component Regression (CCR) technique was used to determine the importance and magnitude of the association of each socioeconomic factor with diet quality, in a global analytic approach.

RESULTS

Increasing age, being male and living below the poverty threshold were predominant factors associated with eating a high energy density diet. Education level was an important factor associated with healthy and adequate food choices, whereas economic resources were predominant factors associated with food diversity and energy density.

CONCLUSIONS

Multiple demographic and socioeconomic circumstances were associated with different diet quality indicators. Efforts to improve diet quality for high-risk groups need an important public health focus.

The burden of asthma among the South Asian and Chinese population residing in Ontario

BACKGROUND

The South Asian and Chinese populations represent a significant portion of the population of Ontario; however, little is known about the burden of respiratory OBJECTIVE: To investigate the prevalence of asthma and the associated health care burden among South Asian and Chinese populations living in Ontario.

METHODS

Using administrative health data for Ontario, the authors identified individuals of South Asian and Chinese descent using a validated surname algorithm and compared the prevalence of asthma in these groups with the general population using an established asthma case definition for the period 2002 to 2010. Also compared were the rates of asthma-specific emergency department visits and hospitalizations among the ethnic groups.

RESULTS

In 2010, the prevalence of asthma in South Asians residing in Ontario was similar to that of the general population (12.1% versus 12.4%), and was increasing at a faster rate than in the general population (0.51%⁄year versus 0.34%⁄year). Compared with the general population, the South Asian population had fewer emergency department visits for asthma, whereas the asthma-related hospitalization rate was greatest among the South Asian population (0.45 per 100 person-years). The Chinese population had the lowest asthma prevalence and associated health care use.

CONCLUSION

The burden of asthma among South Asians in Ontario is increasing and warrants further investigation to determine the reasons for this rise.