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Ðoàn LN, Chau MM, Ahmed N, Cao J, Chan SWC, Yi SS. Turning the Health Equity Lens to Diversity in Asian American Health Profiles. Annu Rev Public Health 2024; 45:169-193. [PMID: 38134402 DOI: 10.1146/annurev-publhealth-060222-023852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
The monolithic misrepresentation of Asian American (AsAm) populations has maintained assumptions that AsAm people are not burdened by health disparities and social and economic inequities. However, the story is more nuanced. We critically review AsAm health research to present knowledge of AsAm health profiles from the past two decades and present findings and opportunities across three topical domains: (a) general descriptive knowledge, (b) factors affecting health care uptake, and (c) effective interventions. Much of the literature emphasized underutilization of health care services; low knowledge and awareness among AsAms about health-related risk factors, prevention, diagnosis, and treatment; inadequate efforts by health systems to improve language access, provider-patient communication, and trust; and the critical roles of community- and faith-based organizations and leaders in health promotion initiatives. Future opportunities for AsAm health research will require adoption of and significant investment in community-engaged research infrastructure to increase representation, funding, and research innovation for AsAm communities.
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Affiliation(s)
- Lan N Ðoàn
- Section for Health Equity, Department of Population Health, NYU Grossman School of Medicine, New York University, New York, NY, USA;
| | - Michelle M Chau
- Section for Health Equity, Department of Population Health, NYU Grossman School of Medicine, New York University, New York, NY, USA;
| | - Naheed Ahmed
- Institute for Excellence in Health Equity, NYU Grossman School of Medicine, New York University, New York, NY, USA
| | - Jiepin Cao
- Section for Health Equity, Department of Population Health, NYU Grossman School of Medicine, New York University, New York, NY, USA;
| | - Sze Wan Celine Chan
- Section for Health Equity, Department of Population Health, NYU Grossman School of Medicine, New York University, New York, NY, USA;
| | - Stella S Yi
- Section for Health Equity, Department of Population Health, NYU Grossman School of Medicine, New York University, New York, NY, USA;
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Li Z, Daniel S, Fujioka K, Umashanker D. Obesity among Asian American people in the United States: A review. Obesity (Silver Spring) 2023; 31:316-328. [PMID: 36695056 PMCID: PMC10108164 DOI: 10.1002/oby.23639] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/10/2022] [Accepted: 10/27/2022] [Indexed: 01/26/2023]
Abstract
Standard measures of obesity, i.e., body weight and BMI, suggest that Asian American people have a lower obesity prevalence than other racial groups in the United States. However, Asian American people face a unique challenge in their pattern of adiposity with central obesity, which raises the risk for multiple comorbidities, such as type 2 diabetes, metabolic syndrome, and cardiovascular disease, at a lower BMI compared with other populations. Several organizations recommend lower BMI cutoffs for obesity in Asian people (BMI ≥25.0 or ≥27.5 kg/m2 ) instead of the standard ≥30.0 kg/m2 threshold. The risks of obesity and related comorbidities in this population are further influenced by diet, physical activity, perceptions of health, and access to information and therapies. Asian-specific parameters for assessing obesity should become a standard part of clinical practice. Asian American people should equally be offered subgroup-specific tailored interventions owing to heterogeneity of this population. Access to medications and surgery should be improved, in part by updating US indications for therapies to reflect race-specific obesity thresholds and through inclusion of Asian American people of all subtypes with lower BMI values in clinical trials.
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Affiliation(s)
- Zhaoping Li
- Center for Human Nutrition, UCLA, Los Angeles, California, USA
| | | | - Ken Fujioka
- Scripps Clinic Del Mar, San Diego, California, USA
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Yom S, Lor M. Advancing Health Disparities Research: The Need to Include Asian American Subgroup Populations. J Racial Ethn Health Disparities 2022; 9:2248-2282. [PMID: 34791615 PMCID: PMC8598103 DOI: 10.1007/s40615-021-01164-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/13/2021] [Accepted: 09/29/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND Despite recognition that the health outcomes of Asian American subgroups are heterogeneous, research has mainly focused on the six largest subgroups. There is limited knowledge of smaller subgroups and their health outcomes. This scoping review identifies trends in the health outcomes, reveals those which are under-researched, and provide recommendations on data collection with 24 Asian American subgroups. METHODS Our literature search of peer-reviewed English language primary source articles published between 1991 and 2018 was conducted across six databases (Embase, PubMed, Web of Sciences, CINAHL, PsychINFO, Academic Search Complete) and Google Scholar, yielding 3844 articles. After duplicate removal, we independently screened 3413 studies to determine whether they met inclusion criteria. Seventy-six studies were identified for inclusion in this review. Data were extracted on study characteristics, content, and findings. FINDINGS Seventy-six studies met the inclusion criteria. The most represented subgroups were Chinese (n = 74), Japanese (n = 60), and Filipino (n = 60), while Indonesian (n = 1), Malaysian (n = 1), and Burmese (n = 1) were included in only one or two studies. Several Asian American subgroups listed in the 2010 U.S. Census were not represented in any of the studies. Overall, the most studied health conditions were cancer (n = 29), diabetes (n = 13), maternal and infant health (n = 10), and cardiovascular disease (n = 9). Studies showed that health outcomes varied greatly across subgroups. CONCLUSIONS More research is required to focus on smaller-sized subgroup populations to obtain accurate results and address health disparities for all groups.
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Affiliation(s)
| | - Maichou Lor
- University of Wisconsin – Madison, Madison, WI USA
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Hypertension, diabetes, and corresponding annual clinical testing utilization: Comparison between Asian Indians and other races/ethnicities. Prev Med 2021; 153:106761. [PMID: 34348134 DOI: 10.1016/j.ypmed.2021.106761] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 07/20/2021] [Accepted: 07/30/2021] [Indexed: 01/21/2023]
Abstract
Asian Indians are at increased risk of developing cardiometabolic diseases. We sought to determine differences between Asian Indians and other races/ethnicities in hypertension and diabetes prevalence and associated annual blood pressure (BP) and fasting blood glucose (FBG) testing. A total of 257,652 adults ≥18 years from the 2011-2018 U.S. National Health Interview Surveys (NHIS) were included. BP and FBG testing in the past 12 months was defined dichotomously (yes/not yes). Racial/ethnic groups included non-Hispanic White (NHW), non-Hispanic Black (NHB), Asian Indian, Other Asians, and Hispanic/Multiracial. We used logistic regression, adjusting for covariates and the survey design. Analyses were completed from 08/2020-06/2021. Asian Indians (N = 3049) had 21% and 99% higher odds of hypertension and diabetes, respectively, than NHWs (aOR [95% CI]; hypertension: 1.21[1.04,1.40], diabetes: 1.99[1.64,2.41]). Accordingly, Asian Indians without diabetes had significantly higher odds of FBG screening than NHWs (Asian Indian: 1.41[1.25,1.59], NHB: 0.99 [0.95,1.04], Other Asian: 1.07[0.98, 1.18], Hispanic: 1.13[1.07,1.20]). Asian Indians without hypertension had a 14% insignificant increase in BP testing compared to NHWs (1.14[0.97,1.33]). Predictors of testing in Asian Indians included older age, doctor's visit, graduate-level education, insurance coverage, and history of hypertension or diabetes. NHBs with diabetes and Hispanics with hypertension had lower odds of FBG testing (0.75[0.66,0.84]) and BP testing (0.85[0.79,0.92]), respectively, than NHWs. Asian Indians have higher odds of diabetes and hypertension than NHWs and higher, but relatively lower, odds of FBG and BP testing. Increasing routine BP and FBG testing in Asian Indians in younger adults may allow for earlier detection of high-risk individuals.
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Baluran DA, Patterson EJ. Examining Ethnic Variation in Life Expectancy Among Asians in the United States, 2012-2016. Demography 2021; 58:1631-1654. [PMID: 34477822 DOI: 10.1215/00703370-9429449] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
As the fastest growing racial group in the United States, understanding the health patterns of Asians is important to addressing health gaps in American society. Most studies have not considered the unique experiences of the ethnic groups contained in the Asian racial group, implying that Asians have a shared story. However, we should expect differences between the ethnic groups given the differences in their timing and place of migration, socioeconomic status, and racialized experiences in the United States. We estimate the life expectancy of the six largest Asian ethnic groups-Chinese, Asian Indians, Filipinos, Vietnamese, Koreans, and Japanese-analyzing data from the Multiple Cause of Death File (2012-2016) and the American Community Survey (2012-2016) in the United States at the national and regional levels. Nationally, Chinese had the highest life expectancy (males e0 = 86.8; females e0 = 91.3), followed by Asian Indians, Koreans, Japanese, Filipinos, and Vietnamese, generally reflecting the pattern expected given their educational attainment, our primary indicator of socioeconomic status. We also found regional differences in life expectancy, where life expectancy for Asians in the West was significantly lower than all other regions. These findings suggest the presence of underlying selection effects associated with settlement patterns among new and traditional destinations. Our results underline the necessity of studying the experiences of the different Asian ethnic groups in the United States, permitting a better assessment of the varying health needs within this diverse racial group.
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Affiliation(s)
- Darwin A Baluran
- Department of Sociology, Vanderbilt University, Nashville, TN, USA
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Gong S, Wang K, Li Y, Zhou Z, Alamian A. Ethnic group differences in obesity in Asian Americans in California, 2013-2014. BMC Public Health 2021; 21:1589. [PMID: 34433450 PMCID: PMC8385855 DOI: 10.1186/s12889-021-11612-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 08/09/2021] [Indexed: 11/29/2022] Open
Abstract
Background Obesity has been generally understudied in Asian Americans. It is important to identify subgroups of Asian Americans at high risk of obesity to help develop targeted interventions for those subgroups. This study aimed to examine the disparities in obesity among Asians (i.e., Chinese, Filipino, Japanese, Korean, and Vietnamese) living in California. Methods A sample of Adult Americans in California (n = 47,970) including Asian American adults (n = 3810) aged 18 years or older were obtained from the 2013–2014 California Health Interview Survey (the U.S. nation’s largest state cross-sectional health survey). Body mass index was calculated using self-reported height and weight. Weight status was determined using the WHO Asian BMI cut points in 4 categories: < 18.5 kg/m2 (underweight), 18.5–22.9 kg/m2 (normal weight), 23–27.5 kg/m2 (overweight), and ≥ 27.5 kg/m2 (obese). Multiple logistic regression analyses were used to estimate odds ratio (OR) and 95% confidence interval (CI) after adjustment for covariates. Results Overall, the prevalence of Asians was 23.3% for obesity and 40.0% for overweight. The obesity prevalence was higher in Asians who were males, aged 45–64 years old, had higher family income, were current smokers, never got married, had lower education level, had an insufficient level of physical activity, and had more frequent consumption of fast foods. After adjusting for other factors, compared to Whites, being Hispanics and Blacks were associated with higher odds of obesity (OR = 1.47, 95%CI = 1.31–1.65; OR = 2.04, 95%CI = 1.65–2.53, respectively); being Chinese, Korean, and Vietnamese were associated with lower odds of obesity (OR = 0.28, 95%CI = 0.18–0.45; OR = 0.14, 95%CI = 0.04–0.46; OR = 0.28, 95%CI = 0.14–0.58, respectively). Compared to Chinese, being Japanese and Filipino were associated with higher odds of obesity (OR = 2.75, 95%CI = 1.52–4.95; OR = 2.90, 95%CI = 1.87–4.49, respectively). Conclusions The prevalence of adult obesity was high among Asian Americans in California. Ethnic/racial disparities in obesity among Asian Americans in California were observed in 2013–2014. Compared to Whites, being Chinese, Korean, Vietnamese were associated with lower odds of obesity. Among Asians, compared to Chinese, being Japanese and being Filipino were associated with higher odds of obesity. These findings can help design better interventions to reduce racial and ethnic disparities in obesity, especially for Asian Americans.
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Affiliation(s)
- Shaoqing Gong
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
| | - Kesheng Wang
- Department of Family and Community Health, School of Nursing, West Virginia University, Morgantown, West Virginia, USA
| | - Ying Li
- Department of Environment Health, College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Arsham Alamian
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida, USA
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Awad SF, Al‐Mawali A, Al‐Lawati JA, Morsi M, Critchley JA, Abu‐Raddad LJ. Forecasting the type 2 diabetes mellitus epidemic and the role of key risk factors in Oman up to 2050: Mathematical modeling analyses. J Diabetes Investig 2021; 12:1162-1174. [PMID: 33112504 PMCID: PMC8264408 DOI: 10.1111/jdi.13452] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/23/2020] [Accepted: 10/26/2020] [Indexed: 12/18/2022] Open
Abstract
AIMS/INTRODUCTION To investigate and forecast type 2 diabetes mellitus epidemic, its related risk factors and cost in Oman by 2050. MATERIALS AND METHODS An age-structured mathematical model was used to characterize type 2 diabetes mellitus epidemiology and trends in Oman between 1990 and 2050. The model was parametrized using current and quality data, including six nationally representative population-based epidemiological surveys for type 2 diabetes mellitus and its key risk factors. RESULTS The projected type 2 diabetes mellitus prevalence increased from 15.2% in 2020 to 23.8% in 2050. The prevalence increased from 16.8 and 13.8% in 2020 among women and men to 26.3 and 21.4% in 2050, respectively. In 2020, 190,489 Omanis were living with type 2 diabetes mellitus compared with 570,227 in 2050. The incidence rate per 1,000 person-years changed from 8.3 in 2020 to 12.1 in 2050. Type 2 diabetes mellitus' share of Oman's national health expenditure grew by 36% between 2020 and 2050 (from 21.2 to 28.8%). Obesity explained 56.7% of type 2 diabetes mellitus cases in 2020 and 71.4% in 2050, physical inactivity explained 4.3% in 2020 and 2.7% in 2050, whereas smoking accounted for <1% of type 2 diabetes mellitus cases throughout 2020-2050. Sensitivity and uncertainty analyses affirmed these predictions. CONCLUSIONS The type 2 diabetes mellitus epidemic in Oman is expected to increase significantly over the next three decades, consuming nearly one-third of the national health expenditure. The type 2 diabetes mellitus burden is heavily influenced by obesity. Interventions targeting this single risk factor should be a national priority to reduce and control the burden of type 2 diabetes mellitus in Oman.
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Affiliation(s)
- Susanne F Awad
- Infectious Disease Epidemiology GroupWeill Cornell Medicine‐QatarCornell UniversityDohaQatar
- World Health Organization Collaborating Center for Disease Epidemiology Analytics on HIV/AIDSSexually Transmitted Infections and Viral HepatitisWeill Cornell Medicine‐QatarDohaQatar
- Department of Population Health SciencesWeill Cornell MedicineCornell UniversityNew York CityNew YorkUSA
| | - Adhra Al‐Mawali
- Center of Studies & ResearchMinistry of HealthMuscatSultanate of Oman
- Strategic Research Program for Non‐communicable DiseaseThe Research Council (TRC)MuscatSultanate of Oman
| | - Jawad A Al‐Lawati
- Directorate General of Primary Health CareMinistry of HealthMuscatSultanate of Oman
| | - Magdi Morsi
- Center of Studies & ResearchMinistry of HealthMuscatSultanate of Oman
| | - Julia A Critchley
- Population Health Research InstituteSt George’s, University of LondonLondonUK
| | - Laith J Abu‐Raddad
- Infectious Disease Epidemiology GroupWeill Cornell Medicine‐QatarCornell UniversityDohaQatar
- World Health Organization Collaborating Center for Disease Epidemiology Analytics on HIV/AIDSSexually Transmitted Infections and Viral HepatitisWeill Cornell Medicine‐QatarDohaQatar
- Department of Population Health SciencesWeill Cornell MedicineCornell UniversityNew York CityNew YorkUSA
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Koirala B, Turkson-Ocran RA, Baptiste D, Koirala B, Francis L, Davidson P, Himmelfarb CD, Commodore-Mensah Y. Heterogeneity of Cardiovascular Disease Risk Factors Among Asian Immigrants: Insights From the 2010 to 2018 National Health Interview Survey. J Am Heart Assoc 2021; 10:e020408. [PMID: 34182790 PMCID: PMC8403310 DOI: 10.1161/jaha.120.020408] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background The Asian population is the fastest-growing immigrant population in the United States. Prior studies have examined the Asian immigrant population as a homogenous group. We hypothesized that there will be heterogeneity in cardiovascular disease risk factors among Asian immigrant subgroups (Indian subcontinent, Southeast Asia, Asia) compared with the non-Hispanic White population. Methods and Results A cross-sectional analysis of the 2010 to 2018 National Health Interview Survey was conducted among 508 941 adults who were born in Asian regions or were non-Hispanic White and born in the United States. Generalized linear models with Poisson distribution were fitted to compare the prevalence of self-reported hypertension, overweight/obesity, diabetes mellitus, high cholesterol, physical inactivity, and current smoking among Asian immigrants compared with White adults, adjusting for known confounders. We included 33 973 Asian immigrants from Southeast Asia (45%), Asia (29%), the Indian subcontinent (26%), and 474 968 White adults. Compared with non-Hispanic White adults, Indian subcontinent immigrants had the highest prevalence of overweight/obesity (prevalence ratio, 1.22; 95% CI, 1.19-1.25); Southeast Asian immigrants had the highest prevalence of high cholesterol (prevalence ratio, 1.16; 95% CI, 1.10-1.23); Indian subcontinent (prevalence ratio, 1.69; 95% CI, 1.49-1.93) and Southeast Asian (prevalence ratio, 1.38; 95% CI, 1.26-1.52) immigrants had a higher prevalence of diabetes. All Asian immigrant subgroups were more likely to be physically inactive and less likely to smoke than White adults. Conclusions We observed significant heterogeneity in cardiovascular disease risk factors among Asian immigrants and a varied prevalence of risk factors compared with non-Hispanic White adults. Providers caring for Asian immigrants should provide tailored and culturally informed care to improve the cardiovascular health of this diverse group.
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Affiliation(s)
| | | | | | | | | | | | - Cheryl Dennison Himmelfarb
- Johns Hopkins School of Nursing Baltimore MD.,Johns Hopkins School of Medicine Baltimore MD.,Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Yvonne Commodore-Mensah
- Johns Hopkins School of Nursing Baltimore MD.,Johns Hopkins Bloomberg School of Public Health Baltimore MD
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Divia Aricatt P, Ashraf SM, Subramanyam K, Avadhani R, Ezhilan J, Subba SH, Ajith Mullasari S, Narasimhan C. Pitfalls in comparison of coronary artery measurements of Indian population with different geographical area studies. Indian Heart J 2021; 73:347-352. [PMID: 34154754 PMCID: PMC8322926 DOI: 10.1016/j.ihj.2021.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 03/23/2021] [Accepted: 04/08/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Coronary artery disease (CAD) is the most common cause of morbidity and mortality especially in the developing countries. Coronary artery measurements (CAM) are the most important factor affecting the procedure and outcome of coronary angioplasty (PCI) as well as coronary by-pass operations (CABG). In this study, we aimed to establish a database for the normal CAM as well as for gender difference among the Indian population using quantitative coronary angiography (QCA) with an objective of assessing normal coronary vessel morphology of patients with normal coronaries. Materials and methods Four thousand angiograms from patients of Indian origin were studied prospectively after procuring the sanction for the same from the ethical committee of the pre-selected hospitals of four states in India. Informed consents were obtained. Post CABG, post PCI patients and patient being diabetic for ≥5 years were also excluded from the study. Results Ten segments from right and left coronary arteries were taken for diameter measurements. These coronary diameters were indexed to body surface area (BSA) (mean diameter mm/m2 BSA). Among, 4000 patients, 933(23.3%) [M:F-521:412] had normal coronaries and 3067 (76.7%) were diseased. Discussion and conclusion The dimensions of the coronary artery segments of Indians were smaller (in BSA indexed and non-indexed data), compared to studies from other continents which can be due to their smaller BSA.
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Affiliation(s)
- Paul Divia Aricatt
- Department of Anatomy, Yenepoya Medical College, Yenepoya (Deemed to be) University, Deralakatte, Mangalore, 575018, Karnataka, India.
| | - S M Ashraf
- Department of Cardio Vascular Sciences, Sahakarana Hrudayalaya, Government Medical College, Pariyaram, Kannur, Kerala, 670503, India.
| | - K Subramanyam
- Department of Interventional Cardiology, K.S Hegde Medical Academy and Hospital, Deralakatte, Mangalore, 575018, Karnataka, India.
| | - Ramakrishna Avadhani
- Department of Anatomy, Yenepoya Medical College, Yenepoya (Deemed to be) University, Deralakatte, Mangalore, 575018, Karnataka, India.
| | - J Ezhilan
- Department of Cardiology, Madras Medical Mission, Chennai, Tamilnadu, 670503, India.
| | - Sonu H Subba
- Department of Community Medicine & Family Medicine, AIIMS, Bhubaneswar, Odhisa, 751019, India.
| | - S Ajith Mullasari
- Department of Cardiology, Madras Medical Mission, Chennai, Tamilnadu, 670503, India.
| | - C Narasimhan
- Department of Cardiology Care Hospital, Banjara Hills, Hyderabad, 500034, India.
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Ma GX, Bhimla A, Zhu L, Beeber M, Aczon F, Tan Y, Quinn SB, Khan O, Gadegbeku CA. Development of an Intervention to Promote Physical Activity and Reduce Dietary Sodium Intake for Preventing Hypertension and Chronic Disease in Filipino Americans. J Racial Ethn Health Disparities 2021; 8:283-292. [PMID: 32495306 PMCID: PMC7710586 DOI: 10.1007/s40615-020-00781-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/19/2020] [Accepted: 05/22/2020] [Indexed: 10/24/2022]
Abstract
Hypertension is a common chronic health condition affecting Filipino Americans. This pilot study examined the feasibility of addressing high rates of hypertension among Filipino Americans through the implementation of a culturally tailored education intervention. Filipino Americans living in the Greater Philadelphia Area were recruited through community-based organizations for participation and were engaged using a community-based participatory research (CBPR) framework. The study included pre- and post-intervention blood pressure measurements, self-reported body mass index, and questionnaires about physical activity and salt intake. The intervention to promote physical activity and reduce salt intake was conducted through two educational sessions and was accompanied by follow-up at 3 months and by the collection of urine samples for 24-h urinary sodium intake biomarker analysis. Following intervention, a non-statistically significant decrease in urine sodium was observed in both the intervention and the control groups. For systolic blood pressure, a reduction of 12.6 mmHg and an increase in 5.3 mmHg was observed in the intervention and control groups, respectively. Diastolic pressure decreased 3.8 mmHg for the intervention group and increased 5.6 mmHg among controls. The culturally tailored education intervention reported here represents a promising tool for blood pressure reduction in high-risk ethnic populations. The methods used were effective for the recruitment and retention of ethnic minorities in a community-based setting.
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Affiliation(s)
- Grace X Ma
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, 3440 N Broad St., Suite 320, Kresge East Bldg, Philadelphia, PA, 19140, USA.
- Department of Clinical Sciences, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA.
| | - Aisha Bhimla
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, 3440 N Broad St., Suite 320, Kresge East Bldg, Philadelphia, PA, 19140, USA
| | - Lin Zhu
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, 3440 N Broad St., Suite 320, Kresge East Bldg, Philadelphia, PA, 19140, USA
| | - Maayan Beeber
- Hunter College, The City University of New York (CUNY), New York, NY, USA
| | - Ferdinand Aczon
- Filipino American Society of South Jersey Inc., Mount Laurel, NJ, 08084, USA
| | - Yin Tan
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, 3440 N Broad St., Suite 320, Kresge East Bldg, Philadelphia, PA, 19140, USA
| | - Sally Boyle Quinn
- Division of Nephrology, Temple University School of Medicine, Philadelphia, PA, 19140, USA
| | - Omar Khan
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, 3440 N Broad St., Suite 320, Kresge East Bldg, Philadelphia, PA, 19140, USA
| | - Crystal A Gadegbeku
- Division of Nephrology, Temple University School of Medicine, Philadelphia, PA, 19140, USA
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Feldman JM, Conderino S, Islam NS, Thorpe LE. Subgroup Variation and Neighborhood Social Gradients-an Analysis of Hypertension and Diabetes Among Asian Patients (New York City, 2014-2017). J Racial Ethn Health Disparities 2021; 8:256-263. [PMID: 32488823 PMCID: PMC7708414 DOI: 10.1007/s40615-020-00779-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 05/19/2020] [Accepted: 05/22/2020] [Indexed: 10/24/2022]
Abstract
Diabetes and hypertension are socially patterned by individual race/ethnicity and by neighborhood economic context, but distributions among Asian subgroups are undercharacterized. We examined variation in prevalence for both conditions, comparing between US Asian subgroups, including within South Asian nationalities, and comparing within subgroups by neighborhood economic context. We obtained data on a non-probability sample of 633,664 patients ages 18-64 in New York City, NY, USA (2014-2017); 30,138 belonged to one of seven Asian subgroups (Asian Indian, Bangladeshi, Pakistani, Chinese, Korean, Japanese, and Filipino). We used electronic health records to classify disease status. We characterized census tract economic context using the Index of Concentration at the Extremes and estimated prevalence differences using multilevel models. Among Asian men, hypertension prevalence was highest for Filipinos. Among Asian women, hypertension prevalence was highest for Filipinas and Bangladeshis. Diabetes prevalence was highest among Pakistanis and Bangladeshis of both genders, exceeding all other Asian and non-Asian groups. There was consistent evidence of an economic gradient for both conditions, whereby persons residing in the most privileged neighborhood tertile had the lowest disease prevalence. The economic gradient was particularly strong for diabetes among Pakistanis, whose prevalence in the most deprived tertile exceeded that of the most privileged by 9 percentage points (95% CI 3, 14). Only Koreans departed from the trend, experiencing the highest diabetes prevalence in the most privileged tertile. US Asian subgroups largely demonstrate similar neighborhood economic gradients as other groups. Disaggregating Asian subgroups, including within South Asian nationalities, reveals important heterogeneity in prevalence.
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Affiliation(s)
- Justin M Feldman
- Department of Population Health, NYU School of Medicine, 180 Madison Ave., 5th Floor, New York, NY, 10016, USA.
| | - Sarah Conderino
- Department of Population Health, NYU School of Medicine, 180 Madison Ave., 5th Floor, New York, NY, 10016, USA
| | - Nadia S Islam
- Department of Population Health, NYU School of Medicine, 180 Madison Ave., 5th Floor, New York, NY, 10016, USA
| | - Lorna E Thorpe
- Department of Population Health, NYU School of Medicine, 180 Madison Ave., 5th Floor, New York, NY, 10016, USA
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Holmes H, Almeida VA, Boushey C, Banna J. Use of Technology for Dietary Assessment in Immigrant Populations. Am J Lifestyle Med 2020; 14:118-121. [PMID: 32231473 DOI: 10.1177/1559827619890948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
To determine the impact of educational programs on immigrant groups in the United States, nutrition educators must have assessment and evaluation tools that use the language and vocabulary of the target population. Filipino Americans exhibit health disparities with regard to several conditions and are an important target for nutrition education. Currently, there are no existing rigorously tested tools in the Tagalog language which also have a low user burden and are designed to measure diet for assessment and evaluation of nutrition education programs. As these programs are generally evaluated using time-intensive dietary assessment tools not tailored specifically to Filipinos, they may not effectively characterize the diet of this population. Given the high adoption rates of mobile phones by populations outside of the United States, mobile apps may represent a best choice for developing tools to assist individuals recently migrating to the United States or speaking English as an additional language. Several tools of this nature have been developed for immigrant groups and hold promise in terms of acceptability. Examples of dietary assessment tools using technology developed for Spanish speakers in the United States are provided. These methods may also be appropriate for addressing the needs of immigrant groups such as Filipinos.
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Affiliation(s)
- Hannah Holmes
- Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources (HH, VAA, JB), University of Hawaii at Manoa, Honolulu, Hawaii.,University of Hawaii Cancer Center (CB), University of Hawaii at Manoa, Honolulu, Hawaii
| | - Vanessa Araujo Almeida
- Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources (HH, VAA, JB), University of Hawaii at Manoa, Honolulu, Hawaii.,University of Hawaii Cancer Center (CB), University of Hawaii at Manoa, Honolulu, Hawaii
| | - Carol Boushey
- Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources (HH, VAA, JB), University of Hawaii at Manoa, Honolulu, Hawaii.,University of Hawaii Cancer Center (CB), University of Hawaii at Manoa, Honolulu, Hawaii
| | - Jinan Banna
- Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources (HH, VAA, JB), University of Hawaii at Manoa, Honolulu, Hawaii.,University of Hawaii Cancer Center (CB), University of Hawaii at Manoa, Honolulu, Hawaii
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13
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Adia AC, Nazareno J, Operario D, Ponce NA. Health Conditions, Outcomes, and Service Access Among Filipino, Vietnamese, Chinese, Japanese, and Korean Adults in California, 2011-2017. Am J Public Health 2020; 110:520-526. [PMID: 32078359 PMCID: PMC7067106 DOI: 10.2105/ajph.2019.305523] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2019] [Indexed: 11/04/2022]
Abstract
Objectives. To determine the impact of data disaggregation on the ability to identify health disparities and needs for future research for Filipino, Vietnamese, Chinese, Japanese, and Korean adults in California.Methods. Using available data from the 2011-2017 California Health Interview Survey, we conducted bivariate and multivariable analyses to assess disparities in health conditions, outcomes, and service access compared with non-Hispanic Whites for Asians as an overall group and for each individual subgroup.Results. As an aggregate category, Asians appeared healthier than did non-Hispanic Whites on most indicators. However, every Asian subgroup had at least 1 disparity disguised by aggregation. Filipinos had the most disparities, with higher prevalence of fair or poor health, being obese or overweight, and having high blood pressure, diabetes, or asthma compared with non-Hispanic Whites (P < .05) in multivariable analyses.Conclusions. Failure to disaggregate health data for individual Asian subgroups disguises disparities and leads to inaccurate conclusions about needs for interventions and research.
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Affiliation(s)
- Alexander C Adia
- Alexander C. Adia, Jennifer Nazareno, and Don Operario are with the Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, RI. Ninez A. Ponce is with the University of California, Los Angeles Fielding School of Public Health and the University of California, Los Angeles Center for Health Policy Research
| | - Jennifer Nazareno
- Alexander C. Adia, Jennifer Nazareno, and Don Operario are with the Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, RI. Ninez A. Ponce is with the University of California, Los Angeles Fielding School of Public Health and the University of California, Los Angeles Center for Health Policy Research
| | - Don Operario
- Alexander C. Adia, Jennifer Nazareno, and Don Operario are with the Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, RI. Ninez A. Ponce is with the University of California, Los Angeles Fielding School of Public Health and the University of California, Los Angeles Center for Health Policy Research
| | - Ninez A Ponce
- Alexander C. Adia, Jennifer Nazareno, and Don Operario are with the Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, RI. Ninez A. Ponce is with the University of California, Los Angeles Fielding School of Public Health and the University of California, Los Angeles Center for Health Policy Research
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14
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Yee LD, Mortimer JE, Natarajan R, Dietze EC, Seewaldt VL. Metabolic Health, Insulin, and Breast Cancer: Why Oncologists Should Care About Insulin. Front Endocrinol (Lausanne) 2020; 11:58. [PMID: 32153503 PMCID: PMC7045050 DOI: 10.3389/fendo.2020.00058] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 01/29/2020] [Indexed: 12/13/2022] Open
Abstract
Studies investigating the potential link between adult pre-menopausal obesity [as measured by body mass index (BMI)] and triple-negative breast cancer have been inconsistent. Recent studies show that BMI is not an exact measure of metabolic health; individuals can be obese (BMI > 30 kg/m2) and metabolically healthy or lean (BMI < 25 kg/m2) and metabolically unhealthy. Consequently, there is a need to better understand the molecular signaling pathways that might be activated in individuals that are metabolically unhealthy and how these signaling pathways may drive biologically aggressive breast cancer. One key driver of both type-2 diabetes and cancer is insulin. Insulin is a potent hormone that activates many pathways that drive aggressive breast cancer biology. Here, we review (1) the controversial relationship between obesity and breast cancer, (2) the impact of insulin on organs, subcellular components, and cancer processes, (3) the potential link between insulin-signaling and cancer, and (4) consider time points during breast cancer prevention and treatment where insulin-signaling could be better controlled, with the ultimate goal of improving overall health, optimizing breast cancer prevention, and improving breast cancer survival.
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15
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Gujral UP, Narayan KMV. Diabetes in Normal-Weight Individuals: High Susceptibility in Nonwhite Populations. Diabetes Care 2019; 42:2164-2166. [PMID: 31748211 PMCID: PMC6868465 DOI: 10.2337/dci19-0046] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Unjali P Gujral
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - K M Venkat Narayan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA.,Nutrition and Health Sciences Program, Graduate Division of Biological and Biomedical Sciences, Laney Graduate School, Emory University, Atlanta, GA.,Department of Medicine, School of Medicine, Emory University, Atlanta, GA
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16
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A Health Profile and Overview of Healthcare Experiences of Cambodian American Refugees and Immigrants Residing in Southern California. J Immigr Minor Health 2019; 21:346-355. [PMID: 29705910 DOI: 10.1007/s10903-018-0736-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Asian Americans are understudied in health research and often aggregated into one homogenous group, thereby disguising disparities across subgroups. Cambodian Americans, one of the largest refugee communities in the United States, may be at high risk for adverse health outcomes. This study compares the health status and healthcare experiences of Cambodian American refugees and immigrants. Data were collected via questionnaires and medical records from two community clinics in Southern California (n = 308). Chi square and t-tests examined the socio-demographic differences between immigrants and refugees, and ANCOVA models compared the mean differences in responses for each outcome, adjusting for age at immigration, education level, and clinic site. Cambodian American refugees reported overall lower levels of health-related quality of life (all p's < 0.05 in unadjusted models) and self-rated health [unadjusted means (SD) = 18.2 (16.8) vs. 21.7 (13.7), p < 0.05], but either similar or more positive healthcare experiences than Cambodian American immigrants. In adjusted analyses, refugees had higher rates of diabetes and cardiovascular disease risk (e.g. heart condition and hypertension; p's < 0.05) compared to Cambodian American immigrants. There were minimal differences in self-reported health behaviors between the two groups. There is a need for more health promotion efforts among Cambodian American refugees and immigrants to improve their health outcomes and perceived wellbeing.
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17
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de Castro AB, Hing AK, Lee NR, Kabamalan MMM, Llave K, Crespi CM, Wang M, Gee G. Cohort profile: the Health of Philippine Emigrants Study (HoPES) to examine the health impacts of international migration from the Philippines to the USA. BMJ Open 2019; 9:e032966. [PMID: 31727665 PMCID: PMC6886980 DOI: 10.1136/bmjopen-2019-032966] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE The Health of Philippine Emigrants Study (HoPES) longitudinally investigates over 3 years whether migrating from the Philippines to the USA results in increased risk for obesity relative to non-migrants in the Philippines. The study is designed to test the healthy immigrant hypothesis by collecting health measures from migrants starting from a pre-migration baseline and enrolling a non-migrant cohort matched on age, gender and education for comparison. PARTICIPANTS A migrant cohort (n=832; 36.5% of eligible individuals) was recruited from clients of the Commission on Filipinos Overseas prior to exiting the Philippines. A non-migrant cohort (n=805; 68.6% eligible individuals) was recruited from community households in municipalities throughout the cities of Manila and Cebu. By intention, these two cohorts are comparable demographically, including urban/rural status of residency in the Philippines at baseline. FINDINGS TO DATE At baseline, compared with non-migrants, migrants report significantly better self-rated health and less depression, and have significantly larger hip circumference and lower waist-to-hip ratio, as well as significantly higher mean systolic blood pressure and higher mean level of apolipoprotein B. Baseline results can offer insight into the health status of both migrant and non-migrant populations and may be useful for obesity prevention efforts. FUTURE PLANS Longitudinal data collection is scheduled to be completed in December 2020 when the final data collection wave (36 months after baseline) will conclude. Both migrant and non-migrant cohorts will be maintained beyond the current prospective study, so long as research funding allows and emerges for new study questions. Findings from future longitudinal analyses can inform the need and design of health-related/relevant interventions, whether clinical, behavioural, educational, or policy, that can be implemented at the individual or population level.
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Affiliation(s)
- A B de Castro
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, Washington, United States
| | - Anna K Hing
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, California, United States
| | - Nanette R Lee
- Office of Population Studies Foundation, Inc, University of San Carlos, Cebu City, Philippines
| | - Maria Midea M Kabamalan
- University of the Philippines Population Institute, College of Social Sciences and Philosophy, University of the Philippines Diliman, Quezon City, Philippines
| | - Karen Llave
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, California, United States
| | - Catherine M Crespi
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, California, United States
| | - May Wang
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, California, United States
| | - Gilbert Gee
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, California, United States
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18
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Sharma V, Coleman S, Nixon J, Sharples L, Hamilton-Shield J, Rutter H, Bryant M. A systematic review and meta-analysis estimating the population prevalence of comorbidities in children and adolescents aged 5 to 18 years. Obes Rev 2019; 20:1341-1349. [PMID: 31342672 PMCID: PMC6851579 DOI: 10.1111/obr.12904] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 04/30/2019] [Accepted: 04/30/2019] [Indexed: 12/11/2022]
Abstract
Evidence for the health impact of obesity has largely focussed on adults. We estimated the population prevalence and prevalence ratio of obesity-associated comorbidities in children and adolescents aged 5 to 18 years. Five databases were searched from inception to 14 January 2018. Population-based observational studies reporting comorbidity prevalence by weight category (healthy weight/overweight/obese) in children and adolescents aged 5 to 18 years from any country were eligible. Comorbidity prevalence, stratified by weight category, was extracted and prevalence ratios (relative to healthy weight) estimated using random effects meta-analyses. Of 9183 abstracts, 52 eligible studies (1 553 683 participants) reported prevalence of eight comorbidities or risk markers including diabetes and nonalcoholic fatty liver disease (NAFLD). Evidence for psychological comorbidities was lacking. Meta-analyses suggested prevalence ratio for prediabetes (fasting glucose ≥ 100 mg/dL) for those with obesity relative to those of a healthy weight was 1.4 (95% confidence interval [CI], 1.2-1.6) and for NAFLD 26.1 (9.4-72.3). In the general population, children and adolescents with overweight/obesity have a higher prevalence of comorbidities relative to those of a healthy weight. This review provides clinicians with information when assessing children and researchers a foundation upon which to build a comprehensive dataset to understand the health consequences of childhood obesity.
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Affiliation(s)
- Vishal Sharma
- Clinical Effectiveness Team, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Susanne Coleman
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Jane Nixon
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Linda Sharples
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | - Maria Bryant
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
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19
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Sims Gould J, Tong C, Ly J, Vazirian S, Windt A, Khan K. Process evaluation of team-based care in people aged >65 years with type 2 diabetes mellitus. BMJ Open 2019; 9:e029965. [PMID: 31377711 PMCID: PMC6687023 DOI: 10.1136/bmjopen-2019-029965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE The prevalence of type 2 diabetes mellitus (T2DM) is increasing globally and there is critical need develop interventions to improve health outcomes among older people. The Group Appointments in Primary Care (GAP) study was a randomised controlled trial designed to test the efficacy of a group and team-based medical visit programme to lower haemoglobin A1c among patients with T2DM. We aimed to understand the barriers and facilitators to implement the GAP intervention within a primary care setting, with an emphasis on patient experience. RESEARCH DESIGN AND METHODS This was a qualitative exploratory study. Data were gathered from semistructured interviews conducted with the first cohort of GAP study participants (n=15) at baseline and intervention completion. GAP participants were aged >65, diagnosed with T2DM and from one primary care clinic. The interview questions identified the patient perspectives and factors relating to their attendance at seven group medical visits that were part of the intervention programme. Data were analysed using framework analysis. RESULTS We identified four themes that captured participants' experiences: (1) Education: learning with professionals, learning with one another; (2) Social Support: common interests, common problems; (3) Setting: ease of location, ease of conversation and (4) Impact: expectations met, empowerment gained. The GAP intervention increased participants' self-reported diabetes literacy and self-management skills. CONCLUSIONS We learnt that: accessible community centres, not primary care offices, were the ideal location for GAP; the consistent leadership of the primary care physician was valued by participants; and, the content related to exercise and healthy diet were viewed as impactful. Also, learning was achieved through content delivered by clinical experts, and by T2DM experts with lived experience-the GAP peers. Our findings highlight the important role of group learning. TRIAL REGISTRATION NUMBER NCT02002143.
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Affiliation(s)
- Joanie Sims Gould
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Catherine Tong
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jessica Ly
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sara Vazirian
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adriaan Windt
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
| | - Karim Khan
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
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20
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Hudda MT, Fewtrell MS, Haroun D, Lum S, Williams JE, Wells JCK, Riley RD, Owen CG, Cook DG, Rudnicka AR, Whincup PH, Nightingale CM. Development and validation of a prediction model for fat mass in children and adolescents: meta-analysis using individual participant data. BMJ 2019; 366:l4293. [PMID: 31340931 PMCID: PMC6650932 DOI: 10.1136/bmj.l4293] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To develop and validate a prediction model for fat mass in children aged 4-15 years using routinely available risk factors of height, weight, and demographic information without the need for more complex forms of assessment. DESIGN Individual participant data meta-analysis. SETTING Four population based cross sectional studies and a fifth study for external validation, United Kingdom. PARTICIPANTS A pooled derivation dataset (four studies) of 2375 children and an external validation dataset of 176 children with complete data on anthropometric measurements and deuterium dilution assessments of fat mass. MAIN OUTCOME MEASURE Multivariable linear regression analysis, using backwards selection for inclusion of predictor variables and allowing non-linear relations, was used to develop a prediction model for fat-free mass (and subsequently fat mass by subtracting resulting estimates from weight) based on the four studies. Internal validation and then internal-external cross validation were used to examine overfitting and generalisability of the model's predictive performance within the four development studies; external validation followed using the fifth dataset. RESULTS Model derivation was based on a multi-ethnic population of 2375 children (47.8% boys, n=1136) aged 4-15 years. The final model containing predictor variables of height, weight, age, sex, and ethnicity had extremely high predictive ability (optimism adjusted R2: 94.8%, 95% confidence interval 94.4% to 95.2%) with excellent calibration of observed and predicted values. The internal validation showed minimal overfitting and good model generalisability, with excellent calibration and predictive performance. External validation in 176 children aged 11-12 years showed promising generalisability of the model (R2: 90.0%, 95% confidence interval 87.2% to 92.8%) with good calibration of observed and predicted fat mass (slope: 1.02, 95% confidence interval 0.97 to 1.07). The mean difference between observed and predicted fat mass was -1.29 kg (95% confidence interval -1.62 to -0.96 kg). CONCLUSION The developed model accurately predicted levels of fat mass in children aged 4-15 years. The prediction model is based on simple anthropometric measures without the need for more complex forms of assessment and could improve the accuracy of assessments for body fatness in children (compared with those provided by body mass index) for effective surveillance, prevention, and management of clinical and public health obesity.
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Affiliation(s)
- Mohammed T Hudda
- Population Health Research Institute, St George's, University of London, London SW17 0RE, UK
| | - Mary S Fewtrell
- Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Dalia Haroun
- College of Natural and Health Sciences, Department of Public Health and Nutrition, Zayed University, Dubai, UAE
| | - Sooky Lum
- Respiratory, Critical Care and Anaesthesia section of III Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Jane E Williams
- Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Jonathan C K Wells
- Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Richard D Riley
- Centre for Prognosis Research, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | - Christopher G Owen
- Population Health Research Institute, St George's, University of London, London SW17 0RE, UK
| | - Derek G Cook
- Population Health Research Institute, St George's, University of London, London SW17 0RE, UK
| | - Alicja R Rudnicka
- Population Health Research Institute, St George's, University of London, London SW17 0RE, UK
| | - Peter H Whincup
- Population Health Research Institute, St George's, University of London, London SW17 0RE, UK
| | - Claire M Nightingale
- Population Health Research Institute, St George's, University of London, London SW17 0RE, UK
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21
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Associations of Asian Ethnicity and Parental Education with Overweight in Asian American Children and Adolescents: An Analysis of 2011-2016 National Health and Nutrition Examination Surveys. Matern Child Health J 2019; 23:504-511. [PMID: 30610532 DOI: 10.1007/s10995-018-2662-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Objectives Asian Americans are highly diverse in cultural, socioeconomic, and health conditions. We aimed to identify socioeconomic and cultural profiles of subgroups of Asian American children at high risk of obesity or overweight to inform targeted interventions. Methods A sample of 841 Asian American children and adolescents ages 6-19 from the 2011-2016 National Health and Nutrition Examination Survey was used. Multivariable logistic regression modeling was conducted. Analyses were also stratified by age (6-11 vs. 12-19). Key variables of interest were Asian ethnicity (Chinese, Korean/Japanese, Filipino, South Asian, and Southeast Asian) and parental educational level. Models adjusted for age, gender, nativity status, parental nativity status, and health insurance coverage. Results Filipino (AOR 2.79; 95% CI 1.30-6.00), Japanese/Korean (AOR 2.55; 95% CI 1.21-5.38), Southeast Asian (AOR 2.54; 95% CI 1.63-3.94), and South Asian (AOR 2.10; 95% CI 1.01-4.36) children ages 6-19 had higher odds of being obese/overweight than Chinese. Filipino (AOR 3.24; 95% CI 1.11-9.49) and Southeast Asian (AOR 2.47; 95% CI 1.22-5.01) ethnicities were associated with higher risk of obesity/overweight in adolescents ages 12-19. Having a parent with a 4-year college or advanced degree was inversely associated with obesity/overweight in US-born Asian adolescents (AOR 0.34; 95% CI 0.14-0.78). Conclusions for Practice Asian American children and adolescents in some Asian ethnic subgroups may be at higher risk of obesity/overweight than in others. Higher parental education level appears to protect US-born Asian American adolescents from being obese/overweight. Multi-sectoral efforts are needed to better understand and address sociocultural processes that increase childhood obesity/overweight in high-risk Asian subgroups.
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22
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Borja-Hart N, Graff JC, Nolan VG, Wang J, Cooper-DeHoff RM, Ancheta IB. Atherosclerotic cardiovascular disease risk assessment and predictors of statin use in Filipino-American Women. J Clin Pharm Ther 2019; 44:632-639. [PMID: 30963623 DOI: 10.1111/jcpt.12837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 02/28/2019] [Accepted: 03/11/2019] [Indexed: 11/26/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Race and gender disparities in the context of appropriate treatment with lipid-lowering therapies do exist. The 2013 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines outlined four groups, three for primary prevention and one for secondary prevention, whom would benefit from statin therapy to target atherosclerotic cardiovascular disease (ASCVD). The application of these recommendations in Filipino women living in the United States is unknown; however, this population is known to have elevated cardiovascular risk. Socio-economic and clinical characteristics that predict statin utilization of this Asian American subgroup need to be explored. METHODS This was an exploratory analysis of data collected during a cross-sectional study of Filipino-American Women (FAW). The Pooled Cohort equation was used to estimate 10-year ASCVD risk. Bivariate analysis was employed to determine the association between statin treatment and clinical and socio-economic factors. Data were analysed using SAS® 9.4; statistical significance was set at P < 0.05. RESULTS AND DISCUSSION A total of 384 women (mean age 56.3 years) were included in the original study, and the average 10-year ASCVD risk was 3.5 ± 3.7%. Upon applying the 2013 ACC/AHA guidelines, 97 FAW were categorized into one of the primary prevention groups. Women considered to benefit from a statin based on the guideline criteria but were not prescribed a statin were considered the not statin treated group (n = 55). From the original cohort, 93 FAW reported current statin therapy use and were categorized as statin treated. The clinical characteristics associated with not being statin treated were as follows: untreated blood pressure (P = 0.012), higher diastolic blood pressure (P = 0.015), higher total cholesterol (P < 0.001), higher triglycerides (P = 0.041), higher low-density lipoprotein (P < 0.001) and higher glucose (P = 0.011). The socio-economic factor associated with not being statin treated was having two or more insurance payers (P = 0.005). Overall, this population had a waist circumference and body mass index (BMI) that exceeds guidelines for Asian women (31.5 or 80 cm). WHAT IS NEW AND CONCLUSION Predictors of statin utilization in FAW are not well documented in the literature. These findings emphasize room for improvement for the prescribing of statins in primary prevention for this study population. Applying culturally appropriate screening strategies to identify cardiovascular risk factors early such as BMI or waist circumference may assist with quantifying patients into one of the statin benefit groups if eligible.
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Affiliation(s)
- Nancy Borja-Hart
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, The University of Tennessee Health Science Center, Nashville, Tennessee
| | - J Carolyn Graff
- Nursing Science Program, College of Nursing, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Vikki G Nolan
- School of Public Health, The University of Memphis, Memphis, Tennessee
| | - Jiajing Wang
- Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Rhonda M Cooper-DeHoff
- Division of Cardiovascular Medicine, Department of Pharmacotherapy and Translational Research, Colleges of Pharmacy and Medicine, University of Florida, Gainesville, Florida
| | - Irma B Ancheta
- Department of Medicine, University of Florida, Jacksonville, Florida
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23
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Quader ZS, Gazmararian JA, McCullough LE. Obesity and understudied minority children: existing challenges and opportunities in epidemiology. BMC Pediatr 2019; 19:103. [PMID: 30971202 PMCID: PMC6458765 DOI: 10.1186/s12887-019-1484-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 04/02/2019] [Indexed: 12/30/2022] Open
Abstract
Background Obesity is a major public health concern in the United States and should be addressed as early as possible, in childhood. Disparities exist in obesity prevalence and its associated comorbidities by racial/ethnic group, however less is known about the smaller racial/ethnic subclasses that are often aggregated and assumed to be homogeneously at risk. As the racial and ethnic composition of the US shifts towards greater diversity, it is important that epidemiologic research addresses these new challenges. Main body In this short communication, we focus on Asian American children given that subgroups are historically understudied and emerging evidence among adults suggest heterogeneous associations for both obesity and cardio-metabolic outcomes. Existing limitations in this research area include: (1) identifying the appropriate measurement of adiposity in Asian American children; (2) determining high-risk cutoffs for intervention; and (3) developing strategies to ensure study robustness. Conclusion Data disaggregation is a necessary approach to understand potentially heterogeneous associations in childhood obesity and cardio-metabolic risk, but epidemiologic investigators must address these challenges. Ultimately, successful strategies could help better identify high risk subgroups, target interventions, and effectively reduce the burden of obesity among American youth.
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Affiliation(s)
- Zerleen S Quader
- Department of Epidemiology, Emory University, CNR 3rd floor, 1518 Clifton Road, NE, Atlanta, GA, 30322, USA.
| | - Julie A Gazmararian
- Department of Epidemiology, Emory University, CNR 3rd floor, 1518 Clifton Road, NE, Atlanta, GA, 30322, USA
| | - Lauren E McCullough
- Department of Epidemiology, Emory University, CNR 3rd floor, 1518 Clifton Road, NE, Atlanta, GA, 30322, USA.,Winship Cancer Institute, Emory University, Atlanta, GA, USA
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A Study of Physical Activity Determinants among High-Risk Hypertensive Filipino and Korean Americans. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16071156. [PMID: 30935110 PMCID: PMC6479917 DOI: 10.3390/ijerph16071156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 03/27/2019] [Accepted: 03/27/2019] [Indexed: 01/24/2023]
Abstract
Physical activity (PA) serves a critical role in maintaining health and preventing chronic diseases, though its influence on high-risk Asian American populations is unclear. The purpose of this study was to determine PA levels among Filipino and Korean Americans at high risk of hypertension and to identify sociodemographic and health-related factors associated with PA levels in these populations. A cross-sectional survey was administered to 137 participants in the Greater Philadelphia Area. Data was collected on PA levels, sociodemographic factors, and health factors. Multinomial logistic regression was conducted to determine predictors associated with low, moderate, and high PA and predictive probabilities were calculated for interaction terms, incorporating ethnicity and blood pressure variables. Overall, 42.33% of participants belonged to the moderately active PA group and 21.90% belonged to the highly active group. In the final multinomial regression model, it was found that having gone to college increased the odds of being in the moderately active PA group (coef. = 1.96, p = 0.034), while having high blood pressure reduced the odds of being in the moderately active PA group (coef. = -2.21, p = 0.022). Lastly, being Korean versus Filipino reduced the odds of being in the highly active category (coef. = -2.89, p = 0.035). Based on predictive probabilities, Koreans and Filipinos with high blood pressure were more likely to belong in the low active PA category (52.31% and 46.33%). These findings highlight the need for culturally relevant PA interventions for promoting and increasing PA levels to prevent and manage hypertension among these populations.
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Mascarenhas M, Kulkarni M, Balen A. Can the ethnic differences in IVF cycle outcome be influenced by the impact of BMI? HUM FERTIL 2019; 23:275-281. [DOI: 10.1080/14647273.2018.1563915] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
| | - Mugdha Kulkarni
- Leeds Fertility, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Adam Balen
- Leeds Fertility, Leeds Teaching Hospital NHS Trust, Leeds, UK
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Bender MS, Cooper BA, Flowers E, Ma R, Arai S. Filipinos Fit and Trim - A feasible and efficacious DPP-based intervention trial. Contemp Clin Trials Commun 2018; 12:76-84. [PMID: 30294699 PMCID: PMC6170935 DOI: 10.1016/j.conctc.2018.09.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/29/2018] [Accepted: 09/18/2018] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Filipino Americans are at higher risk for obesity and related Type 2 diabetes (T2D) compared to other Asian subgroups and non-Hispanic whites. Yet, there are limited research studies to reduce health disparities and improve health outcomes for Filipinos. Weight loss lifestyle intervention trials such as the Diabetes Prevention Program (DPP) can reduce obesity and T2D risks through physical activity and healthy eating. METHODS Thus, we conducted a pilot Fit&Trim (DPP-based) intervention study - a randomized controlled trial 3-month intervention augmented with mobile technology + 3-month maintenance follow-up with a waitlist control. The objective assessed the intervention feasibility and potential efficacy to reduce T2D risks in Filipino Americans with overweight/obesity. The overall study goal was a mean 5% weight reduction. RESULTS Sixty-seven eligible Filipino men and women were enrolled and randomized to either an intervention or waitlist control group. Participant retention was 91%. In Phase 1 (baseline to 3-months), the intervention group had greater weight reduction compared to the waitlist control (-4.3% vs. -0.88%; cross-level interaction = -0.85 (-1.4, -0.35). In Phase 2 (3- to 6-months), after receiving the Fit&Trim intervention, the waitlist group also had similar significant weight reduction [-4.8% (- 0.75 (-0.92, -0.58)]. A majority of intervention group (57%) also maintained their weight loss. Overall, 41% of study participants achieved a 5% weight loss. CONCLUSION The Fit&Trim intervention demonstrated feasibility and potential efficacy for Filipino Americans. Findings warrant a further larger, longer trial to test the Fit&Trim feasibility and effectiveness in a real-world Filipino community setting. CLINICALTRIALSGOV REGISTRATION NUMBER NCT02278939.
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Key Words
- A1C, Glycated Hemoglobin
- Asian americans
- Asians, Asian Americans
- CDC, Center for Disease Control and Prevention
- COPD, chronic obstructive pulmonary disease
- CVD, cardiovascular disease
- Culturally adapted
- DPP, Diabetes Prevention Program
- Filipinos
- Filipinos, Filipino Americans
- Fit&Trim, a culturally tailored DPP-based mobile Health lifestyle intervention for Filipinos
- Healthy nutrition
- Lifestyle intervention
- Mobile technology
- OGTT, oral glucose tolerance test
- PA, physical activity
- Physical activity
- RCT, randomized controlled trial
- Randomized trial
- SBV, screening baseline visit
- SF, San Francisco
- SPSS, Statistical Package for Social Sciences
- T2D, Type 2 Diabetes
- Weight loss
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Affiliation(s)
- Melinda S. Bender
- Family Health Care Nursing Department, University of California San Francisco, School of Nursing, United States
| | - Bruce A. Cooper
- Office of Research & Department of Community Health System, University of California San Francisco, School of Nursing, United States
| | - Elena Flowers
- Department of Physiologic Nursing, University of California San Francisco, School of Nursing, United States
- Institute for Human Genetics, University of California San Francisco, School of Nursing, United States
| | - Raymond Ma
- Institute for Health and Aging, Univeresity of California San Francisco, School of Nursing, United States
| | - Shoshana Arai
- Family Health Care Nursing Department, University of California San Francisco, School of Nursing, United States
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Mui P, Hill SE, Thorpe RJ. Overweight and Obesity Differences Across Ethnically Diverse Subgroups of Asian American Men. Am J Mens Health 2018; 12:1958-1965. [PMID: 30095034 PMCID: PMC6199427 DOI: 10.1177/1557988318793259] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/08/2018] [Accepted: 07/11/2018] [Indexed: 11/16/2022] Open
Abstract
Asian Americans develop health complications at lower BMIs than other racial/ethnic groups. Given increasing overweight and obesity rates nationwide, growing numbers of Asian American men, and limited research on overweight and obesity in this population, understanding overweight and obesity differences across Asian subgroups of men is crucial to advancing health equity. This study examined overweight and obesity prevalence both among ethnic subgroups of Asian American men and compared to non-Hispanic White (NHW) men. Prevalence ratios were derived from 2002 to 2015 National Health Interview Survey data to determine associations between race/ethnicity and (a) overweight, and (b) obesity, across ( n = 221,376) racial/ethnic groups of men (Chinese; Filipino; Asian Indian; Other Asian; NHW). Overweight and obesity for all Asian subgroups were defined using Asian-specific BMI cut points. Adjusted overweight prevalence was higher across all Asian subgroups compared to NHW men, except Filipinos. No significant pairwise relationships were observed for overweight prevalence among Asian subgroups. Filipinos had higher adjusted obesity prevalence compared to NHW men. Comparing among Asian American men, Asian Indians and Other Asians had higher adjusted obesity prevalence relative to Chinese. Filipinos had higher adjusted obesity prevalence compared to all other Asian subgroups (Chinese; Asian Indian; Other Asian). The current findings highlight the need for use of (a) WHO-recommended Asian-specific BMI cut points and (b) data disaggregated by Asian American subgroup, to provide more accurate depictions of overweight and obesity rates and associated health risks. Accounting for subgroup differences is necessary to ensure Asian American men receive equitable, appropriate care.
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Affiliation(s)
- Paulani Mui
- Program for Research on Men’s Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sarah E. Hill
- Program for Research on Men’s Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Roland J. Thorpe
- Program for Research on Men’s Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Thomas A, Janusek L. Obesity Prevention Behaviors in Asian Indian Adolescent Girls: A Pilot Study. J Pediatr Nurs 2018; 42:9-15. [PMID: 30219305 DOI: 10.1016/j.pedn.2018.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/14/2018] [Accepted: 05/15/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE The purpose of this pilot study was to evaluate obesity prevention behaviors of Asian Indian adolescent females and determine the relationship of these behaviors to cardiovascular risk factors. DESIGN AND METHODS A purposive sample of twenty females, 14-18 years of age, was enrolled. Body mass index, percent body fat, waist circumference, and blood pressure were measured to assess cardiovascular risk. Measures of obesity prevention behaviors were physical activity, dietary and sleeping behaviors. To quantify engagement in physical activity, participants wore an accelerometer. The dietary intake was assessed using the web based SuperTracker. Pittsburgh Sleep Quality Index was used to assess sleep behaviors. For data analysis, descriptive statistics was used for demographic characteristics. Correlations were calculated to evaluate the relationship between cardiovascular risk factors and obesity prevention behaviors. RESULTS The majority of the adolescents did not meet recommended physical activity levels. Most reported unhealthy eating behaviors with higher saturated fat intake correlating with higher percent body fat. The cardiovascular risk measures fell below normative values. However, more time spent in sedentary behaviors was related to higher systolic blood pressure, while poor sleep quality was associated with higher diastolic blood pressure and greater BMI. CONCLUSIONS The findings support the unhealthy patterns of physical activity, dietary and sleep behaviors in Asian Adolescent girls and the need for promoting healthy behaviors in this at risk population. PRACTICE IMPLICATIONS The study findings provide a basis for education on healthy behaviors and development of culturally appropriate interventions to prevent obesity.
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Affiliation(s)
- Annie Thomas
- Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, IL, USA.
| | - Linda Janusek
- Marcella Niehoff School of Nursing, Loyola University Chicago, Maywood, IL, USA.
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LeCroy MN, Stevens J. Dietary intake and habits of South Asian immigrants living in Western countries. Nutr Rev 2018; 75:391-404. [PMID: 28591786 DOI: 10.1093/nutrit/nux023] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Previous reviews have indicated that immigration from South Asian to Western countries leads to unhealthy changes in diet; however, these reviews have been limited by the methods used in some included studies. This critical narrative review summarizes findings from original research articles that performed appropriate statistical analyses on diet data obtained using culturally appropriate diet assessment measures. All studies quantitatively compared the diets of South Asian immigrants with those of residents of Western or South Asian countries or with those of South Asian immigrants who had varying periods of time since immigration. Most studies examined total energy and nutrient intake among adults. Total energy intake tended to decrease with increasing duration of residence and immigrant generation, and immigrants consumed less protein and monounsaturated fat compared with Westerners. However, findings for intakes of carbohydrate, total fat, saturated fat, polyunsaturated fat, and micronutrients were mixed. Studies that examine food group intake and include South Asians living in South Asia as a comparison population are needed.
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Affiliation(s)
- Madison N LeCroy
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - June Stevens
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Sotos-Prieto M, Mattei J. Mediterranean Diet and Cardiometabolic Diseases in Racial/Ethnic Minority Populations in the United States. Nutrients 2018; 10:E352. [PMID: 29538339 PMCID: PMC5872770 DOI: 10.3390/nu10030352] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/25/2018] [Accepted: 03/06/2018] [Indexed: 01/02/2023] Open
Abstract
The Mediterranean diet (MedDiet) has been recommended to the general population by many scientific organizations as a healthy dietary pattern, based on strong evidence of association with improved cardiometabolic health, including lower risk of cardiovascular disease, diabetes, and obesity. However, most studies have been conducted in Mediterranean or European countries or among white populations in the United States (US), while few exist for non-Mediterranean countries or racial/ethnic minority populations in the US. Because most existing studies evaluating adherence to the MedDiet use population-specific definitions or scores, the reported associations may not necessarily apply to other racial/ethnic populations that may have different distributions of intake. Moreover, racial/ethnic groups may have diets that do not comprise the typical Mediterranean foods captured by these scores. Thus, there is a need to determine if similar positive effects from following a MedDiet are observed in diverse populations, as well as to identify culturally-relevant foods reflected within Mediterranean-like patterns, that can facilitate implementation and promotion of such among broader racial/ethnic groups. In this narrative review, we summarize and discuss the evidence from observational and intervention studies on the MedDiet and cardiometabolic diseases in racial/ethnic minority populations in the US, and offer recommendations to enhance research on MedDiet for such populations.
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Affiliation(s)
- Mercedes Sotos-Prieto
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
- Department of Food Sciences and Nutrition, School of Applied Health Sciences and Wellness, Ohio University, Athens, OH 45701, USA.
- Diabetes Institute, Ohio University, Athens, OH 45701, USA.
| | - Josiemer Mattei
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA.
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Felicilda-Reynaldo RF, Choi S. U.S. Filipino Adults' Patterns of CAM Use and Medical Pluralism: Secondary Analysis of 2012 National Health Interview Survey. Asian Pac Isl Nurs J 2018; 3:93-104. [PMID: 31037259 PMCID: PMC6482519 DOI: 10.31372/20180303.1003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The cultural health beliefs of the Filipino population and colonial history of medicine in the Philippines could mean high use of complementary and alternative therapies (CAM) and increased engagement in medical pluralism (i.e., combined use of conventional medicine and CAM) among the U.S. Filipino population, the fourth largest immigrant group in the United States. However, there is limited research regarding U.S. Filipinos’ health behaviors related to CAM use and medical pluralism engagement. The purpose of this study was to explore patterns of CAM use and medical pluralism practices of Filipino adults living in the United States. Data from Filipino adult respondents of the 2012 National Health Interview Survey adult CAM supplement were analyzed to determine most common CAM used, most common conditions for which CAM was used as a treatment, reasons for using CAM for treatment of health conditions, and sources of recommendations for CAM as a treatment in this population. Dietary supplements were the most common CAM used by Filipino adults living in the United States. A small number of U.S. Filipino adults reported using CAM to treat pain-related and cardiovascular conditions, with the most common source of recommendations coming from friends and family members. Most common reasons for using CAM for treatment of health condition were: CAM is natural; CAM had a holistic approach, and CAM could be taken/practiced independently. Based on the findings of the study, Filipino adults living in the United States engage in a pluralistic approach to health by using CAM for treatment of health conditions. Analysis of the 2012 NHIS adult CAM supplement provided an overview of Filipino adults’ patterns of CAM use and medical pluralism; however, future research is still needed to explain such health behavior patterns.
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Affiliation(s)
| | - Soyung Choi
- University of Hawaii, John A. Burns School of Medicine, Honolulu, Hawaii, USA
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Gadgil MD, Oza-Frank R, Kandula NR, Kanaya AM. Type 2 diabetes after gestational diabetes mellitus in South Asian women in the United States. Diabetes Metab Res Rev 2017; 33:10.1002/dmrr.2891. [PMID: 28224756 PMCID: PMC5495618 DOI: 10.1002/dmrr.2891] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 02/09/2017] [Accepted: 02/10/2017] [Indexed: 12/30/2022]
Abstract
AIMS Gestational diabetes mellitus (GDM) is a major risk factor for type 2 diabetes. The incidence of both GDM and type 2 diabetes is exceedingly high in South Asian populations. However, the risk of type 2 diabetes after GDM in South Asian women in the United States is unknown. METHODS South Asians aged 40 to 84 years without known cardiovascular disease were enrolled in a community-based cohort called Mediators of Atherosclerosis in South Asians Living in America study. A history of GDM was elicited through self-report, and type 2 diabetes was ascertained by an oral glucose tolerance test. We performed a multivariable logistic regression analysis to examine the odds of type 2 diabetes after GDM history in this cross-sectional analysis. RESULTS About 9.7% of women in the Mediators of Atherosclerosis in South Asians Living in America study self-reported a history of GDM, and were significantly younger, with higher mean diastolic blood pressure and self-reported weight at age 20 and 40 years than women without a history of GDM. In a model adjusted for age, weight at age 40, family history of diabetes, education, income, physical activity, caloric intake, alcohol use, and cigarette smoking, women with a history of GDM had increased odds of having type 2 diabetes compared with women without GDM (OR 3.2; 95% CI 1.3, 7.5). CONCLUSIONS A history of GDM further increases the risk of type 2 diabetes in US South Asian women. Our findings underscore the importance of early postpartum screening in a population at high risk for type 2 diabetes.
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Affiliation(s)
- Meghana D. Gadgil
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Reena Oza-Frank
- Center for Perinatal Research, Research Institute at Nationwide Children's Hospital, Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Namratha R. Kandula
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alka M. Kanaya
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA, USA
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Suzuki A, Choi SY, Lim E, Tauyan S, Banna JC. Evaluation of Factorial Validity and Reliability of a Food Behavior Checklist for Low-Income Filipinos. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2017; 49:593-598.e1. [PMID: 28689613 PMCID: PMC5612474 DOI: 10.1016/j.jneb.2017.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 04/25/2017] [Accepted: 04/26/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To examine factorial validity, test-retest reliability, and internal consistency of a Tagalog-language food behavior checklist (FBC) for a low-income Filipino population. METHODS Participants (n = 160) completed the FBC on 2 occasions 3 weeks apart. Factor structure was examined using principal component analysis. For internal consistency, Cronbach α was calculated. For test-retest reliability, Spearman correlation or intraclass correlation coefficient (ICC) was calculated between scores at the 2 points. RESULTS All but 1 item loaded on 6 factors: fruit and vegetable quantity, fruit and vegetable variety, fast food, sweetened beverage, healthy fat, and diet quality. Cronbach α was .75 for the total scale (range, .39-.76 for subscales). Spearman correlation was 0.78 (ICC, 0.79) for the total scale (range, 0.66-0.80 [ICC, 0.68-0.80] for subscales). CONCLUSIONS AND IMPLICATIONS The FBC demonstrated adequate factorial validity, test-retest reliability, and internal consistency. With additional testing, the FBC may be used to evaluate the US Department of Agriculture's nutrition education programs for Tagalog speakers.
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Affiliation(s)
- Asuka Suzuki
- Department of Human Nutrition, Food, and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawaii at Manoa, Honolulu, HI
| | - So Yung Choi
- Biostatistics Core Facility, Department of Complementary & Integrative Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI
| | - Eunjung Lim
- Biostatistics Core Facility, Department of Complementary & Integrative Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI
| | - Socorro Tauyan
- Department of Human Nutrition, Food, and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawaii at Manoa, Honolulu, HI
| | - Jinan C Banna
- Department of Human Nutrition, Food, and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawaii at Manoa, Honolulu, HI.
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Content analysis of targeted food and beverage advertisements in a Chinese-American neighbourhood. Public Health Nutr 2017; 20:2208-2214. [PMID: 28587693 DOI: 10.1017/s1368980017001070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The current descriptive study aimed to: (i) quantify the number and type of advertisements (ads) located in a Chinese-American neighbourhood in a large, urban city; and (ii) catalogue the targeted marketing themes used in the food/beverage ads. DESIGN Ten pairs of trained research assistants photographed all outdoor ads in a 0·6 mile2 (1·6 km2) area where more than 60·0 % of residents identify as Chinese American. We used content analysis to assess the marketing themes of ads, including references to: Asian cultures; health; various languages; children; food or beverage type (e.g. sugar-sweetened soda). SETTING Lower East Side, a neighbourhood located in the borough of Manhattan in New York City, USA. SUBJECTS Ads (n 1366) in the designated neighbourhood. RESULTS Food/beverage ads were the largest ad category (29·7 %, n 407), followed by services (e.g. mobile phone services; 21·0 %, n 288). Sixty-seven per cent (66·9 %) of beverages featured were sugar-sweetened, and 50·8 % of food ads promoted fast food. Fifty-five per cent (54·9 %) of food/beverage ads targeted Asian Americans through language, ethnicity of person(s) in the ad or inclusion of culturally relevant images. Fifty per cent (50·2 %) of ads were associated with local/small brands. CONCLUSIONS Food/beverage marketing practices are known to promote unhealthy food and beverage products. Research shows that increased exposure leads to excessive short-term consumption among consumers and influences children's food preferences and purchase requests. Given the frequency of racially targeted ads for unhealthy products in the current study and increasing rates of obesity-related diseases among Asian Americans, research and policies should address the implications of food and beverage ads on health.
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Yu Y, Zheng G. Troxerutin protects against diabetic cardiomyopathy through NF‑κB/AKT/IRS1 in a rat model of type 2 diabetes. Mol Med Rep 2017; 15:3473-3478. [PMID: 28440404 PMCID: PMC5436284 DOI: 10.3892/mmr.2017.6456] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 12/09/2016] [Indexed: 12/13/2022] Open
Abstract
Troxerutin is a bioflavonoid, which can be used to treat venous disorders, thrombosis and cerebrovascular diseases. Recent studies have demonstrated that it may also be used to prevent edemas. However, it is not known whether troxerutin protects against the cardiomyopathic complications of diabetes. In the present study, a rat model of type 2 diabetes was used to investigate the potential for troxerutin to protect against diabetic cardiomyopathy, through changes to nuclear factor‑κB (NF‑κB) expression. Troxerutin administration significantly reduced heart rate, blood pressure, blood glucose and plasma triglyceride levels across all measured time points. Furthermore, troxerutin significantly reduced reactive oxygen species levels, NF‑κB protein expression, and suppressed the phosphorylated forms of AKT, insulin receptor substrate 1 (IRS1) and c‑Jun N‑terminal kinase (JNK). These results suggested that troxerutin protects against cardiomyopathy via alterations in NF‑κB, AKT and IRS1 signaling, in a rat model of type 2 diabetes.
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Affiliation(s)
- Yongzhi Yu
- Department of Cardiology, Linzi District People's Hospital, Zibo, Shandong 255400, P.R. China
| | - Guanzhong Zheng
- Department of Cardiology, Linzi District People's Hospital, Zibo, Shandong 255400, P.R. China
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Mirmiran P, Ghorbani Z, Hosseini-Esfahani F. A Narrative Review of Obesity and Its Associated Complications in Iranian Women. WOMEN’S HEALTH BULLETIN 2017. [DOI: 10.17795/whb-40546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Raza Q, Snijder MB, Seidell JC, Peters RJG, Nicolaou M. Comparison of cardiovascular risk factors and dietary intakes among Javanese Surinamese and South-Asian Surinamese in the Netherlands. The HELIUS study. BMC Res Notes 2017; 10:23. [PMID: 28061789 PMCID: PMC5219699 DOI: 10.1186/s13104-016-2352-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 12/17/2016] [Indexed: 11/24/2022] Open
Abstract
Background Ethnic differences regarding the percent of non-communicable diseases have been shown in Asia but the studies on Asian subgroups living in the western countries regarding percent of cardiovascular risk factors and dietary intakes have been scarce. Therefore we compared the percent of cardiovascular risk factors and dietary intakes between Javanese Surinamese who are originally from Indonesia and South-Asian Surinamese who are originally from India. Methods Cross-sectional baseline data of the HELIUS (Healthy Life in an Urban Setting) study were used, including data of 2935 Surinamese participants (197 of Javanese and 2738 of South-Asian origin) out of which 1160 participants (78 Javanese and 1082 South-Asian) additionally reported dietary intake data. Descriptive statistics were used to compare the two ethnic groups regarding cardiovascular disease, diabetes, obesity, hypertension and hypercholesterolemia; in addition, dietary intake of foods like vegetables, red meat, fruit, high fibre foods, low fibre foods, high fat and low fat dairy products, chicken and sugar sweetened beverages were also compared between the two groups. Binary logistic regression analyses were used to adjust for age and sex when comparing the two groups. Results South-Asian Surinamese had a significantly higher percent of abdominal obesity (OR 2.44; CI 1.66–3.57), cardiovascular disease (OR 2.55; CI 1.48–4.35) and diabetes (OR 2.77; CI 1.67–4.60) as compared with Javanese Surinamese after adjustment for age and sex. The percent of obesity (BMI), hypertension, and lipids was not significantly different between the ethnic groups. Javanese Surinamese had a significantly higher intake of red meat and a significantly lower intake of dairy products as compared with South-Asian Surinamese. Intakes of vegetables, grains, fish, fruits, tea and coffee did not significantly differ between the ethnic groups. Both groups showed intake of considerable amount of sugar sweetened beverages. Conclusions Public health practitioners in the Netherlands and elsewhere in the world should take into account the ethnic subgroup differences within the broader groups like Asians when developing interventions related to health among ethnic minorities.
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Affiliation(s)
- Qaisar Raza
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, De Boelelaan 1085, Kamer O534, 1081 HV, Amsterdam, The Netherlands.
| | - Marieke B Snijder
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Jacob C Seidell
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, De Boelelaan 1085, Kamer O534, 1081 HV, Amsterdam, The Netherlands
| | - Ron J G Peters
- Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Mary Nicolaou
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Fuller-Thomson E, Roy A, Tsz-Kit Chan K, Kobayashi KM. Diabetes among non-obese Filipino Americans: Findings from a large population-based study. Canadian Journal of Public Health 2017; 108:e36-e42. [PMID: 31820422 DOI: 10.17269/cjph.108.5761] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 11/24/2016] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Filipino Americans form the second-largest Asian American and Pacific Islanders subgroup. Growing evidence suggests that Filipino Americans have higher rates of diabetes than non-Hispanic whites. The key objectives of this study are 1) to determine the prevalence of diabetes in non-obese Filipino Americans compared to non-obese non-Hispanic whites, and 2) to identify risk factors for diabetes in non-obese Filipino men and women. METHODS Secondary analysis of population-based data from combined waves (2007, 2009 and 2011) of the adult California Health Interview Survey (CHIS). The study sample was restricted to non-obese Filipino Americans (n = 1629) and non-Hispanic whites (n = 72 072). RESULTS Non-obese Filipino Americans had more than twice the odds of diabetes compared to non-Hispanic whites, even after correcting for several known risk factors (OR = 2.80, p < 0.001). For non-obese Filipino men, older age, poverty, cigarette smoking, and being overweight are associated with increased odds for diabetes, while older age was the only factor associated with diabetes among Filipina women. DISCUSSION Diabetes prevention approaches need to be targeted towards non-obese Filipino Americans, due to their high risk of diabetes.
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Affiliation(s)
- Esme Fuller-Thomson
- Faculties of Social Work & Medicine, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada. .,Institute for Life Course and Aging, University of Toronto, Toronto, ON, Canada.
| | - Adity Roy
- Institute for Life Course and Aging, University of Toronto, Toronto, ON, Canada
| | | | - Karen M Kobayashi
- Department of Sociology and Institute on Aging and Lifelong Health, University of Victoria, Victoria, BC, Canada
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Klatsky AL, Zhang J, Udaltsova N, Li Y, Tran HN. Body Mass Index and Mortality in a Very Large Cohort: Is It Really Healthier to Be Overweight? Perm J 2017; 21:16-142. [PMID: 28678695 PMCID: PMC5499607 DOI: 10.7812/tpp/16-142] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
CONTEXT Controversy persists about optimal body weight. Many experts define "normal" (healthy) body mass index (BMI) as 18.5 to 24.9 kg/m2, 25 to 29.9 kg/m2 as overweight, and 30 kg/m2 or greater as obese. Obesity is subdivided into 30 to 34.9 kg/m2 (Grade 1), 35 to 39.9 kg/m2 (Grade 2), and 40 kg/m2 and above (Grade 3). Studies consistently show higher mortality for underweight and Grade 2 or 3 obesity, but results conflict for the overweight category and Grade 1 obesity. OBJECTIVE To study 30-year risk of death related to baseline BMI. DESIGN Retrospective cohort study in a multiracial population of 273,843 persons using logistic regression with 7 covariates (sex, age, race-ethnicity, education, marital status, smoking, alcohol intake). MAIN OUTCOME MEASURES Mortality risk by baseline BMI. RESULTS With average follow-up exceeding 30 years, there were 103,218 deaths: 41,215 attributed to cardiovascular causes and 62,003 to noncardiovascular causes. Odds ratios (and 95% confidence intervals) for all deaths in BMI categories, with a BMI of 18.5 to 24.9 kg/m2 as the referent, were BMI below 18.5 kg/m2 = 1.1 (1.0-2.0), BMI 25 to 29 kg/m2 = 1.1 (1.1-1.2), BMI 30 to 34 kg/m2 = 1.5 (1.4-1.5), BMI 35 to 39 kg/m2 = 2.1 (1.9-2.3), and BMI 40 kg/m2 or higher = 2.7 (2.4-3.0). Disparities existed regarding age, race/ethnicity, cause of death, and interval to death. CONCLUSION Compared with persons with BMI defined as normal, persons who were underweight, overweight, and obese were at increased risk of death over 30 years.
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Affiliation(s)
- Arthur L Klatsky
- Senior Consultant in Cardiology and an Adjunct Investigator in the Division of Research, Kaiser Permanente Medical Care Program in Oakland, CA.
| | | | | | - Yan Li
- Hematologist and Oncologist at the Oakland Medical Center in CA.
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Yoon YS, Choi HS, Kim JK, Kim YI, Oh SW. Differences in the associations of anthropometric measures with insulin resistance and type 2 diabetes mellitus between Korean and US populations: Comparisons of representative nationwide sample data. Obes Res Clin Pract 2016; 10:642-651. [PMID: 26750428 DOI: 10.1016/j.orcp.2015.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 10/15/2015] [Accepted: 11/02/2015] [Indexed: 01/16/2023]
Abstract
BACKGROUNDS Variation among ethnic groups in the association between obesity and insulin resistance (IR)/diabetes has been suggested, but studies reported inconsistent results. We evaluated ethnic differences in the association between obesity and insulin resistance (IR)/diabetes. METHODS We conducted a cross-sectional analysis using Korea (n=18,845) and the USA (n=4657) National Health and Nutrition Examination Survey(NHANES) 2007-2010. We performed statistical comparisons of AUC-ROC (area under the curve in a receiver operating characteristic curve) values for body mass index (BMI), waist circumference (WC) and homeostasis model assessment of insulin resistance (HOMA-IR) to predict IR or diabetes among different ethnic groups. RESULTS AUC-ROC values for BMI and WC for predicting IR were highest in Whites (0.8324 and 0.8468) and lowest in Koreans (0.7422 and 0.7367). Whites showed the highest AUC-ROC values for BMI (0.6869) and WC (0.7421) for predicting diabetes, while the AUC-ROC for HOMA-IR was highest in Koreans (0.8861). Linear regression showed significant interactions between ethnicity and the main effects (all P<0.0001). Increases in BMI were associated with a larger increase in HOMA-IR in Whites (β=0.0719) and WC in Hispanics (β=0.0324), while BMI was associated with a larger increase in fasting glucose in Koreans (β=0.8279) and WC in Blacks (β=0.4037). In addition, the slope for fasting glucose with increasing HOMA-IR was steeper in Koreans (β=16.5952, P<0.001) than in other groups. CONCLUSION The ability of BMI and WC to predict IR and diabetes was highest in Whites, while the ability of HOMA-IR to predict diabetes was highest in Koreans.
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Affiliation(s)
- Yeong Sook Yoon
- Department of Family Medicine, Inje University Ilsan Paik Hospital, Goyang-Si, Gyeonggi-Do, South Korea
| | - Han Seok Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang-Si, Gyeonggi-Do, South Korea
| | - Jin Kuk Kim
- Department of Neurosurgery, Seoul Na Eun Hospital, Seoul, South Korea; Department of Family Medicine, Center for Obesity, Metabolism and Nutrition, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang-Si, Gyeonggi-Do, South Korea
| | - Yu Il Kim
- Department of Family Medicine, Center for Obesity, Metabolism and Nutrition, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang-Si, Gyeonggi-Do, South Korea
| | - Sang Woo Oh
- Department of Family Medicine, Center for Obesity, Metabolism and Nutrition, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang-Si, Gyeonggi-Do, South Korea; Channelopathy Research Center, Dongguk University College of Medicine, Goyang-Si, Gyeonggi-Do, South Korea.
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Maskarinec G, Morimoto Y, Jacobs S, Grandinetti A, Mau MK, Kolonel LN. Ethnic admixture affects diabetes risk in native Hawaiians: the Multiethnic Cohort. Eur J Clin Nutr 2016; 70:1022-7. [PMID: 27026423 PMCID: PMC5014576 DOI: 10.1038/ejcn.2016.32] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 12/11/2015] [Accepted: 01/17/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND/OBJECTIVES Obesity and diabetes rates are high in Native Hawaiians (NHs) who commonly have mixed ancestries. People of Asian ancestry experience a high risk of type 2 diabetes despite the relatively low body weight. We evaluated the impact of ethnic admixture on diabetes risk among NHs in the Multiethnic Cohort (MEC). SUBJECTS/METHODS On the basis of self-reports, 11 521 eligible men and women were categorized into NH/white, NH/other, NH alone, NH/Asian and the most common three ancestry admixture, NH/Chinese/white. Cox proportional hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated with the NH/white category as the reference group; covariates included known confounders-that is, body mass index (BMI), dietary and other lifestyle factors. RESULTS The NH alone category had the highest proportion of overweight and obese individuals and the NH/Asian category the lowest proportion. During 12 years of follow-up after cohort entry at 56 years, 2072 incident cases were ascertained through questionnaires and health plan linkages. All NH categories had higher HRs than the NH/white category before and after adjustment for BMI. In the fully adjusted models, the NH/Asian category showed the highest risk (HR=1.45; 95% CI: 1.27-1.65), followed by NH/other (HR=1.20; 95% CI: 1.03-1.39), NH/Chinese/white (HR=1.19; 95% CI: 1.04-1.37) and NH alone (HR=1.19; 95% CI: 1.03-1.37). The elevated risk by Asian admixture was more pronounced in normal weight than overweight/obese individuals. CONCLUSIONS These findings indicate that Asian admixture in NHs is associated with a higher risk for type 2 diabetes independent of known risk factors and suggest a role for ethnicity-related genetic factors in the development of this disease.
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Affiliation(s)
| | | | - Simone Jacobs
- German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany
| | | | - Marjorie K. Mau
- Department of Native Hawaiian Health, JABSOM, University of Hawaii, Honolulu, HI
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Mui P, Bowie JV, Juon HS, Thorpe RJ. Ethnic Group Differences in Health Outcomes Among Asian American Men in California. Am J Mens Health 2016; 11:1406-1414. [PMID: 27530820 DOI: 10.1177/1557988316664508] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The numbers of Asian American men are continually increasing, yet limited research exists on this understudied population. Addressing this lack of research is necessary to better inform how best to improve quality of care. This study examined health outcome differences across ethnically diverse groups of Asian American men in California, compared with non-Hispanic White men. Using data from the 2007, 2009, and 2011-2012 California Health Interview Survey, distributions of health status and health-related characteristics across ( n = 43,030) racial/ethnic groups of men (Chinese, Japanese, Korean, Filipino, Vietnamese, Other Asian Americans, and non-Hispanic Whites) were calculated. Compared with non-Hispanic Whites, odds of reporting fair or poor health were higher among Vietnamese, while odds of diabetes were higher among Korean, Filipino, and Other Asian Americans. Odds of high blood pressure were higher among Filipino and Vietnamese but lower among Other Asian Americans, while odds of disability were lower across all ethnic groups except Filipino and Vietnamese. This study's findings highlight the importance of understanding ethnic heterogeneity to develop culturally appropriate health interventions for Asian American men.
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Affiliation(s)
- Paulani Mui
- 1 Johns Hopkins University, Baltimore, MD, USA
| | | | - Hee-Soon Juon
- 1 Johns Hopkins University, Baltimore, MD, USA.,2 Thomas Jefferson University, Philadelphia, PA, USA
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Cook WK, Tseng W, Bautista R, John I. Ethnicity, socioeconomic status, and overweight in Asian American adolescents. Prev Med Rep 2016; 4:233-7. [PMID: 27413687 PMCID: PMC4929066 DOI: 10.1016/j.pmedr.2016.06.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 04/28/2016] [Accepted: 06/06/2016] [Indexed: 11/18/2022] Open
Abstract
Asian American children and adolescents are an under-investigated subpopulation in obesity research. This study aimed to identify specific profiles of Asian subgroups at high risk of adolescent overweight with special attention to Asian ethnicity, socioeconomic status (SES), and their interaction. Multiple logistic regression models were fitted using a sample of 1533 Asian American adolescents ages 12–17 from the 2007–2012 California Health Interview Survey (CHIS). In addition to Asian ethnicity and socioeconomic status (assessed by family income and parental education level), age, gender, nativity, and two lifestyle variables, fast food consumption and physical activity, were also controlled for in these models. Key predictors of overweight in Asian American adolescents included certain Asian ethnicities (Southeast Asian, Filipino, and mixed ethnicities), low family income (< 300% of the Federal Poverty Level), and being male. Multiplicative interaction terms between low family income and two ethnicities, Southeast Asian and Vietnamese that had the lowest SES among Asian ethnic groups, were significantly associated with greatly elevated odds of being overweight (ORs = 12.90 and 6.67, respectively). These findings suggest that high risk of overweight in Asian American adolescents associated with low family incomes may be further elevated for those in low-income ethnic groups. Future research might investigate ethnic-group SES as a meaningful indicator of community-level socioeconomic disparities that influence the health of Asian Americans. Southeast Asian and Filipino ethnicities were associated with adolescent overweight. Low family income was positively associated with Asian adolescent overweight. Ethnicity and low family income interacted to increase risk of adolescent overweight.
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Affiliation(s)
- Won Kim Cook
- Asian & Pacific Islander American Health Forum, United States
- Corresponding author.
| | | | | | - Iyanrick John
- Asian & Pacific Islander American Health Forum, United States
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Banna JC, Buchthal OV, Tauyan S. Assessing Face Validity of a Food Behavior Checklist for Limited-resource Filipinos. HAWAI'I JOURNAL OF MEDICINE & PUBLIC HEALTH : A JOURNAL OF ASIA PACIFIC MEDICINE & PUBLIC HEALTH 2015; 74:334-40. [PMID: 26535163 PMCID: PMC4610259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Diet-related chronic health conditions are prevalent in the Filipino American community; however, there is a lack of rigorously validated nutrition education evaluation tools in Tagalog for use in this population. This study aimed to develop and evaluate the face validity of a Tagalog-language food behavior checklist (FBC). A multi-step method was used, involving translation of questionnaire text from English to Tagalog by a team of professionals, creation of accompanying color photographs, cognitive testing with the target population, final review by the team of professionals, and assessment of readability. Subjects for cognitive testing were men (n=6) and women (n=14) 18 years or older in Hawai'i who received or were eligible to receive Supplemental Nutrition Assistance Program (SNAP) benefits, self-identified as Filipino, and preferred Tagalog rather than English. Participants were recruited from churches, the Filipino Center, and other community sites. Cognitive interviews revealed several issues with text and photographs, such as preferences for specific terms, and images that did not adequately illustrate the text. Image changes were made to reflect items most commonly consumed. The team of professionals agreed with participant suggestions. Assessment of readability revealed a reading level appropriate for a low-literacy population of grade 5.9. The multi-step process, which allowed members of the target audience to reveal the appropriateness of the questionnaire, yielded a Tagalog-language FBC found to have adequate face validity. After further evaluation of validity and reliability, this tool may be used to evaluate behavior change resulting from the United States Department of Agriculture's (USDA) nutrition education programs.
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Affiliation(s)
- Jinan C Banna
- Department of Human Nutrition, Food, and Animal Sciences, University of Hawai'i at Manoa, Honolulu, HI (JCB, ST)
| | - Opal Vanessa Buchthal
- Department of Human Nutrition, Food, and Animal Sciences, University of Hawai'i at Manoa, Honolulu, HI (JCB, ST)
| | - Socorro Tauyan
- Department of Human Nutrition, Food, and Animal Sciences, University of Hawai'i at Manoa, Honolulu, HI (JCB, ST)
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Khan KM, Windt A, Davis JC, Dawes M, Liu-Ambrose T, Madden K, Marra CA, Housden L, Hoppmann C, Adams DJ. Group Medical Visits (GMVs) in primary care: an RCT of group-based versus individual appointments to reduce HbA1c in older people. BMJ Open 2015; 5:e007441. [PMID: 26169803 PMCID: PMC4513482 DOI: 10.1136/bmjopen-2014-007441] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 06/05/2015] [Accepted: 06/13/2015] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Type 2 diabetes mellitus (T2DM) affects more than 1.1 million Canadians aged ≥65 years. Group Medical Visits are an emerging health service delivery method. Recent systematic reviews show that they can significantly reduce glycated haemoglobin (HbA1c) levels, but Group Visits have not been evaluated within primary care. We intend to determine the clinical effectiveness, quality of life and economic implications of Group Medical Visits within a primary care setting for older people with T2DM. METHODS AND ANALYSIS A 2-year proof-of-concept, single-blinded (measurement team) randomised control trial to test the efficacy of Group Medical Visits in an urban Canadian primary care setting. Participants ≥65 years old with T2DM (N=128) will be equally randomised to either eight groups of eight patients each (Group Medical Visits; Intervention) or to Individual visits (Standard Care; Controls). Those administering cointerventions are not blinded to group assignment. Our sample size is based on estimates of variance (±1.4% for HbA1c) and effect size (0.9/1.4=0.6) from the literature and from our own preliminary data. Forty participants per group will provide a β likelihood of 0.80, assuming an α of 0.05. A conservative estimation of an effect size of 0.7/1.4 changes the N in the power calculation to 59 per group. Hence, we aim to enrol 64 participants in each study arm. We will use intention-to-treat analysis and compare mean HbA1c (% glycosylated HbA1c) (primary outcome) of Intervention/Control participants at 12 months, 24 months and 1 year postintervention on selected clinical, patient-rated and economic measures. TRIAL REGISTRATION NUMBER NCT02002143.
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Affiliation(s)
- Karim M Khan
- Centre for Mobility and Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adriaan Windt
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer C Davis
- Department of Population & Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Martin Dawes
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Teresa Liu-Ambrose
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ken Madden
- Department of Medicine (Geriatric Medicine), University of British Columbia, Vancouver, British Columbia, Canada
| | - Carlo A Marra
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Laura Housden
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christiane Hoppmann
- Psychology Department, University of British Columbia, Vancouver, British Columbia, Canada
| | - David J Adams
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
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Nie SP, Chen H, Zhuang MQ, Lu M. Anti-diabetic medications do not influence risk of lung cancer in patients with diabetes mellitus: a systematic review and meta-analysis. Asian Pac J Cancer Prev 2015; 15:6863-9. [PMID: 25169538 DOI: 10.7314/apjcp.2014.15.16.6863] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Several preclinical and observational studies have shown that anti-diabetic medications (ADMs) may modify the risk of lung cancer. We performed a systematic review and meta-analysis evaluating the effect of metformin, sulfonylureas (SUs), thiazolidinediones (TZDs), and insulin on the risk of lung cancer in patients with diabetes mellitus (DM). MATERIALS AND METHODS We conducted a systematic search of Pubmed and Web of Science, up to August 20, 2013. We also searched the Conference Proceedings Citation Index (CPCI) and China National Knowledge Infrastructure (CNKI) for abstracts from major meetings. Fixed or random effect pooled measures were selected based on heterogeneity among studies, which was evaluated using Q test and the I2 of Higgins and Thompson. Meta-regression was used to explore the sources of between-study heterogeneity. Publication bias was analyzed by Begg's funnel plot and Egger's regression test. Associations were assessed by odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS A total of 15 studies (11 cohort, 4 case-control) were included in this meta-analysis. In observational studies no significant association between metformin (n=11 studies; adjusted OR=0.99, 95%CI: 0.87-1.12), SUs (n=5 studies; adjusted OR=0.98, 95%CI: 0.79-1.22), or TZDs (n=7 studies; adjusted OR=0.92, 95%CI: 0.75-1.13), insulin (n=6 studies; adjusted OR=1.13, 95%CI: 0.79-1.62) use and risk of developing lung cancer was noted. There was considerable inherent heterogeneity between studies not explained by study design, setting, or location. CONCLUSIONS Meta-analysis of existing studies does not support a protective or harmful association between ADMs use and risk of lung cancer in patients with DM. There was considerable heterogeneity across studies, and future, well-designed, prospective studies would be required for better understanding of any association.
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Affiliation(s)
- Shu-Ping Nie
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, China E-mail :
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Gadgil MD, Anderson CAM, Kandula NR, Kanaya AM. Dietary patterns are associated with metabolic risk factors in South Asians living in the United States. J Nutr 2015; 145:1211-7. [PMID: 25904730 PMCID: PMC4442115 DOI: 10.3945/jn.114.207753] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 03/23/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND South Asians are at high risk of metabolic syndrome, and dietary patterns may influence this risk. OBJECTIVES We aimed to determine prevalent dietary patterns for South Asians in the United States and their associations with risk factors for metabolic syndrome. METHODS South Asians aged 40-84 y without known cardiovascular disease were enrolled in a community-based cohort called Mediators of Atherosclerosis in South Asians Living in America. A validated food frequency questionnaire and serum samples for fasting and 2-h glucose, insulin, glycated hemoglobin, triglycerides, and total and HDL cholesterol were collected cross-sectionally. We used principal component analysis with varimax rotation to determine dietary patterns, and sequential linear and logistic regression models for associations with metabolic factors. RESULTS A total of 892 participants were included (47% women). We identified 3 major dietary patterns: animal protein; fried snacks, sweets, and high-fat dairy; and fruits, vegetables, nuts, and legumes. These were analyzed by tertile of factor score. The highest vs. the lowest tertile of the fried snacks, sweets, and high-fat dairy pattern was associated with higher homeostasis model assessment of insulin resistance (HOMA-IR) (β: 1.88 mmol/L ⋅ uIU/L) and lower HDL cholesterol (β: -4.48 mg/dL) in a model adjusted for age, sex, study site, and caloric intake (P < 0.05). The animal protein pattern was associated with higher body mass index (β: 0.73 m/kg(2)), waist circumference (β: 0.84 cm), total cholesterol (β: 8.16 mg/dL), and LDL cholesterol (β: 5.69 mg/dL) (all P < 0.05). The fruits, vegetables, nuts, and legumes pattern was associated with lower odds of hypertension (OR: 0.63) and metabolic syndrome (OR: 0.53), and lower HOMA-IR (β: 1.95 mmol/L ⋅ uIU/L) (P < 0.05). CONCLUSIONS The animal protein and the fried snacks, sweets, and high-fat dairy patterns were associated with adverse metabolic risk factors in South Asians in the United States, whereas the fruits, vegetables, nuts, and legumes pattern was linked with a decreased prevalence of hypertension and metabolic syndrome.
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Affiliation(s)
- Meghana D Gadgil
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA;
| | - Cheryl AM Anderson
- Division of Preventive Medicine, Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA; and
| | - Namratha R Kandula
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alka M Kanaya
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA
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Araneta MRG, Kanaya AM, Hsu WC, Chang HK, Grandinetti A, Boyko EJ, Hayashi T, Kahn SE, Leonetti DL, McNeely MJ, Onishi Y, Sato KK, Fujimoto WY. Optimum BMI cut points to screen asian americans for type 2 diabetes. Diabetes Care 2015; 38:814-20. [PMID: 25665815 PMCID: PMC4407753 DOI: 10.2337/dc14-2071] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 01/11/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Asian Americans manifest type 2 diabetes at low BMI levels but may not undergo diagnostic testing for diabetes if the currently recommended BMI screening cut point of ≥25 kg/m(2) is followed. We aimed to ascertain an appropriate lower BMI cut point among Asian-American adults without a prior diabetes diagnosis. RESEARCH DESIGN AND METHODS We consolidated data from 1,663 participants, ages ≥45 years, without a prior diabetes diagnosis, from population- and community-based studies, including the Mediators of Atherosclerosis in South Asians Living in America study, the North Kohala Study, the Seattle Japanese American Community Diabetes Study, and the University of California San Diego Filipino Health Study. Clinical measures included a 2-h 75-g oral glucose tolerance test, BMI, and glycosylated hemoglobin (HbA1c). RESULTS Mean age was 59.7 years, mean BMI was 25.4 kg/m(2), 58% were women, and type 2 diabetes prevalence (American Diabetes Association 2010 criteria) was 16.9%. At BMI ≥25 kg/m(2), sensitivity (63.7%), specificity (52.8%), and Youden index (0.16) values were low; limiting screening to BMI ≥25 kg/m(2) would miss 36% of Asian Americans with type 2 diabetes. For screening purposes, higher sensitivity is desirable to minimize missing cases, especially if the diagnostic test is relatively simple and inexpensive. At BMI ≥23 kg/m(2), sensitivity (84.7%) was high in the total sample and by sex and Asian-American subgroup and would miss only ∼15% of Asian Americans with diabetes. CONCLUSIONS The BMI cut point for identifying Asian Americans who should be screened for undiagnosed type 2 diabetes should be <25 kg/m(2), and ≥23 kg/m(2) may be the most practical.
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Affiliation(s)
- Maria Rosario G Araneta
- Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA
| | - Alka M Kanaya
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - William C Hsu
- Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | | | | | - Edward J Boyko
- Seattle Epidemiologic Research and Information Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA Department of Medicine, Veterans Affairs Puget Sound Health Care System, Seattle, WA Department of Medicine, University of Washington, Seattle, WA
| | - Tomoshige Hayashi
- Department of Preventive Medicine and Environmental Health, Osaka City University, Graduate School of Medicine, Osaka, Japan
| | - Steven E Kahn
- Department of Medicine, Veterans Affairs Puget Sound Health Care System, Seattle, WA Department of Medicine, University of Washington, Seattle, WA
| | - Donna L Leonetti
- Department of Anthropology, University of Washington, Seattle, WA
| | | | - Yukiko Onishi
- The Institute for Adult Diseases, Asahi Life Foundation, Tokyo, Japan
| | - Kyoko K Sato
- Department of Preventive Medicine and Environmental Health, Osaka City University, Graduate School of Medicine, Osaka, Japan
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Hsu WC, Araneta MRG, Kanaya AM, Chiang JL, Fujimoto W. BMI cut points to identify at-risk Asian Americans for type 2 diabetes screening. Diabetes Care 2015; 38:150-8. [PMID: 25538311 PMCID: PMC4392932 DOI: 10.2337/dc14-2391] [Citation(s) in RCA: 321] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- William C Hsu
- Asian American Diabetes Initiative, Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | - Maria Rosario G Araneta
- Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA
| | - Alka M Kanaya
- Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA
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Shah AD, Vittinghoff E, Kandula NR, Srivastava S, Kanaya AM. Correlates of prediabetes and type II diabetes in US South Asians: findings from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study. Ann Epidemiol 2014; 25:77-83. [PMID: 25459085 DOI: 10.1016/j.annepidem.2014.10.013] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 10/14/2014] [Accepted: 10/16/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE In this study, we aim to elucidate the role of sociodemographic, lifestyle, and cultural factors in prediabetes and diabetes in South Asian immigrants to the United States, a population at high risk of type II diabetes. METHODS We performed a cross-sectional analysis of a community-based cohort of 899 South Asians without known cardiovascular disease from the Mediators of Atherosclerosis in South Asians Living in America study. Glycemic status was determined by fasting glucose, 2-hour postchallenge glucose, and use of diabetes medication. We used multinomial logistic regression models to estimate the independent associations of sociodemographic, lifestyle, and cultural factors with prediabetes and diabetes, adjusting for confounders identified using directed acyclic graphs. RESULTS Approximately 33% of participants had prediabetes and 25% had diabetes. In multivariate analyses, an independent correlate of prediabetes was low exercise. Additional covariates associated with diabetes included lower family income, less education, high chronic psychological burden score, and greater time spent watching television; and fasting monthly or annually was inversely associated with diabetes prevalence. CONCLUSIONS We found several modifiable risk factors associated with prediabetes and diabetes that may help guide diabetes prevention interventions for South Asian immigrants to the United States.
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Affiliation(s)
- Arti D Shah
- Division of Endocrinology and Metabolism, Department of Medicine, University of California, San Francisco, San Francisco.
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - Namratha R Kandula
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University, Chicago, IL
| | - Shweta Srivastava
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco
| | - Alka M Kanaya
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco; Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco
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