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Jeyaparam S, Agha-Jaffar R, Mullins E, Pinho-Gomes AC, Khunti K, Robinson S. Retrospective cohort study of the association between socioeconomic deprivation and incidence of gestational diabetes and perinatal outcomes. BMC Public Health 2024; 24:184. [PMID: 38225599 PMCID: PMC10790393 DOI: 10.1186/s12889-023-17261-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 11/18/2023] [Indexed: 01/17/2024] Open
Abstract
INTRODUCTION Socioeconomic disparities have been shown to correlate with perinatal mortality and the incidence of type 2 diabetes. Few studies have explored the relationship between deprivation and the incidence of gestational diabetes (GDM). We aimed to identify the relationship between deprivation and incidence of GDM, after adjusting for age, BMI, and ethnicity. We also examined for relationships between deprivation and perinatal outcomes. METHODS A retrospective cohort analysis of 23,490 pregnancies from a major National Health Service Trust in Northwest London was conducted. The 2019 English Indices of Multiple Deprivation was used to identify the deprivation rank and decile for each postcode. Birthweight centile was calculated from absolute birthweight after adjusting for ethnicity, maternal height, maternal weight, parity, sex and outcome (live birth/stillbirth). Logistic regression and Kendall's Tau were used to identify relationships between variables. RESULTS After controlling for age, BMI & ethnicity, Index of Multiple Deprivation postcode decile was not associated with an increased risk of developing gestational diabetes. Each increase in decile of deprivation was associated with an increase in birthweight centile by 0.471 (p < 0.001). After adjusting for confounders, age was associated with a 7.1% increased GDM risk (OR: 1.076, p < 0.001); BMI increased risk by 5.81% (OR: 1.059, p < 0.001). There was no significant correlation between Index of Multiple Deprivation rank and perinatal outcomes. DISCUSSION Our analysis demonstrates that socioeconomic deprivation was not associated with incidence of GDM or adverse perinatal outcomes. Factors such as genetic predisposition and lifestyle habits may likely play a larger role in the development of GDM compared to socioeconomic deprivation alone.
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Affiliation(s)
- Srirangan Jeyaparam
- Department of Metabolism, Digestion & Reproduction, Imperial College London, London, UK.
| | - Rochan Agha-Jaffar
- Department of Metabolism, Digestion & Reproduction, Imperial College London, London, UK
- Department of Metabolic Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Edward Mullins
- Department of Obstetrics & Gynaecology, Imperial College Healthcare NHS Trust, London, UK
- The George Institute for Global Health, London, UK
| | | | | | - Stephen Robinson
- Department of Metabolic Medicine, Imperial College Healthcare NHS Trust, London, UK
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Noukpo SI, Triccas LT, Bonnechère B, Adoukonou T, Feys P, Kossi O. Physical Activity Level, Barriers, and Facilitators for Exercise Engagement for Chronic Community-Dwelling Stroke Survivors in Low-Income Settings: A Cross-Sectional Study in Benin. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20031784. [PMID: 36767151 PMCID: PMC9914131 DOI: 10.3390/ijerph20031784] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/12/2023] [Accepted: 01/15/2023] [Indexed: 05/16/2023]
Abstract
After a stroke incident, physical inactivity is common. People with stroke may perceive several barriers to performing physical activity (PA). This study aimed to document the PA level and understand the barriers and facilitators to engaging in PA for community-dwelling stroke survivors in Benin, a lower middle-income country. A cross-sectional study was conducted in three hospitals in Benin. Levels of PA were recorded by means of the Benin version of the International Physical Activity Questionnaire long form (IPAQ-LF-Benin), which is validated for stroke survivors in Benin. The perceived exercise facilitators and barriers were assessed by the Stroke Exercise Preference Inventory-13 (SEPI-13). A descriptive analysis and associations were performed with a Confidence Interval of 95% and <0.05 level of significance. A total of 87 participants (52 men, mean age of 53 ± 10 years, mean time after a stroke of 11 (IQR: 15) months and an average of 264.5 ± 178.9 m as distance on the 6 min walking test (6MWT) were included. Overall, stroke survivors in Benin reached a total PA of 985.5 (IQR: 2520) metabolic equivalent (METs)-minutes per week and were least active at work, domestic, and leisure domains with 0 MET-minutes per week. The overview of PA level showed that 52.9% of participants performed low PA intensity. However, 41.4% performed moderate PA or walking per day for at least five days per week. Important perceived barriers were lack of information (45.3%), hard-to-start exercise (39.5%), and travelling to places to exercise (29.9%). The preference for exercise was with family or friends, outdoors, for relaxation or enjoyment (90.2%), and receiving feedback (78.3%). Several socio-demographic, clinical, and community factors were significantly associated with moderate or intense PA (p < 0.05) in stroke survivors in this study. Our findings show that the PA level among chronic stroke survivors in Benin is overall too low relative to their walking capacity. Cultural factors in terms of the overprotection of the patients by their entourage and/or the low health literacy of populations to understand the effect of PA on their health may play a role. There is a need for new approaches that consider the individual barriers and facilitators to exercise.
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Affiliation(s)
- Sènadé Inès Noukpo
- Unit of Neurology and NeuroRehabilitation, University Hospital of Parakou, Parakou 01 BP 02, Benin
- REVAL, Rehabilitation Research Center, Hasselt University, 3590 Diepenbeek, Belgium
| | - Lisa Tedesco Triccas
- REVAL, Rehabilitation Research Center, Hasselt University, 3590 Diepenbeek, Belgium
| | - Bruno Bonnechère
- REVAL, Rehabilitation Research Center, Hasselt University, 3590 Diepenbeek, Belgium
- Technology-Supported and Data-Driven Rehabilitation, Data Science Institute, Hasselt University, 3590 Diepenbeek, Belgium
| | - Thierry Adoukonou
- Unit of Neurology and NeuroRehabilitation, University Hospital of Parakou, Parakou 01 BP 02, Benin
- ENATSE, National School of Public Health and Epidemiology, University of Parakou, Parakou 03 BP 10, Benin
- Department of Neurology, Faculty of Medicine, University of Parakou, Parakou 03 BP 10, Benin
| | - Peter Feys
- REVAL, Rehabilitation Research Center, Hasselt University, 3590 Diepenbeek, Belgium
| | - Oyéné Kossi
- Unit of Neurology and NeuroRehabilitation, University Hospital of Parakou, Parakou 01 BP 02, Benin
- REVAL, Rehabilitation Research Center, Hasselt University, 3590 Diepenbeek, Belgium
- ENATSE, National School of Public Health and Epidemiology, University of Parakou, Parakou 03 BP 10, Benin
- Correspondence:
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Rajagopal R. Weight Reduction as an Adjunctive Management Strategy for Diabetic Retinopathy. MISSOURI MEDICINE 2022; 119:42-48. [PMID: 36033134 PMCID: PMC9312462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
As rates of global obesity and diabetes increase, diabetic retinopathy continues to grow as a frequent cause of visual impairment. Despite tremendous recent strides in therapy, a significant fraction of patients remain poorly responsive to modern interventions. Adjunctive therapy in such settings could be widely beneficial. A growing body of evidence suggests that weight reduction strategies for obesity-related diabetes have the potential to serve as important supplements to modern ophthalmic care for preservation of vision.
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Affiliation(s)
- Rithwick Rajagopal
- John F. Hardesty MD Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri
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Dey KC, Zakrzewski-Fruer JK, Smith LR, Jones RL, Bailey DP. The Prevalence of Daily Sedentary Time in South Asian Adults: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179275. [PMID: 34501864 PMCID: PMC8431135 DOI: 10.3390/ijerph18179275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 08/27/2021] [Accepted: 08/29/2021] [Indexed: 11/16/2022]
Abstract
This study aimed to systematically review total daily sedentary time in South Asian adults. Seven electronic databases were searched, identifying relevant articles published in peer-reviewed journals between March 1990 and March 2021. The study was designed in accordance with PRISMA guidelines. Prospective or cross-sectional design studies reporting total daily sedentary time in South Asian adults (aged ≥18 years), reported in English, were included. Study quality and risk of bias were assessed, and the weighted mean total daily sedentary time was calculated. Fourteen full texts were included in this systematic review from studies that were conducted in Bangladesh, India, Norway, Singapore, and the United Kingdom. Pooled sedentary time across all studies was 424 ± 8 min/day. Sedentary time was measured using self-report questionnaires in seven studies, with a weighted mean daily sedentary time of 416 ± 19 min/day. Eight studies used accelerometers and inclinometers with a weighted mean sedentary time of 527 ± 11 min/day. South Asian adults spend a large proportion of their time being sedentary, especially when recorded using objective measures (~9 h/day). These findings suggest that South Asians are an important target population for public health efforts to reduced sedentary time, and researchers and practitioners should seek to standardise and carefully consider the tools used when measuring sedentary time in this population.
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Affiliation(s)
- Kamalesh C. Dey
- Institute for Sport and Physical Activity Research, School of Sport Science and Physical Activity, University of Bedfordshire, Bedford MK41 9EA, UK; (K.C.D.); (L.R.S.); (R.L.J.); (D.P.B.)
| | - Julia K. Zakrzewski-Fruer
- Institute for Sport and Physical Activity Research, School of Sport Science and Physical Activity, University of Bedfordshire, Bedford MK41 9EA, UK; (K.C.D.); (L.R.S.); (R.L.J.); (D.P.B.)
- Correspondence: ; Tel.: +44-(0)1234-793410
| | - Lindsey R. Smith
- Institute for Sport and Physical Activity Research, School of Sport Science and Physical Activity, University of Bedfordshire, Bedford MK41 9EA, UK; (K.C.D.); (L.R.S.); (R.L.J.); (D.P.B.)
| | - Rebecca L. Jones
- Institute for Sport and Physical Activity Research, School of Sport Science and Physical Activity, University of Bedfordshire, Bedford MK41 9EA, UK; (K.C.D.); (L.R.S.); (R.L.J.); (D.P.B.)
| | - Daniel P. Bailey
- Institute for Sport and Physical Activity Research, School of Sport Science and Physical Activity, University of Bedfordshire, Bedford MK41 9EA, UK; (K.C.D.); (L.R.S.); (R.L.J.); (D.P.B.)
- Division of Sport, Health and Exercise Sciences, Department of Life Sciences, Brunel University London, Uxbridge UB8 3PH, UK
- Sedentary Behaviour, Health and Disease Research Group, Brunel University London, Uxbridge UB8 3PH, UK
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Mathew Joseph N, Hanneman SK, Bishop SL. Physical activity, acculturation, and immigrant status of Asian Indian women living in the United States. Appl Nurs Res 2019; 47:52-56. [PMID: 31113548 DOI: 10.1016/j.apnr.2019.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 04/18/2019] [Accepted: 04/28/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Nitha Mathew Joseph
- Department of Undergraduate Studies, Cizik School of Nursing, The University of Texas Health Science Center, 6901 Bertner Avenue, Room 691, Houston, TX 77030, United States of America.
| | - Sandra K Hanneman
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Center for Nursing Research, Room #585, 6901 Bertner Avenue, Houston, TX 77030, United States of America.
| | - Sheryl L Bishop
- School of Nursing, The University of Texas Medical Branch at Galveston, 301 University Blvd., Galveston, TX, United States of America.
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Fortes MDSR, da Rosa SE, Coutinho W, Neves EB. Epidemiological study of metabolic syndrome in Brazilian soldiers. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2019; 63:345-350. [PMID: 30916165 PMCID: PMC10528660 DOI: 10.20945/2359-3997000000115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 12/12/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of this study was to carry out an epidemiological analysis of metabolic syndrome among Brazilian Army soldiers. SUBJECTS AND METHODS Two thousand seven hundred and nineteen male soldiers of the Brazilian Army were evaluated from 2014 to 2016. Characteristics: age = 27.77 (± 8.59) years and BMI = 25.15 (± 3.41) kg/m2. Blood tests and anthropometric measures were performed following the criteria of the International Diabetes Federation Task Force on MS Epidemiology and Prevention, 2009. The epidemiological analysis was based on Odds ratio (OR) with confidence interval (CI). RESULTS The prevalence of MS found was 12.21%. Both WC and BMI proved to be good predictors of changes in MS physiological markers. Increased WC and BMI were strongly associated with all physiological markers. Soldiers with WC ≥ 90 were more likely to present MS with OR = 33.37 (24.37-45.7). Soldiers with WC ≥ 90 also presented high risk of: high triglycerides with OR = 5.98 (4.69-7.61); low HLD-c with OR = 1.78 (1.47-2.16); and increased systolic blood pressure OR = 3.10 (2.55-3.76). Soldiers with BMI ≥ 30 had a high risk of: increased glucose with OR = 2.69 (1.93-3.75); and increased diastolic blood pressure with OR = 3.02 (2.22-4.10). CONCLUSION Both WC and BMI can be considered as good predictors of changes in MS physiological markers. We believe that WC and BMI should be used as screening tools to indicate the soldiers that must undergo blood tests to monitor MS prevalence.
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Affiliation(s)
- Marcos de Sá Rego Fortes
- Instituto de Pesquisa da Capacitação Física do ExércitoRio de JaneiroRJBrasilInstituto de Pesquisa da Capacitação Física do Exército (IPCFEx), Rio de Janeiro, RJ, Brasil
| | - Samir Ezequiel da Rosa
- Instituto de Pesquisa da Capacitação Física do ExércitoRio de JaneiroRJBrasilInstituto de Pesquisa da Capacitação Física do Exército (IPCFEx), Rio de Janeiro, RJ, Brasil
| | - Walmir Coutinho
- Pontifícia Universidade Católica do Rio de JaneiroPontifícia Universidade Católica do Rio de JaneiroRio de JaneiroRJBrasilPontifícia Universidade Católica do Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brasil
| | - Eduardo Borba Neves
- Instituto de Pesquisa da Capacitação Física do ExércitoRio de JaneiroRJBrasilInstituto de Pesquisa da Capacitação Física do Exército (IPCFEx), Rio de Janeiro, RJ, Brasil
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Bernabe-Ortiz A, Perel P, Miranda JJ, Smeeth L. Diagnostic accuracy of the Finnish Diabetes Risk Score (FINDRISC) for undiagnosed T2DM in Peruvian population. Prim Care Diabetes 2018; 12:517-525. [PMID: 30131300 PMCID: PMC6249987 DOI: 10.1016/j.pcd.2018.07.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 07/23/2018] [Accepted: 07/29/2018] [Indexed: 12/18/2022]
Abstract
AIMS To assess the diagnostic accuracy of the Finnish Diabetes Risk Score (FINDRISC) for undiagnosed T2DM and to compare its performance with the Latin-American FINDRISC (LA-FINDRISC) and the Peruvian Risk Score. MATERIALS AND METHODS A population-based study was conducted. T2DM and undiagnosed T2DM were defined using oral glucose tolerance test (OGTT). Risk scores assessed were FINDRISC, LA-FINDRISC and Peruvian Risk Score. Diagnostic accuracy of risk scores was estimated using the c-statistic and the area under the ROC curve (aROC). A simplified version of FINDRISC was also derived. RESULTS Data from 1609 individuals, mean age 48.2 (SD: 10.6), 810 (50.3%) women, were collected. A total of 176 (11.0%; 95%CI: 9.4%-12.5%) were classified as having T2DM, and 71 (4.7%; 95%CI: 3.7%-5.8%) were classified as having undiagnosed T2DM. Diagnostic accuracy of the FINDRISC (aROC=0.69), LA-FINDRISC (aROC=0.68), and Peruvian Risk Score (aROC=0.64) was similar (p=0.15). The simplified FINDRISC, with 4 variables, had a slightly better performance (aROC=0.71) than the other scores. CONCLUSION The performance of FINDRISC, LA-FINDRISC and Peruvian Risk Score for undiagnosed T2DM was similar. A simplified FINDRISC can perform as well or better for undiagnosed T2DM. The FINDRISC may be useful to detect cases of undiagnosed T2DM in resource-constrained settings.
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Affiliation(s)
- Antonio Bernabe-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima 18, Peru; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
| | - Pablo Perel
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
| | - Juan Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima 18, Peru; Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima 31, Peru.
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
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Muilwijk M, Nicolaou M, Qureshi SA, Celis-Morales C, Gill JMR, Sheikh A, Sattar N, Beune E, Jenum AK, Stronks K, van Valkengoed IGM. Dietary and physical activity recommendations to prevent type 2 diabetes in South Asian adults: A systematic review. PLoS One 2018; 13:e0200681. [PMID: 30011314 PMCID: PMC6047810 DOI: 10.1371/journal.pone.0200681] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 07/02/2018] [Indexed: 02/07/2023] Open
Abstract
Intervention trials and guidelines for the prevention of type 2 diabetes (T2D) in populations of South Asian origin often include strategies to improve diet and physical activity that are based on those developed for other populations. These may be suboptimal for the South Asian target populations. We aimed to provide an overview of included recommended dietary and physical activity components, and to identify whether these were supported by evidence of their effectiveness. Databases were searched until September 2017 for intervention studies and guidelines with an adult South Asian population without T2D. The protocol was registered in PROSPERO, registration number: CRD42015207067. The quality of included studies and guidelines was assessed. Dietary and physical activity components, and effects on T2D incidence, glycemic status and adiposity measures, were summarized in tabular format and evaluated narratively. Eighteen intervention studies and four guidelines were identified. Dietary and physical activity components were similar to recommendations for the general population. Intervention studies and guidelines did not reference evidence to support the effectiveness of components included in the intervention for South Asian populations in particular. Moreover, we were unable to assess patterns of components to determine the effects of specific components. Evaluation of current and emerging components among South Asian populations and subgroups seems necessary to formulate more specific recommendations in future intervention studies and guidelines.
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Affiliation(s)
- Mirthe Muilwijk
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- * E-mail:
| | - Mary Nicolaou
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Samera A. Qureshi
- The Norwegian Centre for Migrant and Minority Health Research, Oslo, Norway
| | - Carlos Celis-Morales
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Jason M. R. Gill
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Aziz Sheikh
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, United Kingdom
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Erik Beune
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Anne Karen Jenum
- Department of General Practice, Faculty of Medicine, Institute of Health and Society, Blindern, Oslo, Norway
| | - Karien Stronks
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Irene G. M. van Valkengoed
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Examining sedentary time as a risk factor for cardiometabolic diseases and their markers in South Asian adults: a systematic review. Int J Public Health 2017; 62:503-515. [PMID: 28299392 DOI: 10.1007/s00038-017-0947-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 12/28/2016] [Accepted: 01/11/2017] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES The objective was to systematically review the literature to determine whether sedentary time was associated with cardiometabolic diseases and their risk factors among South Asian adults. METHODS Six electronic databases were searched to identify all studies that examined the association between sedentary time and cardiometabolic diseases (e.g., diabetes, cardiovascular disease) and their risk factors [e.g., body mass index (BMI), waist circumference (WC), lipids, blood pressure (BP), glucose] among South Asian adults. Two independent reviewers performed abstract/full-text screening, data abstraction, and quality assessments. RESULTS Searching identified 1757 potential articles; 22 were used in the analysis. Greater sedentary time was associated with an increased likelihood of diabetes (n = 5), higher BMI (n = 13), WC (n = 3), BP (n = 2), and glucose (n = 4). Thirteen out of 22 studies were of higher quality. CONCLUSION Results identified a trend whereby greater sedentary time was associated with an increased risk for diabetes, and several other cardiometabolic risk factors among South Asian adults. High quality studies are needed to identify whether risk factors are independent of physical activity levels to inform culturally-specific interventions for South Asians.
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Ramírez-Vélez R, Correa-Bautista JE, Ramos-Sepúlveda JA, Piñeros-Álvarez CA, Giraldo LI, Izquierdo M, García-Hermoso A, Rodríguez-Rodríguez F, Cristi-Montero C. Aerobic capacity and future cardiovascular risk in Indian community from a low-income area in Cauca, Colombia. Ital J Pediatr 2017; 43:28. [PMID: 28270174 PMCID: PMC5341371 DOI: 10.1186/s13052-017-0347-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 02/28/2017] [Indexed: 01/18/2023] Open
Abstract
Background Several studies indicates that children’s aerobic capacity levels are predictors of the future risk of non-communicable diseases. Therefore, the aim of this study was to establish the proportion of subjects whose aerobic capacity is indicative of future cardiovascular risk in Indian-Nasa community from a low-income area in Cauca, Colombia. Methods We performed a cross-sectional analysis of morphological component (height, weight, body mass index (BMI), waist circumference, triceps skinfold, subscapular skinfold, and body fat percent [BF%]), and the cardiorespiratory component (course-navette 20 m, shuttle run test and estimation of maximal oxygen consumption by indirect VO2max) from 576 participants (319 boys and 257 girls) aged 10 to 17.9 years, using the standardized FUPRECOL test battery. Results We showed that the boys performed better than the girls in cardiorespiratory fitness. The proportion of subjects with an aerobic capacity indicative of future cardiovascular risk was 7.3%. By sex, 3.8% of boys and 11.7% of girls (X2p = 0.001) displayed an unhealthy aerobic capacity in this study. Conclusion The findings of this study that provide the first data on aerobic capacity health for Colombian Nasa Indian children and adolescents aged 10–17.9 years. Although the known loss of aerobic capacity is a serious consequence of the future risk of non-communicable diseases, the deterioration of physical fitness deserves increased attention among indigenous population.
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Affiliation(s)
- Robinson Ramírez-Vélez
- Centro de Estudios para la Medición de la Actividad Física «CEMA», Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogota, DC, 111221, Colombia.
| | - Jorge Enrique Correa-Bautista
- Centro de Estudios para la Medición de la Actividad Física «CEMA», Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogota, DC, 111221, Colombia
| | - Jeison Alexander Ramos-Sepúlveda
- Grupo de Investigación en Pedagogía, Licenciatura en Ciencias del Deporte y la Educación Física, Institución Universitaria Antonio José Camacho, Cali, Colombia
| | - Carlos Andrés Piñeros-Álvarez
- Grupo de Investigación en Pedagogía, Licenciatura en Ciencias del Deporte y la Educación Física, Institución Universitaria Antonio José Camacho, Cali, Colombia
| | - Lorena Isabel Giraldo
- Grupo de Investigación en Pedagogía, Licenciatura en Ciencias del Deporte y la Educación Física, Institución Universitaria Antonio José Camacho, Cali, Colombia
| | - Mikel Izquierdo
- Department of Health Sciences, Public University of Navarra, Pamplona, Navarra, Spain
| | - Antonio García-Hermoso
- Laboratorio de Ciencias de la Actividad Física, el Deporte y la Salud, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, USACH, Santiago, Chile
| | | | - Carlos Cristi-Montero
- IRyS Group, Physical Education School, Pontificia Universidad Católica de Valparaiso, Valparaíso, Chile
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Time spent in sedentary posture is associated with waist circumference and cardiovascular risk. Int J Obes (Lond) 2017; 41:689-696. [PMID: 28138134 DOI: 10.1038/ijo.2017.30] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 01/14/2017] [Accepted: 01/22/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND The relationship between metabolic risk and time spent sitting, standing and stepping has not been well established. The present study aimed to determine associations of objectively measured time spent siting, standing and stepping, with coronary heart disease (CHD) risk. METHODS A cross-sectional study of healthy non-smoking Glasgow postal workers, n=111 (55 office workers, 5 women, and 56 walking/delivery workers, 10 women), who wore activPAL physical activity monitors for 7 days. Cardiovascular risks were assessed by metabolic syndrome categorisation and 10-year PROCAM (prospective cardiovascular Munster) risk. RESULTS Mean (s.d.) age was 40 (8) years, body mass index 26.9 (3.9) kg m-2 and waist circumference 95.4 (11.9) cm. Mean (s.d.) high-density lipoprotein cholesterol (HDL cholesterol) 1.33 (0.31), low-density lipoprotein cholesterol 3.11 (0.87), triglycerides 1.23 (0.64) mmol l-1 and 10-year PROCAM risk 1.8 (1.7)%. The participants spent mean (s.d.) 9.1 (1.8) h per day sedentary, 7.6 (1.2) h per day sleeping, 3.9 (1.1) h per day standing and 3.3 (0.9) h per day stepping, accumulating 14 708 (4984) steps per day in 61 (25) sit-to-stand transitions per day. In univariate regressions-adjusting for age, sex, family history of CHD, shift worked, job type and socioeconomic status-waist circumference (P=0.005), fasting triglycerides (P=0.002), HDL cholesterol (P=0.001) and PROCAM risk (P=0.047) were detrimentally associated with sedentary time. These associations remained significant after further adjustment for sleep, standing and stepping in stepwise regression models. However, after further adjustment for waist circumference, the associations were not significant. Compared with those without the metabolic syndrome, participants with the metabolic syndrome were significantly less active-fewer steps, shorter stepping duration and longer time sitting. Those with no metabolic syndrome features walked >15 000 steps per day or spent >7 h per day upright. CONCLUSIONS Longer time spent in sedentary posture is significantly associated with higher CHD risk and larger waist circumference.
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Zhou Z, Xi Y, Zhang F, Lu Q, Zhang F, Huang D, Ren H, Wang K, Yin Z. Sedentary Behavior Predicts Changes in Cardiometabolic Risk in Professional Workers: A One-Year Prospective Study. J Occup Environ Med 2017; 58:e117-23. [PMID: 27058488 DOI: 10.1097/jom.0000000000000673] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of the study was to examine the longitudinal influence of sedentary behavior on the development of metabolic syndrome (MS) and cardiometabolic risk in professional workers. METHODS Study participants were 203 professional workers (55.6% female; mean age = 41.9, SD = 11.2,) in low physical activity occupations. Participants' height, weight, waist circumference, fasting plasma glucose, triglycerides, high-density lipoprotein, total cholesterol, and low-density lipoprotein were measured at the baseline and follow-up over 12 months. Accelerometry was used to assess the sedentary time and moderate and vigorous physical activity. RESULTS High level of sedentary behavior at baseline significantly predicted incident MS (odds ratio 4.07, 95% confidence interval 1.69 to 9.76) at follow-up. Similarly, the change in sedentary behavior significantly predicted the change in the cardiometabolic risk score (B = 0.12, SE = 0.06, P = 0.03) from baseline to the follow-up. CONCLUSION Professional workers in low physical activity occupations were engaged in an excessive amount of sedentary behavior that predisposed them to an increased risk of developing cardiometabolic disorders.
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Affiliation(s)
- Zhixiong Zhou
- Capital University of Physical Education and Sports, Beijing (Dr Zhou, Zhang, Lu, Dr Wang); College of Sports Science, Anhui Normal University, Wuhu (Xi, Huang); Health Center, Beijing University of Civil Engineering and Architecture (Zhang); School of Sport Sciences, Beijing Sport University, China (Dr Ren); and Department of Kinesiology, Health and Nutrition, the University of Texas at San Antonio (Dr Yin)
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Ramos-Sepúlveda JA, Ramírez-Vélez R, Correa-Bautista JE, Izquierdo M, García-Hermoso A. Physical fitness and anthropometric normative values among Colombian-Indian schoolchildren. BMC Public Health 2016; 16:962. [PMID: 27619491 PMCID: PMC5020445 DOI: 10.1186/s12889-016-3652-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 09/08/2016] [Indexed: 12/30/2022] Open
Abstract
Background Substantial evidence indicates that children’s physical fitness levels are markers of their lifestyles and their cardio-metabolic health profile and are predictors of the future risk of chronic diseases such as obesity, cardiometabolic disease, skeletal health and mental health. However, fitness reference values for ethnic children and adolescents have not been published in a Latin-American population. Therefore, the aim of the study was to provide sex- and age-specific physical fitness and anthropometric reference standards among Colombian-Indian schoolchildren. Methods A sample of 576 participants (319 boys and 257 girls) aged 10 to 17 years old was assessed using the FUPRECOL test battery. Four components of physical fitness were measured: 1) morphological component: height, weight, body mass index (BMI), waist circumference (WC), triceps skinfold, subscapular skinfold, and body fat (%); 2) musculoskeletal component: handgrip and standing long jump test; 3) motor component: speed/agility test (4 × 10 m shuttle run); and 4) cardiorespiratory component: course-navette 20 m, shuttle run test and estimation of maximal oxygen consumption by VO2max indirect. Centile smoothed curves for the 3rd, 10th, 25th, 50th, 75th, 90th and 97th percentiles were calculated using Cole’s LMS method. Results Our results show that weight, height and BMI in each age group were higher in boys than in girls. In each groups, age showed a significant effect for BMI and WC. Boys showed better than girls in cardiorespiratory fitness, lower- and upper-limb strength and speed/agility and girls performed better in low back flexibility. Conclusion Our results provide for the first time sex- and age-specific physical fitness and anthropometric reference values for Colombian Nasa Indian children and adolescents aged 10–17.9 years.
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Affiliation(s)
- Jeison Alexander Ramos-Sepúlveda
- Grupo de Investigación en Pedagogía, Licenciatura en Ciencias del Deporte y la Educación Física, Institución Universitaria Antonio Jose Camacho, Cali, Colombia.,Vicerrectoria de Investigaciones, Maestría en Ciencias y Tecnologías del Deporte y la Actividad Física, Universidad Manuela Beltrán, Bogotá, D.C, Colombia
| | - Robinson Ramírez-Vélez
- Centro de Estudios en Medición de la Actividad Física (CEMA), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, D.C, Colombia.
| | - Jorge Enrique Correa-Bautista
- Centro de Estudios en Medición de la Actividad Física (CEMA), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, D.C, Colombia
| | - Mikel Izquierdo
- Department of Health Sciences, Public University of Navarra, Pamplona, Spain
| | - Antonio García-Hermoso
- Laboratorio de Ciencias de la Actividad Física, el Deporte y la Salud, Universidad de Santiago de Chile, USACH, Santiago, Chile.,Universidad San Sebastián, Santiago, Chile
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Bernabe-Ortiz A, Smeeth L, Gilman RH, Sanchez-Abanto JR, Checkley W, Miranda JJ, Study Group CRONICASC. Development and Validation of a Simple Risk Score for Undiagnosed Type 2 Diabetes in a Resource-Constrained Setting. J Diabetes Res 2016; 2016:8790235. [PMID: 27689096 PMCID: PMC5027039 DOI: 10.1155/2016/8790235] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 07/27/2016] [Indexed: 01/14/2023] Open
Abstract
Objective. To develop and validate a risk score for detecting cases of undiagnosed diabetes in a resource-constrained country. Methods. Two population-based studies in Peruvian population aged ≥35 years were used in the analysis: the ENINBSC survey (n = 2,472) and the CRONICAS Cohort Study (n = 2,945). Fasting plasma glucose ≥7.0 mmol/L was used to diagnose diabetes in both studies. Coefficients for risk score were derived from the ENINBSC data and then the performance was validated using both baseline and follow-up data of the CRONICAS Cohort Study. Results. The prevalence of undiagnosed diabetes was 2.0% in the ENINBSC survey and 2.9% in the CRONICAS Cohort Study. Predictors of undiagnosed diabetes were age, diabetes in first-degree relatives, and waist circumference. Score values ranged from 0 to 4, with an optimal cutoff ≥2 and had a moderate performance when applied in the CRONICAS baseline data (AUC = 0.68; 95% CI: 0.62-0.73; sensitivity 70%; specificity 59%). When predicting incident cases, the AUC was 0.66 (95% CI: 0.61-0.71), with a sensitivity of 69% and specificity of 59%. Conclusions. A simple nonblood based risk score based on age, diabetes in first-degree relatives, and waist circumference can be used as a simple screening tool for undiagnosed and incident cases of diabetes in Peru.
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Affiliation(s)
- Antonio Bernabe-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- *Antonio Bernabe-Ortiz:
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Robert H. Gilman
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Área de Investigación y Desarrollo, Asociación Benéfica PRISMA, Lima, Peru
| | | | - William Checkley
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - J. Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
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Bradley JM, Wilson JJ, Hayes K, Kent L, McDonough S, Tully MA, Bradbury I, Kirk A, Cosgrove D, Convery R, Kelly M, Elborn JS, O'Neill B. Sedentary behaviour and physical activity in bronchiectasis: a cross-sectional study. BMC Pulm Med 2015; 15:61. [PMID: 25967368 PMCID: PMC4456779 DOI: 10.1186/s12890-015-0046-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 04/22/2015] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The impact of bronchiectasis on sedentary behaviour and physical activity is unknown. It is important to explore this to identify the need for physical activity interventions and how to tailor interventions to this patient population. We aimed to explore the patterns and correlates of sedentary behaviour and physical activity in bronchiectasis. METHODS Physical activity was assessed in 63 patients with bronchiectasis using an ActiGraph GT3X+ accelerometer over seven days. Patients completed: questionnaires on health-related quality-of-life and attitudes to physical activity (questions based on an adaption of the transtheoretical model (TTM) of behaviour change); spirometry; and the modified shuttle test (MST). Multiple linear regression analysis using forward selection based on likelihood ratio statistics explored the correlates of sedentary behaviour and physical activity dimensions. Between-group analysis using independent sample t-tests were used to explore differences for selected variables. RESULTS Fifty-five patients had complete datasets. Average daily time, mean(standard deviation) spent in sedentary behaviour was 634(77)mins, light-lifestyle physical activity was 207(63)mins and moderate-vigorous physical activity (MVPA) was 25(20)mins. Only 11% of patients met recommended guidelines. Forced expiratory volume in one-second percentage predicted (FEV1% predicted) and disease severity were not correlates of sedentary behaviour or physical activity. For sedentary behaviour, decisional balance 'pros' score was the only correlate. Performance on the MST was the strongest correlate of physical activity. In addition to the MST, there were other important correlate variables for MVPA accumulated in ≥10-minute bouts (QOL-B Social Functioning) and for activity energy expenditure (Body Mass Index and QOL-B Respiratory Symptoms). CONCLUSIONS Patients with bronchiectasis demonstrated a largely inactive lifestyle and few met the recommended physical activity guidelines. Exercise capacity was the strongest correlate of physical activity, and dimensions of the QOL-B were also important. FEV1% predicted and disease severity were not correlates of sedentary behaviour or physical activity. The inclusion of a range of physical activity dimensions could facilitate in-depth exploration of patterns of physical activity. This study demonstrates the need for interventions targeted at reducing sedentary behaviour and increasing physical activity, and provides information to tailor interventions to the bronchiectasis population. TRIAL REGISTRATION NCT01569009 ("Physical Activity in Bronchiectasis").
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Affiliation(s)
- Judy M Bradley
- Centre for Health and Rehabilitation Technologies, Institute for Nursing and Health Research, Ulster University, Newtownabbey, Northern Ireland, UK.
| | - Jason J Wilson
- Centre for Health and Rehabilitation Technologies, Institute for Nursing and Health Research, Ulster University, Newtownabbey, Northern Ireland, UK.
| | - Kate Hayes
- Centre for Health and Rehabilitation Technologies, Institute for Nursing and Health Research, Ulster University, Newtownabbey, Northern Ireland, UK.
| | - Lisa Kent
- Northern Ireland Clinical Research Network: Respiratory Health, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK.
| | - Suzanne McDonough
- Centre for Health and Rehabilitation Technologies, Institute for Nursing and Health Research, Ulster University, Newtownabbey, Northern Ireland, UK.
- UKCRC Centre of Excellence for Public Health (Northern Ireland), Belfast, Northern Ireland, UK.
| | - Mark A Tully
- UKCRC Centre of Excellence for Public Health (Northern Ireland), Belfast, Northern Ireland, UK.
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, Northern Ireland, UK.
| | - Ian Bradbury
- Centre for Health and Rehabilitation Technologies, Institute for Nursing and Health Research, Ulster University, Newtownabbey, Northern Ireland, UK.
| | - Alison Kirk
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, Scotland, UK.
| | - Denise Cosgrove
- Northern Ireland Clinical Research Network: Respiratory Health, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK.
| | - Rory Convery
- Southern Health and Social Care Trust, Craigavon Area Hospital, Craigavon, Northern Ireland, UK.
| | - Martin Kelly
- Western Health and Social Care Trust, Altnagelvin Area Hospital, Derry, Northern Ireland, UK.
| | - Joseph Stuart Elborn
- Centre for Infection and Immunity, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, Northern Ireland, UK.
| | - Brenda O'Neill
- Centre for Health and Rehabilitation Technologies, Institute for Nursing and Health Research, Ulster University, Newtownabbey, Northern Ireland, UK.
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Paul L, Brewster S, Wyke S, Gill JMR, Alexander G, Dybus A, Rafferty D. Physical activity profiles and sedentary behaviour in people following stroke: a cross-sectional study. Disabil Rehabil 2015; 38:362-7. [DOI: 10.3109/09638288.2015.1041615] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Lorna Paul
- School of Medicine, University of Glasgow, Glasgow, UK,
| | | | - Sally Wyke
- Institute of Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, UK,
| | - Jason M. R. Gill
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK,
| | | | | | - Danny Rafferty
- School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, UK
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Ghouri N, Purves D, Deans KA, Logan G, McConnachie A, Wilson J, Gill JMR, Sattar N. An investigation of two-dimensional ultrasound carotid plaque presence and intima media thickness in middle-aged South Asian and European men living in the United kingdom. PLoS One 2015; 10:e0123317. [PMID: 25884221 PMCID: PMC4401566 DOI: 10.1371/journal.pone.0123317] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 03/02/2015] [Indexed: 01/09/2023] Open
Abstract
Objectives Ultrasound studies of carotid intima media thickness (cIMT) and plaques are limited in South Asians, a group at elevated cardiovascular disease (CVD) risk. We determined whether South Asians have a difference in these ultrasound markers compared to Europeans living in the United Kingdom and whether measured risk factor(s) could account for any such differences. Methods One hundred South Asian men, aged 40 to 70 years and 100 European men of similar age and BMI, without diagnosed CVD or diabetes, underwent carotid ultrasound for measurement of cIMT and carotid plaque presence. Physical activity, cardiorespiratory fitness, anthropometry and blood pressure were assessed, fasted blood taken for measurement of cardiometabolic risk factors and demographic and lifestyle factors recorded. Results Age-adjusted mean (SD) cIMT was similar in South Asians and Europeans (0.64 (0.16) mm v 0.65 (0.12) mm, p = 0.64). Plaque was present in 48 South Asians and 37 Europeans and overall, there was no age-adjusted difference between South Asian and Europeans for plaque score(odds ratio 1.49, 95% CI, 0.86-2.80, p = 0.16), however, South Asians appeared to have more plaques at a younger age than Europeans; at age 40-50 years the odds of South Asians having plaques was 2.63 (95% CI, 1.16-5.93) times that for Europeans. Conclusions cIMT is similar between healthy South Asian and European men. Whilst there was no overall difference in plaque presence in South Asians, there is an indication of greater plaque prevalence at younger ages - an observation requiring further investigation. Prospective studies linking plaques to CVD outcomes in South Asians are needed to investigate whether these measures help improve CVD risk prediction.
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Affiliation(s)
- Nazim Ghouri
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8TA, United Kingdom
- * E-mail: (NG); (NS)
| | - David Purves
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 8QA, United Kingdom
| | - Kevin A. Deans
- Department of Clinical Biochemistry, Aberdeen Royal Infirmary, Aberdeen, AB25 2ZN, United Kingdom
| | - Greig Logan
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8TA, United Kingdom
- Human Potential Centre, AUT University, Auckland, 1142, New Zealand
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 8QA, United Kingdom
| | - John Wilson
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8TA, United Kingdom
| | - Jason M. R. Gill
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8TA, United Kingdom
| | - Naveed Sattar
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8TA, United Kingdom
- * E-mail: (NG); (NS)
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Perceived and objectively measured physical activity and sedentary time among South Asian women in the UK. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:3152-73. [PMID: 25785499 PMCID: PMC4377957 DOI: 10.3390/ijerph120303152] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 03/09/2015] [Accepted: 03/10/2015] [Indexed: 11/17/2022]
Abstract
Introduction: Limited self-report data suggest that South Asian (SA) women fail to meet physical activity (PA) recommendations. Recent research using objective measures reveals SA women living in the UK have higher PA levels than previously reported, and a pattern of under-reporting PA and sedentary time (ST). There is limited research on SA women’s understanding and experiences of PA/ST, and the cultural contexts and conditions within which they occur. Therefore the aims of this mixed-methods study were to compare perceived PA and ST to objectively measured data and explore PA- and ST-specific contexts, experiences, and sources of PA and ST amongst SA women in the UK. Methods: 24 women were purposively sampled to participate in a semi-structured interview from a larger study of 140 women who wore an accelerometer for 7 days. Demographic and anthropometric data were also collected. Results: Notable qualitative themes on contextualisation were of adequate PA as “keeping busy” or “being healthy”, and of ST as “lazy” or “resting in old age”. Few participants reported being sedentary, and most believed they were sufficiently physically active. Objectively measured PA/ST indicated that 66% women were less active than perceived (with regard to duration and intensity), with none able to estimate duration of ST. Discussion: Findings suggest that overall, SA women have contextualisations of PA/ST that may not coincide with those of researchers, health professionals and policy makers, and lack awareness of the intensity of PA in which they engage and the health risks of high levels of ST. These findings highlight the need for objective measures of PA and ST in this population combined with in-depth qualitative assessments to provide more accurate assessments of these behaviours. This information can subsequently be used to develop health promotion messages and interventions focusing on increasing duration and/or intensity levels of daily activities (e.g., walking, housework) and reducing ST in this population.
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Uemura H, Katsuura-Kamano S, Yamaguchi M, Nakamoto M, Hiyoshi M, Arisawa K. Abundant daily non-sedentary activity is associated with reduced prevalence of metabolic syndrome and insulin resistance. J Endocrinol Invest 2013; 36:1069-75. [PMID: 23886980 DOI: 10.3275/9066] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Non-exercise activity thermogenesis has recently drawn attention because of its potential to prevent weight gain. AIM This study evaluated the relationships between the duration of daily non-sedentary activities and the prevalence of metabolic syndrome and insulin resistance (IR) in the Japanese population. MATERIAL/SUBJECTS AND METHODS A total of 518 eligible subjects (380 men and 138 women) who attended the Tokushima Prefectural General Health Checkup Center and participated in the baseline survey of a cohort study conducted in Tokushima Prefecture, Japan were analyzed. Information about lifestyle characteristics including leisure-time exercise and daily non-exercise activities was obtained from a questionnaire. Logistic and multiple linear regression analyses were performed to evaluate the associations between the duration of daily non-exercise non-sedentary activities (beyond sitting) and prevalence of metabolic syndrome (and its components) and IR. RESULTS Subjects with longer duration of daily non-sedentary activities had significantly lower adjusted odds ratios for metabolic syndrome (p for trend =0.024), abdominal obesity (p for trend =0.023), and low HDLcholesterol levels (p for trend =0.002), after adjustment for sex, age, and other probable covariates including leisure-time exercise. Longer duration of daily non-sedentary activities was further associated with lower homeostasis model of assessment- IR (HOMA-IR) values (p for trend =0.009). CONCLUSIONS Our results suggest that abundant daily non-sedentary activity might be associated with a lower prevalence of metabolic syndrome, especially for the components of central obesity and low HDL-cholesterol levels, and with a lower prevalence of IR, independent of leisure-time exercise.
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Affiliation(s)
- H Uemura
- Department of Preventive Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School, 3-18-15, Kuramoto- cho, Tokushima 770-8503, Japan.
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Solomon TPJ, Thyfault JP. Type 2 diabetes sits in a chair. Diabetes Obes Metab 2013; 15:987-92. [PMID: 23551885 DOI: 10.1111/dom.12105] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 01/18/2013] [Accepted: 03/27/2013] [Indexed: 01/05/2023]
Abstract
The incidence of type 2 diabetes (T2D) continues to skyrocket across the industrialized world leading to soaring medical costs, reduced quality of life and increased mortality rates. Therefore, a more firm understanding of the development of the disease and effective, low cost therapies for prevention and treatment are desperately needed. Accumulating evidence suggests that increased sedentary time (i.e. 'sitting time') combined with reduced physical activity levels, plays both a major role in the development of T2D and may contribute to the worsening of the condition after diagnosis. In this review, we cover these topics and use current scientific evidence to support our belief that 'type 2 diabetes sits in a chair'. We also discuss a relatively new question that has yet to be examined: Would reducing sitting time be an effective treatment for T2D?
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Affiliation(s)
- T P J Solomon
- The Centre of Inflammation and Metabolism, Department of Infectious Diseases, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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Chu AHY, Moy FM. Joint association of sitting time and physical activity with metabolic risk factors among middle-aged Malays in a developing country: a cross-sectional study. PLoS One 2013; 8:e61723. [PMID: 23613917 PMCID: PMC3629118 DOI: 10.1371/journal.pone.0061723] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Accepted: 03/16/2013] [Indexed: 01/13/2023] Open
Abstract
Background Prolonged sitting is associated with increased weight and higher risks for abdominal obesity, dyslipidaemia, hyperglycaemia and hypertension among the adult population. This has been well documented in the West, but studies on these associations are lacking in developing countries, including Malaysia. Objective This cross-sectional study aimed to examine the joint association of sitting time and physical activity with metabolic risk factors among middle-aged working adults. Methodology A total of 686 Malay men and women participated (mean age 45.9±6.5 years). Metabolic syndrome was diagnosed from the modified NCEP ATP III criteria. Self-reported sitting time was obtained with the validated Malay version of the International Physical Activity Questionnaire. Participants were asked about their time spent sitting during travel in a motor vehicle, e.g., car, motorcycle or bus, over the preceding 7 days. Logistic regression was used to estimate the odds ratio with the confidence interval for the combined effects of sitting quartiles and physical activity categories with metabolic risk factors. Results/Significance The prevalence of metabolic syndrome among our participants was 31.9%. Their average total sitting time (including transportation) was 7.6±2.4 h/day. After we adjusted for gender and educational level, higher sitting quartiles and physically inactive groups were associated with higher odds for metabolic syndrome compared with the referent group (sitting <6 h/day and physically active). In the physically active stratum, the odds for metabolic syndrome in participants who sat ≥9.3 h/day was 3.8 times that of participants who sat <6 h/day. Both higher sitting quartiles and insufficient physical activity were associated with adverse effects on abdominal obesity, hypertriglyceridemia and hyperglycaemia. Conclusion In joint analyses of sitting time and physical activity, higher sitting time and insufficient physical activity were deleteriously associated with odds for metabolic risk factors in middle-aged Malay men and women.
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Affiliation(s)
- Anne H Y Chu
- Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
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Waidyatilaka I, Lanerolle P, Wickremasinghe R, Atukorala S, Somasundaram N, de Silva A. Sedentary behaviour and physical activity in South Asian women: time to review current recommendations? PLoS One 2013; 8:e58328. [PMID: 23472180 PMCID: PMC3589267 DOI: 10.1371/journal.pone.0058328] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Accepted: 02/01/2013] [Indexed: 11/18/2022] Open
Abstract
Objective Our aims were to describe activity and sedentary behaviours in urban Asian women, with dysglycaemia (diagnosed at recruitment), and without dysglycaemia and examine the relative contribution of these parameters to their glycaemic status. Methods 2800 urban women (30–45 years) were selected by random cluster sampling and screened for dysglycaemia for a final sample of 272 newly diagnosed, drug naive dysglycaemic and 345 normoglycaemic women. Physical activity and sedentary behaviours were assessed by the International Physical Activity Questionnaire (IPAQ). Demographic data, diet and anthropometry were recorded. Logistic regression analysis assessed contribution of all parameters to dysglycaemia and exposure attributable fractions were calculated. Results The mean energy expenditure on walking (2648.5±1023.7 MET-min/week) and on moderate and vigorous physical activity (4342.3±1768.1 MET-min/week) for normoglycemic women and dysglycaemic women (walking;1046.4±728.4 MET-min/week, moderate and vigorous physical activity; 1086.7±1184.4 MET-min/week) was above the recommended amount of physical activity per week. 94.3% of women spent >1000 MET-minutes/week on activity. Mean sitting and TV time for normoglycaemic and dysglycaemic women were 154.3±62.8, 38.4±31.9, 312.6±116.7 and 140.2±56.5 minutes per day respectively. Physical activity and sedentary behaviour contributed to dysglycaemia after adjustment for family history, diet, systolic blood pressure and Body Mass Index. Exposure attributable fractions for dysglycaemia were; lower physical activity: 78%, higher waist circumference: 94%, and TV viewing time: 85%. Conclusions Urban South Asian women are at risk of dysglycaemia at lower levels of sedentary behaviour and greater physical activity than western populations, indicating the need for re-visiting current physical activity guidelines for South Asians.
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Affiliation(s)
- Indu Waidyatilaka
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Pulani Lanerolle
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Rajitha Wickremasinghe
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Sunethra Atukorala
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Noel Somasundaram
- Endocrine Unit, National Hospital of Colombo, University of Colombo, Sri Lanka
| | - Angela de Silva
- Department of Physiology, Faculty of Medicine, University of Colombo, Sri Lanka
- * E-mail:
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Davis SR, Castelo-Branco C, Chedraui P, Lumsden MA, Nappi RE, Shah D, Villaseca P. Understanding weight gain at menopause. Climacteric 2013; 15:419-29. [PMID: 22978257 DOI: 10.3109/13697137.2012.707385] [Citation(s) in RCA: 340] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this review was to summarize the literature regarding the impact of the menopause transition on body weight and body composition. METHODS We conducted a search of the literature using Medline (Ovid, 1946-present) and PubMed (1966-2012) for English-language studies that included the following search terms: 'menopause', 'midlife', 'hormone therapy' or 'estrogen' combined with 'obesity', 'body weight' or 'body composition'. RESULTS Whereas weight gain per se cannot be attributed to the menopause transition, the change in the hormonal milieu at menopause is associated with an increase in total body fat and an increase in abdominal fat. Weight excess at midlife is not only associated with a heightened risk of cardiovascular and metabolic disease, but also impacts adversely on health-related quality of life and sexual function. Animal and human studies indicate that this tendency towards central abdominal fat accumulation is ameliorated by estrogen therapy. Studies mostly indicate a reduction in overall fat mass with estrogen and estrogen-progestin therapy, improved insulin sensitivity and a lower rate of development of type 2 diabetes. CONCLUSION The hormonal changes across the perimenopause substantially contribute to increased abdominal obesity which leads to additional physical and psychological morbidity. There is strong evidence that estrogen therapy may partly prevent this menopause-related change in body composition and the associated metabolic sequelae. However, further studies are required to identify the women most likely to gain metabolic benefit from menopausal hormone therapy in order to develop evidence-based clinical recommendations.
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Affiliation(s)
- S R Davis
- Women's Health Research Program, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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Objective vs. self-reported physical activity and sedentary time: effects of measurement method on relationships with risk biomarkers. PLoS One 2012; 7:e36345. [PMID: 22590532 PMCID: PMC3348936 DOI: 10.1371/journal.pone.0036345] [Citation(s) in RCA: 308] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Accepted: 04/05/2012] [Indexed: 11/19/2022] Open
Abstract
Purpose Imprecise measurement of physical activity variables might attenuate estimates of the beneficial effects of activity on health-related outcomes. We aimed to compare the cardiometabolic risk factor dose-response relationships for physical activity and sedentary behaviour between accelerometer- and questionnaire-based activity measures. Methods Physical activity and sedentary behaviour were assessed in 317 adults by 7-day accelerometry and International Physical Activity Questionnaire (IPAQ). Fasting blood was taken to determine insulin, glucose, triglyceride and total, LDL and HDL cholesterol concentrations and homeostasis model-estimated insulin resistance (HOMAIR). Waist circumference, BMI, body fat percentage and blood pressure were also measured. Results For both accelerometer-derived sedentary time (<100 counts.min−1) and IPAQ-reported sitting time significant positive (negative for HDL cholesterol) relationships were observed with all measured risk factors – i.e. increased sedentary behaviour was associated with increased risk (all p≤0.01). However, for HOMAIR and insulin the regression coefficients were >50% lower for the IPAQ-reported compared to the accelerometer-derived measure (p<0.0001 for both interactions). The relationships for moderate-to-vigorous physical activity (MVPA) and risk factors were less strong than those observed for sedentary behaviours, but significant negative relationships were observed for both accelerometer and IPAQ MVPA measures with glucose, and insulin and HOMAIR values (all p<0.05). For accelerometer-derived MVPA only, additional negative relationships were seen with triglyceride, total cholesterol and LDL cholesterol concentrations, BMI, waist circumference and percentage body fat, and a positive relationship was evident with HDL cholesterol (p = 0.0002). Regression coefficients for HOMAIR, insulin and triglyceride were 43–50% lower for the IPAQ-reported compared to the accelerometer-derived MVPA measure (all p≤0.01). Conclusion Using the IPAQ to determine sitting time and MVPA reveals some, but not all, relationships between these activity measures and metabolic and vascular disease risk factors. Using this self-report method to quantify activity can therefore underestimate the strength of some relationships with risk factors.
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Blüher S, Markert J, Herget S, Yates T, Davis M, Müller G, Waldow T, Schwarz PEH. Who should we target for diabetes prevention and diabetes risk reduction? Curr Diab Rep 2012; 12:147-156. [PMID: 22298028 DOI: 10.1007/s11892-012-0255-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Bhopal RS. Research agenda for tackling inequalities related to migration and ethnicity in Europe. J Public Health (Oxf) 2012; 34:167-73. [PMID: 22366715 DOI: 10.1093/pubmed/fds004] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Reducing ethnic inequalities and inequities in health needs to become a higher priority for public health research. Active involvement of migrant and ethnic minority populations in European population health research is necessary, for data show important inequalities but evidence, particularly on effectiveness, is sparse and strategic overviews rarer still. Ethnically disaggregated health surveillance systems are developing slowly, and pragmatically, often using country of birth. The principles to adopt, given the gaps between the ideal and the current reality, need wider discussion. Ethics may provide both principles and impetus. Doing no harm, doing good, respecting the research participants' autonomy are good starting points. More emphasis is needed on justice, fairness and equality, participation and communicating effectively. Ethnic minority groups are willing participants in trials once linguistic and trust-related barriers are overcome, though recruitment costs are higher. Guidelines and strategies by European bodies with research funding or enforcement responsibilities are needed. The research community needs an infrastructure within which to collect and utilize evidence. Research can help migrant and ethnic minority groups to participate more fully in our multi-ethnic societies.
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Affiliation(s)
- Raj S Bhopal
- Ethnicity and Health Research Group, Centre for Population Health Sciences, The University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK.
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Celis-Morales CA, Perez-Bravo F, Ibañes L, Sanzana R, Hormazabal E, Ulloa N, Calvo C, Bailey MES, Gill JMR. Insulin resistance in Chileans of European and indigenous descent: evidence for an ethnicity x environment interaction. PLoS One 2011; 6:e24690. [PMID: 21931814 PMCID: PMC3169638 DOI: 10.1371/journal.pone.0024690] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 08/18/2011] [Indexed: 12/24/2022] Open
Abstract
Background Effects of urbanisation on diabetes risk appear to be greater in indigenous populations worldwide than in populations of European origin, but the reasons are unclear. This cross-sectional study aimed to determine whether the effects of environment (Rural vs. Urban), adiposity, fitness and lifestyle variables on insulin resistance differed between individuals of indigenous Mapuche origin compared to those of European origin in Chile. Methodology/Principal Findings 123 Rural Mapuche, 124 Urban Mapuche, 91 Rural European and 134 Urban European Chilean adults had blood taken for determination of HOMA-estimated insulin resistance (HOMAIR) and underwent assessment of physical activity/sedentary behaviour (using accelerometry), cardiorespiratory fitness, dietary intake and body composition. General linear models were used to determine interactions with ethnicity for key variables. There was a significant “ethnicity x environment” interaction for HOMAIR (Mean±SD; Rural Mapuche: 1.65±2.03, Urban Mapuche: 4.90±3.05, Rural European: 0.82±0.61, Urban European: 1.55±1.34, p(interaction) = 0.0003), such that the effect of urbanisation on HOMAIR was greater in Mapuches than Europeans. In addition, there were significant interactions (all p<0.004) with ethnicity for effects of adiposity, sedentary time and physical activity on HOMAIR, with greater effects seen in Mapuches compared to Europeans, an observation that persisted after adjustment for potential confounders. Conclusions/Significance Urbanisation, adiposity, physical activity and sedentary behaviour influence insulin resistance to a greater extent in Chilean Mapuches than Chileans of European descent. These findings have implications for the design and implementation of lifestyle strategies to reduce metabolic risk in different ethnic groups, and for understanding of the mechanisms underpinning human insulin resistance.
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Affiliation(s)
- Carlos A. Celis-Morales
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
- School of Life Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Francisco Perez-Bravo
- Laboratory of Nutritional Genomics, Department of Nutrition, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Luis Ibañes
- Center of Nutrition, Metabolism and Physical Activity (CNEF), Concepcion, Chile
| | - Ruth Sanzana
- Center of Nutrition, Metabolism and Physical Activity (CNEF), Concepcion, Chile
| | - Edison Hormazabal
- Center of Nutrition, Metabolism and Physical Activity (CNEF), Concepcion, Chile
| | - Natalia Ulloa
- Department of Clinical Biochemistry and Immunology, Universidad de Concepción, Concepción, Chile
| | - Carlos Calvo
- Department of Clinical Biochemistry and Immunology, Universidad de Concepción, Concepción, Chile
| | - Mark E. S. Bailey
- School of Life Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Jason M. R. Gill
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
- * E-mail:
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Razeghi E, Heydarian P, Heydari M. The frequency of prediabetes and contributing factors in patients with chronic kidney disease. Rev Diabet Stud 2011; 8:276-81. [PMID: 22189551 PMCID: PMC3280013 DOI: 10.1900/rds.2011.8.276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Revised: 07/27/2011] [Accepted: 08/04/2011] [Indexed: 11/03/2022] Open
Abstract
AIMS Uremia is a prediabetic state, but abnormal glucose metabolism and relative risk factors in non-diabetic chronic kidney disease (CKD) patients are not studied extensively. This study aimed to evaluate prediabetes and contributing factors in patients with CKD. METHODS We studied the frequency of prediabetes (defined as fasting plasma glucose 100-125 mg/dl and 2-h plasma glucose 140-199 mg/dl) and contributing risk factors in 91 (34 women and 57 men) non-diabetic CKD (GFR < 60) patients who were referred to Sina Hospital between November 2010 and November 2011. Impaired fasting glucose and impaired glucose tolerance were regarded as prediabetic state. RESULTS Thirty-eight patients (41.8%), 28 male and 10 female, with mean age of 57.4 ± 17.1 yr, had prediabetes. Among these, 18.7% had impaired fasting glucose, 7.7% impaired glucose tolerance, and 15.4% combined impaired fasting glucose and impaired glucose tolerance. CKD patients with impaired glucose tolerance had more frequently hypertriglyceridemia (85.7% vs. 42.0%, p = 0.001), hypertension (66.6% vs. 31.4%, p = 0.004), and metabolic syndrome according to National Cholesterol Education Program Adult Treatment Panel III (52.3% vs. 25.7%, p = 0.02). Also, mean systolic blood pressure (134.2 ± 13.9 vs. 124.5 ± 20.0, p = 0.004) was higher in CKD patients with impaired glucose tolerance compared to CKD patients with normal glucose. CONCLUSIONS Prediabetes is a frequent condition in CKD patients. Also, hypertriglyceridemia and hypertension are more prevalent in prediabetic CKD patients than in non-diabetic CKD patients.
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Affiliation(s)
- Effat Razeghi
- Nephrology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Peimaneh Heydarian
- Department of Endocrinology and Metabolism, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahshid Heydari
- Nephrology Research Center, Tehran University of Medical Sciences, Tehran, Iran
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