Socio-demographic and dietary factors associated with excess body weight and abdominal obesity among resettled Bhutanese refugee women in Northeast Ohio, United States

Health condition, income loss, food insecurity and other social inequities among migrants and refugees during the COVID-19 pandemic in Brazil

BACKGROUND

Brazil is the destination of many international migrants and refugees and, given the circumstances of their entry into the country, many face difficulties due to the absence of targeted policies. Thus, the objective of this study was to survey the social impact of COVID-19 on international migrants and refugees regarding income loss, food insecurity and other social inequities, and to identify explanatory factors on these aspects.

METHODS

This is a cross-sectional, analytical study. We used a validated instrument applied by trained interviewers. Descriptive analysis and binary logistic regression were performed to identify factors associated with income loss and food insecurity.

RESULTS

A total of 360 individuals from sub-Saharan African and South American countries participated in the study. Individuals who were white, black/brown, yellow, had an occupation/employment, and earned less than one minimum wage were more likely to lose income. Those who reported no income, received less than one minimum wage, and were diagnosed with COVID-19 were more likely to be food insecure.

CONCLUSIONS

The study advances knowledge by identifying factors associated with income loss, food insecurity, and individuals' difficulty in accessing health services and social support measures in Brazil.

Association between inflammation, lipopolysaccharide binding protein, and gut microbiota composition in a New Hampshire Bhutanese refugee population with a high burden of type 2 diabetes

Introduction

South Asian refugees experience a high risk of obesity and diabetes yet are often underrepresented in studies on chronic diseases and their risk factors. The gut microbiota and gut permeability, as assessed through circulating lipopolysaccharide binding protein (LBP), may underlie the link between chronic inflammation and type 2 diabetes (T2D). The composition of the gut microbiota varies according to multiple factors including demographics, migration, and dietary patterns, particularly fiber intake. However, there is no evidence on the composition of the gut microbiota and its relationship with metabolic health in refugee populations, including those migrating to the United States from Bhutan. The objective of this study was to examine glycemic status in relation to LBP, systemic inflammation fiber intake, and gut microbiota composition in Bhutanese refugee adults residing in New Hampshire (n = 50).

Methods

This cross-sectional study included a convenience sample of Bhutanese refugee adults (N = 50) in NH. Established bioinformatics pipelines for metagenomic analysis were used to determine relative genus abundance, species richness, and alpha diversity measures from shallow shotgun sequences. The relationships between inflammatory markers, gut microbiota composition, dietary fiber, and glycemic status were analyzed.

Results

We identified a substantial chronic disease burden in this study population, and observed a correlation between glycemic status, LBP, and inflammation, and a correlation between glycemic status and gut microbiome alpha diversity. Further, we identified a significant correlation between proinflammatory taxa and inflammatory cytokines. SCFA-producing taxa were found to be inversely correlated with age.

Conclusion

To date, this is the most comprehensive examination of metabolic health and the gut microbiome in a Bhutanese refugee population in NH. The findings highlight areas for future investigations of inflammation and glycemic impairment, in addition to informing potential interventions targeting this vulnerable population.

A systematic review of the burden of, access to services for and perceptions of patients with overweight and obesity, in humanitarian crisis settings

INTRODUCTION

Excess body weight causes 4 million deaths annually across the world. The number of people affected by humanitarian crises stands at a record high level with 1 in 95 people being forcibly displaced. These epidemics overlap. Addressing obesity is a post-acute phase activity in non-communicable disease management in humanitarian settings. Information is needed to inform guidelines and timing of interventions. The objective of this review was to explore the prevalence of overweight and obesity in populations directly affected by humanitarian crises; the cascade of care in these populations and perceptions of patients with overweight and obesity.

METHODS

Literature searches were carried out in five databases. Grey literature was identified. The population of interest was non-pregnant, civilian adults who had experience of humanitarian crises (armed conflict, complex emergencies and natural disasters). All study types published from January 1st, 2011, were included. Screening, data extraction and quality appraisal were carried out in duplicate. A narrative synthesis is presented.

RESULTS

Fifty-six reports from forty-five studies were included. Prevalence estimates varied widely across the studies and by subgroups. Estimates of overweight and obesity combined ranged from 6.4% to 82.8%. Studies were heterogenous. Global distribution was skewed. Increasing adiposity was seen over time, in older adults and in women. Only six studies were at low risk of bias. Body mass index was the predominant measure used. There were no studies reporting cascade of care. No qualitative studies were identified.

CONCLUSION

Overweight and obesity varied in crisis affected populations but were rarely absent. Improved reporting of existing data could provide more accurate estimates. Worsening obesity may be prevented by acting earlier in long-term crises and targeting risk groups. The use of waist circumference would provide useful additional information. Gaps remain in understanding the existing cascade of care. Cultural norms around diet and ideal body size vary.

Exploring the Digital Divide among the Bhutanese Refugee Community during COVID-19: Engaged Research in Action

The digital divide proved a critical barrier to accessing information and healthcare during the COVID-19 pandemic and negatively impacted the Bhutanese refugee community. Moving beyond a technological model of the digital divide that highlights a lack of access to computers and the internet, we engaged the community to co-produce a dynamic approach that identifies the impact of socio-cultural and socio-environmental factors as well. Our paper reports on our community-academic research partnership and explores how the digital divide exacerbates health disparities in a midwestern Bhutanese refugee community. Combining the efforts of the community, anthropologists and social workers, this paper reports on the health disparities that confront the community as well as interventions designed to mitigate social inequities.

Dietary Intake and Nutritional Status among Refugees in Host Countries: A Systematic Review

Refugees remain vulnerable to acute food insecurity, malnutrition, and critically inadequate food and nutrient intake after migration, regardless of the economic level of the host country. We conducted this systematic review to summarize and evaluate the dietary intake and nutritional status among refugees resettled in non-camp settings worldwide. We searched PubMed and Web of Science databases to review relevant studies published between 2009 and 2020 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We also conducted an additional manual search through PubMed and Google Scholar. Studies that evaluated both dietary intake and nutritional status of refugees in host countries were included. A total of 15 articles from 10 countries were included and assessed for study quality and outcomes. Poor dietary diversity and insufficient intake of specific food groups were reported. In addition to these dietary patterns, a high prevalence of stunting, underweight, and anemia was reported, particularly among children. A double burden of malnutrition was also observed across and within studies. Post-resettlement dietary intake and nutritional status of refugees are both influenced by factors at the pre- and post-resettlement stages as refugees transition to their host countries. Those factors, including pre-resettlement experiences, host country resources, socioeconomic status, acculturation, and food security, were summarized and presented in a conceptual model. There is a need for comprehensive dietary and health screening as well as culturally appropriate and sustainable nutrition education resources and interventions for refugees to improve their diet and nutrition. Longitudinal studies and novel methodological approaches are also suggested to measure changes in refugees' food intake and nutritional status as well as to further investigate factors associated with these 2 components.

Reflections on researching vulnerable populations: Lessons from a study with Bhutanese refugee women

This paper explores the critical roles of researchers in research involving vulnerable populations. Its purpose is to reflect on the complex nature of vulnerability of Bhutanese refugee women who had resettled in Australia involved in research looking at the barriers to accessing preventive cancer screening. First, we describe the vulnerabilities considered prior to the research study and the actions taken to protect participants while the study was conducted. Second, we discuss those vulnerabilities that we did not anticipate, but were subsequently revealed during the study and consequently included in the study findings. These vulnerabilities should be considered for future research involving similar populations. It is important for researchers to use appropriate research designs that enable the voice of vulnerable people to be heard and to use research strategies that ensure findings are robust and participants are protected and empowered. Potential implications include the development of research practices that take account of the sources of vulnerabilities and consideration of how different vulnerabilities can evolve and affect findings and research recommendations.

Long-Term Physical Health Outcomes of Resettled Refugee Populations in the United States: A Scoping Review

Several studies describe the health of recently resettled refugee populations in the US beyond the first 8 months after arrival. This review summarizes the results of these studies. Scientific articles from five databases published from January 2008 to March 2019 were reviewed. Articles were included if study subjects included any of the top five US resettlement populations during 2008-2018 and if data described long-term physical health outcomes beyond the first 8 months after arrival in the US. Thirty-three studies met the inclusion criteria (1.5%). Refugee adults had higher odds of having a chronic disease compared with non-refugee immigrant adults, and an increased risk for diabetes compared with US-born controls. The most commonly reported chronic diseases among Iraqi, Somali, and Bhutanese refugee adults included diabetes and hypertension. Clinicians should consider screening and evaluating for chronic conditions in the early resettlement period. Further evaluations can build a more comprehensive, long-term health profile of resettled refugees to inform public health practice.

Nutritional Status and Obstacles to Healthy Eating Among Refugees in Geneva

Refugees face various nutritional challenges during and after migration. This cross-sectional, mixed-methods study seeks to investigate the prevalence of undernutrition and obesity among refugees in Geneva, and to identify barriers to healthy eating. Anthropometric measurements of 354 adult refugees were collected between 2017 and 2019 by trained nurses and dietitians. Seven focus group discussions totaling 51 participants, refugees and social workers, investigated conceptions and needs regarding diet. The mean Body Mass Index is 24.6 ± 4.8 kg/m². Women are disproportionately affected by obesity compared to men (p < 0.001). Weight gain post-migration is correlated positively with length of stay in Geneva (p < 0.001). Major obstacles to healthy eating are economic and linguistic. For participants, cooking workshops and free physical activities are highly needed interventions. Post-migration lifestyle interventions should be implemented to prevent weight gain in this population. Such interventions must be multi-level, to overcome structural, social and behavioral barriers to healthy eating.

Forced international migration for refugee food: a scoping review

Recent crisis and conflicts in African countries, the Middle East and the Americas have led to forced population migration and rekindled concern about food security. This article aims to map in the scientific literature the implications of forced migration on food and nutrition of refugees. Scoping Review, and database search: databases: PubMed Central, LILACS, SciElo, Science Direct and MEDLINE. Languages used in the survey were: English, Portuguese and Spanish, with publication year from 2013 to 2018. 173 articles were obtained and after removing of duplicates and full reading, 26 articles were selected and submitted to critical reading by two reviewers, resulting in 18 articles selected. From the analysis of the resulting articles, the following categories emerged: Food Inequity; Cultural Adaptation and Nutrition; Emerging Diseases and Strategies for the Promotion of Nutritional Health. Food insecurity is a marked consequence of forced international migration, and constitutes an emerging global public health problem, since concomitant with increasing population displacements also widens the range of chronic and nutritional diseases.

Community Intervention for Syrian Refugees in Baltimore City: The Lay Health Educator Program at a Local Mosque

This study focused on a partnership with a mosque in Baltimore, MD, and its impact on the local Syrian refugee population through a peer-to-peer healthcare training program. We implemented the Lay Health Educator Program over a 6-week period in an effort to teach members of the mosque about healthcare-related topics that they could then disseminate to the Syrian refugee population that attends the mosque. Physicians and nurses instructed community members on health, healthcare resources, and healthcare information during 2-h long sessions once a week. A total of 18 community members took part in the program, and their participation highlighted that the most significant health issues for the Syrian refugees are "access to healthcare," "mental health," and insight into certain noncommunicable disease. Finally, the community program graduates implemented several health-related campaigns over 2 years in an effort to disseminate information taught to them. In doing so, they significantly impacted the ability of the refugees to assimilate to the US healthcare system.

Multidrug-resistant Staphylococcus aureus Colonization in Healthy Adults Is more Common in Bhutanese Refugees in Nepal than Those Resettled in Ohio

Although studies have shown that human migration is one of the risk factors for the spread of drug-resistant organisms such as methicillin-resistant Staphylococcus aureus (MRSA), surveillance studies examining MRSA among refugee populations in the US are lacking. This study aimed to assess the prevalence and molecular characteristics of S. aureus among Bhutanese refugees living in Nepal and resettled in Northeast Ohio (NEO). One hundred adult Bhutanese refugees from each geographic location were enrolled between August 2015 and January 2016. The participants were interviewed to collect demographic information and potential risk factors for carriage. Nasal and throat swabs were collected for bacterial isolation. All S. aureus isolates were characterized by spa typing and tested for the presence of Panton-Valentine leukocidin (PVL) and mecA genes; selected isolates were tested by multilocus sequence typing (MLST). The overall prevalence of S. aureus was 66.0% and 44.0% in NEO and Nepal, respectively. In Nepal, 5.8% (3/52) of isolates were MRSA and 1.1% (1/88) in NEO. Twenty-one isolates in NEO (23.9%) were multidrug-resistant S. aureus (MDRSA), while 23 (44.2%) in Nepal were MDRSA. In NEO, 41 spa types were detected from 88 S. aureus isolates. In Nepal, 32 spa types were detected from 52 S. aureus isolates. spa types t1818 and t345 were most common in NEO and Nepal, respectively. The overall prevalence of PVL-positive isolates among S. aureus in Nepal and NEO was 25.0% and 10.2%. ST5 was the most common sequence type in both locations. Bhutanese refugees living in Nepal and resettled in NEO had high prevalence of S. aureus and MDRSA. The findings suggest a potential need for CA-MRSA surveillance among the immigrant population in the U S and among people living in Nepal, and a potential need to devise appropriate public health measures to mitigate the risk imposed by community-associated strains of S. aureus and MRSA.

The comparison of waist circumference, waist-to-hip ratio, and waist-to-height ratio among rural women adults in the North of Iran, between the years 2004 and 2013

BACKGROUND

Central obesity is a common health disorder, and the main objective of this study was to compare its changings among rural women in the north of Iran, between the years 2004 and 2013.

METHODS

Two cross-sectional studies were established on the 2839 and 2478 subjects in 2004 (first stage) and 2013 (second stage), respectively. Among 118 villages, 20 were selected using random sampling; they were the same in two studies. Central obesity was defined as waist circumference (WC) > 88 cm, waist-to-hip ratio (WHR) > 0.8, and waist-to-height ratio (WHtR) > 0.5.

RESULTS

The prevalence of central obesity in 2013 based on WC, WHR, and WHtR were 37.4%, 73.5%, and 67.8%, respectively. Compared with 2004, the prevalence of central obesity based on WHR increased as 5.4% (68.1% vs. 73.5%) (P = 0.001), whereas morbid obesity (WHtR > 0.6) based on WHtR decreased as 3.7% in 2013 (28.8% vs. 25.1%) (P = 0.004). Central obesity based on WHR significantly decreased in less or equal 24-year-old group (76.6% vs. 70.1%) (P = 0.003), while it increased in 25-34- (65.1% vs. 74.0%) and in equal or more than 35-year-old group (54.1% vs. 78.9%) (P = 0.001 for all). Moreover, morbid obesity decreased in all age, economic, and education groups (except uneducated one) (P < 0.050 for all).

CONCLUSION

Despite the decrease in central obesity based on WC and WHR indices in 2004-2013 duration, we found the evidence of a decline in sever obesity based on WHtR in that period. These trends have an alarm for health policy makers, not only in this area but also in same communities. Comprehensive studies are recommended to determine the best obesity indicator related to health in future.

Development of Obesity and Related Diseases in African Refugees After Resettlement to United States

Despite increases in obesity and related diseases in developing nations, initial refugee clinical visits do not address these issues. We explored the development of obesity and related diseases in a longitudinal prospective cohort of African refugees resettling in northeastern US. Using state Department of Health data, refugees were linked to a health system. Body mass index, diabetes, hypertension, and hyperlipidemia status were extracted from charts. US regional controls from NAMCS/NHAMCS data were matched by age, sex, race, and visit year. African refugee BMI increased after resettlement at 1 (1.7 ± 2.9, p < 0.0001) and 5 years (3.1 ± 3.7, p < 0.0001), a different trend than matched regional controls (p = 0.01). Refugees had increased rates of diabetes (1.0 vs. 10.8 %, p < 0.0001), hypertension (16.7 vs. 21.6 %, p < 0.0001) and hyperlipidemia (3.9 vs. 10.8 %, p < 0.0001) at 5 years not observed in regional controls. Our findings emphasize the need for interventions during resettlement to prevent development of obesity and related disease in this vulnerable population.

Longitudinal Changes and High-Risk Subgroups for Obesity and Overweight/Obesity Among Refugees in Buffalo, NY, 2004-2014

INTRODUCTION

Very few studies have been conducted on non-communicable diseases among resettled refugees. The purpose of the study was to examine longitudinal changes in obesity and overweight/obesity rates among resettled refugees and identify high-risk subgroups.

METHODS

Longitudinal health assessment data of 818 children (2-18 years) and 1055 adults (≥19 years) were used from a refugee clinic in Buffalo, NY, during 2004-2014. Univariate and bivariate analyses were performed. Risk factors of obesity and overweight/obesity were assessed using multivariate regression models.

RESULTS

Obesity (8.7 to 12.7%) and overweight/obesity (16.9 to 26.7%) rates increased among children over 4.5 years (p < 0.01). Over 3.9 years, overweight/obesity rates increased in men (39.6 to 58.6%, p < 0.01) and women (55.1 to 73.5%, p < 0.01), exceeding the prevalence of overweight/obesity of 65.8% in US-born women. Interestingly, longitudinal overweight/obesity rates decreased among Middle Eastern (81.4 vs 78.0%, p < 0.01) and East European (75.0 vs 70.8%, p < 0.01) women. African children had 2.31-folds (odds ratio [OR] = 2.31; 95% confidence interval [CI] = 1.46-3.67) greater overweight/obesity risk than Asians. African girls who were not overweight or obese at baseline had the highest risk of becoming obese at follow-up visits (OR = 0.21; 95%CI = 0.09-0.52). For each additional year refugees lived in the USA, overweight/obesity risk among men (OR = 1.23; 95%CI = 1.09-1.39) and women (OR = 1.18; 95%CI = 1.04-1.35) increased.

CONCLUSION

Obesity and overweight/obesity rates increased among refugees, but significant variations existed. Overweight/obesity rate among refugee women surpassed the US average. African origin, baseline weight, and longer duration of stay in the USA were risk factors. Culturally tailored programs are needed to prevent obesity and reduce health disparities among refugees.

A Systematic Examination of Food Intake and Adaptation to the Food Environment by Refugees Settled in the United States

The United States is the largest refugee resettlement country in the world. Refugees may face health-related challenges after resettlement in the United States, including higher rates of chronic diseases due to problems such as language barriers and difficulty adapting to new food environments. However, reported refugee diet challenges varied, and no systematic examination has been reported. This study examined refugee food intake pre- and postresettlement in the United States and differences in intake across various refugee groups. We systematically reviewed relevant studies that reported on refugee food intake and adaptation to the US food environment. We searched PubMed for literature published between January 1985 and April 2015, including cross-sectional and prospective studies. Eighteen studies met inclusion criteria. Limited research has been conducted, and most studies were based on small convenience samples. In general, refugees increased meat and egg consumption after resettling in the United States. Changes in refugee intake of vegetables, fruits, and dairy products varied by socioeconomic status, food insecurity, past food deprivation experience, length of stay in the United States, region of origin, and age. South Asians were more likely to maintain traditional diets, and increased age was associated with more conservative and traditional diets. Despite the abundance of food in the United States, postresettlement refugees reported difficulty in finding familiar or healthy foods. More research with larger samples and follow-up data are needed to study how refugees adapt to the US food environment and what factors may influence their food- and health-related outcomes. The work could inform future interventions to promote healthy eating and living among refugees and help to reduce health disparities.

Diabetes among refugee populations: what newly arriving refugees can learn from resettled Cambodians

A growing body of literature suggests that cardiometabolic disease generally and type 2 diabetes specifically are problems among refugee groups. This paper reviews rates of cardiometabolic disease and type 2 diabetes among refugees and highlights their unique risk factors including history of malnutrition, psychiatric disorders, psychiatric medications, lifestyle changes toward urbanization and industrialization, social isolation, and a poor profile on the social determinants of health. Promising interventions are presented for preventing and treating diabetes in these groups. Such interventions emphasize well-coordinated medical and mental health care delivered by cross-cultural and multidisciplinary teams including community health workers that are well integrated into the community. Finally, recommendations for service, policy, and research are made. The authors draw on local data and clinical experience of our collective work with Cambodian American refugees whose 30-year trajectory illustrates the consequences of ignoring diabetes and its risk factors in more recent, and soon to be arriving, refugee cohorts.