TITLE:
Impact of maternal nativity on the prevalence of diabetes during pregnancy among
U.S. ethnic groups.
AUTHOR:
Kieffer EC, Martin JA, Herman WH
AFFILIATION:
School of Public Health, University of Michigan, Ann Arbor, USA. ekieffer@umich.edu
SOURCE:
Diabetes Care 1999 May;22(5):729-35
ABSTRACT:
OBJECTIVE: This study examines the impact of maternal nativity (birthplace) on the overall prevalence of diabetes
during pregnancy and among 15 racial and ethnic groups in the U.S. RESEARCH DESIGN AND METHODS: Birth
certificate data for all resident single live births in the U.S. from 1994 to 1996 were used to calculate reported diabetes
prevalence during pregnancy and to assess the impact of maternal birthplace outside of the 50 states and Washington,
DC, on the risk of diabetes before and after adjustment for differences in maternal age, other sociodemographic
characteristics, and late or no initiation of prenatal care overall and for each racial and ethnic group. RESULTS: Mothers
born outside of the U.S. are significantly more likely to have diabetes during pregnancy. The impact of maternal nativity
on diabetes prevalence is largely explained by the older childbearing age of immigrant mothers. However, adjusted
diabetes risk remains elevated for Asian-Indian, non-Hispanic black, Filipino, Puerto Rican, and Central and South
American mothers who were born outside the U.S. Conversely, birthplace outside the U.S. significantly reduces diabetes
risk for Japanese, Mexican, and Native American women. CONCLUSIONS: Identification, treatment, and follow-up of
immigrant mothers with diabetes during pregnancy may require special attention to language and sociocultural barriers
to effective care. Systematic surveillance of the prevalence and impact of diabetes during pregnancy for immigrant and
nonimmigrant women, particularly in racial and ethnic minority groups, and more detailed studies on the impact of
acculturation on diabetes may increase understanding of the epidemiology of diabetes during pregnancy in our
increasingly diverse society.
TITLE:
Comparison of prevalence and risk factors for microalbuminuria in South Asians and
Europeans with type 2 diabetes mellitus.
AUTHOR:
Mather HM, Chaturvedi N, Kehely AM
AFFILIATION:
Ealing Hospital, Middlesex, UK.
SOURCE:
Diabet Med 1998 Aug;15(8):672-7
ABSTRACT:
Although Type 2 (non-insulin-dependent) diabetes mellitus (Type 2 DM) is more common in South Asians than in
Europeans in the UK, very little is known about complications and their risk factors in South Asians. We sought
microalbuminuria in a cross-sectional study of 583 European and 889 South Asian Type 2 DM clinic attenders to Ealing
Hospital, London, over 1 year. Albumin/creatinine ratios were measured in early morning urines. Prevalence of
microalbuminuria was greater in South Asians compared to Europeans (40% versus 33% in men, p = 0.003, and 33%v
versus 19% in women, p < 0.0001). Glycaemic control was worse and prevalence of hypertension, retinopathy and heart
disease was higher in South Asians. Key risk factors for microalbuminuria in both ethnic groups were glycaemic control,
diabetes duration, blood pressure, triglyceride and retinopathy, but none accounted for the higher microalbuminuria
prevalence in South Asians. Age and sex adjusted odds ratio for microalbuminuria was 1.78 (95% CI 1.02, 2.82, p = 0.02)
in South Asians versus Europeans. After adjustment for confounders, this became 2.07, 95% CI 1.13, 3.79, p = 0.02. We
conclude that microalbuminuria is more common in South Asians with Type 2 DM than in Europeans and, although risk
factor relationships appeared similar in both groups, and some risk factors were more prominent in South Asians, this
cannot account for the high prevalence of microalbuminuria observed in South Asians.
TITLE:
Prevalence, detection, and management of cardiovascular risk factors in different
ethnic groups in south London.
AUTHOR:
Cappuccio FP, Cook DG, Atkinson RW, Strazzullo P
AFFILIATION:
Department of Medicine, St George's Hospital Medical School, London, UK. f.cappuccio@sghms.ac.uk
SOURCE:
Heart 1997 Dec;78(6):555-63
ABSTRACT:
OBJECTIVE: To assess the prevalence of cardiovascular risk factors and their level of detection and management in
three ethnic groups. DESIGN: Population based survey during 1994 to 1996. SETTING: Former Wandsworth Health
Authority in South London. SUBJECTS: 1578 men and women, aged 40 to 59 years; 524 white, 549 of African descent,
and 505 of South Asian origin. MAIN OUTCOME MEASURES: Age adjusted prevalence of hypertension, diabetes,
obesity, raised serum cholesterol, and smoking. RESULTS: Ethnic minorities of both sexes had raised prevalence rates
of hypertension and diabetes compared to white people. Age and sex standardised prevalence ratios for hypertension
were 2.6 (95% confidence interval 2.1 to 3.2) in people of African descent and 1.8 (1.4 to 2.3) in those of South Asian
origin. For diabetes, the ratios were 2.7 (1.8 to 4.0) in people of African descent and 3.8 (2.6 to 5.6) in those of South
Asian origin. Hypertension and diabetes were equally common among Caribbeans and West Africans and among South
Asian Hindus and Muslims. Prevalence of severe obesity was high overall, but particularly among women of African
descent (40% (35% to 45%)). In contrast, raised serum cholesterol and smoking rates were higher among white people.
Of hypertensives, 49% (216 of 442) had adequate blood pressure control. Overall, 18% (80 of 442) of hypertensives and
33% (62 of 188) of diabetics were undetected before our survey. Hypertensive subjects of African descent appeared
more likely to have been detected (p = 0.034) but less likely to be adequately managed (p = 0.085). CONCLUSIONS:
Hypertension and diabetes are raised two- to threefold in South Asians, Caribbeans, and West Africans in Britain.
Detection, management, and control of hypertension has improved, but there are still differences between ethnic groups.
Obesity is above the Health of the Nation targets in all ethnic groups, particularly in women of African descent.
Preventive and treatment strategies for different ethnic groups in Britain need to consider both cultural differences and
underlying susceptibility to different vascular diseases.
TITLE:
Computed axial tomographic scan measurement of abdominal fat distribution and its
correlation with anthropometry and insulin secretion in healthy Asian Indians.
AUTHOR:
Snehalatha C, Ramachandran A, Satyavani K, Vallabi MY, Viswanathan V
AFFILIATION:
Diabetes Research Centre, Royapuram, Madras, India.
SOURCE:
Metabolism 1997 Oct;46(10):1220-4
ABSTRACT:
Asian Indians have high insulin resistance, hyperinsulinemia, a high prevalence of diabetes, and a high waist to hip ratio
(WHR), although the rate of obesity is low. WHR and visceral fat (VF) are highly correlated, and both are associated with
insulin resistance. This study was performed to determine the normal ranges of abdominal fat distribution (subcutaneous
[SF] and VF) in nondiabetic South Indians and also to study its correlations with WHR, plasma insulin, and metabolic
profiles. Fat areas were measured by computed axial tomographic scan at the L4 to L5 level. Mean areas of SF and VF
in men and women in this study were similar to the values in white populations. Women had significantly less VF than
men. Gender differences were observed in the contribution of fat areas to anthropometric, hormonal, and metabolic
variables. In general, in men, total fat (TF) area showed significant independent correlation with body mass index (BMI),
WHR, and total cholesterol, and VF correlated with insulin secretion. In women, TF and BMI were correlated and SF
showed a correlation with total cholesterol. Insulin secretion in women did not show a correlation with fat areas.
TITLE:
Ethnic differences in mortality from cardiovascular disease in the UK: do they persist
in people with diabetes?
AUTHOR:
Chaturvedi N, Fuller JH
AFFILIATION:
Department of Epidemiology and Public Health, University College London.
SOURCE:
J Epidemiol Community Health 1996 Apr;50(2):137-9
ABSTRACT:
STUDY OBJECTIVE: To determine whether ethnic differences in cardiovascular disease mortality persist in people
with non-insulin-dependent diabetes mellitus. DESIGN: This was an ecological study in which routine mortality data
from 1985-86, which coded all mentioned causes of death, provided the numerator. The UK population derived from
1981 census formed the denominator. SETTING: United Kingdom. PARTICIPANTS: Records of all deaths in people
aged 45 years and above were extracted if diabetes was mentioned anywhere on the death certificate. The denominator
was aged five years to approximate to the 1986 population. Mortality rates where a cardiovascular underlying cause was
given were compared between South Asians, African-Caribbeans, and those born in England and Wales. The latter
group formed the standard for directly standardised rate ratios. MAIN RESULTS: Mortality from heart disease was
approximately three times higher in diabetic South Asian born men and women than in those with diabetes born in
England and Wales. This ethnic difference was greatest in the younger age group. Conversely, stroke mortality rates in
African-Caribbeans were 3.5-4 times higher than those in the England and Wales population. Despite this high mortality
from stroke, ischaemic heart disease death rates were not high in African-Caribbean men. CONCLUSIONS: Ethnic
differences in cardiovascular mortality persisted and were greater in those with diabetes. Thus the high risk of heart
disease should be targeted for intervention in South Asians, and the high rates of stroke targeted in African-Caribbeans.
TITLE:
Marked hyperinsulinaemia in postmenopausal, healthy Indian (Asian) women.
AUTHOR:
Berger GM, Naidoo J, Gounden N, Gouws E
AFFILIATION:
Department of Chemical Pathology, University of Natal Medical School, Durban, South Africa.
SOURCE:
Diabet Med 1995 Sep;12(9):788-95
ABSTRACT:
The effect of the menopause on insulin metabolism has not received specific attention in populations prone to
non-insulin-dependent (Type 2) diabetes mellitus (NIDDM). Insignificant or slight alterations in insulin levels have been
reported in postmenopausal women of mainly European ancestry. We thus report on the results of a cross-sectional
study on the correlates of fasting insulin levels in 177 healthy, Indian nurses aged between 25 and 55 years. Fasting
insulin concentration was markedly higher in the 75 postmenopausal subjects (23.9 mU I-1) than in the 102
premenopausal women (11.7 mU I-1 (p < 0.0001). Forty-three (57%) of the postmenopausal subjects had insulin values
more than 20 mU I-1 (the upper normal limit). Stepwise regression analysis on the entire group revealed menopause (p
< 0.0001), waist:hip ratio (p = 0.0001), apolipoprotein E genotype (p = 0.002), and the testosterone: sex hormone binding
globulin ratio (p = 0.0002) as statistically significant, independent predictors of log insulin levels. Age did not account for
the difference between premenopausal and postmenopausal subjects. The apolipoprotein E genotype emerged as a
significant correlate of insulin levels, only in postmenopausal women: epsilon 3/3, 26.3 mU I-1; epsilon 3/4, 51.8 mU I-1
(p = 0.0007). Hyperinsulinaemic postmenopausal subjects had higher fasting glucose levels than normoinsulinemic
nurses (p = 0.03), but glycosylated haemoglobin and fructosamine values were all within the normal range. Thus fasting
hyperinsulinaemia was marked and common among a group of healthy, postmenopausal Indian nurses below the age of
55 years, suggesting that the menopausal transition may permit or provoke insulin resistance in this susceptible
population.
TITLE:
Relation of central obesity and insulin resistance with high diabetes prevalence and
cardiovascular risk in South Asians.
AUTHOR:
McKeigue PM, Shah B, Marmot MG
AFFILIATION:
Department of Community Medicine, University College and Middlesex School of Medicine, London, UK.
SOURCE:
Lancet 1991 Feb 16;337(8738):382-6
ABSTRACT:
The hypothesis that the high mortality from coronary heart disease (CHD) in South Asians settled overseas compared
with other populations is due to metabolic disturbances related to insulin resistance was tested in a population survey of
3193 men and 561 women aged 40-69 years in London, UK. The sample was assembled from industrial workforces and
general practitioners' lists. In comparison with the European group, the South Asian group had a higher prevalence of
diabetes (19% vs 4%), higher blood pressures, higher fasting and post-glucose serum insulin concentrations, higher
plasma triglyceride, and lower HDL cholesterol concentrations. Mean waist-hip girth ratios and trunk skinfolds were
higher in the South Asian than in the European group. Within each ethnic group waist-hip ratio was correlated with
glucose intolerance, insulin, blood pressure, and triglyceride. These results confirm the existence of an insulin resistance
syndrome, prevalent in South Asian populations and associated with a pronounced tendency to central obesity in this
group. Control of obesity and greater physical activity offer the best chances for prevention of diabetes and CHD in South
Asian people.
TITLE:
Diabetes, hyperinsulinaemia, and coronary risk factors in Bangladeshis in east London.
AUTHOR:
McKeigue PM, Marmot MG, Syndercombe Court YD, Cottier DE, Rahman S, Riemersma RA
AFFILIATION:
Department of Community Medicine, University College and Middlesex School of Medicine, London.
SOURCE:
Br Heart J 1988 Nov;60(5):390-6
ABSTRACT:
Immigrants from the Indian subcontinent (South Asians) in England and Wales have higher morbidity and mortality from
coronary heart disease than the general population; this seems to apply to both Hindus and Muslims. Studies in north
west London and Trinidad found that the increased risk of coronary heart disease in Indians was not explained by dietary
fat intakes, smoking, blood pressure, or plasma lipids. In the present study the distribution of coronary risk factors was
measured in an East London borough where the mortality and attack rate from coronary heart disease are higher in the
Asian population, predominantly Muslims from Bangladesh, than in the rest of the population. In a sample of 253 men and
women aged 35-69 from general practice, mean plasma cholesterol concentrations were lower in Bangladeshi than in
European men and women. Mean systolic blood pressures were 10 mm Hg lower in Bangladeshis. Plasma fibrinogen
concentrations were similar in Bangladeshis and Europeans and factor VII coagulant activity was lower in Bangladeshi
than in European men. In contrast with the findings in Hindus in north west London, smoking rates were high in
Bangladeshi men and the ratio of polyunsaturated fatty acids to saturated fatty acids in plasma lipids was lower in
Bangladeshis than in Europeans. Diabetes was three times more common in Bangladeshis than in Europeans and serum
insulin concentrations measured after a glucose load were twice as high in Bangladeshis. High insulin concentrations in
Bangladeshis were associated with high plasma triglyceride and low high-density lipoprotein cholesterol concentrations.