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Diabetes and diabetic retinopathy in people aged 50 years and older in the Republic of Suriname.

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Journal The British journal of ophthalmology
Year 2016
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BACKGROUND/AIMS: Population-based surveys on diabetes and diabetic retinopathy (DR) are necessary to increase awareness and develop screening and therapeutic programmes. The aim was to estimate the prevalence of DR in older adults of different ethnic backgrounds in Suriname. METHODS: Fifty clusters of 60 people aged ≥50 years were randomly selected with a probability proportional to the size of the population unit. Eligible people were randomly selected through compact segment sampling and examined using the Rapid Assessment of Avoidable Blindness plus Diabetic Retinopathy (RAAB + DR) protocol. Participants were classified as having diabetes if they: were previously diagnosed with diabetes; were receiving treatment for glucose control; had a random blood glucose level >200 mg/dL. These participants were dilated for funduscopy, assessed for DR following the Scottish DR grading protocol and evaluated for ethnicity and DR ophthalmic screening frequencies. RESULTS: A total of 2806 individuals was examined (response 93.6%). The prevalence of diabetes was 24.6%. In these patients any type of DR and/or maculopathy occurred in 21.6% and sight-threatening DR in 8.0%. Of the known diabetics, 34.2% never had an eye examination for DR and in 13.0% the last examination was >24 months ago. The prevalence of diabetes was significantly higher in Hindustani people compared with other major ethnic groups. CONCLUSIONS: The prevalence of diabetes and diabetics without regular DR control in people aged ≥50 years in Suriname was higher than expected. The uptake for special services for DR has to be expanded to decrease patient delay and DR-induced blindness.

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The Prevalence, Correlates, Detection and Control of Diabetes among Older People in Low and Middle Income Countries. A 10/66 Dementia Research Group Population-Based Survey.

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Journal PloS one
Year 2016
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BACKGROUND: Little is known of the epidemiology of diabetes among older people in low and middle income countries. We aimed to study and compare prevalence, social patterning, correlates, detection, treatment and control of diabetes among older people in Latin America, India, China and Nigeria. METHODS: Cross-sectional surveys in 13 catchment area sites in nine countries. Diagnosed diabetes was assessed in all sites through self-reported diagnosis. Undiagnosed diabetes was assessed in seven Latin American sites through fasting blood samples (glucose > = 7 mmol/L). RESULTS: Total diabetes prevalence in catchment sites in Cuba (prevalence 24.2%, SMR 116), Puerto Rico (43.4%, 197), and urban (27.0%, 125), and rural Mexico (23.7%, 111) already exceeds that in the USA, while that in Venezuela (20.9%, 100) is similar. Diagnosed diabetes prevalence varied very widely, between low prevalences in sites in rural China (0.9%), rural India (6.6%) and Nigeria (6.0%). and 32.1% in Puerto Rico, explained mainly by access to health services. Treatment coverage varied substantially between sites. Diabetes control (40 to 61% of those diagnosed) was modest in the Latin American sites where this was studied. Diabetes was independently associated with less education, but more assets. Hypertension, central obesity and hypertriglyceridaemia, but not hypercholesterolaemia were consistently associated with total diabetes. CONCLUSIONS: Diabetes prevalence is already high in most sites. Identifying undiagnosed cases is essential to quantify population burden, particularly in least developed settings where diagnosis is uncommon. Metabolic risk factors and associated lifestyles may play an important part in aetiology, but this requires confirmation with longitudinal data. Given the high prevalence among older people, more population research is indicated to quantify the impact of diabetes, and to monitor the effect of prevention and health system strengthening on prevalence, treatment and control.

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The association between fruit and vegetable intake, knowledge of the recommendations, and health information seeking within adults in the U.S. mainland and in Puerto Rico.

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Journal Journal of health communication
Year 2015
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Health information correlates of fruit and vegetable intake and of knowledge of the fruit and vegetable recommendations were examined using bivariate and multivariate regressions with data from the 2007-2008 U.S. National Cancer Institute's Health Information National Trends Survey in the United States and in Puerto Rico. Residents from Puerto Rico had the lowest reported fruit and vegetable intake and the lowest knowledge of the recommended servings of fruits and vegetables to maintain good health, compared with U.S. Hispanics, non-Hispanic Whites, and Blacks. Sixty-seven percent of Puerto Rican residents and 62% of U.S. Hispanics reported never seeking information on health or medical topics. In multivariate analysis, those who never sought information on health or medical topics reported significantly lower fruit and vegetable intake (coefficient = -0.24; 95% CI [-0.38, -0.09]), and were less likely to know the fruit and vegetable recommendations (OR = 0.32; 95% CI [0.20, 0.52]), compared with those who obtained information from their health care providers. Health promotion initiatives in the United States and Puerto Rico have invested in mass media campaigns to increase consumption of and knowledge about fruit and vegetables, but populations with the lowest intake are less likely to seek information. Strategies must be multipronged to address institutional, economic, and behavioral constraints of populations who do not seek out health information from any sources.

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Self-reported physical activity behavior of a multi-ethnic adult population within the urban and rural setting in Suriname.

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Journal BMC public health
Year 2015
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BACKGROUND: Physical activity (PA) plays an important role in the combat against noncommunicable diseases including cardiovascular diseases. In order to develop appropriate PA intervention programs, there is a need to evaluate PA behavior. So far, there are no published data on PA available for Suriname. Therefore, we aim to describe PA behavior among the multi-ethnic population living in urban and rural areas of Suriname. METHODS: The World Health Organization (WHO) STEPwise approach to chronic disease risk factor surveillance (STEPS) was conducted in a national representative sample (N = 5751; 48.6% men) aged 15-64 years between March and September 2013. Physical activity data were assessed using the Global physical activity questionnaire (GPAQ) and analyzed according to the GPAQ guidelines. The prevalence of meeting the recommended PA level and prevalence ratios (PR) were computed. RESULTS: Only 55.5% of the overall population met the WHO recommended PA levels (urban coastal area: 55.7%, rural coastal area: 57.9%, rural interior area: 49.1%). Women were less likely to meet the recommended PA level (49% vs 62.4%; p < 0.0001) and with increasing age the PR for recommended level of PA decreased (p < 0.0001). Compared to the Hindustani's, the largest ethnic group, the Javanese reported the lowest percentage of people meeting recommended PA level (PR = 0.92; p = 0.07). CONCLUSION: Around half of the population meets the recommended PA level. Future lifestyle interventions aiming at increasing PA should especially focus on women and older individuals as they are less likely to meet the recommended levels of PA.

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Social distribution of diabetes, hypertension and related risk factors in Barbados: a cross-sectional study.

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Journal BMJ open
Year 2015
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OBJECTIVE: To describe the distribution of diabetes, hypertension and related behavioural and biological risk factors in adults in Barbados by gender, education and occupation. DESIGN: Multistage probability sampling was used to select a representative sample of the adult population (≥ 25 years). Participants were interviewed using standard questionnaires, underwent anthropometric and blood pressure measurements, and provided fasting blood for glucose and cholesterol measurements. Standard WHO definitions were used. Data were weighted for sampling and non-response, and were age and sex standardised to the 2010 Barbados population. Weighted prevalence estimates were calculated, and prevalence ratios were calculated for behavioural and biological risk factors by demographic and socioeconomic group. RESULTS: Study response rate was 55.0%, with 764 women, 470 men. Prevalence of obesity was 33.8% (95% CI 30.7% to 37.1%); hypertension 40.6% (95% CI 36.5% to 44.9%); and diabetes 18.7% (95% CI 16.2% to 21.4%). Compared with women, men were less likely to be obese (prevalence ratio 0.5; 95% CI 0.4 to 0.7), or physically inactive (0.5; 0.4 to 0.6), but more likely to smoke tobacco (4.1; 2.5 to 6.7) and consume large amounts of alcohol in a single episode (4.6; 2.7 to 7.6). Both diabetes (0.83; 0.65 to 1.05) and hypertension (0.89; 0.79 to 1.02) were lower in men, but not significantly so. In women, higher educational level was related to higher fruit and vegetable intake, more physical activity, less diabetes and less hypercholesterolaemia (p 0.01-0.04). In men, higher education was related only to less smoking (p 0.04). Differences by occupation were limited to smoking in men and hypercholesterolaemia in women. CONCLUSIONS: In this developing country population, sex appears to be a much stronger determinant of behavioural risk factors, as well as obesity and its related risks, than education or occupation. These findings have implications for meeting the commitments made in the 2011 Rio Political Declaration, to eliminate health inequities.

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Cause-of-death disparities in the African diaspora: exploring differences among shared-heritage populations.

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Journal American journal of public health
Year 2015
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OBJECTIVES: We investigated changes in life expectancy (LE) and cause-specific mortality over time, directly comparing African-descent populations in the United States and the Caribbean. METHODS: We compared LE at birth and cause-specific mortality in 6 disease groups between Caribbean countries with a majority (> 90%) African-descent population and US African Americans. RESULTS: The LE improvement among African Americans exceeded that of Afro-Caribbeans so that the LE gap, which favored the Caribbean population by 1.5 years in 1990, had been reversed by 2009. This relative improvement among African Americans was mainly the result of the improving mortality experience of African American men. Between 2000 and 2009, Caribbean mortality rates in 5 of the 6 disease groups increased relative to those of African Americans. By 2009, mortality from cerebrovascular diseases, cancers, and diabetes was higher in Afro-Caribbeans relative to African Americans, with a diabetes mortality rate twice that of African Americans and 4 times that of White Americans. CONCLUSIONS: The Caribbean community made important mortality reductions between 2000 and 2009, but this progress fell short of African American health improvements in the same period, especially among men.

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A comparison of indices of glucose metabolism in five black populations: data from modeling the epidemiologic transition study (METS).

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Journal BMC public health
Year 2015
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BACKGROUND: Globally, Africans and African Americans experience a disproportionate burden of type 2 diabetes, compared to other race and ethnic groups. The aim of the study was to examine the association of plasma glucose with indices of glucose metabolism in young adults of African origin from 5 different countries. METHODS: We identified participants from the Modeling the Epidemiologic Transition Study, an international study of weight change and cardiovascular disease (CVD) risk in five populations of African origin: USA (US), Jamaica, Ghana, South Africa, and Seychelles. For the current study, we included 667 participants (34.8 ± 6.3 years), with measures of plasma glucose, insulin, leptin, and adiponectin, as well as moderate and vigorous physical activity (MVPA, minutes/day [min/day]), daily sedentary time (min/day), anthropometrics, and body composition. RESULTS: Among the 282 men, body mass index (BMI) ranged from 22.1 to 29.6 kg/m(2) in men and from 25.8 to 34.8 kg/m(2) in 385 women. MVPA ranged from 26.2 to 47.1 min/day in men, and from 14.3 to 27.3 min/day in women and correlated with adiposity (BMI, waist size, and % body fat) only among US males after controlling for age. Plasma glucose ranged from 4.6 ± 0.8 mmol/L in the South African men to 5.8 mmol/L US men, while the overall prevalence for diabetes was very low, except in the US men and women (6.7 and 12 %, respectively). Using multivariate linear regression, glucose was associated with BMI, age, sex, smoking hypertension, daily sedentary time but not daily MVPA. CONCLUSION: Obesity, metabolic risk, and other potential determinants vary significantly between populations at differing stages of the epidemiologic transition, requiring tailored public health policies to address local population characteristics.

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Barriers and facilitators to physical activity amongst overweight and obese women in an Afro-Caribbean population: A qualitative study.

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Authors Alvarado M , Murphy MM , Guell C
Journal The international journal of behavioral nutrition and physical activity
Year 2015
Links Pubmed DOI PubMed Central

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BACKGROUND: The proportion of obese women is nearly twice the proportion of obese men in Barbados, and physical inactivity may be a partial determinant. Using qualitative interviews and 'semi-structured' participant observation, the aim of this study was to identify modifiable barriers to physical activity and to explore the factors that facilitate physical activity amongst overweight and obese women in this low-resourced setting. METHODS: Seventeen women aged 25 to 35 years with a BMI ≥25, purposefully sampled from a population-based cross-sectional study conducted in Barbados, were recruited in 2014 to participate in in-depth semi-structured interviews. Twelve of these women participated in one or more additional participant observation sessions in which the researcher joined and observed a routine activity chosen by the participant. More than 50 hours of participant observation data collection were accumulated and documented in field notes. Thematic content analysis was performed on transcribed interviews and field notes using the software Dedoose. RESULTS: Social, structural and individual barriers to physical activity were identified. Social factors related to gender norms and expectations. Women tended to be active with their female friends rather than partners or male peers, and reported peer support but also alienation. Being active also competed with family responsibilities and expectations. Structural barriers included few opportunities for active commuting, limited indoor space for exercise in the home, and low perceived access to convenient and affordable exercise classes. Several successful strategies associated with sustained activity were observed, including walking and highly social, low-cost exercise groups. Individual barriers related to healthy living strategies included perceptions about chronic disease and viewing physical activity as a possible strategy for desired weight loss but less effective than dieting. CONCLUSIONS: It is important to understand why women face barriers to physical activity, particularly in low-resourced settings, and to investigate how this could be addressed. This study highlights the role that gender norms and health beliefs play in shaping experiences of physical activity. In addition, structural barriers reflect a mix of resource-scarce and resource-rich factors which are likely to be seen in a wide variety of developing contexts.

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Global estimates of diabetes prevalence for 2013 and projections for 2035.

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Journal Diabetes research and clinical practice
Year 2014
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INTRODUCTION: Diabetes is a serious and increasing global health burden and estimates of prevalence are essential for appropriate allocation of resources and monitoring of trends. METHODS: We conducted a literature search of studies reporting the age-specific prevalence for diabetes and used the Analytic Hierarchy Process to systematically select studies to generate estimates for 219 countries and territories. Estimates for countries without available source data were modelled from pooled estimates of countries that were similar in regard to geography, ethnicity, and economic development. Logistic regression was applied to generate smoothed age-specific prevalence estimates for adults 20-79 years which were then applied to population estimates for 2013 and 2035. RESULTS: A total of 744 data sources were considered and 174 included, representing 130 countries. In 2013, 382 million people had diabetes; this number is expected to rise to 592 million by 2035. Most people with diabetes live in low- and middle-income countries and these will experience the greatest increase in cases of diabetes over the next 22 years. CONCLUSION: The new estimates of diabetes in adults confirm the large burden of diabetes, especially in developing countries. Estimates will be updated annually including the most recent, high-quality data available.

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Assessing the association of nativity and acculturation to fast food restaurant use and its relationship to metabolic risk factors among US blacks with Afro-Caribbean ethnicity.

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Authors Tull ES , Taylor J
Journal Ethnicity & disease
Year 2014
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OBJECTIVES: This investigation among Afro-Caribbean adults in the United States Virgin Islands (USVI) examined whether acculturation and preference for dining out accounted for variation by nativity in the frequency of fast food restaurant use, and assessed the relationship of fast food restaurant use to body weight and insulin resistance. METHODS: A randomly selected sample of 679 Afro-Caribbean adults (aged ≥ 20 years), including 436 who were foreign-born and 243 who were native-born, were recruited on the island of St. Croix, USVI. Information on demographic characteristics, level of acculturation and dietary practices were obtained from participants by questionnaire. Fasting blood samples, which were measured for glucose and insulin, and anthropometric measurements were also collected from participants. Insulin resistance was estimated by the homeostasis model assessment (HOMA). Relationships between variables were assessed with analysis of variance and logistic regression analyses. RESULTS: In bivariate analyses, birth in the USVI, younger age, being single, greater preference for dining out and higher levels of education and acculturation were significantly (P < .05) associated with fast food restaurant use. In multivariate logistic regression analyses, birth in the USVI, younger age and preference for dining out were independently associated with frequent (≥ 2 days/week) fast food restaurant use. The mean level of HOMA insulin resistance among participants increased significantly with more frequent use of fast food restaurants. CONCLUSIONS: Among Afro-Caribbean adults in the USVI, fast food restaurant use is positively associated with insulin resistance and varies by nativity, but acculturation does not account for this variation.