RESUMEN
AIM: This study examined the associations of high allostatic load (h_ALS) and metabolic syndrome (MetS) with and self-rated poor health (SRPH) in overweight/obese non-Hispanic White (NHW), non-Hispanic Black (NHB), and Mexican American (MA) adults. METHODS: The 2015-16 and 2017-18 US National Health and Nutrition Examination Survey data (n = 4403) were used for this study. RESULTS: Rates of h_ALS in overweight/obese NHW, NHW, and MA participants were 56.9%, 58.8%, and 51.9%, respectively (P < .05). The corresponding rates for MetS were 26.9%, 31.9%, and 46.5%, respectively. High ALS was associated with 2.19 (95% CI: 1.87-4.59), 1.82 (1.42-2.58), and 1.47 (95% CI: 1.08-1.64) increased odds of SRPH in overweight/obese NHW, NHB, and MA, respectively, after adjusting for age, education, gender, income, lifestyle behaviors, and marital status. The corresponding values for MetS were 1.86 (95% CI: 1.54-2.40), 2.77 (95% CI: 1.36-5.63), and 1.22 (95% CI: 1.06-2.32), respectively. CONCLUSIONS: The effect of h_ALS on SRPH was much stronger in NHW, while the effect of MetS was strongest among NHB overweight/obese adults. The result of this study provides further evidence in favor of race/ethnic-tailored interventions, including education and weight control to reduced risks of bodywear and tear and SRPH.
Asunto(s)
Alostasis , Síndrome Metabólico/etnología , Obesidad/etnología , Sobrepeso/etnología , Adulto , Negro o Afroamericano , Anciano , Estudios Transversales , Autoevaluación Diagnóstica , Femenino , Estado de Salud , Humanos , Estilo de Vida , Masculino , Americanos Mexicanos , Persona de Mediana Edad , Encuestas Nutricionales , Población BlancaRESUMEN
AIM: To compare the strength of associations between surrogate indexes of insulin resistance (sIR) and risk of metabolic syndrome (MetS) in non-Hispanic White (NHW), non-Hispanic Black (NHB) and Mexican American (MA) adults. METHODS: The 2013-2016 US National Health and Nutrition Examination Survey data (n = 3435) were used for this study. The associations between sIR that includes Triglyceride/HDL cholesterol ratio (TG/HDL-C), triglyceride glucose (TG) index, visceral adiposity index (VAI), lipid accumulation product (LAP), TG-body mass index (TG-BMI), and TG-waist circumference (TG-WC) and risk for MetS were determined using the prevalence odds ratio (OR) from the logistic regression analyses. Pseudo-R-squared tests were used to estimate the proportion of variance in MetS accounted for by each sIR. Akaike Information Criterion and Bayesian Information Criterion from the multinomial logistic regression analysis were used to compare models that included each sIR and its components separately as predictors of MetS. Areas under curves (AUC) from the receiver-operating characteristic (ROC) were used to detect their diagnostic capabilities. RESULTS: Compared with other sIR, TG-WC (AUC = 0.899; 95% CI: 0.884-0.913 in NHW) and (AUC = 0.893; 95% CI:0.871-0.915 in NHB), and LAP (AUC = 877; 95% CI: 0.861-0.894 in MA) exhibited the highest diagnostic and predictive accuracy for MetS. Compared with other sIR, TG-WC (OR = 22.8; 95% CI:16.6-31.0 in NHW) and (OR = 22.7; 95% CI:13.1-39.3 in NHB), and LAP (OR = 10.6; 95%:6.6-17.0 in MA) were most significantly associated with increased odds of MetS, adjusting for eGFR, age, marital status, CHD, CHF, income, education, physical activity, alcohol use, smoking and use of cholesterol-lowering medication. CONCLUSIONS: TG-WC in NHW and NHB, and LAP in MA are more powerful than other proxies of IR in predicting MetS. TG-WC and LAP can serve as adjunctive tools for screening for MetS in NHW, NHB, and MA.
Asunto(s)
Negro o Afroamericano/estadística & datos numéricos , Índice de Masa Corporal , Resistencia a la Insulina , Síndrome Metabólico/diagnóstico , Americanos Mexicanos/estadística & datos numéricos , Obesidad Abdominal/complicaciones , Población Blanca/estadística & datos numéricos , Adiposidad , Biomarcadores/análisis , Estudios Transversales , Femenino , Estudios de Seguimiento , Humanos , Masculino , Síndrome Metabólico/epidemiología , Síndrome Metabólico/etiología , Persona de Mediana Edad , Pronóstico , Factores de Riesgo , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: Cardiometabolic risk (CMR) factors including hypertension, overweight/obesity, diabetes mellitus, and hyperlipidemia are high among United States ethnic minorities, and the immigrant population continues to burgeon. METHODS AND RESULTS: Hypothesizing that acculturation (length of residence) would be associated with a higher prevalence of CMR factors, the authors analyzed data on 54, 984 US immigrants in the 2010-2014 National Health Interview Surveys. The main predictor was length of residence. The outcomes were hypertension, overweight/obesity, diabetes mellitus, and hyperlipidemia. The authors used multivariable logistic regression to examine the association between length of US residence and these CMR factors.The mean (SE) age of the patients was 43 (0.12) years and half were women. Participants residing in the United States for ≥10 years were more likely to have health insurance than those with <10 years of residence (70% versus 54%, P<0.001). After adjusting for region of birth, poverty income ratio, age, and sex, immigrants residing in the United States for ≥10 years were more likely to be overweight/obese (odds ratio [OR], 1.19; 95% CI, 1.10-1.29), diabetic (OR, 1.43; 95% CI, 1.17-1.73), and hypertensive (OR, 1.18; 95% CI, 1.05-1.32) than those residing in the United States for <10 years. CONCLUSIONS: In an ethnically diverse sample of US immigrants, acculturation was associated with CMR factors. Culturally tailored public health strategies should be developed in US immigrant populations to reduce CMR.
Asunto(s)
Aculturación , Enfermedades Cardiovasculares/epidemiología , Diabetes Mellitus/epidemiología , Emigrantes e Inmigrantes/estadística & datos numéricos , Hiperlipidemias/epidemiología , Hipertensión/epidemiología , Obesidad/epidemiología , Adulto , África/etnología , Anciano , Asia/etnología , Asia Sudoriental/etnología , Estudios Transversales , Europa (Continente)/etnología , Femenino , Encuestas Epidemiológicas , Humanos , India/etnología , Modelos Logísticos , Masculino , México/etnología , Persona de Mediana Edad , Medio Oriente/etnología , Análisis Multivariante , Oportunidad Relativa , Sobrepeso/epidemiología , Prevalencia , Factores de Riesgo , América del Sur/etnología , Factores de Tiempo , Estados Unidos/epidemiología , Adulto JovenRESUMEN
AIM: To determine which cardiometabolic risk factors and clusters of cardiometabolic risk factors that are mostly associated with elevated HbA1c in non-Hispanic White (NHW), non-Hispanic Black (NHB) and Mexican-American (MA) adults who have type 2 diabetes. METHODS: Data (n=2910) from the United States National Health and Nutritional Examination Surveys were used in this study. Elevated HbA1c was defined as having HbA1c value was 7% or greater. Race/ethnicity-specific associations of individual and clustered (2-5 factors) cardiometabolic risk factors with elevated HbA1c were determined using prevalence odds ratio from multivariate logistic regression analyses. Statistical adjustments were made for sex, age, education, income and marital status. RESULTS: Joint occurrence of abdominal obesity, high blood pressure, and elevated triglycerides and joint occurrence of high blood pressure, elevated triglycerides and low HDL were more highly associated with elevated odds of HbA1c compared to other cardiometabolic risk factors joint occurrences. Joint occurrences of abdominal obesity, high blood pressure, and elevated triglycerides was associated with 2.3 (95% CI: 1.2-3.3), 9.1 (95% CI: 2.9-28.7) and 4.8 (95% CI: 2.0-11.5) increased odds of elevated HbA1c in NHW, NHB and MA, respectively. The corresponding values for the joint occurrence of high blood pressure, elevated triglycerides and low HDL was associated with 2.4 (95% CI: 1.2-3.7), 3.5 (95% CI: 1.1-5.5) and 2.6 (95% CI: 1.5-4.7) increased odds of elevated HbA1c in NHW, NHB and MA, respectively. CONCLUSION: This finding calls for consideration of cardiovascular risk factor clustering in deciding medical therapies to optimize glycemic control in individuals with type 2 diabetes. Interventions designed to achieve glycemic control coupled with modification of cardiometabolic risk factors may be crucial in alleviating sequelae resulting from type 2 diabetes.
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Enfermedades Cardiovasculares/epidemiología , Diabetes Mellitus Tipo 2/sangre , Hemoglobina Glucada/metabolismo , Adulto , Negro o Afroamericano , Estudios Transversales , Diabetes Mellitus Tipo 2/etnología , Femenino , Humanos , Hipertensión/epidemiología , Hipoalfalipoproteinemias/epidemiología , Modelos Logísticos , Masculino , Americanos Mexicanos , Análisis Multivariante , Encuestas Nutricionales , Obesidad Abdominal/epidemiología , Oportunidad Relativa , Prevalencia , Factores de Riesgo , Triglicéridos/sangre , Estados Unidos , Población BlancaRESUMEN
OBJECTIVE: We examined the relationship between metabolic syndrome (MetS) and impaired health-related quality of life (HRQoL) in non-Hispanic Whites (NHW), non-Hispanic Black (NHB), and Mexican-Americans (MA). METHODS: Data (n=5170) from 2009-2010 NHANES were used. Subjects perceived poor overall health (POH), poor physical health (PPH), and poor mental health (PMH) status in the past 30 days were used as indices of impaired HRQoL. Race/ethnic-specific associations between MetS and indices of HRQoL were determined using prevalence odds ratios (POR) from logistic regression models. Statistical adjustments were made for age, sex, education, marital status, income and smoking. RESULTS: Rates of POH, PPH and PMH in the past 30 days increased linearly with increased number of components of MetS in NHW, NHB and MA. MetS was associated with increased odds of PPH in NHW (POR=2.34; 95% CI=1.73-3.17) and MA (POR=1.65; 95% CI=1.09-2.50); increased odds of PPH in NHW (POR=1.65; 95% CI=1.18-2.31), NHB (POR=1.83; 95% CI=1.01-3.35), and MA (POR=1.67; 95% CI=1.09-2.83); and increased odds of PMH in NHW (POR=1.50; 95% CI=1.08-2.08), NHB (POR=2.28; 95% CI=1.29-4.01), and MA (POR=1.44; 95% CI=0.80-2.59). Upon adjustment for other independent variables, smoking and lack of education were found associated with increased odds of impaired HRQoL. CONCLUSIONS: MetS is associated with POH, PPH, and PMH in American adults. From clinical standpoint, this study further suggests that HRQoL should be considered in the management of subjects with MetS. Robust public health programs designed to reduce the prevalence of MetS may help in reducing impaired HRQoL, including POH, PPH, and PMH in American adults who have MetS.
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Negro o Afroamericano , Síndrome Metabólico/epidemiología , Americanos Mexicanos , Encuestas Nutricionales , Calidad de Vida , Población Blanca , Adulto , Negro o Afroamericano/estadística & datos numéricos , Distribución por Edad , Escolaridad , Femenino , Educación en Salud , Estado de Salud , Humanos , Modelos Logísticos , Masculino , Síndrome Metabólico/sangre , Síndrome Metabólico/psicología , Americanos Mexicanos/estadística & datos numéricos , Persona de Mediana Edad , Oportunidad Relativa , Prevalencia , Factores de Riesgo , Distribución por Sexo , Clase Social , Estados Unidos/epidemiología , Población Blanca/estadística & datos numéricosRESUMEN
This 2002 Medcen Foundation-funded study explored characteristics of problem drinking among 211 urban Venezuelan Native Americans of Arawak origin. Prevalence of problem drinking using Alcohol Use Disorders Identification Tests was 88.5% among men and 17.3% among women. Periodic binge drinking was marked by loss of control, failure to meet obligations, and alcohol-related trauma. Focus group participants noted that previous occasional binge drinking by men has been replaced by frequent male and female heavy weekend drinking, violence, and death. Limitations and implications are discussed. Awareness of high levels of problem drinking and desire for assistance present compelling mandates for community intervention efforts.
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Alcoholismo/epidemiología , Grupos de Población , Población Urbana , Adulto , Alcoholismo/etnología , Femenino , Grupos Focales , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Venezuela/epidemiologíaRESUMEN
OBJECTIVES: We explored potential effects of cadmium exposure on cardiovascular fitness measures, including gender and racial/ethnic differences. METHODS: Data were from the 1999 to 2000 National Health and Nutrition Examination Survey (NHANES); 1963 participating subjects were included in our analysis. Volume of oxygen consumed at sub-maximum activity (VO(2) max) were recorded in a series of graded exercises; the goal was to elicit 75% of predetermined age-specific heart rates. Cadmium from urine samples was measured in the laboratory using standard methods. Multivariate linear regression analyses were performed to determine potential relationships. RESULTS: Increased urinary cadmium concentrations were generally associated with decreased estimated VO(2) max values. Gender and racial/ethnic differences were also observed. Specifically, associations were statistically significant for white males and Mexican American females. CONCLUSION: Inverse associations between urinary cadmium concentrations and estimated VO(2) max values were observed, including racial and gender differences. The implications of such gender and racial/ethnic differences on long-term cardiovascular health and health disparities of present public health concern warrant further investigation.
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Cadmio/orina , Fenómenos Fisiológicos Cardiovasculares/efectos de los fármacos , Contaminantes Ambientales/orina , Consumo de Oxígeno , Adolescente , Adulto , Población Negra , Niño , Estudios Transversales , Prueba de Esfuerzo , Femenino , Humanos , Modelos Lineales , Masculino , Americanos Mexicanos , Persona de Mediana Edad , Factores Sexuales , Factores Socioeconómicos , Población Blanca , Adulto JovenRESUMEN
OBJECTIVE: To describe changes in the distribution of waist circumference (WC) and abdominal obesity (AO) in white, black, and Mexican-American adults from 1988 through 2000. RESEARCH METHODS AND PROCEDURES: Nationally representative cross-sectional surveys of adults 20 to 79 years of age were examined using data from U.S. National Health and Nutrition Examination Surveys of 1988 to 1994 and 1999 to 2000. AO was defined as WC > or =102 cm in men and > or 88 cm in women. RESULTS: There was a gradient of increasing WC and AO with increasing age in both study periods in whites and blacks. In men, the average increase between the study periods in overall WC in whites, blacks, and Mexican Americans were 3, 3.3, and 3.4 cm, respectively. The corresponding values in women were 2.4, 5.3, and 3.7 cm, respectively. In men, the percentage change in prevalence of AO between 1988 and 2000 ranged from 5.5% in Mexican-American men to 8.2% in white men. In women, there was a 1.7% decrease in AO in Mexican Americans, whereas there was an increase of 6.3% for whites and 7% for blacks. DISCUSSION: Despite increased understanding of the need for screening and treatment for obesity, this study indicates increasing prevalence of AO in white and black Americans. Without concerted effort to reduce the prevalence of overall obesity, the increasing prevalence of AO is likely to lead to increased prevalence of metabolic syndromes in the United States. Our results highlight the need to design evidence-based programs that show promise for long-term health behavior changes to facilitate the prevention of AO and related comorbidities.
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Tejido Adiposo/anatomía & histología , Población Negra , Americanos Mexicanos , Obesidad/epidemiología , Población Blanca , Abdomen/anatomía & histología , Adulto , Índice de Masa Corporal , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas Nutricionales , Estadísticas no Paramétricas , Estados UnidosRESUMEN
The prevalence of type 2 diabetes, impaired glucose tolerance and associated risk factors were compared in sample surveys in Africa and the Caribbean with the Third National Health and Nutrition Survey (NHANES-III) from the United States. A total of 856 Nigerians, 1286 Jamaicans, and 1827 US blacks were included in the study. Body mass index (BMI) increased in a stepwise fashion across the three population groups, ie, 23 kg/m2 in Nigerians, 26 kg/m2 in Jamaicans, and 28 kg/m2 in US blacks. The persons aged 25-74, were 1 percent, 12 percent, 13 percent. Jamaican women were found to have the same prevalence of type 2 diabetes as US women (14 vs 13 percent, respectively); mean BMI was likewise very similar (28 kg/m2 in Jamaican and 29 kg/m2 in US women). BMI and waist-to-hip ratio were both associated with type 2 diabetes prevalence. Findings of this study confirm the marked gradient in type 2 diabetes risk among these genetically related populations and suggest that the blacks in the island nations of the Caribbean and the United States are at particularly high risk. Nigerians exhibited remarkably well-preserved glucose tolerance. Understanding the factors that limit the risk of type 2 diabetes in West Africa, beyond relative absence of obesity, would have considerable public health significance.(Au)
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Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Negro o Afroamericano/estadística & datos numéricos , Índice de Masa Corporal , Diabetes Mellitus Tipo 2/etnología , Intolerancia a la Glucosa/etnología , Biometría , Distribución de Chi-Cuadrado , Jamaica/epidemiología , Nigeria/epidemiología , Oportunidad Relativa , Prevalencia , Análisis de Regresión , Factores de Riesgo , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVE: Prior studies have supported that waist circumference correlates better with visceral adipose tissue and is a better predictor of cardiovascular disease than are BMI and waist-to-hip ratio. In this study, we reexamine the role of waist size on the risk of hypertension and type 2 diabetes in African-origin populations from three contrasting environments. RESEARCH DESIGN AND METHODS: A cross-sectional survey was conducted of 5,042 men and women 25-74 years of age from Nigeria, Jamaica, and the U.S. The relationship between waist, blood pressure, and fasting blood glucose was assessed using multiple linear regression analyses. Logistic regression analyses using sex-specific empirical waist cut-points were used to determine the risks of hypertension and type 2 diabetes. RESULTS: Waist circumference was positively correlated with blood pressure and fasting blood glucose (P < 0.05). Increasing waist quartiles were significantly associated with higher risks of hypertension in the three populations, as estimated from age-adjusted odds ratios obtained from sex-specific logistic regression models. A highly elevated risk of type 2 diabetes-10-fold for Jamaican men and 23-fold for African-American women - was observed in the comparison of lowest to highest quartiles of waist circumference. CONCLUSIONS: Substantial reduction in hypertension and diabetes in men and women is achievable if the waist size is decreased in these populations. Intervention programs designed to reduce waist circumference through lifestyle modification, including exercise and diet, may have significant public health significance in reducing the incidence of hypertension and adult-onset diabetes in these populations (Au)