Ethnic and sex-specific cut-off values for adult obesity in the Suriname health study

Sex-specific body mass index (BMI) and waist circumference (WC) cut-off values have been validated for a limited number of ethnic groups. We aimed to derive these cut-off values for Amerindians, Creoles, Hindustani, Javanese, Maroons and Mixed living in Suriname.

Methods Data from individuals aged 20­65, in the Suriname Health Study was used to derive optimal cut-off values for BMI and WC for the prediction of hypertension (n = 4910) and cardio-metabolic risk (n = 2924). Results from the analysis with Receiver Operating Curves were calculated and compared these with recommended values.

Results The area under the ROC curve was consistently higher for WC compared to BMI among Creoles, Hindustani, Maroons and Mixed. The BMI cut-off values ranged from 24.8 kg/m2 for Creole men and 26.9 kg/m2 for Maroon women to 28.4 kg/m2 and 30.2 kg/m2 for Amerindian men and women, respectively. The WC cut-off values ranged from 80.7 cm for Maroon men, 86.7 cm for Javanese women to 90.8 cm for Hindustani men and 95.7 cm for Amerindian women. Optimal BMI cut-off values approximated Asian cut-off values from the World Health Organization whilst those of WC for men approximated and for women exceeded cut-off values from the International Diabetes Federation.

Evaluating the risk of obstructive sleep apnea in type 2 diabetic patients, and its associations

OBJECTIVE: To assess the prevalence of high risk of Obstructive Sleep Apnoea (OSA) in Type 2 diabetics. To identify risk associations of OSA with obesity, sleep quality, daytime sleepiness and Acanthosis Nigricans. DESIGN AND METHODS: A cross sectional study was done in the diabetic wards of health facilities governed by three Regional Health Authorities in Trinidad. OSA risk was assessed by the Snoring, Tiredness, Observed Apnea, high blood Pressure (STOP) – Body mass index, Age, Neck circumference and Gender (BANG) questionnaire. Sleep quality and daytime sleepiness were also assessed by the Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale respectively. Bioimpedance analysis was also done using a stadiometer and standard bioimpedance scale. RESULTS: A total of 281 diabetic patients and 147 non-diabetic patients were interviewed throughout Trinidad. Females made up the majority of the sample, 67% of the diabetics and 66% of the non diabetics. The prevalence of OSA was found to be 73.2% in type 2 diabetics. Non diabetics had an OSA prevalence of 39.5%. Results from a binary regression showed that having diabetes increased the probability of “High Risk of OSA” by 93.1%. CONCLUSION: The prevalence of high risk of OSA in Trinidad was high in type 2 diabetic patients, and has strong correlations with obesity and Acanthosis Nigricans.

Defining diabetes mellitus - is the matter resolved?

OBJECTIVE: To investigate the theoretical distribution of incident cardiovascular events and retinopathy with respect to 2-hour glucose concentration in a population-based study of Jamaican adults and the implications of these distributions for the diagnosis of diabetes mellitus. METHODS: The American Diabetes Association and WHO diagnostic criteria for diabetes are based on the risk of microvascular complications of diabetes mellitus. There appears to be a threshold glucose concentration for incidence of retinopathy and nephropathy. However, no such threshold is apparent for macrovascular complications of diabetes mellitus. We applied risk estimates of incident cardiovascular disease associated with increasing 2-hour glucose concentration derived from a metaregression analysis of 20 studies to the distribution of 2-hour glucose concentration in the Spanish Town Survey. A sample of 1907 adults aged 25-74 years was recruited by door-to-door canvassing. Oral glucose tolerance testing was conducted after an overnight fast. The theoretical distribution of cardiovascular disease in the Spanish Town Survey was derived and compared with the theoretical distribution of retinopathy based on risk estimates from studies of Pima Indians. RESULTS: The prevalence of diabetes mellitus (2-hour glucose = 11.1 mmol/l) was 13.2 percent and 12.5 percent in subjects who had glucose concentrations between 8 and 11 mmol/l [approximately equivalent to range for impaired glucose tolerance (IGT)]. All cases of incident retinopathy would occur above 2-hour glucose concentration of 11.1 mmol/l. Only 38.5 percent of incident cases of cardiovascular disease would occur in this range while a further 13 percent would occur in the IGT range. Half of the cases would therefore occur in individuals considered to be normoglycaemic. CONCLUSION: The current WHO diagnostic criteria for diabetes mellitus identify all subjects at risk for microvascular complications of diabetes. However, they may miss as many as half of those at risk for cardiovascular disease, the leading cause of morbidity and mortality in diabetes mellitus.(Au)

The optimum time to initiate habitual xylitol gum-chewing for obtaining long-term caries prevention

Habitual xylitol gum-chewing may have a long-term preventive effect by reducing the caries risk for several years after the habitual chewing has ended. The goal of this report was (1) to determine if sorbitol and sorbitol/xylitol mixture provide a long-term benefit, and (2) to determine which teeth benefit most from two-year habitual gum-chewing - those erupting before, during, or after habitual gum-chewing. Children, on average 6 years old, chewing gums sweetened with xylitol, sorbitol, or xylitol/sorbitol mixture. There was a "no gum" control group. Five years after the two-year program of habitual gum-chewing ended, 288 children were re-examined. Compared with the no-gum group, sorbitol gums had no significant long-term effect (relative risk (RR), 0.65; 95 percent confidence interval [c.i]. 0.39 to 1.07; p < 0.18). Xylitol gums and, to a lesser extent, xylitol/sorbitol gum had a long-term preventive effect. During the 5 years after habitual gum-chewing ended, xylitol gums reduced the caries risk 59 percent (RR, 0.41; 95 percent c.i., 0.23 to 0.75; p < 0.0034). Xylitol-sorbitol gums reduced the caries risk 44 percent (RR, 0.56; 95 percent c.i., 0.36 to 0.89; p < 0.02). The long-term caries risk reduction associated with xylitol strongly depended on when teeth erupted (p < 0.02). Teeth that erupted after 1 year of gum-chewing or after the two-year habitual gum use ended had long-term caries risk reduction of 93 percent (p < 0.0054) and 88 percent (p < 0.0004), respectively. Teeth that erupted before the gum-chewing started had no significant long-term prevention (p < 0.30). We concluded that for long-term caries-preventive effects to be maximized, habitual xylitol gum-chewing should be started at least one year before permanent teeth erupt.(AU)

Exercise in the treatment of type 1 diabetes

The benefit of exercise are far-reaching but are more related to cardiovascular health rather than glycaemic control for the person with type I diabetes, although insulin needs may be reduced. Persons with type 2 diabetes with insulin resistance will benefit more than persons with type 1 diabetes. The main benefit for the persons with Type 1 diabetes is a sense of well-being, and knowing that they are able to participate in sport and competition safely. The risks associated with exercise are hypoglycaemia, ketosis, hyperglycaemia and increased risk of complications such as retinopathy, albuminuria and early diabetic kidney disease, peripheral autonomic neuropathy and cardiovascular risk. Retinopathy by itself is not a contraindication to exercise. However, exercise which raises the blood pressure or raises the risk for haemorrhage should be avoided.(AU)

Morbid risk of schizophrenia in first-degree relatives of white and African-Caribbean patients with psychosis

The high rate of schizophrenia among the second-generation African-Caribbean population in Britain has prompted much concern and speculation. Sugarman and Craufurd have reported that the morbid risk in the siblings of second-generation African-Caribbean schizophrenic patients was unusually high compared with that of the siblings of white patients. METHOD: We sought to replicate these findings by comparing the morbid risk for schizophrenia in the first-degree relatives of 111 white and 73 African-Caribbean psychotic probands. The latter comprised 35 first-generation (born in the Caribbean) and 38 second-generation (born in Britain) probands. RESULTS: The morbid risk for schizophrenia was similar for the parents and siblings of white and first-generation African-Caribbean patients, and for the parents of the second-generation African-Caribbean probands. However, the siblings of second-generation African-Caribbean psychotic probands had a morbid risk for schizophrenia that was seven times that of their white counterparts (P = 0.007); similarly, the siblings of second-generation African-Caribbean schizophrenic probands had a morbid risk for schizophrenia that was four times that of their white counterparts (P = 0.05). CONCLUSIONS: These findings replicate those of the earlier report of Sugarman and Craufurd, and suggest either that the second-generation African-Caribbean population in Britain is particularly vulnerable to some environmental risk factors for schizophrenia, or that some environmental factors act selectively on this population in Britain.(AU)

A pilot project of glaucoma in Barbados

The prevalence of open-angle glaucoma is believed to be very high among West Indian blacks. To begin investigating the prevalence and risk factors for glaucoma and other eye diseases in Barbados, WI, a pilot study was conducted. The pilot project identified a stratified, random national sample of 300 persons over 35 years of age who were invited to participate in an ophthalmic examination and an interview. Of those contacted 89 percent were eligible and 95 percent of these agreed to participate. The overall glaucoma prevalence in the participants was 6 percent; it was 13 percent among black and mixed persons over 54 years. Age related cataract, hypertension, and diabetes were frequent findings. Although the sample size of the pilot project is small, the results suggest a high prevalence of glaucoma in Barbados, a finding that merits further study. (AU)

Cholesterol oxides in Indian ghee: possible cause of unexplained high risk of atherosclerosis in Indian immigrant populations

Two populations of immigrants to London and to the West Indies from the Indian subcontinent have greater than expected morbidity and mortality from atherosclerosis but do not show the commonly accepted major risk factors. This study investigated the hypothesis that ghee, a clarified butter product prized in Indian cooking, contains cholesterol oxides and could therefore be an important source of dietary exposure to cholesterol oxides and an explanation for the high atherosclerosis risk. Substantial amounts of cholesterol oxides were found in ghee (12.3 percent of sterols), but not in fresh butter, by thin-layer and high-performance-liquid chromatography. Dietary exposure to cholesterol oxides from ghee may offer a logical explanation for the high frequency of atherosclerotic complications in these Indian population.(AU)

The painful crisis of homozygous sickle cell disease: a study of the risk factors

Some epidemiologic features of the painful crisis in homozygous sickle cell disease were examined in a retrospective study of 995 painful crises. Previously reported associations with cold weather and pregnancy were confirmed. There was a striking increase in painful crises in male patients between the ages of 15 and 25 years, whereas female patients showed little age-related change. The frequency of painful crises correlated positively with hemoglobin levels and reticulocyte counts in female patients. There was a striking increase in painful crises in male patients with hemoglobin levels above 8.5 g/dL (>85 g/L). High hemoglobin levels appear to be an important risk factor for painful crises.(AU)

Transmission of HTLV-I and HIV among homosexual men in Trinidad

Risk for human T-cell lymphotropic virus type (HTLV-I) and human immunodeficiency virus (HIV) infection was evaluated in 100 homosexual or bisexual men from Trinidad. High seropositivity for HTLV-I (15 percent vs 2.4 percent in the general population) was linked to duration of homosexuality and numbers of partners, suggesting that HTLV-I, like HIV, can be transmitted by homosexual sex. Forty percent of homosexuals compared with 0.19 percent of the general population were seropositive for HIV, and sexual contact with US homosexual men and prior history of gonorrhea were major risk factors. The seroprevalence of HIV was three times higher than for HTLV-I, suggesting that HIV is more efficiently transmitted, especially since HIV appears to have been recently introduced into Trinidad. Altered immune status was prominent in individuals infected with HIV and coinfected with HIV and HTLV-I. Whether HIV/HTLV-I coinfection amplifies clinical effects is a hypothesis that will require further evaluation.(AU)

Cardiovascular risk factors in Tobagonians: comparisons with other African populations

Comparative studies on cardiovascular risk factors in Tobagonians with other African populations show that Tobagonians had higher blood pressure levels of body bulk and obesity. T-wave inversion was also more common in Tobagonians were similar to those of two other Caribbean studies and were significantly higher than those of a white population in Wales (AU)

The outcome of pregnancy in patients with haemoglobin AS

The reproductive performance of one hundred and forty-four women with the sickle-cell trait (Hb AS) was studied. The benign antepartum course of this condition was confirmed. Consistent with previous reports, a good perinatal outcome was achieved. The mean birthweight in women with Hb AS was less than in a matched population and the difference was statistically significant (AU)

High total and cardiovascular disease mortality in adults of Indian descent in Trinidad, unexplained by major coronary risk factors

A prospective survey has been undertaken of a total community of 1343 men and 1149 women, aged 35-69 years at recruitment, living in Port-of Spain, Trinidad. By comparison with adults of African descent, age-adjusted relative risks of death from all causes and from cardiovascular diseases were significantly increased in those of Indian origin (0.5 and 0.3, respectively). Adults of European descent had an all-cause and cardiovascular mortality relative risk of 0.8 and 2.1, respectively. These ethnic differences in risk were not explained by systolic blood pressure, fasting blood glucose concentration, serum high-density lipoprotein or low-density lipoprotein concentration, or smoking habits. Differences in risk of cardiovascular death between Indian and European men seemed to be accounted for by the high prevalence of diabetes in Indians (19 percent) but other ethnic contrasts in mortality were unrelated to diabetes mellitus. (AU)

An outbreak of severe BCG axillary lymphadenitis in Saint Lucia, 1982-83

An epidemic of BCG auxillary lymphadenitis affected at least 37 children, primarily infants, in Saint Lucia in late 1982 and early 1983. Eleven infants had spontaneous rupture or required incision and drainage of supportive lymph nodes. Cases developed auxillary lymphadenitis from 1-22 weeks after immuniazation with Connaught BCG vacine, first introduced into the country in September, 1982. No single factor could be reliably implicated as the sole cause of the epidemic. More potent BCG vaccines, such as the Connaught product, give better protection but more reactions than weaker BCG vaccines and may reduce patient compliance with the Expanded Programme on Immunization in general. Those in BCG programmes should be alert to adverse reactions and scrupulous in storing, reconstituting, and administering the correct dose of BCG vaccine intradermally. Keeping good vaccination records and vials of each lot of vaccine used can help to determine whether epidemics of adverse reactions are occuring and what their cause might be. (AU)

Modelling the incidence of childhood diarrhea

Diarrheal disease is a primary cause of childhood mortality and morbidity in developing countries. Significant reduction depends on the identification of high-risk households which can be targetted for proven-effective interventions, such as oral rehydration therapy. This paper describes the development of a household risk assessment model in the context of an on-going diarrheal disease control in Grenada. Contingency and logit analyses of household survey data are used to identify easily observed markers of high-risk households. A three-variable logit model gives accurate predictions of self-reported diarrhea, showing that the approach can be used to develop an effective and efficient risk assessment tool.(AU)

The monitoring of high-risk pregnancy by non-stressed antepartum cardiotocography

One hundred and thirty-eight patients suspected to have utero-placental insuffiency and hence at "high-risk" had 420 tests performed, representing a preliminary experience with non-stressed cardiotocography in antepartum foetal surveillance. A ten-point scoring system based on base-line foetal heart rate, foetal movements, base-line variability and foetal heart rare response to foetal movements and Braxton-Hicks contractions was used to analyse the test results. Perinatal morbidity as evidenced by foetal distress in labour, number of operative deliveries, babies with low Apgar scores of six or less. The perinatal mortality rate was 9/1000 with a score of 7-10 as against arate of 120/1000 with a test score seven. The results compare favourably with other studies, and confirm the usefulness of this technique in monitoring foetal welfare. (AU)

Environmental lead hazard in a high-risk Jamaican population

During the last decade there has been a rapid proliferation of lead smelters, particularly illegal backyard smelters in Jamaica which has increased the risk of lead poisoning to employees and those living in proximity to these operations. Blood samples from 351 persons working in or living near lead smelting factories were analyzed for lead levels. There were 116 children and 235 adults. The mean age of the children was 5.9 years and the mean period of exposure to environmental lead was 5.2 years. The mean age of the adults was 30 years, with the mean period of exposure being 7.1 years. The mean blood lead level in the children was 62.1 ug/dl which was greater than that in adults in whom the mean level was 43.3 ug/dl. Fifty-one per cent of the children and 60 percent of adults had a blood lead level of 40 ug/dl or greater. Toxic levels occur commonly in adults and especially children working in or living near lead smelting operations. Urgent measures are needed to reduce the risk of lead toxicity to this high-risk population and the community. (AU)

Infection in a multidisciplinary intensive care unit at the University Hospital of the West Indies

The records of 1,252 patients were reviewed to determine the incidence of infection, mortality and associated risk factors in our multi-disciplinary intensive care unit (MD-ICU) during the period 1977 to 1982. The infection rate and the mortality rate were 24 percent and 22 percent respectively. The mortality rate in the infected group was 25 percent. The infection rate was higher in the intra-abdominal and trauma group as compared to the cardio-thoracic group (P<0.05). The incidence of ICU-acquired respiratory tract infection (41 percent), wound infection (17 percent) and urinary tract infection (15 percent) was significantly different from non-ICU acquired infections (P<0.05). The commonest site of infection was the respiratory tract (37 percent). The incidence of infection was directly related to the duration of medical devices left in situ and the length of stay in the unit (more than seven days) (AU)

Selected cardiovascular risk factors and electrocardiographic findings: a Tobago study

Cardiovascular risk factors and electrocardiographic findings were evaluated in a rural adult Tobago community. High amplitude R-waves, T-waves items and conduction and rhythm disturbances were the common electrocardiographic findings. Codable items suggestive of ischaemia showed no correlation with age, smoking, cholesterol levels, pulse rate or exercise, but showed a positive correlation in women with high serum uric acid levels and high fasting blood sugar levels, and a negative correlation with alcohol consumption in men (AU)