A practical model for identification of children at risk of excess energy intake in the developing world.

OBJECTIVE: We describe diet quality by demographic factors and weight status among Barbadian children and examine associations with excess energy intake (EI). A screening tool for the identification of children at risk of excess EI was developed. DESIGN: In a cross-sectional survey, the Diet Quality Index-International (DQI-I) was used to assess dietary intakes from repeat 24h recalls among 362 children aged 9-10 years. Participants were selected by probability proportional to size. A model to identify excess energy intake from easily measured components of the DQI-I was developed. SETTING: Barbados.ParticipantsPrimary-school children in Barbados. RESULTS: Over one-third of children were overweight/obese, and mean EI for boys (8644 (se 174·5) kJ/d (2066 (se 41·7) kcal/d)) and girls (8912 (se 169·9) kJ/d (2130 (se 40·6) kcal/d)) exceeded the RDA. Children consuming a variety of food groups, more vegetables and fruits, and lower percentage energy contribution from empty-calorie foods showed reduced likelihood of excess EI. Intake of more than 2400 mg Na/d and higher macronutrient and fatty acid ratios were positively related to the consumption of excess energy. A model using five DQI-I components (overall food group variety, variety for protein source, vegetables, fruits and empty calorie intake) had high sensitivity for identification of children at risk of excess EI. CONCLUSIONS: Children's diet quality, despite low intakes of fruit and vegetables, was within acceptable ranges as assessed by the DQI-I and RDA; however, portion size was large and EI high. A practical model for identification of children at risk of excess EI has been developed.

Prevalence and risk factors associated with obesity in the elderly in Barbados.

This article's objective is to examine the epidemiology of obesity in the urban elderly population of Barbados. A random sample of adults >/= 60 years underwent comprehensive interviews and measurement of their weight, height, and waist circumference (WC). Outcomes of interest were obesity (body mass index [BMI] > 30 kg/m2), high-risk WC (men >/= 102 cm; women >/= 88 cm), and high risk of disease comorbidity (from BMI and WC criteria). Total, 1,508 persons participated (80% response). Women had higher rates of obesity (31% vs. 11.9%), high-risk WC (61.9% vs. 13.9%), and disease co-morbidity risk (51.1% vs. 17.5%) compared to men. Multivariate regression confirmed female gender as an independent predictor of outcomes (p < 0.001). Other predictors were less consistent: self-reported fair/poor health status and eating two (vs. three) meals daily were associated with obesity, whereas semiprofessional occupation and unmarried status predicted high-risk WC. Obesity is highly prevalent among elderly Barbadians. Public health interventions must target this group, particularly women.

Randomized, placebo-controlled trial of product R, a peptide-nucleic acid immunomodulator, in the treatment of adults infected with HIV.

OBJECTIVE: The efficacy of Product R, a nontoxic peptide-nucleic acid, was tested in 43 HIV-infected adults naïve to antiretroviral therapy. METHOD: Patients were randomized to receive Product R (21 patients) or placebo (22 patients). Dosage was two 1 mL subcutaneous injections daily on days 1-14, followed by 1 mL daily on days 22-28, 36-42, and 50-56. The follow-up period lasted until day 120. RESULTS: Mean root CD4 count increased in the Product R group during treatment and was significantly higher (p =.013) by the end of follow-up. Four Product R-treated patients, but none of the control patients, experienced declines in viral load of >0.5 log. At the end of follow-up, the Product R group experienced a mean weight increase (p =.003), whereas the placebo group experienced a mean weight loss. The number of deaths and opportunistic infections were lower in the Product R group than in the placebo group (p =.076). No toxic effects were observed in any of the patients administered Product R. CONCLUSION: These findings suggest that Product R may have efficacy in the treatment of HIV-infected individuals.

Obesity, diabetes, hypertension, and vegetarian status among Seventh-Day Adventists in Barbados: preliminary results.

A population-based sample of Seventh-Day Adventists was studied to determine the relationship between vegetarian status, body mass index (BMI), obesity, diabetes mellitus (DM), and hypertension, in order to gain a better understanding of factors influencing chronic diseases in Barbados. A systematic sampling from a random start technique was used to select participants for the study. A standard questionnaire was used to collect data on demographic and lifestyle characteristics, to record anthropometrics and blood pressure measurements, and to ascertain the hypertension and diabetes status of participants. The sample population consisted of 407 Barbadian Seventh-Day Adventists (SDAs), who ranged in age from 25 to 74 years. One hundred fifty-three (37.6%) participants were male, and 254 (62.4%) were female, and 43.5% were vegetarians. The prevalence rates of diabetes and hypertension were lower among long-term vegetarians, compared to non-vegetarians, and long-term vegetarians were, on average, leaner than non-vegetarians within the same cohort. A significant association was observed between a vegetarian diet and obesity (vegetarian by definition P=.04, self-reported vegetarian P=.009) in this population. Other components of the study population lifestyle should be further analyzed to determine the roles they may plan in lessening the prevalence rates of obesity, diabetes, and hypertension.

Misperceptions, inactivity and maternal factors may drive obesity among Barbadian adolescents.

OBJECTIVES: To describe (1) the prevalence of overweight and obesity and their association with physical activity; (2) the effect of different cut-off points for body mass index (BMI) on weight status categorisation; and (3) associations of weight status with perceptions of body size, health and diet quality. DESIGN: A cross-sectional study. SETTING: Secondary schools in Barbados. SUBJECTS: A cohort of 400 schoolchildren, 11-16 years old, selected to study physical education practices. RESULTS: Prevalence of overweight (15% boys; 17% girls) and obesity (7% boys; 12% girls) was high. Maternal obesity, as defined by the International Obesity Task Force (IOTF) BMI cut-off points, predicted weight status such that reporting an obese mother increased the odds of being overweight by 5.25 (95% confidence interval: 2.44, 11.31). Physical activity was inversely associated with weight status; however levels were low. Recreational physical activity was not associated with weight status in either category. Overweight subjects tended to misclassify themselves as normal weight and those who misclassified perceived themselves to be of similar health status to normal-weight subjects. The National Center for Health Statistics and IOTF BMI cut-off points produced different estimates of overweight and obesity. CONCLUSIONS: Our findings suggest that inadequate physical activity and ignorance related to food and appropriate body size are promoting high levels of adiposity with a strong contribution from maternal obesity, which may be explained by perinatal and other intergenerational effects acting on both sexes. Prevalence studies and local proxy tools for adiposity assessment are needed.

Historical and current predictors of self-reported health status among elderly persons in Barbados.

OBJECTIVE: To understand the relative contribution of past events and of current experiences as determinants of health status among the elderly in the Caribbean nation of Barbados, in order to help develop timely public health interventions for that population. METHODS: The information for this prevalence study was collected in Barbados between December 1999 and June 2000 as part of the "SABE project," a multicenter survey in seven urban areas of Latin America and the Caribbean that evaluated determinants of health and well-being in elderly populations (persons 60 and older). We used ordinal logistic regression to model determinants of self-reported health status, and we assessed the relative contribution of historical socioeconomic indicators and of three current modifiable predictor groups (current socioeconomic indicators, lifestyle risk factors, and disease indicators), using simple measures of association and model fit. RESULTS: Historical determinants of health status accounted for 5.2% of the variation in reported health status, and this was reduced to 2.0% when mediating current experiences were considered. Current socioeconomic indicators accounted for 4.1% of the variation in reported health status, lifestyle risk factors for 7.1%, and current disease indicators for 33.5%. CONCLUSIONS: Past socioeconomic experience influenced self-reported health status in elderly Barbadians. Over half of this influence from past events was mediated through current socioeconomic, lifestyle, and disease experiences. Caring for the sick and reducing lifestyle risk factors should be important considerations in the support of the current elderly. In addition, ongoing programs for poverty reduction and increased access to health care and education should be considered as long-term strategies to improve the health of the future elderly.

Historical and current predictors of self-reported health status among elderly persons in Barbados / Sucesos del pasado y del presente que determinan el estado de salud, según autonotificación, de las personas de edad en Barbados

Objective. To understand the relative contribution of past events and of current experiences as determinants of health status among the elderly in the Caribbean nation of Barbados, in order to help develop timely public health interventions for that population. Methods. The information for this prevalence study was collected in Barbados between December 1999 and June 2000 as part of the "SABE project," a multicenter survey in seven urban areas of Latin America and the Caribbean that evaluated determinants of health and well-being in elderly populations (persons 60 and older). We used ordinal logistic regression to model determinants of self-reported health status, and we assessed the relative contribution of historical socioeconomic indicators and of three current modifiable predictor groups (current socioeconomic indicators, lifestyle risk factors, and disease indicators), using simple measures of association and model fit. Results. Historical determinants of health status accounted for 5.2% of the variation in reported health status, and this was reduced to 2.0% when mediating current experiences were considered. Current socioeconomic indicators accounted for 4.1% of the variation in reported health status, lifestyle risk factors for 7.1%, and current disease indicators for 33.5%. Conclusions. Past socioeconomic experience influenced self-reported health status in elderly Barbadians. Over half of this influence from past events was mediated through current socioeconomic, lifestyle, and disease experiences. Caring for the sick and reducing lifestyle risk factors should be important considerations in the support of the current elderly. In addition, ongoing programs for poverty reduction and increased access to health care and education should be considered as long-term strategies to improve the health of the future elderly

Objetivo. Determinar la contribución relativa de sucesos del pasado y experiencias del presente al estado de salud de las personas de edad en Barbados, a fin de idear intervenciones sanitarias oportunas para esa población. Métodos. La información usada para este estudio de prevalencia se recogió en Barbados entre diciembre de 1999 y junio de 2000 como parte del "proyecto SABE," encuesta multicéntrica efectuada en siete centros urbanos de América Latina y el Caribe para evaluar los factores que inciden en la salud y el bienestar de las personas de edad (de 60 años o más). Mediante regresión logística para datos ordinales se modelaron los factores que inciden en el estado de salud autonotificado, y también se evaluó la contribución relativa de algunos indicadores socioeconómicos del pasado, así como la de tres grupos de factores modificables, relativos al momento presente, con valor pronóstico ­indicadores de situación socioeconómica, factores de riesgo asociados con el estilo de vida e indicadores de enfermedad­,usando medidas sencillas para calcular el grado de asociación y el ajuste del modelo. Resultados. Los sucesos del pasado que tuvieron un efecto determinante sobre la salud explicaron 5,2% de la variación del estado de salud autonotificado, cifra que se redujo a 2,0% cuando se tuvo en cuenta la mediación de experiencias del presente. Los indicadores de la situación socioeconómica actual explicaron 4,1% de la variación en el estado de salud autonotificado; los factores de riesgo relacionados con el estilo de vida explicaron 7,1%, y los indicadores de enfermedad actual, 33,5%. Conclusiones. Las experiencias pasadas de orden socioeconómico influyeron sobre el estado de salud autonotificado por ancianos barbadenses. Más de la mitad de la influencia ejercida por sucesos pasados se vio mediada por experiencias del presente relacionadas con la situación socioeconómica, el estilo de vida y la presencia de enfermedades. El cuidado de los enfermos y la reducción de los factores de riesgo relacionados con el estilo de vida son aspectos de importancia que deben tenerse presentes al prestarles apoyo a las personas que son ancianas en la actualidad. Además, los programas que están en marcha ahora para reducir la pobreza y aumentar el acceso a la atención de salud y a la educación deben considerarse estrategias de largo plazo orientadas a mejorar la salud de los ancianos del futuro

Historical and current predictors of self-reported health status among elderly persons in Barbados

OBJECTIVE. To understand the relative contribution of past events and of current experiences as determinants of health status among the elderly in the Caribbean nation of Barbados, in order to help develop timely public health interventions for that population. METHODS. The information for this prevalence study was collected in Barbados between December 1999 and June 2000 as part of the "SABE project," a multicenter survey in seven urban areas of Latin America and the Caribbean that evaluated the determinants of health and well-being in elderly populations (persons 60 and older). We used ordinal logistic regression to model determinants of self-reported health status, and we assessed the relative contribution of historical socioeconomic indicators and three current modifiable predictor groups (current socioeconomic indicators, lifestyle risk factors, and disease indicators), using simple measures of association and model fit. RESULTS. Historical determinants of health status accounted for 5.2 percent of the variation in reported health status, and this was reduced to 2.0 percent when mediating current experiences were considered. Current socioeconomic indicators accounted for 4.1 percent of the variation in reported health status, lifestyle risk factors for 7.1 percent, and current disease indicators for 33.5 percent. CONCLUSIONS. Past socioeconomic experience influenced self-reported health status in elderly Barbadians. Over half of this influence from past events was mediated through current socioeconomic, lifestyle, and disease experiences. Caring for the sick and reducing lifestyle risk factors should be important considerations in the support of the elderly. In addition, ongoing programs for poverty reduction and increased access to health care and education should be considered as long-term strategies to improve the health of the future elderly (AU)

A multifaceted lifestyle intervention in relatives of diabetics; preliminary results from the Barbados Diabetes Intervention Study (BDIS)

This study was designed to determine whether a twelve-week lifestyle intervention programme could improve the risk factor profile, in high risk subjects for the development of non-insulin-dependent diabetes mellitus. A group of volunteer relatives of diabetics were screened for body mass index (BMI), glucose tolerance and other risk factors, as well as for fitness to participate in an exercise programme. Subjects were randomized to a multifaceted lifestyle intervention programme, comprising aerobic exercise sessions, dietary instruction, diabetes-related medical education, motivation and life management skills, or to non-intervention. Results after twelve weeks confirm that impaired glucose tolerance is more likely to be reversed by a lifestyle intervention programme than by non-intervention, and that statistically and clinically significant improvements in BMI could be obtained in over weight and obese relatives of diabetic subjects.(AU)

Exercise - the West Indian experience: Position statement

The lifestyles of Caribbean population have changed dramatically over the last 40 years from predominantly plantation economies with heavy manual labour to predominantly tourism and services industries with a marked reduction of physical activity. Knowledge, attitude and practice surveys indicated that the majority of adults interviewed do not undertake significant physical activity outside of their work. In Barbados 47 percent claimed to do so, but the key activity, brisk walking, was undertaken only by 28 percent: 60 percent of men and 43 percent of women said they never walked. In Trinidad only 17 percent of men and 6 percent of women reported taking regular exercise. In both countries secondary education was associated with a two-to-three fold higher frequency of exercising. In Barbados, with the highest education and literacy rates, a minority of people over 60 have secondary education, and these figures was much lower in other Caribbean countries. The over 60 population, with a 50 percent prevalence of diabetes are at greatest risk of exercise deficiency and constitute a major challenge for lifestyle change which would improve both diabetes control and cardiovascular fitness. The entire population, however, has undergone a socioeconomic and sociocultural transition which has had a dramatic detrimental effect on health. The major thrust for prevention and management of diabetes and related diseases (obesity, hypertension, hyperlipidaemia and cardiac disease), must therefore be the promotion of healthty lifestyles.(AU)