Food for thought - lessons learned about the eating habits of Barbadian from the Adolescent Health and Fitness study (AHFIT)

OBJECTIVE: To study the eating and exercise habits of adolescent school attenders in Barbados. DESIGN AND METHODS: Four hundred and sixty-two students, randomly selected by class, attending four schools at different points of the "academic rank ladder", were invited to complete a knowledge, attitudes and practices questionnaire, to be measured, and to have their blood drawn. RESULTS: Adolescents whose body mass indices (BMIs) were over 5 kgm-2 were more likely to know of a family member who was overweight or obese (p=0.04) and know of a family member who had diabetes (p=0.03) than were those whose BMIs were less than 25 kgm-2. More of these "bigger" adolescents, compared to their smaller schoolmates, were convinced that they ate in a healthy manner (p<0.001), but did not get enough exercise (p=0.01). CONCLUSIONS: Public health strategies should pay particular attention to the promotion of nutrition and physical activity counselling in adolescents.(Au)

Physical activity in Barbadian secondary school attenders - results from the Adolescent Health and Fitness study (AHFIT)

OBJECTIVE: To study the physical activity habits of adolescent school attenders in Barbados. DESIGN AND METHODS: Four hundred and sixty-two students, randomly selected by school class, attending four schools at different points of the "academic rank ladder", were invited to complete a knowledge, attitudes and practices questionnaire, to be measured, and to have blood drawn. RESULTS: Fifteen percent of these 10-18-year-old students, (males 8 percent, females 20 percent, p<0.001) did not participate in any form of physical activity on a regular basis. The males participated in cycling (54 percent), cricket (52 percent), jogging (50 percent) and football (45 percent), while the females participated in dancing (47 percent) and brisk walking (36 percent). Generally the males were more active than the females. Competing with the physical activity as leisure time activities were more sedentary activities like television viewing, computer and video games, while these adolescents had also experimented with alcohol (60 percent) and cigarettes (9.5 percent). CONCLUSIONS: The role for the health promotion team is clear: to promote increased physical activity in adolescents, to discourage other inappropriate behaviour patterns, and to monitor the influence of adolescent physical activity habits on adult physical activity and ultimately adult disease.(Au)

Hypertension, diabetes, and obesity in Barbados: findings from a recent population-based survey

A stratified random sample of 464 persons aged 40 ato 79 years, drawn from enumeration registers in the Bridgetown area of Barbados, participated in this survey. The prevalence of hypertension (defined as systolic blood pressure of at least 160mm Hg, diastolic blood pressure of at least 95 mm Hg, or use of antihypertensive medication) was 47 percent and 43 percent for women and men, respectively. Diabetes was present in 17 percent of all subjects (18 percent of women and 15 percent of men). Of the 209 hypertensive subjects, 82 percent were aware of their blood pressure status. The proportion of previously diagnosed hypertensive subjects on medication was 72 percent for men and 68 percent for women. Fifty-three percent of men and 42 percent of women were overweight (body mass indices [weight in kilograms divided by height in meters squared] between 25 and 30. However, 30 percent of women and 10 percent of men were obese (body mass indices over 30), supporting the growing recognition of the marked gender disparity in obesity among persons of African origin in the Caribbean. Body mass index was positively associated with hypertension (OR=1.33; 95 percent CI: 1.1-1.6). Obese persons experienced a 2.6 times greater risk of hypertension compared to those with body mass indices below 25. Similar statistically significant associations were observed between diabetes and body mass index: Or comparing body mass index over 30 with body mass index under 25 was 2.5 (95 percent CI: 1.3-5.1) for all subjects, 1.0 (0.3-4.1) for men only, and 5.2 (1.9-14) for women only. Preventing obesity in this population could reduce the incidence of hypertension and diabetes by approximately 30 percent and 33 percent among men and women, respectively. (Au)

Potassium and glucose tolerance in Barbadian hypertensives, treated with thiazides - abstract

This study was designed to assess the metabolic complications of thiazide use in black Barbadian hypertensives, and in particular the relationship between plasma potassium and glucose tolerance, including glycated haemoglobin (HbA1C). Patients attending the QEH Hypertension Clinic, whose blood pressure was controlled on a thiazide diuretic and no more than two other drugs, and who gave informed consent, were randomly assigned to one of four thiazide regimes (plus their other usual drugs): bendrofluazide (B) 5mg, bendrofluazide 5 mg+ potassium (K) 39 meq daily, triamterene/hydrochlorothiazide (T/H), or amiloride/hydrochlorothiazide (A/H). Forty patients completed one-year follow-up. There were no significant differences in any metabolic variables or bloodpressures at baseline. At one year, significant differences were seen for plasma potassium between patients on B and on B + K (p<0.05), between those on B and on T/H (p 0.01) and between the T/H and A/H groups (p<0.05), using Student 't' test. When compared by analysis of variance (ANOVA), these differences were again significant (F + 3.62, p + 0.03). When data of all 40 subjects for the baseline assessment and at one year were analysed as a group, there was a strong negative correlation between change in plasma potassium (K6 - K1), and change in glycated haemoglobin (HbA1C 6 - HbA1C 1) (r = 0.62, p = < 0.01). This is the first time that thiazide-induced changes in plasma potassium, and correction of hypokalaemia have been shown to be correlated withn glycated haemoglobin, and that this relationship applies across the whole range of potassium values. If these results can be confirmed in other study populations, then perhaps thiazides can be safely used without inducing glucose intolerance or diabetes, as long as effective potassium supplementation is achieved. This has far-reaching implications for the cost-effective treatment of hypertension in the Caribbean, and other developing countries(AU)

Hypertension, diabetes mellitus and potassium status in a population sample of black Barbadians: a preliminary report - abstract

The aims of this study were to assess the previously reported hypokalaemia in black Barbadians and investigate relationships between hypertension (diastolic bloodpressue > 90mm Hg and/or systolic bloodpressure > 160mm Hg), diabetes mellitus (DM, fasting plasma glucose > 7.8 mmol/l), diet and potassium (K) status in Barbadians. A stratified random sample by sex and age (40-70 years) was obtained from enumeration registers of a geographically defined area. Of 955 persons invited, 464 (48.6 per cent) responded and they comprised 190 men and 274 women. A general and a food frequency questionnaire for 24-hr. diet recall were administered, and height, weight and bloodpressure (BP) were measured. Fasting plasma glucose, K and sodium levels were measured in blood, and urine volume, sodium and K were determined in a 24-hr. urine collection. The mean plasma of K was 3.8 mmol/l, S.D. 0.44, giving a range (mean ñ 2 S.D.) of 2.9 - 4.7 mmol/l which was almost identical to that previously reported. Both 24-hr. urinary K and sodium showed a weak negative correlation with systolic BP only. K deficiency was not clearly linked to hypertension and neither K deficiency nor current thiazide use was linked to DM. The prevalence of hypertension (25 per cent), DM (11 per cent), obesity, hypokalaemia and moderately low dietary K were high (AU)

Malnutrition and theophylline clearance in the elderly

Thirteen elderly, clinically malnourshed (mean age 75.7) were studied for theophylline clearance before and after treatment for malnutrition. Theophylline half-life and clearance values were within normally reported values though the mean clearance value was greater (p<0.001) than that in a control group. Following treatment for malnutrition the clearance increased by 36 percent (p<0.05). This is an indication that the requirements of geriatric patients may need revision upon the nutritional rehabilitation which is expected following admission to appropriate facilities (AU)

Glycaemic response to local staple foods in diabetics - abstract

This paper reports the results of a pilot study done to investigate the glycaemic response (glycaemic index or G.I.) of fifteen (15) Type II Barbadian diabetics to different test foods. Subjects were fed four test meals of white bread, white rice, split peas and rice and split peas alone. Each meal contained 50gm of carbohydrate. Using white bread as the standard, Glycaemic Indices (G.I) were determined for each food from blood glucose measurements done over a three-hour period following the meal. Glycosylate haemoglobin (HbAlc) levels were measured as a monitor of diabetic control and were found to correlate well with the fasting blood sugar. White rice is shown to have a very high Glycaemic Index, more than four times that of split peas (102 compared to 24). A mixture of split peas and white rice, in a ration of 1:3, produces a significant decrease in G.I. (15.1+6.3, p < 0.05), although the change varied widely. Well-controlled diabetics (with the lowest HbAlc levels) all had a consistent decrease in G. I. on the food combination 28, (p<0.001), whereas poorly-controlled diabetics showed a small but unexpected increase in the G. I. mean 12.7, (p<0.02). There is an inverse relationship between change in G. I. and HbAlc levels, i.e. the better the diabetic control the greater the "split pea effect". In view of the high use of white rice in the Caribbean, there is an urgent need to dermine glycaemic indices of as many common cheap foods being eaten in the Caribbean as possible, and to ensure that these reference values are available to all those involved in diabetic care (AU)

A survey of epilepsy management and control in a hospital out-patient setting - abstract

The majority of patients with a diagnosis of epilepsy, attending the medical or paediatric outpatient clinics or the Casualty Department of the QEH in the three months, August 5 to November 5, 1987, were identified and interviewed by a research nurse. Data were collected on employment, diagnosis, fit frequency, drug regime, and alcohol use. A venous plasma sample was taken for anti-epileptic drug analysis. Two hundred and seventy-nine patients were seen (54 percent male and 46 percent female) aged 26ñ12 years meanñSD). Sixty-two per cent of adults were unemployed, nearly four times the national figure of 18 percent. There had been no attempt to qualify or label the type of epilepsy in 61 percent of patients. Specific diagrams of grand mal, complex partial and focal seizures were made in 19 percent, 18 percent and 4 percent respectively. Petit mal (1 case) appeared to be grossly under-diagnosed. Twenty-nine per cent of patients had had their last fit in the previous week, 20 percent between one week and one month, 25 percent between one and six months, and 22 percent more than six months before. Thus, half were unsatisfactorily and half well controlled. Phenytoin was the most frequently prescribed drug (in 44 percent alone, plus 13 percent in combination) followed by carbamazepine (30 percent and 13 percent) and phenobarbitone (8 percent and 6 percent). Eighty-two per cent of patients were treated with one drug, 17 percent with two and only 1 percent with three. There was a clear positive correlation between drug dose and plasma concentration for phenobarbitone, a less good one for carbamazepine and a poor one for phenytoin. Concentrations fell at high doses, showing poor compliance. More careful dose titration is necessary, using plasma monitoring. This is essential for good epilepsy control. Both doctor and public re-education is needed if patients with epilepsy are to be given a "fair deal" in health-care and employment (AU)

Theophylline clearance in malnourished elderly subjects - abstract

Many factors, including age and nutritional status, can affect drug metabolic rates. This study was designed to assess the metabolising capacity for the anti-asthmatic drug, theophylline, in malnourished elderly subjects before and after nutritional rehabilitation. Thirteen elderly, clinically malnourished subjects (aged 65-88 yrs.) were studied three to four days after admission to hospital for social reasons, and again after ten days of re-feeding with a high calorie, high protein diet. Theophylline half-life (T«) and clearance (CI) were determined from blood samples taken between 3 and 24 hours after a dose of 3.5 mg/kg. Malnutrition was assessed clinically and by serum albumin, haemoglobin and thyroid binding pre-albumin (TBPA). Serum albumin and TBPA were positively correlated and both increased after re-feeding. Theophylline Tu« and Cl values were within reported ranges. Half-lives were the same as those of healthy adult controls, but clearances were greater. Cigarette smokers were among the slowest, suggesting some other factor of malnutrition or acute hospitalisation may accelerate metabolism. On re-feeding, clearances increased by 37 percent, showing a great capacity of the elderly to respond to dietary supplementation; the subjects who were most malnourished had the lowest Cl rates and responded with the greates increase. These results have important implications for the selection of drug dose regimes for elderly hospitalised patients as the drug requirements may changed considerably during rehabilitation (AU)

Delayed diagnosis of complex partial (temporal lobe) epilepsy - abstract

Twelve patients with complex partial epilepsy (CPE) are reviewed. The diagnosis was delayed from two to 43 years of 16.1 ñ 11.6 years (mean ñ S.D.) after fits began. The previous diagnoses had been: petit mal (1), petit mal and grand mal (2), grand mal and bad behaviour (1), "not classical grand mal", (1), chronic epilepsy, retardation and tantrums (1), epilepsy and cerbral palsy (1), fits and strange feelings (1) and "epilepsy" (2). Nine patients were referred because of poor control. In three others the diagnosis was suspected from information on the drug-assay request form that control was poor and a phenothiazine was being prescribed. Control was poor in spite of three anti-epileptics in one patient and two in eight patients (various combinations of five different drugs.) Of these nine patients, five were also receiving a phenothiazine. Two patients were receiving one anti-epileptic and a phenothiazine and one patient a single anti-epileptic. Three patients had clinical toxicity and toxic blood levels at the time of referral. Four had subtherapeutic and two therapeutic levels. Three came to attention before therapeutic drug monitoring was available. Perfect or near perfect control was achieved in two patients, good control in seven and improved control in two. Nine patients were controlled on a single drug (carbamazepine in seven and phentoin in two). The others required both drugs. Phenothiazines were discontinued in all. There is little attempt to type seizures in Barbados and most CPE is undiagnosed. Greater awareness of CPE and more assiduous history-taking would obviate costly diagnostic errors. Seizure control can be dramatically improved by appropriate drug selection (preferably carbamazepine) and meticulous dose titration, with the aid of therapeutic drug monitoring (AU)

Drug assay services and management of epilepsy in Barbados a one year review - abstract

Therapeutic drug monitoring with a clinical pharmacology consultative service has been available in Barbados for one year. Its use is reiewed in 143 epileptic patients, from whom 239 blood samples were drawn. Three hundred and eleven assays were performed by Enzyme Mediated Immunoassay [EMIT] (phenytoin 179, phenobarbitone 85 and carbamzepine 47). Efficiency of prescribing was assessed by comparing plasma levels with Recomended Therapeutic Ranges (RTR). Sixty-eight per cent of all assays were outside the RTR (47 percent below and 21 percent above). Only 24 percent of phenytoin levels were in the RTR, compared with 39 percent for carbamzepine and 49 percent for phenobarbitone. Ten per cent of all assays showed insignificant drug concentrations, indicating severe non-compliance. Assay reports included suggestions for dose adjustments were made in 38 percent. Non-compliance or"on-off" compliance was the major therapeutic problem and was identified in 48 percent, but the clinician recorded compliance counselling in only 27 percent. Reports were frequently not noted, drugs changed instead of doses, or inappropriate dose blood test and tests and (ii) different doctors reviewing. These results demonstrate unsatifactory mangement of epilepsy. Mean annual drug cost for these patients was 10 time the cost of one assay. Improved fit control and projected savings from reduced doses and reduced drug wastage more than justify costs of therapeutic drug monitoring in the Caribbean, when linked with consultative services and education in drug use (AU)