Relationship between Early Life Factors and Renal Function in Afro-Caribbean Young Adults: Analysis from the Jamaica 1986 Birth Cohort Study / Relación entre los factores de los primeros años de vida y la función renal en adultos jóvenes afrocaribeños: análisis del Estudio de Cohorte de Nacimientos de Jamaica en 1986

ABSTRACT Objective: To investigate the relationship between intrauterine growth and renal function among Jamaican young adults. Methods: Data from 744 participants from the Jamaica 1986 Birth Cohort Study were analysed. We evaluated the relationship between infant characteristics (birthweight and gestational age), maternal characteristics at child's birth (age and socio-economic status), and renal function at ages 18-20 years (using estimated glomerular filtration rate (eGFR), calculated using the Schwartz-Lyon equation and urine albumin excretion), or prevalent chronic kidney disease (CKD; defined as eGFR < 60 ml/minute/1.73 m2 or urinary albumin ≥ 30 mg/g creatinine). Associations were examined using multi-level mixed effects regression models. Results: The mean eGFR was 86.3 ml/minute/1.73 m2 among males and 102.4 ml/minute/1.73 m2 among females (p < 0.001). The prevalence of CKD was 8.3% (7.4% males, 9.1% females, p = 0.387). Birthweight was not significantly associated with eGFR in unadjusted models, but after adjustment for potential confounders/mediators (gender, blood pressure, body mass index, maternal occupation and education), individuals born with a low birthweight (< 2.5 kg) had a 5.1% lower eGFR compared to those with a normal birthweight (β = −0.052, p = 0.002). Furthermore, a one standard deviation increase in birthweight was associated with a 2.2% increase in eGFR (β = 0.022, p = 0.044). No statistically significant associations were observed between early life factors and urinary albumin or CKD in adjusted models. Conclusion: There was a high prevalence of CKD in this Afro-Caribbean young population. Lower birthweight was associated with reduced renal function in early adulthood, which may result in an increased risk of CKD later on in adulthood. Early life interventions may also be warranted in addressing the CKD epidemic.

RESUMEN Objetivo: Investigar la relación entre el crecimiento intrauterino y la función renal entre los adultos jóvenes jamaicanos. Métodos: Se analizaron los datos de 744 participantes en el Estudio de Cohorte de Nacimientos de Jamaica en 1986. Se evaluó la relación entre las características infantiles (peso al nacer y edad gestacional), las características maternas a la hora del nacimiento del niño (edad y estado socioeconómico), y la función renal a la edad de 18 a 20 años (utilizando la tasa de filtración glomerular estimada (TFGe), calculada usando la ecuación Schwartz-Lyon y la excreción de albúmina urinaria), o la enfermedad renal crónica prevalente (ERC; definida como TFGe < 60 ml/min/1.73 m2 o albúmina urinaria ≥ 30 mg/g creatinina). Las asociaciones se examinaron mediante modelos multinivel de regresión de efectos mixtos. Resultados: El TFGe fue de 86.3 ml/min/1.73 m2 entre los varones y 102.4 ml/min/1.73 m2 entre las mujeres (p < 0.001). La prevalencia de ERC fue 8.3% (7.4% varones, 9.1% hembras, p = 0.387). El peso al nacer no se asoció significativamente con la TFGe en los modelos no ajustados, pero después de ajustar los factores de confusión/mediación potenciales (género, presión sanguínea, índice de masa corporal, ocupación y educación materna), los individuos con bajo peso al nacer (< 2.5 kg) tenían un TFGe 5.1% más bajo en comparación con aquellos con un peso normal al nacer (β = −0.052, p = 0.002). Además, un aumento de la desviación estándar en el peso al nacer estuvo asociado con un aumento de 2.2% en TFGe (β = 0.022, p = 0.044). No se observaron asociaciones estadísticamente significativas entre los factores de los primeros años de vida y la albúmina urinaria o ERC en los modelos ajustados. Conclusión: Hubo una alta prevalencia de ERC en esta población de jóvenes afrocaribeños.Un peso más bajo al nacer estuvo asociado con una reducción de la función renal en la edad adulta temprana, lo que puede llevar a un mayor riesgo de ERC más tarde en la edad adulta. Las intervenciones en los primeros años de vida también pueden explicarse al abordar la epidemia de ERC.

Household food security, HIV knowledge and dietary patterns among Trinidadian adults: A cross-sectional study

OBJECTIVE: To determine the relationship between food consumption patterns and prevalence of food insecurity among Trinidadian adults. METHODS: A convenience sample of two hundred and twenty selected households participated in the study. Data were collected over a three-month period in the year 2015. A structured paper-based questionnaire was used to collect data on HIV knowledge, food consumption frequency, food security status and sexual risk behaviours. Principal component analysis was used to derive dietary patterns. Multiple logistic regression models were used to determine the association between household food security and HIV knowledge and dietary pattern scores. All models were adjusted for gender, age, ethnicity, employment status and educational status. RESULTS: Two dietary consumption patterns were identified, namely westernized and prudent patterns. Overall, household food insecurity was approximately 65%, with food insecurity with children being that of 41% and without children 63%. Average HIV knowledge was 61.48 ± 15.16% among participants. Higher HIV knowledge (OR = 0.84; p = 0.002) and prudent dietary factor scores (OR = 0.64; p < 0.001) were associated with a greater odds of being food secure. Conversely, higher westernized dietary factor scores (OR = 1.33; p = 0.008) were associated witha greater likelihood of being food insecure. CONCLUSION: Greater awareness to HIV and healthier dietary patterns were seen among individuals from food secure households while persons who had westernized lifestyles were more likely to be from food insecure households. A greater effort is needed by governmental and public health institutions to help reduce the burden of food insecurity in the Caribbean.

Saving the prostate: Predictive factors for participation in prostate cancer screening among older men inTrinidad and Tobago

OBJECTIVE: This study explored factors hypothesized to beassociated to participation in prostate cancer screeningamong older Trinidadian adults.SUBJECTS AND METHODS: A cross-sectional study wasconducted using data collected from self-administeredquestionnaires from adult males aged 40 years and older inthe country of Trinidad. Participant characteristics andparticipation rates in prostate cancer screening weredescribed using means and frequencies. Principal componentanalysis was used to identify dietary patterns.Multi-variable logistic regression models were used toinvestigate the association between sociodemographic,lifestyle, prostate cancer knowledge and health beliefmodel (HBM) characteristics with prostate cancerscreening participation.RESULTS:Atotal of 260 adult males with a mean age of 51.6± 8.15 years were included for all analysis. Approximately50% of participants were screened for prostate cancerwithin the past five years with the majority (73%) optingfor the prostate-specific antigen (PSA). Significantpredictors (p < 0.05) for being screened for prostate cancerwere sociodemographic (age, being married and a monthlyincome of > TT $10 000), being obese, having a familyhistory of cancer and higher health belief scores. Higherwesternized dietary pattern scores and last medicalexamination > 12 months were significant predictors for ahigher likelihood of not being screened for prostate cancer.CONCLUSION: Governmental agencies and health professionalsshould focus on the modifiable factors related tolifestyle and the HBM to encourage older adults to bescreened for prostate cancer. There is a definite need fortargeted intervention programmes addressing barriers andbenefits of prostate cancer screening and health motivationin Trinidad and Tobago.

Role of fathers in overweight prevention: an analysis of a Caribbean cohort

OBJECTIVE: To investigate the role of parental characteristics and maternal perceptions of ways fathers might influence risk of overweight in Caribbean infants. DESIGN AND METHODS: Data from participants in a three island parenting intervention study were analyzed. Maternal and paternal characteristics were obtained by questionnaire at enrolment (infant age 6-10 weeks). At 18 months, 501 infants (82.9% of cohort) had weight and length measured using standardized methods and body mass index (BMI-Z scores) calculated. Participants with Z scores ≥1 were classified as at risk of overweight. Multi-level logistic regression analyses were utilized to assess the effect of parents’ characteristics on the risk of infant overweight. Additionally data from 4 focus group discussions among mothers with infants (6 - 24 months) in Jamaica were used to explore how any effects might be mediated. RESULTS: Overall 20.6% of the children were classified as at risk of overweight. The father was present in 52% of households. Fathers’ presence and higher paternal occupation level were associated with reduced risk of overweight after controlling for maternal age, education, occupation, receptive vocabulary and SES score. The presence of the father in the home (OR[95% CI] =0.78 (0.62 - 0.99)) decreased the odds of overweight in these infants. From focus group discussions mothers reported that the majority of fathers encouraged breastfeeding, healthier meal choices and discouraged use of unhealthy snacks. CONCLUSION: More information on paternal characteristics should be collected in future studies of childhood obesity. Interventions to address childhood overweight should include fathers as part of the strategy.

Turn off the TV?: attitudes towards TV-viewing and childhood obesity in Jamaican mothers

OBJECTIVE: TV-viewing has been associated with childhood obesity and reducing screen time might help address this epidemic in Caribbean children. We explored the attitudes and beliefs of Jamaican mothers on the impact of television viewing on childhood obesity. DESIGN AND METHODS: Community health aides recruited mothers, 18 years and older with children aged 6-24 months, from four primary care clinics in Jamaica. Four focus group discussions (2 rural and 2 urban) were conducted using a semi-structured interview guide. Audio recordings and field notes from discussions were collected by field investigators. Transcripts were reviewed by study investigators and immersion/crystallization techniques were used to identify emerging themes. RESULTS: the mothers had a mean age of 28.26 ñ 6.25 years and 63% were unemployed. Parenting decisions were made based on instinct developed through experience, example and external input (friends, family, community and media) and information not consistent with this instinct was not readily accepted. Among the risk factors for obesity identified by mothers, TV-viewing was not perceived as important. The causal link between TV-viewing and obesity in young children was unclear to mothers. The perceived benefits from TV-viewing on their child’s development outweighed any potential harm and strong evidence would be required to convince them otherwise. CONCLUSION: Jamaican mothers may not easily accept obesity interventions that discourage TV-viewing. Incorporating evidence from credible sources, and interventions focused on healthy growth and development using examples of children developing optimally without the aid of TV, may overcome this perception.

Mamas voices, mamas choices: understanding maternal beliefs that drive decision making around feeding practices which influence childhood obesity

OBJECTIVE: To explore the beliefs shaping maternal decision-making around feeding practices in early childhood in a subset of Jamaican mothers from rural and urban communities. DESIGN AND METHODS: Focus group discussions guided by semi-qualitative questionnaires were conducted with thirty mothers of infants 6-24 months recruited from health clinics in 2 urban and 2 rural Jamaican communities. Data from discussions transcribed from audio recordings and field notes were categorized and interpreted using pre-set themes through an iterative process to identify emergent themes. Analysis was guided by the Theory of Reasoned Action embedded in the Socio-Ecological Perspective. RESULTS: Rural and urban mothers’ beliefs, and by extension their actions, were influenced by (a) their instincts, (b) their accepted knowledge (from personal and observed experience, credible professional input, and personal experimentation), (c) cultural norms (i.e. views of body weight/health relationship and visual perceptions of ‘healthy’); (d) input of experienced family members; and (e) their accepted concept of infants’ innate ability to express needs. Additionally, rural mothers’ beliefs were influenced by non-family social networks. For all mothers, the use of growth charts in portable health records and reliance on specific local television programs with health segments for health information was salient. The latter presents a unique tool for potentially building maternal confidence for healthy feeding practices. CONCLUSION: Early childhood food choices are predominantly dictated by parental belief-driven actions. Effective interventions targeting the impact of maternal feeding practices on childhood obesity should incorporate supportive, credible professional input, address how and what knowledge influences individual beliefs, increase community-wide knowledge, and target cultural norms.