Assessing the association of nativity and acculturation to fast food restaurant use and its relationship to metabolic risk factors among US blacks with Afro-Caribbean ethnicity.

OBJECTIVES: This investigation among Afro-Caribbean adults in the United States Virgin Islands (USVI) examined whether acculturation and preference for dining out accounted for variation by nativity in the frequency of fast food restaurant use, and assessed the relationship of fast food restaurant use to body weight and insulin resistance. METHODS: A randomly selected sample of 679 Afro-Caribbean adults (aged ≥ 20 years), including 436 who were foreign-born and 243 who were native-born, were recruited on the island of St. Croix, USVI. Information on demographic characteristics, level of acculturation and dietary practices were obtained from participants by questionnaire. Fasting blood samples, which were measured for glucose and insulin, and anthropometric measurements were also collected from participants. Insulin resistance was estimated by the homeostasis model assessment (HOMA). Relationships between variables were assessed with analysis of variance and logistic regression analyses. RESULTS: In bivariate analyses, birth in the USVI, younger age, being single, greater preference for dining out and higher levels of education and acculturation were significantly (P < .05) associated with fast food restaurant use. In multivariate logistic regression analyses, birth in the USVI, younger age and preference for dining out were independently associated with frequent (≥ 2 days/week) fast food restaurant use. The mean level of HOMA insulin resistance among participants increased significantly with more frequent use of fast food restaurants. CONCLUSIONS: Among Afro-Caribbean adults in the USVI, fast food restaurant use is positively associated with insulin resistance and varies by nativity, but acculturation does not account for this variation.

Incidence of type 1 and type 2 diabetes in youth in the U.S. Virgin Islands, 2001-2010.

OBJECTIVE: To report the annual incidence of type 1 and type 2 diabetes among youth and to describe characteristics of youth diagnosed with diabetes in the U.S. Virgin Islands (USVI). RESEARCH DESIGN AND METHODS: All residents ≤19 years of age diagnosed with diabetes between January 2001 and December 2010 were identified from review of medical records of all hospitals and confirmed by physician query. RESULTS: A total of 82 eligible patients were identified and the registry ascertainment was estimated to be 98.7% complete. The overall age-adjusted annual incidence rates (per 100, 000) of type 1 and type 2 diabetes for the study period were 15.3 (95% CI: 11.3-20.1) and 9.6 (95% CI: 6.8-13.5), respectively. The incidence of type 1 diabetes increased significantly over the study period, with an epidemic-like threefold increase occurring from 2005 (8.7/100, 000) to 2006 (26.4/100, 000; p = 0.05). The incidence of type 1 diabetes was highest in the 10-19 age group in girls (25.6/100, 000), but no age difference was seen in boys, resulting from the lack of a pubertal peak in non-Hispanic Black boys. The incidence of type 2 diabetes rose significantly between 2001 (5.3/100, 000) and 2010 (12.5/100, 000; p = 0.03). CONCLUSIONS: The incidence of type 1 and type 2 diabetes in youth is increasing in the USVI, similar to global patterns. Further studies are needed to explore the missing pubertal rise in type 1 diabetes incidence in non-Hispanic Black boys and factors associated with the epidemic-like increases observed over the decade.

"Going to the Gym Is Not Congolese's Culture": Examining Attitudes Toward Physical Activity and Risk for Type 2 Diabetes Among Congolese Immigrants.

Purpose The purpose of this study was to explore perceptions and attitudes around physical activity among immigrants from the Democratic Republic of Congo and examine the influence of Congolese cultural beliefs on physical activity practice. Methods In-depth interviews were conducted and augmented by photo-elicitation among 20 Congolese immigrants, distributed equally by gender, aged 35 years or older. The PEN-3 model was used as the cultural conceptual framework. Results Using both the Relationships and Expectations dimension (Perceptions, Enablers, and Nurturers) and Cultural Empowerment dimension (Positive, Existential, and Negative) of the PEN-3 model, emergent themes were categorized around knowing the benefits of being physically active (perceptions), doctor encouragement to be more physically active (enablers), and the habit and local tradition of consuming beer after a soccer match (nurturers). Other emergent themes included Congolese loves to dance (positive), going to the gym is not Congolese culture (existential), and the challenge of increased physical activity (negative). Conclusions Congolese have their intrinsic cultural perceptions and attitudes around types of physical activity. The study disclosed a much more pronounced willingness to dance (as a potential source of increased physical activity) than to go to a gym. As such, if one wants to advocate a regimen of increased physical activity to offset the risk for type 2 diabetes, dance is an alternative to consider among some immigrants.

Internalized racism is associated with elevated fasting glucose in a sample of adult women but not men in Zimbabwe.

OBJECTIVES: Internalized racism (INR) is associated with metabolic abnormalities among African Caribbean women. The current study was conducted to determine if similar associations exist among Black women living in Africa. METHODS: In 2003, a stratified random sample of Black adults ages > or =18 years was drawn from four high-density suburbs of the city of Bulawayo, Zimbabwe. A total of 318 persons (90% of those recruited) participated. Face-to-face interviews were used to gather information on demographic variables, health history, internalized racism, anthropometric measurements and blood pressure. Internalized racism, the extent to which individuals agree with racist stereotypes about their race, was measured with a standardized questionnaire. A fasting blood sugar level was also measured for each participant. Persons with diagnosed diabetes or incomplete data (n=44) were excluded from analyses. RESULTS: Women (n=188) and men (n=86) did not differ significantly by age, INR score, waist circumference or fasting glucose level. The mean body mass index of women (23.6 kg/m2) was higher (P<.05) than that of men (22.3 kg/m2). INR was significantly correlated with waist circumference, diastolic blood pressure and fasting glucose among women but not among men. In multiple logistic regression analyses using the data for women, a high INR remained independently associated with abnormal fasting glucose (odds ratio=2.74, P=.0085) after adjusting for potential confounders including adiposity. CONCLUSIONS: These findings show the consistency of the association of high INR with metabolic abnormalities among Black women in the Diaspora.

A family history of diabetes is related to abnormal insulin sensitivity in African-Caribbean girls of low birth weight: is catch-up weight important?

This retrospective cohort study examined the relationship of birth weight, family history of diabetes (FamHx), and current weight to insulin resistance in Black girls and boys on the Caribbean island of Barbados. A cohort of 56 low birth weight (LBW) and 120 normal birth weight (NBW) adolescents born between January 1, 1986, and December 31, 1988, were recruited for study participation in 2002. FamHx was ascertained by questionnaire. Body mass index (BMI) and waist circumference (WC) were used to assess fat distribution. Fasting blood glucose and insulin were measured from blood samples drawn from each adolescent participant. Insulin resistance was estimated by the homeostasis model assessment (HOMA) technique. These data show that only among LBW girls was a positive (+) FamHx associated with higher HOMA (FamHx "Yes"=1.22 +/- 0.298 vs "No"=0.811 +/- 0.452; P=.032). No significant relationships were observed among boys. Further analyses revealed that compared to their NBW counterparts, LBW girls without FamHx, had a smaller WC (69.70 +/- 9.88cm vs 76.70 +/- 15.64cm, respectively; P=.055). In contrast, LBW girls with a (+) FamHx had similar mean WC (77.71 +/- 16.46cm) to those of NBW girls with (+) FamHx (WC=71.50 +/- 10.38cm; P=.405). These data indicate that along with a family history of diabetes, catch-up weight may be important in assessing diabetes risk in Black Caribbean LBW adolescent girls.

Relationships between perceived stress, coping behavior and cortisol secretion in women with high and low levels of internalized racism.

AIM: It is hypothesized that a chronic defeat response to social or environmental stressors increases the likelihood of dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis with dysregulation of cortisol, accumulation of abdominal fat and development of glucose intolerance. Recent studies show that African-Caribbean women who have a high level of internalized racism (INR) are at increased risk for abdominal obesity and glucose intolerance. The aim of the current study was to determine if African-Caribbean women with high and low INR differ in their levels of perceived stress and defeat coping style, and in the relationship of these factors to cortisol secretion. METHODS: On the island of Dominica, information on perceived stress and coping style was collected from age- and body mass index-matched samples of nondiabetic women aged 25-60 with high (n = 27) and low (n = 26) INR. Cortisol levels for each participant were determined from saliva specimens collected at 8:30 am and 10:30 pm. RESULTS: A higher mean perceived stress score (PSS) and greater tendency to use "restraint," "denial" and "behavioral disengagement" (defeated) coping (BDC) styles were found among women with high INR compared to those with low INR. In the combined sample, PSS and BDC were significantly correlated with an indicator of dysregulation of cortisol. However, in group-specific analyses, adjusting for age and education, these correlations remained significant only among women with high INR. CONCLUSION: These findings support the view that high perceived stress and defeated coping style may be factors that link high INR to dysregulation of cortisol and, perhaps, also to greater risk of metabolic abnormalities.

The Association of Afro-Caribbean Immigrants' Feelings of Disconnection from the Community with the Metabolic Syndrome.

Many immigrants can feel like outsiders in their adopted country. The objective of this study was to determine if psychosocial stress associated with feelings of disconnection from the community is associated with the metabolic syndrome (Met-S) among Afro-Caribbean immigrants. The frequency of the Met-S, based on International Diabetes Federation criteria, was determined for a population-based sample of 406 English-speaking Afro-Caribbean immigrants ages twenty and older in the Virgin Islands of the United States (USVI). Feelings of disconnection were assess with Roger's Life Attitude Inventory. Logistic regression analyses showed that a high level of disconnection was significantly associated with the Met-S [Odds Ratio = 1.64 (95% CI 1.10-2.44)] after adjusting for conventional risk factors and for body mass index. Afro-Caribbean immigrants in the USVI who express a high level of disconnection from the community have an increased risk for the Met-S.

Spirituality moderates the relationship of psychosocial stress to metabolic risk factors among Afro-Caribbean immigrants in the US Virgin Islands.

OBJECTIVE: Spirituality may contribute to the health advantage of foreign-born blacks compared to United States (US)-born blacks. The objective of this study was to test the hypothesis that spirituality attenuates the association of psychosocial stress to stress-associated metabolic risk factors among foreign-born Caribbean blacks living in a US jurisdiction. METHODS: Data on demographic factors, anthropometric measurements (height, weight and waist), fasting glucose and insulin, lifestyle behaviors (smoking and alcohol use), psychosocial stress and spirituality were collected from a population-based sample of 319 Afro-Caribbean immigrants, ages 20 and older, who were recruited between 1995 and 2000 in the Virgin Islands of the United States (USVI). Glucose and insulin measurements were used to estimate insulin resistance by the homeostasis model assessment (HOMA-IR) method. Participants were classified into three levels of spirituality, "low", "medium" and "high" based on the distribution of spirituality scores. Stepwise regression analyses were used to identify the significant predictors of waist circumference and HOMA-IR within each level of spirituality. RESULTS: The predictors of waist circumference and HOMA-IR varied across the levels of spirituality. Psychosocial stress was an independent predictor of waist and HOMA-IR only among participants with a low level of spirituality. CONCLUSION: Spirituality appears to attenuate the association of psychosocial stress to waist circumference and insulin resistance among Afro-Caribbean immigrants in the USVI.

A preliminary assessment of acculturation and its relationship to body size and glucose intolerance among Blacks in the US Virgin Islands.

OBJECTIVES: This study is a preliminary investigation of the relationship of acculturation to body size and glucose intolerance among African Caribbeans living in the United States Virgin Islands (USVI). METHODS: Focus groups were used to identify items for measuring acculturation, and validity and reliability procedures were performed on the items. The acculturation items were administered to a population-based sample of 740 individuals aged 20 years and older. Anthropometric measurements and blood pressure were taken and a fasting blood sample was also drawn. RESULTS: Factor analysis showed that the acculturation items clustered as 3 factors that appeared to represent: 1) the 'adoption' of USVI-American values; 2) 'integration' and practice of USVI customs; and 3) allegiance to 'traditional' African-Caribbean values and customs. Each factor exhibited relationships to demographic variables that were characteristic of acculturation, with the mean adoption (AD) score being significantly (P=.0002) higher for USVI-born persons than for African-Caribbean immigrants [AD=11.3 (95% CI=11.0-11.6) vs AD=10.6 (95% CI=10.4-10.8), respectively], while African-Caribbean immigrants had a higher (P=.0001) traditional score (TS) compared to USVI-born persons [TS=9.0 (95% C=8.8-9.2) vs TS=7.0 (95% CI=6.7-7.2), respectively]. In regression analyses adjusting for age, education, income, smoking, and alcohol consumption, the 'adoption' factor was independently and positively related to BMI (P=.02) among USVI-born African Caribbeans, and to fasting glucose (P=.005) among African-Caribbean immigrants. CONCLUSIONS: Acculturation is associated with increased body size and diabetes risk in African Caribbeans in the USVI and appears to bear a differential impact according to place of birth.

Dyslipidemia and insulin resistance in relation to genetic admixture among Hispanics and non-Hispanic blacks of Caribbean origin.

The tendency to develop insulin resistance and dyslipidemia varies between black Africans, white Europeans, and Amerindian racial groups. Genetic admixture of these three racial groups has resulted in hybrid populations of Hispanics and non-Hispanic blacks. The current study was undertaken to examine the relationship of white European admixture to insulin resistance and dyslipidemia among Hispanics and non-Hispanic blacks of Caribbean origin. The study population included 224 Hispanics and 684 non-Hispanic blacks without a history of diabetes who were recruited between 1995 and 1999 on the island of St. Croix in the U.S. Virgin Islands. For each participant, anthropometric measurements were performed, and a fasting blood sample was analyzed for glucose, insulin, and serum lipids (triglycerides, HDL cholesterol). Genetic admixture was determined from grandparent race data. Hispanics were more likely than non-Hispanic blacks to have dyslipidemia and insulin resistance (measured by HOMA-IR method). White European admixture was significantly and inversely associated with insulin resistance among Hispanics. There was no significant relationship between white European admixture and insulin resistance or dyslipidemia among non-Hispanic blacks. Individuals who classified themselves as Hispanic blacks appeared to have a greater risk for cardiovascular disease than Hispanic whites or non-Hispanic blacks.

Acculturation and psychosocial stress show differential relationships to insulin resistance (HOMA) and body fat distribution in two groups of blacks living in the US Virgin Islands.

The objective of this study was to determine whether acculturation and psychosocial stress exert differential effects on body fat distribution and insulin resistance among native-born African Americans and African-Caribbean immigrants living in the US Virgin Islands (USVI). Data collected from a non-diabetic sample of 183 USVI-born African Americans and 296 African-Caribbean immigrants age > 20 on the island of St. Croix, USVI were studied. Information on demographic characteristics, acculturation and psychosocial stress was collected by questionnaire. Anthropometric measurements were taken, and serum glucose and insulin were measured from fasting blood samples. Insulin resistance was estimated by the homeostasis model assessment (HOMA) method. The results showed that in multivariate regression analyses, controlling for age, education, gender, BMI, waist circumference, family history of diabetes, smoking and alcohol consumption, acculturation was independently related to logarithm of HOMA (InHOMA) scores among USVI-born African Americans, but not among African-Caribbean immigrants. In contrast, among USVI-born African Americans psychosocial stress was not significantly related to InHOMA, while among African-Caribbean immigrants psychosocial stress was independently related to InHOMA in models that included BMI, but not in those which included waist circumference. This study suggests that acculturation and psychosocial stress may have a differential effect on body fat distribution and insulin resistance among native-born and immigrant blacks living in the US Virgin Islands.

Internalized racism, body fat distribution, and abnormal fasting glucose among African-Caribbean women in Dominica, West Indies.

The current study examined the relationship of internalized racism to glucose intolerance in a population of Afro-Caribbean women aged 18 to 55. Also of interest was whether this relationship would be differentially influenced by the type of body fat distribution or confounded by the level of hostility. A total of 244 women were selected from a systematic sample of households on the island of Dominica, West Indies. Demographic data together with information on internalized racism were collected by questionnaire. Anthropometric information and fasting blood glucose were also measured. Women with high levels of internalized racism exhibited an increased risk of elevated fasting glucose compared to those with low levels of internalized racism (odds ratio (OR) = 2.4; 95% confidence interval (CI) = 1.1-5.5). There was no difference in mean body mass index (BMI) by level of internalized racism. However those with high internalized racism had a significantly larger waist circumference after adjusting for age, education, hostility, and elevated fasting glucose status. In multivariate analyses controlling for age, education, hostility, and either weight or BMI, internalized racism remained independently associated with elevated fasting glucose. However, once waist circumference was included in the model, the relationship of internalized racism to elevated fasting glucose was not statistically significant. This study demonstrates a significant relationship between internalized racism and abnormal levels of fasting glucose which may be mediated through abdominal fat. The exact nature of the relationship of internalized racism to glucose intolerance may be an important area of future study.

The relationship of internalized racism to body fat distribution and insulin resistance among African adolescent youth.

This study examined the relationship of internalized racism (INR) and hostility to body fat distribution and insulin resistance in black adolescent children age 14-16 years on the Caribbean island of Barbados. Questionnaire data on psychosocial variables and anthropometric measurements, together with a fasting blood sample, were obtained from 53 low-birthweight and 119 normal-birthweight adolescents. Insulin resistance was calculated using the homeostasis model assessment (HOMA). Spearman correlation analyses showed that both INR (r = 0.244) and hostility (r = 0.204) were significantly (p < 0.05) correlated with waist circumference in girls but not boys. Among girls, age- and birthweight-adjusted mean levels of BMI and waist circumference were greater for those with high levels of INR and hostility compared to those with low levels of both variables. In multiple logistic regression analyses, a high INR remained independently associated [odds ratio = 3.30 (95% CI = 1.30-8.36); p = 0.012] with having an elevated HOMA value in models that included age, income, birthweight, hostility, physical activity and family history of diabetes. The results of the current study show that the positive relationship between INR and metabolic health risk seen in African-Caribbean adults also exists in African Caribbean adolescent youth independent of birthweight.

Glucose intolerance by race and ethnicity in the U.S. Virgin Islands.

This study describes the prevalence on glucose intolerance by race and ethnicity in the United States Virgin Islands. A population-based sample of 1026 individuals 20 years of age or older was recruited on the island of St. Croix, U.S. Virgin Islands, where 80% of the population classify their race as African American and 20% indicate their ethnicity as Hispanic. American Diabetes Association (ADA) criteria was used to classify glucose tolerance for the entire sample. Persons 40 years of age or older (405) were also administered a 2-h oral glucose tolerance test. Among the major race/ethnic groups, the prevalence of diabetes in patients 20 years of age or older (age-adjusted to the 1995 world population) was 14.1% for non-Hispanic blacks (n = 712), 12.1% for Hispanic blacks (n = 145), 13.5% for Hispanic whites (n = 70) and 1.2% for non-Hispanic whites (n = 37). In each group, the prevalence of diabetes increased with age and appeared higher for men. Among individuals 40 years of age or older a slightly higher prevalence of newly diagnosed diabetes was found when using World Health Organization (WHO) criteria compared to ADA criteria (WHO 10.3%, ADA 7.7% for black non-Hispanic persons and WHO 10.4%, ADA 6.0% for all other groups combined). The prevalence of diabetes for African Americans residing in the U.S. Virgin Islands is similar to rates for the African-American population on the United States mainland and is double that of estimates for blacks on neighboring islands.

All-cause mortality in a population-based type 1 diabetes cohort in the U.S. Virgin Islands.

OBJECTIVE: Type 1 diabetes remains a significant source of premature mortality; however, its burden has not been assessed in the U.S. Virgin Islands (USVI). As such, the objective of this study was to estimate type 1 diabetes mortality in a population-based registry sample in the USVI. RESEARCH DESIGN AND METHODS: We report overall and 20-year mortality in the USVI Childhood (<19 years old) Diabetes Registry Cohort diagnosed 1979-2005. Recent data for non-Hispanic blacks from the Allegheny County, PA population-based type 1 diabetes registry were used to compare mortality in the USVI to the contiguous U.S. RESULTS: As of December 31, 2010, the vital status of 94 of 103 total cases was confirmed (91.3%) with mean diabetes duration 16.8 ± 7.0 years. No deaths were observed in the 2000-2005 cohort. The overall mortality rates for those diagnosed 1979-1989 and 1990-1999 were 1852 and 782 per 100,000 person-years, respectively. Overall cumulative survival for USVI was 98% (95% CI: 97-99) at 10 years, 92% (95% CI: 89-95) at 15 years and 73% (95% CI: 66-80) at 20 years. The overall SMR for non-Hispanic blacks in the USVI was 5.8 (95% CI: 2.7-8.8). Overall mortality and cumulative survival for non-Hispanic blacks did not differ between the USVI and Allegheny County, PA. CONCLUSIONS: This study, as the first type 1 diabetes mortality follow-up in the USVI, confirmed previous findings of poor disease outcomes in racial/ethnic minorities with type 1 diabetes.

An outbreak of dengue fever in St. Croix (US Virgin Islands), 2005.

BACKGROUND: Periodic outbreaks of dengue fever occur in the United States Virgin Islands. In June 2005, an outbreak of dengue virus (DENV) serotype-2 with cases of dengue hemorrhagic fever (DHF) was detected in St. Croix, US Virgin Islands. The objective of this report is to describe this outbreak of DENV-2 and the findings of a case-control study examining risk factors for DHF. METHODOLOGY/PRINCIPAL FINDINGS: This is the largest dengue outbreak ever recorded in St. Croix, with 331 suspected dengue cases reported island-wide during 2005 (62.2 cases/10,000 population); 54% were hospitalized, 21% had at least one hemorrhagic manifestation, 28% had thrombocytopenia, 5% had DHF and 1 patient died. Eighty-nine laboratory-positive hospitalized patients were identified. Of these, there were 15 (17%) who met the WHO criteria for DHF (cases) and 74 (83%) who did not (controls). The only variable significantly associated with DHF on bivariate or multivariable analysis was age, with an adjusted odds ratio (95% confidence interval) of 1.033 (1.003,1.064). CONCLUSIONS/SIGNIFICANCE: During this outbreak of DENV-2, a high proportion of cases developed DHF and increasing age was significantly associated with DHF.

Metabolic syndrome among Caribbean-born persons living in the U.S. Virgin Islands.

OBJECTIVES: To determine the frequency of the metabolic syndrome (MS) among four subpopulations in the United States Virgin Islands and to estimate the risk for the MS that is associated with waist circumference cutpoints among overweight and obese individuals. METHODS: In a study undertaken from 1995 to 1999, data on demographic characteristics, anthropometric measurements, blood pressure measurements, and a blood sample were obtained from a population-based cohort of 893 Caribbean-born persons from four population subgroups who were living on Saint Croix (the largest island of the U.S. Virgin Islands) and who did not have a history of diagnosed diabetes. The four subpopulations were: (1) Hispanic white, (2) Hispanic black, (3) non-Hispanic black born in the U.S. Virgin Islands, and (4) non-Hispanic black born elsewhere in the Caribbean. Fasting blood samples were analyzed for glucose, insulin, triglycerides, and high-density lipoprotein cholesterol (HDL-C). National Cholesterol Education Program Adult Treatment Panel III guidelines were used to identify the MS. Insulin resistance was estimated by the homeostasis model assessment (HOMA-IR) method. RESULTS: The overall prevalence of the MS in the sample was 20.5% (95% confidence interval (CI) = 15.3%-25.7%). Persons who had classified themselves as both Hispanic and black had the highest frequency (27.8% (95% CI = 16.3%-39.3%)) of the MS and the highest HOMA-IR scores. After controlling for lifestyle factors and HOMA-IR, Hispanic ethnicity was independently associated with an increased risk of having the MS (odds ratio (OR) = 1.82, (95% CI = 1.07-3.07)), high triglycerides (OR = 3.66 (95% CI = 2.18-6.15)), and low HDL-C (OR = 1.60 (95% CI = 1.04-2.45)). A waist circumference of > 88 cm was associated with an increased risk of metabolic abnormalities among overweight and obese women. CONCLUSIONS: The frequency of the MS among Caribbean-born persons in the U. S. Virgin Islands is comparable to the frequency of the MS among the general population on the mainland of the United States. Among Caribbean-born persons living in the U.S. Virgin Islands, those who are Hispanic blacks may have a greater risk of cardiovascular disease than do other groups.

Metabolic syndrome among Caribbean-born persons living in the U.S. Virgin Islands

OBJETIVOS: Determinar la frecuencia del síndrome metabólico (SM) en cuatro subpoblaciones de residentes de las Islas Vírgenes estadounidenses y calcular el riesgo de sufrir SM asociado con una circunferencia abdominal superior a determinados puntos de corte en personas con sobrepeso y obesidad. MÉTODOS: En un estudio realizado entre 1995 y 1999 se obtuvieron las características demográficas, medidas antropométricas, presión arterial y muestras de sangre de miembros de una cohorte poblacional de 893 personas que pertenecían a cuatro subgrupos poblacionales en Saint Croix (la mayor de las Islas Vírgenes estadounidenses) y que nunca habían recibido un diagnóstico de diabetes. Las cuatro subpoblaciones fueron: 1) hispanos de raza blanca; 2) hispanos de raza negra; 3) personas no hispanas de raza negra nacidas en las Islas Vírgenes estadounidenses y 4) personas no hispanas de raza negra nacidas en otras partes del Caribe. A las muestras de sangre en ayunas se les midieron las concentraciones de glucosa, insulina, triglicéridos y colesterol transportado por lipoproteínas de alta densidad (HDLc). Para identificar el SM se aplicaron las pautas generadas por el Panel III en torno al Tratamiento de Adultos, del Programa Educativo Nacional sobre el Colesterol [National Cholesterol Education Program Adult Treatment Panel III]. La resistencia a la insulina se calculó mediante la valoración de un modelo homeostásico (HOMA-IR). RESULTADOS: La prevalencia general de síndrome metabólico en la muestra fue de 20,5% (intervalo de confianza de 95% [IC95%]: 15,3% a 25,7%). Las personas que se habían clasificado a sí mismas como hispanas y de raza negra tuvieron la frecuencia más alta (27,8% (IC95% = 16,3% a 39,3%)) de SM y los puntajes más altos en el HOMA-IR. Después de hacer ajustes en función de los factores asociados con el estilo de vida y el HOMA-IR, la etnia hispana mostró una asociación independiente con un mayor riesgo de tener SM (razón de posibilidades [RP] = 1,82 (IC95%: 1,07 a 3,07)), triglicéridos séricos elevados (RP = 3,66 (IC95% = 2,18 a 6,15)) y concentraciones séricas bajas de HDLc (RP = 1,60 (IC 95% = 1,04 a 2,45))...

The use of capture-recapture methods to monitor diabetes in Dominica, West Indies / Uso de métodos de captura y recaptura para monitorear la diabetes en Dominica, Indias Occidentales

The aim of this project was to evaluate the utility of capture-recapture (CR) estimation methodology, together with easily accessible sources of information, for monitoring the frequency of diabetes mellitus in a developing country. On the Caribbean island of Dominica, from July 1995 through July 1996, the names were collected of all individuals who were listed in at least one of three sources as having been diagnosed with diabetes during 1995. The sources were the membership list of the Dominica Diabetic Association, a register of patients in seven regional health centers, and clinic records of the Princess Margaret Hospital, which is the main hospital on the island. Capture-recapture techniques were used to estimate the number of Dominicans with diagnosed diabetes who were missed by all three sources of information and to evaluate dependencies among the sources. An ascertainment-corrected prevalence estimate of diagnosed diabetes was then calculated. The three sources identified a total of 1 945 different individuals. When this number was compared with the ascertainment -corrected estimate obtained with CR methodology (2 688), it appeared to represent only 72.3% of the true prevalence of diagnosed diabetes. Most of the under-ascertainment by the data sources was due to cases that were missed in the urban area of the island. This approach to disease monitoring may be useful for other Caribbean countries. However, standardized procedures for collecting and reporting prevalence and morbidity data are needed to maximize its accuracy and cost-effectiveness.

El propósito de este trabajo fue evaluar la utilidad de la metodología de estimación por captura y recaptura (CR), aplicada junto con fuentes de información fácilmente accesibles, para monitorear la frecuencia de diabetes mellitus en un país en desarrollo. En la isla caribeña de Dominica, se recogieron de julio de 1995 a julio de 1996 los nombres de todas las personas que figuraban como mínimo en una de tres fuentes diferentes por haber recibido un diagnóstico de diabetes en el transcurso de 1995. Las fuentes fueron la lista de miembros de la Asociación de Diabetes de Dominica, un registro de los pacientes atendidos en siete centros de salud regionales y las fichas clínicas del Hospital Princess Margaret, que es el más importante de la isla. Se aplicaron técnicas de CR para estimar el número de dominicanos con diabetes diagnosticada que no fueron detectados por ninguna de las tres fuentes, y para evaluar las discrepancias entre las distintas fuentes. Se procedió a calcular la prevalencia estimada de diabetes diagnosticada, corrigiéndola según los datos obtenidos. Las tres fuentes identificaron a un total de 1 945 individuos diferentes. Cuando se comparó con la estimación corregida que se obtuvo por el método de CR (2 688), se observó que esta cifra representaba solamente 72,3% de la verdadera prevalencia de diabetes diagnosticada. La mayor parte de la subdetección en las fuentes de datos correspondió a casos que no fueron captados en la zona urbana de la isla. Esta forma de monitorear la enfermedad podría resultar útil en otros países caribeños. No obstante, hacen falta procedimientos estandarizados de recolección y notificación de datos sobre prevalencia y morbilidad para lograr que este enfoque rinda al máximo en exactitud y costo-efectividad.