Use of Homeostatic Model Assessment Indexes for the Identification of Metabolic Syndrome and Insulin Resistance among Cuban-Americans: A Cross Sectional Study.

Aim: to determine cut off points for The Homeostatic Model Assessment Index 1 and 2 (HOMA-1 and HOMA-2) for identifying insulin resistance and metabolic syndrome among a Cuban-American population. Study Design: Cross sectional. Place and Duration of Study: Florida International University, Robert Stempel School of Public Health and Social Work, Department of Dietetics and Nutrition, Miami, FL from July 2010 to December 2011. Methodology: Subjects without diabetes residing in South Florida were enrolled (N=146, aged 37 to 83 years). The HOMA1-IR and HOMA2-IR 90th percentile in the healthy group (n=75) was used as the cut-off point for insulin resistance. A ROC curve was constructed to determine the cut-off point for metabolic syndrome. Results: HOMA1-IR was associated with BMI, central obesity, and triglycerides (P<0.05). HOMA2-IR was associated with BMI, central obesity, total cholesterol, HDL-cholesterol and LDL-cholesterol (P<0.05). The cut-off points for insulin resistance for HOMA-1 and HOMA-2 were >3.95 and >2.20 and for metabolic syndrome were >2.98 (63.4% sensitivity and 73.3% specificity) and >1.55 (60.6% sensitivity and 66.7% specificity), respectively. Conclusion: HOMA cut-off points may be used as a screening tool to identify insulin resistance and metabolic syndrome among Cuban-Americans living in South Florida.

Ethnic Differences in Insulin Resistance, Adiponectin Levels and Abdominal Obesity: Haitian Americans and African Americans, with and without type 2 Diabetes Mellitus.

Background: Metabolic outcomes of obesity and its associated disorders may not be equivalent across ethnicity and diabetes status. Aim: In this paper, we examined the association of abdominal obesity, by ethnicity and diabetes status, for indicators of glucose metabolism in Blacks. Methods: A cross sectional study was conducted in Haitian Americans (n= 186) and African Americans (n= 148) with and without type 2 diabetes mellitus (T2DM). Student’s t-test and Chi-squared test were used to assess differences in mean and proportion Original Research Article British Journal of Medicine & Medical Research, 4(26): 4455-4469, 2014 4456 values between ethnicities with and without type 2 diabetes mellitus. Relationship between insulin resistance, ethnicity, diabetes status, abdominal obesity, and adiponectin levels were analyzed by analysis of covariance while controlling for confounding variables. Results: Haitian American participants were older (P = .032), had higher fasting plasma glucose (P = .036), and A1C (P = .016), but had lower levels of Hs-CRP (P < .001), insulin and HOMA2-IR and lower abdominal obesity (P = .030), than African Americans. Haitian Americans had significantly lower HOMA2-IR (P = .008) than African Americans when comparing both ethnicities with T2DM, high abdominal obesity, and adiponectin levels lower than the median (<14.75 ng/mL). Conclusion: The clinical significance of observed differences in insulin resistance, abdominal obesity, and adiponectin levels between Haitian Americans and African Americans could assist in forming public health policies that are ethnic specific.

Use of hemoglobin A1C to detect Haitian-Americans with undiagnosed Type 2 diabetes / Utilização de hemoglobina A1C no rastreamento de haitianos americanos com diabetes tipo 2 não diagnosticado

OBJECTIVE: To evaluate the validity of hemoglobin A1C (A1C) as a diagnostic tool for type 2 diabetes and to determine the most appropriate A1C cutoff point for diagnosis in a sample of Haitian-Americans. SUBJECTS AND METHODS: Subjects (n = 128) were recruited from Miami-Dade and Broward counties, FL. Receiver operating characteristics (ROC) analysis was run in order to measure sensitivity and specificity of A1C for detecting diabetes at different cutoff points. RESULTS: The area under the ROC curve was 0.86 using fasting plasma glucose ≥ 7.0 mmol/L as the gold standard. An A1C cutoff point of 6.26% had sensitivity of 80% and specificity of 74%, whereas an A1C cutoff point of 6.50% (recommended by the American Diabetes Association - ADA) had sensitivity of 73% and specificity of 89%. CONCLUSIONS: A1C is a reliable alternative to fasting plasma glucose in detecting diabetes in this sample of Haitian-Americans. A cutoff point of 6.26% was the optimum value to detect type 2 diabetes.

OBJETIVO: Avaliar a validade da hemoglobina A1C (A1C) como ferramenta para o diagnóstico de diabetes tipo 2 e determinar o ponto de corte mais apropriado para a A1C no diagnóstico de uma amostra de haitianos americanos. SUJEITOS E MÉTODOS: Os sujeitos (n = 128) foram recrutados dos condados de Miami-Dade e Broward na Flórida. A análise ROC (Receiver operating characteristics) foi feita de forma a medir a sensibilidade e especificidade de A1C para a detecção do diabetes em diferentes pontos de corte. RESULTADOS: A área sob a curva ROC foi 0,86 usando a glicemia de jejum ≥ 7,0 mmol/L como padrão-ouro. O ponto de corte de 6,26% para a A1C apresentou sensibilidade de 80% e especificidade de 74%, enquanto o ponto de corte de 6,50% (recomendado pela American Diabetes Association - ADA) apresentou uma sensibilidade de 73% e especificidade de 89%. CONCLUSÕES: A A1C foi uma alternativa confiável para a glicemia de jejum na detecção do diabetes nesta amostra de haitianos americanos. Um ponto de corte de 6,26% foi o valor ótimo para a detecção do diabetes tipo 2.

Comparison of self-perceived weight and desired weight versus actual body mass index among adolescents in Jamaica / Comparación del peso autopercibido y el peso deseado frente al índice de masa corporal real en adolescentes de Jamaica

OBJECTIVE: To compare self-perceived body size, desired body size, and actual body mass index (BMI) among adolescents in Jamaica, and to discuss the implications of these perceptions for chronic disease prevention. METHODS: A total of 276 Jamaican adolescents 14-19 years of age, randomly selected from grades 9-12 at 10 high schools participated in the study, which was conducted in October 2007. The perceived and desired BMI were measured using a silhouette of body figures representing nine BMI categories for males and females; these were compared to participants' actual BMI. RESULTS: Mean age was 15.6 ± 1.2 years. Actual BMI values classified 24.6 percent of the participants as underweight; 39.9 percent as normal; 14.5 percent as overweight; and 21 percent as obese. There were significant differences between participants' actual and perceived BMI (P < 0.01), actual and desired BMI (P < 0.01), and perceived and desired BMI (P < 0.01). Gender was significantly different for actual (P < 0.05), perceived, and desired BMI (P < 0.01). Females had significantly higher actual mean BMI than males (P < 0.05). Adolescent males perceived themselves as having a higher BMI and a desired higher BMI than females. There were no differences among ethnicity, age, place of residence, and socioeconomic status on the actual, perceived, and desired BMI in this study population (P > 0.05). CONCLUSIONS: Females had higher actual BMI and lower perceived BMI than males. Jamaican adolescents, irrespective of ethnicity, age, place of residence, and socioeconomic status, had similar BMI. Interventions are needed to improve knowledge of a healthy body weight and the relationships among body weight, lifestyle choices, and the implications of excess body weight on chronic diseases.

OBJETIVO: Comparar el tamaño corporal autopercibido, el tamaño corporal deseado y el índice de masa corporal real (IMC) en adolescentes de Jamaica y analizar las implicaciones de dichas percepciones en la prevención de las enfermedades crónicas. MÉTODOS: El estudio se realizó en octubre del 2007 y participaron 276 adolescentes jamaiquinos de 14 a 19 años de edad, seleccionados aleatoriamente entre los grados 9 y 12 de 10 escuelas secundarias. Se midió el IMC percibido y el deseado usando figuras con una silueta corporal que representaban nueve categorías del IMC para hombres y mujeres, y se compararon con el IMC real de los participantes. RESULTADOS: La media de la edad fue de 15,6 ± 1,2 años. De acuerdo con los valores reales del IMC, 24,6 por ciento de los participantes se clasificaron como con peso inferior al normal; 39.9 por ciento, como normales; 14,5 por ciento, como con sobrepeso; y 21 por ciento, como obesos. Hubo diferencias significativas entre el IMC real y el percibido (P < 0,01), entre el IMC real y el deseado (P < 0,01) y entre el IMC percibido y el deseado (P < 0,01). El sexo constituyó una diferencia significativa para el IMC real (P < 0,05), percibido y deseado (P < 0,01). Las mujeres tenían un IMC real medio significativamente mayor que los hombres (P < 0,05). Los adolescentes varones se autopercibían como con un IMC mayor y un IMC deseado mayor que las mujeres. No hubo diferencias en cuanto al grupo étnico, la edad, el lugar de residencia y la situación socioeconómica en el IMC real, percibido y deseado en esta población de estudio (P > 0,05). CONCLUSIONES: Las mujeres tenían un IMC real mayor y un IMC percibido menor que los hombres. Los adolescentes jamaiquinos tenían un IMC similar, independientemente de su grupo étnico, edad, lugar de residencia o situación socioeconómica. Es necesario realizar intervenciones para mejorar los conocimientos sobre el peso corporal saludable y sobre la relación entre el peso corporal, las opciones de modos de vida y las implicaciones del peso corporal excesivo en las enfermedades crónicas.