Activity, adiposity and weight change in Jamaican adults / Actividad, adiposidad y cambio de peso en los adultos jamaicanos

OBJECTIVE: Populations in developing countries are particularly vulnerable to the development of obesity in the period of rapid transition to a more modernized lifestyle. We sought to determine the relationship between activity energy expenditure (AEE), adiposity and weight change in an adult population undergoing rapid socio-economic transition. METHODS: Total daily energy expenditure (TDEE) was measured using the doubly labelled water method, resting energy expenditure (REE) using indirect calorimetry and AEE calculated as the difference between TDEE and REE, in adults from a working class community in Spanish Town, Jamaica. During six years of follow-up, weight was measured between one and four times. Mixed effects regression modelling was used to test for association between components of the energy budget and weight change. RESULTS: Men (n = 17) weighed more but women (n = 18), had significantly more body fat, 38.5% vs 24.5%, respectively (p < 0.01). Men had higher levels of EE, particularly AEE after adjustment for body weight, 66.3 versus 46.4 kJ/kg.d for men and women, respectively (p < 0.001). At baseline, adjusted AEE was inversely associated with body fat in men and women, r = -0.46 and r = -0.48, respectively (p < 0.05). Mean rate of weight change was + 1.1 and + 1.2 kg/year for men and women, respectively. No component of EE, ie TDEE, REE or AEE, significantly predicted weight change in this small sample. CONCLUSIONS: These results suggest an important role for AEE in maintaining low levels of adiposity. The lack of association between EE and weight change, however, suggests populations in transition are at risk of obesity from environmental factors (eg dietary) other than simply declining physical activity levels.

OBJETIVO: Las poblaciones en los países en vía de desarrollo son particularmente vulnerables al desarrollo de la obesidad en el período de rápida transición a un estilo de vida más moderno. Buscamos determinar la relación entre el gasto energético por actividad (GEA), la adiposidad y el cambio de peso en una población adulta en proceso de rápida transición socio-económica. MÉTODOS: El gasto energético total diario (GETD) fue medido usando el método del agua doblemente marcada, gasto energético en reposo (GER) usando calorimetría indirecta y el GEA calculado como la diferencia entre GETD y GER, en adultos de una comunidad de clase obrera en Spanish Town, Jamaica. Durante seis años de seguimiento, el peso fue medido entre una y cuatro veces. Un modelo de regresión de efectos mixtos fue usado para probar la asociaciF3n entre los componentes del presupuesto de la energEDa y el cambio de peso. RESULTADOS: Los hombres (n = 17) pesaron más pero las mujeres (n = 18) teníEDan significativamente más grasa corporal, 38.5% frente a 24.5%, respectivamente (p < 0.01). Los hombres tenían niveles más altos de GE, particularmente GEA después del ajuste por peso corporal, 66.3 frente a 46.4 kJ/kg.d para los hombres y mujeres, respectivamente (p < 0.001). Al inicio, el GEA ajustado estaba inversamente asociado con la grasa del cuerpo en los hombres y mujeres, r = -0.46 y r = -0.48, respectivamente (p < 0.05). La tasa media de cambio de peso fue +1.1 y +1.2 kg/ano para los hombres y mujeres, respectivamente. Ningún componente de GE, es decir, GETD, GER o GEA, predijo significativamente el cambio de peso en esta muestra pequeña. CONCLUSIONES: Estos resultados sugieren un papel importante del GEA en cuanto a mantener niveles bajos de adiposidad. Sin embargo, la falta de asociación entre GE y cambio de peso, sugiere que las poblaciones en transición corren el riesgo de obesidad debido a factores ambientales (p.ej. dietéticos) distintos de la mera...

Central myelinolysis in a patient with hyponatraemia

We present a case of a 50-year old man who developed mutism and a flaccid quadriparesis within 48 hours of presentation to hospital with severe hyponatraemia. A diagnosis of central pontine myelinolysis was made based on the clinical features and typical appearances on magnetic resonance imaging.

High risk health behaviours among adult Jamaicans / Conductas de Alto Riesgo para la Salud entre los Adultos Jamaicanos

The purpose of this study was to assess the prevalence of high risk health behaviours among adult Jamaicans aged 15-49 years in 2000, and to compare the results with the 1993 survey. A nationally representative sample of 2013 persons aged 15-74 years was surveyed in 2000 using cluster sampling in the Jamaica Healthy Lifestyle Survey (Wilks et al, unpublished). Interviewer administered questionnaires and anthropometrical measurements were done. Data for a sub-sample of adults aged 15-49 years were analyzed The sub-sample included 1401 persons (473 men and 928 women). Significantly more men (18.6) than women (4.3) reported never having had a blood pressure check (p = 0.0001). Approximately one-third of the women reported that they had never had a Pap smear (36.0) or a breast examination (31.2). Current cigarette smoking was reported in 28.6 of men and 7.7 of women (OR 3.73 CI 2.71, 5.15), while 49.0 of men and 15.0 of women ever smoked marijuana (OR 3.28 CI 2.56, 4.20). Significantly more men (28.0) than women (11.7) reported ever having a sexually transmitted disease (OR 2.93 CI 2.16, 3.97); having more than one sexual partner in the past year (49.1 vs 11.4, OR 4.31 CI 3.22, 5.76) and usually using a condom during sexual intercourse (55.3 vs 40.5, OR 1.3 CI 1.11, 1.68). Between 1993 and 2000, significant trends include: more persons reported having a blood pressure check, a reduction in multiple sexual partners, increased condom use at last sex (women), reduced crack/cocaine use (males) and increased marijuana smoking. Although there were some significant positive lifestyle trends between 1993 and 2000, high risk behaviours remain common among Jamaican adults. Comprehensive health promotion programmes are needed to address these risk behaviours

El propósito de este estudio fue evaluar la prevalencia de conductas de alto riesgo para la salud entre adultos jamaicanos comprendidos en las edades de 15 a 49 en el año 2000, y comparar los resultados con la investigación realizada en 1993. Una muestra nacional representativa de 2013 personas comprendidas en las edades de 15 a 74 años, fue sometida a investigación en el 2000, usando el muestreo por cluster del Jamaica Healthy Lifestyle Survey (Wilks et al, inédito). Se realizaron entrevistas en forma de cuestionarios, así como mediciones antropométricas. Se analizaron los datos de una sub-muestra de adultos entre edades de 15 a 49 años. La submuestra incluyó 1401 personas (473 hombres y 928 mujeres). Un número de hombres significativamente mayor (18.6%) que el de las mujeres (4.3%) reportaron no haber tenido nunca un chequeo de la presión (p = 0.0001). Aproximadamente un tercio de las mujeres reportó no haberse hecho nunca la prueba citológica (36.0%) o el examen de mamas (31.2%). El hábito actual de fumar cigarrillos fue reportado en el 28.6% de los hombres y el 7.7% de las mujeres (OR 3.73 CI 2.71, 5.15), mientras que el 49.0% de los hombres y el 15% de las mujeres nunca fumó marihuana (OR 3.28 CI 2.56, 4.20). Significativamente más hombres (28.0%) que mujeres (11.7%) reportaron no haber tenido nunca enfermedades de transmisión sexual (OR 2.93 CI 2.16, 3.97); haber tenido más de una pareja sexual en el año anterior (49.1% vs 11.4%, OR 4.31 CI 3.22, 5.76), y usar comúnmente condón durante el acto sexual (55.3% vs 40.5%, OR 1.3 CI 1.11, 1.68). Entre 1993 y 2000, las tendencias significativas incluyen lo siguiente: más personas reportaron el chequeo de la presión sanguínea, una reducción en las parejas sexuales múltiples, el aumento del uso de condones en el último acto sexual (mujeres), la reducción en el uso de crack/cocaína (hombres), y aumento en el consumo de marihuana para fumar. Aunque hubo algunas tendencias positivas significativas en cuanto al estilo de vida entre 1993 y el 2000, los comportamientos de alto riesgo siguieron siendo comunes entre los adultos jamaicanos. Se necesitan programas generales de la promoción de la salud para abordar estas conductas de alto riesgo.

Falls: A modifiable risk factor for the occurrence of hip fractures in the elderly

The objective of the study was to examine the clinical and demographic features of patients with hip fractures presenting to the Accident and Emergency Department, the University Hospital of the West Indies (UHWI). The study involved all patients with hip fractures registered in the Trauma Registry at the UHWI between January 1, 1998 and December 31, 2001. They were assessed retrospectively for age, gender, associated extrinsic and intrinsic factors, cause of the fall, location when fracture occurred and the site of the femur that was fractured. One hundred and fifty-two persons were identified There were one hundred and eleven women and forty-one men. Seventy-eight per cent of the falls occurred in the over sixty-five-year age group. Ninety per cent of the patients had a fall associated with their fracture. Most of the falls occurred at the patients' homes. This study indicated that falling at home was the commonest associated factor for the occurrence of hip fractures and preventive measures may lead to reductions in the frequency of hip fractures seen in the emergency room

Features of isolated post-challenge hyperglycaemia in Jamaican adults

Isolated post-challenge hyperglycaemia (IPH) can be defined as a two-hour plasma glucose concentration > or = 11.1 mmol/L with a fasting plasma glucose concentration < 7.0 mmol/L. The aim of this prospective study was to determine the prevalence of IPH in a cohort of Jamaican individuals, and to determine if simple clinical features may predict the presence and subsequent diagnosis of IPH. A cohort of 1694 adults aged 25-74 years without physician-diagnosed diabetes mellitus was randomly selected. An oral glucose tolerance test (OGTT) was performed. Anthropometry, blood pressure and lipid profiles were measured. The prevalence of undiagnosed diabetes mellitus by the 1999 World Health Organization criteria was 6.4. IPH accounted for 24 of these cases and 1.4 of the entire population. Individuals with IPH were significantly older, with greater body mass index, waist-hip ratio, systolic blood pressure, fasting blood glucose, total cholesterol and LDL-cholesterol than individuals with normal glucose tolerance. Individuals with IPH were not significantly different from individuals with fasting plasma glucose levels > or = 7 mmol/L (i.e. fasting hyperglycaemia) in anthropometry or blood pressure. However, total cholesterol and LDL-C were significantly elevated in the IPH group. OGTT screening of individuals with impaired fasting glucose (i.e. 6.1-6.9 mmol/l) could reduce the IPH group by 50. Reducing the threshold for fasting glucose to 5.6 mmol/L would correctly classify 87 of the population. We concluded that individuals with IPH have features of the metabolic syndrome, which can aid in selection for screening. OGTT screening of individuals with fasting glucose values of 5.6-6.9 mmol/l is needed to identify IPH

Chronic diseases--facing a public health challenge

Middle income countries like those in the Caribbean can feel proud of their achievements in health care. There has been a dramatic fall-off in infant mortality and crude mortality rates along with significant improvements in life expectancy at birth. However, these countries now find themselves grappling with the burden of chronic non-communicable diseases such as heart disease, stroke, hypertension, diabetes mellitus and cancer. There are good data to support the view that some of these diseases, in particular diabetes mellitus, have assumed epidemic proportions and there is concern that this fact may have been missed by many because of the surreptitious onset, as is the nature of the chronic diseases. The impact of this epidemic may have suffered because of the higher profile of more topical issues like HIV/AIDS even though the former makes a larger contribution to morbidity and mortality statistics. It is now obvious that despite the impact of other factors, lifestyle changes are the major contributors to the epidemic. In populations of similar genetic stock, living in significantly different socio-economic circumstances, the impact of increased dietary salt, increasing obesity and decreased physical activity on the prevalence of hypertension, diabetes mellitus and lipid disorders is unequivocal. Data from the developed world, which has already been through this epidemic of chronic diseases, have shown that increasing technological advances in medical care is an inefficient way to respond to the situation. A multi-sectoral approach is required to tackle this epidemic, including the provision of incentives for healthy eating and widespread opportunities for increased exercise and other physical activities. Continued research into the evolution of the epidemic, including reliable estimates via surveillance methods is a necessary component of our response. The problems and the solutions are not only the responsibilities of the health officials but must involve education, agriculture and other sectors of the economy.

Blood pressure in Jamaican children: relationship to body size and composition

Blood pressure levels in adults and children are related to body size and composition, but some of these relationships are unclear and they have been incompletely described in the Jamaican population. In a cross-sectional survey of 2,332 school children (6-16 years old; 1,046 boys, 1,286 girls), we measured systolic and diastolic blood pressure and pulse rate, and explored their relationship to weight, height, and waist, hip and mid-upper arm circumferences. The effect of these and other derived measures of body composition on blood pressure was explored in univariate and multivariate analysis. Blood pressure increased with age in both boys and girls, although the increase was greater for systolic than for diastolic blood pressure. The increase of systolic blood pressure among boys continued after age 11 years, but that for girls levelled off. Height and weight were the major predictors of blood pressure, but were highly correlated with each other and with all measures of body composition. Age, height and height-sex interaction explained 11.4of systolic blood pressure variation, and the largest incremental contribution to this model was provided by the addition of body mass index or hip circumference, each explaining an additional 2.6of the variance. Lean body mass made a larger contribution to blood pressure than percent fatness. Blood pressure in Jamaican children rises with age and this rise may be steeper in boys than girls. Blood pressure variation is significantly related to several measures of body composition including measures of fatness and fat free mass.