Perceptions of overweight in a Caribbean population: the role of health professionals.

BACKGROUND: The prevalence of obesity and its complications is particularly high in the Caribbean. Underestimation of weight status could explain the failure by subjects concerned to adopt behaviours complying with medical recommendations. Little research is available on the role of health professionals in overweight perception. OBJECTIVE: To examine relationships between overweight underestimation and lack of communication on overweight diagnosis by health professionals in a multicultural Caribbean population. METHODS: A cross-sectional study, lead in 2014 on a sample representative of the population of Saint-Martin (395 subjects, 25-74 years). Overweight perception was assessed on Likert scale. Corpulence was assessed from measured waist circumference (WC). Individuals with excess abdominal adiposity (WC ≥ 80cm for women, ≥ 94cm for men) but stating they did not feel overweight were considered to underestimate their weight status. Patient-reported lack of communication on their diagnosis by health professionals was likewise explored. Respondents' first language defined cultural community. Multivariate analysis used logistic regression. RESULTS: Among individuals presenting excessive WC, 4 out of 10 did not perceive themselves as overweight. Six out of 10 said they had never been told about their weight by a health professional, whether or not they had their weight and waist measured by their referring physician in the preceding year. Independently from WC, overweight underestimation was associated with lack of communication on overweight diagnosis for both sexes. For women, overweight underestimation was associated with belonging to the Creole community. CONCLUSION: Greater care is required when giving a diagnosis of overweight, particularly in social-cultural contexts where weight norms differ.

Association of 2238T>C polymorphism of the atrial natriuretic peptide gene with coronary artery disease in Afro-Caribbeans with type 2 diabetes.

BACKGROUND: The atrial natriuretic peptide (ANP) is known mainly for its effects on kidney function and blood pressure homeostasis. We investigated the association between two ANP polymorphisms and pre-existing coronary artery disease (CAD) in patients of African descent with type 2 diabetes (T2D). METHODS: We conducted a cross-sectional and retrospective study of 218 volunteer Afro-Caribbean patients with T2D. Two polymorphisms (rs5064, 708C>T; and rs5065, 2238T>C) of ANP were genotyped using PCR-restriction fragment length polymorphism analysis. ANCOVA, χ2-test, and logistic regression were used for statistical analysis. RESULTS: Among these patients (92 men; 128 women), 67 (30.7%) had CAD, of whom 75% had had myocardial infarction. The frequency of rs5065-C carriers (TC/CC) was significantly lower in patients with CAD than in those without CAD (24 vs. 41%, P = 0.01). The frequency of hypertension did not differ significantly according to genotype. Univariate logistic regression revealed that male sex, age, dyslipidemia, hypertension, and rs5065-C carrier status were associated significantly with CAD. After adjustment for the variables of interest, the odds ratio (ORs) of CAD for rs5065-C carriers (TC/CC) was 0.50 (0.26-0.96; P = 0.038). No association was found between the rs5064 (708C>T) single-nucleotide polymorphisms (SNPs) and pre-existing CAD or cardiovascular risk factors. CONCLUSIONS: The ANP rs5065 (2238T>C) C allele seems to exert a protective effect against CAD in T2D patients of African descent. The relevance of ANP polymorphisms for CAD should be determined in different populations.

High blood pressure and obesity: disparities among four French Overseas Territories.

BACKGROUND AND PURPOSE: The epidemiological characteristics of hypertension and obesity in French Overseas Territories (FOTs) have never been compared. METHODS: This cross-sectional survey included representative population-based samples of 602, 601, 620 and 605 men and women aged more than 15 years, respectively, from four FOTs of Guadeloupe, Martinique, French Guiana, and French Polynesia. Hypertension was defined as blood pressure (BP) at least 140/90 mmHg or the current use of antihypertensive treatment. RESULTS: The prevalence of hypertension was 29.2% in Guadeloupe, 17.9% in French Guiana, 27.6% in Martinique and 24.5% in French Polynesia. Considering the Guadeloupe population as the reference group, prevalence of hypertension was significantly lower in French Guiana (P < 0.001), even after controlling for age and sex (P = 0.006). Awareness and treatment of hypertension were similar in French Guiana, Martinique and Guadeloupe (68.8-75.1% and 69.0-73.4%, respectively). Awareness was lower in French Polynesia (50.0%, adjusted P value = 0.04), as was treatment of hypertension (32.4%, adjusted P value = 0.001). Control of hypertension was also lower in French Polynesia (8.8%, adjusted P value = 0.001) compared with the other territories (29.7-31.8%). French Polynesia had the highest prevalence of obesity (33.1%, adjusted P value < 0.001) as compared with the other territories (17.9-22.8%). It had also the largest population attributable fraction of hypertension due to obesity (35.5%) compared with Guadeloupe (13.3%), Martinique (12.3%) and French Guiana (23.6%). CONCLUSION: Wide variations were observed in the prevalence and the management of hypertension between these FOTs, and an especially challenging low control of hypertension was found in French Polynesia. Obesity appears a key target to prevent hypertension, particularly in French Polynesia.

Improving stroke prevention in the French West Indies: limits to lay knowledge of risk factors.

BACKGROUND AND PURPOSE: We sought to evaluate lay knowledge and understanding of cardiovascular diseases in the French West Indies. METHODS: In 2007, a cross-sectional study of 1005 randomly selected men and women (54%) age 25 to 74 years from Guadeloupe and stratified by sex, age, and region was established to ascertain the population's knowledge and awareness of chronic diseases. Questions were asked about the respondent's knowledge of cardiovascular risk factors as well as their opinions and beliefs about measures to prevent these diseases. RESULTS: Knowledge about stroke prevention in this sample was lower than for heart disease, with 69% of women and 65% of men reporting that precautions can be taken to avoid a stroke versus 84% and 77%, respectively, for heart disease. "Avoid stress" was the most commonly cited stroke prevention measure, with 35% of women and 27% of men reporting it. The first spontaneous item cited for heart disease prevention was "physical exercise or sport," reported by 47% of women and 45% of men. We hypothesize that knowledge of stroke and stroke risk factors is poor in Guadeloupe or that it reflects culturally adapted health promotion messages from doctors. CONCLUSIONS: Knowledge and awareness were found to be lower for stroke than for heart diseases. Changes in health promotion strategies are required in the French West Indies to improve the population's overall awareness of these diseases and to narrow the gap between knowledge and practice.

Controlling arterial hypertension in the French West Indies: a separate strategy for women?

BACKGROUND: To estimate the prevalence, awareness and treatment of arterial hypertension in Guadeloupe. METHODS: In 2007, a cross-sectional study of 1005 men and women (54%) aged 25-74 years from Guadeloupe, stratified by sex, age and region was set up to determine the prevalence of hypertension. Blood pressure (BP) was measured using an automated device and hypertension was defined as having a mean BP ≥ 140/90 mmHg or receiving drug treatment. RESULTS: The prevalence of hypertension was 33% for men and 37% for women (P = 0.62). Among hypertensive respondents, 57% of men and 80% of women were aware of being hypertensive (P < 0.001). BP was controlled for 22 and 44% of hypertensive men and women, respectively (P < 0.001). Compared with men (14%), 31% of women were obese (≥ 30 kg/m²). In multivariate analyses, body mass index (BMI) was associated with hypertension in both sexes after controlling for age, occupation, education, alcohol consumption, smoking status and physical activity. Compared with subjects with a normal BMI, obese men were three times [odds ratio (OR) = 3.4, 95% confidence interval (CI) = 1.8-6.6 P < 0.001] and obese women two times more likely (OR = 2.0, 95% CI = 1.2-3.4, P = 0.017) to be hypertensive. In women, low educational attainment was also associated with hypertension (OR = 2.1 95% CI = 1.1-4.0, P = 0.030) and mean diastolic BP decreased as educational attainment increased after controlling for confounders (F = 5.0, df 2, P = 0.007). CONCLUSIONS: Strong gender disparities in hypertension were identified. Separate strategies in addressing hypertension in men and women are needed, with an improvement in men's follow-up care and health promotion, focussed on nutrition, targeted at women.

Adiponectin multimers and ADIPOQ T45G in coronary artery disease in Caribbean type 2 diabetic subjects of African descent.

Ethnic differences may affect the association of adiponectin (Ad) multimers with coronary artery disease (CAD). We analyzed the associations of total Ad, Ad multimers, and T45G polymorphism of ADIPOQ gene with pre-existing CAD. We carried out a cross-sectional study of 216 Afro-Caribbean type 2 diabetic (T2D) subjects. Levels of total Ad, high molecular weight (HMW), middle molecular weight (MMW), and low molecular weight (LMW) isoforms were measured. Subjects were genotyped. Of the subjects studied, 57 had pre-existing CAD, 77% of whom have had myocardial infarction. Subjects with CAD had lower Ad levels (total and multimers) and a higher frequency carried the minor allele 45G, GG/TG, (18% vs. 8%, P = 0.03) than subjects without CAD. In logistic regression analysis, the models used evaluate Ad in the context of adjustment for metabolic syndrome characteristics. The adjusted odds ratio (OR) of CAD was increased significantly (by factors of 1.05-3.27) for males, older subjects, low high-density lipoprotein cholesterol (HDL-C), high triglycerides (TGs), and carriers of the 45 G allele. For Ad, in model 1 (including only total Ad) the adjusted OR was 2.30; P = 0.03 and, in model 2 (including the three multimers, but not total Ad), the adjusted ORs were 0.73; P = 0.52 (HMW), 2.90; P = 0.01 (MMW), and 2.08; P = 0.09 (LMW). The T45G polymorphism in the ADIPOQ gene and hypoadiponectinemia were associated with CAD in our T2D subjects of predominantly African background. This effect of Ad level was mainly related to the MMW Ad form.

Prevalence and therapeutic control of hypertension in French Caribbean regions.

OBJECTIVE: To describe characteristics of hypertension in French Caribbean regions. DESIGN: A cross-sectional worksite study. SETTING AND PARTICIPANTS: A random sample of 6136 workers referred for annual check-up from Martinique, French Guyana and Guadeloupe. An average of three consecutive measurements was taken as the blood pressure (BP) level. An additional visit was required in subjects not taking antihypertensive medications with an average BP over 140/90 mmHg. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Hypertension prevalence, awareness, treatment and control. RESULTS: The age-specific prevalence of hypertension, based on two visits, increased from 3.2% in men below 30 years to 46.9% in those older than 50 years. The corresponding values found in women were 1.8 and 42.6%. The overall prevalence was 19.5% in men and 18.9% in women. The rate of awareness remained low while age increased. The use of antihypertensive medications slowly increased with age, but overall the rate remained lower in men compared with women. Up to 71% of hypertensive women received antihypertensive medications. Compared with previous studies, a high proportion of adequately treated patients was found among women (44.9%). Only 30.4% of hypertensive men were treated, and as a result the control rate was lower (13.3%). CONCLUSION: Major sex-related differences are found in the control of high BP, with an unexpected high rate observed among Caribbean women. Better awareness and higher treatment rates play an important role in explaining such results. This may be important, especially in developing countries, where poor control of hypertension is a major cause of cardiovascular diseases.