Availability and price of healthier food choices and association with obesity prevalence in New Zealand Maori.

BACKGROUND AND OBJECTIVES: Examine availability and price of healthier foods-vs-regular counterparts and their association with obesity. METHODS AND STUDY DESIGN: A cross-sectional survey of weight and height among Maori in 2 urban and 96 rural areas in the Waikato/Lakes Districts-NZ (year 2004-06) was undertaken. Concurrently, availability of 11 'healthier' food in fast-food-outlets was examined by location (urban vs rural) and median income (high-low). In supermarkets, five-specific 'regular' foods were scored against 'healthier' counterparts (white-vs-wholemeal bread, with-skin-vs-skinless chicken, regular-vs-trim meat, standard-vs-trim milk, sugarsweetened- beverages vs-water) for in-store availability and price according to the Nutrition Environment Measures Survey. RESULTS: Overall, 3,817 Maori (BMI: women: 32.9±7.8 kg/m2; men: 33.1±6.7 kg/m2) were included with 451 food-outlets in two urban-clusters and 698 food-outlets in 96 rural-clusters. Fast-foods: The availability of healthier food choices was higher for 8/11 items in rural and low-income areas than urban and high-income areas. Multivariate analysis considered location and income as cofactors. No association between number of fast-food-outlets/cluster and healthier foods/cluster with obesity prevalence (General/Maori BMI cutoffs) was observed. Supermarkets: Water was cheaper than sugar-sweetened-beverages and negatively associated with obesity prevalence (General r=-0.53, p=0.03; Maori r=-0.53, p=0.03); high availability scores for trim milk compared to standard milk correlated with higher obesity prevalence (General r=0.49, p=0.04; Maori r=0.57, p=0.01). CONCLUSIONS: Bottled water vs sugar-sweetened-beverages prices were inversely associated with obesity. This supports the argument to regulate the availability and price of sugar-sweetened-beverages in NZ. The positive association of the availability of trim milk with the prevalence of obesity warrants investigation into individual's dietary and food-purchase behaviour.

Diabetes among Maori women with self-reported past gestational diabetes mellitus in a New Zealand Maori community.

BACKGROUND: Gestational diabetes mellitus (GDM) is a risk factor for subsequent development of type 2 diabetes mellitus (T2DM). We have investigated the extent of this risk among Maori women without known diabetes. MATERIALS AND METHODS: We recruited 2786 Maori women aged 28-86 years between 2004 and 2006, without diagnosed diabetes from the Waikato and Southern Lakes regions, via media, community and general practitioner channels, and invited them for an oral glucose tolerance test (OGTT). RESULTS: Fifty (1.8%) women reported previous GDM (pGDM). The prevalence decreased significantly with age (P = 0.009). Women aged <50 years with pGDM had higher body mass index (35.6 ± 6.7 vs 32.4 ± 7.7 kg/m2 , P < 0.01), waist circumference (105.3 ± 18.8 vs 96.9 ± 16.6 cm, P < 0.01), fasting blood glucose (5.5 ± 1.0 vs 5.1 ± 0.8 mmol/L, P ≤ 0.01), two-hour post-prandial blood glucose (6.6 ± 3.0 vs 5.6 ± 2.1 mmol/L, P < 0.01) and HbA1c (6.0 ± 0.8 vs 5.8 ± 0.6%, P < 0.05) than women without pGDM. PGDM was a significant risk factor for undiagnosed diabetes (odds ratio 4.0; (5% confidence interval 1.67-9.71). Undiagnosed diabetes was significantly more prevalent among women with than without pGDM aged <40 years (20.0% vs 1.5%). CONCLUSION: Self-reported past GDM was a significant risk factor for undiagnosed diabetes in this Maori population, particularly among women aged <40 years, highlighting the importance of targeting this group for more intensive screening.

Mapping the availability and accessibility of healthy food in rural and urban New Zealand--Te Wai o Rona: Diabetes Prevention Strategy.

OBJECTIVE: Uptake of advice for lifestyle change for obesity and diabetes prevention requires access to affordable 'healthy' foods (high in fibre/low in sugar and fat). The present study aimed to examine the availability and accessibility of 'healthy' foods in rural and urban New Zealand. DESIGN: We identified and visited ('mapped') 1230 food outlets (473 urban, 757 rural) across the Waikato/Lakes areas (162 census areas within twelve regions) in New Zealand, where the Te Wai O Rona: Diabetes Prevention Strategy was underway. At each site, we assessed the availability of 'healthy' foods (e.g. wholemeal bread) and compared their cost with those of comparable 'regular' foods (e.g. white bread). RESULTS: Healthy foods were generally more available in urban than rural areas. In both urban and rural areas, 'healthy' foods were more expensive than 'regular' foods after adjusting for the population and income level of each area. For instance, there was an increasing price difference across bread, meat, poultry, with the highest difference for sugar substitutes. The weekly family cost of a 'healthy' food basket (without sugar) was 29.1% more expensive than the 'regular' basket ($NZ 176.72 v. $NZ 136.84). The difference between the 'healthy' and 'regular' basket was greater in urban ($NZ 49.18) than rural areas ($NZ 36.27) in adjusted analysis. CONCLUSIONS: 'Healthy' foods were more expensive than 'regular' choices in both urban and rural areas. Although urban areas had higher availability of 'healthy' foods, the cost of changing to a healthy diet in urban areas was also greater. Improvement in the food environment is needed to support people in adopting healthy food choices.

Optimal waist cutpoint for screening for dysglycaemia and metabolic risk: evidence from a Maori cohort.

We sought to identify the sex-specific cut-off in waist circumference which best identifies those with metabolic abnormalities consistent with the metabolic syndrome (MS) among Maori, the indigenous people of New Zealand of Polynesian origin. In 3816 self-identified Maori (2742 women, 1344 men) a 75 g oral glucose tolerance test, fasting lipid, anthropometric and blood pressure measurements were made. MS components were defined by Adult Treatment Panel (ATP) III criteria. Waist cut-off was defined using receiver operating characteristic (ROC) curve analysis to define the presence of at least two of the other MS components ( > or = 2MS). Prevalence of > or = 2MS was high (42.1 %). In males and females, waist was as good, or better, a predictor of > or = 2MS (area under ROC 0.73 women, 0.68 men) as waist:hip ratio (0.66, 0.67), BMI (0.72, 0.68) or percentage body fat (0.70, 0.68). The prediction of dysglycaemia using anthropometric variables followed a similar pattern to > or = 2MS. Waist circumference to predict > or = 2MS or dysglycaemia in Maori women and men was 98 cm and 103 cm. Applying this cut-off to the International Diabetes Federation (IDF) criteria would identify 27.8 % (34.0 % males, 25.5 % females) with the MS with an OR for > or = 2MS (adjusted for sex, smoking and age) of 3.5 (95 % CI 3.1, 4.0). Age >48 years, smoking and being male increased the odds of the MS. These waist cut-offs should be considered in both clinical practice and to optimise the definition of the MS for Maori. The validity of these criteria in other Polynesian groups should be confirmed.

Prevalence of undiagnosed diabetes, impaired glucose tolerance, and impaired fasting glucose among Maori in Te Wai o Rona: Diabetes Prevention Strategy.

AIMS: To describe the prevalence of undiagnosed diabetes, impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) ("dysglycaemia") among Maori. METHODS: Te Wai o Rona: Diabetes Prevention Strategy was a trial of lifestyle change among Maori families in the Waikato/Lakes areas of New Zealand. All Maori family household members aged > or = 28 years, without known diabetes, were invited to participate through primary care, community, and media approaches. Participants were invited to have an oral glucose tolerance test (OGTT). RESULTS: Of the 3817 eligible Maori, mean BMI was 32.9+/-7.8 kg/m2 (women) and 33.1+/-6.7 kg/m2 (men). The age standardised prevalence of undiagnosed diabetes was higher among men than women (6.5[5.8-7.4]% vs 4.2[3.6-4.8]%), as was that for IFG (5.4[4.7-6.1]% vs 3.0[2.3-3.5]%), but not IGT (8.5[7.6-9.4]% vs 9.7[8.7-10.6]%) with no rural-urban differences. The prevalence of dysglycaemia increased with increasing BMI with no clear inflection point and was 1.33(1.11-1.60) greater among those with a community services card after adjusting for age, sex and BMI. CONCLUSIONS: Undiagnosed diabetes, IGT, and IFG remain common among Maori, particularly men, the very obese, and those with greater socioeconomic disadvantage. There remains significant opportunity to reduce Maori morbidity and premature mortality through diabetes case-finding and intervention.

Low prevalence of retinopathy, but high prevalence of nephropathy among Maori with newly diagnosed diabetes-Te Wai o Rona: Diabetes Prevention Strategy.

AIMS/HYPOTHESIS: To describe the prevalence of retinopathy and microalbuminuria at diagnosis of diabetes in a predominantly Maori study population. METHODS: Biomedical assessment including photographic retinal examination was undertaken among 157 (68.9% of eligible) members of Maori families (3.3% non-Maori) diagnosed with diabetes during a community screening programme (n=5240) as part of a diabetes prevention strategy. RESULTS: Mean HbA1c of those with newly diagnosed diabetes was 7.8+/-1.5% with 34.4% having an HbA1c >/=8.0%. Retinopathy was present in 3 (1.7%) subjects, cataracts in 3.2%, microalbuminuria in 29.6% and albuminuria in 7.7%. After adjusting for covariates, only smoking was a risk factor for microalbuminuria/proteinuria (current and former smokers: increased 3.81(1.32-11.0) and 3.67(1.30-10.4) fold, respectively). CONCLUSIONS: The prevalence of retinopathy at diagnosis was lower than in previous studies, yet that of microalbuminuria/proteinuria remained high. The retinopathy data suggest that case detection for diabetes in the community may be improving, but that other strategies among those at risk of diabetes, including those promoting smoking cessation, will be needed to reduce the risk of renal disease among Maori with diabetes.

First national audit of the outcomes of care in young people with diabetes in New Zealand: high prevalence of nephropathy in Maori and Pacific Islanders.

BACKGROUND: Diabetes is an important cause of morbidity and mortality amongst young people. Despite improvements in technology, maintenance of good glycaemic control is hard to achieve. METHODS: In July 2003, 12 paediatric and adult hospital-based diabetes services across New Zealand were invited to take part in an audit of the process and outcomes of care. By March 2004, 9 centres had submitted data on 1282 (1117 with Type 1 diabetes, 105 with Type 2) children and young people born after 1 January 1978. RESULTS: There were significant centre differences in terms of glycaemic control, rates of microvascular complications and complication screening. The group mean HbA1c was 9.1 plus and minus 0.3%. Amongst 789 people aged 16-25 years, the prevalence of retinopathy was 12.8% (range 0-26%); nephropathy was 17.1% (range 7-28 %). Of those with a duration of diabetes <10 years, 25% had retinopathy and 27% nephropathy. Over the age of 12, microalbuminuria was more common amongst Maori and Pacific Islanders (43.8%) compared to Europeans (17%) or Others (17.8%). This was independent of the type of diabetes. CONCLUSIONS: This is the largest study of young people with diabetes undertaken in New Zealand. The results confirm the difficulty of achieving good glycaemic control in children and young adults. Microvascular complications were common, particularly in those of long duration, and cardiovascular risk factors were present in many young adults. The difference in average HbA1c% between centres was highly significant and independent of other factors. Type 2 diabetes mellitus in young people was associated with early onset nephropathy and dyslipidaemia (almost from diagnosis), thus suggesting the need for earlier diagnosis.