Readiness of primary care centres for a community-based intervention to prevent and control noncommunicable diseases in the Caribbean: A participatory, mixed-methods study.

INTRODUCTION: Epidemiological transition to NCDs is a challenge for fragile health systems in the Caribbean. The Congregations Taking Action against NCDs (CONTACT) Study intervention proposes that trained health advocates (HAs) from places of worship (PoWs), supervised by nurses at nearby primary healthcare centres (PHCs), could facilitate access to primary care among vulnerable communities. Drawing on participatory and systems thinking, we explored the capacity of local PHCs in three Caribbean countries to support this intervention. METHODS: Communities in Jamaica (rural, urban), Guyana (rural) and Dominica (Indigenous Kalinago Territory) were selected for CONTACT because of their differing socio-economic, cultural, religious and health system contexts. Through mixed-method concept mapping, we co-developed a list of perceived actionable priorities (possible intervention points ranked highly for feasibility and importance) with 48 policy actors, healthcare practitioners and civic society representatives. Guided in part by the concept mapping findings, we assessed the readiness of 12 purposefully selected PHCs for the intervention, using a staff questionnaire and an observation checklist to identify enablers and constrainers. RESULTS: Concept mapping illustrated stakeholder optimism for the intervention, but revealed perceptions of inadequate primary healthcare service capacity, resources and staff training to support implementation. Readiness assessments of PHCs identified potential enablers and constrainers that were consistent with concept mapping results. Staff support was evident. Constraints included under-staffing, which could hinder supervision of HAs; and inadequate essential NCD medicines, training in NCDs and financial and policy support for embedding community interventions. Despite a history of socio-political disadvantage, the most enabling context was found in the Kalinago Territory, where ongoing community engagement activities could support joint development of programmes between churches and PHCs. CONCLUSION: Multi-sectoral stakeholder consultation and direct PHC assessments revealed viability of the proposed POW-PHC partnership for NCD prevention and control. However, structural and policy support will be key for implementing change.

Current obstetric outcomes in Jamaican women with sickle hemoglobinopathy - a balance of risks for aspirin?

OBJECTIVES: Sickle cell disease (SCD) occurs in 2.8 % of our Jamaican antenatal population with homozygous HbSS being most associated with adverse maternal and perinatal outcomes. METHODS: A retrospective comparative analysis of HbSS, HbSC and HbSßThal pregnancy outcomes at the University Hospital of the West Indies (UHWI) between January 2012 and December 2022 was conducted. RESULTS: Of 120 patients (138 pregnancies), obesity occurred in 36 % (20/56) of the 'non-HbSS' group, i.e. HbSßThal (55 %, 5/9) and HbSC (32 %, 15/47) combined vs. 9.7 % of the HbSS (8/82). HbSS patients had more crises requiring transfusions, acute chest syndrome (ACS), maternal 'near-misses' (OR=10.7, 95 % 3.5-32.3; p<0.001), hospitalizations (OR 7.6, 95 % CI 3.4-16.9; p<0.001), low birth weight (LBW) neonates (OR 3.1, 1.1-8.9; p=0.037) and preterm birth (OR=2.6, 1.2-5.8; p=0.018) compared to HbSC and HbSßThal. Low dose aspirin was prescribed in 43 %. Logistic regression showed those NOT on aspirin (n=76) had more miscarriages (22 v. 2 %), were LESS likely to have a live birth (75 v. 95 % (0.2, 0.04-0.57, p=0.005)), but surprisingly had fewer painful crises (28 v. 46 % (0.5, 0.03-0.9, p=0.03)). CONCLUSIONS: HbSS women had a 10-fold excess of maternal near-misses. Additional research may further clarify the effects of aspirin on pregnancy outcomes as related to SCD genotypes.

Optimización del desempeño del observador al medir la presión arterial en el consultorio: declaración de posición de la Comisión Lancet de Hipertensión

[RESUMEN]. La hipertensión arterial es una causa modificable muy prevalente de enfermedades cardiovasculares, accidentes cerebrovasculares y muerte. Medir con exactitud la presión arterial es fundamental, dado que un error de medición de 5 mmHg puede ser motivo para clasificar incorrectamente como hipertensas a 84 millones de personas en todo el mundo. En la presente declaración de posición se resumen los procedimientos para optimizar el desempeño del observador al medir la presión arterial en el consultorio, con atención especial a los entornos de ingresos bajos o medianos, donde esta medición se ve complicada por limitaciones de recursos y tiempo, sobrecarga de trabajo y falta de suministro eléctrico. Es posible reducir al mínimo muchos errores de medición con una preparación adecuada de los pacientes y el uso de técnicas estandarizadas. Para simplificar la medición y prevenir errores del observador, deben usarse tensiómetros semiautomáticos o automáticos de manguito validados, en lugar del método por auscultación. Pueden ayudar también la distribución de tareas, la creación de un área específica de medición y el uso de aparatos semiautomáticos o de carga solar. Es fundamental garantizar la capacitación inicial y periódica de los integrantes del equipo de salud. Debe considerarse la implementación de programas de certificación de bajo costo y fácilmente accesibles con el objetivo de mejorar la medición de la presión arterial.

[ABSTRACT]. High blood pressure (BP) is a highly prevalent modifiable cause of cardiovascular disease, stroke, and death. Accurate BP measurement is critical, given that a 5-mmHg measurement error may lead to incorrect hypertension status classification in 84 million individuals worldwide. This position statement summarizes procedures for optimizing observer performance in clinic BP measurement, with special attention given to low-to-middle-income settings, where resource limitations, heavy workloads, time constraints, and lack of electrical power make measurement more challenging. Many measurement errors can be minimized by appropriate patient preparation and standardized techniques. Validated semi-automated/automated upper arm cuff devices should be used instead of auscultation to simplify measurement and prevent observer error. Task sharing, creating a dedicated measurement workstation, and using semi-automated or solar-charged devices may help. Ensuring observer training, and periodic re-training, is critical. Low-cost, easily accessible certification programs should be considered to facilitate best BP measurement practice.

[RESUMO]. A hipertensão é uma causa altamente prevalente de doença cardiovascular, acidente vascular cerebral e morte. A medição precisa da pressão arterial (PA) é um aspecto crítico, uma vez que erros de mensuração da ordem de 5 mmHg podem levar a uma classificação incorreta do status de hipertensão em 84 milhões de pessoas em todo o mundo. O presente posicionamento resume os procedimentos para otimizar o desempenho do observador (o indivíduo responsável pela mensuração da PA) na mensuração clínica da PA, com atenção especial para contextos de baixa a média renda, onde recursos limitados, cargas de trabalho pesadas, restrições de tempo e falta de energia elétrica tornam mais desafiadora a tarefa de medir a PA. Muitos erros de mensuração podem ser minimizados pela preparação adequada do paciente e pelo uso de técnicas padronizadas. Para simplificar a mensuração e evitar erros do observador, devem-se utilizar dispositivos semiautomatizados ou automatizados validados, com manguito para braço, ao invés de auscultação. O compartilhamento de tarefas, a criação de uma estação de trabalho dedicada à mensuração e o uso de dispositivos semiautomatizados ou com carga solar podem ajudar. É essencial que seja assegurado o treinamento e retreinamento periódico do observador. Programas de certificação de baixo custo e de fácil acesso devem ser considerados para facilitar a adoção das melhores práticas na mensuração da PA.

Optimización del desempeño del observador al medir la presión arterial en el consultorio: declaración de posición de la Comisión Lancet de Hipertensión / Optimizing observer performance of clinic blood Pressure measurement: a position statement from the Lancet Commission on Hypertension Group / Otimização do desempenho do observador na medição clínica da pressão arterial: posicionamento do Grupo da Lancet Commission on Hypertension

RESUMEN La hipertensión arterial es una causa modificable muy prevalente de enfermedades cardiovasculares, accidentes cerebrovasculares y muerte. Medir con exactitud la presión arterial es fundamental, dado que un error de medición de 5 mmHg puede ser motivo para clasificar incorrectamente como hipertensas a 84 millones de personas en todo el mundo. En la presente declaración de posición se resumen los procedimientos para optimizar el desempeño del observador al medir la presión arterial en el consultorio, con atención especial a los entornos de ingresos bajos o medianos, donde esta medición se ve complicada por limitaciones de recursos y tiempo, sobrecarga de trabajo y falta de suministro eléctrico. Es posible reducir al mínimo muchos errores de medición con una preparación adecuada de los pacientes y el uso de técnicas estandarizadas. Para simplificar la medición y prevenir errores del observador, deben usarse tensiómetros semiautomáticos o automáticos de manguito validados, en lugar del método por auscultación. Pueden ayudar también la distribución de tareas, la creación de un área específica de medición y el uso de aparatos semiautomáticos o de carga solar. Es fundamental garantizar la capacitación inicial y periódica de los integrantes del equipo de salud. Debe considerarse la implementación de programas de certificación de bajo costo y fácilmente accesibles con el objetivo de mejorar la medición de la presión arterial.(AU)

ABSTRACT High blood pressure (BP) is a highly prevalent modifiable cause of cardiovascular disease, stroke, and death. Accurate BP measurement is critical, given that a 5-mmHg measurement error may lead to incorrect hypertension status classification in 84 million individuals worldwide. This position statement summarizes procedures for optimizing observer performance in clinic BP measurement, with special attention given to low-tomiddle- income settings, where resource limitations, heavy workloads, time constraints, and lack of electrical power make measurement more challenging. Many measurement errors can be minimized by appropriate patient preparation and standardized techniques. Validated semi-automated/automated upper arm cuff devices should be used instead of auscultation to simplify measurement and prevent observer error. Task sharing, creating a dedicated measurement workstation, and using semi-automated or solar-charged devices may help. Ensuring observer training, and periodic re-training, is critical. Low-cost, easily accessible certification programs should be considered to facilitate best BP measurement practice.(AU)

RESUMO A hipertensão é uma causa altamente prevalente de doença cardiovascular, acidente vascular cerebral e morte. A medição precisa da pressão arterial (PA) é um aspecto crítico, uma vez que erros de mensuração da ordem de 5 mmHg podem levar a uma classificação incorreta do status de hipertensão em 84 milhões de pessoas em todo o mundo. O presente posicionamento resume os procedimentos para otimizar o desempenho do observador (o indivíduo responsável pela mensuração da PA) na mensuração clínica da PA, com atenção especial para contextos de baixa a média renda, onde recursos limitados, cargas de trabalho pesadas, restrições de tempo e falta de energia elétrica tornam mais desafiadora a tarefa de medir a PA. Muitos erros de mensuração podem ser minimizados pela preparação adequada do paciente e pelo uso de técnicas padronizadas. Para simplificar a mensuração e evitar erros do observador, devem-se utilizar dispositivos semiautomatizados ou automatizados validados, com manguito para braço, ao invés de auscultação. O compartilhamento de tarefas, a criação de uma estação de trabalho dedicada à mensuração e o uso de dispositivos semiautomatizados ou com carga solar podem ajudar. É essencial que seja assegurado o treinamento e retreinamento periódico do observador. Programas de certificação de baixo custo e de fácil acesso devem ser considerados para facilitar a adoção das melhores práticas na mensuração da PA.(AU)

Birth weight and maternal socioeconomic circumstances were inversely related to systolic blood pressure among Afro-Caribbean young adults.

OBJECTIVES: In this study, we examined the effects of birth weight (BWT) and early life socioeconomic circumstances (SEC) on systolic blood pressure (SBP) and diastolic blood pressure (DBP) among Jamaican young adults. STUDY DESIGN AND SETTING: Longitudinal study of 364 men and 430 women from the Jamaica 1986 Birth Cohort Study. Information on BWT and maternal SEC at child's birth was linked to information collected at 18-20 years old. Sex-specific multilevel linear regression models were used to examine whether adult SBP/DBP was associated with BWT and maternal SEC. RESULTS: In unadjusted models, SBP was inversely related to BWT z-score in both men (ß, -0.82 mm Hg) and women (ß, -1.18 mm Hg) but achieved statistical significance for women only. In the fully adjusted model, one standard deviation increase in BWT was associated with 1.16 mm Hg reduction in SBP among men [95% confidence interval (CI): 2.15, 0.17; P = 0.021] and 1.34 mm Hg reduction in SBP among women (95% CI: 2.21, 0.47; P = 0.003). Participants whose mothers had lower SEC had higher SBP compared with those with mothers of high SEC (ß, 3.4-4.8 mm Hg for men, P < 0.05 for all SEC categories and 1.8-2.1 for women, P > 0.05). CONCLUSION: SBP was inversely related to maternal SEC and BWT among Jamaican young adults.

Nutrient intakes and dysglycaemia in populations of West African origin.

Examining the relationship between glucose intolerance and dietary intake in genetically similar populations with different dietary patterns and rates of type 2 diabetes may provide important insights into the role of diet in the pathogenesis of this disease. The objective of the present study was to assess the relationship between dietary variables and dysglycaemia/type 2 diabetes among three populations of African origin. The study design consists of a cross-sectional study of men and women of African descent aged 24-74 years from Cameroon (n 1790), Jamaica (n 857) and Manchester, UK (n 258) who were not known to have diabetes. Each participant had anthropometric measurements and underwent a 2 h 75 g oral glucose tolerance test. Habitual dietary intake was estimated with quantitative FFQ, developed specifically for each country. The age-adjusted prevalence of undiagnosed type 2 diabetes in Cameroon was low (1·1 %), but it was higher in Jamaica (11·6 %) and the UK (12·6 %). Adjusted generalised linear and latent mixed models used to obtain OR indicated that each 1·0 % increment in energy from protein, total fat and saturated fats significantly increased the odds of type 2 diabetes by 9 (95 % CI 1·02, 1·16) %, 5 (95 % CI, 1·01, 1·08) % and 16 (95 % CI 1·08, 1·25) %, respectively. A 1 % increase in energy from carbohydrates and a 0·1 unit increment in the PUFA:SFA ratio were associated with significantly reduced odds of type 2 diabetes. The results show independent effects of dietary factors on hyperglycaemia in African origin populations. Whether modifying intake of specific macronutrients helps diabetes prevention needs testing in randomised trials.

Tracing Jamaican community childhood cohorts: influences of growth from 0 to 5 years on height, weight and blood pressure of adults aged 35+ years

OBJECTIVE: To investigate the early postnatal growth-chronic disease hypothesis, we decided to trace two total community cohorts of Jamaican children (Studies A & B). DESIGN AND METHODS: Prenatal and postnatal under-nutrition were widespread in the Caribbean in the early-mid 20th century. Current rates of some chronic diseases (high blood pressure (BP), diabetes) may reflect recent lifestyle and body mass index (BMI) changes, superimposed on these early constraints on childhood growth. Study A comprised children born between 1962 and 1963 and their recalled birth weight, weight at 1 month and height from 3 months were noted and other details were measured 1-3 monthly for 5 years, with re-measures at age 10-11 years (n=177). In study B (n=417), similar parameters were noted for all children <5 years, until 5 years of age. If traced, we took lifestyle enquiries, standardised measures of current height, weight, BP and fasting blood glucose. RESULTS: In Study A, 130 children (73 percent) were traced: 35 had migrated overseas (26 with whereabouts known), 3 died, 5 were ill/pregnant, leaving 87 available and known locally. Of 65 invited, 61 (28 men, 33 women) were seen. Of 205 initially sampled in Study B, 24 had migrated, 5 died, and 2 were ill so that 174 (85 percent) were still known locally but not yet followed. Study A: Univariate correlations between growth in height from 3 months to 5 years and current systolic BP (SBP) of adults aged 35+ years were inverse, at -0.21. Adjusted for current BMI, these changed to -0.25; further adjusting for initial 3-month height reduced the co-relation to -0.17 (p<0.02). Earlier height increments (to 2, 3 or 4 years) were more weakly inversely related to adult SBP, as was growth in weight, univariate -0.10, and after adjusting for current BMI and weight, -0.15 (p<0.05). Adjusted correlations with diastolic BP were prominent (-0.37) from 3 months to 4 years but not up to 5 years. Height and weight had tracked markedly from 0 to 5 years, those who grew the least having higher adult BP. CONCLUSION: Tracing adult cohorts from these earlier childhood studies in modern Jamaica is practical, worthwhile sample sizes can be achieved (>70 percent) and from this previously relatively undernourished community, those who grew least from 0 to 5 years had higher BP, even after accounting for initial size.(Au)

Standardized comparison of glucose intolerance in West African-origin populations of rural and urban Cameroon, Jamaica, and Caribbean migrants to Britain

OBJECTIVE: To compare the prevalence of glucose intolerance in genetically similar African-origin populations within Cameroon and from Jamaica and Britain. RESEARCH DESIGN AND METHODS: Subjects studied were from rural and urban Cameroon or from Jamaica, or were Caribbean migrants, mainly Jamaican, living in Manchester, England. Sampling bases included a local census of adults aged 25-74 years in Cameroon, districts statistically representative in Jamaica, and population registers in Manchester. African-Caribbean ethnicity required three grandparents of this ethnicity. Diabetes was defined by the World Health Organization (WHO) 1985 criteria using a 75-g oral glucose tolerance test (2-h > or = 11.1 mmol/l or hypoglycemic treatment) and by the new American Diabetes Association criteria (fasting glucose > or = 7.0 mmol/l or hypoglycemic treatment). RESULTS: For men, mean BMIs were greatest in urban Cameroon and Manchester (25-27 kg/m2); in women, these were similarly high in urban Cameroon and Jamaica and highest in Manchester (27-28 kg/m2). The age-standardized diabetes prevalence using WHO criteria was 0.8 percent in rural Cameroon, 2.0 percent in urban Cameroon, 8.5 percent in Jamaica, and 14.6 percent in Manchester, with no difference between sexes (men: 1.1 percent, 1.0 percent, 6.5 percent, 15.3 percent, women: 0.5 percent, 2.8 percent, 10.6 percent, 14.0 percent), all tests for trend P < 0.001. Impaired glucose tolerance was more frequent in Jamaica. CONCLUSIONS: The transition in glucose intolerance from Cameroon to Jamaica and Britain suggests that environment determines diabetes prevalence in these populations of similar genetic origin.(Au)

Prevalence of diabetes and impaired glucose tolerance in Nigerians, Jamaicans and US blacks

The prevalence of type 2 diabetes, impaired glucose tolerance and associated risk factors were compared in sample surveys in Africa and the Caribbean with the Third National Health and Nutrition Survey (NHANES-III) from the United States. A total of 856 Nigerians, 1286 Jamaicans, and 1827 US blacks were included in the study. Body mass index (BMI) increased in a stepwise fashion across the three population groups, ie, 23 kg/m2 in Nigerians, 26 kg/m2 in Jamaicans, and 28 kg/m2 in US blacks. The persons aged 25-74, were 1 percent, 12 percent, 13 percent. Jamaican women were found to have the same prevalence of type 2 diabetes as US women (14 vs 13 percent, respectively); mean BMI was likewise very similar (28 kg/m2 in Jamaican and 29 kg/m2 in US women). BMI and waist-to-hip ratio were both associated with type 2 diabetes prevalence. Findings of this study confirm the marked gradient in type 2 diabetes risk among these genetically related populations and suggest that the blacks in the island nations of the Caribbean and the United States are at particularly high risk. Nigerians exhibited remarkably well-preserved glucose tolerance. Understanding the factors that limit the risk of type 2 diabetes in West Africa, beyond relative absence of obesity, would have considerable public health significance.(Au)

Nutrient intakes among UK African-Caribbeans: changing risk of coronary heart disease [letter]

Present findings in a food-frequency questionnaire (FFQ) given to Caribbean-born people of African descent, to try and determine why this section of the population has lower rates of coronary heart disease (COD). Findings; statistics; Greater consumption of fruits and vegetables found in the people who answered the FFQ.(AU)

The Trp64 A rg mutation of the B3- Adrenergic Receptor Is associated with hyperglycemia and current body mass index in Jamaican women

The Trp64Arg mutation the the beta3-adrenergic receptor (beta3-AR) has been linked to earlier onset of non-insulin-dependent diabetes mellitus (NIDDM), insulin resistance, abdominal obesity, and an increase capacity to gain weight in some European and Japanese populations. We studied the prevalence of the mutation and its association with NIDDM and obesity in our population, in which both rates are high, especially in women. The frequency of the homozygous mutation was 1.53 percent, and of the Arg allele, 10.5 percent. Rates were similar in men and women. Significantly higher body mass index (BMI), weight, hip circumference, and fasting and postchallenge 2 hour blood glucose concentrations were associated with the presence of the Arg allele in women but not in men. The association with weight and hip measurements and with hyperglycemia was present only in women aged less than 55 years. In multivariate analysis, the mutation was associated with the BMI and sex in a model that also included age. The variation in fasting and 2 hour blood glucose levels were predicted by beta3-AR, gender, age and BMI. These results suggest that the presence of the mutation contributes to obesity and hyperglycemia in our female population.(AU)

Obesity and dysglycaemia in Jamaican women: does the Trp64Arg mutation of B-3 adrenergic receptor play a role?

The Trp64Arg mutation of B3 adrenergic receptor (B3AR) has been linked to earlier onset of non insulin dependent diabetes (NIDDM), insulin resistance, abdominal obesity and increased capacity to gain weight in some European and Japanese populations. We studied the prevalence of the mutation and its association with NIDDM and obesity in our population in which both rates are high, especially in women. The frequency of the homozygous mutation was 1.53 percent and of the Arg allele, 10.5 percent. Rates were similar in males and females. Significantly higher levels of BMI weight, hip circumference, fasting and post challenge 2h blood glucose concentrations were associated with the presence of the Arg allele in women but not in men. The association with weight and hip measurements and with hyperglycaemia was present only in women >55 years. In multivariate analysis the mutation was associated with BMI and gender in a model that also included age. The variation in fasting and 2h blood glucose levels was predicted by B3 Ar, gender, age and MBI. These results suggest that the presence of the mutation contributes to obesity and hyperglycaemia in our female population. (AU)

Differences in food and nutrient intake by age, place of birth and patterns of food choice in British African-Caribbean population sample

Epidemiological studies examining differences in disease patterns between migrant and resident populations suggest lifestyle factors including diet may be responsible. This paper reports an exploration of the food and nutrient intake of a randomly selected African-Caribbean (AfC) population sample resident in Manchester, UK. A quantitative food frequency questionnaire developed specifically for this population was interview administered. Over 80 percent of those invited completed the questionnaire (102 men, 153 women; mean age 54 and 49 years, respectively). Subjects following a traditional West Indian diet had a lower percent energy provided by fat compared to those following a non-traditional diet (men: traditional 30.4 percent vs. non-traditional 33.1 percent; women: traditional 32.6 percent vs 31.6 percent non-traditional). Those subjects born in the Caribbean (mean age 59 years) had a lower percent energy provided by fat compared to younger (mean age 30 years) UK born AfC subjects (31 percent vs 35 percent for both men and women). At present the AfC population is consuming a diet lower in fat than the majority white population and one that is in line with Government recommendations that no more than 35 percent of food energy is to be provided by fat. This could be an explanation for the lower rates of coronary heart disease (CHD) seen in the British AfC population. However, as younger AfC are selecting a more European type diet, higher in fat, this could result in change in CHD risk.(AU)

Sick genes, sick individuals, or sick populations with chronic disease? An international example from a standardized study of glucose tolerance and high blood pressure

Intensive searches for genes predisposing to or "causing" chronic disease are based on familial patterns indicating gene based inheritance. Rose's paradigm, less popular with clinical scientist thinking in individuals, is that populations give rise to their extreme values who become patients. For diabetes (NIDDM), population-based twin registers (e.g. Denmark) show little mono-to-di-zygotic difference, a suggesting major hospital ascertainment bias in ascribing a genetic basis to NIDDM. Here we examined geographically dispersed populations of West African origin, or similar genetic background within Cameroon, then between Jamaica and African-Caribbean (AfC) migrants to Britain (70 percent from Jamaica). Carefully representive samples were drawn from local population registers in rural and urban Cameroon, Jamaica and Manchester, UK. Results, on similar genetic backgrounds in the Cameroon, and between Jamaica and Manchester, suggest factors affecting energy balance (intake versus expenditure) rather than gene differences determine diabetes and, probably, hypertension rates in these and, probably, most populations.(AU)

Ethnic differences in glucose tolerance: the diet (fatty acid) rather than genetic variation

This study examined the possible role of plasma fatty acids (FA) and serum lipid composition in ethnic differences in glucose tolerance (GT). In carefully taken population samples (77 percent response) aged 45-74 years, 75 g GT test results were compared between 100 African-Caribbeans (AfC) [53 women (w)], 188 white Europeans (60w) and 113 Gujratis (55w), excluding known diabetics. 2 hr normoglycaemic (ng) AfC (n=70) had considerably lower age and sex adjusted fasting non-esterified (NE) FA at 0.42 (mean, 95 percent CI 0.36-0.48) mmol/l vs 0.58 (0.52-0.64) mmol/l in Europeans and 0.58 (0.51-0.65) mmol/l in Gujratis (F=8.2, p=0.0004). NEfA were significantly (26-52 percent) greater in, with no ethnic difference between, glucose intolerants (GIT). Gujratis had higher proportion of serum linoleate (18.2n-6) at 35.3 (34-36.6 percent) than AfC (27.4, 26-29 percent) or whites (24, 23-26 percent) but half or less of docosahexanoate (22:6n-3) - 1.2(0.8-15)percent vs 2.7(2.3-3) percent and 2.4(2-2.8) percent in both ng and GIT groups. With BMI and insulin, NEFA were independently associated with 2 hr glucose accounting for much of the ethnic difference.(AU)

Standardised comparison of glucose tolerance and diabetes prevalence in four African/African-Caribbean populations in Britain, Jamaica and Cameroon

To study factors promoting the emergence of diabetes in African-Caribbean (AfC) as the second largest ethnic minority in Britain and how these compare with genetically similar populations in Jamaica (origin of 80 percent AfC) and Cameroon, using the same protocol we carried out 75g glucose tolerance tests in representative community samples aged 25-74 years, by WHO criteria. As results were similar by gender, sexes are combined here. [See table] Diabetes prevalence (age-standardised) increased from Africa to the Caribbean to Europe and was highest in Manchester men. Body mass index showed a striking increase from rural to younger urban Cameroonians. Increasing NIDDM prevalence is paralleled across site by changes in nutritional and lifestyle factors, also measured using standardised methods. Even in Cameroon, prevalence approaches rates in whites in Europe.(AU)

Prevelance of NIDDM among populations of the African diaspora

OBJECTIVES: Rates of non-insulin-dependent diabetes mellitus have risen sharply in recent years among blacks in the U.S. and the U.K. Increase in risk have likewise been observed in the island nations of the Caribbean and in urban West Africa. To date, however, no systematic comparison of the geographic variation of NIDDM among black populations have been undertaken. RESEARCH DESIGN AND METHODS: In the course of an international collaborative study on cardiovascular disease, we used a standardized protocol to determine the rates of NIDDM and associated risk factors in populations of the African diaspora. Representative samples were drawn from sites in Nigeria, St. Lucia, Barbados, Jamaica, the United States, and the United Kingdom. A total of 4,823 individuals aged 25-74 years were recruited, all sites combined. RESULTS: In sharp contrast to a prevalence of 2 percent in Nigeria, age-adjusted prevalences of self-reported NIDDM were 9 percent in the Caribbean and 11 percent in the U.S. and the U.K. Mean BMI ranged from 22 kg/m2 among men in West Africa to 31 kg/m2 in women in the U.S. Disease prevalence across sites was essentially collinear with obesity, pointing to site differences in the balance between energy intake and expenditure as the primary determinant of differential NIDDM risk among these populations. CONCLUSIONS: In ethnic groups sharing a common genetic ancestry, these comparative data demonstrate the determing influence of changes in living conditions on the population risk of NIDDM.(AU)

Development of food frequency questionnaires in three population samples of African origin from Cameroon, Jamaica and Caribbean migrants to the UK

OBJECTIVES: To develop the methods for assessment of food and nutrient intake using standardized food frequency questionnaires (FFQ) in three African origin populations from Cameroon, Jamaica and Caribbean migrants to the United Kingdom. DESIGN: Cross-sectional assessment of diet from a representative sample in each site, using either a 2-day food dairy or a 24-h recall method to determine food for inclusion on the food frequency questionnaire. SETTING: A rural and urban site in Cameroon, Evodoula and Cite Verte in Yaounde, respectively; a district in Kingston, Jamaica; Afro-Caribbeans living in central Manchester, UK. SUBJECTS: Aged 25-79 years, 61 from the Cameroonian urban site, 62 from village site; 102 subjects from Jamaica (additional analysis on a subsample of 20): 29 subjects from Manchester, UK. MAIN OUTCOME MEASURES: Food contributing to nutrients in each site to allow the development of a FFQ. RESULTS: A high response rate was obtained in each site. Comparison of macronutrient intakes between the sites showed that carbohydrate was the most important contributor to energy intake in Jamaica (55 percent) and the least in the rural Cameroon. In rural Cameroon, fat (mainly palm oil) was the most important contributor to energy intake (44 percent). Manchester had the highest contribution of protein energy (17 percent). Food contributing to toal energy, protein, fat and carbohydrate were determined. In rural Cameroon, the top 10 food items contributed 66 percent of the total energy intake compared to 37 percent for the top 10 foods in Manchester. Food contributing to energy were similar in Jamaica and Manchester. Cassava contributed 40 percent of the carbohydrate intake in rural Cameroon and only 6 percent in urban Cameroon. One FFQ has been developed for use in both sites in Cameroon containing 76 food items. The FFQ for Jamaica contains 69 foods and for Manchester 108 food items. CONCLUSION: Considerable variations exist within sites (Cameroon) and between sites in foods which are important contributors to nutrient intakes. With careful exploration of eating habits it has been possible to develop standardized, but locally appropriate FFQs for use in African populations in different countries.(AU)

A comparative study of hypertension prevalence, awareness, treatment and control rates in St. Lucia, Jamaica and Barbados

Cardiovascular diseases represent the most common cause of death in the English-speaking Caribbean, and hypertension represents the most important predisposing condition. However, direct between-country comparative studies in the Caribbean have not previously been undertaken. OBJECTIVE: To obtain estimates of hypertension prevalence, awareness, treatment and control in three countries in the Caribbean. DESIGN: Population-based samples of adults aged 25-74 years in St. Lucia, Barbados and Jamaica were surveyed regarding their cardiovascular health and their blood pressures were measured using a highly standardized protocol. A reference site was available from a collaborative study among blacks in metropolitan Chicago, Illinois, USA, RESULTS: At the 160/95 mmHg threshold, age-adjusted hypertension prevalence estimates for Jamaica, St. Lucia and Barbados were 17.5, 18.3 and 21.5 percent, respectively, and 24.7, 26.9 and 27.9 percent, respectively, at the 140/90 mmHg threshold. The corresponding estimate for the Chicago site at the 140/90 mmHg threshold was 33.2 percent. The gradient in prevalence resembled the gradient in body mass index (25.7 kg/m2 in Jamaica to 29.3 kg/m2 in the USA). At the 160/95 mmHg threshold, the proportion of all hypertensives who were aware of their disease, pharmacologically treated and controlled was highest in Barbados (90, 85 and 72 percent, respectively) and lowest in St. Lucia (74, 59 and 35 percent respectively). Men, particularly those aged less than 55 years, were less likely to have their hypertension treated and controlled. CONCLUSIONS: Compared with estimates from earlier independent surveys, considerable progress has been made in hypertension detection and control in these countries, which should lead to sizable reductions in the burden of cardiovascular disease (AU)