Ambulatory blood pressure and blood lipids in a multiethnic sample of healthy adults.

OBJECTIVES: Elevated blood pressure (BP), elevated serum cholesterol, and aberrant lipoprotein fractions (low levels of high-density lipoprotein (HDL) and high levels of low-density lipoprotein fractions and triglycerides) have all been used as measures that assess the "metabolic syndrome" and more recently in indexes of allostatic load, which are designed to assess the degree of integrated metabolic pathology. While there are ample data regarding the interrelationships of these measures in various pathophysiological settings, there are limited data regarding the interrelationship of ambulatory BP (ABP) and blood lipids in healthy subjects. The present study evaluates ABP-blood lipid relationships in a multiethnic sample of healthy adults. METHODS: The subjects were 37 men (age = 40.9 ± 10.7 years) and 42 women (age = 35.8 ± 10.4 years) who were employed as hotel workers in Hawaii. Each wore an ABP monitor for one midweek workday and had pressures averaged in three daily microenvironments (work, home, and during sleep). They also had fasting blood samples taken for lipid profiling. RESULTS: Multivariate analysis of covariance shows that there was a strong inverse relationship between HDL and both systolic (P < 0.006) and diastolic (P < 0.006) BP, overall and in each microenvironment, but no statistically significant relationships with other lipid measures. CONCLUSION: These results suggest lipids and BP do not act as a group in healthy adults but that higher HDL is associated with lower BP. This latter finding is consistent with research that shows that HDL promotes vasodilation via its effect on endothelial nitric oxide synthase.

Blood pressure and lifestyle on Saba, Netherlands Antilles.

During the 20th century, infectious disease morbidity and mortality generally waned whereas chronic degenerative diseases posed a growing burden at the global level. The population on Saba, Netherlands Antilles has recently experienced such an epidemiologic transition, and hypertension was reported to be extraordinarily high, although no prevalences have been reported and relationships with lifestyle factors associated with rapid modernization have not been explored. In this study, a medical and demographic questionnaires, as well as body composition and blood pressure measures were collected from 278 Saban men and women aged 18-91 years. When age and sex adjusted, 48% of the population was hypertensive. Age, BMI, and Afro-Caribbean descent were all associated with higher blood pressures. In a second phase, 124 individuals of the 278 were invited to receive a longer questionnaire on individual exposure to modernizing influences such as travel and education. Higher blood pressure was associated with having lived in fewer different places in the past; those who stayed only on Saba or Statia had higher blood pressures than those who had also lived in more modernized areas. However, this was no longer statistically significant after adjustment for age and BMI. Lifestyle incongruity was positively associated with higher blood pressure in that those with more discord between material wealth and income were more likely to be hypertensive, and this remained statistically significant after adjustment for age and adiposity. In summary, hypertension is highly prevalent on Saba and tended to be associated with greater age, adiposity, Afro-Caribbean ancestry, and lifestyle incongruity.

Household economic strategies and nutritional anthropometry of women in American Samoa and highland Bolivia.

This study compares findings from research projects involving different genetic, environmental, and cultural contexts: a study of lifestyle and health from American Samoa (ASLS) and the Bolivian project. Reproduction and Ecology in Provincia Aroma (REPA). This paper presents analyses of varying economic strategies and their association with nutritional status indicators in each population. The ASLS sample includes 66 Samoan women and the REPA sample includes 210 Aymara women. Principle components analysis of household economic resources within each sample extracted two significant factors: one represents modernizing influences including education and occupational status, and the other represents ethnographically salient traditional economic behavior. The traditional pattern includes adding household members in Samoa and selling agricultural products in Bolivia. This analysis places each woman along two continua, traditional and modern, based on her household mobilization of economic resources, permitting an understanding of the patterns underlying household economic behavior that is not possible in univariate analyses of socioeconomic variables. For the Bolivian women the strategy involving more education and higher occupational status was associated with higher measures of several nutritional status indicators, including body mass index, arm muscle area, and peripheral skinfolds. But among the Samoan women, where substantial obesity was the norm, there were no significant differences in anthropometric measurements based on economic strategies. These data argue for the importance of directly measuring the potential consequences of variation in household economic strategies rather than merely inferring such, and of assessing ethnographically relevant aspects of household economic production rather than limiting analyses to non-context-specific economic indicators such as income. This focus on household strategy is likely to be fruitful especially where economic and nutritional conditions are marginal. The findings from Bolivia also support efforts in developing countries to improve girls' education, and thereby occupational prospects, as a means to improve their health status as women.

Apolipoprotein polymorphisms and phenotypic variability in American Samoans: Preliminary data.

Human apolipoprotein genetic variation is associated with phenotypic variability in body habitus and in lipid and glucose metabolism, interrelated aspects of human physiology. In this study, structural variation at the apolipoprotein E and H loci, documented for 67 residents of American Samoa, was investigated for associations with body habitus, plasma glucose, glycated hemoglobin, pulse rate, and blood pressure. Compared to men with the common APO E*3 allele, those with APO E*2 had higher weight, percent trunk fat, ratio of subscapular to triceps skinfold, and larger subscapular, suprailiac, and medial calf skinfolds; men with the APO E*4 allele had lower weight, body mass index (BMI), upper arm circumference, estimated arm muscle circumference, and a smaller suprailiac skinfold. Such variability by apolipoprotein E types was not observed in Samoan women nor when men and women were combined for analysis with or without statistical control for sex. At the APO H locus, little difference in aspects of body habitus was observed between men carrying the most common APO H*2 allele and the less common APO H*1 allele. Percent trunk fat and the subscapular to triceps skinfold ratio tended to be larger in women with the APO H*1 allele. Plasma glucose and glycated hemoglobin were lower in Samoans with the APO E*2 and E*4 alleles, but higher in those with the APO H*1 allele. Blood pressure and pulse rate were lower and higher, respectively, in those with the APO E*4 allele. The observed associations differ from those observed in Caucasian, Japanese, and Hispanic samples, and support suggestions that associations between apolipoprotein polymorphisms and morphological measures vary across ethnic groups. © 1993 Wiley-Liss, Inc.

Changes in some health status characteristics of American Samoan men: Preliminary observations from a 12-year follow-up study.

One of the concomitants of the rapid socioeconomic and medical changes which occurred in American Samoa beginning with World War II has been an increase in chronic diseases, especially cardiovascular disease and diabetes. As part of the Samoan Studies Project, a 1976 survey focusing on obesity and blood pressure was conducted in American Samoa. A total of 624 men age 18 or greater were seen at that time. In 1989 we conducted a follow-up examination of 31 of these men, reassessing blood pressure, and also examining blood glucose and previously diagnosed health problems, focusing on chronic diseases such as hypertension, stroke, cancer, and diabetes. In a prospective analysis of mortality, Crews (Hum. Biol. 60:417-433, 1988) found that 111 American Samoan men who had blood pressures measured in a public health department survey in 1975 and subsequently died between 1975 and 1981, had higher average systolic and diastolic blood pressures than the 2,588 survivors (140/88 vs. 129/84). Using these data, the 1989 sample was stratified according to the 1976 blood pressure measurement of the men and a sample of 14 normotensive men (1976 blood pressure <140/90) and 17 hypertensives (1976 blood pressure ≥140/90) was selected. The average age, weight, and number of cigarettes smoked per day was not significantly different for these two groups at the 12-year follow-up. However, several indicators of health status did differ. The hypertensive group had significantly higher systolic and diastolic blood pressures (P ≤ 0.001). Additionally, the hypertensive group had higher random blood glucose values (P ≤ 0.005) and were significantly more likely to be hypertensive and/or have impaired glucose tolerance (P ≤ 0.001). Change in weight was predictive of change in blood pressure, but not of absolute value of blood pressure. This paper notes the importance of elevated blood pressure as a predictor of future chronic disease risk for Samoan men. © 1993 Wiley-Liss, Inc.

Infant feeding and infant health in American Samoa.

This study examines the association between infant feeding patterns and health for 6,267 Samoan children born between 1976 and 1982, and represented in the Well Baby Clinic records at the LBJ Tropical Medical Center, American Samoa. The visits to the clinic were aggregated by trimester of age during the first year of life. For each trimester, the principal source of milk was determined, and the children were categorized as breast-fed if they were taking only breast milk, bottle-fed if they were getting no breast milk, or mixed-fed if they were getting both breast milk and milk from other sources. Symptoms and complaints noted in the records were assigned to ICD categories. Associations between source of milk and disease category were analyzed. The Samoan infants were found to be quite healthy for a tropical developing population, as evidenced by both growth in weight and length, as well as by frequency of illnesses. The most common specific disease category, aside from miscellaneous symptoms, was ICD 8, respiratory problems. Gastrointestinal diseases were rare for a developing area. There was an association between source of milk and illness (yes/no) for both the second and third trimesters. In both cases breast-fed infants were healthier than the mixed-fed infants, and during the second trimester the contrast was significant with bottle-fed infants also. When examined by ICD category, breast-fed infants tended to be less likely to have problems in any of the categories, but the only significant differences were between mixed-fed (lower prevalence) and bottle-fed infants during the first trimester for ICD 3, primarily nutritional problems; and for breast-fed (lower prevalence) and mixed-fed infants for ICD 9, digestive problems. These findings highlight the need for additional household work to delineate associations with the growth and health of Samoan infants.