Gestational diabetes mellitus in Cameroon: prevalence, risk factors and screening strategies.

Background: The burden of gestational diabetes (GDM) and the optimal screening strategies in African populations are yet to be determined. We assessed the prevalence of GDM and the performance of various screening tests in a Cameroonian population. Methods: We carried out a cross-sectional study involving the screening of 983 women at 24-28 weeks of pregnancy for GDM using serial tests, including fasting plasma (FPG), random blood glucose (RBG), a 1-hour 50g glucose challenge test (GCT), and standard 2-hour oral glucose tolerance test (OGTT). GDM was defined using the World Health Organization (WHO 1999), International Association of Diabetes and Pregnancy Special Group (IADPSG 2010), and National Institute for Health Care Excellence (NICE 2015) criteria. GDM correlates were assessed using logistic regressions, and c-statistics were used to assess the performance of screening strategies. Findings: GDM prevalence was 5·9%, 17·7%, and 11·0% using WHO, IADPSG, and NICE criteria, respectively. Previous stillbirth [odds ratio: 3·14, 95%CI: 1·27-7·76)] was the main correlate of GDM. The optimal cut-points to diagnose WHO-defined GDM were 5·9 mmol/L for RPG (c-statistic 0·62) and 7·1 mmol/L for 1-hour 50g GCT (c-statistic 0·76). The same cut-off value for RPG was applicable for IADPSG-diagnosed GDM while the threshold was 6·5 mmol/L (c-statistic 0·61) for NICE-diagnosed GDM. The optimal cut-off of 1-hour 50g GCT was similar for IADPSG and NICE-diagnosed GDM. WHO-defined GDM was always confirmed by another diagnosis strategy while IADPSG and GCT independently identified at least 66·9 and 41·0% of the cases. Interpretation: GDM is common among Cameroonian women. Effective detection of GDM in under-resourced settings may require simpler algorithms including the initial use of FPG, which could substantially increase screening yield.

Lifecourse predictors of adult fibrinogen levels: the Newcastle Thousand Families Study.

BACKGROUND: Research investigating early life effects on fibrinogen levels in adult life has produced conflicting results. The aim of this study was to examine and quantify the direct and indirect associations between fetal, infancy and adult risk factors and fibrinogen levels, at age 49-51 years, using data from the Newcastle Thousand Families Study. METHODS: Detailed information was collected prospectively during childhood, including birth weight, duration of being breast fed and socio-economic conditions. At age 49-51 years, 574 study members returned self-completion questionnaires and 412 attended for clinical examination, including the measurement of plasma fibrinogen concentrations in 173 men and 221 women. These data were analysed using linear regression and path analyses. RESULTS: Poorer quality housing conditions at birth (p=0.001), longer duration of being breast fed (p=0.025), lower current body fat percentage (p<0.001), not being a current smoker (p<0.001) and moderate current alcohol consumption (p=0.002) were significant independent predictors of lower plasma fibrinogen concentration at age 49-51 years. No association was observed between plasma fibrinogen concentration and standardised birth weight or with time since stopping smoking among former smokers. CONCLUSION: Concentration of plasma fibrinogen in adulthood is influenced by a range of factors from different stages of life. Although birth weight was not a predictor, there were significant associations with housing conditions in early life and duration of being breast fed. Regardless, the strongest predictors were smoking and contemporary percent body fat. Therefore, modification of these factors would be the most likely way to reduce concentrations of plasma fibrinogen in adulthood.

Metabolic profile of sub-Saharan African patients presenting with first-ever-in-lifetime stroke: association with insulin resistance.

BACKGROUND: To assess the pattern of metabolic profile associated with first stroke episode in a hospital setting in Cameroon. METHODS: All patients admitted for first-ever-in-lifetime stroke over a 6-month period were eligible for inclusion in the study. The 84% participation rate yielded 57 of 68 patients between 16 and 85 years of age. Fifty-seven control subjects were selected to match patients included for age range, sex, and known hypertension and diabetes. We measured fasting serum glucose, insulin, and lipids in controls and in patients between days 3 and 7 after admission. RESULTS: Total cholesterol was comparable in patients and controls (172.6 ± 39.5 v 175.4 ± 49.7 mg/dL; P = .75), as were triglycerides (129.4 ± 56.1 v 122.4 ± 60.7 mg/dL; P = .53). high-density lipoprotein cholesterol (HDL-C) levels were lower in patients than in controls (37.4 ± 20.6 v 50.2 ± 18.0 mg/dL; P = .001), with comparable levels of low-density lipoprotein cholesterol (LDL-C; 109.4 ± 43.0 v 100.7 ± 48.8 mg/dL; P = .32). The LDL-C/HDL-C ratio was higher in patients compared to controls (4.0 ± 3.0 v 2.3 ± 1.7; P = .0001), as was the total cholesterol/HDL-C ratio (5.9 ± 3.5 v 3.9 ± 1.8; P = .0001). Compared to controls, stroke patients had higher fasting insulin levels (5.9 ± 5.4 v 2.3 ± 3.2 IU/mL; P < .001) and higher insulin resistance as measured by the homeostatic model assessment of insulin resistance (1.9 ± 2.2 v 0.7 ± 1.0; P = .001). CONCLUSIONS: Stroke is associated with markers of insulin resistance, low serum levels of HDL, and high total cholesterol/HDL ratio in this African population. Studies with a larger sample size and cohort designs are warranted to explore the causal pathways, persistence of these abnormalities, and population-specific cut points.

The relatively small contribution of birth weight to blood pressure at age 49-51 years in the Newcastle Thousand Families Study.

BACKGROUND: Whereas a large number of previous studies suggest an association between birth weight and later blood pressure, others do not. Controversy surrounds the relative importance of these associations, in particular in relation to more modifiable factors in later life. The aim of this study was to investigate the relative contributions of a range of factors from across life to variations in SBP and DBP in the Newcastle Thousand Families Study. METHODS AND RESULTS: Detailed information was collected prospectively during childhood, including birth weight, duration breast fed and socioeconomic conditions. At age 49-51 years, 574 study members returned self-completion questionnaires and 412 underwent clinical examination, including measurement of DBP and SBP. These data were analysed using linear regression and path analyses. After adjustment for all other significant variables, decreased birth weight, standardized for sex and gestational age (P = 0.035), increased BMI (P < 0.001) and being male (P = 0.034) were independently associated with raised SBP and DBP. Social class at birth (P = 0.044) was also independently associated with DBP. BMI was found to be the most important predictor, with a small relative contribution of standardized birth weight. CONCLUSION: Adult blood pressure is influenced by numerous factors, acting both directly and indirectly during an individual's lifetime. Inverse associations of standardized birth weight, although statistically significant, were of relatively small importance, with the majority of variation being explained by more modifiable factors in adulthood, in particular adult BMI.

Do obese but metabolically normal women differ in intra-abdominal fat and physical activity levels from those with the expected metabolic abnormalities? A cross-sectional study.

BACKGROUND: Obesity remains a major public health problem, associated with a cluster of metabolic abnormalities. However, individuals exist who are very obese but have normal metabolic parameters. The aim of this study was to determine to what extent differences in metabolic health in very obese women are explained by differences in body fat distribution, insulin resistance and level of physical activity. METHODS: This was a cross-sectional pilot study of 39 obese women (age: 28-64 yrs, BMI: 31-67 kg/m2) recruited from community settings. Women were defined as 'metabolically normal' on the basis of blood glucose, lipids and blood pressure. Magnetic Resonance Imaging was used to determine body fat distribution. Detailed lifestyle and metabolic profiles of participants were obtained. RESULTS: Women with a healthy metabolic profile had lower intra-abdominal fat volume (geometric mean 4.78 l [95% CIs 3.99-5.73] vs 6.96 l [5.82-8.32]) and less insulin resistance (HOMA 3.41 [2.62-4.44] vs 6.67 [5.02-8.86]) than those with an abnormality. The groups did not differ in abdominal subcutaneous fat volume (19.6 l [16.9-22.7] vs 20.6 [17.6-23.9]). A higher proportion of those with a healthy compared to a less healthy metabolic profile met current physical activity guidelines (70% [95% CIs 55.8-84.2] vs 25% [11.6-38.4]). Intra-abdominal fat, insulin resistance and physical activity make independent contributions to metabolic status in very obese women, but explain only around a third of the variance. CONCLUSION: A sub-group of women exists who are metabolically normal despite being very obese. Differences in fat distribution, insulin resistance, and physical activity level are associated with metabolic differences in these women, but account only partially for these differences. Future work should focus on strategies to identify those obese individuals most at risk of the negative metabolic consequences of obesity and on identifying other factors that contribute to metabolic status in obese individuals.

Type 2 diabetes management in nurse-led primary healthcare settings in urban and rural Cameroon.

AIMS: To implement a protocol-driven primary nurse-led care for type 2 diabetes in rural and urban Cameroon. METHODS: We set-up three primary healthcare clinics in Yaounde (Capital city) and two in the Bafut rural health district. Participants were 225 (17% rural) patients with known or newly diagnosed type 2 diabetes, not requiring insulin, referred either from a baseline survey (38 patients, 17%), or secondarily attracted to the clinics. Protocol-driven glucose and blood pressure control were delivered by trained nurses. The main outcomes were trajectories of fasting capillary glucose and blood pressure indices, and differences in the mean levels between baseline and final visits. RESULTS: The total duration of follow-up was 1110 patient-months. During follow-up, there was a significant downward trend in fasting capillary glucose overall (p<0.001) and in most subgroups of participants. Between baseline and final visits, mean fasting capillary glucose dropped by 1.6 mmol/L (95% CI: 0.8-2.3; p< or =0.001). Among those with hypertension, blood pressure also decreased significantly for systolic and marginally for diastolic blood pressure. No major significant change was noticed for body weight. CONCLUSIONS: Nurses may be potential alternatives to improve access to diabetes care in settings where physicians are not available.

A review of co-morbidity between infectious and chronic disease in Sub Saharan Africa: TB and diabetes mellitus, HIV and metabolic syndrome, and the impact of globalization.

BACKGROUND: Africa is facing a rapidly growing chronic non-communicable disease burden whilst at the same time experiencing continual high rates of infectious disease. It is well known that some infections increase the risk of certain chronic diseases and the converse. With an increasing dual burden of disease in Sub Saharan Africa the associations between diseases and our understanding of them will become of increased public health importance. AIMS: In this review we explore the relationships reported between tuberculosis and diabetes mellitus, human immunodeficiency virus, its treatment and metabolic risk. We aimed to address the important issues surrounding these associations within a Sub Saharan African setting and to describe the impact of globalization upon them. FINDINGS: Diabetes has been associated with a 3-fold incident risk of tuberculosis and it is hypothesised that tuberculosis may also increase the risk of developing diabetes. During co-morbid presentation of tuberculosis and diabetes both tuberculosis and diabetes outcomes are reported to worsen. Antiretroviral therapy for HIV has been associated with an increased risk of developing metabolic syndrome and HIV has been linked with an increased risk of developing both diabetes and cardiovascular disease. Globalization is clearly related to an increased risk of diabetes and cardiovascular disease. It may be exerting other negative and positive impacts upon infectious and chronic non-communicable disease associations but at present reporting upon these is sparse. CONCLUSION: The impact of these co-morbidities in Sub Saharan Africa is likely to be large. An increasing prevalence of diabetes may hinder efforts at tuberculosis control, increasing the number of susceptible individuals in populations where tuberculosis is endemic, and making successful treatment harder. Roll out of anti-retroviral treatment coverage within Sub Saharan Africa is an essential response to the HIV epidemic however it is likely to lead to a growing number of individuals suffering adverse metabolic consequences. One of the impacts of globalization is to create environments that increase both diabetes and cardiovascular risk but further work is needed to elucidate other potential impacts. Research is also needed to develop effective approaches to reducing the frequency and health impact of the co-morbidities described here.

Sex differences in the association between infant feeding and blood cholesterol in later life: the Newcastle thousand families cohort study at age 49-51 years.

Previous studies have suggested an association between being breastfed and later cholesterol levels. We investigated whether duration of total and exclusive breastfeeding were related to circulating total, HDL and LDL cholesterol and triglyceride measures at age 50, and whether such associations differ between men and women. Members of the Newcastle thousand families study were followed from birth in 1947. Men (n = 179) and 226 women (n = 226) with blood cholesterol and triglyceride measures at age 50 and with prospectively recorded duration of both total and exclusive breastfeeding were included. Neither total duration nor duration of exclusive breastfeeding were associated with the outcome measures when analysing both sexes together. However, in sex specific analyses significant associations between duration of exclusive breastfeeding and both total and LDL cholesterol (adjusted regression coefficient (r) per 30 days = 0.12 mmol/l (95% CI 0.04-0.20) P = 0.004 for total cholesterol and adjusted r per 30 days = 0.10 mmol/l (95% CI 0.02-0.18) P = 0.016 for LDL cholesterol) were seen for women with no significant associations observed in men. Significant interactions between duration of exclusive breastfeeding and sex were seen for total and LDL cholesterol (P = 0.02 and P = 0.03, respectively) with a near-significant interaction for HDL cholesterol (P = 0.06). In all cases, greater increases in cholesterol with increasing duration of exclusive breastfeeding were seen for women than for men. In conclusion, the association between breastfeeding and adult cholesterol levels differs between men and women and in women remains a significant association even after adjustment for potential confounders. However, our findings may not reflect the situation in younger generations.

Diabetes Mellitus: Indigenous naming, indigenous diagnosis and self-management in an African setting: the example from Cameroon.

BACKGROUND: The objective was to examine how the indigenous naming, indigenous self-diagnosis and management of diabetes evolved with awareness in order to develop a socially oriented theoretical model for its care. METHODS: The data was collected through a one-year extended participant observation in Bafut, a rural health district of Cameroon. The sample consisted of 72 participants in a rural health district of Cameroon (men and women) with type 2 diabetes. We used participant observation to collect data through focus group discussions, in depth interviews and fieldwork conversations. The method of analysis entailed a thick description, thematic analysis entailing constant comparison within and across FGD and across individual participants and content analysis. RESULTS: The core concepts identified were the evolution of names for diabetes and the indigenous diagnostic and self-management procedures. Participants fell into one of two naming typologies: (a) Naming excluding any signs and symptoms of diabetes; (b) naming including signs and symptoms of diabetes. Participants fell into two typologies of diagnostic procedures: (a) those that use indigenous diagnostic procedures for monitoring and controlling diabetes outcomes and b) those that had initially used it only for diagnosis and continued to use them for self management. These typologies varied according to how participants' awareness evolved and the impact on self-diagnosis and management. CONCLUSION: The evolution of names for diabetes was an important factor that influenced the subsequent self-diagnosis and management of diabetes in both traditional and modern biomedical settings.

"Obesity" and "Clinical Obesity" Men's understandings of obesity and its relation to the risk of diabetes: a qualitative study.

BACKGROUND: The 2007 Wanless report highlights the ever increasing problem of obesity and the consequent health problems. Obesity is a significant cause of diabetes. An increasing evidence base suggests that in terms of reducing diabetes and CVD risk, it is better to be "fit and fat" than unfit and of normal weight. There has been very little previous research into the understandings that men in the general population hold about the issues of weight, exercise and health; we therefore undertook this study in order to inform the process of health promotion and diabetes prevention in this group. METHODS: A qualitative study in North East England General Practice using a purposive sample of men aged 25 and 45 years (selection process designed to include 'normal', 'overweight' and 'obese' men). One to one audio-recorded semi structured interviews focused on: overweight and obesity, diet, physical activity and diabetes. Transcripts were initially analysed using framework analysis. Emerging themes interlinked. RESULTS: The men in this study (n = 17) understand the word obesity differently from the clinical definition; "obesity" was used as a description of those with fat in a central distribution, and understandings of the term commonly take into account fitness as well as weight. Men in their late 30s and early 40s described becoming more aware of health issues. Knowledge of what constitutes a 'healthy lifestyle' was generally good, but men described difficulty acting upon this knowledge for various reasons e.g. increasing responsibilities at home and at work. Knowledge of diabetes and the link between obesity and diabetes was poor. CONCLUSION: Men in this study had a complex understanding of the interlinked importance of weight and fitness in relation to health. Obesity is understood as a description of people with centrally distributed fat, in association with low fitness levels. There is a need to increase understanding of the causes and consequences of diabetes. Discussion of increased health awareness by men round the age of 40 may indicate a window of opportunity to intervene at this time.

A common intron 2 polymorphism of the glucocorticoid receptor gene is associated with insulin resistance in men.

OBJECTIVE: Clinical similarities between the metabolic syndrome and Cushing's syndrome have led to speculation of genetic association between them. The Bcl1 polymorphism in intron 2 of the glucocorticoid receptor (GR) gene has been associated with insulin resistance/hyperinsulinaemia. Our objective was to test the association of rs2918419, a T-->C single nucleotide change in intron 2 downstream of the Bcl1 locus, with components of the metabolic syndrome and its interaction with the Bcl1 locus. DESIGN AND METHODS: We genotyped a subsample of 325 White subjects (116 men) in the Newcastle Heart Project (NHP), a population-based study in north-east England. Gender-specific statistical analysis by stepwise backward multiple regression was performed to test the association of allele status with adiposity, glucose and insulin responses to oral glucose tolerance test (OGTT), fasting lipids and blood pressure. RESULTS: Minor allele frequency was 0.14 for rs2918419 and 0.39 for the Bcl1 polymorphism. rs2918419 was associated with higher fasting insulin concentration and insulin resistance in men but not in women. Contrary to earlier studies, the Bcl1 polymorphism on its own was not associated with insulin resistance/hyperinsulinaemia in either gender. Subjects carrying variant rs2918419 alleles also had variant alleles at the Bcl1 locus. In men, but not women, Bcl1 variant alleles on a background of rs2918419 wild-type alleles associated with lower fasting insulin compared to wild-type alleles at both loci or variant alleles at both loci. CONCLUSIONS: We report that rs2918419 was linked with hyperinsulinaemia and insulin resistance in men. Carrying Bcl1 variant alleles without rs2918419 was not associated with hyperinsulinaemia/insulin resistance. Previous reports of the association of Bcl1 polymorphism with obesity-related characteristics may reflect linkage disequilibrium with rs2918419.

Diabetes- and nondiabetes-related lower extremity amputation incidence before and after the introduction of better organized diabetes foot care: continuous longitudinal monitoring using a standard method.

OBJECTIVE: There is a lack of continuous longitudinal population-based data on lower extremity amputation (LEA) in the U.K. We present here accurate data on trends in diabetes-related (DR) LEAs and non-DRLEAs in the South Tees area over a continuous 5-year period. RESEARCH DESIGN AND METHODS: All cases of LEA from 1 July 1995 to 30 June 2000 within the area were identified. Estimated ascertainment using capture-recapture analysis approached 100% for LEAs in the area. Data were collected longitudinally using the standard method of the Global Lower Extremity Amputation Study protocol. RESULTS: Over 5 years there were 454 LEAs (66.3% men) in the South Tees area, of which 223 were diabetes related (49.1%). Among individuals with diabetes, LEA rates went from 564.3 in the first year to 176.0 of 100,000 persons with diabetes in the fifth year. Over the same period, non-DRLEAs increased from 12.3 to 22.8 of 100,000 persons without diabetes. The relative risk of a person with diabetes undergoing an LEA went from being 46 times that of a person without diabetes to 7.7 at the end of the 5 years. The biggest improvement in LEA incidence was seen in the reduction of repeat major DRLEAs. CONCLUSIONS: Our data show that in the South Tees area at a time when major non-DRLEA rates increased, major DRLEA rates have fallen. These diverging trends mark a significant improvement in care for patients with diabetic foot disease as a result of better organized diabetes care.

Diabetes and the risk of tuberculosis: a neglected threat to public health?

OBJECTIVES: Tuberculosis (TB) remains a major global public health problem. In the past, a relationship between TB and diabetes mellitus (DM) was recognized, and its importance was acknowledged through joint treatment clinics. However, this is rarely highlighted in current research or control priorities. This paper aims to evaluate the evidence for an association between these two diseases. METHODS: A Medline literature search was undertaken, supplemented by checking references and contacting experts. We critically appraised studies that quantified the association between TB and DM, and were published after 1995. We assessed study quality according to criteria such as sample size, method of selection of cases and controls, losses to follow-up, quality and method of control of confounding, and summarized the results narratively and in tabular form. RESULTS: All studies identified statistically significant and clinically important associations, with the increase in risk or odds of TB varying between 1.5- and 7.8-fold for those with DM. Risk was highest at younger ages. Most studies had not measured and controlled adequately for potential major confounders. DISCUSSION: There is strong evidence for an association between TB and DM, which has potential public health implications. Further well-designed studies are needed to assess the magnitude precisely.

Sex hormone-binding globulin and androgen levels in immigrant and British-born premenopausal British Pakistani women: evidence of early life influences?

In women, raised insulin levels are associated with low sex hormone-binding globulin (SHBG) and high androgen levels, which are in turn linked to infertility. Since insulin resistance and hyperinsulinemia are major health problems for South Asians living in Western countries, we predicted that British Pakistani women would have low SHBG and raised androgen levels compared to European women. Given low birth weights in Pakistan, and known links between low birth weight and insulin resistance in later life, we also predicted that immigrant women born in Pakistan would have lower levels of SHBG and higher levels of androgens than British-born British Pakistani women. We assessed SHBG, testosterone, and the free androgen index (FAI) from a single serum sample taken on days 9-11 of the menstrual cycle from 20-40-year-old women living in the UK: 30 immigrants from Pakistan, 30 British-born British Pakistani women, and 25 British-born women of European origin. Age-adjusted analyses showed no significant differences in SHBG, testosterone, or FAI between British-born Pakistani and European-origin women. However, immigrant British Pakistani women had a significantly higher FAI than British-born British Pakistani women. Adjustment for body mass index, waist-to-hip ratio, and smoking status did not affect these results, but further adjustment for height, a marker of early environment, reduced the P-value for the difference in FAI between immigrant and British-born British Pakistani women to below significance. It is possible that the poorer early environment of immigrant British Pakistani women was at least partially responsible for their relatively high levels of free androgens.

Association of glucocorticoid receptor polymorphism A3669G in exon 9beta with reduced central adiposity in women.

The glucocorticoid receptor (GR) may be a common link between human obesity/metabolic syndrome and Cushing's syndrome. The effects of glucocorticoids are mediated through the functional isoform, GRalpha. An alternative isoform, GRbeta, behaves as a dominant negative inhibitor of GRalpha and has been implicated as a contributing factor to glucocorticoid resistance. A naturally occurring ATTTA to GTTTA single nucleotide polymorphism (A3669G) located in the 3' end of exon 9beta results in increased stability of GRbeta mRNA and increased GRbeta protein expression. Enhanced GRbeta expression may result in greater inhibition of GRalpha transcriptional activity, resulting in glucocorticoid insensitivity. To test the hypothesis that the 3669G allele would result in a phenotype less likely to express features of glucocorticoid excess, we studied the prevalence of this polymorphism and its relationship with obesity and features of the metabolic syndrome in 322 Europid and 262 South-Asian subjects in northeast England. We report evidence that 3669G allele is associated with reduced central obesity in Europid women and a more favorable lipid profile in Europid men. These data suggest that the 3669G allele may attenuate the undesirable effects of glucocorticoids on fat distribution and lipid metabolism, although its penetrance may vary in different ethnic groups.

Life course determinants of insulin secretion and sensitivity at age 50 years: the Newcastle thousand families study.

BACKGROUND: Suboptimal nutrition during fetal life and infancy is suggested to increase insulin resistance in adulthood. This study investigated the proportion of variance in insulin secretion and resistance accounted for by factors operating at different stages of life using a cohort of all 1142 births in the city of Newcastle, UK in May and June 1947. METHODS: Detailed information was collected prospectively during childhood, including birth weight, growth and socio-economic circumstances. At age 50, 412 study members attended for clinical examination. Fasting and 30-min plasma insulin and glucose levels were determined and HOMA-IR and insulin secretion derived. RESULTS: Birth weight was not a significant predictor of HOMA-IR after adjustment for percent body-fat and waist-hip ratio. Duration of breastfeeding was significantly negatively associated with HOMA-IR in men. For both genders, fetal life explained directly little variation in either HOMA-IR or insulin secretion (0.1-5.6%). Compared to early life, adult lifestyle and body composition directly explained larger proportions of the variances for insulin secretion and HOMA-IR for men (11 and 22% respectively) and women (5.9 and 34%). CONCLUSIONS: Insulin secretion is largely unexplained by these data. For insulin resistance, the evidence suggests a limited impact of early life and a larger impact of adult factors.

Randomised controlled trial evaluating lifestyle interventions in people with impaired glucose tolerance.

AIM: To evaluate the effectiveness of lifestyle interventions in people with impaired glucose tolerance (IGT). METHODS: Participants with IGT (n=78), diagnosed on two consecutive oral glucose tolerance tests (OGTTs), were randomly assigned to a 2-year lifestyle intervention or to a control group. Main outcome measures were changes from baseline in: nutrient intake; physical activity; anthropometry, glucose tolerance and insulin sensitivity. Measurements were repeated at 6, 12 and 24 months follow-up. RESULTS: After 24 months follow-up, there was a significant fall in total fat consumption (difference in change between groups (Delta intervention-Delta control)= -17.9, 95% confidence interval (CI) -33.6 to -2.1g/day) as a result of the intervention. Body mass was significantly lower in the intervention group compared with controls after 6 months (-1.6, 95% CI -2.9 to -0.4 kg) and 24 months (-3.3, 95% CI -5.7 to -0.89 kg). Whole body insulin sensitivity, assessed by the short insulin tolerance test (ITT), improved after 12 months in the intervention group (0.52, 95% CI 0.15-0.89%/min). CONCLUSIONS: These findings complement the findings of the Finnish Diabetes Prevention Study and the American Diabetes Prevention Study, both of which tested intensive interventions, by showing that pragmatic lifestyle interventions result in improvements in obesity and whole body insulin sensitivity in individuals with IGT, without change in other cardiovascular risk factors.

Self-reported work strain is lower in South Asian than European people: cross-sectional survey.

OBJECTIVE: Jobs with high levels of demand and low levels of control have been linked to the risk of coronary heart disease (CHD). Limited evidence is available about the contribution of job characteristics to the increased risk of CHD in UK South Asian people. We aimed to describe psychosocial work characteristics in South Asian compared with European people. DESIGN: Cross-sectional study in Newcastle upon Tyne, UK, using self-reported measures of job demand, decision latitude, skill utilisation and social support at work in an age and sex stratified representative population sample of 652 adults of European (391) and South Asian (261) ethnic origin. RESULTS: Compared to European people, fewer South Asian men (57% vs 47%) but more South Asian women (22% vs 48%) were employed. South Asian people were more likely than European people to be self-employed (33% vs 7% among men). Employed South Asian people were better educated and had higher income than European people. Compared to European men, more South Asian men had high job control (42% vs 35%) but similar proportions had high job demand (42% vs 41%). Fewer South Asian men had jobs that allowed a high use of skill, but more had high decision latitude. These differences were partly explained by higher rates of self-employment among South Asian people. South Asian people were more likely to be in low demand/high control jobs, while European people occupied a wider range of jobs, in low control and in high demand/high control occupations. More detailed sub-group analyses were not reliable because of small numbers. CONCLUSION: In a representative population sample the overall balance of job demand and control was similar in South Asian and European people, though South Asian people tended to be in jobs characterised by low skill and high decision latitude. These findings do not support the suggestion that increased work strain contributes to the increased risk of CHD in UK South Asian people.

Exposure over the life course to an urban environment and its relation with obesity, diabetes, and hypertension in rural and urban Cameroon.

BACKGROUND: This study aimed to assess the association between lifetime exposure to urban environment (EU) and obesity, diabetes, and hypertension in an adult population of Sub-Saharan Africa. METHODS: We studied 999 women and 727 men aged > or =25 years. They represent all the adults aged > or =25 years living in households randomly selected from a rural and an urban community of Cameroon with a 98% and 96% participation rate respectively. Height, weight, blood pressure, and fasting blood glucose were measured in all subjects. Current levels of physical activity (in metabolic equivalents [MET]) were evaluated through the Sub-Saharan African Activity Questionnaire. Chronological data on lifetime migration were collected retrospectively and expressed as the total (EUt) or percentage (EU%) of lifetime exposure to urban environment. RESULTS: Lifetime EUt was associated with body mass index (BMI) (r = 0.42; P < 0.0001), fasting glycaemia (r = 0.23; P < 0.0001), and blood pressure (r = 0.17; P < 0.0001) but not with age. The subjects who recently settled in a city (< or =2 years) had higher BMI (+2.9 kg/m(2); P < 0.001), fasting glycaemia (+0.8 mmol/l; P < 0.001), systolic (+23 mmHg; P < 0.001) and diastolic (+9 mmHg; P = 0.001) blood pressure than rural dwellers with a history of 2 years EU. EU during the first 5 years of life was not, on its own, associated with glycaemia or BMI. However, both lifetime EUt and current residence were independently associated with obesity and diabetes. The association between lifetime EUt and hypertension was not independent of current residence and current level of physical activity. CONCLUSIONS: This study suggests that for the study of obesity and diabetes, in addition to current residence, both lifetime exposure to an urban environment and recent migration history should be investigated.