Association of physical activity, smoking, and alcohol intake with CVD-related hospital discharge in people of European, South Asian, or African descent.

BACKGROUND: It is unclear whether the beneficial effects of certain lifestyle factors are equally strong in ethnic minority populations in Europe. This study explores whether this association of physical activity, smoking, and alcohol intake with cardiovascular disease (CVD)-related hospital discharge differs among South Asian Surinamese, African Surinamese, or Dutch descent living in the Netherlands. DESIGN: Prospective cohort. METHODS: We obtained baseline data from 370 South Asian, 689 African, and 567 Dutch participants (aged 35-60 years) of the SUNSET study (2001-2003). Follow up ended in December 2007. We used Cox proportional hazards models to study the associations of lifestyle factors with CVD-related hospital discharge. RESULTS: In the overall study population, low amount of physical activity (hazard ratio, HR 1.88, 95% CI 1.23-2.86), current smoking (HR 1.63, 95% CI 1.20-2.22), and nondrinking (HR 1.52, 95% CI 1.04-2.23) were associated with CVD-related hospital admission. There was no statistically significant effect of ethnicity on these associations. For instance, the adjusted HR for CVD-related hospital discharge regarding a low amount of physical activity was 2.77 (95% CI 1.31-5.87) for Africans, 1.53 (95% CI 0.76-3.05) for South Asians, and 1.55 (95% CI 0.73-3.30) for the Dutch. The p-value for ethnicity by lifestyle interaction was 0.41. CONCLUSION: We did not find a different association across ethnic groups of South Asian Surinamese, African Surinamese, or Dutch descent between physical activity, smoking, and alcohol intake and 5-year hazard of a CVD-related hospital discharge. We recommend confirmation in multiethnic studies in other contexts.

Cross national study of leisure-time physical activity in Dutch and English populations with ethnic group comparisons.

BACKGROUND: Variations between countries in leisure-time physical activity (LTPA) can be used to test the convergence thesis, which expects that ethnic minority groups change towards the LTPA levels of the native population of host countries. The aim of this study was to test whether similar differences in LTPA between the native populations of England and the Netherlands are also observed among the Indian and African descent groups living in these countries. METHODS: We used English and Dutch population-based health surveys that included participants aged 35-60 years of European (n(english) = 14,723, n(dutch) = 567), Indian (n(english) = 1264, n(dutch) = 370) and African-Caribbean (n(english) = 1112, n(dutch) = 689) descent. Levels of LTPA (30-minute walking, any reported cycling, gardening, dancing and playing sports) were estimated with age-sex-standardized prevalence rates. Comparisons among groups were made using adjusted Prevalence Ratios (PRs). RESULTS: Within both countries and compared with the European group, Indian and African groups had lower levels of gardening and cycling, whereas the African groups had higher levels of dancing. Between countries, among the European groups, the Netherlands showed higher prevalence of cycling than England, PR = 2.26 (95% CI: 2.06-2.48), and this was 2.85 (1.94-4.19) among Indian descent, and 2.77 (2.05-3.73) among African descent. For playing sports, this was PR = 1.30 (1.23-1.38), 1.43 (1.24-1.66) and 1.22 (1.10-1.34), whereas for gardening this was PR = 0.71 (0.65-0.78), 0.65 (0.52-0.81) and 0.75 (0.62-0.90), respectively. Walking and dancing showed inconsistent differences between the countries and ethnic groups. CONCLUSION: This cross-national comparison supports the expectation that LTPA of Indian and African descent groups converge towards the national levels of England and the Netherlands respectively.

The association of leisure-time physical activity and active commuting with measures of socioeconomic position in a multiethnic population living in the Netherlands: results from the cross-sectional SUNSET study.

BACKGROUND: In most European origin populations measures of socioeconomic position are positively associated with leisure time physical activity (LTPA), this is unclear for active commuting. In addition, these associations have scarcely been studied in ethnic minority groups, who often have a high cardiovascular disease risk. Because of the expected public health potential, we assessed the relationship of active commuting and LTPA with measures of socioeconomic position across two large ethnic minority groups in the Netherlands as compared to the European-Dutch population. METHODS: We included South Asian-Surinamese (n = 370), African-Surinamese (n = 689), and European-Dutch (n = 567) from the cross-sectional population-based SUNSET study (2001-2003). Active commuting and LTPA were assessed by the SQUASH physical activity questionnaire and calculated in square-root-transformed metabolic equivalents of task-hours/week (SQRTMET). Socioeconomic position was indicated by level of education (low/high) and occupational class (low/high). We used age-adjusted linear regression models to assess the association between physical activity and socioeconomic position. RESULTS: Compared to the European-Dutch men, South Asian-Surinamese men engaged in lower levels of commuting activity and LTPA, and South Asian-Surinamese women engaged in lower levels of LTPA than their European-Dutch counterparts. Differences between the African Surinamese and the European-Dutch were small. We observed a positive gradient in active commuting activity for education in European-Dutch men (beta high education was 0.93, 95%CI: 0.45-1.40 SQRTMET higher versus low education), in South Asian-Surinamese men (beta: 0.56, 0.19-0.92), but not in African-Surinamese men (-0.06, -0.45-0.33, p for ethnicity-interaction = 0.002). In women we observed a positive gradient in active commuting activity and occupational class in European-Dutch women, and less strongly in South Asian-Surinamese and African-Surinamese women (p for ethnicity-interaction = 0.02). For LTPA and socioeconomic position, we observed no statistically significant interaction by ethnicity. CONCLUSIONS: The positive gradient for socioeconomic position observed in European-Dutch was less strong, in particular for active commuting, among the South Asian-Surinamese and the African-Surinamese. This indicates that the typical focus on physical activity interventions in lower socioeconomic groups could work for European-Dutch populations, but this strategy may not be entirely applicable in the ethnic minority groups.

Total physical activity might not be a good measure in the relationship with HDL cholesterol and triglycerides in a multi-ethnic population: a cross-sectional study.

BACKGROUND: Evidence suggests that physical activity (PA) has a beneficial effect on high-density lipoprotein cholesterol (HDL) and triglycerides. However, observational studies show contrasting results for this association between different ethnic groups. It is unclear whether this is due to differences in the PA composition. The aim of this study was to assess the relationship of the total PA, along with its intensity and duration, with HDL and triglycerides in a multi-ethnic population. METHODS: The study population was sampled from the SUNSET study and included: 502 European- Dutch, 338 Hindustani-Surinamese, and 596 African-Surinamese participants living in Amsterdam, the Netherlands. We assessed PA with the SQUASH questionnaire. We calculated age-sex-adjusted betas, geometric mean ratios (GMRs), and prevalence ratios (PRs) to assess the relationship of PA with HDL and triglycerides. RESULTS: In the adjusted models, the highest total PA tertile compared to the lowest tertile was beneficially associated with HDL (beta: 0.08, 95% CI: 0.00, 0.16 and PR low HDL 0.59, 95% CI: 0.39, 0.88) and triglycerides (GMR: 0.93, 95% CI: 0.83, 1.03 and PR: 0.56, 95% CI: 0.29, 1.08) for the African-Surinamese. No statistically significant associations appeared for total PA among the European-Dutch and Hindustani-Surinamese. The adjusted models with the intensity score and HDL showed beneficial associations for the European-Dutch (beta: 0.06, 95% CI: 0.03, 0.10) and African-Surinamese (beta: 0.06, 0.02, 0.10), for log triglycerides for the European-Dutch (beta: -0.08, 95% CI: -0.12, 0.03), Hindustani-Surinamese (beta: -0.06, 95% CI: -0.16, 0.03), and African-Surinamese (beta: -0.04, 95% CI: -0.10, 0.01). Excepting HDL in African-Surinamese, the duration score was unrelated to HDL and triglycerides in any group. CONCLUSIONS: Activity intensity related beneficially to blood lipids in almost every ethnic group. The activity duration was unrelated to blood lipids, while the total PA 'summary score' was associated only with blood lipids for African-Surinamese. The difference in total PA composition is the most probable explanation for ethnic differences in the total PA association with blood lipids. Multi-ethnic observational studies should include not only a measure of the total PA, but other measures of PA as well, particularly the intensity of activity.

Whole grain, bran, and germ intake and risk of type 2 diabetes: a prospective cohort study and systematic review.

BACKGROUND: Control of body weight by balancing energy intake and energy expenditure is of major importance for the prevention of type 2 diabetes, but the role of specific dietary factors in the etiology of type 2 diabetes is less well established. We evaluated intakes of whole grain, bran, and germ in relation to risk of type 2 diabetes in prospective cohort studies. METHODS AND FINDINGS: We followed 161,737 US women of the Nurses' Health Studies (NHSs) I and II, without history of diabetes, cardiovascular disease, or cancer at baseline. The age at baseline was 37-65 y for NHSI and 26-46 y for NHSII. Dietary intakes and potential confounders were assessed with regularly administered questionnaires. We documented 6,486 cases of type 2 diabetes during 12-18 y of follow-up. Other prospective cohort studies on whole grain intake and risk of type 2 diabetes were identified in searches of MEDLINE and EMBASE up to January 2007, and data were independently extracted by two reviewers. The median whole grain intake in the lowest and highest quintile of intake was, respectively, 3.7 and 31.2 g/d for NHSI and 6.2 and 39.9 g/d for NHSII. After adjustment for potential confounders, the relative risks (RRs) for the highest as compared with the lowest quintile of whole grain intake was 0.63 (95% confidence interval [CI] 0.57-0.69) for NHSI and 0.68 (95% CI 0.57-0.81) for NHSII (both: p-value, test for trend <0.001). After further adjustment for body mass index (BMI), these RRs were 0.75 (95% CI 0.68-0.83; p-value, test for trend <0.001) and 0.86 (95% CI 0.72-1.02; p-value, test for trend 0.03) respectively. Associations for bran intake were similar to those for total whole grain intake, whereas no significant association was observed for germ intake after adjustment for bran. Based on pooled data for six cohort studies including 286,125 participants and 10,944 cases of type 2 diabetes, a two-serving-per-day increment in whole grain consumption was associated with a 21% (95% CI 13%-28%) decrease in risk of type 2 diabetes after adjustment for potential confounders and BMI. CONCLUSIONS: Whole grain intake is inversely associated with risk of type 2 diabetes, and this association is stronger for bran than for germ. Findings from prospective cohort studies consistently support increasing whole grain consumption for the prevention of type 2 diabetes.

Cross-sectional growth references and implications for the development of an international growth standard for school-aged children and adolescents.

Normative data are needed to create a reference that indicates optimal development of weight in relation to height and age, particularly in the face of the unfolding obesity epidemic. The body-mass index (BMI) has some serious limitations: it is a relatively poor predictor of current and future fatness. Currently, however, there are few available alternatives, with the possible exception of waist circumference or skinfolds. The use of cross-sectional references to construct a BMI-reference curve is problematic when there are period and cohort effects. Ideally, a reference would be based on longitudinal data in populations with little underweight, overweight, and obesity. In the meantime cross-sectional data in appropriate populations could be used to construct BMI percentiles linking BMI values at age 5 to those at age 18 (or 21) that would correspond with adult BMI values reflecting optimal health (e.g., that would correspond to adult BMI values between 21 and 23 kg/m2).