Mary Nicolaou

Behavioural risk factors in two generations of non-Western migrants: do trends converge towards the host population?

Migrant mortality does not conform to a single pattern of convergence towards prevalence rates in the host population. To understand better how migrant mortality develops, it is necessary to further investigate how the underlying behavioural determinants change following migration. We studied whether the prevalence of behavioural risk factors over two generations of Turkish and Moroccan migrants converge towards the prevalence rates in the Dutch population. From a random sample from the population register of Amsterdam, 291 Moroccan and 505 Turkish migrants, aged 15–30, participated in a structured interview that included questions on smoking, alcohol consumption, physical inactivity and weight/height. Data from the Dutch population were available from Statistics Netherlands. By calculating age-adjusted Odds Ratio’s, prevalence rates among both generations were compared with prevalence rates in the host population for men and women separately. We found indications of convergence across generations towards the prevalence rates in the host population for smoking in Turkish men, for overweight in Turkish and Moroccan women and for physical inactivity in Turkish women. Alcohol consumption, however, remained low in all subgroups and did not converge towards the higher rates in the host population. In addition, we found a reversed trend among Turkish women regarding smoking: the second generation smoked significantly more, while the first generation did not differ from ethnic Dutch. In general, behavioural risk factors in two generations of non-Western migrants in the Netherlands seem to converge towards the prevalence rates in the Dutch population. However, some subgroups and risk factors showed a different pattern.

Cultural and social influences on food consumption in Dutch residents of Turkish and Moroccan origin: a qualitative study

OBJECTIVE To explore the social and cultural influences on food intake in 2 non-Western migrant origin groups. The authors were particularly interested in the influence of the traditional culture and its relevance within the context of migration and associated changes in social, economic and cultural context, including acculturation. DESIGN Qualitative focus group discussions. SETTING City of Amsterdam, the Netherlands. PARTICIPANTS Young adults of Turkish and Moroccan migrant origin. PHENOMENON OF INTEREST Social and cultural influences on food intake. ANALYSIS Focus groups were recorded, transcribed, and analyzed using framework analysis. RESULTS A dominant theme that emerged is that of hospitality and the central role of food herein. Hospitality is rooted within the cultural and religious tradition of both groups. Additional themes that emerged were: cultural identity; migration and lifestyle change; and acculturation. CONCLUSIONS AND IMPLICATIONS Among Dutch residents of Turkish and Moroccan migrant origin, the central role of food in culture coupled with the changes that come about as a result of migration create an environment of abundance that can lead to overeating, which may impact energy balance and overweight development. These results indicate that younger members of migrant origin populations continue to value their traditional food cultures, underpinning the need for interventions to be culturally sensitive.

Risk groups for overweight and obesity among Turkish and Moroccan migrants in The Netherlands

OBJECTIVES The association between sociodemographic factors and acculturation with overweight/obesity in Turks and Moroccans was studied to identify target groups for prevention. STUDY DESIGN A cross-sectional study was undertaken among a sample of 1384 Turks and Moroccans aged 35-74 years in Amsterdam, The Netherlands. METHODS Data were collected by structured face-to-face interviews. Body mass index (BMI) was calculated from self-reported height and weight data. Sociodemographic variables collected were sex, age, educational level, marital status, parity and income level. Acculturation was measured by cultural orientation and length of residence in The Netherlands. Data of 1095 Turks and Moroccans were analysed using logistic regression, with overweight/obesity (BMI 25.0) as the dependent variable. RESULTS The prevalence of overweight/obesity was high (57-89%). Age, marital status, parity, income level, cultural orientation and length of residence were not associated or only weakly associated with overweight/obesity. Educational level and overweight/obesity were strongly associated in Turkish women (odds ratio 4.56; 95% confidence intervals 1.54-13.51). CONCLUSIONS The high prevalence of overweight/obesity in Turkish and Moroccan migrants varies little across sociodemographic groups and is not associated with acculturation. Poorly educated Turkish women are at particularly high risk.

Effectiveness of Cultural Adaptations of Interventions Aimed at Smoking Cessation, Diet, and/or Physical Activity in Ethnic Minorities. A Systematic Review

Background The importance of cultural adaptations in behavioral interventions targeting ethnic minorities in high-income societies is widely recognized. Little is known, however, about the effectiveness of specific cultural adaptations in such interventions. Aim To systematically review the effectiveness of specific cultural adaptations in interventions that target smoking cessation, diet, and/or physical activity and to explore features of such adaptations that may account for their effectiveness. Methods Systematic review using MEDLINE, PsycINFO, Embase, and the Cochrane Central Register of Controlled Trials registers (1997–2009). Inclusion criteria: a) effectiveness study of a lifestyle intervention targeted to ethnic minority populations living in a high income society; b) interventions included cultural adaptations and a control group that was exposed to the intervention without the cultural adaptation under study; c) primary outcome measures included smoking cessation, diet, or physical activity. Results Out of 44904 hits, we identified 17 studies, all conducted in the United States. In five studies, specific cultural adaptations had a statistically significant effect on primary outcomes. The remaining studies showed no significant effects on primary outcomes, but some presented trends favorable for cultural adaptations. We observed that interventions incorporating a package of cultural adaptations, cultural adaptations that implied higher intensity and those incorporating family values were more likely to report statistically significant effects. Adaptations in smoking cessation interventions seem to be more effective than adaptations in interventions aimed at diet and physical activity. Conclusion This review indicates that culturally targeted behavioral interventions may be more effective if cultural adaptations are implemented as a package of adaptations, the adaptation includes family level, and where the adaptation results in a higher intensity of the intervention. More systematic experiments are needed in which the aim is to gain insight in the best mix of cultural adaptations among diverse populations in various settings, particularly outside the US.

Prevalence, awareness, treatment, and control of hypertension among Ghanaian population in Amsterdam, the Netherlands: the GHAIA study

Background: Migration from sub-Saharan Africa to industrialized countries has increased tremendously over the last few decades, yet very little is known about the health status of sub-Saharan African populations living in industrialized communities. The aim of this study was to assess prevalence, levels of awareness, treatment, and control of hypertension among the largest sub-Saharan African group (Ghanaians) living in the Netherlands. Methods: Cross-sectional study of Ghanaian adults aged 18–60 years in Amsterdam, the Netherlands. Results: The overall prevalence of hypertension was 55%. Of these, about half were aware of their condition, 45% were receiving antihypertensive medication, and 15% were controlled (blood pressure <140/90 mmHg). The prevalence rates of hypertension, awareness, and treatment were similar among males and females. However, males had a lower blood pressure control rate than females. Among all hypertensives, 22% of females had their blood pressure controlled compared with 5.8% in males: adjusted prevalence ratio (APR) 3.94 (95% CI 1.05–14.79). Among those receiving treatment for their hypertension, 48% of females were controlled compared with only 13% of males: APR 4.08 (95% CI 1.20–13.87). Conclusion: Hypertension is a major problem among this recently migrated sub-Saharan African population. Furthermore, hypertension control rate is very low particularly in males. Urgent measures are needed to halt the increasing prevalence of hypertension and to improve hypertension control among these populations.

A prospective cohort study of dietary patterns of non-western migrants in the Netherlands in relation to risk factors for cardiovascular diseases: HELIUS-Dietary Patterns

BackgroundIn Western countries the prevalence of cardiovascular disease (CVD) is often higher in non-Western migrants as compared to the host population. Diet is an important modifiable determinant of CVD. Increasingly, dietary patterns rather than single nutrients are the focus of research in an attempt to account for the complexity of nutrient interactions in foods. Research on dietary patterns in non-Western migrants is limited and may be hampered by a lack of validated instruments that can be used to assess the habitual diet of non-western migrants in large scale epidemiological studies. The ultimate aims of this study are to (1) understand whether differences in dietary patterns explain differences in CVD risk between ethnic groups, by developing and validating ethnic-specific Food Frequency Questionnaires (FFQs), and (2) to investigate the determinants of these dietary patterns. This paper outlines the design and methods used in the HELIUS-Dietary Patterns study and describes a systematic approach to overcome difficulties in the assessment and analysis of dietary intake data in ethnically diverse populations.Methods/DesignThe HELIUS-Dietary Patterns study is embedded in the HELIUS study, a Dutch multi-ethnic cohort study. After developing ethnic-specific FFQs, we will gather data on the habitual intake of 5000 participants (18-70 years old) of ethnic Dutch, Surinamese of African and of South Asian origin, Turkish or Moroccan origin. Dietary patterns will be derived using factor analysis, but we will also evaluate diet quality using hypothesis-driven approaches. The relation between dietary patterns and CVD risk factors will be analysed using multiple linear regression analysis. Potential underlying determinants of dietary patterns like migration history, acculturation, socio-economic factors and lifestyle, will be considered.DiscussionThis study will allow us to investigate the contribution of the dietary patterns on CVD risk factors in a multi-ethnic population. Inclusion of five ethnic groups residing in one setting makes this study highly innovative as confounding by local environment characteristics is limited. Heterogeneity in the study population will provide variance in dietary patterns which is a great advantage when studying the link between diet and disease.

A Cross-National Comparative Study of Blood Pressure and Hypertension Between English and Dutch South-Asian– and African-Origin Populations: The Role of National Context

BACKGROUND We compare patterns of blood pressure (BP) and prevalence of hypertension between white-Dutch and their South-Asian and African minority groups with their corresponding white-English and their South-Asian and African ethnic minority groups; and the contribution of physical activity, body sizes, and socioeconomic position (SEP); and the quality of BP treatment that may underlie differences in mean BP. METHODS Secondary analyses of population-based studies of 13,999 participants from the United Kingdom and the Netherlands. RESULTS Compared with Dutch South-Asians, all English South-Asian men and women had lower BP and prevalence of hypertension except for systolic BP in English-Indian men. Among Africans, the systolic BP did not differ, but the diastolic BP levels were lower in English-Caribbean and English- (sub-Sahara) African men and women than in their Dutch-African counterparts. English-Caribbeans had a lower prevalence of hypertension than Dutch-Africans. Compared with white-Dutch, white-English men and women had higher systolic BP levels, but lower diastolic BP levels. There were no differences in the prevalence of hypertension between the white groups. Most differences remained unchanged after adjustment for SEP, lifestyle, and body sizes in all ethnic groups. BP control rates were substantially lower among Dutch-African and Dutch South-Asian hypertensives than among their English counterparts (except Indians). CONCLUSIONS We found marked variations in BP and hypertension prevalence between comparable ethnic groups in England and the Netherlands. Poor BP control among Dutch South-Asians and Africans contributed to their disadvantage of the relatively high BP levels.

Educational inequalities in metabolic syndrome vary by ethnic group: evidence from the SUNSET study.

BACKGROUND Compared with Whites, many ethnic minority groups have higher prevalence of metabolic syndrome. The reasons for these ethnic inequalities in health are incompletely understood. The main objective was to examine whether socio-economic position (SEP) as measured by education was related to the prevalence of metabolic syndrome in different ethnic groups in Amsterdam, The Netherlands. METHODS A random sample of healthy adults aged 35-60 years. SEP was measured by educational level (secondary school and below (low), and vocational school and above (high)). Metabolic syndrome was measured according to the International Diabetic Federation guidelines. RESULTS Low education was negatively related to metabolic syndrome but only in White-Dutch people. Among White-Dutch men, the age adjusted prevalence ratio (95% confidence intervals) for low education was 1.46 (95% CI: 1.01-2.10) versus high education. Among White-Dutch women, the adjusted odds ratios for low education was 2.26 (95% CI: 1.39-3.68) versus high education. In both White-Dutch men and women, low education was related to several components of metabolic syndrome. Among African-Surinamese and Hindustani-Surinamese, no significant associations were found between low education and metabolic syndrome and its components. CONCLUSION Low education is associated with increased risk of metabolic syndrome among White-Dutch people but not among other ethnic groups. Community-based strategies to improve metabolic profiles may have to be ethnically devised. Among White-Dutch, targeting people with lower SEP may have an impact. However, among ethnic minority groups, both low and high socio-economic groups may have to be equally targeted to have an impact in reducing ethnic inequalities in health.

Rationale and cross-sectional study design of the Research on Obesity and type 2 Diabetes among African Migrants: the RODAM study.

Introduction Obesity and type 2 diabetes (T2D) are highly prevalent among African migrants compared with European descent populations. The underlying reasons still remain a puzzle. Gene–environmental interaction is now seen as a potential plausible factor contributing to the high prevalence of obesity and T2D, but has not yet been investigated. The overall aim of the Research on Obesity and Diabetes among African Migrants (RODAM) project is to understand the reasons for the high prevalence of obesity and T2D among sub-Saharan Africans in diaspora by (1) studying the complex interplay between environment (eg, lifestyle), healthcare, biochemical and (epi)genetic factors, and their relative contributions to the high prevalence of obesity and T2D; (2) to identify specific risk factors within these broad categories to guide intervention programmes and (3) to provide a basic knowledge for improving diagnosis and treatment. Methods and analysis RODAM is a multicentre cross-sectional study among homogenous sub-Saharan African participants (ie, Ghanaians) aged >25 years living in rural and urban Ghana, the Netherlands, Germany and the UK (http://rod-am.eu/). Standardised data on the main outcomes, genetic and non-genetic factors are collected in all locations. The aim is to recruit 6250 individuals comprising five subgroups of 1250 individuals from each site. In Ghana, Kumasi and Obuasi (urban stratum) and villages in the Ashanti region (rural stratum) are served as recruitment sites. In Europe, Ghanaian migrants are selected through the municipality or Ghanaian organisations registers. Ethics and dissemination Ethical approval has been obtained in all sites. This paper gives an overview of the rationale, conceptual framework and methods of the study. The differences across locations will allow us to gain insight into genetic and non-genetic factors contributing to the occurrence of obesity and T2D and will inform targeted intervention and prevention programmes, and provide the basis for improving diagnosis and treatment in these populations and beyond.

Newly Proposed Body Adiposity Index (BAI) by Bergman et al. Is Not Strongly Related to Cardiovascular Health Risk

circumference/(height1.5–18)) and to assess its association with CV risk factors and cytokines. The CoLaus Study is a cross-sectional study aimed at assessing the prevalence of CV risk factors as the molecular determinants of CV disease in the white population of Lausanne, Switzerland, a town of 117,161 inhabitants, of which 79,420 are of Swiss nationality. The sampling procedure and methodology have been previously described (3). We collected data on adiposity markers (BMI, waist circumference, and body fat as assessed by tetrapolar bioimpedance), CV risk factors (systolic and diastolic blood pressure, total low-density lipoprotein and high-density lipoprotein-cholesterol, triglycerides and glucose), insulin (which enabled the assessment of homeostatic model assessment) and different cytokines (leptin, adiponectin, C-reactive protein, and tumor necrosis factor-α). Levels of these cytokines were measured using a multiplexed particle-based flow cytometric cytokine assay (4). We used Spearman nonparametric correlations to assess the relationship between the BAI and all health variables of interest, stratified by gender (Table 1). A stepwise linear regression was run to assess which adiposity markers (BAI, BMI, waist circumference, and body fat) were most associated to CV risk factors (triglycerides were log-transformed) and log-transformed cytokines, again stratifying by gender and controlling for age. The BAI correlated significantly (P < 0.05) and positively with age, other adiposity markers, most CV risk factors, and cytokines, while negative correlations were found for high-density lipoprotein cholesterol and adiponectin. The correlations between BAI and health variables were similar to those between BMI and the health variables (Table 1). Stepwise multivariate linear regression analysis showed that the BAI significantly (P < 0.05) predicted diastolic blood pressure, fasting glucose levels, high-density lipoprotein cholesterol, leptin, and adiponectin in women independently of the other adiposity markers, while no association was found for all other variables. In men, the adiposity index independently and significantly (P < 0.05) predicted adiponectin, high-density lipoproteincholesterol and C-reactive protein only. The analysis also showed that, for each gender, the other adiposity markers were associated with more CV and cytokine variables than the new BAI. We conclude that while the new BAI is significantly related to bioelectrical impedance measured body fat, it appears to be of lesser interest than other more established adiposity markers regarding the association with CV risk factors or inflammatory markers. Further studies are welcomed to further assess the clinical utility of the BAI and its relationship to CV risk factors and other health parameters, particularly in diverse populations.