Reena Oza-Frank

Age at Arrival and Risk of Obesity Among US Immigrants

Although immigrants are a rapidly growing subgroup, little is known about overweight/obesity among the foreign‐born in the United States, especially regarding the effect of age at arrival. This study determined whether overweight/obesity prevalence is associated with age at arrival of immigrants to the United States. We analyzed data on 6,421 adult immigrants from the New Immigrant Survey (NIS), a study that is nationally representative of adult immigrants with newly acquired legal permanent residence (LPR). Multiple regression analyses tested the effects of duration of residence and age at arrival on overweight/obesity, defined by BMI of ≥25 kg/m2, and self‐reported dietary change score. We found the relationship between duration of residence and overweight/obesity prevalence varied by age at arrival (P < 0.001). Immigrants ≤20‐years old at arrival who had resided in the United States ≥15 years were 11 times (95% confidence interval: 5.33, 22.56) more likely to be overweight/obese than immigrants <20‐years old at arrival who had resided in the United States ≤1 year. By comparison, there was no difference in overweight/obesity prevalence by duration among immigrants who arrived at >50 years of age. Higher self‐reported dietary change is also associated with overweight/obesity. In conclusion, immigrants younger than 20 at arrival in the United States may be at higher risk of overweight/obesity with increasing duration of residence than those who arrive at later ages. Obesity prevention among young US immigrants should be a priority.

Asian Americans: Diabetes Prevalence Across U.S. and World Health Organization Weight Classifications

OBJECTIVE To compare diabetes prevalence among Asian Americans by World Health Organization and U.S. BMI classifications. RESEARCH DESIGN AND METHODS Data on Asian American adults (n = 7,414) from the National Health Interview Survey for 1997–2005 were analyzed. Diabetes prevalence was estimated across weight and ethnic group strata. RESULTS Regardless of BMI classification, Asian Indians and Filipinos had the highest prevalence of overweight (34–47 and 35–47%, respectively, compared with 20–38% in Chinese; P < 0.05). Asian Indians also had the highest ethnic-specific diabetes prevalence (ranging from 6–7% among the normal weight to 19–33% among the obese) compared with non-Hispanic whites: odds ratio (95% CI) for Asian Indians 2.0 (1.5–2.6), adjusted for age and sex, and 3.1 (2.4–4.0) with additional adjustment for BMI. CONCLUSIONS Asian Indian ethnicity, but not other Asian ethnicities, was strongly associated with diabetes. Weight classification as a marker of diabetes risk may need to accommodate differences across Asian subgroups.

Overweight and Diabetes Prevalence Among US Immigrants

OBJECTIVES We estimated the prevalence of overweight and diabetes among US immigrants by region of birth. METHODS We analyzed data on 34 456 US immigrant adults from the National Health Interview Survey, pooling years 1997 to 2005. We estimated age- and gender-adjusted and multivariable-adjusted overweight and diabetes prevalence by region of birth using logistic regression. RESULTS Both men (odds ratio [OR] = 3.3; 95% confidence interval [CI] = 1.9, 5.8) and women (OR = 4.2; 95% CI = 2.3, 7.7) from the Indian subcontinent were more likely than were European migrants to have diabetes without corresponding increased risk of being overweight. Men and women from Mexico, Central America, or the Caribbean were more likely to be overweight (men: OR = 1.5; 95% CI = 1.3, 1.7; women: OR = 2.0; 95% CI = 1.7, 2.2) and to have diabetes (men: OR = 2.0; 95% CI = 1.4, 2.9; women: OR = 2.0; 95% CI = 1.4, 2.8) than were European migrants. CONCLUSIONS Considerable heterogeneity in both prevalence of overweight and diabetes by region of birth highlights the importance of making this distinction among US immigrants to better identify subgroups with higher risks of these conditions.

Epidemiology of Invasive Pneumococcal Disease Among High-Risk Adults Since the Introduction of Pneumococcal Conjugate Vaccine for Children

BACKGROUND Certain chronic diseases increase risk for invasive pneumococcal disease (IPD) and are indications for receipt of 23-valent pneumococcal polysaccharide vaccine (PPV23). Since the pediatric introduction of 7-valent pneumococcal conjugate vaccine (PCV7) in 2000, incidence of IPD among adults has declined. The relative magnitude of these indirect effects among persons with and without PPV23 indications is unknown. METHODS We evaluated IPD incidence among adults with and without PPV23 indications using population- and laboratory-based data collected during 1998-2009 and estimates of the denominator populations with PPV23 indications from the National Health Interview Survey. We compared rates before and after PCV7 use by age, race, PPV23 indication, and serotype. RESULTS The proportion of adult IPD cases with PPV23 indications increased from 51% before to 61% after PCV7 introduction (P < .0001). PCV7-serotype IPD declined among all race, age, and PPV23 indication strata, ranging from 82% to 97%. Overall IPD rates declined in most strata, by up to 65%. However, incidence remained highest among adults with PPV23 indications compared with those without (34.9 vs 8.8 cases per 100 000 population, respectively). Apart from age ≥65 years, diabetes is now the most common indication for PPV23 (20% of all cases vs 10% of cases in 1998-1999). CONCLUSIONS Although IPD rates have declined among adults, adults with underlying conditions remain at increased risk of IPD and comprise a larger proportion of adult IPD cases in 2009 compared with 2000. A continued increase in the prevalence of diabetes among US adults could lead to increased burden of pneumococcal disease.

Type 2 Diabetes in Asians: Prevalence, Risk Factors, and Effectiveness of Behavioral Intervention at Individual and Population Levels

This review summarizes the current data on diabetes risk factors, prevalence, and prevention efforts in Asia and Asian migrant populations. Studies indicate that type 2 diabetes mellitus is a large and growing threat to public health in Asian populations. Furthermore, Asian subgroups (e.g., South Asians/Asian Indians, Chinese) have unique risk factor profiles for developing diabetes, which differ from other populations and between Asian ethnic groups. Lifestyle intervention programs are effective in preventing diabetes in Asians, as with other ethnicities. The strength of these findings is lessened by the lack of systematically collected data using objective measurements. Large epidemiologic studies of diabetes prevalence and risk factor profiles and translational trials identifying sustainable and culturally acceptable lifestyle programs for Asian subgroups are needed.

Report of a National Heart, Lung, And Blood Institute Workshop: heterogeneity in cardiometabolic risk in Asian Americans In the U.S. Opportunities for research.

The Asian and Pacific Islander population (Asian Americans) in the U.S. has increased dramatically in the last few decades. Yet, data on cardiovascular disease (CVD) in this population are scarce. The National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health conducted an Expert Workshop to: 1) assess the importance of studying CVD in Asian Americans in the U.S.; and 2) consider strategic options for further investigations of CVD in this population. There is considerable geographical, ethnic, cultural, and genetic diversity within this population. Limited data also suggest striking differences in the risk of CVD, obesity, type 2 diabetes mellitus, and other CVD risk factors across the Asian-American population. The Asian-American population is a new diverse pool with less contemporary genetic and cultural admixture relative to groups that have lived in the U.S. for generations, plus it is diverse in lifestyle including culture, diet, and family structure. This diversity provides a window of opportunity for research on genes and gene-environment interactions and also to investigate how acculturation/assimilation to U.S. lifestyles affects health and CVD risk among relatively homogenous groups of recent immigrants. Given the heterogeneity in body weight, body size, and CVD risk, the Asian-American population in the U.S. offers a unique model to study the interaction and relationships between visceral adiposity and adipose tissue distribution and beta cell function, insulin resistance, and atherosclerosis.

Trends in Nutrient Intake among Adults with Diabetes in the United States: 1988-2004

BACKGROUND Weight loss through dietary modification is key to type 2 diabetes self-management, yet few nationally representative data exist on dietary trends among people with diabetes. OBJECTIVE To examine dietary changes, via nutrient intakes, among US adults with diabetes between 1988 and 2004. DESIGN Nutrition data from the cross-sectional National Health and Nutrition Examination Surveys (Phase I: 1988-1990 and Phase II: 1991-1994) and 1999-2004 of adults with self-reported diabetes were examined. Twenty-four-hour dietary recall data were used to assess changes in energy; carbohydrate; protein; total, saturated, polyunsaturated, and monounsaturated fat; cholesterol; fiber; sodium; and alcohol intake. STATISTICAL ANALYSES Consumption of total energy and specific nutrients per day were estimated by survey, controlled for age and sex, using multiple linear regression and adjusted means (with standard errors). RESULTS Between 1988 and 2004 there was no significant change in self-reported total energy consumption among adults with self-reported diabetes (1,941 kcal/day in 1988-1990 to 2,109 kcal/day in 2003-2004, P for trend=0.22). However, there was a significant increase in the consumption of carbohydrate (209 g/day in 1988-1990 to 241 g/day in 2003-2004; P for trend=0.02). In analyses stratified by age group, changes in dietary consumption were noted among persons aged 45 to 64 years; specifically, increases in total energy (1,770 to 2,100 kcal/day, P for trend =0.01) and carbohydrate consumption (195 to 234 g/day, P for trend=0.02). CONCLUSIONS Despite recommendations to lose weight, daily energy consumption by individuals with diabetes showed no significant change, except in individuals aged 45 to 64 years, where an increase was observed. Overall, there was an increase in carbohydrate consumption. Emphasizing the equal importance of energy reduction and changes in dietary composition for people with diabetes is important for optimal self-management.

A systematic review of overweight, obesity, and type 2 diabetes among Asian American subgroups.

This systematic review synthesizes data published between 1988 and 2009 on mean BMI and prevalence of overweight, obesity, and type 2 diabetes among Asian subgroups in the U.S. We conducted systematic searches in Pub- Med for peer-reviewed, English-language citations that reported mean BMI and percent overweight, obesity, and diabetes among South Asians/Asian Indians, Chinese, Filipinos, Koreans, and Vietnamese. We identified 647 database citations and 23 additional citations from hand-searching. After screening titles, abstracts, and full-text publications, 97 citations remained. None were published between 1988 and 1992, 28 between 1993 and 2003, and 69 between 2004 and 2009. Publications were identified for the following Asian subgroups: South Asian (n=8), Asian Indian (n=20), Chinese (n=44), Filipino (n=22), Korean (n= 8), and Vietnamese (n=3). The observed sample sizes ranged from 32 to 4245 subjects with mean ages from 24 to 78 years. Among samples of men and women, the lowest reported mean BMI was in South Asians (22.1 kg/m(2)), and the highest was in Filipinos (26.8 kg/m(2)). Estimates for overweight (12.8-46.7%) and obesity (2.1-59.0%) were variable. Among men and women, the highest rate of diabetes was reported in Asian Indians with BMI ≥ 30 kg/m(2) (32.9%, age and sex standardized). This review suggests heterogeneity among U.S. Asian populations in cardiometabolic risk factors, yet comparisons are limited due to variability in study populations, methods, and definitions used in published reports. Future efforts should adopt standardized methods to understand overweight, obesity and diabetes in this growing U.S. ethnic population.

Effect of length of residence on overweight by region of birth and age at arrival among US immigrants.

OBJECTIVE To estimate associations between the length of residence and overweight among US immigrants by region of birth and age at arrival. DESIGN Cross-sectional data from the National Health Interview Survey 1997-2005 were pooled. Multivariate-adjusted prevalence and OR were computed to test associations of length of residence and overweight. SETTING United States. SUBJECTS Immigrant adults aged 18-74 years. RESULTS The odds of being overweight were three times higher in migrants from Mexico, South America, Europe, Russia, Africa and the Middle East residing in the US for >15 years than their counterparts residing in the United States for <5 years. On the other hand, migrants from the Indian subcontinent and Southeast (SE) Asia had no association between the length of residence and overweight prevalence. Among both men and women, weight differences emerged as early as 5 years after arrival among those arriving at 18-24 years of age (OR 1.5-1.8). The odds of being overweight was higher among Hispanic men arriving before the age of 18 years than the European migrants (Mexico OR 1.7, 95 % CI 1.3, 2.2; South America OR 1.5, 95 % CI 1.0, 2.3), whereas the odds of being overweight among those from Africa and SE Asia was lower (OR 0.5, 95 % CI 0.3, 0.9 and OR 0.5, 95 % CI 0.4, 0.8, respectively). Among women who arrived at 25-44 years of age, the odds of being overweight among those from Africa and the Indian subcontinent was higher than the European migrants (OR 2.9, 95 % CI 1.7, 5.0 and OR 1.8, 95 % CI 1.8, 2.8, respectively). CONCLUSIONS We found associations between the length of residence and overweight to vary by region of birth and age at arrival, highlighting the importance of these characteristics in assessing overweight risk among the US immigrants.

Report of a National Heart, Lung, and Blood Institute Workshop

The Asian and Pacific Islander population (Asian Americans) in the U.S. has increased dramatically in the last few decades. Yet, data on cardiovascular disease (CVD) in this population are scarce. The National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health conducted an Expert Workshop to: 1) assess the importance of studying CVD in Asian Americans in the U.S.; and 2) consider strategic options for further investigations of CVD in this population. There is considerable geographical, ethnic, cultural, and genetic diversity within this population. Limited data also suggest striking differences in the risk of CVD, obesity, type 2 diabetes mellitus, and other CVD risk factors across the Asian-American population. The Asian-American population is a new diverse pool with less contemporary genetic and cultural admixture relative to groups that have lived in the U.S. for generations, plus it is diverse in lifestyle including culture, diet, and family structure. This diversity provides a window of opportunity for research on genes and gene-environment interactions and also to investigate how acculturation/assimilation to U.S. lifestyles affects health and CVD risk among relatively homogenous groups of recent immigrants. Given the heterogeneity in body weight, body size, and CVD risk, the Asian-American population in the U.S. offers a unique model to study the interaction and relationships between visceral adiposity and adipose tissue distribution and beta cell function, insulin resistance, and atherosclerosis.