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Introduction. Pima Indians living in the United States (U.S.) have the highest prevalence of type 2 diabetes mellitus in the world. Their Mexican counterparts, living a traditional lifestyle in the mountain of Sonora, Mexico, have at least five times less diabetes than the U.S. Pima Indians. The effects of a traditional lifestyle in reducing type 2 diabetes risk factors and the association of factors to type 2 diabetes were evaluated in a sample of 1211 genetically related Pima Indians living different lifestyles (224 from Mexico and 887 from U.S.). Subsets of these populations were used to address specific questions. First, differences in insulin resistance between subjects with normal glucose tolerance (194 Mexican versus 449 U.S. Pima) were evaluated. Second, the effect of physical activity and obesity explaining differences in metabolic syndrome prevalence were evaluated in 224 and 447 Mexican and U.S. Pima Indians. Third, factors associated with type 2 diabetes were evaluated in each Pima Indian population (224 from Mexico and 887 from U.S.). Methods. Demographic, physical, biochemical, and lifestyle factors were measured in 1996 in a cross-sectional study of Pima Indians 20 years of age or older living in Maycoba, Sonora Mexico and contrasted to results from a sample of U.S. Pima Indians participating in an ongoing epidemiological study that used similar methods and selection criteria. Insulin resistance was estimated by both fasting insulin and homeostasis model assessment-insulin resistance (HOMA-IR). Metabolic syndrome was defined using the Third Report of the National Cholesterol Education Program's Adult Treatment Panel III (NCEP III) criteria. Body mass index (BMI) was calculated by dividing weigh in kilograms by the square of height in meters (Kg/m2). Physical activity was measured using a questionnaire developed for the U.S. Pima Indians and adapted to the Mexican Pima Indian population. Type 2 diabetes was defined according to the 1999 WHO criteria after an oral glucose tolerance test. Multiple linear regression analysis was used to answer the first question (related to differences in insulin resistance) and multiple logistic regressions analysis to answer the second (related with differences in metabolic syndrome) and third questions (related to factors associated with type 2 diabetes). Results. Insulin resistance was much lower in the Mexican Pima Indians than in genetically related U.S. counterparts, even after controlling for differences in obesity, age and sex. In addition, the unadjusted prevalence of metabolic syndrome was 24.1% and 56.6 % in the Mexican and U.S. Pima Indians, respectively. However, most of the difference in metabolic syndrome prevalence was explained by differences in obesity and physical activity. Furthermore, in Mexican Pima Indians, type 2 diabetes was independently associated with age, fasting insulin, and waist circumference. In the U.S. Pima Indians, type 2 diabetes was associated with with age, sex, fasting insulin, total cholesterol, blood pressure and physical activity. Conclusion. The findings underscore the importance of lifestyle in the prevention of type 2 diabetes risk factors, such as insulin resistance and metabolic syndrome, even in individuals with high propensity to develop diabetes.
The primary objective of this dissertation project was to describe the pattern of effect modification caused by sociocultural status on identified risk factors for Type 2 diabetes. This case-control study included 244 Mexican American women, between the ages of 50-79, who were enrolled in the Observational Study of the Women's Health Initiative (WHI) in San Diego, Tucson, or San Antonio between 1994-1997. Seventy-eight diabetics and 166 nondiabetics were included in the study. As a supplement to data already collected by the WHI, a telephone survey was used to gather information on acculturation and diabetes related knowledge and behavior. Results support previous findings that increased age; a positive family history of diabetes, obesity, and centralized adiposity; and a sedentary lifestyle are important independent predictors of diabetes. The risk of diabetes associated with obesity is moderated by acculturation in a nonlinear fashion. Specifically, risk of diabetes associated with obesity was lowest at either the high or the low end of the acculturation spectrum, but highest in the midrange. The risk of diabetes associated with a higher waist hip ratio increases with income and acculturation. With respect to educational status, the risk of disabetes is related in a nonlinear fashion and is magnified for women with 7th-12th grade education. However, in the presence of other risk factors such as family history of diabetes and age, the importance of sociocultural status as an effect modifier diminishes.
The International Textbook of Diabetes Mellitus has been a successful, well-respected medical textbook for almost 20 years, over 3 editions. Encyclopaedic and international in scope, the textbook covers all aspects of diabetes ensuring a truly multidisciplinary and global approach. Sections covered include epidemiology, diagnosis, pathogenesis, management and complications of diabetes and public health issues worldwide. It incorporates a vast amount of new data regarding the scientific understanding and clinical management of this disease, with each new edition always reflecting the substantial advances in the field. Whereas other diabetes textbooks are primarily clinical with less focus on the basic science behind diabetes, ITDM's primary philosophy has always been to comprehensively cover the basic science of metabolism, linking this closely to the pathophysiology and clinical aspects of the disease. Edited by four world-famous diabetes specialists, the book is divided into 13 sections, each section edited by a section editor of major international prominence. As well as covering all aspects of diabetes, from epidemiology and pathophysiology to the management of the condition and the complications that arise, this fourth edition also includes two new sections on NAFLD, NASH and non-traditional associations with diabetes, and clinical trial evidence in diabetes. This fourth edition of an internationally recognised textbook will once again provide all those involved in diabetes research and development, as well as diabetes specialists with the most comprehensive scientific reference book on diabetes available.
We are what we eat. That old expression seems particularly poignant every time we have our blood drawn for a routine physical to check our cholesterol levels. And, it's not just what we eat that affects our health. Whole ranges of behaviors ultimately make a difference in how we feel and how we maintain our health. Lifestyle choices have enormous impact on our health and well being. But, how do we communicate the language of good health so that it is uniformly received-and accepted-by people from different cultures and backgrounds? Take, for example, the case of a 66 year old Latina. She has been told by her doctor that she should have a mammogram. But her sense of fatalism tells her that it is better not to know if anything is wrong. To know that something is wrong will cause her distress and this may well lead to even more health problems. Before she leaves her doctor's office she has decided not to have a mammogram-that is until her doctor points out that having a mammogram is a way to take care of herself so that she can continue to take care of her family. In this way, the decision to have a mammogram feels like a positive step. Public health communicators and health professionals face dilemmas like this every day. Speaking of Health looks at the challenges of delivering important messages to different audiences. Using case studies in the areas of diabetes, mammography, and mass communication campaigns, it examines the ways in which messages must be adapted to the unique informational needs of their audiences if they are to have any real impact. Speaking of Health looks at basic theories of communication and behavior change and focuses on where they apply and where they don't. By suggesting creative strategies and guidelines for speaking to diverse audiences now and in the future, the Institute of Medicine seeks to take health communication into the 21st century. In an age where we are inundated by multiple messages every day, this book will be a critical tool for all who are interested in communicating with diverse communities about health issues.
The number of persons diagnosed with diabetes increased 5x between 1958 & 1997. More than 16 million Amer. have diabetes, more than half of them women, with the prevalence of diabetes at least 2-4 times higher among women of color. The report looks at the socioeconomic environ. that has contributed to the increase of diabetes & the challenges we face as we seek to educate women about the behavioral changes necessary for prevention. The report is structured to reflect the manifestations of diabetes at different stages of women's life, including the threat of type 1 & the emergence of type 2 diabetes in youth, gestational diabetes among women of childbearing age, & type 2 diabetes as a disease of middle-aged & older women. Charts & tables.
Cardiovascular, respiratory, and related conditions cause more than 40 percent of all deaths globally, and their substantial burden is rising, particularly in low- and middle-income countries (LMICs). Their burden extends well beyond health effects to include significant economic and societal consequences. Most of these conditions are related, share risk factors, and have common control measures at the clinical, population, and policy levels. Lives can be extended and improved when these diseases are prevented, detected, and managed. This volume summarizes current knowledge and presents evidence-based interventions that are effective, cost-effective, and scalable in LMICs.
Disease processes among American Indians and Alaska Natives often have distinct manifestations that need to be considered by clinicians and health policy makers involved with these populations. Equally important, all aspects of Indian life—including health—are governed by the special relationship between Indian tribes and the U.S. federal government. For American Indian Health, Everett R. Rhoades has gathered a distinguished group of scholars and practitioners to present a comprehensive assessment of the health of American Indian peoples today and the delivery of health services to them.
The Director of this study, Abraham Kagan, has comprehensively summarized the design and main finndings of the study in this book. The Honolulu Heart Program compared and contrasted ethnic Japanese men living in different cultural environments--Honolulu and mainland Japan--assessed their relative risk factors. The study supported many of the existing views on risk factors but also showed suprising trends. One of the trends shows moderate alcohol consumption is a preventative factor. In recent years the risk factors for cardiovascular diseases have become common knowledge. The recently completed Honolulu Heart Program is the largest targeted study to evaluate scientifically such risk factors.