Biomedical subjects

A M Hodge

Publications and source records attributed to A M Hodge.

26 records · Page 2Linked to original sources

PubMed1995

Prevalence and secular trends in obesity in Pacific and Indian Ocean island populations.

Surveys conducted in 10 Pacific island populations and in the multiethnic populations of Mauritius and Rodrigues in the Indian Ocean have provided data on the prevalence of obesity, potential etiological factors and medical hazards associated with obesity. The results indicate that the prevalence of obesity (by body mass index (BMI) in some of these populations is among the highest in the world. Obesity related to degree of modernization is more common in urban than in rural locations and tends to be found more often in women. In two populations where longitudinal data were available, there were dramatic increases in prevalence over relatively short time periods. Obesity contributed to the risk of non-insulin-dependent diabetes mellitus (NIDDM) and was associated with other risk factors for cardiovascular disease (CVD) in all populations, but no relationship could be found with total mortality in three ethnic groups for whom data were available. A genetic susceptibility to obesity combined with social pressures that favor high energy intakes and reduced physical activity are believed to be important in these populations. The challenge for the future lies in developing culturally appropriate programs for preventing obesity and thus reducing associated morbidity, while continuing to research its behavioral and genetic determinants.

Adult↗

PubMed1995

Modernity and obesity in coastal and Highland Papua New Guinea.

OBJECTIVE: To investigate the association between individual degree of modernization and obesity in Papua New Guineans using a score of relative 'modernity'. DESIGN: Cross-sectional survey in six populations with varying degrees of modernity. Independent effects of modernity score, components of modernity score, age and physical activity were assessed in relation to general obesity (body mass index (BMI)) and body fat distribution (waist-hip ratio (WHR)). A sub-study of the relationship between diet and modernity was also performed. SETTING: Population-based samples of subjects in three Highland and three coastal locations in the developing country of Papua New Guinea (PNG). SUBJECTS: 1877 subjects > or = 25 years of age attended the survey. MEASUREMENTS: Age, physical activity, BMI, WHR, 2-h oral glucose tolerance test, and modernity score, based on area of origin, father's employment, type and duration of individual's employment, education, years in an urban centre, housing type and spouse score. RESULTS: More modern subjects had higher mean BMI and lower levels of physical activity, and mean WHR also varied with modernity in men but not women. In linear regression analysis, total modernity score was significantly associated with both BMI and WHR in men and women, independently of age and physical activity. When components of the modernity score were examined, younger age, more sophisticated housing and increasing number of years in an urban centre were independently associated with BMI in men and women, while education level and reduced physical activity were also significant predictors in men. Associations with WHR were weaker. Results of the dietary sub-study suggested that the lowest energy and nutrient intakes occurred in the least modern men and women. CONCLUSION: Aspects of modernity, such as more sophisticated housing and greater number of years spent in an urban centre, may be markers of higher income and increasing adoption of Western ways, which in turn are associated with physical inactivity and increased availability of energy-dense Western food, thus promoting obesity in this rapidly developing Pacific nation.

Adult↗

PubMed1994

Extraordinary prevalence of non-insulin-dependent diabetes mellitus and bimodal plasma glucose distribution in the Wanigela people of Papua New Guinea.

OBJECTIVE: To determine the current prevalence of impaired glucose tolerance (IGT) and non-insulin-dependent diabetes mellitus (NIDDM) in Melanesians of three coastal Papua New Guinean communities, to relate this to previous studies, and to investigate plasma glucose distributions in these populations. DESIGN: Cross-sectional survey, using 75 g oral glucose tolerance tests and World Health Organization criteria. SETTING: Rural Papuan villages of Wanigela and Kalo, and Wanigela people of the urban squatter settlement of Koki, Port Moresby. SUBJECTS: All adults aged 25 years or more living in the three communities were eligible, with response rates of 77.2% (Koki), 88.1% (Wanigela) and 72.5% (Kalo). MAIN OUTCOME MEASURES: Prevalence of abnormal glucose tolerance, risk factor levels, fasting and two-hour plasma glucose concentration. RESULTS: Age-standardised prevalence of NIDDM in Koki Wanigelas was 27.5% in men and 33.0% in women; an additional 20.5% of men and 22.0% of women had IGT. Even in the youngest age group (25-34 years), 36.5% of subjects had abnormal glucose tolerance. The overall prevalences of NIDDM and IGT in rural Wanigelas were 11.7% and 17.0% respectively. In Kalo both were uncommon. The prevalences of IGT and NIDDM in Koki had doubled over a 14-year period. The age-standardised prevalence of abnormal glucose tolerance in the Koki Wanigelas is the second highest in the world after the Arizona Pima Indians, and higher than in Micronesian Nauruans, even though the latter are more obese. Both fasting and two-hour glucose concentrations in all age groups in Koki were clearly bimodal, a mixture of two log-normal distributions. CONCLUSIONS: The Wanigela people of Papua New Guinea have an extra-ordinary susceptibility to glucose intolerance which is exposed after adoption of modern lifestyle habits. A "founder effect" may explain the high frequency of a diabetogenic genotype in this population.

Adult↗

PubMed1994

The epidemiology of obesity.

Obesity and pattern of fat distribution are both important factors related to poor health outcomes. Many measures of obesity and fat distribution pattern have been employed by different authors and to facilitate interpopulation comparisons and interpretation of secular trends it is necessary that standardized methods for measurement and classification are set in place. The use of BMI as a measure of fatness for epidemiological studies is widely accepted, easily measured and BMI predicts morbidity and mortality in many populations. The most appropriate level at which to define obesity is a matter of debate but systems which use BMI > or = 25 and < or = 30 kg/m2 as overweight, and BMI > 30 kg/m2 as obese for all adults are simple, easily remembered, already widely used and BMIs above 30 kg/m2 are clearly associated with increased risk of morbidity and mortality. In some populations there may be a case for using a lower cut-off but not unless there is specific evidence to support this. For the present WHR is probably the best method for assessing fat distribution, although waist circumference on its own may be more useful in determining risk levels. Standard sites for measurement of both waist and hip girths have been described. There is a large variation in the prevalence of obesity across the populations for which data is available, with high prevalences of obesity and dramatic secular trends especially apparent in modernizing Pacific Island populations. The 'thrifty genotype' hypothesis has been invoked to try and explain this situation. The clustering of obesity, NIDDM and CVD risk factors has been recognized and various 'syndromes' have been described which group different factors together, with hyperinsulinaemia and insulin resistance proposed as the underlying problem.

Age Distribution↗

PubMed1994

Dramatic increase in the prevalence of obesity in western Samoa over the 13 year period 1978-1991.

Obesity and an increasing prevalence of associated conditions such as diabetes and cardiovascular disease are frequently observed in Pacific populations as lifestyles become more modernized. In 1978, a survey conducted in three geographically defined populations in Western Samoa showed large differences in the prevalence of obesity (body mass index (BMI) > or = 30 kg/m2) between rural and urban populations. A follow-up survey using similar methods was performed in 1991 to examine the current level of obesity in these three locations and to assess changes over time. Cross-sectional differences in the prevalence of obesity, mean BMI and waist-hip circumference ratio (WHR) between urban Apia and rural Poutasi and Tuasivi were examined after adjusting for age. There were higher levels of obesity in urban vs rural areas: 74% of women in Apia were obese compared with 62% in Poutasi and 56% in Tuasivi. In men, comparable figures were 57%, 44% and 36% for Apia, Poutasi and Tuasivi respectively. Mean BMIs followed the same pattern. By contrast, WHR varied little between locations. Even in subjects aged 25-34 years, more than 50% of women in all locations, and 45% of urban men were obese. Increasing physical activity in men, but not women, was associated with lower mean BMI. Increasing education level and job status were associated with increasing BMI but these relationships were significant only in men. Multivariate analysis showed age, location (urban), occupation (high status, women), and in men, physical inactivity, to be independently associated with increased risk of obesity. Prevalence of obesity increased dramatically between 1978 and 1991 in all locations, but especially in Tuasivi, where in males the increase was 297% and in females 115%. There was a rightward shift in the distribution of body mass index in both sexes and all locations. These extreme increases in the prevalence of obesity, even in young adults, over the relatively short 13-year study period suggest an increasing burden of chronic diseases facing Western Samoa in the future, and emphasize the need for effective intervention to bring about lifestyle modification.

Anthropometry↗

PubMed1993

Abnormal glucose tolerance and alcohol consumption in three populations at high risk of non-insulin-dependent diabetes mellitus.

The associations of alcohol intake with the prevalence and incidence of non-insulin-dependent diabetes mellitus (NIDDM) and impaired glucose tolerance were examined in three populations at high risk for NIDDM. Population-based surveys performed in Mauritius in 1987, in Kiribati in 1981, and in Nauru in 1982 and 1987 provided data on alcohol intake, glucose tolerance, and associated risk factors for NIDDM in over 8,700 subjects not previously known to be diabetic. There was no consistent relation of alcohol intake to fasting or 2-hour glucose concentration in either prevalence or prospective studies. Odds ratios for newly diagnosed NIDDM associated with increasing alcohol intake were not significantly different from unity in any population in either prevalence or prospective data. Alcohol consumption was, however, related to other metabolic parameters associated with cardiovascular disease and NIDDM, i.e., increased systolic blood pressure, fasting triglycerides, uric acid, and high density lipoprotein cholesterol and a reduction in 2-hour insulin. The results of this study do not support the hypothesis of an independent effect of alcohol consumption on the development of NIDDM, but increased alcohol consumption is associated with variation in other cardiovascular disease risk factors in these three populations.

Adult↗

PubMed1993

Association of body mass index and waist-hip circumference ratio with cardiovascular disease risk factors in Micronesian Nauruans.

The relationship of body mass index (BMI) and waist-hip circumference ratio (WHR) with cardiovascular disease (CVD) risk factors was examined in adult Nauruans, a population with a particularly high prevalence of non-insulin dependent diabetes mellitus and obesity, with mean BMI 34.2 kg/m2 in males and 34.9 kg/m2 in females aged > or = 20 years. In univariate analysis for men, fasting and 2 h insulin (after a 75 g glucose load), total cholesterol, high density lipoprotein (HDL)/total cholesterol ratio and uric acid levels varied significantly across tertiles of BMI but not WHR, while fasting and 2 h glucose and fasting triglyceride levels were significantly associated with both BMI and WHR. Neither systolic nor diastolic blood pressure were related to BMI tertiles, but diastolic blood pressure was associated with WHR. High density lipoprotein cholesterol was not associated with tertiles of BMI or WHR in men. In women, BMI and WHR had similar univariate associations. When the effects of BMI and WHR were studied simultaneously by analysis of covariance, adjusting for age, BMI explained more of the variance in risk factor levels in men than did WHR for fasting and 2 h insulin, total cholesterol, HDL cholesterol, HDL/total cholesterol ratio and uric acid, while in women, BMI was more important for 2 h insulin, 2 h glucose and uric acid, and equal with WHR for fasting insulin. Waist-hip circumference ratio was more important for fasting plasma glucose, fasting triglycerides and both systolic and diastolic blood pressure in men and women. There was little evidence for statistically important interaction between BMI and WHR in relation to risk factor levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen↗

PubMedDate not supplied

Factors associated with impaired vibration perception in Mauritians with normal and abnormal glucose tolerance. Mauritius NCD Study Group.

Vibration perception threshold (VPT) was measured in 1185 Indian, Creole, and Chinese men and women in Mauritius, where the current prevalence of diabetes mellitus in adults aged 25-74 years is estimated to be 13%. Vibration perception threshold was measured using a biothesiometer, at seven sites in the hand, wrist, foot, and ankle, during a population survey in 76% of 574 known diabetic patients (KDM), 79% of 525 newly diagnosed diabetic patients (NDM), 18% of 1121 subjects with impaired glucose tolerance (IGT), and in 127 normal subjects. The association of VPT with glucose tolerance and other risk factors was assessed in order to identify individuals most at risk of foot ulceration and to determine whether risk factors and normal levels for VPT in these ethnic groups were consistent with those reported for Caucasians. After adjusting for age and height, geometric mean VPT at six of seven sites increased significantly with worsening glucose tolerance and increasing duration of diabetes in both men and women, VPT also increased significantly with level of fasting plasma glucose in men, but not women. Smoking and alcohol consumption had no effect on VPT, and body-mass index (BMI) was positively associated only at some sites. Chinese subjects had lower VPTs than Indians or Creoles. In multiple linear regression models, age, male gender, duration of diabetes, ethnic group, and height (lower extremity sites) were significantly associated with VPT among diabetic subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗