One hundred bi- or homosexual men as well as 100 heterosexual men of similar age were asked about maternal stressful events that may have occurred during their prenatal life. A significantly increased incidence of prenatal stress was found in bisexual and, particularly, in homosexual men. This finding suggests that prenatal stress in males may represent a risk factor for the etiogenesis of sexual deviations in later life.
BackgroundEmerging data suggests that in sub-Saharan Africa β-cell-failure in the absence of obesity is a frequent cause of type 2 diabetes (diabetes). Traditional diabetes risk scores assume that obesity-linked insulin resistance is the primary cause of diabetes. Hence, it is unknown whether diabetes risk scores detect undiagnosed diabetes when the cause is β-cell-failure.AimsIn 528 African-born Blacks living in the United States [age 38 ± 10 (Mean ± SE); 64% male; BMI 28 ± 5 kg/m2] we determined the: (1) prevalence of previously undiagnosed diabetes, (2) prevalence of diabetes due to β-cell-failure vs. insulin resistance; and (3) the ability of six diabetes risk scores [Cambridge, Finnish Diabetes Risk Score (FINDRISC), Kuwaiti, Omani, Rotterdam, and SUNSET] to detect previously undiagnosed diabetes due to either β-cell-failure or insulin resistance.MethodsDiabetes was diagnosed by glucose criteria of the OGTT and/or HbA1c ≥ 6.5%. Insulin resistance was defined by the lowest quartile of the Matsuda index (≤ 2.04). Diabetes due to β-cell-failure required diagnosis of diabetes in the absence of insulin resistance. Demographics, body mass index (BMI), waist circumference, visceral adipose tissue (VAT), family medical history, smoking status, blood pressure, antihypertensive medication, and blood lipid profiles were obtained. Area under the Receiver Operator Characteristics Curve (AROC) estimated sensitivity and specificity of each continuous score. AROC criteria were: Outstanding: >0.90; Excellent: 0.80–0.89; Acceptable: 0.70–0.79; Poor: 0.50–0.69; and No Discrimination: 0.50.ResultsPrevalence of diabetes was 9% (46/528). Of the diabetes cases, β-cell-failure occurred in 43% (20/46) and insulin resistance in 57% (26/46). The β-cell-failure group had lower BMI (27 ± 4 vs. 31 ± 5 kg/m2P < 0.001), lower waist circumference (91 ± 10 vs. 101 ± 10cm P < 0.001) and lower VAT (119 ± 65 vs. 183 ± 63 cm3, P < 0.001). Scores had indiscriminate or poor detection of diabetes due to β-cell-failure (FINDRISC AROC = 0.49 to Cambridge AROC = 0.62). Scores showed poor to excellent detection of diabetes due to insulin resistance, (Cambridge AROC = 0.69, to Kuwaiti AROC = 0.81).ConclusionsAt a prevalence of 43%, β-cell-failure accounted for nearly half of the cases of diabetes. All six diabetes risk scores failed to detect previously undiagnosed diabetes due to β-cell-failure while effectively identifying diabetes when the etiology was insulin resistance. Diabetes risk scores which correctly classify diabetes due to β-cell-failure are urgently needed.
To identify determinants of daily life stress in Africans in America, 156 African-born Blacks (Age: 40 ± 10 years (mean ± SD), range 22–65 years) who came to the United States as adults (age ≥ 18 years) were asked about stress, sleep, behavior and socioeconomic status. Daily life stress and sleep quality were assessed with the Perceived Stress Scale (PSS) and Pittsburgh Sleep Quality Index (PSQI), respectively. High-stress was defined by the threshold of the upper quartile of population distribution of PSS (≥16) and low-stress as PSS < 16. Poor sleep quality required PSQI > 5. Low income was defined as <40 k yearly. In the high and low-stress groups, PSS were: 21 ± 4 versus 9 ± 4, p < 0.001 and PSQI were: 6 ± 3 versus 4 ± 3, p < 0.001, respectively. PSS and PSQI were correlated (r = 0.38, p < 0.001). The odds of high-stress were higher among those with poor sleep quality (OR 5.11, 95% CI: 2.07, 12.62), low income (OR 5.03, 95% CI: 1.75, 14.47), and no health insurance (OR 3.01, 95% CI: 1.19, 8.56). Overall, in African-born Blacks living in America, daily life stress appears to be linked to poor quality sleep and exacerbated by low income and lack of health insurance.
Background: Abnormal glucose tolerance (Abnl-GT) is a summary term for prediabetes and diabetes. The main etiologic determinant of Abnl-GT may be either β-cell failure or insulin resistance (IR). In African-born Blacks Abnl-GT may be predominantly due to β-cell failure rather than IR. Whether perceived and physiological stress profiles differ when Abnl-GT is due to β-cell failure rather than IR is uncertain. Aims: In 197 African-born Blacks living in the US (age: 38±11 (mean±SD); 58% men; BMI 28±5 kg/m 2 ) the perceived and physiological stress profiles were assessed based on Abnl-GT etiology. Methods: OGTT were performed. Abnl-GT was defined as FPG ≥100 mg/dL and/or glucose at 2h≥140 mg/dL. IR was defined by the lowest quartile of the Matsuda index (≤2.97). Abnl-GT-IR required Abnl-GT and IR. Beta-cell failure was defined as Abnl-GT without IR. The 10 question Cohen Perceived Stress Scale (PSS) was applied. Allostatic Load (ALS) included 10 variables: SBP, DBP, Pulse, cholesterol, HDL, homocysteine, BMI, A1C, Albumin, hs-CRP. Statistical analyses included t-tests, Chi-squares, and multiple regressions. Results: Abnl-GT occurred in 39% (77/197), with Abnl-GT-β-cell failure in 56% (43/77) and Abnl-GT-IR in 44% (34/77). The Abnl-GT-IR had higher BMI (31±5 vs 28±4) and WC (101±10 vs 90±11) vs Abnl-GT-β-cell failure, both P <0.01. PSS did not differ between groups. ALS was higher in Abnl-GT-IR vs the Abnl-GT-β-cell failure ( P <0.01). Yet, regression analyses, adjusted for age and sex, showed significant associations between PSS and ALS in the Abnl-GT-β-cell-failure-group ( P =0.01) ( Figure 1A ). However, PSS and ALS were insignificantly associated in the Abnl-GT-IR-group ( P =0.42) ( Figure 1B ). Conclusions: In Abnl-GT-β-cell failure, perceived stress may influence allostatic load. Reasons for the link between perceived stress and allostatic load in Abnl-GT due to β-cell failure need exploration.
Background: Africa is experiencing the most rapid rise of type 2 diabetes (T2D) in the world. In addition, Africa has the highest proportion of undiagnosed cases. If people with T2D are undiagnosed, then complications progress, outcomes are poor, and social and financial costs escalate. Our goal with this review is to determine whether Life-Style Intervention (LSI) as primary treatment can lead to remission of T2D. LSI generally includes some combination of dietary change, weight loss, exercise, and counseling. If LSI alone leads to high rates of T2D remission, this will provide both the impetus and justification for investing scarce health care resources in programs which would convert undiagnosed T2D into diagnosed T2D. Methods: PubMed, Embase, Cochrane and CINAHL were searched between September 1 st and September 13 th , 2021 for studies that assessed whether LSI, as the only treatment would lead to remission in either newly diagnosed or established T2D. Results: The search identified 1162 articles. After removal of duplicates (n=291), 871 are being screened for eligibility. To date, data have been extracted from 11 of the articles which met the inclusion criteria. None of the 11 studies were conducted in Africa. Three of the 11 studies reported on newly diagnosed T2D cases. All three were successful in achieving a high rate of T2D remission with LSI. Strategies which were successful in converting T2D to prediabetes included: (1) a caloric decrease of only 500 less than predicted maintenance; (2) a low carbohydrate diet; and (3) a 10% loss in baseline weight. Exercise and counseling regimens varied widely between the three trials. The eight articles which enrolled patients with known T2D focused largely on very low calorie diets and intensive psychologic support and counseling. Factors in these studies which were associated with success were: T2D duration less than 5 years, weight loss of >10% in the first year, and higher insulin concentrations at baseline. Conclusion: Literature review, even if scant, will provide currently known best practices. They will help us move forward in the design of culturally sensitive lifestyle interventions that would be acceptable to African participants and economically attractive to government and health care agencies.
Abnormal-glucose tolerance (Abnl-GT) is due to an imbalance between β-cell function and insulin resistance (IR) and is a major risk factor in cardiovascular disease (CVD). In sub-Saharan Africa, β-cell failure is emerging as an important cause of Abnl-GT (Abnl-GT-β-cell-failure). Visceral adipose tissue (VAT) volume and hyperlipidemia are major contributors to CVD risk when Abnl-GT is due to IR (Abnl-GT-IR). Yet, the CVD profile associated with Abnl-GT-β-cell failure is unknown. Therefore, our goals in 450 African-born Blacks (Male: 65%; Age: 39 ± 10 years; BMI 28 ± 5 kg/m2), living in America were to: (1) determine Abnl-GT prevalence and etiology; (2) assess by Abnl-GT etiology, associations between four understudied subclinical CVD risk factors in Africans: (a) subclinical myocardial damage (high-sensitivity troponin T (hs-cTnT)); (b) neurohormonal regulation (N-terminal pro-Brain-natriuretic peptide (NT-proBNP)); (c) coagulability (fibrinogen); (d) inflammation (high-sensitivity C-reactive protein (hsCRP)), as well as HbA1c, Cholesterol/HDL ratio and VAT. Glucose tolerance status was determined by the OGTT. IR was defined by the threshold at the lowest quartile for the Matsuda Index (≤ 2.97). Abnl-GT-IR required both Abnl-GT and IR. Abnl-GT-β-cell-failure was defined as Abnl-GT without IR. VAT was assessed by CT-scan. For both the Abnl-GT-β-cell-failure and Abnl-GT-IR groups, four multiple regression models were performed for hs-cTnT; NT-proBNP; fibrinogen and hsCRP, as dependent variables, with the remaining three biomarkers and HbA1c, Cholesterol/HDL and VAT as independent variables. Abnl-GT occurred in 38% (170/450). In the Abnl-GT group, β-cell failure occurred in 58% (98/170) and IR in 42% (72/170). VAT and Cholesterol/HDL were significantly lower in Abnl-GT-β-cell-failure group vs the Abnl-GT-IR group (both P < 0.001). In the Abnl-GT-β-cell-failure group: significant associations existed between hscTnT, fibrinogen, hs-CRP, and HbA1c (all P < 0.05), and none with Cholesterol/HDL or VAT. In Abnl-GT-IR: hs-cTnT, fibrinogen and hsCRP significantly associated with Cholesterol/HDL (all P < 0.05) and NT-proBNP inversely related to fibrinogen, hsCRP, HbA1c, Cholesterol/HDL, and VAT (all P < 0.05). The subclinical CVD risk profile differed between Abnl-GT-β-cell failure and Abnl-GT-IR. In Abnl-GT-β-cell failure subclinical CVD risk involved subclinical-myocardial damage, hypercoagulability and increased inflammation, but not hyperlipidemia or visceral adiposity. For Abnl-GT-IR, subclinical CVD risk related to subclinical myocardial damage, neurohormonal dysregulation, inflammation associated with hyperlipidemia and visceral adiposity. ClinicalTrials.gov Identifier: NCT00001853.
Background: In African populations, attitudes towards both optimal body size and healthful weights are evolving. Due to the adverse effect of obesity on health, larger body sizes are beginning to be seen as less ideal. Our goal was to determine body size satisfaction in African immigrants who were obese. Methods: The participants were 326 African-born Blacks enrolled in the Africans in America cohort and living in metropolitan Washington DC (female: 39%, age 40±11y (mean±SD). The African region of origin of the participants were: West: 49% (161/326), Central 12% (39/326) and East: 39% (126/326). Twenty-seven percent (89/326) of the countries of origin were francophone. Enrollees were asked to rank their current body size and ideal body size according to the Stunkard Figure Rating Scale. Body size satisfaction was determined by the difference between perceived and wish body size. Results: BMI was higher in women than men (29.1±4.9 vs. 27.0±3.9 kg/m 2 , P<0.001). The overall prevalence of obesity was 27% (88/326) and higher in women than men (38% vs 20%, P=0.001). Among participants with obesity, there was no difference by sex in degree of dissatisfaction due to high body size (OR 2.14, 95% CI: 0.48, 9.58, P=0.32). Attitudes towards body size in participants with obesity were: 1% (1/88) considered themselves too small, 8% (7/88) just right and 91% (80/88) too large (Figure). These results did not vary by African region of origin or francophone status. Conclusions: The majority of African immigrants with obesity were dissatisfied with their high BMI. To optimize health, risk factors associated with weight gain and body size dissatisfaction should be addressed.
Introduction: Beyond the challenge of changing countries, cultures and continents, African-born Blacks living in the United States must cope with the stress of daily life. We assessed daily life stress and evaluated the influence of sleep as well as key socioeconomic and behavioral factors in 156 African-born Blacks (Age: 40±10y (mean±SD), BMI: 27.6±4.2 kg/m 2 , Male: 60%) who came to the United States as adults (≥age 18y). Methods: Daily life stress was assessed with the Perceived Stress Scale 10 (PSS) (range 0 to 40). Stressed was defined as the PSS threshold at the upper quartile for the population distribution (≥16) and Non-Stressed as PSS<16. Sleep was assessed with the Pittsburgh Sleep Quality Index (PSQI) (range 0 to 21). Poor Sleep Quality was defined by traditional criteria, specifically PSQI>5. Logistic regression was used to determine the odds of being Stressed because of: Poor Sleep Quality, low income (<40k/y), no health insurance, no college degree, no life partner, smoking, alcohol consumption, sedentary behavior and United States residency≥10y. Results: In the Stressed vs. Non-Stressed, PSS were: 21±4 vs. 9±4, P <0.001 and PSQI were: 6±3 vs. 4±3, P <0.001, respectively. The Pearson correlation coefficient for the relationship between PSS and PSQI was: r=0.38, P <0.001. The odds of being Stressed were significant if income was low (OR 7.1, P <0.001), health insurance was absent (OR 4.7, P <0.001), the person had no life partner (OR 2.5, P =0.017), or was a smoker (OR 5.6, P =0.023). United States residence≥10y tended to decrease the odds of being in the Stressed category (OR 0.5, P =0.058). Of note, the group with United States residence≥10y had a higher rate of income≥40k than the group with US residence<10y (71% vs. 32%, P <0.001). Conclusions: Daily life stress in African-born Blacks is closely tied to poor sleep quality and exacerbated by low income, lack of health insurance and no life partner. The decreased stress associated with longer duration of United States residence may be due to better economic status.
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