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: Sub-Saharan Africa has the highest percentage of people in the world living with diabetes who are undiagnosed. To avoid end-organ damage, identification of undiagnosed diabetes needs prioritization. Glucola (75g glucose) used for the oral glucose tolerance test (OGTT) is expensive and rarely available in sub-Saharan Africa. Due to hemoglobinopathies, G6PD deficiency, and challenges associated with fasting, both A1C and fasting plasma glucose (FPG) may be diagnostically unreliable. As an alternative to the OGTT, we developed the Pastry Sugar Tolerance Test (PSTT). For the PSTT, pastry sugar (75g glucose powder) is dissolved in hot water. Pastry sugar is more widely available in sub-Saharan Africa and nine times less expensive than Glucola. Objective: Our goals were to determine the diagnostic agreement for the detection of diabetes between the OGTT and: (1) PSTT, (2) A1C and (3) FPG. Methods: The participants were 36 African-born Blacks enrolled in the Africans in America study (male: 67%; age: 42±10y (mean±SD); BMI: 28.5±5.2 kg/m2). At Visit 1, each enrollee had an OGTT, A1C and FPG. At Visit 2, which occurred 8±3 days after Visit 1, a PSTT was performed. Glucose tolerance status was based on glucose results from the OGTT. The kappa-statistic was used to determine the diagnostic agreement between the OGTT and each of the following: PSTT, A1C and FPG. Results: Based on the OGTT, diabetes, prediabetes and normal glucose tolerance occurred in 11%(4/36), 33%(12/36) and 56%(20/36) resp. For diabetes, diagnostic agreement between the OGTT and PSTT was excellent (κ=0.99) but much lower for the OGTT and A1C (κ=0.64) and the OGTT and FPG (κ=0.38) (Figure). Conclusions: This pilot study has revealed that for diabetes screening, the PSTT has excellent diagnostic agreement with the OGTT, is less expensive than the OGTT, and is more accurate than A1C or FPG.
As the insulin assay is expensive and often unavailable in low income countries, the triglyceride-glucose index (TyG) is undergoing global evaluation as both a surrogate marker of insulin resistance (IR) and predictor of cardiovascular disease (CVD). Yet the value of the TyG in African-born populations is uncertain. Therefore, in 555 African-born Blacks currently living in the Washington, DC area (Age: 39±0.4y (mean±SE), Male: 65% (358/555), BMI: 27.7±0.2 kg/m2) we determined: 1) ability of TyG to predict the presence of IR; and 2) correlations between TyG and four lipid parameters, specifically HDL-C and LDL-C, LDL-particle size and LDL-number. Fasting lipid profiles and OGTT were performed. IR was defined by the lowest quartile of the Matsuda Index (≤2.85). Ability of TyG to predict IR was assessed with AUC-ROC curve. Pearson correlations were performed between the lipids and both TyG and Matsuda Index. Diabetes, prediabetes and normal glucose tolerance occurred in 7% (37/555), 31% (173/555) and 62% (345/555) resp. AUC-ROC for the prediction of IR by TyG was 0.75±0.02. Correlations between the lipids and both TyG and Matsuda Index were highly significant (Table). But correlations with each lipid were stronger with TyG than Matsuda Index. Overall, TyG is marker of IR in Africans and may be better than Matsuda Index in predicting CVD because of stronger correlations with atherogenic lipids. Disclosure C.Worthy: None. J.Gatete: None. J.Hurston: None. B.R.Schenk: None. L.Mabundo: None. C.Dubose: None. R.Jagannathan: None. A.E.Sumner: None.
A1C represents glycated hemoglobin A and is a non-fasting measure of average glycemia which has been used since 2010 to diagnose abnormal glucose tolerance (Abnl-GT) (a summary term for diabetes and prediabetes). However, A1C may not correlate with average glucose in the presence of anemia, G6PD deficiency and certain hemoglobinopathies. Two non-fasting markers of glycemia which have been proposed as alternatives to A1C are fructosamine (FA) and glycated albumin (GA). FA is a measure of all plasma glycated proteins. Whereas GA is a subfraction of FA. Emerging data suggests that in the diagnosis of Abnl-GT, GA is superior to FA. Critical to the value of a diagnostic test is assessing reproducibility. Therefore, we examined the reproducibility of A1C, FA and GA by performing all three tests 9±4d (mean±SD) apart in 209 African-born Blacks living in the Washington, DC area. Diagnostic sensitivity of A1C, FA and GA for the detection of Abnl-GT was determined by thresholds at the upper quartile of each, specifically ≥5.7%, 235 umol/L and 14.6%, respectively. A1C was assessed by high performance liquid chromatography, FA by colorimetric nitroblue tetrazolium assay and GA by enzymatic assay. Coefficients of variation (CV) were calculated. Kappa statistic (k-statistic) was used to measure diagnostic reproducibility. Strength of agreement by k-statistic is: slight: 0.0 to 0.20, fair: 0.21-0.40, moderate: 0.41-0.60, substantial: 0.61-0.80; excellent: 0.81-1.0. The CV for A1C, FA and GA were: 2%, 3% and 2% respectively, and the k-statistics were: 0.86, 0.59, 0.89 respectively. In short, the diagnostic agreement between A1C and GA on different days was excellent but only moderate for FA. This may explain why GA appears to be a better measure of Abnl-GT than FA. Variation in FA may be greater than the variation in GA because FA encompasses all plasma proteins rather than specifically albumin. Disclosure J.Gatete: None. B.R.Schenk: None. J.Hurston: None. C.Dubose: None. L.Mabundo: None. C.Worthy: None. R.Jagannathan: None. D.B.Sacks: Other Relationship; Sebia, Trinity. A.E.Sumner: None.
Achieving early diagnosis of type 2 diabetes (T2D) in Africans is challenging. The Glucola used in the OGTT is expensive and unavailable in most African countries. Alternatives to the OGTT are fasting plasma glucose (FPG) and A1C, but they have a low diagnostic sensitivity in Africans. As an alternative to the Glucola (75g glucose) used in the OGTT, we developed the Pastry Sugar Tolerance Test (PSTT) with pastry sugar (75g glucose powder) dissolved in hot water. Pastry sugar is inexpensive and widely available in Africa. Hence, our aim was to determine the diagnostic agreement between (1) OGTT and PSTT; (2) OGTT and A1C; (3) OGTT and FPG in the detection of T2D in 48 African-born Blacks living in America (male: 67%; age: 41±10y (mean±SD)). At Visit 1, an OGTT, A1C and FPG were performed. At Visit 2, which occurred 8±3 days later, a PSTT was performed (Fig). ADA criteria were used for the OGTT, A1C≥6.5% and FPG≥126 mg/dL. Agreement between tests was determined by κ-statistic. T2D, prediabetes and normal glucose tolerance occurred in 8% (4/48), 31% (15/48) and 61% (29/48), resp. All individuals with T2D were detected by both the OGTT and PSTT (κ=0.99). Yet, A1C only detected 50% (2/4) (κ=0.65), and FPG only detected 25% (1/4) (κ=0.38) of Africans with T2D. This pilot study suggests that in the detection of T2D, agreement between the PSTT and the OGTT may be both excellent and superior to A1C and FPG. Disclosure B.R.Schenk: None. A.E.Sumner: None. J.Hurston: None. J.Gatete: None. C.Dubose: None. L.Mabundo: None. S.Yang: None. C.Worthy: None. A.B.Courville: None. R.Jagannathan: None.
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