Objective-To examine the hypothesis, in a community not studied before, that insulin resistance associated with centralised adiposity is the mechanism underlying the predisposition of Asian immigrant communities to both ischaemic heart disease and diabetes mellitus.Design-Cross sectional study within one socioeconomic stratum.Setting-Two factories in the textile sector in Bradford, West Yorkshire.Subjects-Male manual workers of Asian (110) and non-Asian origin (156) aged 20-65 years.Results-Diabetes was almost three times more prevalent in the Asian group. Two hours after an oral glucose load Asian men had double the serum insulin concentrations of non-Asian men (p < 0 0001). Asian men also had significantly lower concentrations of plasma total cholesterol (p < 0 03), high density lipoprotein cholesterol (HDL) (HDL2, p < 0-0001; HDL3, p < 0-0001), and apolipoprotein AI (p < 0 0001). Fasting plasma triglyceride concentrations were slightly higher (p = 0 072) in the Asian men; thus the ratio of triglyceride cholesterol was higher (p = 0 006). The interrelation between serum insulin and plasma lipid concentrations indicated metabolic differences between the ethnic groups. Insulin concentrations were associated with cholesterol concentrations in the Asian men only and there was a lack of association between triglyceride, low density lipoprotein cholesterol, and HDL cholesterol in this group. The risk marker profile in the Asian men was therefore quite different to that of their non-Asian counterparts and was associated with a greater tendency to centralised adiposity.Conclusion-These data support the insulin resistance hypothesis and thus have important implications for

As part of a study of risk markers for ischaemic heart disease in Bradford, dietary intakes were assessed for 286 male manual workers of Asian and Caucasian origins using a 3‐day diet diary and a food‐frequency questionnaire. Caucasian men were found to eat more variable diets, the choice of foods being partly dependent on the canteen facilities in the workplace. Processed meat products and sweet baked goods featured almost daily, whereas intake of fresh fruit and salads did not. Most Asian meals followed the traditional pattern of curry (lamb/mutton, chicken, vegetable and occasionally white fish) with chapatis and, less frequently, rice. Salad and yoghurt were often eaten with the curry and fresh fruit was frequently consumed after the meal. Such meals were consumed one or more times per day. Although overall vegetable consumption was of a similar frequency in both ethnic groups, the Asian men ate a greater variety. The frequency of ‘fried food’ consumption was similar for both Asian and Caucasian diets although different types of foods were consumed. These different dietary patterns were reflected in higher estimated intakes of protein and sugar amongst Caucasians and lower intakes of fibre, compared with Asian men. Total fat intakes and P:S ratios were highest in the Hindu group although both Caucasian and Asian men were estimated to consume more total fat than is currently recommended. The results of this study highlight the need for ‘healthy eating’ advice to be designed specifically for the ethnic group in question, rather than for general healthy eating messages to be translated into the appropriate language. Although conducted within one population only, this study should be of interest to all dietitians working in multi‐cultural communities.

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Activation of the hypothalamic-pituitary-adrenal axis leads to secretion of cortisol, which binds to peripheral glucocorticoid receptor and mediates a complex series of metabolic and immune effects. Cortisol also binds to receptors in the hypothalamus and pituitary, and inhibits further secretion of adrenocorticotropic hormone thus preventing an excessive response. Excess glucocorticoid effect is seen in Cushings disease, adrenal adenomas/carcinomas and in glucocorticoid resistance. Within such pathology there are health consequences of excessive glucocorticoid action, including obesity, hypertension, and glucose intolerance or diabetes. We hypothesized that increased glucocorticoid receptor in peripheral tissue might mediate an excess glucocorticoid effect in the absence of increased cortisol secretion. The objective of the study was to investigate the relationship between glucocorticoid receptor density in leukocytes and health risk indices relevant to obesity and diabetes in a sample of Caucasian and African American subjects. Comparison of glucocorticoid receptor concentration with subject body mass index, percentage body fat, waist circumference, insulin resistance, plasma cortisol levels, gender, and lipid profiles were conducted. Increased glucocorticoid receptor density significantly correlated with body mass index, percentage body fat, waist circumference, and insulin resistance. No significant correlation was observed for glucocorticoid receptor density with lipid profiles. Furthermore, no significant differences were observed in glucocorticoid receptor density between Caucasian and African American subjects or male and female participants. Our results show that high risk health conditions, such as obesity and type-2 diabetes, may be associated with a form of hypothalamic-pituitary-adrenal axis dysfunction, characterized by localized leukocyte glucocorticoid receptor over-expression.

Background Screening for cognitive impairment is required at Medicare Annual Wellness Visits (AWV). Subjective or objective methods are suggested, but there is no one screening tool specified by Centers for Medicare and Medicaid Services (CMS). We assessed screening methods, its outcomes, and potential disparities in cognitive screening at AWV. Method Retrospective chart reviews were done for 1,493 adults 55+ who had initial AWV at a single academic medical center ambulatory site between January 2011 and March 2017. Demographics, assessment type, and positive screens noted by provider were collected. Subjective assessments were by history/direct observation alone. Objective assessments are noted in Table 1. Multiple logistic regression with stepwise variable selection via AIC were done. Results Mean age was 73.6 years (SD=7.9); 828 (55.5%) were female; 1191 (79.8%) were white (Table 2). 1,311 were screened for cognitive impairment, 120 were not screened, and 62 had an established diagnosis. Of those screened, 87.5% were screened using objective methods; greater age (p<0.001), African American race as compared to white race (p<0.001), and non‐English primary language (p=0.03) were associated with increased probability of positive screens. In subjective screening (n=163), speaking a non‐English primary language was associated with higher probability of positive screening (p = 0.04). In patients with positive screens through any method, 41 had no further cognitive assessment planned, 19 had plans for follow‐up, 15 were referred to neurology. Conclusion AWV are an opportunity to screen for underdiagnosed cognitive impairment. Clinicians in our study used a myriad of tests, despite each test’s unique limitations. Greater age, African American race, non‐English primary language being associated with increased probability of positive objective screening is consistent with the literature. In subjective screenings, patients with non‐English primary language were more likely to screen positive, suggesting that in AWV, non‐English speaking patients may be at a disadvantage for standard cognitive screening. Despite positive cognitive screening, the majority had no further cognitive assessment planned during the visit. Our study suggests that more research should focus on a standardized cognitive screening and decision making after a positive cognitive screening at AWV.