Diabetes in the Caribbean: results of a population survey from Spanish Town, Jamaica

Wilks, Rainford; Rotimi, Charles N.; Bennett, Franklyn I.; McFarlane-Anderson, N.; Kaufman, Jay S.; Anderson, S. G.; Cooper, Richard S.; Cruickshank, J.; Forrester, Terrence

doi:10.1046/j.1464-5491.1999.00151.x

Cited by 71 publications

(74 citation statements)

References 31 publications

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“…Even then, overweight and obesity were observed in our study sample, consistent with previous reports conducted in larger samples from other Caribbean Islands (36)(37)(38). Furthermore, we did not ascertain the family history of the subjects who participated in the laboratory studies, although the offspring of Caribbean patients with type 2 diabetes have been shown to have increased insulin resistance and cardiovascular risk factors compared with subjects with no family history of diabetes (15,39).…”

Section: Discussionsupporting

confidence: 86%

Indices of obesity, dyslipidemia, and insulin resistance in apparently healthy Caribbean subjects

Ezenwaka

Kalloo

2003

Clinical Laboratory Analysis

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Reports from developing countries indicate that a rise in the socioeconomic level is a risk factor for metabolic disorders. We aimed to assess the indices of obesity, dyslipidemia, and insulin resistance among fairly literate healthy adults in a multidisciplinary institution in Trinidad. The study included 156 volunteers (46 males and 110 females, 17-40 years old). The subjects provided information on age, ethnicity, educational attainment, and occupation in self-administered, closed-ended questionnaires. Waist and hip circumferences (cm), weight (kg), and height (m) were measured. Fasting blood samples were taken for glucose, insulin, and lipid determinations in 78 subjects who volunteered for laboratory measurements. Insulin resistance was determined with homeostasis model assessment (HOMA). Of the 156 subjects studied, 83% had received tertiary education, and had no previous record of body mass index (BMI); 8% were obese, 17% were overweight, and 27% were underweight. Laboratory measurements in 78 subjects revealed 28% hypercholesterolemia and 20% hyperinsulinemia. There were no significant gender-related differences in these prevalence rates (P>0.05). The identification of obesity, underweight, hyperinsulinemia, and hypercholesterolemia in this healthy population suggests that screening for the indices of metabolic disorders in a healthy population would be potentially useful for the early identification and treatment of metabolic-related disorders.

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Section: Discussionsupporting

confidence: 86%

Indices of obesity, dyslipidemia, and insulin resistance in apparently healthy Caribbean subjects

Ezenwaka

Kalloo

2003

Clinical Laboratory Analysis

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“…18 The prevalence of the T594M allele was 6.2% (103 heterozygotes), similar to the frequency observed in the DHS cohort. Mean BP was indistinguishable between the subjects with and without the T594M allele in this population (Table 2).…”

Section: Association Of T594m Allele With Hypertension In Jamaican Sasupporting

confidence: 80%

Epithelial Sodium Channel Allele T594M Is Not Associated With Blood Pressure or Blood Pressure Response to Amiloride

et al. 2006

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Abstract-The T594M allele of the epithelial sodium channel ␤-subunit has been proposed as a gain-of-function mutation leading to salt-sensitive hypertension in blacks that is particularly responsive to the specific sodium channel antagonist amiloride. However, the positive associations derive from small convenience samples, and the amiloride challenge study lacked a control group. We determined whether the T594M allele was associated with hypertension and blood pressure (BP) response to amiloride in 2 well-characterized random population samples including 3137 Dallas County subjects and 1666 Jamaican blacks. In multivariate models, the T594M allele was not predictive of systolic BP (adjusted odds ratio for hypertension 1.1; 95% confidence interval, 0.7 to 1.8). Amiloride treatment did not lower the BP of 6 T594M heterozygotes significantly more than in 22 control subjects (Pϭ0.8). We conclude that the T594M allele does not contribute significantly to BP in blacks and does not predict a significantly superior response to amiloride therapy. Key Words: hypertension, genetic Ⅲ ion channels Ⅲ sodium P eople of African descent are particularly susceptible to developing salt-sensitive hypertension, but the molecular mechanisms are poorly understood. The renal epithelial sodium channel (ENaC) constitutes the final common pathway for the reabsorption of the final 2% of filtered sodium from the distal nephron. A missense mutation in the ␤-subunit of the human ENaC gene (T594M allele of SCNN1B or ␤-ENaC) has been found only in persons of African descent and has been implicated as a gain-of-function mutation causing impaired renal sodium excretion and salt-sensitive hypertension. 1-3 The allele was found to be present in 6% of blacks overall and to be highly enriched in a hypertensive clinic population compared with normotensive controls. 2 Additional evidence for an association with hypertension was reported in a larger clinic population. 4 However, the enthusiasm generated from these positive association studies 2,4,5 has been tempered by independent reports that failed to confirm such an association. 6,7 The conflicting data surrounding this allele might derive from inadequate sample size, sampling biases inherent in clinic populations, the variability in resting blood pressure (BP) over time, confounding effects of drug treatment, and the multiplicity of environmental exposures and signaling pathways involved in the regulation of resting BP.The BP responsiveness to certain drugs, which predominately target a single BP-regulating pathway, might link more directly with the genetic underpinnings of hypertension than resting BP alone. The potassium-sparing diuretic amiloride, a specific ENaC antagonist, is normally a weak antihypertensive agent but has been proposed as the ideal treatment for hypertension in blacks carrying the T594M allele. 3 In a study of 14 T594M heterozygotes with mild-to-moderate hypertension, amiloride monotherapy was as effective in controlling BP as usual empiric combination therapy with 2 or 3 stan...

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“…A study conducted in 2000 projects that the worldwide T2DM estimated prevalence of 2.8% will rise to 4.4% by 2030 (1). Diabetes is more common in certain ethnic groups, namely Blacks (2) and Hispanics (3); therefore, many countries in Latin America show a high or rising prevalence of T2DM (4,5). Despite evidencebased clinical recommendations and guidelines for the Region of the Americas on diabetes care, significant delivery barriers have been identified by studies in Brazil (6), Chile (7), Jamaica (8), and Mexico (9).…”

mentioning

confidence: 99%

Control of type 2 diabetes mellitus among general practitioners in private practice in nine countries of Latin America

Stewart¹,

Tambascia²,

Guzmán³

et al. 2007

Rev Panam Salud Publica

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Diabetes in the Caribbean: results of a population survey from Spanish Town, Jamaica

Cited by 71 publications

References 31 publications

Indices of obesity, dyslipidemia, and insulin resistance in apparently healthy Caribbean subjects

Indices of obesity, dyslipidemia, and insulin resistance in apparently healthy Caribbean subjects

Epithelial Sodium Channel Allele T594M Is Not Associated With Blood Pressure or Blood Pressure Response to Amiloride

Control of type 2 diabetes mellitus among general practitioners in private practice in nine countries of Latin America

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