Diabetes mellitus in the black communities of Southern Africa

Joffe, B. I.; Seftel, H. C.

doi:10.1111/j.1365-2796.1994.tb01047.x

Cited by 27 publications

(21 citation statements)

References 30 publications

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“…Thus, the greater increase in visceral fat area and total FFA levels observed in the OWW may predispose these subjects to cardiovascular disease 4 whilst the more pronounced decrease in glucose tolerance in the OBW may predispose this population to type 2 diabetes. 6 In summary, this study demonstrates a negative association between adiposity and glucose oxidation rates and furthermore, OBW may experience suppression of glucose oxidation at a lower level of plasma FFA than OWW. The former group also have poorer suppression of early postprandial FFA concentrations than OWW whilst the OWW have higher late postprandial FFA levels than the OBW.…”

Section: Discussionmentioning

confidence: 52%

“…1 The prevalence of both diseases is increasing within the black population of South Africa in conjunction with increased industrialisation and acculturation in Africa in general. 2,3 Epidemiological studies have shown that the prevalence of certain obesity-related disorders differs between black and white urban women in South Africa: mortality from ischaemic heart disease is very rare in obese black South Africans (8a100 000 vs 55a100 000), 4 whilst hypertension (30 vs 15%) 5 and type 2 diabetes (7.0 vs 3.6%) 6 are more common. Therefore, a greater understanding is required of the biochemical mechanisms mediating the relationship between obesity and associated disorders within these two populations.…”

Section: Introductionmentioning

confidence: 99%

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Weight-related differences in glucose metabolism and free fatty acid production in two South African population groups

et al. 2001

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OBJECTIVE:The effects of free fatty acids (FFA), leptin, tumour necrosis factor (TNF) a and body fat distribution on in vivo oxidation of a glucose load were studied in two South African ethnic groups. DESIGN AND MEASUREMENTS: Anthropometric and various metabolic indices were measured at fasting and during a 7 h oral glucose tolerance test (OGTT). Body composition was measured using bioelectrical impedance analysis and subcutaneous and visceral fat mass was assessed using a ®ve-and two-level CT-scan respectively. Glucose oxidation was evaluated by measuring the ratio of 13 CO 2 to 12 CO 2 in breath following ingestion of 1-13 C-labelled glucose. SUBJECTS: Ten lean black women (LBW), ten obese black women (OBW), nine lean white women (LWW) and nine obese white women (OWW) were investigated after an overnight fast. RESULTS: Visceral fat levels were signi®cantly higher (P`0.01) in obese white than black women, despite similar body mass indexes (BMIs). There were no ethnic differences in glucose oxidation however; in the lean subjects of both ethnic groups the area under the curve (AUC) was higher than in obese subjects (P`0.05 for both) and was found to correlate negatively with weight (r 70.69, P`0.01) after correcting for age. Basal TNFa concentrations were similar in all groups. Percentage suppression of FFAs at 30 min of the OGTT was 24 AE 12% in OWW and 738 AE 23% (P`0.05) in OBW, ie the 30 min FFA level was higher than the fasting level in the latter group. AUC for FFAs during the late postprandial period (120 ± 420 min) was signi®cantly higher in OWW than OBW (P`0.01) and LWW (P`0.01) and correlated positively with visceral fat mass independent of age (r 0.78, P`0.05) in the OWW only. Leptin levels were higher (P`0.01) both at fasting and during the course of the OGTT in obese women from both ethnic groups compared to the lean women. CONCLUSIONS: Glucose oxidation is reduced in obese subjects of both ethnic groups; inter-and intra-ethnic differences were observed in visceral fat mass and FFA production and it is possible that such differences may play a role in the differing prevalences of obesity-related disorders that have been reported in these two populations.

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Section: Discussionmentioning

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Weight-related differences in glucose metabolism and free fatty acid production in two South African population groups

et al. 2001

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“…This association was evidenced, with a predominance of insulin secretory defect in metabolic studies of atypical diabetes [1,2,9]. Predominant insulin secretory defect is known to be a feature of Type II diabetes in populations of African ancestry [14,15].…”

Section: For Debatementioning

confidence: 99%

Adult-onset idiopathic Type I or ketosis-prone Type II diabetes: evidence to revisit diabetes classification

Sobngwi

Gautier

2002

Diabetologia

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“…1,2 Moreover, the urban obese BW, who are as Westernized in diet and lifestyle as the white women (WW), more commonly present with hypertension (30% vs 15%) 2 and non-insulin-dependent diabetes mellitus (7% vs 3.6%). 3,4 The lower incidence 5 and mortality from ischemic heart disease in the BW (8a100,000 compared with 55a100,000 in the WW), 6 may be partly caused by a more favorable lipid pro®le, 7,8 but could also be related to other factors that have not yet been identi®ed. Our group has recently shown that obesity in our BW is not as benign 9 as has previously been suggested.…”

Section: Introductionmentioning

confidence: 99%

Evidence for insulin resistance in black women from South Africa

et al. 2000

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OBJECTIVE: The rate of glucose disposal was determined in 10 black and 10 white obese nondiabetic urban women from South Africa to assess insulin resistance. DESIGN AND METHODS: Euglycemic hyperinsulinemic clamp and body composition analysis. RESULTS: Age, body mass index (BMI), anthropometric measurements and body composition were similar in both groups of women. A ®ve-level computed tomography (CT) scan showed a similar mean subcutaneous fat mass in both groups of women (black obese women 555 AE 9.0 vs white obese women 532 AE 6.0 cm 2 ), but less visceral fat in black obese women (90 AE 3.0 vs 121 AE 3.1 cm 2 ; P`0.05). Black obese women had higher fasting free fatty acid (997 AE 69 vs 678 AE 93 m mmolal; P`0.05) and lactate concentrations (1462 AE 94 vs 1038 AE 39 m mmolal; P`0.05), but lower fasting insulin levels (87 AE 12 vs 155 AE 9 pmolal; P`0.001). Black obese women also had a more favorable HDL: total cholesterol ratio (30.5% vs 23.0%; P`0.04). The mean glucose disposal rate (M) and disposal expressed as glucose sensitivity index (MaI) were reduced in the black obese women vs white obese women (M: 7.1 AE 0.8 vs 13.7 AE 1.0 mmolakg Á min À1 Â100; P`0.01, and MaI: 0.12 AE 0.01 vs 0.24 AE 0.02 mmolakg Á min À1 apmolal Â1000; P`0.01). Only black obese women showed a signi®cant decrease in C-peptide levels during the clamp (2.9 AE 0.22 vs 1.2 AE 0.12 nmolal; P`0.001). During the euglycemic period, the black obese women had higher lactate levels at all time points, but only the white obese women had increased lactate levels (918 AE 66 to 1300 AE 53 m mmolal; P`0.05). CONCLUSION: Black obese women demonstrate a higher degree of insulin resistance, despite less visceral fat and a higher HDL: total-cholesterol ratio. In addition, endogenous b b-cell secretory function in black obese women appears to be more sensitive to the suppressive effect of exogenous insulin administration. The signi®cant increase in lactate levels in white obese women con®rms that they are more insulin sensitive.

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Diabetes mellitus in the black communities of Southern Africa

Cited by 27 publications

References 30 publications

Weight-related differences in glucose metabolism and free fatty acid production in two South African population groups

Weight-related differences in glucose metabolism and free fatty acid production in two South African population groups

Adult-onset idiopathic Type I or ketosis-prone Type II diabetes: evidence to revisit diabetes classification

Evidence for insulin resistance in black women from South Africa

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