Increase in prevalence of obesity and diabetes and decrease in plasma cholesterol in a central Australian Aboriginal community

Abstract

Objective: To document change in prevalence of obesity, diabetes and other cardiovascular diease (CVD) risk factors, and trends in dietary macronutrient intake, over an eight-year period in a rural Aboriginal community in central Australia.Design: Sequential cross-sectional community surveys in 1987, 1991 and 1995. Subjects: All adults (15 years and over) in the community were invited to participate. In 1987In , 1991 (87% of eligible adults), 331 (76%) and 304 (68%), respectively, were surveyed.Main outcome measures: Body mass index and waist: hip ratio; blood glucose level and glucose tolerance; fasting total and high density lipoprotein (HDL) cholesterol and triglyceride levels; and apparent dietary intake (estimated by the store turnover method).Intervention: A community-based nutrition awareness and healthy lifestyle program, 1988-1990.Results: At the eight-year follow-up, the odds ratios (95% Cis) for CVD risk factors relative to baseline were obesity, 1.84 (1.28-2.66); diabetes, 1.83 (1.11-3.03); hypercholesterolaemia, 0.29 (0.2CH>.42); and dyslipidaemia (high triglyceride plus low HDL cholesterol level), 4.54 (2.84-7.29). In younger women (15-24 years), there was a trebling in obesity prevalence and a four-to fivefold increase in diabetes prevalence. Store turnover data suggested a relative reduction in the consumption of refined carbohydrates and saturated fats. Conclusion:Interventions targeting nutritional factors alone are unlikely to greatly alter trends towards increasing prevalences of obesity and diabetes. In communities where healthy food choices are limited, the role of regular physical activity in improving metabolic fitness may also need to be emphasised.

Evidence for low high-density lipoprotein cholesterol levels in Australian indigenous peoples: a systematic review

“…All were cross-sectional assessments taken at a single time point, except one [22], where three sequential cross-sectional surveys were undertaken across a single community (1987, 1991 and 1995). Here, because retention rates varied across sex and age group, and cases were not matched across time points; data from each year were extracted and presented separately.…”

“…Only three studies had fewer females than males: 39% [9]; 48% [36]; and 49% [32], while in all other studies the proportion of females ranged from 54-86%. Although some study response rates were low (down to 14%) [34,35], six of 15 studies reported response rates ≥ 80% [9,23,33,37-39] and one study reported response rates of between 57-97%, depending on survey year [22]. Two studies did not report a response rate [20,24] and in another, data were retrieved from medical records so that a community response rate was not applicable [33].…”

“…Two studies did not report a response rate [20,24] and in another, data were retrieved from medical records so that a community response rate was not applicable [33]. Another study reported male and female response rates separately; these varied from 53% (males, 1995) to 96% (females, 1989) [22]. Included studies were conducted between 1987-2008.…”

“…A score of 10 points was considered very high quality; 8–9 high quality; 7–6 moderate quality; and < 5 low quality. Different surveys reported in a single study [22] were assessed separately. HDL-C data from the 2000 AusDiab study [31] - a national randomized cluster study- provided the non-Indigenous, Australian population reference.…”

“…In 1979 very low mean HDL-C levels (0.85 mmol/L) were reported from a small, rural- Western Australian cohort of young Aboriginal men (<35 years of age) [26] and from a rural community in central Australia, where mean HDL-C levels decreased over an eight year period as obesity and diabetes prevalence increased [22]. Using the same criteria, a recent report determined low HDL-C prevalence in a national Indigenous cohort as 70.2% [27].…”