Migrating Populations and Health: Risk Factors for Cardiovascular Disease and Metabolic Syndrome

Abstract

Purpose of ReviewTo summarize results of recent studies of migrants in Europe and North America and ongoing efforts to adapt strategies to provide them with inclusive sensitive health care. Recent Findings Major predisposing factors for developing hypertension, obesity, diabetes, and the metabolic syndrome in migrating populations and refugees were identified. Susceptibility to the metabolic syndrome is predominantly due to environmental factors and psychological stress. Acculturation also contributes to the emergence of cardiovascular (CV) risk factors in first-generation adult immigrants. Increased risk for later development of hypertension and dyslipidemia has also been detected in adolescent immigrants. Targets for public health efforts were based on data that show important differences in CV risk factors and prevalence of the metabolic syndrome among ethnic immigrant groups. Studies in young adults focused on lifestyle and dietary behaviors and perceptions about weight and body image, while the focus for older adults was end-of-life issues. Summary Two important themes have emerged: barriers to health care, with a focus on cultural and language barriers, and violence and its impact on immigrants' mental health.

SCORE2 cardiovascular risk prediction models in an ethnic and socioeconomic diverse population in the Netherlands: an external validation study

“…The observed differences, however, could still be the result of differences in traditional risk factors (such as diabetes, smoking and hypertension), driving the higher observed risks in these subgroups. 5 , 10 , 15 , 16 , 17 , 18 …”

Hyperlipidaemia and Weight Amongst Afghani Refugees Attending a General Practice Clinic in Regional Australia

“…A similar phenomenon is seen in immigrants [15] however the rate of weight gain in immigrants is slower than in refugee populations and rates of overweight/obesity in immigrants approximate rather than exceed the host population. Additionally migrants have lower rates of metabolic disease compared to non-migrants [16] despite their increasing BMI ("the healthy immigrant effect") whereas refugees have increased rates of obesity-related chronic disease compared to non-refugees with some studies finding a greater burden of obesity-related disease than would be expected for the BMI suggesting that weight gain potentially confers greater metabolic risk in this population than in others [17]. These differences between refugees and migrants suggests there may be factors in the refugee experience beyond migration that increases risks of obesity and obesity-related disease.…”

The mortality risk after myocardial infraction in migrants compared with natives: a systematic review and meta-analysis

“…Furthermore, the advantages of the healthy migrant effect in migrants disappear over time, often 5–10 years after immigration, and the health status of migrants is equal to or worse than that of natives ( 7 , 43 , 54 ). For example, cultural adaptation leads to lifestyle changes, including changes in physical activity levels and diet, resulting in increased rates of hypertension, obesity, and diabetes in migrants ( 55 ), which are traditional risk factors for MI. Over time, the adverse effects of these disadvantages accumulate, leading to a poorer prognosis for migrants compared to natives.…”