The prevalence of diabetes in the rural and urban Polynesian population of Western Samoa

One of the first people to introduce the metabolic syndrome -or trisyndrome mé tabolique -in the scientific literature was Camus in 1966 [1]. However, this entity did not receive much interest until Reaven in 1988 introduced syndrome X, characterised by hypertension, impairment in glucose and lipid metabolism and insulin resistance [2]. The metabolic syndrome -also called the insulin resistance syndrome -is a multifaceted syndrome characterised by five major abnormalities: obesity, hypertension, insulin resistance, glucose intolerance (impaired glucose tolerance/non-insulin-dependent diabetes mellitus (NIDDM)), and dyslipidaemia (hypertriglyceridaemia and low HDL-cholesterol). In addition, a number of other abnormalities such as microalbuminuria, hyperuricaemia, hyperfibrinogenaemia and increased levels of plasminogen activator inhibitor I and low concentrations of tissue plasminogen activator are often associated with the syndrome. The clinical importance of the metabolic syndrome is mainly due to the clustering of simultaneously occurring atherosclerotic risk factors in the same individual [2][3][4][5][6][7][8][9].The aetiology of the metabolic syndrome is poorly understood; both genetic and environmental factors are involved [2][3][4][5][6][7][8][9]. Possible common denominators for the various components of the syndrome are not known, although hyperinsulinaemia/insulin resistance are important characteristics in most of the abnormalities.The prevalence rate of the metabolic syndrome varies depending on the population studied and the definition applied. As in any syndrome, not all features are present in the same individual. The estimated prevalence rate of the metabolic syndrome in western countries is 25-35 % [2-9]. On the other hand, both Ferrannini and Rupp [8, 9] have reported that only about one-third of an adult study population was free of all major characteristics of the metabolic syndrome. Since the prevalence of hypertension, insulin resistance and glucose intolerance usually increase with increasing age, the prevalence of the metabolic syndrome will probably also rise in the aging western society.A number of pharmacological therapies can be used for the treatment of the metabolic syndrome; but the results of most of the available therapies are often unsatisfactory, although some trials with metformin and thiazolidinediones have been encouraging [6, 10, 11].Low levels of physical activity are related to most components of the metabolic syndrome [12][13][14][15][16]. Consequently this offers a unique opportunity to employ increased physical activity in the prevention and treatment of the metabolic syndrome and its components. This review will focus on the role of physical activity and exercise in the prevention and treatment of the metabolic syndrome. ObesityThe prevalence of obesity (body mass index (BMI) > 27 kg/m 2 ) is currently 25-35 % in most western societies, and is increasing [17]. If the prevalence continues to increase, as during the past decades, by the year 2230, 100 % of the adult Uni...

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“…Consequently the beneficial effects of exercise and physical activity in prevention of NIDDM are numerous [120,121].…”

Section: Glucose Intolerancementioning

confidence: 99%

Exercise and the metabolic syndrome

1997

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“…Polynesian people have a high prevalence of obesityrelated health problems, 1 such as coronary heart disease, 2 non-insulin dependent diabetes mellitus 3 and hypertension. 4,5 The mean body mass index (BMI) in these populations is very high compared with those of European descent.…”

Section: Introductionmentioning

confidence: 99%

Body size and composition in Polynesians

et al. 1999

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OBJECTIVES: To compare the relationship between body size and body composition in New Zealanders of Polynesian and European descent and to develop speci®c regression equations for fat mass for Polynesians. SUBJECTS: 189 Maori (93 males, 96 females), 185 Samoans (88 males, 97 females) and 241 Europeans (89 males, 152 females) aged 20 ± 70 y. MEASUREMENTS: Height, weight, four skinfold thicknesses, bioelectrical impedance analysis (BIA) and dual energy X-ray absorptiometry (DXA). RESULTS: At higher body mass index levels, Polynesians (Maori and Samoans combined) had a signi®cantly higher ratio of lean mass : fat mass compared with Europeans. Four multiple regression equations incorporating resistance and reactance, height and weight, sum of four skinfolds or sum of two skinfolds were developed in two-thirds of the Polynesian participants using DXA fat mass as the dependent variable. In the remaining one-third of participants, the mean difference between fat mass predicted by these equations (r 2 range 0.89 ± 0.93) and DXA fat mass ranged from 7 0.06 to 0.25 kg (s.d. 7 3.67 to 3.71 kg). CONCLUSION: At higher BMI levels, Polynesians were signi®cantly leaner than Europeans, implying the need for separate BMI de®nitions of overweight and obesity for Polynesians. The regression equations using BIA, height and weight or skinfold thicknesses were good predictors of body composition in Polynesians.

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“…The Tokelau baseline study carried out in 1968-1971 gave prevalence rates of 2.3% in the men and 6.1% in the women [5] which are comparable with some of the other groups such as Niue [30], Rarotonga [30] and urban Samoa [9].…”

Section: Discussionmentioning

confidence: 85%

“…Higher rates in women are relatively common in the Pacific [9,29,34]. The relationship between exercise, diet and obesity is complex and the factors are difficult to separate in observational studies [35][36][37].…”

Section: Discussionmentioning

confidence: 99%

“…The high prevalence rates of Type 2 (non-insulin-dependent) diabetes, gout, hypertension and coronary heart disease in some groups of Polynesians has initiated a series of epidemiological studies in the Pacific [1][2][3][4][5][6][7][8][9][10]. These studies suggest that Polynesians, and, to a varying degree, Melanesians and Micronesians [11,121, have a genetic predisposition to a disease complex of obesity, hypertension, coronary artery disease, gout and diabetes.…”

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confidence: 99%

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Type 2 (non-insulin-dependent) diabetes mellitus, migration and westernisation: The Tokelau Island Migrant study

Østbye

Welby²,

Prior³

et al. 1989

Diabetologia

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Summary. The migration of Tokelauans from a traditional atoll in the Pacific to urban New Zealand is associated with an increased prevalence and incidence of Type 2 (non-insulindependent) diabetes mellitus over the period [1968][1969][1970][1971][1972][1973][1974][1975][1976][1977][1978][1979][1980][1981][1982]. During the same period, a lesser but definite increase is seen among non-migrants in Tokelau. The age standardised prevalence rates rose from 7.5 and 11.7 to 10.8 and 19.9 per 100 respectively in the male and female migrants compared with an increase from 3.0 and 8.7 to 7.0 and 14.3 per 100 in the nonmigrant males and females respectively. The incidence of diabetes is shown to be consistently higher in the migrants compared to the non-migrants giving relative risks of 1.5 in males and 1.9 in females. The factors most likely contributing to this difference, are changes to a higher calorie, high protein diet, higher alcohol consumption, a greater weight gain and altered levels of physical activity in the migrants. A number of populations in the Pacific have been shown to have a low rate of diabetes in their traditional setting, but may have a genetic predisposition for diabetes which responds to factors in the urban industrialised environment and life-style. The social and economic changes taking place in Tokelau are also clearly increasing the risk of diabetes. To reverse these trends and prevent the development of complications of Type 2 diabetes, it will be important to institute preventive programmes and to follow up the population in both environments for long-term outcomes, including mortality.

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The prevalence of diabetes in the rural and urban Polynesian population of Western Samoa

Cited by 46 publications

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Exercise and the metabolic syndrome

Exercise and the metabolic syndrome

Body size and composition in Polynesians

Type 2 (non-insulin-dependent) diabetes mellitus, migration and westernisation: The Tokelau Island Migrant study

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