Vitamin D deficiency amongst minority ethnic groups in the UK: a cross sectional study

Background

Vitamin D deficiency is common amongst minority groups in Britain but its magnitude amongst South Asian (SA) and Black African-Caribbean (AC) groups is not well defined. The steroidal, endocrine nature of vitamin D provides it with a putative link with cardiovascular disease (CVD), and we hypothesised that aberrant levels of this hormone would reflect a heightened risk of CVD in these ethnic groups.

Methods

SA (n = 1105, 57% male) and AC (n = 748, 51% male) were recruited as part of a community heart failure study from 20 primary care practices, Birmingham, UK. Vitamin D₂/D₃ levels were measured to determine rates of total vitamin D status, which were age/sex adjusted.

Results

The majority of SAs had severe vitamin D deficiency (42.2%, 95% CI: 39.2–45.1), which was more frequent than in AC (12.5%, 10.2–14.9, p < 0.001. Vitamin status in SA and AC was unrelated to the presence of osteoporosis, and on multivariate analysis of SA, vitamin D levels were independently associated with age (β = 0.18, p < 0.001), haemoglobin (β = 0.12, p = 0.002), and negatively with alkaline phosphatase (a marker of bone mineralisation, β = − 0.11, p = 0.022). Amongst AC, vitamin D was independently associated with having ever smoked (β = − 0.13, p = 0.006) and systolic blood pressure (β = 0.10, p = 0.038).

Conclusions

Vitamin D deficiency is a frequent biochemical observation amongst minority groups in Britain but the clinical significance is unclear, and ethnically specific. A proportionate susceptibility to bone disease is not apparent in either minority group.     

Differences in the risk of cardiovascular disease across ethnic groups: UK Biobank observational study

Background and aimsTo describe sociodemographic, lifestyle, environmental and traditional clinical risk factor differences between ethnic groups and to investigate the extent to which such differences confound the association between ethnic groups and the risk of cardiovascular disease (CVD)Methods and resultsA total of 440,693 white European (55.9% women), 7305 South Asian (48.6%) and 7628 black African or Caribbean (57.7%) people were included from UK Biobank. Associations between ethnicity and cardiovascular outcomes (composite of non-fatal stroke, non-fatal myocardial infarction and CVD death) were explored using Cox-proportional hazard models. Models were adjusted for sociodemographic, lifestyle, environmental and clinical risk factors. Over a median (IQR) of 12.6 (11.8, 13.3) follow-up years, there were 22,711 (5.15%) cardiovascular events in white European, 463 (6.34%) in South Asian and 302 (3.96%) in black African or Caribbean individuals. For South Asian people, the cardiovascular hazard ratio (HR) compared to white European people was 1.28 (99% CI [1.16, 1.43]). For black African or Caribbean people, the HR was 0.80 (0.66, 0.97). The elevated risk of CVD in South Asians remained after adjusting for differences in sociodemographic, lifestyle, environmental and clinical factors, whereas the lower risk in black African or Caribbean was largely attenuated.ConclusionsSouth Asian, but not black African or Caribbean individuals, have a higher risk of CVD compared to white European individuals. This higher risk in South Asians was independent of sociodemographic, lifestyle, environmental and clinical factors.     

Acculturation and the prevalence of pain amongst South Asian minority ethnic groups in the UK

BACKGROUND: Musculoskeletal pain is reported more commonly by South Asians in the UK than by white Europeans. This may result from a variety of factors, including cultural differences, and thus we investigated the extent to which differences in the prevalence of pain within the South Asian population could be explained by differences in acculturation (the extent to which immigrants take on the culture of their host population). METHODS: Nine hundred and thirty-three Europeans and 1914 South Asian (1165 Indian, 401 Pakistani and 348 Bangladeshi) subjects were recruited from the age-sex registers of 13 general practices in areas with high densities of South Asian populations (Bolton, Oldham, Ashton-under-Lyne and Birmingham). A 28-item acculturation scale was developed, based, on aspects including use of language, clothing style, and use of own-culture media. Principle component analysis generated a score (range 0-100), which was validated against constructs expected to relate to acculturation, such as years of full time education and time spent in the UK. The presence of widespread pain was assessed by the answer to the question 'Have you suffered from pain all over the body in the past month?' RESULTS: Widespread pain was more common in all three South Asian ethnic groups than in the white Europeans [odds ratio (OR) = 3.7, 95% confidence interval (CI) 2.9-4.9], with this increase ranging from 2.7 to 5.8 in the different South Asian subgroups. There was a similar increase in consultation rates for pain. Within the South Asians, pooling all three groups, there was a strong negative association between acculturation score and widespread pain, which remained after adjusting for age and sex: [OR (95% CI) per standard deviation decrease in acculturation score -1.2 (1.0-1.3)]. Adjusting for acculturation accounted for some, but not all, of the differences between the ethnic groups in the prevalence of widespread pain: OR 2.0 (95% CI 1.4-3.0). CONCLUSIONS: Widespread pain is more commonly reported in South Asians though there are interesting differences within the South Asian community. Lower acculturation has a strong influence on the reporting of pain, but cannot explain all of the difference between South Asian and European populations.     

Prevalence of thyroid disorders in North Indian Type 2 diabetic subjects: A cross sectional study

Background

Type 2 diabetes mellitus (T2DM) is a major health burden worldwide with many patients encountering thyroid dysfunction later in their life. Various studies have found that diabetes and thyroid disorders mutually influence each other and both disorders tend to coexists. However, the prevalence of thyroid dysfunction and associated clinical variables in these patients has not been investigated.

Circulating soluble E-selectin levels and the Ser 128Arg polymorphism in individuals from different ethnic groups

BACKGROUND AND AIM: An association between the Ser128 Arg polymorphism and coronary heart disease (CHD) has been previously demonstrated in a white population. The aim of this study was to investigate whether the Ser128 Arg polymorphism of the E-selectin gene is associated with soluble E-selectin levels in individuals from a multiethnic population. METHODS AND RESULTS: Plasma sE-selectin levels and the Ser128 Arg E-selectin gene polymorphism were determined in 244 white (109 females), 176 of African origin (90 females) and 208 South Asian (95 females) healthy individuals living in England selected from the Wandsworth Heart and Stroke Study (WHSS). The substitution of serine for arginine (A to C mutation) was more common in whites (9.6%) and South Asians (7.9%) compared to the people of African origin (3.7%); p=0.005. The C mutation had no effect on sE-selectin levels in any ethnic group. CONCLUSIONS: We found a lower frequency of this polymorphism in the people of African origin who have a low CHD risk. However, in this study the polymorphism was not associated with circulating sE-selectin levels. Whether it plays a role in determining ethnic differences in vascular disease via a mechanism affecting leukocyte recruitment remains to be determined.     

The challenge of kidney transplantation among minority ethnic groups in the UK

The increased rate of renal failure secondary to diabetes among minority ethnic groups compared to Caucasians in the UK has been well documented. However, the impact of this phenomenon on kidney transplant services has been relatively unexplored. The Government has recently published its 'Tackling Health Inequalities: A Programme for Action' report which emphasises the importance of reducing health inequalities at all levels of the health service. This article provides a timely review of the UK's national transplant database examining the provision of kidney transplant services to minority ethnic groups in the United Kingdom. It seeks to explore the demographics of the database by focusing upon waiting list data, donor data, and recipient data. Inequalities do currently exist in transplant services and the solutions to rectifying this situation are complex. However, the financial and human burden of not addressing these inequalities encourages some immediate action.     

甲状腺功能异常对老年人认知功能的影响

甲状腺功能异常在老年人中较常见,它不仅影响老年人的躯体功能,还可能引起注意力、记忆、情感等认知功能障碍.已有研究从动物实验、神经电生理、神经影像等角度对甲状腺功能与认知功能之间的关系展开探讨.此外,在临床工作中,甲状腺功能异常引起的严重认知功能损害易与老年性痴呆相混淆.因此,医务人员需重视,避免误诊.及时、合理地纠正老年人甲状腺功能异常,可能有利于认知能力的恢复.     

维持性血液透析患者亚临床甲状腺功能异常与心脏结构的关系

目的:探讨维持性血液透析(MHD)患者亚临床甲状腺功能异常和心脏结构的变化及其之间的关系。方法:选择MHD患者100例,透析时间3个月且病情稳定。排除临床甲状腺功能亢进或甲状腺功能减退。电化学发光仪检测甲状腺功能,包括游离三碘甲状腺原氨酸(FT3)、游离四碘甲状腺原氨酸(FT4)、促甲状腺激素(TSH),并测定同型半胱氨酸(Hcy)和C反应蛋白(CRP)。收集患者临床资料和血清生化指标。根据甲状腺功能分为亚临床甲状腺功能异常组和正常组。并应用心脏超声心动图测定患者左房内径(LAD)、左室舒张末内径(LVEDd)、左室收缩末内径(LVEDs)、左室后壁厚度(LVPWT)、室间隔厚度(IVST)、左心室质量指数(LVMI)、LVEF和相对室壁厚度(RWT)等。分析甲状腺功能和心脏结构的关系。结果:100例MHD患者中检出甲状腺功能异常者49例(49%)。甲状腺功能异常组Hcy、CRP高于正常组(P0.05),甲状腺功能异常组患者LAD,LVEDd,LVEDs,LVPWT,IVST,LVMI、RWT均高于甲状腺功能正常组(P0.05),而LVEF低于正常组(P0.01)。多因素Logistic回归分析显示FT3与左心室肥厚的发生呈负相关。结论:MHD患者常伴甲状腺功能异常,主要表现为FT3下降。FT3下降与左心室肥厚密切相关。     

Subclinical thyroid dysfunction and blood pressure: a community-based study

OBJECTIVE: Overt hypothyroidism and hyperthyroidism are associated with hypertension, but it is uncertain whether the same is true of subclinical hypothyroidism and hyperthyroidism. DESIGN, SUBJECTS AND MEASUREMENTS: Cross-sectional study of 2033 participants (aged 17-89 years) in the Busselton Thyroid Study who did not have a history of thyroid disease. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and the prevalence of hypertension (defined as SBP >or=140 mmHg, DBP >or=90 mmHg or on treatment for hypertension) in subjects with thyroid dysfunction and euthyroid subjects were compared using linear regression models. Subjects with treated hypertension (N = 299) were excluded from analyses of SBP and DBP but included in analyses of hypertension prevalence. RESULTS: Mean SBP, DBP and the prevalence of hypertension did not differ significantly between subjects with subclinical hypothyroidism (N = 105) and euthyroid subjects (N = 1859), nor did they differ between subjects with serum TSH concentrations in the upper reference range (2.0-4.0 mU/l; N = 418) and those with TSH concentrations in the lower reference range (0.4-2.0 mU/l; N = 1441). The prevalence of hypertension was higher in subjects with subclinical hyperthyroidism than euthyroid subjects (prevalence odds ratio 2.8, 95% confidence interval 1.3-6.0 adjusted for age, age(2) and sex), but this was based on a small number of subjects with subclinical hyperthyroidism (N = 35). CONCLUSIONS: Subclinical hypothyroidism is not associated with hypertension. The observed association between subclinical hyperthyroidism and hypertension requires confirmation in a larger sample.     

Epidemiology of inflammatory bowel disease in racial and ethnic migrant groups

AIM To summarise the current literature and define patterns of disease in migrant and racial groups.METHODS A structured key word search in Ovid Medline and EMBASE was undertaken in accordance with PRISMA guidelines. Studies on incidence, prevalence and disease phenotype of migrants and races compared with indigenous groups were eligible for inclusion. RESULTS Thirty-three studies met the inclusion criteria. Individual studies showed significant differences in incidence, prevalence and disease phenotype between migrants or race and indigenous groups. Pooled analysis could only be undertaken for incidence studies on South Asians where there was significant heterogeneity between the studies [95% for ulcerative colitis(UC), 83% for Crohn's disease(CD)]. The difference between incidence rates was not significant with a rate ratio South Asian: Caucasian of 0.78(95%CI: 0.22-2.78) for CD and 1.39(95%CI: 0.84-2.32) for UC. South Asians showed consistently higher incidence and more extensive UC than the indigenous population in five countries. A similar pattern was observed for Hispanics in the United States. Bangladeshis and African Americans showed an increased risk of CD with perianal disease. CONCLUSION This review suggests that migration and race influence the risk of developing inflammatory bowel disease. This may be due to different inherent responses upon exposure to an environmental trigger in the adopted country. Further prospective studies on homogenous migrant populations are needed to validate these observations, with a parallel arm for in-depth investigation of putative drivers.     

Rheumatoid arthritis and thyroid dysfunction: A cross-sectional study and a review of the literature

Thyroid dysfunction appears to show increased prevalence in many autoimmune diseases; however, this comorbidity has not been properly investigated in patients with RA. This issue was addressed in this cross-sectional study.Using the database of the Clalit Health Services (CHS) in Israel, RA patients were paired with age- and sex-matched controls to compare the prevalence of hypothyroidism and hyperthyroidism. Chi-squared and t-tests were used for univariate analysis and a logistic regression model was used for multivariate analysis.The study included 11,782 patients with RA and 57,973 controls. The rate of thyroid dysfunction diseases in RA patients was increased compared with the prevalence in controls (16.0% and 11.7%, p < 0.001, for hypothyroidism; and 2.33% and 1.81%, p < 0.001 in hyperthyroidism, respectively). In a multivariate analysis, RA was associated with hypothyroidism (OR = 1.42, 95% CI 1.34–1.50) and hyperthyroidism (OR = 1.26, 95% CI 1.10–1.45).RA is associated with thyroid dysfunction. Therefore, physicians treating patients with RA should be aware of the possibility of comorbid thyroid dysfunction and treat accordingly.     

Relationship of metabolic syndrome and its components with thyroid dysfunction in Algerian patients

Aims

The aim of this study is to evaluate the prevalence of the metabolic syndrome and its compounds in subjects with different thyroid status.

The prevalence of alpha-thalassemia amongst Tai and Mon-Khmer ethnic groups residing in northern Thailand: A population-based study

Background: Northern Thailand is one of the highest α-thalassemia incidence areas where 30–40% of inhabitants have been reported to carry aberrant α-globin genes. However, all previous α-thalassemia prevalence surveys in northern Thailand have been undertaken without consideration of ethnicity. Here we report the prevalence of α-thalassemia genes in 4 Tai (Yong, Yuan, Khuen, Lue) and 4 Mon-Khmer speaking populations (Blang, Mon, Paluang, Lawa).

Methods: DNA extracted from 141 individuals was genotyped for 4 α-thalassemia deletional types (--^SEA, --^THAI, -α^3.7, -α^4.2) using MultiplexGap-PCR analysis and 2 non-deletional types (Hb CS, Hb Pakse) using dot-blot hybridization technique.

Results and discussion: A total of 33 α-thalassemia carrying individuals (23.4%) were detected of which 32 were heterozygotes and one was a homozygote. The most common α-thalassemia detected were -α^3.7 (17.7%) and --^SEA (3.5%), while Hb CS was detected in 2.1% of cases. No occurrence of --^THAI, -α^4.2 and Hb Pakse was observed. The prevalence of α-thalassemia carriers varied between the different ethnic groups, with the Yuan having the highest prevalence of α-thalassemia carriers (50%) while the Lawa had the lowest prevalence (0%). The Paluang had a high prevalence (42%) of a single deletion type (-α^3.7) possibly related to the endogamous marriage traditions of this ethnic group.

Conclusion: The extreme variation of α-thalassemia prevalence among the different ethnic groups highlights the significantly different genetic backgrounds found in these peoples, as consequences of dissimilar cultures. Our study suggests that ethnicity must be considered in any of the disease-causing allele prevalence surveys in this region.     

Familial Mediterranean fever in the Iranian population: MEFV mutations in different ethnic groups

Background and aimsFamilial Mediterranean Fever (FMF) is an ethnically restricted genetic disease, found commonly among Mediterranean population, as well as Armenians, Turks, Arabs and Jews. The disease is caused by mutations in the MEFV gene, encoding the Pyrin protein. The aim of this study was to determine the mutation frequency in the clinically diagnosed FMF patients and the carrier rate among healthy first-degree relatives of patients from Iran.Methods59 patients (<17 years old) with clinical diagnosis of FMF in the absence of colchicine and 82 healthy family members, in three different ethnic groups were screened for the 5 most common MEFV mutations (M694V, M694I, M680I, V726A and E148Q).ResultsThe mean age of patients (27 females: 32 males) was 7.8 ± 3.23. Fever (94.9%) and abdominal pain (77.9%) was the most common clinical finding. Allele frequencies were different among different ethnic groups of Iranian population (p = 0.03). The most frequent mutation was M694V (29.6%) followed by M694I (8%), M680I (15%), V726A (16%) and E148Q (8%): homozygous (18.6%), compound heterozygous (52.5%) and simple heterozygous (16.9%). we could not detect any mutations in 16.95% of our patients. 9 (18%) healthy relatives were detected to have mutations of FMF.ConclusionsM694V was the most common MEFV mutation in various ethnic groups of Iranian patients.     

High prevalence of subclinical thyroid dysfunction and the relationship between thyrotropin levels and cardiovascular risk factors in residents of the coastal area of China

OBJECTIVES:

To investigate the prevalence of subclinical thyroid dysfunction and the relationship between thyrotropin levels and cardiovascular risk factors in residents of the coastal area of China.

METHODS:

Atotalof4256individuals(mean[±SD]age50.51±14.24years; 2079 males, 2177 females,) were enrolled in the present study. Sex, blood pressure, body mass index, waist-to-hip ratio, serum levels of fasting glucose, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, uric acid and smoking status were measured. The relationship between thyrotropin levels and cardiovascular risk factors was analyzed.

RESULTS:

The overall prevalence of thyroid dysfunction was 11.07%. The prevalence of subclinical hypothyroidism (6.32%) was higher than that of hyperthyroidism (1.53%). The prevalence of thyroid dysfunction among female subjects was higher than that among male subjects (16.54% versus 5.34%, respectively; P<0.001). Significant differences were detected with respect to body mass index (P=0.026), waist-to-hip ratio (P<0.001), fasting glucose levels (P=0.001), total cholesterol levels (P=0.013), triglyceride levels (P=0.003) and smoking status according to different thyrotropin levels.

CONCLUSION:

The prevalence of thyroid dysfunction was high in residents of China’s coastal area. Significant differences were detected with regard to body mass index, waist-to-hip ratio, fasting glucose levels, total cholesterol levels, triglyceride levels and smoking status according to different thyrotropin levels.     

胺碘酮对老年心律失常患者甲状腺功能的影响

目的探讨口服小剂量胺碘酮(AD)对老年心律失常患者甲状腺功能的作用和影响.方法老年冠心病心律失常住院患者56例,均给予负荷量AD(600mg/d),6d后渐减至维持剂量(50～100mg/d);放射免疫法测定甲状腺激素水平.结果服用AD第6天即可见甲状腺激素水平变化,与用药前相比较,总三碘甲状腺原氨酸(TT3)和游离三碘甲状腺原氨酸(FT3)1个月时下降幅度最大,分别由(1.7±0.7)nmol/L、(3.1±1.1)pmol/L下降为(1.4±0.6)nmol/L、(2.3±1.6)pmol/L,下降了17.2%和27.6%(均为P<0.01);促甲状腺激素(TSH)、游离甲状腺激素(FT4)3个月时上升达峰值,由(2.1±1.6)mU/L和(16.2±4.0)pmol/L升为(4.4±4.7)mU/L及(20.7±4.8)pmol/L,分别为118.8%和15.2%(均为P<0.01),总甲状腺素(TT4)于6个月达峰,由(126.3±20.5)nmol/L升为(154.1±32.6)nmol/L(22.0%,P<0.01).监测1年,仅有12例出现TSH异常上升,6例TSH>15.0mU/L者给予左旋甲状腺片后,有4例逐渐恢复正常.结论老年心律失常患者、特别是安装心脏起搏器的老年患者服用AD第6天即可检测到甲状腺激素水平的变化,1～6个月变化最显著,但大多数变化是在正常值范围内.     

亚克汀病碘代谢下丘脑—垂体—甲状腺轴功能的研究

本文报道未经补碘防治的7～14岁亚克汀儿童碘代谢、下丘脑-垂体-甲状腺轴功能情况。结果发现低尿碘、高代偿、激素性甲减为亚克汀儿童碘代谢、下丘脑—垂体—甲状腺轴功能状态的特征。碘缺乏为本病区亚克汀的基本发病因素。激素性甲减为亚克汀发病机理的基本环节。TSH、FT_4同时检测应列为亚克汀诊断较 IQ 更为早期发现的敏感指标。