A conceptual framework for managing modifiable risk factors for cardiovascular diseases in Fiji (original) (raw)

Continued increases in hypertension over three decades in Fiji, and the influence of obesity

Journal of hypertension, 2015

To analyse trends during 1980-2011 in hypertension prevalence and SBP/DBP by sex in Fiji Melanesian (i-Taukei) and Indian adults aged 25-64 years; and to assess effects of BMI. Unit record data from five population-based surveys were included (n = 14 191). Surveys were adjusted to the nearest previous census to improve national representativeness. Hypertension was defined as SBP at least 140 mmHg and/or DBP at least 90 mmHg and/or on medication for hypertension. Regression (Poisson and linear) was used to assess period trends. Over 1980-2011 hypertension prevalence (%) and mean blood pressure (BP) (SBP/DBP mmHg) increased significantly (P < 0.001) in both sexes and ethnicities. Increases in hypertension were: from 16.2 to 41.3% in i-Taukei men (mean BP from 122/73 to 135/81); from 20.5 to 37.8% in Indian men (mean BP from 122/74 to 133/81); from 25.9 to 36.9% in i-Taukei women (mean BP from 126/76 to 132/81); and from 17.6 to 33.1% in Indian women (mean BP 117/71 to 130/81). The ...

Diabetes and obesity trends in Fiji over 30 years

Journal of diabetes, 2015

No systematic comparison has been conducted in Fiji using all suitable surveys of type 2 diabetes mellitus (T2DM) and obesity prevalence, after adjusting for differences in methodology, definitions and demographic characteristics. Unit records from 6 cross-sectional surveys of Fiji adults were included. Surveys were variously adjusted for age, ethnicity (Fiji Melanesians, i-Taukei, and Fijians of Asian Indian descent, Indians) and urban-rural by sex to previous censuses to improve national representativeness. Trends were assessed using meta-regression (random effect models) and estimates projected to 2020. Poisson regression of strata was used to assess effect of BMI increases on T2DM period trends. Over 1980-2011, T2DM prevalence increased from 3.2 to 11.1% (1.32%/5yrs) in i-Taukei men; 5.3-13.6% (1.40%/5yrs) i-Taukei women; 11.1-17.9% (1.24%/5yrs) Indian men; 11.2-19.9% (1.71%/5yrs) Indian women. Projected T2DM prevalence in 2020 is 13.3% in i-Taukei men; 16.7% i-Taukei women; 23....

Mortality in Micronesian Nauruans and Melanesian and Indian Fijians Is Not Associated with Obesity

American Journal of Epidemiology, 1996

The association of obesity with mortality was investigated in population-based samples of Micronesian Nauruans (n = 1,400), Melanesian Fijians (n = 1,279), and Indian Fijians (n = 1,182), over 10 years from 1982 in Nauru, and 11 years from 1980 in Fiji. At the end of follow-up, vital status was known for all Nauruans and all but 3.5% of Fijians. Mortality rates were higher in Nauru than Fiji, and in Melanesians than Indians. The mean body mass index of decedents was similar to or less than (Nauruan men, p < 0.001) that of survivors in each sex-ethnic group. Crude mortality rates showed an inverse relation with body mass index in Nauruan men, with inconsistent relations in other sex-ethnic groups. After stratification by diabetes status, there was no relation between mortality and obesity in nondiabetic subjects, but an inverse relation was observed among diabetic subjects in each population. These findings persisted even after the exclusion of subjects who died within the first 2 years of follow-up. After controlling for age, smoking, and diabetes status in Cox proportional hazard models, body mass index (as a continuous variable) was not related to mortality in any sex/ethnic group and tended to be negatively associated with mortality risk. Interactions of body mass index with age, smoking, and diabetes status were not significant. Mortality risk was significantly increased in older subjects and in diabetic subjects, and cigarette smoking also increased risk in some groups. Stratification of analyses according to cigarette smoking did not alter the nature of the results. The association of mortality and body mass index categorized by quartiles was also investigated. After adjusting for age alone, or age, smoking, and diabetes status, the lower quartiles of body mass index were consistently associated with the highest relative risk for mortality. Quadratic terms for body mass index did not improve Cox models in subjects with normal glucose tolerance. Relations with cardiovascular disease mortality were also assessed and results were inconsistent, although positive trends were observed in Nauruan women (p = 0.02) and Melanesian men (p = 0.06). Overall, there was little evidence to suggest that obesity was a risk factor for total or cardiovascular mortality in these populations. However, obesity is clearly associated with a high risk of diabetes and other morbid conditions and at least on this basis it would seem desirable to prevent obesity in these and other Pacific populations.

Dietary patterns and risk factors of diabetes mellitus among urban indigenous women in Fiji

The dietary patterns of indigenous Fijians are changing rapidly. Dietary relationships in regard to the prevalence of diabetes are poorly studied in Fiji. A survey was conducted to show the relationship of dietary patterns and other lifestyle factors for the development of diabetes among urban indigenous women in Fiji. A sample of 200 Fijian women aged 30-39 who agreed to participate were interviewed by the use of semiquantitative food frequency, 3 day-24 h recall study. Physical activity and ceremonial dietary customs were also taken into consideration. Anthropometry included measurements of height, weight, waist and hip. Total percentage bodyfat measurements and glycosuria tests were also conducted. The results showed high rates of obesity manifested in high percentage bodyfat, high body mass index (BMI) and high waist and hip ratio (WHR). The mean 24 h dietary intake exhibited a moderate intake of protein, high intake of fat and a low intake of carbohydrate. The carbohydrate redu...

Modifiable Cardiovascular Disease Risk Factors among Indigenous Populations

Advances in Preventive Medicine, 2014

Objective. To identify modifiable cardio-metabolic and lifestyle risk factors among indigenous populations from Australia (Aboriginal Australians/Torres Strait Islanders), New Zealand (Māori), and the United States (American Indians and Alaska Natives) that contribute to cardiovascular disease (CVD).Methods. National health surveys were identified where available. Electronic databases identified sources for filling missing data. The most relevant data were identified, organized, and synthesized.Results. Compared to their non-indigenous counterparts, indigenous populations exhibit lower life expectancies and a greater prevalence of CVD. All indigenous populations have higher rates of obesity and diabetes, hypertension is greater for Māori and Aboriginal Australians, and high cholesterol is greater only among American Indians/Alaska Natives. In turn, all indigenous groups exhibit higher rates of smoking and dangerous alcohol behaviour as well as consuming less fruits and vegetables. A...

A Case Study of Metabolic Syndrome without Hypertension in a Fijian Coastal Fishing Village

J Hum …, 2012

We describe a case study involving obesity, health, and body image on small island of Nayau, in the Lau Group, Fiji. Nayau is a remote island of Fiji where traditional subsistence activities are practiced. They have only recently had exposure to Western media and television. Traditionally, large body sizes are valued as signs of health and happiness. As such, obesity can be considered a culture bound syndrome in this culture. The key aims of our study were to 1) to conduct qualitative and quantitative research on eating behaviors, body image, and activity patterns; 2) to measure the body mass indexes (BMI) of study participants, and; 3) to identify differences in health indicators related to obesity among Fijians and Western society. Our main findings were first, that although body image ideals are changing, most adult men and women still are overweight/ obese and tend to value larger body sizes. Second, adult Fijians engage in physical activity nearly 70% of the time during daytime hours, representing more than three times as much activity as the average adult American. Third, while the obesity, diabetes, and hypertension are often seen as linked in the “metabolic syndrome,” in Nayau, adults have similar rates of obesity and diabetes as in the U.S., but they have very low rates of hypertension. We examine possible explanations for the pattern of diabetes and hypertension including diet, activity patterns, and stress levels.

Dietary trend and diabetes: its association among indigenous Fijians 1952 to 1994

Asia Pacific Journal of Clinical Nutrition, 2001

The dietary trends of indigenous Fijians have changed drastically in the past 50 years. Deviating from the traditional food consumption pattern and traditional lifestyle may have increased the incidence and prevalence of non-communicable diseases. The aim of this study is to examine the dietary trends of the indigenous Fijians in relation to the prevalence of diabetes from

Community screening for cardiovascular risk factors and levels of treatment in a rural Māori cohort

Australian and New Zealand Journal of Public Health, 2011

āori are the indigenous people of New Zealand (NZ), comprising approximately 15% of the national population. A major disparity exists between Māori and non-Māori in cardiovascular mortality, which remains the leading cause of premature death and disability in New Zealand. 1,2 Furthermore, recent health statistics indicate that those living in rural areas are worse off than urban New Zealanders, including for prevalence of ischaemic heart disease. 3 Rural Māori have a shorter life expectancy than urban Māori, with 1.2 years difference for women and 1.5 years difference for men. 3 The combination of resource accessibility and ethnic disparities may additionally disadvantage rural Māori communities with respect to health outcomes. Recent data on cardiovascular disease (CVD) and its risk factors in Māori has been obtained from mortality or hospital statistics, 1,4 from diagnoses in general practice, 5 and in urban Auckland communities, 6-10 but we lack information about the state of Māori cardiovascular health in rural communities. In addition, disease rates and risk factors in indigenous population groups may be underestimated if these groups do not have equivalent access to health care or CVD screening. This underestimation will occur in studies based on clinical databases. It will also occur in population studies that rely on self-report of doctor-diagnosed conditions, such as the New Zealand Health Survey. 11 A study in 1962 12 assessed coronary heart disease as part of a wider health survey of