Cardiovascular risk amongst migrant and non-migrant Greenland Inuit in a gender perspective

Abstract

Aims: The effects of migration on cardiovascular risk factors are often gender specific. The purpose of the present study was to analyse the association of migration from Greenland to Denmark with cardiovascular risk factors in a gender-specific perspective. Methods: Cross-sectional population surveys among adult Inuit in Greenland and Inuit migrants in Denmark (n=1542). General Linear Models adjusted for age, smoking, diet (seal, fish, and fruit), and alcohol consumption. Results:Blood pressure was significantly higher among Inuit migrants of either sex than among the Inuit in Greenland. Among women, HDL-cholesterol concentrations were 1.59 mmol/l in Greenland and 1.83 among migrants (p<0.001), while obesity and HbA_1c were significantly lower among the migrants. Blood lipids, HbA_1c, and obesity did not differ between men in Greenland and migrants. Smoking, diet, and alcohol consumption differed significantly among migrants and non-migrants. Adjusted for the consumption of seal meat and alcohol, the difference in HDL cholesterol for men (1.44 and 1.66 mmol/l; p=0.002) was of a similar magnitude to that of women. Conclusions: Migration was associated with cardiovascular risk factors in different ways among men and women. Some of the gender difference could be explained by dietary differences among male and female migrants and non-migrants, or in the case of HDL cholesterol by a different association with the consumption of seal meat for men and women, but a large unexplained residual remained. Overall cardiovascular risk was higher among migrant than non-migrant males, while for women some risk factors were better and some worse among the migrants.

Keywords

Cardiovascular risk factors diet gender Greenland HDL cholesterol Inuit migration

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References

Bjerregaard P. , Young TK , Hegele RA

Low incidence of cardiovascular disease among the Inuit — what is the evidence?

Atherosclerosis 2003;166:351—57.

Marmot MG Geography of blood pressure and hypertension. Br Med Bull 1984;40:380—86.

He J. , Tell GS , Tang YC , Mo PS , He GO Effect of migration on blood pressure: the Yi people study. Epidemiology 1991;2:88—97.

Miller GJ , Beckles GLA , Byam NTA , Price SGL , Carson DC , Kirkwood BR , Baker IA , Bainton D. Serum lipoprotein concentrations in relation to ethnic composition and urbanization in men and women of Trinidad, West Indies. Int J Epidemiol 1984;13:413—21.

Reddy KK , Ramachandraiah T. , Reddanna P. , Thyagaraju K. Serum lipid peroxides and lipids in urban and rural Indian men. Arch Environ Health 1994;49:123—7.

Torun B. , Stein AD , Schroeder D. , Grajeda R. , Conlisk A. , Rodriguez M. , Mendez H. , Martorell R. Rural-to-urban migration and cardiovascular disease risk factors in young Guatemalan adults. Int J Epidemiol 2002 ;31:218— 26.

Bhatnagar D. , Anand IS , Durrington PN , Patel DJ , Wander GS , Mackness MI , Creed F. , Tomenson B. , Chandrashekhar Y. , Winterbotham M. , Britt RP , Keil JE , Sutton GC Coronary risk factors in people from the Indian subcontinent living in West London and their siblings in India. Lancet 1995;345:405—9.

Heng CK , Saha N. , Tay JSH , Low PS Plasma lipids and lipoprotein(a) levels in the Chinese from China and Singapore . Ann Acad Med Singapore 1997 ;26:303—7.

Patel JV , Vyas A. , Cruickshank JK , Prabhakaran D. , Hughes E. , Reddy KS , Mackness MI , Bhatnagar D. , Durrington PN Impact of migration on coronary heart disease risk factors: Comparison of Gujaratis in Britain and their contemporaries in villages of origin in India . Atherosclerosis 2006;185:297—306.

10.

Hara H. , Egusa G. , Yamakido M. , Kawate R. The high prevalence of diabetes mellitus and hyperinsulinemia among the Japanese-Americans living in Hawaii and Los Angeles. Diabetes Res Clin Pract 1994;24:s37—42.

11.

Stanhope JM , Prior IAM. The Tokelau Island Pacific Ocean Migrant Study Prevalence and Incidence of Diabetes Mellitus. N Z Med J 1980;92:417—21.

12.

Dowse GK , Gareeboo H. , Zimmet PZ , Alberti KG , Tuomilehto J. , Fareed D. , Brissonnette LG , Finch CF High prevalence of NIDDM and impaired glucose tolerance in Indian, Creole, and Chinese Mauritians. Mauritius Noncommunicable Disease Study Group. Diabetes 1990;39:390—96.

13.

Mbanya JC , Cruickshank JK , Forrester T. , Balkau B. , Ngogang JY , Riste L. , Forhan A. , Anderson NM , Bennett F. , Wilks R. Standardized comparison of glucose intolerance in west African-origin populations of rural and urban Cameroon, Jamaica, and Caribbean migrants to Britain. Diabetes Care 1999;22:434—40.

14.

Winkelstein W. , Kagan A. , Kato H. , Sacks ST Epidemiological studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California: Blood pressure distributions. Am J Epidemiol 1975;102: 502—13.

15.

Lahmann PH , Lissner L. , Gullberg B. , Berglund G. Differences in body fat and central adiposity between Swedes and European immigrants: The Malmö diet and cancer study. Obesity Res 2000;8:620—31.

16.

McDonald JT , Kennedy S. Is migration to Canada associated with unhealthy weight gain? Overweight and obesity among Canada's immigrants. Soc Sci Med 2005;61: 2469—81.

17.

Bjerregaard P. , Jørgensen ME , Borch-Johnsen K. Serum lipids of Greenland Inuit in relation to Inuit genetic heritage, westernisation, and migration . Atherosclerosis 2004;174: 391—8.

18.

Bjerregaard P. , Jørgensen ME , Andersen S. , Mulvad G. , Borch-Johnsen K. Decreasing overweight and central fat patterning with westernisation among the Inuit in Greenland and Inuit migrants. Int J Obes 2002;26:1503—10.

19.

Bjerregaard P. , Jørgensen ME , Lumholt P. , Mosgaard L. , Borch-Johnsen K. Higher blood pressure among Inuit migrants in Denmark than among the Inuit in Greenland . J Epidemiol Community Health 2002;56:279—84.

20.

Moustgaard H. , Bjerregaard P. , Borch-Johnsen K. , Jørgensen ME Diabetes among Inuit migrants in Denmark. Int J Circumpolar Health 2005;64:354—64.

21.

Togeby L. Grønlændere i Danmark. En overset minoritet [Greenlanders in Denmark. An overlooked minority. In Danish] Århus : Aarhus Universitetsforlag; 2002 .

22.

Bjerregaard P. , Curtis T. , Borch-Johnsen K. , Mulvad G. , Becker U. , Andersen S. , Backer V. Inuit health in Greenland: A population survey of life style and disease in Greenland and among Inuit living in Denmark. Int J Circumpolar Health 2003;62(Suppl 1):1—79.

23.

Glümer C. , Jørgensen T. , Borch-Johnsen K. Prevalences of diabetes and impaired glucose regulation in a Danish population: the Inter99 study . Diabetes Care 2003;26: 2335—40.

24.

Thun MJ , Peto R. , Lopez AD , Monaco JH , Henley SJ , Heath CW Jr , Doll R. Alcohol consumption and mortality among middle-aged and elderly U.S. adults. N Engl J Med 1997 ;337:1705—14.