Cardiovascular and diabetes risk profiles of children and adolescents attending diabetes screening clinics in rural Alberta according to ethnicity
Cardiovascular and diabetes risk profiles of children and adolescents attending diabetes screeningclinics in rural Alberta according to ethnicity.Richard T. Oster and Ellen L. TothDepartment of Medicine, University of AlbertaIntroductionDiabetes prevalence rates are reportedly 2-5 times higher among CanadianAboriginal populations (1-3), and diabetes-related complications occur morefrequently (4, 5). The problem is expected to worsen dramatically with theincreasing prevalence of obesity, metabolic syndrome and type 2 diabetes inAboriginal youth (2). However, little is known regarding diabetes risk-factorsamong youth.In the province of Alberta we accessed databases of three separatecommunity-based diabetes and diabetes risk screening projects, creating aunique subject pool of First Nations, Métis and non-Aboriginal children andadolescents without diabetes.Objective: To examine diabetes and/or cardiovascular risk profiles in FirstNation, Métis and non-Aboriginal children and adolescents in rural Alberta.MethodMobile clinics equipped with healthcare personnel and portable technologytravelled into each of the 44 Alberta First Nations communities, as well asrural Aboriginal ‘off-reserve’ and remote Alberta communities. A total of 456children and adolescents without diabetes were screened (220 First Nations,192 Métis and 44 non-Aboriginal – mostly Mennonite). Ages were 6-17.BMI, waist circumference, hemoglobin A1c (A1c), plasma glucose, serumlipids (HDL, LDL, triglycerides, and total cholesterol) and blood pressure wasmeasured.The prevalence of obesity (>95th percentile), high waist circumference (>90thpercentile), hypertension (>95th percentile), hypertriglyceridemia (fasting>1.41 mmol/L), hypercholesterolemia (total cholesterol >4.39 mmol/L), lowHDL (<1.18 mmol/L), high LDL (>2.84 mmol/L), high total cholesterol toHDL ratio (>3.94), high plasma fasting glucose (>5.5 mmol/L) and high A1c(>6.1%) was assessed.ConclusionBetween group comparisons for prevalence of selectedabnormalitiesDifferences between groups were tested using overall Chi-Square tests.Additional Logistic regression analyses were used to assess between groupdifferences after adjusting for age and gender. Odds ratios (OR) weredetermined relative to First Nations.Each screening project was approved by the Health Research Ethics Boardat the University of Alberta. This research was approached as a partnershipbetween Alberta’s Métis communities, Alberta First Nations communities andthe University of Alberta.References1. Hemmelgarn BR et al. Alberta Diabetes Atlas. 2007:127-40. 4. Molitch ME et al. Diabetes Care. 27 Suppl1:S79-83, 2004.2. Young TK et al. CMAJ. 163:561-566, 2000. 5. Zhang Y et al. Hypertension. 47:410-414, 2006.3. Dannenbaum D et al. Canadian Journal of Diabetes. 32:46, 2008.Statistical analysisEthicsResultsFirst Nations Métis Non-Aboriginal Overall p-valueObese 50.5% 52.1% 34.1% < 0.05High waist 49.1% 47.6% 20.5% < 0.01Hypertension 23.6% 24.5% 35.7% 0.07Hypercholesterolemia 24.1% 25.1% 7.3% < 0.05Low HDL 56.2% 50.3% 36.6% < 0.05High totalcholesterol:HDL ratio27.1% 24.6% 9.8% < 0.05High A1c 0.9% 1.1% 0.0% 0.31Odds ratio Lower limit of95% CIUpper limit of95% CIp-valueObeseMétis 1.02 0.69 1.51 0.91Non-Aboriginal 0.48 0.24 0.96 < 0.05High WaistMétis 0.92 0.62 1.36 0.68Non-Aboriginal 0.27 0.12 0.58 < 0.01HypertensionMétis 1.12 0.70 1.80 0.63Non-Aboriginal 1.93 0.94 3.97 0.07HypercholesterolemiaMétis 1.07 0.66 1.71 0.79Non-Aboriginal 0.24 0.07 0.83 < 0.05Low HDLMétis 0.84 0.55 1.29 0.43Non-Aboriginal 0.46 0.23 0.94 < 0.05High totalcholesterol:HDL ratioMétis 0.93 0.57 1.52 0.77Non-Aboriginal 0.30 0.10 0.89 < 0.05High A1cMétis 1.01 0.71 1.49 0.93Non-Aboriginal 0.97 0.61 1.48 0.91Comparison of normal weight, overweight and obesity prevalence● There were no differences in diabetes/cardiovascular risk between FirstNation and Métis subjects.● First Nation and Métis individuals had a significantly higher prevalence ofobesity compared to non-Aboriginal individuals (p<0.05).● Compared to Métis and First Nation youth, non-Aboriginal individuals hada lower prevalence abnormal waist circumference, hypercholesterolemia,low HDL levels, and high cholesterol: HDL ratio (p<0.05).● High A1c was very uncommon and no ethnic differences emerged. LDL,triglyceride and plasma glucose results are not presented as too fewindividuals attended in the fasted state.● After adjusting for age and sex, Métis and First Nations children andadolescents had consistently and significantly more abnormalities than non-Aboriginals.Odds ratios and 95% CI for between groups comparisons relative toFirst Nations adjusted for age and sex0%10%20%30%40%50%60%70%80%90%100%First Nations Métis Non-AboriginalPrevalence(%)ObeseOverweightNormal weightAn important limitation was that subjects were not from a population-basedsample and may have been selected because of their risks (e.g. obesity orfamily history); however this would likely be true for all groups. Though ourresults may not be representative, they provide novel community-basedinformation. Possible differences in risk factors for Aboriginal versus non-Aboriginal children and adolescents could be due to genetic or non-geneticfactors.