2009 (May) Canadian Obesity Network Annual Conference, poster presentation by BRAID Research

1. Cardiovascular and diabetes risk profiles of children and adolescents attending diabetes screening
clinics in rural Alberta according to ethnicity.
Richard T. Oster and Ellen L. Toth
Department of Medicine, University of Alberta
Introduction
Diabetes prevalence rates are reportedly 2-5 times higher among Canadian
Aboriginal populations (1-3), and diabetes-related complications occur more
frequently (4, 5). The problem is expected to worsen dramatically with the
increasing prevalence of obesity, metabolic syndrome and type 2 diabetes in
Aboriginal youth (2). However, little is known regarding diabetes risk-factors
among youth.
In the province of Alberta we accessed databases of three separate
community-based diabetes and diabetes risk screening projects, creating a
unique subject pool of First Nations, Métis and non-Aboriginal children and
adolescents without diabetes.
Objective: To examine diabetes and/or cardiovascular risk profiles in First
Nation, Métis and non-Aboriginal children and adolescents in rural Alberta.
Method
Mobile clinics equipped with healthcare personnel and portable technology
travelled into each of the 44 Alberta First Nations communities, as well as
rural Aboriginal ‘off-reserve’ and remote Alberta communities. A total of 456
children 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, serum
lipids (HDL, LDL, triglycerides, and total cholesterol) and blood pressure was
measured.
The prevalence of obesity (>95th percentile), high waist circumference (>90th
percentile), hypertension (>95th percentile), hypertriglyceridemia (fasting
>1.41 mmol/L), hypercholesterolemia (total cholesterol >4.39 mmol/L), low
HDL (<1.18 mmol/L), high LDL (>2.84 mmol/L), high total cholesterol to
HDL ratio (>3.94), high plasma fasting glucose (>5.5 mmol/L) and high A1c
(>6.1%) was assessed.
Conclusion
Between group comparisons for prevalence of selected
abnormalities
Differences between groups were tested using overall Chi-Square tests.
Additional Logistic regression analyses were used to assess between group
differences after adjusting for age and gender. Odds ratios (OR) were
determined relative to First Nations.
Each screening project was approved by the Health Research Ethics Board
at the University of Alberta. This research was approached as a partnership
between Alberta’s Métis communities, Alberta First Nations communities and
the University of Alberta.
References
1. 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 analysis
Ethics
Results
First Nations Métis Non-Aboriginal Overall p-value
Obese 50.5% 52.1% 34.1% < 0.05
High waist 49.1% 47.6% 20.5% < 0.01
Hypertension 23.6% 24.5% 35.7% 0.07
Hypercholesterolemia 24.1% 25.1% 7.3% < 0.05
Low HDL 56.2% 50.3% 36.6% < 0.05
High total
cholesterol:HDL ratio
27.1% 24.6% 9.8% < 0.05
High A1c 0.9% 1.1% 0.0% 0.31
Odds ratio Lower limit of
95% CI
Upper limit of
95% CI
p-value
Obese
Métis 1.02 0.69 1.51 0.91
Non-Aboriginal 0.48 0.24 0.96 < 0.05
High Waist
Métis 0.92 0.62 1.36 0.68
Non-Aboriginal 0.27 0.12 0.58 < 0.01
Hypertension
Métis 1.12 0.70 1.80 0.63
Non-Aboriginal 1.93 0.94 3.97 0.07
Hypercholesterolemia
Métis 1.07 0.66 1.71 0.79
Non-Aboriginal 0.24 0.07 0.83 < 0.05
Low HDL
Métis 0.84 0.55 1.29 0.43
Non-Aboriginal 0.46 0.23 0.94 < 0.05
High total
cholesterol:HDL ratio
Métis 0.93 0.57 1.52 0.77
Non-Aboriginal 0.30 0.10 0.89 < 0.05
High A1c
Métis 1.01 0.71 1.49 0.93
Non-Aboriginal 0.97 0.61 1.48 0.91
Comparison of normal weight, overweight and obesity prevalence
● There were no differences in diabetes/cardiovascular risk between First
Nation and Métis subjects.
● First Nation and Métis individuals had a significantly higher prevalence of
obesity compared to non-Aboriginal individuals (p<0.05).
● Compared to Métis and First Nation youth, non-Aboriginal individuals had
a 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 few
individuals attended in the fasted state.
● After adjusting for age and sex, Métis and First Nations children and
adolescents had consistently and significantly more abnormalities than non-
Aboriginals.
Odds ratios and 95% CI for between groups comparisons relative to
First Nations adjusted for age and sex
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
First Nations Métis Non-Aboriginal
Prevalence(%)
Obese
Overweight
Normal weight
An important limitation was that subjects were not from a population-based
sample and may have been selected because of their risks (e.g. obesity or
family history); however this would likely be true for all groups. Though our
results may not be representative, they provide novel community-based
information. Possible differences in risk factors for Aboriginal versus non-
Aboriginal children and adolescents could be due to genetic or non-genetic
factors.