Populations of African descent are at the forefront of the worldwide epidemic of type 2 diabetes mellitus (T2DM). The burden of T2DM is amplified by diagnosis after preventable complications of the disease have occurred. Earlier detection would result in a reduction in undiagnosed T2DM, more accurate statistics, more informed resource allocation and better health. An underappreciated factor contributing to undiagnosed T2DM in populations of African descent is that screening tests for hyperglycaemia, specifically, fasting plasma glucose and HbA, perform sub-optimally in these populations. To offset this problem, combining tests or adding glycated albumin (a nonfasting marker of glycaemia), might be the way forward. However, differences in diet, exercise, BMI, environment, gene-environment interactions and the prevalence of sickle cell trait mean that neither diagnostic tests nor interventions will be uniformly effective in individuals of African, Caribbean or African-American descent. Among these three populations of African descent, intensive lifestyle interventions have been reported in only the African-American population, in which they have been found to provide effective primary prevention of T2DM but not secondary prevention. Owing to a lack of health literacy and poor glycaemic control in Africa and the Caribbean, customized lifestyle interventions might achieve both secondary and primary prevention. Overall, diagnosis and prevention of T2DM requires innovative strategies that are sensitive to the diversity that exists within populations of African descent.

IntroductionAllostatic load score (ALS) summarizes the physiological effect of stress on cardiovascular, metabolic and immune systems. As immigration is stressful, ALS could be affected.ObjectiveAssociations between age of immigration, reason for immigration, and unhealthy assimilation behavior and ALS were determined in 238 African immigrants to the United States (age 40 ± 10, mean ± SD, range 21–64 years).MethodsALS was calculated using 10 variables from three domains; cardiovascular (SBP, DBP, cholesterol, triglyceride, homocysteine), metabolic [BMI, A1C, albumin, estimated glomerular filtration rate (eGFR)], and immunological [high-sensitivity C-reactive protein (hsCRP)]. Variables were divided into sex-specific quartiles with high-risk defined by the highest quartile for each variable except for albumin and eGFR, which used the lowest quartile. One point was assigned if the variable was in the high-risk range and 0 if not. Unhealthy assimilation behavior was defined by a higher prevalence of smoking, alcohol consumption, or sedentary activity in immigrants who lived in the US for ≥10 years compare to <10 years.ResultsSixteen percent of the immigrants arrived in the US as children (age < 18 years); 84% arrived as adults (age ≥ 18 years). Compared to adulthood immigrants, childhood immigrants were younger (30 ± 7 vs. 42 ± 9, P < 0.01) but had lived in the US longer (20 ± 8 vs. 12 ± 9 years, P < 0.01). Age-adjusted ALS was similar in childhood and adulthood immigrants (2.78 ± 1.83 vs. 2.73 ± 1.69, P = 0.87). For adulthood immigrants, multiple regression analysis (adj R2 = 0.20) revealed older age at immigration and more years in the US were associated with higher ALS (both P < 0.05); whereas, current age, education, income, and gender had no significant influence (all P ≥ 0.4). The prevalence of smoking, alcohol intake, and physical activity did not differ in adulthood immigrants living in the US for ≥10 years vs. <10 years (all P ≥ 0.2). Reason for immigration was available for 77 participants. The reasons included: family reunification, lottery, marriage, work, education, and asylum. Compared to all other reasons combined, immigration for family reunification was associated with the lowest ALS (1.94 ± 1.51 vs. 3.03 ± 1.86, P = 0.03).ConclusionAfrican immigrants do not appear to respond to the stress of immigration by developing unhealthy assimilation behaviors. However, older age at immigration and increased duration of stay in the US are associated with higher ALS; whereas, family reunification is associated with lower ALS. IdentifierNCT00001853

The relationship between diet and a number of chronic health conditions has been well established. One of the most widely utilized tools for mediating this relationship is carbohydrate counting and dietary exchange systems. At the same time, nutrition and dietetics professionals have begun to stress the importance of cultural competency by encouraging all professionals to develop a comfort level with the ethnic, religious and contextual background of their patients. This paper is intended to support that movement by introducing nutrition professionals to the most common Jamaican foods as interpreted through the exchange list system. Across the entire Caribbean, trends have demonstrated increasing rates of type 2 diabetes mellitus (T2DM) accompanied by elevated rates of obesity. At present in Jamaica, T2DM is the second most common non-communicable chronic disease. Rates among immigrants and individuals of Jamaican heritage in the United States are unknown but are believed to mirror these trends. Understanding the food choices of this population will be vital to providing appropriate and meaningful nutrition treatment options. This paper addresses an important need and serves as a model for how to introduce other cultural traditions in cuisine to professionals in the fields of nutrition and dietetics.

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African immigrants living in the United States are exposed to the stress of changing continents and cultures. Therefore African immigrants are exposed to two types of environmental stress; first, stress related to navigating new social and economic realities; and second, stress due to work, education and a sedentary lifestyle in the United States. To evaluate the effect of these stressors on health, we calculated the allostatic load score in two groups of Africans: childhood immigrants who came to the United States before 18 years of age, and adulthood immigrants who came to the United States at 18 years of age or older. Allostatic load is a measure of the influence of environmental stress on physiological function. It is calculated for each individual by assigning one point for each high risk cardiovascular, inflammatory, and metabolic biomarker present. The higher the allostatic load score, the greater the impact of stress on physiologic dysregulation. As no consensus exists on which biomarkers to include in the calculation of allostatic load score, we used four different published equations to evaluate allostatic load in 213 African immigrants (age: 40±10y,(mean±SD) range 21-64y; BMI: 27.7±4.5 kg/m 2 ; male: 70% (149 of 213); adulthood immigrants: 81% (181 of 213)). By multiple regression, the effect of age, age at immigration, duration of stay in the United States, income, education and exercise on allostatic load score was determined. Overall, childhood immigrants were younger than adulthood immigrants (29±7 vs. 41±9y, P <0.01). However, length of residence in the United States was longer for childhood immigrants than adulthood immigrants (19±8 vs. 12±9y, P<0.01). Regardless of which equation for allostatic load score was used, childhood immigrants had lower allostatic load scores than adulthood immigrants, ( P <0.01). Among adulthood immigrants, the age range of immigration was 18 to 61y; within this group, lower age of immigration was associated with lower allostatic load scores ( P <0.05). In addition, as length of stay in the United States increased, allostatic load score increased in adulthood immigrants ( P <0.01) but not childhood immigrants ( P >0.6). For both groups of immigrants, low income, lack of a college education and low levels of exercise did not increase allostatic load score ( P >0.3). Overall, the factor which appears to have the greatest impact on the physiologic health of African immigrants is age of immigration. Africans who emigrated as children experience less physiologic stress than their counterparts who emigrated as adults.