Transcript Gerstenbluth

6-5-2014
Epidemiology of the Metabolic
Syndrome in Curacao
Metabolic Syndrome ?
• “a group of risk factors that occur together
and increase the risk for coronary artery
disease, stroke, and type 2 diabetes” (NIH)
• all of the risks for the syndrome are related
to obesity
• 2 most important : central obesity & insulin
resistance
Lifestyle in Medicine
March 29 till 31 & April 1, 2014 - Curacao
HILTON Hotel
Izzy Gerstenbluth
Izzy Gerstenbluth
Prevalence of some chronic
conditions all age groups
SXM Statia Saba Bon Cur
Metabolic syndrome is present if you have
three or more of the following signs:
•
•
•
•
•
Blood pressure ≥ 130/85 mmHg
Fasting blood glucose ≥ 100 mg/dL
Large waist circumference
Low HDL cholesterol
Triglycerides ≥ than 150 mg/dL
% 25
20
15
10
5
0
Complaints
joints
Izzy Gerstenbluth
% 70
60
50
40
30
20
10
0
Hypertension
Izzy Gerstenbluth
Diabetes
Izzy Gerstenbluth
Prevalence of some chronic
conditions ageSXMgroup
65+ years
Statia Saba Bon Cur
Complaints
joints
Hypertension
Diabetes
HT& DM: Secondary Pathology
•
•
•
•
•
•
Retinopathy
Nephropathy (Dialysis)
Neuropathy
Vascular disease (Amputations)
Myocardial Infarctions
Stroke
Izzy Gerstenbluth
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6-5-2014
Anthropometrics
Obesity: Common Risk Factor
•
•
•
•
Hypertension
Diabetes Mellitus
Back & Joint complaints
Different types of cancer
•
•
•
•
Izzy Gerstenbluth
Izzy Gerstenbluth
Obesity indicators by age
Obesity (BMI ≥ 30)
Men
(Saba, Statia, Bonaire)
Men
Women
WHR>.95
60
%
40.4
46.4
29
40
20
30.7
29.6
St Maarten
Statia
BMI (kg/m2) ≥ 25
BMI (kg/m2) ≥ 30
WC 102 (m) 88 (f) cm
WHR 0.95 (m) 0.80 (f)
Overweight:
Overall obesity:
central obesity:
Central obesity:
30.9
36.2
19.6
18.5
18.7
Saba
Bonaire
Curaçao
0
Women
WC>102
BMI>30
WHR>.80
% 100
100
80
80
60
60
40
40
20
20
0
WC>88
BMI>30
0
18-24 25-34 35-44 45-54 55-64 65-74 75+
18-24 25-34 35-44 45-54 55-64 65-74 75+
age
age
Izzy Gerstenbluth
Izzy Gerstenbluth
1954
2004
Energie
Verbruik
54
--Energie
Inname
+++
Izzy Gerstenbluth
Bron: National Geographic augustus 2004
Met dank aan prof dr Remy Hirasing
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6-5-2014
Consumption of fruit and vegetables
Physical exercise
(% Participants who consume fruit and
vegetables (almost) everyday)
(% Participants who practice any form of
physical exercise at least once a week)
Women
Fruit
Men
Vegetables
60
100
%
80
60
52.4
37.5
56.5
40
30.4
31.9
35.8
30.8
46.5
20
40
20
47.8
%
63.1
33.6
38.5
31.3
46.3
51.2
0
St Maarten
Statia
Saba
Bonaire
18.8
19.1
24.1
34.2
19.5
St Maarten
Statia
Saba
Bonaire
Curaçao
0
Curaçao
Izzy Gerstenbluth
Izzy Gerstenbluth
Socio-economic inequalities
Socio-economic differences in
obesity
On all five islands, people of lower SES:
• Have more health problems (poorer physical,
mental, and perceived health)
• Have unhealthier lifestyles (eating habits,
smoking)
• Have among women a higher prevalence of
obesity
• Make less use of preventive services (dental
check-ups, pap tests)
• Despite their poorer health status, do not make
more use of GP and specialist care
Women of lower SES:
• have higher BMI but are less inclined to call
themselves overweight
• have less knowledge of obesity, exercise and
healthy eating
• have a less favorable attitude towards exercise and
healthy eating
• eat less healthy
• engage less in exercise than women of higher SES
Izzy Gerstenbluth
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6-5-2014
Projection prevalence HT
Projection prevalence DM
(Sources: Curacao Health Study, CBS Population prognoses Curacao)
(Sources: Curacao Health Study, CBS Population prognoses Curacao)
(overall 14.5% SR!)
(overall 5.6% SR!)
Males
Males
Females
Females
% 9
8
7
6
5
4
3
2
1
0
% 25
20
15
10
5
0
1995 2000 2005 2010 2015 2020 2025 2030
1995 2000 2005 2010 2015 2020 2025 2030
Izzy Gerstenbluth
Izzy Gerstenbluth
kinderen geboren in 1997
gemeten schooljaar 2008/2009
Overgewicht bij kinderen op
Curaçao
% 25
percentages
(BMI-waarden
WHO 2007)
100%
60%
50%
10-11 jr
18
,8
%
15
,2
%
14
,9
%
20%
5-6 jr
17
,2
%
15
,5
%
30%
5
20
,4
%
40%
10
66
,0
%
70%
15
64
,7
%
80%
1996-2000
2000-2005
67
,3
%
90%
20
geen overgewicht
overgewicht
obesitas
10%
15-16 jr
0%
jongens
meisjes
Izzy Gerstenbluth
% Overgewicht & Obees: BMI
V 60+
72
V<60
70,1
Totaal
65,8
M<60
59,9
60
40
30
20
V 60+
79,6
80
V<60
63,6
70
M 60+
54,6
V 60+
49,7
V<60
44,2
50
%
% verhoogd risico: taille omtrek
in centimeters (WC)
90
80
70
totaal
Izzy Gerstenbluth
Totaal
38,2
60
Totaal
56
% 50
M<60
29,6
40
M 60+
18,5
M<60
34,3
M 60+
32,4
30
20
10
% overgewicht/obees
% obees (BMI>=30kg/m2)
(BMI>=25kg/m2) Izzy Gerstenbluth
10
% verhoogd
risico (WC m≥102; v≥88)
Izzy Gerstenbluth
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6-5-2014
10 meest voorkomende aandoeningen BZV
Onderzoek 2007
Uitgelicht: verhoogde bloeddruk
Totaal % HBD: zelfrapportage blijkt onderrapportage
%
0
5
10
15
20
25
30
35
55
Totaal
50
31,7
1. Hoge Bloeddruk
50
16,3
2 suikerziekte
14,7
3. Gewrichtsslijtage
Totaal
41,9
45
10,0
4. Rugaandoening
5. Duizeligheid
9,7
6. Psychische problemen
9,3
40
%
7. Glaucoom
8. Gewrichtsontsteking
9. hartkwaal of hartinfarct
10. Migraine
Totaal
31,7
30
6,2
5,7
25
5,5
8,4
[Bij mannen] Prostaatklachten
[Bij vrouwen] Verzakking
35
6,9
20
Zelfrapportage
HBD
6,2
Gemeten HBD
Gemeten HBD +
med
HBD: meting geeft ander beeld
Behandeling
Vooral % mannen met verhoogde bloeddruk blijkt hoger
Vooral advies/navolging medicijnen,
leefstijlfactoren ondergeschikt.
Mannen<60 vaker HBD dan Vrouwen<60
Ouderen >60 vaker HBD den jongeren<60
90
80
m 60+
68,4
70
v60+
74,2
84,1
78
80
70
Neemt laatste 2 weken
voorgeschreven medicijnen
64,1
Volgt speciaal dieet
60
v60+
54,1
60
50
totaal
50
50
%
40
m 60+
33,6
totaal
31,7
30
m<60
18,7
20
40
m<60
43,8
30
20
v<60
28,4
v<60
23,5
Volgt advies af te vallen
%
29
24,724,7
18,6
10
22,2
23,1
26 27
meer lichamelijke beweging
22
Insuline
2,6
0
diagnose HBD (n=233)
diagnose verhoogd
cholesterol (n=117)
diagnose diabetes
(n=101)
10
Zelfrapportage HBD
Izzy Gerstenbluth
Gemeten HBD + med
Effect van behandeling HBD
Slechts 25% van diagnose groep HBD, weet
bloeddruk te onderdrukken met medicijnen
geen hbd gemeten
wel hbd gemeten
geen hbd + medicatie
100%
90%
80%
 NL: 2007 ca 35.600 new strokes
̴ 210/100.000
50-70% of all strokes admitted
25%
32,5%
70%
 Cur: Clinical strokes ̴ 250 per year
60%
50%
68,0%
40%
30%
Stroke incidence
67,5%
20%
(75% of total)
̴ 227/100.000
10%
7,0%
0%
niet bewust HBD (n=469)
Izzy Gerstenbluth
wel bewust HBD (n=200)
CSQ March 2014; Gerstenbluth / Lourents / Rico
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Number of registered strokes
age and stroke II
by agegroup and sex per year (n=903)
Female
proportion of patients having strokes before 50 years and before 65 years
Male
male
125
%
female
50
45.7
100
40
33.1
75
30
50
20
13.0
10.1
10
25
0
0
<=50
51-70
71-90
91+
2010
<=50
51-70
71-90
91+
<=50
2011
51-70
71-90
91+
2012
<=50
51-70
71-90
≤50 years
91+
≤65 years
2013
CSQ March 2014; Gerstenbluth / Lourents / Rico
CSQ March 2014; Gerstenbluth / Lourents / Rico
Riskfactors I
Comparisons Young Strokes
yes
 < 50: NL: 2.5% Cur: 11.6%
no
unknow n
700
600
500
 <65: USA: 34% Cur: 39.9%
400
(CDC data)
300
200
100
0
cardioembolism
current tobacco use
diabetes mellitus
hypercholesterolemia
hypertension
32.2% has Diabetes Mellitus, 31.7 % has Hypercholesterolemia, 79.3 % has Hypertension
CSQ March 2014; Gerstenbluth / Lourents / Rico
CSQ March 2014; Gerstenbluth / Lourents / Rico
risk factors by type of stroke
tobacco use
hypertension
diabetes mellitus
substance use
Riskfactors II
hypercholesterolemia
other riskfactor
% 90
80
70
60
Hypertension + Diabetes Mellitus:
28.6%
(n=259)
Hypertension + Hypercholesterolemia:
27.6%
(n=249)
Hypercholesterolemia + Diabetes Mellitus:
13.7%
(n=124)
Hypertension + Diabetes Mellitus + hypercholesterolemia:
12.6%
(n=114)
50
40
30
20
10
0
ischemic
intracerebral
subarchnoidal
CSQ March 2014; Gerstenbluth / Lourents / Rico
other/unspecified
CSQ March 2014; Gerstenbluth / Lourents / Rico
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6-5-2014
Izzy Gerstenbluth
Izzy Gerstenbluth
Pyramide (Seidell 2005)
toegepast op Curacao 2007
‘Pyramide’ (Seidell 2005) toegepast op Curacao 2007
Morbid obesity +
severe complications
Surgery: YES in the hospitals
Obesity + morbidity
Specialists + pharmacotherapy:
Yes
Overweight + risk
factor management
Primary care + dietitian, tertiary
prevention: YES
Overweight
Self management: yes medicine,
diet, exercise etc
High risk
Early identification, secondary
prevention: jgz
Population
Health promotion, primary
prevention: borstvoeding stimuleren,
Hartstichting, particuliere initiatieven
Education:little bit
Physical env
Izzy Gerstenbluth
Sociocult env
MICRO
Economic env
MACRO
ANGELO modelIzzy Gerstenbluth
Courtesy Dr. P.J. Offringa,
Izzy Gerstenbluth
SXM
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6-5-2014
“Rise up with me against the
organization of misery”
Pablo Neruda
Masha Danki!
´
Big Mama´ Hortence Brouwn, Curaçao 1999
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