Journal of the New Zealand Medical Association, 17-December-2004, Vol 117 No 1207
This Issue in the Journal
Insulin resistance in a rural Maori community
D Tipene-Leach, H Pahau, N Joseph, K Coppell, K McAuley, C Booker, S Williams, J Mann
Diabetes is known to be common among New Zealand Maori. This study shows that nearly half of the adult population surveyed on the East Coast of the North Island have insulin resistance. Insulin resistance is believed to be the earliest identifiable phase of type 2 diabetes and a major risk factor for heart disease. The fact that insulin resistance is particularly prevalent in young people endorses the need for early lifestyle intervention.
Risk factors for type 2 diabetes in postmenopausal New Zealand women: a cross-sectional study
S Rose, B Lawton, A Dowell, A Fenton
This paper investigates risk factors associated with type 2 diabetes in 3377 postmenopausal New Zealand (NZ) women. A diabetes risk analysis tool revealed that over half were at ‘high risk’ for developing diabetes in the future. Over half of this predominantly NZ European sample had modifiable risk factors including overweight or obesity, and physical inactivity. These data highlight the urgent need to identify those with modifiable risk factors before they develop type 2 diabetes in order to appropriately target lifestyle intervention programs.
Body size, body composition, and fat distribution: a comparison of young New Zealand men of European, Pacific Island, and Asian Indian ethnicities
E Rush, L Plank, V Chandu, M Laulu, D Simmons, B Swinburn, C Yajnik
The World Health Organization (WHO) threshold for classification of obesity is a BMI (weight in kilograms divided by square of height in metres) of 30. This study of young New Zealand men of European, Pacific Island, and Asian Indian ethnicities showed that, for the same BMI, Pacific Island men had markedly less fat and more muscle while Asian Indian had more fat and less muscle than European men. A BMI of 30 in the European men was equivalent to a BMI of 33 in Pacific Island and 25 in Asian Indian men, respectively, who had relatively more abdominal fat. Universal BMI thresholds are not appropriate for comparison of obesity prevalence between these ethnic groups.
Obesity and health-related quality of life: results from a weight loss trial
C Ni Mhurchu, D Bennett, R Lin, M Hackett, A Jull, A Rodgers
The New Zealand population is becoming increasingly overweight and it is well known that this is an important cause of disease and death. This study measured health-related quality of life among 250 participants in a weight loss trial and compared results with the general population. Findings showed that overweight and obese adults experience significantly impaired quality of life compared to population norms, particularly in the physical function domains. Small reductions in body weight did not improve quality of life in this substantially overweight population. The study confirms that obesity has a significant negative impact on the health-related quality of life of New Zealand adults.
Gastric bypass surgery for severe obesity: what can be achieved?
M He, R Stubbs
The results of gastric bypass surgery performed at the Wakefield Clinic (Wellington, New Zealand) in over 300 severely obese individuals are presented. They show a mean percentage of excess weight loss of around 70% within 2 years of surgery with good maintenance of weight loss out to 5 years. In the majority of those with serious comorbidities including type 2 diabetes, hypertension, dyslipidaemia, asthma, and obstructive sleep apnoea, these were either resolved or substantially improved following surgery.
Cost-effectiveness of physical activity counselling in general practice
R Elley, N Kerse, B Arroll, B Swinburn, T Ashton, E Robinson
Physical activity counselling in primary healthcare using the Green Prescription is not only effective but also cost-effective. A randomised controlled trial in the Waikato showed that brief advice (to become more active) from a general practitioner or practice nurse, accompanied by a Green Prescription, increased exercise levels over 12 months. And with increases in exercise levels, savings in healthcare are likely in the long term—because active people have lower rates of heart disease, diabetes, stroke, osteoporosis, and other diseases.
Diabetes in children and young adults in Waikato Province, New Zealand: outcomes of care
A Scott, S Whitcombe, D Bouchier, P Dunn
Diabetes remains an important cause of morbidity and mortality among young people. Despite improvements in technology, maintenance of good glycaemic control is hard to achieve particularly during the teenage years. Young people with diabetes in Waikato have poor glycaemic control (HbA1c 9.2%) and after 10 years over a quarter have evidence of early kidney and eye complications. These results are similar to published European studies but little is known about the outcomes of care in the rest of New Zealand.
Under-reporting of diabetes on death certificates among a population with diabetes in Otago Province, New Zealand
K Coppell, K McBride, S Williams
In New Zealand, little information is known about the under-reporting of diabetes on death certificates—a recognised problem worldwide. This study (using data from the Otago Diabetes Register) found that diabetes was not mentioned on the death certificates of 45% of 508 patients known to have diabetes. If the impact of the diabetes epidemic on mortality is to be monitored appropriately in New Zealand, attention needs to be given to improving the completion of death certificates, including always recording diabetes when it is present, irrespective of whether it is considered to be the underlying or a contributing cause of death.
Indigenous disparities in disease-specific mortality, a cross-country comparison: New Zealand, Australia, Canada, and the United States
D Bramley, P Hebert, R Jackson, M Chassin
Indigenous peoples suffer from poor health and lower life expectancy. This study compares indigenous mortality with non-indigenous mortality in New Zealand, Australia, Canada, and the United States. Findings show that New Zealand Maori and Australian Aboriginals and Torres Strait Islander suffer from the highest levels of mortality and also the largest levels of inequity when compared to their non-indigenous population. Diabetes mortality is especially high for all indigenous peoples included in this study. Action is required to address indigenous health disparities and to improve the quality of indigenous mortality data.
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