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'Why free sugars consumption should be below 15 kg per person per year in industrialised countries: the dental evidence'.
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Dentistry in New Zealand from the pioneer era to the present.
As a final year undergraduate dental student at the University of Manchester, I visited the school of dentistry at the University of Otago in Dunedin, New Zealand (South Island) for the month of July, 1991 to do research for my non-clinical elective. This article is a description of some of the history of dentistry, dental education and the local way of life I glimpsed during this visit.
Body mass index and percent body fat: a meta analysis among different ethnic groups.
OBJECTIVE: To study the relationship between percent body fat and body mass index (BMI) in different ethnic groups and to evaluate the validity of the BMI cut-off points for obesity. DESIGN: Meta analysis of literature data. SUBJECTS: Populations of American Blacks, Caucasians, Chinese, Ethiopians, Indonesians, Polynesians and Thais. MEASUREMENTS: Mean values of BMI, percent body fat, gender and age were adapted from original papers. RESULTS: The relationship between percent body fat and BMI differs in the ethnic groups studied. For the same level of body fat, age and gender, American Blacks have a 1.3 kg/m2 and Polynesians a 4.5 kg/m2 lower BMI compared to Caucasians. By contrast, in Chinese, Ethiopians, Indonesians and Thais BMIs are 1.9, 4.6, 3.2 and 2.9 kg/m2 lower compared to Caucasians, respectively. Slight differences in the relationship between percent body fat and BMI of American Caucasians and European Caucasians were also found. The differences found in the body fat/BMI relationship in different ethnic groups could be due to differences in energy balance as well as to differences in body build. CONCLUSIONS: The results show that the relationship between percent body fat and BMI is different among different ethnic groups. This should have public health implications for the definitions of BMI cut-off points for obesity, which would need to be population-specific.
Body size and composition in Polynesians.
OBJECTIVES: To compare the relationship between body size and body composition in New Zealanders of Polynesian and European descent and to develop specific regression equations for fat mass for Polynesians. SUBJECTS: 189 Maori (93 males, 96 females), 185 Samoans (88 males, 97 females) and 241 Europeans (89 males, 152 females) aged 20-70 y. MEASUREMENTS: Height, weight, four skinfold thicknesses, bioelectrical impedance analysis (BIA) and dual energy X-ray absorptiometry (DXA). RESULTS: At higher body mass index levels, Polynesians (Maori and Samoans combined) had a significantly higher ratio of lean mass:fat mass compared with Europeans. Four multiple regression equations incorporating resistance and reactance, height and weight, sum of four skinfolds or sum of two skinfolds were developed in two-thirds of the Polynesian participants using DXA fat mass as the dependent variable. In the remaining one-third of participants, the mean difference between fat mass predicted by these equations (r2 range 0.89-0.93) and DXA fat mass ranged from -0. 06 to +0.25 kg (s.d. -3.67 to +3.71 kg). CONCLUSION: At higher BMI levels, Polynesians were significantly leaner than Europeans, implying the need for separate BMI definitions of overweight and obesity for Polynesians. The regression equations using BIA, height and weight or skinfold thicknesses were good predictors of body composition in Polynesians.
Ethnic differences in perceptions of body size in middle-aged European, Maori and Pacific people living in New Zealand.
OBJECTIVES: The aim of this study was to compare perceptions of body size in European, Maori and Pacific Islands people with measured body mass index (BMI), waist-to-hip ratio and change in BMI since age 21 y. Socio-demographic factors that influenced perceptions of body size were also investigated. DESIGN: Cross-sectional survey. METHODS: Participants were 5554 workers, aged > or =40 y, recruited from companies in New Zealand during 1988-1990. RESULTS: Prevalences of BMI>25 kg/m2 were: Europeans, 64.7% men, 47.2% women; Maori, 93.2% men, 80.6% women; and Pacific Islanders, 94.1% men, 92.9% women. Similarly, prevalences of BMI >30 kg/m2 were: Europeans, 14.4% men, 14.6% women; Maori, 55.0% men, 41.9% women; and Pacific Islanders, 55.1% men, 71.7% women. At each perception of body size category, Maori and Pacific Islands men and women had a higher BMI than European men and women, respectively. BMI increased with increasing perception of body size in all gender and ethnic groups. Since age 21, increases in BMI were highest in Pacific Islands people and increased with increasing perceptions of body size category in all ethnic and gender groups. BMI adjusted odds (95% CI) of being in a lower perception category for body size were 1.70 (1.38-2.12) in Maori and 8.99 (7.30-11.09) in Pacific people compared to Europeans, 1.27 (1.13-1.42) times higher for people with no tertiary education, 1.41 (1.25-1.59) times higher in people with low socioeconomic status, and 0.94 (0.92- 0.95) for change in BMI since age 21. CONCLUSION: Nutritional programs aimed at reducing levels of obesity should be ethnic-specific, addressing food and health in the context of their culture, and also take into account the socioeconomic status of the group. On the population level, obesity reduction programs may be more beneficial if they are aimed at the maintenance of weight at age 21.
Relationships between glycaemic abnormalities, obesity and insulin resistance in nondiabetic Polynesians of New Caledonia.
OBJECTIVE: Polynesians in New Caledonia have an increased risk for developing diabetes, compared to Melanesians or Europeans. They are also more prone to obesity. The aim of this study was to analyse differences in the pre-diabetic state that may explain the varying susceptibility to diabetes between these three ethnic groups, focusing on the balance between insulin resistance and capacity of pancreatic cells to secrete insulin. DESIGN AND SUBJECTS: The CALDIA Study is a population-based cross-sectional survey of diabetes prevalence conducted in New Caledonia. All participants who did not have diabetes, according to the results of a 0-2 h oral glucose tolerance test (n=392), were selected for analysis. RESULTS: Compared to Europeans, Polynesians and Melanesians had significantly higher body mass indices (BMI) and waist-to-hip ratios (WHRs). Polynesians had higher fasting plasma glucose values than Europeans or Melanesians (6.03 mmol/l, vs 5.78 and 5.46, respectively; P<0.0001). Fasting plasma insulin level and the estimate of insulin resistance by homeostasis model assessment were not significantly different between the three ethnic groups. Homeostasis model assessment estimate of beta-cell secretory capacity was lower in Polynesians compared to the two other ethnic groups (83.1 mU/mmol, vs 119.3 and 125.2, respectively; P<0.02). CONCLUSION: Despite a high prevalence of central obesity, as judged by high BMI and WHR, in Polynesians of New Caledonia, their high risk of diabetes may be more strongly related to a defect in insulin secretion capacity than to insulin resistance.
Towards understanding the origin and dispersal of Austronesians in the Solomon Sea: HLA class II polymorphism in eight distinct populations of Asia-Oceania.
HLA class II nucleotide sequence polymorphisms were examined in eight ethnic groups of Asia-Oceania using DNA typing methods. Allele frequencies and characteristic DR/DQ haplotypes were determined and compared with those of other populations of Asia-Oceania. Genetic distances were measured to show the genetic relationship within the studied populations as well as between the studied populations and previously published populations. Phylogenetic trees were constructed based on HLA allele frequencies using the neighbour-joining method. The populations, mainly Trobriand Islanders, Roro, Tolai, Western Samoans and Taiwanese Aborigines, are characterized by a reduced diversity at the HLA loci examined, especially for DPB1. The high frequency of the 'Asian'-specific DPB1*0501 allele in Trobrianders and Roro, but also in Western Samoans and Taiwanese Aborigines, was the most striking result. The prevalence of DPB1*0501 and the short genetic distance from Trobriander and Roro to Taiwanese Aborigines provide evidence that the origin of the Austronesian odyssey is south-east Asia, and Taiwan could be an important part of it. The relatedness of Trobrianders to the Polynesian population from Western Samoa indicates a probable recent common ancestor. The observed lack of diversity may reflect bottleneck(s) and/or limited diversity of the founding population. Analysis of HLA class I antigens, together with mt-DNA and Y-chromosomal studies, will give us further information about the settlement of the Trobriand and other islands during the colonization of the Pacific.
Hermeneutic notions illuminate cross-cultural nursing experiences.
AIM OF PAPER: To articulate selected hermeneutic notions for the purpose of extending current understanding of cross-cultural nursing practice. BACKGROUND: This paper builds upon the findings of a New Zealand project that explored the experience of nursing people from cultures other than one's own (Spence 1999). The project asserted that the notions of prejudice, paradox and possibility portray a nursing view of this phenomenon. ARGUMENT: The discussion is based on philosophical hermeneutics as interpreted from the works of Gadamer (1996), Taylor (1985a, 1985b, 1995) and Lampert (1997). However the emphasis in this paper, rather than being methodological, is on showing how specific hermeneutic notions contribute to deeper understanding of the nature of cross-cultural practice. It is argued that contact with, and the capacity to explore, the play of conflicting prejudices and possibilities enhances understanding of the complex and paradoxical nature of cross-cultural nursing.
Inter-island movements and population differentiation in a pelagic seabird.
We used mark-resight data and amplified fragment length polymorphism (AFLP) markers to assess movements and gene flow between Central Pacific breeding colonies of the great frigatebird, Fregata minor. Of 715 adult frigatebirds marked on Tern Island and Johnston Atoll, 21.3% were resighted at other frigatebird colonies at least 582 km away. Mark-resight data indicated regular movement of males and females between Tern Island and Johnston Atoll (873 km apart), and less frequent movements to other islands; no birds marked on Tern or Johnston were seen on Christmas Island, but one was seen in the Philippines, 7627 km from where it was marked. Despite the regular occurrence of interisland movements, Bayesian analyses of AFLP data showed significant genetic differentiation between Tern Island and Johnston Atoll, and more pronounced differentiation between these two islands and the more distant Christmas Island. The AFLP profiles of three birds breeding on Tern Island fell within the profile-cluster typical for Christmas Island birds, both in a nonmetric multidimensional scaling analysis and in a population assignment test, suggesting dispersal events from Christmas Island to Tern Island. Several factors could explain the persistence of genetic structure despite frequent movements between colonies: many movements occurred during the nonbreeding season, many breeding-season movements did not involve mate-acquisition behaviours and individuals that do disperse may be selected against, as suggested by morphometric differences between colonies. The persistence of genetic structure among breeding colonies despite significant interisland movements suggests limits to the effectiveness of migration as a homogenizing force in this broadly distributed, extremely mobile species.
Paediatric nephrotic syndrome in Auckland, New Zealand.
OBJECTIVE: To review children with nephrotic syndrome in Auckland, New Zealand. METHODS: All children admitted to Auckland Children's Hospital between January 1984 and December 1994 with nephrotic syndrome and a renal biopsy had their charts retrospectively reviewed and the appropriate information summarised. RESULTS: Fifty-seven children biopsied with nephrotic syndrome were available for review. The mean age at diagnosis was 5.4 years, standard deviation (SD) 3.9 years, with mean follow-up of 5.7 years. The histologies of the renal biopsies were: minimal change nephrotic syndrome (MCNS) in 37%, focal segmental glomerulosclerosis in 19%, membranoproliferative glomerulonephritis (MPGN) in 23% and other causes in 21%. Maori children were most likely to have MPGN. Steroid resistance was present in 66% of children. End stage renal failure developed in 26% of patients and chronic renal failure in 4% of patients. CONCLUSION: In this series the proportion of children with MCNS is low and significant numbers of children with nephrotic syndrome progressed to chronic renal failure and end stage renal failure.
Incidence and risk factors for neonatal hypoglycaemia among women with gestational diabetes mellitus in South Auckland.
AIMS: To describe the incidence and risk factors for neonatal hypoglycaemia among the offspring of women with gestational diabetes mellitus (GDM) in South Auckland, New Zealand METHODS: A retrospective audit was undertaken of singleton pregnancies delivered between 1991 and 1994. Data were obtained for 373 women and their deliveries (57 European, 76 Maori, 198 Pacific Islands, 42 other). RESULTS: Pacific Islands women were most likely to have large babies with neonatal hypoglycaemia in spite of a high use of insulin. Postnatally Maori and Pacific Islands women had a high incidence of Type 2 diabetes mellitus (21.4, 21.7 vs. 4.3% Europeans, 12.0% others, P =0.035). Babies experiencing hypoglycaemia were more likely to have a mother with past GDM (51.2 vs. 27.2%, P = 0.01) and greater hyperglycaemia (at diagnosis fasting 6.8 +/- 1.7 vs. 5.7 +/- 1.1 mmol/l, P < 0.001; finger-prick glucose 5.7 +/- 1.0 vs. 5.2 +/- 0.8 mmol/l, P < 0.001). Macrosomia, Caesarian section and special care baby unit admission were more common in pregnancies complicated by neonatal hypoglycaemia. CONCLUSIONS: Maternal hyperglycaemia was a major contributing factor to neonatal hypoglycaemia in this population. Undiagnosed Type 2 diabetes was common among Maori and Pacific Islands women, confirming the need for earlier detection and treatment.
Predisposition to nephropathy in Polynesians is associated with family history of renal disease, not diabetes mellitus.
AIMS: Familial clustering of diabetes and nephropathy suggests that either common environmental or inherited mechanisms are important in developing diabetic nephropathy. If an inherited mechanism is important, the albumin excretion rate might be increased in those at future risk. This study aimed to determine whether people with a family history of diabetes or people with a family history of renal disease were most at risk. METHODS: In a two-by-two factorial study of urinary albumin in non-diabetic Polynesians, 90 people with a first degree relative (FDR) with end-stage renal failure (ESRF) and diabetes (group 1) were compared with 90 people with a FDR with non-diabetic ESRF (group 2), with 90 people with a FDR with diabetes but no known nephropathy (group 3) and 90 people with no known relatives with either diabetes or nephropathy (group 4). Groups were matched for ethnicity and age. RESULTS: Subjects with a family history of ESRF (groups 1 and 2) had an increased mean albumin-creatinine ratio (1.25 vs. 1.00 mg/mmol, P = 0.01), but in subjects with a family history of diabetes (groups 1 and 3), the mean ratios were not significantly different from those without a family history of diabetes (1.06 vs. 1.17 mg/mmol; P = 0.2). In those with a family history of nephropathy, fasting blood glucose and systolic blood pressure were increased, while fasting insulin and 2 h insulin concentrations were lower. A family history of diabetes was associated with an increased fasting blood glucose and 2-h blood glucose. By multiple linear regression, the mean systolic blood pressure (P = 0.02), the 2-h glucose concentration (P = 0.05), a family history of renal failure (P = 0.04), female sex (P = 0.0001) and the total cholesterol (P = 0.01) were each independently associated with microalbuminuria, while a family history of diabetes was not (P = 0.09). CONCLUSIONS: These data suggest that among Polynesians there is no specific inherited tendency to diabetic nephropathy per se. The risk of nephropathy does not appear to be associated with the degree of familial risk of diabetes itself. Rather, the risk of diabetic nephropathy may be the result of a familial risk of nephropathy from any cause and is associated with diabetes through relative hypoinsulinaemia and hyperglycaemia.
Polynesians: prone to obesity and Type 2 diabetes mellitus but not hyperinsulinaemia.
AIMS: To compare the extent of hyperinsulinaemia among New Zealand Europeans and Polynesians (an ethnic group at high risk of Type 2 diabetes mellitus). METHODS: A cross-sectional survey from randomly selected households was conducted in inner urban South Auckland. Subjects were either European, Maori or Pacific Islands Polynesians aged 40-79 years and were screened for diabetes using a random blood glucose. Those with an elevated result, and 20% randomly selected from those with a normal screening result, were invited to a 75-g glucose tolerance test. WHO criteria (1998) for diabetes were used. RESULTS: In those aged 40-59 years, total prevalence of diabetes was 7.5 (6.2-9.0)% in Europeans but 21.1 (16.6-25.6)% among Maori and 25.0 (19.8-30.1)% among Pacific peoples; obesity (body mass index >or= 31.0 kg/m2) was present in 26% Europeans, 63% Maori and 69% Pacific peoples. Non-diabetic Polynesians were relatively hyperglycaemic and hyperinsulinaemic. After adjusting for the degree of obesity, Polynesians had similar insulin levels to Europeans. CONCLUSIONS: These findings indicate that Polynesians are not intrinsically insulin resistant as a group, a prerequisite found in most other ethnic groups at high risk of Type 2 diabetes mellitus. The high prevalence of Type 2 diabetes in Polynesians could be the result of their high prevalence of obesity.
Serological complications of a major ABO incompatible bone marrow transplantation in a Polynesian with aplastic anemia.
A 24-year-old, blood-group O Polynesian woman with multiple red blood cell antibodies received a group A, HLA-compatible, sex-matched bone marrow transplantation as treatment for severe aplastic anemia. High retransplantation titers of ABO isohemagglutinins were successfully reduced by repeated plasmaphereses. Despite gross in vitro incompatibility in the routine crossmatch, technetium-labelled red blood cell survival studies performed immediately prior to transplantation predicted that a small proportion of the donor erythrocytes would neutralize residual postplasmapheresis isoantibody. Donor marrow was subsequently infused without significant hemolysis. Although anti-A titers were low immediately posttransplantation, these rose progressively, approaching pretransplantation levels at the time of documented marrow engraftment at day 18. One week later the bone marrow graft was rejected. Retransplantation was successfully performed using marrow from an ABO compatible, sex-mismatched sibling donor. Radioisotopic studies were helpful in evaluating donor-recipient red blood cell incompatibility during the ABO incompatible transplantation, and again at retransplantation in the presence of circulating isoantibody to donor red blood cells. High levels of ABO isoagglutinins prior to plasmapheresis and rapidly rising titers posttransplantation may have predicted bone marrow graft rejection in this patient.
The Jk(a-b-) phenotype in New Zealand Polynesians.
The Kidd locus phenotype Jk(a-b-) was detected in 0.9 percent of Polynesians living in New Zealand. Over a period of 13 years, nine examples of anti-Jk3 were detected, one of which caused a delayed hemolytic transfusion reaction. Other examples resulted in mild hemolytic disease of the newborn. The anti-Jk3 reacted as an inseparable antibody, confirmed that inheritance of the Jk(a-b-) phenotype was best explained by the presence of a silent Jk allele.
Frequencies of the Jk(a-b-) phenotype in Polynesian ethnic groups.
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Genomic characterization of the kidd blood group gene:different molecular basis of the Jk(a-b-) phenotype in Polynesians and Finns.
BACKGROUND: The clinically important Kidd (JK) blood group antigens are carried by the urea transporter in red cells. The rare Jk(a-b-) phenotype can be caused by homozygosity at the JK locus for a silent allele, JK: This phenotype has been recorded in many ethnic groups, but it is most abundant among people originating from the Polynesian Islands and Finland. The molecular basis for Jk(a-b-) is unknown in these populations. STUDY DESIGN AND METHODS: Blood samples from individuals of Swedish, Polynesian, and Finnish origin were collected and characterized by routine JK blood group serology and JK genotyping. Genomic DNA covering the exons and intervening introns of the JK gene coding region was amplified by polymerase chain reaction, and fragments were directly sequenced. RESULTS: Exon and partial intron sequences in the coding region of the JK gene were determined. Finnish and Polynesian Jk alleles were analyzed; the only deviations from consensus were a splice-site mutation (G-->A) in Polynesians, causing skipping of exon 6, and a T871C substitution predicted to disrupt a potential N-glyco-sylation motif (NSS-->NSP) in Finns. Methods for rapid detection of silent Jk alleles were developed for clinical application. CONCLUSION: Polynesians and Finns have two different molecular alterations in their Jk alleles, both of which can now be determined by polymerase chain reaction.