Triglyceride glucose index as an indicator of cardiovascular risk in Syrian refugees

Background: The triglyceride glucose (TyG) index is a quick and inexpensive approach to measure insulin resistance. The aim of this study was to evaluate the TyG index’s ability to predict cardiovascular risk and determine the TyG index cutoff values in Syrian refugees. Methods: A retrospective research study was conducted with 756 Syrian refugees. Data on demographics and clinical laboratory assessments were obtained from refugee’s files. The formula Ln [fasting triglycerides (mg/dL) × fasting plasma glucose (mg (dL)/2] was used to calculate the TyG index. The Framingham risk score was used to calculate ten-year cardiovascular risk. The TyG index cutoff point was determined using the receiver operating characteristic curve (ROC). Results: Included participants had a mean age of 56.76 ± 10.78 years and a mean body mass index (BMI) of 27.42 ± 4.03 kg/m2. 28.57% of the subjects were smokers, and the majority were female (56.75%). A significant moderate correlation was observed between TyG index and Framingham score (r = 0.428, p < 0.001). ROC curve analysis for TyG index and Framingham score showed an area under the curve (AUC) of 0.741 (95% CI = 0.691–0.791; p < 0.001). The cutoff value of the TyG index to recognize intermediate/high risk Framingham risk score was 9.33, with a sensitivity of 64.3%, and specificity of 75.0%. Conclusion: Our findings determine that, given a TyG index cutoff value of 9.33, the TyG index has a predictive ability to assess ten-year cardiovascular risk by comparison to the Framingham risk score in a high-risk group of Syrian refugees and can be used as an independent indicator of cardiovascular risk

Triglyceride Glucose Index as an Indicator of Cardiovascular Risk in Syrian Refugees

Ameerah Hasan Ibrahim,1 Alaa Mahmoud Hammad,1 Walid Al-Qerem,1 Hakam Alaqabani,1,2 F Scott Hall,3 Fawaz Alasmari4 1Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan; 2Strathclyde Institute of Pharmacy and Biomedical sciences, University of Strathclyde, Glasgow, UK; 3Department of Pharmacology and Experimental Therapeutics, College of Pharmacy and Pharmaceutical Sciences, University of Toledo, Toledo, OH, USA; 4Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh, Saudi ArabiaCorrespondence: Alaa Mahmoud Hammad, Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, P.O. Box 130, Amman, 11733, Jordan, Tel +962-6-4291511, Fax +962-6-4291432, Email [email protected]: The triglyceride glucose (TyG) index is a quick and inexpensive approach to measure insulin resistance. The aim of this study was to evaluate the TyG index’s ability to predict cardiovascular risk and determine the TyG index cutoff values in Syrian refugees.Methods: A retrospective research study was conducted with 756 Syrian refugees. Data on demographics and clinical laboratory assessments were obtained from refugee’s files. The formula Ln [fasting triglycerides (mg/dL) × fasting plasma glucose (mg (dL)/2] was used to calculate the TyG index. The Framingham risk score was used to calculate ten-year cardiovascular risk. The TyG index cutoff point was determined using the receiver operating characteristic curve (ROC).Results: Included participants had a mean age of 56.76 ± 10.78 years and a mean body mass index (BMI) of 27.42 ± 4.03 kg/m2. 28.57% of the subjects were smokers, and the majority were female (56.75%). A significant moderate correlation was observed between TyG index and Framingham score (r = 0.428, p < 0.001). ROC curve analysis for TyG index and Framingham score showed an area under the curve (AUC) of 0.741 (95% CI = 0.691– 0.791; p < 0.001). The cutoff value of the TyG index to recognize intermediate/high risk Framingham risk score was 9.33, with a sensitivity of 64.3%, and specificity of 75.0%.Conclusion: Our findings determine that, given a TyG index cutoff value of 9.33, the TyG index has a predictive ability to assess ten-year cardiovascular risk by comparison to the Framingham risk score in a high-risk group of Syrian refugees and can be used as an independent indicator of cardiovascular risk.Keywords: TyG index, Framingham risk score, ROC, Syrian refugees, cardiovascular ris

Nutritional and health status of adult Syrian refugees in the early years of asylum in Germany: a cross-sectional pilot study

Background: Migration is usually accompanied by changes in the social, cultural, and religious environment, socioeconomic status, and housing conditions, all of which affect nutritional health. In a cross-sectional study, we assessed the dietary intake as well as nutritional and health situation in a population of Syrian refugees who have resided in Germany for at least six months up to four years since 2015. The primary aim of this pilot study was to evaluate the nutritional and health status in comparison to reference values. Methods: Between December 2018 and March 2020, 114 adult Syrian refugees were included in the study. The subjects filled out questionnaires on sociodemographic variables, exercise, and nutrition behavior (three-day nutrition record). After a fasting blood draw, the subjects were examined for anthropometric parameters (height, weight, body mass index, waist circumference, waist-hip ratio, and body composition via a bioelectrical impedance analyzer). Various blood markers including iron status, hematological parameters, Vitamin D status, lipid metabolism, glucose metabolism, and total homocysteine (tHcy) were measured. Results: About half of the participants (71 male, 43 female) had lived in Germany for less than three years. Over 60% of men and 30% of women were overweight (BMI 25–30 kg/m2) or obese (BMI > 30 kg/m2), while 79% of men and 74% of women observed an elevated body fat mass. The evaluation of the three-day nutrition records revealed an unfavorable supply situation for numerous critical nutrients. More than half of the women (53.5%) had depleted iron stores (serum ferritin  10 nmol/l. Fasting insulin levels and the HOMA-IR index indicate a risk for insulin resistance. Hyperlipidemia was prevalent, especially in males with 24% showing hypertriglyceridemia (> 150 mg/dl) and LDL-hypercholesterolemia (> 130 mg/dl). Conclusions: The nutritional and health status of the cohort of Syrian refugees in Germany examined in this study is unsatisfactory, and many of the investigated refugees are at risk for developing cardiovascular disease and type 2 diabetes mellitus. Further studies are required to investigate the nutritional and health situation of refugees. This is obligatory to find ways to avoid malnutrition with all its associated health, sociodemographic, and economic consequences

Dietary patterns and the risk of metabolic syndrome among HIV positive individuals from selected health facilities in Lusaka district, Zambia.

ThesisThe relationship between diet and the risk of metabolic syndrome has not yet been established among HIV positive individuals in Zambia. Around 37.9 million people globally are believed to be living with HIV infection and in Zambia 1.2 million people are living with the same infection. HIV infection and antiretroviral therapy use are associated with disturbance in glucose and lipid metabolism. It is estimated that approximately 25% of the world’s population has metabolic syndrome. The prevalence of metabolic syndrome among HIV positive individuals in Zambia is not known. In the Sub-Saharan Africa population, including Zambia, the prevalence of metabolic syndrome and its differential contribution by HIV status is not yet established. However, the rapid urbanization, demographic and epidemiological transitions and as well as changes in lifestyle that have been observed in SSA have been associated with the emergency of cardiovascular diseases which are metabolic syndrome components. The main objective of this study was to determine the dietary patterns and the risk of metabolic syndrome among HIV positive individuals. A cross-sectional study was conducted among the 180 subjects from April to July 2020 in the three sampled health facilities that offer antiretroviral services from the twenty six health facilities in Lusaka District. Participants completed a structured questionnaire on socio-demographic characteristics and a 53-item food frequency questionnaire. Anthropometric measurements (weight, height and waist circumference) were also obtained and analysed. Blood pressure was also analysed by the use of the sygmomanometre. Blood metabolites for cholesterol, triglycerides and glucose were analysed at the laboratory. Dietary patterns from food frequent questionnaire were identified using Principal Component Analysis (PCA). Binary logistic regression analysis was performed to evaluate the association of extracted dietary patterns as well as other lifestyles patterns with metabolic syndrome and its metabolic abnormalities. Out of the 180 participants, 53% (n=96) of them were women. Physical measurements indicated that 39% (n=70) of the respondents had high waist to hip ratio, high waist circumference was observed among females 21% (n=38) than among males 4% (n=7). Respondents with elevated blood pressure were 33% (n=60), elevated total cholesterol levels were 52% (n=93) and elevated triglycerides levels were 46% (n=83). Through PCA analysis, three dietary clusters were identified which included omnivorous; “staples, animal products and vi fruits”, vegetarian; “legumes and nuts” and the other one, unclassified; “fats and oils, other foods and beverages and vegetables”. None of the food clusters showed significant association with metabolic syndrome or its components. The findings of this study showed that metabolic syndrome among HIV positive individuals is zero. However, raised blood pressure, 33% (n=60) was the only metabolic syndrome predictor with the rest of the parameters being predictors of non-communicable disease. Therefore interventions such as consumption of low energy yielding foods during group and community health messaging sessions could be implemented so as to keep the zero prevalence levels of metabolic syndrome in Zambia at bay

City Life: Three Papers Investigating the Healthcare Experience of Refugees With Noncommunicable Diseases Residing in Urban Settings Across the Middle East and North Africa

The last decade has been defined by the forced displacement of an unprecedented number of people, on a scale not seen since World War II. As of 2018, more than 71 million people across the globe have been forced to migrate as a result of conflict, natural disasters, drought and famine. More than 19 million crossed international borders seeking safety, and were formally registered as refugees. Forced migration has placed stress and pressure on surrounding low-and middle-income countries. This has been most notable in the Middle East and North Africa as a result of the crisis in Syria. Host countries in the Middle East and North Africa are overwhelmed by this rapid influx, particularly by the healthcare needs of this population. Stakeholders face difficulties providing health services to refugees, owing to the increased number of refugees in urban settings, the large demands on host country health systems and the epidemiologic transition towards non-communicable diseases (NCDs). Health challenges have been exacerbated by weaknesses in the global humanitarian architecture, that result in a fragmented and competitive sector that is unprepared for the current context. Few comparative analyses have examined the diversity of policies and practices aimed at improving services for urban-based refugees with NCDs in the MENA region. Furthermore, a variety of quantitative studies examined NCD incidence, prevalence and service utilization. However, these studies have quickly become outdated and do not explore, in adequate depth, the refugee experience and perspective on accessing NCD services in urban settings. Lastly, numerous NCD interventions have been recommended for LMICs. However, very little guidance exists to support actors addressing these health concerns in crisis-affected contexts. As a result, this dissertation is presented in three papers and responds to these gaps in the literature. Each paper focuses on a specific aim and research question and together they identify and provide recommendations for improvement to service delivery and policy formulation. Paper 1 identifies policies and practices, implemented by host countries and humanitarian actors, aimed at improving access to NCD services for urban refugees in the Middle East and North Africa. Paper 2 examines, using qualitative methods, the healthcare access experience of urban-based Syrian refugees who have been diagnosed with NCDs in Jordan. The third portion of this dissertation (Paper 3) is a policy series that provides recommendations for the government of Jordan and humanitarian actors to improve healthcare access for urban-based refugees with NCDs. It is anticipated that this series of publications will be relevant to traditional and non-traditional actors that respond to the health needs of refugees in urban settings in the MENA region

Addressing Non-Communicable Diseases in Fragile Lebanon: A Mixed-Methods Research Study

Introduction: Lebanon has faced a substantial increase in the burden of NonCommunicable Diseases (NCD) over the last decade. There is a dearth of research focusing on health systems and policy responses to NCD. This PhD thesis analyses how the NCD burden is addressed in the context of fragile Lebanon and identifies policy-, health system- and community-related factors affecting NCD prevention and control. Methodology: This thesis adopts a pragmatic paradigm and incorporates: 1. a political economy analysis of NCD, based on a literature review; 2. a system analysis of NCD prevention and control, based on semi-structured interviews and group-model building workshops with 79 health providers and community members in urban Greater Beirut; 3. a survey with 941 persons living with NCDs to identify the magnitude of key factors affecting NCD control in Greater Beirut. Findings: The political economy analysis revealed an unbalanced power relationship between NCD policy promoters (e.g. civil society) and blockers(e.g. private entities). This has led to a gap in the prevention policy landscape. Care is provided under the auspices of a highly privatized hospital-centric model where services are offered for commercial gain rather than public good. The systems analysis validated these insights, with health provider and community participants linking the challenging socio-political environment to lacking prevention policy/action. This increases NCD incidence and creates barriers in accessing care. Experiences with NCD care were noted to be varied and influenced by perceptions of service quality and trust in providers. The survey confirmed that inequities in access to care exist in Greater Beirut and highlighted that service delivery patterns differ by provider. Communities evaluated different dimensions of trust in healthcare and identified gaps in the reliability, fairness and fidelity of the current system. Conclusions: The thesis concludes with an overview of how to strengthen Lebanon’s response to NCDs

The impact of armed conflict on morbidity and mortality globally

Introduction Empirical evidence isolating the independent effect of armed conflict on health is scant, has methodological limitations, and neglects a growing burden of non-communicable diseases (NCDs). This thesis aims to evaluate the impact of armed conflict on civilian morbidity and mortality globally. Methods Two systematic reviews assessed the existing evidence on conflict and NCDs (Chapters 4 & 5). Longitudinal, fixed effects panel regression models used data from the Uppsala Conflict Data Program and Global Burden of Disease to assess relationships between four armed conflict specifications and health outcomes. Outcomes included all-cause and cause-specific civilian mortality (Chapter 6), and maternal and child mortality and health service coverage (Chapter 7). Models were adjusted for ten confounders, lagged by between one and ten years, and were age- and -sex stratified. Multiple sensitivity analyses assessed model robustness. Results Systematic review findings found positive but inconsistent associations between conflict and NCDs, although two thirds of studies had low methodological quality. Empirical research chapters included 193 countries between 1990 and 2017 and found that more intense conflicts (wars) drove associations. Wars were associated with an increase in civilian mortality by 81.5 per 100,000 population (95% CI 14.3-148.8), predicting 29.4 million (95% CI 22.1-36.6) deaths globally over the study period, two thirds of which were from communicable, maternal, neonatal, and nutritional diseases and 20% of which were from NCDs. Males appeared more affected than females, particularly for deaths from injuries, and point estimates were largest for children under 5 years and adults over 69 years. Wars were positively associated with all maternal and child health indicators, predicting 14.1 million (95% CI 11.5-16.7) infant deaths. Sensitivity analyses demonstrated robustness of findings. Discussion This thesis comprehensively and robustly contributes to understanding the detrimental impact of conflict on civilian morbidity and mortality globally, including on NCDs and across the life course.Open Acces