Abstract
BackgroundThe burden of metabolic risk factors for cardiovascular disease (CVD), such as type 2 diabetes, elevated cholesterol and hypertension, is unequally distributed across ethnic groups. Recent findings suggest an association of infectious burden (IB) and metabolic risk factors, but data from ethnic groups are scarce. Therefore, we investigated ethnic differences in IB and its association with metabolic risk factors.MethodsWe included 440 Dutch, 320 Turkish and 272 Moroccan participants, 18–70 years, of the 2004 general health survey in Amsterdam, the Netherlands. IB was defined by seropositivity to the sum of 6 infections: Herpes Simplex Virus 1 and 2; Hepatitis A, B and C; and Helicobacter pylori. Associations between IB categories 4–6 (high), 3 (intermediate) and 0–2 (low) infections and metabolic risk factors were assessed by logistic regression. Finally, we determined the contribution of IB to the association between ethnicity and the metabolic risk factors by comparing adjusted logistic regression models with and without IB categories.ResultsA high IB was more frequently observed among the Turkish and Moroccans than among the Dutch. After adjustment for age, sex, ethnicity, educational level, physical activity and body mass index, high IB was associated with type 2 diabetes (odds ratio high vs low IB (OR) =2.14, 95%-confidence interval (CI) 1.05–4.36). The association was weaker and not statistically significant, for elevated cholesterol (OR = 1.39, 95%-CI 0.82–2.34) and hypertension (OR = 1.49, 95%-CI 0.88–2.51). IB attenuated ethnic differences particularly for type 2 diabetes.ConclusionsOur study showed that Turkish and Moroccan adults in Amsterdam have a higher IB than Dutch adults, which was associated with the differences in type 2 diabetes. Due to the cross-sectional nature of the study, we cannot draw a conclusions with regards to the time-sequence of cause and effect. Nevertheless, the findings ask for further research into the nature of association of IB with metabolic risk factors in a longitudinal setting.
Highlights
The burden of metabolic risk factors for cardiovascular disease (CVD), such as type 2 diabetes, elevated cholesterol and hypertension, is unequally distributed across ethnic groups
From the infections measured in the total population of the Amsterdam Health Monitor, we considered herpes simplex virus 1 (HSV1), herpes simplex virus 2 (HSV2), hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV) and H. pylori as these had been measured in the full population and had been included in previous definitions of infectious burden (IB) based on their presumed associations with CVD [13,14,15,16,17,18,19,20,21]
Bold = significantly different from the reference category within the specific model, * Overall P-value of < 0.05 for the adjusted model; All models were adjusted for age, sex and ethnicity, IB infectious burden measured by the number of infections (HSV1, HSV2, HAV, HBV, HCV and H.pylori) a participant was seropositive for
Summary
The burden of metabolic risk factors for cardiovascular disease (CVD), such as type 2 diabetes, elevated cholesterol and hypertension, is unequally distributed across ethnic groups. Recent findings suggest an association of infectious burden (IB) and metabolic risk factors, but data from ethnic groups are scarce. The burden of CVD and its metabolic risk factors, such as type 2 diabetes mellitus ( diabetes), elevated cholesterol levels and hypertension [3,4,5], is unequally distributed across populations. Some studies showed an association between IB and the prevalence of metabolic risk factors of CVD, such as insulin resistance [18], diabetes [19], low HDL-cholesterol levels [20, 21], hypertension [22] and higher systolic- and diastolic blood pressure [19]
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