African-Caribbean Men Research Articles

Associations of Fecal Microbiota with Ectopic Fat in African Caribbean Men.

The gut microbiome has been associated with visceral fat (VAT) in European and Asian populations; however, associations with VAT and with ectopic fats among African-ancestry individuals are not known. Our objective was to investigate cross-sectional associations of fecal microbiota diversity and composition with VAT and ectopic fat, as well as body mass index (BMI), among middle-aged and older African Caribbean men. We included in our analysis n = 193 men (mean age = 62.2 ± 7.6 years; mean BMI = 28.3 ± 4.9 kg/m2) from the Tobago Health Study. We assessed fecal microbiota using V4 16s rRNA gene sequencing. We evaluated multivariable-adjusted associations of microbiota features (alpha diversity, beta diversity, microbiota differential abundance) with BMI and with computed tomography-measured VAT and ectopic fats (pericardial and intermuscular fat; muscle and liver attenuation). Lower alpha diversity was associated with higher VAT and BMI, and somewhat with higher pericardial and liver fat. VAT, BMI, and pericardial fat each explained similar levels of variance in beta diversity. Gram-negative Prevotellaceae and Negativicutes microbiota showed positive associations, while gram-positive Ruminococcaceae microbiota showed inverse associations, with ectopic fats. Fecal microbiota features associated with measures of general adiposity also extend to metabolically pernicious VAT and ectopic fat accumulation in older African-ancestry men.

Abstract P151: Increased Gain of Skeletal Muscle Adiposity in Middle-Aged African Caribbean Men With Type 2 Diabetes

While type 2 diabetes (T2D) is a known risk factor for the acceleration of muscle loss with aging, less is known about the impact of T2D on skeletal muscle fat infiltration (i.e., myosteatosis) and overall adiposity. Myosteatosis increases with aging, is greater in African as compared to European ancestry individuals, and plays an important role in the development of T2D. Thus, we investigated the association of T2D with changes in body adiposity distribution, with a particular interest in myosteatosis. T2D was identified by self-report, use of hypoglycemic agents, or fasting glucose levels of ≥ 126 mg/dL. Longitudinal changes in computed tomography-measured calf skeletal muscle density [as an inverse surrogate measure of intramuscular adiposity (mg/cm 3 )] and dual-energy X-ray absorptiometry-measured regional and whole body fat were examined by T2D status over an average of 6 years in 724 African-Caribbean men aged 40-54 years from the Tobago Health Study. Total body, arm, leg, and trunk adiposity increased to a significantly greater extent among men without compared to with T2D. In contrast, men with T2D had a 1.6 times greater decrease in calf skeletal muscle density compared with their non-diabetic counterparts (p=0.03). T2D is associated with lower gains in general adiposity, but an increased gain in skeletal muscle adiposity among middle aged African Caribbean men. Our novel findings suggest that middle-aged African Caribbean men with T2D might be at especially high risk for increased gain of myosteatosis. Interventions targeted for men in this age group could focus on controlling diabetes, slowing myosteatosis, and promoting healthy aging.

Abstract P147: Alcohol Consumption and Its Relation to Ectopic Adiposity in African Caribbean Men

Introduction: Alcohol intake and ectopic fat are associated with cardiometabolic diseases. While previous studies primarily focused on visceral and/or liver fat, few studies to date have investigated the associations of alcohol intake with skeletal muscle fat infiltration, a fat depot which might contribute to the increased risk of diabetes and hypertension in African ancestry populations. Methods: Alcohol intake (drinks/day) was assessed using a 146-item semi-quantitative food frequency questionnaire in the Tobago Health Study (N=800). Ectopic fat was measured in the abdomen and thigh in a subset of this cohort (N=706, mean age=63.94 (8.66) years, mean BMI=27.72 (4.65) kg/m 2 ) using computed tomography. Men were divided into current drinkers/not current drinkers, and the current drinkers were further subdivided into types of alcohol consumed (wine, beer/stout, or liquor). Results: A majority of men (56.1%) were not current drinkers. Of drinking men, 76.1% were light drinkers (<1 drink/day), 17.4% were moderate drinkers (1-3 drinks/day), and 6.5% were heavy drinkers (>3 drinks/day). Men who did not drink were slightly older (65.1 vs 62.5, p<0.001), with less visceral adiposity (91.4 vs. 101.9 cm 3 , p=0.002) and less psoas muscle fat (0.59 vs 0.64 cm 3 , p=0.017) than men who drank, independent of age. In fully adjusted models, drinking liquor was positively associated with BMI, waist circumference, visceral and subcutaneous adiposity, while drinking beer was positively associated with thigh muscle fat (Table). Conclusion: Alcohol intake was associated with greater ectopic fat accumulation in all studied compartments, except in the liver, in this cohort of African Caribbean men, who mostly had low alcohol consumption. We also report a novel finding that observed relationships differ by type of alcohol. † Adjusted for total energy intake, age, walking (hours/week), TV watching (≥14 hours/week), current smoking, diabetes, hypertension, and statin use status. * Additional adjustment for BMIHU = Houndsfield Units

PHYSICAL ACTIVITY, SEDENTARY BEHAVIORS AND MYOSTEATOSIS IN AFRICAN CARIBBEANS

Abstract Skeletal muscle fat infiltration (myosteatosis) leads to poorer muscle quality and function with aging, and is emerging as a predictor of skeletal muscle strength, mobility, and metabolic disorders. Few studies investigated the association of physical activity (PA) and sedentary behavior (SB) with myosteatosis, especially in African Caribbeans, a vastly under-studied, rapidly growing population. We examined the associations of objectively measured PA and SB (Bodymedia SenseWear Armbands) worn over 7 days with calf muscle density (mg/cm3), a marker of intra-muscular fat (Stratec XCT-2000), in older adult African Caribbean men (N=355, mean age 62 years) and women (N=682, mean age 59 years) of the Tobago Health Study. Compared to men, women were younger with higher BMI, more SB, less light (LPA) and moderate to vigorous PA (MVPA), and lower muscle density (p< 0.05, age-adjusted). Meeting MVPA guidelines (150 min MVPA/week) was associated with greater muscle density in obese men and women (p=0.03, p=0.09 respectively, age-adjusted). Adjusting for age, BMI, smoking, diabetes, hypertension, and lipid-lowering treatment, we assessed sex stratified partial spearman correlations between PA and SB and muscle density. MVPA was more strongly correlated with greater muscle density in men (r=0.15, p=0.01) than in women (r=0.07, p=0.09), while SB was associated with lower muscle density in women (r=-0.08, p=.044), but not significantly in men (r=-0.10, p=0.12). Our novel findings indicate that the association between PA and SB with myosteatosis may differ by sex. These findings may have important implications for sex specific activity guidelines related to skeletal muscle health in African Caribbeans.

Abstract P561: Reallocation of Sedentary Time With Light Physical Activity is Associated With Higher Sleep Efficiency in African Caribbeans

Introduction: Sleep efficiency (or sleep continuity, i.e., a ratio of time spent sleeping to time spent in bed), is inversely associated with hypertension, impaired glucose metabolism, CVD risk, and mortality risk. Prolonged sedentary behavior and physical activity are independently associated with sleep efficiency. However, it is not well documented how substituting time in sedentary behavior with physical activity affects sleep efficiency, especially among African-ancestry populations, who are at high risk for CVD. Aim: To determine if displacement of sedentary time with activity was cross-sectionally associated with higher sleep efficiency among African Caribbean men (n=231) and women (n=668) from the Tobago Health Study. Methods: Sleep efficiency, sedentary behavior (SB), light physical activity (LPA), and moderate to vigorous physical activity (MVPA) were collected using a SenseWear Pro Armband. Participants wore the armband at all times, except in water, for 4-7 days. We used the Isotemporal Substitution Framework paired with linear regression to examine associations of SB, LPA and MVPA with sleep efficiency adjusting for age, education, BMI, hypertension, diabetes, smoking, alcohol consumption, caffeine intake, and sleep medication. Results: Men (mean age ± Standard deviation: 63.2 ± 8.2 years; mean BMI 28.2 ± 4.8 kg/m 2 ) spent on average less time in SB (12.4 ± 2.9 hours/day) and more time in LPA (4.7 ± 2.1 hours /day) and MVPA (0.92 ± 0.88 hours/day) than women (mean age 55.6 ± 8.7 years; mean BMI 31.8 ± 6.4 kg/m 2 ) (all p-vales <0.001). Men had lower sleep efficiency (74.6% ± 10.4) than women (81.2% ± 0.96; p-value <0.001). Cross-sectionally reallocating 1 hour of SB with LPA was associated with a 1% higher sleep efficiency (p-value=0.016) in men and with a 0.37% higher sleep efficiency in women (p-value=0.074). In men, reallocating 1 hour of SB with MVPA and 1 hour of LPA with MVPA were significantly associated with lower sleep efficiency [-1.9% (p-value=0.014) and -2.8% (p-value=0.017), respectively]; in women these associations were not statistically significant. Interaction term for sex and sleep efficiency was statistically significant (p-value <0.0001). Conclusions: In this population with short sleep duration, reallocating 1 hour of SB with LPA was associated with higher sleep efficiency in both genders. In contrast, among men only, reallocating 1 hour of SB to MVPA and 1 hour of LPA to MVPA were unexpectedly associated with lower sleep efficiency. Further research is warranted to understand these relationships longitudinally to determine how truly replacing SB for activities of different intensities impacts sleep health, which could then potentially inform lifestyle guidelines in older Caribbeans. In this highly sedentary population, interventions aimed at increasing LPA may be easier to implement and maintain and provide greater sleep and overall health benefit.

Black men's experiences of support following treatment for prostate cancer in England: A qualitative study.

Prostate cancer is a leading cause of death in black men in the United Kingdom (UK). Evidence suggests that unmet supportive care needs are prevalent in contemporary healthcare, particularly for men with advanced prostate cancer, whilst less has been written specifically about the supportive care needs of black men. Therefore this study will examine black men's experiences of support following prostate cancer treatment in England. A qualitative research design was employed. Twenty black African and black Caribbean men were interviewed on a face-to-face basis to obtain insightful information about their experiences of prostate cancer. Interviews were recorded and transcribed. Data were analysed using thematic analysis which allowed for emergent themes. In this study there were six emergent themes. These were: dealing with the treatment effect, support from loved ones, individuals and organisations, healthcare support, spirituality, and positivity. Black men used different coping strategies to deal with the side effects of treatment. Black men experienced a range of supportive care needs. Some men felt that their individual needs as black men were not met by healthcare professionals, although no specific reasons were forthcoming as to why they felt this way. Healthcare professionals should be aware of the support mechanisms that black men have used throughout the prostate cancer journey and to consider these approaches when treating and caring for black men.

Improving adult behavioural weight management services for diverse UK Black Caribbean and Black African ethnic groups: a qualitative study of insights from potential service users and service providers.

A significantly higher proportion of UK Black ethnic adults live with overweight or obesity, compared to their White British counterparts. The role of obesity in excess infection rates and mortality from COVID-19 has increased the need to understand if weight management interventions are appropriate and effective for Black ethnic groups. There is a paucity of existing research on weight management services in Black populations, and whether anticipated or experienced institutional and interpersonal racism in the healthcare and more widely affects engagement in these services. Understanding the lived experience of target populations and views of service providers delivering programmes is essential for timely service improvement. A qualitative study using semi-structured interviews was conducted in June-October 2021 among 18 Black African and Black Caribbean men and women interested in losing weight and 10 weight management service providers. The results highlighted a positive view of life in the United Kingdom (UK), whether born in the UK or born abroad, but one which was marred by racism. Weight gain was attributed by participants to unhealthy behaviours and the environment, with improving appearance and preventing ill health key motivators for weight loss. Participants relied on self-help to address their overweight, with the role of primary care in weight management contested as a source of support. Anticipated or previously experienced racism in the health care system and more widely, accounted for some of the lack of engagement with services. Participants and service providers agreed on the lack of relevance of existing services to Black populations, including limited culturally tailored resources. Community based, ethnically matched, and flexibly delivered weight management services were suggested as ideal, and could form the basis of a set of recommendations for research and practice. Cultural tailoring of existing services and new programmes, and cultural competency training are needed. These actions are required within systemic changes, such as interventions to address discrimination. Our qualitative insights form the basis for advancing further work and research to improve existing services to address the weight-related inequality faced by UK Black ethnic groups.

A Caribbean Community in the North Atlantic: DISCO, Labour Migration, and the Creation of Whitney Pier, Nova Scotia, c. 1900–1930

Over the course of the late nineteenth and early twentieth centuries, the Dominion Iron and Steel Company in Sydney, Nova Scotia (DISCO) hired thousands of migrant labourers. Many of the workers settled in the nearby Whitney Pier. Among them were hundreds of African American and Caribbean men attracted by the promise of good wages and living conditions. Other people, including women and children, followed afterward. A history of Whitney Pier’s Black community demonstrates not only how industry and urbanization changed in the area at the time but also how the community negotiated those changes and in so doing established a unique subculture around the areas where the Caribbean migrants lived and socialized.

Thigh and Calf Myosteatosis are Strongly Associated with Muscle and Physical Function in African Caribbean Men.

African Caribbeans have higher levels of myosteatosis than other populations; however, little is known about the impact of myosteatosis on physical function in African Caribbeans. Herein, we examined the association between regional myosteatosis of the calf, thigh, and abdomen versus physical function in 850 African-Ancestry men aged 64.2 ± 8.9 (range 50-95) living on the Caribbean Island of Tobago. Myosteatosis was measured using computed tomography and included intermuscular adipose tissue (IMAT) and muscle density levels of the thigh, calf, psoas, and paraspinous muscles. Outcomes included grip strength, time to complete 5 chair-rises, and 4-meter gait speed. Associations were quantified using separate linear models for each myosteatosis depot and were adjusted for age, height, demographics, physical activity, and chronic diseases. Beta coefficients were presented per standard deviation of each myosteatosis depot. Higher thigh IMAT was the only IMAT depot significantly associated with weaker grip strength (β = -1.3 ± 0.43 kg, p = .003). However, lower muscle density of all 4 muscle groups was associated with weaker grip strength (all p < .05). Calf and thigh myosteatosis (IMAT and muscle density) were significantly associated with both worse chair rise time and gait speed (all p < .05), whereas psoas IMAT and paraspinous muscle density were associated with gait speed. Myosteatosis of the calf and thigh-but not the abdomen-were strongly associated with grip strength and performance measures of physical function in African Caribbean men. However, posterior abdominal myosteatosis may have some utility when abdominal images are all that are available.

"We're talking about black men here, there's a difference"; cultural differences in socialised knowledge of prostate cancer risk: A qualitative research study.

To detail social knowledge of prostate cancer risk amongst cultural groups. Prostate cancer is the most common cancer in men, and black men are at the highest risk. Despite this, black men are the least likely to be diagnosed early with prostate cancer. It is important to understand why this is so that these men can receive early access to effective treatment and support. A constructivist grounded theory methodology was used. Data were collected between December 2015 and October 2017; seventeen men were interviewed, and eighteen men took part in focus groups. There were differences in the way the men constructed their understanding of risks for prostate cancer. The social construction of prostate cancer risk knowledge was mediated by the way the men were socialised to understand and accept this risk. The Somali and African Caribbean men placed social importance on the healthy body, whereas the white working class men seemed to find social value through the unwell body. This research proposes the theory that social constructions of knowledge mediate the way men perceive and accept their risk for prostate cancer. Understanding socially-derived knowledge of risk may mediate the acceptance of factors relating to prostate cancer. This knowledge may help health providers and third sector organisations produce targeted health-related information. Health practitioners may also benefit from understanding how socially constructed ideas of the body could influence the way men respond to conversations about prostate cancer so that tailored and culturally appropriate support can be offered.

Inflammatory status, body composition and ethnic differences in bone mineral density: The Southall and Brent Revisited Study.

Ethnic differences in bone mineral density (BMD) and fracture risk are well-described; the aim of this study was to investigate whether central adiposity or inflammatory status contribute to these ethnic differences in BMD in later life.The Southall and Brent Revisited study (SABRE) is a UK-based tri-ethnic cohort of men and women of European, South Asian or African Caribbean origin. At the most recent SABRE follow-up (2014–2018), in addition to measures of cardiometabolic phenotype, participants had dual-energy X-ray absorptiometry (DXA) bone and body composition scans. Multiple linear regression was used to determine whether markers of body composition, central adiposity or inflammatory status contributed to ethnic differences in BMD.In men and women, age- and height-adjusted BMD at all sites was higher in African Caribbeans compared to Europeans (femoral neck: standardised β (95% confidence interval): men: 1.00SD (0.75, 1.25); women: 0.77SD (0.56, 0.99)). South Asian men had higher BMD than European men at the hip (femoral neck: 0.34SD (95%CI: 0.15, 0.54)). Although adjustment for body mass index (BMI) or lean mass index (LMI) at the lumbar spine reduced the size of the difference in BMD between African Caribbean and European men (age and height adjusted difference: 0.35SD (0.08, 0.62); age and BMI adjusted difference: 0.25SD (−0.02, 0.51)), in both men and women ethnic differences remained after adjustment for measures of central adiposity (estimated visceral adipose tissue mass (VAT mass) and android to gynoid ratio) and inflammation (interleukin-6 (logIL-6) and C-reactive protein (logCRP)). Furthermore, in women, we observed ethnic differences in the relationship between BMI (overall interaction: p = 0.04), LMI (p = 0.04) or VAT mass (p = 0.009) and standardised lumbar spine BMD.In this tri-ethnic cohort, ethnic differences in BMD at the femoral neck, total hip or lumbar spine were not explained by BMI, central adiposity or inflammatory status. Given ethnic differences in fracture incidence, it is important to further investigate why ethnic differences in BMD exist.

A constructivist grounded theory study on decision-making for treatment choice among Black African and Black Caribbean prostate cancer survivors.

Despite Black African (BA) and Black Caribbean (BC) men having a disproportionately high risk (1 in 4) of developing prostate cancer (CaP), there is limited understanding of their decision-making for treatment choice. This study explored decision-making for treatment choice among BA/BC men treated for CaP. Using constructivist grounded theory, face-to-face, Skype and telephone interviews were conducted with 25 Black men (8 BA, 17 BC) recruited in England between October 2016 and March 2018. Data were analysed using constant comparison until saturation was achieved. Data analysis yielded three broad categories: 'coming to terms with the prostate cancer diagnosis', 'getting empowerment through information-seeking' and 'choosing a treatment option'. Priority for survival substantially motivated BA/BC men to take up radical treatment for their CaP. However, decision-making for a particular treatment option was a more complex process which was shaped by an intersection between biological, behavioural, medical, personal and cultural factors. Healthcare providers need to consider the complexity of decision-making process for CaP treatment among BA/BC men and tailor cancer care services to reflect cultural sensitivity and person-centredness. This could potentially minimise treatment decision regrets and improve men's psychological wellbeing along the CaP survivorship pathway.

Association of physical activity with blood pressure in African ancestry men.

This study tested the association of objectively measured physical activity with blood pressure and hypertension in African Caribbean men, an understudied population segment known to be at high-risk for cardiovascular disease (CVD) which has low levels of high-exertion physical activity. Men (N = 310) were from the Tobago Health Study and aged 50–89 years. Systolic (SBP) and diastolic (DBP) blood pressures were measured using an automated device, and hypertension was defined as SBP ≥ 140 mmHg, DBP ≥ 90 mmHg, or current use of antihypertensive medication. Physical activity was measured using the SenseWear Pro armband (SWA) and consisted of daily time engaged in sedentary behavior (SB), light physical activity (LPA), and moderate to vigorous activity (MVPA), as well as daily step count. Multiple regression analyses using the isotemporal substitution framework were used to test for associations between activity and blood pressures. Models were adjusted in stages for SWA wear time, age, antihypertensive medication use, alcohol consumption, smoking, diabetes, CVD, family history of hypertension, salt intake, and adiposity.Replacement of SB with LPA was associated with lower SBP adjusted for wear time (β = -0.84, p < 0.05), but attenuated after adjustment for age. Replacement of SB with LPA was associated with lower DBP (β = -0.50) and lower odds of hypertension (OR = 0.88), adjusted for wear time and age (both p < 0.05). All model associations of replacement of SB with LPA were stronger when restricted to men not taking antihypertensive medications, regardless of their hypertension status.These results support the strategy of increasing light physical activity for blood pressure management in high-risk Afro-Caribbean men.

Association between sleep quality and type 2 diabetes at 20-year follow-up in the Southall and Brent REvisited (SABRE) cohort: a triethnic analysis

BackgroundThe risk of developing type 2 diabetes associated with poor sleep quality is comparable to other lifestyle factors (eg, overweight, physical inactivity). In the UK, these risk factors could not...

Abstract P070: Longer Sleep Duration Is Associated With Less Myosteatosis In African Caribbean Adults

Introduction: Skeletal muscle is the largest organ in the human body and vital to maintaining metabolic homeostasis. Increased skeletal muscle fat infiltration (i.e. myosteatosis) is now recognized as a major risk factor for cardio-metabolic diseases, independent of general obesity. Modifications in lifestyle, such as sleep, to reduce myosteatosis would be of great public health importance. However, studies of this relationship often use subjective data and are lacking in minority populations. The aim of this study was to examine the relation between objectively measured sleep duration and myosteatosis at the calf among African Caribbeans. Methods: Data were collected on men (n=393) and women (n=438) from the Tobago Health Study. Sleep duration and physical activity was collected using a SenseWear Pro Armband (BodyMedia, Inc.). Participants were instructed to wear the armband at all times, except in water, for 4-7 days. Measures of muscle density, intermuscular adipose tissue (IMAT), and area were obtained by peripheral QCT scans of the calf (Stratec XCT-2000). Model covariates included age, sex, BMI, diabetes, alcohol intake, smoking, and moderate to vigorous physical activity (MVPA). Linear regression was used to assess the relationship of sleep duration on skeletal muscle. Results: Mean sleep duration was 5.5 hours/day (Min 2.2, Max 11.6). Overall, participants were aged 58.7 years, had a BMI of 30.2 kg/m 2 , spent an average of 42 min/day in MVPA, and 18% were diabetic. In fully adjusted models, longer sleep duration was associated with smaller muscle area, but greater muscle density and less IMAT (all P&lt;0.03). There was no interaction of sleep and sex on muscle density, area and IMAT (p-value=0.5184; 0.2730; 0.0954). Conclusions: In African Caribbean men and women, longer sleep duration was associated with less myosteatosis, as well as, less muscle area at the calf. Further research is warranted to understand this relationship longitudinally in order to determine how it may inform lifestyle guidelines in the Caribbean.

Relative associations of abdominal and thigh compositions with cardiometabolic diseases in African Caribbean men.

BackgroundRegional body compositions are differentially associated with cardiometabolic risk factors. Simultaneous inclusion of both upper and lower body composition predictors in models is not often done, and studies which do include both measures (1) tend to exclude some tissue(s) of potential metabolic relevance, and (2) have used study populations with underrepresentation of individuals with African ancestries. Further, most body composition analyses do not employ compositional data analytic approaches, which may result in spurious associations.ObjectiveThe objective of this analysis was to assess associations of abdominal and thigh adipose (AT) and muscle tissues with hypertension and type 2 diabetes using compositional data analytic methods.Research Design and MethodsThis cross‐sectional analysis included 610 African Caribbean men (median age: 62 years; mean BMI: 27.8 kg/m2). Abdominal (three components: subcutaneous [ASAT] and visceral [VAT] AT, ‘other’ abdominal tissue) and mid‐thigh (four components: subcutaneous and intermuscular AT, muscle, bone) compositions were measured by computed tomography; additive log ratio transformations were applied to each composition. Regression models were used to simultaneously assess associations of abdominal and thigh component ratios with continuous risk factors (blood pressures, fasting glucose and insulin, HOMA‐IR) and disease categories.ResultsA two‐fold increase in ASAT:‘Other’ ratio was associated with higher continuous risk factors and with odds of being in a higher hypertension (OR: 1.77, 95%CI: 1.10–2.84) or diabetes (OR: 1.81, 95%CI: 1.06–3.10) category. A two‐fold increased VAT ratio was only associated with higher log‐insulin and log‐HOMA‐IR (β = 0.10, p < 0.05 for both), while a two‐fold increased thigh muscle:bone ratio was associated with a lower diabetes category (OR: 0.37, 95%CI: 0.14–1.01).ConclusionsThese findings support ASAT as a significant driver of cardiometabolic disease in African Ancestry populations, independent of other abdominal and thigh tissues.

What are the experiences of black African and African Caribbean men during the transition to fatherhood?

This study aimed to explore the experiences of men from African and African Caribbean heritage on transition to fatherhood and support received. Semi-structured interviews were undertaken with eight black fathers living in the south east of England. Four themes were identified: preparation for fatherhood; experiences post birth; influences on ideas about fatherhood; and reflections on transition and suggestions for support for future fathers. While some fathers benefited from formal support, others did not attend antenatal classes and there was uncertainty around healthcare roles identified during the men's experiences post birth. Findings highlight the importance of extended family and friends in providing advice and the importance of culture in forming the identity of African fathers.

Body Composition Across the Adult Lifespan in African Caribbean Men: The Tobago Longitudinal Study of Aging.

Body composition and muscle strength change vary by age and ethnicity, and have a major impact on health and physical function. Little is known about the patterns of these changes in African-ancestry populations. Herein, we examined age-specific (5-year age groups) rates-of-change in lean and fat mass in 1918 African-ancestry men on the Caribbean island of Tobago (baseline age: 62.0±11.8 years, range: 40-99 years). Body composition (DXA) and grip strength were measured at three time points (baseline, 4- and 9-year follow-up). Annualized rates of change were calculated with all 3 time-points using Generalized Estimating Equations. We found that whole body lean mass declined at constant rate until age 65 (-0.72%/year; 95% CI: -0.76, -0.67), which accelerated to -0.92 %/year (-1.02, -0.82) among those 65-69, and again to -1.16 %/year (-1.30, -1.03 ) among those aged 70+. Whole body fat mass increased by a near constant rate of 2.93 %/year (2.72, 3.15%) across the lifespan. Finally, grip strength decline accelerated at age 50, and about 2x faster than lean mass through the lifespan after the age of 50. To conclude, in African-Caribbean men, the acceleration in muscle strength decline precedes the acceleration in lean mass decline by 10-15 years, suggesting decrements in factors other than lean mass drive this initial acceleration in muscle strength decline. We also found that African-Caribbean men undergo a constant shift to a more adipogenic phenotype throughout the adult lifespan (aged 40-99), which likely contributes to age-related loss of muscle and physical function.

Cardiovascular disease recurrence and long-term mortality in a tri-ethnic British cohort: a retrospective study

Abstract Background People of South Asian and of African Caribbean descent have elevated risks of some cardiovascular diseases compared to Europeans. How ethnicity relates to recurrent risk, and explanations for between ethnic group differences in recurrence are unclear. We characterized long-term risk of major adverse cardiovascular event (MACE) and mortality following a non-fatal cardiovascular event in a tri-ethnic British cohort. Methods We linked hospital and mortality records of a population-based cohort of South Asian, African Caribbean and European men and women aged 40–69 years with no prior history of cardiovascular disease. We identified index and recurrent cardiovascular events (stroke, transient ischaemic attack, myocardial infarction, or ischaemic heart disease), and mortality from 1988 to 2017. Using multivariable proportional hazards models, we separately calculated the adjusted hazard ratios (HR) of MACE and death following index event. We adjusted for demographics, vascular and lifestyle risk factors. We used interaction terms to evaluate if diabetes or decade of index event modified the association between ethnicity and outcomes. Results We included 801 participants with first non-fatal cardiovascular events, 647 coronary and 127 cerebrovascular, of whom 335 (41.8%) were European, 396 (49.5%) South Asian, and 70 (8.7%) African Caribbean. During a mean follow-up of 5.3 years, 537 patients developed MACE and 338 died. Crude incidence rate of MACE was higher in South Asians (135.9 per 1000-person-years) compared to Europeans (117.1) and African Caribbeans (123.6). Higher risk of MACE in South Asian compared to Europeans was eliminated in the adjusted models (HR 0.97, 95% confidence interval 0.77–1.21), whereas their mortality advantage was eliminated when the younger age at index event was accounted for (HR 0.95, 0.72–1.26). African Caribbeans had similar outcomes to Europeans (HR MACE 1.04, 0.74–1.47; and HR death 1.07, 0.70–1.64). There was no modification by diabetes for outcomes, whereas survival following index event improved more in South Asian, than African Caribbean, compared to European over three decades (Pinteraction = 0.04). Conclusions Baseline vascular risk factors explained the observed ethnic variation in cardiovascular disease recurrence and long-term mortality, with a relative improvement in survival of minority ethnic groups over time. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): UK Medical Research Council, Wellcome Trust

Black African and black Caribbean men’s understanding and experiences of prostate cancer post-treatment in England: a qualitative study

Aim Black African and black Caribbean men are two to three times more likely to be diagnosed with prostate cancer compared with white men, and some appear to have little knowledge of the disease. The aim of this study was to examine black African and black Caribbean men’s understanding and experience of prostate cancer post-treatment and to create a video to raise awareness in the African and Caribbean communities of the importance of testing.Method In total 20 black African and black Caribbean men were interviewed using a qualitative approach and the data were analysed thematically.Findings There was a lack of knowledge and understanding of prostate cancer among the study sample, who were also sometimes exposed to misinformation within the black community, including herbal remedies. Some participants believed their racial features were a barrier to the way in which limited information was shared with them by healthcare professionals.Conclusion There is a need to raise awareness about prostate cancer in black communities to educate men about the disease and its effects. Additionally, evidence-based information about the disease is required to educate black men and to reduce the effects of misinformation and herbal remedies on their well-being. In the health sector, unconscious bias should be recognised, addressed and avoided to ensure inclusive and person-centred care regardless of ethnicity.