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Aim: This study assesses community readiness to prevent overweight/obesity among Ghanaian immigrants in Greater Manchester, England. Subject and method: The Community Readiness Model (CRM) was applied using a semi-structured interview tool with 13 key informants (religious and other key community members) addressing five readiness dimensions. A maximum of 9 points per dimension (from 1 = no awareness to 9 = high level of community ownership), was assigned, alongside qualitative textual thematic analysis. Results: The mean readiness score indicated that the study population was in the “vague awareness stage” (3.08 ± 0.98). The highest score was observed for community knowledge of the issue (4.42 ± 0.99) which was in the pre-planning phase, followed by community climate (vague awareness; 3.58 ± 0.62). The lowest scores were seen for resources (denial/resistance; 2.70 ± 0.61) and knowledge of efforts (no awareness; 1.53 ± 0.44). Findings identified structural barriers, including poor living conditions as a result of poorly paid menial jobs and high workload, contributing to the adoption of unhealthy lifestyle behaviours. Socio-cultural factors such as fatalism, hereditary factors, and social status were associated with acceptance of overweight. Conclusion: Despite recognising overweight/obesity as an important health issue in these communities, especially among women, it is not seen as a priority for targeting change. To help these communities to become more ready for interventions that tackle overweight/obesity, the focus should initially be to address the structural barriers identified, including reducing poverty, alongside designing interventions that work with these structural barriers, and thereafter focus on the socio-cultural factors.

AbstractEarly-life environmental and nutritional exposures are considered to contribute to the differences in cardiovascular disease (CVD) burden. Among sub-Saharan African populations, the association between markers of early-life exposures such as leg length and sitting height and CVD risk is yet to be investigated. This study assessed the association between leg length, sitting height, and estimated 10-year atherosclerotic cardiovascular disease (ASCVD) risk among Ghanaian-born populations in Europe and Ghana. We constructed sex-specific quintiles for sitting height and leg length for 3250 participants aged 40–70 years (mean age 52 years; men 39.6%; women 60.4%) in the cross-sectional multicenter Research on Diabetes and Obesity among African Migrants study. Ten-year risk of ASCVD was estimated using the Pooled Cohort Equations; risk ≥7.5% was defined as “elevated” CVD risk. Prevalence ratios (PR) were estimated to determine the associations between sitting height, leg length, and estimated 10-year ASCVD risk. For both men and women, mean sitting height and leg length were highest in Europe and lowest in rural Ghana. Sitting height was inversely associated with 10-year ASCVD risk among all women (PR for 1 standard deviation increase of sitting height: 0.75; 95% confidence interval: 0.67, 0.85). Among men, an inverse association between sitting height and 10-year ASCVD risk was significant on adjustment for study site, adult, and parental education but attenuated when further adjusted for height. No association was found between leg length and estimated 10-year ASCVD risk. Early-life and childhood exposures that influence sitting height could be the important determinants of ASCVD risk in this adult population.

Background/objectives: Socioeconomic inequalities in diet quality are consistently reported, but few studies have investigated whether and how such inequalities vary across ethnic groups. This study aimed to examine differences in diet quality and socioeconomic patterning of diet quality across ethnic groups. Subjects/methods: Cross-sectional data from the HELIUS study were used. Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Turkish and Moroccan adults (aged 18–70 years) were randomly sampled, stratified by ethnicity. Dietary intake was estimated among a subsample (n= 4602) from 200-item, ethnic-specific food frequency questionnaires, and diet quality was assessed using the Dutch Healthy Diet Index 2015 (DHD15-Index). Wald tests were used to compare non-Dutch and Dutch participants. Adjusted linear regression models were used to examine differences in DHD15-Index by three indicators of socioeconomic position: educational level, occupational status and perceived financial difficulties. All analyses were stratified by sex. Results: Dutch participants had lower median DHD15-Index than most ethnic minority participants (P< 0.001). Lower educational level was associated with lower DHD15-Index among Dutch men (Ptrend< 0.0001), South-Asian Surinamese men (Ptrend= 0.01), Dutch women (Ptrend= 0.0001), African Surinamese women (Ptrend= 0.002) and Moroccan women (Ptrend= 0.04). Lower occupational status was associated with lower DHD15-Index in Dutch men, β−7.8 (95% CI −11.7, −3.9) and all women (β−4.4 to −8.8), except Turkish women. DHD15-Index was not associated with perceived financial difficulties in most groups. Conclusions: We observed variations in diet quality across ethnic groups. Low socioeconomic position was not consistently associated with poor diet quality in all ethnic groups. This may be due to ethnicity-specific retention of traditional diets, irrespective of socioeconomic position.

Trillions of microorganisms inhabit the human gut and are regarded as potential key factors for health1,2. Characteristics such as diet, lifestyle, or genetics can shape the composition of the gut microbiota2–6and are usually shared by individuals from comparable ethnic origin. So far, most studies assessing how ethnicity relates to the intestinal microbiota compared small groups living at separate geographical locations7–10. Using fecal 16S ribosomal RNA gene sequencing in 2,084 participants of the Healthy Life in an Urban Setting (HELIUS) study11,12, we show that individuals living in the same city tend to share similar gut microbiota characteristics with others of their ethnic background. Ethnicity contributed to explain the interindividual dissimilarities in gut microbiota composition, with three main poles primarily characterized by operational taxonomic units (OTUs) classified as Prevotella(Moroccans, Turks, Ghanaians), Bacteroides(African Surinamese, South-Asian Surinamese), and Clostridiales (Dutch). The Dutch exhibited the greatest gut microbiota α-diversity and the South-Asian Surinamese the smallest, with corresponding enrichment or depletion in numerous OTUs. Ethnic differences in α-diversity and interindividual dissimilarities were independent of metabolic health and only partly explained by ethnic-related characteristics including sociodemographic, lifestyle, or diet factors. Hence, the ethnic origin of individuals may be an important factor to consider in microbiome research and its potential future applications in ethnic-diverse societies. Stool microbiota composition correlates with the ethnic backgrounds of people living in the same city, suggesting that geographical location and ethnicity have distinct effects on microbiota.

BackgroundThe prevalence of diabetes has been shown to be socially patterned but the direction of the association in low-income countries and among migrant populations in Europe has varied in the literature. This study examined the association between socioeconomic position (SEP) and diabetes in Ghanaians in Europe and in Ghana.MethodsData were derived from the multicentre Research on Obesity and Diabetes among African Migrants (RODAM) study of Ghanaian adults aged 25–70 years residing in Europe (Amsterdam, Berlin and London) and in urban and rural Ghana. Educational attainment (elementary, secondary or higher) and occupational class (low or high) were used as indicators of SEP. Age-standardised prevalence of diabetes and prevalence ratios were evaluated separately for men and women of different SEP in Ghana and Europe.ResultsA total of 5290 participants were included in the analyses. The prevalence of diabetes decreased with increasing level of education in Ghanaian men and women in Europe and in men in urban Ghana, whereas diabetes prevalence increased with increasing level of education in men and women in rural Ghana. The association between occupational class and the prevalence of diabetes followed a less consistent pattern in men and women in the different locations.ConclusionsThe association of diabetes and SEP differed in rural Ghana compared with urban settings in Ghana and Europe and comparing men and women, highlighting the complex interaction of SEP and the development of diabetes. These findings have important implications for diabetes prevention strategies in Ghanaians in different locations.

Background:Migration from sub-Saharan Africa to industrialized countries has increased tremendously over the last few decades, yet very little is known about the health status of sub-Saharan African populations living in industrialized communities. The aim of this study was to assess prevalence, levels of awareness, treatment, and control of hypertension among the largest sub-Saharan African group (Ghanaians) living in the Netherlands.Methods:Cross-sectional study of Ghanaian adults aged 18–60 years in Amsterdam, the Netherlands.Results:The overall prevalence of hypertension was 55%. Of these, about half were aware of their condition, 45% were receiving antihypertensive medication, and 15% were controlled (blood pressure <140/90 mmHg). The prevalence rates of hypertension, awareness, and treatment were similar among males and females. However, males had a lower blood pressure control rate than females. Among all hypertensives, 22% of females had their blood pressure controlled compared with 5.8% in males: adjusted prevalence ratio (APR) 3.94 (95% CI 1.05–14.79). Among those receiving treatment for their hypertension, 48% of females were controlled compared with only 13% of males: APR 4.08 (95% CI 1.20–13.87).Conclusion:Hypertension is a major problem among this recently migrated sub-Saharan African population. Furthermore, hypertension control rate is very low particularly in males. Urgent measures are needed to halt the increasing prevalence of hypertension and to improve hypertension control among these populations.

To investigate the role of vitamin D in explaining ethnic differences in blood pressure among three ethnic groups in the Netherlands (ethnic Dutch, African Surinamese, and south Asian Surinamese).

We determined whether the overall lower prevalence of type II diabetes in England versus the Netherlands is observed in South-Asian-Indian and African-Caribbean populations. Additionally, we assessed the contribution of health behavior, body size, and socioeconomic position to observed differences between countries.

ABSTRACTBackground: West African immigrants in Europe are disproportionally affected by metabolic conditions compared to European host populations. Nutrition transition through urbanisation and migration may contribute to this observations, but remains to be characterised.Objective: We aimed to describe the dietary behaviour and its socio-demographic factors among Ghanaian migrants in Europe and their compatriots living different Ghanaian settings.Methods: The multi-centre, cross-sectional RODAM (Research on Obesity and Diabetes among African Migrants) study was conducted among Ghanaian adults in rural and urban Ghana, and Europe. Dietary patterns were identified by principal component analysis.Results: Contributions of macronutrient to the daily energy intake was different across the three study sites. Three dietary patterns were identified. Adherence to the ‘mixed’ pattern was associated with female sex, higher education, and European residency. The ‘rice, pasta, meat, and fish’ pattern was associated with male sex, younger age, higher education, and urban Ghanaian environment. Adherence to the ‘roots, tubers, and plantain’ pattern was mainly related to rural Ghanaian residency.Conclusion: We observed differences in food preferences across study sites: in rural Ghana, diet concentrated on starchy foods; in urban Ghana, nutrition was dominated by animal-based products; and in Europe, diet appeared to be highly diverse.

BackgroundDifferences in dietary patterns between ethnic groups have often been observed. These differences may partially be a reflection of differences in socio-economic status (SES) or may be the result of differences in the direction and strength of the association between SES and diet.ObjectiveWe aimed to examine ethnic differences in dietary patterns and the role of socio-economic indicators on dietary patterns within a multi-ethnic population.DesignCross-sectional multi-ethnic population-based study.SettingAmsterdam, the Netherlands.SubjectsPrincipal component analysis was used to identify dietary patterns among Dutch (n=1,254), South Asian Surinamese (n=425), and African Surinamese (n=784) participants. Levels of education and occupation were used to indicate SES. Linear regression analysis was used to examine the association between ethnicity and dietary pattern scores first and then between socio-economic indicators and dietary patterns within and between ethnic groups.Results‘Noodle/rice dishes and white meat’, ‘red meat, snacks, and sweets’ and ‘vegetables, fruit and nuts’ patterns were identified. Compared to the Dutch origin participants, Surinamese more closely adhered to the ‘noodle/rice dishes and white meat’ pattern which was characterized by foods consumed in a ‘traditional Surinamese diet’. Closer adherence to the other two patterns was observed among Dutch compared to Surinamese origin participants. Ethnic differences in dietary patterns persisted within strata of education and occupation. Surinamese showed greater adherence to a ‘traditional’ pattern independent of SES. Among Dutch participants, a clear socio-economic gradient in all dietary patterns was observed. Such a gradient was only present among Surinamese dietary oatterns to the ‘vegetables, fruit and nuts’ pattern.ConclusionsWe found a selective change in the adherence to dietary patterns among Surinamese origin participants, presumably a move towards more vegetables and fruits with higher SES but continued fidelity to the traditional diet.