International Journal of Epidemiology, Vol 26, 297-306, Copyright © 1997 by International Epidemiological Association
AM Hodge, GK Dowse, P Toelupe, VR Collins and PZ Zimmet
BACKGROUND: Obesity and non-insulin-dependent diabetes mellitus (NIDDM)
have increased in prevalence in Polynesian Western Samoans over the 13-
year period 1978-1991, as the population undergoes an 'epidemiological
transition'. METHODS: We therefore investigated changes in the frequency of
dyslipidaemia over the same period in adults aged 25-74 years, and examined
factors associated with dyslipidaemia in cross- sectional and longitudinal
data. Subjects were drawn from three geographically defined locations
representing different degrees of modernization. RESULTS: The
age-standardized prevalence of dyslipidaemia increased in each location
between 1978 (n = 1197) and 1991 (n = 1748) with the prevalence of
hypercholesterolaemia (> or = 5.5 mmol/l) increasing from 18% to 36% (P
< 0.001), and that of hypertriglyceridaemia (> or = 2.0 mmol/l)
increasing from 9% to 15% (P < 0.001) in the capital city, Apia. In 1991
the highest serum concentrations of total, high density lipoprotein (HDL)
and calculated low density lipoprotein (LDL) cholesterol were found in
Poutasi (intermediate level of modernization), and the highest triglyceride
levels in urbanized Apia. Higher levels of body mass index (BMI), waist-
hip ratio (WHR), glucose intolerance, fasting insulin concentration,
physical inactivity, educational level, and occupational status were all
associated with adverse lipid levels in univariate data. Obesity (BMI in
women, WHR in men) and survey location were the most important correlates
of abnormal lipid levels in logistic regression models. Fasting insulin was
also independently associated with high triglyceride levels in men, while
in women the increasing levels of fasting insulin were associated with
adverse levels of total, LDL and HDL cholesterol, and triglycerides. In
longitudinal data (n = 311), lower baseline levels of cholesterol and
triglycerides were associated with greater increases in either parameter at
follow-up. Elevated fasting insulin and female gender also predicted
increasing cholesterol concentrations, and urban residence predicted an
increase in triglyceride levels. CONCLUSIONS: Current levels of
dyslipidaemia in Western Samoa are similar to those observed in developed
Western populations, and are increasing rapidly. These findings, considered
along with the high prevalence of other cardiovascular disease risk factors
in Samoans, including smoking, obesity and NIDDM, suggest that
cardiovascular disease will be a major health concern in the future.
ARTICLES
The association of modernization with dyslipidaemia and changes in lipid levels in the Polynesian population of Western Samoa
International Diabetes Institute, Caulfield, Victoria, Australia.
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