Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2018

Open Access 01-12-2018 | Research article

Ethnic differences in infectious burden and the association with metabolic risk factors for cardiovascular disease: a cross-sectional analysis

Authors: Lara Hartog, Martijn S. van Rooijen, Joanne Ujčič-Voortman, Maria Prins, Irene G. M. van Valkengoed

Published in: BMC Public Health | Issue 1/2018

Login to get access

Abstract

Background

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. Therefore, we investigated ethnic differences in IB and its association with metabolic risk factors.

Methods

We 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.

Results

A 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.

Conclusions

Our 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.
Appendix
Available only for authorised users
Literature
1.
Anand SS, Yusuf S. Stemming the global tsunami of cardiovascular disease. Lancet. 2016;377:529–32.CrossRef
2.
3.
Ujcic-Voortman JK, Schram MT, Jacobs-van der Bruggen MA, Verhoeff AP, Baan CA. Diabetes prevalence and risk factors among ethnic minorities. Eur J Pub Health. 2009;19:511–5.CrossRef
4.
Ujcic-Voortman JK, Bos G, Baan CA, Uitenbroek DG, Verhoeff AP, Seidell JC. Ethnic differences in total and HDL cholesterol among Turkish, Moroccan and Dutch ethnic groups living in Amsterdam, the Netherlands. BMC Public Health. 2010;10:1–8.CrossRef
5.
Agyemang C, Ujcic-voortman J, Uitenbroek D, Foets M. Prevalence and management of hypertension among Turkish, Moroccan and native Dutch ethnic groups in Amsterdam, the Netherlands: the Amsterdam health monitor survey. J Hypertens. 2006;24:2169–76.CrossRefPubMed
6.
Yusuf S, Hawken S, Ôunpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2016;364:937–52.CrossRef
7.
Bos V, Kunst AE, Keij-deerenberg IM, Garssen J, Mackenbach JP. Ethnic inequalities in age- and cause-specific mortality in The Netherlands. Int J of Epidemiol. 2004;33:1112–9.CrossRef
8.
Daryani A, Berglund L, Anderson A, Kocturk T, Becker W, Vessby B. Risk factors for coronary heart disease among immigrant women from Iran and Turkey. Etnicity Dis. 2005;15:213–20.
9.
Jenum AK, Diep LM, Holmboe-Ottesen G, Holme IMK, Kumar BN, Birkeland KI. Diabetes susceptibility in ethnic minority groups from Turkey, Vietnam, Sri Lanka and Pakistan compared with Norwegians - the association with adiposity is strongest for ethnic minority women. BMC Public Health. 2012;12:150.CrossRefPubMedPubMedCentral
10.
Glenday K, Kumar BN, Tverdal A, Meyer HE. Cardiovascular disease risk factors among five major ethnic groups in Oslo, Norway : the Oslo immigrant health study. Eur J Prev Cardiol. 2016;13:348–55.CrossRef
11.
Oliveira CPMS, Kappel CR, Siqueira ER, Lima VMR, Stefano JT, Michalczuk MT, et al. Effects of hepatitis C virus on cardiovascular risk in infected patients: a comparative study. Int J Cardiol. 2013;164:221–6.CrossRefPubMed
12.
Simanek AM, Dowd JB, Pawelec G, Melzer D, Dutta A, Aiello AE. Seropositivity to cytomegalovirus, inflammation, all-cause and cardiovascular disease-related mortality in the United States. PLoS One. 2011;6:e16103.CrossRefPubMedPubMedCentral
13.
Di Pietro M, Sessa R, Di Pietro M, Filardo S, Turriziani O, Sessa R, et al. Infectious burden and atherosclerosis: a clinical issue. World J Clin Cases. 2014;2:240–9.CrossRefPubMedPubMedCentral
14.
Rosenfeld ME, Campbell LA. Pathogens and atherosclerosis: update on the potential contribution of multiple infectious organisms to the pathogenesis of atherosclerosis. Thromb Haemost. 2011;106:858–67.CrossRefPubMed
15.
Epstein SE, Zhu J, Burnett MS, Zhou YF, Vercellotti G, Hajjar D. Infection and atherosclerosis. Arterioscler Thromb Vasc Biol. 2000;20:1417–21.CrossRefPubMed
16.
Zhu J, Quyyumi AA, Norman JE, Csako G, Waclawiw MA, Shearer GM, et al. Effects of total pathogen burden on coronary artery disease risk and C-reactive protein levels. Am J Cardiol Elsevier. 2016;85:140–6.CrossRef
17.
Elkind MSV, Ramakrishnan P, Moon YP, Boden-Albala B, Liu KM, Spitalnik SL, et al. Infectious burden and risk of stroke: the northern Manhattan study. Arch Neurol. 2010;67:33–8.CrossRefPubMed
18.
Fernández-Real J-M, López-Bermejo A, Vendrell J, Ferri M-J, Recasens M, Ricart W. Burden of infection and insulin resistance in healthy middle-aged men. Diabetes Care. 2006;29:1058–64.CrossRefPubMed
19.
Steptoe A, Shamaei-Tousi A, Gylfe Å, Henderson B, Bergström S, Marmot M. Socioeconomic status, pathogen burden and cardiovascular disease risk. Heart. 2007;93(12):1567–70.CrossRefPubMedPubMedCentral
20.
Vilkuna-Rautiainen T, Pussinen PJ, Roivainen M, Petäys T, Jousilahti P, Hovi T, et al. Serum antibody response to periodontal pathogens and herpes simplex virus in relation to classic risk factors of cardiovascular disease. Int J Epidemiol. 2006;35:1486–94.CrossRefPubMed
21.
Georges J-L, Rupprecht HJ, Blankenberg S, Poirier O, Bickel C, Hafner G, et al. Impact of pathogen burden in patients with coronary artery disease in relation to systemic inflammation and variation in genes encoding cytokines. Am J Cardiol. 2016;92(5):515–21.CrossRef
22.
Liu L, Liu Y, Tong W, Ye H, Zhang X, Cao W, et al. Pathogen Burden in Essential Hypertension. Circ J. 2007;71:1761–4.CrossRefPubMed
23.
Zajacova A, Dowd JB, Aiello AE. Socioeconomic and race/ethnic patterns in persistent infection burden among U.S. adults. J Gerontol Ser A Biol Sci Med Sci. 2009;64:272–9.CrossRef
24.
Nazmi A, Diez-Roux AV, Jenny NS, Tsai MY, Szklo M, Aiello AE. The influence of persistent pathogens on circulating levels of inflammatory markers: a cross-sectional analysis from the multi-ethnic study of atherosclerosis. BMC Public Health. 2010;10:1–8.CrossRef
25.
Fischbacher CM, Bhopal R, Blackwell CC, Ingram R, Unwin NC, White M, et al. IgG is higher in south Asians than Europeans: does infection contribute to ethnic variation in cardiovascular disease? Arterioscler Thromb Vasc Biol. 2003;23:703–4.CrossRefPubMed
26.
Kramer MA, Uitenbroek DG, Ujcic-Voortman JK, Pfrommer C, Spaargaren J, Coutinho RA. Ethnic differences in HSV1 and HSV2 seroprevalence in Amsterdam, The Netherlands. Eur Secur. 2008;13:4–8.
27.
Baaten GGG, Sonder GJB, Dukers NHTM, Coutinho RA, Van den Hoek JAR. Population-based study on the seroprevalence of hepatitis a, B, and C virus infection in Amsterdam, 2004. J Med Virol. 2007;79:1802–10.CrossRefPubMed
28.
Nicolaas H, Wobma E, Ooijevaar J. Annual report integration 2010. Den Haag: Centraal Bureau voor de Statistiek; 2010.
29.
Uitenbroek DG, Ujcic-Voortman JK, Janssen AP, Tichelman PJ, Verhoeff AP. Gezond zijn en gezond leven in Amsterdam. Amsterdamse gezondheidsmonitor 2004. GGD Amsterdam: cluster Epidemiologie, Documentatie en Gezondheidsbevordering; 2004.
30.
Michel A, Waterboer T, Kist M, Pawlita M. Helicobacter pylori multiplex serology. Helicobacter. 2009;14:525–35.CrossRefPubMed
31.
den Heeten J, Verweij AO. Identificatie en registratie van ethnische herkomst: een handleiding voor registratie en beleid. Den Haag: VNG; 1993.
32.
Senior PA, Bhopal R. Ethnicity as a variable in epidemiological research. BMJ Br Med J. 1994;309:327–30.CrossRef
33.
Kemper HCG, Ooijendijk WTM en Stiggelbout M. Consensus over de Nederlandse Norm Gezond Bewegen. TSG. 2000;78:180–3.
34.
Devroey D, Vantomme K, Betz W, Vandevoorde J, Kartounian J. A review of the treatment guidelines on the Management of low Levels of high-density lipoprotein cholesterol. Cardiology. 2004;102:61–6.CrossRefPubMed
35.
A Global brief on hypertension. Silent killer, global public health crisis. World Health Organisation day. Geneva: WHO press; 2013. Report NO: WHO/DCO/WHD/2013.2
36.
Zuure FR, Bouman J, Martens M, Vanhommerig JW, Urbanus AT, Davidovich U, et al. Screening for hepatitis B and C in first-generation Egyptian migrants living in the Netherlands. Liver Int. 2013;33:727–38.CrossRefPubMed
37.
Baaten GGG, Sonder GJB, van der Loeff S, Coutinho RA MF, den Hoek JAR V. Fecal-orally transmitted diseases among travelers are decreasing due to better hygienic standard at travel destination. J Travel Med. 2010;17:322–8.CrossRefPubMed
38.
Williams DR, Yan Y, Jackson JS, Anderson NB. Racial differences in physical and mental health: socio-economic status, stress and discrimination. J Health Psychol. 1997;2:335–51.CrossRefPubMed
39.
Lutsey PL, Pankow JS, Bertoni AG, Szklo M, Folsom AR. Serologic evidence of infections and type 2 diabetes: the MultiEthnic study of atherosclerosis. Diabet Med. 2009;26:149–52.CrossRefPubMedPubMedCentral
40.
Vahdat K, Pourbehi MR, Ostovar A, Hadavand F, Bolkheir A, Assadi M, et al. Association of pathogen burden and hypertension: The Persian Gulf healthy heart study. Am J Hypertens. 2013;26:1140–7.CrossRefPubMed
41.
Butler SO, Btaiche IF, Alaniz C. Relationship between hyperglycemia and infection in critically ill patients. Pharmacotherapy. 2005;25:963–76.CrossRefPubMed
42.
Rothenbacher D, Brenner H, Hoffmeister A, Mertens T, Persson K, Koenig W. Relationship between infectious burden, systemic inflammatory response, and risk of stable coronary artery disease: role of confounding and reference group. Atherosclerosis. 2016;170:339–45.CrossRef
43.
Ujcic-Voortman J, De Wit MA, Uitenbroek DG, Tuinebreijer WC, Viet L, Verhoeff AP. Lichamelijk onderzoek en diagnostische interviews geïntegreerd in een algemene gezondheidsenquête onder de Amsterdamse multiculturele populatie. TSG. 2009;87:351–9.CrossRef
44.
Xu N, Wu H, Li D, Wang J. Diagnostic accuracy of glycated hemoglobin compared with oral glucose tolerance test for diagnosing diabetes mellitus in Chinese adults: a meta-analysis. Diabetes Res Clin Pract. 2016;106:11–8.CrossRef
45.
Kenning I, Kerandi H, Luehr D, Margolis K, O’Connor P, Pereira C, Schlichte A, Woolley T. Institute for Clinical Systems Improvement. Hypertension Diagnosis and Treatment. Updated November. 2014.
46.
Selvin E, Crainiceanu CM, Brancati FL, Coresh J. Short-term variability in measures of glycemia and implications for the classification of diabetes. Arch Intern Med. 2007;167:1545–51.CrossRefPubMed
47.
Vasiliki K, Ioannis F, Stamatios S, Constantina A, Dimitris T, Stafanadis C, et al. Cardiovascular disease and hepatitis C virus infection: and irrelevant statement or a hot relationship. Cardiol Rev. 2015;23:11–7.CrossRef
Metadata
Title
Ethnic differences in infectious burden and the association with metabolic risk factors for cardiovascular disease: a cross-sectional analysis
Authors
Lara Hartog
Martijn S. van Rooijen
Joanne Ujčič-Voortman
Maria Prins
Irene G. M. van Valkengoed
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2018
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-018-5162-x

Other articles of this Issue 1/2018

BMC Public Health 1/2018 Go to the issue

Research article

Liquor licences issued to Australian schools

Research article

Reproductive health knowledge among college students in Kenya

Research article

Support for a point-of-sale cigarette display ban among smokers: findings from the international tobacco control (ITC) Netherlands survey

Research article

“How am I going to live?”: exploring barriers to ART adherence among adolescents and young adults living with HIV in Uganda

Research article

Non-response bias in estimates of prevalence of club-based sport participation from an Australian national physical activity, recreation and sport survey

Research article

Public health implications of changing patterns of recruitment into the South African mining industry, 1973–2012: a database analysis