Journal of Immigrant and Minority Health

, Volume 13, Issue 1, pp 101–110 | Cite as

Risk Factors for Type 2 Diabetes Among Female Pakistani Immigrants: The InvaDiab-DEPLAN Study on Pakistani Immigrant Women Living in Oslo, Norway

  • Victoria Telle HjellsetEmail author
  • Benedikte Bjørge
  • Hege R. Eriksen
  • Arne T. Høstmark


The risk for type 2 diabetes (T2D) in Pakistani immigrants is high. The aim of this study was to provide an update of the risk of T2D and the metabolic syndrome (MetS) in female Pakistani immigrants living in Oslo, Norway. Female Pakistani immigrants (n = 198, age 25–63) were interviewed, and data related to T2D, including anthropometric measurements, blood data, heart rate, and level of physical activity, were determined. Ninety-eight pecentage had body mass index (BMI > 23 kg m−2) and 39% were obese (BMI ≥ 30). Impaired glucose tolerance (IGT) was found in 37%, MetS in 41%, and T2D in 13%, using fasting glucose. By score evaluation, approximately 90% had risk of T2D. The participants had low energy expenditure, despite acceptable number of steps walked during a day. The risk of T2D is very high in female Pakistani immigrants in Oslo.


Glucose Lipids Obesity Pakistani immigrant women 



The technical assistance of Eva Kristensen and Monica Morris is gratefully acknowledged.


  1. 1.
    King H, Aubert RE, Herman WH. Global burden of diabetes, 1995–2025: prevalence, numerical estimates, and projections. Diabetes Care. 1998;21:1414–31.CrossRefPubMedGoogle Scholar
  2. 2.
    Bhopal R, Hayes L, White M, Unwin N, Harland J, Ayis S, et al. Ethnic and socio-economic inequalities in coronary heart disease, diabetes and risk factors in Europeans and South Asians. J Public Health Med. 2002;24:95–105.CrossRefPubMedGoogle Scholar
  3. 3.
    Mbanya J-C, Gan D, Allgot B, Bakker K, Brown JB, Roglic G et al. The metabolic syndrome. In: Diabetes atlas. International Diabetes Federation; 2006. p. 307–13.Google Scholar
  4. 4.
    Ramachandran A, Snehalatha C, Dharmaraj D, Viswanathan M. Prevalence of glucose intolerance in Asian Indians. Urban–rural difference and significance of upper body adiposity. Diabetes Care. 1992;15:1348–55.CrossRefPubMedGoogle Scholar
  5. 5.
    Jenum AK, Stensvold I, Thelle DS. Differences in cardiovascular disease mortality and major risk factors between districts in Oslo. An ecological analysis. Int J Epidemiol. 2001;30(Suppl 1):S59–65.PubMedGoogle Scholar
  6. 6.
    Reaven P. Metabolic syndrome. J Insur Med. 2004;36:132–42.PubMedGoogle Scholar
  7. 7.
    Lindstrom J, Tuomilehto J. The diabetes risk score: a practical tool to predict type 2 diabetes risk. Diabetes Care. 2003;26:725–31.CrossRefPubMedGoogle Scholar
  8. 8.
    Silventoinen K, Pankow J, Lindstrom J, Jousilahti P, Hu G, Tuomilehto J. The validity of the Finnish diabetes risk score for the prediction of the incidence of coronary heart disease and stroke, and total mortality. Eur J Cardiovasc Prev Rehabil. 2005;12:451–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Mohan V, Deepa R, Deepa M, Somannavar S, Datta M. A simplified Indian diabetes risk score for screening for undiagnosed diabetic subjects. J Assoc Physicians India. 2005;53:759–63.PubMedGoogle Scholar
  10. 10.
    Ramachandran A, Snehalatha C, Vijay V, Wareham NJ, Colagiuri S. Derivation and validation of diabetes risk score for urban Asian Indians. Diabetes Res Clin Pract. 2005;70:63–70.CrossRefPubMedGoogle Scholar
  11. 11.
    Blair SN, Kohl HW, Barlow CE, Paffenbarger RS, Gibbons LW, Macera CA. Changes in physical-fitness and all-cause mortality––a prospective-study of healthy and unhealthy men. JAMA. 1995;273:1093–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Manson JE, Skerrett PJ, Greenland P, VanItallie TB. The escalating pandemics of obesity and sedentary lifestyle. A call to action for clinicians. Arch Intern Med. 2004;164:249–58.CrossRefPubMedGoogle Scholar
  13. 13.
    Manson JE, Greenland P, LaCroix AZ, Stefanick ML, Mouton CP, Oberman A, et al. Walking compared with vigorous exercise for the prevention of cardiovascular events in women. N Engl J Med. 2002;347:716–25.CrossRefPubMedGoogle Scholar
  14. 14.
    Hostmark AT, Blom PC. Previous exercise nullifies the plasma triacylglycerol response to repeated fructose ingestion in young men. Acta Physiol Scand. 1985;125:553–4.CrossRefPubMedGoogle Scholar
  15. 15.
    Hostmark AT, Ekeland GS, Beckstrom AC, Meen HD. Postprandial light physical activity blunts the blood glucose increase. Prev Med. 2006;42:369–71.CrossRefPubMedGoogle Scholar
  16. 16.
    Andersen E, Hostmark AT. Effect of a single bout of resistance exercise on postprandial glucose and insulin response the next day in healthy, strength-trained men. J Strength Cond Res. 2007;21:487–91.PubMedGoogle Scholar
  17. 17.
    Aadland E, Hostmark AT. Very light physical activity after a meal blunts the rise in blood glucose and insulin. The Open Nutr J. 2008;2:94–9.CrossRefGoogle Scholar
  18. 18.
    Ware JE Jr. SF-36 health survey update. Spine. 2000;25:3130–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Craig CL, Marshall AL, Sjostrom M, Bauman AE, Booth ML, Ainsworth BE, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;35:1381–95.CrossRefPubMedGoogle Scholar
  20. 20.
    Derogatis LR, Lipman RS, Rickels K, Uhlenhuth EH, Covi L. The hopkins symptom checklist (HSCL): a self-report symptom inventory. Behav Sci. 1974;19:1–15.CrossRefPubMedGoogle Scholar
  21. 21.
    Derogatis LR, Lipman RS, Rickels K, Uhlenhuth EH, Covi L. The Hopkins symptom checklist (HSCL). A measure of primary symptom dimensions. Mod Probl Pharmacopsychiatr. 1974;7:79–110.Google Scholar
  22. 22.
    Lindstrom J, Peltonen M, Tuomilehto J. Lifestyle strategies for weight control: experience from the Finnish diabetes prevention study. Proc Nutr Soc. 2005;64:81–8.CrossRefPubMedGoogle Scholar
  23. 23.
    Saaristo T, Peltonen M, Lindstrom J, Saarikoski L, Sundvall J, Eriksson JG, et al. Cross-sectional evaluation of the Finnish diabetes risk score: a tool to identify undetected type 2 diabetes, abnormal glucose tolerance and metabolic syndrome. Diabetes Vasc Dis Res. 2005;2:67–72.CrossRefGoogle Scholar
  24. 24.
    St-Onge M, Mignault D, Allison DB, Rabasa-Lhoret R. Evaluation of a portable device to measure daily energy expenditure in free-living adults. Am J Clin Nutr. 2007;85:742–9.PubMedGoogle Scholar
  25. 25.
    Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14:377–81.PubMedGoogle Scholar
  26. 26.
    Alfheim K. Vellykket landskonferanse i NOKLUS. 2008. Tidsskr. Nor Legeforening.Google Scholar
  27. 27.
    Parkes JL, Slatin SL, Pardo S, Ginsberg BH. A new consensus error grid to evaluate the clinical significance of inaccuracies in the measurement of blood glucose. Diabetes Care. 2000;23:1143–8.CrossRefPubMedGoogle Scholar
  28. 28.
    Steele MK, Schrock L, Baum J. Performance of the new Contour blood glucose monitoring system with capillary blood. 2007; Bayer HealthCare.Google Scholar
  29. 29.
    WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363:157–63.Google Scholar
  30. 30.
    Kumar BN. Ethnic differences in obesity and related risk factors for cardiovascular diseases among immigrants in Oslo, Norway. Oslo: University of Oslo; 2006.Google Scholar
  31. 31.
    Midthjell K, Kruger O, Holmen J, Tverdal A, Claudi T, Bjorndal A, et al. Rapid changes in the prevalence of obesity, known diabetes in an adult Norwegian population. The nord-trondelag health surveys 1984–1986 and 1995–1997. Diabetes Care. 1999;22:1813–20.CrossRefPubMedGoogle Scholar
  32. 32.
    Tverdal A. Prevalence of obesity among persons aged 40–42 years in two periods. Tidsskr Nor Laegeforen. 2001;121:667–72.PubMedGoogle Scholar
  33. 33.
    Jenum AK, Holme I, Graff-Iversen S, Birkeland KI. Ethnicity and sex are strong determinants of diabetes in an urban Western society: implications for prevention. Diabetologia. 2005;48:435–9.CrossRefPubMedGoogle Scholar
  34. 34.
    Hildrum B, Mykletun A, Dahl AA, Midthjell K. Metabolic syndrome and risk of mortality in middle-aged versus elderly individuals: the Nord-Trondelag Health Study (HUNT). Diabetologia. 2009;52:583–90.Google Scholar
  35. 35.
    Zahid N, Claussen B, Hussain A. Diabetes and impaired glucose tolerance in a rural area in Pakistan and associated risk factors. Diabetes Metab Syndr Clin Res Rev. 2008;2:125–30.CrossRefGoogle Scholar
  36. 36.
    Rexrode KM, Carey VJ, Hennekens CH, Walters EE, Colditz GA, Stampfer MJ, et al. Abdominal adiposity and coronary heart disease in women. JAMA. 1998;280:1843–8.CrossRefPubMedGoogle Scholar
  37. 37.
    Alberti KG, Zimmet P, Shaw J. Metabolic syndrome––a new world-wide definition. A Consensus Statement from the International Diabetes Federation. Diabetes Med. 2006;23:469–80.CrossRefGoogle Scholar
  38. 38.
    Diaz VA, Mainous AG III, Baker R, Carnemolla M, Majeed A. How does ethnicity affect the association between obesity and diabetes? Diabetes Med. 2007;24:1199–204.CrossRefGoogle Scholar
  39. 39.
    Sumner AE. The relationship of body fat to metabolic disease: influence of sex and ethnicity. Gend Med. 2008;5:361–71.CrossRefPubMedGoogle Scholar
  40. 40.
    Hu G, Tuomilehto J, Silventoinen K, Barengo N, Jousilahti P. Joint effects of physical activity, body mass index, waist circumference and waist-to-hip ratio with the risk of cardiovascular disease among middle-aged Finnish men and women. Eur Heart J. 2004;25:2212–9.CrossRefPubMedGoogle Scholar
  41. 41.
    Colditz GA, Willett WC, Rotnitzky A, Manson JE. Weight gain as a risk factor for clinical diabetes mellitus in women. Ann Intern Med. 1995;122:481–6.PubMedGoogle Scholar
  42. 42.
    Simmons D, Williams DR, Powell MJ. Prevalence of diabetes in different regional and religious south Asian communities in coventry. Diabetes Med. 1992;9:428–31.CrossRefGoogle Scholar
  43. 43.
    Alvestad B, Jenssen HN, Larun L, Palmer J, Pøsberg J, Sætre U. Har fysisk trening på arbeidsplassen effekt på sykefravær? Tidsskr Nor Laegeforen. 1998;118:1718–21.PubMedGoogle Scholar
  44. 44.
    Kumar BN, Meyer HE, Wandel M, Dalen I, Holmboe-Ottesen G. Ethnic differences in obesity among immigrants from developing countries, in Oslo, Norway. Int J Obes (Lond). 2006;30:684–90.CrossRefGoogle Scholar
  45. 45.
    Dale AC, Midthjell K, Nilsen TI, Wiseth R, Vatten LJ. Glycaemic control in newly diagnosed diabetes patients and mortality from ischaemic heart disease: 20 years follow-up of the HUNT study in Norway. Eur Heart J. 2009;30:1372–7.Google Scholar
  46. 46.
    Shaw JE, Hodge AM. de Court, Chitson P, Zimmet PZ. Isolated post-challenge hyperglycaemia confirmed as a risk factor for mortality. Diabetologia. 1999;42:1050–4.CrossRefPubMedGoogle Scholar
  47. 47.
    Temelkova-Kurktschiev TS, Koehler C, Henkel E, Leonhardt W, Fuecker K, Hanefeld M. Postchallenge plasma glucose and glycemic spikes are more strongly associated with atherosclerosis than fasting glucose or HbA1c level. Diabetes Care. 2000;23:1830–4.CrossRefPubMedGoogle Scholar
  48. 48.
    Cavalot F, Petrelli A, Traversa M, Bonomo K, Fiora E, Conti M, et al. Postprandial blood glucose is a stronger predictor of cardiovascular events than fasting blood glucose in type 2 diabetes mellitus, particularly in women: lessons from the San Luigi Gonzaga diabetes study. J Clin Endocrinol Metab. 2006;91:813–9.CrossRefPubMedGoogle Scholar
  49. 49.
    Physical Activity Guidelines for Americans. 2008. U.S. Department of Health and Human Services.Google Scholar
  50. 50.
    McArdle WD, Katch FI, Katch VL. Exercise Physiology, energy, nutrition and human performance, 5th edn. Baltimore: Lippincott Williams & Wilkins; 2001.Google Scholar
  51. 51.
    Ihlebaek C, Eriksen HR, Ursin H. Prevalence of subjective health complaints (SHC) in Norway. Scand J Public Health. 2002;30:20–9.CrossRefPubMedGoogle Scholar
  52. 52.
    Syed HR, Dalgard OS, Dalen I, Claussen B, Hussain A, Selmer R et al. psychosocial factors and distress: a comparison between ethnic Norwegians and ethnic Pakistanis in Oslo, Norway. BMC Public Health. 2006;6:182.Google Scholar
  53. 53.
    Thapa SB, Dalgard OS, Claussen B, Sandvik L, Hauff E. Psychological distress among immigrants from high- and low-income countries: findings from the Oslo Health Study. Nord J Psychiatry. 2007;61:459–65.CrossRefPubMedGoogle Scholar
  54. 54.
    Sørgaard AJ, Selmer R, Bjertness E, Thelle DS. The Oslo health study. The impact of self-selection in a large, population based survey. Int J Equity Health. 2004;3:3.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Victoria Telle Hjellset
    • 1
    Email author
  • Benedikte Bjørge
    • 2
  • Hege R. Eriksen
    • 3
  • Arne T. Høstmark
    • 1
  1. 1.Institute of General Practice and Community MedicineUniversity of OsloBlindernNorway
  2. 2.Department of NutritionUniversity of OsloBlindernNorway
  3. 3.Faculty of Psychology, and Unifob HealthUniversity of BergenBergenNorway

Personalised recommendations