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Health Needs and Global Cardiovascular Risk of Chinese First-Generation Migrants in Europe: Which Peculiarities?

  • Pietro Amedeo ModestiEmail author
  • Maria Calabrese
  • Giorgio Galanti
  • Piergiuseppe Cala’
Chapter
Part of the Updates in Hypertension and Cardiovascular Protection book series (UHCP)

Abstract

Changes occurring in Asian countries have now implications also for Europe where a high prevalence of T2DM was observed among subjects originating from India, Pakistan, Bangladesh, Sri Lanka, Nepal, Bhutan, and the Maldives. The Chinese community in Italy and Spain, mostly represented by first-generation migrants, is numerically consistent. The prevalence of prediabetes and type 2 diabetes mellitus in this ethnic group was recently found as high as in China. The potential consequences of ineffective prevention and management of diabetes and other cardiovascular risk factors in Chinese communities living in Europe on the future burden of cardiovascular diseases might be remarkable. However, cultural factors may limit the possibility to reach minority groups with interventions addressed to the native population so that implementation of specific intervention strategies is specifically needed.

Keywords

Cardiovascular prevention Ethnicity Immigration Health policies 

References

  1. 1.
    Rechel B, Mladovsky P, Ingleby D, et al. Migration and health in an increasingly diverse Europe. Lancet. 2013;381(9873):1235–45.CrossRefGoogle Scholar
  2. 2.
    Collaboration NCDRF. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128.9 million children, adolescents, and adults. Lancet. 2017;390(10113):2627–42.CrossRefGoogle Scholar
  3. 3.
    Blacher J, Levy B, Mourad JJ, et al. From epidemiological transition to modern cardiovascular epidemiology: hypertension in the 21st century. Lancet. 2016;388(10043):530–2.CrossRefGoogle Scholar
  4. 4.
    GBD 2016 Causes of Death Collaborators. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100):1151–210.CrossRefGoogle Scholar
  5. 5.
    Krishnamurthi RV, Feigin VL, Forouzanfar MH, et al. Global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet Glob Health. 2013;1(5):e259–81.CrossRefGoogle Scholar
  6. 6.
    Feigin VL, Roth GA, Naghavi M, et al. Global burden of stroke and risk factors in 188 countries, during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet Neurol. 2016;15(9):913–24.CrossRefGoogle Scholar
  7. 7.
    [A mass survey of diabetes mellitus in a population of 300,000 in 14 provinces and municipalities in China (author’s transl)]. Zhonghua Nei Ke Za Zhi. 1981;20(11):678–83.Google Scholar
  8. 8.
    Pan XR, Yang WY, Li GW, et al. Prevalence of diabetes and its risk factors in China, 1994. National Diabetes Prevention and Control Cooperative Group. Diabetes Care. 1997;20(11):1664–9.CrossRefGoogle Scholar
  9. 9.
    Gu D, Reynolds K, Duan X, et al. Prevalence of diabetes and impaired fasting glucose in the Chinese adult population: International Collaborative Study of Cardiovascular Disease in Asia (InterASIA). Diabetologia. 2003;46(9):1190–8.CrossRefGoogle Scholar
  10. 10.
    Yang WY, Lu JM, Weng JP, et al. Prevalence of diabetes among men and women in China. N Engl J Med. 2010;362(12):1090–101.CrossRefGoogle Scholar
  11. 11.
    Xu Y, Wang L, He J, et al. Prevalence and control of diabetes in Chinese adults. JAMA. 2013;310(9):948–59.CrossRefGoogle Scholar
  12. 12.
    Global Burden of Disease Study Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386(9995):743–800.CrossRefGoogle Scholar
  13. 13.
    Murray CJ, Barber RM, Foreman KJ, et al. Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: quantifying the epidemiological transition. Lancet. 2015;386(10009):2145–91.CrossRefGoogle Scholar
  14. 14.
    Zhou M, Wang H, Zhu J, et al. Cause-specific mortality for 240 causes in China during 1990-2013: a systematic subnational analysis for the Global Burden of Disease Study 2013. Lancet. 2016;387(10015):251–72.CrossRefGoogle Scholar
  15. 15.
    Harland JO, Unwin N, Bhopal RS, et al. Low levels of cardiovascular risk factors and coronary heart disease in a UK Chinese population. J Epidemiol Community Health. 1997;51(6):636–42.CrossRefGoogle Scholar
  16. 16.
    Unwin N, Harland J, White M, et al. Body mass index, waist circumference, waist-hip ratio, and glucose intolerance in Chinese and Europid adults in Newcastle, UK. J Epidemiol Community Health. 1997;51(2):160–6.CrossRefGoogle Scholar
  17. 17.
    Primatesta P, Bost L, Poulter NR. Blood pressure levels and hypertension status among ethnic groups in England. J Hum Hypertens. 2000;14(2):143–8.CrossRefGoogle Scholar
  18. 18.
    Bhopal RS, Humphry RW, Fischbacher CM. Changes in cardiovascular risk factors in relation to increasing ethnic inequalities in cardiovascular mortality: comparison of cross-sectional data in the health surveys for England 1999 and 2004. BMJ Open. 2013;3(9):e003485.CrossRefGoogle Scholar
  19. 19.
    Gong Z, Zhao D. Cardiovascular diseases and risk factors among Chinese immigrants. Intern Emerg Med. 2016;11(3):307–18.CrossRefGoogle Scholar
  20. 20.
    Petrelli A, Di Napoli A, Rossi A, et al. Self-perceived health status among immigrants in Italy. Epidemiol Prev. 2017;41(3–4 (Suppl 1)):11–7.PubMedGoogle Scholar
  21. 21.
    Piepoli MF, Hoes AW, Agewall S, et al. European guidelines on cardiovascular disease prevention in clinical practice: the Sixth Joint Task Force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of 10 societies and by invited experts) developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J. 2016;37(29):2315–81.CrossRefGoogle Scholar
  22. 22.
    Modesti PA, Han Y, Jing Y, et al. Design and arrangement of the CHIP (CHinese in Prato) study. Epidemiol Prev. 2014;38(6):357–63.PubMedGoogle Scholar
  23. 23.
    Stuart-Shor EM, Berra KA, Kamau MW, et al. Behavioral strategies for cardiovascular risk reduction in diverse and underserved racial/ethnic groups. Circulation. 2012;125(1):171–84.CrossRefGoogle Scholar
  24. 24.
    Modesti PA, Agostoni P, Agyemang C, et al. Cardiovascular risk assessment in low-resource settings: a consensus document of the European Society of Hypertension Working Group on Hypertension and Cardiovascular Risk in Low Resource Settings. J Hypertens. 2014;32(5):951–60.CrossRefGoogle Scholar
  25. 25.
    Modesti PA, Bianchi S, Borghi C, et al. Cardiovascular health in migrants: current status and issues for prevention. A collaborative multidisciplinary task force report. J Cardiovasc Med. 2014;15(9):683–92.CrossRefGoogle Scholar
  26. 26.
    Grace C, Begum R, Subhani S, et al. Prevention of type 2 diabetes in British Bangladeshis: qualitative study of community, religious, and professional perspectives. BMJ. 2008;337:a1931.CrossRefGoogle Scholar
  27. 27.
    Artinian NT, Fletcher GF, Mozaffarian D, et al. Interventions to promote physical activity and dietary lifestyle changes for cardiovascular risk factor reduction in adults: a scientific statement from the American Heart Association. Circulation. 2010;122(4):406–41.CrossRefGoogle Scholar
  28. 28.
    Xu Z, Qi X, Dahl AK, et al. Waist-to-height ratio is the best indicator for undiagnosed Type 2 diabetes. Diabet Med. 2013;30(6):e201–e7.CrossRefGoogle Scholar
  29. 29.
    Wang X, Bots ML, Yang F, et al. Prevalence of hypertension in China: a systematic review and meta-regression analysis of trends and regional differences. J Hypertens. 2014;32(10):1919–27; discussion 27.CrossRefGoogle Scholar
  30. 30.
    Sun GZ, Guo L, Wang XZ, et al. Prevalence of atrial fibrillation and its risk factors in rural China: a cross-sectional study. Int J Cardiol. 2015;182:13–7.CrossRefGoogle Scholar
  31. 31.
    Zhou M, Astell-Burt T, Bi Y, et al. Geographical variation in diabetes prevalence and detection in China: multilevel spatial analysis of 98,058 adults. Diabetes Care. 2015;38(1):72–81.CrossRefGoogle Scholar
  32. 32.
    Li W, Gu H, Teo KK, et al. Hypertension prevalence, awareness, treatment, and control in 115 rural and urban communities involving 47 000 people from China. J Hypertens. 2016;34(1):39–46.CrossRefGoogle Scholar
  33. 33.
    Wang W, Jiang B, Sun H, et al. Prevalence, incidence, and mortality of stroke in China: results from a Nationwide Population-Based Survey of 480 687 adults. Circulation. 2017;135(8):759–71.CrossRefGoogle Scholar
  34. 34.
    Modesti PA, Calabrese M, Perruolo E, et al. Sleep history and hypertension burden in first-generation Chinese migrants settled in Italy: the CHIinese in Prato cross-sectional survey. Medicine (Baltimore). 2016;95(14):e3229.CrossRefGoogle Scholar
  35. 35.
    Modesti PA, Calabrese M, Marzotti I, et al. Prevalence, awareness, treatment, and control of hypertension among Chinese first-generation migrants and Italians in Prato, Italy: the CHIP study. Int J Hypertens. 2017;2017:6402085.CrossRefGoogle Scholar
  36. 36.
    Zhao LC, Stamler J, Yan LJL, et al. Blood pressure differences between northern and southern Chinese: role of dietary factors the international study on macronutrients and blood pressure. Hypertension. 2004;43(6):1332–7.CrossRefGoogle Scholar
  37. 37.
    Kesteloot H, Huang DX, Li YL, et al. The relationship between cations and blood pressure in the People’s Republic of China. Hypertension. 1987;9(6):654–9.CrossRefGoogle Scholar
  38. 38.
    Liu L, Ikeda K, Yamori Y. Twenty-four hour urinary sodium and 3-methylhistidine excretion in relation to blood pressure in Chinese: results from the China-Japan cooperative research for the WHO-CARDIAC study. Hypertens Res. 2000;23(2):151–7.CrossRefGoogle Scholar
  39. 39.
    Yamori Y, Liu L, Mu L, et al. Diet-related factors, educational levels and blood pressure in a Chinese population sample: findings from the Japan-China Cooperative Research Project. Hypertens Res. 2002;25(4):559–64.CrossRefGoogle Scholar
  40. 40.
    Hu M, Chen Z, Lin S, Lin X, Wang M, Wu J. Investigation and analysis on the salt intake of residents in Fujian province. Chinese J Control Endemic Dis [Zhong Guo Di Fang Bing Fang Zhi Za Zhi]. 2010;6:435–7.Google Scholar
  41. 41.
    Zhang JY, Yan LX, Tang JL, et al. Estimating daily salt intake based on 24 h urinary sodium excretion in adults aged 18-69 years in Shandong, China. BMJ Open. 2014;4(7):e005089.CrossRefGoogle Scholar
  42. 42.
    Han W, Hu Y, Tang Y, et al. Relationship between urinary sodium with blood pressure and hypertension among a Kazakh community population in Xinjiang, China. J Hum Hypertens. 2017;31(5):333–40.CrossRefGoogle Scholar
  43. 43.
    Shao S, Hua Y, Yang Y, et al. Salt reduction in China: a state-of-the-art review. Risk Manag Healthc Policy. 2017;10:17–28.CrossRefGoogle Scholar
  44. 44.
    World Health Organization. Guideline: sodium intake for adults and children. Geneva: World Health Organization (WHO); 2012.Google Scholar
  45. 45.
    Yongqing Z, Ming W, Jian S, et al. Prevalence, awareness, treatment and control of hypertension and sodium intake in Jiangsu Province, China: a baseline study in 2014. BMC Public Health. 2016;16:56.CrossRefGoogle Scholar
  46. 46.
    Modesti PA, Calabrese M, Malandrino D, et al. New findings on type 2 diabetes in first-generation Chinese migrants settled in Italy: Chinese in Prato (CHIP) cross-sectional survey. Diabetes Metab Res Rev. 2017;33(2):e2835.CrossRefGoogle Scholar
  47. 47.
    Moller JB, Dalla Man C, Overgaard RV, et al. Ethnic differences in insulin sensitivity, beta-cell function, and hepatic extraction between Japanese and Caucasians: a minimal model analysis. J Clin Endocrinol Metab. 2014;99(11):4273–80.CrossRefGoogle Scholar
  48. 48.
    Yabe D, Seino Y, Fukushima M, et al. Beta cell dysfunction versus insulin resistance in the pathogenesis of type 2 diabetes in East Asians. Curr Diab Rep. 2015;15(6):602.CrossRefGoogle Scholar
  49. 49.
    Tanaka S, Horimai C, Katsukawa F. Ethnic differences in abdominal visceral fat accumulation between Japanese, African-Americans, and Caucasians: a meta-analysis. Acta Diabetol. 2003;40:S302–S4.CrossRefGoogle Scholar
  50. 50.
    Lear SA, Humphries KH, Kohli S, et al. Visceral adipose tissue accumulation differs according to ethnic background: results of the Multicultural Community Health Assessment Trial (M-CHAT). Am J Clin Nutr. 2007;86(2):353–9.CrossRefGoogle Scholar
  51. 51.
    Ryden L, Grant PJ, Anker SD, et al. ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2013;34(39):3035–+.CrossRefGoogle Scholar
  52. 52.
    Barba C, Cavalli-Sforza T, Cutter J, et al. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363(9403):157–63.CrossRefGoogle Scholar
  53. 53.
    Chiu M, Austin PC, Manuel DG, et al. Deriving ethnic-specific BMI cutoff points for assessing diabetes risk. Diabetes Care. 2011;34(8):1741–8.CrossRefGoogle Scholar
  54. 54.
    Carulli L, Rondinella S, Lombardini S, et al. Review article: diabetes, genetics and ethnicity. Aliment Pharmacol Ther. 2005;22:16–9.CrossRefGoogle Scholar
  55. 55.
    Yajnik CS, Lubree HG, Rege SS, et al. Adiposity and hyperinsulinemia in Indians are present at birth. J Clin Endocr Metab. 2002;87(12):5575–80.CrossRefGoogle Scholar
  56. 56.
    Mckeigue PM, Pierpoint T, Ferrie JE, et al. Relationship of glucose-intolerance and hyperinsulinemia to body-fat pattern in South Asians and Europeans. Diabetologia. 1992;35(8):785–91.PubMedGoogle Scholar
  57. 57.
    WHO. Appropriate body-mass index in Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363(9412):902.CrossRefGoogle Scholar
  58. 58.
    Misra A, Chowbey P, Makkar BM, et al. Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management. J Assoc Physicians India. 2009;57:163–70.PubMedGoogle Scholar
  59. 59.
    Bei-Fan Z, Working CMAG. Predictive values of body mass index and waist circumference for risk factors of certain related diseases in Chinese adults: study on optimal cut-off points of body mass index and waist circumference in Chinese adults. Asia Pac J Clin Nutr. 2002;11:S685–S93.CrossRefGoogle Scholar
  60. 60.
    Zimmet PZ, Alberti KG. Introduction: globalization and the non-communicable disease epidemic. Obesity (Silver Spring). 2006;14(1):1–3.CrossRefGoogle Scholar
  61. 61.
    Modesti PA, Galanti G, Cala’ P, et al. Lifestyle interventions in preventing new type 2 diabetes in Asian populations. Intern Emerg Med. 2015;11(3):375–84.CrossRefGoogle Scholar
  62. 62.
    Hsu WC, Araneta MRG, Kanaya AM, et al. BMI cut points to identify at-risk Asian Americans for type 2 diabetes screening. Diabetes Care. 2015;38(1):150–8.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Pietro Amedeo Modesti
    • 1
    Email author
  • Maria Calabrese
    • 2
  • Giorgio Galanti
    • 3
  • Piergiuseppe Cala’
    • 4
  1. 1.Department of Clinical and Experimental MedicineUniversity of FlorenceFirenzeItaly
  2. 2.Diabetology UnitHospital of Prato, Azienda USL Toscana CentroPratoItaly
  3. 3.Department of Clinical and Experimental MedicineUniversity of Florence Medical SchoolFlorenceItaly
  4. 4.Direzione Generale Diritti di cittadinanza e Coesione Sociale, Regione Toscana, Settore “Prevenzione collettiva”FlorenceItaly

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