title: Worse cardiometabolic health in African immigrant men than African American men: reconsideration of the healthy immigrant effect.
abstract: BACKGROUND
  The healthy immigrant effect is a phrase that has been used for decades to describe better cardiometabolic health in African immigrants than African Americans. The recent global increase in cardiometabolic diseases raises the possibility that immigrant health may be changing. Therefore, a new assessment of cardiometabolic health in African immigrants is warranted.
  
  
  METHODS
  Glucose tolerance status, blood pressure, and visceral adipose tissue (VAT) volume were compared in 214 self-identified healthy men comprised of 138 African immigrants, 76 African Americans, mean age 36±9 years [mean±standard deviation (SD); range 20-64 years]. Insulin resistance was defined by the lowest quartile of the insulin sensitivity index (SI≤2.28 mU/L(-1)·min(-1)). The waist circumference (WC) which predicts insulin resistance was determined using receiver operating characteristic curves and the Youden index.
  
  
  RESULTS
  Body mass index (BMI) and WC were lower in African immigrants than African Americans (BMI, 27.4±3.8 vs. 29.3±5.5 kg/m(2), P<0.01; WC, 91±11 vs. 97±16 cm, P<0.01). However, blood pressure, fasting glucose, and 2-hr glucose were higher in the African immigrants (all P<0.01). In addition, African immigrants had a higher prevalence of previously undiagnosed diabetes (8% vs. 0%, P<0.01) and prediabetes (35% vs. 22%, P<0.01). After adjusting for WC, African immigrants had more visceral adipose tissue (VAT) than African Americans (P<0.01). Consequently, the WC that predicted insulin resistance was 92 cm in African immigrants but 102 cm in African Americans.
  
  
  CONCLUSIONS
  African immigrants were less obese than African Americans but had worse cardiometabolic health, specifically higher glucose levels, more hypertension, and greater visceral adiposity. Overall, the healthy immigrant effect may no longer be valid.
authors.affiliation: 1 Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health , Bethesda, Maryland.
authors.forename: Michelle Y
authors.initials: MY
authors.lastname: O'Connor
authors.forename: Caroline K
authors.initials: CK
authors.lastname: Thoreson
authors.forename: Madia
authors.initials: M
authors.lastname: Ricks
authors.forename: Amber B
authors.initials: AB
authors.lastname: Courville
authors.forename: Francine
authors.initials: F
authors.lastname: Thomas
authors.forename: Jianhua
authors.initials: J
authors.lastname: Yao
authors.forename: Peter T
authors.initials: PT
authors.lastname: Katzmarzyk
authors.forename: Anne E
authors.initials: AE
authors.lastname: Sumner
mesh_terms: D050153:Abdominal Fat / Q000378:metabolism; D000328:Adult; D000349:Africa / Q000208:ethnology; D001741:Black or African American / Q000706:statistics & numerical data*; D000367:Age Factors; D001786:Blood Glucose / Q000378:metabolism; D001835:Body Weight; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000378:metabolism / Q000503:physiopathology; D015331:Cohort Studies; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005260:Female; D006304:Health Status; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D008659:Metabolic Diseases / Q000453:epidemiology* / Q000378:metabolism / Q000503:physiopathology; D008875:Middle Aged; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D001786:Blood Glucose