Prevention of type 2 diabetes and poor mental health amongst immigrants from the Middle-East to Sweden

Sammanfattning: Background: Type 2 diabetes (T2D) and poor mental health are two major public health concerns in Europe. Ethnicity is identified as a risk marker for both conditions. Middle-Eastern immigrants represent the largest group of non-European immigrants in Sweden and are at increased risk for T2D. In clinical trials, lifestyle interventions focusing on physical activity and healthy diet have been shown to delay/prevent the onset of T2D. Physical activity also has therapeutic effects on anxiety and depression. However, the evidence related to the efficacy of such interventions in non-European immigrants is scarce. Aims: In residents of Malmö born in Iraq or Sweden, to study the prevalence and risk factors associated with poor mental health (Paper I). In a Middle-Eastern immigrant population at high risk for T2D, to elaborate on the effects of a culturally adapted lifestyle intervention on lifestyle habits & cardio-metabolic profile (Paper II), on objectively measured physical activity (Paper III), on dietary habits (Paper IV) as well as on mental health (Paper V). Methods: Paper I: The MEDIM study, a population-based cross-sectional study, conducted between 2010 and 2012. Iraqi-born and Swedish-born residents of Malmö (30-75 years) were randomly selected from the census register and invited to participate. Physical examinations were performed and fasting blood samples were collected. Information on lifestyle, socio-demography and mental health was provided through questionnaires. Logistic regression was used to study the associations. Paper II-V: The MEDIM intervention study, a randomised controlled trial, recruiting Iraqi immigrants at high risk of T2D, was conducted from January to June 2015. High risk for T2D was defined as having a body mass index (≥ 28 kg/m2) and/or waist circumference (≥80 cm in women, and ≥94 cm in men) and/or pre-diabetes. The participants were randomised to the control group (CG) or the intervention group (IG). Anthropometric measurements, blood tests and oral glucose tolerance test were performed at the start, mid-term and end of the study. Information on socio-demography and lifestyle habits was collected. Physical activity data was collected using accelerometers. Linear mixed models and proportional odds model were assessed. The intervention was adapted to match Middle-Eastern culture and comprised of seven group sessions including one cooking class. Results: Paper I: Compared to Swedes (n=634), anxiety was three times and depression five times as prevalent in Iraqi immigrants (n=1255). Iraqis had three times higher odds of anxiety/depression. Physical inactivity, economic insecurity, inability to trust people and smoking were associated with anxiety and depression in the Iraqis. Paper II: A reduction in body weight (0.4% per month), LDL-cholesterol levels (2.1% per month), as well as improvement in insulin sensitivity index (10.9% per month), was observed in the IG (n=50) compared to the CG (n=46). Paper III: An increase in number of hours/day spent in light-intensity activities and in least sedentary activities within the sedentary behaviour range was observed in the IG compared to the CG. Paper IV: No significant changes in dietary intake were observed in the IG compared to the CG, however the IG exhibited favourable trends in intake of energy, sucrose, fats & carbohydrates. Paper V: The odds of scoring lower on Montgomery Åsberg Depression Rating Scale (MADRS-S) and Hospital Anxiety & Depression Scale (HADS) for depression at follow-up vs. baseline were higher in the IG compared to the CG. P-values <0.05 were considered significant. Conclusion: Middle-Eastern immigrants exhibit high levels of anxiety and depression which is strongly associated with physical inactivity. Adopting a culturally sensitive lifestyle intervention approach in primary health care settings could be potentially beneficial for improving lifestyle habits and reducing the risk of T2D and poor mental health in this vulnerable immigrant population.