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Cardiometabolic disease in Black African and Caribbean populations: an ethnic divergence in pathophysiology?

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journal contribution
posted on 2024-01-04, 16:44 authored by Reuben M Reed, Martin B Whyte, Louise M Goff

In the UK, populations of Black African and Caribbean (BAC) ethnicity suffer higher rates of cardiometabolic disease than White Europeans (WE). Obesity, leading to increased visceral adipose tissue (VAT) and intrahepatic lipid (IHL), has long been associated with cardiometabolic risk, driving insulin resistance and defective fatty acid/lipoprotein metabolism. These defects are compounded by a state of chronic low-grade inflammation, driven by dysfunctional adipose tissue. Emerging evidence has highlighted associations between central complement system components and adipose tissue, fatty acid metabolism and inflammation; it may therefore sit at the intersection of various cardiometabolic disease risk factors. However, increasing evidence suggests an ethnic divergence in pathophysiology, whereby current theories fail to explain the high rates of cardiometabolic disease in BAC populations. Lower fasting and postprandial triacylglycerol (TAG) has been reported in BAC, alongside lower VAT and IHL deposition, which are paradoxical to the high rates of cardiometabolic disease exhibited by this ethnic group. Furthermore, BAC have been shown to exhibit a more antiinflammatory profile, with lower tumour necrosis factor- and greater interleukin-10. In contrast, recent evidence has revealed greater complement activation in BAC compared to WE, suggesting its dysregulation may play a greater role in the high rates of cardiometabolic disease experienced by this population. This review outlines the current theories of how obesity is proposed to drive cardiometabolic disease, before discussing evidence for ethnic differences in disease pathophysiology between BAC and WE populations.

History

Author affiliation

Leicester Diabetes Research Centre, University of Leicester

Version

  • AM (Accepted Manuscript)

Published in

Proceedings of the Nutrition Society

Publisher

Cambridge University Press (CUP)

issn

0029-6651

eissn

1475-2719

Copyright date

2023

Available date

2024-01-04

Language

en

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