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Skip Navigation Linksראשי > רשימת כתבי עת > Israeli Journal of Family Practice - גליון מס' 127 > The Prevalence of Type 2 Diabetes in Bukharian Jews
פברואר 2006 February | גיליון מס' 127 .No
צור קשר
חברי מערכת
רשימת גליונות קודמים
שער הגליון
מאמר מקורי
The Prevalence of Type 2 Diabetes in Bukharian Jews




G Nitay MD, A Kiderman MD, A Lahad MD, N Davidov, A Furst FRCP RCPS (Glasg.)
Department of Family Medicine, the Hebrew University-Hadassah Medical School, Jerusalem, Israel; and The Israel General Health Services HMO (‘Sherutei Briut Clallit’) Jerusalem area, Israel

Address for Correspondence:
Dr. Nitay Gila, Department of Family Medicine, the Hebrew University-Hadassah Medical School, Jerusalem 91120, Israel, E-mail: gila-n@barak-online.net

Abstract
Background: the prevalence of Type 2 diabetes often varies significantly amongst different ethnic groups for reasons that are still not well understood
Objective: to investigate a widely-held belief among Israeli health personnel that Jews of Bukharian origin have a high prevalence of Type 2 diabetes
Methods: cross-sectional matched-control study during 2000 to 2003 among more than 400 adult Bukharian Jews attending a large community health-care clinic in Jerusalem, Israel
Results: using American Diabetes Association diagnostics, and after controlling for age and BMI, 92 out of 409 (23%) Bukharian Jews were found to have Type 2 diabetes compared with 81 out of a 452 (18%) controls matched for both age and sex. This difference was statistically significant (OR=1.43,p=0.04).
Conclusion: This is the first study supporting the belief that Bukharian Jews have a high prevalence of Type 2 diabetes. It thus adds this Jewish ethnic group to others already characterized by this health characteristic. Further studies among Jewish communities of Bukharian origin would be helpful for consolidating this finding.
Key Words: Jews, Bokhara, Type 2 diabetes

Type 2 diabetes is a universally common and chronic condition affecting almost every adult population. Although its pathogenesis remains obscure, genetic influences are thought to play a role as an increased prevalence is found in certain homologous ethnic groups (1-3) whose members are consequently at greater than average risk for developing the condition. Knowledge of an increased propensity to Type 2 diabetes is important not only for physicians treating individual patients but also for public health and other medical agencies with overall responsibilities for community health care.
For 2000 years the Jews of Bukhara existed as a genetically isolated population in central Asia. Recently, however, they have emigrated in large numbers to Israel, the United States, Germany and elsewhere albeit so far they have usually continued to live as distinct communities within their adopted country. Health workers in Israel working among this particular ethnic population have long believed its prevalence of Type 2 diabetes to be higher than in many other groups.
In this study we investigated this belief.

Materials and Methods
The study was undertaken between 2000 and 2003 in a large family medicine practice clinic in the Neveh Ya’acov neighborhood of Jerusalem belonging to the Israel General Health Management Organization. This suburb has a large concentration of Jews of Bukharian ethnic origin. At the time of the study each of the five family physicians working in the clinic looked after a defined population of about 1400 patients of all ages whose demographic and medical data were held on a computerized database directly accessible through personal terminals in each consulting room.
Patients of Bukharian origin aged 40 or more registered in the clinic were identified from this database utilizing the physicians’ and nurses’ a priore personal knowledge of the patients acquired over many years contact. Where doubt existed the patient was contacted directly and Bukharian origin thereby confirmed or excluded. In addition, other individuals in the clinic database whose family name ended in ‘ev’ or ’ov’ (markers for possible Bukharian origin) were located and questioned by staff to determine their origin. In this way 474 Jewish patients of Bukharian origin over the age of forty were identified, 409 (86%) of whom clinical data were eventually obtained. All had immigrated to Israel from former central Asian Soviet republics between 1970 and 2000 and they were equally distributed among the five family medicine practices in the clinic. A control group of patients was constructed by matching each of the 409 Bukharian patients with the next alphabetically listed non-Bukharian patient of the same age and sex in the clinic database.
In order to strengthen the power of the study this initially 409 strong control group was increased by 43 selected in proportion to the numbers in the study population age-groups and in a similarly random fashion to which the original 409 control subjects had been chosen. Thus the final study control group numbered 452.
The clinic database was then searched for diagnoses of Type 2 diabetes among both groups of patients using criteria of the American Diabetes Association (4). Each case of Type 2 diabetes so detected was verified by reviewing the most recently recorded fasting blood glucose estimation of the patient concerned and, similarly, accurate height and weight measurements were carried out.  

Statistical  Analysis
Student’s t test was used for analyzing continuous variables and the chi-squared test for analyzing categorical variables. All tests were two-tailed. A logistic regression controlling for age groups was used to compare the rates of diabetes in both groups. A multivariate linear regression model was used to compare the BMI of patients in both study groups after controlling for age and sex. Cox regression was used 
to compare the age of the patients between the two groups after controlling for sex and BMI.



Results
The matching procedure used yielded similarly aged populations of both Bukharian and non-Bukharian patients (Table 1).
After controlling for age group the Bukharian population was found to have a 23% rate of Type 2 diabetes (92/407) compared with a rate of 18% (81/452) in the controls
(Table 1). This difference was statistically significant (OR=1.43, p=0.04).
Bukharian patients with Type 2 diabetes had a slightly greater body weight and BMI (79.4+/-13.9; 30.2+/-5.1) than those in the control group (78.1+/-13.6; 29.7+/-4.8) but these differences were not significant after controlling for age and gender. Using Cox regression with age at the time of developing Type 2 diabetes and controlling for gender demonstrated no differences in the age of onset of diabetes between the two groups. This lessens the likelihood that the differences in the observed rate of Type 2 diabetes by age were due to differences in either body weight or BMI.

Discussion
Type 2 diabetes is a major health challenge for primary care medicine, especially in rapidly expanding elderly populations. Although its diagnosis and consequent treatment are often delayed for many years, prevention and early effective treatment have recently been causally implicated in reducing the risk of complications. If it is true that for as-yet unknown reasons certain discrete groups have an increased predisposition to Type 2 diabetes then such knowledge would be valuable for changing the approach to its detection and treatment among such populations.
Until relatively recently Bukharian Jews lived continuously for more than 2000 years in almost complete cultural and genetic isolation as separate communities within the Turkish and Mongolian peoples of central Asia. Their religious observances precluded marriages with outsiders and, similarly, dictated a particular lifestyle requiring the exclusive consumption of traditional (kosher) food. Bukharian Jews only began emigrating from their traditional homelands in the nineteenth century although many still remain in the now independent former Soviet republics of Uzbekistan, Tajikistan, Turkmenistan and Kazakhstan. Two large waves of Bukharian Jews arrived in Israel in the 1970s and 1990s and many of them made their home in the new Jerusalem neighborhood of Neveh Ya’acov.
A brief survey of previous Type 2 diabetes prevalence studies in Israel and elsewhere highlights the difficulty of comparing the results. Early community studies among different Jewish ethnic groups in Israel found a Type 2 diabetes prevalence of between 0% in new-immigrant Jews of Kurdish origin and 14.4% among veteran Kurdish immigrants (women aged 50 to 59) (5). The same study also found the overall prevalence of Type 2 diabetes in Israel comparable to that in other western countries but with a much higher rate evident in veteran immigrants compared with more recent arrivals. A subsequent study (6) among Jewish ethnic groups living in Jerusalem found a prevalence rate for definite or probable Type 2 diabetes of between 8.2% in the 45-54 y. group and 21.3% in the oldest group (>75 y). These differences in rates were attributed to a combination of genetic and lifestyle influences. Additional Israeli prevalence studies (7–10) in other ethnic groups using a variety of methodologies found Type 2 diabetes rates ranging from a low of 2.1% in Ethiopian Jews to a high of about 18% in a mixed Jewish population in the Negev area in southern Israel. Yet another study (11) found a prevalence of Type 2 diabetes in Soviet Jewish immigrants aged >45 y. from 2.4% to 17% depending on age. Here the relationship between prevalence and a western lifestyle was inconsistent. The Israel Center for Disease Control (12) estimates the present prevalence of all diabetes in Israeli adults to be 4% to 10 % with a minimum rate of <1% in the population under 45 and a maximum rate of about 17% in the over 75s. Variations in the prevalence rate of Type 2 diabetes among different ethnic groups have also been found in international studies (13–15) although direct comparisons are again problematic on account of differing methodologies.
As this study was neither prospective nor based on a representative sample of all Bukharian Jews living in Israel its findings must therefore be interpreted with caution. Notwithstanding these limitations however, the 23% Type 2 diabetes prevalence found among Bukharian Jews was significantly higher than the 18% prevalence in a matched non-Bukharian control population attending the same primary care clinic. Further, this difference could not be accounted for by variations in body weight or BMI.
These results thus lend support to the already widely held belief that for genetic or other reasons Jews of Bukharian origin may be especially prone to develop Type 2 diabetes. A more comprehensive prevalence study would be invaluable for consolidating this conclusion.  

References
1. Lorenzo C, Serrano-Rios M, Martinez-Larad MT, Gabriel, R, Williams K, Gonzalez-Villalpando C, Stern MP, Hazuda HP, Haffner SM. Was the historic contribution of Spain to the Mexican gene pool partially  responsible for the higher prevalence of Type 2 diabetes in Mexican-origin populations? Diabetes Care 2002;24:2059-2064
2. Riste L, Khan F, Cruickshank K. High prevalence of Type 2 diabetes in all ethnic groups, including Europeans, in a British inner city. Diabetic Care 2001;24:1377-1383
3. Al-Lawati JA, Al Riyami AM, Mohammed Aj, Jousilahti P. Increasing prevalence of diabetes mellitus in Oman. Diabetes Res Clin Pract 1997;38:185-190
4. American Diabetes Association Report of the expert committee on the diagnosis and classification of diabetes mellitus.  Diabetes Care 1997;20:1183-1197
5. Cohen AM. Prevalence of diabetes among different ethnic Jewish groups in Israel. Metabolism 1961;10:50-58
6. Donchin M, Kark JD, Abramson JH, Epstein L, Hopp C. Prevalence of diabetes among ethnic groups in Jerusalem. Isr J Med Sci 1984;20:578-583
7. Loboshitsky R, Attar S, Kofti G, Tamir A, Degani Y, Flatto I. Prevalence of diabetes and glucose intolerance in Ethiopian immigrants. Harefuah 1995;128:406-408 (In Hebrew)
8. Cohen AM, Fidel J, Cohen B, Yodfat Y, Eisenberg S. Late-onset diabetes in Israel. Isr J Med Sci 1979;15:1003-1008
9. Herman JB, Mount FW, Mealie JH, Groen JJ, Dublin TD, Neufield NH, Riss E. Diabetes prevalence and serum uric acid. Observations among 10,000 men in a survey of ischemic heart disease in Israel. Diabetes 1967:16:858-868
10. Neuman L, Weitzman S. The prevalence of Type II diabetes in the Negev. Harefuah 1990:119:264-265 (In Hebrew)
11. Ben-Nun L. The frequency of chronic diseases and socio-demographic characteristics among new immigrants form the former Soviet Union during their first year at a primary care clinic.  Harefuah 1994;127:441-45 (In Hebrew)
12. Israel Center of Disease Control. Publication No. 209 Health Status in Israel 1999. Jerusalem, Israel Ministry of Health, 2002
13. Harris MI, Flegal KM, Cowie CC, Eberhardt MS, Goldstein DE, Little RR, Wiedmeyer H-M, Byrd-Holt DD. Prevalence of diabetes, impaired fasting glucose and impaired glucose tolerance in U.S. adults. Diabetes Care 1998;21:518-524
14. Leiter LA, Barr  A, Belanger A, Lubin S, Ross SA, Tildesley HD, Fontaine N. Diabetes screening in Canada (DIASCAN). Diabetes Care 2001;24:1038-1043
15. Snitker S, Mitchell BD, Shulsiner AR. Physical activity and prevention of Type 2 diabetes. Lancet 2003;361:87-88


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