We found that the epidemiologic transition from communicable to noncommunicable diseases is well underway in the 2 small, rural Grenadian islands of Carriacou and Petite Martinique. Despite the lack of fast-food restaurants and a reported traditional diet of healthy fresh produce and seafood, about one-third of study participants were obese, and almost one-third had metabolic syndrome. Although the epidemiologic transition may be a recent phenomenon in the southern Caribbean region and although these 2 islands are rural and geographically isolated, CVD risk factors are at least as common among residents of Carriacou and Petite Martinique as they are in African Americans (10
). The difference in diet among age groups indicates potential future public health problems associated with CVD risk. A dramatic increase in CVD in the next 10 to 20 years is expected, particularly given the dietary patterns among younger Grenadians, who are consuming less fish and more red meat, poultry, fried meats, and other fried foods than their older counterparts. Additionally, these dietary patterns are more pronounced among women than among men. Among Grenadians, having lived abroad is actually associated with a healthier diet and may be a modifying factor in this epidemiologic transition, although this may depend on a person's age.
The transition to CVD risk factors is occurring in Grenada in conjunction with a tradition of very high fish consumption, which is higher among Grenadians of all ages than in the United States (12
). The consumption of fish and its constituent omega-3 fatty acids, eicosapentaenoic acid, and docosahexaenoic acid, has been consistently associated with improved cardiovascular health (13
). Beneficial effects of these unique fatty acids include a reduction in risk for sudden cardiac death (14
), nonfatal acute coronary syndromes (12
), and hospital admissions among people with congestive heart failure (18
). In addition, the replacement of saturated fat with such long-chain polyunsaturated fatty acids has been associated with reduced levels of insulin resistance (19
), the current most widely accepted risk factor for metabolic syndrome (22
). Moreover, even in Japan, whose residents have a much higher level of fish consumption than those of most other countries, eicosapentaenoic acid supplementation has been associated with reduced risk of nonfatal coronary events (23
). These facts may help explain the lower prevalence of CVD among Grenadians than would be expected, based on their risk factors.
Abdominal obesity and associated lifestyle factors are more prevalent among women than men in Grenada. Abdominal obesity and metabolic syndrome are more prevalent among women than among men in other developing countries and are associated with a sedentary lifestyle (24
). Another island with a population of African origin with very high levels of fish consumption is the Republic of Seychelles. The Seychelles is experiencing rapid economic development, and obesity is common; obesity rates in the Seychelles (30%) are similar to those in Grenada (25%) (28
). The age-standardized rate of obesity in adults in the Seychelles is 5 times greater among women than men (20.9 vs 4.2%) (29
). Studies report that women in the Seychelles are less physically active than men, as is the case in the non-African populations of urban east India (30
) and Saudi Arabia (31
). Although obesity issues among women are not confined to those of African ethnicity, studies of African Americans, particularly women, indicate a lack of social pressure to be slim and a reduced stigma associated with obesity (32
Emigration to Western countries has been associated with increased risk for CVD because of many factors, including transition to more urban environments, physical inactivity, a more energy-rich and atherogenic diet (3
), gene-environment interactions, stress, and ethnic susceptibility (34
). More sedentary lifestyles and high-fat diets have been associated with urbanization and its associated affluence and disruptions in traditional cultures. Another factor associated with urbanization is a transition to work that is devoid of physical labor. In developing rural countries, underprivileged and increasingly urban residents are predominantly lean, are engaged in physical labor, and have a very low risk of CVD. The trend in Grenada, however, is that people who have lived outside that country for more than 10 years tend to have healthier diets than those who have not lived outside Grenada or have done so for 10 years or less. This trend is particularly striking among women, who already have more worrisome dietary trends than men. Thus, migration status and fish consumption among Grenadians may be important considerations in preventing a more rapid epidemiologic transition in this poor, developing nation of ethnically African inhabitants. These trends, which may influence the health of future generations of Grenadians and residents of other Caribbean nations, warrant further study.
Our study had several strengths and limitations. Involvement of local community members on the research team enhanced trust between the community and the US investigators. The study sample was recruited using a community-based participatory research strategy that leveraged community leaders and community-based and community-driven marketing techniques. A limitation is that participants represented a self-selected convenience sample. Although this sampling technique is not optimal, we were able to recruit an estimated 57% of the residents of the islands of Petite Martinique and Carriacou. Much of the data collected were self-reported. This was a cross-sectional study; therefore, an assessment of any causal relationship of lifestyle and migration factors with CVD is not possible. Our ability to gather highly detailed dietary and other lifestyle data was limited by researchers' concerns that a long questionnaire would limit the ability to recruit an adequate study sample and local community concerns about medical research.
Grenada, a developing nation that is experiencing an epidemiologic transition from infectious to chronic, degenerative diseases, has substantial rates of CVD risk factors among young and middle-aged adults. Because dietary risk factors are more prevalent among young women than young men, public health measures to reduce the prevalence of CVD in Grenada may be most effective if they target women before they reach adulthood. Although migration from developing to developed nations is commonly associated with unhealthy lifestyle changes, among Grenadians, living in a Western country for more than 10 years is associated with better dietary habits than among those who have not lived outside Grenada. Further study of the relationship of migration to CVD risk in people living in the Caribbean is necessary to understand the process of epidemiologic transition and to stem the increase of chronic diseases in countries with challenged medical care systems.