Nigel Unwin's research while affiliated with University of Exeter and other places
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Publications (174)
Introduction
Food security in Small Island Developing States (SIDS) is an international policy priority. SIDS have high rates of nutrition-related non-communicable diseases, including obesity and type 2 diabetes, micronutrient deficiencies and, in many, persistent childhood stunting. This is associated with an increasing reliance on imported proces...
Background
Complex factors drive inconsistent access to safe and nutritious food among Small Island Developing States (SIDS), including geographic isolation, limited natural resources, urbanisation, and extreme weather events, leading to decreasing food production and increasing reliance on food imports. However, this may have been impacted by rece...
Small island developing states (SIDS) have a high burden of nutrition-related disease associated with nutrient-poor, energy-dense diets. In response to these issues, we assessed the effectiveness of nutrition-based interventions on nutritional status (under-nutrition) and metabolic health (over-nutrition) among persons in SIDS. We included SIDS-bas...
Background
Small Island Developing States (SIDS) are commonly burdened by high rates of nutrition related non-communicable diseases, micronutrient deficiencies, and, in many, persistent childhood stunting. Most of these issues are related to dietary changes, driven by food systems increasingly dominated by global markets and products and vulnerable...
Background
Small Island Developing States (SIDS) in the Caribbean and Pacific have high burdens of nutrition related disease, including type 2 diabetes, cardiovascular diseases, and other non-communicable diseases (NCDs), micronutrient deficiencies and in several countries substantial, persistent, childhood stunting and wasting. These burdens are a...
Background
Non-communicable diseases are the leading cause of mortality across the Caribbean and similar Low and Middle Income Country regions. Structural determinants include a marked increase in the dependency on food imports and the proliferation of processed and fast foods, including sugar-sweetened beverages. In this project, we emphasised the...
Rapid weight loss using a very low-calorie diet (VLCD) for 2 to 3 months followed by weight maintenance has been shown to lead to the restoration of normal glucose and insulin metabolism in people recently diagnosed with type 2 diabetes. We explored the barriers and facilitators of adhering to a VLCD for remission in an Afro-Caribbean population. T...
Small Island Developing States (SIDS) have high burdens of nutrition-related chronic diseases. This has been associated with lack of access to adequate and affordable nutritious foods and increasing reliance on imported foods. Our aim in this study was to investigate dietary patterns and food insecurity and assess their associations with socio-demo...
Background:
Peripheral arterial disease (PAD) is a risk factor for amputation and systemic atherosclerotic disease. Barbados has a high diabetes prevalence, and 89% of diabetes-related hospital admissions are for foot problems. Foot examination is infrequent in Barbados primary care. The prevalence and potential risk factors for PAD in people with...
Diabetes and obesity present a high and increasing burden of disease in the Caribbean that have failed to respond to prevention policies and interventions. These conditions are the result of a complex system of drivers and determinants that can make it difficult to predict the impact of interventions. In partnership with stakeholders, we developed...
Small Island Developing States (SIDS) share high burdens of nutrition-related conditions, including non-communicable diseases, associated with an increasing reliance on imported, processed foods. Improving health through increasing the production and consumption of local, nutritious foods is a policy objective of many SIDS governments. This study a...
There is a scarcity of research on building nutrition-sensitive value chains (NSVCs) to improve diets and nutrition outcomes of populations in the Caribbean. This study contributes to filling this research gap by outlining a participatory approach to evaluating a NSVC model for “farm to fork” (F2F) school feeding in the Eastern Caribbean Island of...
Según la Organización Mundial de la Salud (OMS), la hipertensión arterial, la hiperglucemia en ayunas, el sobrepeso y la obesidad se encuentran entre los principales factores de riesgo de muerte de la población mundial. Estas alteraciones fueron responsables de 23% de las muertes en el mundo en el 2004 y de 31% de las registradas en las Américas en...
The World Health Organization (WHO) Global Action Plan on Physical Activity recommends adopting a systems approach to implementing and tailoring actions according to local contexts. We held group model-building workshops with key stakeholders in the Caribbean region to develop a causal loop diagram to describe the system driving the increasing phys...
Background: Remission of type 2 diabetes through weight loss is possible in a high proportion of persons with a recent diagnosis, but a major challenge is achieving sufficient weight loss.
Objectives: In the first study of this type in the Caribbean, we investigated factors associated with successful weight loss in adults in a diabetes remission in...
Background
The high burden of disease related to malnutrition in Small Island Developing States (SIDS) has been exacerbated by increasing levels of food insecurity (FI) and loss of food sovereignty. Internationally, household, or individual level FI is associated with poorer diets and nutritional status. Our study aimed to investigate whether there...
Introduction
Body mass index (BMI) and waist circumference (WC) cut-offs associated with hyperglycemia may differ by ethnicity. We investigated the optimal BMI and WC cut-offs for identifying hyperglycemia in the predominantly Afro-Caribbean population of Barbados.
Research design and methods
A cross-sectional study of 865 individuals aged ≥25 yea...
Executive Summary
This document updates the 1999 World Health Organization (WHO) classification of diabetes. It prioritizes clinical care and guides health professionals in choosing appropriate treatments at the time of diabetes diagnosis, and provides practical guidance to clinicians in assigning a type of diabetes to individuals at the time of di...
Many Small Island Developing States (SIDS) lead global rates in obesity and non-communicable chronic diseases (NCDs). Drivers for this are complex and include lack of food sovereignty, evidenced by an increasing reliance on cheap nutrient-poor food imports and a focus on export orientated cash crop production for much local agriculture. To better i...
Consuming sugar-sweetened beverages (SSBs) has been associated with increased rates of obesity and type 2 diabetes, making SSBs an increasingly popular target for taxation. In addition to changing prices, the introduction of an SSB tax may convey information about the health risks of SSBs (a signalling effect). If SSB taxation operates in part by p...
Objective:
To identify and describe summarized evidence on factors associated with diet and physical activity in low- and middle-income countries in Africa and the Caribbean by performing a scoping review of reviews.
Methods:
We searched the Medline®, LILACS, Scopus, Global Health and Web of Science databases for reviews of factors associated wi...
Our objective was to describe, for the first time in an English-speaking Caribbean country, the contribution of ultra-processed foods (UPFs) to nutrients linked to non-communicable disease. Using a cross-sectional study design, dietary data were collected from two non-consecutive 24-h dietary recalls. Recorded food items were then classified accord...
Background
Even before the COVID-19 pandemic, one in two people in Africa were food insecure. The burden of malnutrition remains high (e.g. childhood stunting, anaemia in women of reproductive age) or are increasing (e.g. overweight and obesity). A range of coordinated actions are required to improve this situation, including increasing local food...
CONTEXT
COVID-19 mitigation measures including border lockdowns, social distancing, de-urbanization and restricted movements have been enforced to reduce the risks of COVID-19 arriving and spreading across PICs. To reduce the negative impacts of COVID-19 mitigation measures, governments have put in place a number of interventions to sustain food an...
At the time of writing, it is unclear how the COVID-19 pandemic will play out in rapidly urbanising regions of the world. In these regions, the realities of large overcrowded informal settlements, a high burden of infectious and non-communicable diseases, as well as malnutrition and precarity of livelihoods, have raised added concerns about the pot...
2020 will go down in history as the year when the global community was awakened to the fragility of human health and the interdependence of the ecosystem, economy, and humanity. Amid the COVID-19 pandemic, the vulnerability of people with diabetes during a public health emergency became evident by their at least 2 times increased risk of severe dis...
Small Island Developing States (SIDS) have high and increasing rates of diet-related diseases. This situation is associated with a loss of food sovereignty and an increasing reliance on nutritionally poor food imports. A policy goal, therefore, is to improve local diets through improved local production of nutritious foods. Our aim in this study wa...
Background
Non-communicable diseases (NCDs) are the leading cause of death globally. While upstream approaches to tackle NCD risk factors of poor quality diets and physical inactivity have been trialled in high income countries (HICs), there is little evidence from low and middle-income countries (LMICs) that bear a disproportionate NCD burden. Sub...
Objective:
Sugar-sweetened beverage (SSB) taxes have been implemented widely. We aimed to use a pre-existing nutritional survey data to inform SSB tax design by assessing: (1) baseline consumption of SSBs and SSB-derived free sugars, (2) the percentage of SSB-derived free sugars that would be covered by a tax and (3) the extent to which a tax woul...
The impacts of the COVID-19 pandemic on food and nutrition insecurity are likely to be significant for Small Island Developing States due to their high dependence on foreign tourism, reliance on imported foods and underdeveloped local food production systems. SIDS are already experiencing high rates of nutrition-related death and disability, includ...
Findings of the application of Community Foods and Health (CFaH) methods to evaluate community food production initiatives impacts on diets and health in Fiji and Solomon Islands.
The Caribbean island of Barbados has a high burden of diabetes and cardiovascular disease. Dietary habits were last described in 2005. A representative population‐based sample (n = 363, aged 25–64 years) provided two nonconsecutive 24‐hr dietary recalls in this cross‐sectional study. Mean daily nutrient intakes were compared with the Dietary Guidel...
Aims:
To estimate the number of deaths attributable to diabetes in 20-79-year-old adults in 2019.
Methods:
The following were used to estimate the number of deaths attributable to diabetes: all-cause mortality estimates from the World Health Organization life table, country level age- and sex-specific estimates of diabetes prevalence in 2019 and...
Many Small Island Developing States of the Caribbean experience a triple burden of malnutrition with high rates of obesity, undernutrition in children, and iron deficiency anemia in women of reproductive age, driven by an inadequate, unhealthy diet. This study aimed to map the complex dynamic systems driving unhealthy eating and to identify potenti...
Aims:
To provide global estimates of diabetes prevalence for 2019 and projections for 2030 and 2045.
Methods:
A total of 255 high-quality data sources, published between 1990 and 2018 and representing 138 countries were identified. For countries without high quality in-country data, estimates were extrapolated from similar countries matched by e...
Non-communicable diseases (NCDs) are a major cause of deaths globally, and cardiovascular disease (CVD) is the leading cause of these deaths. 42% of NCD deaths are premature (occurring before the age of 70 years). As part of the United Nations 3rd Sustainable Development Goal (SDG) on health and wellbeing, target 3.4 is to reduce premature mortalit...
OBJECTIVES/SPECIFIC AIMS: The aim is to investigate if sustained weight loss due to caloric restriction can be achieved in a community setting, using faith-based organisations (FBOs) as hubs; and if this weight loss can lead to the re-establishment of normal metabolism (using the normalisation of blood sugar levels while off glucose lowering medica...
Background
The World Health Organization has advocated for sugar-sweetened beverage (SSB) taxes as part of a broader non-communicable disease prevention strategy, and these taxes have been recently introduced in a wide range of settings. However, much is still unknown about how SSB taxes operate in various contexts and as a result of different tax...
Objectives
In Barbados, high case fatality rates have been reported after myocardial infarction (MI) with higher rates in women than men. To explore this inequality, we examined documented pharmacological interventions for ST-segment elevated myocardial infarction (STEMI), non-STEMI (NSTEMI) and unstable and chronic angina in women and men.
Design...
Objective: To investigate the feasibility of addressing the public health concerns of tobacco consumption through increased taxation, while preserving or augmenting government revenues in Grenada.
Methods: Purposive sampling methods were used to ensure data availability and geographical representativeness. Average price per 20-pack of the most-sol...
Objective
To identify, assess, and compare existing policies on noncommunicable diseases (NCDs) in the Caribbean, gaps in policy responses, and the factors influencing successful policy development and implementation following the Port of Spain Declaration of 2007. Specifically, to examine policies that target the upstream determinants of two NCD r...
Objective
To examine the historical trends of premature death due to cardiovascular disease and diabetes mellitus (CVD-DM) in the Caribbean and to identify any associations between these trends and health care expenditure.
Methods
Death data were obtained from the World Health Organization Mortality Database; population data, from the United Natio...
Objectives
To conduct an analysis of the most recent data on diabetes and its risk factors by gender and other social determinants of health to understand why its prevalence is higher among women than men in the Caribbean; to inform policy agenda-setting for diabetes prevention and control in the Caribbean; and to identify gaps in the evidence that...
Objective
To explore what is known on community-based food production initiatives (CFPIs) in Small Island Developing States, particularly the health, social, economic, and environmental impacts of and on CFPIs.
Methods
This was a systematic scoping review using 14 electronic databases to identify articles published from 1997 to 2016 on the topic o...
Objectives
Noncommunicable diseases (NCDs) are a threat to social and economic development, including in the Caribbean. In 2007 the Caribbean Community (CARICOM) held the world's first-ever summit of heads of government on NCD prevention and control and issued the landmark Declaration of Port-of-Spain: Uniting to Stop the Epidemic of Chronic NCDs....
This report examines the experiences of Small Island Developing States in the Caribbean— Barbados, Dominica, Jamaica, and in the Pacific— Fiji, Nauru, and Tonga with specific governmental regulatory measures to reduce the risk of obesity and associated diet-related chronic noncommunicable diseases (NCDs), as well as the obstacles and opportunities...
Objectives
In 2007, the Caribbean Community (CARICOM) convened the world's first-ever heads of government summit on noncommunicable diseases (NCDs) and issued the landmark Declaration of Port-of-Spain: Uniting to Stop the Epidemic of Chronic NCDs. Since then, ministry of health (MoH) focal points in each country have self-reported annually on their...
Background
Many studies have found an increased risk of pulmonary tuberculosis (PTB) among those with diabetes mellitus (DM). However, evidence on whether the association is bidirectional remains sparse. This study investigates DM rates among those with and without prior tuberculosis (TB) disease as well as the reverse.
Methods
Data on a UK genera...
Background
High sodium diets with inadequate potassium and high sodium-to-potassium ratios are a known determinant of hypertension and cardiovascular disease (CVD). The Caribbean island of Barbados has a high prevalence of hypertension and mortality from CVD. Our objectives were to estimate sodium and potassium excretion, to compare estimated level...
Background:
Prostate cancer remains the leading cause of cancer deaths among Caribbean men. However, little data exists on the influence of social factors on prostate cancer in the Caribbean setting. This article supports the 2011 Rio Political Declaration on addressing health inequalities by presenting a systematic review of evidence on the role...
Background
Both fasting plasma glucose (FPG) and HbA1c are recommended for the diagnosis of diabetes and prediabetes by the American Diabetes Association (ADA), and for diabetes by the World Health Organization. The ADA guidance is influential on clinical practice in many developing countries, including in the Caribbean and Latin America. We aimed...
Background:
Immigrants are sometimes found to have better health than locally born populations. We examined the mortality experience of South Asian origin and white European origin individuals living in Newcastle upon Tyne, UK.
Methods:
A linked 17-21 year mortality follow-up of a cross-sectional study of European (n=825) and South Asian (n=709)...
A 10% excise tax on sugar sweetened beverages (SSBs) was implemented in Barbados in September 2015. A national evaluation has been established to assess the impact of the tax. We present a descriptive analysis of initial price changes following implementation of the SSB tax using price data provided by a major supermarket chain in Barbados over the...
Background
Depressive disorder is the largest contributor to years lived with disability in the Caribbean, adding 948 per 100,000 in 2013. Depression is also a major risk factor for suicidal behaviour. Social inequalities influence the occurrence of depression, yet little is known about the social inequalities of this condition in the Caribbean. In...
Aim: The purpose of this study was to document in people with type 2 diabetes (T2DM) in Barbados, attitudes and beliefs that may result in psychological insulin resistance.
Methods: A representative, population-based, sample of 175 eligible people with T2DM 25 years of age and over was surveyed by telephone. The 20-item insulin treatment appraisal...
Background
Breast cancer is the leading cause of cancer deaths among women in the Caribbean and accounts for >1 million disability adjusted life years. Little is known about the social inequalities of this disease in the Caribbean. In support of the Rio Political Declaration on addressing health inequities, this article presents a systematic review...
We fully support the views expressed in The Lancet Diabetes & Endocrinology's Editorial about ensuring affordable access to insulin and the proposal to add analogue insulin to the WHO Essential Medicines list. The International Insulin Foundation in its 2011 position statement called for “the universal access for persons with type 1 diabetes to lif...
Aims:
With regards to insulin initiation in Barbados we explored primary care doctor (PCD) perception, healthcare system factors and predictors of PCD reluctance to initiate insulin.
Methods:
PCDs completed a questionnaire based on the theory of planned behaviour (TPB) and a reluctance to initiate insulin scale. Using linear regression, we explo...
Background
Current understanding of population physical activity (PA) levels and sedentary behaviour in developing countries is limited, and based primarily on self-report. We described PA levels using objective and self-report methods in a developing country population. MethodsPA was assessed in a cross-sectional, representative sample of the popu...
Background:
Data on disparities in mortality within low and middle income countries are limited, with little published data from the Caribbean or Central America. Our aim was to investigate disparities in overall and cause specific premature adult mortality in the multi-ethnic middle income country of Belize.
Methods:
Mortality data from Belize...
Data to support the sensitivity analysis.
(DOCX)
Background: Government policy measures have a key role to play in the prevention and control of non-communicable diseases (NCDs). The Caribbean, a middle-income region, has the highest per capita burden of NCDs in the Americas. Our aim was to examine policy development and implementation between the years 2000 and 2013 on NCD prevention and control...