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RISK FACTORS FOR BENIGN PROSTATIC HYPERPLASIA AMONG MIGRANT BANGLADESHI MEN IN LONDON

Dr Gillian R. Bentley

Durham University (formerly at University College London)

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The project was begun in mid-2004 and is still ongoing due to the recruitment of a PhD student, Kesson Magid, who is primarily working on completing data collection and analyses. The project has taken longer than anticipated, partly because of the unexpected difficulties in recruiting men (particularly younger men and second generation men) and the longer periods of time required to reach full sample sizes, and also because of expansion of the project beyond the original objectives. However, there is a much larger sample of Bangladesh men still resident in Bangladesh than was originally anticipated covering a wide age range.

The original goals were to assess prostate health in relation to changing environments and lifestyles among South Asian immigrants to the UK using Bangladesh migrants as the target South Asian group. It was hypothesized that Bangladeshi men who spent a greater amount of time in the UK would have diets that are higher in saturated fats and sugar content, would have higher testosterone levels, higher glucose levels, a higher BMI and waist-to-hip ratio, a greater incidence of lower urinary tract symptoms (LUTS) and would consequently be at higher risk for benign prostatic hyperplasia (BPH). There are five study groups of men aged 20-70 each numbering 70:
1) first generation Bangladeshi men who migrated to the UK as adults (>18 years)
2) first generation Bangladeshi men who migrated to the UK as children (<13 years)
3) second-generation Bangladeshi men born and raised in the UK to parents born in Bangladesh
4) men still resident in Sylhet, NE Bangladesh from where most migrants originate and
5) a reference group of London men of European descent.

The data which has been collected includes:
1) a general demographic and health questionnaire on migration history, marital status, lifestyle, and health
2) a semi-quantitative food frequency questionnaire
3) the International Prostate Symptom Score to evaluate the occurrence and severity of LUTS
4) thrice daily saliva samples (two in the early morning and one late at night)
5) blood-spot samples following an overnight fast to assess blood glucose levels
6) Anthropometric data to assess height, weight, skin-fold thicknesses and BMI

The project has been expanded to allow the collection of additional blood spots on filter paper for analysis of follicle-stimulating hormone [FSH], luteinizing hormone [LH], and growth hormone [GH], thyroid-stimulating hormone (TSH) and prolactin (PRL) using an innovative microsphere-based immunoassay developed at Northwestern University, Chicago. This technique allows for the analyses of multiple reproductive hormones using blood spot samples.

It is important to analyse these additional hormones in order to be able to understand better the differences seen in testosterone levels (from preliminary data) between the 6 groups that are being studied, and to examine in particular the hypothalamo-pituitary-gonadal axis responsible for steroid production.

Matched blood and saliva samples are also being taken from a subgroup of 20 men aged 20-40 in order to validate the correlation between blood and salivary testosterone. (A recent study among non-western subjects calls into question previously accepted high correlations, and would affect our interpretations of the data if not validated in this population). Kesson Magid has been awarded a Bogue Research Fellowship from UCL to enable him to travel to Northwestern University in May 2008 to undertake these analyses in the laboratory of our colleague.

The significance of the Project has been recognized by the awards won by Kesson Magid to carry out further work on the project as outlined below:

Kesson has also been short-listed for the ESRC - POST (Parliamentary Office of Science and Technology) initiative which allows ESRC students to spend three months in POST working on issues of public policy interest. He has applied to work on topics related to ethnicity and health and has an interview in late January.

Results to Date

The total numbers of subjects that have been recruited so far (target n=70 for each group) is as follows:
Group 1 -- Adult migrants: 65
Group 2 -- Child migrants: 26
Group 3 -- Second generation: 12
Group 4 -- Bangladeshi residents: 107
Group 5 -- London men of European descent: 56

Four papers and four posters have been presented at national and international meetings resulting in four published abstracts. One manuscript for potential submission to Nature is currently being prepared with second choice of the journal Human Reproduction. Copies of the published abstracts and A4 versions of the Posters have been sent to Prostate UK who have been acknowledged in all these presentations.

Publications

Abstracts:
2008 KS Magid, FU Ahamed, GR Bentley. Ecological and life course effects on mid upper arm somatic muscle allocation and skeletal stature among Bangladeshi male migrants to the UK. American Journal of Physical Anthropology, Supplement 46:145-6.
2007 Magid KS, Ahamed FU, and Bentley GR. Changes in mid upper arm somatic muscle allocation among Bangladeshi male migrants to the UK. American Journal of Human Biology 19(2):246-290.
2006 Effects of adult migration on male salivary testosterone. KS Magid, F Uddin Ahamed, DW Lawson, RT Chatterton, and GR Bentley. American Journal of Human Biology 18:262.
2005 Magid K, Ahamed FU, Lawson DW, Bentley GR Lower urinary tract symptoms and risk for benign prostatic hyperplasia among migrant Bangladeshi men in London. American Journal of Human Biology. 17(2):218 - 233.

Invited Presentations:
2007 Magid KS. Reproductive ecology of health and hormones in migrant Bangladeshi males. Durham University Postgraduate Seminar. November 2007
2006 Bangladeshi-born adult migrants to the UK show greater salivary testosterone than sedentees. KS Magid, RT Chatterton, F Uddin Ahamed, G R Bentley. Seminar on the Ecology of the Male Life Course. Organized by the International Union for the Scientific Study of Population Scientific Panel on Evolutionary Perspectives in Demography. Castle of Rauischholzhausen, Marburg, Germany (October).

Presentations:
2007 Magid KS, Ahamed FU, Bentley GR. Life course effects of presumed changes in energetic availability on testosterone profiles, skeletal stature and muscle mass among Bangladeshi male migrants to the UK. London Evolutionary Research Network 5th Annual Conference. LSE, September 2007.
2006 Effects of adult migration on male salivary testosterone. KS Magid, F Uddin Ahamed, DW Lawson, RT Chatterton, and GR Bentley. Paper presented at the annual meeting of the Human Biology Association, Anchorage, AL, USA.

Posters:
2008 Ecological and life course effects on mid upper arm somatic muscle allocation and skeletal stature among Bangladeshi male migrants to the UK. KS Magid, FU Ahamed, and GR Bentley. Abstract accepted for poster presentation at the Annual Meeting of the American Association of Physical Anthropologists, Columbus, OH, USA.
2007 Changes in mid upper arm somatic muscle allocation among Bangladeshi male migrants to the UK. KS Magid, F Uddin Ahamed, GR Bentley. Abstract submitted to the Annual Meeting of the Human Biology Association, Philadelphia, PA, USA 2006 No effect of marriage or fatherhood on salivary testosterone levels in Bangladeshi men. KS Magid, RT Chatterton, F Uddin Ahamed, and GR Bentley. Poster presented at the annual meeting of the Human Behavior and Evolution Society, Philadelphia, PA, USA.
2005 Lower urinary tract symptoms and risk for benign prostatic hyperplasia among migrant Bangladeshi men in London. K Magid, F Uddin Ahamed, DW Lawson, and GR Bentley. Poster presented at the annual meeting of the Human Biology Association, Milwaukee, WI, USA.

Research final report 18 January 2008
Project 2003/07

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