The Mauritius study

Mauritius and Rodrigues are islands in the south-eastern part of the Indian Ocean. Major changes in lifestyle have been seen during the last fifty years, including less physical activity and introduction of a westernised diet. In parallel, the disease panorama has changed from high infant mortality and infectious diseases to lifestyle-related diseases such as cardiovascular disease and type 2 diabetes.

The population in Mauritius are descendants to immigrants from South Asia, Africa and China, i.e., approximately 60% of the world population are represented. Mauritius is probably the only developing country that has followed the development of non-communicable diseases (NCD) and associated risk factors over a long time-period and continues to do so.

Sunset in Mauritius. ImageStefan Söderberg

In the mid-eighties, the Mauritian government initiated a study on the prevalence of type 2 diabetes and cardiovascular disease, in collaboration with WHO and international experts. Altogether seven population-based surveys have been performed between 1987 and 2021, and approximately 39 000 (!) examinations have been recorded. The intention is to repeat the survey every fifth year.

The ethnicities of the participants have been 71% South Asians (India/Pakistan), 24% Creoles (Africa) and 5% Chinese, which reflects well the ethnical distribution of the population. Previous participants were followed up in 2007 and 92% were successfully traced. Studies have also been performed on the neighbouring island Rodrigues where the majority of the population are Creoles. During the follow-up survey in 2010, 97% of the 9 700 participants were traced.

At each survey, participants were interviewed about living conditions, lifestyle and health, and anthropometry and blood pressure were measured. Biochemistry including lipids and an oral glucose tolerance test (OGTT) were performed Altogether approximately 28 000 electrocardiograms (ECG) were recorded in participants aged 35 years and older, all of which have been coded in Kaunas, Lithuania for signs of ischemic heart disease (Minnesota criteria) and myocardial hypertrophy.

The Mauritius NCD study was initially administrated by the International Diabetes Institute in Melbourne, Australia under the leadership of Professor Paul Zimmet (honorary doctorate at Umeå University 2022) together with Professor Jaakko Tuomilehto (Finland) and Professor George Alberti (United Kingdom). Today, the study is administrated and financed by the Ministry of health in Mauritius under the leadership of Doctor Sudhir Kowlessur.

Professor Stefan Söderberg at the Department of Public Health and Clinical Medicine was introduced to the Mauritius NCD study during his postdoc (2001–2002) in Professor Zimmet’s research team at IDI in Melbourne. Söderberg has since then continued to assist in the performance of the surveys and to analyse data. Today, Umeå university and the Department of Public Health and Clinical medicine have been granted the privilege to curate and analyse data generated in the Mauritius and Rodrigues NCD study.

How to do research on Mauritius data

If you would like to use the data from the Mauritius study, you need to apply using the application form below. 

See list of variables for an overview of data that are available for research.

Before sharing of data, the application will be evaluated by senior researchers within the network. Rules for publication are stated in the application form. Ethical approval must be obtained. 

Contact the Section of Biobank and Registry Support (BRS) for discussion: info.brs@umu.se.

Publications

Publications available in international peer-reviewed journals based on data from the Mauritius study since 2004.

1. Söderberg S, Zimmet P, Tuomilehto J, de Courten M, Dowse GK, Chitson P, Stenlund H, Gareeboo H, Alberti KG, Shaw J. High incidence of type 2 diabetes and increasing conversion rates from impaired fasting glucose and impaired glucose tolerance to diabetes in Mauritius. J Intern Med. 2004;256:37-47. doi: 10.1111/j.1365-2796.2004.01336.x
2. Söderberg S. [Snabbt ökande prevalens av diabetes på Mauritius varslar om en epidemi bland en stor del av jordens befolkning]. Lakartidningen. 2005;102:631.
3. Söderberg S, Zimmet P, Tuomilehto J, de Courten M, Dowse GK, Chitson P, Gareeboo H, Alberti KG, Shaw JE. Increasing prevalence of Type 2 diabetes mellitus in all ethnic groups in Mauritius. Diabet Med. 2005;22:61-68. doi: 10.1111/j.1464-5491.2005.01366.x
4. Tapp RJ, Zimmet PZ, Harper CA, McCarty DJ, Chitson P, Tonkin AM, Soderberg S, Taylor HR, Alberti KG, Tuomilehto J, et al. Six year incidence and progression of diabetic retinopathy: results from the Mauritius diabetes complication study. Diabetes Res Clin Pract. 2006;73:298-303. doi: 10.1016/j.diabres.2006.02.009
5. Cameron AJ, Zimmet PZ, Soderberg S, Alberti KG, Sicree R, Tuomilehto J, Chitson P, Shaw JE. The metabolic syndrome as a predictor of incident diabetes mellitus in Mauritius. Diabet Med. 2007;24:1460-1469. doi: 10.1111/j.1464-5491.2007.02288.x
6. Cameron AJ, Boyko EJ, Sicree RA, Zimmet PZ, Söderberg S, Alberti KG, Tuomilehto J, Chitson P, Shaw JE. Central obesity as a precursor to the metabolic syndrome in the AusDiab study and Mauritius. Obesity (Silver Spring). 2008;16:2707-2716. doi: 10.1038/oby.2008.412
7. Nan H, Qiao Q, Soderberg S, Pitkaniemi J, Zimmet P, Shaw J, Alberti G, Uusitalo U, Pauvaday V, Chitson P, et al. Serum uric acid and incident diabetes in Mauritian Indian and Creole populations. Diabetes Res Clin Pract. 2008;80:321-327. doi: 10.1016/j.diabres.2008.01.002
8. Nyamdorj R, Qiao Q, Soderberg S, Pitkaniemi J, Zimmet P, Shaw J, Alberti G, Nan H, Uusitalo U, Pauvaday V, et al. Comparison of body mass index with waist circumference, waist-to-hip ratio, and waist-to-stature ratio as a predictor of hypertension incidence in Mauritius. J Hypertens. 2008;26:866-870. doi: 10.1097/HJH.0b013e3282f624b7
9. Gao WG, Qiao Q, Pitkaniemi J, Wild S, Magliano D, Shaw J, Soderberg S, Zimmet P, Chitson P, Knowlessur S, et al. Risk prediction models for the development of diabetes in Mauritian Indians. Diabet Med. 2009;26:996-1002. doi: 10.1111/j.1464-5491.2009.02810.x
10. Nyamdorj R, Qiao Q, Soderberg S, Pitkaniemi JM, Zimmet PZ, Shaw JE, Alberti KG, Pauvaday VK, Chitson P, Kowlessur S, et al. BMI compared with central obesity indicators as a predictor of diabetes incidence in Mauritius. Obesity (Silver Spring). 2009;17:342-348. doi: 10.1038/oby.2008.503
11. Zhang L, Qiao Q, Tuomilehto J, Hammar N, Janus ED, Soderberg S, Mohan V, Ramachandran A, Dong YH, Lam TH, et al. Blood lipid levels in relation to glucose status in seven populations of Asian origin without a prior history of diabetes: the DECODA study. Diabetes Metab Res Rev. 2009;25:549-557. doi: 10.1002/dmrr.994
12. Lilja M, Rolandsson O, Shaw JE, Pauvaday V, Cameron AJ, Tuomilehto J, Alberti KG, Zimmet PZ, Soderberg S. Higher leptin levels in Asian Indians than Creoles and Europids: a potential explanation for increased metabolic risk. Int J Obes (Lond). 2010;34:878-885. doi: 10.1038/ijo.2010.19
13. Magliano DJ*, Söderberg S*, Zimmet PZ, Cartensen B, Balkau B, Pauvaday V, Kowlessur S, Tuomilehto J, Alberti KG, Shaw JE. Mortality, all-cause and cardiovascular disease, over 15 years in multiethnic mauritius: impact of diabetes and intermediate forms of glucose tolerance. *Shared first. Diabetes Care. 2010;33:1983-1989. doi: 10.2337/dc10-0312
14. Nyamdorj R, Pitkaniemi J, Tuomilehto J, Hammar N, Stehouwer CD, Lam TH, Ramachandran A, Janus ED, Mohan V, Soderberg S, et al. Ethnic comparison of the association of undiagnosed diabetes with obesity. Int J Obes (Lond). 2010;34:332-339. doi: 10.1038/ijo.2009.225
15. Zhang L, Qiao Q, Tuomilehto J, Janus ED, Lam TH, Ramachandran A, Mohan V, Stehouwer CD, Dong Y, Nakagami T, et al. Distinct ethnic differences in lipid profiles across glucose categories. J Clin Endocrinol Metab. 2010;95:1793-1801. doi: 10.1210/jc.2009-2348
16. Harding JL, Soderberg S, Shaw JE, Zimmet PZ, Pauvaday V, Kowlessur S, Tuomilehto J, Alberti KG, D JM. All-cause cancer mortality over 15 years in multi-ethnic Mauritius: the impact of diabetes and intermediate forms of glucose tolerance. Int J Cancer. 2012;131:2385-2393. doi: 10.1002/ijc.27503
17. Magliano DJ, Söderberg S, Zimmet PZ, Chen L, Joonas N, Kowlessur S, Larhubarbe J, Gaoneadry D, Pauvaday V, Tuomilehto J, et al. Explaining the increase of diabetes prevalence and plasma glucose in Mauritius. Diabetes Care. 2012;35:87-91. doi: 10.2337/dc11-0886
18. Cameron AJ, Magliano DJ, Soderberg S. A systematic review of the impact of including both waist and hip circumference in risk models for cardiovascular diseases, diabetes and mortality. Obes Rev. 2013;14:86-94. doi: 10.1111/j.1467-789X.2012.01051.x
19. Hare MJ, Magliano DJ, Zimmet PZ, Soderberg S, Joonas N, Pauvaday V, Larhubarbe J, Tuomilehto J, Kowlessur S, Alberti KG, et al. Glucose-independent ethnic differences in HbA1c in people without known diabetes. Diabetes Care. 2013;36:1534-1540. doi: 10.2337/dc12-1210
20. Cameron AJ, Soderberg S, Magliano DJ. Comment on 'General and abdominal obesity parameters and their combination in relation to mortality: a systematic review and meta-regression analysis'. Eur J Clin Nutr. 2014;68:140. doi: 10.1038/ejcn.2013.187
21. Tanamas SK, Magliano DJ, Balkau B, Tuomilehto J, Kowlessur S, Soderberg S, Zimmet PZ, Shaw JE. The performance of diabetes risk prediction models in new populations: the role of ethnicity of the development cohort. Acta Diabetol. 2015;52:91-101. doi: 10.1007/s00592-014-0607-x
22. Tabesh M, Shaw JE, Zimmet PZ, Soderberg S, Kowlessur S, Timol M, Joonas N, Alberti GMM, Tuomilehto J, Shaw BJ, et al. Meeting American Diabetes Association diabetes management targets: trends in Mauritius. Diabet Med. 2017;34:1719-1727. doi: 10.1111/dme.13447
23. Kowlessur S, Hu Z, Heecharan J, Wang J, Dai J, Tuomilehto JO, Soderberg S, Zimmet P, Barengo NC. Predictors of Hypertension in Mauritians with Normotension and Prehypertension at Baseline: A Cohort Study. Int J Environ Res Public Health. 2018;15. doi: 10.3390/ijerph15071394
24. Tabesh M, Shaw JE, Zimmet PZ, Soderberg S, Koye DN, Kowlessur S, Timol M, Joonas N, Sorefan A, Gayan P, et al. Association between type 2 diabetes mellitus and disability: What is the contribution of diabetes risk factors and diabetes complications? Journal of diabetes. 2018;10:744-752. doi: 10.1111/1753-0407.12659
25. Taki H, Tuomilehto J, Zimmet P, Tamosiunas A, Kowlessur S, Magliano DJ, Shaw JE, Soderberg S*, Nilsson U*. Left ventricular hypertrophy: an ECG-based study of prevalence and risk factors in a multiethnic population. Shared last. Open Heart. 2023;10. doi: 10.1136/openhrt-2023-002495

The studies are funded and administered by the Ministry of Health of Mauritius, and led by Dr Sudhir Kowlessur.