Serum lipids and modernization in coastal and highland Papua New Guinea

Prevalence of non-communicable diseases and their risk factors in Papua New Guinea: A systematic review

INTRODUCTION

The mortality associated with non-communicable diseases has increased significantly in most countries in the World Health Organization Western Pacific Region over the last 20 years, as have the underlying risk factors. This study aimed to collate evidence on the prevalence of four major non-communicable diseases and their risk factors in Papua New Guinea in order to inform appropriate policy for their prevention and management.

METHODS

We performed a systematic review of Papua New Guinea-based population prevalence studies of cardiovascular diseases, type 2 diabetes mellitus, chronic respiratory diseases, and cancers, as well as non-communicable disease risk factors published before 2016. Five online databases were searched and screened against eligibility criteria according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

RESULTS

A total of 57 articles were included in this review, most of which (n = 48) were published prior to 2000. Eleven articles reported on diabetes, six reported on chronic lung disease/asthma, two reported on cardiovascular diseases, and two reported cancer as the primary outcome, while the remaining 36 papers reported non-communicable disease risk factors.

CONCLUSION

This review demonstrated variations in the prevalence of non-communicable diseases (0%-19%) and their risk factors (0%-80.6%) attributed to the lifestyle and genetic diversity of the Papua New Guinea population. There is a strong suggestion that the prevalence of non-communicable diseases (particularly type 2 diabetes mellitus) and key non-communicable disease risk factors (hypertension, overweight, and obesity) has increased, but there is a lack of recent data. As such, there is an urgent need for new and up-to-date data in all areas of Papua New Guinea.

Prevalence of non-communicable disease risk factors in three sites across Papua New Guinea: a cross-sectional study

Papua New Guinea (PNG) is a culturally, environmentally and ethnically diverse country of 7.3 million people experiencing rapid economic development and social change. Such development is typically associated with an increase in non-communicable disease (NCD) risk factors.

AIM

To establish the prevalence of NCD risk factors in three different regions across PNG in order to guide appropriate prevention and control measures.

METHODS

A cross-sectional survey was undertaken with randomly selected adults (15-65 years), stratified by age and sex recruited from the general population of integrated Health and Demographic Surveillance Sites in West Hiri (periurban), Asaro (rural highland) and Karkar Island (rural island), PNG. A modified WHO STEPS risk factor survey was administered along with anthropometric and biochemical measures on study participants.

RESULTS

The prevalence of NCD risk factors was markedly different across the three sites. For example, the prevalences of current alcohol consumption at 43% (95% CI 35 to 52), stress at 46% (95% CI 40 to 52), obesity at 22% (95% CI 18 to 28), hypertension at 22% (95% CI 17 to 28), elevated levels of cholesterol at 24% (95% CI 19 to 29) and haemoglobin A1c at 34% (95% CI 29 to 41) were highest in West Hiri relative to the rural areas. However, central obesity at 90% (95% CI 86 to 93) and prehypertension at 55% (95% CI 42 to 62) were most common in Asaro whereas prevalences of smoking, physical inactivity and low high-density lipoprotein-cholesterol levels at 52% (95% CI 45 to 59), 34% (95% CI 26 to 42) and 62% (95% CI 56 to 68), respectively, were highest in Karkar Island.

CONCLUSION

Adult residents in the three different communities are at high risk of developing NCDs, especially the West Hiri periurban population. There is an urgent need for appropriate multisectoral preventive interventions and improved health services. Improved monitoring and control of NCD risk factors is also needed in all regions across PNG.

Central obesity and coronary risk factors

A cross-sectional study of 130 Bengalee Hindu men (mean age=50.3 years; SD=10.5 years) was undertaken to investigate the relationship of body mass index (BMI), waist circumference (WC) and waist-hip ratio (WHR) with total cholesterol (TC), high density (HDL-C), low density (LDL-C) and very low-density (VLDL-C) lipoprotein cholesterol, fasting plasma glucose (FPG) and triglycerides (FTG). Correlation studies revealed that WHR was significantly correlated (r=0.245, p<0.01) with TC. WC and WHR had significant correlations with VLDL-C, FPG and FTG. All subjects were further divided into two groups based on WHR<0.95 (centrally non-obese, CNO) and WHR>0.95 (centrally obese, CO) following the US Joint National Committee (JNC) guidelines. Students’ t-test revealed that CO subjects (n=83) had a significantly higher mean TC (p<0.05), VLDL (p<0.05), FPG (p<0.01) and FTG (p<0.05) compared with CNO individuals (n=47). Results of analysis of variance (ANOVA) of central obesity status (CNO=no, CO=yes) and BMI (BMI tertiles used as a categorical variable) with these metabolic variables revealed that CO status had a significant effect (p<0.05) on TC, VLDL-C, FPG and FTG. BMI tertiles did not a have significant effect on any of these metabolic variables. There was no significant BMI tertile-central obesity status interaction. It can therefore be concluded that the JNC guidelines of WHR>0.95 to define central obesity can be used, irrespective of BMI, among this population, to identify individuals who have enhanced metabolic risk factors of coronary heart disease (CHD). Furthermore, it can be routinely used for health promotion purposes among Bengalee men.

Blood cholesterol level and prevalence of hypercholesterolaemia in developing countries: a review of population-based studies carried out from 1979 to 2002

BACKGROUND

While the age-specific rates of cardiovascular diseases (CVD) are declining in many developed countries, the epidemic is accelerating in most developing countries. Elevated serum total cholesterol (TC) is one of the major risk factors for atherosclerotic CVD. This review was carried out to describe the current situation in mean TC and in the prevalence of hypercholesterolaemia in developing countries.

DESIGN AND METHODS

A search for papers published in medical journals from 1990 to 2002 was performed using the MEDLINE database. A total of 37 articles were selected according to previously defined criteria containing information on mean blood total cholesterol and/or hypercholesterolaemia from 38 developing countries.

RESULTS

Hypercholesterolaemia is a public health problem in most of the developing countries reviewed. A positive association between the population mean TC and the GNP per capita was evidenced.

CONCLUSIONS

Differences in methodology between national surveys make international comparisons difficult. Nevertheless, low-cost dietary interventions and the development of primary prevention strategies are needed to reduce the already existing public health problem of elevated TC in developing countries.

Nutrition, lipids, and cardiovascular disease

The evolving epidemic of cardiovascular disease in many newly industrialized societies will bankrupt their health care systems and reduce the available resources for other health priorities. Therefore, the prevention of this epidemic, or at least slowing the increase, is of the highest priority. The development of coronary heart disease (CHD) is an example of a common source epidemic due to increased consumption of saturated fat and cholesterol, low intakes of polyunsaturated fat, and increasing obesity. Hypertension, cigarette smoking, and diabetes mellitus contribute to risk of disease. The prevention of atherosclerosis beginning in young adults is of paramount importance. Careful monitoring of the evolving epidemic of CHD, including noninvasive evaluation of atherosclerosis, is important. A high-risk approach is very successful but expensive.

Awareness of atherosclerosis risk factors in Nigeria

Non-communicable diseases, which include hypertension and diabetes mellitus, have become an important cause of morbidity and mortality in Nigeria. The determination of serum lipid levels is used routinely to assess the risk of atherosclerosis. This study was performed in order to determine the frequency of serum lipid requests in the community. Information on both lipid and total chemical pathology requests for the study period (May 1998 to April 2000) was obtained from the Department of Chemical Pathology, University of Ilorin Teaching Hospital, whilst data on the total hospital attendance was obtained from the hospital's Record Department. The number of serum lipid requests increased from year to year (May 1998 to April 1999 = 780; May 1999 to April 2000 = 1,357; May 2000 to April 2001 = 1,382). The percentages of total requests for serum Lipids when compared with the total laboratory requests for the period of study were 12.0%, 13.3% and 14.0% for the first, second and third year respectively. More men than women had their serum lipid levels determined; 31.3% of the patients had hyper-cholesterolaemia (> 5.2 mmol/L), while 9.9% had values > or = 6.2 mmol/L. Industrial disputes (strikes) affected our results. For the three-year period there was no remarkable increase in the use of the lipid profile facilities available in the centre. This reflects the inadequate awareness of lipid disorders as a risk factor for atherosclerosis.

Cardiovascular risk factors of migrants in Port Moresby from the highlands and island villages, Papua New Guinea

This study examined cardiovascular disease (CVD) risk factors, i.e., obesity, blood pressures, and serum lipoproteins and apoproteins, in relation to sociocultural characteristics in two rural-urban migrant populations (n = 173 adult males and females) in Port Moresby, the capital of Papua New Guinea. Tari migrants from the highlands and Balopa migrants from the islands differ genetically. More importantly, the lifestyle of the latter is more Westernized than that of the former in both Port Moresby and their homelands. The results demonstrate that CVD risk factors vary markedly among the origin/sex groups and that the length of stay in Port Moresby on CVD risk factors was significant only in Balopa males, most of whom had professional or skilled full-time jobs and were considered to have more stress. This study identified different CVD risk factors in the migrant groups: obesity or fatness for the Balopa migrants, and serum lipoproteins and apoproteins, particularly lipoprotein(a), for the Tari migrants. Am. J. Hum. Biol. 12:655-664, 2000. Copyright 2000 Wiley-Liss, Inc.

Effects of a traditional lifestyle on the cardiovascular risk profile: the Amondava population of the Brazilian Amazon. Comparison with matched African, Italian and Polish populations

OBJECTIVE

To determine the relationships between lifestyle and cardiovascular risk factors among the Brazilian Amondava, one of the world's most isolated populations.

DESIGN

Cross-sectional, population-based study. Four age- and sex-matched samples from Brazil Africa, Italy and Poland, representing different levels of modernization, were compared. Body weight, height, blood pressure, serum cholesterol and glycaemia were measured, and a standard questionnaire administered. Data concerning dietary habits and physical activity were collected. A personal socio-economic score was calculated, on the basis of type of economy, level of formal education, type of occupation, type of habitat, availability of piped water and electricity, main source of income, housing conditions, availability of radio, television or personal computer, knowledge of a second language, and organized health facilities.

SETTING

Primary epidemiological screening, at an institution.

RESULTS

Among the Amondava blood pressure was always <140/90 mm Hg, it did not increase with age and was not correlated with any other variable; 46.6% of subjects had systolic blood pressure <100 mm Hg. Blood pressure among the Amondava (109.6+/-11.1/69.5+/-6.4 mm Hg) was on average lower (P<0.0001) than in all other samples. Among the Amondava, the concentration of total cholesterol was always <200 mg/dl, i.e. similar to that of Africans whose diet included large amounts of vegetable foodstuffs; 90% had glycaemia (<80 mg/dl), and their mean value was the lowest (55.1+/-14.9 mg/dl) of all the groups.

CONCLUSIONS

In addition to a possible genetic predisposition not analysed in this study, a traditional lifestyle (no contact with civilization, diet based on complex carbohydrates and vegetables, high energy expenditure) may protect against the development of hypertension, hypercholesterolaemia, and diabetes.