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Masango B, Goedecke JH, Ramsay M, Storbeck KH, Micklesfield LK, Chikowore T. Postprandial glucose variability and clusters of sex hormones, liver enzymes, and cardiometabolic factors in a South African cohort of African ancestry. BMJ Open Diabetes Res Care 2024; 12:e003927. [PMID: 38453238 PMCID: PMC10921533 DOI: 10.1136/bmjdrc-2023-003927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/16/2024] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION This study aimed to, first, determine the clusters of sex hormones, liver enzymes, and cardiometabolic factors associated with postprandial glucose (PPG) and, second to evaluate the variation these clusters account for jointly and independently with polygenic risk scores (PRSs) in South Africans of African ancestry men and women. RESEARCH DESIGN AND METHODS PPG was calculated as the integrated area under the curve for glucose during the oral glucose tolerance test (OGTT) using the trapezoidal rule in 794 participants from the Middle-aged Soweto Cohort. Principal component analysis was used to cluster sex hormones, liver enzymes, and cardiometabolic factors, stratified by sex. Multivariable linear regression was used to assess the proportion of variance in PPG accounted for by principal components (PCs) and type 2 diabetes (T2D) PRS while adjusting for selected covariates in men and women. RESULTS The T2D PRS did not contribute to the PPG variability in both men and women. In men, the PCs' cluster of sex hormones, liver enzymes, and cardiometabolic explained 10.6% of the variance in PPG, with PC1 (peripheral fat), PC2 (liver enzymes and steroid hormones), and PC3 (lipids and peripheral fat) contributing significantly to PPG. In women, PC factors of sex hormones, cardiometabolic factors, and liver enzymes explained a similar amount of the variance in PPG (10.8%), with PC1 (central fat) and PC2 (lipids and liver enzymes) contributing significantly to PPG. CONCLUSIONS We demonstrated that inter-individual differences in PPG responses to an OGTT may be differentially explained by body fat distribution, serum lipids, liver enzymes, and steroid hormones in men and women.
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Affiliation(s)
- Bontle Masango
- Division of Human Genetics, National Health Laboratory Service (NHLS), School of Pathology, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
- South African Medical Research Council/University of the Witwatersrand, Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
- Biomedical Research and Innovation Platform, South African Medical Research Council, Cape Town, South Africa
| | - Julia H Goedecke
- South African Medical Research Council/University of the Witwatersrand, Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
- Biomedical Research and Innovation Platform, South African Medical Research Council, Cape Town, South Africa
| | - Michèle Ramsay
- Sydney Brenner Institute for Molecular Bioscience, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Karl-Heinz Storbeck
- Department of Biochemistry, Stellenbosch University, Stellenbosch, South Africa
| | - Lisa K Micklesfield
- South African Medical Research Council/University of the Witwatersrand, Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Tinashe Chikowore
- South African Medical Research Council/University of the Witwatersrand, Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
- Harvard Medical School, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Konlan KD, Lee H, Lee M, Kim Y, Lee H, Abdulai JA. Risk factors associated with the incidence and prevalence of hypertension in Ghana: an integrated review (2016-2021). INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2023; 33:1132-1147. [PMID: 35578383 DOI: 10.1080/09603123.2022.2076814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 05/07/2022] [Indexed: 06/15/2023]
Abstract
This study synthesized the risk factors associated with hypertension among adolescents and adults in Ghana. A systematic search in four databases between 2016 and 2021 retrieved 119 Ghanaian studies, and through screening, 16 were selected. Thematic analysis was used to synthesize extracted data. Prevalence of hypertension ranged from 13.0% to 28.4% and prehypertension 22.0% to 51.4%. The non-modifiable hypertension risk factors were age, marital status, gender, and residence. The modifiable risk factors were consuming additional table salt, salted meat, alcohol, canned meats, smoking, and psychological factors, including stress and anxiety. Also, higher education and socio-economic status, employment, access to medical insurance, overweight, and higher BMI were risk factors. Targeted, sustained, systematic, and effective intervention programs should target high-risk people.
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Affiliation(s)
- Kennedy Diema Konlan
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea
- Department of Public Health Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Hyeonkyeong Lee
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea
- College of Nursing, Brain Korea 21 FOUR Project, Yonsei University, Seoul, South Korea
| | - Mikyung Lee
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea
- College of Nursing, Brain Korea 21 FOUR Project, Yonsei University, Seoul, South Korea
| | - Youlim Kim
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea
- College of Nursing, Brain Korea 21 FOUR Project, Yonsei University, Seoul, South Korea
| | - Hyeyeon Lee
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea
| | - Juliana Asibi Abdulai
- University for Development Studies, University Health Services (Nursing), Tamale, Northern Region, Ghana
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Dalla Zuanna T, Batzella E, Russo F, Pitter G, Canova C. Migrant status disparities in blood pressure: a multiple mediation analysis of modifiable factors. J Epidemiol Glob Health 2023; 13:547-556. [PMID: 37421555 PMCID: PMC10468480 DOI: 10.1007/s44197-023-00136-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 06/25/2023] [Indexed: 07/10/2023] Open
Abstract
BACKGROUND We examined differences in blood pressure (BP) levels between first-generation immigrants and natives in adult residents in Northeast Italy, and investigated the role of lifestyle behaviors, body mass index (BMI), and education as potentially modifiable mediating factors. METHODS We included 20-69-year-old participants from the Health Surveillance Program of the Veneto Region (n = 37,710). Immigrants born in a high migratory pressure country (HMPC) were further grouped into geographical macro-areas. The outcomes were systolic BP (SBP) and hypertension. Multiple mediation analyses were performed to determine the contribution of each mediator of the SBP/migrant status association. RESULTS Of the 37,380 subjects included, 8.7% were born in an HMPC. BMI, education, alcohol, sweets and meat consumption were included as potential mediators. A small advantage in SBP was seen for immigrants compared to natives (β = - 0.71,95%CI - 1.30; - 0.10). The direct effect (net of the covariates) of immigrant status on SBP was a reduction of 1.62 mmHg (95%CI - 2.25; - 0.98). BMI played the highest suppressive role (β = 1.14,95%CI 0.99; 1.35), followed by education. Alcohol consumption amplified the health advantage of immigrants. The suppressing effect of BMI was particularly evident among women and North Africans compared to natives. Similar results were seen for hypertension rates. CONCLUSIONS Although causation cannot be proven given the cross-sectional design, our findings identify BMI as the most effective target to preserve the health advantage of immigrants with respect to BP levels.
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Affiliation(s)
- Teresa Dalla Zuanna
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Via Loredan 18, 35100, Padua, Italy
| | - Erich Batzella
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Via Loredan 18, 35100, Padua, Italy
| | - Francesca Russo
- Directorate of Prevention, Food Safety, and Veterinary Public Health-Veneto Region, Venice, Italy
| | - Gisella Pitter
- Screening and Health Impact Assessment Unit, Azienda Zero-Veneto Region, Padua, Italy
| | - Cristina Canova
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Via Loredan 18, 35100, Padua, Italy.
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MICKLESFIELD LISAK, WESTGATE KATE, SMITH ANTONIA, KUFE CLEMENTN, MENDHAM AMYE, LINDSAY TIM, WIJNDAELE KATRIEN, GOEDECKE JULIAH, BRAGE SOREN. Physical Activity Behaviors of a Middle-Age South African Cohort as Determined by Integrated Hip and Thigh Accelerometry. Med Sci Sports Exerc 2022; 54:1493-1505. [PMID: 35658390 PMCID: PMC9390235 DOI: 10.1249/mss.0000000000002940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
PURPOSE Descriptive studies of objectively measured physical activity behaviors in African populations are rare. We developed a method of combining hip and thigh accelerometery signals to quantify and describe physical behaviors in middle-age South African men and women. METHODS We integrated signals from two triaxial accelerometers worn simultaneously during free-living, in a subsample of the Middle-age Soweto Cohort ( n = 794; mean (SD) age, 53.7 (6.3) yr). Acceleration time series from the accelerometers were combined and movement-related acceleration was derived using Euclidean Norm Minus One (in milligrams), to determine total movement volume (mean Euclidean Norm Minus One) and nonmovement time (<28 m g ), light-intensity physical activity (LPA; 28-85 m g ), and moderate- to vigorous-intensity physical activity (MVPA; >85 m g ); thigh pitch angle and a sleep diary were used to divide nonmovement time (in minutes per day) into sleep, awake sitting/lying, and standing. Sociodemographic factors were self-reported, and weight and height were measured. RESULTS Mean (SD) wear time was 128 (48) h. Movement volume was 15.0 (6.5) m g for men and 12.2 (3.4) m g for women. Men spent more time in MVPA and sitting/lying, whereas women spent more time standing. Age was inversely associated with movement volume, MVPA, and LPA. When compared with their normal-weight counterparts, men who were overweight or obese spent less time in MVPA, whereas women who were overweight or obese spent less time in LPA and more time sitting/lying. Socioeconomic status was inversely associated with total movement volume, MVPA, and time spent sleeping, and positively associated with time spent sitting/lying, in both men and women. CONCLUSIONS Integrating signals from hip and thigh accelerometers enables characterization of physical behaviors that can be applied in an African population.
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Affiliation(s)
- LISA K. MICKLESFIELD
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit (DPHRU), Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, SOUTH AFRICA
| | - KATE WESTGATE
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UNITED KINGDOM
| | - ANTONIA SMITH
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UNITED KINGDOM
| | - CLEMENT N. KUFE
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit (DPHRU), Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, SOUTH AFRICA
| | - AMY E. MENDHAM
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit (DPHRU), Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, SOUTH AFRICA
- Research Centre for Health through Physical Activity, Lifestyle and Sport, Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, SOUTH AFRICA
| | - TIM LINDSAY
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UNITED KINGDOM
| | - KATRIEN WIJNDAELE
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UNITED KINGDOM
| | - JULIA H. GOEDECKE
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit (DPHRU), Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, SOUTH AFRICA
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, SOUTH AFRICA
| | - SOREN BRAGE
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UNITED KINGDOM
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Mukoma G, Wrottesley SV, Kagura J, Oni T, Micklesfield L, Norris SA. The relationships between socioeconomic status, dietary knowledge and patterns, and physical activity with adiposity in urban South African women. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2022. [DOI: 10.1080/16070658.2022.2076374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Gudani Mukoma
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephanie V Wrottesley
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
| | - Juliana Kagura
- Division of Epidemiology and Biostatistics, University of the Witwatersrand, South Africa
| | - Tolu Oni
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
- Research Initiative for Cities Health and Equity, University of Cape Town, Cape Town, South Africa
| | - Lisa Micklesfield
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
| | - Shane A Norris
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
- Institute for Developmental Science and Global Health Research Institute, University of Southampton, Southampton, UK
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Xiao L, Le C, Wang GY, Fan LM, Cui WL, Liu YN, Shen JR, Golden AR. Socioeconomic and lifestyle determinants of the prevalence of hypertension among elderly individuals in rural southwest China: a structural equation modelling approach. BMC Cardiovasc Disord 2021; 21:64. [PMID: 33530935 PMCID: PMC7851929 DOI: 10.1186/s12872-021-01885-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/21/2021] [Indexed: 12/12/2022] Open
Abstract
Background This study examines the association between socioeconomic and lifestyle factors and the prevalence of hypertension among elderly individuals in rural Southwest China. Methods A cross-sectional survey of 4833 consenting adults aged ≥ 60 years in rural regions of Yunnan Province, China, was conducted in 2017. Data on individual socioeconomic status, sleep quality, physical activity level, and family history of hypertension were collected with a standardized questionnaire. Blood pressure, fasting blood glucose, height, weight, and waist circumference were also measured. An individual socioeconomic position (SEP) index was constructed using principal component analysis. Structural equation modelling (SEM) was applied to analyse the association between socioeconomic and lifestyle factors and the prevalence of hypertension. Results The overall prevalence of hypertension was 50.6% in the study population. Body fat distribution, including measures of obesity and central obesity, had the greatest total effect on hypertension (0.21), followed by family history of hypertension (0.14), biological sex (0.08), sleep quality (− 0.07), SEP (− 0.06), physical inactivity (0.06), and diabetes (0.06). Body fat distribution, SEP, and family history of hypertension had both direct and indirect effects on hypertension, whereas physical inactivity, diabetes, and sleep quality were directly associated with the prevalence of hypertension. Biological sex was indirectly associated with the prevalence of hypertension. Conclusions SEP, body fat distribution, physical inactivity, diabetes, and sleep quality critically influence the prevalence of hypertension. Future interventions to prevent and control hypertension should give increased attention to individuals with low SEP and should focus on controlling diabetes and obesity, increasing physical activity levels, and improving quality of sleep among older adults aged ≥ 60 years in rural Southwest China.
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Affiliation(s)
- Li Xiao
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming, 650500, China.,First Affiliated Hospital of Dali Medical University, Dali, China
| | - Cai Le
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming, 650500, China.
| | - Gui-Yi Wang
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming, 650500, China
| | - Lu-Ming Fan
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming, 650500, China
| | - Wen-Long Cui
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming, 650500, China
| | - Ying-Nan Liu
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming, 650500, China
| | - Jing-Rong Shen
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming, 650500, China
| | - Allison Rabkin Golden
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming, 650500, China
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Mchiza ZJR, Parker WA, Hossin MZ, Heshmati A, Labadarios D, Falkstedt D, Koupil I. Social and Psychological Predictors of Body Mass Index among South Africans 15 Years and Older: SANHANES-1. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16203919. [PMID: 31618952 PMCID: PMC6843690 DOI: 10.3390/ijerph16203919] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 09/20/2019] [Accepted: 09/21/2019] [Indexed: 12/01/2022]
Abstract
This study investigated how psychological distress and the proxies for social position combine to influence the risk of both underweight and overweight in South Africans aged 15 years and older. This was a cross-sectional study that included 2254 men and 4170 women participating in the first South African National Health and Nutrition Examination Survey (SANHANES-1). An analysis exploring the associations of social and mental health characteristics with body mass index (BMI) was conducted using binary and multinomial logistic regressions. Results suggested that, overall, women had a higher risk of overweight/obesity compared to men (age-adjusted odds ratio [AOR] 4.65; 95% confidence intervals [CI] 3.94–5.50). The gender effect on BMI was smaller in non-African participants (AOR 3.02; 95% CI 2.41–3.79; p-value for interaction = 0.004). Being employed and having a higher level of education were associated with higher risks of overweight and obesity and a lower risk of underweight. Being single or without a spouse and poor mental health were found to increase the odds of being underweight, especially in men. To conclude, there are strong social gradients and important gender and ethnic differences in how BMI is distributed in the South African population.
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Affiliation(s)
| | - Whadi-Ah Parker
- Social Aspects of Public Health (SAPH), Human Sciences Research Council, Cape Town 8000, South Africa.
| | - Muhammad Zakir Hossin
- Department of Public Health Sciences, Karolinska Institutet, Stockholm SE-171 76, Sweden.
| | - Amy Heshmati
- Department of Public Health Sciences, Stockholm University, Stockholm SE-106 91, Sweden.
- Centre for Health Equity Studies, Stockholm University, Stockholm SE-106 91, Sweden.
| | - Demetre Labadarios
- Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg 7505, South Africa.
| | - Daniel Falkstedt
- Department of Public Health Sciences, Karolinska Institutet, Stockholm SE-171 76, Sweden.
| | - Ilona Koupil
- Department of Public Health Sciences, Karolinska Institutet, Stockholm SE-171 76, Sweden.
- Department of Public Health Sciences, Stockholm University, Stockholm SE-106 91, Sweden.
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