Preventing Multimorbidity with Lifestyle Interventions in Sub-Saharan Africa: A New Challenge for Public Health in Low and Middle-Income Countries

A longitudinal macro analysis of social determinants of health and their impacts on HIV prevalence and nutritional deficiencies in Sub-Saharan Africa

Sub-Saharan Africa faces a dual public health crisis of HIV and nutritional deficiencies driven by profound socio-economic disparities. Despite significant micro-study research, macro-level, longitudinal patterns and causal dynamics remain underexplored. This study employs Panel Auto-regressive distributed lags, Panel Granger causality, and Vector auto-correction model to examine the influence of social determinants on HIV prevalence and nutritional deficiencies across Sub-Saharan Africa. The study further carried out robustness diagnostics using Driscoll - Kraay standard error regression to confirm the reliability of the results. For HIV prevalence, income, education, and employment reduce rates over the long term, while healthcare access and housing quality show positive associations. Short-term effects show the benefits of income and healthcare access, with other factors showing limited impact. For nutritional deficiencies, income, education, employment, and housing quality significantly reduce malnutrition in the long term, while healthcare access correlates positively. Short-term effects show the immediate role of income and housing quality. The causal results show unidirectional links between income, education, employment, and housing quality to HIV. Housing quality and income exhibit bidirectional causality. No causal link exists between HIV and nutritional deficiencies. The study recommends the need for income support programs, expanded educational access, skill development, and strengthened healthcare systems.

Frailty, multimorbidity, and polypharmacy: Proposal of the new concept of the geriatric triangle

As people age, the prevalence of frailty, multimorbidity, and polypharmacy increases, presenting significant challenges in geriatric medicine. These three elements are interrelated in a bidirectional manner, forming what can be termed the "geriatric triangle." The complexity of their interconnections means that addressing each issue in isolation is insufficient for achieving an effective resolution. Thus, a comprehensive understanding of this geriatric triangle is essential for appropriate geriatric management. This review aims to illuminate the relationships within the geriatric triangle and to offer insights into potential strategies for managing these interconnected challenges. Geriatr Gerontol Int 2025; 25: 657-662.

Study on the impact of rural public sports facilities and instructors on residents' participation in sports activities in China

Objective

This study aims to explore how rural public sports facilities and their instructors influence the participation of rural residents in sports activities under the background of China's rural revitalization strategy. The goal is to provide strategies for the effective use and management of rural sports facilities, thereby encouraging rural residents to actively participate in sports activities, improve their quality of life, and support comprehensive rural revitalization.

Methods

A cross-sectional study design was used, employing a stratified sampling method to distribute questionnaires to 5,000 residents in the eastern, central, western, and southern regions of China. Data analysis was conducted using R4.1.3 software. The main research indicators included the funding sources of sports facilities and the composition of social sports instructors, while residents' basic characteristics were considered secondary indicators for correlation, regression, and cross-analysis.

Results

Analysis of 3,956 valid questionnaires revealed that increasing age led to a decrease in the frequency of sports activities (-0.098), while higher education levels increased activity frequency (0.097). Facilities provided by county sports bureaus significantly promoted participation in sports activities (B = 0.320, p < 0.001). Facilities donated by villagers or township enterprises and the sports lottery fund also effectively increased participation (B = 0.219, p < 0.001; B = 0.159, p = 0.011). Sports facility instructors, particularly urban residents and retirees, significantly positively impacted activity time, while the absence of instructors reduced residents' participation in sports activities (B = -0.445, p < 0.001).

Conclusion

Age and education level are negatively correlated with sports activity participation, while the source of public sports facilities, especially those provided by county sports bureaus, the sports lottery fund, and village committees, significantly enhance participation. The presence of social sports instructors significantly increases the time and frequency of residents' sports activities. Policymakers need to focus on the construction and management of public sports facilities, develop and utilize diversified funding sources, and enhance the role of sports facility instructors. By providing professional guidance and organizing diverse sports activities, rural residents' enthusiasm for participation can be effectively stimulated.

Risk Factors Associated With Coronary Disease in Saudi Arabia: A Comprehensive Review

Coronary artery disease (CAD) has become a major health challenge across the globe and is one of the major causes of mortality and morbidity in several countries. In Saudi Arabia, recent studies have emphasized the burden of CAD. Therefore, in this study, we aim to assess the risk factors associated with CAD in Saudi Arabia. The Population, Intervention, Comparison, and Outcome (PICO) model was used to refine the research question, which defined patients with CAD and identified risk factors and prevention strategies. PubMed, Web of Science, and Google Scholar were searched from January 1, 2010, until December 1, 2024. The common risk factors were diabetes, hypertension, obesity, and smoking, indicating their significant impact on health outcomes and the urgency for focus prevention strategies such as education and routine clinical screening. The risk factors contributing to CAD emphasize the need for targeted public health intervention and improvement in the management of risk factors in addition to specific health education content to improve healthy habits in the community.

Association of biochemical indicators with multimorbidity in 19,624 older adult individuals with chronic diseases: a study from Jindong District, Jinhua City, China

Background

Chronic disease multimorbidity is influenced by multiple factors, but with little knowledge on the impact of biochemical indicators. This study aims to investigate the prevalence of multimorbidity of chronic diseases among older adult individuals in the community, as well as the factors related to biochemical indicators associated with chronic disease multimorbidity.

Methods

The study included 19,624 older adult individuals aged 60 and above in Jindong District, Jinhua City, Zhejiang Province, China. Participants completed a national standardized older adult health examination in the community. Chi-square tests and logistic regression were employed to evaluate the potential factors of biochemical indicators related to multimorbidity of chronic diseases.

Results

The multimorbidity rate of chronic diseases in older adult patients is 70.3%. Each chronic disease coexists with one or more other chronic diseases in over 75% of cases. Among the biochemical indicators, hemoglobin (Hb) (OR = 1.46, 95%CI: 1.13-1.90), white blood cell count (WBC) (OR = 1.25, 95%CI: 1.02-1.54), red blood cell count (RBC) (OR = 1.36, 95%CI: 1.10-1.69), urinary protein (U-PRO) (OR = 1.10, 95%CI: 1.02-1.19), urinary glucose (U-GLU) (OR = 1.44, 95%CI: 1.23-1.67), alanine aminotransferase (ALT) (OR = 1.71, 95%CI: 1.39-2.10), aspartate aminotransferase (AST) (OR = 1.22, 95%CI: 1.05-1.41), creatinine (Cr) (OR = 1.28, 95%CI: 1.16-1.42), uric acid (UA) (OR = 1.36, 95%CI: 1.22-1.51), total cholesterol (TC) (OR = 1.76, 95%CI: 1.59-1.95), triglycerides (TG) (OR = 2.63, 95%CI: 2.46-2.82), low-density lipoprotein cholesterol (LDL-C) (OR = 1.84, 95%CI: 1.60-2.11), high-density lipoprotein cholesterol (HDL-C) (OR = 10.99, 95%CI: 8.12-14.90), and fasting blood glucose (FBG) (OR = 1.89, 95%CI: 1.74-2.05) are associated with the risk of multimorbidity of chronic diseases (p < 0.05). Among these, lipid parameters demonstrated the strongest associations with multimorbidity risk, with low HDL-C showing an 11-fold increase and elevated TG a 2.63-fold increase.

Conclusion

This study found that the prevalence of multimorbidity among older adult individuals in this region reached 70.3%. Multiple biochemical indicators were significantly associated with multimorbidity, particularly lipid parameters (low HDL-C and elevated TG), glucose parameters (elevated FBG and positive U-GLU), liver function (elevated ALT), and hemoglobin levels. These findings provide important evidence for research on factors associated with multimorbidity in the older adult population.

A systematic review of the mechanisms influencing engagement in diabetes prevention programmes for people with pre-diabetes

AIMS

To identify barriers and enablers that influence engagement in and acceptability of diabetes prevention programmes for people with pre-diabetes. The results will provide insights for developing strategies and recommendations to improve design and delivery of diabetes prevention programmes with enhanced engagement and acceptability for people with pre-diabetes.

METHODS

This review used a critical realist approach to examine context and mechanisms of diabetes prevention programmes. Medline, Embase, PsycInfo, Cinahl, Web of Science, Scopus and Pre-Medline were searched for English language studies published between 2000 and 2023. A quality assessment was conducted using Joanna Briggs Institute critical appraisal tools.

RESULTS

A total of 90 papers met inclusion criteria. The included studies used a variety of quantitative and qualitative methodologies. Data extracted focused on barriers and enablers to engagement in and acceptability of diabetes prevention programmes, with seven key mechanisms identified. These included financial, environmental, personal, healthcare, social and cultural, demographic and programme mechanisms. Findings highlighted diverse factors that influenced engagement in preventive programmes and the importance of considering these factors when planning, developing and implementing future diabetes prevention programmes.

CONCLUSIONS

Mechanisms identified in this review can inform design and development of diabetes prevention programmes for people with pre-diabetes and provide guidance for healthcare professionals and policymakers. This will facilitate increased participation and engagement in preventive programmes, potentially reducing progression and/or incidence of pre-diabetes to type 2 diabetes and improving health outcomes.

Latent class analysis of chronic disease co-occurrence, clustering and their determinants in India using Study on global AGEing and adult health (SAGE) India Wave-2

Background

Understanding chronic disease prevalence, patterns, and co-occurrence is pivotal for effective health care planning and disease prevention strategies. In this paper, we aimed to identify the clustering of major non-communicable diseases among Indian adults aged ≥50 years based on their self-reported diagnosed non-communicable disease status and to find the risk factors that heighten the risk of developing the identified disease clusters.

Methods

We utilised data from the nationally representative survey Study on Global AGEing and Adult Health (SAGE Wave-2). The eligible sample size was 6298 adults aged ≥50 years. We conducted the latent class analysis to uncover latent subgroups of multimorbidity and the multinomial logistic regression to identify the factors linked to observed latent class membership.

Results

The latent class analysis grouped our sample of men and women >49 years old into three groups - mild multimorbidity risk (41%), moderate multimorbidity risk (30%), and severe multimorbidity risk (29%). In the mild multimorbidity risk group, the most prevalent diseases were asthma and arthritis, and the major prevalent disease in the moderate multimorbidity risk group was low near/distance vision, followed by depression, asthma, and lung disease. Angina, diabetes, hypertension, and stroke were the major diseases in the severe multimorbidity risk category. Individuals with higher ages had an 18% and 15% higher risk of having moderate multimorbidity and severe multimorbidity compared to those in the mild multimorbidity category. Females were more likely to have a moderate risk (3.36 times) and 2.82 times more likely to have severe multimorbidity risk.

Conclusions

The clustering of diseases highlights the importance of integrated disease management in primary care settings and improving the health care system to accommodate the individual's needs. Implementing preventive measures and tailored interventions, strengthening the health and wellness centres, and delivering comprehensive primary health care services for secondary and tertiary level hospitalisation may cater to the needs of multimorbid patients.

Epigenetic aging in older people living with HIV in Eswatini: a pilot study of HIV and lifestyle factors and epigenetic aging

BACKGROUND

People living with HIV (PLHIV) on effective antiretroviral therapy are living near-normal lives. Although they are less susceptible to AIDS-related complications, they remain highly vulnerable to non-communicable diseases. In this exploratory study of older PLHIV (OPLHIV) in Eswatini, we investigated whether epigenetic aging (i.e., the residual between regressing epigenetic age on chronological age) was associated with HIV-related parameters, and whether lifestyle factors modified these relationships. We calculated epigenetic aging focusing on the Horvath, Hannum, PhenoAge and GrimAge epigenetic clocks, and a pace of biological aging biomarker (DunedinPACE) among 44 OPLHIV in Eswatini.

RESULTS

Age at HIV diagnosis was associated with Hannum epigenetic age acceleration (EAA) (β-coefficient [95% Confidence Interval]; 0.53 [0.05, 1.00], p = 0.03) and longer duration since HIV diagnosis was associated with slower Hannum EAA (- 0.53 [- 1.00, - 0.05], p = 0.03). The average daily dietary intake of fruits and vegetables was associated with DunedinPACE (0.12 [0.03, 0.22], p = 0.01). The associations of Hannum EAA with the age at HIV diagnosis and duration of time since HIV diagnosis were attenuated when the average daily intake of fruits and vegetables or physical activity were included in our models. Diet and self-perceived quality of life measures modified the relationship between CD4+ T cell counts at participant enrollment and Hannum EAA.

CONCLUSIONS

Epigenetic age is more advanced in OPLHIV in Eswatini in those diagnosed with HIV at an older age and slowed in those who have lived for a longer time with diagnosed HIV. Lifestyle and quality of life factors may differentially affect epigenetic aging in OPLHIV. To our knowledge, this is the first study to assess epigenetic aging in OPLHIV in Eswatini and one of the few in sub-Saharan Africa.

HIV, multimorbidity, and health-related quality of life in rural KwaZulu-Natal, South Africa: A population-based study

Health-related quality of life (HRQoL) assesses the perceived impact of health status across life domains. Although research has explored the relationship between specific conditions, including HIV, and HRQoL in low-resource settings, less attention has been paid to the association between multimorbidity and HRQoL. In a secondary analysis of cross-sectional data from the Vukuzazi ("Wake up and know ourselves" in isiZulu) study, which identified the prevalence and overlap of non-communicable and infectious diseases in the uMkhanyakunde district of KwaZulu-Natal, we (1) evaluated the impact of multimorbidity on HRQoL; (2) determined the relative associations among infectious diseases, non-communicable diseases (NCDs), and HRQoL; and (3) examined the effects of controlled versus non-controlled disease on HRQoL. HRQoL was measured using the EQ-5D-3L, which assesses overall perceived health, five specific domains (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression), and three levels of problems (no problems, some problems, and extreme problems). Six diseases and disease states were included in this analysis: HIV, diabetes, stroke, heart attack, high blood pressure, and TB. After examining the degree to which number of conditions affects HRQoL, we estimated the effect of joint associations among combinations of diseases, each HRQoL domain, and overall health. Then, in one set of ridge regression models, we assessed the relative impact of HIV, diabetes, stroke, heart attack, high blood pressure, and tuberculosis on the HRQoL domains; in a second set of models, the contribution of treatment (controlled vs. uncontrolled disease) was added. A total of 14,008 individuals were included in this analysis. Having more conditions adversely affected perceived health (r = -0.060, p<0.001, 95% CI: -0.073 to -0.046) and all HRQoL domains. Infectious conditions were related to better perceived health (r = 0.051, p<0.001, 95% CI: 0.037 to 0.064) and better HRQoL, whereas non-communicable diseases (NCDs) were associated with worse perceived health (r = -0.124, p<0.001, -95% CI: 0.137 to -0.110) and lower HRQoL. Particular combinations of NCDs were detrimental to perceived health, whereas HIV, which was characterized by access to care and suppressed viral load in the large majority of those affected, was counterintuitively associated with better perceived health. With respect to disease control, unique combinations of uncontrolled NCDs were significantly related to worse perceived health, and controlled HIV was associated with better perceived health. The presence of controlled and uncontrolled NCDs was associated with poor perceived health and worse HRQoL, whereas the presence of controlled HIV was associated with improved HRQoL. HIV disease control may be critical for HRQoL among people with HIV, and incorporating NCD prevention and attention to multimorbidity into healthcare strategies may improve HRQoL.

Epigenetic aging in older people living with HIV in Eswatini: a pilot study of HIV and lifestyle factors and epigenetic aging

Background

People living with HIV (PLHIV) on effective antiretroviral therapy (ART) are living near-normal lives. Although they are less susceptible to AIDS-related complications, they remain highly vulnerable to non-communicable diseases (NCD). In this exploratory study of older PLHIV (OPLHIV) in Eswatini, we investigated whether biological aging (i.e., the difference between epigenetic age and chronological age, termed 'epigenetic age acceleration [EAA]') was associated with HIV-related parameters, and whether lifestyle factors modified these relationships. We calculated EAA focusing on the second-generation epigenetic clocks, PhenoAge and GrimAge, and a pace of aging biomarker (DunedinPACE) among 44 OPLHIV in Eswatini.

Results

Among participants, the PhenoAge clock showed older epigenetic age (68 years old [63, 77]) but a younger GrimAge epigenetic age (median=56 years old [interquartile range=50, 61]) compared to the chronological age (59 years old [54, 66]). Participants diagnosed with HIV at an older age showed slower DunedinPACE (β-coefficient [95% Confidence Interval]; -0.02 [-0.04, -0.01], p=0.002) and longer duration since HIV diagnosis was associated with faster DunedinPACE (0.02 [0.01, 0.04], p=0.002). The average daily dietary intake of fruits and vegetables was associated with faster DunedinPACE (0.12 [0.03, 0.22], p=0.01) and modified the relationship between HIV status variables (number of years living with HIV since diagnosis, age at HIV diagnosis, CD4+ T cell counts) and PhenoAge EAA, and DunedinPACE.

Conclusions

Biological age is accelerated in OPLHIV in Eswatini, with those living with HIV for a longer duration at risk for faster biological aging. Lifestyle factors, especially healthier diets, may attenuate biological aging in OPLHIV. To our knowledge, this is the first study to assess biological aging in Eswatini and one of the few in sub-Saharan Africa.

Spanish version of the self-care self-efficacy scale: A validation study in community-dwelling older adults with chronic multimorbidity

OBJECTIVE

To test the psychometric properties of the Spanish version of the Self-Care Self-Efficacy Scale (SCSES-Sp) in community-dwelling older adults with chronic multimorbidity.

METHODS

A sample of 1013 community-dwelling older adults with chronic multimorbidity participated in an observational cross-sectional study that was carried out in 3 phases.

RESULTS

Confirmatory factor analysis showed that the SCSES-Sp has 4 dimensions: "self-efficacy in self-care behaviours based on clinical knowledge", "self-efficacy in self-care maintenance", "self-efficacy in self-care monitoring", and "self-efficacy in self-care management". A panel of independent experts considered the content of the SCSES-Sp valid. Convergent validity analysis showed moderate-strong correlations between all of the SCSES-Sp's dimensions and the reference criteria chosen. Reliability was good for the SCSES-Sp and all its dimensions. Test-retest reliability analysis showed that the SCSES-Sp was temporally stable.

CONCLUSIONS

The SCSES-Sp is a valid and reliable tool to assess self-efficacy in self-care in Spanish-speaking, community-dwelling older adults with chronic multimorbidity.

Effects of turmeric (Curcuma longa) supplementation on glucose metabolism in diabetes mellitus and metabolic syndrome: An umbrella review and updated meta-analysis

AIMS

This study aims to comprehensively review the existing evidence and conduct analysis of updated randomized controlled trials (RCTs) of turmeric (Curcuma longa, CL) and its related bioactive compounds on glycemic and metabolic parameters in patients with type 2 diabetes (T2DM), prediabetes, and metabolic syndrome (MetS) together with a sub-group analysis of different CL preparation forms.

METHODS

An umbrella review (UR) and updated systematic reviews and meta-analyses (SRMAs) were conducted to evaluate the effects of CL compared with a placebo/standard treatment in adult T2DM, prediabetes, and MetS. The MEDLINE, Embase, The Cochrane Central Register of Control Trials, and Scopus databases were searched from inception to September 2022. The primary efficacy outcomes were hemoglobin A1C (HbA1C) and fasting blood glucose (FBG). The corrected covered area (CCA) was used to assess overlap. Mean differences were pooled across individual RCTs using a random-effects model. Subgroup and sensitivity analyses were performed for various CL preparation forms.

RESULTS

Fourteen SRMAs of 61 individual RCTs were included in the UR. The updated SRMA included 28 studies. The CCA was 11.54%, indicating high overlap across SRMAs. The updated SRMA revealed significant reduction in FBG and HbA1C with CL supplementation, obtaining a mean difference (95% confidence interval [CI]) of -8.129 (-12.175, -4.084) mg/dL and -0.134 (-0.304, -0.037) %, respectively. FBG and HbA1C levels decreased with all CL preparation forms as did other metabolic parameters levels. The results of the sensitivity and subgroup analyses were consistent with those of the main analysis.

CONCLUSION

CL supplementation can significantly reduce FBG and HbA1C levels and other metabolic parameters in T2DM and mitigate related conditions, including prediabetes and MetS.

TRIAL REGISTRATION

PROSPERO (CRD42016042131).

Solid Fuel Use and the Progression of Multimorbidity in Middle-Aged Chinese Participants: A Prospective Cohort Study

Objectives: This study aimed to examine the association of solid fuel use for cooking and heating with the progression of multimorbidity. Methods: A total of 5,437 participants from the China Health and Retirement Longitudinal Study were included. Multivariate logistic regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for the associations of the independent and joint effects of solid fuel use for cooking and heating with the progression of multimorbidity. Results: The proportion of participants reporting solid fuel use for both cooking and heating was 59.0% at baseline. Solid fuel use for both cooking and heating was associated with the progression of multimorbidity (adjusted OR: 1.42, 95% CI: 1.19-1.70), compared with clean fuel use for both. Conclusion: Solid fuel use for cooking and heating play an important role in the progression of multimorbidity. Therefore, solid fuel reduction should be considered in developing multimorbidity control and prevention programmes.

Strategies to improve health status among adults with multimorbidity: A scoping review

Although public health and medical care advancements have enabled an increased lifespan among many populations around the world, there is an ongoing need to enhance the health span of adults and older adults. Due to the increasingly substantial prevalence of multiple chronic conditions, also known as multimorbidity, this scoping review aims to identify and describe the current literature on programs or interventions to improve the health status of and to prevent further chronic conditions among adults and older adults who are already living with multimorbidity. Of the 2898 articles identified from a search of PubMed and Embase, 72 underwent full-text screening and 14 were included in the review. A total of 8 articles included both adult and older adult participants, while 6 articles involved only participants who were older adults. The articles reported a variety of settings, components and key outcomes, and reported varying degrees of success in improving the health status of the participants. Some of the interventions were tailored to a specific population such as individuals receiving home care services, nursing home residents or individuals who were living with obesity along with multiple co-occurring conditions. While many interventions involved dimensions of physical activity and healthy eating to improve health status, many interventions also utilized a combination of components to enhance the impact of the initiative. Overall, this scoping review highlights the literature and the continued need for multifaceted research that can help inform future programs and policies to support individuals living with multimorbidity.

Disparities in the Prevalence of Childhood Obesity-Related Comorbidities: A Systematic Review

Background

Non-communicable diseases among children are serious consequences of childhood obesity. However, less is known about the disparities in childhood obesity comorbidities burden. This review describes the salient pattern of disparities in the prevalence of childhood obesity-related non-communicable diseases and relevant inequalities in both high- and low/medium-income countries.

Method

A systematic literature search was performed in MEDLINE, Embase, CINAHL, PsycInfo, Scopus, and Web of Science databases by two independent reviewers. Inclusion criteria were as follows: age 2–18 years; the prevalence or incidence of childhood obesity comorbidities reported; and studies published in English from January 2010 to date. No restrictions on the setting. The prevalence data were analyzed using range and median for subgroups based on the country's development status, gender, and geographical region.

Results

Our search identified 6,837 articles, out of which we examined 145 full-text articles and included 54 articles in the analysis. The median prevalence of childhood obesity-related hypertension was 35.6 vs. 12.7% among middle- and low-income countries compared with high-income countries; 37.7 vs. 32.9% among boys compared with girls; and 38.6, 25.3, and 20.1% in Asia, South America, and Europe, respectively. For metabolic syndrome, the median prevalence was 26.9 vs. 5.5% among middle- and low-income countries compared with high-income countries; 55.2 vs. 12.0% among boys compared with girls; and 40.3, 25.8, and 7.7% in South America, Asia, and Europe, respectively. The prevalence of childhood obesity-related non-alcoholic fatty liver disease was 47.5 vs. 23% among middle- and low-income countries compared with high-income countries; and 52.1, 39.7, and 23.0% in Asia, South America, and Europe, respectively. The median prevalence of dyslipidemia was 43.5 vs. 63% among middle- and low-income countries compared with high-income countries; 55.2 vs. 12.0% among boys compared to girls; and 73.7 and 49.2% in Australia and Europe, respectively.

Conclusion

There are disparities in the prevalence of childhood obesity-related hypertension, metabolic syndrome, and non-alcoholic fatty liver disease, with middle- and low-income countries, boys, and Asian region having higher prevalence. Implementing targeted interventions for childhood obesity comorbidities should consider socioeconomic disparities and strengthening of research surveillance methods for a better understanding of non-communicable disease burden in the pediatric population.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO, identifier: CRD42021288607.