Rural and urban differences in metabolic profiles in a Cameroonian population

Prevalence of metabolic syndrome and its components among rural and urban populations at a provincial hospital in Northern Rwanda: a cross-sectional study

Introduction

Africa has long been associated with high infectious disease rates and nutritional deficiencies. However, due to lifestyle changes and nutritional transitions driven by industrialization, NCDs and over-nutrition now coexist with infectious diseases. Our study assessed the prevalence and risk factors of metabolic syndrome (MetS) and its components in rural and urban populations.

Methods

this cross-sectional study enrolled participants aged 35 and 65 years presenting at a provincial hospital in Rwanda. We collected demographic, lifestyle, anthropometric, laboratory, and clinical data using the World Health Organization STEPwise tool for NCDs. We used the NCEP ATP III criteria to define the MetS criteria.

Results

of the 422 study participants, the majority; 322 (76.5%) were females and the overall median (IQR) age was 47 (40-53) years. Overall, 156 (37.0%) of the participants resided in a rural area. The overall frequency of MetS was 219 (51.9%) (95% CI 47.1-56.7) and was significantly higher in participants resident in an urban area 152 (57.1%) vs 67 (42.9%) rural areas (p=0.005). Hypoalphalipoproteinaemia was the most prevalent single component of the MetS 253 (61.3%) and was also the single most prevalent component in participants from urban settings; 166 (63.6%), whilst in rural-based participants, hypertension 98 (62.8%) was the most prevalent MetS component. On multivariable logistic regression analysis, BMI, LDL-C, TC, and increased age were significantly associated with MetS in participants residing in both rural and urban areas.

Conclusion

a high frequency of MetS was observed in the present study with a higher frequency occurring in urban participants. Targeted health education on behavioral risk factors is recommended.

Rural versus urban healthcare through the lens of health behaviors and access to primary care: a post-hoc analysis of the Romanian health evaluation survey

BACKGROUND

Worldwide, rural populations are recognized to be exposed to increased health challenges due to their living and working environment, socioeconomic status, and access to health services. According to the Romanian Country Health Profile 2023, approximately 46% of all deaths recorded in Romania in 2019 could be attributed to behavioral risk factors such as tobacco smoking, dietary risks, alcohol consumption and low physical activity. No data on rural versus urban areas are available to date, and research is needed to document health inequalities, identify barriers to health services, and explore solutions.

METHODS

This study is an analysis of data collected during the Health Evaluation Survey carried out by the National Institute of Public Health in 2022 and aimed to reveal differences in health risk factors between rural and urban areas. The analysis was carried out under the methodological framework of the Health Evaluation Survey 2022, which is coordinated by the National Institute of Public Health.

RESULTS

Our study's objectively measured data revealed that the overall health profile of rural communities is characterized by lower education levels, lower incomes, and higher binge drinking rates than those of their urban counterparts. Additionally, rural inhabitants more often have high blood pressure, are more overweight and obese (per body mass index measurements) and have higher fasting plasma glucose. The health profile of the urban population revealed higher education levels and greater proportions of people with adequate monthly income, people with daily alcohol consumption, people who smoke, and people with hypercholesterolemia. Access to primary health care evaluated through proxy indicators was lower in rural areas but was relatively good overall.

CONCLUSIONS

Our analysis of the health profile of rural communities revealed a greater prevalence of obesity and overweight, especially among women, and an increased prevalence of heavy drinking among men. Access to primary health care evaluated through proxy indicators is lower in rural areas but is relatively good overall. Lower education levels and the possibility of lower health literacy underpin the need for targeted health education campaigns. Sustainable strategies for rural health need to be identified, especially in the field of health promotion and disease prevention programs.

TRIAL REGISTRATION

This study is observational research involving human participants where no interventions were applied to the study population.

Intake of foods high in saturated fats, vegetarian dietary pattern, and sociodemographic characteristics associated with body weight in Peruvian university students

Background

The prevalence of obesity continues to increase among university students and the general population. Consumption of a diet high in saturated fats could be one of the risk factors.

Objective

The consumption of foods high in saturated fats, the vegetarian diet pattern, and sociodemographic characteristics associated with excess body weight (overweight/obesity) were evaluated in Peruvian university students.

Methods

A cross-sectional study was carried out selecting 5,608 Peruvian university students through no probabilistic convenience sampling. The survey was carried out during the months of February and April 2022. The Chi-square test and binary logistic regression analysis were used to evaluate the association between diet (saturated fats intake and dietary pattern) and sociodemographic factors with excess body weight in a cross-sectional analysis.

Results

It was observed that students who reported high consumption of foods high in saturated fats (ORB = 1.14) and those who had a non-vegetarian dietary pattern (ORB = 2.76) were found to be more likely to have excess body weight. On the contrary, students who reported adherence to the vegetarian diet pattern for more than 5 years were less likely to be overweight or obese (ORB = 0.84). Being ≥26 years of age (ORB = 3.28), living in urban areas (ORB = 1.68) and coastal areas of the country (ORB = 1.17), and enrolled in the engineering faculty (ORB = 1.19), were significantly associated with excess body weight.

Conclusion

The findings of the current study evidenced several factors associated with excess body weight in university students. Therefore, it is necessary to promote and implement healthy lifestyle programs, considering sociodemographic and dietary aspects such as age and dietary intake to control and prevent obesity in university students.

Analysis of adherence to a healthy lifestyle among vegetarian and non-vegetarian Peruvian university students: A cross-sectional survey

BACKGROUND

Evidence shows that a healthy lifestyle can promote physical and mental well-being in the general population. However, there are few studies that assess the adherence to a healthy lifestyle in vegetarian and non-vegetarian university students. The purpose of this study was to evaluate the differences in adherence to a healthy lifestyle between vegetarian and non-vegetarian university students in Peru.

METHODS

A cross-sectional study was carried out considering data from 6,846 students selected by non-probabilistic convenience sampling. The Diet and Healthy Lifestyle Scale (DEVS), the Peruvian validation of the Vegetarian Lifestyle Index (VLI), was used. In addition, sociodemographic and anthropometric data such as weight and height were collected. Body mass index (BMI) was also calculated.

RESULTS

Semi-vegetarian and vegetarian students had a high healthy lifestyle score compared to non-vegetarians. In addition, vegetarian diets showed a significantly higher proportion among students with a lower BMI (normal and underweight). Students with excess body weight (overweight and obesity) were less likely to report healthy lifestyle. In the overall population analyzed, it was observed that the levels of health and lifestyle behaviors, such as daily exercise and sunlight exposure, were mostly moderate and low. Additionally, sweets intake was high, while healthy food consumption such as fruits, vegetables, legumes, and whole grains was low.

CONCLUSION

The current findings show that although vegetarians had better adherence to a healthy lifestyle, interventions in the university setting are needed to improve healthy lifestyle in university students.

Characteristics of participants who take up screening tests for diabetes and lipid disorders: a systematic review

OBJECTIVES

To perform a systematic review on the characteristics of participants who attended screening programmes with blood glucose tests, lipid profiles or a combination of them, respectively.

DESIGN

Systematic review following the Meta-analysis Of Observational Studies in Epidemiology checklist.

DATA SOURCES

PubMed and Medline databases for English literature from 1 January 2000 to 1 April 2020.

ELIGIBILITY CRITERIA

Original observational studies that reported baseline characteristics of apparently healthy adult participants screening for diabetes and lipid disorders were included in this review.

DATA EXTRACTION

We examined their sociodemographic characteristics, including age, gender, body mass index (BMI) and lifestyle habits. The quality of the included articles was evaluated by the Appraisal of Cross-sectional Studies.

RESULTS

A total of 33 articles involving 38 studies in 22 countries were included and analysed in this systematic review. Overall, there was a higher participation rate among subjects who were female in all screening modalities (female vs male: 46.6%-63.9% vs 36.1%-53.4% for diabetes screening; 48.8%-58.4% vs 41.6%-51.2% for lipid screening; and 36.4%-76.8% vs 23.2%-63.6% for screening offering both). Compared with the BMI standard from the WHO, participants in lipid screening had lower BMI (male: 23.8 kg/m2 vs 24.2 kg/m2, p<0.01; female: 22.3 kg/m2 vs 23.6 kg/m2, p<0.01). Furthermore, it is less likely for individuals of lower socioeconomic status to participate in diabetes or lipid screening in developed areas.

CONCLUSIONS

We identified that individuals from lower socioeconomic groups were less likely to take up programmes for diabetes and/or lipid screening in developed areas. These populations are also likely to be at higher risk of non-communicable diseases. Future studies should investigate the barriers and facilitators of screening among non-participants, where targeted interventions to enhance their screening uptake are warranted.

Epidemiology of Overweight and Obesity in Adults Living in Cameroon: A Systematic Review and Meta-Analysis

OBJECTIVE

This study aimed to summarize current data on overweight and obesity among adults living in Cameroon.

METHODS

PubMed, Embase, Web of Science, Global Index Medicus, African Journals Online, and local databases were searched for population-based cross-sectional studies conducted in the general population from January 2000 to December 2017. A random-effects model was used to pool data.

RESULTS

Overall, 26 studies (55,155 participants) were included. The prevalence of overweight was 26.0% (95% CI: 17.6%-35.3%) based on BMI. Furthermore, the overall prevalence of obesity was 15.1% (95% CI: 9.3%-22.1%) based on BMI, 16.4% (95% CI: 10.8%-22.8%) based on waist circumference ≥ 102 cm for males and ≥ 88 cm for females, 36.7% (95% CI: 26.8%-47.2%) based on waist circumference ≥ 94 cm for males and ≥ 80 cm for females, 32.6% (95% CI: 26.9%-38.7%) based on waist to hip ratio ≥ 0.90 for males and ≥ 0.85 for females, and 31.9% (95% CI: 27.8%-36.2%) based on percent body fat ≥ 25% for males and ≥ 35% for females. Overall, the burden was higher in females compared with males; there was no difference between urban and rural settings or between studies conducted in 2000 to 2009 and 2010 to 2016.

CONCLUSIONS

The burden of overweight and obesity is high among adults in Cameroon, putting many at increased risk for developing associated metabolic and cardiovascular complications.

Body composition and physical activity as mediators in the relationship between socioeconomic status and blood pressure in young South African women: a structural equation model analysis

OBJECTIVES

Varying hypertension prevalence across different socioeconomic strata within a population has been well reported. However, the causal factors and pathways across different settings are less clear, especially in sub-Saharan Africa. Therefore, this study aimed to compare blood pressure (BP) levels and investigate the extent to which socioeconomic status (SES) is associated with BP, in rural and urban South Africa women.

SETTING

Rural and urban South Africa.

DESIGN

Cross-sectional.

PARTICIPANTS

Cross-sectional data on SES, total moderate and vigorous physical activity (MVPA), anthropometric and BP were collected on rural (n=509) and urban (n=510) young black women (18-23 years age). Pregnant and mentally or physically disabled women were excluded from the study.

RESULTS

The prevalence of combined overweight and obesity (46.5% vs 38.8%) and elevated BP (27.0% vs 9.3%) was higher in urban than rural women, respectively. Results from the structural equation modelling showed significant direct positive effects of body mass index (BMI) on systolic BP (SBP) in rural, urban and pooled datasets. Negative direct effects of SES on SBP and positive total effects of SES on SBP were observed in the rural and pooled datasets, respectively. In rural young women, SES had direct positive effects on BMI and was negatively associated with MVPA in urban and pooled analyses. BMI mediated the positive total effects association between SES and SBP in pooled analyses (ß 0.46; 95% CI 0.15 to 0.76).

CONCLUSIONS

Though South Africa is undergoing nutritional and epidemiological transitions, the prevalence of elevated BP still varies between rural and urban young women. The association between SES and SBP varies considerably in economically diverse populations with BMI being the most significant mediator. There is a need to tailor prevention strategies to take into account optimising BMI when designing strategies to reduce future risk of hypertension in young women.

Prevalence of prediabetes and diabetes mellitus among adults residing in Cameroon: A systematic review and meta-analysis

AIMS

To summarize current data on the prevalence of prediabetes and diabetes mellitus in Cameroon.

METHODS

Population-based cross-sectional studies published between January 1, 2000 and April 30, 2017 including apparently healthy adults residing in Cameroon were searched in PubMed, EMBASE, African Journals Online, and African Index Medicus. We used a random-effects model to pool data.

RESULTS

All included studies had a low risk of bias. Six studies were conducted in an urban setting only, one in a rural setting only, and five in both settings. The overall prevalence of diabetes mellitus was 5.8% (95%CI 4.1-7.9; 12 studies) in a pooled sample of 37,147 participants. The prevalence of prediabetes was 7.1% (95%CI: 3.0-21.9; 4 studies) in a pooled sample of 5,872 people. In univariable meta-regression analysis, the prevalence of diabetes mellitus increased with age, hypertension, overweight and obesity. There was no difference for sex and settings (rural versus urban).

CONCLUSIONS

This study reports a relatively high prevalence of diabetes mellitus and prediabetes in Cameroon, with no difference between urban and rural settings and between sexes. The main drivers include increasing age, overweight and obesity. Community-based educational programs are needed to tackle the burden of the disease in the country.

The lipid profile of HIV-infected patients receiving antiretroviral therapy in a rural Cameroonian population

BACKGROUND

Long term use of antiretroviral therapy (ART) in persons living with human immunodeficiency virus (PLWHIV) is associated with disturbances in blood lipids which should be monitored. More data on such disturbances are needed in Cameroon to persuade the country program to institute their routine monitoring. We then sought to determine the prevalence and timing of dyslipidaemia in PLWHIV and receiving ART in a predominantly rural Cameroonian setting.

METHODS

A cross-sectional study conducted between August and October 2012 in HIV-infected persons aged 15 years or more and receiving first-line ART for at least six months at The Nkongsamba Regional Hospital in Cameroon. Lipid assays were carried out by enzymatic-linked colorimetric methods. A multiple logistic regression model was used to assess for factors related to dyslipidaemia.

RESULTS

Included were 114 participants of whom 83 (72.8%) were females. Their median age was 43 years (IQR: 36-51) and their median CD4 count was 436 cells/μl (IQR: 275-585) after a median duration on ART of 36 months (IQR: 12-60). The prevalence of dyslipidaemia was 70.2%. Hypercholesterolaemia was observed in 34 (29.8%) patients. One-third of them had a high LDL-cholesterol level (LDL-c≥130 mg/dl). Hypertriglyceridaemia (TG≥150 mg/dl) was present in 59 (51.8%) cases. The proportion of patients with a low HDL-cholesterol (HDL-c<40 mg/dl) was 18.4% while those with a ratio of TC/HDL-c≥5 were about 16.7%. A duration of 2-4 years on ART (adjusted Odd Ratio, aOR=5.22, 95% CI: 1.43-19.06, p=0.01), current smokers (aOR=15.94, 95% CI: 1.13-225.61, p=0.04) and a concurrent metabolic disease (aOR=12.54, 95% CI: 1.02-153.86, p=0.48) were independently associated with pro-atherogenic LDL-c values. Alcohol users had a more friendly LDL-c profile (aOR=0.24, 95% CI: 0.07-0.74, p=0.01).

CONCLUSION

The study has demonstrated a high prevalence of dyslipidaemia in HIV-patients receiving first-line ART in a predominantly rural setting of Cameroon. There is a need for the country HIV program to institute laboratory monitoring of blood lipids in patients over two years on first line ART with a focus on smokers.

No Improvement in Metabolic Health Condition of 40-74-year-old Rural Residents One Year After Screening

Objective: Japan introduced a new metabolic syndrome (MetS) screening and intervention program. However, the specific benefits of the program have not yet been identified. The aim of our study was to highlight the role of the program in reducing risks related to MetS in a Japanese rural area.

Methods: We used data from a prospective observational cohort study of all users who underwent an annual health checkup at a public clinic in a rural area. The subjects of the present study were all users aged 40–74 years who participated in the MetS program between January and September 2010. We ultimately analyzed a total of 413 subjects followed up 12 months after enrolment. The subjects were divided into two groups based on the need for educational support: support and non-support. In each group, we compared the subjects’ MetS conditions at baseline and 12 months later.

Results: Thus, 88 subjects out of 413 were assigned to the support group. Among the support group subjects, there were no significant changes in glycemic metabolism, lipid metabolism, blood pressure and accumulation of visceral fat between the baseline and follow-up checkups. Among the non-support group subjects, there were no significant changes in glycemic metabolism, lipid metabolism and blood pressure between the baseline and follow-up checkups, but there were significant changes for the worse in accumulation of visceral fat with time.

Conclusion: Unfortunately, the metabolic conditions of the rural subjects who participated in a new MetS screening and intervention program did not improve with time. Our findings underscore the importance of developing educational intervention programs to encourage the general population to modify their lifestyle and acquire healthier habits.

Emerging economies and diabetes and cardiovascular disease

Diabetes and cardiovascular diseases (CVDs) are increasing in epidemic proportions globally, with the most marked increase in emerging economies. Among emerging economies, China and India have the highest numbers of people with diabetes and CVD. Over the last two decades, 80% of CVD and diabetes mortality occurred in low- and middle-income countries, suggesting that these disorders have become a leading threat to public health in most of the developing countries. The burden of CVD and diabetes in the developing countries affects the productive younger age group, and this has serious economic implications. Diabetes shares many characteristics and risk factors with CVD, and thus the risk for CVD also escalates with the increase in prevalence of diabetes. Both genetic and environmental factors play a major role in causation of diabetes and CVD. However, the major drivers of this dual epidemic are demographic changes with increased life expectancy, lifestyle changes due to rapid urbanization, and industrialization. To reduce the burden of diabetes and CVD in the coming decades, emerging economies need to set national goals for early diagnosis, effective management, and primary prevention of these disorders. In order to curb the epidemic of diabetes and CVD, population-based, multisectoral, multidisciplinary, and culturally relevant approaches including various departments of the government as well as non-governmental agencies are required.