Obesity and its health impact in Africa: a systematic review

Multisectoral interventions for urban health in Africa: a mixed-methods systematic review

Increasing evidence suggests that urban health objectives are best achieved through a multisectoral approach. This approach requires multiple sectors to consider health and well-being as a central aspect of their policy development and implementation, recognising that numerous determinants of health lie outside (or beyond the confines of) the health sector. However, collaboration across sectors remains scarce and multisectoral interventions to support health are lacking in Africa. To address this gap in research, we conducted a mixed-method systematic review of multisectoral interventions aimed at enhancing health, with a particular focus on non-communicable diseases in urban African settings. Africa is the world's fastest urbanising region, making it a critical context in which to examine the impact of multisectoral approaches to improve health. This systematic review provides a valuable overview of current knowledge on multisectoral urban health interventions and enables the identification of existing knowledge gaps, and consequently, avenues for future research. We searched four academic databases (PubMed, Scopus, Web of Science, Global Health) for evidence dated 1989-2019 and identified grey literature from expert input. We identified 53 articles (17 quantitative, 20 qualitative, 12 mixed methods) involving collaborations across 22 sectors and 16 African countries. The principle guiding the majority of the multisectoral interventions was community health equity (39.6%), followed by healthy cities and healthy urban governance principles (32.1%). Targeted health outcomes were diverse, spanning behaviour, environmental and active participation from communities. With only 2% of all studies focusing on health equity as an outcome and with 47% of studies published by first authors located outside Africa, this review underlines the need for future research to prioritise equity both in terms of research outcomes and processes. A synthesised framework of seven interconnected components showcases an ecosystem on multisectoral interventions for urban health that can be examined in the future research in African urban settings that can benefit the health of people and the planet.Paper ContextMain findings: Multisectoral interventions were identified in 27.8% of African countries in the African Union, targeted at major cities with five sectors present at all intervention stages: academia or research, agriculture, government, health, and non-governmental.Added knowledge: We propose a synthesised framework showcasing an ecosystem on multisectoral interventions for urban health that can guide future research in African urban settings.Global health impact for policy and action: This study reveals a crucial gap in evidence on evaluating the long-term impact of multisectoral interventions and calls for partnerships involving various sectors and robust community engagement to effectively deliver and sustain health-promoting policies and actions.

Prevalence and associated factors of overweight and obesity among persons with type 2 diabetes in Africa: a systematic review and meta-analysis

BACKGROUND

Type 2 diabetes and obesity are serious public health concerns globally and a growing burden in Africa. Both conditions have serious repercussions on health when they co-occur, yet the extent of their co-occurrence in Africa remains unknown. Therefore, this review aimed to identify the prevalence and associated factors of overweight and obesity among persons with type 2 diabetes in Africa.

METHOD

A systematic search was conducted on PubMed, MEDLINE, Embase, African Index Medicus (AIM), and African Journals Online (AJOL) for observational studies that reported the prevalence of overweight and/or obesity among type 2 diabetes patients in Africa. The prevalence data from individual studies were aggregated through a random-effects meta-analysis. The I² statistic was used to evaluate between-studies heterogeneity, while subgroup analysis and mixed-effects meta-regression were performed to identify sources of heterogeneity. We assessed publication bias using funnel plots and Egger's test. This review adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines.

RESULTS

Of 1753 records retrieved, 80 articles were eligible for this review, with 74 cross-sectional studies included in the meta-analysis. The pooled prevalence of overweight and obesity was 35.6% and 25.6% respectively, while the overall prevalence of both overweight and obesity was 61.4%. Also, the pooled prevalence of both overweight and obesity across the five geographical areas in Africa ranged from 56.9% in East Africa to 88.5% in Southern Africa. Nineteen factors were significantly associated with overweight and obesity among patients with type 2 diabetes.

CONCLUSION

The high prevalence of overweight and obesity among patients with type 2 diabetes is a significant public health concern that transcends geographical boundaries within Africa. The findings from this review highlight the need for innovative weight management interventions that are tailored to the cultural context of the African setting.KEY MESSAGESThere was a high prevalence of overweight and obesity among the type 2 diabetes patients.Nineteen factors were identified to be significantly associated with overweight and obesity among type 2 diabetes patients.Only 12 out of the 80 included studies primarily focused on the prevalence of overweight and/or obesity which reflects a dearth of interest in this topic.

Does obesity Kuznets curve exist in developing economies? Evidence from 38 African countries based on heterogeneous panel data analysis on income-level classification

Introduction

The global pandemic disease known as the obesity epidemic has spread throughout the planet. Particularly, Africa is facing a growing problem of obesity, and the trend is rising. This is a result of a ticking time bomb. Given the claim that multiple socio-economic factors significantly affect the diversity in obesity rates between nations, economic development can be seen as a key contributor to this variation.

Methods

Relying on the aforementioned avowal, this extant research examines the relationship between obesity and economic growth using urbanization, trade openness, and unemployment as intermittent variables within the Obesity Kuznets Curve (OKC) framework. Using panel data from 1990 to 2020, a panel of 38 African countries subdivided into income levels (Low income, Lower-middle income, and Upper-middle income) were analyzed. With the presence of residual cross-sectional reliance and slope heterogeneity, the Augmented Mean Group (AMG) econometric approach is employed.

Results

Key outcomes from the mentioned estimation method unveiled that economic growth positively impacts obesity among all the study panels. Variably, unemployment was evidenced to have a palpable positive impact on obesity concerning Low-income economies whereas on the side of the Lower-middle income panel together with Upper-middle income economies and the aggregated panel, a significant negative relationship is observed with obesity. Further, urbanization enhanced obesity in the Low-income panel and the aggregated panel of African nations, whereas an adverse effect is identified in both the Lower-middle and Upper-middle economies in Africa. Moreover, except for Low-income African economies, all the other panels of African nations in terms of income levels were noted to have a significant negative effect on obesity from trade openness.

Discussion

Finally, the long-run coefficients indicated that the OKC is valid among all panels of African countries. The study thus preferably suggests in African economies that addressing the inverted U-shape relationship between obesity and economic growth requires a multifaceted approach that considers the evolving dynamics of both factors. Policy makers should, therefore, aim to balance promoting economic growth and safeguarding public health through targeted interventions and long-term strategies.

The impact of obesity on postoperative complications and short-term survival after liver transplantation

BACKGROUND AND AIMS

Obesity is considered a risk factor for perioperative complications, but its effect on patients undergoing liver transplantation (LT) remains unclear. This study was conducted to analyze the impact of obesity on early morbidity and mortality risk following LT.

METHODS

A multicenter study of outcomes in patients submitted to LT between 2009 and 2019 was conducted. Recipients were stratified into obese (BMI ≥ 30 kg/m2) and nonobese patients (BMI < 30 kg/m2). Early postoperative complications were compared and 30-day and 1-year patient and graft survival were assessed by Kaplan-Meier method. Primary graft nonfunction (PGNF) was defined as the presence of total bilirubin > 10 mg/dl, INR > 1.6 or ALT > 2000 U/l within the first week after LT.

RESULTS

A total of 1608 patients were included after applying exclusion criteria, nonobese (1149, 71.46%) and obese patients (459, 28.54%). There were no significant differences in age, sex, Model for End-stage Liver Disease, Charlson comorbidity score, ethnicity, waiting list time and ischemia time. There were significantly higher rates of vascular (17.58% vs 23.53%, P = 0.021) and biliary complications (27.68% vs 35.73%, P = 0.006) and PGNF (11.40% vs 12.20%, P = 0.021) in obese patients. There was a significantly increased risk for long-term graft failure; however, there was no significant difference in patient survival after LT.

CONCLUSION

Obese patients have significantly increased morbidity in terms of vascular and biliary complications and PGNF after LT. They have a higher risk for worse 1-year graft survival in comparison to controls.

The prevalence and determinants of non-communicable diseases among Ghanaian adults: A survey at a secondary healthcare level

The current epidemiological transition of diseases in Ghana necessitates understanding their burden and the associated context-specific risk factors to inform disease prevention strategies. To determine the prevalence and determinants of selected Non-Communicable Diseases (NCDs) among patients seeking healthcare services in a secondary health facility in Ghana. A facility-based survey was conducted among adult patients 18 years and above between May and July 2021, using a multi-stage sampling approach. Data regarding the prevalence of NCDs, participants' socio-demographics and lifestyle factors of NCDs were obtained using Modified STEPwise Approach to NCD Risk Factor Surveillance (STEPS). The Chi-square test and regression analysis were performed to identify the risk factors of NCDs at P < 0.05. The participants comprised 480 patients with a mean age of 37.7±16.5 years, and 57.7% (277/480) of them were females. The overall prevalence of the selected NCDs was 26.7% (CI = 0.23-0.31), of which hypertension (22.7%) was the most prevalent. More than half (54.2%) of the participants engaged in alcohol consumption and 54% were physically inactive. The odds of developing NCDs were higher in females (CI = 1.32-4.10, P = 0.004), older adults (CI = 4.11-20.68, P <0.001), overweight/obese adults (CI = 1.65-4.70, P < 0.001), family history (CI = 0.15-0.46, P<0.001), and alcohol consumption (CI = 0.12-0.40, P < 0.001). There was an overall high prevalence of NCDs, strongly influenced by the participants' age, sex, BMI, alcohol consumption, and family history. These determinants should be highlighted as part of the campaign for preventive action plans.

Effects of social determinants of health on obesity among urban women of reproductive age

Obesity is a major global public health problem. It is spreading very fast in low- and middle-income countries and has reached world record levels in some of them. In Ghana, it has increased by over 65% among urban women in the past three decades. This study investigated the effects of social determinants of health on obesity among women in urban Ghana. The study analyzed the Ghana demographic and health survey data. These are nationally representative data collective every five years across low- and middle-income countries. A total of 1,204 urban women were included in the analysis. Body mass index was the outcome variable of interest. We used logistic regression to model the effects of the various social determinants of health on obesity. The results showed that 40% (95% confidence interval (CI) = 25.4, 57.0) and 36.7% (95% CI = 25.6, 49.3) of women who had higher education and those whose partners had higher education suffered from obesity, respectively. Women living in rich households had a five times higher prevalence of obesity than those in poor households (28.8% vs 5.7%). Further, 33.4% (95% CI = 18.5, 19.3) of women who occupied managerial positions were obese. The results from the multivariable logistic regression analysis suggested that compared to women in poor households, those in rich households were 3.4 times (95% CI = 1.31, 8.97) more likely to suffer from obesity. Women whose main occupation was agriculture were 81% (aOR = 0.19; 95% CI = 0.034, 0.99) less likely to suffer from obesity compared to those with no occupation. The results suggest that the various social determinants of health (SDH) included in the analysis significantly influence obesity outcomes. Women and partner education levels, occupying a managerial position, and living in rich households increase the risk of obesity. Interventions to address the rising obesity in urban Ghana should have specific packages targeted at these sub-groups.

Physical activity, lifestyle, sociocultural factors and prevalence of excess weight gain among postmenopausal women: A cross-sectional study

BACKGROUND

Most women experienced postmenopausal symptoms during the menopause transition, and they are a common reason for seeking medical attention and lifestyle modification during this phase of life.

OBJECTIVE

This study assessed the physical activity, lifestyle, and sociocultural levels-associated prevalence of excess weight (overweight and obesity) among postmenopausal women (PW) in Bono-East (Techiman) region, Ghana.

DESIGN

This is cross-sectional study.

METHOD

This was a cross-sectional study conducted at Bono-East regional capital, Techiman in Ghana over 5 months. Self-administered questionnaires were used to obtain sociodemographic data, physical activity, lifestyle, and sociocultural associated prevalence of excess weight. Anthropometric indices including ((body mass index (BMI), waist-to-height ratio (WHtR), and waist-to-hip ratio (WHR)) were assessed.

RESULTS

A total of 393 postmenopausal women with a mean age of 60.09 ± 6.24 years participated in the study. When reporting prevalence, obesity, and overweight were distinguished. Using the anthropometric parameters (BMI, WHtR, and WHR) as measured for being overweight, the prevalent rates were 35.7%, 21.7%, and 9.0% respectively. Also, when using obesity, the prevalent rate was 37.8%, 70.1%, and 82.0% using BMI, WHtR, and WHR, respectively. Over 55 (55.2%) of the study participants engaged in moderate physical activities, 23.1% were low and 21.7% with high physical activities. Housewives and unemployed participants are shown to have a higher risk of gaining weight (obese) especially when assessed with WHR and WHtR. Most participants responded that cultural beliefs prevent them from losing weight. Most participants had a poor attitude toward their eating habits.

CONCLUSION

According to the findings, postmenopausal Ghanaian women showed a high level of obesity and a moderate level of being overweight. The cultural perception of beauty influences Ghanaian postmenopausal women's physical activity level and dietary habits.

Multimorbidity in South Africa: Is the health system ready?

Background: Multimorbidity is likely to be a significant contributor to ill health and inequality in South Africa and yet has been largely overlooked. Purpose: This paper focuses on the findings of a recent large study that highlighted emerging issues - namely (i) the high levels of multimorbidity among three key groups - older adults, women, and the wealthy; (ii) discordant and concordant disease clusters among the multimorbid. Research Design: Narrative. Study Sample and Data Collection: Not applicable. Results: We discuss the implications of each emerging issue for health systems policy and practice. Conclusion: Although key policies are identified, many of these policies are not implemented and are therefore not part of routine practice, leaving much space for improvement.

Obesity Pillars Roundtable: Body mass index and body composition in Black and Female individuals. Race-relevant or racist? Sex-relevant or sexist?

Background

Body mass index (BMI or weight in kilograms/height in meters2) is the most common metric to diagnose overweight and obesity. However, a body composition analysis more thoroughly assesses adiposity, percent body fat, lean body mass (i.e., including skeletal muscle), and sometimes bone mineral density. BMI is not an accurate assessment of body fat in individuals with increased or decreased muscle mass; the diagnostic utility of BMI in individuals is also influenced by race and sex.

Methods

Previous Obesity Pillars Roundtables addressed the diagnostic limitations of BMI, the importance of android and visceral fat (especially among those with South and East Asian ancestry), and considerations of obesity among individuals who identify as Hispanic, diverse in sexual-orientation, Black, Native American, and having ancestry from the Mediterranean and Middle East regions. This roundtable examines considerations of BMI in Black and female individuals.

Results

The panelists agreed that body composition assessment was a more accurate measure of adiposity and muscle mass than BMI. When it came to matters of race and sex, one panelist felt: "race is a social construct and not a defining biology." Another felt that: "BMI should be a screening tool to prompt further evaluation of adiposity that utilizes better diagnostic tools for body composition." Regarding bias and misperceptions of resistance training in female individuals, another panelist stated: "I have spent my entire medical career taking care of women and have never seen a woman unintentionally gain 'too much' muscle mass and bulk up from moderate strength training."

Conclusions

Conveying the importance of race and sex regarding body composition has proven challenging, with the discussion sometimes devolving into misunderstandings or misinformation that may be perceived as racist or sexist. Body composition analysis is the ultimate diagnostic equalizer in addressing the inaccuracies and biases inherent in the exclusive use of BMI.

Magnitude and risks of overweight/obesity among adults in Welkite town, Southern Ethiopia: A community based cross-sectional study

Background

Currently, adult overweight/obesity affects a high proportion of the population in low and middle-income countries, mostly in urban areas. Although some studies have been conducted on overweight/obesity in Ethiopia, most of them have focused on school children and adolescents, and there is limited evidence of overweight/obesity among adults at the community level. Therefore, the present study aimed to assess the magnitude of overweight/obesity and risk factors among adults in Welkite town, Southern Ethiopia.

Methods

A Community-based cross-sectional study was done among 524 adults aged 18 and more years in Welkite town, Southern Ethiopia, from February through March 2020. A multistage sampling technique was undertaken to recruit study participants. An interviewer-guided structured questionnaire was used for data collection. Overweight or obesity was identified using body mass index. The bivariate and multivariate analyses were employed to see an association using binary logistic regression.

Results

The magnitude of overweight and obesity was 22.2% (95% CI: 0.19, 0.26). Being female (AOR = 2.40, 95% CI: 1.34, 4.27), age group 30–47 years (AOR = 3.26, 95% CI: 1.52, 6.97) and 48–66 years (AOR = 2.56, 95% CI: 1.07, 6.08), average monthly income (AOR = 2.64, 95% CI: 1.51, 4.60), had own transport (AOR = 2.48, 95% CI: 1.03, 5.93), eating meat ≥ four times per week (AOR = 3.33, 95% CI: 1.03, 10.74), not involve vigorous-intensity activity (AOR = 2.96, 95% CI: 1.55, 5.64), spent sitting or reclining ≥181 minutes per day (AOR = 1.88, 95% CI: 1.08, 3.26), and consuming alcohol (AOR = 2.23, 95% CI: 1.29, 3.82) were risks for overweight and obesity.

Conclusions

The magnitude of overweight and obesity among adults was high. Factors such as being female, increasing age, physical inactivity, having own transportation, high average monthly income, eating meat, sitting or reclining more and equal to 181+ minutes per day, and consumption of alcohol increased the risk of overweight and obesity significantly. Hence, preventive interventions focusing on females, age groups of 30-66yrs, encouraging Physical activity, reducing meat frequency, and reducing alcohol consumption are essential to prevent the emergence of adulthood overweight/obesity.

A retrospective database study of the demographic features and glycemic control of patients with type 2 diabetes in Kinshasa, Democratic Republic of the Congo

BACKGROUND

The Kin-Antwerp project aimed at improving the quality of care provided to patients with diabetes in Kinshasa, the Democratic Republic of the Congo in Central Africa, including the digitalisation of routine clinical data to improve patients' follow-up. We aim to analyse the data of a study population of Kin-Antwerp to characterise their demographic features, assess their achievement of glycemic target over time, and identify groups requiring prioritised attention.

METHODS

We performed a secondary database analysis of routinely collected information from primary care patients with type 2 diabetes followed from 1991 to 2019. Data included demographics (age, sex), anthropometrics (weight, height), clinical parameters (blood pressure, plasma glucose), and anti-diabetic treatments. Achievement of glycemic target, defined as fasting plasma glucose < 126 mg/dL, over time was assessed using a multilevel mixed-effects logistic regression model.

RESULTS

Our study population of patients with type 2 diabetes (N = 8976) comprised a higher proportion of women (67%) and patients between 40 and 65 years old (70.4%). At the first follow-up, most patients were on treatment with insulin (56.5%) and had glycemic levels under the target (79.9%). Women presented more often with obesity (27.4%) and high systolic blood pressure (41.8%) than men (8.6% and 37.0%, respectively). Patients had a median follow-up of 1.8 (interquartile range: 0.5-3.4) years. Overall, the odds of achieving glycemic target increased by 18.4% (odds ratio: 1.184, 95% CI: 1.130 to 1.239; p < 0.001) per year of follow-up. Stratified analyses suggested that the odds of achieving glycemic control over time increased among older patients (> 40 years), but not among younger patients (< 40 years).

CONCLUSION

In our study population, an overall poor glycemic control was observed albeit with a modest improvement in the achievement of glycemic target throughout patients' follow-up. Younger patients may benefit from prioritised attention to achieve glycemic targets. Based on the information provided by the database, continue monitoring and improvement of the project Kin-Antwerp is recommended. Introducing further efforts to improve type 2 diabetes management should include robust glycemia-monitoring tools and haemoglobin A1c, as well as further outlining self-management strategies.

Inequity in the Distribution of Non-Communicable Disease Multimorbidity in Adults in South Africa: An Analysis of Prevalence and Patterns

Objectives: The present study examined the prevalence and patterns of non-communicable disease multimorbidity by wealth quintile among adults in South Africa.

Methods: The South African National Income Dynamics Study Wave 5 was conducted in 2017 to examine the livelihoods of individuals and households. We analysed data in people aged 15 years and older (N = 27,042), including self-reported diagnosis of diabetes, stroke, heart disease and anthropometric measurements. Logistic regression and latent class analysis were used to analyse factors associated with multimorbidity and common disease patterns.

Results: Multimorbidity was present in 2.7% of participants. Multimorbidity was associated with increasing age, belonging to the wealthiest quintile group, increasing body mass index and being a current smoker. Having secondary education was protective against multimorbidity. Three disease classes of multimorbidity were identified: Diabetes and Hypertension; Heart Disease and Hypertension; and Stroke and Hypertension.

Conclusion: Urgent reforms are required to improve health systems responsiveness to mitigate inequity in multimorbidity patterns in the adult population of South Africa as a result of income inequality.

Socioeconomic inequalities in intergenerational overweight and obesity transmission from mothers to offsprings in South Africa

This study assesses socioeconomic inequality in the intergenerational transmission of overweight and obesity from mothers to offsprings in South Africa, including the factors contributing to inequality. Data were drawn from the 2017 National Income Dynamic Study, which collected anthropometric and socioeconomic information. Non-pregnant mothers aged 15–49 years and their offsprings 0–14 years were included in the analysis. The dependent variables used in the study were the intergenerational transmission of overweight and obesity. Socioeconomic inequality was assessed using the concentration index. A positive index means that intergenerational overweight and obesity is more likely among the wealthier populations, while a negative index signifies the opposite. The concentration index was decomposed to understand the factors that explain inequalities in the transmission of overweight and obesity from mothers to offsprings. Concentration indices for the intergenerational transmission of overweight and obesity were positive for boys (0.17) and girls (0.23). Thus the intergenerational transmission of overweight and obesity occurs more among wealthier mothers. Although factors explaining socioeconomic inequality in the intergenerational transmission of overweight and obesity differed by offspring sex, mother's marital status (+38%) and socioeconomic status (around +8%) were central determinants of socioeconomic inequalities in intergenerational overweight, while mother's smoking (around +25%), education (about +13%) and employment status (around +12%) contributed to intergenerational obesity inequality. Policies to reduce overweight and obesity burdens and the intergenerational transmission of overweight and obesity in South Africa should target women who bear a significant burden of overweight and obesity and could transmit them to their offsprings. The policies should also recognise the key factors explaining these socioeconomic inequalities. This approach will reduce the future burden of diseases associated with overweight and obesity in South Africa and improve the country's overall health outcomes.

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Intergenerational overweight and obesity occurs more among richer mothers.

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Mother's marital status influenced intergenerational overweight inequality.

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Intergenerational obesity inequality was attributed to mother's smoking status.

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Factors explaining intergenerational health inequalities differed by offspring sex.

Interactions between Vitamin D Genetic Risk and Dietary Factors on Metabolic Disease-Related Outcomes in Ghanaian Adults

The Ghanaian population is experiencing an upsurge in obesity and type 2 diabetes (T2D) due to rapid urbanization. Besides dietary factors, vitamin D-related genetic determinants have also been shown to contribute to the development of obesity and T2D. Hence, we aimed to examine the interactions between dietary factors and vitamin D-related genetic variants on obesity and T2D related outcomes in a Ghanaian population. Three hundred and two healthy Ghanaian adults (25-60 years old) from Oforikrom, Municipality in Kumasi, Ghana were randomly recruited and had genetic tests, dietary consumption analysis, and anthropometric and biochemical measurements of glucose, HbA1c, insulin, cholesterol, and triglycerides taken. A significant interaction was identified between vitamin D-GRS and fiber intake (g/day) on BMI (pinteraction = 0.020) where those who were consuming low fiber (≤16.19 g/d) and carrying more than two risk alleles for vitamin D deficiency (p = 0.01) had a significantly higher BMI. In addition, an interaction between vitamin D-GRS and fat intake (g/day) on HbA1c (total fat, pinteraction = 0.029) was found, where participants who had a lower total fat intake (≤36.5 g/d), despite carrying more than two risk alleles, had significantly lower HbA1c (p = 0.049). In summary, our study has identified novel gene-diet interactions of vitamin D-GRS with dietary fiber and fat intakes on metabolic traits in Ghanaian adults.

Effect of age and sex on the associations between potential modifiable risk factors and both type 2 diabetes and impaired fasting glycaemia among West African adults

Background

Type 2 diabetes mellitus (T2DM) is becoming one of the leading causes of morbidity and mortality worldwide, including among Africans. Knowledge of the association between traditional risk factors and both diabetes and pre-diabetes, and whether these differ by age and sex, is important for designing targeted interventions. However, little is known about these associations for African populations.

Methods

The study used data from WHO STEPS surveys, comprising 15,520 participants (6,774 men and 8,746 women) aged 25–64 years, from 5 different West African countries, namely Burkina Faso (4,711), Benin (3,816), Mali (1,772), Liberia (2,594), and Ghana (2,662). T-test and chi-square tests were used to compare differences in the prevalence of traditional risk factors for both sexes. Multinomial logistic regression was conducted to ascertain the relative risks (RR) and 95% confidence intervals (CI) for both T2DM and impaired fasting glucose (IFG) relating to each risk factor, including obesity [defined by BMI, waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR)], high blood pressure (HBP), fruit and vegetable consumption, physical inactivity, alcohol consumption, and smoking. Models for each of these traditional risk factors and interactions with age and sex were fitted.

Results

Factors associated with T2DM and IFG were age, obesity [defined by BMI, WC, WHtR, and WHR], HBP, smoking, physical inactivity, and fruit and vegetable consumption (p < 0.05). Analysis of interaction effects showed few significant differences in associations between risk factors and T2DM according to age or sex. Significant interaction with age was observed for HBP*age and T2DM [RR; 1.20, 95% CI: (1.01, 1.42)) (p = 0.04)], WHtR*age and T2DM [RR; 1.23, 95% CI: (1.06, 1.44) (p = 0.007)] and WHR*age and IFG [RR: 0.79, 95% CI: (0.67, 0.94) (p = 0.006)]. Some interactions with age and sex were observed for the association of alcohol consumption and both IFG and T2DM, but no clear patterns were observed.

Conclusion

The study found that with very few exceptions, associations between traditional risk factors examined and both IFG and T2DM did not vary by age or sex among the West African population. Policies and public health intervention strategies for the prevention of T2DM and IFG should target adults of any age or sex in West Africa.

Overweight and obesity in non-pregnant women of childbearing age in South Africa: subgroup regression analyses of survey data from 1998 to 2017

Background

Overweight and obesity in adults are increasing globally and in South Africa (SA), contributing substantially to deaths and disability from non-communicable diseases. Compared to men, women suffer a disproportionate burden of obesity, which adversely affects their health and that of their offspring. This study assessed the changing patterns in prevalence and determinants of overweight and obesity among non-pregnant women in SA aged 15 to 49 years (women of childbearing age (WCBA)) between 1998 and 2017.

Methods

This paper conducts secondary data analysis of seven consecutive nationally representative household surveys—the 1998 and 2016 SA Demographic and Health Surveys, 2008, 2010–2011, 2012, 2014–2015 and 2017 waves of the National Income Dynamics Survey, containing anthropometric and sociodemographic data. The changing patterns of the overweight and obesity prevalence were assessed across key variables. The inferential assessment was based on a standard t-test for the prevalence. Adjusted odds ratios from logistic regression analysis were used to examine the factors associated with overweight and obesity at each time point.

Results

Overweight and obesity prevalence among WCBA in SA increased from 51.3 to 60.0% and 24.7 to 35.2%, respectively, between 1998 and 2017. The urban-rural disparities in overweight and obesity decreased steadily between 1998 and 2017. The prevalence of overweight and obesity among WCBA varied by age, population group, location, current smoking status and socioeconomic status of women. For most women, the prevalence of overweight and/or obesity in 2017 was significantly higher than in 1998. Significant factors associated with being overweight and obese included increased age, self-identifying with the Black African population group, higher educational attainment, urban area residence, and wealthier socioeconomic quintiles. Smoking was inversely related to being overweight and obese.

Conclusions

The increasing trend in overweight and obesity in WCBA in SA demands urgent public health attention. Increased public awareness is needed about obesity and its health consequences for this vulnerable population. Efforts are needed across different sectors to prevent excessive weight gain in WCBA, focusing on older women, self-identified Black African population group, women with higher educational attainment, women residing in urban areas, and wealthy women.

Overall and central obesity and prostate cancer risk in African men

PURPOSE

African men are disproportionately affected by prostate cancer (PCa). Given the increasing prevalence of obesity in Africa, and its association with aggressive PCa in other populations, we examined the relationship of overall and central obesity with risks of total and aggressive PCa among African men.

METHODS

Between 2016 and 2020, we recruited 2,200 PCa cases and 1,985 age-matched controls into a multi-center, hospital-based case-control study in Senegal, Ghana, Nigeria, and South Africa. Participants completed an epidemiologic questionnaire, and anthropometric factors were measured at clinic visit. Multivariable logistic regression was used to examine associations of overall and central obesity with PCa risk, measured by body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR), respectively.

RESULTS

Among controls 16.4% were obese (BMI ≥ 30 kg/m2), 26% and 90% had WC > 97 cm and WHR > 0.9, respectively. Cases with aggressive PCa had lower BMI/obesity in comparison to both controls and cases with less aggressive PCa, suggesting weight loss related to cancer. Overall obesity (odds ratio: OR = 1.38, 95% CI 0.99-1.93), and central obesity (WC > 97 cm: OR = 1.60, 95% CI 1.10-2.33; and WHtR > 0.59: OR = 1.68, 95% CI 1.24-2.29) were positively associated with D'Amico intermediate-risk PCa, but not with risks of total or high-risk PCa. Associations were more pronounced in West versus South Africa, but these differences were not statistically significant.

DISCUSSION

The high prevalence of overall and central obesity in African men and their association with intermediate-risk PCa represent an emerging public health concern in Africa. Large cohort studies are needed to better clarify the role of obesity and PCa in various African populations.

A comprehensive review on phytochemicals for fatty liver: are they potential adjuvants?

Non-alcoholic fatty liver disease (NAFLD) is considered the hepatic manifestation of metabolic syndrome and, as such, is associated with obesity. With the current and growing epidemic of obesity, NAFLD is already considered the most common liver disease in the world. Currently, there is no official treatment for the disease besides weight loss. Although there are a few synthetic drugs currently being studied, there is also an abundance of herbal products that could also be used for treatment. With the World Health Organization (WHO) traditional medicine strategy (2014-2023) in mind, this review aims to analyze the mechanisms of action of some of these herbal products, as well as evaluate toxicity and herb-drug interactions available in literature.

Association Between Some Different Obesity Anthropometric Indices and Type 2 Diabetes Mellitus in Middle-Aged and Elderly Chinese Men and Women in Beijing, China: A Cross-Sectional Study

BACKGROUND

Obesity can lead to the development of type 2 diabetes mellitus (T2DM). However, the predictive power of different obesity anthropometric indices (ObAIs) for T2DM varies with race and geographical area. Therefore, the study aimed to investigate the association between different ObAIs and T2DM and determine the best index for screening T2DM in middle-aged and elderly men and women in Beijing, China.

METHODS

A cross-sectional study was conducted in Shijingshan district (Beijing, China) from November 2011 to August 2012, involving a total of 14,558 subjects aged ≥40 years. Data on demographic information, lifestyle, history of T2DM, hypertension and dyslipidemia were collected. Body height, body weight, waist circumference (WC), hip circumference, and blood pressure were recorded. The oral glucose tolerance test or a standard meal test and blood lipid test were performed. The relationship between different ObAIs and T2DM was analyzed using multiple logistic regression.

RESULTS

After adjustment for age, smoking status, alcohol intake, occupation and education degree, diabetes family history, hypertension and dyslipidemia, body mass index (BMI), WC, waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) were positively associated with T2DM in both men and women. Compared with the lowest BMI, WC, WHR, and WHtR quartiles, ORs of the highest quartiles were 2.131 (95% CI: 1.465-3.099), 1.752 (95% CI: 1.270-2.417), 1.342 (95% CI: 1.072-1.678), 2.739 (95% CI: 2.293-3.271) in men and 1.837 (95% CI: 1.584-2.130), 3.122 (95% CI: 1.980-4.924), 3.781 (95% CI: 2.855-5.007), 2.379 (85% CI: 2.040-2.775), respectively, in women. The areas under ROC curve of BMI, WC, WHR, and WHtR for men were 0.584 (95% CI: 0.568-0.600), 0.509 (95% CI: 0.492-0.525), 0.501 (95% CI: 0.485-0.518), and 0.642 (95% CI: 0.627-0.658) and 0.619 (95% CI: 0.607-0.632), 0.709 (95% CI: 0.697-0.720), 0.741 (95% CI: 0.730-0.752), and 0.654 (95% CI: 0.642-0.666), respectively, for women.

CONCLUSION

WHtR and WHR have been found to perform better as predictors of T2DM in middle-aged and elderly Chinese men and women, respectively.

Multilevel Analysis of Urban-Rural Variations of Body Weights and Individual-Level Factors among Women of Childbearing Age in Nigeria and South Africa: A Cross-Sectional Survey

Background: An unhealthy body weight is an adverse effect of malnutrition associated with morbidity among women of childbearing age. While there is increasing attention being paid to the body weights of children and adolescents in Nigeria and South Africa, a major surge of unhealthy body weight in women has received less attention in both countries despite its predominance. The purpose of this study was to explore the prevalence of body weights (underweight, normal, overweight, and obese) and individual-level factors among women of childbearing age by urban-rural variations in Nigeria and South Africa. Methods: This study used the 2018 Nigeria Demographic Health Survey data (n = 41,821) and 2016 South Africa Demographic Health Survey (n = 8514). Bivariate, multilevel, and intracluster correlation coefficient analyses were used to determine individual-level factors associated with body weights across urban-rural variations. Results: The prevalence of being overweight or obese among women was 28.2% and 44.9%, respectively, in South Africa and 20.2% and 11.4% in Nigeria. A majority, 6.8%, of underweight women were rural residents in Nigeria compared to 0.8% in South Africa. The odds of being underweight were higher among women in Nigeria who were unemployed, with regional differences and according to breastfeeding status, while higher odds of being underweight were found among women from poorer households, with differences between provinces and according to cigarette smoking status in South Africa. On the other hand, significant odds of being overweight or obese among women in both Nigeria and South Africa were associated with increasing age, higher education, higher wealth index, weight above average, and traditional/modern contraceptive use. Unhealthy body weights were higher among women in clustering areas in Nigeria who were underweight (intracluster correlation coefficient (ICC = 0.0127), overweight (ICC = 0.0289), and obese (ICC = 0.1040). Similarly, women of childbearing age in clustering areas in South Africa had a lower risk of experiencing underweight (ICC = 0.0102), overweight (ICC = 0.0127), and obesity (ICC = 0.0819). Conclusions: These findings offer a deeper understanding of the close connection between body weights variations and individual factors. Addressing unhealthy body weights among women of childbearing age in Nigeria and South Africa is important in preventing disease burdens associated with body weights in promoting Sustainable Development Goal 3. Strategies for developing preventive sensitization interventions are imperative to extend the perspectives of the clustering effect of body weights on a country level when establishing social and behavioral modifications for body weight concerns in both countries.

The Lancet women and cardiovascular disease Commission: reducing the global burden by 2030

Cardiovascular disease is the leading cause of death in women. Decades of grassroots campaigns have helped to raise awareness about the impact of cardiovascular disease in women, and positive changes affecting women and their health have gained momentum. Despite these efforts, there has been stagnation in the overall reduction of cardiovascular disease burden for women in the past decade. Cardiovascular disease in women remains understudied, under-recognised, underdiagnosed, and undertreated. This Commission summarises existing evidence and identifies knowledge gaps in research, prevention, treatment, and access to care for women. Recommendations from an international team of experts and leaders in the field have been generated with a clear focus to reduce the global burden of cardiovascular disease in women by 2030. This Commission represents the first effort of its kind to connect stakeholders, to ignite global awareness of sex-related and gender-related disparities in cardiovascular disease, and to provide a springboard for future research.

Carbohydrate-dense snacks are a key feature of the nutrition transition among Ghanaian adults - findings from the RODAM study

BACKGROUND

African populations in sub-Saharan Africa and African migrants in Europe are facing a rapid upsurge in obesity. This trend has been related to urbanization, migration and associated shifts in lifestyle, including dietary habits. Whether changes in eating patterns contribute to the rising burden of obesity among African populations is currently unknown.

OBJECTIVE

Our aims in conducting this study were to characterize eating patterns among Ghanaian adults living in their country of origin and in Europe and to explore associations of meal patterns with body mass index (BMI).

DESIGN

Within the cross-sectional RODAM (Research on Obesity and Diabetes among African Migrants) study, data of single 24-h dietary recalls from Ghanaian adults in rural Ghana (n = 20), urban Ghana (n = 42), and Europe (n = 172) were recorded. Eating frequencies, energy intake, and macronutrient composition of eating occasions (EOs, i.e. meals or snacks) were compared between study sites based on descriptive statistics and χ 2-/Kruskal-Wallis tests.

RESULTS

A rising gradient of EO frequencies from rural Ghana through urban Ghana to Europe was observed, mainly reflecting the differences in snacking frequencies (≥1 snack per day: 20 vs. 48 vs. 52%, P = 0.008). Meal frequencies were similar across study sites (≥3 meals per day: 30 vs. 33 vs. 38%, P = 0.80). Meals were rich in carbohydrates (median 54.5, interquartile range (IQR): 43.2-64.0 energy%) and total fats (median: 27.0, IQR: 19.9-34.4 energy %); their protein content was lowest in rural Ghana, followed by urban Ghana and Europe (P = 0.0005). Snacks mainly contained carbohydrates (median: 75.7, IQR: 61.0-89.2 energy%). In linear regression analyses, there was a non-significant trend for an inverse association between snacking frequencies and BMI.

DISCUSSION AND CONCLUSIONS

The observed integration of carbohydrate-dense snacks into the diet supports the growing evidence for a nutrition transition among African populations undergoing socioeconomic development. This analysis constitutes a starting point to further investigate the nutritional implications of increased snacking frequencies on obesity and metabolic health in these African populations.

Monitoring Information-Seeking Patterns and Obesity Prevalence in Africa With Internet Search Data: Observational Study

BACKGROUND

The prevalence of chronic conditions such as obesity, hypertension, and diabetes is increasing in African countries. Many chronic diseases have been linked to risk factors such as poor diet and physical inactivity. Data for these behavioral risk factors are usually obtained from surveys, which can be delayed by years. Behavioral data from digital sources, including social media and search engines, could be used for timely monitoring of behavioral risk factors.

OBJECTIVE

The objective of our study was to propose the use of digital data from internet sources for monitoring changes in behavioral risk factors in Africa.

METHODS

We obtained the adjusted volume of search queries submitted to Google for 108 terms related to diet, exercise, and disease from 2010 to 2016. We also obtained the obesity and overweight prevalence for 52 African countries from the World Health Organization (WHO) for the same period. Machine learning algorithms (ie, random forest, support vector machine, Bayes generalized linear model, gradient boosting, and an ensemble of the individual methods) were used to identify search terms and patterns that correlate with changes in obesity and overweight prevalence across Africa. Out-of-sample predictions were used to assess and validate the model performance.

RESULTS

The study included 52 African countries. In 2016, the WHO reported an overweight prevalence ranging from 20.9% (95% credible interval [CI] 17.1%-25.0%) to 66.8% (95% CI 62.4%-71.0%) and an obesity prevalence ranging from 4.5% (95% CI 2.9%-6.5%) to 32.5% (95% CI 27.2%-38.1%) in Africa. The highest obesity and overweight prevalence were noted in the northern and southern regions. Google searches for diet-, exercise-, and obesity-related terms explained 97.3% (root-mean-square error [RMSE] 1.15) of the variation in obesity prevalence across all 52 countries. Similarly, the search data explained 96.6% (RMSE 2.26) of the variation in the overweight prevalence. The search terms yoga, exercise, and gym were most correlated with changes in obesity and overweight prevalence in countries with the highest prevalence.

CONCLUSIONS

Information-seeking patterns for diet- and exercise-related terms could indicate changes in attitudes toward and engagement in risk factors or healthy behaviors. These trends could capture population changes in risk factor prevalence, inform digital and physical interventions, and supplement official data from surveys.

Understanding cardiovascular disease in day-to-day living for African people: a qualitative metasynthesis

BACKGROUND

Globally, cardiovascular disease (CVD) accounts for 45% of all chronic non-communicable disease deaths and 31% of all deaths. CVD has remained the primary cause of death in the world for the past fifteen years. Compared to other continents, CVD and its risk factors are highly prevalent in Africa, but the continent also displays a low-level of knowledge and awareness of CVD, and poor perception of its risk factors. Little research has been done on the connection between the daily lived experiences of African people and the high prevalence and poor perception of CVD and its risk factors on the African continent. The aim of this study is to provide an in-depth understanding of the daily, lived experiences of African people and the connections between these experiences and the prevention, control, and management of CVD and its risk factors.

METHODS

A systematic search was performed in PubMed, CINAHL, EMBASE, Psych INFO, and Web of Science databases to identify published English qualitative studies of CVD and its risk factors. Qualitative metasynthesis included structured techniques of data immersion and quality appraisal, thematic synthesis, and reciprocal translation.

RESULTS

Seven studies met the inclusion criteria. Four major themes were identified from the metasynthesis: 1) understanding and beliefs about CVD; 2) perceived causes/risk factors for CVD; 3) understanding and belief about obesity; 4) perceived treatment options for CVD. The metasynthesis identified a consistent disconnect among African people between seeing CVD as a deadly and chronic disease and their perceptions of the minimal signs and symptoms of the disease in the early stages. This was further compounded by the gap between traditional healers and health care professionals.

CONCLUSIONS

Perceptions of CVD, its risk factors, and treatments were influenced by religious and cultural factors. Given the minimal signs and symptoms experienced in the early stages of the disease, there was a consistent disconnect among African people between seeing CVD as a deadly and chronic illness. Further investigations of the religious and cultural influences and educational programs related to these areas of disconnect are needed to improve the knowledge, attitudes, and beliefs of African people.

The association between fetal growth and neonatal adiposity in urban South African infants

OBJECTIVE

To examine associations between maternal body mass index (BMI), gestational weight gain (GWG) and fetal growth and neonatal adiposity in urban South Africans.

METHODS

Maternal BMI was assessed at recruitment and GWG (kg/week) was calculated. Longitudinal fetal growth was measured via ultrasound and modelled using Superimposition by Translation and Rotation (SITAR). Neonatal adiposity was assessed using air displacement plethysmography or dual-energy X-ray absorptiometry. Multiple linear regression models were used to examine associations between maternal BMI, GWG and SITAR fetal growth parameters and neonatal fat mass index (FMI; kg/m³ ) in 304 mother-neonate pairs.

RESULTS

In pooled analyses, longitudinally modelled abdominal circumference size (β = 0.64 kg/m³ , P < .001) and velocity (β = 8.39 kg/m³ , P < .001) and biparietal diameter velocity (β = 4.55 kg/m³ , P = .020) were positively associated with neonatal FMI. GWG was positively associated with neonatal FMI in preliminary models (β = 1.07 kg/m³ per 1 kg/week; P = .040), with pooled models indicating mediation via fetal growth.

CONCLUSION

In utero abdominal growth is predictive of neonatal adiposity. Additionally, greater fetal growth - particularly of the abdominal circumference - mediates the effect of GWG on neonatal adiposity. In settings such as South Africa, strategies to ensure healthy pregnancy weight gain can contribute to prevention of intergenerational obesity risk.

Temporal, geographical and demographic trends of stroke prevalence in China: a systematic review and meta-analysis

Background

China has made large efforts to reduce stroke prevalence. We aimed to systematically examine the prevalence of stroke in China over the past two decades.

Methods

Databases, including China National Knowledge Infrastructure, Wanfang, VIP, and PubMed, were systematically searched for studies published in English or Chinese that reported stroke prevalence in China during 2000–2017. Meta-analysis was conducted to estimate the pooled stroke prevalence and the variations in stroke prevalence subgroups stratified by age, gender, time period, and region.

Results

In total, 96 papers met the inclusion criteria. Meta-analysis showed that the overall estimated national prevalence was 5.1% (5.0–5.3%) with large variations across regions: 3.1% (2.5–3.6%) in south China, 3.4% (3.0–3.8%) in southwest China, 3.6% (3.3–3.8%) in east China, 5.0% (4.7–5.4%) in central China, 5.8% (4.6–7.1%) in northwest China, 6.0% (5.0–7.0%) in northeast China, and 8.0% (7.4–8.5%) in north China. Men had a higher prevalence than women [7.3% (6.9–7.7%) vs. 5.6% (5.2–6.0%)]. Stroke prevalence increased with age, was 1.2% (1.0–1.3%), 2.9% (2.6–3.2%), 5.9% (5.2–6.5%), and 8.7% (8.0–9.5%) in the 40–49, 50–59, 60–69, and ≥70 years old groups, respectively.

Conclusions

Men, people being older, or living in northern China had higher stroke prevalence. More vigorous efforts are needed in China to prevent stroke.

Magnitude of Overweight, Obesity and Insufficient Physical Sports Activities Among Secondary School Students in Kinondoni Municipal, Dar es Salaam

INTRODUCTION

There is an overwhelming increase of Non-Communicable Disease worldwide such as diabetes and cardiovascular diseases. Overweight and obesity are highly associated with development of these diseases. Unhealthy lifestyle such as excessive sugar, alcohol intake and lack of adequate physical activities has been associated with development of obesity. However, these risk factors are not well elucidated among adolescents in Tanzania. We conducted this survey to determine obesity, overweight, self-reported physical activities, and preferred foods among secondary school students in Kinondoni Municipal in Dar es salaam, Tanzania.

METHODS

A cross sectional descriptive survey was conducted among secondary school students at Kambangwa and Makumbusho secondary schools in Kinondoni municipal in Dar es Salaam city. A simple random sampling technique was used to select participating schools with systemic random selection procedure was used to select participants. A pre structured, self-administered questionnaire was used to collect demographic information from the participants. Anthropometric measurement for Body Mass Index (BMI) was done using standard tools. Interpretation of the findings was done using World Health Organization (WHO) standard charts for age and sex. Data were analysed using Statistical Package for Social Sciences (SPSS version 20; SPSS Inc., Chicago, US).

RESULTS

A total of 234 participants were enrolled in the study. A total of 204 (87.2%) of study participants reported to regularly participate in physical sports activities. Furthermore, Males reported to participate more in physical sports activities compared to females (χ2 (1) =8.13., p = 0.004). During sex-wise comparison, 30 (46.2%) of males reported to participate in sports once per week compared to 71 (51.5%) of females. Reported frequency was influenced by participants' sex (χ2 (3) =16.4., p= 0.001). A total of 28 (12%) participants reported fruits as their favourite food. Food preference was influenced by the participants' sex (X 2 (5) =13.1., p < 0.02). 32(47.7%) of males reported fresh fruits juice as their favourite drink compared to 106(63.5%) of females) while 6(9%) of males reported to prefer commercial industrial juice compared to 4 (2.4%) of females.

CONCLUSION

Obesity and overweight are prevalent among secondary school adolescents in Kinondoni Municipal, Dar es salaam. In addition, the magnitude of physical activities was below the recommended amount. Therefore, awareness campaigns and advocacy programs aiming at preventive measures against NCDs such as healthy eating behaviour and promotion of physical activities among adolescents should be given high priority.

Bone Metabolism in Adolescents and Adults Undergoing Roux-En-Y Gastric Bypass: a Comparative Study

OBJECTIVE

To compare the bone metabolism of adolescents and adults with obesity before undergoing a Roux-en-Y gastric bypass (RYGB) and 6 and 12 months after the surgery.

MATERIALS AND METHODS

Adolescents (G1) and adults (G2) with obesity assessed before (T0), six (T1), and 12 months after (T2) RYGB. Sun exposure, serum concentrations of 25(OH)D, calcium, phosphorous, magnesium, zinc, alkaline phosphatase, parathyroid hormone (PTH), and bone mineral density (BMD) were evaluated.

RESULTS

Sixty adolescents and 60 adults were assessed. At T0, there was no significant difference between the groups' serum 25(OH)D levels (G1 21.87 + 7.52 ng/mL, G2 21.73 + 7.60 ng/mL, p = 0.94) or sun exposure (G1 17 ± 2.0 min/day, G2 13.2 ± 5.2 min/day, p = 0.85). G1 had high levels of inadequacy of calcium (66.7%), phosphorous (80.0%), and zinc (18.3%) at T0 and had a significant fall in their 25(OH)D (p < 0.01) and magnesium (p < 0.01) levels from T1 to T2. G2 saw a significant lowering of their serum zinc levels from T0 to T1 and T2 (T1 p < 0.01; T2 p < 0.01). In both groups, there was a significant rise in PTH from T1 to T2 (G1 p = 0.04, G2 p = 0.02) and from T0 to T2 (G1 and G2 p < 0.01). In G2, 40.4% of individuals with osteopenia and osteoporosis presented inadequacy of 25(OH)D.

CONCLUSION

RYGB was found to worsen the inadequacy of micronutrients related to bone metabolism and was associated with secondary hyperparathyroidism and low BMD values, especially among the adolescents. The irreversible damaging effects of obesity on bone metabolism can occur in adolescence.

Evaluation of Several Anthropometric and Metabolic Indices as Correlates of Hyperglycemia in Overweight/Obese Adults

AIM

Rapid and growing rise in obesity and diabetes mellitus, as serious human health-threatening issues, is alarming. The aim of the present study was assessing the accuracy of several obesity indices to predict hyperglycemia in overweight and obese Iranian populations and determining the value of such indices in comparison to the conventional parameters. We also evaluated new latent combined scores in this matter.

PATIENTS AND METHODS

Overall, there were 2088 patients recruited from the weight loss clinic of Sina Hospital, an educational hospital of Tehran University of Medical Sciences for this cross-sectional study. Demographic information, anthropometric indices and biochemical measurements were collected and calculated. The multivariable regression modeling as well as area under the receiver-operating characteristic (ROC) analysis was used. To detect the existence of new combined scores, we used SEM (structural equation modeling) analysis through SmartPLS.

RESULTS

Combined latent scores and WHtR (waist-to-height ratio) gave us a higher area under the curve in predicting hyperglycemia associated with WC (waist circumference) in women, whereas FFMI (fat-free mass index) gave low values. Additionally, BRI (body roundness index) and latent scores had slightly higher AUC values in predicting hyperglycemia in men. According to the age-adjusted odds ratio (OR) in the presence of hyperglycemia, OR was the highest for WHR (waist to hip ratio) in women (OR, 7.74; 95% confidence interval [CI], 1.71-15.13). The association of WHR and hyperglycemia remained significant by adjusting for BMI (body mass index), WC and menopausal status.

CONCLUSION

WHR had the strongest association with hyperglycemia in women with only sufficient discrimination ability. However, neither BSI (body shape index) and BAI (body adiposity index) nor FMI (fat mass index) and FFMI were superior to BMI (body mass index), WC or WHtR in predicting hyperglycemia. It was revealed that BRI and combined scores had a more predictive power compared to the BSI, BAI, FMI and FFMI, simplifying hyperglycemia evaluation.

Health service utilization and direct healthcare costs associated with obesity in older adult population in Ghana

Obesity is a major risk factor for many chronic diseases and disabilities, with severe implications on morbidity and mortality among older adults. With an increasing prevalence of obesity among older adults in Ghana, it has become necessary to develop cost-effective strategies for its management and prevention. However, developing such strategies is challenging as body mass index (BMI)-specific utilization and costs required for cost-effectiveness analysis are not available in this population. Therefore, this study examines the associations between health services utilization as well as direct healthcare costs and overweight (BMI ≥25.00 and &lt;30.00 kg/m2) and obesity (BMI ≥30.00 kg/m2) among older adults in Ghana. Data were used from a nationally representative, multistage sample of 3350 people aged 50+ years from the World Health Organization’s Study on global AGEing and adult health (WHO-SAGE; 2014/15). Health service utilization was measured by the number of health facility visits over a 12-month period. Direct costs (2017 US dollars) included out-of-pocket payments and the National Health Insurance Scheme (NHIS) claims. Associations between utilization and BMI were examined using multivariable zero-inflated negative binomial regressions; and between costs and BMI using multivariable two-part regressions. Twenty-three percent were overweight and 13% were obese. Compared with normal-weight participants, overweight and obesity were associated with 75% and 159% more inpatient admissions, respectively. Obesity was also associated with 53% additional outpatient visits. One in five of the overweight and obese population had at least one chronic disease, and having chronic disease was associated with increased outpatient utilization. The average per person total costs for overweight was $78 and obesity was $132 compared with $35 for normal weight. The NHIS bore approximately 60% of the average total costs per person expended in 2014/15. Overweight and obese groups had significantly higher total direct healthcare costs burden of $121 million compared with $64 million for normal weight in the entire older adult Ghanaian population. Compared with normal weight, the total costs per person associated with overweight increased by 73% and more than doubled for obesity. Even though the total prevalence of overweight and obesity was about half of that of normal weight, the sum of their cost burden was almost doubled. Implementing weight reduction measures could reduce health service utilization and costs in this population.

Rapidly increasing prevalence of overweight and obesity in older Ghanaian adults from 2007-2015: Evidence from WHO-SAGE Waves 1 & 2

BACKGROUND

Studies on changes in the prevalence and determinants of obesity in older adults living in sub-Saharan Africa are scarce. We examined recent changes in obesity prevalence and associated factors for older adults in Ghana between 2007/08 and 2014/15.

METHODS

Data on adults aged 50 years and older in Ghana were drawn from the WHO SAGE 2007/08 (Wave 1; n = 4158) and 2014/15 (Wave 2; n = 1663). The weighted prevalence of obesity, overweight, normal weight and underweight, and of high central adiposity were compared in 2007/08 and 2014/15. Multinomial and binomial logistic regressions were used to examine whether the determinants of weight status based on objectively measured body mass index and waist circumference changed between the two time periods.

RESULTS

The prevalence of overweight (2007/08 = 19.6%, 95% CI: 18.0-21.4%; 2014/15 = 24.5%, 95% CI: 21.7-27.5%) and obesity (2007/08 = 10.2%, 95% CI: 8.9-11.7%; 2014/15 = 15.0%, 95% CI: 12.6-17.7%) was higher in 2014/15 than 2007/08 and more than half of the population had high central adiposity (2007/08 = 57.7%, 95% CI: 55.4-60.1%; 2014/15 = 66.9%, 95% CI: 63.7-70.0%) in both study periods. While the prevalence of overweight increased in both sexes, obesity prevalence was 16% lower in males and 55% higher in females comparing 2007/08 to 2014/15. Female sex, urban residence, and high household wealth were associated with higher odds of overweight/obesity and high central adiposity. Those aged 70+ years had lower odds of obesity in both study waves. In 2014/15, females who did not meet the recommended physical activity were more likely to be obese.

CONCLUSION

Over the 7-year period between the surveys, the prevalence of underweight decreased and overweight increased in both sexes, while obesity decreased in males but increased in females. The difference in obesity prevalence may point to differential impacts of past initiatives to reduce overweight and obesity, potential high-risk groups in Ghana, and the need to increase surveillance.

Trend in overweight and obesity among women of reproductive age in Uganda: 1995-2016

Countries in Sub-Saharan Africa (SSA) are experiencing rising burdens of overweight/obesity and associated non-communicable diseases. As in other developing regions, this epidemiological transition in African countries is believed to be resulting from changes in dietary, sociodemographic structure and lifestyle factors. To date, not much is known about the prevalence and sociodemographic patterns of overweight/obesity in Uganda, especially among women of reproductive age. Therefore, this study aimed to address this research gap by using nationally representative data on women of this age group in Uganda.

METHODS

This study involved analysis of cross-sectional data on 19,395 women aged between 15 and 49 years from Uganda Demographic and Health Survey for the years 1995-2016. Overweight/obesity was measured using body mass index as per World Health Organization guidelines, and logistic regression methods were used to identify the sociodemographic predictors.

RESULTS

There has a been significant rise in the prevalence of overweight (9.77% in 1995 vs. 16.21% in 2016) and obesity (1.99% in 1995 vs. 6.21% in 2016) since the first survey in 1995, with the most noticeable increase occurring in the central region that accounted for a combined prevalence of 17.22% in 1995 compared with 37. 21% in 2016. Multivariate analysis showed an increased likelihood of having overweight/obesity among women who live in the urban areas, have primary and above primary education, from non-poor households and users of radio and TV.

CONCLUSION

During the last two decades, there has been a slow but steady rise in the prevalence of overweight and obesity among women of reproductive age in Uganda. The present findings highlight the need for an enhanced attention on growing overweight/obesity within the broader goal improving maternal and child health in the country.

Cardiovascular Disease Healthcare Utilization in Sub-Saharan Africa: A Scoping Review

Sub-Saharan African (SSA) countries face a growing burden of cardiovascular disease (CVD), attributed to economic, nutritional, demographic, and epidemiological transitions. These factors increase the prevalence of CVD risk factors, and the CVD burden overlaps with a high prevalence of infectious diseases. This review aimed to understand CVD healthcare utilization determinants and levels in SSA. We conducted a systematic search of the literature on major databases for the period 2008⁻2018 using exhaustive combinations of CVD and utilization indicators as search terms. Eighteen studies from eight countries were included in this review. Most studies (88.8%) followed the quantitative methodology and largely focused on inpatient stroke care. Two-thirds of patients sought care within 24 h of suffering a stroke, and the length of stay (LOS) in hospital ranged between 6 and 81 days. Results showed a rising trend of CVD admissions within total hospital admissions. Coverage of physiotherapy services was limited and varied between countries. While few studies included rural populations, utilization was found to be negatively associated with rural residence and socioeconomic status. There is a need to extend healthcare provision in SSA to ensure access to the CVD continuum of care.

Magnitude and predictors of normal-weight central obesity- the AWI-Gen study findings

Background: Normal-weight central obesity is associated with higher mortality than general obesity as defined by body mass index, particularly in the absence of central fat distribution.Objective: The aim of this study was to examine the magnitude and predictors of normal-weight central obesity in an urban informal settlement setting in Kenya.Methods: We used data from the AWI-Gen study, a cross-sectional survey targeting randomly selected consenting adults between the ages of 40-60 in two urban informal settlements of Nairobi between 2014 and 2016. Central obesity was determined using waist circumference, waist to hip ratio, visceral fat thickness, and subcutaneous fat thickness. General obesity was determined using body mass index (BMI).Results: About 20.0% of participants in the study had general obesity. The prevalence of central obesity as measured by waist circumference was 52.0%, by waist-to-hip ratio was 53.5%, by visceral fat thickness was 32.4% and by subcutaneous fat thickness was 49.2%. The prevalence of normal-weight central obesity in the study population was highest when measured by waist to hip ratio (38.1%) and lowest when measured by visceral fat thickness (18.1%). Factors associated with normal-weight central obesity as assesses by waist circumference were being female, of older age, and in full-time employment. Older age was associated with normal-weight central obesity as assessed by waist to hip ratio.Conclusion: The findings highlight a significant prevalence of normal-weight central obesity among adults in a poor urban setting in Kenya, pointing to women as a key target group for focused interventions. Longitudinal studies are needed to establish whether there is a link between normal-weight central obesity and mortality in such settings as has been found in other settings.

Obesity matters but is not perceived: A cross-sectional study on cardiovascular disease risk factors among a population-based probability sample in rural Zambia

Background

Sub-Saharan Africa, including Zambia, has experienced an increase in overweight and obesity due to rapid lifestyle changes associated with recent economic growth. We explored the prevalence and correlates of overweight and obesity in rural Zambia. We also investigated the role of self-perception of body weight in weight control given the local socio-cultural context.

Methods

In this cross-sectional study, we recruited 690 residents of the Mumbwa district aged 25–64 years through a multistage, clustered, household random sampling. We administered a questionnaire and collected anthropometric and bio-behavioral data from May to July 2016. Factors associated with body mass index (BMI) ≥25 kg/m² and underestimation of body weight were assessed using multiple logistic regression.

Results

Of the weighted sample of 689 participants (335 men and 354 women), 185 (26.8%) had BMI ≥25 kg/m². In multivariate analyses, female gender, age 45–64 years, tertiary education, higher fruit and vegetable intake, high blood pressure, abnormal blood lipid profile, and Hemoglobin A1c ≥5.7% were significantly associated with BMI ≥25 kg/m². Among participants with BMI ≥25 kg/m², 14.2% and 58.2% perceived themselves as being underweight and normal weight, respectively. Age 45–64 years was the only factor significantly associated with body weight underestimation. Preference for obesity was reported by 17.5% and 3.6% of respondents with BMI <25 kg/m² and BMI≥25 kg/m², respectively; “looks attractive” and “fear of being perceived as HIV-positive” were the main reasons.

Conclusion

In rural Zambia, overweight and obesity are prevalent and significantly associated with alterations in blood pressure, blood lipid profile, and glucose metabolism. However, most subjects with BMI ≥25 kg/m² underestimated their body weight; some preferred obesity, in part due to cultural factors and HIV-related stigma. A health promotion program that addresses such perceptions and body weight underestimation should be urgently introduced in Zambia.

Gender and socio-demographic distribution of body mass index: The nutrition transition in an adult Angolan community

This cross-sectional survey with 2357 subjects aged 15 to 64 years from a ruralurban community in Bengo Province, Angola, aimed to evaluate the gender differences in the prevalence of body mass index categories and how socio-demographic characteristics influence it. Women presented a significantly higher prevalence of obesity (10.5% versus 2.8%) but the underweight frequency was similar to men (10.2% versus 12.4%). Overweight and obesity increased with age, with underweight being more prevalent in the age group 15 to 24 years. Obesity was more prevalent among individuals living with a companion (in a marital relation), decreased with education (in women), but was higher in rural areas, and for those with a higher family monthly income, in both genders. The prevalence of obesity and underweight were similar in women, reflecting a nutrition transition state. Like in other African communities, women present a higher prevalence of overweight and obesity them men, but the values of underweight are similar between genders. This stresses the need of designed health interventions for women, to face the double burden and accumulation of risk factors in women.

Low potassium and high sodium intakes: a double health threat to Cape Verdeans

BACKGROUND

Cape Verde presents a high rate of cardiovascular diseases. Low potassium and high sodium intakes are related to cardiovascular diseases. However, studies regarding these two micronutrients continue to be rare in African urban settings. This work aims to estimate potassium and sodium intakes and to analyse the self-reported salt intake by gender and by type of urban area in the city of Praia - the capital of Cape Verde.

METHODS

In the first stage (n = 1912), an intra-urban study was designed in two types of urban areas (formal and informal), using a sampling strategy based on random selection of geographical coordinates, in order to apply a questionnaire. In a second stage, a 24-h dietary recall and anthropometric measurements were performed by local nutritionists. Potassium and sodium intakes were estimated for 599 participants (149 men and 450 women). Non-parametric methods (including quantile regression) were used in the statistical analysis.

RESULTS

In informal areas, a higher percentage of women reported having hypertension (31.0%) compared to formal areas (19.7%). Based on 24-h dietary recall, median potassium intake for men was 2924.2 mg/day and for women and 2562.6 mg/day. Almost 70.0% of men and 80.0% of women ingested less than the recommended 3510 mg/day of potassium. In informal areas, men and women presented high medians of sodium intakes compared to formal areas (men: 4131.2 vs 3014.6 mg/day and women: 3243.4 vs 2522.4 mg/day). On the other hand, the percentage of participants exceeding 2000 mg/day for sodium was high (≥70.8%), even for participants that self-reported low-salt intake. Quantile regression models revealed effects of the type of urban area and gender in the potassium and sodium intakes, at least, in some quartiles, accounting for age, academic qualifications, and professional situation.

CONCLUSIONS

A low potassium intake and a high sodium intake were found in Praia. Thus, efficient health education campaigns and health promotion are needed and should be tailored considering gender and urban areas.

Risk factors and complications of lower limb cellulitis in Africa: a systematic review

OBJECTIVE

To summarise available data on the risk factors, complications and the factors associated with complications of lower limb cellulitis in Africa.

METHODS

We did electronic searches on PubMed, EMBASE, Scopus and African Journals Online from 1 January 1986 to 30 October 2017, extracted and summarised data on the risk factors, complications and the factors associated with the complications of lower limb cellulitis from eligible literature.

RESULTS

A total of seven studies were retained for final review after the search and screening processes. Local risk factors of cellulitis reported were: disruption of the skin barrier, neglected wounds, toe-web intertrigo, leg ulcers, use of depigmentation drugs and leg oedema. Obesity was the only reported general risk factor of cellulitis. Five studies reported on the complications of cellulitis which included: abscess formation, necrotising fasciitis, bullae, haemorrhagic lesions, necrosis, phlebitis and amputations. Nicotine addiction, chronic use of non-steroidal anti-inflammatory drugs, delay in the initiation of antibiotic treatment and elevated erythrocyte sedimentation rate were risk factors of complications of lower limb cellulitis identified from three studies.

CONCLUSION

This review highlights the important role of local risk factors in the pathogenesis of lower limb cellulitis in Africa. The association between voluntary skin depigmentation and lower limb cellulitis should alert public health authorities and the general population to the health risks associated with this practice. The identification and improved management of the risk factors of lower limb cellulitis and its complications could go a long way in decreasing the morbidity and health costs incurred by lower limb cellulitis in Africa.

Roux-en-Y Gastric Bypass Aggravates Vitamin A Deficiency in the Mother-Child Group

OBJECTIVE

The objectives of this study are to compare the nutritional status of vitamin A in women who previously underwent Roux-en-Y gastric bypass (RYGB) who became pregnant or did not, in the same period after surgery, and to assess its effects on mother and child health.

METHODOLOGY

A retrospective longitudinal study conducted with women who previously underwent RYGB, paired by age and BMI measured before surgery, divided into group 1 (G1) comprising 77 women who did not become pregnant and group 2 (G2) with 39 women in their third gestational trimester. Both groups were assessed before surgery (T0) and in the same interval after surgery: less than or equal to 1 year (T1) or over 1 year (T2), during a maximum of 2 years. Serum concentrations of retinol and β-carotene, night blindness (NB), and gestational and neonatal complications were investigated [urinary tract infection, iron deficiency anemia, hypertensive syndrome of pregnancy, dumping syndrome, birth weight, gestational age at birth (GAB), and correlation between weight and GAB]. Data were analyzed by the Statistical Package for Social Sciences 21.0 (p < 0.05).

RESULTS

RYGB reduced the serum levels of retinol and β-carotene, especially before the first postsurgical year. When associated with pregnancy, inadequacy rate was 55% higher in T1 and T2. Comparing G1 to G2, we noted that pregnancy in women undergoing RYGB can contribute to increased inadequacy of retinol and β-carotene, reaching a higher percentage of women with NB after 1 postsurgical year. High prevalence of pregnancy/neonatal complications was found in T1 and T2. NB was correlated with inadequacy of β-carotene.

CONCLUSION

Pregnancy after RYGB aggravates vitamin A deficiency, increases the percentage of NB cases, and can contribute to pregnancy and neonatal complications even in 1 postsurgical year.

Cardiometabolic Risk Factors among Healthcare Workers: A Cross-Sectional Study at the Sefwi-Wiawso Municipal Hospital, Ghana

BACKGROUND

There is a dearth of information about the burden of cardiometabolic risk factors among the Ghanaian health workforce in the Western Region. This study sought to determine the prevalence of cardiometabolic risk factors among healthcare workers at the Sefwi-Wiawso Municipal Hospital in the Western Region of Ghana.

MATERIALS AND METHODS

A hospital-based cross-sectional study involving 112 employees of the Sefwi-Wiawso Municipal Hospital was conducted. The cardiometabolic risk variables assessed were obesity, hypertension, dyslipidaemia, and diabetes. Sociodemographic parameters were also captured. The prevalence of hypertension and obesity was determined using the JNC VII panel and WHO BMI criteria for obesity classifications. Blood lipids and glucose concentrations were evaluated using standard methods.

RESULTS

The prevalence of hypertension and prehypertension was 16.07% and 52.68%, respectively. About 38.39% of participants were overweight, and 12.50% were obese. Atherogenic dyslipidaemia was 26.79%, whereas prediabetes glycaemic levels and diabetes incidence were 5.41% and 4.50%, respectively. Fifty percent (50.00%) of participants presented at least one cardiometabolic risk factor. Aging and adiposity were associated with increasing cardiometabolic risk.

CONCLUSION

Cardiometabolic risk factors are prevalent among healthcare providers in Sefwi-Wiawso. The cardiometabolic dysregulation observed among this cohort of healthcare professionals may be modulated by age and adiposity.

Central Obesity in Africans: Anthropometric Assessment of Abdominal Adiposity and its Predictors in Urban Nigerians

OBJECTIVE

To assess the occurrence of central obesity and identify its predictors in urban Africans using anthropometric tools. Another objective was to evaluate the anthropometric indices and their interaction with various cardiovascular risk factors.

METHODS

In an obesity survey in a major Nigerian city, we measured the prevalence of central obesity in 998 randomly selected men and women using the IDF (International Diabetes Federation) criteria. Normalized values of three anthropometric indices, waist circumference (WC), WHR (waist-to-hip ratio) and WHtR (waist-to-height ratio) were also employed in assessing central adiposity and its predictors in the population.

RESULTS

Most (61%) female participants had central obesity compared with 9% of the males based on the IDF waist criteria. Higher income level and physical inactivity were associated with central obesity (p < 0.001). In multivariate analyses, older participants and women were more likely to have central obesity (p < 0.001), but men had higher WHR than women at the same body mass index. WC was a stronger predictor of glucose intolerance than WHR, whereas WHR was more predictive of hypertension than WC. WHR showed a strong relationship with hypertension but not with glucose intolerance. WHtR was predictive of plasma glucose and diastolic blood pressure. WC showed strongest correlation with other indices.

CONCLUSIONS

Central obesity was highly prevalent among women in this sample. It was associated with age, gender, socioeconomic status, physical inactivity, and it predicted glucose intolerance and hypertension. WC was a major determinant of both cardiovascular risk factors. It showed best correlation with other anthropometric indices.

Body size perceptions and preferences favor overweight in adult Saharawi refugees

Background

Culture affects body image and body size perceptions from an early age and in many African countries, overweight has been associated with richness, health, strength, and fertility. The present study investigated body size perceptions and preferences in an African refugee population.

Methods

The cross-sectional study was comprised of 180 and 175 randomly selected Saharawi women and men, respectively, between 18 and 80 years. Stunkard’s body figure scale was used to identify self-perceived body size, desired body size and desired body size in the opposite gender.

Results

Approximately half of the participants had a correct self-perceived body size; among them 70% did not have a desire to have a smaller body size. Among women who preferred a body size corresponding to overweight in men, 77% also had a desired body size corresponding to overweight; compared to 43% for men. The youngest participants (18–25 years) were the least likely to overestimate their body size in comparison to the older participants (26–45 years and 46–80 years).

Conclusion

We found an overall preference for an overweight body size, and a significant difference in body size perception associated with age.

Traditional Malian Solid Foods Made from Sorghum and Millet Have Markedly Slower Gastric Emptying than Rice, Potato, or Pasta

From anecdotal evidence that traditional African sorghum and millet foods are filling and provide sustained energy, we hypothesized that gastric emptying rates of sorghum and millet foods are slow, particularly compared to non-traditional starchy foods (white rice, potato, wheat pasta). A human trial to study gastric emptying of staple foods eaten in Bamako, Mali was conducted using a carbon-13 (¹³C)-labelled octanoic acid breath test for gastric emptying, and subjective pre-test and satiety response questionnaires. Fourteen healthy volunteers in Bamako participated in a crossover design to test eight starchy staples. A second validation study was done one year later in Bamako with six volunteers to correct for endogenous ¹³C differences in the starches from different sources. In both trials, traditional sorghum and millet foods (thick porridges and millet couscous) had gastric half-emptying times about twice as long as rice, potato, or pasta (p < 0.0001). There were only minor changes due to the ¹³C correction. Pre-test assessment of millet couscous and rice ranked them as more filling and aligned well with postprandial hunger rankings, suggesting that a preconceived idea of rice being highly satiating may have influenced subjective satiety scoring. Traditional African sorghum and millet foods, whether viscous in the form of a thick porridge or as non-viscous couscous, had distinctly slow gastric emptying, in contrast to the faster emptying of non-traditional starchy foods, which are popular among West African urban consumers.

Prevalence and Predictors of Overweight and Obesity among Somalis in Norway and Somaliland: A Comparative Study

BACKGROUND AND AIM

The knowledge about the health status of Somalis in Norway and Somaliland is limited. This paper reports the results of a comparative study on the prevalence and predictors of overweight/obesity among Somalis in Norway and Somaliland.

METHOD

We conducted two cross-sectional studies using the same tools and procedures, between 2015 and 2016. The study population was adults aged 20-69 years (n=1110 (Somaliland) and n=220 (Norway)).

RESULTS

The prevalence of obesity (body mass index (BMI) ≥30 kg/m²) was 44% and 31% in women in Norway and Somaliland, respectively. In contrast, the prevalence of obesity was low in men (9% in Norway; 6% in Somaliland). Although the prevalence of high BMI was higher in Somali women in Norway than women in Somaliland, both groups had the same prevalence of central obesity (waist circumference (WC) ≥ 88 cm). In men, the prevalence of central obesity (WC ≥ 102 cm) was lower in Somaliland than in Norway. For women in Somaliland, high BMI was associated with lower educational level and being married.

CONCLUSION

The prevalence of overweight and obesity is high among Somali immigrants in Norway, but also among women in Somaliland. The high prevalence of overweight and obesity, particularly among women, calls for long-term prevention strategies.