Detecting and Managing Childhood Onset Hypertension in Africa: A Call to Action

PURPOSE OF REVIEW

To review recent evidence on childhood hypertension across Africa, identifying knowledge gaps, challenges and priorities, and highlight clinical perspectives in managing primary hypertension.

RECENT FINDINGS

Only 15 of the 54 African countries reported on absolute blood pressure (BP) measures, elevated BP, pre- and/or hypertension. The reported hypertension prevalence ranged between 0.0 and 38.9%, while elevated BP and/or pre-hypertnesion ranged from 2.7 to 50.5%. Childhood BP nomograms are lacking across Africa and the rates of hypertension were based on guidelines developed in countries with the lowest to no number of children from African ancestry. The recent studies across Africa also showed little to no detail when reporting BP specific methodology. No recent data informing the use or effectiveness of antihypertensive agents in children and adolesents are available. Childhood hypertension is on the rise, while data from Africa remains vastly under-represented. Collaborative research, resources, and policies need to be strengthened in addressing the growing public health concern of childhood onset hypertension on this continent.

Cardiovascular risk and kidney function profiling using conventional and novel biomarkers in young adults: the African-PREDICT study

BACKGROUND

Low- and middle-income countries experience an increasing burden of chronic kidney disease. Cardiovascular risk factors, including advancing age, may contribute to this phenomenon. We (i) profiled cardiovascular risk factors and different biomarkers of subclinical kidney function and (ii) investigated the relationship between these variables.

METHODS

We cross-sectionally analysed 956 apparently healthy adults between 20 and 30 years of age. Cardiovascular risk factors such as high adiposity, blood pressure, glucose levels, adverse lipid profiles and lifestyle factors were measured. Various biomarkers were used to assess subclinical kidney function, including estimated glomerular filtration rate (eGFR), urinary albumin, uromodulin and the CKD273 urinary proteomics classifier. These biomarkers were used to divide the total population into quartiles to compare extremes (25th percentiles) on the normal kidney function continuum. The lower 25th percentiles of eGFR and uromodulin and the upper 25th percentiles of urinary albumin and the CKD273 classifier represented the more unfavourable kidney function groups.

RESULTS

In the lower 25th percentiles of eGFR and uromodulin and the upper 25th percentile of the CKD273 classifier, more adverse cardiovascular profiles were observed. In multi-variable adjusted regression analyses performed in the total group, eGFR associated negatively with HDL-C (β= -0.44; p < 0.001) and GGT (β= -0.24; p < 0.001), while the CKD273 classifier associated positively with age and these same risk factors (age: β = 0.10; p = 0.021, HDL-C: β = 0.23; p < 0.001, GGT: β = 0.14; p = 0.002).

CONCLUSION

Age, lifestyle and health measures impact kidney health even in the third decade.

The fecal microbiotas of women of Pacific and New Zealand European ethnicities are characterized by distinctive enterotypes that reflect dietary intakes and fecal water content

Obesity is a complex, multifactorial condition that is an important risk factor for noncommunicable diseases including cardiovascular disease and type 2 diabetes. While prevention and management require a healthy and energy balanced diet and adequate physical activity, the taxonomic composition and functional attributes of the colonic microbiota may have a supplementary role in the development of obesity. The taxonomic composition and metabolic capacity of the fecal microbiota of 286 women, resident in Auckland New Zealand, was determined by metagenomic analysis. Associations with BMI (obese, nonobese), body fat composition, and ethnicity (Pacific, n = 125; NZ European women [NZE], n = 161) were assessed using regression analyses. The fecal microbiotas were characterized by the presence of three distinctive enterotypes, with enterotype 1 represented in both Pacific and NZE women (39 and 61%, respectively), enterotype 2 mainly in Pacific women (84 and 16%) and enterotype 3 mainly in NZE women (13 and 87%). Enterotype 1 was characterized mainly by the relative abundances of butyrate producing species, Eubacterium rectale and Faecalibacterium prausnitzii, enterotype 2 by the relative abundances of lactic acid producing species, Bifidobacterium adolescentis, Bifidobacterium bifidum, and Lactobacillus ruminis, and enterotype 3 by the relative abundances of Subdoligranulum sp., Akkermansia muciniphila, Ruminococcus bromii, and Methanobrevibacter smithii. Enterotypes were also associated with BMI, visceral fat %, and blood cholesterol. Habitual food group intake was estimated using a 5 day nonconsecutive estimated food record and a 30 day, 220 item semi-quantitative Food Frequency Questionnaire. Higher intake of 'egg' and 'dairy' products was associated with enterotype 3, whereas 'non-starchy vegetables', 'nuts and seeds' and 'plant-based fats' were positively associated with enterotype 1. In contrast, these same food groups were inversely associated with enterotype 2. Fecal water content, as a proxy for stool consistency/colonic transit time, was associated with microbiota taxonomic composition and gene pools reflective of particular bacterial biochemical pathways. The fecal microbiotas of women of Pacific and New Zealand European ethnicities are characterized by distinctive enterotypes, most likely due to differential dietary intake and fecal consistency/colonic transit time. These parameters need to be considered in future analyses of human fecal microbiotas.

Prevalence of nutrition risk and associated risk factors among New Zealand pre-school children

AIM

To determine the prevalence of nutrition risk using the validated, Nutrition Screening Tool for Every Pre-schooler (NutriSTEP) among pre-school children in New Zealand (NZ) and to identify socio-demographic factors associated with nutrition risk.

METHODS

Parents/caregivers of NZ pre-school children (aged 2-5 years) completed an online survey including NutriSTEP, both parent and child height and weight, as well as socio-demographic characteristics. The 17-item NutriSTEP responses were scored between 0 and 4; where item scores ≥2 indicate risk, and the maximum score is 68. Participants were stratified into low-risk (score ≤ 20) and moderate to high-risk (score > 20) groups. Strength of associations between nutrition risk and socio-demographic characteristics were explored using binary regression analysis.

RESULTS

Of 505 pre-school children, 96 (19%) were at moderate to high risk (median interquartile range NutriSTEP score 24 [22-26]) and 409 (81%) were at low risk (score 13 [10-16]). Pre-school children at highest risk were non-NZ European (P = 0.002), with solo parents (P = 0.002), from households with incomes ≤$50 000 (P ≤ 0.021) and with non-university educated parents (P ≤ 0.0001). More than 30% of pre-schoolers were at high risk for inadequate consumption of fruit, vegetables, grains, milk products, meat and meat alternatives, as well as exposure to screens during meals and overuse of supplements.

CONCLUSIONS

A fifth of NZ pre-school children were at moderate to high nutrition risk and may not have met the nutrition guidelines. Economic and ethnic disparities were apparent. Using NutriSTEP may assist to identify NZ pre-school children at highest nutrition risk who may benefit from appropriate nutrition support.

Chronotype Differences in Body Composition, Dietary Intake and Eating Behavior Outcomes: A Scoping Systematic Review

The timing and nutritional composition of food intake are important zeitgebers for the biological clocks in humans. Thus, eating at an inappropriate time (e.g., during the night) may have a desynchronizing effect on the biological clocks and, in the long term, may result in adverse health outcomes (e.g., weight gain, obesity, and poor metabolic function). Being a very late or early chronotype not only determines preferred sleep and wake times but may also influence subsequent mealtimes, which may affect the circadian timing system. In recent years, an increased number of studies have examined the relation between chronotype and health outcomes, with a main focus on absolute food intake and metabolic markers and, to a lesser extent, on dietary intake distribution and eating behavior. Therefore, this review aimed to systematically determine whether chronotype indirectly affects eating behaviors, dietary intake (timing, choice, nutrients), and biomarkers leading to body composition outcomes in healthy adults. A systematic literature search on electronic databases (PubMed, CINAHL, MEDLINE, SCOPUS, Cochrane library) was performed (International Prospective Register of Systematic Reviews number: CRD42020219754). Only studies that included healthy adults (aged >18 y), classified according to chronotype and body composition profiles, using outcomes of dietary intake, eating behavior, and/or biomarkers, were considered. Of 4404 articles, 24 met the inclusion criteria. The results revealed that late [evening type (ET)] compared with early [morning type (MT)] chronotypes were more likely to be overweight/obese with poorer metabolic health. Both MT and ET had similar energy and macronutrient intakes, consuming food during their preferred sleep-wake timing: later for ET than MT. Most of the energy and macronutrient intakes were distributed toward nighttime for ET and exacerbated by unhealthy eating behaviors and unfavorable dietary intakes. These findings from our systematic review give further insight why higher rates of overweight/obesity and unhealthier metabolic biomarkers are more likely to occur in ET.

The Effect of a 14-Day gymnema sylvestre Intervention to Reduce Sugar Cravings in Adults

Gymnemic-acids (GA) block lingual sweet taste receptors, thereby reducing pleasantness and intake of sweet food. Objective: To examine whether a 14-day gymnema-based intervention can reduce sweet foods and discretionary sugar intake in free-living adults. Healthy adults (n = 58) were randomly allocated to either the intervention group (INT) or control group (CON). The intervention comprised of consuming 4 mg of Gymnema sylvestre containing 75% gymnema acids, a fibre and vitamin supplement, and an associated healthy-eating guide for 14 days; participants in the CON group followed the same protocol, replacing the GA with a placebo mint. Amount of chocolate bars eaten and sensory testing were conducted before and after the 14-day intervention (post-GA or placebo dosing on days zero and 15, respectively). Food frequency questionnaires were conducted on days zero, 15 and after a 28-day maintenance period to examine any changes in intake of sweet foods. A range of statistical procedures were used to analyse the data including Chi square, t-test and two-way analysis of variance. Post dosing, INT consumed fewer chocolates (2.65 ± 0.21 bars) at day zero than CON (3.15 ± 0.24 bars; p = 0.02); there were no differences between groups at day 15 (INT = 2.77 ± 0.22 bars; CON = 2.78 ± 0.22 bars; p = 0.81). At both visits, a small substantive effect (r < 0.3) was observed in the change in pleasantness and desire ratings, with INT showing a slight increase while CON showed a small decrease over the 14-day period. No differences were found in the intake of 9 food categories between groups at any timepoint. There were no differences in consumption of low sugar healthy foods between visits, or by group. The 14-day behavioural intervention reduced pleasantness and intake of chocolate in a laboratory setting. There was no habituation to the mint over the 14-day period. This study is the first to investigate the effect of longer-term gymnema acid consumption on sweet food consumption outside of a laboratory setting; further research is needed to assess how long the effect of the 14-day intervention persists.

Enablers and barriers to prevent weight-regain post bariatric surgery - A qualitative enquiry

BACKGROUND

Weight-regain is commonly experienced after bariatric surgery. This qualitative enquiry aimed to explore participants' self-reported enablers and barriers to prevent future weight-regain post-surgery.

METHODS

Eligible adults were recruited at 12-months post-bariatric-surgery at Counties Manukau, Auckland. Participants were invited to attend data collection at their 18-month group nutrition-education session, and to participate in a focus group at 21-months post-surgery. Thematic analysis was used to evaluate patient experiences.

RESULTS

Participants (n = 28) were mostly female (73.2 %), New Zealand European (41.5 %), and had gastric sleeve surgery (92.3 %). Five key themes emerged from the analysis: A Life Changing Health Journey - participants experienced a decrease in obesity-related comorbidities and a subsequent decrease in medications. Weight change and food intolerances impacted quality of life. Challenge of managing a New Healthy Lifestyle - financial stress, buying healthier foods and social events were new challenges, often centred on food. Changing Eating Behavior - all participants struggled managing eating behaviors. Mindset Changes - post-surgery most participants had a positive mindset, increased confidence, and feelings of happiness. However, many struggled with mindset around weight and food. A need for On-going Support - most felt under-supported and expressed a need for longer, specific follow-up care.

CONCLUSION

Post-surgery group education sessions provided participants with increased support from both health professionals and peers on the same journey, to overcome struggles such as binge eating or identifying new coping strategies. Findings provide important insights into the challenges patients with bariatric surgery face and key learnings to develop specific supports for future care practices.

Next Level Health: a holistic health and wellbeing program to empower New Zealand women

Improving equity in women's health requires gender-specific and empowering approaches. However, health programs often disempower women by adopting a 'one-size-fits-all' approach that emphasizes diet, exercise and weight loss over other important aspects like sleep and mental wellbeing. This article reports on the design of Next Level Health (NLH), a program that aims to empower women through developing a wide range of health behaviors to support their holistic wellbeing. NLH is grounded by ethics, theory and evidence to support women to make achievable, sustainable changes that are relevant to their everyday lives. Women utilized the NLH framework to develop an integrative health routine across six domains: physical activity, sleep, nutrition, eating behavior, self-care and stress management. The framework guided them to set small, incremental goals that were adaptive to their needs and built from their existing circumstances. Participants reflected on their progress with a facilitator during monthly meetings, accessed a social media support page and received monthly text messages. Health programs remain an essential approach to improving women's health alongside community- and policy-level strategies. The development of NLH exemplifies how evidence may partner with modern health promotion values to inform relevant and ethical program design for women.

Empowering Women in the Face of Body Ideals: A Scoping Review of Health Promotion Programs

Achieving women's health equity and empowerment is a global priority. In a Western context, women are often disempowered by the value society places on body size, shape or weight, which can create a barrier to health. Health promotion programs can exacerbate women's preoccupations with their bodies by focusing outcomes toward achieving an "ideal" body size. Women's health promotion activities should be empowering if the desired outcomes are to improve their health and well-being long-term. This review sought to identify key elements from health promotion programs that aimed to empower women. A search was conducted in PubMed, MEDLINE, Web of Science, Scopus, CINAHL complete, and Academic Search Premiere databases. The search yielded 27 articles that collectively reported on 10 different programs. Through thematic synthesis, each article was analyzed for (1) key program features employed to empower women and (2) how such programs evaluated women's health. Seven themes resulted, of which five describe key empowering features (active participation, social support, sustainable change, holistic health perspective, strength-based approach) and two evaluation characteristics (assessment across multiple health domains and a mixed-method design). The findings from this review can assist health promoters to design and improve initiatives that aim to empower women.

Evaluating a novel dietary diversity questionnaire to assess dietary diversity and adequacy of New Zealand women

OBJECTIVES

We sought to develop and evaluate the relative validity of a dietary diversity questionnaire (DDQ) that reflects food-group diversity, food variety, and micronutrient adequacy among New Zealand women.

METHODS

A cross-sectional study included New Zealand women (Auckland based; ages 16-45 y, n = 101), completing a 7-d DDQ and 4-d weighed food record (reference method). The relative validity of the DDQ was evaluated by correlating nutritious and discretionary dietary diversity scores (DDSs; number of food groups) and food-variety scores (number of foods), calculated from both methods. The dietary mean adequacy ratio (MAR; micronutrient intakes relative to estimated average requirements) was calculated from the weighed food record and correlated to dietary diversity and food-variety scores from the DDQ to assess construct validity. Cross-tabulation was used to explore dietary diversity measures versus adequacy ratios. Significance was set at P < 0.05.

RESULTS

The median (interquartile range) DDSs (maximum 25) from the DDQ-23 (21-23)-and the weighed food record-18 (17-19)-were significantly correlated (r_s = 0.33, P < 0.001), as were the food-variety scores (maximum 237)-respectively, 75 (61-87) and 45 (37-52) (r_s = 0.22, P < 0.03). A mean (± SD) MAR of 0.94 ± 0.04 suggested a near-adequate diet, but one-third of foods consumed were from discretionary sources. Nutritious DDS was significantly correlated with MAR for micronutrients (r_s = 0.20, P ≤ 0.05). An inverse trend was observed between discretionary DDS and MAR.

CONCLUSIONS

The DDQ is a quick, low-burden tool for describing nutritious and discretionary dietary diversity reflecting micronutrient adequacy in high-income settings. It requires further validation across different time frames, population groups, and settings.

Outcomes of a culturally informed weight-loss competition for New Zealand Indigenous and Pacific peoples: a quasi-experimental trial

Background

Reducing obesity prevalence among marginalised subgroups with disproportionately high obesity rates is challenging. Given the promise of incentives and group-based programmes we trialled a culturally tailored, team-based weight-loss competition with New Zealand Māori (Indigenous) and Pacific Island people.

Methods

A quasi-experimental 12-months trial was designed. The intervention consisted of three six-months competitions, each with seven teams of seven members. Eligible participants were aged 16 years and older, with a BMI ≥30 kg/m² and being at risk of or already diagnosed with type-2 diabetes or cardiovascular disease. Height, weight and waist circumference were measured at baseline, 6 and 12 months.

Results

Recruitment of a control group (n = 29) versus the intervention (n = 132) was poor and retention rates were low (52 and 27% of intervention participants were followed-up at six and 12 months, respectively). Thus, analysis of the primary outcome of individual percentage weight loss was restricted to the 6-months follow-up data. Although not significant, the intervention group appeared to lose more weight than the control group, in both the intention to treat and complete-case analyses.

Conclusions

The intervention promoted some behaviour change in eating behaviours, and a resulting trend toward a reduction in waist circumference.

Trial registration

ACTRN12617000871347 Registered 15/6/2017 Retrospectively registered.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40795-021-00457-9.

Adaptation and reliability of 'Nutrition Screening Tool for Every Preschooler' (NutriSTEP) for use as a parent administered questionnaire in New Zealand

AIM

To adapt the validated Canadian Nutrition Screening Tool for Every Pre-schooler (NutriSTEP), for use in New Zealand and test its reliability to identify nutrition risk in pre-school children aged 2-5 years, as a parent administered questionnaire.

METHODS

Adaptations to the Canadian NutriSTEP were undertaken by three registered dietitians (expert review), followed by intercept interviews with pre-schooler parents (n = 26). A second expert review was conducted to finalise the adaptions for online reliability testing. A further 79 pre-schooler parents completed online administrations of the Canadian and adapted NutriSTEP tools, 4 weeks apart in a blinded manner. Intraclass correlation coefficients (ICCs) were used to verify test-retest reliability between the administrations. Individual questionnaire items were verified for reliability between administrations through Cohen's κ statistic (κ), Pearson's χ² value and Fisher's exact test.

RESULTS

Online administrations of the Canadian and adapted NutriSTEP tools were determined to be reliable (ICC = 0.91; P < 0.001). Between NutriSTEP administrations, 13 out of 17 questionnaire items had adequate (κ > 0.5) agreement, one item had excellent agreement (κ > 0.75) with a significant relationship (P < 0.05) between all items. Sensitivity for the adapted NutriSTEP was higher for pre-schoolers at nutrition risk (31.6%) versus the Canadian version (20.3%). Risk items were highest for low intake of breads and cereals (58.2%), milk and milk products (51.9%), meat and meat alternatives (40.5%), child controlling the amount consumed (35.4%) and vegetable intake (34.2%).

CONCLUSION

The Canadian NutriSTEP and the adapted NutriSTEP were reliable between online administrations when completed by parents in the community. The adapted NutriSTEP identified an additional nine preschoolers at increased nutrition risk, demonstrating increased sensitivity in comparison to the Canadian NutriSTEP. Nutrition risk can be identified in early childhood to prevent the development of chronic disease. The adapted NutriSTEP should be considered for future use to identify preschoolers at increased nutrition risk and guide appropriate nutrition intervention.

Nutrient Dense, Low-Cost Foods Can Improve the Affordability and Quality of the New Zealand Diet-A Substitution Modeling Study

The high prevalence of non-communicable disease in New Zealand (NZ) is driven in part by unhealthy diet selections, with food costs contributing to an increased risk for vulnerable population groups. This study aimed to: (i) identify the nutrient density-to-cost ratio of NZ foods; (ii) model the impact of substituting foods with a lower nutrient density-to-cost ratio with those with a higher nutrient density-to-cost ratio on diet quality and affordability in representative NZ population samples for low and medium socioeconomic status (SES) households by ethnicity; and (iii) evaluate food processing level. Foods were categorized, coded for processing level and discretionary status, analyzed for nutrient density and cost, and ranked by nutrient density-to-cost ratio. The top quartile of nutrient dense, low-cost foods were 56% unprocessed (vegetables, fruit, porridge, pasta, rice, nuts/seeds), 31% ultra-processed (vegetable dishes, fortified bread, breakfast cereals unfortified <15 g sugars/100 g and fortified 15-30 g sugars/100 g), 6% processed (fruit juice), and 6% culinary processed (oils). Using substitution modeling, diet quality improved by 59% and 71% for adults and children, respectively, and affordability increased by 20-24%, depending on ethnicity and SES. The NZ diet can be made healthier and more affordable when nutritious, low-cost foods are selected. Processing levels in the healthier, modeled diet suggest that some non-discretionary ultra-processed foods may provide a valuable source of low-cost nutrition for food insecure populations.

Vascular Ageing in Youth: A Call to Action

Extensive evidence shows that risk factors for cardiovascular disease (CVD) begin to develop early in life. Childhood obesity and elevated blood pressure (BP) have become overwhelmingly challenging, with 57% of today's children predicted to be obese by the age of 35 years, and global rates of hypertension in children and adolescents increasing by 75% from 2000 to 2015. Thus, there is an urgent need for tools that can assess early CVD risk in youth, which may lead to better risk stratification, preventative intervention, and personalised medicine. Vascular ageing (the deterioration in vascular structure and function) is a pivotal progenitor of health degeneration associated with elevated BP. Exposure to adverse environmental and genetic factors from fetal life promotes the development and accumulation of subclinical vascular changes that direct an individual towards a trajectory of early vascular ageing (EVA)-an independent predictor of target organ damage in the heart, brain, and kidneys. Therefore, characterising vascular ageing from youth may provide a window into cardiovascular risk later in life. However, vascular ageing measurements only have value when techniques are accurate/validated and when reliable thresholds are available for defining normal ranges and ranges that signal increased risk of disease. The aim of this paper is to summarise current evidence on the importance of vascular ageing assessment in youth and the impact of interventions to prevent or delay EVA, to highlight the need for standardisation and validation of measurement techniques in children and adolescents, and the importance of establishing reference values for vascular ageing measures in this population.

Objectively Measured Physical Activity Is Associated With Body Composition and Metabolic Profiles of Pacific and New Zealand European Women With Different Metabolic Disease Risks

Objective: To assess associations between physical activity (PA), body composition, and biomarkers of metabolic health in Pacific and New Zealand European (NZE) women who are known to have different metabolic disease risks. Methods: Pacific (n = 142) or NZE (n = 162) women aged 18-45 years with a self-reported body mass index (BMI) of either 18.5-25.0 kg⋅m-2 or ≥30.0 kg⋅m-2 were recruited and subsequently stratified as either low (<35%) or high (≥35%) BF%, with approximately half of each group in either category. Seven-day accelerometery was used to assess PA levels. Fasting blood was analysed for biomarkers of metabolic health, and whole body dual-energy X-ray absorptiometry (DXA) was used to estimate body composition. Results: Mean moderate-to-vigorous physical activity (MVPA; min⋅day-1) levels differed between BF% (p < 0.05) and ethnic (p < 0.05) groups: Pacific high- 19.1 (SD 15.2) and low-BF% 26.3 (SD 15.6) and NZE high- 30.5 (SD 19.1) and low-BF% 39.1 (SD 18.4). On average Pacific women in the low-BF% group engaged in significantly less total PA when compared to NZE women in the low-BF% group (133 cpm); no ethnic difference in mean total PA (cpm) between high-BF% groups were observed: Pacific high- 607 (SD 185) and low-BF% 598 (SD 168) and NZE high- 674 (SD 210) and low-BF% 731 (SD 179). Multiple linear regression analysis controlling for age and deprivation showed a significant inverse association between increasing total PA and fasting plasma insulin among Pacific women; every 100 cpm increase in total PA was associated with a 6% lower fasting plasma insulin; no significant association was observed in NZE women. For both Pacific and NZE women, there was an 8% reduction in fasting plasma insulin for every 10-min increase in MVPA (p ≤ 0.05). Conclusion: Increases in total PA and MVPA are associated with lower fasting plasma insulin, thus indicating a reduction in metabolic disease risk. Importantly, compared to NZE, the impact of increased total PA on fasting insulin may be greater in Pacific women. Considering Pacific women are a high metabolic disease risk population, these pre-clinical responses to PA may be important in this population; indicating promotion of PA in Pacific women should remain a priority.

Factors associated with low-intake dehydration among older inpatients: A pilot study

OBJECTIVES

To assess fluid intake among older inpatients and factors associated with low-intake dehydration.

METHODS

Daily fluid intake and access were assessed within the 24-hour period, and blood was drawn to measure serum osmolality.

RESULTS

Of 89 patients, 16% and 27% had serum osmolality ≥ 300 (dehydrated) and 295-299 mOsm/kg (impending dehydration), respectively. Median (IQR) total fluid intake was 1.7 (1.6, 1.9) L/day. Fluid intake from beverages (P = .06) and water (P = .02) was higher in hydrated than impending/dehydrated patients. Of all fluid sources, only water intake was associated with hydration status (P = .02). The adjusted odds of serum osmolality ≥ 295 were increased for patients in the first (<0.3 L, P = .007) and second (0.3-0.8 L, P = .04) tertiles of water intake than those in the third tertile (≥0.8 L). Bladder control difficulty was associated with lower water intake (P = .03).

CONCLUSION

Monitoring water intake and assisting patients with bladder control difficulty may be key strategies to maintain hydration.

Are all Sedentary Behaviors Equal? An Examination of Sedentary Behavior and Associations with Indicators of Disease Risk Factors in Women

Sedentary behavior increases risk for non-communicable diseases; associations may differ within different contexts (e.g., leisure time, occupational). This study examined associations between different types of sedentary behavior and disease risk factors in women, using objectively measured accelerometer-derived sedentary data. A validation study (n = 20 women) classified sedentary behavior into four categories: lying down; sitting (non-active); sitting (active); standing. A cross-sectional study (n = 348 women) examined associations between these classifications and disease risk factors (body composition, metabolic, inflammatory, blood lipid variables). Participants spent an average of 7 h 42 min per day in sedentary behavior; 58% of that time was classified as non-active sitting and 26% as active sitting. Non-active sitting showed significant (p ≤ 0.001) positive correlations with BMI (r = 0.244), body fat percent (r = 0.216), body mass (r = 0.236), fat mass (r = 0.241), leptin (r = 0.237), and negative correlations with HDL-cholesterol (r = −0.117, p = 0.031). Conversely, active sitting was significantly (p ≤ 0.001) negatively correlated with BMI (r = −0.300), body fat percent (r = −0.249), body mass (r = −0.305), fat mass (r = −0.320), leptin (r = −0.259), and positively correlated with HDL-cholesterol (r = 0.115, p = 0.035). In summary, sedentary behavior can be stratified using objectively measured accelerometer-derived activity data. Subsequently, different types of sedentary behaviors may differentially influence disease risk factors. Public health initiatives should account for sedentary classifications when developing sedentary behavior recommendations.

Predictors Linking Obesity and the Gut Microbiome (the PROMISE Study): Protocol and Recruitment Strategy for a Cross-Sectional Study on Pathways That Affect the Gut Microbiome and Its Impact on Obesity

Background

The prevalence of obesity has increased substantially over recent decades and is associated with considerable health inequalities. Although the causes of obesity are complex, key drivers include overconsumption of highly palatable, energy-dense, and nutrient-poor foods, which have a profound impact on the composition and function of the gut microbiome. Alterations to the microbiome may play a critical role in obesity by affecting energy extraction from food and subsequent energy metabolism and fat storage.

Objective

We report the study protocol and recruitment strategy of the PRedictors linking Obesity and the gut MIcrobiomE (PROMISE) study, which characterizes the gut microbiome in 2 populations with different metabolic disease risk (Pacific and European women) and different body fat profiles (normal and obese). It investigates (1) the role of gut microbiome composition and functionality in obesity and (2) the interactions between dietary intake; eating behavior; sweet, fat, and bitter taste perception; and sleep and physical activity; and their impact on the gut microbiome, metabolic and endocrine regulation, and body fat profiles.

Methods

Healthy Pacific and New Zealand (NZ) European women aged between 18 and 45 years from the Auckland region were recruited for this cross-sectional study. Participants were recruited such that half in each group had either a normal weight (body mass index [BMI] 18.5-24.9 kg/m²) or were obese (BMI ≥30.0 kg/m²). In addition to anthropometric measurements and assessment of the body fat content using dual-energy x-ray absorptiometry, participants completed sweet, fat, and bitter taste perception tests; food records; and sleep diaries; and they wore accelerometers to assess physical activity and sleep. Fasting blood samples were analyzed for metabolic and endocrine biomarkers and DNA extracted from fecal samples was analyzed by shotgun sequencing. Participants completed questionnaires on dietary intake, eating behavior, sleep, and physical activity. Data were analyzed using descriptive and multivariate regression methods to assess the associations between dietary intake, taste perception, sleep, physical activity, gut microbiome complexity and functionality, and host metabolic and body fat profiles.

Results

Of the initial 351 women enrolled, 142 Pacific women and 162 NZ European women completed the study protocol. A partnership with a Pacific primary health and social services provider facilitated the recruitment of Pacific women, involving direct contact methods and networking within the Pacific communities. NZ European women were primarily recruited through Web-based methods and special interest Facebook pages.

Conclusions

This cross-sectional study will provide a wealth of data enabling the identification of distinct roles for diet, taste perception, sleep, and physical activity in women with different body fat profiles in modifying the gut microbiome and its impact on obesity and metabolic health. It will advance our understanding of the etiology of obesity and guide future intervention studies involving specific dietary approaches and microbiota-based therapies.

Trial Registration

Australian New Zealand Clinical Trials Registry ACTRN12618000432213; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370874

International Registered Report Identifier (IRRID)

RR1-10.2196/14529

Dietary Patterns in New Zealand Women: Evaluating Differences in Body Composition and Metabolic Biomarkers

The combinations of food consumed together (dietary patterns) may have a greater influence on health than nutrients or food groups consumed independently. This study investigated the relationship between dietary patterns, body composition and metabolic biomarkers of premenopausal New Zealand women from three ethnic groups. In total, 408 New Zealand European, Māori and Pacific women aged 16-45 years participated in the Women's EXPLORE (EXamining Predictors Linking Obesity Related Elements) study. Participants completed a 220-item food frequency questionnaire. Several body composition parameters and metabolic biomarkers were measured. Dietary patterns were extracted by principal component analysis and dietary pattern scores were categorised into tertiles to assess links with other measured parameters. Women with higher scores for the 'refined and processed' pattern were younger, had higher body mass index, total body fat, plasma leptin and plasma insulin (p < 0.001), and lower plasma ghrelin levels (p < 0.05) than women with lower scores. In addition, more Māori (51%) and Pacific (68%) women followed the 'refined and processed' pattern, while more New Zealand European women (40%) followed the 'sweet and savoury snacking' pattern. These data show that dietary pattern analysis is a useful tool to assess links between diet and metabolic health. It further reveals interesting ethnic group-specific differences in dietary pattern use.

Ethnic-specific suggestions for physical activity based on existing recreational physical activity preferences of New Zealand women

OBJECTIVES

Recreational physical activities of New Zealand women were examined to develop ethnic-specific suggestions encouraging physical activity (PA) participation as a targeted approach to reduce obesity rates among different groups.

METHODS

Healthy Māori, Pacific and European women (n=331; 16-45 years of age) completed an online Recent Physical Activity Questionnaire to assess recreational PA and adherence to PA guidelines. Existing PA preferences were tailored to make ethnic-specific suggestions aimed at increasing PA participation.

RESULTS

Achievement of PA guidelines was: Māori 74%; Pacific 60%; European 70%. Highest participation across all women was for walking (Māori 72%, Pacific 60%, European 83%), followed by floor exercise (Māori 54%, Pacific 37%, European 56%). Gym-type activities (e.g. weights, aerobics) and jogging were also common across ethnic groups. Group/team activities (dance, netball, touch football) were among the top 10 activities for Māori and Pacific, but not European women.

CONCLUSION

Obesity rates among specific ethnic groups of New Zealand women might be reduced by promoting activities that are: family/whānau-oriented (netball, touch), community-linked (hula, dance) and outdoor-based. Implications for public health: Tailoring existing PA preferences to develop ethnic-specific sets of activity suggestions could be important avenues to increase PA participation, improving the PA habits and subsequent health of New Zealand women and their communities.

Adherence to daily dietary and activity goals set within a Māori and Pacific weight loss competition

BACKGROUND

New Zealand Pacific and Māori populations measure disproportionately high on the international body mass index (BMI). Information is needed on what behavioural weight loss goals to recommend and how to attract and retain them in interventions. Our team weight loss competition trial for participants with a BMI ≥30 used cash prizes to incentivise completion of nine daily behaviour goals. This paper evaluates the theoretical merit of and adherence to these goals.

METHODS

A qualitative component evaluation methodology was used. Trial data on team activity, demographics and anthropometric outcome data were extracted to determine frequency of daily goal completion by teams throughout the competition and to describe participant characteristics. T-tests were used to compare completion rates of the challenges, challenge completion by day of week and between weekdays and weekends. To examine adherence to the daily challenge activity over 24 weeks the total amount of completed challenges adjusted for number of active teams was plotted by week. A Body Shape Index (ABSI) was used to determine individual anthropometric change from baseline to 8, 16 and 24 weeks. Program documents were analysed to identify barriers to adherence and retention of participants.

RESULTS

Of 19 teams (N = 130) who began only five teams performed daily goals across the whole 24 weeks. Adherence was highest during the first 8 weeks. No difference in performance between goals was found suggesting they were equally viable, though tasks worth less points were performed more frequently. Goal completion was higher on weekdays. The behaviour goals appeared to have theoretical merit in that more members of high performing teams experienced a positive change in their ABSI.

CONCLUSIONS

Incentives offer a promising strategy for encouraging retention in weight loss interventions. This study suggests that participants in a competition will perform incentivised tasks. The findings however, are limited by missing data and high drop out of individuals and whole teams. Further research is needed on how to increase retention.

Development and evaluation of a food frequency questionnaire to assess nutrient intakes of adult women in New Zealand

AIM

In New Zealand, there are few adequate food frequency questionnaires for assessing dietary intake. This study aimed to develop and assess the relative validity of a multi-nutrient, culturally appropriate, semi-quantitative food frequency questionnaire for use in young adult New Zealand women (the New Zealand Women's Food Frequency Questionnaire (NZWFFQ)).

METHODS

Women (n = 110) aged 16-45 years of Māori, Pacific or European ethnicity completed a NZWFFQ assessing dietary intake over the previous month, and a 4-day weighed food record. Relative validity was evaluated by comparing nutrient intakes from the NZWFFQ with the food record using Spearman's rank correlation coefficients, cross-classification, the weighted kappa statistic and Bland-Altman analysis.

RESULTS

Nutrient intake was higher from the NZWFFQ compared with the food record for all nutrients (range: 1%-64% difference) except alcohol (-16% difference). Energy-adjusted correlations ranged from 0.23 to 0.67 (average 0.48). Correct classification into same and adjacent quartiles was over 70% for all nutrients except folate and vitamin D. Gross misclassification into opposite quartiles ranged from 1% (monounsaturated fat, magnesium, calcium) to 10% (iron). The weighted kappa showed poor agreement for vitamin D and folate, fair agreement for most nutrients, and moderate agreement for fibre, vitamin E, magnesium, calcium and phosphorus.

CONCLUSIONS

The NZWFFQ overestimated intake of nearly all nutrients. While not suitable for assessing absolute intake, the NZWFFQ is suitable for ranking individuals based on nutrient intake demonstrating reasonable relative validity for this purpose.

An innovative team-based weightloss competition to reduce cardiovascular and diabetes risk among Māori and Pacific people: rationale and method for the study and its evaluation

Background

Obesity rates for New Zealand (NZ) Pacific and Māori (NZ indigenous people) are among the highest in the world. Long-term results of weight management programmes for adults have been modest but primarily focused on individuals. This paper describes the rationale and methodology for a trial of a culturally tailored team-based weightloss competition conducted online with community level support.

Methods/Design

A quasi-experimental design was used to compare an intervention and control group. Three six-month competitions with seven teams of seven Māori or Pacific people (N = 147) were run. Eligible participants were: Māori or Pacific, 16 years of age and above, obese (BMI ≥30 kg/m²) and either at risk of or already diagnosed with type 2 diabetes (HbA1c >50 mmol/mol) or cardiovascular disease.

The intervention facilitated group use of an internet-based competition offering financial incentives, education and support. The primary outcome was percentage of individual weight lost at 12-months. Secondary outcomes were percentage reduced total cholesterol and glycated haemoglobin (HbA1c). Data collected at baseline, 6-months and 12-months included: height, body weight, blood lipids and HbA1c, eating and dieting habits, family support, food access, alcohol use, nutrition literacy, activity levels, perceptions of weight, stress and sleep, and, perceived contagion effect. Process evaluation tasks will inform acceptability.

Discussion

An attractive, easy to understand weight change programme that effectively reduces disease risk among Māori and Pacific is desperately needed. Web-based delivered support and information to largely self-directed teams could also ease exponential rises in costs to the health system.

Trial registration

Trial Id: ACTRN12617000871347.

Asymmetric dimethylarginine and symmetric dimethylarginine prospectively relates to carotid wall thickening in black men: the SABPA study

The relationship of both asymmetric (ADMA) and symmetric (SDMA) dimethylarginine with carotid wall thickness is inconclusive especially among black populations. We aimed to compare carotid intima media thickness (cIMT) and dimethylarginine levels in 75 black and 91 white men at baseline and after a 3-year follow-up, and to investigate associations of percentage change in cIMT with percentage change in dimethylarginine levels (ADMA and SDMA). Plasma levels of ADMA and SDMA were determined with a liquid chromatography mass spectrometry method and B-mode ultrasonography was used to determine the cIMT at baseline and follow-up. In black men, mean cIMT (p = 0.79) and ADMA levels (p = 0.67) remained the same, but SDMA levels were lower (p < 0.001) when comparing baseline and follow-up. In white men, cIMT increased (p < 0.001), but both mean ADMA and SDMA levels decreased (p < 0.001) over time. In black men, percentage change in cIMT was positively associated with percentage change in ADMA (R ² = 0.49; β = 0.46; p < 0.001) and percentage change in SDMA (R ² = 0.46; β = 0.41; p < 0.001). These associations were absent in the white men. Despite lower mean SDMA and similar ADMA and cIMT in black men, percentage change in cIMT was independently associated with percentage change in ADMA and percentage change in SDMA. These results suggest an important role for ADMA and SDMA lowering strategies to delay carotid wall thickening, especially in black populations prone to the development of cardiovascular disease.

Is Sweet Taste Perception Associated with Sweet Food Liking and Intake?

A range of psychophysical taste measurements are used to characterize an individual’s sweet taste perception and to assess links between taste perception and dietary intake. The aims of this study were to investigate the relationship between four different psychophysical measurements of sweet taste perception, and to explore which measures of sweet taste perception relate to sweet food intake. Forty-four women aged 20–40 years were recruited for the study. Four measures of sweet taste perception (detection and recognition thresholds, and sweet taste intensity and hedonic liking of suprathreshold concentrations) were assessed using glucose as the tastant. Dietary measurements included a four-day weighed food record, a sweet food-food frequency questionnaire and a sweet beverage liking questionnaire. Glucose detection and recognition thresholds showed no correlation with suprathreshold taste measurements or any dietary intake measurement. Importantly, sweet taste intensity correlated negatively with total energy and carbohydrate (starch, total sugar, fructose, glucose) intakes, frequency of sweet food intake and sweet beverage liking. Furthermore, sweet hedonic liking correlated positively with total energy and carbohydrate (total sugar, fructose, glucose) intakes. The present study shows a clear link between sweet taste intensity and hedonic liking with sweet food liking, and total energy, carbohydrate and sugar intake.

Recent advances in understanding hypertension development in sub-Saharan Africa

Consistent reports indicate that hypertension is a particularly common finding in black populations. Hypertension occurs at younger ages and is often more severe in terms of blood pressure levels and organ damage than in whites, resulting in a higher incidence of cardiovascular disease and mortality. This review provides an outline of recent advances in the pathophysiological understanding of blood pressure elevation and the consequences thereof in black populations in Africa. This is set against the backdrop of populations undergoing demanding and rapid demographic transition, where infection with the human immunodeficiency virus predominates, and where under and over-nutrition coexist. Collectively, recent findings from Africa illustrate an increased lifetime risk to hypertension from foetal life onwards. From young ages black populations display early endothelial dysfunction, increased vascular tone and reactivity, microvascular structural adaptions as well as increased aortic stiffness resulting in elevated central and brachial blood pressures during the day and night, when compared to whites. Together with knowledge on the contributions of sympathetic activation and abnormal renal sodium handling, these pathophysiological adaptations result in subclinical and clinical organ damage at younger ages. This overall enhanced understanding on the determinants of blood pressure elevation in blacks encourages (a) novel approaches to assess and manage hypertension in Africa better, (b) further scientific discovery to develop more effective prevention and treatment strategies and

Proposed new industry code on unhealthy food marketing to children and young people: will it make a difference?

Reducing the exposure of children and young people to the marketing of unhealthy foods is a core strategy for reducing the high overweight and obesity prevalence in this population. The Advertising Standards Authority (ASA) has recently reviewed its self-regulatory codes and proposed a revised single code on advertising to children. This article evaluates the proposed code against eight criteria for an effective code, which were included in a submission to the ASA review process from over 70 New Zealand health professors. The evaluation found that the proposed code largely represents no change or uncertain change from the existing codes, and cannot be expected to provide substantial protection for children and young people from the marketing of unhealthy foods. Government regulations will be needed to achieve this important outcome.

Cardiac Troponin T as Early Marker of Subclinical Cardiovascular Deterioration in Black Hypertensive Women

BACKGROUND

Hypertensive heart disease is a rising concern, especially among black South African women. As high sensitivity cardiac troponin T (cTnT) is a marker of cardiomyocyte damage, we determined the potential link of (i) systemic endothelial dysfunction (reflected by urinary albumin-to-creatinine ratio), (ii) large artery stiffness, (iii) cardiac volume load (estimated by the N-terminal prohormone B-type natriuretic peptide (Nt-proBNP)), and (iv) ECG left ventricular hypertrophy in post-menopausal black women.

METHODS

In 121 (50 normotensive and 71 hypertensive) black women (mean age: 60.6 years), basic cardiovascular assessments including blood pressure and ECG were performed, along with plasma and urinary biomarkers including cTnT.

RESULTS

The cTnT levels (p=0.049) along with Nt-proBNP (p=0.003), pulse pressure (p<0.0001) and the Cornell product (p=0.030) were higher in hypertensive than normotensive women. Only in hypertensive women, was cTnT independently associated with urinary albumin-to-creatinine ratio (β=0.25; p=0.019), pulse pressure (β=0.31; p=0.019), Nt-proBNP (β=0.47; p<0.0001) and Cornell product (β=0.31; p=0.018). An independent association between albumin-to-creatinine ratio and cTnT was also evident in normotensive women (β=0.34; p=0.037).

CONCLUSION

We found cTnT to be a useful marker in an elderly black population relating to several measures of cardiovascular deterioration - from subclinical endothelial dysfunction to left ventricular hypertrophy.

Quantification of systemic renin-angiotensin system peptides of hypertensive black and white African men established from the RAS-Fingerprint®

Objective:

The objective of this study was to make use of a quantitative and qualitative approach comparing the systemic renin-angiotensin system (RAS) of hypertensive black and white African men by using RAS equilibrium analysis.

Materials and methods:

This sub-study involved 23 black (n = 15) and white (n = 8) hypertensive men aged 39.5–41 years, living in the North West Province of South Africa. The RAS-Fingerprinting was determined with LC-MS/MS quantification of angiotensin peptides. Blood pressure and other variables were determined with known methods.

Results:

The main finding of this study was the significant lower Ang I (<5.0 and 45.1 pg/ml; p = 0.005) and Ang II (15.6 and 123.9 pg/ml; p ⩽ 0.001) encountered in the hypertensive black African men compared to their white counterparts. Levels of Ang 1-5 (downstream metabolite of Ang 1-7) (1.8 and 3.0 pg/ml), were detected in black and white hypertensive men, respectively.

Conclusions:

The observed differences between circulating RAS components, which are reflected via equilibrium angiotensin levels, point to a distinctive molecular regulation of the RAAS in the two study cohorts. The increased peripheral resistance observed in hypertensive black individuals might take over a dominant role in control of blood pressure in this study population. A novel highly sensitive LC-MS/MS method resolved the issue of peptide recovery variations during sample preparation by using internal standards for each individual angiotensin metabolite.

Exploring the Relationship between Body Composition and Eating Behavior Using the Three Factor Eating Questionnaire (TFEQ) in Young New Zealand Women

Obesity is a leading cause of morbidity and mortality, yet is preventable. This study aimed to investigate associations between body mass index, body fat percentage and obesity-related eating behaviors. Women (n = 116; 18–44 years) were measured for height, weight and body fat using air displacement plethysmography (BodPod). Women completed the validated Three Factor Eating Questionnaire to assess their eating behaviors using Restraint, Disinhibition and Hunger eating factor categories and sub-categories. The eating behavior data were analyzed for associations with body mass index and body fat percentage, and comparisons across body mass index and body fat percentage categories (< vs. ≥25 kg/m²; < vs. ≥30%, respectively). Women had a mean (standard deviation) body mass index of 23.4 (3.5) kg/m², and body fat percentage of 30.5 (7.6)%. Disinhibition was positively associated with both body mass index (p < 0.001) and body fat percentage (p < 0.001). Emotional Disinhibition was positively associated with body fat percentage (p < 0.028). Women with low Restraint and high Disinhibition had significantly higher body mass index and body fat percentage than women with high Restraint and low Disinhibition. Disinhibition seems likely to be an important contributor to obesity. Tailored intervention strategies focused on counteracting Disinhibition should be a key target area for managing weight/fat gain.

Understanding Pasifika youth and the obesogenic environment, Auckland and Wellington, New Zealand

AIM

In New Zealand, the burden of obesity is greatest among Pacific people, especially in children and adolescents. We investigated the factors of the obesogenic environment that were indigenous to Pasifika youths' social-cultural context, their food purchasing behaviours, and associated anthropometric measures.

METHODS

An exploratory study of 30 Pasifika youth aged 16-24 years in Wellington and Auckland, New Zealand.

RESULTS

A large proportion of the participants were obese (mean body mass index: 31.0kg/m2; waistto-hip ratio: 0.84; waist-to-height ratio: 0.6), suggesting that the future health and wellbeing trajectory of the studied Pasifika youth is poor. Purchasing behaviours of food and snacks over a 7-day period provided meaningful insights that could be a useful future research tool to examine the role of their physical environment on food access and availability.

CONCLUSIONS

From this exploratory study, we highlight the following: (i) the future health trajectory of Pasifika youth is poor. Developing the youths' healthy lifestyle knowledge may lend itself to developing culturally relevant intervention programmes; (ii) identifying the enablers and barriers within the Pasifika ontext of an obesogenic environment can provide very useful information; (iii) use of spatial analysis using purchased food receipts adds to the current knowledge base of obesity-related research, although this was an exploratory investigation. We need to address these highlights if we are to reverse the trend of obesity for this population.

Predictors and risks of body fat profiles in young New Zealand European, Māori and Pacific women: study protocol for the women's EXPLORE study

BACKGROUND

Body mass index (BMI) (kg/m(2)) is used internationally to assess body mass or adiposity. However, BMI does not discriminate body fat content or distribution and may vary among ethnicities. Many women with normal BMI are considered healthy, but may have an unidentified "hidden fat" profile associated with higher metabolic disease risk. If only BMI is used to indicate healthy body size, it may fail to predict underlying risks of diseases of lifestyle among population subgroups with normal BMI and different adiposity levels or distributions. Higher body fat levels are often attributed to excessive dietary intake and/or inadequate physical activity. These environmental influences regulate genes and proteins that alter energy expenditure/storage. Micro ribonucleic acid (miRNAs) can influence these genes and proteins, are sensitive to diet and exercise and may influence the varied metabolic responses observed between individuals. The study aims are to investigate associations between different body fat profiles and metabolic disease risk; dietary and physical activity patterns as predictors of body fat profiles; and whether these risk factors are associated with the expression of microRNAs related to energy expenditure or fat storage in young New Zealand women. Given the rising prevalence of obesity globally, this research will address a unique gap of knowledge in obesity research.

METHODS/DESIGN

A cross-sectional design to investigate 675 NZ European, Māori, and Pacific women aged 16-45 years. Women are classified into three main body fat profiles (n = 225 per ethnicity; n = 75 per body fat profile): 1) normal BMI, normal body fat percentage (BF%); 2) normal BMI, high BF%; 3) high BMI, high BF%. Regional body composition, biomarkers of metabolic disease risk (i.e. fasting insulin, glucose, HbA1c, lipids), inflammation (i.e. IL-6, TNF-alpha, hs-CRP), associations between lifestyle factors (i.e. dietary intake, physical activity, taste perceptions) and microRNA expression will be investigated.

DISCUSSION

This research targets post-menarcheal, premenopausal women, potentially exhibiting lifestyle behaviours resulting in excess body fat affecting metabolic health. These behaviours may be characterised by specific patterns of microRNA expression that will be explored in terms of tailored solutions specific to body fat profile groups and ethnicities.

TRIAL REGISTRATION

ACTRN12613000714785.

Leptin is positively associated with blood pressure in african men with a low body mass index: the SAfrEIC study

Severe underweight may be a risk factor for hypertension in developing countries, although the manner whereby this occurs is unknown. Leptin is known to exert both beneficial and detrimental vascular effects, and is predictive of poor cardiovascular outcome at high levels, but also at low levels. We explored the relationship between blood pressure and leptin in black men from South Africa with a body mass index (BMI) in the underweight to normal range. We included 113 African men (BMI≤25 kg/m(2)) and took anthropometric, biochemical and cardiovascular measures. The blood pressure-leptin relationship was then investigated along quintiles of leptin and within BMI stratified median split (20 kg/m(2)) groups. Blood pressure increased across leptin quintiles 1-3 (p for trend≤0.040), whereas no relationship was observed along quintiles 3 to 5 (p for trend≥0.14) (adjusted for age and waist circumference). Blood pressure was similar in the two BMI median split groups (p≥0.083). In the low BMI group only, blood pressure associated positively with leptin following unadjusted, partial, and full adjustment (systolic blood pressure and diastolic blood pressure: R(2)=0.20-0.27, β=0.32-0.34, p≤0.009). Decreasing leptin levels are not likely to contribute to hypertension prevalence in the underweight. Rather, in African men with a BMI≤20 kg/m(2), low leptin levels are positively and independently associated with elevated blood pressure, which is not seen at higher BMI (20-25 kg/m(2)). Our findings suggest a differential concentration dependent vascular effect of leptin in underweight and normal weight African men.

Dietary determinants of and possible solutions to iron deficiency for young women living in industrialized countries: a review

Iron deficiency is a concern in both developing and developed (industrialized) countries; and young women are particularly vulnerable. This review investigates dietary determinants of and possible solutions to iron deficiency in young women living in industrialized countries. Dietary factors including ascorbic acid and an elusive factor in animal protein foods (meat; fish and poultry) enhance iron absorption; while phytic acid; soy protein; calcium and polyphenols inhibit iron absorption. However; the effects of these dietary factors on iron absorption do not necessarily translate into an association with iron status and iron stores (serum ferritin concentration). In cross-sectional studies; only meat intake has consistently (positively) been associated with higher serum ferritin concentrations. The enhancing effects of ascorbic acid and meat on iron absorption may be negated by the simultaneous consumption of foods and nutrients which are inhibitory. Recent cross-sectional studies have considered the combination and timing of foods consumed; with mixed results. Dietary interventions using a range of focused dietary measures to improve iron status appear to be more effective than dietary approaches that focus on single nutrients or foods. Further research is needed to determine optimal dietary recommendations for both the prevention and treatment of iron deficiency.

8-Oxo-7,8-dihydro-2'-deoxyguanosine, reactive oxygen species and ambulatory blood pressure in African and Caucasian men: the SABPA study

Various studies indicate a relationship between increased oxidative stress and hypertension, resulting in increased DNA damage and consequent excretion of 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxodG). The aim of this study was to compare urinary 8-oxodG levels in African and Caucasian men and to investigate the association between ambulatory blood pressure (BP) and pulse pressure (PP) with 8-oxodG in these groups. We included 98 African and 92 Caucasian men in the study and determined their ambulatory BP and PP. Biochemical analyses included, urinary 8-oxodG, reactive oxygen species (ROS) (measured as serum peroxides), ferric reducing antioxidant power (FRAP), total glutathione (GSH), glutathione peroxidase (GPx) and glutathione reductase (GR) activity. The African men had significantly higher systolic (SBP) and diastolic blood pressure (DBP) (both p < 0.001). Assessment of the oxidative stress markers indicated significantly lower 8-oxodG levels (p < 0.001) in the African group. The African men also had significantly higher ROS (p = 0.002) with concomitant lower FRAP (p < 0.001), while their GSH levels (p = 0.013) and GR activity (p < 0.001) were significantly higher. Single and partial regression analyses indicated a negative association between urinary 8-oxodG levels with SBP, DBP and PP only in African men. These associations were confirmed in multiple regression analyses (SBP: R(2) = 0.41; β = -0.25; p = 0.002, DBP: R(2) = 0.30; β = -0.21; p = 0.022, PP: R(2) = 0.30; β = -0.19; p = 0.03). Our results revealed significantly lower urinary 8-oxodG in African men, accompanied by a negative association with BP and PP. We propose that this may indicate a dose-response relationship in which increased oxidative stress may play a central role in the up-regulation of antioxidant defence and DNA repair mechanisms.

Evaluation of waist-to-height ratio to predict 5 year cardiometabolic risk in sub-Saharan African adults

BACKGROUND AND AIMS

Simple, low-cost central obesity measures may help identify individuals with increased cardiometabolic disease risk, although it is unclear which measures perform best in African adults. We aimed to: 1) cross-sectionally compare the accuracy of existing waist-to-height ratio (WHtR) and waist circumference (WC) thresholds to identify individuals with hypertension, pre-diabetes, or dyslipidaemia; 2) identify optimal WC and WHtR thresholds to detect CVD risk in this African population; and 3) assess which measure best predicts 5-year CVD risk.

METHODS AND RESULTS

Black South Africans (577 men, 942 women, aged >30years) were recruited by random household selection from four North West Province communities. Demographic and anthropometric measures were taken. Recommended diagnostic thresholds (WC > 80 cm for women, >94 cm for men; WHtR > 0.5) were evaluated to predict blood pressure, fasting blood glucose, lipids, and glycated haemoglobin measured at baseline and 5 year follow up. Women were significantly more overweight than men at baseline (mean body mass index (BMI) women 27.3 ± 7.4 kg/m(2), men 20.9 ± 4.3 kg/m(2)); median WC women 81.9 cm (interquartile range 61-103), men 74.7 cm (63-87 cm), all P < 0.001). In women, both WC and WHtR significantly predicted all cardiometabolic risk factors after 5 years. In men, even after adjusting WC threshold based on ROC analysis, WHtR better predicted overall 5-year risk. Neither measure predicted hypertension in men.

CONCLUSIONS

The WHtR threshold of >0.5 appears to be more consistently supported and may provide a better predictor of future cardiometabolic risk in sub-Saharan Africa.

Daily kiwifruit consumption did not improve blood pressure and markers of cardiovascular function in men with hypercholesterolemia

Increasing fruit and vegetable consumption is a key lifestyle modification in the prevention and treatment of hypertension. Kiwifruit has previously been shown to have favorable effects on blood pressure (BP), likely through inhibiting angiotensin I-converting enzyme activity. We hypothesized that the replacement of 2 fruit servings in a healthy diet with 2 green kiwifruit a day would significantly improve BP and other markers of cardiovascular function, including heart rate, stroke volume, cardiac output, and total peripheral resistance, in a group of hypercholesterolemic men. Using a controlled cross-over study design, 85 subjects completed a 4-week healthy diet run-in period before randomization to one of two 4-week intervention sequences in which they either consumed 2 green kiwifruit a day plus a healthy diet (intervention) or consumed a healthy diet alone (control). Blood pressure and other measures of cardiovascular function (using a Finometer MIDI [Finapres Medical Systems B.V, Amsterdam, The Netherlands] and standard oscillometric device) and anthropometric measurements were taken before and at the end of the treatment periods. A physical activity questionnaire was completed during the last visit. Subjects were found to be predominantly normotensive (43.5%) or prehypertensive (50.6%) and quite physically active (>30 minutes of moderate to vigorous physical activity/day in >80% subjects). No significant differences were seen for BP or any of the other markers, including heart rate, stroke volume, cardiac output, and total peripheral resistance. In conclusion, in this hypercholesterolemic, nonhypertensive group, no beneficial effects on BP or other markers of cardiovascular function were seen when consuming 2 kiwifruit a day against the background of a healthy diet.