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Ekoru K, Young EH, Dillon DG, Gurdasani D, Stehouwer N, Faurholt-Jepsen D, Levitt NS, Crowther NJ, Nyirenda M, Njelekela MA, Ramaiya K, Nyan O, Adewole OO, Anastos K, Compostella C, Dave JA, Fourie CM, Friis H, Kruger IM, Longenecker CT, Maher DP, Mutimura E, Ndhlovu CE, Praygod G, Pefura Yone EW, Pujades-Rodriguez M, Range N, Sani MU, Sanusi M, Schutte AE, Sliwa K, Tien PC, Vorster EH, Walsh C, Gareta D, Mashili F, Sobngwi E, Adebamowo C, Kamali A, Seeley J, Smeeth L, Pillay D, Motala AA, Kaleebu P, Sandhu MS. HIV treatment is associated with a two-fold higher probability of raised triglycerides: Pooled Analyses in 21 023 individuals in sub-Saharan Africa. Glob Health Epidemiol Genom 2018; 3:e7. [PMID: 29881632 PMCID: PMC5985947 DOI: 10.1017/gheg.2018.7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 04/08/2018] [Accepted: 04/10/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Anti-retroviral therapy (ART) regimes for HIV are associated with raised levels of circulating triglycerides (TG) in western populations. However, there are limited data on the impact of ART on cardiometabolic risk in sub-Saharan African (SSA) populations. METHODS Pooled analyses of 14 studies comprising 21 023 individuals, on whom relevant cardiometabolic risk factors (including TG), HIV and ART status were assessed between 2003 and 2014, in SSA. The association between ART and raised TG (>2.3 mmol/L) was analysed using regression models. FINDINGS Among 10 615 individuals, ART was associated with a two-fold higher probability of raised TG (RR 2.05, 95% CI 1.51-2.77, I2=45.2%). The associations between ART and raised blood pressure, glucose, HbA1c, and other lipids were inconsistent across studies. INTERPRETATION Evidence from this study confirms the association of ART with raised TG in SSA populations. Given the possible causal effect of raised TG on cardiovascular disease (CVD), the evidence highlights the need for prospective studies to clarify the impact of long term ART on CVD outcomes in SSA.
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Affiliation(s)
- K. Ekoru
- Department of Medicine, University of Cambridge, Cambridge, UK
- Global Health and Populations Group, Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK
| | - E. H. Young
- Department of Medicine, University of Cambridge, Cambridge, UK
- Global Health and Populations Group, Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK
| | - D. G. Dillon
- Weill Cornell Medical College, New York City, New York, USA
| | - D. Gurdasani
- Department of Medicine, University of Cambridge, Cambridge, UK
- Global Health and Populations Group, Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK
| | - N. Stehouwer
- University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - D. Faurholt-Jepsen
- Department of Infectious Diseases, University of Copenhagen (Rigshospitalet), Copenhagen, Denmark
| | - N. S. Levitt
- Division of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - N. J. Crowther
- Department of Chemical Pathology, National Health Laboratory Service, University of the Witwatersrand Medical School, Johannesburg, South Africa
| | - M. Nyirenda
- Malawi Epidemiology and Intervention Research Unit, Malawi, Lilongwe
| | - M. A. Njelekela
- Department of Physiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - K. Ramaiya
- Shree Hindu Mandal Hospital, Dar es Salaam, Tanzania
| | - O. Nyan
- Royal Victoria Teaching Hospital, School of Medicine, University of The Gambia, Banjul, The Gambia
| | - O. O. Adewole
- Department of Medicine, Obafemi Awolowo University, Ile Ife, Nigeria
| | - K. Anastos
- Albert Einstein College of Medicine, Bronx NY, USA
| | - C. Compostella
- Department of Medicine, University of Padua, Padua, Italy
| | - J. A. Dave
- Division of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - C. M. Fourie
- HART (Hypertension in Africa Research Team), North-West University, Potchefstroom, South Africa
| | - H. Friis
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Denmark
| | - I. M. Kruger
- Africa Unit for Transdisciplinary Health Research (AUTHeR), North-West University, Potchefstroom, South Africa
| | | | - D. P. Maher
- Special Programme for Research & Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - E. Mutimura
- Albert Einstein College of Medicine, Bronx NY, USA
| | - C. E. Ndhlovu
- Clinical Epidemiology Resource Training Centre, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - G. Praygod
- National Institute for Medical Research, Tanzania, Dar es Salaam
| | | | - M. Pujades-Rodriguez
- Epicentre, Médecins Sans Frontières, Paris, France
- Department of Epidemiology and Public Health, University College of London, Clinical Epidemiology Group, London, UK
| | - N. Range
- National Institute for Medical Research, Tanzania, Dar es Salaam
| | - M. U. Sani
- Cardiology Unit, Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - M. Sanusi
- Cardiology Unit, Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - A. E. Schutte
- HART (Hypertension in Africa Research Team), North-West University, Potchefstroom, South Africa
- MRC Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - K. Sliwa
- Soweto Cardiovascular Research Unit, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - P. C. Tien
- Department of Medicine, University of California, San Francisco, USA
| | - E. H. Vorster
- Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - C. Walsh
- Department of Nutrition and Dietetics, University of the Free State, Bloemfontein, South Africa
| | - D. Gareta
- Africa Health Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - F. Mashili
- National Institute for Medical Research, Tanzania, Dar es Salaam
| | - E. Sobngwi
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Cameroon, Yaoundé
| | - C. Adebamowo
- Institute of Human Virology, Abuja, Nigeria
- Department of Epidemiology and Public Health, Institute of Human Virology and Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, USA
| | - A. Kamali
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
| | - J. Seeley
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
| | - L. Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - D. Pillay
- Africa Health Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - A. A. Motala
- Department of Diabetes and Endocrinology, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - P. Kaleebu
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
| | - M. S. Sandhu
- Department of Medicine, University of Cambridge, Cambridge, UK
- Global Health and Populations Group, Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK
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Fritz T, Caidahl K, Krook A, Lundström P, Mashili F, Osler M, Szekeres FLM, Östenson CG, Wändell P, Zierath JR. Effects of Nordic walking on cardiovascular risk factors in overweight individuals with type 2 diabetes, impaired or normal glucose tolerance. Diabetes Metab Res Rev 2013; 29:25-32. [PMID: 22887834 DOI: 10.1002/dmrr.2321] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Accepted: 07/20/2012] [Indexed: 01/16/2023]
Abstract
BACKGROUND Physical activity remains a valuable prevention for metabolic disease. The effects of Nordic walking on cardiovascular risk factors were determined in overweight individuals with normal or disturbed glucose regulation. METHODS We included 213 individuals, aged 60 ± 5.3 years and with body mass index (BMI) of 30.2 ± 3.8 kg/m(2); of these, 128 had normal glucose tolerance (NGT), 35 had impaired glucose tolerance (IGT) and 50 had type 2 diabetes mellitus (T2DM). Participants were randomized to unaltered physical activity or to 5 h per week of Nordic walking with poles, for a 4-month period. Dietary habits were unaltered. BMI, waist circumference, blood pressure, glucose tolerance, clinical chemistry, maximal oxygen uptake (peak VO(2)) and self-reported physical activity (questionnaire) were assessed at the time of inclusion and after 4 months. The participants in the exercise-intervention group kept a walking diary. RESULTS In the NGT exercise group, self-reported physical activity increased markedly, and body weight (-2.0 ± 3.8 kg), BMI (-0.8 ± 1.4 kg/m(2)) and waist circumference (-4.9 ± 4.4 cm) (mean ± SD) decreased. Exercise power output (12.9 ± 9.9 W) and peak VO(2) (2.7 ± 2.8 mL/kg/min) increased in the IGT exercise group. More cardiovascular risk factors were improved after exercise intervention in people with NGT compared with those with IGT or T2DM. Exercise capacity improved significantly in all three groups of participants who reported at least 80% compliance with the scheduled exercise. CONCLUSIONS Nordic walking improved anthropometric measurements and exercise capacity. However, unsupervised Nordic walking may not provide a sufficient increase in exercise intensity to achieve ultimate health-promoting benefits on the cardiovascular parameters assessed in this study, particularly for those with disturbed glucose regulation.
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Affiliation(s)
- T Fritz
- Center for Family and Community Medicine, Karolinska Institutet, Huddinge, Sweden
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