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Sagastume D, Sibongwere DK, Kidima O, Kembo DM, N’keto JM, Dimbelolo JC, Nkakirande DB, Kabundi JCK, Peñalvo JL. Improving lifestyle behaviours among women in Kisantu, the Democratic Republic of the Congo: A protocol of a cluster randomised controlled trial. PLoS One 2022; 17:e0274517. [PMID: 36084047 PMCID: PMC9462713 DOI: 10.1371/journal.pone.0274517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 08/03/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction As the prevalence of obesity among women of reproductive age is increasing in sub-Saharan Africa, the burden of lifestyle-related conditions is expected to rise quickly. This study aims to develop and evaluate a multi-component health promotion programme for a healthy lifestyle to ultimately prevent the onset of type 2 diabetes and gestational diabetes among adult women in Kisantu, the Democratic Republic of the Congo. Methods and analysis This study is a cluster randomised controlled trial whereby two groups of three healthcare centres each, matched by population size coverage and geographical area, will be randomised to an intervention or a comparison group. Adult women of reproductive age (18–49 years), non-pregnant or first-trimester pregnant, will be recruited from the healthcare centres. 144 women in the intervention centres will follow a 24-month multi-component health promotion programme based on educational and motivational strategies whereas the comparison centres (144 participants) will be limited to a basic educational strategy. The programme will be delivered by trained peer educators and entails individualised education sessions, education and physical activity group activities, and focus groups. Topics of an optimal diet, physical activity, weight management and awareness of type 2 and gestational diabetes will be covered. The primary outcome is the adherence to a healthy lifestyle measured by a validated closed-ended questionnaire and secondary outcomes include anthropometric measurements, clinical parameters, diet diversity and the level of physical activity. Participants from both groups will be assessed at baseline and every 6 months by trained health professionals from the recruiting healthcare centres. Data will be summarised by measures of central tendency for continuous outcomes, and frequency distribution and percentages for categorical data. The primary and secondary outcomes will be quantified using statistical mixed models. Ethics This research was approved by the Institutional Review Board of the Institute of Tropical Medicine Antwerp in Belgium (IRB/RR/AC/137) and the Ethical Committee of the University of Kinshasa in the Democratic Republic of the Congo (ESP/CE/130/2021). Any substantial change to the study protocol must be approved by all the bodies that have approved the initial protocol, before being implemented. Also, this journal will be informed regarding any protocol modification. Written informed consent will be required and obtained for all participants. No participant may be enrolled on the study until written informed consent has been obtained. Trial registration number NCT05039307.
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Affiliation(s)
- Diana Sagastume
- Department of Public Health, Non-Communicable Diseases Unit, Institute of Tropical Medicine, Antwerp, Belgium
- * E-mail:
| | | | - Olivier Kidima
- Memisa, Brussels, Belgium
- Memisa Representation in Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Diertho Mputu Kembo
- BDOM-Kisantu Centre Pastoral/Mission Catholique Kisantu, Kisantu, Democratic Republic of the Congo
| | | | | | - Dorothée Bulemfu Nkakirande
- Division des Maladies Non Transmissibles, Direction Surveillance Epidémiologique, Ministère de la Santé, Kinshasa, Democratic Republic of the Congo
| | | | - José L. Peñalvo
- Department of Public Health, Non-Communicable Diseases Unit, Institute of Tropical Medicine, Antwerp, Belgium
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Bibangambah P, Hemphill LC, Acan M, Tsai AC, Sentongo RN, Kim JH, Yang IT, Siedner MJ, Okello S. Prevalence and correlates of carotid plaque in a mixed HIV-serostatus cohort in Uganda. BMC Cardiovasc Disord 2021; 21:593. [PMID: 34911457 PMCID: PMC8672630 DOI: 10.1186/s12872-021-02416-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/07/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The extent to which the risk of atherosclerotic cardiovascular disease (ACVD) is increased among people living with HIV (PLWH) in sub-Saharan Africa remains unknown. SETTING Cross-sectional analysis nested within the Ugandan Noncommunicable Diseases and Aging Cohort, including PLWH in rural Uganda > 40 years taking antiretroviral therapy (ART) for at least 3 years, and a population-based control group of HIV-uninfected age- and sex-matched persons. METHODS We conducted carotid ultrasonography and collected ACVD risk factor data. Our outcome of interest was carotid plaque, defined as > 1.5 mm thickness from the intima-lumen interface to the media-adventitia interface. We fit multivariable logistic regression models to estimate correlates of carotid plaque including HIV-specific and traditional cardiovascular risk factors. RESULTS We enrolled 155 (50.2%) PLWH and 154 (49.8%) HIV-uninfected comparators, with a mean age of 51.4 years. Among PLWH, the median CD4 count was 433 cells/mm3 and 97.4% were virologically suppressed. Carotid plaque prevalence was higher among PLWH (8.4% vs 3.3%). HIV infection (aOR 3.90; 95% CI 1.12-13.60) and current smokers (aOR 6.60; 95% CI 1.22-35.80) had higher odds of carotid plaque, whereas moderate (aOR 0.13, 95% CI 0.01-1.55) and vigorous intensity of physical activity (aOR 0.34, 95% CI 0.07-1.52) were associated with decreased odds of carotid plaque. CONCLUSION In rural Uganda, PLWH have higher prevalence of carotid plaque compared to age- and sex-matched HIV-uninfected comparators. Future work should explore how biomedical and lifestyle modifications might reduce atherosclerotic burden among PLWH in the region.
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Affiliation(s)
- Prossy Bibangambah
- Department of Radiology, Mbarara University of Science and Technology, P.O. Box, 1410, Mbarara, Uganda.
| | - Linda C. Hemphill
- grid.32224.350000 0004 0386 9924Massachusetts General Hospital, Boston, MA USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA
| | - Moses Acan
- grid.33440.300000 0001 0232 6272Department of Radiology, Mbarara University of Science and Technology, P.O. Box, 1410 Mbarara, Uganda
| | - Alexander C. Tsai
- grid.32224.350000 0004 0386 9924Massachusetts General Hospital, Boston, MA USA
| | - Ruth N. Sentongo
- grid.33440.300000 0001 0232 6272Department of Radiology, Mbarara University of Science and Technology, P.O. Box, 1410 Mbarara, Uganda
| | - June-Ho Kim
- grid.32224.350000 0004 0386 9924Massachusetts General Hospital, Boston, MA USA
| | - Isabelle T. Yang
- grid.254880.30000 0001 2179 2404Geisel School of Medicine at Dartmouth, Hanover, NH USA
| | - Mark J. Siedner
- grid.33440.300000 0001 0232 6272Department of Radiology, Mbarara University of Science and Technology, P.O. Box, 1410 Mbarara, Uganda ,grid.32224.350000 0004 0386 9924Massachusetts General Hospital, Boston, MA USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA
| | - Samson Okello
- grid.33440.300000 0001 0232 6272Department of Radiology, Mbarara University of Science and Technology, P.O. Box, 1410 Mbarara, Uganda
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Jang HJ, Oh H. Trends and Inequalities in Overall and Abdominal Obesity by Sociodemographic Factors in Korean Adults, 1998-2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084162. [PMID: 33920007 PMCID: PMC8070993 DOI: 10.3390/ijerph18084162] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/01/2021] [Accepted: 04/09/2021] [Indexed: 12/16/2022]
Abstract
Few studies have comprehensively examined the nationwide trends in overall and abdominal obesity prevalence and related sociodemographic inequalities in Korea. In the Korea National Health and Nutrition Examination Survey 1998–2018, we estimated the age-standardized prevalence of overall (body mass index ≥ 25 kg/m2) and abdominal obesity (waist circumference ≥ 90 cm men, ≥85 cm women) in each sociodemographic subgroup of Korean adults (aged 19–79 years). For each survey year, weighted logistic regression was performed to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between obesity prevalence and sociodemographic factors. During the study period, the prevalence of overall and abdominal obesity increased in men (24.8% to 42.4%; 20.1% to 32.1%; respectively) but only a small change was observed in women (26.5% to 26.0%; 22.7% to 20.9%; respectively). Obesity prevalence increased in all sociodemographic groups of men but varied across groups in women. In women, income (4th vs. 1st quartiles in 2016–2018: OR (95% CI) = 0.66 (0.56–0.78) overall obesity; 0.60 (0.51–0.71) abdominal obesity) and education (college or higher vs. high school or less: 0.62 (0.54–0.72) overall obesity; 0.58 (0.50–0.68) abdominal obesity) were inversely associated with obesity prevalence, and the gaps became more pronounced since 2007. Our data suggest that the inequalities in obesity prevalence by sex and by socioeconomic status have become more apparent over time in Korea.
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Affiliation(s)
- Ha-Jin Jang
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul 02841, Korea;
| | - Hannah Oh
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul 02841, Korea;
- Division of Health Policy and Management, College of Health Sciences, Korea University, Seoul 02841, Korea
- Correspondence: ; Tel.: +82-2-3290-5678
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Halli SS, Prasad JB, Biradar RA. Increased blood glucose level following hysterectomy among reproductive women in India. BMC Womens Health 2020; 20:211. [PMID: 32967655 PMCID: PMC7513479 DOI: 10.1186/s12905-020-01075-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In recent years, the hysterectomy, a surgical removal of the uterus, has received increased attention in health policy debates in India. The trigger for this was a series of media reports that highlighted an unusual surge in the number of women undergoing hysterectomies with a significant number of cases involving young and early menopausal women from low-income families. When menopause occurs as a result of hysterectomy, then the hormones such as estrogen and progesterone affect how the body cells respond to insulin. To date, we have not come across a national study following blood glucose levels among women who undergo a hysterectomy. METHODS The study used the Indian fourth round of National Family Health Survey data, which is a cross-sectional nationally representative sample of 699,686 women in the age group 15-49 years and conducted during 2015-16. Bivariate and multivariate logistic regressions were used to examine the effect of hysterectomy on blood glucose level of > 140 mg/dl among women of reproductive age groups. RESULTS The blood glucose level of > 140 mg/dl was much higher among women who had undergone a hysterectomy (12.2%) compared to non-hysterectomy women (5.7%). The pattern holds true among relevant background characteristics such as age, place of residence, education, caste, religion, wealth, marital status, body mass index (BMI), anaemia and consumption of tobacco. The adjusted odds after controlling for significant background factors, women who underwent hysterectomy experienced 15% higher odds of blood glucose level of > 140 mg/dl compared those who did not. CONCLUSIONS The results indicated increased blood glucose level among women post hysterectomy. Hence, the government of India should consider developing evidence-based policies and programming to provide effective targeted interventions for the better reproductive health of women.
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Affiliation(s)
- Shiva S. Halli
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0T6 Canada
| | - Jang Bahadur Prasad
- Department of Epidemiology and Biostatistics, KLE University, Belgaum, Karnataka 590010 India
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Hilawe EH, Yatsuya H, Kawaguchi L, Aoyama A. Differences by sex in the prevalence of diabetes mellitus, impaired fasting glycaemia and impaired glucose tolerance in sub-Saharan Africa: a systematic review and meta-analysis. Bull World Health Organ 2014; 91:671-682D. [PMID: 24101783 DOI: 10.2471/blt.12.113415] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 02/21/2013] [Accepted: 03/25/2013] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To assess differences between men and women in the prevalence of diabetes mellitus, impaired fasting glycaemia and impaired glucose tolerance in sub-Saharan Africa. METHODS In September 2011, the PubMed and Web of Science databases were searched for community-based, cross-sectional studies providing sex-specific prevalences of any of the three study conditions among adults living in parts of sub-Saharan Africa (i.e. in Eastern, Middle and Southern Africa according to the United Nations subregional classification for African countries). A random-effects model was then used to calculate and compare the odds of men and women having each condition. FINDINGS In a meta-analysis of the 36 relevant, cross-sectional data sets that were identified, impaired fasting glycaemia was found to be more common in men than in women (OR: 1.56; 95% confidence interval, CI: 1.20-2.03), whereas impaired glucose tolerance was found to be less common in men than in women (OR: 0.84; 95% CI: 0.72-0.98). The prevalence of diabetes mellitus - which was generally similar in both sexes (OR: 1.01; 95% CI: 0.91-1.11) - was higher among the women in Southern Africa than among the men from the same subregion and lower among the women from Eastern and Middle Africa and from low-income countries of sub-Saharan Africa than among the corresponding men. CONCLUSION Compared with women in the same subregions, men in Eastern, Middle and Southern Africa were found to have a similar overall prevalence of diabetes mellitus but were more likely to have impaired fasting glycaemia and less likely to have impaired glucose tolerance.
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Affiliation(s)
- Esayas Haregot Hilawe
- Department of Public Health and Health Systems, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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Yatsuya H, Li Y, Hilawe EH, Ota A, Wang C, Chiang C, Zhang Y, Uemura M, Osako A, Ozaki Y, Aoyama A. Global Trend in Overweight and Obesity and Its Association With Cardiovascular Disease Incidence. Circ J 2014; 78:2807-18. [DOI: 10.1253/circj.cj-14-0850] [Citation(s) in RCA: 145] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hiroshi Yatsuya
- Department of Public Health, Fujita Health University School of Medicine
- Department of Cardiology, Fujita Health University School of Medicine
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine
| | - Yuanying Li
- Department of Public Health, Fujita Health University School of Medicine
| | - Esayas Haregot Hilawe
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine
- Department of Public Health, School of Medicine, Mekelle University
| | - Atsuhiko Ota
- Department of Public Health, Fujita Health University School of Medicine
| | - Chaochen Wang
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine
| | - Chifa Chiang
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine
| | - Yan Zhang
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine
| | - Mayu Uemura
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine
| | - Ayaka Osako
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University School of Medicine
| | - Atsuko Aoyama
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine
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Ferdinand KC. Improved Identification and Antihypertension Pharmacotherapy in Cardiorenal Metabolic Syndrome: Focus on Racial/Ethnic Minorities, Olmesartan Medoxomil, and Combination Therapy. Cardiorenal Med 2012; 2:256-267. [PMID: 23380878 DOI: 10.1159/000342968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Cardiorenal metabolic syndrome (CRS) is a global health care concern in view of aging in certain populations, increased obesity, changing lifestyles, and its close association with type 2 diabetes mellitus and cardiovascular morbidity and mortality. Determining the appropriate criteria for CRS has been somewhat controversial, and efforts to fully describe and define the syndrome are still ongoing. Nonetheless, improving knowledge of the syndrome among health care professionals will help to identify patients who may require pharmacological and therapeutic lifestyle intervention, particularly with regards to addressing high-normal blood pressure and hypertension. This article reviews current clinical guidelines with a focus on the identification, especially in racial/ethnic minorities, treatment, and associated cardiovascular morbidity and mortality of high blood pressure and hypertension in patients with CRS. Efficacy and outcomes studies that provide insight into the selection of an initial antihypertensive regimen in this population will be discussed. Finally, a brief review of the benefits of olmesartan medoxomil and combination therapy and patient factors in the management of hypertension with CRS will be addressed.
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Affiliation(s)
- Keith C Ferdinand
- Tulane School of Medicine, Tulane Heart and Vascular Institute, New Orleans, La., USA
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Kalk WJ, Joffe BI, Sumner AE. The waist circumference of risk in black South african men is lower than in men of European ancestry. Metab Syndr Relat Disord 2011; 9:491-5. [PMID: 21875336 PMCID: PMC3225062 DOI: 10.1089/met.2011.0063] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Central obesity measured by waist circumference is a cardiovascular disease (CVD) risk factor; however, the waist circumference of risk in populations of African descent has not been identified. The International Diabetes Federation currently suggests that cutoffs established in men of European descent be applied to sub-Saharan men-a waist circumference ≥94 cm. SUBJECTS AND METHODS Participants were 203 South African black men with type 2 diabetes mellitus (T2DM). They were divided into quartiles of waist circumference (>88 cm, 88-94 cm, 95-103 cm, >103 cm). Cardiovascular risk factors, including insulin resistance (IR), measured by modified homeostasis model assessement of IR (HOMA-IR), and the triglycerides-to-high-density lipoprotein cholesterol (TG-to-HDL-C) ratio, were compared across quartiles. RESULTS Age, duration of diabetes, glycosylated hemoglobin (HbA1c), blood pressure, urinary albumin excretion, and smoking were similar across waist circumference quartiles. Overall, for both lipids and measures of IR, there was variation across waist circumference quartiles, but no significant differences between quartiles 2 and 3. Therefore, data from these two quartiles were pooled. Between the first and second+third (88-103 cm) quartiles, there were significant differences in HDL-C (1.30±0.43, 1.10±0.43 mmol/L, P=0.003), TG (medians 1.10, 1.60 mmol/L P<0.001), low-density lipoprotein cholesterol (LDL-C; 2.40±0.93, 2.85±1.03 mmol/L, P=0.01), non-HDL-C (3.05±1.18, 3.70±1.16 mmol/L, P=0.002), HOMA-IR (medians 0.90, 2.10, P<0.001), and TG-to-HDL-C ratio (medians 0.89, 1.17, P<0.001). Additional comparisons were made between men with waist circumference <90 cm and 90-93 cm. Values for each lipid and for IR parameters were more favorable in the <90-cm group (all P<0.05). CONCLUSIONS For black South African diabetic men, CVD risk substantially increased with waist circumference >90 cm. The waist circumference cut point of >94 cm has the potential to misclassify many black South African diabetic men at risk for CVD.
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Affiliation(s)
- W John Kalk
- Department of Medicine University of the Witwatersrand, Johannesburg, South Africa.
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