Deriving an optimal threshold of waist circumference for detecting cardiometabolic risk in sub-Saharan Africa

Predictive ability of anthropometric indices in identifying metabolic syndrome among US adolescents 10 to 19 years old: Analysis from the National Health and Nutrition Examination Survey 2011 to 2018 data set

OBJECTIVE

The aim of this study was to identify the best anthropometric indices for predicting metabolic syndrome in US adolescents.

METHODS

A cross-sectional study analyzed data of adolescents ages 10 to 19 y using the National Health and Nutrition Examination Survey 2011 to 2018 data. The receiver operating characteristic areas under the curve (AUCs) of waist circumference z score, body roundness index, body mass index, and A Body Shape Index in identifying predicting metabolic syndrome were assessed. Furthermore, sensitivity, specificity, positive predictive value, negative predictive value, and positive and negative likelihood ratios of all anthropometric indices were calculated.

RESULTS

A total of 5496 adolescents were included in the analysis. Waist circumference z score had an AUC of 0.90 (95% CI, 0.89-0.91), sensitivity of 95.0% (95% CI, 89.4-98.1), and specificity of 74.8% (95% CI, 73.6, 76.0). Body roundness index had an AUC of 0.88 (95% CI, 0.87-0.89), sensitivity of 96.7% (95% CI, 91.7-99.1), and specificity of 75.2% (95% CI, 74.1-76.4). Body mass index z score had an AUC of 0.83 (95% CI, 0.81-0.85), sensitivity of 97.5% (95% CI, 92.9-99.5), and specificity of 68.2% (95% CI, 66.9-69.4). A Body Shape Index had an AUC of 0.59 (95% CI, 0.56-0.61), sensitivity of 75.0% (95% CI, 66.3-82.5), and specificity of 50.9% (95% CI, 49.5-52.2).

CONCLUSIONS

Our study found waist circumference z score and body roundness index were the best predictors of predicting metabolic syndrome compared with body mass index z score and A Body Shape Index in both boys and girls. We recommend that future studies develop global cutoff points for these anthropometric indices and examine their performance in a multi-country setting.

Cardiovascular Risk Estimation Based on Country-of-Birth- and Country-of-Residence-Specific Scores among Migrants in the Netherlands: The HELIUS Study

BACKGROUND

Regional and country-specific cardiovascular risk algorithms have been developed to improve CVD risk prediction. But it is unclear whether migrants' country-of-residence or country-of-birth algorithms agree in stratifying the CVD risk of these populations. We evaluated the risk stratification by the different algorithms, by comparing migrant country-of-residence-specific scores to migrant country-of-birth-specific scores for ethnic minority populations in the Netherlands.

METHOD

data from the HELIUS study was used in estimating the CVD risk scores for participants using five laboratory-based (Framingham, Globorisk, Pool Cohort Equation II, SCORE II, and WHO II) and three nonlaboratory-based (Framingham, Globorisk, and WHO II) risk scores with the risk chart for the Netherlands. For the Globorisk, WHO II, and SCORE II risk scores, we also computed the risk scores using risk charts specified for the migrant home country. Risk categorization was first done according to the specification of the risk algorithm and then simplified to low (green), moderate (yellow and orange), and high risk (red).

RESULTS

we observed differences in risk categorization for different risk algorithms ranging from 0% (Globorisk) to 13% (Framingham) for the high-risk category, as well as differences in the country-of-residence- and country-of-birth-specific scores. Agreement between different scores ranged from none to moderate. We observed a moderate agreement between the Netherlands-specific SCORE II and the country-of-birth SCORE II for the Turkish and a nonagreement for the Dutch Moroccan population.

CONCLUSION

disparities exist in the use of the country-of-residence-specific, as compared to the country-of-birth, risk algorithms among ethnic minorities living in the Netherlands. Hence, there is a need for further validation of country-of-residence- and country-of-birth-adjusted scores to ascertain appropriateness and reliability.

Identifying a metabolomics profile associated with masked hypertension in two independent cohorts: Data from the African-PREDICT and SABPA studies

Individuals with masked hypertension (MHT) have a greater risk of adverse cardiovascular outcomes than normotensive (NT) individuals. Exploring metabolomic differences between NT and MHT individuals may help provide a better understanding of the etiology of MHT. We analyzed data from 910 young participants (83% NT and 17% MHT) (mean age 24 ± 3 years) from the African-PREDICT and 210 older participants (63% NT and 37% MHT) from the SABPA (mean age 42 ± 9.6 years) studies. Clinic and ambulatory blood pressures (BPs) were used to define BP phenotypes. Urinary amino acids and acylcarnitines were measured using liquid chromatography time-of-flight mass spectrometry in SABPA and liquid chromatography tandem mass spectrometry in the African-PREDICT studies. In the SABPA study, amino acids (leucine/isoleucine, valine, methionine, phenylalanine), free carnitine (C0-carnitine), and acylcarnitines C3 (propionyl)-, C4 (butyryl)-carnitine and total acylcarnitine) were higher in MHT than NT adults. In the African-PREDICT study, C0- and C5-carnitines were higher in MHT individuals. With unadjusted analyses in NT adults from the SABPA study, ambulatory SBP correlated positively with only C3-carnitine. In MHT individuals, positive correlations of ambulatory SBP with leucine/isoleucine, valine, methionine, phenylalanine, C0-carnitine and C3-carnitine were evident (all p < 0.05). In the African-PREDICT study, ambulatory SBP correlated positively with C0-carnitine (r = 0.101; p = 0.006) and C5-carnitine (r = 0.195; p < 0.001) in NT adults and C5-carnitine in MHT individuals (r = 0.169; p = 0.034). We demonstrated differences between the metabolomic profiles of NT and MHT adults, which may reflect different stages in the alteration of branched-chain amino acid metabolism early on and later in life.

Factors Associated with Improved Knowledge of Metabolic Syndrome in Female Market Traders

Metabolic syndrome (MetS) is considered to be a clustering of cardiometabolic diseases and is emerging as a public health concern. There is little evidence of this disease in market traders, and so the aim of this study was to determine the prevalence and knowledge of MetS. In this cross-sectional study, anthropometry, blood pressure and bloods were collected using standardized methods to detect the prevalence of MetS using the harmonized method in a cohort of female Ghanaian market traders (n = 338). A questionnaire documented the knowledge of MetS. Linear regression was used to investigate the factors associated with knowledge and was reported as adjusted β values. Forty-two percent (n = 142) had MetS. The overall knowledge of MetS was low, driven by education (β = 0.22, p = 0.0001), low levels of high-density lipoprotein-cholesterol (β = -0.15, p = 0.018) and affiliation with the Ewe cultural group (β = -0.19, p = 0.0004). As females working in a sedentary occupation, market traders are vulnerable to MetS. Our findings indicate the urgent need for culturally sensitive education to promote healthy behaviours.

The Effect of Obesity on the Waist Circumference Cut-Point Used for the Diagnosis of the Metabolic Syndrome in African Women: Results from the SWEET Study

Waist circumference (WC) is one of the diagnostic criteria for metabolic syndrome (MetS). However, studies have shown that the waist cut-point may be influenced by BMI. The aim of this study was to, therefore, determine whether the presence of obesity influences the WC cut-point used to diagnose MetS in sub-Saharan African women. The second aim was to determine whether calculated cut-points of other waist-related and dual-energy X-ray absorptiometry (DXA)-determined anthropometric measures used for the diagnosis of MetS were also influenced by BMI. Biochemical, simple anthropometric and dual-energy X-ray absorptiometry-derived anthropometric data were collected in 702 black South African women from the Study of Women Entering and in Endocrine Transition (SWEET). A receiver operating characteristic curve analysis was used to determine waist, waist-to-hip (WHR) and waist-to-height ratios, body shape index (ABSI), total body fat, trunk fat, and peripheral (arm + leg) fat cut-points for MetS (without waist) in subjects with BMI above or below the median value. The estimated WC cut-points (107 cm, 93.5 cm) for women with high BMI and low BMI, respectively, and the cut-points for the other anthropometric variables for the diagnosis of MetS were greater in high BMI women compared to low BMI women. The exceptions were WHR and ABSI, for which the cut-points were very similar in both BMI groups, and peripheral fat, where the cut-point was lower in the high BMI group. Logistic regression analysis demonstrated that WC was associated with a higher risk (odds ratio [95% CIs]: 1.07 [1.04, 1.10]; p < 0.0001), whilst hip was associated with a lower risk (0.97 [0.94, 0.99]; p = 0.02) for MetS. These data suggest that with increasing BMI, the higher levels of protective gluteofemoral fat lead to the requirement for higher WC cut-points for MetS diagnosis. The opposing associations of waist and hip with MetS risk make WHR a more appropriate variable for diagnosing MetS among African women as the WHR cut-point is less influenced by increasing BMI than is WC, which was also observed for ABSI.

Waist circumference thresholds predicting incident dysglycaemia and type 2 diabetes in Black African men and women

AIMS

To determine the waist circumference (WC) thresholds for the prediction of incident dysglycaemia and type 2 diabetes (T2D) in Black South African (SA) men and women and to compare these to the advocated International Diabetes Federation (IDF) Europid thresholds.

MATERIALS AND METHODS

In this prospective study, Black SA men (n = 502) and women (n = 527) from the Middle-aged Sowetan Cohort study who had normal or impaired fasting glucose at baseline (2011-2015) were followed up until 2017 to 2018. Baseline measurements included anthropometry, blood pressure and fasting glucose, HDL cholesterol and triglyceride concentrations. At follow-up, glucose tolerance was assessed using an oral glucose tolerance test. The Youden index was used to determine the optimal threshold of WC to predict incident dysglycaemia and T2D.

RESULTS

In men, the optimal WC threshold was 96.8 cm for both dysglycaemia and T2D (sensitivity: 56% and 70%; specificity: 74% and 70%, respectively), and had higher specificity (P < 0.001) than the IDF threshold of 94 cm. In women, the optimal WC threshold for incident dysglycaemia was 91.8 cm (sensitivity 86%, specificity 37%) and for T2D it was 95.8 cm (sensitivity 85%, specificity 45%), which had lower sensitivity, but higher specificity to predict incident dysglycaemia and T2D than the IDF threshold of 80 cm (sensitivity: 97% and 100%; specificity: 12% and 11%, respectively)).

CONCLUSIONS

We show for the first time using prospective cohort data from Africa that the IDF Europid WC thresholds are not appropriate for an African population, and show that African-specific WC thresholds perform better than the IDF Europid thresholds to predict incident dysglycaemia and T2D.

Soluble (Pro)renin Receptor Is Adversely Associated with Indices of Left Ventricular Structure and Function: The African-PREDICT Study

This study aims to compare soluble (pro)renin receptor [s(P)RR] levels between black and white adults and to explore the associations of left ventricular (LV) structure and function with s(P)RR in the total and ethnicity-stratified groups. The study sample included 1172 apparently healthy black (n = 587) and white (n = 585) participants of the African-PREDICT study aged 20−30 years. Echocardiography was performed to determine relative wall thickness (RWT), LV mass index, LV ejection fraction and stroke volume index (SVi). s(P)RR was analyzed from serum samples, while plasma renin activity-surrogate (PRA-S) and eq angiotensin II were determined using the RAS™ Fingerprint. s(P)RR was higher in the white participants compared to the black participants (p < 0.001). In multivariable-adjusted linear regression analyses, we observed a positive association between RWT and s(P)RR (β = 0.141; p = 0.005) and negative associations of LV ejection fraction (β = −0.123; p = 0.016) and SVi (β = −0.144; p = 0.004) with s(P)RR only in white adults. Higher s(P)RR observed in white vs. black participants was associated with higher RWT and poorer LV function only in young white adults but not in their black counterparts. These results suggest that s(P)RR may contribute to LV remodeling and dysfunction in white populations due to its role in volume−pressure regulation and its proinflammatory as well as profibrotic effects.

Metabolic syndrome, associated factors and optimal waist circumference cut points: findings from a cross-sectional community-based study in the elderly population in Asmara, Eritrea

OBJECTIVE

The aim of the study was to investigate the prevalence of metabolic syndrome (MetSyn), associated factors, and optimal waist circumference (WC) cut points in a subset of the elderly population in Asmara, Eritrea.

DESIGN

A community-based cross-sectional study conducted between January and June 2018.

SETTING

Asmara, Eritrea.

PARTICIPANTS

Demographic, clinical biochemistry and anthropometric information were collected from a total of 319 elderly participants of African lineage (54.5% men vs 45.5% women).

MAIN OUTCOME MEASURES

Lipid profiles, fasting plasma glucose (FPG), anthropometric data, clinical profiles and demographic characteristic of patients were described. MetSyn was defined according to the International Diabetes Federation harmonised criteria.

RESULTS

The median age (IQR) of study participants was 67 (IQR: 63-72 years)-men 68 (IQR: 64-74) years versus women 65 (IQR: 62-70) years, p=0.002. The prevalence of MetSyn was 90 (28.4%). Abnormal values in MetSyn components were as follows: systolic blood pressure/diastolic blood pressure ≥130/85 mm Hg or use of hypertension medication 133 (41.7%); overweight/obesity, 55 (25.1%); abdominal obesity 129 (40.4); low-density lipoproptein cholesterol (LDL-C) >130 mg/dL, 139 (43.6%); total cholesterol >200 mg/dL, 152 (47.6%); non-high-density lipoproptein cholesterol (HDL-C)>130 mg/dL, 220 (69.0%) and FPG (≥100-125 mg/dL), 35 (12.7%) and FPG>125.17 (6.2%). Multivariate logistic regression analysis indicated that sex (females) (adjusted OR (aOR) 4.69, 95% CI 2.47 to 8.92); non-HDL-C (aOR 1.09, 95% CI 1.05 to 1.14); LDL-C >130 mg/dL (aOR 2.63, 95% CI 1.09 to 6.37) and body mass index (aOR 1.20, 95% CI 1.10 to 1.32) were independently associated with the presence of MetSyn. Optimal cut points for WC in men yielded a value of 85.50 cm, a sensitivity of 76.0%, a specificity of 61.0% and an area under receiver operating characteristics curve (AUROC) value of 74.0, 95% CI (65.7 to 82.4). For women, the WC at a cut point value of 80.50 cm yielded the highest Youden index (0.41) with a sensitivity of 80%, a specificity of 39%, and an AUROC of 73.4, 95% CI (64.8 to 82.5).

CONCLUSIONS

The MetSyn is highly prevalent in a subset of apparently healthy elderly population in Asmara, Eritrea. The findings support opportunistic and/or programmatic screening for CVD risk in the elderly during outpatient visits.

Obesity and CKD in Sub-Saharan Africa: A Narrative Review

Obesity is a major public health problem in the developed world, where it has reached an epidemic status over the last few decades. In parallel with this, the prevalence of chronic kidney disease (CKD) has increased. Although obesity is a risk factor for hypertension and diabetes, it is also independently associated with the development and progression of CKD. Two-third of patients with CKD worldwide will be residents of developing countries by the year 2030. Risk factors for CKD are prevalent in the sub-Saharan Africa region; this review discusses the available data regarding the relationship between obesity and CKD. The prevalence of CKD appears to correlate with increasing adiposity in sub-Saharan Africa; however, limited data are currently available, and the analysis of this association is further complicated by a variety of parameters used to define obesity. (eg, body mass index vs waist circumference). Longer, large-scale studies are needed to inform the prevalence and kidney implications of obesity in sub-Saharan Africa.

Assessment of Anthropometric Indices for Optimal Cut-Offs for Obesity Screening in a South African Adolescent Population

Simple Summary

The diagnosis of obesity in sub-Saharan African children relies on cut-off values for body mass index percentile (pBMI) and waist-to-height ratio (WtHR) established in western populations. Hence, this study assessed anthropometric indices to determine optimal cut-off values for obesity screening in the South African adolescent population. Findings from this study showed that the cut-off value for pBMI was p85.2th, which improved the sensitivity of the test by approximately 30% compared to the CDC recommended BMI percentile of p95.0th. Moreover, the optimal cut-off for WHtR was 0.481, which was close to the recommended cut-off value of 0.5. This study reveals a lower pBMI cut-off value, different from the CDC recommended cut-off, for screening obesity in a South African adolescent population and suggests that the optimal pBMI cut-off for obesity screening may be ethnic-specific.

Abstract

The assessment of obesity in sub-Saharan Africa relies on cut-offs established from western populations. This study assessed anthropometric indices to determine optimal cut-off values for obesity screening in the South African adolescent population. A cross-sectional study involving 1144 (796 females and 348 males) adolescents aged 11–17 years from the Eastern Cape Province of South African was conducted. Anthropometric parameters were measured. Receiver operating characteristic (ROC) analysis was performed to assess the sensitivity and specificity of obesity screening tools and establish cut-offs. The optimal cut-offs for obesity in the cohort using waist-to-height ratio (WHtR) as reference were: neck circumference (NC) = 30.6 cm, mid-upper arm circumference (MUAC) = 25.9 cm, waist circumference (WC) = 75.1 cm, hip circumference (HC) = 92.15 cm and body mass index percentile (pBMI) = p85.2th. The new pBMI cut-off value at p85.2th improved the sensitivity of the test by approximately 30% compared to the CDC recommended BMI percentile (pBMIr) of p95.0th. When pBMI was used as reference, the optimal cut-offs in the cohort were: WHtR = 0.481, NC = 30.95 cm, MUAC = 27.95 cm, WC = 76.1 cm and HC = 95.75 cm. The WHtR optimal cut-off of 0.481 was close to the recommended cut-off value of 0.5. The predicted prevalence of obesity obtained using cut-offs from ROC analysis was higher than those from recommended references. All cut-off values for the various anthropometric measures generally increased with age for all percentile ranges. This study reveals a lower pBMI cut-off value, different from the CDC recommended cut-off, for screening obesity in a South African adolescent population. The study has established that the optimal pBMI cut-off for obesity screening may be ethnic-specific.

Using the first nationwide survey on non-communicable disease risk factors and different definitions to evaluate the prevalence of metabolic syndrome in Burkina Faso

BACKGROUND

The burden of cardiovascular diseases is rising in the developing world including Sub-Saharan Africa. The rapid rise of cardiovascular disease burden is in part due to undetected and uncontrolled cardiovascular risk factors. The clustering of metabolic syndrome (MetS) components is associated with a high risk of cardiovascular diseases. This complex biochemical disorder is still poorly studied in western Africa. In this study, we aimed to determine the prevalence of metabolic syndrome and its determinants among the adult population in Burkina Faso.

METHODS

We performed a secondary analysis of the data from the first national survey on non-communicable diseases risk factors using the World Health Organization (WHO) Stepwise approach. We included 4019 study participants aged 25 to 64 years. The metabolic syndrome prevalence was estimated using six different definitions.

RESULTS

The mean age was 38.6±11.1 years. Women represented 52.4% and three quarters (75%) lived in rural areas. The overall prevalence of metabolic syndrome according to the different definitions was 1.6% (95%CI:1.1-2.2) for the American College of Endocrinology, 1.8% (95%CI: 1.3-2.4) for the WHO, 4.3% (95%CI:3.5-5.2) for the National Cholesterol Education Program Adult Treatment Panel III, 6.2% (95%CI: 5.1-7.6) for the AAH/NHBI, 9.6%(95%CI: 8.1-11.3) for the International Diabetes Federation and 10.9% (95%: 9.2-12.7) for the Joint Interim Statement. The metabolic syndrome components with the highest prevalence were low High density lipoprotein (63.3%), abdominal obesity (22.3%) and hypertension (20.6%). People living in urban areas and those with older age have higher prevalence of metabolic syndrome regardless of the definition used.

CONCLUSION

Our findings suggest various levels of prevalence of MetS according to the definition used. Identifying the most appropriate criteria for MetS among the adult population is important to early detect and treat this syndrome and its components at the primary health care level to control the rising burden of cardiovascular diseases in the context of ongoing epidemiological transition in the country.

Anthropometric cut-offs to identify hyperglycemia in an Afro-Caribbean population: a cross-sectional population-based study from Barbados

INTRODUCTION

Body mass index (BMI) and waist circumference (WC) cut-offs associated with hyperglycemia may differ by ethnicity. We investigated the optimal BMI and WC cut-offs for identifying hyperglycemia in the predominantly Afro-Caribbean population of Barbados.

RESEARCH DESIGN AND METHODS

A cross-sectional study of 865 individuals aged ≥25 years without known diabetes or cardiovascular disease was conducted. Hyperglycemia was defined as fasting plasma glucose ≥5.6 mmol/L or hemoglobin A_1c ≥5.7% (39 mmol/mol). The Youden index was used to identify the optimal cut-offs from the receiver operating characteristic (ROC) curves. Further ROC analysis and multivariable log binomial regression were used to compare standard and data-derived cut-offs.

RESULTS

The prevalence of hyperglycemia was 58.9% (95% CI 54.7% to 63.0%). In women, optimal BMI and WC cut-offs (27 kg/m² and 87 cm, respectively) performed similarly to standard cut-offs. In men, sensitivities of the optimal cut-offs of BMI ≥24 kg/m² (72.0%) and WC ≥86 cm (74.0%) were higher than those for standard BMI and WC obesity cut-offs (30.0% and 25%-46%, respectively), although with lower specificity. Hyperglycemia was 70% higher in men above the data-derived WC cut-off (prevalence ratio 95% CI 1.2 to 2.3).

CONCLUSIONS

While BMI and WC cut-offs in Afro-Caribbean women approximate international standards, our findings, consistent with other studies, suggest lowering cut-offs in men may be warranted to improve detection of hyperglycemia. Our findings do, however, require replication in a new data set.

Optimal cut-offs of five anthropometric indices and their predictive ability of type 2 diabetes in a nationally representative Kenyan study

Background

Type 2 diabetes (T2D) is one of the top non-communicable diseases in Kenya and prevention strategies are urgently needed. Intervening to reduce obesity is the most common prevention strategy. However, black populations develop T2D at lower obesity levels and it is unclear which anthropometric cut-offs could provide the best predictive ability for T2D risk. This study, therefore, aimed to determine the optimal anthropometric cut-offs and their predictive ability of T2D in Kenya.

Methods

The study included 2159 participants (59% women) aged 35-70 years from the Kenya STEPwise survey conducted in 2014. Five anthropometric indices were used-body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR), waist to height ratio (WHtR) and waist divided by height^0.5(WHt.5R). Diabetes was defined as a fasting blood glucose of ≥7.0 mmol/l or a previous diagnosis by a health worker. Optimal anthropometric cut-offs and their receiver operating characteristics, such as the area under the curve (AUC), were computed.

Results

Overall, the optimal cut-off for BMI, WC, WHR, WHtR and WHt.5R were 24.8 kg.m^-2, 90 cm, 0.88, 0.54 and 6.9. On disaggregation by sex, the optimal cut-off for BMI, WC, WHR WHtR and WHt.5R was 27.1 kg.m^-2, 87 cm, 0.85, 0.55 and 6.9 in women, and 24.8 kg.m^-2, 91 cm, 0.88, 0.54 and 6.9 in men. Overall, WC (AUC 0.71 (95% confidence interval 0.65, 0.76)) WHtR (AUC 0.71 (0.66, 0.76)) and WHt.5R (AUC 0.70 (0.65,0.75)) had a better predictive ability for T2D than BMI (AUC 0.68 (0.62, 0.73)).

Conclusions

WC, WHtR and WHt.5R were better predictors of T2D than BMI and should be used for risk stratification in Kenya. A WC cut-off of 87cm in women and 91cm in men, a WHtR cut-off of 0.54 or a WHt.5R of 6.9 in both men and women should be used to identify individuals at an elevated risk of T2D.

The Influence of Anthropometric Indices and Intermediary Determinants of Hypertension in Bangladesh

Hypertension is a major public health burden in Bangladesh. However, studies considering the underlying multifaceted risk factors of this health condition are sparse. The present study concurrently examines anthropometric parameters and intermediary factors influencing hypertension risk in Bangladesh. Using the 2018 World Health Organisation (WHO) STEPwise approach to non-communicable disease risk factor surveillance (STEPS) study conducted in Bangladesh and involving 8019 nationally representative adult respondents, bivariate and multivariate logistic regression analyses were performed to determine the association between anthropometrics, other intermediary factors and hypertension. The regression results were presented using the odds ratio (OR) and adjusted odds ratio (AOR) at 95% confidence intervals (CIs). The risk of hypertension was higher among females and males who were 40 years and older. However, among females, those who were age 60 years and older were more than twice and thrice more likely to be hypertensive compared to those in the younger age groups (18–39, 40–59). Females who were obese (body mass index [BMI], waist to hip ratio [WHR], waist to height ratio [WHtR]) or had high waist circumference [WC] were twice as likely to be hypertensive. Males and females who were physically active, consuming more fruits and vegetables daily and educated had lower odds of developing hypertension. Key findings suggest that the association between anthropometric indices (body mass index [BMI], waist to hip ratio [WHR], waist to height ratio [WHtR]), waist circumference [WC]), other intermediary determinants (e.g., education, physical activity) and hypertension exist across gender and with increasing age among adults in Bangladesh. Developing appropriate public health interventions (e.g., regular assessment of anthropometric parameters) for early identification of the risk and pattern of hypertension through appropriate screening and diagnosis is required to meet the specific health needs of the adult Bangladesh population.

Anthropometric indices and their cut-off points in relation to type 2 diabetes among Ghanaian migrants and non-migrants: The RODAM study

AIMS

To compare body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) as determinants of type 2 diabetes (T2DM) and determine optimal cut-offs in a sub-Saharan African population.

METHODS

Data from the RODAM study including Ghanaians aged 25-70 living in rural Ghana, urban Ghana and Europe were used. Logistic regression was used to assess associations between BMI, WC, WHR and T2DM status, by sex and site. Area under the curve (AUC) were constructed to discriminate between indices and establish performance and cut-off values.

RESULTS

WHR had the strongest association with T2DM in men and women across sites, except for rural men. The highest adjusted odds ratio (aOR) and AUC were in rural women for WHR (aOR = 2.09, 95%CI = 1.47-2.99; AUC = 0.71). Among migrants, WHR had higher AUCs compared with BMI (p < 0.01) and WC (p < 0.05). Cut-offs for BMI and WC in men were lower compared with the WHO reference across sites (WC: 85.4-93.7 vs 102 cm, BMI: 23.1-28.2 vs 30.0 kg/m²).

CONCLUSIONS

WHR outperformed BMI and WC as anthropometric indices in relation to T2DM among Ghanaian migrants. The lower BMI and WC cut-offs for T2DM than WHO established standards, highlights the need for African specific cut-offs to avoid missing high risk populations.

Waist circumference and low high-density lipoprotein cholesterol as markers of cardiometabolic risk in Kenyan adults

Background

Abdominal obesity predict metabolic syndrome parameters at low levels of waist circumference (WC) in Africans. At the same time, the African lipid profile phenotype of low high-density lipoprotein (HDL) cholesterol without concomitant elevated triglyceride levels renders high triglyceride levels detrimental to cardiometabolic health unsuitable for identifying cardiometabolic risk in black African populations.

Objectives

We aimed to identify simple clinical measures for cardiometabolic risk based on WC and HDL in an adult Kenyan population in order to determine which of the two predictors had the strongest impact.

Methods

We used linear regression analyses to assess the association between the two exposure variables WC and HDL with cardiometabolic risk factors including ultrasound-derived visceral (VAT) and subcutaneous adipose tissue (SAT) accumulation, fasting and 2-h venous glucose, fasting insulin, fasting lipid profile, and blood pressure in adult Kenyans (n = 1 370), and a sub-population with hyperglycaemia (diabetes and pre-diabetes) (n = 196). The same analyses were performed with an interaction between WC and HDL to address potential effect modification. Ultrasound-based, semi-quantitative hepatic steatosis assessment was used as a high-risk measure of cardiometabolic disease.

Results

Mean age was 38.2 (SD 10.7) (range 17–68) years, mean body mass index was 22.3 (SD 4.5) (range 13.0–44.8) kg/m², and 57.8% were women. Cardiometabolic risk was found in the association between both WC and HDL and all outcome variables (p<0.05) except for HDL and SAT, fasting and 2-h venous glucose. Additive cardiometabolic risk (WC and HDL interaction) was found for SAT, low-density lipoprotein cholesterol, and triglycerides. No differences in the association between WC and HDL and the outcome variables were found when comparing the full study population and the hyperglycaemia sub-population. Increase in WC and HDL were both associated with hepatic steatosis (OR 1.09, p<0.001, and OR 0.46, p = 0.031, respectively).

Conclusion

In adult Kenyans, increasing WC identified more cardiometabolic risk factors compared to HDL.

Poor cardiovascular health is associated with subclinical atherosclerosis in apparently healthy sub-Saharan African populations: an H3Africa AWI-Gen study

BACKGROUND

The cardiovascular health index (CVHI) introduced by the American Heart Association is a valid, accessible, simple, and translatable metric for monitoring cardiovascular health in a population. Components of the CVHI include the following seven cardiovascular risk factors (often captured as life's simple 7): smoking, dietary intake, physical activity, body mass index, blood pressure, glucose, and total cholesterol. We sought to expand the evidence for its utility to under-studied populations in sub-Saharan Africa, by determining its association with common carotid intima-media thickness (CIMT).

METHODS

We conducted a cross-sectional study involving 9011 participants drawn from Burkina Faso, Ghana, Kenya, and South Africa. We assessed established classical cardiovascular risk factors and measured carotid intima-media thickness of the left and right common carotid arteries using B-mode ultrasonography. Adjusted multilevel mixed-effect linear regression was used to determine the association of CVHI with common CIMT. In the combined population, an individual participant data meta-analyses random-effects was used to conduct pooled comparative sub-group analyses for differences between countries, sex, and socio-economic status.

RESULTS

The mean age of the study population was 51 ± 7 years and 51% were women, with a mean common CIMT of 637 ± 117 μm and CVHI score of 10.3 ± 2.0. Inverse associations were found between CVHI and common CIMT (β-coefficients [95% confidence interval]: Burkina Faso, - 6.51 [- 9.83, - 3.20] μm; Ghana, - 5.42 [- 8.90, - 1.95]; Kenya, - 6.58 [- 9.05, - 4.10]; and South Africa, - 7.85 [- 9.65, - 6.05]). Inverse relations were observed for women (- 4.44 [- 6.23, - 2.65]) and men (- 6.27 [- 7.91, - 4.64]) in the pooled sample. Smoking (p < 0.001), physical activity (p < 0.001), and hyperglycemia (p < 0.001) were related to CIMT in women only, while blood pressure and obesity were related to CIMT in both women and men (p < 0.001).

CONCLUSION

This large pan-African population study demonstrates that CVHI is a strong marker of subclinical atherosclerosis, measured by common CIMT and importantly demonstrates that primary prevention of atherosclerotic cardiovascular disease in this understudied population should target physical activity, smoking, obesity, hypertension, and hyperglycemia.

Hypercholesterolemia and related risk factors in a cohort of patients with diabetes and hypertension in Maputo, Mozambique

INTRODUCTION

some studies reported that 25.5% of African population presents hypercholesterolemia; however, epidemiology of hypercholesterolemia in Africa is poorly described. Mozambique is experiencing a constant growth of non-communicable diseases, but scarce data are available about hypercholesterolemia. Our study aims at describing the prevalence of hypercholesterolemia in patients with diabetes and hypertension in Mozambique and investigate possible risk factors.

METHODS

we conducted a cross-sectional study involving all the patients diagnosed with hypertension and/or diabetes from June 2018 to November 2020 in the Zimpeto DREAM Centre (Maputo, Mozambique). For each patient, anthropometric, clinical and laboratory data were collected. Hypercholesterolemia was defined as total blood cholesterol >200 mg/dL. Univariable and multivariable analysis were perfumed.

RESULTS

a total of 885 patients were included, 76.2% (n=674) female. Hypertension alone was diagnosed in 670 (75.7%) patients, diabetes in 109 (12.3%) patients and 106 (11.9%) both diseases. Hypercholesterolemia was present in 410 (46.3%) patients and it was more prevalent in patients diagnosed with both diabetes and hypertension (52.8%), as compared to the patients diagnosed with hypertension (46.9%) or diabetes alone (36.7%). In the multivariable analysis, the only factors independently associated with hypercholesterolemia were female sex (aOR 1.77, 95% CI 1.26-2.48, p=0.001) and a body mass index >25kg/m2 (aOR 1.50, 95% CI 1.11-2.04, p=0.008).

CONCLUSION

our results highlight the need for a specific focus on female and obese/overweight patients, especially if diagnosed with both hypertension and diabetes, to promptly detect metabolic disorders and establish temporary preventive measures for cardiovascular events.

Optimal waist circumference cutoff values to predict cardiometabolic alterations in a Venezuela national representative sample. The EVESCAM study

BACKGROUND

Waist circumference (WC) value reflects abdominal adiposity, but the amount abdominal fat that is associated to cardiometabolic risk factors varies among ethnicities. Determination of metabolic abnormalities has not undergone a WC adaptation process in Venezuela.

AIMS

The aim of the study was (1) to determine the optimal WC cutoff value associated with ≥2 cardiometabolic alterations and (2) incorporating this new WC cutoff, to determine the prevalence of abdominal obesity and cardiometabolic risk factors related in Venezuela.

METHODS

The study was national population-based, cross-sectional, and randomized sample, from 2014 to 2017. To assess performance of WC for identifying cardiometabolic alterations, receiver operating characteristics curves, area under the curve (AUC), sensitivity, specificity, and positive likelihood ratios were calculated.

RESULTS

Three thousand three hundred eighty-seven adults were evaluated with mean age of 41.2 ± 15.8 years. Using the best tradeoff between sensitivity and specificity, WC cutoffs of 90 cm in men (sensitivity = 72.4% and specificity = 66.1%) and 86 cm in women (sensitivity = 76.2% and specificity = 61.4%) were optimal for aggregation of ≥2 cardiometabolic alterations. AUC was 0.75 in men and 0.73 in women using these new cutoffs. Prevalence of abdominal obesity and metabolic syndrome was 59.6% (95 CI; 57.5-61.7) and 47.6% (95 CI; 45.2-50.0), respectively. Cardiometabolic risk factors were associated with being men, higher age, adiposity, and living in northern or western regions.

CONCLUSION

The optimal WC values associated with cardiometabolic alterations were 90 cm in men and 86 cm in women. More than half of the Venezuelan population had abdominal obesity incorporating this new WC cutoff.

Triglyceride-Glucose Index and Related Parameters Predicted Metabolic Syndrome in Nigerians

Background: Triglyceride-glucose (TyG) index, a product of triglyceride and fasting plasma glucose, is a novel tool that can identify people with metabolic syndrome (MS). It is unknown if TyG index can identify MS among Nigerians.

Methods: Cross-sectional health screening conducted between August and December 2018, among staff and students of Ekiti State University/Ekiti State University Teaching Hospital, Nigeria, Ado-Ekiti. The analysis included 473 participants, aged ≥18 years. Anthropometric indices and blood pressure were measured by standard protocol. Fasting lipid profile and blood glucose were determined. TyG index and product of TyG and anthropometric indices were calculated, and MS defined according to the harmonized criteria. The diagnostic ability of TyG index and related parameters to identify people with MS was determined with the area under curve (AUC) of receiver operating characteristic curves. Stepwise logistic regression analyses were used to generate odd ratios (ORs) for prediction of MS.

Results: The mean age of the participants was 39.2 (11.4) years and there were 173 (36.6%) men. In all participants, TyG-waist to height ratio (TyG-WHtR) shows the largest AUC for MS detection (0.863, 95% confidence interval, CI: 0.828–0.892) followed by TyG-waist circumference (TyG-WC) (0.858, 95% CI: 0.823–0.888), TyG-body mass index (TyG-BMI) (0.838, 95% CI: 0.802–0.870), TyG index (0.796, 95% CI: 0.757–0.831), WHtR (0.791, 95% CI: 0.752–0.827), and TyG-waist-to-hip ratio (TyG-WHpR) (0.771, 95% CI: 0.730–0.808) in that order. Gender analysis revealed that TyG-WC and TyG-WHtR have largest AUC in both genders. Before and after adjustment, TyG-WHtR (OR: 6.86, 95% CI: 3.94–11.93) and TyG index (OR: 5.91, 95% CI: 3.01–11.59) presented the highest OR in all participants, respectively.

Conclusions: TyG index is effective in identifying MS in this cross-sectional study, and the product of TyG index and anthropometric indices improved identification and prediction of MS.

The Cardiotonic Steroid Marinobufagenin Is a Predictor of Increased Left Ventricular Mass in Obesity: The African-PREDICT Study

The endogenous Na+/K+-ATPase inhibitor, marinobufagenin (MBG), strongly associates with salt intake and a greater left ventricular mass index (LVMi) in humans and was shown to promote cardiac fibrosis and hypertrophy in animals. The adverse effects of MBG on cardiac remodeling may be exacerbated with obesity, due to an increased sensitivity of Na+/K+-ATPase to MBG. This study determined whether MBG is related to the change in LVMi over time in adults with a body mass index (BMI) ≥30 kg/m2 (obese) and <30 kg/m2 (non-obese). The study followed 275 healthy participants (aged 20-30 years) from the African-Prospective study on the Early Detection and Identification of Cardiovascular disease and Hypertension (African-PREDICT) study over 4.5 years. At baseline, we measured 24 h urine MBG excretion. MBG levels were positively associated with salt intake. LVMi was determined by two-dimensional echocardiography at baseline and after >4.5 years. With multivariate adjusted analyses in obese adults (N = 56), we found a positive association of follow-up LVMi (Adjusted (Adj.) R2 = 0.35; Std. β = 0.311; p = 0.007) and percentage change in LVMi (Adj. R2 = 0.40; Std. β = 0.336; p = 0.003) with baseline MBG excretion. No association of LVMi (Adj. R2 = 0.37; p = 0.85) or percentage change in LVMi (Adj. R2 = 0.19; p = 0.68) with MBG excretion was evident in normal weight adults (N = 123). These findings suggest that obese adults may be more sensitive to the adverse cardiac effects of MBG and provide new insight into the potential role of dietary salt, by way of MBG, in the pathogenesis of cardiac remodeling in obese individuals.

Identifying Africans with undiagnosed diabetes: Fasting plasma glucose is similar to the hemoglobin A1C updated Atherosclerosis Risk in Communities diabetes prediction equation

AIMS

Seventy percent of Africans living with diabetes are undiagnosed. Identifying who should be referred for testing is critical. Therefore we evaluated the ability of the Atherosclerosis Risk in Communities (ARIC) diabetes prediction equation with A1C added (ARIC + A1C) to identify diabetes in 451 African-born blacks living in America (66% male; age 38 ± 10y (mean ± SD); BMI 27.5 ± 4.4 kg/m²).

METHODS

All participants denied a history of diabetes. OGTTs were performed. Diabetes diagnosis required 2-h glucose ≥200 mg/dL. The five non-invasive (Age, parent history of diabetes, waist circumference, height, systolic blood pressure) and four invasive variables (Fasting glucose (FPG), A1C, triglycerides (TG), HDL) were obtained. Four models were tested: Model-1: Full ARIC + A1C equation; Model-2: All five non-invasive variables with one invasive variable excluded at a time; Model-3: All five non-invasive variables with one invasive variable included at a time; Model-4: Each invasive variable singly. Area under the receiver operator characteristic curve (AROC) predicted diabetes. Youden Index identified optimal cut-points.

RESULTS

Diabetes occurred in 7% (30/451). Model-1, the full ARIC + A1C equation, AROC = 0.83. Model-2: With FPG excluded, AROC = 0.77 (P = 0.038), but when A1C, HDL or TG were excluded AROC remained unchanged. Model-3 with all non-invasive variables and FPG alone, AROC=0.87; but with A1C, TG or HDL included AROC declined to ≤0.76. Model-4: FPG as a single predictor, AROC = 0.87. A1C, TG, or HDL as single predictors all had AROC ≤ 0.74. Optimal cut-point for FPG was 100 mg/dL.

CONCLUSIONS

To detect diabetes, FPG performed as well as the nine-variable updated ARIC + A1C equation.

Improved Detection of Abnormal Glucose Tolerance in Africans: The Value of Combining Hemoglobin A1c With Glycated Albumin

OBJECTIVE

In African-born Blacks living in America, we determined by BMI category 1) prevalence of abnormal glucose tolerance (Abnl-GT) and 2) diagnostic value and reproducibility of hemoglobin A1c (HbA1c), fructosamine, and glycated albumin (GA).

RESEARCH DESIGN AND METHODS

Participants (n = 416; male, 66%; BMI 27.7 ± 4.5 kg/m2 [mean ± SD]) had an oral glucose tolerance test with HbA1c, GA, and fructosamine assayed. These glycemic markers were repeated 11 ± 7 days later. Abnl-GT diagnosis required 0 h ≥5.6 mmol/L (≥100 mg/dL) and/or 2 h ≥7.8 mmol/L (≥140 mg/dL). Thresholds for HbA1c, GA, and fructosamine were the values at the 75th percentile for the population (39 mmol/mol [5.7%], 14.2%, and 234 μmol/L, respectively).

RESULTS

Abnl-GT prevalence in the nonobese was 34% versus 42% in the obese (P = 0.124). Reproducibility was excellent for HbA1c and GA (both κ ≥ 0.8), but moderate for fructosamine (κ = 0.6). Focusing on HbA1c and GA in the nonobese, we found as single tests the sensitivities of HbA1c and GA were 36% versus 37% (P = 0.529). Combining HbA1c and GA, sensitivity increased to 58% because GA identified 37% of Africans with Abnl-GT not detected by HbA1c (P value for both tests vs. HbA1c alone was <0.001). For the obese, sensitivities for HbA1c, GA, and the combined tests were 60%, 27%, and 67%, respectively. Combined test sensitivity did not differ from HbA1c alone (P = 0.25) because GA detected only 10% of obese Africans with Abnl-GT not detected by HbA1c.

CONCLUSIONS

Adding GA to HbA1c improves detection of Abnl-GT in nonobese Africans.

HIV and metabolic syndrome in an Ethiopian population

BACKGROUND

The global prevalence of metabolic syndrome (MS) is increasing due to lifestyle changes. Studies have found that MS is associated with human immunodeficiency virus (HIV) and antiretroviral treatment (ART), but controversies still exist on associations between HIV and MS.

AIMS

To assess associations between HIV and MS among ART-naïve HIV positive individuals compared to HIV negative individuals.

SUBJECTS AND METHODS

A cross-sectional study among ART-naïve HIV positive and HIV negative individuals recruited from HIV treatment and testing facilities in Ethiopia. Information was collected on components of MS: waist circumference, triglycerides, high-density lipoprotein cholesterol (HDL-C), blood pressure and fasting plasma glucose (FPG). Data were analysed using logistic and linear regression stratified by sex and adjusted for age, wealth and education.

RESULTS

Data from 329 HIV positive and 100 HIV negative individuals were included. HIV positive status was associated with higher odds of MS in women (OR: 3.56, 95%CI: 1.25; 10.15) (n = 292), but not in men (OR: 0.98, 95%CI: 0.22; 4.30) (n = 137), interaction: p= .11. Associations between HIV and components of MS were strongest for HDL-C among women and for FPG among men. The most prevalent components of MS in HIV positive individuals were elevated triglycerides, reduced HDL-C and elevated FPG.

CONCLUSIONS

HIV was associated with MS among ART-naïve women, suggesting that MS should be evaluated before initiating ART and monitored during treatment to identify those at risk of developing diabetes and cardiovascular disease (CVD).

A comparison of the associations between adiposity and lipids in Malawi and the United Kingdom

BACKGROUND

The prevalence of excess adiposity, as measured by elevated body mass index (BMI) and waist-hip ratio (WHR), is increasing in sub-Saharan African (SSA) populations. This could add a considerable burden of cardiovascular and metabolic diseases for which these populations are currently ill-prepared. Evidence from white, European origin populations shows that higher adiposity leads to an adverse lipid profile; whether these associations are similar in all SSA populations requires further exploration. This study compared the association of BMI and WHR with lipid profile in urban Malawi with a contemporary cohort with contrasting socioeconomic, demographic, and ethnic characteristics in the United Kingdom (UK).

METHODS

We used data from 1248 adolescents (mean 18.7 years) and 2277 Malawian adults (mean 49.8 years), all urban-dwelling, and from 3201 adolescents (mean 17.8 years) and 6323 adults (mean 49.7 years) resident in the UK. Adiposity measures and fasting lipids were assessed in both settings, and the associations of BMI and WHR with total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG) were assessed by sex and age groups in both studies.

RESULTS

Malawian female adults were more adipose and had more adverse lipid profiles than their UK counterparts. In contrast, Malawian adolescent and adult males were leaner and had more favourable lipid profiles than in the UK. Higher BMI and WHR were associated with increased TC, LDL-C and TG and reduced HDL-C in both settings. The magnitude of the associations of BMI and WHR with lipids was mostly similar or slightly weaker in the Malawian compared with the UK cohort in both adolescents and adults. One exception was the stronger association between increasing adiposity and elevated TC and LDL-C in Malawian compared to UK men.

CONCLUSIONS

Malawian adult women have greater adiposity and more adverse lipid profiles compared with their UK counterparts. Similar associations of adiposity with adverse lipid profiles were observed for Malawian and UK adults in most age and sex groups studied. Sustained efforts are urgently needed to address the excess adiposity and adverse lipid profiles in Malawi to mitigate a future epidemic of cardio-metabolic disease among the poorest populations.

Comparison of dietary and plasma phospholipid fatty acids between normal weight and overweight black South Africans according to metabolic health: The PURE study

BACKGROUND

Information regarding circulating fatty acids (FA) in association with metabolic health in black Africans is scarce, while the usefulness of circulating FAs as biomarkers of dietary fat intake and predictors for medical conditions is increasing.

OBJECTIVE

We compared eleven dietary and the levels of 26 plasma phospholipid FAs in metabolically healthy and unhealthy phenotypes in black South African adults.

METHODS

Adults from the South African arm of the Prospective Urban and Rural Epidemiology study baseline (n = 711) were categorised into four groups, namely normal weight without metabolic syndrome (MetS) (MHNW), normal weight with MetS (MUNW), metabolically healthy overweight/obese (MHO) and metabolically unhealthy overweight/obese (MUO). Dietary and plasma phospholipid FAs were measured by a quantitative food frequency questionnaire and gas chromatography-tandem mass spectrometry, respectively. We compared dietary FAs, plasma phospholipid FAs, and estimated desaturase activity between the metabolic status groups using ANCOVA adjusted for age and energy intake.

RESULTS

MetS was diagnosed in 35% of the participants. After adjustment for age and total energy intake, in comparison to the MHNW reference group, saturated dietary FAs (C14:0 to C18:0) and alpha-linolenic acid intakes were higher in both overweight/obese groups (MHO and MUO), while linoleic acid intakes were higher in the MUO group only. Plasma levels of most saturated FAs (C18:0 to C22:0) and PUFAs were higher, whereas selected MUFAs, palmitic acid, and estimated desaturase activities were lower in the overweight/obese groups.

CONCLUSIONS

The overweight groups generally had higher fat intakes than normal-weight groups, but lower plasma levels of palmitic, palmitoleic, oleic, cis-vaccenic and estimated desaturase activities. Therefore, in this population, lower plasma levels of palmitic, palmitoleic, oleic, and cis-vaccenic acids and decreased estimated desaturase activities may be biomarkers of abnormal metabolic health in overweight/obese study participants.

The silent epidemic of obesity in The Gambia: evidence from a nationwide, population-based, cross-sectional health examination survey

OBJECTIVES

Non-communicable diseases account for 70% of global deaths; 80% occur in low-income and middle-income countries. The rapid increase of obesity in sub-Saharan Africa is a concern. We assessed generalised and abdominal obesity and their associated risk factors among adults in The Gambia.

DESIGN

Nationwide cross-sectional health examination survey using the WHO STEPwise survey methods.

SETTING

The Gambia.

PARTICIPANTS

This study uses secondary analysis of a 2010 nationally representative random sample of adults aged 25-64 years (78% response rate). The target sample size was 5280, and 4111 responded. Analysis was restricted to non-pregnant participants with valid weight and height measurements (n=3533).

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome variable was generalised obesity, using WHO body mass index (BMI) thresholds. Analyses used non-response weighting and adjusted for the complex survey design. We conducted multinomial logistic regression analysis to identify factors associated with BMI categories. The secondary outcome variable was abdominal obesity, defined as high waist circumference (using the International Diabetes Federation thresholds for Europeans).

RESULTS

Two-fifths of adults were overweight/obese, with a higher obesity prevalence in women (17%, 95% CI 14.7 to 19.7; men 8%, 95% CI 6.0 to 11.0). 10% of men and 8% of women were underweight. Urban residence (adjusted relative risk ratio 5.8, 95% CI 2.4 to 14.5), higher education (2.3, 1.2 to 4.5), older age, ethnicity, and low fruit and vegetable intake (2.8, 1.1 to 6.8) were strongly associated with obesity among men. Urban residence (4.7, 2.7 to 8.2), higher education (2.6, 1.1 to 6.4), older age and ethnicity were associated with obesity in women.

CONCLUSION

There is a high burden of overweight/obesity in The Gambia. While obesity rates in rural areas were lower than in urban areas, obesity prevalence was higher among rural residents in this study compared with previous findings. Preventive strategies should be directed at raising awareness, discouraging harmful beliefs on weight, and promoting healthy diets and physical activity.

HIV infection, and overweight and hypertension: a cross-sectional study of HIV-infected adults in Western Kenya

Background

Non-communicable diseases (NCDs) are increasing in Kenya, where HIV/AIDS remains a leading cause of death; however, few studies have investigated obesity and hypertension among adults with HIV infection. We conducted a cross-sectional study in Homa Bay, Western Kenya, during 2015 to determine the prevalence of overweight/obesity and hypertension among HIV-infected adults and to identify their risk factors.

Results

Anthropometric measurements and a structured questionnaire were administered to adults with HIV infection receiving care at Mbita Sub-county Hospital. A total of 251 HIV-positive individuals were enrolled. More women were overweight (17.2%) and obese (3.6%) than underweight (8.3%). The prevalence of abdominal obesity was high in women (62.7%), especially those aged 30–39 years. The prevalence of hypertension was 9.8% and 11.8% in men and women, respectively. Male participants tended to develop hypertension at an early age. Multivariate analysis showed that female sex was significantly associated with abdominal obesity. Regarding clinical factors, we identified an association between overweight and a history of opportunistic infections, as well as between hypertension and World Health Organization clinical stage. Sixty percent of HIV-infected participants assumed that a very thin body size indicated HIV infection.

Conclusions

The main findings of this study include a greater prevalence of overweight than underweight as well as a high prevalence of abdominal obesity among women. Social perception toward body size among people with HIV infection might remain problematic. Individuals living with HIV in Kenya should receive preventive intervention for overweight and abdominal obesity, with consideration of relevant social and cultural aspects.

Obesity and cardiovascular disease risk among Africans residing in Europe and Africa: the RODAM study

BACKGROUND

The association between anthropometric variables and cardiovascular disease (CVD) risk among Africans is unclear. We examined the discriminative ability of anthropometric variables and estimate cutoffs for predicting CVD risk among Africans.

METHODS

The Research on Obesity and Diabetes among African Migrants (RODAM) study was a multisite cross-sectional study of Africans in Ghana and Europe. We calculated AHA/ACC Pooled Cohort Equations (PCE) scores for 3661 participants to ascertain CVD risk, and compared a body shape index (ABSI), body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), Relative Fat Mass (RFM), and Waist to Height Ratio (WHtR). Logistic regression and receiver operating curve analyses were performed to derive cutoffs for identifying high predicted CVD risk (PCE score ≥7.5%).

RESULTS

Among men, WC (adjusted Odds Ratio (aOR): 2.25, 95% CI; 1:50-3:37) was strongly associated with CVD risk. Among women, WC (aOR: 1.69, 95% CI: 1:33-2:14) also displayed the strongest association with CVD risk in the BMI-adjusted model but WHR displayed the strongest fit. All variables were superior discriminators of high CVD risk in men (c-statistic range: 0.887-0.891) than women (c-statistic range: 0.677-0.707). The optimal WC cutoff for identifying participants at high CVD risk was 89 cm among men and identified the most cases (64%). Among women, the recommended WC cutoff of 94 cm or WHR cutoff of 0.90 identified the most cases (92%).

CONCLUSIONS

Anthropometric variables were stronger discriminators of high CVD risk in African men than women. Greater WC was associated with high CVD risk in men while WHR and WC were associated with high CVD risk in women.

Annual transition probabilities of overweight and obesity in older adults: Evidence from World Health Organization Study on global AGEing and adult health

Overweight/obesity is becoming increasingly prevalent in sub-Saharan Africa including Ghana. However, transition probabilities, an essential component to develop cost-effective measures for weight management is lacking in this population. We estimated annual transition probabilities between three body mass index (BMI) categories: normal weight (BMI ≥18.5 and <25.0 kg/m2), overweight (BMI ≥25.0 and <30.0 kg/m2), and obesity (BMI ≥30.0 kg/m2), among older adults aged ≥50 years in Ghana. Data were used from a nationally representative, multistage sample of 1496 (44.3% females) older adults in both Waves 1 (2007/8) and 2 (2014/15) of the Ghana WHO SAGE. A multistage Markov model was used to estimate annual transition probabilities. We further examined the impact of specific socio-economic factors on the transition probabilities. At baseline, 22.8% were overweight and 11.1% were obese. The annual transition probability was 4.0% (95% CI: 3.4%, 4.8%) from normal weight to overweight, 11.1% (95% CI: 9.5%, 13.0%) from overweight to normal weight and 4.9% (95% CI: 3.8%, 6.2%) from overweight to obesity. For obese individuals, the probability of remaining obese, transitioning to overweight and completely reverting to normal weight was 90.2% (95% CI: 87.7%, 92.3%), 9.2% (95% CI: 7.2%, 11.6%) and 0.6% (95% CI: 0.4%, 0.8%) respectively. Being female, aged 50-65 years, urban residence, having high education and high wealth were associated with increased probability of transitioning into the overweight or obese categories. Our findings highlight the difficulty in transitioning away from obesity, especially among females. The estimated transition probabilities will be essential in health economic simulation models to determine sustainable weight management interventions.

Prevalence and sex-specific patterns of metabolic syndrome in rural Uganda

Background and aims

In sub-Saharan Africa, infectious diseases are still the leading causes of mortality; however, this may soon be surpassed by non-communicable illnesses, namely hypertension, diabetes and cardiovascular disease. This study determined the prevalence and patterns of metabolic syndrome and cardio-risk factors in men and women in rural Uganda.

Methods

A household-based, cross-sectional survey was carried out following the WHO STEP-wise approach to surveillance. It included demographic and lifestyle questionnaires, anthropometric measurements and biochemical analyses. Of the 200 randomly recruited participants, 183 successfully completed two steps of the study and 161 provided blood samples.

Results

Data were collected from 183 adults, aged 18–69 years; 62% were female. Based on the National Cholesterol Education Program-Adult Treatment Panel-III criteria, the prevalence of metabolic syndrome was 19.1% (95% CI 14.0 to 22.5). Elevated fasting plasma glucose was observed in 14.2% (95% CI 9.1 to 19.3) of participants, hypertriglyceridaemia in 16.9% (95% CI 12.1 to 23.1); hypertension in 36.1% (95% CI 29.0 to 43.0) and 52.5% (95% CI 45.2 to 59.6) had low HDL (high-density lipoprotein) cholesterol. Abdominal obesity was found in 24.6% (95% CI 18.8 to 31.4) of participants. Sex disparities were significant for several risk factors. Females had significantly higher prevalence of abdominal obesity (38.6% vs 1.5% in males, p=0.001) and twice the rates of low HDL (65.8% vs 30.4%, p=0.001). Men tended to have higher but not significant rates of hypertension (42.0% vs 32.5%) and smoked significantly more than women (49.3% vs 21.1%, p<0.001). Alcohol consumption was also higher in men (55.1% vs 18.4%, p<0.001) and quantities consumed were approximately three times greater than in females (p<0.001).

Conclusion

Metabolic syndrome exists at worrying rates in the rural Ugandan population. Sex disparities are evident in risk factor prevalence, reflecting physiological variables and deeply entrenched cultural and lifestyle norms.

Sex and area differences in the association between adiposity and lipid profile in Malawi

Background

Evidence from high-income countries shows that higher adiposity results in an adverse lipid profile, but it is unclear whether this association is similar in Sub-Saharan African (SSA) populations. This study aimed to assess the association between total and central adiposity measures and lipid profile in Malawi, exploring differences by sex and area of residence (rural/urban).

Methods

In this cross-sectional study, data from 12 096 rural and 12 847 urban Malawian residents were used. The associations of body mass index (BMI) and waist to hip ratio (WHR) with fasting lipids (total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C) and triglycerides (TG)) were assessed by area and sex.

Results

After adjusting for potential confounders, higher BMI and WHR were linearly associated with increased TC, LDL-C and TG and reduced HDL-C. BMI was more strongly related to fasting lipids than was WHR. The associations of adiposity with adverse lipid profile were stronger in rural compared with urban residents. For instance, one SD increase in BMI was associated with 0.23 mmol/L (95% CI 0.19 to 0.26) increase in TC in rural women and 0.13 mmol/L (95% CI 0.11 to 0.15) in urban women. Sex differences in the associations between adiposity and lipids were less evident.

Conclusions

The consistent associations observed of higher adiposity with adverse lipid profiles in men and women living in rural and urban areas of Malawi highlight the emerging adverse cardio-metabolic epidemic in this poor population. Our findings underline the potential utility of BMI in estimating cardiovascular risk and highlight the need for greater investment to understand the long-term health outcomes of obesity and adverse lipid profiles and the extent to which lifestyle changes and treatments effectively prevent and modify adverse cardio-metabolic outcomes.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Association between anthropometric indicators of obesity and cardiovascular risk factors among adults in Shanghai, China

Background

To determine the optimal cut-off values and evaluate the associations of body mass index (BMI), waist circumference (WC) and waist-height ratio (WHtR) with cardiovascular disease (CVD) risk factors.

Methods

A large-scale cross-sectional survey was conducted among 35,256 adults aged 20–74 years in Shanghai between June 2016 and December 2017. Receiver operating characteristic (ROC) analyses were conducted to assess the optimal cut-off anthropometric indices of CVD risk factors including hypertension, diabetes, dyslipidemia and hyperuricemia. Multivariate Logistic regression models were preformed to evaluate the odds ratio of CVD risk factors.

Results

The area under the curve (AUC) of WHtR was significantly greater than that of BMI or WC in the prediction of hypertension and diabetes, and AUCs were higher in women than men. The optimal cut-off values of WHtR were approximately 0.51 in both sexes, while the cut-off values of BMI and WC were higher for men compared with women. The optimal cutoff values of BMI and WC varied greatly across different age groups, but the difference in WHtR was relatively slight. Among women, the optimal threshold of anthropometric indices appeared to increase with age for hypertension and diabetes. The odds ratio between anthropometric indices and CVD risk factors were attenuated with age. WHtR had the greatest odds ratio for CVD risk factors among adults under 60 years old except for women with hypertension, while among 60–74 years, BMI yielded the greatest odds ratio in terms of all CVD outcomes except for women with diabetes.

Conclusions

WHtR had the best performance for discriminating hypertension and diabetes and potentially be served as a standard screening tool in public health. The associations between three anthropometric indices and CVD risk factors differed by sex and decreased with age. These findings indicated a need to develop age- and gender-specific difference and make effective strategies for primary prevention of CVDs.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7366-0) contains supplementary material, which is available to authorized users.

Differences in cardiometabolic risk markers among ethnic groups in Queensland, Australia

Very little is known about the cardiometabolic risk of migrants who settle in Australia. This study investigated differences in cardiometabolic risk markers among ethnic groups attending a tailored healthy lifestyle program in Queensland, Australia; and differences in these markers between those living in Australia for shorter versus longer periods of time. Baseline data collected between October 2014 and June 2017 from the Living Well Multicultural-Lifestyle Modification Program were used. People living in ethnic communities in Queensland who were ≥18 years old, and not underweight were eligible to participate. Independent variables were ethnicity and length of time in Australia. Outcomes were cardiometabolic risk markers including BMI, waist circumference, weight-to-height ratio (WHtR) and hypertension. Analyses were done separately for each independent variable. Linear and logistic regressions were run for continuous and binary outcomes with differences/Odds ratios reported respectively. Multivariable analyses showed that Burmese/Vietnamese had an average BMI lower than Afghani/Arabic (3.7 points), Somalian/Sudanese (4.7 points) and Pacific Islander (11.6 points) (p < 0.001) respectively. Differences in waist circumference between Burmese/Vietnamese with Sri Lankan/Bhutanese, Afghani/Arabic, Somalian/Sudanese and Pacific Islander were 6.3, 8.4, 9.1 and 24.0 cm (p < 0.01) respectively. Although Burmese/Vietnamese also had lower average WHtR compared to the others, the differences were not significant for Somalian/Sudanese. Moreover, Sri Lankan/Bhutanese and Pacific Islander were more likely to be hypertensive compared to Burmese/Vietnamese (p < 0.05). Immigrants living in Australia >5years had on average 1.2 points higher BMI, 2.4cm larger waist circumference, and 0.02 points higher WHtR (p < 0.05) compared to those living for ≤5 years. Long-stay immigrants were also more likely to be hypertensive than short-stay immigrants (p < 0.01). In conclusion, cardiometabolic risk is significantly different among ethnic groups in Queensland with Pacific Islanders having the highest risk. Immigrants living in Australia >5 years had higher risks compared to those living in Australia for shorter periods of time.

The Risk of Myocardial Infarction and Ischemic Stroke According to Waist Circumference in 21,749,261 Korean Adults: A Nationwide Population-Based Study

BACKGROUND

Waist circumference (WC) is a well-known obesity index that predicts cardiovascular disease (CVD). We studied the relationship between baseline WC and development of incident myocardial infarction (MI) and ischemic stroke (IS) using a nationwide population-based cohort, and evaluated if its predictability is better than body mass index (BMI).

METHODS

Our study included 21,749,261 Koreans over 20 years of age who underwent the Korean National Health Screening between 2009 and 2012. The occurrence of MI or IS was investigated until the end of 2015 using National Health Insurance Service data.

RESULTS

A total of 127,289 and 181,637 subjects were newly diagnosed with MI and IS. The incidence rate and hazard ratio of MI and IS increased linearly as the WC level increased, regardless of adjustment for BMI. When the analyses were performed according to 11 groups of WC, the lowest risk of MI was found in subjects with WC of 70 to 74.9 and 65 to 69.9 cm in male and female, and the lowest risk of IS in subjects with WC of 65 to 69.9 and 60 to 64.9 cm in male and female, respectively. WC showed a better ability to predict CVD than BMI with smaller Akaike information criterion. The optimal WC cutoffs were 84/78 cm for male/female for predicting MI, and 85/78 cm for male/female for predicting IS.

CONCLUSION

WC had a significant linear relationship with the risk of MI and IS and the risk began to increase from a WC that was lower than expected.

The role of intergenerational educational mobility and household wealth in adult obesity: Evidence from Wave 2 of the World Health Organization's Study on global AGEing and adult health

BACKGROUND

Obesity has emerged as a major risk factor for non-communicable diseases in low and middle-income countries but may not follow typical socioeconomic status (SES)-related gradients seen in higher income countries. This study examines the associations between current and lifetime markers of SES and BMI categories (underweight, normal weight, overweight, obese) and central adiposity in Ghanaian adults.

METHODS

Data from 4,464 adults (2,610 women) who participated in the World Health Organization's Study on global AGEing and adult health (SAGE) Wave 2 were examined. Multilevel multinomial and binomial logistic regression models were used to examine associations. SES markers included parental education, individual education, intergenerational educational mobility and household wealth. Intergenerational educational mobility was classified: stable-low (low parental and low individual education), stable-high (high parental and high individual education), upwardly (low parental and high individual education), or downwardly mobile (high parental and low individual education).

RESULTS

The prevalence of obesity (12.9%) exceeded the prevalence of underweight (7.2%) in the population. High parental and individual education were significantly associated with higher odds of obesity and central adiposity in women. Compared to the stable low pattern, stable high (obesity: OR = 3.15; 95% CI: 1.96, 5.05; central adiposity: OR = 1.75; 95% CI: 1.03, 2.98) and upwardly (obesity: OR = 1.71; 95% CI: 11.13, 2.60; central adiposity: OR = 1.60; 95% CI: 1.08, 2.37) mobile education patterns were associated with higher odds of obesity and central adiposity in women, while stable high pattern was associated with higher odds of overweight (OR = 1.88; 95% CI: 1.11, 3.19) in men. Additionally, high compared to the lowest household wealth was associated with high odds of obesity and central adiposity in both sexes.

CONCLUSION

Stable high and upwardly mobile education patterns are associated with higher odds of obesity and central adiposity in women while the stable high pattern was associated with higher odds of overweight in men.

Risk factors of pre-hypertension and hypertension among non-pregnant women of reproductive age in northeastern Tanzania: a community based cross-sectional study

OBJECTIVES

To determine risk factors of pre-hypertension and hypertension in a cohort of 1247 rural Tanzanian women before conception.

METHODS

Demographic and socioeconomic data, anthropometric measurements, past medical and obstetric history and other risk factors for pre-hypertension and hypertension were collected using a structured questionnaire. Multiple logistic regression analysis was used to evaluate the associations between anthropometric indices and other risk factors of pre-hypertension and hypertension. The predictive power of different anthropometric indicators for identification of pre-hypertension and hypertension patients was determined by Receiver Operating Characteristic curves (ROC).

RESULTS

The median (range) age was 28.0 (18-40) years. The age-standardised prevalences of pre-hypertension and hypertension were 37.2 (95% CI 34.0-40.6) and 8.5% (95%CI 6.7-10.8), respectively. Of hypertensive patients (n = 98), only 20 (20.4%) were aware of their condition. In multivariate analysis, increasing age, obesity and haemoglobin levels were significantly associated with pre-hypertension and hypertension.

CONCLUSION

Despite a low prevalence of hypertension, over one third of the women had pre-hypertension. This poses a great challenge ahead as pre-hypertensive women may progress into hypertension as they grow older without appropriate interventions. Obesity was the single most important modifiable risk factor for pre-hypertension and hypertension.