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

Cardiovascular diseases in Africa in the twenty-first century: Gaps and priorities going forward

In 2015, the United Nations set important targets to reduce premature cardiovascular disease (CVD) deaths by 33% by 2030. Africa disproportionately bears the brunt of CVD burden and has one of the highest risks of dying from non-communicable diseases (NCDs) worldwide. There is currently an epidemiological transition on the continent, where NCDs is projected to outpace communicable diseases within the current decade. Unchecked increases in CVD risk factors have contributed to the growing burden of three major CVDs-hypertension, cardiomyopathies, and atherosclerotic diseases- leading to devastating rates of stroke and heart failure. The highest age standardized disability-adjusted life years (DALYs) due to hypertensive heart disease (HHD) were recorded in Africa. The contributory causes of heart failure are changing-whilst HHD and cardiomyopathies still dominate, ischemic heart disease is rapidly becoming a significant contributor, whilst rheumatic heart disease (RHD) has shown a gradual decline. In a continent where health systems are traditionally geared toward addressing communicable diseases, several gaps exist to adequately meet the growing demand imposed by CVDs. Among these, high-quality research to inform interventions, underfunded health systems with high out-of-pocket costs, limited accessibility and affordability of essential medicines, CVD preventive services, and skill shortages. Overall, the African continent progress toward a third reduction in premature mortality come 2030 is lagging behind. More can be done in the arena of effective policy implementation for risk factor reduction and CVD prevention, increasing health financing and focusing on strengthening primary health care services for prevention and treatment of CVDs, whilst ensuring availability and affordability of quality medicines. Further, investing in systematic country data collection and research outputs will improve the accuracy of the burden of disease data and inform policy adoption on interventions. This review summarizes the current CVD burden, important gaps in cardiovascular medicine in Africa, and further highlights priority areas where efforts could be intensified in the next decade with potential to improve the current rate of progress toward achieving a 33% reduction in CVD mortality.

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

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

Prevalence of Underweight, Overweight and Obesity among Adults in Urban Bissau, Western Africa

Overweight and obesity affect a large proportion of the population and are important causes of death in both developed and low- and middle-income countries. In Guinea-Bissau, there are no previous population-based studies assessing this phenomenon. Therefore, we aimed to quantify the prevalence of underweight, overweight, and obesity among adults in Bissau. A stratified and cluster sample of 935 adults was assembled in 2021 and was evaluated using standardized questionnaires and anthropometric measurements, following the World Health Organization Stepwise Approach to Chronic Disease Risk Factor Surveillance. Underweight, obesity, and overweight were defined by body mass index based on the World Health Organization definitions. The prevalence of overweight and obesity was 48.7% among women and 25.0% among men. The proportion of women with abdominal obesity was 14 times higher than it was in men (35.3% vs. 2.5%). The prevalence of overweight and obesity increased with age and income. Underweight was more prevalent in the age group of 18 to 24 years (18.4% in women and 28.9% in men) and was less frequent among individuals with higher socioeconomic status. In conclusion, the prevalence of overweight and obesity is similar to the trends that are observed in many other urbanized populations in Africa and is already a major public health issue in urban Guinea-Bissau.

Dietary Diversity as a Risk Factor for Obesity in Algerian Patients with Type 2 Diabetes Mellitus

Although the incidence of "diabesity" (coexistence of type 2 diabetes and obesity) is alarmingly increasing in Algeria, the diet-diabesity link has not been well defined. This study aimed to explore the association between dietary diversity score (DDS) and obesity among Algerian type 2 diabetic patients. It was a cross-sectional observational study involving 390 type 2 diabetic patients. Anthropometric data were gathered, and dietary intake information was obtained through a 24-h dietary recall method, which was used to calculate DDS. Potential confounders such as age, sex, smoking, physical activity and energy intake were controlled for using multivariate logistic regression. A total of 160 patients (41.3%) were classified as obese. As expected, obese patients had a higher body mass index, waist circumference, hip circumference, body fat and fat mass index. Furthermore, obese patients more frequently met carbohydrate recommendations and had a higher intake of meat and protein. Female sex, hypertension, low physical activity and high meat and protein intake were positively associated with diabesity. Additionally, higher DDS was positively associated with diabesity after adjusting for confounders. Thus, a more diversified diet may be a risk factor for obesity among Algerian type 2 diabetic patients.

Prevalence of abdominal obesity and its association with cardiovascular risk among the adult population in Burkina Faso: findings from a nationwide cross-sectional study

OBJECTIVE

The objective of this study is to determine the prevalence of abdominal obesity, its predictors and its association with cardiovascular risk among adults in Burkina Faso.

DESIGN

We performed a secondary analysis of data from a national cross-sectional study, using WHO STEPwise approach.

SETTING

The study was conducted in Burkina Faso, in all the 13 regions of the country.

PARTICIPANTS

Our study involved 4308 adults of both sexes, aged between 25 and 64 years.

PRIMARY AND SECONDARY OUTCOMES

Our primary outcome was abdominal obesity, which was defined using a cut-off point of waist circumference (WC) of ≥94 cm for men and ≥80 cm for women. The secondary outcome was very high WC (≥102 cm for men and ≥88 cm for women) (for whom weight management is required).

RESULTS

The mean age of participants was 38.5±11.1 years. The age-standardised prevalence of abdominal obesity was 22.5% (95% CI 21.3% to 23.7%). This prevalence was 35.9% (95% CI 33.9% to 37.9%) among women and 5.2% (95% CI 4.3% to 6.2%) among men. In urban areas, the age-standardised prevalence of abdominal obesity was 42.8% (95% CI 39.9% to 45.7%) and 17.0% (95% CI 15.7% to 18.2%) in rural areas. The age-standardised prevalence of very high WC was 10.2% (95% CI 9.3% to 11.1%). The main predictors of abdominal obesity were being female, increased age, married status, high level of education and living in urban areas. Abdominal obesity was also significantly associated with high blood pressure (adjusted prevalence ratio (aPR): 1.30; 95% CI 1.14 to 1.47) and hypercholesterolaemia (aPR: 1.52; 95% CI 1.18 to 1.94). According to the combination matrix between body mass index and WC, 14.6% of the adult population in Burkina Faso had an increased cardiometabolic risk.

CONCLUSION

Our study showed a high prevalence of abdominal obesity and a high proportion of adults who require weight management strategies to prevent cardiometabolic complications. Strategies to reduce the burden of abdominal obesity and very high WC should be considered by Burkina Faso's policy-makers.

Multimorbidity from Chronic Conditions among Adults in Urban Slums: The AWI-Gen Nairobi Site Study Findings

Background:

In the era of double burden of infectious and non-communicable diseases in sub-Saharan Africa, the burden of multimorbidity is likely to be common. However, there is limited evidence on the burden and its associated factors in the sub-Saharan African context.

Objective:

The aim of this study was to determine the levels and identify determinants of multimorbidity from chronic conditions in two urban slums in Nairobi.

Methods:

Data collected from 2003 study participants aged 40–60 years in two urban slums of the Nairobi Urban Health and Demographic Surveillance System in 2015 were used. Using self-report, anthropometry and key biomarkers, data on 16 conditions including chronic diseases, behavioral disorders and metabolic abnormalities were gathered. Lifetime multimorbidity defined by the occurrence of at least two chronic conditions in an individual at any time during their life course was computed. Factors associated with lifetime multimorbidity were identified using multiple logistic regression.

Findings:

A total of 2,081 chronic conditions were identified among 1,302 individuals. While 701 (35.0%) had no chronic condition, single morbidity was reported in 726 (36.2%) of the study population. The overall prevalence of lifetime multimorbidity was 28.7%. The prevalence of dyads and triads of simultaneous occurrences of conditions (episodic multimorbidity) was 20.8% and 6.1%, respectively. Single morbidity was positively associated with gender and alcohol consumption; and negatively associated with employment. Women, older people, the unemployed, current smokers and current alcohol consumers had higher levels of lifetime multimorbidity in the study population.

Interpretation:

The findings of this study indicate that a considerable proportion of adults living in urban slums experience multimorbidity from chronic conditions. Further studies with a better rigor to establish temporal associations between socio-demographic factors and the occurrence of chronic conditions are needed to explore the impacts and implications on health status and health system.

Spatial analysis of the prevalence of obesity and overweight among women in Ghana

OBJECTIVE

Identifying hot spots for the overweight aids in effective public health interventions due to the associated public health burden and morbidities. This study, therefore aimed to explore and determine the spatial disparities in the overweight/obesity prevalence among women in Ghana. The study also aims at modelling the average body mass index (BMI) values using the spatial regression and the performance compared with the standard regression model.

DESIGN

This is a cross-sectional study using data from the 2014 Ghana Demographic and Health Survey (GDHS).

SETTING

The study was set in Ghana.

PARTICIPANTS AND METHODS

Data on 4393 non-pregnant women aged 15-49 years from the 2014 GDHS. Both global (Moran's I) and the local indicators for spatial dependence were examined through the mapped BMI values across the country by clusters. An estimated spatial lag model was used to explain the spatial differences in the average body sizes of women.

RESULTS

The overall prevalence of overweight/obesity among reproductive women in Ghana was 35.4%, and this was highly prevalent among educated women (p<0.001), those from wealthy households (p<0.001) and dwelling in an urban setting (p<0.001). Significant clustering (Moran's I=0.3145, p<0.01) of overweight/obesity was observed with hot spots (clustering) in Greater Accra, Central, Western and Ashanti regions. The spatial lag model was the best fit based on the Likelihood ratio test and the Akaike information criterion and Bayesian information criterion values. The mean age of women and household wealth were significant factors accounting for the increase in the average cluster body size (BMI) of women and the spatial differences.

CONCLUSION

The prevalence of overweight/obesity was high and spatially clustered in the southern, middle and coastal regions. Geographic specific and effective public health interventions and strategies are needed to address the growing morbidity burden associated with the rise in the average body sizes of reproductive women.

Visceral obesity and muscle mass determined by CT scan and surgical outcome in patients with advanced ovarian cancer. A retrospective cohort study

OBJECTIVE

Visceral obesity (VO) is a risk factor for developing postoperative complications in patients undergoing abdominal oncological surgery. However, in ovarian cancer patients this influence of body composition on postoperative morbidity is not well established. The aim of this study is to assess the association between body composition and complications in patients with advanced ovarian cancer undergoing cytoreductive surgery.

METHODS

Patients with FIGO stage 3 or 4 ovarian cancer between 2006 and 2017 were included. Visceral fat area, total skeletal mass and total fat area were measured on a single slice on the level of L3-L4 of the preoperative CT-scan. VO was defined as visceral fat ≥100cm². The perioperative data were extracted retrospectively. A multivariate logistic regression analysis was performed to test the predictive value of multiple variables such as body composition, albumin levels and preoperative morbidity.

RESULTS

298 consecutive patients out of nine referring hospitals were included. VO patients were more likely to be hypertensive (38% vs 17% p < 0.001), and to have an ASA 3 score (21% vs 10% P = 0.012). Complications occurred more often in VO patients (43% vs 21% P < 0.001). Thrombotic events were found in 4.9% of VO patients versus 0.6% of the non-visceral obese patients (p = 0.019). VO(OR: 4.37, p < 0.001), hypertension (OR:1.9, p = 0.046) and duration of surgery (OR: 1.004, p = 0.017) were predictors of post-surgical complications. Muscle mass is not a predictor of complications.

CONCLUSION

Visceral obesity is associated with a higher occurrence of complications in patients with advanced ovarian cancer undergoing cytoreductive surgery.

Dietary diversity and physical activity as risk factors of abdominal obesity among adults in Dilla town, Ethiopia

BACKGROUND

Globally, the prevalence of obesity is on the rise and has nearly tripled since 1975. In Ethiopia, despite not having well-documented evidence, abdominal obesity has been increasing dramatically, particularly in urban settings. Therefore, this study is intended to determine the prevalence and risk factors of abdominal obesity among adults in Dilla town, Ethiopia.

METHODS

A community-based cross-sectional study was conducted between January and February 2018 in Dilla Town. A multi-stage sampling technique was employed to recruit 663 adults. The study was conducted in accordance with the World Health Organization (WHO) STEP wise approach. Waist circumference was measured using a flexible metric tape mid-way between the lowest rib and iliac crest with the participant standing at the end of gentle expiration. Abdominal obesity was determined using the International Diabetes Federation cutoff. A logistic regression model was fitted to identify risk factors of abdominal obesity. Adjusted odds ratio (AOR) with corresponding 95% confidence interval (CI) was calculated to show the strength of association.

RESULTS

A total of 634 adults participated in the study with a response rate of 95.6%. This study revealed that 155 (24.4%) [95% CI: (21.50, 27.80)] adults were abdominally obese. Higher odds of being abdominally obese were noted among adults with a high [AOR = 4.61, 95% CI: (2.51-8.45)] and middle [AOR = 3.22, 95% CI: (1.76-5.88)] wealth rank, consuming less diversified diet [AOR = 2.05, 95% CI: (1.31-3.19)], physical inactivity [AOR = 2.68, 95% CI: (1.70-4.22)] and being female [AOR = 1.92, 95% CI: (1.13-3.28)].

CONCLUSIONS

The prevalence of abdominal obesity among adults in Dilla town is considerably high, and became an emerging nutrition related problem. Being in the middle and high wealth rank, physical inactivity, consuming less diversified diet, and being female were the risk factors of abdominal obesity.