Obesity in South Africa

A comprehensive review on phytochemicals for fatty liver: are they potential adjuvants?

Non-alcoholic fatty liver disease (NAFLD) is considered the hepatic manifestation of metabolic syndrome and, as such, is associated with obesity. With the current and growing epidemic of obesity, NAFLD is already considered the most common liver disease in the world. Currently, there is no official treatment for the disease besides weight loss. Although there are a few synthetic drugs currently being studied, there is also an abundance of herbal products that could also be used for treatment. With the World Health Organization (WHO) traditional medicine strategy (2014-2023) in mind, this review aims to analyze the mechanisms of action of some of these herbal products, as well as evaluate toxicity and herb-drug interactions available in literature.

Socioeconomic Inequalities and Obesity in South Africa-A Decomposition Analysis

Background: Prior evidence shows that inequalities are related to overweight and obesity in South Africa. Using data from a recent national study, we examine the socioeconomic inequalities associated with obesity in South Africa and the factors associated with it. Methods: We use quantitative data from the South African National Health and Nutrition Examination Survey (SANHANES-1) carried out in 2012. We estimate the concentration index (CI) to identify inequalities and decompose the CI to explore the determinants of these inequalities. Results: We confirm the existence of pro-rich inequalities associated with obesity in South Africa. The inequalities among males are larger (CI of 0.16) than among women (CI of 0.09), though more women are obese than men. Marriage increases the risk of obesity for women and men, while smoking decreases the risk of obesity among men significantly. Higher education is associated with lower inequalities among females. Conclusions: We recommend policies to focus on promoting a healthy lifestyle, including the individual’s perception of a healthy body size and image, especially among women.

Prevalence and associated factors of overweight/obesity among type2 diabetic outpatients in Southwest Ethiopia

PURPOSE

Type 2 diabetes mellitus is a major global health threat worldwide. Obesity and overweight is major risk factor for its development. This study aimed to assess the prevalence and associated factors of overweight/obesity among diabetic outpatients at Jimma Medical Center, Southwest Ethiopia.

METHODS

Hospital-based, cross-sectional study was conducted during March 02 to June 30, 2020 among systematically selected participants at the study area. Bivariable and multivariable binary logistic regression were used to identify the factors associated with outcome variable. Variables with a p value of<0.25 on bivariable logistic regression were considered candidates for multivariable regression. On multivariable logistic regression variables with p-value of <0.05 were considered as significantly associated with overweight/obesity.

RESULTS

A total of 334 participants with mean age of 51.42 ± 13.33 years were included in the study. The prevalence of overweight/obesity among the study population was 36.2%. According to multivariable logistic regression analysis, residence (AOR = 1.8, 95%CI:1, 3), higher income tercile (AOR = 3.4, 95%CI:1.8, 6.7), family history of overweight and obesity (AOR = 1.9, 95%CI:1.1,3.4), comorbid hypertension (AOR = 2.4, 95%CI:1.4,4) and physical inactivity (AOR = 2.1, 95%CI:1.2,3.5) were significantly associated with overweight/obesity.

CONCLUSION

There was a high prevalence of overweight/obesity among study participants. It was found that higher income tercile, residence, family history of overweight and obesity, comorbid hypertension and physical inactivity were significantly associated with overweight/obesity.

More than myalgia: An unusual presentation of exertional rhabdomyolysis

Exertional or exercise-induced rhabdomyolysis (ER) is a condition in which excessive and unaccustomed physical activity results in skeletal muscle damage. The ER is a relatively uncommon condition but can have very serious consequences such as acute renal failure, severe electrolyte abnormalities, acid base disturbances and death if not recognised and managed appropriately. The risk factors for rhabdomyolysis exist in our local setting, hence, it is paramount that healthcare practitioners (GPs) in our settings be made aware of ER, its prevention and symptoms. Cases of ER are often reported in sports men or women. Here, we report a case of a 33-year-old healthy female, with clinical and serological presentation, which is typical of ER following the commencement of a regimen of exercise to lose weight.

Ischaemic heart disease, stroke, and their cardiometabolic risk factors in Africa: current challenges and outlook for the future

INTRODUCTION

Although cardiovascular diseases (CVDs) are among the leading causes of death in Sub-Saharan Africa (SSA), prevention is not a priority and effective treatments are not widely available. This perspective discusses the burden, challenges, and potential opportunities for improvement of CVD prevention and control efforts in SSA.

AREAS COVERED

This paper focuses on ischemic heart disease and stroke, and their key contributors of obesity, hypertension, diabetes and dyslipidaemia which are well-established, rapidly rising, and significant contributors to disease burden in SSA. However, their prevention, detection, treatment and control of are currently disorganized, inconsistent, unreliable, and insufficient with most SSA countries not geared to respond to this growing problem. National policies are frequently lacking or, if available, remain poorly implemented, for the control of these conditions. Primary healthcare systems have not adapted to cope with these rising CVD burdens and remain weak, underfunded and under resourced. Numerous barriers at the healthcare service, healthcare provider, and patient levels prevent optimal CVD risk factor care.

EXPERT OPINION

Innovative approaches such as task-shifting with the reallocation of care to lower-level healthcare workers and the potential use of inexpensive technological options should be encouraged to provide equitable CVD preventive and curative solutions to SSA's poor.

The Potential Therapeutic Value of Medicinal Plants in the Management of Metabolic Disorders

Metabolic syndrome (MetS) is a prevalent, multifactorial and complex disease that is associated with an increased risk of developing diabetes and other major cardiovascular complications. The rise in the global prevalence of MetS has been attributed to genetic, epigenetic, and environmental factors. The adoption of sedentary lifestyles that are characterized by low physical activity and the consumption of high-energy diets contributes to MetS development. Current management criteria for MetS risk factors involve changes in lifestyle and the use of pharmacological agents that target specific biochemical pathways involved in the metabolism of nutrients. Pharmaceutical drugs are usually expensive and are associated with several undesirable side effects. Alternative management strategies of MetS risk factors involve the use of medicinal plants that are considered to have multiple therapeutic targets and are easily accessible. Medicinal plants contain several different biologically active compounds that provide health benefits. The impact of phytochemicals present in local medicinal plants on sustainable health and well-being of individuals has been studied for many years and found to involve a plethora of complex biochemical, metabolic, and physiological mechanisms. While some of these phytochemicals are the basis of mainstream prescribed drugs (e.g., metformin, reserpine, quinine, and salicin), there is a need to identify more medicinal plants that can be used for the management of components of MetS and to describe their possible mechanisms of action. In this review, we assess the potential health benefits of South African ethnomedicinal plants in protecting against the development of health outcomes associated with MetS. We aim to provide the state of the current knowledge on the use of medicinal plants and their therapeutically important phytochemicals by discussing the current trends, with critical examples from recent primary references of how medicinal plants are being used in South African rural and urban communities.

Physical Health Status of Emergency Care Providers in South Africa

Background: Emergency care providers (ECPs) have a physically, mentally, and emotionally demanding profession. Therefore, they are predisposed to cardiovascular and other non-communicable disease risk factors. Objectives: The objective of the study was to determine the physical health status of ECPs in the North West province of South Africa through a selected anthropometric and other health parameter test battery. Methods: Ninety-one ECPs (64 males, 27 females) took part in the study voluntarily for health screening tests including body mass index (BMI), lean body mass (LBM), resting heart rate (RHR), blood pressure (BP), skinfold measurement, waist circumference (WC), waist-to-hip ratio (WHR), fasting blood glucose (FBG), and total cholesterol (TC). The collected data were subjected to statistical analysis using the Statistical Package for Social Sciences (SPSS) version 25 (IBM). Results: The participants demonstrated a mean BMI of 28.2 ± 5.5 kg/m2, body fat of 26 ± 7.6 %, and LBM of 58.6 ± 10 kg. Significant differences were seen in height (170.5 ± 6.2 vs. 160.7 ± 5.3 cm), BF% (22.5 ± 5.3 vs. 34.2 ± 6.2 %), and LBM (62.3 ± 8 vs. 49.2 ± 8.2 kg) between males and females (P ≤ 0.05). Mean systolic BP was 122 ± 15 mmHg, and diastolic BP was 81 ± 10 mmHg. Mean WC was 90.8 ± 11.4 cm. Other health parameters included mean FBG of 5.1 ± 2.4 mmol/L and mean TC of 4.9 ± 0.7 mmol/L. Significant differences were seen in WHR (0.88 ± 0.04 vs. 0.79 ± 0.06) between males and females (P ≤ 0.05). Conclusions: A significant number of ECPs presented with cardiovascular and other NCD risk factors such as hypertension, obesity, high WC, elevated FBG, and abnormal levels of TC. This can be attributed to the nature of their occupation such as working irregular shifts leading to sleep deprivation, being exposed to psychological trauma, poor nutrition during shifts, and/or lack of exercise. Stress management is an important part of these workers’ rehabilitation program. A well-formulated employee wellness program is required to set remedial measures in place.

Analysis of main risk factors contributing to obesity in the region of East Africa: meta-analysis

Background

Over a few decades obesity has become a major global health problem. Its prevalence worldwide has more than doubled since 1980. The situation is expected to worsen in the future, especially in the developing countries that experience nutrition transition due to economic growth. It contributes to reduction in malnutrition which supports an increase in obesity prevalence.

Objectives

The aim of this study was to analyse the predictors of obesity in the region of East Africa.

Methods

Meta-analysis of existing studies was used in order to find the different risk factors and their significance in obesity development. Data extracted from 16 published academic research articles described the situation in East African countries. The significance of the effect of each variable was tested by means of an asymptotic chi-square test, or Fisher's exact (factorial) test and the risk ratios were calculated.

Results

Based on the chi-square test and the risk ratios of the aggregated data, three risk factors were found to be significant in the development of obesity – gender, type of residence and socio-economic status. In East African countries, women are significantly more likely to be obese. Living in an urban area and socioeconomic status are also positively associated with obesity. Because of insufficient data three other risk factors did not prove to be of any significance – alcohol consumption, smoking and education level.

Conclusion

Conclusions of this meta-analysis confirm world trends but we also found results that are not in line with them (e.g. education). This meta-analysis confirms the huge existing research gap concerning obesity predictors in the East African region.

Sleepiness Score-Specific Outcomes of a Novel Tongue Repositioning Procedure for the Treatment of Continuous Positive Airway Pressure-Resistant Obstructive Sleep Apnea

Background:

The gold standard of treatment for obstructive sleep apnea (OSA) is continuous positive airway pressure (CPAP). However, more than a third of patients have such difficulty with its chronic use such that they seek other options or choose to remain untreated. We evaluated sleepiness score-specific outcomes and the use of CPAP after tongue repositioning surgery for the treatment of OSA.

Patients and Methods:

A self-administered questionnaire was completed pre- and postoperatively by 10 patients who underwent tongue repositioning surgery for the treatment of OSA from October 2010 to December 2012. The questionnaire included the Epworth Sleepiness Scale (ESS) for the assessment of daytime somnolence and questions regarding CPAP use and overall satisfaction.

Results:

Preoperatively, 6 patients were “very sleepy” (ESS ≥16), 4 patients were “sleepy” (ESS = 10–16), and 0 patients were “not sleepy” (ESS ≤10). 30 days postoperatively, sleepiness scores decreased (10 patients were “not sleepy” (ESS ≤10) with 0 patients “very sleepy” or “sleepy;” P = 0.002). Thus, the median ESS score for the “very sleepy” and “sleepy,” decreased from 20 to 4 and 13 to 5, respectively, and the “nonsleepy” group increased from 0 to 4. After a 180-day review, the improved ESS scores remained unchanged (the median for “very sleepy” decreased to 3.5 that for “sleepy” remained at 5, and the median for “not sleepy” decreased to 3.5). Surgery decreased CPAP use by 100%. The surgery was judged to be worthwhile by all 10 of patients using a questionnaire, and all 10 patients said that they would recommend the treatment to other patients with OSA.

Conclusions:

These preliminary data indicate that tongue-repositioning surgery for the treatment of OSA may be effective in improving excessive daytime sleepiness. These proof-of-concept data require confirmation in an appropriately powered controlled study.

Income inequality and cardiovascular disease risk factors in a highly unequal country: a fixed-effects analysis from South Africa

Background

Chronic stress associated with high income inequality has been hypothesized to increase CVD risk and other adverse health outcomes. However, most evidence comes from high-income countries, and there is limited evidence on the link between income inequality and biomarkers of chronic stress and risk for CVD. This study examines how changes in income inequality over recent years relate to changes in CVD risk factors in South Africa, home to some of the highest levels of income inequality globally.

Methods

We linked longitudinal data from 9356 individuals interviewed in the 2008 and 2012 National Income Dynamics Study to district-level Gini coefficients estimated from census and survey data. We investigated whether subnational district income inequality was associated with several modifiable risk factors for cardiovascular disease (CVD) in South Africa, including body mass index (BMI), waist circumference, blood pressure, physical inactivity, smoking, and high alcohol consumption. We ran individual fixed-effects models to examine the association between changes in income inequality and changes in CVD risk factors over time. Linear models were used for continuous metabolic outcomes while conditional Poisson models were used to estimate risk ratios for dichotomous behavioral outcomes.

Results

Both income inequality and prevalence of most CVD risk factors increased over the period of study. In longitudinal fixed-effects models, changes in district Gini coefficients were not significantly associated with changes in CVD risk factors.

Conclusions

Our findings do not support the hypothesis that subnational district income inequality is associated with CVD risk factors within the high-inequality setting of South Africa.

Electronic supplementary material

The online version of this article (10.1186/s12939-018-0741-0) contains supplementary material, which is available to authorized users.

Metabolic Syndrome After HIV Acquisition in South African Women

BACKGROUND

Noncommunicable diseases are common among chronically infected patients with HIV in the developed world, but little is known about these conditions in African cohorts. We assessed the epidemiology of metabolic syndrome among young South African women during the first 3 years after HIV acquisition.

METHODS

A total of 160 women were followed prospectively in the CAPRISA 002 Acute Infection study. Metabolic syndrome was defined as a constellation of hyperlipidemia, hypertension, hyperglycemia/diabetes, and abdominal obesity. Time trends were assessed using generalized estimation equation models.

RESULTS

Median age was 24 years and body mass index 27 kg/m. Prevalence of metabolic syndrome at infection was 8.7% increasing to 19.2% over 36 months (P = 0.001). The proportion of women with body mass index >30 kg/m increased from 34.4% to 47.7% (P = 0.004), those with abnormal waist circumference and elevated blood pressure increased from 33.5% to 44.3% (P = 0.060) and 23.8% to 43.9% (P < 0.001), respectively. Incidence of metabolic syndrome was 9.13/100 person-years (95% CI: 6.02 to 13.28). Predictors of metabolic syndrome were age (per year increase odds ratio (OR) = 1.12; 95% CI: 1.07 to 1.16), time postinfection (per year OR = 1.47; 95% CI: 1.12 to 1.92), family history of diabetes (OR = 3.13; 95% CI: 1.71 to 5.72), and the human leukocyte antigen (HLA)-B*81:01 allele (OR = 2.95; 95% CI: 1.21 to 7.17), whereas any HLA-B*57 or B*58:01 alleles were protective (OR = 0.34; 95% CI: 0.15 to 0.77). HIV-1 RNA (OR = 0.89; 95% CI: 0.62 to 1.27) and CD4 count (OR = 1.03; 95% CI: 0.95 to 1.11) did not predict metabolic syndrome.

CONCLUSIONS

The high burden of metabolic conditions in young South African HIV-infected women highlights the need to integrate noncommunicable disease and HIV care programs. Interventions to prevent cardiovascular disease must start at HIV diagnosis, rather than later during the disease course.

"Culture Is So Interspersed": Child-Minders' and Health Workers' Perceptions of Childhood Obesity in South Africa

Introduction. Forty-one million children globally are overweight or obese, with most rapid rate increases among low- and middle-income nations. Child-minders and health workers play a crucial role in obesity prevention efforts, but their perceptions of childhood obesity in low- and middle-income countries are poorly understood. This study aims to (1) explore child-minders and health workers' perceptions of the causes, consequences, potential strategies, and barriers for childhood obesity prevention and intervention in Cape Town, South Africa and (2) to provisionally test the fit of a socioecological framework to explain these perceptions. Methods. Twenty-one interviews were recorded, transcribed, and analyzed through analytic induction. Results. Participants identified multilevel factors and contexts, as well as potential consequences and priorities of interest in addressing childhood obesity. An adapted childhood obesity perceptions model was generated, which introduces an overarching cultural dimension embedded across levels of the socioecological framework. Conclusions. Culture plays a pivotal role in explaining obesogenic outcomes, and the results of this study demonstrate the need for further research investigating how obesity perceptions are shaped by cultural frames (e.g., social, political, and historical). Understanding the causes, consequences, and potential interventions to address obesity through a cultural lens is critical for promoting health in low- and middle-income nations.

Pregnant in a foreign city: A qualitative analysis of diet and nutrition for cross-border migrant women in Cape Town, South Africa

How do migrant women navigate their food environment during pregnancy? Foods are imbued with new meanings in a new place, and in low-and-middle-income countries including South Africa, a changing food environment leaves the poor, including many migrants, vulnerable to malnutrition. Thus, one of the ways economic and social vulnerability may be experienced and reproduced is via the foods one consumes. Examining food perceptions in the context of pregnancy offers a potentially powerful lens on wellbeing.

METHODS

Nine focus group discussions (N = 48) with Somali, Congolese, and Zimbabwean men and women, and 23 in-depth interviews with Congolese, Somali and Zimbabwean women living in Cape Town were conducted, exploring maternal and infant nutrition. We used thematic analysis to guide analysis.

RESULTS

(1) Participants described longing for self-categorised "traditional" foods, yet had limited access and little time and space to prepare these foods in the manner they had back home. (2) Sought-after foods available-and even celebratory-for migrants in Cape Town during pregnancy tended to be calorie-dense, nutrient poor fast foods and junk foods. (3) The fulfilment of cravings was presented as the embodiment of health during pregnancy. (4) Iron-folic acid supplementation was perceived as curative rather than preventive. (5) While participants did not describe hunger during pregnancy, food scarcity seemed possible.

DISCUSSION

Food perceptions during pregnancy reflected migrants' orientation towards home. Fast foods were widely acceptable and available during pregnancy. These foods were not perceived to have negative health consequences. Nutrition interventions targeting migrants should consider the symbolic nature of food, the increasingly globalised food environment in urban LMIC settings, as well as the contexts in which health perceptions evolve.

Allelic variants of the Melanocortin 4 receptor (MC4R) gene in a South African study group

Obesity is a global epidemic that results in significant morbidity and mortality. Mutations in the melanocortin 4 receptor (MC4R) gene, which codes for a G-protein-coupled receptor responsible for postprandial satiety signaling, have been associated with monogenic obesity. The prevalence of obesity is on the increase in South Africa, and it is hypothesized that mutations in MC4R are a contributing factor. The aim of this study was to perform a retrospective assessment of the relationship between allelic variants of MC4R and BMI in a South African study cohort. DNA was isolated from a demographically representative cohort of 297 individuals and the entire MC4R gene sequenced by Sanger sequencing. Eight previously reported MC4R variants were identified in 42 of the 297 (14.1%) study participants. The most frequently observed MC4R alleles were V103I (4.0%), I170V (1.5%), and I198I (1.2%), while the remaining five variants together constituted 1.18%. Five compound heterozygotes were also detected. Although MC4R variants were rare, the majority of variation was observed in individuals of Black African ancestry. No statistically significant associations with BMI were reported. Given that lifestyle interventions have limited success in decreasing obesity, there is an urgent need to perform large-scale population studies to further elucidate the molecular underpinnings of this disease.

Prevalence of obesity and overweight and associated factors among financial institution workers in Accra Metropolis, Ghana: a cross sectional study

BACKGROUND

Certain professions are associated with low physical activity. Workers in such professions spend the most part of their adult working lives less engaged in physical activity if they don't consciously exercise outside of working hours. This increases their risk of obesity and its associated diseases. This study determined the prevalence of obesity and overweight and associated factors among workers of a financial institution in Accra Metropolis, Ghana.

METHODS

A cross-sectional study was conducted among 180 workers of a financial institution in Accra using the World Health Organization's STEPS (STEPwise approach) instrument for non-communicable disease risk factor surveillance. Relevant sociodemographic information were recorded and BMI was computed for each respondent.

RESULTS

The overall prevalence of obesity and overweight among the bank workers was 55.6 % (17.8 % obese and 37.8 % overweight). After adjusting for other variables, physical activity (OR = 0.34, 95 % CI = 0.13-0.89, p = 0.03), alcohol consumption (OR = 3.00, 95 % CI = 1.35, 6.68, p = 0.007), marital status (OR = 2.74, 95 % CI = 0.96-7.85, p = 0.04), sex (OR = 2.78, 95 % CI = 1.23-6.33, p = 0.01), and age (OR = 1.10, 95 % CI = 1.01-1.20, p = 0.036) were significantly associated with obesity and overweight.

CONCLUSION

Being physically inactive, consumption of alcohol, being married and a female, in addition to old age, increase the risk of obesity and overweight significantly. These factors should inform policy makers in developing strategies to reduce the burden of obesity and overweight among this category of workers.

Leptin links with plasminogen activator inhibitor-1 in human obesity: the SABPA study

The relationship between obesity and the development of cardiovascular disease is well established. However, the underlying mechanisms contributing to vascular disease and increased cardiovascular risk in the obese remain largely unexplored. Since leptin exerts direct vascular effects, we investigated leptin and the relationship thereof with circulating markers of vascular damage, namely plasminogen activator inhibitor-1 antigen (PAI-1(ag)), von Willebrand factor antigen (vWF(ag)) and urinary albumin-to-creatinine ratio (ACR). The study included a bi-ethnic population of 409 African and Caucasian teachers who were stratified into lean (<0.5) and obese (⩾0.5) groups according to waist-to-height ratio. We obtained ambulatory blood pressure measurements and determined serum leptin levels, PAI-1(ag), vWF(ag) and ACR, as markers of vascular damage. The obese group had higher leptin (P<0.001) and PAI-1(ag) (P<0.001) levels and a tendency existed for higher vWF(ag) (P=0.068). ACR did not differ between the two groups (P=0.21). In single regression analyses positive associations existed between leptin and all markers of vascular damage (all P<0.001) only in the obese group. After adjusting for covariates and confounders in multiple regression analyses, only the association between leptin and PAI-1(ag) remained (R(2)=0.440; β=0.293; P=0.0021). After adjusting for gender, ethnicity and age, additional analyses indicated that leptin also associated with fibrinogen and clot lysis time in both lean and obese groups, which in turn is associated with 24- h blood pressure and pulse pressure. This result provides evidence that elevated circulating leptin may directly contribute to vascular damage, possibly through mechanism related to thrombotic vascular disease.

A comparison of the cardiometabolic profile of black South Africans with suspected non-alcoholic fatty liver disease (NAFLD) and excessive alcohol use

Excessive alcohol use and non-alcoholic fatty liver disease (NAFLD) are putative cardiovascular disease risk factors. In order to ease the identification of these conditions on primary health care level, we aimed to determine and compare the demographic and cardiometabolic characteristics of excessive alcohol users and those with suspected NAFLD in black South Africans. In the Prospective Urban Rural Epidemiology study (North West Province, South Africa, N = 2021, collected in 2005) we selected 338 participants, namely: 1) alcohol users (N = 143) reporting 'yes' to alcohol intake, with high gamma-glutamyl transferase (GGT) ≥80 U/L and a percentage carbohydrate deficient transferrin (%CDT) ≥2%; 2) non-alcohol users (N = 127) self-reporting 'no' to alcohol intake with GGT ≤30 U/L and %CDT ≤2%; and 3) NAFLD group (N = 68) who were non-drinkers with GGT levels ≥60 U/L and %CDT ≤ 2%. The demographics indicated that the alcohol users were mostly men (73%) with a body mass index (BMI) of 19.8 (15.2-27.3) kg/m(2), 90% of which were smokers. Systolic blood pressure (SBP) of alcohol users significantly correlated with high-density lipoprotein cholesterol (HDL-C) (β = 0.24; p = 0.003) and waist circumference (WC) (β = 0.22; p = 0.006). Non-alcohol users were mostly women (84%) with a BMI of 26.0 (18.0-39.2) kg/m(2) and blood pressure in this group related positively with triglycerides. The NAFLD group were also mostly women (72%) with a comparatively larger WC (p < 0.001) and an adverse metabolic profile (total cholesterol: 5.55 ± 1.69 mmol/L; glycosylated hemoglobin: 6.03 (4.70-9.40) %). Diastolic blood pressure in the NAFLD group associated positively with WC (β = 0.27; p = 0.018). We therefore found disparate gender and cardiometabolic profiles of black South Africans with suspected NAFLD and excessive alcohol use. The described profiles may aid health care practitioners in low resource settings when using these crude screening measures of gender, obesity indices (and self-reported alcohol use) to identify individuals at risk.

Associations Between Orphan and Vulnerable Child Caregiving, Household Wealth Disparities, and Women's Overweight Status in Three Southern African Countries Participating in Demographic Health Surveys

This study examines whether orphan and vulnerable children (OVC) primary caregivers are facing absolute household wealth (AWI) disparities, the association between AWI and women's overweight status, and the modifying role of OVC primary caregiving status on this relationship. Demographic Health Surveys data (2006-2007) from 20 to 49 year old women in Namibia (n = 6,305), Swaziland (n = 2,786), and Zambia (n = 4,389) were analyzed using weighted marginal means and logistic regressions. OVC primary caregivers in Namibia and Swaziland had a lower mean AWI than other women in the same country. In Zambia, OVC primary caregivers had a lower mean AWI score than non-primary caregivers living with an OVC but a higher mean AWI score than non-OVC primary caregivers. In Swaziland and Zambia, even small increases in household wealth were associated with higher odds for being overweight regardless of women's caregiving status. Only in Namibia, OVC primary caregiving modified the effect of the previous association. Among Namibian OVC primary caregivers, women who had at least medium household wealth (4 or more AWI items) were more likely to be overweight than their poorest counterparts (0 or 1 AWI items). OVC primary caregivers are facing household wealth disparities as compared to other women from their communities. Future studies/interventions should consider using population-based approaches to reach women from every household wealth level to curb overweight in Swaziland and Zambia and to focus on specific household wealth characteristics that are associated with OVC primary caregivers' overweight status in Namibia.

Decomposing race and gender differences in underweight and obesity in South Africa

Using data from the National Income Dynamics Study, we document differentials in both underweight and obesity across race and gender in post-Apartheid South Africa. Using a nonlinear decomposition method, we decompose these differences across gender within race and then across race within gender. Less than one third of the differences in obesity and underweight across gender are explained by differences in covariates. In contrast, at least 70% of the obesity differences across race are explained by differences in covariates. Behavioral variables such as smoking and exercise explain the largest part of the bodyweight differentials across gender. For bodyweight differentials across race within gender, however, socioeconomic status and background variables have the largest explanatory power for obesity differentials, while background variables play the key role in explaining the underweight differentials. These results indicate that eradicating obesity and underweight differentials will require targeting policies to specific groups.

Racial comparison of receptor-defined breast cancer in Southern African women: subtype prevalence and age-incidence analysis of nationwide cancer registry data

BACKGROUND

Receptor-defined breast cancer proportions vary across Africa. They have important implications for survival prospects and research priorities.

METHODS

We studied estrogen receptor (ER), progesterone receptor (PR), and HER2 receptor statuses in two multiracial Southern African countries with routine diagnostic immunohistochemistry. A total of 12,361 women with histologically confirmed breast cancer diagnosed at age ≥20 years during (i) 2009-2011 from South Africa's national cancer registry (public sector) and (ii) 2011-2013 from Namibia's only cancer hospital were included. Crude, age, and age + laboratory-adjusted ORs of receptor status were analyzed using logistic regression, and age-incidence curves were analyzed using Poisson regression.

RESULTS

A total of 10,047 (81%) women had known ER status. Ranking of subtypes was consistent across races: ER(+)/PR(+)HER2(-) was most common (race-specific percentage range, 54.6%-64.8%), followed by triple-negative (17.4%-21.9%), ER(+)/PR(+)HER2(+) (9.6%-13.9%), and ER(-)PR(-)HER2(+) (7.8%-10.9%). Percentages in black versus white women were 33.8% [95% confidence (CI), 32.5-35.0] versus 26.0% (24.0-27.9) ER(-); 20.9% (19.7-22.1) versus 17.5% (15.4-19.6) triple-negative; and 10.7% (9.8-11.6) versus 7.8% (6.3-9.3) ER(-)PR(-)HER2(+). Indian/Asian and mixed-ancestry women had intermediate values. Age-incidence curves had similar shapes across races: rates increased by 12.7% per year (12.2-13.1) across ER subtypes under the age of 50 years, and thereafter slowed for ER(+) (1.95%) and plateaued for ER(-) disease (-0.1%).

CONCLUSIONS

ER(+) breast cancer dominates in all Southern African races, but black women have a modest excess of aggressive subtypes.

IMPACT

On the basis of the predominant receptor-defined breast tumors in Southern Africa, improving survival for the growing breast cancer burden should be achievable through earlier diagnosis and appropriate treatment.

Incongruence in body image and body mass index: A surrogate risk marker in Black women for type 2 diabetes mellitus

Background

Excess weight contributes to the development and progression of Type 2 diabetes mellitus (T2DM). Distorted body image amongst urban Black women and the perception that thinness is linked with HIV, may however be compounding the problem, particularly in areas with a high HIV burden.

Objectives

This study aimed to compare the perception of body image in urban Black women with and without T2DM.

Methods

A cross-sectional comparative study was conducted on 328 Black women systematically sampled into two groups (with and without T2DM). Body mass index (BMI) (weight [kg]/height [m²]) was determined and the adapted Stunkard Body Image Silhouettes for Black women was used to determine perceived body image (PBI).

Results

Seventy-two per cent had T2DM and in this group 89% were obese, with a mean BMI of 39.5 kg/m² (s.d. ± 8.5). In the non-diabetes group (NDG) 44% were obese, with a mean BMI of 31.3 kg/m² (s.d. ± 9.0) Black women underestimated their body image across all weight categories (p < 0.05). Both groups (99% of the study group) also perceived thinness as being associated with HIV.

Conclusions

This study identified an incongruence between PBI and actual BMI amongst urban Black women. This, combined with their belief that thinness is associated with HIV, places those with T2DM at risk of secondary complications arising from diabetes mellitus, and those without diabetes mellitus at a higher risk of developing T2DM. A discrepancy between PBI and BMI may therefore serve as a risk marker to alert clinicians to use a more ethno-cultural specific approach in engaging with urban Black women regarding weight loss strategies in the future.

Obesity and its health impact in Africa: a systematic review

Abstract

Obesity and its association with co-morbidities in Africa are on the rise. This systematic review examines evidence of obesity and its association with co-morbidities within the African continent. Comparative studies conducted in Africa on adults 17 years and older with mean body mass index (BMI) ≥ 28 kg/m² were included. Five electronic databases were searched. Surveys, case–control and cohort studies from January 2000 to July 2010 were evaluated. Of 720 potentially relevant articles, 10 met the inclusion criteria. Prevalence of obesity was higher in urban than rural subjects with significant increases in obesity rates among women. Inflammatory marker levels were significantly elevated among Africans compared with Caucasians. The co-relationship between obesity and chronic diseases was also highlighted. This systematic review demonstrates that while obesity remains an area of significant public health importance to Africans, particularly in urban areas, there is little evidence of proper diagnosis, treatment and/or prevention.

Hypertension and obesity in adults living in a high HIV prevalence rural area in South Africa

Hypertension and excess body weight are major risk factors of cardiovascular morbidity and mortality in developing countries. In countries with a high HIV prevalence, it is unknown how increased antiretroviral treatment and care (ART) coverage has affected the prevalence of overweight, obesity, and hypertension. We conducted a health survey in 2010 based on the WHO STEPwise approach in 14,198 adult resident participants of a demographic surveillance area in rural South Africa to investigate factors associated with hypertension and excess weight including HIV infection and ART status. Women had a significantly higher median body mass index (BMI) than men (26.4 vs. 21.2 kg/m(2), p<0.001). The prevalence of obesity (BMI ≥ 30 kg/m(2)) in women (31.3%, 95% confidence interval (CI) 30.2-32.4) was 6.5 times higher than in men (4.9%, 95% CI 4.1-5.7), whereas prevalence of hypertension (systolic or diastolic blood pressure ≥ 140 or 90 mm Hg, respectively) was 1.4 times higher in women than in men (28.5% vs 20.8%, p<0.001). In multivariable regression analysis, both hypertension and obesity were significantly associated with sex, age, HIV and ART status. The BMI of women and men on ART was on average 3.8 (95% CI 3.2-3.8) and 1.7 (95% CI 0.9-2.5) kg/m(2) lower than of HIV-negative women and men, respectively. The BMI of HIV-infected women and men not on ART was on average 1.2 (95% CI 0.8-1.6) and 0.4 (95% CI -0.1-0.9) kg/m(2) lower than of HIV-negative women and men, respectively. Obesity was a bigger risk factor for hypertension in men (adjusted odds ratio (aOR) 2.99, 95% CI 2.00-4.48) than in women (aOR 1.64, 95% CI 1.39-1.92) and overweight (25 ≤ BMI<30) was a significant risk factor for men only (aOR 1.53 95% CI 1.14-2.06). Our study suggests that, cardiovascular risk factors of hypertension and obesity differ substantially between women and men in rural South Africa.

Diabetes buddies: peer support through a mobile phone buddy system

PURPOSE

The purpose of this study is to test the feasibility and acceptability of a mobile phone-based peer support intervention among women in resource-poor settings to self-manage their diabetes. Secondary goals were to evaluate the intervention's effectiveness to motivate diabetes-related health choices.

METHODS

Women with diabetes (n = 22) in Cape Town, South Africa, participated in a 12-week program focused on providing and applying knowledge of health routines to manage diabetes. Women were linked with a buddy via a mobile phone for support and were questioned daily about a health behavior via text message. Women were assessed at recruitment and then 3 and 6 months later by a trained interviewer using a mobile phone for data collection. The women were evaluated on technology uptake, reduction of body mass index, blood glucose levels, and increases in positive coping and general health-seeking behaviors.

RESULTS

Women exchanged 16 739 text messages to buddies and received 3144 texts from the project. Women responded to 29% of texted questions (n = 1321/14 582). Women attended at least 9 of 12 possible intervention sessions; a third attended all 12 sessions (n = 8/22). Between baseline and 3 months, women increased their sleep and reported a higher level of positive action and social support coping, yet blood glucose increased by 3.3 points. From 3 to 6 months, spiritual hope decreased and diastolic blood pressure increased. One year later, the 22 women continue to attend meetings.

CONCLUSIONS

Mobile phones are an easy and reliable way to provide peer support and disseminate health messages. Both positive and negative changes were observed in this pilot study.

Prevalence of obesity and overweight in urban adult Nigerians

Obesity is increasingly a major health problem in parts of the developing world. It has reached epidemic proportions among Africans living in the Western Hemisphere; similar potential may exist in urban Africa. We explored this possibility in an urban setting in Nigeria, Africa's most populous nation. A screening survey was carried out among randomly selected 998 civil servants, 581 men and 417 women, in Ibadan, a major Nigerian city. Biographical data were collected using standardized questionnaires, and measurements of anthropometric indices, blood pressures and plasma glucose concentration. Obesity and overweight were defined by body mass index based on international criteria. Prevalence of obesity was 8.82% (confidence interval [CI]=7.13%, 10.75%), overweight 17.45% (CI=15.12%, 19.95%), and overweight plus obesity=26.18% (CI=23.47%, 29.03%). Prevalence of obesity among the women was 17.27% (CI=13.76%, 21.24%) and for men 2.75% (CI=1.58%, 4.43%). Among the women 42% were obese or overweight compared with 15% of the male population. Obesity and overweight were associated with higher socioeconomic status. Prevalence of obesity and overweight in the study population is comparable to rates seen in many industrialized countries, and rapidly emerging urbanized populations in Africa.

Type 2 diabetes mellitus and obesity in sub-Saharan Africa

While communicable diseases such as human immunodeficiency virus/acquired immune deficiency syndrome, malaria, and tuberculosis have continued to pose greater threats to the public health system in sub-Saharan Africa (SSA), it is now apparent that non-communicable diseases such as diabetes mellitus are undoubtedly adding to the multiple burdens the peoples in this region suffer. Type 2 diabetes mellitus (T2DM) is the most common form of diabetes (90-95%), exhibiting an alarming prevalence among peoples of this region. Its main risk factors include obesity, rapid urbanization, physical inactivity, ageing, nutrition transitions, and socioeconomic changes. Patients in sub-Saharan Africa also show manifestations of beta-cell dysfunction and insulin resistance. However, because of strained economic resources and a poor health care system, most of the patients are diagnosed only after they have overt symptoms and complications. Microvascular complications are the most prevalent, but metabolic disorders and acute infections cause significant mortality. The high cost of treatment of T2DM and its comorbidities, the increasing prevalence of its risk factors, and the gaps in health care system necessitate that solutions be planned and implemented urgently. Aggressive actions and positive responses from well-informed governments appear to be needed for the conducive interplay of all forces required to curb the threat of T2DM in sub-Saharan Africa. Despite the varied ethnic and transitional factors and the limited population data on T2DM in sub-Saharan Africa, this review provides an extensive discussion of the literature on the epidemiology, risk factors, pathogenesis, complications, treatment, and care challenges of T2DM in this region.

Body mass index and waist circumference in Mozambique: urban/rural gap during epidemiological transition

In 2005 we evaluated a nationally representative sample of the Mozambican adult population (n=2913; 25-64 years old) following the STEPwise approach to chronic disease risk factor surveillance to estimate urban-rural differences in overweight and obesity and waist circumferences. The prevalences of obesity and overweight were, respectively, 6.8% (95% CI: 5.1-8.6) and 11.8% (95% CI: 8.4-15.4) among women, and 2.3% (95% CI: 1.1-3.6) and 9.4% (95% CI: 5.7-13.1) among men. Overweight/obesity was more frequent in urban settings (age-, income- and education-adjusted prevalence ratios; women, 2.76, 95% CI: 1.82-4.18; men, 1.76, 95% CI: 0.80-3.85). The average waist circumference in Mozambique was 75.2cm (95% CI: 74.3-76.0) in women, significantly higher in urban than rural areas (age-, income- and education-adjusted β=3.6cm, 95% CI: 1.6-5.5) and 76.1cm (95% CI: 75.0-77.3) in men, with no urban-rural differences (adjusted β=1.3cm, 95% CI: -0.9 to 3.5). Our results show urban-rural differences, as expected in a country under epidemiological transition, with urban areas presenting a higher prevalence of overweight/obesity, but age- and education-specific estimates suggesting a trend towards smaller divergences. The development and implementation of strategies to manage the foreseeable obesity-related healthcare demands are needed.

DEXA-assessed regional body composition changes in young female military soldiers following 12-weeks of periodised training

Dual-energy X-ray absorptiometry (DEXA) was used to assess whole body and regional soft tissue mass, fat mass and lean body mass compositional changes in 68 female recruits (age 20.8 +/- 1.14 years; body mass 59.5 +/- 8.79 kg; stature 159.57 +/- 5.53 cm) pre- and post 12-weeks of military basic training. A decrease in total body fat tissue mass (10.2%) and regional percent fat (10.9%) was measured with an increase in total lean body mass (8.7%). Of interest were the differences in the responses in the tissue composition of the arms (16.2% loss in fat mass with an 11.6% gain in lean mass), trunk (17.0% decrease in fat mass with a 10.4% increase in lean mass) and the legs (10.5% increase in lean mass but no change in fat mass). These findings show the importance of considering regional rather than whole body composition changes when assessing the effects of a training programme. STATEMENT OF RELEVANCE: Female soldiers experienced a change in total body fat tissue (-10.2%) and lean body mass (+8.7%) after basic training; however, no significant fat mass decrease was evident in the leg region. Regional rather than whole body composition changes need to be considered when assessing the effects of a training programme.

Secular trends in skeletal maturity in South Africa: 1962-2001

BACKGROUND

Secular trends are usually monitored through changes in size and earlier maturation. Skeletal maturity has rarely been used as a biological indicator of secular trend.

AIM

To observe secular changes in the skeletal maturity of urban South African adolescents between 1962 and 2001.

SUBJECTS AND METHODS

Data from the Pretoria National Nutrition Survey were compared with a cross-sectional survey of children from the Johannesburg-Soweto based Birth to Twenty birth cohort study. Adolescents aged 9-11 years from each survey were included in the analysis. Skeletal maturity was assessed using the Greulich-Pyle technique. Height, weight, triceps and subscapular skinfolds were also measured.

RESULTS

The skeletal maturity of white males and females in 2001 was in advance of the 1962 cohort by an average of 3.4 months and 2.0 months, respectively. Black males and females in 2001 were significantly in advance of the 1962 cohort by an average of 9.7 months and 15.8 months, respectively (p<0.01).

CONCLUSION

Significant secular increases in the skeletal maturity of urban black South African children occurred between 1962 and 2001. Non-significant increases were seen in white children. The significant secular increases were concordant with increases in stature and adiposity during this period. The increase in skeletal maturity may reflect the removal of growth constraint, particularly in black children.

Obesity and regional fat distribution in Kenyan populations: impact of ethnicity and urbanization

BACKGROUND

Obesity is increasing rapidly in Africa, and may not be associated with the same changes in body composition among different ethnic groups in Africa.

OBJECTIVE

To assess abdominal visceral and subcutaneous fat thickness, prevalence of obesity, and differences in body composition in rural and urban Kenya.

SUBJECTS AND METHODS

In a cross-sectional study carried out among Luo, Kamba and Maasai in rural and urban Kenya, abdominal visceral and subcutaneous fat thicknesses were measured by ultrasonography. Height and weight, waist, mid-upper arm circumferences, and triceps skinfold thickness were measured. Body mass index (BMI), arm fat area (AFA) and arm muscle area (AMA) were calculated.

RESULTS

Among 1430 individuals (58.3% females) aged 17-68 years, abdominal visceral and subcutaneous fat, BMI, AFA and waist circumference (WC) increased with age, and were highest in the Maasai and in the urban population. AMA was only higher with increasing age among males. The prevalence of overweight (BMI > or = 25) (39.8% vs. 15.8%) and obesity (BMI > or = 30) (15.5% vs. 5.1%) was highest in the urban vs. rural population.

CONCLUSION

Abdominal visceral and subcutaneous fat thickness was higher with urban residency. A high prevalence of overweight and obesity was found. The Maasai had the highest overall fat accumulation.

Prevalence and time trends in obesity among adult West African populations: a meta-analysis

The objective of this study was to determine the distribution of and trends in obesity in adult West African populations. Between February and March 2007, a comprehensive literature search was conducted using four electronic databases. Journal hand searches, citations and bibliographic snowballing of relevant articles were also undertaken. To be included, studies had to be population-based, use well-defined criteria for measuring obesity, present data that allowed calculation of the prevalence of obesity and sample adult participants. Studies retrieved were critically appraised. Meta-analysis was performed using the DerSimonian-Laird random effect model. Twenty-eight studies were included. Thirteen studies were conducted in urban settings, 13 in mixed urban/rural and one in rural setting. Mean body mass index ranged from 20.1 to 27.0 kg(2). Prevalence of obesity in West Africa was estimated at 10.0% (95% CI, 6.0-15.0). Women were more likely to be obese than men, odds ratios 3.16 (95% CI, 2.51-3.98) and 4.79 (95% CI, 3.30-6.95) in urban and rural areas respectively. Urban residents were more likely to be obese than rural residents, odds ratio 2.70 (95% CI, 1.76-4.15). Time trend analyses indicated that prevalence of obesity in urban West Africa more than doubled (114%) over 15 years, accounted for almost entirely in women. Urban residents and women have particularly high risk of overweight/obesity and obesity is rising fast in women. Policymakers, politicians and health promotion experts must urgently help communities control the spread of obesity in West Africa.

Should obesity be blamed for the high prevalence rates of hypertension in black South African women?

Hypertension is highly prevalent in South Africa, resulting in high stroke mortality rates. Since obesity is very common among South African women, it is likely that obesity contributes to the hypertension prevalence. The aims were to determine whether black African women have higher blood pressures (BPs) than Caucasian women, and whether obesity is related to their cardiovascular risk. African (N=102) and Caucasian (N=115) women, matched for age and body mass index, were included. Correlations between obesity (total body fat, abdominal obesity and peripheral fat) and cardiovascular risk markers (haemodynamic parameters, lipids, inflammatory markers, prothrombotic factors, adipokines, HOMA-IR (homoeostasis model assessment insulin resistance)) were compared between the ethnic groups (adjusted for age, smoking, alcohol and physical activity). Comparisons between low- and high-BP groups were also made for each ethnic group. Results showed that African women had higher BP (P<0.01) with increased peripheral vascular resistance. Surprisingly, African women showed significantly weaker correlations between obesity measures and cardiovascular risk markers when compared to Caucasian women (specifically systolic BP, arterial resistance, cardiac output, fibrinogen, plasminogen activator inhibitor-1, leptin and resistin). Interestingly, the latter risk markers were also not significantly different between low- and high-BP African groups. African women, however, presented significant correlations of obesity with triglycerides, C-reactive protein and HOMA that were comparable to the Caucasian women. Although urban African women have higher BP than Caucasians, their obesity levels are weakly related to traditional cardiovascular risk factors compared to Caucasian women. The results, however, suggest a link with the development of insulin resistance.

A time bomb of cardiovascular risk factors in South Africa: results from the Heart of Soweto Study "Heart Awareness Days"

BACKGROUND

There is strong anecdotal evidence that many urban communities in Sub-Saharan Africa are in epidemiologic transition with the subsequent emergence of more affluent causes of heart disease. However, data to describe the risk factor profile of affected communities is limited.

METHODS

During 9 community screening days undertaken in the predominantly Black African community of Soweto, South Africa (population 1 to 1.5 million) in 2006-2007, we examined the cardiovascular risk factor profile of volunteers. Screening comprised a combination of self-reported history and a clinical assessment that included calculation of body mass index (BMI), blood pressure and random blood glucose and total cholesterol levels.

RESULTS

In total, we screened a total of 1691 subjects (representing almost 0.2% of the total population). The majority (99%) were Black African, there were more women (65%) than men and the mean age was 46+/-14 years. Overall, 78% of subjects were found to have >or=1 major risk factor for heart disease. By far the most prevalent risk factor overall was obesity (43%) with significantly more obese women than men (23% versus 55%: OR 1.76 95% CI 1.62 to 1.91: p<0.001). A further 33% of subjects had high blood pressures (systolic or diastolic) and 13% an elevated (non-fasting) total blood cholesterol level: no statistically significant differences between the sexes were found. There was a positive correlation between increasing BMI and other risk factors including elevated systolic (r(2)=0.046, p<0.001) and diastolic blood pressure (r(2)=0.032, p<0.001) with overweight subjects three times more likely to have concurrent hypercholesterolemia (OR 3.3, 95% CI 2.1 to 5.3: p<0.01).

CONCLUSIONS

These unique pilot data strongly suggest a high prevalence of related risk factors for heart disease in this urban black African population in epidemiologic transition. Further research is needed to confirm our findings and to determine their true causes and potential consequences.