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

Prevalence and associated factors of overweight and obesity among persons with type 2 diabetes in Africa: a systematic review and meta-analysis

BACKGROUND

Type 2 diabetes and obesity are serious public health concerns globally and a growing burden in Africa. Both conditions have serious repercussions on health when they co-occur, yet the extent of their co-occurrence in Africa remains unknown. Therefore, this review aimed to identify the prevalence and associated factors of overweight and obesity among persons with type 2 diabetes in Africa.

METHOD

A systematic search was conducted on PubMed, MEDLINE, Embase, African Index Medicus (AIM), and African Journals Online (AJOL) for observational studies that reported the prevalence of overweight and/or obesity among type 2 diabetes patients in Africa. The prevalence data from individual studies were aggregated through a random-effects meta-analysis. The I² statistic was used to evaluate between-studies heterogeneity, while subgroup analysis and mixed-effects meta-regression were performed to identify sources of heterogeneity. We assessed publication bias using funnel plots and Egger's test. This review adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines.

RESULTS

Of 1753 records retrieved, 80 articles were eligible for this review, with 74 cross-sectional studies included in the meta-analysis. The pooled prevalence of overweight and obesity was 35.6% and 25.6% respectively, while the overall prevalence of both overweight and obesity was 61.4%. Also, the pooled prevalence of both overweight and obesity across the five geographical areas in Africa ranged from 56.9% in East Africa to 88.5% in Southern Africa. Nineteen factors were significantly associated with overweight and obesity among patients with type 2 diabetes.

CONCLUSION

The high prevalence of overweight and obesity among patients with type 2 diabetes is a significant public health concern that transcends geographical boundaries within Africa. The findings from this review highlight the need for innovative weight management interventions that are tailored to the cultural context of the African setting.KEY MESSAGESThere was a high prevalence of overweight and obesity among the type 2 diabetes patients.Nineteen factors were identified to be significantly associated with overweight and obesity among type 2 diabetes patients.Only 12 out of the 80 included studies primarily focused on the prevalence of overweight and/or obesity which reflects a dearth of interest in this topic.

Prevalence of the metabolic syndrome in African populations: A systematic review and meta-analysis

BACKGROUND

The metabolic syndrome (MS) is a leading cause of death worldwide. Several studies have found MS to be prevalent in various African regions. However, no specific estimates of MS prevalence in African populations exist. The aim of this study was to estimate the overall prevalence of MS in the African populations.

METHODS

A systematic review was conducted in PubMed, Web of Science, Africa Index Medicus, and African Journal Online Scopus to find studies published up to the 15th of August 2022. Pooled prevalence was calculated based on six diagnostic methods. The pooled prevalence of MS was estimated using a random-effects model. Our risk of bias analysis was based on the Hoy et al. tool. A Heterogeneity (I2) assessment was performed, as well as an Egger test for publication bias. PROSPERO number CRD42021275176 was assigned to this study.

RESULTS

In total, 297 studies corresponding to 345 prevalence data from 29 African countries and involving 156 464 participants were included. The overall prevalence of MS in Africa was 32.4% (95% CI: 30.2-34.7) with significant heterogeneity (I2 = 98.9%; P<0.001). We obtained prevalence rates of 44.8% (95% CI: 24.8-65.7), 39.7% (95% CI: 31.7-48.1), 33.1% (95% CI: 28.5-37.8), 31.6% (95% CI: 27.8-35.6) and 29.3% (95% CI: 25.7-33) using the WHO, revised NCEP-ATP III, JIS, NCEP/ATP III and IDF definition criteria, respectively. The prevalence of MS was significantly higher in adults >18 years with 33.1% (95%CI: 30.8-35.5) compared to children <18 years with 13.3% (95%CI: 7.3-20.6) (P<0.001). MS prevalence was significantly higher in females with 36.9% (95%CI: 33.2-40.7) compared to males with 26.7% (95%CI: 23.1-30.5) (P<0.001). The prevalence of MS was highest among Type 2 diabetes patients with 66.9% (95%CI: 60.3-73.1), followed by patients with coronary artery disease with 55.2% (95%CI: 50.8-59.6) and cardiovascular diseases with 48.3% (95%CI: 33.5-63.3) (P<0.001). With 33.6% (95% CI: 28.3-39.1), the southern African region was the most affected, followed by upper-middle income economies with 35% (95% CI: 29.5-40.6).

CONCLUSION

This study, regardless of the definition used, reveals a high prevalence of MS in Africa, confirming the ongoing epidemiological transition in African countries. Early prevention and treatment strategies are urgently needed to reverse this trend.

Enhanced Predictive Value of Lipid Accumulation Product for Identifying Metabolic Syndrome in the General Population of China

The purpose of this research was to evaluate the lipid accumulation product (LAP)'s accuracy and predictive value for identifying metabolic syndrome (MS) in the general Chinese population compared with other obesity indicators. Baseline survey information from a population-based cohort study carried out in Shanghai's Songjiang District was used in this research. Odds ratios (OR) and a 95% confidence interval (CI) were obtained by logistic regression. The ability of each variable to detect MS was assessed using the receiver operating characteristic curve (ROC). The optimum cut-off point for each indicator was selected using Youden's index. The survey involved 35,446 participants in total. In both genders, the prevalence of MS rose as the LAP increased (p < 0.001). The LAP's AUC was 0.901 (95%CI: 0.895-0.906) in males and 0.898 (95%CI: 0.893-0.902) in females, making it substantially more predictive of MS than other variables (BMI, WC, WHR, WHtR). The optimal cutoff point of the LAP for men and women was 36.04 (Se: 81.91%, Sp: 81.06%) and 34.95 (Se: 80.93%, Sp: 83.04%). The Youden index of the LAP was 0.64 for both sexes. Our findings imply that the LAP, compared to other obesity markers in China, is a more accurate predictor of MS.

Gallbladder disease is associated with the risk of cardiovascular disease among Uyghurs in Xinjiang: a prospective cohort study

BACKGROUND

Gallbladder disease (GBD) can increase the risk of cardiovascular disease (CVD). However, GBD has rarely been reported in the less developed, rural areas of Xinjiang. This study aimed to determine the prevalence of GBD and incidence of CVD in a prospective cohort study in rural Xinjiang. Moreover, the study aimed to explore the association between GBD and CVD within this cohort.

METHODS

The study cohort included 11,444 Uyghur adults in Xinjiang, 3^rd division, from the 51st Mission. Study groups were classified according to whether GBD was present or absent at baseline. The occurrence of CVD was the end event. Demographic, anthropometric, and biochemical data were recorded, and the incidence of CVD in the GBD and non-GBD groups analysed. Cox proportional hazards regression models were used to assess the association between GBD and CVD and factors associated with their incidence. Several subgroup analyses were performed to assess CVD incidence in different subgroups. The interaction between GBD and cardiometabolic risk factors, and subsequent risk of developing CVD, was evaluated.

RESULTS

Prevalence of GBD in the study cohort was 10.29%. After a median follow-up of 4.92 years, the cumulative incidence of CVD in the study cohort was 10.49%, 8.43% in males and 12.65% in females. CVD incidence was higher in the GBD group (34.04% vs. 7.78%, HR = 4.96, 95% CI: 4.40-5.59). After multivariate adjustment, the risk of CVD remained higher in the GBD group (HR = 2.89, 95% CI: 2.54-3.29). Subgroup analyses showed male sex, smoking, alcohol consumption, lack of exercise, and abnormal renal function were all associated with increased risk of CVD. Moreover, the risk of CVD was markedly higher in GBD combined with cardiometabolic risk factors (hypertension, T2DM, dyslipidaemia, overweight, and abdominal obesity), than in cardiometabolic risk factors alone and this was higher in the GBD group than in the non-GBD group regardless of whether cardiometabolic risk factors were combined.

CONCLUSION

GBD is an important independent risk factor for CVD development. Awareness of these associations will raise concerns among clinicians about the risk of cardiovascular disease in patients with GBD.

The cardiometabolic profile and related dietary intake of Ugandans living with HIV and AIDS

Introduction

Suboptimal diet and physical inactivity downgrade the putative benefits of Antiretroviral Therapy (ART) among People Living with HIV (PLWH). However, there is paucity of literature on dietary intake and cardiometabolic profiles of PLWH in Uganda.

Methods

A cross-sectional study among PLWH in Uganda was conducted. Dietary intake was assessed using a 24h recall method of 2 non-consecutive days. The short International Physical Activity Questionnaire assessed participants' physical activity. Fasted blood samples were analyzed for Fasting Blood Glucose (FBG), total cholesterol, LDL-c, HDL-c and triglycerides. Blood pressure and anthropometric measurements were performed following step 2 of the WHO STEPS.

Results

253 patients completed in this study. A high prevalence of low HDL-c (31.9%), abdominal obesity (44.5%), high BMI (51.6%), raised FBG (45.3%), high SBP (31.5%), elevated triglycerides (26.4%) and metabolic syndrome (28%) was found. More women were identified with metabolic syndrome (31.5%) than men (19.2%). Low prevalence of high LDL-c (4.7%) and total cholesterol (9.8%) was found. Diets had a high carbohydrate (65.8 ± 10.4) E% and fiber intake (30.1 ± 12.7) g with minimal PUFA (6.1 ± 2.3) E%, fruits and vegetables (1.4 servings). High proportions were found of unmet intake for vitamin A (38.2%), B₁(48.8%), B₂ (29.6%), B₁₂ (29%), folate (61.4%), Ca (76%), Zn (53.1%) and Mg (41.7%). Mean MET min was 6,700 ± 5,509 and over 68% of the participants had >3,000 MET min.

Conclusion

Our findings reveal a high prevalence of metabolic disturbances among PLWH in Uganda and further highlight that their diets are suboptimal with low fruits and vegetable intake

Metabolic Dysfunction-Associated Fatty Liver Disease Is Associated with the Risk of Incident Cardiovascular Disease: A Prospective Cohort Study in Xinjiang

In 2020, a group of international experts proposed a new term ‘metabolic dysfunction-associated fatty liver disease’ (MAFLD) to replace ‘non-alcoholic fatty liver disease’. This study aimed to describe the epidemic characteristics of MAFLD, incidence of cardiovascular disease (CVD), and relationship between MAFLD and incident CVD. In 2016, 12,794 Uyghur adults from Kashgar, Xinjiang, were grouped according to the presence or absence of MAFLD. The primary outcome was the occurrence of CVD events. Fatty liver was diagnosed using ultrasound. The prevalence of MAFLD was 16.55%. After excluding patients with previous CVD, 11,444 participants were followed up for a median period of 4.7 years. During the follow-up period, the overall CVD incidence was 10.40% (1190/11,444). The incidence of CVD in the patients with MAFLD was significantly higher than that in the non-MAFLD patients (18.38% vs. 9.02%, p < 0.001; multivariable-adjusted hazard ratio = 1.37, 95% CI = 1.20−1.56). The prevalence of MAFLD was relatively low, whereas the incidence of CVD was relatively high among the Uyghur adults in rural Xinjiang. Individuals with MAFLD have a higher risk of developing CVD independent of traditional cardiovascular risk factors, obesity, type 2 diabetes mellitus (T2DM), and dyslipidaemia.

Metabolic Syndrome During Pregnancy: Prevalence and Determinants Among Pregnant Women Followed-Up at the Dschang District Hospital, West Region of Cameroon

PURPOSE

Metabolic syndrome (MS) during pregnancy constitutes a serious threat to the mother and child health that will shortly become a major public health issue, especially in developing countries. However, in Cameroon, epidemiological data on MS during pregnancy are still scarce. The aim of this study was to determine the prevalence and determinants of MS among pregnant women followed-up at the Dschang District Hospital (DDH), in the west region of Cameroon.

PATIENTS AND METHODS

This study was a hospital based cross-sectional study, carried out among pregnant women followed-up at the antenatal care unit of the DDH, from September 2019 to June 2020. Participants were assessed on sociodemographic, lifestyle parameters, and dietary habits using standardized and structured questionnaires. Anthropometric parameters, blood pressure, and biochemical markers were measured using standard procedures. Metabolic syndrome was diagnosed using the HNLBI/AHA definition, modified for pregnant women by Chatzi et al. A participant was recorded as having MS if presenting at least three of the following criteria: Pre-gestational BMI >30 kg/m2; triglycerides ≥150 mg/dl; HDL cholesterol <50 mg/dl; SBP ≥130/DBP ≥85 mm/Hg; and fasting blood glucose ≥100 mg/dl.

RESULTS

Six hundred and four (604) pregnant women were included in the study. The prevalence of MS was 17.88% (95% CI: 15.03-21.14) and its most frequent individual components were low levels of HDL-cholesterol (66.23% (95% CI: 62.36-69.88)) and hypertriglyceridemia (28% (95% CI: 54.31-62.15)). Grand multiparous shows a higher risk of presenting MS (OR:3.06, 95% CI: 1.24-7.12; p = 0.011) compared to nulliparous. Pregestational BMI appears to be the best predictor of MS during pregnancy even after adjustment on age, parity, lifestyle and dietary habits (OR: 46.46, 95% CI: 15.58-138.49; p ˂ 0.0001).

CONCLUSION

The prevalence of MS on pregnant women in the Dschang health district is 17.88% (95% CI: 15.03-21.14) and its major determinant is pre-gestational obesity. This work provides quality preliminary data for the design and improvement of prevention strategies.

Sex/Gender Differences in Obesity Prevalence, Comorbidities, and Treatment

PURPOSE OF REVIEW

Obesity is a heterogeneous condition, yet sex/gender is rarely considered in the prevention or clinical care of this disease. This review examined and evaluated recent literature regarding the influence of sex and gender on obesity prevalence, comorbidities, and treatment in adults.

RECENT FINDINGS

Obesity is more prevalent in women than men in most countries, but in some countries and population subgroups, this gap is more pronounced. Several obesity-related comorbidities, including type 2 diabetes and hypertension, demonstrate sex-specific pathways. Women, compared to men, are more likely to be diagnosed with obesity and seek and obtain all types of obesity treatment including behavioral, pharmacological, and bariatric surgery. Men tend to have greater absolute weight loss, but this difference is attenuated once accounting for baseline weight. Obesity is a multifactorial condition with complex interactions among sex/gender, sociocultural, environmental, and physiological factors. More sex/gender research is needed to investigate mechanisms underlying sex/gender differences in prevalence, comorbidities, and treatment, identify ways to increase men's interest and participation in obesity treatment, and examine differences in obesity prevalence and treatments for transgender and gender non-conforming individuals.

Metabolically healthy obesity and unhealthy normal weight rural adults in Xinjiang: prevalence and the associated factors

BACKGROUND

This study aimed to describe the prevalence of metabolically healthy obesity (MHO) and metabolically unhealthy normal weight (MUNW) rural adults in Xinjiang and to explore their influencing factors.

METHODS

We selected 13,525 Uyghur, Kazakh and Han participants in Kashi, Yili and Shihezi areas in Xinjiang from 2009 to 2010. Weight status was classified according to body mass index. Metabolic phenotype was further defined based on the National Cholesterol Education Program Adult Treatment Panel III criteria.

RESULTS

The prevalence of normal weight, overweight, and obesity were 51.6, 30.2, and 14.4%, respectively. The mean age of the population was 45.04 years. The prevalence of MHO was 5.5% overall and was 38.5% among obese participants. The prevalence of MUNW was 15.5% overall and was 30.1% among normal weight participants. A metabolically healthy phenotype among obese individuals was positively associated with females and vegetable consumption ≥4 plates per week. However, this was inversely associated with higher age, red meat consumption ≥2 kg per week, and larger waist circumference (WC). Conversely, a metabolically unhealthy phenotype among normal-weight individuals was positively associated with higher age, red meat consumption ≥2 kg per week, and larger WC; this was however inversely associated with vegetable consumption ≥4 plates per week.

CONCLUSIONS

The prevalence of MHO among obese adults in Xinjiang is higher than that of Han adults, while the prevalence of MUNW among normal weight adults is lower than that among Han adults. In obese and normal weight participants, higher age, more red meat consumption, and larger WC increase the risk of metabolic abnormality, and more vegetable consumption reduces the risk of metabolic abnormality.

Prevalence of metabolic syndrome and its associated risk factors among staffs in a Malaysian public university

Public health systems are concerned with the commensurate rise of metabolic syndrome (MetS) incidence across populations worldwide, due to its tendency to amplify greater risk of diabetes and cardiovascular diseases within communities. This study aimed to determine the prevalence of MetS and its associated risk factors among staffs in a Malaysian public university. A cross-sectional study was conducted among 538 staffs from the Universiti Kebangsaan Malaysia (UKM) between April and June 2019. MetS was defined according to JIS "Harmonized" criteria. A questionnaire that consisted of items on socio-demographics, lifestyle risk behaviors and personal medical history information was administered to participants. Subsequently, a series of physical examination and biochemical assessment was conducted at the hall or foyer of selected faculties in the university. Descriptive and inferential statistics were conducted using SPSS version 22.0. Multivariate models were yielded to determine the risk factors associated with MetS. Statistical significance was set at P < 0.05. The overall prevalence of MetS was 20.6%, with men having greater prevalence than women (24.9% vs. 18.3%). Prevalence of MetS increased with age. Factors contributed to MetS in the overall sample were BMI, hypertension, diabetes and physical activity of moderate intensity. Diabetes and hypertension were significantly associated with MetS in men, whereas BMI, diabetes and hyperlipidemia were significantly associated with MetS in women. Lifestyle behaviors and cardio-metabolic risk factors were associated with MetS for the overall sample, and across genders.

Comparison of anthropometric indices for predicting the risk of metabolic syndrome in older adults

Background. The prevalence of obesity and metabolic syndrome (MetS) is increasing, worldwide. Using a simple, efficient and reliable tool for predicting MetS is an essential approach in preventive health programs. The aim of this study was to compare the different anthropometric indices in predicting metabolic syndrome in older adults.Methods. This cross-sectional study is a part of the Amirkola Health and Ageing cohort Project (2011-2016). Of total, 1,488 older people aged 60-92 years were entered to the study. Medical and personal information of participants were collected by a questionnaire. After measuring the height, weight, waist circumference, hip circumference and neck circumference, body mass index, waist to hip ratio, waist to height ratio, abdominal volume index and conicity index were calculated. Independent t-test, chi-square and ROC curve were used to analyze the data.Results. Based on ATPIII-2005 diagnostic criteria, the prevalence of metabolic syndrome was 71.57%.The prevalence in female was higher than male. All of examined anthropometric indices, except neck circumference (p = 0.10), showed a significant difference in people with MetS compared to the individuals without metabolic syndrome (p<0.001). Waist to height ratio showed the largest area under the curve for predicting MetS (0.786; 95% CI: 0.76-0.81) followed by BMI (0.746; 95% CI: 0.71-0.77), AVI (0.745; 95% CI: 0.71-0.77), and waist circumference (0.743; 95% CI: 0.71-0.77).Conclusion. Waist to height ratio was the best predictor of MetS in older adults.

Metabolic Syndrome Among Working Adults in Eastern Ethiopia

PURPOSE

Metabolic syndrome (MetS) has become a public health challenge in low-income countries due to changing lifestyle and the food environment. However, studies on the prevalence of metabolic syndrome and associated factors are limited in Ethiopia. Therefore, this study assessed the prevalence of MetS and its associated factors among working adults in eastern Ethiopia.

METHODS

A cross-sectional study was conducted involving 1,164 working adults from December 2018 to February 2019. Data were collected following the World Health Organization (WHO) STEPwise approach. The data collection tools include a structured questionnaire, anthropometric, and biochemical measurements. Prevalence was calculated using International Diabetes Federation criteria. A Poisson regression model with robust variance estimation was used to investigate the independent variable's association with MetS. An adjusted prevalence ratio with 95% confidence interval was reported to show associations.

RESULTS

The prevalence of MetS was 20.1% (95% CI=17.8-22.4) among the participants. It was more prevalent among females (APR:=1.62, 95% CI=1.31-2.00), those of 35-44 years of age (APR:=3.14, 95% CI=1.19-8.28), 45-54 years of age (APR=4.42, 95% CI=1.66-11.77), and 55-64 years of age (APR=6.03, 95% CI=2.27-16.06), khat chewers (APR=1.30, 95% CI=1.06-1.60), those with 8 or more hours of sedentary behavior (APR=2.29, 95% CI=1.88-2.80), and those consuming alcohol 5-6 days per week (APR=1.81, 95% CI=1.20-2.74). The prevalence was significantly lower in those eating five or more fruits and vegetables servings per day (APR=0.04, 95% CI=0.01-0.27).

CONCLUSION

A high prevalence of MetS was observed among working adults in eastern Ethiopia. Strengthening workplace health promotion programs is necessary to reduce the negative consequences of MetS in workplaces and protect productivity.