Overweight and obesity in non-pregnant women of childbearing age in South Africa: subgroup regression analyses of survey data from 1998 to 2017

Overweight and obesity trends and associated factors among reproductive women in Ethiopia

BACKGROUND

In low- and middle-income countries, the double burden of malnutrition is prevalent. Many countries in Africa are currently confronted with overweight and obesity, particularly among women, coupled with an increase in the prevalence of non-communicable diseases.

OBJECTIVE

This study examines trends in overweight and obesity among Ethiopian women of reproductive age from 2005 to 2016, and identifies associated factors.

METHODS

We used three consecutive datasets from 2005 (n = 14070), 2011 (n = 16515), and 2016 (n = 15683) demographic health survey years. Multilevel logistic regression was used to identify the determinant factors among individual- and cluster-level variables.

RESULTS

The prevalence of overweight and obesity among reproductive women in Ethiopia increased steadily from 6.09% in 2005 to 8.54% in 2011, and 10.16% in 2016. However, mixed patterns were observed among the regions of the country. We found that age, education, living in urban areas, and living in a rich community are associated with becoming overweight and obese. For instance, the odds of becoming overweight and obese among women aged 35-49 were higher than those among women aged 15-24 (odds ratio [OR] = 3.62, 95% Confidence Interval [CI]:2.64-4.97). Women who completed secondary school have higher odds than those without formal education (OR = 1.64, 95% CI:1.19-2.26).

CONCLUSION

To our knowledge, this is the first study to investigate trends in the nationwide prevalence of overweight and obesity and the associated factors among Ethiopian women. This study warrants further follow-up research to identify the pathways between overweight and obesity and their probable factors.

Kisspeptin signalling and its correlation with placental ultrastructure and clinical outcomes in pregnant South African women with obesity and gestational diabetes

INTRODUCTION

Gestational diabetes mellitus (GDM) is a major pregnancy metabolic disorder and is strongly linked with obesity. Kisspeptin is a hormone that increases several thousand-fold in the maternal circulation during human pregnancy, with placenta as its main source. Studies have suggested that kisspeptin regulates trophoblast invasion and promotes pancreatic insulin secretion and peripheral insulin sensitivity.

METHODS

In a well-characterized cohort of pregnant South African women and molecular and histological techniques, this study explored the impact and interaction of maternal obesity and GDM on kisspeptin (KISS1) signalling in relation to placental morphology and maternal and neonatal parameters.

RESULTS

We found that GDM had no effect on placental KISS1 and KISS1R (KISS1 receptor) mRNA and/or protein expression. However, obesity reduced placental KISS1R mRNA expression even though overall KISS1 protein abundance or localization was not different from the non-obese group. Maternal and cord circulating KISS1 concentrations did not vary with obesity or GDM, but maternal circulating KISS1 was positively correlated with placenta weight in non-GDM obese women, and negatively correlated with placental intervillous space volume in non-GDM non-obese women. Cord serum KISS1 was positively correlated with infant weight in GDM obese women, but negatively correlated with maternal BMI in the non-obese GDM group. Placental syncytiotrophoblast extracellular vesicles exhibited detectable KISS1 and its abundance was ∼50 % lower in those from obese GDM compared to non-GDM women.

DISCUSSION

This study shows maternal obesity and GDM can modulate placental kisspeptin signalling and placental morphological development with potential pathophysiological implications for clinically-relevant pregnancy and perinatal outcomes.

Maternal weight and its association with risk of overweight in offspring: a trajectory analysis from a birth cohort in China

BACKGROUND

Most studies on the association of maternal pregnancy weight with offspring weight trajectory have a short follow-up time. This study aimed to explore the associations of maternal prepregnancy body mass index (BMI) and gestational weight gain (GWG) with childhood weight trajectories in a 7-year birth cohort.

METHODS

A total of 946 mother-child pairs (467 boys and 479 girls) from a longitudinal birth cohort in Tianjin City, China, were included in this study, ranging from pregnancy to offspring at 7 years. The outcome variable was defined as overweight or not overweight in offspring at the last round. A group-based trajectory model was applied to identify childhood BMI trajectory groups.

RESULTS

Five discrete BMI trajectory groups were identified and characterized as constant underweight (25.2%), constant normal weight (42.8%), and high or increasing trajectory [at risk of overweight (16.9%), progressive overweight (11.0%) and progressive obesity (4.1%)]. Maternal prepregnancy overweight was associated with 1.72 (95% CI 1.14-2.60, P = 0.01) to 4.02 (95% CI 1.94-8.36, P < 0.001) times the risk of all high or increasing trajectory groups, and excessive GWG was related to groups at risk of overweight [relative risk ratio (RRR) 2.09, 95% CI 1.27-3.46, P = 0.004] and progressive obesity (RRR 3.33, 95% CI 1.13-9.79, P = 0.029). Children in all high or increasing trajectory groups were associated with greater overweight risk at the last round [risk ratios (RRs) ranged from 3.54 (95% CI 2.53-4.95, P < 0.001) to 6.18 (95% CI 4.05-9.42, P < 0.001)].

CONCLUSION

Maternal prepregnancy overweight and excessive gestational weight gain were associated with increasing or high-level childhood body mass index trajectories as well as a greater risk of overweight at 7 years.

Dietary determinants of overnutrition among hypertensive patients in southwest Ethiopia: an ordinal regression model

Overnutrition is a recognized risk factor for hypertension, but evidence is lacking among hypertensive patients for tailored dietary interventions. This study assessed dietary factors in 331 hypertensive patients in southwest Ethiopia. The data was collected through a questionnaire and analyzed using factor analysis. Body mass index (BMI) was calculated, and a BMI above 25 kg m-2 was considered overnutrition. An ordinal logistic regression model was used to model the data and control confounders. Adjusted odds ratio and p-values were reported. Among the 331 respondents, consumption of cereals and grains (57.0%); roots and tubers (58.5); and legumes (50.0%), while 28.6% drink alcohol, was common. About 29.0% (24.1-34.2) had overnutrition (22%, 17.6-26.6%, overweight and 7.0%, 4.5-10.3%, obesity). While the predicted odds of overnutrition were higher among males (AOR = 2.85; 1.35-6.02), married (AOR = 1.47; 0.69-3.12), illiterates (AOR = 2.09; 1.18-3.72), advanced age (AOR = 1.65; 0.61-4.61), government employees (AOR = 6.83; 1.19-39.2), and urban dwellers (AOR = 4.06; 1.76-9.36), infrequent vegetable consumption (AOR = 1.47; 0.72-2.96) and lower and higher terciles of cereals and animal-source food consumption (AOR = 1.56; 0.72-3.34). Overnutrition among hypertensive patients was significantly high and associated with unhealthy dietary consumption, educational status, residence, and occupation, emphasizing the need for targeted dietary counseling.

Pregnancy and diabetic ketoacidosis: fetal jeopardy and windows of opportunity

Background

Diabetic ketoacidosis (DKA) during pregnancy poses significant risks to both the mother and fetus, with an increased risk of fetal demise. Although more prevalent in women with Type I diabetes (T1D); those with Type 2 diabetes (T2D) and gestational diabetes mellitus (GDM) can also develop DKA. A lack of information about DKA during pregnancy exists worldwide, including in South Africa.

Objective

This study examined the characteristics and outcomes associated with DKA during pregnancy.

Methods

The study took place between 1 April 2020 and 1 October 2022. Pregnant women with DKA, admitted to Tygerberg Hospital's Obstetric Critical Care Unit (OCCU) were included. Maternal characteristics, precipitants of DKA, adverse events during treatment, and maternal-fetal outcomes were examined.

Results

There were 54 episodes of DKA among 47 women. Most DKA's were mild and occurred in the third trimester. Pregestational diabetes dominated (31/47; 60%), with 47% having T1D and 94% requiring insulin. Seven women (7/47, 15%; T2D:6, T1D:1) had two episodes of DKA during the same pregnancy. Most women (32/47; 68%) were either overweight or obese. Yet, despite the T2D phenotype, biomarkers indicated that auto-immune diabetes was prevalent among women without any prior history of T1D (6/21; 29%). Twelve women (26%) developed gestational hypertension during pregnancy, and 17 (36%) pre-eclampsia. Precipitating causes of DKA included infection (14/54; 26%), insulin disruption (14/54; 26%) and betamethasone administration (10/54; 19%). More than half of the episodes of DKA involved hypokalemia (35/54, 65%) that was associated with fetal death (P=0.042) and hypoglycemia (28/54, 52%). Preterm birth (<37 weeks' gestation) occurred in 85% of women. No maternal deaths were recorded. A high fetal mortality rate (13/47; 28%) that included 11 spontaneous intrauterine deaths and two medical terminations, was observed.

Conclusion

Women with DKA have a high risk of fetal mortality as well as undiagnosed auto-immune diabetes. There is a strong link between maternal hypokalemia and fetal loss, suggesting an opportunity to address management gaps in pregnant women with DKA.

Dietary pattern and other factors of breast cancer among women: a case control study in Northwest Ethiopia

INTRODUCTION

Breast cancer is presently the most commonly diagnosed cancer in women, and it stands as the leading cause of cancer-related deaths worldwide. Notably, breast cancer rates have seen a significant increase in sub-Saharan African countries, including Ethiopia. Several risk factors contribute to breast cancer, some of which can be modified, while others are inherent. Promoting a healthier diet is strongly encouraged as a preventive measure against breast cancer. However, it's noteworthy that no previous research has investigated the connection between dietary patterns and the risk of breast cancer among Ethiopian women. Therefore, the primary objective of the current study is to examine the relationship between dietary patterns, socioeconomic and behavior factors associated with breast cancer in Ethiopian women.

METHODS

A case-control study was conducted at an institution in Bahir Dar, Northwest Ethiopia, involving 260 women, comprising 86 cases and 174 controls. We administered a standardized and validated questionnaire to assess a range of sociodemographic, reproductive, clinical, lifestyle, and dietary characteristics through face-to-face interviews. To analyze the differences between the cases and controls, we employed the Chi-square test. Furthermore, we assessed the relationships between these variables using binary multivariate logistic regression. To measure the association between variables, we utilized odds ratios with 95% confidence intervals.

RESULTS

The results of the multivariate analysis indicated that participants in the younger age group had significantly lower odds of developing breast cancer (AOR = 0.05; 95% CI: 0.00-0.91) compared to those in the older age group. Additionally, women who breastfed their children for shorter durations were 3.66 times more likely to develop breast cancer (AOR = 3.66; 95% CI: 2.78-6.89) than those who breastfed for longer periods. Furthermore, women with sedentary lifestyles faced a significantly higher risk of breast cancer, with odds 10.53 times greater (AOR = 10.53; 95% CI: 5.21-21.36) than their counterparts who engaged in moderate or highly active lifestyles. Lastly, participants who had previously undergone chest therapy were 6.43 times more likely to develop breast cancer (AOR = 6.43; 95% CI: 3.20-13.90) compared to those who had not.

CONCLUSIONS

Breast cancer prevention interventions, including breastfeeding counseling and increased physical activity should be recognized as a central strategy for lowering breast cancer risk. Furthermore, healthcare providers should aim to minimize exposure to chest radiation therapy.

Influence of 8 Weeks of Tabata High-Intensity Interval Training and Nanocurcumin Supplementation on Inflammation and Cardiorespiratory Health among Overweight Elderly Women

Nanocurcumin (NaC) and high-intensity interval training (HIIT) play crucial role in weight and inflammation control. The purpose of the current study was to evaluate the separate and combined effects of 8 weeks of Tabata-HIIT and NaC supplementation on the NOD-like receptor family pyrin domain-containing 3 (NLRP3) inflammasome, long non-coding RNA myocardial infarction associated transcript (lncRNA MIAT) expression, body composition, and cardiorespiratory health in elderly overweight women. A total of 48 healthy overweight elderly women were randomly divided into four groups: NaC, Tabata-HIIT+Pla, Tabata-HIIT+NaC, and placebo. Participants underwent a Tabata HIIT program (2 days per week, at 80∼0% of maximal HR) and NaC supplementation (daily 80 mg in two 40 mg capsules) for 8 weeks. Blood sampling, cardiorespiratory hemodynamic responses, and body composition evaluations were obtained before and after treadmill stress testing at the baseline timepoint and following 8 weeks of intervention. The mRNA of lncRNA-MIAT and NLRP3 were measured by real-time polymerase chain reaction. After 8 weeks, a significant improvement was observed in body composition and cardiorespiratory hemodynamics in the Tabata-HIIT groups compared to the NaC alone and placebo groups (P<0.05). Tabata training, both with and without the addition of nano curcumin supplementation, did not result significant effect on the resting levels of lncRNA-MIAT expression (P>0.05). Nevertheless, NaC supplementation along with Tabata training led to a significant reduction in NLRP3 inflammasome. In addition, NaC supplementation in overweight/preobese women improved systemic inflammation during treadmill stress testing. These findings indicating the suppressive effects of non-pharmacologic interventions on the sympathetic system and downregulation of the inflammasome.

Risk factors for breast cancer among women in Ekurhuleni Metropolitan Municipality, Gauteng province of South Africa, 2017‒2020: a case-control study

Introduction

Breast cancer (BC) is the most common cancer among women in South Africa (SA), with an age-standardised incidence rate of 52.6 and an age-standardised mortality rate of 16.0 per 100,000 population. There is a paucity of evidence on the risk factors for BC among women of all races in SA. Given the rising prevalence of BC in SA, literature-based evidence is critical for the appropriate dissemination of preventative measures. This study aimed to identify the risk factors associated with the development of BC among women in Ekhuruleni Metropolitan Municipality.

Methods

An unmatched case-control study was conducted from 1 January 2017 to 31 December 2020 using secondary data extracted from the Ekurhuleni Population-Based Cancer Registry. Unconditional multivariable logistic regression analysis was carried out using the adjusted odds ratio (aOR). The variables race, employment, human immunodeficiency virus (HIV), smoking and alcohol status were included in the multivariable logistic regression model while the model was adjusted for age.

Results

A total of 2,217 cases and 851 controls were enrolled in the study. The mean age (±SD) in years was 55.7 (±15.2). The White population group, being self-employed and being HIV positive was significantly associated with reduced odds of BC development. HIV-positive women were 61% less likely to have BC than women who were HIV-negative (aOR 0.39; 95% confidence interval (CI): 0.27‒0.57). White women were 65% less likely to have BC than women of other races (aOR 0.35; 95% CI: 0.29‒0.43). Self-employed women were 59% less likely to have BC than women who were formally employed (aOR 0.41; 95% CI: 0.18‒0.97). No evidence of association was observed between tobacco smoking and BC as well as alcohol consumption and BC.

Conclusion

There was a 65% reduction in BC risk among White women compared to other races. HIV-positive women demonstrated a 61% lower likelihood of BC while self-employed women showed a 59% reduced risk of developing BC. These findings suggest that being White, self-employed or HIV-positive may provide some protection against BC. However, additional research is needed to validate these results and establish the underlying reasons behind these associations.

Early postpartum HbA1c after hyperglycemia first detected in pregnancy-Imperfect but not without value

BACKGROUND

South African women of childbearing age are disproportionally affected by obesity and at significant risk of Type 2 Diabetes Mellitus (T2DM). Unless pregnant, they do not readily undergo screening for T2DM. With a local focus on improved antenatal care, hyperglycemia is often first detected in pregnancy (HFDP). This may erroneously be attributed to Gestational Diabetes Mellitus (GDM) in all without considering T2DM. Glucose evaluation following pregnancy is essential for early detection and management of women with T2DM in whom persistent hyperglycemia is to be expected. Conventional testing with an oral glucose tolerance test (OGTT) is cumbersome, prompting investigation for alternate solutions.

AIM

To compare the diagnostic performance of HbA1c to the current gold standard OGTT in women with HFDP 4-12 weeks post-delivery.

METHODS

Glucose homeostasis was assessed with OGTT and HbA1c in 167 women with HFDP, 4-12 weeks after delivery. Glucose status was based on American Diabetes Association criteria.

RESULTS

Glucose homeostasis was assessed at 10 weeks (IQR 7-12) after delivery. Of the 167 participants, 52 (31%) had hyperglycemia, which was comprised of 34 (20%) prediabetes and 18 (11%) T2DM. Twelve women in the prediabetes subgroup had diagnostic fasting plasma glucose (FPG) and 2-hour plasma glucose (2hPG), but in two-thirds of the patients (22/34) only one time point proved diagnostic. The FPGs and the 2hPGs of six women with HbA1c-based T2DM were both within the prediabetes diagnostic range. According to the HbA1c measurements, 85% of 52 participants with gold standard OGTT defined hyperglycemia (prediabetes and T2DM) as well as 15 of 18 women with postpartum persistent T2DM were correctly classified. According to FPG, 15 women with persistent hyperglycemia would have been missed (11 with prediabetes and four with T2DM; 29%). When compared to an OGTT, a single HbA1c of 6.5% (48mmol/mol) postpartum demonstrated a sensitivity of 83% and specificity of 97% for the identification of T2DM.

CONCLUSION

HbA1c may improve access to postpartum testing in overburdened clinical settings where the required standards of OGTT cannot be guaranteed. HbA1c is a valuable test to detect women who will benefit most from early intervention but cannot unequivocally replace OGTT.

Population-based temporal trends and ethnic disparity in breast cancer mortality in South Africa (1999-2018): Joinpoint and age-period-cohort regression analyses

Globally, breast cancer is the leading cause of cancer deaths, accounting for 15.5% of female cancer deaths in 2020. Breast cancer is also the leading cause of female cancers in South Africa. The rapid epidemiological transition in South Africa may have an impact on the trends in breast cancer mortality in the country. We therefore evaluated the trends in the breast cancer mortality in SA over 20 years (1999-2020).

Methods

Joinpoint regression analyses of the trends in crude and age-standardized mortality rates (ASMR) of breast cancer among South African women were conducted from 1999 to 2018 using mortality data from Statistics South Africa. Age-period-cohort regression analysis was then conducted to evaluate the independent effect of age, period, and cohort on breast cancer mortality, and analysis was stratified by ethnicity.

Results

The mortality rate of breast cancer (from 9.82 to 13.27 per 100,000 women) increased at around 1.4% per annum (Average Annual Percent Change (AAPC): 1.4%, 95% CI:0.8-2.0, P-value< 0.001). Young women aged 30-49 years (1.1%-1.8%, P-value< 0.001) had increased breast cancer mortality. The risk of breast cancer mortality increased among successive birth cohorts from 1924 to 1928 but decreased among recent cohorts born from 1989 to 1993. In 2018, the breast cancer mortality rate among Blacks (9.49/100,000 women) was around half of the rates among the non-Blacks. (Coloreds: 18.11 per 100,000 women; Whites: 17.77/100,000 women; Indian/Asian: 13.24 per 100,000 women).

Conclusions

Contrary to the trends in high- and middle-income countries, breast cancer mortality increased in South Africa especially among young women. Breast cancer prevention programs should be intensified and should also target young women. The marked disparity in ethnic burden of breast cancer should be considered during planning and implementation of interventions.

Multimorbidity in South Africa: Is the health system ready?

Background: Multimorbidity is likely to be a significant contributor to ill health and inequality in South Africa and yet has been largely overlooked. Purpose: This paper focuses on the findings of a recent large study that highlighted emerging issues - namely (i) the high levels of multimorbidity among three key groups - older adults, women, and the wealthy; (ii) discordant and concordant disease clusters among the multimorbid. Research Design: Narrative. Study Sample and Data Collection: Not applicable. Results: We discuss the implications of each emerging issue for health systems policy and practice. Conclusion: Although key policies are identified, many of these policies are not implemented and are therefore not part of routine practice, leaving much space for improvement.

Effectiveness of Nurse-led Lifestyle Modification Intervention on Obesity Among Young Women in India

Background

Obesity management in young women necessitates interventions that include dietary modification and physical exercise. High-intensity lifestyle modification is effective in managing obesity in young women.

Objectives

The study determined the effectiveness of a nurse-led lifestyle modification intervention (NLLMI) on obesity among young women in India.

Methods

The study adopted a quasi-experimental pre- and post-interventional control group research design. The study was conducted among obese young women in the communities of Jabalpur, Madhya Pradesh, India. The participants were selected using convenient sampling technique. The sample included 150 women in the study group and 150 in the control group. The NLLMI comprising of exercises and dietary modifications were taught to the participants for 30 min three times a week for 24 weeks. Thereafter, they were encouraged to follow the diet and perform the exercises on their own for the next 12 weeks. Practice diary was maintained by the participants and they were encouraged to continue the intervention through the phone. The participants in the control group did not engage in the NLLMI until the post-test. However, they did receive the same NLLMI after the trial was over.

Results

There was a high statistically significant difference (p = 0.001) between the study group and the control group the after 12th and 24th weeks of NLLMI. The study group had a significant reduction in BMI after the intervention.

Conclusions

Young obese women may benefit from a NLLMI if they regularly follow the healthy eating habits and physical exercise.

Country-Level Variations in Overweight and Obesity among Reproductive-Aged Women in Sub-Saharan Countries

Background: Overweight and obesity in adults are on the rise around the world, contributing significantly to noncommunicable disease deaths and disability. Women bear a disproportionate burden of obesity when compared with men, which has a negative impact on their health and the health of their children. The objective of this study was to examine the country-level prevalence of overweight and obesity among women of reproductive age in sub-Saharan countries. Methods: A total of 504,264 women from 2006 to 2021 were examined using cross-sectional Demographic and Health Surveys data. The outcome variables for this study include: (a) women who are overweight according to body mass index (BMI) (25.0–29.9kg/m2); (b) women who are obese according to BMI (≥30.0 kg/m2). Results: Eswatini (28%), Mauritania (27%), South Africa (26%), Gabon, Lesotho and Ghana (25% each) had the highest prevalences of overweight. In addition, obesity prevalence was highest in South Africa (36%), Mauritania (27%), Eswatini (23%), Lesotho (20%), Gabon (19%) and Ghana (15%), respectively. Overweight and obesity were more prevalent among older women, those living in urban areas, women with secondary/higher education and those in the richest household wealth quintiles. Conclusion: The risk factors for overweight and obesity, as well as the role that lifestyle changes play in preventing obesity and the associated health risks, must be made more widely known. In order to identify those who are at risk of obesity, we also recommend that African countries regularly measure their citizens’ biometric characteristics.

Obesity and Neurocognitive Performance of Memory, Attention, and Executive Function

Background: Obesity has been linked to an increased risk of dementia in the future. Obesity is known to affect core neural structures, such as the hippocampus, and frontotemporal parts of the brain, and is linked to memory, attention, and executive function decline. The overwhelming majority of the data, however, comes from high-income countries. In undeveloped countries, there is little evidence of a link between obesity and neurocognition. The aim of this study was to investigate the effects of BMI on the key cognitive functioning tasks of attention, memory, and executive function in a South African cohort. Methods: A total of 175 females (NW: BMI = 18.5–24.9 kg/m2 and OB: BMI > 30.0 kg/m2) aged 18–59 years (M = 28, SD = 8.87 years) completed tasks on memory, attention, and executive functioning. Results: There was a statistically significant difference between the groups. The participants who had a BMI corresponding with obesity performed poorly on the tasks measuring memory (p = 0.01), attention (p = 0.01), and executive function (p = 0.02) compared to the normal-weight group. Conclusions: When compared to normal-weight participants, the findings confirm the existence of lowered cognitive performance in obese persons on tasks involving planning, decision making, self-control, and regulation. Further research into the potential underlying mechanism by which obesity impacts cognition is indicated.