Metabolic syndrome and its predictors in an urban population in Kenya: A cross sectional study

Determinants and prevalence of metabolic syndrome among the adult population in Hargeisa, Somaliland: A community-based cross-sectional study

BACKGROUND

Metabolic syndrome (met-s) is a medical condition that includes abdominal obesity, hyperlipidemia, high blood glucose, and high blood pressure. It is associated with a high risk of developing cardiovascular diseases and type 2 diabetes mellitus. The condition was believed to be a challenge mostly faced by developed nations. A few studies conducted showed that met-s is increasing and becoming more common in Africa, where it was considered rare. The study aimed to assess the determinants and prevalence of met-s among the adult population in Hargeisa town, Somaliland, in 2023.

METHODS

A community-based cross-sectional study among 498 adults living in all eight districts of Hargeisa, was carried out from August to September 2023. The sample size was divided proportionally by the number of households in selected sub-districts. Systematic random sampling was employed to select the households in the sub-districts. One adult from each household was selected and assessed. Data were collected using the STEPwise approach of the World Health Organization. The data were analysed using International Diabetic Federation (IDF) criteria for metabolic syndrome with SPSS version 25. Bivariate and multivariate analyses using logistic regression were performed.

RESULT

In total, 498 adults participated in the study. The prevalence of met-s was 26.7% in IDF (males 11% vs. females 38.9%). Being of an advanced age of 45-54 years (AOR = 3.6, CI 1.17-11.27), 55-64 years (AOR = 6.1, CI 1.88-19.83), >64 (AOR = 9.1 CI 2.41-34.92), being a woman (AOR = 10.8, CI 5.3-21.8), being overweight or obese (AOR = 4.5, CI 2.5-8), sedentary behavior (AOR = 3.5, CI 1.6-7.5), and lack of physical exercise (AOR = 0.39, CI 0.17-0.88) were significantly associated with met-s.

CONCLUSION

The met-s was predominant in our findings. Community-based prevention strategies and actions are necessary if the met-s and its potential consequences are needed to be mitigated.

Frequency and Sex-Specific Associations of Metabolic Syndrome in Rwandans Seeking Outpatient Care: A Cross Sectional, Single Centre Study

Background

The prevalence of cardiometabolic diseases is escalating in sub-Saharan Africa (SSA) alongside the prevailing high burden of communicable diseases. Although many countries in SSA, including Rwanda, have existing data on the prevalence of individual components of the MetS, many SSA countries have insufficient data to guide policy makers on the magnitude of MetS. This study sought to determine the magnitude of MetS and its associated risk factors by sex at a referral teaching hospital in Rwanda.

Methods

A cross-sectional, study was conducted among adults aged 35 to 65 years presenting at Ruhengeri Referral Teaching Hospital, Rwanda. We collected socio-clinicodemographic data using the World Health Organization (WHO) STEPwise tool for non-communicable diseases. We used the National Cholesterol Education Program Adult Treatment Panel III criteria for MetS.

Results

Overall, 99 (23.5%) males and 322 (76.5%) female participants with mean ± SD age 47.5 ± 8.2 years were enrolled. The overall frequency of MetS was 51.9% (95% CI: 47.0-56.8) and was significantly higher (p < 0.001) in females 193 (59.4%) compared to males 26 (26.3%). Significant differences by sex were also noted in the proportions of visceral obesity; 70.4% vs 7.1% (p < 0.001), hypoalphalipoproteinaemia 36.1% vs 69.7% (p < 0.0001), type 2 diabetes mellitus; 18.4% vs 31.6% (p = 0.020) and body mass index 25.9 ± 15.6 vs 28.2 ± 6.4 (p = 0.032). On multivariate logistic regression, older age (odds ratio (OR) 1.05; 95% confidence interval ((CI) 1.01-1.10)), higher body weight (OR 1.06; 95% CI 1.04-1.08) and higher total cholesterol (1.25; 95% CI 1.05 -1.74) were significantly associated with MetS in females; whereas only higher body weight (OR1.10; 95% CI 1.04-1.18) was significantly associated with MetS in males.

Conclusion

A high frequency of MetS was observed in the present study, which was higher among females. Our findings emphasize the need for tailored prevention and intervention strategies to mitigate the long-term impact of MetS.

Gender-specific accuracy of lipid accumulation product index for the screening of metabolic syndrome in general adults: a meta-analysis and comparative analysis with other adiposity indicators

BACKGROUND

Lipid accumulation product (LAP) is a novel predictor index of central lipid accumulation associated with metabolic and cardiovascular diseases. This study aims to investigate the accuracy of LAP for the screening of metabolic syndrome (MetS) in general adult males and females and its comparison with other lipid-related indicators.

METHODS

A systematic literature search was conducted in PubMed, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and ProQuest for eligible studies up to May 8, 2024. Outcomes were pooled mean difference (MD), odds ratio (OR), and diagnostic accuracy parameters (sensitivity, specificity, and area under the summary receiver operating characteristic [AUSROC] curve). Comparative analysis was conducted using Z-test.

RESULTS

Forty-three studies involving 202,313 participants (98,164 males and 104,149 females) were included. Pooled MD analysis showed that LAP was 45.92 (P < 0.001) and 41.70 units (P < 0.001) higher in men and women with MetS, respectively. LAP was also significantly associated with MetS, with pooled ORs of 1.07 (P < 0.001) in men and 1.08 (P < 0.001) in women. In men, LAP could detect MetS with a pooled sensitivity of 85% (95% CI: 82%-87%), specificity of 81% (95% CI: 80%-83%), and AUSROC curve of 0.88 (95% CI: 0.85-0.90), while in women, LAP had a sensitivity of 83% (95% CI: 80%-86%), specificity of 80% (95% CI: 78%-82%), and AUSROC curve of 0.88 (95% CI: 0.85-0.91). LAP had a significantly higher AUSROC curve (P < 0.05) for detecting MetS compared to body mass index (BMI), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), body roundness index (BRI), a body shape index (ABSI), body adiposity index (BAI), conicity index (CI) in both genders, and waist circumference (WC) and abdominal volume index (AVI) in females.

CONCLUSION

LAP may serve as a simple, cost-effective, and more accurate screening tool for MetS in general adult male and female populations.

Sociodemographic Factors Associated with Improved Metabolic Syndrome in Slum Dwelling Adults in Kenya: A Randomized Controlled Trial

Background

Sociodemographic factors have been implicated in cardiovascular health with differential morbidity and mortality. It is essential to comprehend how sociodemographic factors contribute to the improvement of Metabolic Syndrome (MetS), the primary cardiovascular diseases indicator.

Objective

Determine the role of sociodemographic factors in improving MetS among adults residing in the Slums of Nairobi, Kenya.

Methods

Adults with MetS participated in this randomized controlled trial study for a period of 12-months. A random assignment was used to place eligible participants in the intervention or control groups. The intervention group received lifestyle intervention that entails not using tobacco products or alcohol, exercising, and adhering to recommended dietary guidelines, while the control group had standard medical care. Clinical, biochemistry, and lifestyle habits were measured before and a year after the intervention. The association between the sociodemographic factors and the improvement in MetS was examined using a multiple logistic regression model with backward conditional.

Results

In the intervention group, lack of improvement in metabolic syndrome was significantly higher among aged (≥50 years) respondents [AOR = 9.097; P < .001]; Protestants [AOR = 7.292; P = .017] and Catholics [AOR = 5.270; P = .050]. Compared to unemployed, formally employed respondents had an 84.6% lower chance of having MetS [AOR = 0.154; P = .005]. Within the control group, lack of improvement in metabolic syndrome was significantly higher among aged (≥50 years) respondents [AOR = 5.013; P = .047]. Compared to respondents who had less than $100, individuals with monthly incomes between $100 and $500 had a roughly 10-fold [AOR = 10.499; P = .024] higher chance of having MetS.

Conclusion

In the current study, the findings show that sociodemographic factors namely: advanced age, unemployment, being Protestants and Catholics as well as higher income were negatively associated with improvement in MetS. The findings indicate that social factors have impact in the management and intervention outcomes of CVDs. Programmers and policy makers should plan interventions for CVD prevention and response with these factors in mind.

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.

Characterization of the Gut Microbiota in Urban Thai Individuals Reveals Enterotype-Specific Signature

Gut microbiota play vital roles in human health, utilizing indigestible nutrients, producing essential substances, regulating the immune system, and inhibiting pathogen growth. Gut microbial profiles are dependent on populations, geographical locations, and long-term dietary patterns resulting in individual uniqueness. Gut microbiota can be classified into enterotypes based on their patterns. Understanding gut enterotype enables us to interpret the capability in macronutrient digestion, essential substance production, and microbial co-occurrence. However, there is still no detailed characterization of gut microbiota enterotype in urban Thai people. In this study, we characterized the gut microbiota of urban Thai individuals by amplicon sequencing and classified their profiles into enterotypes, including Prevotella (EnP) and Bacteroides (EnB) enterotypes. Enterotypes were associated with lifestyle, dietary habits, bacterial diversity, differential taxa, and microbial pathways. Microbe-microbe interactions have been studied via co-occurrence networks. EnP had lower α-diversities than those in EnB. A correlation analysis revealed that the Prevotella genus, the predominant taxa of EnP, has a negative correlation with α-diversities. Microbial function enrichment analysis revealed that the biosynthesis pathways of B vitamins and fatty acids were significantly enriched in EnP and EnB, respectively. Interestingly, Ruminococcaceae, resistant starch degraders, were the hubs of both enterotypes, and strongly correlated with microbial diversity, suggesting that traditional Thai food, consisting of rice and vegetables, might be the important drivers contributing to the gut microbiota uniqueness in urban Thai individuals. Overall findings revealed the biological uniqueness of gut enterotype in urban Thai people, which will be advantageous for developing gut microbiome-based diagnostic tools.

Ferritin and its association with anaemia in a healthy adult population in Kenya

BACKGROUND

Iron deficiency is the commonest cause of anaemia worldwide. Serum ferritin is the most sensitive non-invasive indicator of iron stores but its utility is compromised in inflammatory states as it is an acute phase reactant. This study sought to estimate the burden of iron deficiency in a healthy adult population residing in Kenya and to determine the association between various ferritin cut-offs and anaemia in a population known to have chronic low-grade inflammation.

METHODS

Healthy adults aged 18-65 years were recruited from urban towns in 4 counties in Kenya at average altitudes of 1683-2099m above sea level as part of a global study conducted by the International Federation of Clinical Chemistry (IFCC) to determine reference intervals (RIs) for common laboratory tests. We analyzed complete blood count (CBC), C-reactive protein, iron, transferrin, transferrin saturation and ferritin data.

RESULTS

We obtained data from 528 participants. There were 254 (48.1%) males and 274 females (51.9%). Based on a ferritin cut-off of 15 μg/L and Hb cut-offs of 14.5 g/dL and 12 g/dL, the prevalence of iron deficiency anaemia was 0.8% and 7.3% in males and females respectively. The odds of having anaemia was highest if one had a ferritin value less than 15 μg/L with a sensitivity of 28.6% and specificity of 98.4% in males, and sensitivity of 83.3% and specificity of 78.0% in females.

CONCLUSION

Only the ferritin cut-off of 15 ug/L had an association with anaemia where it can be used for ruling out iron deficiency as the cause. Sex specific ferritin cut-offs for diagnosing iron deficiency in adults in sub-Saharan Africa need to be derived by comparing ferritin levels to stainable iron in bone marrow aspirates and trephines in order to ensure that we are using appropriate clinical decision limits.

Lipid accumulation product is a reliable indicator for identifying metabolic syndrome: the China Multi-Ethnic Cohort (CMEC) Study

BACKGROUND

Previous studies have shown that lipid accumulation product (LAP) was associated with the risk of cardiometabolic disease. It is not clear whether LAP could be used as a marker to identify metabolic syndrome (MetS) among Chinese ethnic groups.

AIM

To assess the reliability of LAP as a maker to identify MetS among Dong adults.

DESIGN

Population-based cross-sectional study.

METHOD

We included 6494 Dong individuals (1403 patients) aged 30-79 years from southwest China. MetS was established by Chinese Diabetes Society. Logistic regression model was utilized to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Receiver operating characteristic (ROC) curve was utilized to calculate area under the ROC curve (AUC) and 95% CIs to obtain the identification ability for MetS.

RESULTS

The risk of MetS was increased with per 5 units increase of LAP (OR 1.37 [95% CI, 1.34-1.39]). Similar results were found in subgroup analyses and sensitivity analyses. Clustered metabolic risk associated with per 5 units increase of LAP was observed for people with 1 (OR 1.59 [95% CI, 1.53-1.65]), 2 (2.15 [2.06-2.24]), 3 (2.59 [2.48-2.71]), 4 (2.81 [2.69-2.95]) and 5 (3.03 [2.87-3.21]) MetS components. LAP presented higher AUC (0.915 [95% CI, 0.907-0.923]) than other included obesity indices (P < 0.05).

CONCLUSION

These data support evidence that LAP was related to the risk of MetS, had a high AUC and could be a reliable index for identifying MetS patients among Dong adults in Chinese.

Prevalence of Metabolic Syndrome and its Components in Kanifing Municipality, The Gambia

Background

Metabolic syndrome (MetS) is a complex syndrome with clustering of interrelated risk factors for cardiovascular disease and diabetes. Its rising worldwide prevalence has been largely related to the increasing obesity. In The Gambia, the last and only time a MetS related study was conducted, and then reported, was 21 years. Therefore, there is need for evaluating the prevalence of MetS and its components in the country.

Objective

This study was aimed to evaluate the prevalence of MetS and its individual components in Kanifing Municipality (KM).

Methods

It was a cross-sectional study conducted at Kanifing General Hospital, Kanifing Municipality. Data obtained from each participants included anthropometric indices, blood pressure, fasting plasma glucose, triglyceride and high-density lipoprotein levels, and clinical information.

Results

One hundred and thirty-six participants were included in the analysis. The overall MetS prevalence was 54.4% with significant female predominance (female, 58%; male, 29.4%; P=0.025). The most predominant component among the study population was central obesity (raised WC) (72.8%). Hypertriglyceridemia was found to be the strongest predictor of MetS among our participants (OR: 118.13; 95% CI: 33.79-412.77; P < 0.001).

Conclusion

Our study discloses a very high prevalence of MetS among the participants, and a significant female predominance, with central obesity the commonest Mets component. The results suggest that hypertriglyceridemia is the strongest predictor of metabolic syndrome in our study participants.

Epidemiology, risk factors, social determinants of health, and current management for non-alcoholic fatty liver disease in sub-Saharan Africa

Non-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease globally and is estimated to affect approximately 25% of the world's population. Data about the prevalence and incidence of NAFLD in Africa are scarce, but the prevalence is estimated to be 13·5% for the general population. This is likely to be an underestimate considering the increasing burden of non-communicable diseases, particularly the rising prevalence of obesity and type 2 diabetes, driven by the overlapping challenges of food insecurity, nutritional transition, and associated increased consumption of calorie-dense foods. Establishing the true prevalence of NAFLD, raising public awareness around the risk factors behind the increase in NAFLD, and proactively addressing all components of metabolic syndrome will be important to combat this silent epidemic, which will have long-term health-care costs and economic consequences for the region.

The Accuracy of Visceral Adiposity Index for the Screening of Metabolic Syndrome: A Systematic Review and Meta-Analysis

BACKGROUND AND AIMS

Visceral adiposity index (VAI) is a novel marker of fat distribution and function which incorporates both anthropometric and laboratory measures. Recently, several studies have suggested VAI as a screening tool for metabolic syndrome (MetS). Here, we aimed to consolidate the results of these studies by performing a systematic review and meta-analysis.

METHODS AND RESULTS

We searched PubMed and EMBASE online databases for eligible studies that investigated the association of VAI and MetS. After reviewing 294 records, we included 33 eligible papers with a sum of 20516 MetS and 53242 healthy participants. The risk of bias in the included studies was assessed, and the relevant data was extracted. All included studies reported a significant association between VAI and MetS screening, but were highly heterogeneous in their reported effects. We pooled the diagnostic test accuracy metrics of VAI for MetS screening and showed that it has a moderate-to-high accuracy with an area under the summary receiver operating characteristics curve of 0.847, a pooled sensitivity of 78%, and a pooled specificity of 79%. Besides, we pooled the difference in means of VAI between patients with MetS and healthy controls, revealing that VAI was 2.15 units higher in MetS patients.

CONCLUSIONS

VAI is an accurate, low-cost, and widely available screening marker for MetS. However, further studies are needed to evaluate its applicability in clinical practice, determine an optimal cut-off, and identify populations that would benefit the most from it.

[Metabolic hepatic steatosis associated with obesity in adults living in Burkina Faso]

Introduction

la stéatopathie métabolique est-elle une priorité de santé en Afrique? Le but était d´étudier les facteurs épidémiologiques et les manifestations hépatiques (anomalies biologiques et la stéatose échographique) associés au syndrome métabolique (SM) chez les adultes suivis en ambulatoire.

Méthodes

étude multicentrique transversale avec un suivi longitudinal des patients. Elle a été menée de mars 2015 à août 2019 dans la ville de Ouagadougou. Etaient inclus les malades présentant un SM selon les critères harmonisés pour les africains subsahariens.

Résultats

la fréquence du SM était à 15,74%. Il y a eu un recrutement 3,8 fois plus rapide de patients la dernière année. Les femmes (57,04) étaient majoritaires; l´âge moyen de 44,69 ans. Le surpoids et l´obésité concernaient 87,32%. Les composantes du SM retrouvées étaient: la dyslipidémie (64,79%), l´hyperglycémie (49,30%), l´HTA (45,07%), le tour de taille moyen de 98,68 cm chez les hommes et de 101,13 cm chez les femmes. L´infection virale B était associée chez 19,01% et celle au HIV chez 1,40%. Une patiente présentait un syndrome de polykystose ovarienne. Une tradithérapie était en cours chez 14,08%. Les transaminases étaient normales chez 73,94%. Une stéatose hépatique échographique était retrouvée chez 71,13%. Le Fibroscan® avait été effectué par 40,42%. Le résultat de la stéatose était discordant de celui échographique chez 56,14%.

Conclusion

pour réduire le SM et ses composantes, il est nécessaire de lutter contre l´obésité (surtout féminine). Une meilleure accessibilité au Fibroscan® permettra d´améliorer sa prise en charge au Burkina Faso.

Magnitude and Associated Factors of Metabolic Syndrome Among Adult Urban Dwellers of Northern Ethiopia

BACKGROUND

Metabolic Syndrome (MetS) is becoming a big public health problem in developing countries like Ethiopia. Developing countries have an almost two-fold higher risk of death due to non-communicable diseases (NCDs) compared to high-income countries. This study aimed to assess the magnitude and factors associated with MetS among adult residents of Mekelle city.

METHODS

A population-based cross-sectional study was carried out among 266 randomly selected adults from July to September 2019. Data were collected on socio-demographic, clinical, anthropometric, and lifestyle characteristics using a structured questionnaire adapted from the WHO STEPs survey tool. Fasting Blood Glucose (FBG) and lipid profiles were tested using a blood sample. Bivariate and multivariable logistic regression analyses were used to identify factors associated with MetS and variables were considered statistically significant at p ≤0.05.

RESULTS

The findings of this study showed the magnitude of MetS was 21.8%. The proportion of MetS was relatively higher among women (24.6%) than men (18.5%). Raised blood pressure was the most prominent (42.5%) component of MetS followed by central obesity (41.7%). The magnitude of the other components of MetS was 38.0%, 21.4%, and 14.3% for elevated triglyceride, raised FBG, and low HDL-C, respectively. Advanced age, medium and high monthly income, walking less than 10 minutes per day, raised Body Mass Index (BMI), higher waist to hip ratio, and elevated total cholesterol were significantly associated with a higher risk of metabolic syndrome.

CONCLUSION

In this study, we found a high prevalence of metabolic syndrome and its components, which highlights an urgent need for a public health strategy for its prevention, early diagnosis, and management.

Determination of optimal cut-off values for waist circumferences used for the diagnosis of the metabolic syndrome among Batswana adults (ELS 32)

BACKGROUND

To date, no definitive waist circumference (WC) cut-off values for abdominal obesity (AO) have been established for sub-Saharan Africa, including Botswana. Therefore, the classification of AO among these populations is based on European values. For accurate diagnosis of the metabolic syndrome (MetS), cut-off values reflective of the population investigated must be used.

OBJECTIVE

The study was an attempt to determine optimal cut-off values for AO among Batswana adults.

METHODS

The receiver operating characteristic curve was used to determine the optimal cut-off values for predicting at least two other risk factors of the MetS. Data were used from a descriptive cross-sectional study employing a complex multi-stage cluster sampling. Demographic and anthropometric measurements (weight and height, waist and hip circumferences), blood pressure, and blood glucose, triglycerides, high-density lipoprotein cholesterol and total cholesterol levels were collected from 384 men and 416 women in Gaborone and the surrounding villages.

RESULTS

The ability of waist circumference to predict at least two other risk factors of the MetS gave cut-off values of ≥ 91.0 cm (sensitivity 69.1% and specificity of 90.8%, area under the curve 0.85) for men and ≥ 82.3 cm (sensitivity of 88.6% and specificity of 58.9%, area under the curve of 0.76) for women.

CONCLUSIONS

There is a difference between the cut-off values for Europeans with those determined for Batswana adults. Inconsistencies in cut-off values used have the potential for undesirable consequences for cardiovascular risk stratification and prioritisation of preventative strategies for AO and the MetS. The need to determine population-, ethnic- and gender-based cut-off values for AO for Batswana adults has never been more paramount.

Association of dietary patterns and practices on metabolic syndrome in adults with central obesity attending a mission hospital in Kenya: a cross-sectional study

OBJECTIVE

Dietary patterns and practices can predispose or protect against metabolic syndrome (MetS) in humans. Despite the growing problem of MetS in adults, the underpinning dietary behaviour is poorly understood. We determined the dietary patterns and practices relevant to MetS in adults with central obesity attending a mission hospital in Kenya.

STUDY DESIGN

Descriptive, cross-sectional.

SETTING

Outpatient clinic of a mission-based hospital in Nairobi.

PARTICIPANTS

Adults (N=404) aged 18-64 years diagnosed with central obesity as per the International Diabetes Federation definition for MetS.

PRIMARY OUTCOMES

Anthropometric measurements, clinical-biochemical markers and dietary components, quantity and frequency of food intake, as well as time-lapse between consumption of dinner and sleeping.

RESULTS

A high (87.2%) prevalence of MetS was observed for respondents who reported consumption of large amount of carbohydrates (p<0.001), proteins (p<0.001), processed/fast foods (p<0.001) and sugar (p=0.009). Frequent consumption of legumes (p<0.001), nuts (p<0.001), fruits (p<0.001) and vegetables (p=0.021) was linked to reduced MetS. Additionally, longer interval between eating dinner and going to bed was associated with reduced MetS.

CONCLUSION

Regular consumption of fruits, vegetables, legumes and nuts, as well as observing sometime after eating dinner before sleeping, was the dietary pattern significantly associated with a lower risk of MetS. Whereas, consumption of a large quantity of carbohydrates, proteins, processed/fast foods and sugar is likely to predispose to MetS. The findings underscore the need to focus on specific dietary intake patterns including frequency, quantity, quality and variety for MetS prevention and management. The MetS-related interventions could be implemented during individual consultation, group and community health messaging sessions.

Determination of reference intervals for common chemistry and immunoassay tests for Kenyan adults based on an internationally harmonized protocol and up-to-date statistical methods

BACKGROUND

Due to a lack of reliable reference intervals (RIs) for Kenya, we set out to determine RIs for 40 common chemistry and immunoassay tests as part of the IFCC global RI project.

METHODS

Apparently healthy adults aged 18-65 years were recruited according to a harmonized protocol and samples analyzed using Beckman-Coulter analyzers. Value assigned serum panels were measured to standardize chemistry results. The need for partitioning reference values by sex and age was based on between-subgroup differences expressed as standard deviation ratio (SDR) or bias in lower or upper limits (LLs and ULs) of the RI. RIs were derived using a parametric method with/without latent abnormal value exclusion (LAVE).

RESULTS

Sex-specific RIs were required for uric acid, creatinine, total bilirubin (TBil), total cholesterol (TC), ALT, AST, CK, GGT, transferrin, transferrin saturation (TfSat) and immunoglobulin-M. Age-specific RIs were required for glucose and triglyceride for both sexes, and for urea, magnesium, TC, HDL-cholesterol ratio, ALP, and ferritin for females. LAVE was effective in optimizing RIs for AST, ALT, GGT iron-markers and CRP by reducing influence of latent anemia and metabolic diseases. Thyroid profile RIs were derived after excluding volunteers with anti-thyroid antibodies. Kenyan RIs were comparable to those of other countries participating in the global study with a few exceptions such as higher ULs for TBil and CRP.

CONCLUSIONS

Kenyan RIs for major analytes were established using harmonized protocol from well-defined reference individuals. Standardized RIs for chemistry analytes can be shared across sub-Saharan African laboratories with similar ethnic and life-style profile.

Obesity Indices for Identifying Metabolic Syndrome Among Type Two Diabetes Patients Attending Their Follow-Up in Dessie Referral Hospital, North east Ethiopia

INTRODUCTION

Worldwide, metabolic syndrome is a common problem among T2DM patients. Even though the International Diabetes Federation recommended waist circumference as a diagnostic tool for metabolic syndrome, the appropriate indices and cut-off point remain controversial.

OBJECTIVE

To assess obesity indices in identifying metabolic syndrome among type 2 diabetes mellitus patients in Dessie Referral Hospital, North east Ethiopia.

METHODS

A hospital-based cross-sectional study was conducted among 363 consecutively selected T2DM in Dessie Referral Hospital from February to March 2017. Data were collected by interviewer-administered questionnaire. Height, weight, waist circumference, hip circumference, lipid profile, blood glucose levels and blood pressure were taken. Descriptive statistics were computed. Receiver operator characteristic curve analysis with a 95% confidence interval and p-value <0.05 was used to identify the discriminate ability of each index, while the optimal cut point of each index was determined by Youden's index.

RESULTS

A total of 330 study participants were included in the study. Based on ATP III definition, the magnitude of metabolic syndrome among T2DM patients was 59.4% (53.6-64.5%). Waist to height ratio (optimal cut point=0.54, AUC=0.85) and waist circumference (optimal cut point= 83 cm, AUC=0.75) were the best predictor of metabolic syndrome for women and men, respectively. For the entire study participant, waist to height ratio (optimal cut point=0.51, AUC=0.79) was the best predictor of metabolic syndrome among type 2 diabetes patients.

CONCLUSION AND RECOMMENDATION

Waist to height ratio and waist circumference was the best predictor of metabolic syndrome for women and men, respectively. So, appropriate indices optimal cut-off point should be included to diagnose metabolic syndrome among T2DM.

Potential Role of New Anthropometric Parameters in Childhood Obesity with or Without Metabolic Syndrome

BACKGROUND

Obese children and adolescents are more prone to have metabolic syndrome (MS).MS is a cluster of cardiovascular risk factors associated with insulin resistance. Body round index [BRI], visceral adiposity index [VAI] and a body shape index [ABSI] are among the new obesity anthropometric parameters.

AIM

To evaluate the new markers for obesity in children and their possible association with other laboratory and clinical variables of MS.

METHODS

Eighty nine obese children and 40 controls aged 10-18 years were recruited. Full history taking, thorough clinical examination, anthropometric and biochemical features were performed in the studied groups. Subcutaneous fat thickness (SFT) and visceral fat thickness (VFT) were estimated by ultrasonography.

RESULTS

Obese children, exhibited significantly higher values in all anthropometric measurements (P < 0.001). Diastolic and systolic blood pressure were significantly higher (P < 0.001) in the obese group. ABSI, BRI and VAI have been found to be significantly higher in obese subjects (P < 0.001), with no significant gender difference. BMI, WHtR, WC/HR, SBP, DBP, subcutaneous fat thickness and visceral fat thickness, Liver Span, ABSI, BRI, VAI and HOMA_IR were significantly higher among children with MS than those without MS. Positive significant correlations of VAI with BMI, WC/Ht, WC/Hip, SBP, DBP, SFT, VFT, Liver size and HOMA-IR (r = 0.384, 0.239, 0.268, 0.329, 0.516, 0.320, 0.254, 0.251, and 0.278 respectively) are shown. The area under the ROC curve (AUC) of BMI, VAI, ABSI, BRI for predicting MS was 0.802 (0.701-0.902), 0.737 (0.33-0.841), 0.737 (0.620-0.855), 0.816 (0.698-0.934).

CONCLUSION

We suggest using the VAI and WHtR indexes, as they are better predictor of MS.

Prevalence of Metabolic Syndrome and Its Components in Bamboutos Division's Adults, West Region of Cameroon

The prevalence of metabolic syndrome (MetS) and its associated risks remain unappreciated in Bamboutos Division, west region of Cameroon. This study aimed to evaluate the prevalence of MetS, its individual components, and associated risk factors among Bamboutos Division's adults population using a Joint Interim Statement of the International Diabetes Federation (IDF) Task Force on Epidemiology and Prevention definitions parameters. A cross-sectional study was conducted from May 2016 to May 2018 in Mbouda ADLUCEM Hospital and Mbouda District Hospital, two reference hospitals in Bamboutos Division, west region of Cameroon. Interview, physical and clinical examinations, and lipid and fasting blood glucose measurements were conducted for 604 adults. The definition of MetS proposed by IDF was used. The prevalence of MetS was 32.45% with highly significant female predominance (46.11% for females and 14.01 % for males). In the entire participants, the most common abnormalities were low-HDL (82.78%) and hypertriglyceridemia (53.97%) [p<0.001]. Participants with obesity (OR: 16.34; 95% CI: 9.21-28.96), overweight (OR: 7.45; 95% CI: 4.17-13.30), and highest hs-CRP (hs-CRP >11 mg/l) had a higher risk of developing MetS. The most common MetS component was abdominal obesity (OR: 353.13; 95% CI: 136.16-915.81). MetS is prevalent among Bamboutos Division's adults in west region of Cameroon and abdominal obesity is the most common MetS component. This study highlights the need for evidence-based prevention, diagnosis, and management of MetS and its associated factors among Bamboutos Division's adults in Cameroon.

Cross-sectional correlates of nesfatin and lipopolysaccharide binding protein in metabolic syndrome patients with and without prediabetes

Background Metabolic syndrome (MetS) and prediabetes (preDM) have crosslinked pathophysiologies with central obesity and insulin resistance (IR). This study aimed to compare and correlate nesfatin and lipopolysaccharide binding protein (LBP) plasma levels, adiposity, atherogenicity and hematological indices between non-diabetic MetS, newly diagnosed drug naive pre-diabetic MetS patients vs. normoglycemic lean controls. Materials and methods In a cross-sectional study, 29 apparently healthy controls, 29 non-diabetic MetS subjects and 30 preDM-MetS patients were recruited. Results The LBP level (ng/mL) was substantially higher in both MetS (non- and pre-diabetic) groups compared to healthy controls. In contrast, circulating level of nesfatin (pg/mL) was lower, though not significantly; in both pre-diabetic and non-diabetic MetS patients compared to lean normoglycemic controls. No correlation was found between nesfatin and LBP in MetS pool (n = 59). Remarkably unlike blood indices; adiposity indices [body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height (WHtR) ratio, hip circumference (HC), body adiposity index (BAI), visceral adiposity index (VAI), lipid accumulation product (LAP) but not conicity index (CI)], atherogenicity indices [(atherogenicity index of plasma (AIP = Log10(TG/HDL-C ratio)), low density lipoprotein cholesterol to high density lipoprotein cholesterol ratio (LDL-C/HDL-C) and non-high density lipoprotein cholesterol (non-HDL-C)] were substantially higher in both MetS (non- and pre-diabetic) groups vs. those of controls. Exceptionally pronounced and proportional nesfatin-DBP and LBP-BAI correlations were identified in total MetS pool (both non-diabetic and pre-diabetic). Conclusions Nesfatin and LBP can be potential targets and surrogate biomarkers to use as putative prognostic/predictive tools for the prevention and treatment for MetS and related disorders.

The risk of metabolic syndrome as a result of lifestyle among Ellisras rural young adults

The study aimed to investigate the association between metabolic syndrome (MetS) and lifestyle risk factors among Ellisras adults. A cross-sectional study was conducted on 624 adults (306 males and 318 females). MetS was defined according to the criteria of the International Diabetes Federation. The prevalence of MetS was 23.1% (8.6% males and 36.8 % females). Females appeared to have higher mean values for waist circumference (WC), fasting blood glucose (FBG), total cholesterol (TCHOL) and low-density lipoprotein cholesterol (LDL-C), while males had high mean values for high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), systolic blood pressure (SBP) and diastolic blood pressure (DBP). No significant age and gender differences were observed for dietary intake. Significantly more females (51.9%) presented with increased WC than males (4.6%). Participants who had a high dietary energy intake were significantly less likely to present with larger WC (OR: 0.250 95% CI [0.161; 0.389]), low HDL-C (OR: 0.306 95% CI [0.220; 0.425]) and high LDL-C (OR: 0.583 95% CI [0.418; 0.812]) but more likely to present with elevated FBG (OR: 1.01 95% CI [0.735; 1.386]), high TCHOL (OR: 1.039 95% CI [0.575; 1.337]), high TG (OR: 1.186 95% CI [0.695; 2.023]) and hypertension (OR: 5.205 95% CI [3.156; 8.585]). After adjusting for age, gender, smoking, and alcohol status, high energy intake was more than two times likely to predict MetS in adults with a large WC (OR: 2.766 95% CI [0.863; 3.477] and elevated FBG (OR: 2.227 95% CI [1.051; 3.328]). Therefore, identifying groups that are at an increased risk and those that are in their early stages of MetS will help improve and prevent the increase of the MetS in the future.

Metabolic Syndrome Among Antiretroviral Therapy-Naive Versus Experienced HIV-Infected Patients Without Preexisting Cardiometabolic Disorders in Western Kenya

Metabolic syndrome (MetS), a cluster of cardiovascular disease risk factors, is increasingly common in people living with HIV; however, data on prevalence and the role of antiretroviral therapy (ART) as a risk factor for MetS in sub-Saharan Africa are lacking. We conducted a cross-sectional study to assess the prevalence and risk factors for MetS among ART-naive and ART-experienced HIV-infected adults without preexisting cardiometabolic disorders in Western Kenya using validated questionnaires and laboratory tests after overnight fasting. We used logistic regression to identify associations between traditional risk factors, HIV disease characteristics, ART, and MetS. Study participants included 164 ART-experienced patients, majority (56%) on tenofovir/lamivudine/nevirapine regimen, and 136 ART-naive patients. The median age was 40 (interquartile range, 33-46) years and 64% were women. Median HIV infection and ART use were 4.6 (1.7-7.9) and 4.8 (2.7-7.8) years, respectively. Prevalence of MetS did not differ between ART-experienced (16.9%) and -naive (15.2%) groups. ART-experienced patients had higher rates of elevated fasting blood sugars and lower rates of low high-density lipoprotein-cholesterol. The prevalence of abnormal waist circumference, elevated blood pressure, and hypertriglyceridemia were comparable between the two groups. Older age, female sex, and high body mass index were independently associated with diagnosis of MetS. Traditional risk factors rather than ART-related effects were more important predictors of MetS in this cohort and may have been influenced by ART type and exclusion of preexisting hypertension and diabetes. HIV-infected patients without preexisting cardiometabolic disorders should be monitored for metabolic abnormalities regardless of ART.

Prevalence and factors associated with metabolic syndrome in an urban population of adults living with HIV in Nairobi, Kenya

Introduction

Metabolic syndrome affects 20-25% of the adult population globally. It predisposes to cardiovascular disease and Type 2 diabetes. Studies in other countries suggest a high prevalence of metabolic syndrome among HIV-infected patients but no studies have been reported in Kenya. The objective of this study was to assess the prevalence and factors associated with metabolic syndrome in adult HIV-infected patients in an urban population in Nairobi, Kenya.

Methods

In a cross-sectional study design, conducted at Riruta Health Centre in 2016, 360 adults infected with HIV were recruited. A structured questionnaire was used to collect data on socio-demography. Blood was collected by finger prick for fasting glucose and venous sampling for lipid profile.

Results

Using the harmonized Joint Scientific Statement criteria, metabolic syndrome was present in 19.2%. The prevalence was higher among females than males (20.7% vs. 16.0%). Obesity (AOR = 5.37, P < 0.001), lack of formal education (AOR = 5.20, P = 0.002) and family history of hypertension (AOR = 2.06, P = 0.029) were associated with increased odds of metabolic syndrome while physical activity (AOR = 0.28, P = 0.001) was associated with decreased odds.

Conclusion

Metabolic syndrome is prevalent in this study population. Obesity, lack of formal education, family history of hypertension, and physical inactivity are associated with metabolic syndrome. Screening for risk factors, promotion of healthy lifestyle, and nutrition counselling should be offered routinely in HIV care and treatment clinics.

Comparison of equations for estimating glomerular filtration rate in screening for chronic kidney disease in asymptomatic black Africans: a cross sectional study

BACKGROUND

Several equations have been developed to estimate glomerular filtration rate (eGFR). The common equations used were derived from populations predominantly comprised of Caucasians with chronic kidney disease (CKD). Some of the equations provide a correction factor for African-Americans due to their relatively increased muscle mass and this has been extrapolated to black Africans. Studies carried out in Africa in patients with CKD suggest that using this correction factor for the black African race may not be appropriate. However, these studies were not carried out in healthy individuals and as such the extrapolation of the findings to an asymptomatic black African population is questionable. We sought to compare the proportion of asymptomatic black Africans reported as having reduced eGFR using various eGFR equations. We further compared the association between known risk factors for CKD with eGFR determined using the different equations.

METHODS

We used participant and laboratory data collected as part of a global reference interval study conducted by the Committee of Reference Intervals and Decision Limits (C-RIDL) under the International Federation of Clinical Chemistry (IFCC). Serum creatinine values were used to calculate eGFR using the Cockcroft-Gault (CG), re-expressed 4 variable modified diet in renal disease (4v-MDRD), full age spectrum (FAS) and chronic kidney disease epidemiology collaboration equations (CKD-EPI). CKD classification based on eGFR was determined for every participant.

RESULTS

A total of 533 participants were included comprising 273 (51.2%) females. The 4v-MDRD equation without correction for race classified the least number of participants (61.7%) as having an eGFR equivalent to CKD stage G1 compared to 93.6% for CKD-EPI with correction for race. Only age had a statistically significant linear association with eGFR across all equations after performing multiple regression analysis. The multiple correlation coefficients for CKD risk factors were higher for CKD-EPI determined eGFRs.

CONCLUSIONS

This study found that eGFR determined using CKD-EPI equations better correlated with a prediction model that included risk factors for CKD and classified fewer asymptomatic black Africans as having a reduced eGFR compared to 4v-MDRD, FAS and CG corrected for body surface area.