1
|
Mthethwa WS, Mampofu ZM, Mokwena MA, Ramoshaba NE. The relationship between mid-upper arm circumference and blood pressure in Walter Sisulu University community. Blood Press 2024; 33:2296904. [PMID: 38254330 DOI: 10.1080/08037051.2023.2296904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/13/2023] [Indexed: 01/24/2024]
Abstract
Prevalence of hypertension is increasing to higher levels in South Africa. Anthropometric measures for obesity are well known to predict the development of hypertension. However, the relationship between mid-upper arm circumference (MUAC) and blood pressure (BP) is scant in South African communities such as universities. Therefore, this study was aimed at investigating the correlation between MUAC and BP among the community of Walter Sisulu University (WSU). A total of 230 participants from WSU (students and staff members), 113 females and 117 males aged ≥ 18 years participated in this cross-sectional study. MUAC, systolic BP (SBP) and diastolic BP (DBP) were measured using standard procedures. In a Pearson's correlation analysis, MUAC was positively correlated with SBP and DBP in both women (SBP; r = 0.53, P< 0.001; DBP; r = 0.45 P < 0.001) and men (SBP; r = 0.29 P = 0.001; DBP; r = 0.25 P = 0.007). Furthermore, in the multivariable-adjusted regression analysis, MUAC was positively associated with SBP in women only (adjusted R2 = 0.489, β = 0.29 (95% CI = 0.16; 2.08)), P =0.023) after adjusted for age, body fat percentage, waist-to-height ratio, smoking and alcohol. MUAC is positively correlated with BP in women, not in men of WSU community. MUAC, as a simple and low-cost quantifiable parameter, could be employed as a risk indicator in the early detection and prevention of cardiovascular diseases (CVDs) in women.
Collapse
Affiliation(s)
- Wenzile S Mthethwa
- Department of Human Biology, Walter Sisulu University, Nelson Mandela Drive, Mthatha5117, South Africa
| | - Zuqaqambe M Mampofu
- Department of Human Biology, Walter Sisulu University, Nelson Mandela Drive, Mthatha5117, South Africa
| | - Madigoahle A Mokwena
- Department of Human Biology, Walter Sisulu University, Nelson Mandela Drive, Mthatha5117, South Africa
| | - Nthai E Ramoshaba
- Department of Human Biology, Walter Sisulu University, Nelson Mandela Drive, Mthatha5117, South Africa
| |
Collapse
|
2
|
Yoo JH, Kim T, Lee J. Association Between Lifestyle Behaviors and Obesity Among Stroke Survivors. West J Nurs Res 2024; 46:552-560. [PMID: 38804635 DOI: 10.1177/01939459241254777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
AIM The aim was to investigate factors influencing obesity among stroke survivors based on demographics and lifestyle behaviors. BACKGROUND Stroke survivors are more likely to experience stroke recurrence within a few years. As obesity is a traditional risk factor for stroke, obesity should be managed in stroke survivors to prevent stroke recurrence. METHODS A cross-sectional secondary data analysis analyzed data from the 2017 United States Behavioral Risk Factor Surveillance System (BRFSS) survey. Demographics, frequency of vegetable and fruit intake, smoking, alcohol use, physical activity, and sleep were examined. RESULTS Among 1032 stroke survivors, 57.8% were obese. Advanced age, female sex, veteran status, at least once-daily fruit intake, current smoking, and lack of physical activity were associated with obesity. CONCLUSION Stroke survivors should be encouraged to pursue healthy behaviors to manage obesity. Appropriate transitional care, including diet education and tailored exercise, can be an effective strategy.
Collapse
Affiliation(s)
- Jee-Hye Yoo
- College of Nursing, CHA University, Pocheon-si, South Korea
| | - TaeHee Kim
- Division of Nursing, Yongin Severance Hospital, Yongin-si, South Korea
| | - JuHee Lee
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea
| |
Collapse
|
3
|
Zhang Z, Peng W, Sun S, Ma J, Sun Y, Zhang F. Predicting the onset of overweight in Chinese high school students: a machine-learning approach in a one-year prospective cohort study. Endocrine 2024:10.1007/s12020-024-03902-4. [PMID: 38856840 DOI: 10.1007/s12020-024-03902-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 05/29/2024] [Indexed: 06/11/2024]
Abstract
OBJECTIVE This study aimed to develop and evaluate machine-learning models for predicting the onset of overweight in adolescents aged 14‒17, utilizing easily collectible personal information. METHODS This study was a one-year prospective cohort study. Baseline data were collected through anthropometric measurements and questionnaires, and the incidence of overweight was calculated one year later via anthropometric measurements. Predictive factors were selected through univariate analysis. Six machine-learning models were developed for predicting the onset of overweight. The SHapley Additive exPlanations (SHAP) was used for global and local interpretation of the models. RESULTS Out of 1,241 adolescents, 204 (16.4%) were identified as overweight after one year. Nineteen features were associated with the overweight incidence in univariable analysis. Participants were randomly divided into a training group and a testing group in a 7:3 ratio. The Light Gradient Boosting Machine (LGBM) algorithm achieved outperformed other models, achieving the following metrics: Accuracy (0.956), Recall (0.812), Specificity (0.983), F1-score (0.855), AUC (0.961). Importance ranking revealed that the top 11 minimal feature set can maintain the stability of model performance. CONCLUSIONS The onset of overweight in adolescents was accurately predicted using easily collectible personal information. The LGBM-based model exhibited superior performance. Oversampling technique notably improved model performance. The model interpretation technique provided innovative strategies for managing adolescent overweight/obesity.
Collapse
Affiliation(s)
- Zikang Zhang
- Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, 230031, PR China
- University of Science and Technology of China, Hefei, 230026, PR China
| | - Wei Peng
- Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, 230031, PR China
- CAS Hefei Institute of Technology Innovation, Hefei, 230088, PR China
| | - Shaoming Sun
- Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, 230031, PR China.
- CAS Hefei Institute of Technology Innovation, Hefei, 230088, PR China.
| | - Jianguo Ma
- College of Physical Education, Chuzhou University, Chuzhou, 239000, PR China.
| | - Yining Sun
- Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, 230031, PR China
| | - Fangwen Zhang
- Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, 230031, PR China
- University of Science and Technology of China, Hefei, 230026, PR China
| |
Collapse
|
4
|
Asosega KA, Aidoo EN, Adebanji AO, Owusu-Dabo E. Examining the risk factors for overweight and obesity among women in Ghana: A multilevel perspective. Heliyon 2023; 9:e16207. [PMID: 37229171 PMCID: PMC10205511 DOI: 10.1016/j.heliyon.2023.e16207] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 05/27/2023] Open
Abstract
Overweight/obesity prevalence is on the increase in epidemic proportions across Low- and Middle-Income countries (LMICs). The public health burden associated with obesity/overweight cannot be underestimated due to its association with chronic health outcomes. This study investigated the individual- and community level risk factors for obesity/overweight among reproductive women. The data used consist of 4393 reproductive women and form part of the 2014 Ghana Demographic and Health Survey (GDHS). Information on these women are clustered within 427 communities. A 2-tier random intercept multilevel logistic model was used to assess the effect of individual- and community level factors on the likelihood of a woman to be obese/overweight. The obesity/overweight prevalence among reproductive women was estimated to be 35.5% (95% CI: 34.04, 36.90%), which significantly differed across clusters. Most at risk were women from middle-income households (aOR = 2.85; 95% CI: 2.28, 3.56), upper-income households (aOR = 5.019, 95% CI: 3.85, 6.55), attaining secondary education (aOR = 1.74; 95% CI: 1.41, 2.16), and higher (aOR = 1.63; 95% CI: 1.14, 2.33), old age (20-29 years (aOR = 4.26; 95% CI: 3.142,5.78); 30-39 years (aOR = 8.59; 95% CI: 6.15, 12.00); 40-49 years (aOR = 12.81; 95% CI: 9.10, 18.16)). Significant differences in the probability of being overweight/obese between different communities were observed (MOR = 1.39). The high prevalence of overweight/obesity requires urgent public health interventions to prevent future public health crises. Efforts to strengthen the healthcare system, encourage lifestyle modification, and public health education are needed to solidify the gains of ensuring a healthy population by 2030 (SDG 3).
Collapse
Affiliation(s)
- Killian Asampana Asosega
- Department of Statistics and Actuarial Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Department of Mathematics and Statistics, University of Energy and Natural Resources, Sunyani, Ghana
| | - Eric Nimako Aidoo
- Department of Statistics and Actuarial Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Atinuke Olusola Adebanji
- Department of Statistics and Actuarial Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ellis Owusu-Dabo
- Department of Global and International Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| |
Collapse
|
5
|
Quantifying impact of obesity on cardiometabolic comorbidities and public health implications: Insights from South Africa. Obes Res Clin Pract 2023; 17:122-129. [PMID: 36870866 DOI: 10.1016/j.orcp.2023.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 02/03/2023] [Accepted: 02/10/2023] [Indexed: 03/06/2023]
Abstract
INTRODUCTION South Africa has the highest obesity and hypertension rates in the African region. In this cross-sectional study, we aimed to quantify the correlates and burden of obesity and their impacts on cardiometabolic conditions. METHODS The study population was 80,270 men(41 %) and women(59 %) who participated in South African national surveys (2008-to-2017). Weighted-logistic regression models and the population attributable risk (PAR %) were used after accounting for the correlation structure of the risk factors in a multifactorial setting. RESULTS Overall, 63 % of the women and 28 % of the men were either overweight or obese. Parity was identified as the most influential factor and exclusively associated with 62 % of the obesity in women; being married/cohabiting had the highest impact on obesity in men and associated with 37 % of the obesity. Overall, 69 % of them had comorbidities including hypertension, diabetes and heart disease. More than 40 % of the comorbidities were attributed to overweight/obesity. CONCLUSION Developing culturally appropriate prevention programs are urgently needed to raise awareness of obesity, hypertension and their impacts on severe cardiometabolic diseases. This approach would also significantly reduce COVID-19 related poor health outcomes and premature deaths.
Collapse
|
6
|
[Nutritional status in Ecuadorian adults and its distribution according to socio-demographic characteristics. A cross-sectional study]. NUTR HOSP 2023; 40:102-108. [PMID: 36537333 DOI: 10.20960/nh.04083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Introduction Introduction: 30 % of the world population currently has overweight and obesity problems, while in Ecuador this is 64.68 %. The identification of population groups more vulnerable to overweight and obesity is a basic issue to establish better public policies. Objective: to identify the population groups at risk of overweight and obesity according to socio-demographic determinants (ethnicity, marital status, poverty and age). Methods: a cross-sectional study. Data from 89,212 adults of both sexes were analyzed. Body mass index (BMI) was used to assess the prevalence of overweight and obesity, and multiple linear regression analysis was performed to relate BMI to sociodemographic determinants. Results: women had an average of 1.03 kg/m2 more than men, and BMI rose by 0.04 kg/m2 for each year of age. In relation to marital status, married people presented 1.14 kg/m2 more than single people. Taking into account the poverty quintiles and q1 as a reference category, quintiles 2, 3 and 4 showed a higher BMI of 0.65, 0.88, 0.77 and 0.41 kg/m2, respectively (p < 0.001). Regarding ethnicity, indigenous people had a BMI 0.78 kg/m2 less than whites; Montubios and Afro-Americans had 0.37 and 0.61 kg/m2, respectively, more than whites. People residing in the urban area present 0.41 kg/m2 more than the residents in the rural area. Conclusions: we identified groups of higher nutritional risk such as women and married people for overweight and obesity, while indigenous people and the poorest people were at risk for low weight, which indicates that in Ecuador adults have problems of both excess and deficit. It is necessary to implement policies aimed at specific population groups.
Collapse
|
7
|
Ukoha WC, Mtshali NG. Integration of preconception care into the bachelor of nursing curriculum: An exploratory qualitative study. Heliyon 2023; 9:e13304. [PMID: 36798778 PMCID: PMC9925950 DOI: 10.1016/j.heliyon.2023.e13304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 01/24/2023] [Accepted: 01/27/2023] [Indexed: 01/30/2023] Open
Abstract
Background The significance of ensuring high quality of care has become apparent in nursing and midwifery education worldwide, especially in low- and middle-income countries. This has led to upgrades of the nursing curriculum to include several aspects of care that have been overlooked with recent evidence-based care. Objectives To explore the integration of preconception care (PCC) into the Bachelor of nursing curriculum in South Africa. Design An exploratory qualitative study. Setting and participants This study was conducted in a higher education institution in South Africa that has recently revised its Bachelor of nursing curriculum. Data sources were Bachelor educators and program documents. Methods Individual in-depth interviews were conducted among ten nurse educators. Interviews were complemented with an analysis of the curriculum documents for the Bachelor of nursing program using the BEKA (benchmarking, evidencing, knowing, and applying) model of curriculum analysis and evaluation. Findings Benchmarking and evidencing of the Bachelor of nursing curriculum reveals a high level of compliance with the externally set standards. Both data sources pointed to some degree of incorporating the preconception care concept into the curriculum. The educators perceived that for full integration to occur, preconception care should be taught as a standalone topic. Lack of focus and poor perception was further reported as barriers to introducing the concept. Most preconception care components and services were taught to students throughout the four hundred levels of the nursing program, especially in the sexual and reproductive health module. Gaps were noted in female genital mutilation, mental health, environmental health, preconception vaccination, and other aspects where preconception care needs emphasis. Conclusions There has been a high level of integration of preconception care competency in the Bachelor of nursing curriculum. Especially in the sexual and reproductive health module, most preconception care components are taught to students. However, there is a need to emphasise the preconception nursing management of women with certain conditions. To ensure nurses' role in providing health for all, safeguarding reproductive health, and maintaining the health continuum is enhanced.
Collapse
|
8
|
Ayoola A, Ssekubugu R, Grabowski MK, Ssekasanvu J, Kigozi G, Mustapha A, Reynolds SJ, Ekstrom AM, Nordenstedt H, Enriquez R, Gray RH, Wawer MJ, Kagaayi J, Post WS, Chang LW. Overweight and obesity in south central Uganda: A population-based study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001051. [PMID: 36962650 PMCID: PMC10021145 DOI: 10.1371/journal.pgph.0001051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 10/03/2022] [Indexed: 11/22/2022]
Abstract
Obesity is a rapidly growing global health challenge, but there are few population-level studies from non-urban settings in sub-Saharan Africa. We evaluated the prevalence of overweight (body mass index (BMI)>25 kg/m2), obesity (BMI>30 kg/m2), and associated factors using data from May 2018 to November 2020 from the Rakai Community Cohort Study, a population-based cohort of residents aged 15 to 49 living in forty-one fishing, trading, and agrarian communities in South Central Uganda. Modified Poisson regression was used to estimate adjusted prevalence risk ratios (PRR) and 95% confidence intervals (CI) in 18,079 participants. The overall mean BMI was 22.9 kg/m2. Mean BMI was 21.5 kg/m2 and 24.1 kg/m2 for males and females, respectively. The prevalence of overweight and obesity were 22.8% and 6.2%, respectively. Females had a higher probability of overweight/obesity (PRR: 4.11, CI: 2.98-5.68) than males. For female participants, increasing age, higher socioeconomic status, residing in a trading or fishing community (PRR: 1.25, CI 1.16-1.35 and PRR: 1.17, CI 1.10-1.25, respectively), being currently or previously married (PRR: 1.22, CI 1.07-1.40 and PRR: 1.16, CI 1.01-1.34, respectively), working in a bar/restaurant (PRR: 1.29, CI 1.17-1.45), trading/shopkeeping (PRR: 1.38, CI 1.29-1.48), and reporting alcohol use in the last year (PRR: 1.21, CI 1.10-1.33) were risk factors for overweight/obese. For male participants, increasing age, higher socioeconomic status, being currently married (PRR: 1.94, CI 1.50-2.50), residing in a fishing community (PRR: 1.68, CI 1.40-2.02), working in a bar/restaurant (PRR: 2.20, CI 1.10-4.40), trading/shopkeeping (PRR: 1.75, CI 1.45-2.11), or fishing (PRR: 1.32, CI 1.03-1.69) increased the probability of overweight/obesity. Non-Muslim participants, male smokers, and HIV-positive females had a lower probability of overweight/obese. The prevalence of overweight/obesity in non-urban Ugandans is substantial. Targeted interventions to high-risk subgroups in this population are needed.
Collapse
Affiliation(s)
- Adeoluwa Ayoola
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Stanford University School of Medicine, Stanford, California, United States of America
| | - Robert Ssekubugu
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Mary Kathryn Grabowski
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Joseph Ssekasanvu
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Godfrey Kigozi
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Aishat Mustapha
- Department of Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Steven J. Reynolds
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Division of Intramural Research, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
- Department of Infectious Diseases, South Central Hospital, Stockholm, Sweden
| | - Anna Mia Ekstrom
- Department of Infectious Diseases, South Central Hospital, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
- Department of Medicine and Infectious Diseases, Danderyd University Hospital, Stockholm, Sweden
| | - Helena Nordenstedt
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
- Department of Medicine and Infectious Diseases, Danderyd University Hospital, Stockholm, Sweden
| | - Rocio Enriquez
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Ronald H. Gray
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Maria J. Wawer
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Joseph Kagaayi
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Wendy S. Post
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Larry W. Chang
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| |
Collapse
|
9
|
Quantifying the temporal changes in geographical-level contributions of risk factors to hypertension (2008-2017): Results from national surveys. Prev Med 2022; 163:107222. [PMID: 36027992 DOI: 10.1016/j.ypmed.2022.107222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/06/2022] [Accepted: 08/18/2022] [Indexed: 11/20/2022]
Abstract
South Africa has one of the world's highest proportions of hypertensive individuals, which has become a major public health problem. Understanding the temporal and spatial patterns in hypertension rates is crucial for evaluating the existing prevention and care models, which have not been fully understood in South Africa. The geoadditive models were used to quantify the geographical clustering of hypertension in the Black South African population enrolled in the most recent cross-sectional national surveys (2008-2017). Population-attributable risks were calculated for modifiable risk factors. 80,270 men (41%) and women (59%) aged 15+ were included. Using the 2017 guidelines, 52% of the men and 51% of the women were classified as hypertensive. As expected, these proportions were slightly lower when we used the previous guidelines (48% and 47% for men and women, respectively). There was significant geospatial heterogeneity in hypertension prevalence with substantial province-specific disparities. Western, Northern, and Eastern Capes were the most significant provinces, with >50% of the hypertensive men and women. The population-level impact of obesity remained high in all provinces, where 33%-to-57% and 47%-to-65% of hypertensives were exclusively associated with obese/overweight men and women respectively. Despite some improvements in certain areas, most of the country is behind the targeted levels set in 2011/2013. Identifying the most relevant risk factors and their sub-geographical-level contributions to hypertension may have significant public health implications for developing and implementing cost-effective prevention programs to raise awareness of healthy diet and lifestyle behaviours.
Collapse
|
10
|
Wand H, Vujovich-Dunn C, Moodley J, Reddy T, Naidoo S. Developing and Validating Risk Algorithm for Hypertension in South Africa: Results from a Nationally Representative Cohort (2008-2017). High Blood Press Cardiovasc Prev 2022; 29:451-461. [PMID: 35917033 PMCID: PMC9537209 DOI: 10.1007/s40292-022-00534-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/04/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction There is compelling evidence of significant country-level disparities where African countries, particularly South Africa, have the highest hypertension rates in the world. Aim To develop and validate a simple risk scoring algorithm for hypertension in a large cohort (80,270) of South African men and women. Methods Multivariable logistic regression models were used to build our hypertension risk scoring algorithm and validated externally and internally using the standard statistical techniques. We also compared our risk scores with the results from the Framingham risk prediction model for hypertension. Results Six factors were identified as the significant correlates of hypertension: age, education, obesity, smoking, alcohol intake and exercise. A score of ≥ 25 (out of 57) for men and ≥ 35 (out of 75) for women were selected as the optimum cut-points with 82% (43%) and 83% (49%) sensitivity (specificity) for males and females, respectively in the development datasets. We estimated probabilities of developing hypertension using the Framingham risk prediction model, which were higher among those with higher scores for hypertension. Conclusions Identifying, targeting and prioritising individuals at highest risk of hypertension will have significant impact on preventing severe cardiometabolic diseases by scaling up healthy diet and life-style factors. Our six-item risk scoring algorithm may be included as part of hypertension prevention and treatment programs by targeting older individuals with high body fat measurements who are at highest risk of developing hypertension. Supplementary Information The online version contains supplementary material available at 10.1007/s40292-022-00534-5.
Collapse
Affiliation(s)
- Handan Wand
- Biostatistics and Databases Program, Kirby Institute, University of New South Wales (UNSW Sydney), Level 6, Wallace Wurth Building, Kensington, Sydney, NSW 2052 Australia
| | - Cassandra Vujovich-Dunn
- Biostatistics and Databases Program, Kirby Institute, University of New South Wales (UNSW Sydney), Level 6, Wallace Wurth Building, Kensington, Sydney, NSW 2052 Australia
| | | | - Tarylee Reddy
- Biostatistics Unit, South African Medical Research Council, Durban, Kwazulu-Natal South Africa
| | | |
Collapse
|
11
|
Nglazi MD, Ataguba JE. Socioeconomic inequalities in intergenerational overweight and obesity transmission from mothers to offsprings in South Africa. SSM Popul Health 2022; 19:101170. [PMID: 36033348 PMCID: PMC9399383 DOI: 10.1016/j.ssmph.2022.101170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 06/19/2022] [Accepted: 07/10/2022] [Indexed: 11/25/2022] Open
Abstract
This study assesses socioeconomic inequality in the intergenerational transmission of overweight and obesity from mothers to offsprings in South Africa, including the factors contributing to inequality. Data were drawn from the 2017 National Income Dynamic Study, which collected anthropometric and socioeconomic information. Non-pregnant mothers aged 15–49 years and their offsprings 0–14 years were included in the analysis. The dependent variables used in the study were the intergenerational transmission of overweight and obesity. Socioeconomic inequality was assessed using the concentration index. A positive index means that intergenerational overweight and obesity is more likely among the wealthier populations, while a negative index signifies the opposite. The concentration index was decomposed to understand the factors that explain inequalities in the transmission of overweight and obesity from mothers to offsprings. Concentration indices for the intergenerational transmission of overweight and obesity were positive for boys (0.17) and girls (0.23). Thus the intergenerational transmission of overweight and obesity occurs more among wealthier mothers. Although factors explaining socioeconomic inequality in the intergenerational transmission of overweight and obesity differed by offspring sex, mother's marital status (+38%) and socioeconomic status (around +8%) were central determinants of socioeconomic inequalities in intergenerational overweight, while mother's smoking (around +25%), education (about +13%) and employment status (around +12%) contributed to intergenerational obesity inequality. Policies to reduce overweight and obesity burdens and the intergenerational transmission of overweight and obesity in South Africa should target women who bear a significant burden of overweight and obesity and could transmit them to their offsprings. The policies should also recognise the key factors explaining these socioeconomic inequalities. This approach will reduce the future burden of diseases associated with overweight and obesity in South Africa and improve the country's overall health outcomes. Intergenerational overweight and obesity occurs more among richer mothers. Mother's marital status influenced intergenerational overweight inequality. Intergenerational obesity inequality was attributed to mother's smoking status. Factors explaining intergenerational health inequalities differed by offspring sex.
Collapse
|
12
|
Pourfarzi F, Rezaei S, Zahirian Moghadam T, Zandian H, Dibazar F. The socio-economic inequality in body mass index: a PERSIAN cohort-based cross-sectional study on 20,000 Iranian adults. BMC Endocr Disord 2022; 22:178. [PMID: 35840953 PMCID: PMC9287943 DOI: 10.1186/s12902-022-01096-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 07/11/2022] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION The aim of the present study was to explore and determine the association between BMI and socio-economic factors in Iran. METHODS Adults aged 35 to 70 (n = 20,460) were included from Ardabil Non-Communicable Disease (ArNCD) cohort study. BMI was calculated as kg/m2. Principal Component Analysis (PCA) was used to determine the socio-economic quintiles. Multivariate linear regression was performed to analyze the association of BMI as dependent variable with explanatory variables, Additionally, decomposition analyzing conducted to identify factors that explained wealth-related inequality in obesity. RESULTS The prevalence of overweight and obese people was 83.7% (41.4% overweight and 42.5% obese) wherein the highest frequency of obese people belonged to the age group of 45 to 49 years old (19.9%) and to the illiterate people (33.1%). The results of multivariate linear regression model showed that age, being female, marriage, lower education level, having chronic disease, alcohol use, and higher socioeconomic level positively associated with obesity. The results of the decomposition model showed that the most important variables affecting socioeconomic inequality in higher BMI level were socioeconomic status (75.8%), being women (5.6%), education level (- 4.1%), and having chronic disease (2.4%). CONCLUSION BMI showed significant association with socio-economic status, where richest people had significantly higher BMI than poorest group. Considering the direct role of high BMI in non-communicable diseases, new policies are needed to be developed and implemented by means of diet intervention and increased physical activity to control the BMI in the population of Iran.
Collapse
Affiliation(s)
- Farhad Pourfarzi
- Digestive Disease Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Satar Rezaei
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Telma Zahirian Moghadam
- Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
- Department of Community Medicine, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Hamed Zandian
- Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
- Department of Community Medicine, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Foad Dibazar
- Department of Community Medicine, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| |
Collapse
|
13
|
Direct and Indirect Determinants of Body Mass Index in Both Major Ethnic Groups Experiencing the Nutritional Transition in Cameroon. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106108. [PMID: 35627645 PMCID: PMC9141336 DOI: 10.3390/ijerph19106108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 11/24/2022]
Abstract
In the context of rapid nutritional transitions in Africa, few studies have analyzed the etiology of obesity by considering the driver pathways that predict body mass index (BMI). The aim of this study is to innovatively identify these driver pathways, including the main sociodemographic and socioecological drivers of BMI. We conducted a rural–urban quantitative study in Cameroon (n = 1106; balanced sex ratio) to explore this issue. We recruited participants and reported several sociodemographic characteristics (e.g., marital status, socioeconomic status (SES), and ethnicity). We then assessed three main socioecological drivers of BMI (body weight perception, dietary intake, and physical activity) and conducted bioanthropometric measurements. We identified several driver pathways predicting BMI. In Cameroon, Bamiléké ethnicity, higher SES, being married, and older age had positive effects on BMI through overweight valorization and/or dietary intake. Accordingly, we found that being Bamiléké, married, and middle-aged, as well as having a higher SES, were factors that constituted at-risk subgroups overexposed to drivers of obesity. As such, this study highlights the necessity of investigating the complex driver pathways that lead to obesity. Therefore, better identification of the subgroups at risk for obesity will help in developing more targeted population health policies in countries where this burden is a major public health issue.
Collapse
|
14
|
Bang GA, Nana Oumarou B, Savom EP, Sosso MA. Sleeve gastrectomy in the surgical management of obesity in Cameroon (a sub-Saharan country): A single-institute retrospective review of 30-day postoperative morbidity and mortality. Surg Open Sci 2022; 8:57-61. [PMID: 35392579 PMCID: PMC8980483 DOI: 10.1016/j.sopen.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/03/2022] [Accepted: 03/04/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND METHODS RESULTS CONCLUSION Sleeve gastrectomy is a safe procedure in a sub-Saharan African low setting. Bleeding is the only intraoperative complication encountered in 14.3% of cases. The prevalence of 30-day postoperative morbidity of sleeve gastrectomy is 38.1%. Postoperative 30-day complications after sleeve gastrectomy are minor. The 30-day postoperative mortality after sleeve gastrectomy is nil.
Collapse
Affiliation(s)
- Guy Aristide Bang
- Digestive and Laparoscopic Surgery Unit, National Insurance Fund Health Centre of Essos, Yaoundé, Cameroon
- Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Corresponding author at: Department of Surgery and Specialities, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, PO Box: 1364, Yaoundé, Cameroon.
| | - Blondel Nana Oumarou
- Digestive and Laparoscopic Surgery Unit, National Insurance Fund Health Centre of Essos, Yaoundé, Cameroon
| | - Eric Patrick Savom
- Digestive and Laparoscopic Surgery Unit, National Insurance Fund Health Centre of Essos, Yaoundé, Cameroon
- Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Maurice Aurélien Sosso
- Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| |
Collapse
|
15
|
Zhu S, Sun C, Zhang L, Du X, Tan X, Peng S. Incidence Trends and Survival Prediction of Malignant Skin Cancer: A SEER-Based Study. Int J Gen Med 2022; 15:2945-2956. [PMID: 35313550 PMCID: PMC8934145 DOI: 10.2147/ijgm.s340620] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/24/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Methods Results Conclusion
Collapse
Affiliation(s)
- Sirong Zhu
- School of Public Health, Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Chao Sun
- School of Public Health, Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Longjiang Zhang
- School of Public Health, Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Xiaoan Du
- School of Public Health, Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Xiaodong Tan
- School of Public Health, Wuhan University, Wuhan, Hubei, People’s Republic of China
- School of Nursing, Wuchang University of Technology, Wuhan, Hubei, People’s Republic of China
- Correspondence: Xiaodong Tan; Shuzhen Peng, Email ;
| | - Shuzhen Peng
- The People’s Hospital of Huangpi, Wuhan, Hubei, People’s Republic of China
| |
Collapse
|
16
|
Nglazi MD, Ataguba JEO. Overweight and obesity in non-pregnant women of childbearing age in South Africa: subgroup regression analyses of survey data from 1998 to 2017. BMC Public Health 2022; 22:395. [PMID: 35216565 PMCID: PMC8874296 DOI: 10.1186/s12889-022-12601-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 01/19/2022] [Indexed: 11/14/2022] Open
Abstract
Background Overweight and obesity in adults are increasing globally and in South Africa (SA), contributing substantially to deaths and disability from non-communicable diseases. Compared to men, women suffer a disproportionate burden of obesity, which adversely affects their health and that of their offspring. This study assessed the changing patterns in prevalence and determinants of overweight and obesity among non-pregnant women in SA aged 15 to 49 years (women of childbearing age (WCBA)) between 1998 and 2017. Methods This paper conducts secondary data analysis of seven consecutive nationally representative household surveys—the 1998 and 2016 SA Demographic and Health Surveys, 2008, 2010–2011, 2012, 2014–2015 and 2017 waves of the National Income Dynamics Survey, containing anthropometric and sociodemographic data. The changing patterns of the overweight and obesity prevalence were assessed across key variables. The inferential assessment was based on a standard t-test for the prevalence. Adjusted odds ratios from logistic regression analysis were used to examine the factors associated with overweight and obesity at each time point. Results Overweight and obesity prevalence among WCBA in SA increased from 51.3 to 60.0% and 24.7 to 35.2%, respectively, between 1998 and 2017. The urban-rural disparities in overweight and obesity decreased steadily between 1998 and 2017. The prevalence of overweight and obesity among WCBA varied by age, population group, location, current smoking status and socioeconomic status of women. For most women, the prevalence of overweight and/or obesity in 2017 was significantly higher than in 1998. Significant factors associated with being overweight and obese included increased age, self-identifying with the Black African population group, higher educational attainment, urban area residence, and wealthier socioeconomic quintiles. Smoking was inversely related to being overweight and obese. Conclusions The increasing trend in overweight and obesity in WCBA in SA demands urgent public health attention. Increased public awareness is needed about obesity and its health consequences for this vulnerable population. Efforts are needed across different sectors to prevent excessive weight gain in WCBA, focusing on older women, self-identified Black African population group, women with higher educational attainment, women residing in urban areas, and wealthy women.
Collapse
Affiliation(s)
- Mweete Debra Nglazi
- Health Economics Unit, School of Public Health & Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, 7925, South Africa.
| | - John Ele-Ojo Ataguba
- Health Economics Unit, School of Public Health & Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, 7925, South Africa.,Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| |
Collapse
|
17
|
Thamrin SA, Arsyad DS, Kuswanto H, Lawi A, Arundhana AI. Obesity Risk-Factor Variation Based on Island Clusters: A Secondary Analysis of Indonesian Basic Health Research 2018. Nutrients 2022; 14:nu14050971. [PMID: 35267946 PMCID: PMC8912714 DOI: 10.3390/nu14050971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 02/01/2023] Open
Abstract
Obesity has become a rising global health problem affecting quality of life for adults. The objective of this study is to describe the prevalence of obesity in Indonesian adults based on the cluster of islands. The study also aims to identify the risk factors of obesity in each island cluster. This study analyzes the secondary data of Indonesian Basic Health Research 2018. Data for this analysis comprised 618,910 adults (≥18 years) randomly selected, proportionate to the population size throughout Indonesia. We included 20 variables for the socio-demographic and obesity-related risk factors for analysis. The obesity status was defined using Body Mass Index (BMI) ≥ 25 kg/m2. Our current study defines 7 major island clusters as the unit analysis consisting of 34 provinces in Indonesia. Descriptive analysis was conducted to determine the characteristics of the population and to calculate the prevalence of obesity within the provinces in each of the island clusters. Multivariate logistic regression analyses to calculate the odds ratios (ORs) was performed using SPSS version 27. The study results show that all the island clusters have at least one province with an obesity prevalence above the national prevalence (35.4%). Six out of twenty variables, comprising four dietary factors (the consumption of sweet food, high-salt food, meat, and carbonated drinks) and one psychological factor (mental health disorders), varied across the island clusters. In conclusion, there was a variation of obesity prevalence of the provinces within and between island clusters. The variation of risk factors found in each island cluster suggests that a government rethink of the current intervention strategies to address obesity is recommended.
Collapse
Affiliation(s)
- Sri Astuti Thamrin
- Department of Statistics, Faculty of Mathematics and Natural Science, Universitas Hasanuddin, Makassar 90245, Indonesia;
- Correspondence: ; Tel./Fax: +62-(411)-588-551
| | - Dian Sidik Arsyad
- Department of Epidemiology, Faculty of Public Health, Universitas Hasanuddin, Makassar 90245, Indonesia;
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, 3584CS Utrecht, The Netherlands
| | - Hedi Kuswanto
- Department of Statistics, Faculty of Mathematics and Natural Science, Universitas Hasanuddin, Makassar 90245, Indonesia;
| | - Armin Lawi
- Department of Mathematics, Faculty of Mathematics and Natural Science, Universitas Hasanuddin, Makassar 90245, Indonesia;
| | - Andi Imam Arundhana
- Department of Nutrition, Faculty of Public Health, Universitas Hasanuddin, Makassar 90245, Indonesia;
- Central Clinical School, Faculty of Medicine and Health Science, The University of Sydney, Sydney 2050, Australia
| |
Collapse
|
18
|
Chukwuonye II, Ohagwu KA, Ogah OS, John C, Oviasu E, Anyabolu EN, Ezeani IU, Iloh GUP, Chukwuonye ME, Raphael CO, Onwuchekwa U, Okafor UH, Oladele C, Obi EC, Okwuonu CG, Iheji O, Nwabuko OC, Nnoli MA, Okpechi IG. Prevalence of overweight and obesity in Nigeria: Systematic review and meta-analysis of population-based studies. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000515. [PMID: 36962450 PMCID: PMC10021772 DOI: 10.1371/journal.pgph.0000515] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 05/01/2022] [Indexed: 11/19/2022]
Abstract
In Nigeria, several studies have assessed the prevalence of overweight/obesity with different reports. The purpose of this study was to use a systematic review and meta-analysis to analyze these overweight and obesity reports from different locations in Nigeria over the last ten years. In addition, there was a dearth of systematic reviews and meta-analyses on the prevalence, trends, and demographic characteristics of overweight and obesity in the country. This was a systematic review and meta-analysis of cross-sectional population-based studies among adult Nigerians on the prevalence of overweight/ obesity (defined by body mass index) published from January 2010 to December 2020. Relevant abstracts were scrutinized and articles that included adults of all age groups and were not restricted to a particular group of people (e.g. university community) were selected. Each article was scrutinized by more than 2 authors before selection. The prevalence of overweight/obesity among all participants, among men and among women in Nigeria and its 6 geopolitical zones was determined. All analyses were performed using STATA version 14 (Stata Corp. College Station, Texas, USA). Thirty-three studies were selected and the number of participants was 37,205. The estimated prevalence of overweight and obesity was 27.6%, and 14.5% respectively. The prevalence of overweight among men and among women was 26.3% and 28.3% respectively and, the prevalence of obesity among men and women was 10.9% and 23.0% respectively. The prevalence of overweight in the 6 geopolitical zones was Southeast 29.3%, Southwest 29.3%, South-south 27.9%, Northwest 27.2%, North-central 25.3%, Northeast 20.0% and obesity South-south 24.7%, Southeast 15.7%, Southwest 13.9%, Northwest 10.4%, North-central 10.2%, Northeast 6.4%. Egger's tests showed no statistically significant publication bias among the studies that reported the overweight and obesity prevalence respectively (p = 0.225, P 0.350). The prevalence of overweight/obesity in Nigeria is high. The southern geopolitical zones had a higher prevalence of overweight/obesity.
Collapse
Affiliation(s)
| | - Kenneth Arinze Ohagwu
- Department of Internal Medicine, Federal Medical Centre Umuahia, Umuahia, Nigeria
- General Medicine and Emergency Care, West Cumberland Hospital, Cumbria, Emgland
| | - Okechukwu Samuel Ogah
- Department of Internal Medicine, University College Hospital, University of Ibadan, Ibadan, Nigeria
| | - Collins John
- Department of Paediatrics, Jos University Teaching Hospital Jos, Katon Rikkos, Nigeria
| | - Efosa Oviasu
- Department of Internal Medicine, University of Benin Teaching Hospital, Benin, Nigeria
| | - Ernest Ndukaife Anyabolu
- Department of Internal Medicine, Chukwuemeka Odumegwu Ojukwu University Teaching Hospital Awka, Awka, Nigeria
| | | | | | | | - Caleb Ogechi Raphael
- Department of Dietetics and Nutrition, Jos University Teaching Hospital, Jos, Nigeria
| | - Uwa Onwuchekwa
- Department of Internal Medicine, Abia State University Teaching Hospital, Aba, Nigeria
| | | | - Clement Oladele
- Department of Internal Medicine, Federal Medical Centre Bida, Bida, Nigeria
| | - Emmanuel Chukwuebuka Obi
- Department of Internal Medicine, Federal Medical Centre Umuahia, Umuahia, Nigeria
- Department of Internal Medicine, Federal Medical Centre Bida, Bida, Nigeria
| | | | - Okechukwu Iheji
- Department of Internal Medicine, Federal Medical Centre Umuahia, Umuahia, Nigeria
| | | | - Martin Anazodo Nnoli
- Department of Pathology, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Ikechi G Okpechi
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
19
|
Manafe M, Chelule PK, Madiba S. Views of Own Body Weight and the Perceived Risks of Developing Obesity and NCDs in South African Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111265. [PMID: 34769782 PMCID: PMC8583329 DOI: 10.3390/ijerph182111265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 11/16/2022]
Abstract
Obesity has become a serious public health problem worldwide and is linked to an increased risk of non-communicable diseases (NCDs). Poor self-perception of body weight is postulated to play a negative role in curbing increased rates of obesity. This study investigated the views of own body weight and perceived risk of developing NCDs in South African adults. This was a community-based quantitative study. Descriptive statistics were used, and logistic regression analysis was conducted on the data. A total of 1050 respondents took part in the study. Of the 161 respondents who perceived themselves to be normal weight, 98.8% (n = 159) misperceived their body weight. The majority of respondents (>90%) who were overweight according to the calculated BMI perceived no risk of developing obesity-related diseases. Most of the respondents, 46% (n = 253), believed that body weight was influenced by heredity. The method used for weight loss by 57% (n = 173) of the respondents was exercising at home. There was a statistically significant association between Body Mass Index (BMI), employment status, risk of developing diabetes, and body weight misperception (p < 0.05). Misperception of body weight was common among the study respondents and may influence weight control intervention strategies. Health promotion targeting personal behaviour, such as body weight self-perception, is crucial in supporting targeted strategies to address obesity in South Africa.
Collapse
Affiliation(s)
- Mashudu Manafe
- Department of Human Nutrition & Dietetics, Sefako Makgatho Health Sciences University, Pretoria 0001, South Africa
- Correspondence: ; Tel.: +27-829636751 or +27-125214547
| | - Paul K. Chelule
- Department of Public Health, Sefako Makgatho Health Sciences University, Pretoria 0001, South Africa; (P.K.C.); (S.M.)
| | - Sphiwe Madiba
- Department of Public Health, Sefako Makgatho Health Sciences University, Pretoria 0001, South Africa; (P.K.C.); (S.M.)
| |
Collapse
|
20
|
Akokuwebe ME, Idemudia ES. Prevalence and Socio-Demographic Correlates of Body Weight Categories Among South African Women of Reproductive Age: A Cross-Sectional Study. Front Public Health 2021; 9:715956. [PMID: 34760860 PMCID: PMC8572979 DOI: 10.3389/fpubh.2021.715956] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 09/13/2021] [Indexed: 02/02/2023] Open
Abstract
Background: The shift in disease patterns has been connected with increased body weight burden, becoming a major public health concern in South Africa, as previous studies have assessed overweight or obesity among certain populations. However, little is known about bodyweight burden (underweight, overweight, and obesity) among women aged 15-49 years. Therefore, this study was conducted to identify the prevalence and its associated socio-demographic correlates of bodyweight categories among women of reproductive age in South Africa. Methods: The present study used the South Africa Demographic Health Survey (2016 SADHS) data for 2016. A total of 3,263 women of reproductive age were included in the analysis. Both bivariable and multivariable logistics regressions were performed to determine the prevalence and socio-demographic correlates of bodyweight categories among women in South Africa. Thus, this study used the criteria of the WHO standard body mass index (BMI) cut-offs to classify bodyweight categories. The odds ratios (ORs) with 95% CIs were estimated for potential determinants included in the final model. Results: The overall prevalence of body weight burden was 66.5%, with 4.9% underweight, 27.1% overweight, and 34.5% obese (p < 0.05). The identified factors associated with underweight among women of reproductive age were those from "other" population group [adjusted odds ratio (AOR) 2.65: 95% CI 1.40-5.00], rural residence (AOR 1.23: 95% CI 0.75-2.02), and Northern Cape Province (AOR 1.58: 95% CI 0.65-3.87). For overweight/obese, the main factors were those aged 45-49 years (AOR 10.73: 95% CI 7.41-15.52), tertiary education (AOR 1.41: 95% CI 0.97-2.03), and residing in Eastern Cape (AOR 1.27: 95% CI 0.82-1.99) and KwaZulu-Natal Provinces (AOR 1.20: 95% CI 0.78-1.84). Conclusion: The findings presented in this study indicate the concurrence of underweight and overweight/obese among women aged 15-49 years in South Africa. Despite underweight prevalence being on the decline, yet overweight/obese is increasing over time. The health implication of body weight burden needs rapid and effective interventions, focusing on factors such as rural, education, population group, older age 45-49 years, and Provinces (Northern Cape, Eastern Cape, and KwaZulu-Natal) - the high-risk groups identified herein are of most importance to curb the growing burden among South African women of reproductive age.
Collapse
|
21
|
Bell D, Schultz Hansen K. Relative Burdens of the COVID-19, Malaria, Tuberculosis, and HIV/AIDS Epidemics in Sub-Saharan Africa. Am J Trop Med Hyg 2021; 105:1510-1515. [PMID: 34634773 PMCID: PMC8641365 DOI: 10.4269/ajtmh.21-0899] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/10/2021] [Indexed: 02/01/2023] Open
Abstract
COVID-19 has had considerable global impact; however, in sub-Saharan Africa, it is one of several infectious disease priorities. Prioritization is normally guided by disease burden, but the highly age-dependent nature of COVID-19 and that of other infectious diseases make comparisons challenging unless considered through metrics that incorporate life-years lost and time lived with adverse health. Therefore, we compared the 2020 mortality and disability-adjusted life-years (DALYs) lost estimates for malaria, tuberculosis, and HIV/AIDS in sub-Saharan African populations with more than 12 months of COVID-19 burden (until the end of March 2021) by applying known age-related mortality to United Nations estimates of the age structure. We further compared exacerbations of disease burden predicted from the COVID-19 public health response. Data were derived from public sources and predicted exacerbations were derived from those published by international agencies. For sub-Saharan African populations north of South Africa, the estimated recorded COVID-19 DALYs lost in 2020 were 3.7%, 2.3%, and 2.4% of those for tuberculosis, HIV/AIDS, and malaria, respectively. Predicted exacerbations of these diseases were greater than the estimated COVID-19 burden. Including South Africa and Lesotho, COVID-19 DALYs lost were < 12% of those for other compared diseases; furthermore, the mortality of compared diseases were dominant in all age groups younger than 65 years. This analysis suggests the relatively low impact of COVID-19. Although all four epidemics continue, tuberculosis, HIV/AIDS, and malaria remain far greater health priorities based on their disease burdens. Therefore, resource diversion to COVID-19 poses a high risk of increasing the overall disease burden and causing net harm, thereby further increasing global inequities in health and life expectancy.
Collapse
Affiliation(s)
- David Bell
- Independent Consultant, Issaquah, Washington
| | - Kristian Schultz Hansen
- Department of Public Health and Centre for Health Economics and Policy, University of Copenhagen, Copenhagen, Denmark
- The National Research Center of Working Environment, Copenhagen, Denmark
| |
Collapse
|
22
|
Gradidge PJL, Draper CE, Casteleijn D, Palmeira A. Pharmaceutical workers' perceptions of physical activity and healthy eating: a qualitative study. BMC Res Notes 2021; 14:350. [PMID: 34496969 PMCID: PMC8425005 DOI: 10.1186/s13104-021-05765-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 08/27/2021] [Indexed: 11/10/2022] Open
Abstract
Objective The public health message ‘move for health’ is relevant given the high prevalence of insufficient physical activity, particularly in African countries. The call for behaviour modification including limiting unhealthy dietary patterns in these settings is therefore critical; however, there is limited knowledge on the adoption of health promotion strategies in the workplace. This study aimed to investigate workers’ perceptions of physical activity and healthy eating. Results Five focus groups were conducted with 28 participants employed in a South African pharmaceutical manufacturing company to explore perceptions of physical activity and healthy eating. Results showed that two categories emerged: physical activity and unhealthy behaviours. Participants recognised the importance of obtaining sufficient physical activity in various domains, however believed that contemporary lifestyle limited opportunities for movement. Likewise, participants viewed healthy eating as unrealistic due to financial constraints. There was however agreement that total physical activity time could be increased during recreational pursuits outside of vocational time and may include intermittent walking for travel. These findings are important for workplace interventions and provide a more robust understanding of workers’ perceptions of physical activity and healthy eating. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-021-05765-8.
Collapse
Affiliation(s)
- Philippe Jean-Luc Gradidge
- Centre for Exercise Science and Sports Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Catherine E Draper
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Daleen Casteleijn
- Occupational Therapy Department, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - António Palmeira
- CIDEFES, University Lusóphone, Lisbon, Portugal.,Executive Director, International Society of Behavioral Nutrition and Physical Activity (ISBNPA), Minneapolis, MN, United States of America
| |
Collapse
|
23
|
Agustina R, Meilianawati, Fenny, Atmarita, Suparmi, Susiloretni KA, Lestari W, Pritasari K, Shankar AH. Psychosocial, Eating Behavior, and Lifestyle Factors Influencing Overweight and Obesity in Adolescents. Food Nutr Bull 2021; 42:S72-S91. [PMID: 34282658 DOI: 10.1177/0379572121992750] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Adolescent overweight and obesity (AOO) is a global public health problem and risk for noncommunicable diseases. Understanding context-specific risks is crucial for interventions. OBJECTIVE Determine the prevalence of AOO in the Indonesian National Health Survey (INHS) 2013, assess the 5-year trend from 2013 to 2018, and identify risks. METHODS We selected adolescents aged 10 to 19 years (n = 174 290) from the INHS 2013 and used hierarchical logistic regression to identify gender-specific risks for those aged 15 to 19 years (n = 77 534). Change in AOO was assessed by comparison to INHS 2018 reports. RESULTS The national AOO prevalence increased over 5 years by 48% in young adolescents (13-15 years) and 85% in older ones (16-18 years). High prevalence areas included the urban location of Jakarta (20.9%) and the remote rural region of Papua (19.4%). Overall, AOO risks were being sedentary, male, lower education, married, younger adolescent, and school enrollment, with urban residence and higher wealth being persistent risks for all analyses. Data for depressive symptoms were available for older adolescents whose additional risks were being sedentary, depressive symptoms, and high-fat diet. Male risks were being sedentary and lower education, and female risks were being married, depressive symptoms, high-fat intake, and lower education. Higher intake of fruits and vegetables and fewer sweets did not protect against AOO if a high-fat diet was consumed. CONCLUSIONS Adolescent overweight and obesity in Indonesia is rapidly increasing, especially in older adolescents and males, and with gender-specific risks. Customized multisectoral interventions to identify strategies for lifestyle change are urgently needed.
Collapse
Affiliation(s)
- Rina Agustina
- Department of Nutrition, 95338Faculty of Medicine, Universitas Indonesia-Dr. Cipto, Mangunkusumo General Hospital, Jakarta, Indonesia.,Human Nutrition Research Center, Indonesian Medical Education and Research Institute (HNRC-IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Meilianawati
- Department of Nutrition, 95338Faculty of Medicine, Universitas Indonesia-Dr. Cipto, Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Fenny
- Department of Nutrition, 95338Faculty of Medicine, Universitas Indonesia-Dr. Cipto, Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Atmarita
- National Institute of Health Research and Development (NIHRD), Ministry of Health, Jakarta, Indonesia
| | - Suparmi
- National Institute of Health Research and Development (NIHRD), Ministry of Health, Jakarta, Indonesia
| | - Kun A Susiloretni
- Semarang Health Polytechnic Ministry of Health-Poltekkes Kemenkes Semarang, Indonesia
| | - Wiji Lestari
- Department of Nutrition, 95338Faculty of Medicine, Universitas Indonesia-Dr. Cipto, Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Kirana Pritasari
- Directorate of Public Health, Ministry of Health, Jakarta, Indonesia
| | - Anuraj H Shankar
- Centre for Tropical Medicine and Global Health, Oxford University, Oxford, UK
| |
Collapse
|
24
|
Risk factors for overweight and obesity among women of reproductive age in Dar es Salaam, Tanzania. BMC Nutr 2021; 7:37. [PMID: 34266482 PMCID: PMC8283918 DOI: 10.1186/s40795-021-00445-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/24/2021] [Indexed: 11/11/2022] Open
Abstract
Background Overweight and obesity have increased considerably in low- and middle-income countries over the past few decades, particularly among women of reproductive age. This study assessed the role of physical activity, nutrient intake and risk factors for overweight and obesity among women in Dar es Salaam, Tanzania. Methods We conducted a cross-sectional survey among 1004 women aged 15–49 years in the Dar es Salaam Urban Cohort Study (DUCS) from September 2018 to January 2019. Dietary intake was assessed using a food frequency questionnaire (FFQ). Physical activity was assessed using the Global Physical Activity Questionnaire (GPAQ) using metabolic equivalent tasks (MET). Modified poison regression models were used to evaluate associations between physical activity and nutrient intake with overweight/obesity in women, controlling for energy and other factors. Results The mean (±SD) age of study women was 30.2 (±8.1) years. Prevalence of overweight and obesity was high (50.4%), and underweight was 8.6%. The risk of overweight/obesity was higher among older women (35–49 vs 15–24 years: PR 1.59; 95% CI: 1.30–1.95); women of higher wealth status (PR 1.24; 95% CI: 1.07–1.43); and informally employed and married women. Attaining moderate to high physical activity (≥600 MET) was inversely associated with overweight/obesity (PR 0.79; 95% CI: 0.63–0.99). Dietary sugar intake (PR 1.27; 95% CI: 1.03–1.58) was associated with increased risk, and fish and poultry consumption (PR 0.78; 95% CI: 0.61–0.99) with lower risk of overweight/obesity. Conclusion Lifestyle (low physical activity and high sugar intake), age, wealth status, informal employment and marital status were associated with increased risk of overweight/obesity, while consumption of fish and poultry protein was associated with lower risk. The study findings underscore the need to design feasible and high-impact interventions to address physical activity and healthy diets among women in Tanzania.
Collapse
|
25
|
Kirschbaum TK, Theilmann M, Sudharsanan N, Manne-Goehler J, Lemp JM, De Neve JW, Marcus ME, Ebert C, Chen S, Aryal KK, Bahendeka SK, Norov B, Damasceno A, Dorobantu M, Farzadfar F, Fattahi N, Gurung MS, Guwatudde D, Labadarios D, Lunet N, Rayzan E, Saeedi Moghaddam S, Webster J, Davies JI, Atun R, Vollmer S, Bärnighausen T, Jaacks LM, Geldsetzer P. Targeting Hypertension Screening in Low- and Middle-Income Countries: A Cross-Sectional Analysis of 1.2 Million Adults in 56 Countries. J Am Heart Assoc 2021; 10:e021063. [PMID: 34212779 PMCID: PMC8403275 DOI: 10.1161/jaha.121.021063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background As screening programs in low‐ and middle‐income countries (LMICs) often do not have the resources to screen the entire population, there is frequently a need to target such efforts to easily identifiable priority groups. This study aimed to determine (1) how hypertension prevalence in LMICs varies by age, sex, body mass index, and smoking status, and (2) the ability of different combinations of these variables to accurately predict hypertension. Methods and Results We analyzed individual‐level, nationally representative data from 1 170 629 participants in 56 LMICs, of whom 220 636 (18.8%) had hypertension. Hypertension was defined as systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or reporting to be taking blood pressure–lowering medication. The shape of the positive association of hypertension with age and body mass index varied across world regions. We used logistic regression and random forest models to compute the area under the receiver operating characteristic curve in each country for different combinations of age, body mass index, sex, and smoking status. The area under the receiver operating characteristic curve for the model with all 4 predictors ranged from 0.64 to 0.85 between countries, with a country‐level mean of 0.76 across LMICs globally. The mean absolute increase in the area under the receiver operating characteristic curve from the model including only age to the model including all 4 predictors was 0.05. Conclusions Adding body mass index, sex, and smoking status to age led to only a minor increase in the ability to distinguish between adults with and without hypertension compared with using age alone. Hypertension screening programs in LMICs could use age as the primary variable to target their efforts.
Collapse
Affiliation(s)
- Tabea K Kirschbaum
- Heidelberg Institute of Global Health Medical Faculty and University Hospital University of Heidelberg Germany
| | - Michaela Theilmann
- Heidelberg Institute of Global Health Medical Faculty and University Hospital University of Heidelberg Germany
| | - Nikkil Sudharsanan
- Heidelberg Institute of Global Health Medical Faculty and University Hospital University of Heidelberg Germany
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases Massachusetts General HospitalHarvard Medical School Boston MA
| | - Julia M Lemp
- Heidelberg Institute of Global Health Medical Faculty and University Hospital University of Heidelberg Germany
| | - Jan-Walter De Neve
- Heidelberg Institute of Global Health Medical Faculty and University Hospital University of Heidelberg Germany
| | - Maja E Marcus
- Department of Economics and Centre for Modern Indian Studies University of Goettingen Germany
| | - Cara Ebert
- RWI-Leibniz Institute for Economic Research Berlin Germany
| | - Simiao Chen
- Heidelberg Institute of Global Health Medical Faculty and University Hospital University of Heidelberg Germany.,Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Krishna K Aryal
- Monitoring Evaluation and Operational Research Project Abt Associates Kathmandu Nepal
| | | | | | | | - Maria Dorobantu
- Cardiology Department Emergency Hospital of Bucharest Romania
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center Endocrinology and Metabolism Population Sciences Institute Tehran University of Medical Sciences Tehran Iran
| | - Nima Fattahi
- Non-Communicable Diseases Research Center Endocrinology and Metabolism Population Sciences Institute Tehran University of Medical Sciences Tehran Iran
| | - Mongal S Gurung
- Health Research and Epidemiology Unit Policy and Planning Division Ministry of Health Thimphu Bhutan
| | - David Guwatudde
- Department of Epidemiology and Biostatistics School of Public Health Makerere University Kampala Uganda
| | - Demetre Labadarios
- Faculty of Medicine and Health Sciences Stellenbosch University Stellenbosch South Africa
| | - Nuno Lunet
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica Faculdade de Medicina da Universidade do Porto Porto Portugal
| | - Elham Rayzan
- Non-Communicable Diseases Research Center Endocrinology and Metabolism Population Sciences Institute Tehran University of Medical Sciences Tehran Iran
| | - Sahar Saeedi Moghaddam
- Endocrinology and Metabolism Research Center Endocrinology and Metabolism Clinical Sciences Institute Tehran University of Medical Sciences Tehran Iran
| | - Jacqui Webster
- The George Institute for Global HealthUniversity of New South Wales Sydney Australia
| | - Justine I Davies
- Institute of Applied Health Research University of Birmingham United Kingdom.,Centre for Global Surgery Department of Global Health Stellenbosch University Cape Town South Africa.,Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit Faculty of Health Sciences School of Public Health University of the Witwatersrand Johannesburg South Africa
| | - Rifat Atun
- Department of Global Health and Population Harvard T.H. Chan School of Public Health Boston MA
| | - Sebastian Vollmer
- Department of Economics and Centre for Modern Indian Studies University of Goettingen Germany
| | - Till Bärnighausen
- Heidelberg Institute of Global Health Medical Faculty and University Hospital University of Heidelberg Germany.,Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Lindsay M Jaacks
- Department of Global Health and Population Harvard T.H. Chan School of Public Health Boston MA.,Public Health Foundation of India New Delhi India.,Global Academy of Agriculture and Food Security The University of Edinburgh Midlothian United Kingdom
| | - Pascal Geldsetzer
- Heidelberg Institute of Global Health Medical Faculty and University Hospital University of Heidelberg Germany.,Division of Primary Care and Population Health Department of Medicine Stanford University Stanford CA
| |
Collapse
|
26
|
Macharia PM, Joseph NK, Snow RW, Sartorius B, Okiro EA. The impact of child health interventions and risk factors on child survival in Kenya, 1993-2014: a Bayesian spatio-temporal analysis with counterfactual scenarios. BMC Med 2021; 19:102. [PMID: 33941185 PMCID: PMC8094495 DOI: 10.1186/s12916-021-01974-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/25/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND During the millennium development goals period, reduction in under-five mortality (U5M) and increases in child health intervention coverage were characterised by sub-national disparities and inequities across Kenya. The contribution of changing risk factors and intervention coverage on the sub-national changes in U5M remains poorly defined. METHODS Sub-national county-level data on U5M and 43 factors known to be associated with U5M spanning 1993 and 2014 were assembled. Using a Bayesian ecological mixed-effects regression model, the relationships between U5M and significant intervention and infection risk ecological factors were quantified across 47 sub-national counties. The coefficients generated were used within a counterfactual framework to estimate U5M and under-five deaths averted (U5-DA) for every county and year (1993-2014) associated with changes in the coverage of interventions and disease infection prevalence relative to 1993. RESULTS Nationally, the stagnation and increase in U5M in the 1990s were associated with rising human immunodeficiency virus (HIV) prevalence and reduced maternal autonomy while improvements after 2006 were associated with a decline in the prevalence of HIV and malaria, increase in access to better sanitation, fever treatment-seeking rates and maternal autonomy. Reduced stunting and increased coverage of early breastfeeding and institutional deliveries were associated with a smaller number of U5-DA compared to other factors while a reduction in high parity and fully immunised children were associated with under-five lives lost. Most of the U5-DA occurred after 2006 and varied spatially across counties. The highest number of U5-DA was recorded in western and coastal Kenya while northern Kenya recorded a lower number of U5-DA than western. Central Kenya had the lowest U5-DA. The deaths averted across the different regions were associated with a unique set of factors. CONCLUSION Contributions of interventions and risk factors to changing U5M vary sub-nationally. This has important implications for targeting future interventions within decentralised health systems such as those operated in Kenya. Targeting specific factors where U5M has been high and intervention coverage poor would lead to the highest likelihood of sub-national attainment of sustainable development goal (SDG) 3.2 on U5M in Kenya.
Collapse
Affiliation(s)
- Peter M. Macharia
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Noel K. Joseph
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Robert W. Snow
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Benn Sartorius
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA USA
| | - Emelda A. Okiro
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| |
Collapse
|
27
|
Simo LP, Agbor VN, Temgoua FZ, Fozeu LCF, Bonghaseh DT, Mbonda AGN, Yurika R, Dotse-Gborgbortsi W, Mbanya D. Prevalence and factors associated with overweight and obesity in selected health areas in a rural health district in Cameroon: a cross-sectional analysis. BMC Public Health 2021; 21:475. [PMID: 33691650 PMCID: PMC7944596 DOI: 10.1186/s12889-021-10403-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 02/07/2021] [Indexed: 12/28/2022] Open
Abstract
Background Overweight and obesity are major public health problems worldwide, with projections suggesting a proportional increase in the number of affected individuals in developing countries by the year 2030. Evidence-based preventive strategies are needed to reduce the burden of overweight and obesity in developing countries. We assessed the prevalence of, and factors associated with overweight and obesity in selected health areas in West Cameroon. Methods Data were collected from a community-based cross-sectional study, involving the consecutive recruitment of participants aged 18 years or older. Overweight and obesity were defined according to the WHO classification. The statistical software R (version 3.5.1, The R Foundation for statistical computing, Vienna, Austria) was used for statistical analysis. Multivariable logistic regression analysis was used to assess independent factors associated with overweight and obesity, and obesity. Results Records of 485 participants were included for analysis. The age and sex-standardized prevalence of overweight, obesity, and overweight and obesity were 31.1% (95% CI, 27.0–35.2), 18.9% (95% CI, 14.9–22.9), and 50.1% (95% CI, 45.7–54.6), respectively. In multivariable analysis, being female (adjusted OR [aOR] = 2.79, 95% CI = 1.69–4.63), married (aOR = 3.90, 95% CI = 2.23–6.95), and having secondary or tertiary education (aOR = 3.27, 95% CI = 1.77–6.17) were associated with higher odds of overweight and obesity, while current smokers had lower odds of overweight and obesity (aOR = 0.37, 95% CI = 0.16–0.82) when compared to their respective counterpart. Compared to their respective reference categories, being female being (aOR = 3.74, 95% CI = 2.01–7.30), married (aOR = 2.58, 95% CI = 1.37–5.05) and having secondary or tertiary education (aOR = 2.03, 95% CI = 1.00–4.23) were associated with higher odds of obesity after adjustments for confounding. Conclusion We observed a high prevalence of overweight and obesity in this study. The odds of overweight and obesity was higher in females, married participants, and those with higher levels of education. Community-based interventions to control overweight and obesity should consider targeting these groups. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10403-w.
Collapse
Affiliation(s)
- Larissa Pone Simo
- Clinical Research Education, Networking & Consultancy (CRENC), Douala, Cameroon
| | - Valirie Ndip Agbor
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK. .,Department of Clinical Research, Health Education and Research Organization (HERO), Douala, Cameroon.
| | | | | | | | | | - Raymond Yurika
- Technical Group for Tuberculosis Control, North West Regional Delegation of Public Health, Bamenda, Cameroon
| | - Winfred Dotse-Gborgbortsi
- School of Geography and Environmental Science, Highfield, University of Southampton, Southampton, SO17 1BJ, UK
| | - Dora Mbanya
- Faculty of Health Sciences, the University of Bamenda, Bamenda, Cameroon.,Yaoundé University Teaching Hospital (YUTH), Yaoundé, Cameroon
| |
Collapse
|
28
|
COVID-19 and Vulnerable Populations in Sub-Saharan Africa. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021. [PMID: 33656721 DOI: 10.1007/978-3-030-59261-5_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
The novel corona virus 2019 (COVID-19) outbreak which started in Hubei province in China has now spread to every corner of the earth. While the pandemic started later in Africa, it is now found in all African countries to varying degrees. It is thought that the prevalence and severity of disease is influenced by a number of non-communicable diseases (NCDs) which are all becoming increasingly prevalent in sub-Saharan Africa (SSA). In addition, SSA bears the major burden of human immunodeficiency virus (HIV) and tuberculosis (TB) infections. While data from Europe and the United States show that children are spared severe disease, it is uncertain if the same holds true in SSA where children suffer from sickle cell disease and malnutrition in addition to other infectious diseases. There is limited data from Africa on the effects of these conditions on COVID-19. In this review, we discuss the epidemiology of some of these conditions in Africa and the possible pathogenesis for the interactions of these with COVID-19.
Collapse
|
29
|
Tunkara-Bah H, Badjan HJ, Senghore T. Dietary factors associated with being overweight and obese among school-going adolescents in Region One, The Gambia. Heliyon 2021; 7:e06486. [PMID: 33763617 PMCID: PMC7973295 DOI: 10.1016/j.heliyon.2021.e06486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/20/2020] [Accepted: 03/08/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The purpose of this study was to determine the dietary factors associated with being overweight and obese among school-going adolescents in Region One, The Gambia. METHOD This was a school-based cross-sectional study and 1008 students from eight Senior Secondary Schools in Region one of The Gambia participated in it. Data were collected through questionnaire self-administered method, and weight and height measurements. Using the age and gender-specific cutoff points proposed by World Health Organization, body mass index (BMI) was calculated using the weight and height measures. The data were analyzed using frequencies for underweight, overweight, and obesity, and the association between dietary factors and weight status of participants was determined using the Chi-square test. FINDINGS Out of the 1008 students recruited in the study, 981 of them completed and returned the questionnaires, resulting in a total response rate of 97%. The mean age of the participants was 17.3 years (SD = 1.9) and 385 of them (39.2%) were from grade 10. There were 627 (63.9%) females. The mean BMI for all the students was 20.0 ± 3.4 kg/m2. Most of the students (n = 672; 68.5 %) had normal body weight, but 226 (23%), 76 (7.7 %) and 7 (0.7%) of them were underweight, overweight and obese respectively. There was a significantly higher number of female students who were overweight (n = 64, 10.2%) than their male counterparts (χ2 = 72.336, p < 0.001). The frequency of drinking sugar added juices and full cream milk, eating fish, shrimps, oysters, lobsters, and snacks such as cakes and biscuits were significantly associated with overweight and obesity among the participants (p < 0.05). In conclusion, the problem of under-nutrition and over-nutrition co-existed among the students which were associated with poor eating habits.
Collapse
|
30
|
Danquah FI, Ansu-Mensah M, Bawontuo V, Yeboah M, Kuupiel D. Prevalence, incidence, and trends of childhood overweight/obesity in Sub-Saharan Africa: a systematic scoping review. ACTA ACUST UNITED AC 2020; 78:109. [PMID: 33292679 PMCID: PMC7599109 DOI: 10.1186/s13690-020-00491-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/20/2020] [Indexed: 02/08/2023]
Abstract
Background The growing burden of non-communicable diseases (NDC), particularly in low-and middle-income countries, poses a significant threat to global health. Obesity and overweight constitute major risk factors of NCDs such as heart diseases, diabetes, and kidney disease, and as a result, contribute significantly to the development of chronic morbidities, reduced quality of life, and increased risk of premature death. This study described evidence on the prevalence, incidence, and trends of childhood overweight and obesity in sub-Sahara Africa (SSA). Methods We conducted a systematic scoping review employing the Arksey and O’Malley framework, Levac et al. recommendations, and the Joanna Briggs Institute guidelines. To obtain relevant published articles for this review, we performed a comprehensive keywords search in PubMed, Google Scholar, Web of Science, and CINAHL via EBSCOhost platform for studies published between 2009 and June 2019. Guided by the eligibility criteria, title and abstracts, as well as the full-text articles were independently screened in parallel by two investigators. All relevant data were independently extracted by two investigators using a piloted form designed in Microsoft and thematic analysis conducted. Results Of the 81 included studies obtained from 250,148 potentially eligible articles, the majority (25) conducted in South Africa followed by 18 in Nigeria. Six studies were conducted in Ethiopia (6), Tanzania (5), Kenya (4), Cameroon (4), Ghana (3), Uganda (2), Mozambique (2), and Sudan (2). One study each was conducted in Botswana, Gambia, Lesotho, Mauritius, Seychelles, Togo, and Zimbabwe. The remaining three articles were multi-country studies. Most (81.5%) of the included studies were cross-sectional surveys and the majority (79) focused on both male and female participants. The majority (80/81) of the included studies reported on the prevalence of childhood overweight/obesity, 8 on the trends of childhood overweight/obesity, and one presented evidence on the incidence of childhood overweight and obesity in SSA. Conclusion This review demonstrates limited studies on childhood overweight/obesity in most SSA countries although the included studies suggest an increasing burden. Considering the consequences of childhood obesity, there is a need for more primary researches to inform policies decision and implementation to halt the rise of childhood obesity/overweight in SSA. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-020-00491-2.
Collapse
Affiliation(s)
- Frederick Inkum Danquah
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
| | - Monica Ansu-Mensah
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
| | - Vitalis Bawontuo
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana.,Research for Sustainable Development Consult, Sunyani, Ghana
| | - Matilda Yeboah
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
| | - Desmond Kuupiel
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana. .,Research for Sustainable Development Consult, Sunyani, Ghana. .,Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001, South Africa.
| |
Collapse
|
31
|
Mansur MA, Indriasari R, Jafar N. Body image and weight-control behaviors among adolescent girls with low-mid socioeconomic background. ENFERMERIA CLINICA 2020. [DOI: 10.1016/j.enfcli.2020.06.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
32
|
Pengpid S, Peltzer K. The prevalence and associated factors of underweight and overweight/obesity among adults in Kenya: evidence from a national cross-sectional community survey. Pan Afr Med J 2020; 36:338. [PMID: 33193991 PMCID: PMC7603835 DOI: 10.11604/pamj.2020.36.338.21215] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 01/14/2020] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION the study aimed to investigate the prevalence and factors associated with underweight and overweight or obesity in an adult population in Kenya. METHODS data from a cross-sectional nationally representative community-based study in Kenya (N=4283, 18-69 years) conducted in 2015 was utilized. Assessments included anthropometric, interview, blood pressure and biochemistry mesures. Multinomial logistic regression was used to assess the determinants of underweight and overweight or obesity relative to normal weight. RESULTS in all, 11.9% of the study sample was underweight (BMI <18.5kg/m2), 60.1% had normal weight (BMI 18.5-24.9kg/m2), 18.9% overweight (25.0-29.9kg/m2) and 9.1% obesity (BMI ≥30.0kg/m2). In adjusted multinomial logistic regression, male sex (adjusted relative risk ratio-ARRR: 1.47, confidence interval-CI: 1.01, 2.13), lower education (ARRR: 0.63, CI: 0.46, 0.88), lower wealth status (ARRR: 0.47, CI: 0.29, 0.78), inadequate fruit and vegetable consumption (ARRR: 1.79, CI: 1.19, 2.70), adding daily sugar into beverages (ARRR: 1.49, CI: 1.01, 2.22) and having no hypertension (ARRR: 0.54, CI: 0.40, 0.74) were associated with underweight. Factors associated with overweight or obesity were middle and older age (ARRR: 2.15, CI: 1.46, 3.80), being female (ARRR: 0.30, CI: 0.22, 0.41), higher education (ARRR: 1.61, CI: 1.26, 2.24), greater wealth (ARRR: 2.38, CI: 1.41, 3.50), being a Kikuyu by ethnic group (ARRR: 1.68, CI: 1.19, 2.37), urban residence (ARRR: 1.45, CI: 1.06, 1.99), no current tobacco use (ARRR: 0.39, CI: 0.24, 0.54), low physical activity (ARRR: 1.49, CI: 1.02, 2.18) and having hypertension (ARRR: 1.96, CI: 1.54, 2.50). CONCLUSION more than one in ten were underweight and almost three in ten were overweight or obese among adults in Kenya. Several risk factors, including sociodemographic, lifestyle and health status risk variables, were identified for underweight and overweight or obesity, which can assist in developing intervention strategies targeting both these conditions.
Collapse
Affiliation(s)
- Supa Pengpid
- ASEAN Institute for Health Development, Mahidol University, Salaya, Phutthamonthon, Nakhonpathom, Thailand
- Department of Research and Innovation, University of Limpopo, Turfloop, South Africa
| | - Karl Peltzer
- Department of Research and Innovation, University of Limpopo, Turfloop, South Africa
| |
Collapse
|
33
|
Bengtson AM, Phillips TK, le Roux SM, Brittain K, Buba A, Abrams EJ, Myer L. Postpartum obesity and weight gain among human immunodeficiency virus-infected and human immunodeficiency virus-uninfected women in South Africa. MATERNAL & CHILD NUTRITION 2020; 16:e12949. [PMID: 31943774 PMCID: PMC7296802 DOI: 10.1111/mcn.12949] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 11/26/2019] [Accepted: 12/29/2019] [Indexed: 02/06/2023]
Abstract
In South Africa, up to 40% of pregnant women are living with human immunodeficiency virus (HIV), and 30-45% are obese. However, little is known about the dual burden of HIV and obesity in the postpartum period. In a cohort of HIV-uninfected and HIV-infected pregnant women initiating antiretroviral therapy in Cape Town, South Africa, we examined maternal anthropometry (weight and body mass index [BMI]) from 6 weeks through 12 months postpartum. Using multinomial logistic regression, we estimated associations between baseline sociodemographic, clinical, behavioural, and HIV factors and being overweight-obese I (BMI 25 to <35), or obese II-III (BMI >35), compared with being underweight or normal weight (BMI <25), at 12 months postpartum. Among 877 women, we estimated that 43% of HIV-infected women and 51% of HIV-uninfected women were obese I-III at enrollment into antenatal care, and 51% of women were obese I-III by 12 months postpartum. On average, both HIV-infected and HIV-uninfected women gained, rather than lost, weight between 6 weeks and 12 months postpartum, but HIV-uninfected women gained more weight (3.3 kg vs. 1.7 kg). Women who were obese I-III pre-pregnancy were more likely to gain weight postpartum. In multivariable analyses, HIV-infection status, being married/cohabitating, higher gravidity, and high blood pressure were independently associated with being obese II-III at 12 months postpartum. Obesity during pregnancy is a growing public health concern in low- and middle-income countries, including South Africa. Additional research to understand how obesity and HIV infection affect maternal and child health outcomes is urgently needed.
Collapse
Affiliation(s)
- Angela M. Bengtson
- Department of EpidemiologyBrown University School of Public HealthRhode Island
| | - Tamsin K. Phillips
- Division of Epidemiology and Biostatistics, School of Public Health and Family MedicineUniversity of Cape TownCape TownSouth Africa
| | - Stanzi M. le Roux
- Division of Epidemiology and Biostatistics, School of Public Health and Family MedicineUniversity of Cape TownCape TownSouth Africa
| | - Kirsty Brittain
- Division of Epidemiology and Biostatistics, School of Public Health and Family MedicineUniversity of Cape TownCape TownSouth Africa
| | - Allison Buba
- ICAP, Mailman School of Public Health and Department of Pediatrics, Vagelos College of Physicians & SurgeonsColumbia UniversityNew York CityNew YorkUSA
| | - Elaine J. Abrams
- ICAP, Mailman School of Public Health and Department of Pediatrics, Vagelos College of Physicians & SurgeonsColumbia UniversityNew York CityNew YorkUSA
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health and Family MedicineUniversity of Cape TownCape TownSouth Africa
| |
Collapse
|
34
|
Robinson JM, Breed MF. The Lovebug Effect: Is the human biophilic drive influenced by interactions between the host, the environment, and the microbiome? THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 720:137626. [PMID: 32146404 DOI: 10.1016/j.scitotenv.2020.137626] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 02/27/2020] [Accepted: 02/27/2020] [Indexed: 06/10/2023]
Abstract
Psychological frameworks are often used to investigate the mechanisms involved with our affinity towards, and connection with nature--such as the Biophilia Hypothesis and Nature Connectedness. Recent revelations from microbiome science suggest that animal behaviour can be strongly influenced by the host's microbiome--for example, via the bidirectional communication properties of the gut-brain axis. Here, we build on this theory to hypothesise that a microbially-influenced mechanism could also contribute to the human biophilic drive - the tendency for humans to affiliate and connect with nature. Humans may be at an evolutionary advantage through health-regulating exchange of environmental microbiota, which in turn could influence our nature affinity. We present a conceptual model for microbially-influenced nature affinity, calling it the Lovebug Effect. We present an overview of the potential mechanistic pathways involved in the Lovebug Effect, and consider its dependence on the hologenome concept of evolution, direct behavioural manipulation, and host-microbiota associated phenotypes independent of these concepts. We also discuss its implications for human health and ecological resilience. Finally, we highlight several possible approaches to scrutinise the hypothesis. The Lovebug Effect could have important implications for our understanding of exposure to natural environments for health and wellbeing, and could contribute to an ecologically resilient future.
Collapse
Affiliation(s)
- Jake M Robinson
- Department of Landscape, The University of Sheffield, S10 2TN, UK; inVIVO Planetary Health, of the Worldwide Universities Network (WUN), NJ 10704, USA; The Healthy Urban Microbiome Initiative (HUMI), Australia.
| | - Martin F Breed
- College of Science and Engineering, Flinders University, Bedford Park, SA 5042, Australia; The Healthy Urban Microbiome Initiative (HUMI), Australia
| |
Collapse
|
35
|
Sartorius B, Sartorius K, Green R, Lutge E, Scheelbeek P, Tanser F, Dangour AD, Slotow R. Spatial-temporal trends and risk factors for undernutrition and obesity among children (<5 years) in South Africa, 2008-2017: findings from a nationally representative longitudinal panel survey. BMJ Open 2020; 10:e034476. [PMID: 32273314 PMCID: PMC7245449 DOI: 10.1136/bmjopen-2019-034476] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To assess space-time trends in malnutrition and associated risk factors among children (<5 years) in South Africa. DESIGN Multiround national panel survey using multistage random sampling. SETTING National, community based. PARTICIPANTS Community-based sample of children and adults. SAMPLE SIZE 3254 children in wave 1 (2008) to 4710 children in wave 5 (2017). PRIMARY OUTCOMES Stunting, wasting/thinness and obesity among children (<5). Classification was based on anthropometric (height and weight) z-scores using WHO growth standards. RESULTS Between 2008 and 2017, a larger decline nationally in stunting among children (<5) was observed from 11.0% to 7.6% (p=0.007), compared with thinness/wasting (5.2% to 3.8%, p=0.131) and obesity (14.5% to 12.9%, p=0.312). A geographic nutritional gradient was observed with obesity more pronounced in the east of the country and thinness/wasting more pronounced in the west. Approximately 73% of districts had an estimated wasting prevalence below the 2025 target threshold of 5% in 2017 while 83% and 88% of districts achieved the necessary relative reduction in stunting and no increase in obesity respectively from 2012 to 2017 in line with 2025 targets. African ethnicity, male gender, low birth weight, lower socioeconomic and maternal/paternal education status and rural residence were significantly associated with stunting. Children in lower income and food-insecure households with young malnourished mothers were significantly more likely to be thin/wasted while African children, with higher birth weights, living in lower income households in KwaZulu-Natal and Eastern Cape were significantly more likely to be obese. CONCLUSIONS While improvements in stunting have been observed, thinness/wasting and obesity prevalence remain largely unchanged. The geographic and sociodemographic heterogeneity in childhood malnutrition has implications for equitable attainment of global nutritional targets for 2025, with many districts having dual epidemics of undernutrition and overnutrition. Effective subnational-level public health planning and tailored interventions are required to address this challenge.
Collapse
Affiliation(s)
- Benn Sartorius
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Kurt Sartorius
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Rosemary Green
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Elizabeth Lutge
- KwaZulu-Natal Department of Health, South African Government Department, Durban, South Africa
| | - Pauline Scheelbeek
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Frank Tanser
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- College of Social Science, University of Lincoln, Lincoln, UK
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
| | - Alan D Dangour
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Rob Slotow
- School of Life Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| |
Collapse
|
36
|
Najafi F, Soltani S, Karami Matin B, Kazemi Karyani A, Rezaei S, Soofi M, Salimi Y, Moradinazar M, Hajizadeh M, Barzegar L, Pasdar Y, Hamzeh B, Haghdoost AA, Malekzadeh R, Poustchi H, Eghtesad S, Nejatizadeh A, Moosazadeh M, Zare Sakhvidi MJ, Joukar F, Hashemi-Shahri SM, Vakilian A, Niknam R, Faramarzi E, Akhavan Akbari G, Ghorat F, Khaledifar A, Vahabzadeh D, Homayounfar R, Safarpour AR, Hosseini SV, Rezvani R, Hosseini SA. Socioeconomic - related inequalities in overweight and obesity: findings from the PERSIAN cohort study. BMC Public Health 2020; 20:214. [PMID: 32046684 PMCID: PMC7014739 DOI: 10.1186/s12889-020-8322-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 02/05/2020] [Indexed: 12/21/2022] Open
Abstract
Background Overweight and obesity are major health concerns worldwide, with adverse health consequences during the life span. This study measured socioeconomic inequality in overweight and obesity among Iranian adults. Methods Data were extracted from 129,257 Iranian adults (aged 35 years and older) participated in the Prospective Epidemiologic Research Studies in IrAN (PERSIAN) in 14 provinces of Iran in 2014. Socioeconomic-related inequality in overweight and obesity was estimated using the Concentration Index (Cn). The Cn further decomposed to find factors explaining the variability within the Socioeconomic related inequality in overweight and obesity. Results Of the total number of participants, 1.98, 26.82, 40.76 and 30.43% had underweight, normal weight, overweight and obesity respectively. The age-and sex standardized prevalence of obesity was higher in females than males (39.85% vs 18.79%). People with high socioeconomic status (SES) had a 39 and 15% higher chance of being overweight and obese than low SES people, respectively. The positive value of Cn suggested a higher concentration of overweight (0.081, 95% confidence interval [CI]; 0.074–0.087) and obesity (0.027, 95% CI; 0.021–0.034) among groups with high SES. There was a wide variation in socioeconomic-related inequality in overweight and obesity rate across 14 provinces. The decomposition results suggested that SES factor itself explained 66.77 and 89.07% of the observed socioeconomic inequalities in overweight and obesity among Iranian adults respectively. Following SES, province of residence, physical activity, using hookah and smoking were the major contributors to the concentration of overweight and obesity among the rich. Conclusions Overall, we found that overweight and obesity is concentrated among high SES people in the study population. . Accordingly, it seems that intersectional actions should be taken to control and prevent overweight and obesity among higher socioeconomic groups.
Collapse
Affiliation(s)
- Farid Najafi
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shahin Soltani
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran. .,Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Behzad Karami Matin
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ali Kazemi Karyani
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Satar Rezaei
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Moslem Soofi
- Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Yahya Salimi
- Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mehdi Moradinazar
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Hajizadeh
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, Canada
| | - Loghman Barzegar
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Yahya Pasdar
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Behrooz Hamzeh
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ali Akbar Haghdoost
- Modeling in Health Research Center, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Reza Malekzadeh
- Liver and pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Poustchi
- Liver and pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sareh Eghtesad
- Liver and pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Azim Nejatizadeh
- Molecular Medicine Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mahmood Moosazadeh
- Health Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Javad Zare Sakhvidi
- Occupational Health Research Centre, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Farahnaz Joukar
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Alireza Vakilian
- Dept. of Neurology, Medical School, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Ramin Niknam
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Elnaz Faramarzi
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical sciences, Tabriz, Iran
| | - Ghodrat Akhavan Akbari
- Digestive Disease Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Fershteh Ghorat
- Traditional and Complementary Medicine Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Arsalan Khaledifar
- Modeling in Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Davoud Vahabzadeh
- Social Determinants of Health Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Reza Homayounfar
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Ali Reza Safarpour
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Reza Rezvani
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyyed Ahmad Hosseini
- Nutrition and Metabolic Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| |
Collapse
|
37
|
Mchiza ZJR, Parker WA, Hossin MZ, Heshmati A, Labadarios D, Falkstedt D, Koupil I. Social and Psychological Predictors of Body Mass Index among South Africans 15 Years and Older: SANHANES-1. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16203919. [PMID: 31618952 PMCID: PMC6843690 DOI: 10.3390/ijerph16203919] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 09/20/2019] [Accepted: 09/21/2019] [Indexed: 12/01/2022]
Abstract
This study investigated how psychological distress and the proxies for social position combine to influence the risk of both underweight and overweight in South Africans aged 15 years and older. This was a cross-sectional study that included 2254 men and 4170 women participating in the first South African National Health and Nutrition Examination Survey (SANHANES-1). An analysis exploring the associations of social and mental health characteristics with body mass index (BMI) was conducted using binary and multinomial logistic regressions. Results suggested that, overall, women had a higher risk of overweight/obesity compared to men (age-adjusted odds ratio [AOR] 4.65; 95% confidence intervals [CI] 3.94–5.50). The gender effect on BMI was smaller in non-African participants (AOR 3.02; 95% CI 2.41–3.79; p-value for interaction = 0.004). Being employed and having a higher level of education were associated with higher risks of overweight and obesity and a lower risk of underweight. Being single or without a spouse and poor mental health were found to increase the odds of being underweight, especially in men. To conclude, there are strong social gradients and important gender and ethnic differences in how BMI is distributed in the South African population.
Collapse
Affiliation(s)
| | - Whadi-Ah Parker
- Social Aspects of Public Health (SAPH), Human Sciences Research Council, Cape Town 8000, South Africa.
| | - Muhammad Zakir Hossin
- Department of Public Health Sciences, Karolinska Institutet, Stockholm SE-171 76, Sweden.
| | - Amy Heshmati
- Department of Public Health Sciences, Stockholm University, Stockholm SE-106 91, Sweden.
- Centre for Health Equity Studies, Stockholm University, Stockholm SE-106 91, Sweden.
| | - Demetre Labadarios
- Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg 7505, South Africa.
| | - Daniel Falkstedt
- Department of Public Health Sciences, Karolinska Institutet, Stockholm SE-171 76, Sweden.
| | - Ilona Koupil
- Department of Public Health Sciences, Karolinska Institutet, Stockholm SE-171 76, Sweden.
- Department of Public Health Sciences, Stockholm University, Stockholm SE-106 91, Sweden.
| |
Collapse
|
38
|
Martins-Silva T, Vaz JDS, Mola CLD, Assunção MCF, Tovo-Rodrigues L. Prevalence of obesity in rural and urban areas in Brazil: National Health Survey, 2013. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2019; 22:e190049. [PMID: 31460664 DOI: 10.1590/1980-549720190049] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 07/13/2018] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To investigate the role of the domiciliary situation in the prevalence of general and abdominal obesity through the National Health Survey of 2013. METHODOLOGY General obesity (body mass index ≥ 30 kg/m2) and abdominal obesity (waist circumference ≥ 102 cm in men and ≥ 88 cm in women) in rural and urban areas were described according to sex and macroregion. Crude and adjusted Poisson regression models were used to test the association between obesity and household situation, with the significance level of 5%. RESULTS The study included 59,226 individuals. Out of these, 20.7% presented general obesity and 38% abdominal obesity (higher in women: 24.3 and 52%, respectively). The highest prevalences of general obesity were observed in southern urban areas, for both sexes (20.8% in men and 26.5% in women). In rural areas, the highest prevalences were observed for the central-west region (17.2%) in men and in the south region (27.4%) in women. In males, after adjusting for demographic variables, living in rural areas was associated with lower prevalences of general obesity in the North (prevalence ratios - PR = 0.60; confidence interval of 95% - 95%CI 0.40 - 0.89) and Northeast (PR = 0.47, 95%CI 0,38 - 0.59), and for abdominal obesity in all regions. For women in the Midwest, the rural household situation was associated with lower prevalences of obesity. (PR = 1.11, 95%CI 1.01 - 1.23). CONCLUSIONS The results evidenced the role of the domiciliary situation among outcomes at the national level, with lower prevalence of general and abdominal obesity in men living in rural areas. However, higher prevalences were found among women, especially for abdominal obesity.
Collapse
Affiliation(s)
- Thais Martins-Silva
- Programa de Pós-graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal de Pelotas - Pelotas (RS), Brasil
| | - Juliana Dos Santos Vaz
- Programa de Pós-graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal de Pelotas - Pelotas (RS), Brasil.,Faculdade de Nutrição, Universidade Federal de Pelotas - Pelotas (RS), Brasil
| | - Christian Loret de Mola
- Programa de Pós-graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal de Pelotas - Pelotas (RS), Brasil.,Faculdade de Enfermagem, Universidade Federal de Pelotas - Pelotas (RS), Brasil
| | - Maria Cecília Formoso Assunção
- Programa de Pós-graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal de Pelotas - Pelotas (RS), Brasil
| | - Luciana Tovo-Rodrigues
- Programa de Pós-graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal de Pelotas - Pelotas (RS), Brasil
| |
Collapse
|
39
|
Lartey ST, Magnussen CG, Si L, Boateng GO, de Graaff B, Biritwum RB, Minicuci N, Kowal P, Blizzard L, Palmer AJ. Rapidly increasing prevalence of overweight and obesity in older Ghanaian adults from 2007-2015: Evidence from WHO-SAGE Waves 1 & 2. PLoS One 2019; 14:e0215045. [PMID: 31425568 PMCID: PMC6699701 DOI: 10.1371/journal.pone.0215045] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 07/26/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Studies on changes in the prevalence and determinants of obesity in older adults living in sub-Saharan Africa are scarce. We examined recent changes in obesity prevalence and associated factors for older adults in Ghana between 2007/08 and 2014/15. METHODS Data on adults aged 50 years and older in Ghana were drawn from the WHO SAGE 2007/08 (Wave 1; n = 4158) and 2014/15 (Wave 2; n = 1663). The weighted prevalence of obesity, overweight, normal weight and underweight, and of high central adiposity were compared in 2007/08 and 2014/15. Multinomial and binomial logistic regressions were used to examine whether the determinants of weight status based on objectively measured body mass index and waist circumference changed between the two time periods. RESULTS The prevalence of overweight (2007/08 = 19.6%, 95% CI: 18.0-21.4%; 2014/15 = 24.5%, 95% CI: 21.7-27.5%) and obesity (2007/08 = 10.2%, 95% CI: 8.9-11.7%; 2014/15 = 15.0%, 95% CI: 12.6-17.7%) was higher in 2014/15 than 2007/08 and more than half of the population had high central adiposity (2007/08 = 57.7%, 95% CI: 55.4-60.1%; 2014/15 = 66.9%, 95% CI: 63.7-70.0%) in both study periods. While the prevalence of overweight increased in both sexes, obesity prevalence was 16% lower in males and 55% higher in females comparing 2007/08 to 2014/15. Female sex, urban residence, and high household wealth were associated with higher odds of overweight/obesity and high central adiposity. Those aged 70+ years had lower odds of obesity in both study waves. In 2014/15, females who did not meet the recommended physical activity were more likely to be obese. CONCLUSION Over the 7-year period between the surveys, the prevalence of underweight decreased and overweight increased in both sexes, while obesity decreased in males but increased in females. The difference in obesity prevalence may point to differential impacts of past initiatives to reduce overweight and obesity, potential high-risk groups in Ghana, and the need to increase surveillance.
Collapse
Affiliation(s)
- Stella T. Lartey
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Costan G. Magnussen
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Lei Si
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
- The George Institute for Global Health, University of New South Wales, Kensington, NSW, Australia
| | - Godfred O. Boateng
- Department of Nutrition, T.H. Chan School of Public Health, Harvard University, Boston, MA, United States of America
| | - Barbara de Graaff
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | | | - Nadia Minicuci
- National Research Council, Neuroscience Institute, Padova, Italy
| | - Paul Kowal
- World Health Organization (WHO), Geneva, Switzerland
- University of Newcastle Research Centre for Generational Health and Ageing, Newcastle, New South Wales, Australia
| | - Leigh Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Andrew J. Palmer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
- Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
40
|
Trends in Prevalence and Related Risk Factors of Overweight and Obesity among Women of Reproductive Age in Zimbabwe, 2005-2015. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16152758. [PMID: 31382360 PMCID: PMC6695964 DOI: 10.3390/ijerph16152758] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 07/24/2019] [Accepted: 07/31/2019] [Indexed: 01/17/2023]
Abstract
Background: The prevalence of non-communicable diseases is rising in low and middle-income countries (LMICs) such as Zimbabwe, yet, the risk factors associated with overweight and obesity among women in the country have not been explored. This study investigated the trends in prevalence and demographic, socioeconomic and behavioral risk factors of overweight and obesity among Zimbabwean women of reproductive age (15–49 years) from 2005–2015. Methods: Data from the 2005/2006, 2010/2011 and 2015 Zimbabwe Demographic and Health Survey (ZDHS) were analyzed. Multiple logistic regression models were used to examine the associations between demographic, socioeconomic, behavioral risk factors and obesity and overweight (body mass index (BMI) ≥ 25.0 kg/m2). We further estimated the prevalence of overweight and obesity over the period covered by the surveys. Results: The prevalence of overweight and obesity increased substantially from 25.0% in 2005 to 36.6% in 2015. Some of the risk factors for overweight and obesity were older age (40+) (adjusted odds ratio (aOR) = 4.73; 95% confidence interval (CI) = 3.73–6.01) in 2015, being married, high economic status, being employed, residence in urban areas and alcohol use. Educational attainment and smoking status were not associated with overweight and obesity across all surveys. Conclusions: We provide the first detailed analysis of trends and risk factors for overweight and obesity between 2005 and 2015 among women in Zimbabwe. The findings indicate that women of reproductive age are at high, and increasing, risk of excess weight. Thus, prevention and control measures are needed to address the high prevalence of overweight and obesity in Zimbabwe.
Collapse
|
41
|
Attitudes and perceptions among urban South Africans towards sugar-sweetened beverages and taxation. Public Health Nutr 2019; 23:374-383. [PMID: 31179956 DOI: 10.1017/s1368980019001356] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE A tax on sugar-sweetened beverages (SSB) was introduced in South Africa in April 2018. Our objective was to document perceptions and attitudes among urban South Africans living in Soweto on factors that contribute to their SSB intake and on South Africa's use of a tax to reduce SSB consumption. DESIGN We conducted six focus group discussions using a semi-structured guide. SETTING The study was conducted in Soweto, Johannesburg, South Africa, 3 months before South Africa's SSB tax was implemented. PARTICIPANTS Adults aged 18 years or above living in Soweto (n 57). RESULTS Participants reported frequent SSB consumption and attributed this to habit, addiction, advertising and wide accessibility of SSB. Most of the participants were not aware of the proposed SSB tax; when made aware of the tax, their responses included both beliefs that it would and would not result in reduced SSB intake. However, participants indicated cynicism with regard to the government's stated motivation in introducing the tax for health rather than revenue reasons. CONCLUSIONS While an SSB tax is a policy tool that could be used with other strategies to reduce people's high level of SSB consumption in Soweto, our findings suggest a need to complement the SSB tax with a multipronged behaviour change strategy. This strategy could include both environmental and individual levers to reduce SSB consumption and its associated risks.
Collapse
|
42
|
Jaacks LM, Vandevijvere S, Pan A, McGowan CJ, Wallace C, Imamura F, Mozaffarian D, Swinburn B, Ezzati M. The obesity transition: stages of the global epidemic. Lancet Diabetes Endocrinol 2019; 7:231-240. [PMID: 30704950 PMCID: PMC7360432 DOI: 10.1016/s2213-8587(19)30026-9] [Citation(s) in RCA: 566] [Impact Index Per Article: 113.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/06/2019] [Accepted: 01/07/2019] [Indexed: 02/06/2023]
Abstract
The global prevalence of obesity has increased substantially over the past 40 years, from less than 1% in 1975, to 6-8% in 2016, among girls and boys, and from 3% to 11% among men and from 6% to 15% among women over the same time period. Our aim was to consolidate the evidence on the epidemiology of obesity into a conceptual model of the so-called obesity transition. We used illustrative examples from the 30 most populous countries, representing 77·5% of the world's population to propose a four stage model. Stage 1 of the obesity transition is characterised by a higher prevalence of obesity in women than in men, in those with higher socioeconomic status than in those with lower socioeconomic status, and in adults than in children. Many countries in south Asia and sub-Saharan Africa are presently in this stage. In countries in stage 2 of the transition, there has been a large increase in the prevalence among adults, a smaller increase among children, and a narrowing of the gap between sexes and in socioeconomic differences among women. Many Latin American and Middle Eastern countries are presently at this stage. High-income east Asian countries are also at this stage, albeit with a much lower prevalence of obesity. In stage 3 of the transition, the prevalence of obesity among those with lower socioeconomic status surpasses that of those with higher socioeconomic status, and plateaus in prevalence can be observed in women with high socioeconomic status and in children. Most European countries are presently at this stage. There are too few signs of countries entering into the proposed fourth stage of the transition, during which obesity prevalence declines, to establish demographic patterns. This conceptual model is intended to provide guidance to researchers and policy makers in identifying the current stage of the obesity transition in a population, anticipating subpopulations that will develop obesity in the future, and enacting proactive measures to attenuate the transition, taking into consideration local contextual factors.
Collapse
Affiliation(s)
- Lindsay M Jaacks
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.
| | | | - An Pan
- Department of Epidemiology and Biostatistics, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Craig J McGowan
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Chelsea Wallace
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Fumiaki Imamura
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Boyd Swinburn
- School of Population Health, The University of Auckland, Auckland, New Zealand; Global Obesity Centre, Deakin University, Melbourne, VIC, Australia
| | - Majid Ezzati
- School of Public Health, MRC-PHE Centre for Environment and Health, and WHO Collaborating Centre on NCD Surveillance and Epidemiology, Imperial College London, London, UK
| |
Collapse
|
43
|
Lartey ST, Magnussen CG, Si L, de Graaff B, Biritwum RB, Mensah G, Yawson A, Minicuci N, Kowal P, Boateng GO, Palmer AJ. The role of intergenerational educational mobility and household wealth in adult obesity: Evidence from Wave 2 of the World Health Organization's Study on global AGEing and adult health. PLoS One 2019; 14:e0208491. [PMID: 30625141 PMCID: PMC6326547 DOI: 10.1371/journal.pone.0208491] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 11/19/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Obesity has emerged as a major risk factor for non-communicable diseases in low and middle-income countries but may not follow typical socioeconomic status (SES)-related gradients seen in higher income countries. This study examines the associations between current and lifetime markers of SES and BMI categories (underweight, normal weight, overweight, obese) and central adiposity in Ghanaian adults. METHODS Data from 4,464 adults (2,610 women) who participated in the World Health Organization's Study on global AGEing and adult health (SAGE) Wave 2 were examined. Multilevel multinomial and binomial logistic regression models were used to examine associations. SES markers included parental education, individual education, intergenerational educational mobility and household wealth. Intergenerational educational mobility was classified: stable-low (low parental and low individual education), stable-high (high parental and high individual education), upwardly (low parental and high individual education), or downwardly mobile (high parental and low individual education). RESULTS The prevalence of obesity (12.9%) exceeded the prevalence of underweight (7.2%) in the population. High parental and individual education were significantly associated with higher odds of obesity and central adiposity in women. Compared to the stable low pattern, stable high (obesity: OR = 3.15; 95% CI: 1.96, 5.05; central adiposity: OR = 1.75; 95% CI: 1.03, 2.98) and upwardly (obesity: OR = 1.71; 95% CI: 11.13, 2.60; central adiposity: OR = 1.60; 95% CI: 1.08, 2.37) mobile education patterns were associated with higher odds of obesity and central adiposity in women, while stable high pattern was associated with higher odds of overweight (OR = 1.88; 95% CI: 1.11, 3.19) in men. Additionally, high compared to the lowest household wealth was associated with high odds of obesity and central adiposity in both sexes. CONCLUSION Stable high and upwardly mobile education patterns are associated with higher odds of obesity and central adiposity in women while the stable high pattern was associated with higher odds of overweight in men.
Collapse
Affiliation(s)
- Stella T. Lartey
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Costan G. Magnussen
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Lei Si
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
- The George Institute for Global Health, University of New South Wales, Kensington, NSW, Australia
| | - Barbara de Graaff
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | | | - George Mensah
- Department of Community Health, University of Ghana, Accra, Ghana
| | - Alfred Yawson
- Department of Community Health, University of Ghana, Accra, Ghana
| | - Nadia Minicuci
- National Research Council, Neuroscience Institute, Padova, Italy
| | - Paul Kowal
- World Health Organization (WHO), Geneva, Switzerland
- University of Newcastle Research Centre for Generational Health and Ageing, Newcastle, New South Wales, Australia
| | - Godfred O. Boateng
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Andrew J. Palmer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| |
Collapse
|
44
|
Todowede OO, Sartorius B, Magula N, Schutte AE. Association of predicted 10 years cardiovascular mortality risk with duration of HIV infection and antiretroviral therapy among HIV-infected individuals in Durban, South Africa. Diabetol Metab Syndr 2019; 11:105. [PMID: 31890039 PMCID: PMC6916025 DOI: 10.1186/s13098-019-0502-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 12/06/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND South Africa has the largest population of human immunodeficiency virus (HIV) infected patients on antiretroviral therapy (ART) realising the benefits of increased life expectancy. However, this population may be susceptible to cardiovascular disease (CVD) development, due to the chronic consequences of a lifestyle-related combination of risk factors, HIV infection and ART. We predicted a 10-year cardiovascular mortality risk in an HIV-infected population on long-term ART, based on their observed metabolic risk factor profile. METHODS We extracted data from hospital medical charts for 384 randomly selected HIV-infected patients aged ≥ 30 years. We defined metabolic syndrome (MetS) subcomponents using the International Diabetes Federation definition. A validated non-laboratory-based model for predicting a 10-year CVD mortality risk was applied and categorised into five levels, with the thresholds ranging from very low-risk (< 5%) to very high-risk scores (> 30%). RESULTS Among the 384 patients, with a mean (± standard deviation) age of 42.90 ± 8.20 years, the proportion of patients that were overweight/obese was 53.3%, where 50.9% had low high-density lipoprotein (HDL) cholesterol and 21 (17.5%) had metabolic syndrome. A total of 144 patients with complete data allowed a definitive prediction of a 10-year CVD mortality risk. 52% (95% CI 44-60) of the patients were stratified to very low risk (< 5%) compared to 8% (95% CI 4-13) that were at a very high risk (> 30%) of 10-year CVD mortality. The CVD risk grows with increasing age (years), 57.82 ± 6.27 among very high risk and 37.52 ± 4.50; p < 0.001 in very low risk patients. Adjusting for age and analysing CVD risk mortality as a continuous risk score, increasing duration of HIV infection (p = 0.002) and ART (p = 0.007) were significantly associated with increased predicted 10 year CVD mortality risk. However, there was no association between these factors and categorised CVD mortality risk as per recommended scoring thresholds. CONCLUSIONS Approximately 1 in 10 HIV-infected patients is at very high risk of predicted 10-year CVD mortality in our study population. Like uninfected individuals, our study found increased age as a major predictor of 10-year mortality risk and high prevalence of metabolic syndrome. Additional CVD mortality risk due to the duration of HIV infection and ART was seen in our population, further studies in larger and more representative study samples are encouraged. It recommends an urgent need for early planning, prevention and management of metabolic risk factors in HIV populations, at the point of ART initiation.
Collapse
Affiliation(s)
- Olamide O. Todowede
- Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001 South Africa
| | - Benn Sartorius
- Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001 South Africa
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, USA
- Faculty of Infectious and Tropical Medicine, London School of Hygiene and Tropical Medicine, London, UK
| | - Nombulelo Magula
- Department of Internal Medicine, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Aletta E. Schutte
- Hypertension in Africa Research Team, North-West University, Potchefstroom, South Africa
- Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| |
Collapse
|
45
|
Seboko AM, Conradie MM, Kruger MJ, Ferris WF, Conradie M, van de Vyver M. Systemic Factors During Metabolic Disease Progression Contribute to the Functional Decline of Adipose Tissue-Derived Mesenchymal Stem Cells in Reproductive Aged Females. Front Physiol 2018; 9:1812. [PMID: 30631282 PMCID: PMC6315119 DOI: 10.3389/fphys.2018.01812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 12/04/2018] [Indexed: 12/28/2022] Open
Abstract
It is known that advanced metabolic disorders such as type 2 diabetes compromise the functional and regenerative capacity of endogenous adipose-tissue resident stem cells (ADSCs). It is, however, still unclear at which stage of disease progression ADSCs become compromised and whether systemic factors contribute to their functional decline. It was therefore hypothesized that inflammatory changes in the systemic microenvironment during distinct stages of disease progression negatively affect the functional capacity of ADSCs. A total of forty-seven (n = 47) black African reproductive aged females (32 ± 8 years; mean ± SD) were included in this study and subdivided into: (a) healthy lean (C; body mass index, BMI ≤ 25 kg/m2), (b) healthy overweight/obese (OB; BMI ≥ 25 kg/m2), (c) obese metabolic syndrome (MetS; BMI ≥ 30 kg/m2), and (d) type 2 diabetes mellitus (T2DM; previously diagnosed and on treatment) groups. Participants underwent anthropometric assessments and a DXA scan to determine their body composition and adipose indices. Each persons’ systemic metabolic- (cholesterol, HDL, LDL, triglycerides, and blood glucose) and inflammatory profiles (CRP, SDF1α, TNFα, IL6, IL8, IL10, and IFNy) were also evaluated. Participant-derived serum was then used to treat an ADSC cell line in vitro and its effect on viability (MTT-based assay), proliferation (BrdU), migration (wound healing assay), and osteogenic differentiation assessed. When exposed to serum derived from overweight/obese individuals (with or without metabolic syndrome), both the proliferative and migratory responses of ADSCs were less pronounced than when exposed to healthy control serum. Serum IL6 concentrations were identified as a factor influencing the proliferation of ADSCs, suggesting that long-term disruption to the systemic cytokine balance can potentially disrupt the proliferative responses of ADSCs. Obese participant-derived serum (with and without metabolic syndrome) furthermore resulted in lipid accumulation during osteogenic differentiation. This study, therefore demonstrated that systemic factors in obese individuals, regardless of the presence of metabolic syndrome, can be detrimental to the multifunctional properties of ADSCs.
Collapse
Affiliation(s)
- Ascentia M Seboko
- Division of Endocrinology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - M M Conradie
- Division of Endocrinology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - M J Kruger
- Division of Endocrinology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - William Frank Ferris
- Division of Endocrinology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Magda Conradie
- Division of Endocrinology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Mari van de Vyver
- Division of Endocrinology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
46
|
Tateyama Y, Techasrivichien T, Musumari PM, Suguimoto SP, Zulu R, Macwan’gi M, Dube C, Ono-Kihara M, Kihara M. Obesity matters but is not perceived: A cross-sectional study on cardiovascular disease risk factors among a population-based probability sample in rural Zambia. PLoS One 2018; 13:e0208176. [PMID: 30496252 PMCID: PMC6264511 DOI: 10.1371/journal.pone.0208176] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 11/13/2018] [Indexed: 01/12/2023] Open
Abstract
Background Sub-Saharan Africa, including Zambia, has experienced an increase in overweight and obesity due to rapid lifestyle changes associated with recent economic growth. We explored the prevalence and correlates of overweight and obesity in rural Zambia. We also investigated the role of self-perception of body weight in weight control given the local socio-cultural context. Methods In this cross-sectional study, we recruited 690 residents of the Mumbwa district aged 25–64 years through a multistage, clustered, household random sampling. We administered a questionnaire and collected anthropometric and bio-behavioral data from May to July 2016. Factors associated with body mass index (BMI) ≥25 kg/m2 and underestimation of body weight were assessed using multiple logistic regression. Results Of the weighted sample of 689 participants (335 men and 354 women), 185 (26.8%) had BMI ≥25 kg/m2. In multivariate analyses, female gender, age 45–64 years, tertiary education, higher fruit and vegetable intake, high blood pressure, abnormal blood lipid profile, and Hemoglobin A1c ≥5.7% were significantly associated with BMI ≥25 kg/m2. Among participants with BMI ≥25 kg/m2, 14.2% and 58.2% perceived themselves as being underweight and normal weight, respectively. Age 45–64 years was the only factor significantly associated with body weight underestimation. Preference for obesity was reported by 17.5% and 3.6% of respondents with BMI <25 kg/m2 and BMI≥25 kg/m2, respectively; “looks attractive” and “fear of being perceived as HIV-positive” were the main reasons. Conclusion In rural Zambia, overweight and obesity are prevalent and significantly associated with alterations in blood pressure, blood lipid profile, and glucose metabolism. However, most subjects with BMI ≥25 kg/m2 underestimated their body weight; some preferred obesity, in part due to cultural factors and HIV-related stigma. A health promotion program that addresses such perceptions and body weight underestimation should be urgently introduced in Zambia.
Collapse
Affiliation(s)
- Yukiko Tateyama
- Department of Global Health and Socio-epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- * E-mail:
| | - Teeranee Techasrivichien
- Department of Global Health and Socio-epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Patou Masika Musumari
- Department of Global Health and Socio-epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - S. Pilar Suguimoto
- Department of Global Health and Socio-epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Medical Education Center, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Richard Zulu
- Institute of Economic and Social Research, University of Zambia, Lusaka, Zambia
| | - Mubiana Macwan’gi
- Institute of Economic and Social Research, University of Zambia, Lusaka, Zambia
| | | | - Masako Ono-Kihara
- Department of Global Health and Socio-epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masahiro Kihara
- Department of Global Health and Socio-epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| |
Collapse
|
47
|
Yaya S, Ekholuenetale M, Bishwajit G. Differentials in prevalence and correlates of metabolic risk factors of non-communicable diseases among women in sub-Saharan Africa: evidence from 33 countries. BMC Public Health 2018; 18:1168. [PMID: 30309337 PMCID: PMC6182823 DOI: 10.1186/s12889-018-6085-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 10/01/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Even with the widespread recognition of non- communicable diseases (NCDs) in sub-Saharan Africa region, yet, sufficient evidence-based surveillance systems to confirm the prevalence and correlates of these diseases is lacking. In an attempt to understand the problem of NCDs in resource-constrained settings, this study was conducted to establish the pattern of the risk factors of NCDs in sub-Sahara Africa region. METHODS The current Demographic and Health Survey (DHS) data sets from 33 countries in sub-Sahara Africa region were used in this study. The individual woman component of DHS 2008-2016 was used. The outcome variables include anemia, hypertension and body mass index (underweight, overweight and obesity). BMI was categorized into; underweight (BMI < 18.5 kg/m2), normal (BMI 18.5-24.9 kg/m2), overweight (BMI 25.0-29.9 kg/m2) and obesity (BMI ≥30 kg/m2). Hemoglobin level: anemic < 12.0 g/dL (< 120 g/L) for women. Hypertension was defined as systolic blood pressure (SBP) ≥140 mmHg and/or diastolic blood pressure (DBP) ≥90 mmHg. Binary and multinomial logistic regression models were used to investigate the correlates of the variables. RESULTS The percentage of hypertension was highest among women in Lesotho with about 17.3% and lowest among women in Burundi (1.0%). Anemia was prevalent among sub-Saharan Africa women; where more than half of the women from several countries were anemic with Gabon (60.6%) reporting the highest prevalence. The percentage of obesity in sub-Saharan Africa showed that Lesotho (19.9%), Gabon (18.9%) and Ghana (15.6%) were the prominent countries with obese women, while Madagascar (1.1%) had the minimum obese women. Body mass index was significantly associated with hypertension and anemia. The behavioural or modifiable factors of hypertension and body mass index were; smoking, fruits, vegetables and alcohol consumption. While the non-modifiable significant factors include; age, residence, religion, education, wealth index, marital status, employment and number of children ever born. However, anemia shared similar factors except that smoking and vegetable consumption were not statistically significant. In addition, involvement in exercise was associated with anemia and hypertension. CONCLUSION The problem of NCDs and associated factors remains high among women of reproductive age in sub-Sahara region. The findings of this study suggest that promotion of regular positive health care-seeking behaviour, screening and early treatment are essential to mitigate the burden of NCDs. Furthermore, preventive interventions of NCDs risk factors should be strengthened among key population through behavior change communication with support from government and stakeholders in health care.
Collapse
Affiliation(s)
- Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, 120 University Private, Ottawa, ON K1N 6N5 Canada
| | - Michael Ekholuenetale
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Ghose Bishwajit
- School of International Development and Global Studies, University of Ottawa, 120 University Private, Ottawa, ON K1N 6N5 Canada
| |
Collapse
|
48
|
Thomas R, Burger R, Hauck K. Richer, wiser and in better health? The socioeconomic gradient in hypertension prevalence, unawareness and control in South Africa. Soc Sci Med 2018; 217:18-30. [PMID: 30292072 DOI: 10.1016/j.socscimed.2018.09.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 09/19/2018] [Accepted: 09/20/2018] [Indexed: 10/28/2022]
Abstract
The socioeconomic gradient in chronic conditions is clear in the poorest and wealthiest of countries, but extant evidence on this relationship in low- and middle-income countries is inconclusive. We use data gathered between 2008 and 2012 from a nationally representative sample of over 10,000 South African adults, and objective health measures to analyse the differential effects of education, income and other factors on the prevalence of hypertension, individuals' awareness and control of hypertensive status. Prevalence of hypertension is high at 38% among women and 34% among men. 59% of hypertensive individuals are unaware of their status. We find prevalence and unawareness of hypertension are a public health concern across all income groups in South Africa. Higher income is however associated with effective control amongst men. Completing secondary education is associated with 7 mmHg lower blood pressure only in a small sub-group of women but is associated with 22 percentage point higher likelihood of effective hypertension control amongst women. We conclude that poorer and less educated individuals are particularly at high risk of cardiovascular disease in South Africa.
Collapse
Affiliation(s)
- Ranjeeta Thomas
- Department of Health Policy, London School of Economics and Political Science, Cowdray House, Houghton Street, London, WC2A 2AE, United Kingdom.
| | - Ronelle Burger
- Department of Economics, Stellenbosch University, South Africa
| | - Katharina Hauck
- School of Public Health, Imperial College London, United Kingdom
| |
Collapse
|
49
|
Alves D, Santos Z, Amado M, Craveiro I, Delgado AP, Correia A, Gonçalves L. Low potassium and high sodium intakes: a double health threat to Cape Verdeans. BMC Public Health 2018; 18:995. [PMID: 30092771 PMCID: PMC6085717 DOI: 10.1186/s12889-018-5911-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 07/27/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Cape Verde presents a high rate of cardiovascular diseases. Low potassium and high sodium intakes are related to cardiovascular diseases. However, studies regarding these two micronutrients continue to be rare in African urban settings. This work aims to estimate potassium and sodium intakes and to analyse the self-reported salt intake by gender and by type of urban area in the city of Praia - the capital of Cape Verde. METHODS In the first stage (n = 1912), an intra-urban study was designed in two types of urban areas (formal and informal), using a sampling strategy based on random selection of geographical coordinates, in order to apply a questionnaire. In a second stage, a 24-h dietary recall and anthropometric measurements were performed by local nutritionists. Potassium and sodium intakes were estimated for 599 participants (149 men and 450 women). Non-parametric methods (including quantile regression) were used in the statistical analysis. RESULTS In informal areas, a higher percentage of women reported having hypertension (31.0%) compared to formal areas (19.7%). Based on 24-h dietary recall, median potassium intake for men was 2924.2 mg/day and for women and 2562.6 mg/day. Almost 70.0% of men and 80.0% of women ingested less than the recommended 3510 mg/day of potassium. In informal areas, men and women presented high medians of sodium intakes compared to formal areas (men: 4131.2 vs 3014.6 mg/day and women: 3243.4 vs 2522.4 mg/day). On the other hand, the percentage of participants exceeding 2000 mg/day for sodium was high (≥70.8%), even for participants that self-reported low-salt intake. Quantile regression models revealed effects of the type of urban area and gender in the potassium and sodium intakes, at least, in some quartiles, accounting for age, academic qualifications, and professional situation. CONCLUSIONS A low potassium intake and a high sodium intake were found in Praia. Thus, efficient health education campaigns and health promotion are needed and should be tailored considering gender and urban areas.
Collapse
Affiliation(s)
- Daniela Alves
- Instituto de Higiene e Medicina Tropical - Universidade Nova de Lisboa, IHMT-UNL, Rua da Junqueira 100, 1349-008 Lisbon, Portugal
- Global Health and Tropical Medicine, GHTM, IHMT-UNL, Lisbon, Portugal
| | - Zélia Santos
- Instituto de Higiene e Medicina Tropical - Universidade Nova de Lisboa, IHMT-UNL, Rua da Junqueira 100, 1349-008 Lisbon, Portugal
| | - Miguel Amado
- Civil Enginnering Research and Inovation for Sustainability, CERis, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
| | - Isabel Craveiro
- Instituto de Higiene e Medicina Tropical - Universidade Nova de Lisboa, IHMT-UNL, Rua da Junqueira 100, 1349-008 Lisbon, Portugal
- Global Health and Tropical Medicine, GHTM, IHMT-UNL, Lisbon, Portugal
| | - António Pedro Delgado
- Instituto de Higiene e Medicina Tropical - Universidade Nova de Lisboa, IHMT-UNL, Rua da Junqueira 100, 1349-008 Lisbon, Portugal
- Direção Nacional da Saúde, Ministério da Saúde, Praia, Cape Verde
| | - Artur Correia
- Instituto de Higiene e Medicina Tropical - Universidade Nova de Lisboa, IHMT-UNL, Rua da Junqueira 100, 1349-008 Lisbon, Portugal
- Comité de Coordenação Combate à SIDA, Ministério da Saúde, Praia, Cape Verde
| | - Luzia Gonçalves
- Instituto de Higiene e Medicina Tropical - Universidade Nova de Lisboa, IHMT-UNL, Rua da Junqueira 100, 1349-008 Lisbon, Portugal
- Global Health and Tropical Medicine, GHTM, IHMT-UNL, Lisbon, Portugal
- Centro de Estatística e Aplicações da Universidade de Lisboa, Lisbon, Portugal
| |
Collapse
|
50
|
Sartorius B, Sartorius K, Taylor M, Aagaard-Hansen J, Dukhi N, Day C, Ndlovu N, Slotow R, Hofman K. Rapidly increasing body mass index among children, adolescents and young adults in a transitioning population, South Africa, 2008-15. Int J Epidemiol 2018; 47:942-952. [PMID: 29253189 PMCID: PMC6005035 DOI: 10.1093/ije/dyx263] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/21/2017] [Accepted: 12/04/2017] [Indexed: 11/18/2022] Open
Abstract
Background There is a global epidemic of overweight and obesity; however, this rate of increase is even greater in some low- and middle-income countries (LMIC). South Africa (SA) is undergoing rapid socioeconomic and demographic changes that have triggered a rapid nutrition transition. The paper focuses on the recent rate of change of body mass index (BMI) among children, adolescents and young adults, further stratified by key sociodemographic factors. Methods We analysed mean BMI of 28 247 individuals (including children) from 7301 households by age and year, from anthropometric data from four national cross-sectional (repeated panel) surveys using non-linear fitted curves and associated 95% confidence intervals. Results From 2008 to 2015, there was rapid rise in mean BMI in the 6-25 age band, with the highest risk (3-4+ BMI unit increase) among children aged 8-10 years. The increase was largely among females in urban areas and of middle-high socioeconomic standing. Prominent gains were also observed in certain rural areas, with extensive geographical heterogeneity across the country. Conclusions We have demonstrated a major deviation from the current understanding of patterns of BMI increase, with a rate of increase substantially greater in the developing world context compared with the global pattern. This population-wide effect will have major consequences for national development as the epidemic of related non-communicable disease unfolds, and will overtax the national health care budget. Our refined understanding highlights that risks are further compounded for certain groups/places, and emphasizes that urgent geographical and population-targeted interventions are necessary. These interventions could include a sugar tax, clearer food labelling, revised school feeding programmes and mandatory bans on unhealthy food marketing to children.The scenario unfolding in South Africa will likely be followed in other LMICs.
Collapse
Affiliation(s)
- B Sartorius
- Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - K Sartorius
- Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
- Faculty of Commerce, University of the Witwatersrand, Johannesburg, South Africa
| | - M Taylor
- Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - J Aagaard-Hansen
- Steno Diabetes Center Copenhagen, Gentofte, Denmark, and MRC Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - N Dukhi
- Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - C Day
- Health Systems Trust, Westville, South Africa
| | - N Ndlovu
- Health Systems Trust, Westville, South Africa
| | - R Slotow
- School of Life Sciences, University of KwaZulu-Natal, Durban, South Africa
- Department of Genetics, Evolution and Environment, University College London, London, UK
| | - K Hofman
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|