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Choo-Kang C, Reese TO, Micklesfield LK, Bovet P, Bedu-Addo K, Forrester T, Gilbert JA, Goedecke JH, Plange-Rhule J, Lambert EV, Layden BT, Rae DE, Viswanathan B, Luke A, Dugas L. Silhouette showcards confirm altered obesity-associated body image perception in international cohort study of African-origin populations. BMJ Open 2024; 14:e065498. [PMID: 38458795 DOI: 10.1136/bmjopen-2022-065498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2024] Open
Abstract
OBJECTIVES Given the increasing prevalence of obesity and need for effective interventions, there is a growing interest in understanding how an individual's body image can inform obesity prevention and management. This study's objective was to examine the use of silhouette showcards to measure body size perception compared with measured body mass index, and assess body size dissatisfaction, in three different African-origin populations spanning the epidemiological transition. An ancillary objective was to investigate associations between body size perception and dissatisfaction with diabetes and hypertension. SETTING Research visits were completed in local research clinics in respective countries. PARTICIPANTS Seven hundred and fifty-one African-origin participants from the USA and the Republic of Seychelles (both high-income countries), and Ghana (low/middle-income country). PRIMARY AND SECONDARY OUTCOME MEASURES Silhouette showcards were used to measure perceived body size and body size dissatisfaction. Objectively measured body size was measured using a scale and stadiometer. Diabetes was defined as fasting blood glucose ≥126 mg/dL and hypertension was defined as ≥130 mm Hg/80 mm Hg. RESULTS Most women and men from the USA and Seychelles had 'Perceived minus Actual weight status Discrepancy' scores less than 0, meaning they underestimated their actual body size. Similarly, most overweight or obese men and women also underestimated their body size, while normal weight men and women were accurately able to estimate their body size. Finally, participants with diabetes were able to accurately estimate their body size and similarly desired a smaller body size. CONCLUSIONS This study highlights that overweight and obese women and men from countries spanning the epidemiological transition were unable to accurately perceive their actual body size. Understanding people's perception of their body size is critical to implementing successful obesity prevention programmes across the epidemiological transition.
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Affiliation(s)
- Candice Choo-Kang
- Public Health Scienes, Loyola University Chicago, Maywood, Illinois, USA
| | - Tyler O Reese
- Department of Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Lisa K Micklesfield
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, Gauteng, South Africa
| | - Pascal Bovet
- University Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
- Ministry of Health, Lisbon, Portugal
| | - Kweku Bedu-Addo
- Department of Physiology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Terrence Forrester
- Solutions for Developing Countries, The University of the West Indies, Kingston, Jamaica
| | - Jack A Gilbert
- Department of Pediatrics, University of California San Diego, La Jolla, California, USA
| | - Julia H Goedecke
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Jacob Plange-Rhule
- Department of Physiology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Estelle V Lambert
- Health through Physical Activity, Lifestyle and Sport Research Centre, University of Cape Town, Rondebosch, South Africa
| | - Brian T Layden
- Division of Endocrinology, Diabetes, and Metabolism, University of Illinois Chicago, Chicago, Illinois, USA
- Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois, USA
| | - Dale E Rae
- Health through Physical Activity, Lifestyle and Sport Research Centre, University of Cape Town, Rondebosch, South Africa
| | - Bharathi Viswanathan
- Unit for Prevention and Control of Cardiovascular Disease, Republic of Seychelles Ministry of Health, Mont Fleuri, Seychelles
| | - Amy Luke
- Public Health Sciences, Loyola University Chicago, Chicago, Illinois, USA
| | - Lara Dugas
- Public Health Sciences, Loyola University Chicago, Chicago, Illinois, USA
- Division of Epidemiology & Biostatistics, University of Cape Town, Rondebosch, South Africa
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Marfo AFA, Marfo JS, Plange-Rhule J, Hollingworth S. Trends in antihypertensive use among privately insured hypertensive clients in Ghana. J Hum Hypertens 2024:10.1038/s41371-023-00885-z. [PMID: 38168617 DOI: 10.1038/s41371-023-00885-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 11/03/2023] [Accepted: 12/06/2023] [Indexed: 01/05/2024]
Abstract
The objective of the study was to describe the patterns of antihypertensive medicines (AHM) in a selected national population in Ghana. The claims data for all privately insured patients in Ghana over three years to 2018 were analysed. The classes of medicines used, the dose by time, gender and age, and generic status were examined. In addition, the use in Defined Daily Dose (DDD) per 1000 population per day was estimated. Classes of AHM prescribed were CCB, ARB, ACEI, diuretics, and BB. Amlodipine, nifedipine, losartan, lisinopril, and bendroflumethiazide accounted for 74% of all use. The most widely used single CCB was amlodipine 3.92 DDD/1,000 population/day in 2016, 3.92 DDD/1,000 population/day in 2017, and 4.92 DDD/1,000 population/day in 2018. In those aged 51-60 years, use of CCB in women (74.0 DDD/1,000 population/day) was almost twice that of men (38.3 DDD/1,000 population/day). The top ten medicines accounted for 93% of all single medicine products in 2018. Most single medicine products was generic (76.5% in 2016; 79.9% in 2017 and 83.1% in 2018) whiles most fixed combination products were branded (73.0% in 2016; 89.7% in 2017 and 91.3% in 2018). The patterns of AHM use are clinically expected although the Ghana Standard Treatment guidelines are not directive about lines of treatment.
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Affiliation(s)
- Afia Frimpomaa Asare Marfo
- Faculty of Pharmacy and Pharmaceutical sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - John Serbe Marfo
- School of Business, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Jacob Plange-Rhule
- Dept of Physiology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Samantha Hollingworth
- Faculty of Pharmacy and Pharmaceutical sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- School of Pharmacy, University of Queensland, Woolloongabba, QLD, 4102, Australia
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3
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Halsey LG, Careau V, Ainslie PN, Alemán-Mateo H, Andersen LF, Anderson LJ, Arab L, Baddou I, Bandini L, Bedu-Addo K, Blaak EE, Blanc S, Bonomi AG, Bouten CVC, Bovet P, Brage S, Buchowski MS, Butte NF, Camps SG, Casper R, Close GL, Colbert LH, Cooper JA, Cooper R, Dabare P, Das SK, Davies PSW, Deb S, Nyström CD, Dietz W, Dugas LR, Eaton S, Ekelund U, Hamdouchi AE, Entringer S, Forrester T, Fudge BW, Gillingham M, Goris AH, Gurven M, Haisma H, Hambly C, Hoffman DJ, Hoos MB, Hu S, Joonas N, Joosen A, Katzmarzyk P, Kempen KP, Kimura M, Kraus WE, Kriengsinyos W, Kuriyan R, Kushner RF, Lambert EV, Lanerolle P, Larsson CL, Lessan N, Löf M, Martin CK, Matsiko E, Meijer GA, Morehen JC, Morton JP, Must A, Neuhouser M, Nicklas TA, Ojiambo RM, Pietilainen KH, Pitsiladis YP, Plange-Rhule J, Plasqui G, Prentice RL, Rabinovich R, Racette SB, Raichen DA, Ravussin E, Redman L, Reilly JJ, Reynolds RM, Roberts S, Samaranayake D, Sardinha LB, Schuit AJ, Silva AM, Sinha S, Sjödin AM, Stice E, Stunkard A, Urlacher SS, Valencia ME, Valenti G, van Etten LM, Van Mil EA, Verbunt JA, Wells JCK, Wilson G, Wood B, Yoshida T, Zhang X, Murphy-Alford A, Loechl C, Luke A, Pontzer H, Rood J, Sagayama H, Westerterp KR, Wong WW, Yamada Y, Speakman JR. Greater male variability in daily energy expenditure develops through puberty. Biol Lett 2023; 19:20230152. [PMID: 37727077 PMCID: PMC10509569 DOI: 10.1098/rsbl.2023.0152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/31/2023] [Indexed: 09/21/2023] Open
Abstract
There is considerably greater variation in metabolic rates between men than between women, in terms of basal, activity and total (daily) energy expenditure (EE). One possible explanation is that EE is associated with male sexual characteristics (which are known to vary more than other traits) such as musculature and athletic capacity. Such traits might be predicted to be most prominent during periods of adolescence and young adulthood, when sexual behaviour develops and peaks. We tested this hypothesis on a large dataset by comparing the amount of male variation and female variation in total EE, activity EE and basal EE, at different life stages, along with several morphological traits: height, fat free mass and fat mass. Total EE, and to some degree also activity EE, exhibit considerable greater male variation (GMV) in young adults, and then a decreasing GMV in progressively older individuals. Arguably, basal EE, and also morphometrics, do not exhibit this pattern. These findings suggest that single male sexual characteristics may not exhibit peak GMV in young adulthood, however total and perhaps also activity EE, associated with many morphological and physiological traits combined, do exhibit GMV most prominently during the reproductive life stages.
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Affiliation(s)
- Lewis G. Halsey
- School of Life and Health Sciences, University of Roehampton, London SW15 4JD, UK
| | - Vincent Careau
- Department of Biology, University of Ottawa, Ottawa, Ontario, Canada
| | - Philip N. Ainslie
- Research Institute for Sport & Exercise Sciences, Liverpool John Moores University, Liverpool, L3 3AF, UK
| | - Heliodoro Alemán-Mateo
- Coordinación de Nutrición, Centro de Investigación en Alimentación y Desarrollo (CIAD), A.C., Carretera Gustavo Enrique Astiazarán Rosas, No. 46, Col. La Victoria, C.P. 83304, Hermosillo, Sonora, México
| | - Lene F. Andersen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, 0317 Oslo, Norway
| | - Liam J. Anderson
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Leonore Arab
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Issad Baddou
- Unité Mixte de Recherche en Nutrition et Alimentation, CNESTEN-Université Ibn Tofail, Rabat, PC.10100, Morocco
| | - Linda Bandini
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Kweku Bedu-Addo
- Department of Physiology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ellen E. Blaak
- Department of Human Biology, Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre, Maastricht, 6200 MD, Netherlands
| | - Stephane Blanc
- Institut Pluridisciplinaire Hubert Curien, CNRS Université de Strasbourg, Strasbourg, France
| | | | - Carlijn V. C. Bouten
- Department of Biomedical Engineering and Institute for Complex Molecular Systems, Eindhoven Unversity of Technology, Eindhoven, The Netherlands
| | - Pascal Bovet
- University Center for primary care and public health (Unisante), 1012 Lausanne, Switzerland
| | - Soren Brage
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Maciej S. Buchowski
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Nancy F. Butte
- Department of Pediatrics, Baylor College of Medicine, USDA/ARS Children's Nutrition Research Center, Houston, TX, 77030, USA
| | - Stephan G. Camps
- imec within OnePlanet Research Center, 6708 WE, Wageningen, The Netherlands
| | - Regina Casper
- Stanford University School of Medicine, Department of Psychiatry, Stanford, CA 94305, USA
| | - Graeme L. Close
- Research Institute for Sport & Exercise Sciences, Liverpool John Moores University, Liverpool, L3 3AF, UK
| | | | | | - Richard Cooper
- Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL 60153, USA
| | - Prasangi Dabare
- Department of Physiotherapy, Faculty of Allied Health Sciences, General Sir John Kotelawala Defence University, Sri Lanka
| | - Sai Krupa Das
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, 02111, USA
| | - Peter S. W. Davies
- Child Health Research Centre, Level 6 Centre for Children's Health Research, University of Queensland, 62 Graham Street, South Brisbane, Queensland, 4101, Australia
| | - Sanjoy Deb
- Centre for Nutraceuticals, School of Life Sciences, University of Westminster, London, UK
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | | | | | - Lara R. Dugas
- Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL 60153, USA
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Simon Eaton
- UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
| | - Ulf Ekelund
- Department of Sport Medicine, Norwegian School of Sport Sciences, PO Box 4014, 0806 Ulleval Stadion, Oslo, Norway
| | - Asmaa El Hamdouchi
- Unité Mixte de Recherche en Nutrition et Alimentation, CNESTEN-Université Ibn Tofail, Rabat, PC.10100, Morocco
| | - Sonja Entringer
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Medical Psychology, Berlin, Germany
- University of California Irvine, Irvine, CA, USA
| | - Terrence Forrester
- Solutions for Developing Countries, University of the West Indies, Mona, Kingston, Jamaica
| | - Barry W. Fudge
- Physiology Department, Aspire Academy, Doha, PO Box 22287, Qatar
| | - Melanie Gillingham
- Department of Molecular and Medical Genetics, Oregon Health & Science University, Portland, OR 97239, USA
| | - Annelies H. Goris
- imec within OnePlanet Research Center, 6708 WE, Wageningen, The Netherlands
| | - Michael Gurven
- Department of Anthropology, University of California Santa Barbara, Santa Barbara, CA 93106, USA
| | - Hinke Haisma
- Population Research Centre, Faculty of Spatial Sciences, Landleven 1, 9747AD, University of Groningen, Groningen, Netherlands
| | - Catherine Hambly
- Institute of Biological and Environmental Sciences, University of Aberdeen, Aberdeen, AB24 2TZ, UK
| | - Daniel J. Hoffman
- Department of Nutritional Sciences, Program in International Nutrition, Rutgers University, New Brunswick, NJ 08901 USA
| | - Marije B. Hoos
- Department of Human Biology, Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre, Maastricht, 6200 MD, Netherlands
| | - Sumei Hu
- Institute of Genetics and development Biology, Chinese Academy of Sciences, Beichen Xi lu, Beijing, People's Republic of China
| | - Noorjehan Joonas
- Central health Laboratory, Ministry of Health and Wellness, Port Louis, 72259, Mauritius
| | - Annemiek Joosen
- imec within OnePlanet Research Center, 6708 WE, Wageningen, The Netherlands
| | - Peter Katzmarzyk
- Pennington Biomedical Research Center, Baton Rouge, LA, 70808, USA
| | - Kitty P. Kempen
- imec within OnePlanet Research Center, 6708 WE, Wageningen, The Netherlands
| | - Misaka Kimura
- Institute for Active Health, Kyoto University of Advanced Science, Kyoto, Japan
| | | | | | - Rebecca Kuriyan
- Division of Nutrition, St John's Research Institute, Bangalore, Karnataka - 560034, India
| | | | - Estelle V. Lambert
- Health through Physical Activity, Lifestyle and Sport Research Centre, Division of Exercise Science and Sports Medicine (ESSM), FIMS International Collaborating Centre of Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Pulani Lanerolle
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Christel L. Larsson
- Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg SE-405 30, Sweden
| | - Nader Lessan
- Imperial College London Diabetes Centre, Abu Dhabi, United Arab Emirates
| | - Marie Löf
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Corby K. Martin
- Pennington Biomedical Research Center, Baton Rouge, LA, 70808, USA
| | - Eric Matsiko
- Department of Human Nutrition and Dietetics, University of Rwanda, Kigali, Rwanda
| | - Gerwin A. Meijer
- Department of Human Biology, Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre, Maastricht, 6200 MD, Netherlands
| | - James C. Morehen
- Research Institute for Sport & Exercise Sciences, Liverpool John Moores University, Liverpool, L3 3AF, UK
| | - James P. Morton
- Research Institute for Sport & Exercise Sciences, Liverpool John Moores University, Liverpool, L3 3AF, UK
| | - Aviva Must
- Tufts University School of Medicine, Boston, USA
| | - Marian Neuhouser
- Division of Public Health Sciences, Fred Hutchinson Cancer Center and School of Public Health, University of Washington, Seattle, WA, 98109, USA
| | - Theresa A. Nicklas
- Department of Pediatrics, Baylor College of Medicine, USDA/ARS Children's Nutrition Research Center, Houston, TX, 77030, USA
| | - Robert M. Ojiambo
- Moi University, Eldoret, Kenya
- University of Global Health Equity, Rwanda
| | | | | | - Jacob Plange-Rhule
- Department of Physiology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Guy Plasqui
- Department of Nutrition and Movement Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Ross L. Prentice
- Division of Public Health Sciences, Fred Hutchinson Cancer Center and School of Public Health, University of Washington, Seattle, WA, 98109, USA
| | | | - Susan B. Racette
- College of Health Solutions, Arizona State University, Phoenix, AZ, 85004, USA
| | - David A. Raichen
- Biological Sciences and Anthropology, University of Southern California, CA, USA
| | - Eric Ravussin
- Pennington Biomedical Research Center, Baton Rouge, LA, 70808, USA
| | - Leanne Redman
- Pennington Biomedical Research Center, Baton Rouge, LA, 70808, USA
| | - John J. Reilly
- Department of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Rebecca M. Reynolds
- Centre for Cardiovascular Sciences, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Susan Roberts
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, 02111, USA
| | - Dulani Samaranayake
- Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Luís B. Sardinha
- Exercise and health laboratory, CIPER, Faculdade Motricidade Humana, Universidade de Lisboa, Portugal
| | - Albertine J. Schuit
- Executive Board, Tilburg University, Tilburg, Noord-Brabant, 5037 AB, The Netherlands
| | - Analiza M. Silva
- Exercise and health laboratory, CIPER, Faculdade Motricidade Humana, Universidade de Lisboa, Portugal
| | - Srishti Sinha
- Division of Nutrition, St John's Research Institute, Bangalore, Karnataka - 560034, India
| | - Anders M. Sjödin
- Department of Nutrition, Exercise and Sports, Copenhagen University, Copenhagen, Denmark
| | - Eric Stice
- PhD Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305
| | - Albert Stunkard
- University of Pennsylvania Perelman School of Medicine Department of Psychiatry
| | | | - Mauro Eduardo Valencia
- Coordinación de Nutrición, Centro de Investigación en Alimentación y Desarrollo (CIAD), A.C., Carretera Gustavo Enrique Astiazarán Rosas, No. 46, Col. La Victoria, C.P. 83304, Hermosillo, Sonora, México
| | - Giulio Valenti
- imec within OnePlanet Research Center, 6708 WE, Wageningen, The Netherlands
| | - Ludo M. van Etten
- Department of Nutrition and Movement Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Edgar A. Van Mil
- Chair Youth, Food and Health, Maastricht University, 5911 BV, Venlo, and Lifestyle Medicine Center for Children, Jeroen Bosch Hospital 5223 GW `s-Hertogenbosch, The Netherlands
| | - Jeanine A. Verbunt
- imec within OnePlanet Research Center, 6708 WE, Wageningen, The Netherlands
| | - Jonathan C. K. Wells
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
| | - George Wilson
- Research Institute for Sport & Exercise Sciences, Liverpool John Moores University, Liverpool, L3 3AF, UK
| | - Brian Wood
- University of California Los Angeles, Los Angeles, 90095, USA
- Department of Human Behavior, Ecology, and Culture, Max Planck Institute for Evolutionary Anthropology, Leipzig 04103, Germany
| | - Tsukasa Yoshida
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
| | - Xueying Zhang
- Shenzhen Key Laboratory of Metabolic Health, Center for Energy Metabolism and Reproduction, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Alexia Murphy-Alford
- Nutritional and Health Related Environmental Studies Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Cornelia Loechl
- Nutritional and Health Related Environmental Studies Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Amy Luke
- Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL 60153, USA
| | - Herman Pontzer
- Dept. of Evolutionary Anthropology, Duke University, Durham NC 27708, USA
- Duke Global Health Institute, Duke University, Durham NC 27708, USA
| | - Jennifer Rood
- Pennington Biomedical Research Center, Baton Rouge, LA, 70808, USA
| | - Hiroyuki Sagayama
- Faculty of Health and Sport Sciences, University of Tsukuba, Ibaraki, 305-8574, Japan
| | - Klaas R. Westerterp
- Department of Human Biology, Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre, Maastricht, 6200 MD, Netherlands
| | - William W. Wong
- Department of Pediatrics, Baylor College of Medicine, USDA/ARS Children's Nutrition Research Center, Houston, TX, 77030, USA
| | - Yosuke Yamada
- Institute for Active Health, Kyoto University of Advanced Science, Kyoto, Japan
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
| | - John R. Speakman
- Institute of Biological and Environmental Sciences, University of Aberdeen, Aberdeen, AB24 2TZ, UK
- Shenzhen Key Laboratory of Metabolic Health, Center for Energy Metabolism and Reproduction, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
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4
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Ecklu-Mensah G, Choo-Kang C, Maseng MG, Donato S, Bovet P, Viswanathan B, Bedu-Addo K, Plange-Rhule J, Oti Boateng P, Forrester TE, Williams M, Lambert EV, Rae D, Sinyanya N, Luke A, Layden BT, O'Keefe S, Gilbert JA, Dugas LR. Gut microbiota and fecal short chain fatty acids differ with adiposity and country of origin: the METS-microbiome study. Nat Commun 2023; 14:5160. [PMID: 37620311 PMCID: PMC10449869 DOI: 10.1038/s41467-023-40874-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 08/11/2023] [Indexed: 08/26/2023] Open
Abstract
The relationship between microbiota, short chain fatty acids (SCFAs), and obesity remains enigmatic. We employ amplicon sequencing and targeted metabolomics in a large (n = 1904) African origin cohort from Ghana, South Africa, Jamaica, Seychelles, and the US. Microbiota diversity and fecal SCFAs are greatest in Ghanaians, and lowest in Americans, representing each end of the urbanization spectrum. Obesity is significantly associated with a reduction in SCFA concentration, microbial diversity, and SCFA synthesizing bacteria, with country of origin being the strongest explanatory factor. Diabetes, glucose state, hypertension, obesity, and sex can be accurately predicted from the global microbiota, but when analyzed at the level of country, predictive accuracy is only universally maintained for sex. Diabetes, glucose, and hypertension are only predictive in certain low-income countries. Our findings suggest that adiposity-related microbiota differences differ between low-to-middle-income compared to high-income countries. Further investigation is needed to determine the factors driving this association.
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Affiliation(s)
- Gertrude Ecklu-Mensah
- Department of Pediatrics, Center for Microbiome Innovation, University of California San Diego, La Jolla, CA, USA
| | - Candice Choo-Kang
- Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, USA
| | - Maria Gjerstad Maseng
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Dep. of Gastroenterology, Oslo University Hospital, Oslo, Norway
- Bio-Me, Oslo, Norway
| | - Sonya Donato
- Department of Pediatrics, Center for Microbiome Innovation, University of California San Diego, La Jolla, CA, USA
| | - Pascal Bovet
- University Center for Primary Care and Public Health (Unisanté), Lausanne University Hospital, Lausanne, Switzerland
- Ministry of Health, Victoria, Republic of Seychelles
| | | | - Kweku Bedu-Addo
- Department of Physiology, SMS, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Jacob Plange-Rhule
- Department of Physiology, SMS, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Prince Oti Boateng
- Department of Physiology, SMS, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Terrence E Forrester
- Solutions for Developing Countries, University of the West Indies, Mona, Kingston, Jamaica
| | - Marie Williams
- Solutions for Developing Countries, University of the West Indies, Mona, Kingston, Jamaica
| | - Estelle V Lambert
- Research Unit for Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa
| | - Dale Rae
- Research Unit for Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa
| | - Nandipha Sinyanya
- Research Unit for Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa
| | - Amy Luke
- Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, USA
| | - Brian T Layden
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
- Jesse Brown Veterans Affairs Medical Center, Chicago, IL, USA
| | - Stephen O'Keefe
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jack A Gilbert
- Department of Pediatrics, Center for Microbiome Innovation, University of California San Diego, La Jolla, CA, USA.
| | - Lara R Dugas
- Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, USA.
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
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5
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Gilbert J, Ecklu-Mensah G, Maseng MG, Donato S, Coo-Kang C, Dugas L, Bovet P, Bedu-Addo K, Plange-Rhule J, Forrester T, Lambert E, Rae D, Luke A, Layden B, O'Keefe S. Gut microbiota and fecal short chain fatty acids differ with adiposity and country of origin: The METS-Microbiome Study. Res Sq 2023:rs.3.rs-2791107. [PMID: 37090540 PMCID: PMC10120767 DOI: 10.21203/rs.3.rs-2791107/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
The relationship between gut microbiota, short chain fatty acid (SCFA) metabolism, and obesity is still not well understood. Here we investigated these associations in a large (n=1904) African origin cohort from Ghana, South Africa, Jamaica, Seychelles, and the US. Fecal microbiota diversity and SCFA concentration were greatest in Ghanaians, and lowest in the US population, representing the lowest and highest end of the epidemiologic transition spectrum, respectively. Obesity was significantly associated with a reduction in SCFA concentration, microbial diversity and SCFA synthesizing bacteria. Country of origin could be accurately predicted from the fecal microbiota (AUC=0.97), while the predictive accuracy for obesity was inversely correlated to the epidemiological transition, being greatest in Ghana (AUC = 0.57). The findings suggest that the microbiota differences between obesity and non-obesity may be larger in low-to-middle-income countries compared to high-income countries. Further investigation is needed to determine the factors driving this association.
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Affiliation(s)
| | | | | | | | | | | | - Pascal Bovet
- University Center for Primary Care and Public Health
| | | | | | | | | | | | - Amy Luke
- Loyola University School of Medicine
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6
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Speakman JR, de Jong JMA, Sinha S, Westerterp KR, Yamada Y, Sagayama H, Ainslie PN, Anderson LJ, Arab L, Bedu-Addo K, Blanc S, Bonomi AG, Bovet P, Brage S, Buchowski MS, Butte NF, Camps SGJA, Cooper JA, Cooper R, Das SK, Davies PSW, Dugas LR, Ekelund U, Entringer S, Forrester T, Fudge BW, Gillingham M, Ghosh S, Goris AH, Gurven M, Halsey LG, Hambly C, Haisma HH, Hoffman D, Hu S, Joosen AM, Kaplan JL, Katzmarzyk P, Kraus WE, Kushner RF, Leonard WR, Löf M, Martin CK, Matsiko E, Medin AC, Meijer EP, Neuhouser ML, Nicklas TA, Ojiambo RM, Pietiläinen KH, Plange-Rhule J, Plasqui G, Prentice RL, Racette SB, Raichlen DA, Ravussin E, Redman LM, Roberts SB, Rudolph MC, Sardinha LB, Schuit AJ, Silva AM, Stice E, Urlacher SS, Valenti G, Van Etten LM, Van Mil EA, Wood BM, Yanovski JA, Yoshida T, Zhang X, Murphy-Alford AJ, Loechl CU, Kurpad A, Luke AH, Pontzer H, Rodeheffer MS, Rood J, Schoeller DA, Wong WW. Total daily energy expenditure has declined over the past three decades due to declining basal expenditure, not reduced activity expenditure. Nat Metab 2023; 5:579-588. [PMID: 37100994 PMCID: PMC10445668 DOI: 10.1038/s42255-023-00782-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 03/08/2023] [Indexed: 04/28/2023]
Abstract
Obesity is caused by a prolonged positive energy balance1,2. Whether reduced energy expenditure stemming from reduced activity levels contributes is debated3,4. Here we show that in both sexes, total energy expenditure (TEE) adjusted for body composition and age declined since the late 1980s, while adjusted activity energy expenditure increased over time. We use the International Atomic Energy Agency Doubly Labelled Water database on energy expenditure of adults in the United States and Europe (n = 4,799) to explore patterns in total (TEE: n = 4,799), basal (BEE: n = 1,432) and physical activity energy expenditure (n = 1,432) over time. In males, adjusted BEE decreased significantly, but in females this did not reach significance. A larger dataset of basal metabolic rate (equivalent to BEE) measurements of 9,912 adults across 163 studies spanning 100 years replicates the decline in BEE in both sexes. We conclude that increasing obesity in the United States/Europe has probably not been fuelled by reduced physical activity leading to lowered TEE. We identify here a decline in adjusted BEE as a previously unrecognized factor.
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Affiliation(s)
- John R Speakman
- Shenzhen Key Laboratory of Metabolic Health, Center for Energy Metabolism and Reproduction, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.
- Institute of Biological and Environmental Sciences, University of Aberdeen, Aberdeen, UK.
- State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, China.
- CAS Center of Excellence in Animal Evolution and Genetics, Kunming, China.
| | - Jasper M A de Jong
- Department of Comparative Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Molecular Biosciences, The Wenner-Gren Institute, Stockholm University, Stockholm, Sweden
| | - Srishti Sinha
- St Johns Medical college, Bengaluru, India
- Nutritional and Health Related Environmental Studies Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Klaas R Westerterp
- School of Nutrition and Translational Research in Metabolism (NUTRIM), University of Maastricht, Maastricht, the Netherlands.
| | - Yosuke Yamada
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan.
- Institute for Active Health, Kyoto University of Advanced Science, Kyoto, Japan.
| | - Hiroyuki Sagayama
- Faculty of Health and Sport Sciences, University of Tsukuba, Ibaraki, Japan.
| | - Philip N Ainslie
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Liam J Anderson
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Lenore Arab
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Kweku Bedu-Addo
- Department of Physiology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Stephane Blanc
- Nutritional Sciences, University of Wisconsin, Madison, WI, USA
- Institut Pluridisciplinaire Hubert Curien, CNRS Université de Strasbourg, Strasbourg, France
| | | | - Pascal Bovet
- University Center for Primary care and Public Health (Unisanté), Lausanne University Hospital, Lausanne, Switzerland
- Ministry of Health, Victoria, Seychelles
| | - Soren Brage
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Maciej S Buchowski
- Division of Gastroenterology, Hepatology and Nutritiion, Department of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Nancy F Butte
- Department of Pediatrics, Baylor College of Medicine, USDA/ARS Children's Nutrition Research Center, Houston, TX, USA
| | - Stefan G J A Camps
- School of Nutrition and Translational Research in Metabolism (NUTRIM), University of Maastricht, Maastricht, the Netherlands
| | - Jamie A Cooper
- Nutritional Sciences, University of Wisconsin, Madison, WI, USA
- Nutritional Sciences, University of Georgia, Athens, GA, USA
| | - Richard Cooper
- Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University, Maywood, IL, USA
| | - Sai Krupa Das
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Peter S W Davies
- Child Health Research Centre, Centre for Children's Health Research, University of Queensland, South Brisbane, Queensland, Australia
| | - Lara R Dugas
- Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University, Maywood, IL, USA
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Ulf Ekelund
- Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Sonja Entringer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Medical Psychology, Berlin, Germany
- University of California Irvine, Irvine, CA, USA
| | - Terrence Forrester
- Solutions for Developing Countries, University of the West Indies, Kingston, Jamaica
| | | | - Melanie Gillingham
- Department of Molecular and Medical Genetics, Oregon Health & Science University, Portland, OR, USA
| | | | - Annelies H Goris
- IMEC within OnePlanet Research Center, Wageningen, the Netherlands
| | - Michael Gurven
- Department of Anthropology, University of California Santa Barbara, Santa Barbara, CA, USA
| | - Lewis G Halsey
- School of Life and Health Sciences, University of Roehampton, London, UK
| | - Catherine Hambly
- Institute of Biological and Environmental Sciences, University of Aberdeen, Aberdeen, UK
| | - Hinke H Haisma
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, the Netherlands
| | - Daniel Hoffman
- Department of Nutritional Sciences, Program in International Nutrition, Rutgers University, New Brunswick, NJ, USA
| | - Sumei Hu
- Shenzhen Key Laboratory of Metabolic Health, Center for Energy Metabolism and Reproduction, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, China
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, Beijing Engineering and Technology Research Center of Food Additives, National Soybean Processing Industry Technology Innovation Center, Beijing Technology and Business University, Beijing, China
| | - Annemiek M Joosen
- School of Nutrition and Translational Research in Metabolism (NUTRIM), University of Maastricht, Maastricht, the Netherlands
| | - Jennifer L Kaplan
- Department of Comparative Medicine, Yale School of Medicine, New Haven, CT, USA
| | | | | | | | - William R Leonard
- Department of Anthropology, Northwestern University, Evanston, IL, USA
| | - Marie Löf
- Department of Biosciences and Nutrition, Karolinska Institute, Stockholm, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Corby K Martin
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Eric Matsiko
- Department of Human Nutrition and Dietetics, University of Rwanda, Kigali, Rwanda
| | - Anine C Medin
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Erwin P Meijer
- School of Nutrition and Translational Research in Metabolism (NUTRIM), University of Maastricht, Maastricht, the Netherlands
| | - Marian L Neuhouser
- Division of Public Health Sciences, Fred Hutchinson Cancer Center and School of Public Health, University of Washington, Seattle, WA, USA
| | - Theresa A Nicklas
- Department of Pediatrics, Baylor College of Medicine, USDA/ARS Children's Nutrition Research Center, Houston, TX, USA
| | - Robert M Ojiambo
- Moi University, Eldoret, Kenya
- University of Global Health Equity, Kigali, Rwanda
| | | | - Jacob Plange-Rhule
- Department of Physiology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Guy Plasqui
- Department of Nutrition and Movement Sciences, Maastricht University, Maastricht, the Netherlands
| | - Ross L Prentice
- Division of Public Health Sciences, Fred Hutchinson Cancer Center and School of Public Health, University of Washington, Seattle, WA, USA
| | - Susan B Racette
- Program in Physical Therapy and Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - David A Raichlen
- Biological Sciences and Anthropology, University of Southern California, Los Angeles, CA, USA
| | - Eric Ravussin
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | | | - Susan B Roberts
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Michael C Rudolph
- Department of Physiology and Harold Hamm Diabetes Center, Oklahoma University Health Sciences, Oklahoma City, OK, USA
| | - Luis B Sardinha
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
| | | | - Analiza M Silva
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
| | | | - Samuel S Urlacher
- Department of Anthropology, Baylor University, Waco, TX, USA
- Child and Brain Development program, CIFAR, Toronto, Ontario, Canada
| | - Giulio Valenti
- School of Nutrition and Translational Research in Metabolism (NUTRIM), University of Maastricht, Maastricht, the Netherlands
| | - Ludo M Van Etten
- School of Nutrition and Translational Research in Metabolism (NUTRIM), University of Maastricht, Maastricht, the Netherlands
| | - Edgar A Van Mil
- Maastricht University, Campus Venlo and Lifestyle Medicine Center for Children, Jeroen Bosch Hospital's-Hertogenbosch, Hertogenbosch, the Netherlands
| | - Brian M Wood
- University of California Los Angeles, Los Angeles, CA, USA
- Department of Human Behavior, Ecology, and Culture, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| | - Jack A Yanovski
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Tsukasa Yoshida
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
| | - Xueying Zhang
- Shenzhen Key Laboratory of Metabolic Health, Center for Energy Metabolism and Reproduction, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- Institute of Biological and Environmental Sciences, University of Aberdeen, Aberdeen, UK
| | - Alexia J Murphy-Alford
- Nutritional and Health Related Environmental Studies Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Cornelia U Loechl
- Nutritional and Health Related Environmental Studies Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | | | - Amy H Luke
- Division of Epidemiology, Department of Public Health Sciences, Loyola University School of Medicine, Maywood, IL, USA.
| | - Herman Pontzer
- Evolutionary Anthropology, Duke University, Durham, NC, USA.
- Duke Global Health Institute, Duke University, Durham, NC, USA.
| | - Matthew S Rodeheffer
- Department of Comparative Medicine, Yale School of Medicine, New Haven, CT, USA.
- Center of Molecular and Systems Metabolism, Yale University, New Haven, CT, USA.
- Department of Physiology, Yale University, New Haven, CT, USA.
| | - Jennifer Rood
- Pennington Biomedical Research Center, Baton Rouge, LA, USA.
| | - Dale A Schoeller
- Biotech Center and Nutritional Sciences, University of Wisconsin, Madison, WI, USA.
| | - William W Wong
- Department of Pediatrics, Baylor College of Medicine, USDA/ARS Children's Nutrition Research Center, Houston, TX, USA.
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7
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Ecklu-Mensah G, Choo-Kang C, Gjerstad Maseng M, Donato S, Bovet P, Bedu-Addo K, Plange-Rhule J, Forrester TE, Lambert EV, Rae D, Luke A, Layden BT, O’Keefe S, Gilbert JA, Dugas LR. Gut microbiota and fecal short chain fatty acids differ with adiposity and country of origin: The METS-Microbiome Study. bioRxiv 2023:2023.03.21.533195. [PMID: 36993742 PMCID: PMC10055249 DOI: 10.1101/2023.03.21.533195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
The relationship between the gut microbiota, short chain fatty acid (SCFA) metabolism, and obesity remains unclear due to conflicting reports from studies with limited statistical power. Additionally, this association has rarely been explored in large scale diverse populations. Here, we investigated associations between fecal microbial composition, predicted metabolic potential, SCFA concentrations, and obesity in a large ( N = 1,934) adult cohort of African-origin spanning the epidemiologic transition, from Ghana, South Africa, Jamaica, Seychelles, and the United States (US). The greatest gut microbiota diversity and total fecal SCFA concentration was found in the Ghanaian population, while the lowest levels were found in the US population, respectively representing the lowest and the highest end of the epidemiologic transition spectrum. Country-specific bacterial taxa and predicted-functional pathways were observed, including an increased prevalence of Prevotella , Butyrivibrio , Weisella and Romboutsia in Ghana and South Africa, while Bacteroides and Parabacteroides were enriched in Jamaican and the US populations. Importantly, 'VANISH' taxa, including Butyricicoccus and Succinivibrio , were significantly enriched in the Ghanaian cohort, reflecting the participants' traditional lifestyles. Obesity was significantly associated with lower SCFA concentrations, a decrease in microbial richness, and dissimilarities in community composition, and reduction in the proportion of SCFA synthesizing bacteria including Oscillospira , Christensenella , Eubacterium , Alistipes , Clostridium and Odoribacter . Further, the predicted proportions of genes in the lipopolysaccharide (LPS) synthesis pathway were enriched in obese individuals, while genes associated with butyrate synthesis via the dominant pyruvate pathway were significantly reduced in obese individuals. Using machine learning, we identified features predictive of metabolic state and country of origin. Country of origin could accurately be predicted by the fecal microbiota (AUC = 0.97), whereas obesity could not be predicted as accurately (AUC = 0.65). Participant sex (AUC = 0.75), diabetes status (AUC = 0.63), hypertensive status (AUC = 0.65), and glucose status (AUC = 0.66) could all be predicted with different success. Interestingly, within country, the predictive accuracy of the microbiota for obesity was inversely correlated to the epidemiological transition, being greatest in Ghana (AUC = 0.57). Collectively, our findings reveal profound variation in the gut microbiota, inferred functional pathways, and SCFA synthesis as a function of country of origin. While obesity could be predicted accurately from the microbiota, the variation in accuracy in parallel with the epidemiological transition suggests that differences in the microbiota between obesity and non-obesity may be larger in low-to-middle countries compared to high-income countries. Further examination of independent study populations using multi-omic approaches will be necessary to determine the factors that drive this association.
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Affiliation(s)
| | - Candice Choo-Kang
- Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, USA
| | - Maria Gjerstad Maseng
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Dep. of Gastroenterology, Oslo University Hospital, Oslo, Norway
- Bio-Me, Oslo, Norway
| | - Sonya Donato
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Pascal Bovet
- University Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland& Ministry of Health, Republic of Seychelles Department of Physiology, SMS
| | - Kweku Bedu-Addo
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Terrence E. Forrester
- Solutions for Developing Countries, University of the West Indies, Mona, Kingston, Jamaica
| | - Estelle V. Lambert
- Research Unit for Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa
| | - Dale Rae
- Research Unit for Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa
| | - Amy Luke
- Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, USA
| | - Brian T. Layden
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
- Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois, USA
| | | | - Jack A. Gilbert
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Lara R. Dugas
- Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, USA
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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8
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Yamada Y, Zhang X, Henderson MET, Sagayama H, Pontzer H, Watanabe D, Yoshida T, Kimura M, Ainslie PN, Andersen LF, Anderson LJ, Arab L, Baddou I, Bedu-Addo K, Blaak EE, Blanc S, Bonomi AG, Bouten CVC, Bovet P, Buchowski MS, Butte NF, Camps SG, Close GL, Cooper JA, Cooper R, Das SK, Dugas LR, Eaton S, Ekelund U, Entringer S, Forrester T, Fudge BW, Goris AH, Gurven M, Halsey LG, Hambly C, El Hamdouchi A, Hoos MB, Hu S, Joonas N, Joosen AM, Katzmarzyk P, Kempen KP, Kraus WE, Kriengsinyos W, Kushner RF, Lambert EV, Leonard WR, Lessan N, Martin CK, Medin AC, Meijer EP, Morehen JC, Morton JP, Neuhouser ML, Nicklas TA, Ojiambo RM, Pietiläinen KH, Pitsiladis YP, Plange-Rhule J, Plasqui G, Prentice RL, Rabinovich RA, Racette SB, Raichlen DA, Ravussin E, Redman LM, Reilly JJ, Reynolds RM, Roberts SB, Schuit AJ, Sardinha LB, Silva AM, Sjödin AM, Stice E, Urlacher SS, Valenti G, Van Etten LM, Van Mil EA, Wells JCK, Wilson G, Wood BM, Yanovski JA, Murphy-Alford AJ, Loechl CU, Luke AH, Rood J, Westerterp KR, Wong WW, Miyachi M, Schoeller DA, Speakman JR. Variation in human water turnover associated with environmental and lifestyle factors. Science 2022; 378:909-915. [PMID: 36423296 PMCID: PMC9764345 DOI: 10.1126/science.abm8668] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Water is essential for survival, but one in three individuals worldwide (2.2 billion people) lacks access to safe drinking water. Water intake requirements largely reflect water turnover (WT), the water used by the body each day. We investigated the determinants of human WT in 5604 people from the ages of 8 days to 96 years from 23 countries using isotope-tracking (2H) methods. Age, body size, and composition were significantly associated with WT, as were physical activity, athletic status, pregnancy, socioeconomic status, and environmental characteristics (latitude, altitude, air temperature, and humidity). People who lived in countries with a low human development index (HDI) had higher WT than people in high-HDI countries. On the basis of this extensive dataset, we provide equations to predict human WT in relation to anthropometric, economic, and environmental factors.
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Affiliation(s)
- Yosuke Yamada
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan
- Institute for Active Health, Kyoto University of Advanced Science, Kyoto, Japan
| | - Xueying Zhang
- Shenzhen Key Laboratory of Metabolic Health, Center for Energy Metabolism and Reproduction, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- Institute of Biological and Environmental Sciences, University of Aberdeen, Aberdeen, UK
| | - Mary E T Henderson
- School of Life and Health Sciences, University of Roehampton, London, UK
| | - Hiroyuki Sagayama
- Faculty of Health and Sport Sciences, University of Tsukuba, Ibaraki, Japan
| | - Herman Pontzer
- Department of Evolutionary Anthropology, Duke University, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Daiki Watanabe
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan
- Institute for Active Health, Kyoto University of Advanced Science, Kyoto, Japan
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
| | - Tsukasa Yoshida
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan
- Institute for Active Health, Kyoto University of Advanced Science, Kyoto, Japan
| | - Misaka Kimura
- Institute for Active Health, Kyoto University of Advanced Science, Kyoto, Japan
| | - Philip N Ainslie
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Lene F Andersen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Liam J Anderson
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Lenore Arab
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Issad Baddou
- Unité Mixte de Recherche en Nutrition et Alimentation, CNESTEN-Université Ibn Tofail URAC39, Regional Designated Center of Nutrition Associated with AFRA/IAEA, Rabat, Morocco
| | - Kweku Bedu-Addo
- Department of Physiology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ellen E Blaak
- Department of Human Biology, Maastricht University, Maastricht, Netherlands
| | - Stephane Blanc
- Nutritional Sciences, University of Wisconsin, Madison, WI, USA
- Institut Pluridisciplinaire Hubert Curien, CNRS Université de Strasbourg, UMR7178, France
| | | | | | - Pascal Bovet
- University Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Maciej S Buchowski
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Nancy F Butte
- Department of Pediatrics, Baylor College of Medicine, US Department of Agriculture (USDA)/Agricultural Research Service (ARS) Children's Nutrition Research Center, Houston, TX, USA
| | - Stefan G Camps
- Maastricht University, Maastricht, Netherlands
- Clinical Nutrition Research Centre (CNRC), Singapore Institute of Food and Biotechnology Innovation (SIFBI), Agency of Science, Technology and Research (A*STAR), Singapore
| | - Graeme L Close
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Jamie A Cooper
- Nutritional Sciences, University of Georgia, Athens, GA, USA
| | - Richard Cooper
- Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University, Maywood, IL, USA
| | - Sai Krupa Das
- USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Lara R Dugas
- Public Health Sciences, Loyola University of Chicago, Maywood, IL, USA
- Division of Epidemiology and Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Simon Eaton
- Developmental Biology and Cancer Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Ulf Ekelund
- Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Sonja Entringer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Psychology, Berlin, Germany
- Department of Pediatrics, University of California Irvine, Irvine, CA, USA
| | - Terrence Forrester
- Solutions for Developing Countries, University of the West Indies, Mona, Kingston, Jamaica
| | | | | | - Michael Gurven
- Department of Anthropology, University of California Santa Barbara, Santa Barbara, CA, USA
| | - Lewis G Halsey
- School of Life and Health Sciences, University of Roehampton, London, UK
| | - Catherine Hambly
- Institute of Biological and Environmental Sciences, University of Aberdeen, Aberdeen, UK
| | - Asmaa El Hamdouchi
- Unité Mixte de Recherche en Nutrition et Alimentation, CNESTEN-Université Ibn Tofail URAC39, Regional Designated Center of Nutrition Associated with AFRA/IAEA, Rabat, Morocco
| | | | - Sumei Hu
- Beijing Technology and Business University, Beijing, China
| | - Noorjehan Joonas
- Central Health Laboratory, Ministry of Health and Wellness, Mauritius
| | | | | | | | | | - Wantanee Kriengsinyos
- Institute of Nutrition, Mahidol University, Salaya, Phutthamonthon, Nakon-Pathom, Thailand
| | - Robert F Kushner
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Estelle V Lambert
- Health Through Physical Activity, Lifestyle and Sport Research Centre (HPALS) Division of Exercise Science and Sports Medicine (ESSM), FIMS International Collaborating Centre of Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - William R Leonard
- Department of Anthropology, Northwestern University, Evanston, IL, USA
| | - Nader Lessan
- Imperial College London Diabetes Centre, Abu Dhabi, United Arab Emirates
- Imperial College London, London, UK
| | - Corby K Martin
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Anine C Medin
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | | | - James C Morehen
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
- The FA Group, Burton-Upon-Trent, Staffordshire, UK
| | - James P Morton
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Marian L Neuhouser
- Division of Public Health Sciences, Fred Hutchinson Cancer Center and School of Public Health, University of Washington, Seattle, WA, USA
| | - Theresa A Nicklas
- Department of Pediatrics, Baylor College of Medicine, US Department of Agriculture (USDA)/Agricultural Research Service (ARS) Children's Nutrition Research Center, Houston, TX, USA
| | - Robert M Ojiambo
- Kenya School of Medicine, Moi University, Eldoret, Kenya
- Rwanda Division of Basic Sciences, University of Global Health Equity, Rwanda
| | - Kirsi H Pietiläinen
- Obesity Research Unit, Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, and Abdominal Center, Obesity Center, HealthyWeightHub, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Yannis P Pitsiladis
- School of Sport and Service Management, University of Brighton, Eastbourne, UK
| | - Jacob Plange-Rhule
- Department of Physiology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Guy Plasqui
- Department of Nutrition and Movement Sciences, Maastricht University, Maastricht, Netherlands
| | - Ross L Prentice
- Division of Public Health Sciences, Fred Hutchinson Cancer Center and School of Public Health, University of Washington, Seattle, WA, USA
| | | | - Susan B Racette
- Program in Physical Therapy and Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA, and College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - David A Raichlen
- Biological Sciences and Anthropology, University of Southern California, Los Angeles, CA, USA
| | - Eric Ravussin
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | | | | | - Rebecca M Reynolds
- Centre for Cardiovascular Sciences, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Susan B Roberts
- USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Albertine J Schuit
- School of Social and Behavioral Sciences, University of Tilburg, Tilburg, Netherlands
| | - Luis B Sardinha
- Exercise and Health Laboratory, CIPER, Faculdade Motricidade Humana, Universidade de Lisboa, Portugal
| | - Analiza M Silva
- Exercise and Health Laboratory, CIPER, Faculdade Motricidade Humana, Universidade de Lisboa, Portugal
| | - Anders M Sjödin
- Department of Nutrition, Exercise and Sports, Copenhagen University, Copenhagen, Denmark
| | - Eric Stice
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Samuel S Urlacher
- Department of Anthropology, Baylor University, Waco, TX, USA
- Child and Brain Development Program, Canadian Institute for Advanced Research (CIFAR), Toronto, Ontario, Canada
| | - Giulio Valenti
- Phillips Research, Eindoven, Netherlands
- Maastricht University, Maastricht, Netherlands
| | | | - Edgar A Van Mil
- Maastricht University, Brightlands Campus Greenport Venlo and Lifestyle Medicine Center for Children, Jeroen Bosch Hospital, Hertogenbosch, Netherlands
| | - Jonathan C K Wells
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - George Wilson
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Brian M Wood
- Department of Anthropology, University of California Los Angeles, Los Angeles, CA, USA
- Max Planck Institute for Evolutionary Anthropology, Department of Human Behavior, Ecology, and Culture, Leipzig, Germany
| | - Jack A Yanovski
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Alexia J Murphy-Alford
- Nutritional and Health-Related Environmental Studies Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Cornelia U Loechl
- Nutritional and Health-Related Environmental Studies Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Amy H Luke
- Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Chicago, IL, USA
| | - Jennifer Rood
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | | | - William W Wong
- Department of Pediatrics, Baylor College of Medicine, US Department of Agriculture (USDA)/Agricultural Research Service (ARS) Children's Nutrition Research Center, Houston, TX, USA
| | - Motohiko Miyachi
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
| | - Dale A Schoeller
- Biotechnology Center and Department of Nutritional Sciences, University of Wisconsin, Madison, WI, USA
| | - John R Speakman
- Shenzhen Key Laboratory of Metabolic Health, Center for Energy Metabolism and Reproduction, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- Institute of Biological and Environmental Sciences, University of Aberdeen, Aberdeen, UK
- State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, China
- CAS Center of Excellence in Animal Evolution and Genetics, Kunming, China
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9
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Reese TO, Bovet P, Choo-Kang C, Bedu-Addo K, Forrester T, Gilbert JA, Goedecke JH, Lambert EV, Layden BT, Micklesfield LK, Plange-Rhule J, Rae D, Viswanathan B, Luke A, Dugas LR. Utility of silhouette showcards to assess adiposity in three countries across the epidemiological transition. PLOS Glob Public Health 2022; 2:e0000127. [PMID: 36962336 PMCID: PMC10021870 DOI: 10.1371/journal.pgph.0000127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 03/31/2022] [Indexed: 01/10/2023]
Abstract
The Pulvers' silhouette showcards provide a non-invasive and easy-to-use way of assessing an individual's body size perception using nine silhouette shapes. However, their utility across different populations has not been examined. This study aimed to assess: 1) the relationship between silhouette perception and measured anthropometrics, i.e., body mass index (BMI), waist circumference (WC), waist-height-ratio (WHtR), and 2) the ability to predict with silhouette showcards anthropometric adiposity measures, i.e., overweight and obesity (BMI ≥ 25 kg/m2), obesity alone (BMI ≥ 30 kg/m2), elevated WC (men ≥ 94 cm; women ≥ 80 cm), and WHtR (> 0.5) across the epidemiological transition. 751 African-origin participants, aged 20-68 years old, from the United States (US), Seychelles, and Ghana, completed anthropometrics and selected silhouettes corresponding to their perceived body size. Silhouette performance to anthropometrics was examined using a least-squares linear regression model. A receiver operator curve (ROC) was used to investigate the showcards ability to predict anthropometric adiposity measures. The relationship between silhouette ranking and BMI were similar between sexes of the same country but differed between countries: 3.65 [95% CI: 3.34-3.97] BMI units/silhouette unit in the US, 3.23 [2.93-3.74] in Seychelles, and 1.99 [1.72-2.26] in Ghana. Different silhouette cutoffs predicted obesity differently in the three countries. For example, a silhouette ≥ five had a sensitivity/specificity of 77.3%/90.6% to predict BMI ≥ 25 kg/m2 in the US, but 77.8%/85.9% in Seychelles and 84.9%/71.4% in Ghana. Ultimately, silhouettes predicted BMI, WC, and WHtR similarly within each country and sex but not across countries. Our data suggest that Pulvers' silhouette showcards may be a helpful tool to predict anthropometric and adiposity measures in different populations when direct measurement cannot be performed. However, no universal silhouette cutoff can be used for detecting overweight or obesity status, and population-specific differences may stress the need to calibrate silhouette showcards when using them as a survey tool in different countries.
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Affiliation(s)
- Tyler O. Reese
- Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, United States of America
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Pascal Bovet
- Unit for Prevention and Control of Cardiovascular Disease, Ministry of Health, Victoria, Republic of Seychelles
- University Center for Primary Care and Public Health, Lausanne, Switzerland
| | - Candice Choo-Kang
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois, United States of America
| | - Kweku Bedu-Addo
- Department of Physiology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Terrence Forrester
- Solutions for Developing Countries, University of the West Indies, Mona, Kingston, Jamaica
| | - Jack A. Gilbert
- Department of Surgery, Microbiome Center, University of Chicago, Chicago, Illinois, United States of America
| | - Julia H. Goedecke
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Research Centre for Health through Physical Activity, Lifestyle and Sport, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Estelle V. Lambert
- Department of Surgery, Microbiome Center, University of Chicago, Chicago, Illinois, United States of America
| | - Brian T. Layden
- Division of Endocrinology, Diabetes, and Metabolism, University of Illinois at Chicago, Chicago, Illinois, United States of America
- Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois, United States of America
| | - Lisa K. Micklesfield
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Research Centre for Health through Physical Activity, Lifestyle and Sport, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Pediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jacob Plange-Rhule
- Department of Physiology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Dale Rae
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Research Centre for Health through Physical Activity, Lifestyle and Sport, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Bharathi Viswanathan
- Unit for Prevention and Control of Cardiovascular Disease, Ministry of Health, Victoria, Republic of Seychelles
| | - Amy Luke
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois, United States of America
| | - Lara R. Dugas
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois, United States of America
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Research Centre for Health through Physical Activity, Lifestyle and Sport, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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10
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Kekulawala M, Samba A, Braunschweig Y, Plange-Rhule J, Turpin C, Johnson TRB, Anderson FWJ. Obstetric capacity strengthening in Ghana results in wide geographic distribution and retention of certified Obstetrician/Gynaecologists: A quantitative analysis. BJOG 2022; 129:1757-1761. [PMID: 35157341 DOI: 10.1111/1471-0528.17121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 01/26/2022] [Accepted: 01/31/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Melani Kekulawala
- School of Public Health, Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan, USA.,College of Medicine and Life Sciences, University of Toledo, Toledo, Ohio, USA
| | - Ali Samba
- Department of Obstetrics and Gynaecology, University of Ghana, Accra, Ghana
| | - Yael Braunschweig
- School of Public Health, Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan, USA.,Department of Family Medicine, Stanford University, Stanford, California, USA
| | | | - Cornelius Turpin
- Department of Obstetrics and Gynaecology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Timothy R B Johnson
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
| | - Frank W J Anderson
- School of Public Health, Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan, USA.,Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
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11
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Baghdan D, Dugas LR, Choo-Kang C, Plange-Rhule J, Bovet P, Viswanathan B, Forrester T, Lambert EV, Riesen W, Korte W, Choudhry MA, Luke A. The associations between alcohol intake and cardiometabolic risk in African-origin adults spanning the epidemiologic transition. BMC Public Health 2021; 21:2210. [PMID: 34863124 PMCID: PMC8642964 DOI: 10.1186/s12889-021-12128-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/29/2021] [Indexed: 11/18/2022] Open
Abstract
Background Cardiometabolic (CM) risk affects approximately 25% of adults globally, and is diagnosed by meeting 3 out of 5 of the following CM risk factors: elevated blood pressure, high triglycerides, elevated blood sugar, low high-density lipoprotein (HDL) level, and abdominal obesity. Adults with CM risk are approximately 22% more likely to have higher mortality rates, and alcohol consumption may be associated with higher CM risk. While previous studies have investigated this potential connection, the majority of them did not include African-origin adults. Therefore, the study aimed to explore the association between alcohol intake and CM risk in 5 African-origin cohorts, spanning the epidemiologic transition in Ghana, South Africa, Jamaica, Seychelles and the United States of America. Methods Measurements included clinical measures for CM risk and self-reported alcohol consumption. Each participant was categorized into one of three drinking categories: non-drinker, light drinker (1–3 drinks daily for men and 1–2 drinks daily for women) and heavy drinker (4 or more drinks every day for men and 3 or more drinks per day for women). Using non-drinker status as the reference, the association between alcohol consumption status and prevalence of each of the five CM risk factors and overall elevated CM risk (having 3 out of 5 risk factors) was explored, adjusting for site, age and sex. Associations were explored using logistic regression and significance was determined using odds ratios (OR) and 95% confidence intervals. Results Neither light nor heavy drinking was associated with increased odds for having higher CM risk compared to nondrinkers (OR = 1.05, p = 0.792 and OR = 1.11, p = 0.489, respectively). However, light drinking was associated with lower odds for having low high density lipoproteins (HDL) cholesterol (OR = 0.69, p = 0.002) and increased risk for high triglycerides (OR = 1.48, p = 0.030). Heavy drinking was associated with elevated blood pressure (OR = 1.59, p = 0.002), high triglycerides (OR = 1.73, p = 0.006) and decreased risk of low HDL-cholesterol (OR = 0.621, p < 0.0005). Finally, country-specific analyses indicated that the relationship between heavy drinking and elevated CM risk varied widely across sites. Conclusion While several CM risk factors were associated with alcohol consumption, the associations were inconsistent and varied widely across five international cohorts of African-origin. Future studies should focus on understanding the individual site-related effects. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12128-2.
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Affiliation(s)
- Danny Baghdan
- Parkinson School of Health Sciences & Public Health, Loyola University Chicago, 2160 S. 1st Ave, Maywood, IL, 60153, USA
| | - Lara R Dugas
- Parkinson School of Health Sciences & Public Health, Loyola University Chicago, 2160 S. 1st Ave, Maywood, IL, 60153, USA. .,Division of Epidemiology and Biostatics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Candice Choo-Kang
- Parkinson School of Health Sciences & Public Health, Loyola University Chicago, 2160 S. 1st Ave, Maywood, IL, 60153, USA
| | | | | | - Bharathi Viswanathan
- Ministry of Health and Social Development, Public Health Authority, Victoria Hospital, Mahé, Republic of Seychelles
| | - Terrence Forrester
- Solutions for Developing Countries, University of the West Indies, Mona, Kingston, Jamaica
| | - Estelle V Lambert
- Research Unit for Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa
| | - Walter Riesen
- Center for Laboratory Medicine, Canton Hospital, St. Gallen, Switzerland
| | - Wolfgang Korte
- Center for Laboratory Medicine, Canton Hospital, St. Gallen, Switzerland
| | | | - Amy Luke
- Parkinson School of Health Sciences & Public Health, Loyola University Chicago, 2160 S. 1st Ave, Maywood, IL, 60153, USA
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12
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Fei N, Choo-Kang C, Reutrakul S, Crowley SJ, Rae D, Bedu-Addo K, Plange-Rhule J, Forrester TE, Lambert EV, Bovet P, Riesen W, Korte W, Luke A, Layden BT, Gilbert JA, Dugas LR. Gut microbiota alterations in response to sleep length among African-origin adults. PLoS One 2021; 16:e0255323. [PMID: 34495955 PMCID: PMC8425534 DOI: 10.1371/journal.pone.0255323] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/14/2021] [Indexed: 12/15/2022] Open
Abstract
Sleep disorders are increasingly being characterized in modern society as contributing to a host of serious medical problems, including obesity and metabolic syndrome. Changes to the microbial community in the human gut have been reportedly associated with many of these cardiometabolic outcomes. In this study, we investigated the impact of sleep length on the gut microbiota in a large cohort of 655 participants of African descent, aged 25-45, from Ghana, South Africa (SA), Jamaica, and the United States (US). The sleep duration was self-reported via a questionnaire. Participants were classified into 3 sleep groups: short (<7hrs), normal (7-<9hrs), and long (≥9hrs). Forty-seven percent of US participants were classified as short sleepers and 88% of SA participants as long sleepers. Gut microbial composition analysis (16S rRNA gene sequencing) revealed that bacterial alpha diversity negatively correlated with sleep length (p<0.05). Furthermore, sleep length significantly contributed to the inter-individual beta diversity dissimilarity in gut microbial composition (p<0.01). Participants with both short and long-sleep durations exhibited significantly higher abundances of several taxonomic features, compared to normal sleep duration participants. The predicted relative proportion of two genes involved in the butyrate synthesis via lysine pathway were enriched in short sleep duration participants. Finally, co-occurrence relationships revealed by network analysis showed unique interactions among the short, normal and long duration sleepers. These results suggest that sleep length in humans may alter gut microbiota by driving population shifts of the whole microbiota and also specific changes in Exact Sequence Variants abundance, which may have implications for chronic inflammation associated diseases. The current findings suggest a possible relationship between disrupted sleep patterns and the composition of the gut microbiota. Prospective investigations in larger and more prolonged sleep researches and causally experimental studies are needed to confirm these findings, investigate the underlying mechanism and determine whether improving microbial homeostasis may buffer against sleep-related health decline in humans.
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Affiliation(s)
- Na Fei
- Microbiome Center, Department of Surgery, University of Chicago, Chicago, IL, United States of America
| | - Candice Choo-Kang
- Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, United States of America
| | - Sirimon Reutrakul
- Department of Psychiatry & Behavioral Sciences, Biological Rhythms Research Laboratory, Rush University Medical Center, Chicago, IL, United States of America
| | - Stephanie J. Crowley
- Department of Psychiatry & Behavioral Sciences, Biological Rhythms Research Laboratory, Rush University Medical Center, Chicago, IL, United States of America
| | - Dale Rae
- Research Unit for Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa
| | - Kweku Bedu-Addo
- Research Unit for Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa
| | - Jacob Plange-Rhule
- Research Unit for Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa
| | - Terrence E. Forrester
- Solutions for Developing Countries, University of the West Indies, Mona, Kingston, Jamaica
| | - Estelle V. Lambert
- Department of Physiology, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Pascal Bovet
- University Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
- Ministry of Health, Victoria, Republic of Seychelles
| | - Walter Riesen
- University Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
- Ministry of Health, Victoria, Republic of Seychelles
| | - Wolfgang Korte
- Center for Laboratory Medicine, Canton Hospital, St. Gallen, Switzerland
| | - Amy Luke
- Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, United States of America
| | - Brian T. Layden
- Department of Psychiatry & Behavioral Sciences, Biological Rhythms Research Laboratory, Rush University Medical Center, Chicago, IL, United States of America
- Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois, United States of America
| | - Jack A. Gilbert
- University of California San Diego, San Diego, California, United States of America
| | - Lara R. Dugas
- Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, United States of America
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
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13
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Westerterp KR, Yamada Y, Sagayama H, Ainslie PN, Andersen LF, Anderson LJ, Arab L, Baddou I, Bedu-Addo K, Blaak EE, Blanc S, Bonomi AG, Bouten CVC, Bovet P, Buchowski MS, Butte NF, Camps SGJA, Close GL, Cooper JA, Das SK, Cooper R, Dugas LR, Ekelund U, Entringer S, Forrester T, Fudge BW, Goris AH, Gurven M, Hambly C, El Hamdouchi A, Hoos MB, Hu S, Joonas N, Joosen AM, Katzmarzyk P, Kempen KP, Kimura M, Kraus WE, Kushner RF, Lambert EV, Leonard WR, Lessan N, Martin CK, Medin AC, Meijer EP, Morehen JC, Morton JP, Neuhouser ML, Nicklas TA, Ojiambo RM, Pietiläinen KH, Pitsiladis YP, Plange-Rhule J, Plasqui G, Prentice RL, Rabinovich RA, Racette SB, Raichlen DA, Ravussin E, Reynolds RM, Roberts SB, Schuit AJ, Sjödin AM, Stice E, Urlacher SS, Valenti G, Van Etten LM, Van Mil EA, Wells JCK, Wilson G, Wood BM, Yanovski J, Yoshida T, Zhang X, Murphy-Alford AJ, Loechl CU, Luke AH, Pontzer H, Rood J, Schoeller DA, Wong WW, Speakman JR. Physical activity and fat-free mass during growth and in later life. Am J Clin Nutr 2021; 114:1583-1589. [PMID: 34477824 PMCID: PMC8574623 DOI: 10.1093/ajcn/nqab260] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/14/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Physical activity may be a way to increase and maintain fat-free mass (FFM) in later life, similar to the prevention of fractures by increasing peak bone mass. OBJECTIVES A study is presented of the association between FFM and physical activity in relation to age. METHODS In a cross-sectional study, FFM was analyzed in relation to physical activity in a large participant group as compiled in the International Atomic Energy Agency Doubly Labeled Water database. The database included 2000 participants, age 3-96 y, with measurements of total energy expenditure (TEE) and resting energy expenditure (REE) to allow calculation of physical activity level (PAL = TEE/REE), and calculation of FFM from isotope dilution. RESULTS PAL was a main determinant of body composition at all ages. Models with age, fat mass (FM), and PAL explained 76% and 85% of the variation in FFM in females and males < 18 y old, and 32% and 47% of the variation in FFM in females and males ≥ 18 y old, respectively. In participants < 18 y old, mean FM-adjusted FFM was 1.7 kg (95% CI: 0.1, 3.2 kg) and 3.4 kg (95% CI: 1.0, 5.6 kg) higher in a very active participant with PAL = 2.0 than in a sedentary participant with PAL = 1.5, for females and males, respectively. At age 18 y, height and FM-adjusted FFM was 3.6 kg (95% CI: 2.8, 4.4 kg) and 4.4 kg (95% CI: 3.2, 5.7 kg) higher, and at age 80 y 0.7 kg (95% CI: -0.2, 1.7 kg) and 1.0 kg (95% CI: -0.1, 2.1 kg) higher, in a participant with PAL = 2.0 than in a participant with PAL = 1.5, for females and males, respectively. CONCLUSIONS If these associations are causal, they suggest physical activity is a major determinant of body composition as reflected in peak FFM, and that a physically active lifestyle can only partly protect against loss of FFM in aging adults.
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Affiliation(s)
| | - Yosuke Yamada
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan,Institute for Active Health, Kyoto University of Advanced Science, Kyoto, Japan
| | - Hiroyuki Sagayama
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
| | - Philip N Ainslie
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Lene F Andersen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Liam J Anderson
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom,Crewe Alexandra Football Club, Crewe, United Kingdom
| | - Lenore Arab
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Issaad Baddou
- Unité Mixte de Recherche en Nutrition et Alimentation, CNESTEN–Université Ibn Tofail URAC39, Regional Designated Center of Nutrition Associated with African Regional Agreement for Research/International Atomic Energy Agency, Rabat, Morocco
| | - Kweku Bedu-Addo
- Department of Physiology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ellen E Blaak
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Stephane Blanc
- Nutritional Sciences, University of Wisconsin, Madison, WI, USA,Institut Pluridisciplinaire Hubert Curien. CNRS Université de Strasbourg, UMR7178, Strasbourg, France
| | | | - Carlijn V C Bouten
- Department of Biomedical Engineering and Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Pascal Bovet
- University Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Maciej S Buchowski
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Nancy F Butte
- Department of Pediatrics, Baylor College of Medicine, USDA/Agricultural Research Service Children's Nutrition Research Center, Houston, TX, USA
| | - Stefan G J A Camps
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Graeme L Close
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Jamie A Cooper
- Nutritional Sciences, University of Wisconsin, Madison, WI, USA
| | - Sai K Das
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Richard Cooper
- Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University, Maywood, IL, USA
| | - Lara R Dugas
- Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University, Maywood, IL, USA
| | - Ulf Ekelund
- Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Sonja Entringer
- Institute of Medical Psychology, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany,Department of Pediatrics, University of California Irvine, Irvine, CA, USA
| | - Terrence Forrester
- Solutions for Developing Countries, University of the West Indies, Mona, Kingston, Jamaica
| | - Barry W Fudge
- Institute of Biomedical and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Annelies H Goris
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Michael Gurven
- Department of Anthropology, University of California Santa Barbara, Santa Barbara, CA, USA
| | - Catherine Hambly
- Institute of Biological and Environmental Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Asmaa El Hamdouchi
- Unité Mixte de Recherche en Nutrition et Alimentation, CNESTEN–Université Ibn Tofail URAC39, Regional Designated Center of Nutrition Associated with African Regional Agreement for Research/International Atomic Energy Agency, Rabat, Morocco
| | - Marije B Hoos
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Sumei Hu
- State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, China
| | - Noorjehan Joonas
- Central Health Laboratory, Ministry of Health and Wellness, Port Louis, Mauritius
| | - Annemiek M Joosen
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | | | - Kitty P Kempen
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Misaka Kimura
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
| | | | - Robert F Kushner
- Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Estelle V Lambert
- Research Unit for Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa
| | - William R Leonard
- Department of Anthropology, Northwestern University, Evanston, IL, USA
| | - Nader Lessan
- Imperial College London Diabetes Centre, Imperial College London, London, United Kingdom
| | - Corby K Martin
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Anine C Medin
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway,Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Erwin P Meijer
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - James C Morehen
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom,The FA Group, Burton-Upon-Trent, United Kingdom
| | - James P Morton
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Marian L Neuhouser
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center and School of Public Health, University of Washington, Seattle, WA, USA
| | - Theresa A Nicklas
- Department of Pediatrics, Baylor College of Medicine, USDA/Agricultural Research Service Children's Nutrition Research Center, Houston, TX, USA
| | - Robert M Ojiambo
- Department of Medical Physiology, Moi University, Eldoret, Kenya,Department of Biomedical Sciences, University of Global Health Equity, Butaro, Rwanda
| | | | - Yannis P Pitsiladis
- Collaborating Centre of Sports Medicine, University of Brighton, Eastbourne, United Kingdom
| | - Jacob Plange-Rhule
- Department of Physiology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Guy Plasqui
- Department of Nutrition and Movement Sciences, Maastricht University, Maastricht, The Netherlands
| | - Ross L Prentice
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center and School of Public Health, University of Washington, Seattle, WA, USA
| | - Roberto A Rabinovich
- Department of Respiratory Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Susan B Racette
- Program in Physical Therapy and Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - David A Raichlen
- Biological Sciences and Anthropology, University of Southern California, Los Angeles, CA, USA
| | - Eric Ravussin
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Rebecca M Reynolds
- Centre for Cardiovascular Sciences, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Susan B Roberts
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Albertine J Schuit
- School of Social and Behavioural Sciences, University of Tilburg, Tilburg, The Netherlands
| | - Anders M Sjödin
- Department of Nutrition, Exercise and Sports, Copenhagen University, Copenhagen, Denmark
| | - Eric Stice
- Department of Psychiatry, Stanford University, Stanford, CA, USA
| | | | - Giulio Valenti
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Ludo M Van Etten
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Edgar A Van Mil
- Faculty of Health, Medicine and Life Sciences, and Faculty of Science and Engineering, Maastricht University, Maastricht, The Netherlands
| | - Jonathan C K Wells
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - George Wilson
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Brian M Wood
- Department of Antropology, University of California Los Angeles, Los Angeles, CA, USA,Department of Human Behavior, Ecology, and Culture, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| | - Jack Yanovski
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, USA
| | - Tsukasa Yoshida
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
| | - Xueying Zhang
- Institute of Biological and Environmental Sciences, University of Aberdeen, Aberdeen, United Kingdom,State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, China
| | - Alexia J Murphy-Alford
- Nutritional and Health-Related Environmental Studies Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Cornelia U Loechl
- Nutritional and Health-Related Environmental Studies Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Amy H Luke
- Division of Epidemiology, Department of Public Health Sciences, Loyola University School of Medicine, Maywood, IL, USA
| | - Herman Pontzer
- Evolutionary Anthropology, Duke University, Durham, NC, USA,Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Jennifer Rood
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Dale A Schoeller
- Biotech Center and Nutritional Sciences, University of Wisconsin, Madison, WI, USA
| | - William W Wong
- Department of Pediatrics, Baylor College of Medicine, USDA/Agricultural Research Service Children's Nutrition Research Center, Houston, TX, USA
| | - John R Speakman
- Address correspondence to JRS (E-mail: ) and AHL, HP, JR, HS, DAS, YY, and WWW as members of the database management group and additional corresponding authors
| | - International Atomic Energy Agency Doubly Labeled Water database group
BranthStefanUniversity of Uppsala, Uppsala, SwedenColbertLisa HKinesiology, University of Wisconsin, Madison, WI, USADe BruinNiels CErasmus University, Rotterdam, NetherlandsDutmanAlice ETNO Quality of Life, Zeist, NetherlandsElmståhlSölveLund University, Lund, SwedenFogelholmMikaelDepartment of Food and Nutrition, Helsinki, FinlandHarrisTamaraNIH, Bethesda, MD, USAHeijligenbergRikAcademic Medical Center of Amsterdam University, Amsterdam, NetherlandsJorgensenHans UBispebjerg Hospital, Copenhagen, DenmarkLarssonChristel LRothenbergElisabet MUniversity of Gothenburg, Gothenburg, SwedenMcCloskeyMargaretRoyal Belfast Hospital for Sick Children, Belfast, United KingdomMeijerGerwin APannemansDaphne LSchulzSabineVan den Berg-EmonsRitaVan GemertWim GWilhelmineWVerboeket-van deVenneVerbuntJeanine AMaastricht University, Maastricht, NetherlandsPhilippaertsRenaat MKatholieke University Leuven, Leuven, BelgiumSubarAmyEpidemiology and Genomics, Division of Cancer Control, NIH, Bethesda, MD, USATanskanenMinnaUniversity of Jyväskilä, Jyväskilä, FinlandUauyRicardoInstitute of Nutrition and Food Technology (INTA), University of Chile, Santiago, ChileVelthuis-te WierikErica JTNO Nutrition and Food Research Institute, Zeist, Netherlands
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14
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Kruzel-Davila E, Sankofi BM, Kubi Amos-Abanyie E, Ghansah A, Nyarko A, Agyemang S, Awandare GA, Szwarcwort-Cohen M, Reiner-Benaim A, Hijazi B, Ulasi I, Raji YR, Boima V, Osafo C, May Adabayeri V, Matekole M, Olanrewaju TO, Ajayi S, Mamven M, Antwi S, Ademola AD, Plange-Rhule J, Arogundade F, Akyaw PA, Winkler CA, Salako BL, Ojo A, Skorecki K, Adu D. HIV Viremia Is Associated With APOL1 Variants and Reduced JC-Viruria. Front Med (Lausanne) 2021; 8:718300. [PMID: 34513880 PMCID: PMC8429812 DOI: 10.3389/fmed.2021.718300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/05/2021] [Indexed: 11/23/2022] Open
Abstract
Variants in the Apolipoprotein L1 (APOL1) gene (G1-rs60910145, rs73885319, G2-rs71785313) are common in Africans and in individuals of recent African ancestry and are associated with an increased risk of non-diabetic chronic kidney disease (CKD) and in particular of HIV associated nephropathy (HIVAN). In light of the significantly increased risk of HIVAN in carriers of two APOL1 risk alleles, a role in HIV infectivity has been postulated in the mechanism of APOL1 associated kidney disease. Herein, we aim to explore the association between HIV viremia and APOL1 genotype. In addition, we investigated interaction between BK and JC viruria, CKD and HIV viremia. A total of 199 persons living with HIV/AIDS (comprising 82 CKD cases and 117 controls) from among the participants in the ongoing Human Heredity and Health in Africa (H3Africa) Kidney Disease Research Network case control study have been recruited. The two APOL1 renal risk alleles (RRA) genotypes were associated with a higher risk of CKD (OR 12.6, 95% CI 3.89-40.8, p < 0.0001). Even a single APOL1 RRA was associated with CKD risk (OR 4.42, 95% CI 1.49-13.15, p = 0.007). The 2 APOL1 RRA genotypes were associated with an increased probability of having HIV viremia (OR 2.37 95% CI 1.0-5.63, p = 0.05). HIV viremia was associated with increased CKD risk (OR 7.45, 95% CI 1.66-33.35, P = 0.009) and with a significant reduction of JC virus urine shedding (OR 0.35, 95% CI 0.12-0.98, p = 0.046). In contrast to prior studies, JC viruria was not associated with CKD but was restricted in patients with HIV viremia, regardless of CKD status. These findings suggest a role of APOL1 variants in HIV infectivity and emphasize that JC viruria can serve as biomarker for innate immune system activation.
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Affiliation(s)
- Etty Kruzel-Davila
- Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
- Nephrology Department, Rambam Health Care Campus, Haifa, Israel
| | - Barbara Mensah Sankofi
- College of Health Sciences, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
- West African Centre for Cell Biology of Infectious Pathogens, College of Basic and Applied Sciences, University of Ghana, Accra, Ghana
| | - Ernestine Kubi Amos-Abanyie
- College of Health Sciences, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Anita Ghansah
- College of Health Sciences, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Alexander Nyarko
- College of Health Sciences, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Seth Agyemang
- West African Centre for Cell Biology of Infectious Pathogens, College of Basic and Applied Sciences, University of Ghana, Accra, Ghana
- University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Gordon A. Awandare
- West African Centre for Cell Biology of Infectious Pathogens, College of Basic and Applied Sciences, University of Ghana, Accra, Ghana
| | | | | | - Basem Hijazi
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Ifeoma Ulasi
- Department of Medicine, College of Health Sciences University of Nigeria, Enugu, Nigeria
| | | | - Vincent Boima
- University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Charlotte Osafo
- University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Victoria May Adabayeri
- University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Michael Matekole
- University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Timothy O. Olanrewaju
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Samuel Ajayi
- Department of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Manmak Mamven
- Department of Medicine, University of Abuja, Abuja, Nigeria
| | - Sampson Antwi
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Jacob Plange-Rhule
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Priscilla Abena Akyaw
- College of Health Sciences, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Cheryl A. Winkler
- Department of Medicine, Frederick National Laboratory for Cancer Research (NIH), Frederick, MD, United States
| | | | - Akinlolu Ojo
- School of Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Karl Skorecki
- Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
- Rambam Health Care Campus, Haifa, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Dwomoa Adu
- University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
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15
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Pontzer H, Yamada Y, Sagayama H, Ainslie PN, Andersen LF, Anderson LJ, Arab L, Baddou I, Bedu-Addo K, Blaak EE, Blanc S, Bonomi AG, Bouten CVC, Bovet P, Buchowski MS, Butte NF, Camps SG, Close GL, Cooper JA, Cooper R, Das SK, Dugas LR, Ekelund U, Entringer S, Forrester T, Fudge BW, Goris AH, Gurven M, Hambly C, El Hamdouchi A, Hoos MB, Hu S, Joonas N, Joosen AM, Katzmarzyk P, Kempen KP, Kimura M, Kraus WE, Kushner RF, Lambert EV, Leonard WR, Lessan N, Martin C, Medin AC, Meijer EP, Morehen JC, Morton JP, Neuhouser ML, Nicklas TA, Ojiambo RM, Pietiläinen KH, Pitsiladis YP, Plange-Rhule J, Plasqui G, Prentice RL, Rabinovich RA, Racette SB, Raichlen DA, Ravussin E, Reynolds RM, Roberts SB, Schuit AJ, Sjödin AM, Stice E, Urlacher SS, Valenti G, Van Etten LM, Van Mil EA, Wells JCK, Wilson G, Wood BM, Yanovski J, Yoshida T, Zhang X, Murphy-Alford AJ, Loechl C, Luke AH, Rood J, Schoeller DA, Westerterp KR, Wong WW, Speakman JR. Daily energy expenditure through the human life course. Science 2021; 373:808-812. [PMID: 34385400 DOI: 10.1126/science.abe5017] [Citation(s) in RCA: 188] [Impact Index Per Article: 62.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 06/21/2021] [Indexed: 12/12/2022]
Abstract
Total daily energy expenditure ("total expenditure") reflects daily energy needs and is a critical variable in human health and physiology, but its trajectory over the life course is poorly studied. We analyzed a large, diverse database of total expenditure measured by the doubly labeled water method for males and females aged 8 days to 95 years. Total expenditure increased with fat-free mass in a power-law manner, with four distinct life stages. Fat-free mass-adjusted expenditure accelerates rapidly in neonates to ~50% above adult values at ~1 year; declines slowly to adult levels by ~20 years; remains stable in adulthood (20 to 60 years), even during pregnancy; then declines in older adults. These changes shed light on human development and aging and should help shape nutrition and health strategies across the life span.
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Affiliation(s)
- Herman Pontzer
- Department of Evolutionary Anthropology, Duke University, Durham, NC, USA. .,Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Yosuke Yamada
- Institute for Active Health, Kyoto University of Advanced Science, Kyoto, Japan. .,National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
| | - Hiroyuki Sagayama
- Faculty of Health and Sport Sciences, University of Tsukuba, Ibaraki, Japan.
| | - Philip N Ainslie
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Lene F Andersen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, 0317 Oslo, Norway
| | - Liam J Anderson
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK.,Crewe Alexandra Football Club, Crewe, UK
| | - Lenore Arab
- David Geffen School of Medicine, University of California, Los Angeles
| | - Issaad Baddou
- Unité Mixte de Recherche en Nutrition et Alimentation, CNESTEN-Université Ibn Tofail URAC39, Regional Designated Center of Nutrition Associated with AFRA/IAEA, Rabat, Morocco
| | - Kweku Bedu-Addo
- Department of Physiology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Stephane Blanc
- Department of Nutritional Sciences, University of Wisconsin, Madison, WI, USA.,Institut Pluridisciplinaire Hubert Curien, CNRS Université de Strasbourg, UMR7178, France
| | | | | | - Pascal Bovet
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Maciej S Buchowski
- Division of Gastroenterology, Hepatology, and Nutritiion, Department of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Nancy F Butte
- Department of Pediatrics, Baylor College of Medicine, USDA/ARS Children's Nutrition Research Center, Houston, TX, USA
| | | | - Graeme L Close
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Jamie A Cooper
- Department of Nutritional Sciences, University of Wisconsin, Madison, WI, USA
| | - Richard Cooper
- Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University, Maywood, IL, USA
| | - Sai Krupa Das
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, 711 Washington Street, Boston, MA 02111, USA
| | - Lara R Dugas
- Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University, Maywood, IL, USA
| | - Ulf Ekelund
- Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Sonja Entringer
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Medical Psychology, Berlin, Germany.,School of Medicine, University of California Irvine, Irvine, CA, USA
| | - Terrence Forrester
- Solutions for Developing Countries, University of the West Indies, Mona, Kingston, Jamaica
| | - Barry W Fudge
- Department of Biomedical and Life Sciences, University of Glasgow, Glasgow, UK
| | | | - Michael Gurven
- Department of Anthropology, University of California Santa Barbara, Santa Barbara, CA, USA
| | - Catherine Hambly
- Institute of Biological and Environmental Sciences, University of Aberdeen, Aberdeen, UK
| | - Asmaa El Hamdouchi
- Unité Mixte de Recherche en Nutrition et Alimentation, CNESTEN-Université Ibn Tofail URAC39, Regional Designated Center of Nutrition Associated with AFRA/IAEA, Rabat, Morocco
| | | | - Sumei Hu
- State Key Laboratory of Molecular developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, China
| | - Noorjehan Joonas
- Central Health Laboratory, Ministry of Health and Wellness, Candos, Mauritius
| | | | | | | | - Misaka Kimura
- Institute for Active Health, Kyoto University of Advanced Science, Kyoto, Japan
| | | | - Robert F Kushner
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Estelle V Lambert
- Health through Physical Activity, Lifestyle and Sport Research Centre (HPALS), Division of Exercise Science and Sports Medicine (ESSM), FIMS International Collaborating Centre of Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - William R Leonard
- Department of Anthropology, Northwestern University, Evanston, IL, USA
| | - Nader Lessan
- Imperial College London Diabetes Centre, Abu Dhabi, United Arab Emirates and Imperial College London, London, UK
| | - Corby Martin
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Anine C Medin
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, 0317 Oslo, Norway.,Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, 4630 Kristiansand, Norway
| | | | - James C Morehen
- The FA Group, Burton-Upon-Trent, Staffordshire, UK.,Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - James P Morton
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Marian L Neuhouser
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center and School of Public Health, University of Washington, Seattle, WA, USA
| | - Teresa A Nicklas
- Department of Pediatrics, Baylor College of Medicine, USDA/ARS Children's Nutrition Research Center, Houston, TX, USA
| | - Robert M Ojiambo
- Kenya School of Medicine, Moi University, Eldoret, Kenya.,Rwanda Division of Basic Sciences, University of Global Health Equity, Rwanda
| | | | - Yannis P Pitsiladis
- School of Sport and Service Management, University of Brighton, Eastbourne, UK
| | - Jacob Plange-Rhule
- Department of Physiology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Guy Plasqui
- Department of Nutrition and Movement Sciences, Maastricht University, Maastricht, Netherlands
| | - Ross L Prentice
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center and School of Public Health, University of Washington, Seattle, WA, USA
| | | | - Susan B Racette
- Program in Physical Therapy and Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - David A Raichlen
- Biological Sciences and Anthropology, University of Southern California, CA, USA
| | - Eric Ravussin
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Rebecca M Reynolds
- Centre for Cardiovascular Sciences, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Susan B Roberts
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, 711 Washington Street, Boston, MA 02111, USA
| | - Albertine J Schuit
- School of Social and Behavioral Sciences, University of Tilburg, Tilburg, Netherlands
| | - Anders M Sjödin
- Department of Nutrition, Exercise and Sports, Copenhagen University, Copenhagen, Denmark
| | - Eric Stice
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford CA, USA
| | | | - Giulio Valenti
- Maastricht University, Maastricht, Netherlands.,Phillips Research, Eindoven, Netherlands
| | | | - Edgar A Van Mil
- Maastricht University, Maastricht and Lifestyle Medicine Center for Children, Jeroen Bosch Hospital, Hertogenbosch, Netherlands
| | - Jonathan C K Wells
- Population, Policy, and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - George Wilson
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Brian M Wood
- Department of Anthropology, University of California Los Angeles, Los Angeles, CA, USA.,Department of Human Behavior, Ecology, and Culture, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| | - Jack Yanovski
- Growth and Obesity, Division of Intramural Research, NIH, Bethesda, MD, USA
| | - Tsukasa Yoshida
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
| | - Xueying Zhang
- Institute of Biological and Environmental Sciences, University of Aberdeen, Aberdeen, UK.,State Key Laboratory of Molecular developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, China
| | - Alexia J Murphy-Alford
- Nutritional and Health Related Environmental Studies Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Cornelia Loechl
- Nutritional and Health Related Environmental Studies Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Amy H Luke
- Division of Epidemiology, Department of Public Health Sciences, Loyola University School of Medicine, Maywood, IL, USA.
| | - Jennifer Rood
- Pennington Biomedical Research Center, Baton Rouge, LA, USA.
| | - Dale A Schoeller
- Biotech Center and Nutritional Sciences University of Wisconsin, Madison, WI, USA.
| | - Klaas R Westerterp
- Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre, Maastricht, Netherlands.
| | - William W Wong
- Department of Pediatrics, Baylor College of Medicine, USDA/ARS Children's Nutrition Research Center, Houston, TX, USA.
| | - John R Speakman
- Center for Energy Metabolism and Reproduction, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China. .,Institute of Biological and Environmental Sciences, University of Aberdeen, Aberdeen, UK.,State Key Laboratory of Molecular developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, China.,CAS Center of Excellence in Animal Evolution and Genetics, Kunming, China
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16
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Mehta S, Ruth Dugas L, Choo-Kang C, Bovet P, Forrester T, Bedu-Addo K, Lambert EV, Plange-Rhule J, Riesen W, Korte W, Luke A. Consumption of Monounsaturated Fatty Acids Is Associated with Improved Cardiometabolic Outcomes in Four African-Origin Populations Spanning the Epidemiologic Transition. Nutrients 2021; 13:2442. [PMID: 34371950 PMCID: PMC8308507 DOI: 10.3390/nu13072442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/24/2021] [Accepted: 07/05/2021] [Indexed: 12/13/2022] Open
Abstract
Long-chain omega-3 PUFAs, specifically eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are of increasing interest because of their favorable effect on cardiometabolic risk. This study explores the association between omega 6 and 3 fatty acids intake and cardiometabolic risk in four African-origin populations spanning the epidemiological transition. Data are obtained from a cohort of 2500 adults aged 25-45 enrolled in the Modeling the Epidemiologic Transition Study (METS), from the US, Ghana, Jamaica, and the Seychelles. Dietary intake was measured using two 24 h recalls from the Nutrient Data System for Research (NDSR). The prevalence of cardiometabolic risk was analyzed by comparing the lowest and highest quartile of omega-3 (EPA+ DHA) consumption and by comparing participants who consumed a ratio of arachidonic acid (AA)/EPA + DHA ≤4:1 and >4:1. Data were analyzed using multiple variable logistic regression adjusted for age, gender, activity, calorie intake, alcohol intake, and smoking status. The lowest quartile of EPA + DHA intake is associated with cardiometabolic risk 2.16 (1.45, 3.2), inflammation 1.59 (1.17, 2.16), and obesity 2.06 (1.50, 2.82). Additionally, consuming an AA/EPA + DHA ratio of >4:1 is also associated with cardiometabolic risk 1.80 (1.24, 2.60), inflammation 1.47 (1.06, 2.03), and obesity 1.72 (1.25, 2.39). Our findings corroborate previous research supporting a beneficial role for monounsaturated fatty acids in reducing cardiometabolic risk.
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Affiliation(s)
- Supal Mehta
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, USA;
| | - Lara Ruth Dugas
- Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL 60153, USA; (C.C.-K.); (A.L.)
| | - Candice Choo-Kang
- Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL 60153, USA; (C.C.-K.); (A.L.)
| | - Pascal Bovet
- University Center for Primary Care and Public Health (Unisanté), 1010 Lausanne, Switzerland;
- Unit for Prevention and Control of Cardiovascular Diseases, Ministry of Health, Victoria P.O. Box 52, Seychelles
| | - Terrence Forrester
- Solutions for Developing Countries, University of the West Indies, Mona, Kingston 7, Jamaica;
| | - Kweku Bedu-Addo
- Department of Physiology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; (K.B.-A.); (J.P.-R.)
| | - Estelle Vicki Lambert
- Research Centre for Health through Physical Activity, Lifestyle and Sport, University of Cape Town, Cape Town 7700, South Africa;
| | - Jacob Plange-Rhule
- Department of Physiology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; (K.B.-A.); (J.P.-R.)
| | - Walter Riesen
- Center for Laboratory Medicine St. Gallen, 9000 St. Gallen, Switzerland; (W.R.); (W.K.)
| | - Wolfgang Korte
- Center for Laboratory Medicine St. Gallen, 9000 St. Gallen, Switzerland; (W.R.); (W.K.)
| | - Amy Luke
- Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL 60153, USA; (C.C.-K.); (A.L.)
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17
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Pontzer H, Brown MH, Wood BM, Raichlen DA, Mabulla AZP, Harris JA, Dunsworth H, Hare B, Walker K, Luke A, Dugas LR, Schoeller D, Plange-Rhule J, Bovet P, Forrester TE, Thompson ME, Shumaker RW, Rothman JM, Vogel E, Sulistyo F, Alavi S, Prasetyo D, Urlacher SS, Ross SR. Evolution of water conservation in humans. Curr Biol 2021; 31:1804-1810.e5. [PMID: 33675699 DOI: 10.1016/j.cub.2021.02.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/07/2020] [Accepted: 02/17/2021] [Indexed: 10/22/2022]
Abstract
To sustain life, humans and other terrestrial animals must maintain a tight balance of water gain and water loss each day.1-3 However, the evolution of human water balance physiology is poorly understood due to the absence of comparative measures from other hominoids. While humans drink daily to maintain water balance, rainforest-living great apes typically obtain adequate water from their food and can go days or weeks without drinking4-6. Here, we compare isotope-depletion measures of water turnover (L/d) in zoo- and rainforest-sanctuary-housed apes (chimpanzees, bonobos, gorillas, and orangutans) with 5 diverse human populations, including a hunter-gatherer community in a semi-arid savannah. Across the entire sample, water turnover was strongly related to total energy expenditure (TEE, kcal/d), physical activity, climate (ambient temperature and humidity), and fat free mass. In analyses controlling for those factors, water turnover was 30% to 50% lower in humans than in other apes despite humans' greater sweating capacity. Water turnover in zoo and sanctuary apes was similar to estimated turnover in wild populations, as was the ratio of water intake to dietary energy intake (∼2.8 mL/kcal). However, zoo and sanctuary apes ingested a greater ratio of water to dry matter of food, which might contribute to digestive problems in captivity. Compared to apes, humans appear to target a lower ratio of water/energy intake (∼1.5 mL/kcal). Water stress due to changes in climate, diet, and behavior apparently led to previously unknown water conservation adaptations in hominin physiology.
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Affiliation(s)
- Herman Pontzer
- Department of Evolutionary Anthropology, Duke University, Durham, NC 27708, USA; Duke Global Health Institute, Duke University, Durham, NC 27708, USA.
| | - Mary H Brown
- Lester E. Fisher Center for the Study and Conservation of Apes, Lincoln Park Zoo. Chicago, IL 60614, USA
| | - Brian M Wood
- Department of Anthropology, Univ. California Los Angeles, Los Angeles, CA 90095, USA; Department of Human Behavior, Ecology and Culture, Max Plank Inst. Evolutionary Anthropology, Leipzig, Germany
| | - David A Raichlen
- Department of Biological Sciences, Univ. Southern California, Los Angeles, CA 90089, USA
| | - Audax Z P Mabulla
- Department of Archaeology and Heritage Studies, University of Dar es Salaam, Tanzania
| | - Jacob A Harris
- Inst. Human Origins, School of Human Evolution & Social Change, Arizona State Univ, Tempe, AZ 85287, USA
| | - Holly Dunsworth
- Department of Sociology and Anthropology, University of Rhode Island, Kingston, RI 02881, USA
| | - Brian Hare
- Department of Evolutionary Anthropology, Duke University, Durham, NC 27708, USA
| | - Kara Walker
- School of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607, USA
| | - Amy Luke
- Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, USA
| | - Lara R Dugas
- Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, USA
| | - Dale Schoeller
- Nutritional Sciences, Biotechnology Center, University of Wisconsin-Madison, Madison, WI 53705, USA
| | | | - Pascal Bovet
- Ministry of Health, Republic of Seychelles & Center of Primary Care and Public Health (Unisanté), Lausanne, Switzerland; Ministry of Health, Victoria, Mahé, Seychelles
| | - Terrence E Forrester
- UWI Solutions for Developing Countries, The University of the West Indies, Kingston 7, Jamaica
| | | | - Robert W Shumaker
- Indianapolis Zoo, Indianapolis, IN 46222, USA; Department of Anthropology and Center for Integrated Study of Animal Behavior, Indiana University, Bloomington, IN 47405, USA; Krasnow Institute for Advanced Study, George Mason University, Fairfax, Virginia 22030, USA
| | - Jessica M Rothman
- Department of Anthropology, Hunter College of the City University of New York, New York, NY 10065, USA; New York Consortium in Evolutionary Primatology, New York, NY 10065, USA
| | - Erin Vogel
- Department of Anthropology, Rutgers, the State University of New Jersey, New Brunswick, NJ, USA; Department of Ecology and Evolution, Rutgers, the State University of New Jersey, New Brunswick, NJ, USA
| | | | - Shauhin Alavi
- Department of Ecology of Animal Societies, Max Planck Institute of Animal Behavior, Konstanz, Germany; Centre for the Advanced Study of Collective Behaviour, University of Konstanz, Konstanz, Germany; Department of Biology, University of Konstanz, Konstanz, Germany
| | - Didik Prasetyo
- Department of Anthropology, Rutgers, the State University of New Jersey, New Brunswick, NJ, USA; Department of Ecology and Evolution, Rutgers, the State University of New Jersey, New Brunswick, NJ, USA; Biology Faculty, Universitas Nasional, Jakarta, Indonesia
| | - Samuel S Urlacher
- Department of Anthropology, Baylor University, Waco, TX 76798, USA; Child and Brain Development Program, CIFAR, Toronto, Canada
| | - Stephen R Ross
- Lester E. Fisher Center for the Study and Conservation of Apes, Lincoln Park Zoo. Chicago, IL 60614, USA
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18
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Speakman JR, Yamada Y, Sagayama H, Berman ESF, Ainslie PN, Andersen LF, Anderson LJ, Arab L, Baddou I, Bedu-Addo K, Blaak EE, Blanc S, Bonomi AG, Bouten CVC, Bovet P, Buchowski MS, Butte NF, Camps SGJA, Close GL, Cooper JA, Creasy SA, Das SK, Cooper R, Dugas LR, Ebbeling CB, Ekelund U, Entringer S, Forrester T, Fudge BW, Goris AH, Gurven M, Hambly C, El Hamdouchi A, Hoos MB, Hu S, Joonas N, Joosen AM, Katzmarzyk P, Kempen KP, Kimura M, Kraus WE, Kushner RF, Lambert EV, Leonard WR, Lessan N, Ludwig DS, Martin CK, Medin AC, Meijer EP, Morehen JC, Morton JP, Neuhouser ML, Nicklas TA, Ojiambo RM, Pietiläinen KH, Pitsiladis YP, Plange-Rhule J, Plasqui G, Prentice RL, Rabinovich RA, Racette SB, Raichlen DA, Ravussin E, Reynolds RM, Roberts SB, Schuit AJ, Sjödin AM, Stice E, Urlacher SS, Valenti G, Van Etten LM, Van Mil EA, Wells JCK, Wilson G, Wood BM, Yanovski J, Yoshida T, Zhang X, Murphy-Alford AJ, Loechl CU, Melanson EL, Luke AH, Pontzer H, Rood J, Schoeller DA, Westerterp KR, Wong WW. A standard calculation methodology for human doubly labeled water studies. Cell Rep Med 2021; 2:100203. [PMID: 33665639 PMCID: PMC7897799 DOI: 10.1016/j.xcrm.2021.100203] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/16/2020] [Accepted: 01/20/2021] [Indexed: 11/25/2022]
Abstract
The doubly labeled water (DLW) method measures total energy expenditure (TEE) in free-living subjects. Several equations are used to convert isotopic data into TEE. Using the International Atomic Energy Agency (IAEA) DLW database (5,756 measurements of adults and children), we show considerable variability is introduced by different equations. The estimated rCO2 is sensitive to the dilution space ratio (DSR) of the two isotopes. Based on performance in validation studies, we propose a new equation based on a new estimate of the mean DSR. The DSR is lower at low body masses (<10 kg). Using data for 1,021 babies and infants, we show that the DSR varies non-linearly with body mass between 0 and 10 kg. Using this relationship to predict DSR from weight provides an equation for rCO2 over this size range that agrees well with indirect calorimetry (average difference 0.64%; SD = 12.2%). We propose adoption of these equations in future studies.
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Affiliation(s)
- John R Speakman
- Center for Energy Metabolism and Reproduction, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.,Institute of Biological and Environmental Sciences, University of Aberdeen, Aberdeen, UK.,State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, China.,CAS Center of Excellence in Animal Evolution and Genetics, Kunming, China
| | - Yosuke Yamada
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan.,Institute for Active Health, Kyoto University of Advanced Science, Kyoto, Japan
| | - Hiroyuki Sagayama
- Faculty of Health and Sport Sciences, University of Tsukuba, Ibaraki, Japan
| | | | - Philip N Ainslie
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Lene F Andersen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, 0317 Oslo, Norway
| | - Liam J Anderson
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK.,Crewe Alexandra Football Club, Crewe, UK
| | - Lenore Arab
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Issaad Baddou
- Unité Mixte de Recherche en Nutrition et Alimentation, CNESTEN- Université Ibn Tofail URAC39, Regional Designated Center of Nutrition Associated with AFRA/IAEA, Rabat, Morocco
| | - Kweku Bedu-Addo
- Department of Physiology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Stephane Blanc
- Nutritional Sciences, University of Wisconsin, Madison, WI, USA.,Institut Pluridisciplinaire Hubert Curien, CNRS Université de Strasbourg, UMR7178, Strasbourg, France
| | | | - Carlijn V C Bouten
- Department of Biomedical Engineering and Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Pascal Bovet
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Maciej S Buchowski
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Nancy F Butte
- Department of Pediatrics, Baylor College of Medicine, USDA/ARS Children's Nutrition Research Center, Houston, TX, USA
| | | | - Graeme L Close
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Jamie A Cooper
- Nutritional Sciences, University of Wisconsin, Madison, WI, USA
| | - Seth A Creasy
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado Anschulz Medical Campus, Aurora, CO, USA
| | - Sai Krupa Das
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA, USA
| | - Richard Cooper
- Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University, Maywood, IL, USA
| | - Lara R Dugas
- Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University, Maywood, IL, USA
| | | | - Ulf Ekelund
- Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Sonja Entringer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Medical Psychology, Berlin, Germany.,University of California, Irvine, Irvine, CA, USA
| | - Terrence Forrester
- Solutions for Developing Countries, University of the West Indies, Mona, Kingston, Jamaica
| | | | | | - Michael Gurven
- Department of Anthropology, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Catherine Hambly
- Institute of Biological and Environmental Sciences, University of Aberdeen, Aberdeen, UK
| | - Asmaa El Hamdouchi
- Unité Mixte de Recherche en Nutrition et Alimentation, CNESTEN- Université Ibn Tofail URAC39, Regional Designated Center of Nutrition Associated with AFRA/IAEA, Rabat, Morocco
| | | | - Sumei Hu
- State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, China
| | - Noorjehan Joonas
- Central Health Laboratory, Ministry of Health and Wellness, Port Louis, Mauritius
| | | | | | | | - Misaka Kimura
- Institute for Active Health, Kyoto University of Advanced Science, Kyoto, Japan
| | | | | | - Estelle V Lambert
- Research Unit for Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa
| | - William R Leonard
- Department of Anthropology, Northwestern University, Evanston, IL, USA
| | - Nader Lessan
- Imperial College London Diabetes Centre, Imperial College London, London, UK
| | | | - Corby K Martin
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Anine C Medin
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, 0317 Oslo, Norway.,Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, 4630 Kristiansand, Norway
| | | | - James C Morehen
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK.,The FA Group, Burton-Upon-Trent, Staffordshire, UK
| | - James P Morton
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Marian L Neuhouser
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center and School of Public Health, University of Washington, Seattle, WA, USA
| | - Theresa A Nicklas
- Department of Pediatrics, Baylor College of Medicine, USDA/ARS Children's Nutrition Research Center, Houston, TX, USA
| | - Robert M Ojiambo
- Moi University, Eldoret, Kenya.,University of Global Health Equity, Kigali, Rwanda
| | | | | | - Jacob Plange-Rhule
- Department of Physiology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Guy Plasqui
- Department of Nutrition and Movement Sciences, Maastricht University, Maastricht, the Netherlands
| | - Ross L Prentice
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center and School of Public Health, University of Washington, Seattle, WA, USA
| | | | - Susan B Racette
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA, USA
| | - David A Raichlen
- Biological Sciences and Anthropology, University of Southern California, Los Angeles, CA, USA
| | - Eric Ravussin
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Rebecca M Reynolds
- Centre for Cardiovascular Sciences, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Susan B Roberts
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA, USA
| | | | - Anders M Sjödin
- Department of Nutrition, Exercise and Sports, Copenhagen University, Copenhagen, Denmark
| | | | | | | | | | - Edgar A Van Mil
- Maastricht and Lifestyle Medicine Center for Children, Jeroen Bosch Hospital's-Hertogenbosch, Maastricht University, Maastricht, the Netherlands
| | - Jonathan C K Wells
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - George Wilson
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Brian M Wood
- University of California, Los Angeles, Los Angeles, CA, USA.,Department of Human Behavior, Ecology, and Culture, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| | - Jack Yanovski
- Growth and Obesity, Division of Intramural Research, NIH, Bethesda, MD, USA
| | - Tsukasa Yoshida
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
| | - Xueying Zhang
- Center for Energy Metabolism and Reproduction, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.,Institute of Biological and Environmental Sciences, University of Aberdeen, Aberdeen, UK
| | - Alexia J Murphy-Alford
- Nutritional and Health Related Environmental Studies Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Cornelia U Loechl
- Nutritional and Health Related Environmental Studies Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Edward L Melanson
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado Anschulz Medical Campus, Aurora, CO, USA.,Eastern Colorado VA Geriatric Research, Education and Clinical Center, Aurora, CO, USA.,Division of Geriatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Amy H Luke
- Division of Epidemiology, Department of Public Health Sciences, Loyola University School of Medicine, Maywood, IL, USA
| | - Herman Pontzer
- Evolutionary Anthropology, Duke University, Durham, NC, USA.,Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Jennifer Rood
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Dale A Schoeller
- Biotech Center and Nutritional Sciences, University of Wisconsin, Madison, WI, USA
| | - Klaas R Westerterp
- School of Nutrition and Translational Research in Metabolism, University of Maastricht, Maastricht, the Netherlands
| | - William W Wong
- Department of Pediatrics, Baylor College of Medicine, USDA/ARS Children's Nutrition Research Center, Houston, TX, USA
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19
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Safianu R, Plange-Rhule J. An Assessment of Usual Salt Intake among Older Normotensive Adults in Atonsu, a Suburb of Kumasi in the Ashanti Region of Ghana. Int J Hypertens 2020; 2020:7053654. [PMID: 33145108 PMCID: PMC7596423 DOI: 10.1155/2020/7053654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 09/21/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Globally, sodium intake has been found to be far above the normal level required by the body. Within countries, variations in salt intake exist between rural communities and urban communities. Experimental and epidemiological studies as well as studies involving clinical trials show the existence of adverse effect of salt consumption on the blood pressure of adults. The study evaluated salt intake among older normotensive adults in Atonsu, a suburb of Kumasi in the Ashanti region of Ghana. METHODS Participants were randomly selected from five churches which constituted cluster samples. A questionnaire was administered to participants for demographic information and dietary and lifestyle assessments. The study targeted 100 participants, twenty from each of the five churches. Eighty-two individuals gave their informed consent. Out of the 82 who gave their informed consent, 15 withdrew and 67 completed the course. The 67 participants comprised 36 (53.7%) men and 31 (46.3%) women. Systolic and diastolic blood pressure, BMI, urinary sodium, urinary potassium, serum creatinine, serum sodium, and serum potassium concentrations were also measured. RESULTS Participants' mean age was 52.3 ± 8.7 years. Participants had 24 hr urinary sodium excretion of 153.0 ± 26.9 mmol/day. All participants indicated that they consume foods high in salt even though none of them added salt to their diet at table. Mean 24 hr urinary potassium was 52.5 ± 12.9 mmol/day. Mean systolic blood pressure was 119.9 ± 10.8 mmHg and mean diastolic blood pressure was 72.5 ± 7.3 mmHg. Their mean BMI was 23.7 ± 3.5 kg/m2. CONCLUSION The participants who can be described as quite old and normotensive were high salt consumers, indicated by their dietary assessment and urinary sodium excretion, even though they had normal blood pressure.
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Affiliation(s)
- Rufai Safianu
- Department of Basic Medical Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Jacob Plange-Rhule
- Department of Physiology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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20
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Asante KP, Iwelunmor J, Apusiga K, Gyamfi J, Nyame S, Adjei KGA, Aifah A, Adjei K, Onakomaiya D, Chaplin WF, Ogedegbe G, Plange-Rhule J. Uptake of Task-Strengthening Strategy for Hypertension (TASSH) control within Community-Based Health Planning Services in Ghana: study protocol for a cluster randomized controlled trial. Trials 2020; 21:825. [PMID: 33008455 PMCID: PMC7530961 DOI: 10.1186/s13063-020-04667-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 08/09/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Physician shortage is a major barrier to hypertension (HTN) control in Ghana, with only one physician to 10,000 patients in 2015, thus limiting its capacity for HTN control at the primary care level such as the Community Health Planning and Services (CHPS) compounds, where most Ghanaians receive care. A Task-Shifting Strategy for HTN control (TASSH) based on the WHO Cardiovascular (CV) Risk Package is an evidence-based strategy for mitigating provider- and systems-level barriers to optimal HTN control. Despite its effectiveness, TASSH remains untested in CHPS zones. Additionally, primary care practices in low- and middle-income countries (LMICs) lack resources and expertise needed to coordinate multilevel system changes without assistance. The proposed study will evaluate the effectiveness of practice facilitation (PF) as a quality improvement strategy for implementing TASSH within CHPS zones in Ghana. METHODS Guided by the Consolidated Framework for Implementation Research and the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework, we will evaluate, in a hybrid clinical effectiveness-implementation design, the effect of PF on the uptake of an evidence-based TASSH, among 700 adults who present to 70 CHPS zones with uncontrolled HTN. Components of the PF strategy include (a) an advisory board that provides leadership support for implementing the intervention within the CHPS zones and (b) trained task-strengthening facilitators (TSFs) who serve as practice coaches to provide training, and performance feedback to community health officers (CHOs) who will deliver TASSH at the CHPS zones. For this purpose, the TSFs are trained to identify, counsel, and refer adults with uncontrolled HTN to community health centers in Bono East Region of Ghana. DISCUSSION Uptake of community-based evidence-supported interventions for hypertension control in Ghana is urgently needed to address the CVD epidemic and its associated morbidity, mortality, and societal costs. Findings from this study will provide policymakers and other stakeholders the "how to do it" empirical literature on the uptake of evidence-based task-strengthening interventions for HTN control in Ghana and will serve as a model for similar action in other low, middle-income countries. TRIAL REGISTRATION ClinicalTrials.gov, NCT03490695 . Registered on 6 April 2018. PROTOCOL VERSION AND DATE Version 1, date: 21 August, 2019.
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Affiliation(s)
- Kwaku Poku Asante
- Kintampo Health Research Centre, Ghana Health Service, P.O. Box 200, Kintampo, Ghana.
| | - Juliet Iwelunmor
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
| | - Kingsley Apusiga
- Department of Physiology, School of Medical Science, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Joyce Gyamfi
- Department of Population Health, NYU Langone Health, New York, NY, USA
| | - Solomon Nyame
- Kintampo Health Research Centre, Ghana Health Service, P.O. Box 200, Kintampo, Ghana
| | - Kezia Gladys Amaning Adjei
- Department of Physiology, School of Medical Science, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Angela Aifah
- Department of Population Health, NYU Langone Health, New York, NY, USA
| | - Kwame Adjei
- Kintampo Health Research Centre, Ghana Health Service, P.O. Box 200, Kintampo, Ghana
| | | | | | - Gbenga Ogedegbe
- Department of Population Health, NYU Langone Health, New York, NY, USA
| | - Jacob Plange-Rhule
- Department of Physiology, School of Medical Science, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
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21
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Rae DE, Dugas LR, Roden LC, Lambert EV, Bovet P, Plange-Rhule J, Forrester T, Riesen W, Korte W, Crowley SJ, Reutrakul S, Luke A. Associations between self-reported sleep duration and cardiometabolic risk factors in young African-origin adults from the five-country modeling the epidemiologic transition study (METS). Sleep Health 2020; 6:469-477. [PMID: 32321687 DOI: 10.1016/j.sleh.2020.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 02/14/2020] [Accepted: 03/04/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To investigate associations between self-reported sleep duration and cardiometabolic (CM) risk factors in African-origin adults residing in five countries spanning the epidemiologic transition. DESIGN Cross-sectional. SETTING AND PARTICIPANTS Ghanaian (n = 491), South African (n = 503), Jamaican (n = 508), Seychellois (n = 501) and American (n = 480) men and women. MEASUREMENTS Self-reported sleep duration was obtained using questionnaires. Sex- and site-stratified logistic regression analyses investigated relationships between sleep duration, individual CM risk factors and a binary CM risk variable (presence of ≥3 CM risk factors), adjusting for age, physical activity and education. RESULTS Sleep duration distributions varied by cohort: 44.5%, 41.4%, 35.9%, 16.8% and 2.5% of American, Jamaican, Seychellois, Ghanaian and South African men reported <7 h sleep per night respectively (p < 0.001). Similarly, 42.6%, 28.6%, 25.2%, 12.8% and 1.5% of American, Jamaican, Seychellois, Ghanaian and South African women reported <7 h sleep respectively (p < 0.001). American men reporting ≤6 h sleep were more likely to be in the elevated CM risk group (OR: 2.52, 95%CI: 1.02, 6.22, p = 0.045) and to have a high waist circumference (OR: 2.44, 95%CI: 1.07, 5.57, p = 0.034) compared to those reporting 8 h sleep. Jamaican women reporting ≤6 h sleep (OR: 2.53, 95%CI: 1.19, 5.36, p = 0.016) and American women reporting 7 h sleep (OR: 2.71, 95%CI: 1.17, 6.26, p = 0.002) were more likely to be obese than those reporting 8 h sleep. CONCLUSIONS Associations between short sleep and CM risk factors were only evident in the American men and women and Jamaican women. Future interventions to address CM risk and sleep health may need to be country-specific when targeting high-risk populations.
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Affiliation(s)
- Dale Elizabeth Rae
- Health through Physical Activity, Lifestyle and Sport Research Centre & Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Lara Ruth Dugas
- Public Health Sciences, Loyola University Chicago, Chicago, IL, USA
| | - Laura Catherine Roden
- Health through Physical Activity, Lifestyle and Sport Research Centre & Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; School of Life Sciences, Faculty of Health and Life Sciences, Coventry University, Coventry CV1 2DS, UK
| | - Estelle Vicki Lambert
- Health through Physical Activity, Lifestyle and Sport Research Centre & Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Pascal Bovet
- University Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland & Ministry of Health, Seychelles
| | | | - Terrence Forrester
- Solutions for Developing Countries, University of the West Indies, Mona, Kingston, Jamaica
| | - Walter Riesen
- Center for Laboratory Medicine, Canton Hospital, St. Gallen, Switzerland
| | - Wolfgang Korte
- Center for Laboratory Medicine, Canton Hospital, St. Gallen, Switzerland
| | - Stephanie J Crowley
- Biological Rhythms Research Laboratory, Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Sirimon Reutrakul
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Amy Luke
- Public Health Sciences, Loyola University Chicago, Chicago, IL, USA
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22
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Gyamfi J, Allegrante JP, Iwelunmor J, Williams O, Plange-Rhule J, Blackstone S, Ntim M, Apusiga K, Peprah E, Ogedegbe G. Application of the Consolidated Framework for Implementation Research to examine nurses' perception of the task shifting strategy for hypertension control trial in Ghana. BMC Health Serv Res 2020; 20:65. [PMID: 31996195 PMCID: PMC6990487 DOI: 10.1186/s12913-020-4912-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 01/15/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The burden of hypertension in many low-and middle-income countries is alarming and requires effective evidence-based preventative strategies that is carefully appraised and accepted by key stakeholders to ensure successful implementation and sustainability. We assessed nurses' perceptions of a recently completed Task Shifting Strategy for Hypertension control (TASSH) trial in Ghana, and facilitators and challenges to TASSH implementation. METHODS Focus group sessions and in-depth interviews were conducted with 27 community health nurses from participating health centers and district hospitals involved in the TASSH trial implemented in the Ashanti Region, Ghana, West Africa from 2012 to 2017. TASSH evaluated the comparative effectiveness of the WHO-PEN program versus provision of health insurance for blood pressure reduction in hypertensive adults. Qualitative data were analyzed using open and axial coding techniques with emerging themes mapped onto the Consolidated Framework for Implementation Research (CFIR). RESULTS Three themes emerged following deductive analysis using CFIR, including: (1) Patient health goal setting- relative priority and positive feedback from nurses, which motivated patients to make healthy behavior changes as a result of their health being a priority; (2) Leadership engagement (i.e., medical directors) which influenced the extent to which nurses were able to successfully implement TASSH in their various facilities, with most directors being very supportive; and (3) Availability of resources making it possible to implement the TASSH protocol, with limited space and personnel time to carry out TASSH duties, limited blood pressure (BP) monitoring equipment, and transportation, listed as barriers to effective implementation. CONCLUSION Assessing stakeholders' perception of the TASSH implementation process guided by CFIR is crucial as it provides a platform for the nurses to thoroughly evaluate the task shifting program, while considering the local context in which the program is implemented. The feedback from the nurses informed barriers and facilitators to implementation of TASSH within the current healthcare system, and suggested system level changes needed prior to scale-up of TASSH to other regions in Ghana with potential for long-term sustainment of the task shifting intervention. TRIAL REGISTRATION Trial registration for parent TASSH study: NCT01802372. Registered February 27, 2013.
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Affiliation(s)
- Joyce Gyamfi
- Department of Health and Behavior Studies, Teachers College, Columbia University, 525 West 120 Street, New York, NY 10027 USA
| | - John P. Allegrante
- Department of Health and Behavior Studies, Teachers College, Columbia University, 525 West 120 Street, New York, NY 10027 USA
| | - Juliet Iwelunmor
- Behavioral Science and Health Education, College for Public Health and Social Justice, Salus Center, Saint Louis University, 3545 Lafayette Ave., Saint Louis, MO 63103 USA
| | - Olajide Williams
- Columbia University Medical Center, 710 West 168th Street, New York, NY 10032 USA
| | - Jacob Plange-Rhule
- Department of Physiology, Kwame Nkrumah University of Science and Technology, Private Mail Bag University Post Office KNUST, Kumasi, Ghana
| | - Sarah Blackstone
- Health and Behavioral Studies Building, James Madison University, MSC 4301,235 Martin Luther King Jr Way, Harrisonburg, VA 22807 USA
| | - Michael Ntim
- Department of Physiology, Kwame Nkrumah University of Science and Technology, Private Mail Bag University Post Office KNUST, Kumasi, Ghana
| | - Kingsley Apusiga
- Department of Physiology, Kwame Nkrumah University of Science and Technology, Private Mail Bag University Post Office KNUST, Kumasi, Ghana
- College of Global Public Health, New York University, 726 Broadway, New York, NY 10012 USA
| | - Emmanuel Peprah
- College of Global Public Health, New York University, 726 Broadway, New York, NY 10012 USA
| | - Gbenga Ogedegbe
- Department of Population Health/ Section for Global Health, NYU School of Medicine, 180 Madison Avenue, New York, NY 10016 USA
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Aifah A, Iwelunmor J, Akwanalo C, Allison J, Amberbir A, Asante KP, Baumann A, Brown A, Butler M, Dalton M, Davila-Roman V, Fitzpatrick AL, Fort M, Goldberg R, Gondwe A, Ha D, He J, Hosseinipour M, Irazola V, Kamano J, Karengera S, Karmacharya BM, Koju R, Maharjan R, Mohan S, Mutabazi V, Mutimura E, Muula A, Narayan KMV, Nguyen H, Njuguna B, Nyirenda M, Ogedegbe G, van Oosterhout J, Onakomaiya D, Patel S, Paniagua-Ávila A, Ramirez-Zea M, Plange-Rhule J, Roche D, Shrestha A, Sharma H, Tandon N, Thu-Cuc N, Vaidya A, Vedanthan R, Weber MB. The Kathmandu Declaration on Global CVD/Hypertension Research and Implementation Science: A Framework to Advance Implementation Research for Cardiovascular and Other Noncommunicable Diseases in Low- and Middle-Income Countries. Glob Heart 2020; 14:103-107. [PMID: 31324363 DOI: 10.1016/j.gheart.2019.05.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 05/25/2019] [Indexed: 01/05/2023] Open
Affiliation(s)
- Angela Aifah
- New York University School of Medicine, New York, NY, USA
| | - Juliet Iwelunmor
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA.
| | | | - Jeroan Allison
- University of Massachusetts Medical School, Worcester, MA, USA
| | | | | | - Ana Baumann
- Washington University in St. Louis, St. Louis, MO, USA
| | - Angela Brown
- Washington University in St. Louis, St. Louis, MO, USA
| | - Mark Butler
- New York University School of Medicine, New York, NY, USA
| | - Milena Dalton
- New York University School of Medicine, New York, NY, USA
| | | | | | | | - Robert Goldberg
- University of Massachusetts Medical School, Worcester, MA, USA
| | | | - Duc Ha
- Vietnam Ministry of Health, Ha Noi City, Vietnam
| | - Jiang He
- Tulane University, New Orleans, LA, USA
| | - Mina Hosseinipour
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Vilma Irazola
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | | | | | | | - Rajendra Koju
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - Rashmi Maharjan
- Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | | | | | - Eugene Mutimura
- Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | | | | | - Hoa Nguyen
- Baylor Scott & White Health, Temple, TX, USA
| | | | | | | | | | | | | | | | - Manuel Ramirez-Zea
- Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | | | - Dina Roche
- Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | | | | | - Nikhil Tandon
- All India Institute of Medical Sciences, Delhi, India
| | | | - Abhinav Vaidya
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA; Moi Teaching and Referral Hospital, Eldoret, Kenya
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Mobula LM, Sarfo S, Arthur L, Burnham G, Ansong D, Plange-Rhule J, Ofori-Adjei D. A novel initiative to improve access to medicines for control of non-communicable diseases in low-and middle- income countries. Gates Open Res 2019. [DOI: 10.12688/gatesopenres.12798.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The global burden of non-communicable diseases (NCDs) is growing, and access to prevention and treatment strategies remain limited, especially for those in low- and middle-income countries (LMICs). Novel approaches are needed to improve access and affordability of medicines that can treat NCDs in LMICs. The Access and Affordability Initiative (AAI) is a public private partnership aiming to improve access to and availability of essential medicines for the treatment of NCDs and strengthening of health systems. Through this novel initiative a prospective cohort of patients with hypertension and diabetes were followed in Ghana and the Philippines to examine the effect of differential pricing on access to treatment of hypertension and diabetes. An integrated approach including differential pricing, health systems strengthening, improved supply chain management and greater affordability can improve access to medicines for NCDs. While differential pricing has several advantages for improving the affordability of NCD medicines in LMICs, it can’t overcome all barriers as a standalone approach. An integrated approach to health systems strengthening, supply chain management and affordability are needed to overcome key challenges in getting medicines for NCD to patients in LMICs. Availability and affordability of medicines to treat NCDs among vulnerable patients will help achieve Universal Health Coverage (UHC).
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Sarfo FS, Mobula LM, Arthur L, Plange-Rhule J, Burnham G, Sablah J, Gavor E, Ansong D, Sarfo-Kantanka O, Adu Gyamfi R, Duah J, Abraham B, Ofori-Adjei D. Differential pricing of medicines to improve access to medicines for hypertension and diabetes control in Ghana: The Ghana Access and Affordability Program, a multi-center prospective trial. Gates Open Res 2019. [DOI: 10.12688/gatesopenres.13044.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background: Access to medicines for hypertension and diabetes mellitus (DM) management is challenging in resource-limited countries. We sought to assess whether differential pricing of medicines based on socio-economic status would improve affordability of antihypertensive and anti-diabetic medications. A quasi-experimental, prospective cohort study was implemented at five Ghanaian health facilities, using medicines differentially priced by three pharmaceutical companies. Methods: Adult patients ≥18 years with hypertension or DM were enrolled and assigned to a lower tiered differential price (DP arm) or market price (MP arm) based on minimum wage earning or a score >6/18 on a multi-dimensional poverty index scale. Study medicines were purchased at either the DP or MP when prescribed. Participants were followed for 18 months to assess blood pressure (BP) and glycemic control. Predictors of ability to purchase study medicines were assessed using parsimonious logistic regression models. Results: 3,296 participants were enrolled with mean age of 57±12.7 years, 76.6% females. 1,869 (56.7%) had hypertension, 422 (12.8%) had DM, and 1,005 (30.5%) with both hypertension and DM. Average follow-up was 14 months. There were prescriptions of study medications for 526 participants of which 238 (45.2%) were able to make purchases at DP 60.9% versus MP 39.1%. Independent predictors of purchasing ability were higher income, MP arm, willingness to purchase additional medicines, and being at tertiary level institution. Conclusions: Approximately 45% of Ghanaians could afford prescribed study medicines provided at a differential pricing mechanism albeit at an unsustainable basis. Further price reductions are expected to enhance access to medicines for hypertension and DM control.
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Fei N, Bernabé BP, Lie L, Baghdan D, Bedu-Addo K, Plange-Rhule J, Forrester TE, Lambert EV, Bovet P, Gottel N, Riesen W, Korte W, Luke A, Kliethermes SA, Layden BT, Gilbert JA, Dugas LR. The human microbiota is associated with cardiometabolic risk across the epidemiologic transition. PLoS One 2019; 14:e0215262. [PMID: 31339887 PMCID: PMC6656343 DOI: 10.1371/journal.pone.0215262] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 06/04/2019] [Indexed: 02/07/2023] Open
Abstract
Oral and fecal microbial biomarkers have previously been associated with cardiometabolic (CM) risk, however, no comprehensive attempt has been made to explore this association in minority populations or across different geographic regions. We characterized gut- and oral-associated microbiota and CM risk in 655 participants of African-origin, aged 25-45, from Ghana, South Africa, Jamaica, and the United States (US). CM risk was classified using the CM risk cut-points for elevated waist circumference, elevated blood pressure and elevated fasted blood glucose, low high-density lipoprotein (HDL), and elevated triglycerides. Gut-associated bacterial alpha diversity negatively correlated with elevated blood pressure and elevated fasted blood glucose. Similarly, gut bacterial beta diversity was also significantly differentiated by waist circumference, blood pressure, triglyceridemia and HDL-cholesterolemia. Notably, differences in inter- and intra-personal gut microbial diversity were geographic-region specific. Participants meeting the cut-points for 3 out of the 5 CM risk factors were significantly more enriched with Lachnospiraceae, and were significantly depleted of Clostridiaceae, Peptostreptococcaceae, and Prevotella. The predicted relative proportions of the genes involved in the pathways for lipopolysaccharides (LPS) and butyrate synthesis were also significantly differentiated by the CM risk phenotype, whereby genes involved in the butyrate synthesis via lysine, glutarate and 4-aminobutyrate/succinate pathways and LPS synthesis pathway were enriched in participants with greater CM risk. Furthermore, inter-individual oral microbiota diversity was also significantly associated with the CM risk factors, and oral-associated Streptococcus, Prevotella, and Veillonella were enriched in participants with 3 out of the 5 CM risk factors. We demonstrate that in a diverse cohort of African-origin adults, CM risk is significantly associated with reduced microbial diversity, and the enrichment of specific bacterial taxa and predicted functional traits in both gut and oral environments. As well as providing new insights into the associations between the gut and oral microbiota and CM risk, this study also highlights the potential for novel therapeutic discoveries which target the oral and gut microbiota in CM risk.
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Affiliation(s)
- Na Fei
- Microbiome Center, Department of Surgery, University of Chicago, Chicago, IL, United States of America
| | - Beatriz Peñalver Bernabé
- Microbiome Center, Department of Surgery, University of Chicago, Chicago, IL, United States of America
| | - Louise Lie
- Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, United States of America
| | - Danny Baghdan
- Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, United States of America
| | - Kweku Bedu-Addo
- Department of Physiology, SMS, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Jacob Plange-Rhule
- Department of Physiology, SMS, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Terrence E. Forrester
- Solutions for Developing Countries, University of the West Indies, Mona, Kingston, Jamaica
| | - Estelle V. Lambert
- Research Unit for Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa
| | - Pascal Bovet
- Institute of Social & Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
- Ministry of Health, Mahé, Victoria, Republic of Seychelles
| | - Neil Gottel
- Microbiome Center, Department of Surgery, University of Chicago, Chicago, IL, United States of America
| | - Walter Riesen
- Center for Laboratory Medicine, Canton Hospital, St. Gallen, Switzerland
| | - Wolfgang Korte
- Center for Laboratory Medicine, Canton Hospital, St. Gallen, Switzerland
| | - Amy Luke
- Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, United States of America
| | - Stephanie A. Kliethermes
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Brian T. Layden
- Division of Endocrinology, Diabetes, and Metabolism, University of Illinois at Chicago, Chicago, IL, United States of America
- Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois, United States of America
| | - Jack A. Gilbert
- Microbiome Center, Department of Surgery, University of Chicago, Chicago, IL, United States of America
| | - Lara R. Dugas
- Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, United States of America
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Nyame S, Iwelunmor J, Ogedegbe G, Adjei KGA, Adjei K, Apusiga K, Gyamfi J, Asante KP, Plange-Rhule J. Capacity and Readiness for Implementing Evidence-Based Task-Strengthening
Strategies for Hypertension Control in Ghana: A Cross-Sectional
Study. Glob Heart 2019; 14:129-134. [DOI: 10.1016/j.gheart.2019.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 05/25/2019] [Indexed: 11/24/2022] Open
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Blackstone S, Iwelunmor J, Plange-Rhule J, Gyamfi J, Quakyi NK, Ntim M, Addison A, Ogedegbe G. 'I believe high blood pressure can kill me:' using the PEN-3 Cultural Model to understand patients' perceptions of an intervention to control hypertension in Ghana. Ethn Health 2019; 24:257-270. [PMID: 28675047 DOI: 10.1080/13557858.2017.1346178] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 05/17/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Currently in Ghana, there is an on-going task-shifting strategy in which nurses are trained in hypertension management. While this study will provide useful information on the viability of this approach, it is not clear how patients in the intervention perceive hypertension, the task-shifting strategy, and its effects on blood pressure management. The objective of this paper is to examine patients' perceptions of hypertension and hypertension management in the context of an on-going task-shifting intervention to manage blood pressure control in Ghana. DESIGN Forty-two patients participating in the Task Shifting Strategy for Hypertension program (23 males, 19 females, and mean age 61. 7 years) completed in-depth, qualitative interviews. Interviews were transcribed, and key words and phrases were extracted and coded using the PEN-3 Cultural Model as a guide through open and axial coding techniques, thus allowing rich exploration of the data. RESULTS Emergent themes included patients' perceptions of hypertension, which encompassed misperceptions of hypertension and blood pressure control. Additional themes included enablers and barriers to hypertension management, and how the intervention nurtured lifestyle change associated with blood pressure control. Primary enabling factors included the supportive nature of TASSH nurses, while notable barriers were financial constraints and difficulty accessing medication. Nurturing factors included the motivational interviewing and patient counseling which instilled confidence in the patients that they could make lasting behavior changes. CONCLUSIONS This study offers a unique perspective of blood pressure control by examining how patients view an on-going task-shifting initiative for hypertension management. The results of this study shed light on factors that can help and hinder individuals in low-resource settings with long-term blood pressure management.
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Affiliation(s)
- Sarah Blackstone
- a Department of Kinesiology and Community Health , University of Illinois Urbana-Champaign , Champaign , IL , USA
| | - Juliet Iwelunmor
- a Department of Kinesiology and Community Health , University of Illinois Urbana-Champaign , Champaign , IL , USA
| | - Jacob Plange-Rhule
- b Department of Physiology , Kwame Nkrumah University of Science and Technology , Kumasi , Ghana
| | - Joyce Gyamfi
- c Department of Population Health, School of Medicine , New York University , New York , NY , USA
| | - Nana Kofi Quakyi
- c Department of Population Health, School of Medicine , New York University , New York , NY , USA
| | - Micheal Ntim
- b Department of Physiology , Kwame Nkrumah University of Science and Technology , Kumasi , Ghana
| | - Abigail Addison
- c Department of Population Health, School of Medicine , New York University , New York , NY , USA
| | - Gbenga Ogedegbe
- c Department of Population Health, School of Medicine , New York University , New York , NY , USA
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Mobula LM, Sarfo FS, Carson KA, Burnham G, Arthur L, Ansong D, Sarfo-Kantanka O, Plange-Rhule J, Ofori-Adjei D. Predictors of glycemic control in type-2 diabetes mellitus: Evidence from a multicenter study in Ghana. Translational Metabolic Syndrome Research 2018. [DOI: 10.1016/j.tmsr.2018.09.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Dugas LR, Bernabé BP, Priyadarshini M, Fei N, Park SJ, Brown L, Plange-Rhule J, Nelson D, Toh EC, Gao X, Dong Q, Sun J, Kliethermes S, Gottel N, Luke A, Gilbert JA, Layden BT. Decreased microbial co-occurrence network stability and SCFA receptor level correlates with obesity in African-origin women. Sci Rep 2018; 8:17135. [PMID: 30459320 PMCID: PMC6244201 DOI: 10.1038/s41598-018-35230-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 10/28/2018] [Indexed: 02/07/2023] Open
Abstract
We compared the gut microbial populations in 100 women, from rural Ghana and urban US [50% lean (BMI < 25 kg/m2) and 50% obese (BMI ≥ 30 kg/m2)] to examine the ecological co-occurrence network topology of the gut microbiota as well as the relationship of short chain fatty acids (SCFAs) with obesity. Ghanaians consumed significantly more dietary fiber, had greater microbial alpha-diversity, different beta-diversity, and had a greater concentration of total fecal SCFAs (p-value < 0.002). Lean Ghanaians had significantly greater network density, connectivity and stability than either obese Ghanaians, or lean and obese US participants (false discovery rate (FDR) corrected p-value ≤ 0.01). Bacteroides uniformis was significantly more abundant in lean women, irrespective of country (FDR corrected p < 0.001), while lean Ghanaians had a significantly greater proportion of Ruminococcus callidus, Prevotella copri, and Escherichia coli, and smaller proportions of Lachnospiraceae, Bacteroides and Parabacteroides. Lean Ghanaians had a significantly greater abundance of predicted microbial genes that catalyzed the production of butyric acid via the fermentation of pyruvate or branched amino-acids, while obese Ghanaians and US women (irrespective of BMI) had a significantly greater abundance of predicted microbial genes that encoded for enzymes associated with the fermentation of amino-acids such as alanine, aspartate, lysine and glutamate. Similar to lean Ghanaian women, mice humanized with stool from the lean Ghanaian participant had a significantly lower abundance of family Lachnospiraceae and genus Bacteroides and Parabacteroides, and were resistant to obesity following 6-weeks of high fat feeding (p-value < 0.01). Obesity-resistant mice also showed increased intestinal transcriptional expression of the free fatty acid (Ffa) receptor Ffa2, in spite of similar fecal SCFAs concentrations. We demonstrate that the association between obesity resistance and increased predicted ecological connectivity and stability of the lean Ghanaian microbiota, as well as increased local SCFA receptor level, provides evidence of the importance of robust gut ecologic network in obesity.
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Affiliation(s)
- Lara R Dugas
- Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA.
| | | | - Medha Priyadarshini
- Division of Endocrinology, Diabetes, and Metabolism, University of Illinois at Chicago, Chicago, IL, USA
| | - Na Fei
- Microbiome Center, Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Seo Jin Park
- Department of Microbiology-Immunology, Northwestern University, Chicago, Illinois, USA
| | - Laquita Brown
- Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | | | - David Nelson
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, USA
| | - Evelyn C Toh
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, USA
| | - Xiang Gao
- Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Qunfeng Dong
- Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Jun Sun
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Stephanie Kliethermes
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Wisconsin, USA
| | - Neil Gottel
- Microbiome Center, Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Amy Luke
- Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Jack A Gilbert
- Microbiome Center, Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Brian T Layden
- Division of Endocrinology, Diabetes, and Metabolism, University of Illinois at Chicago, Chicago, IL, USA.,Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois, USA
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Sarfo FS, Mobula LM, Sarfo-Kantanka O, Adamu S, Plange-Rhule J, Ansong D, Gyamfi RA, Duah J, Abraham B, Ofori-Adjei D. Estimated glomerular filtration rate predicts incident stroke among Ghanaians with diabetes and hypertension. J Neurol Sci 2018; 396:140-147. [PMID: 30471633 PMCID: PMC6330840 DOI: 10.1016/j.jns.2018.11.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/10/2018] [Accepted: 11/14/2018] [Indexed: 02/07/2023]
Abstract
Background Sub-Saharan Africa is currently experiencing a high burden of both chronic kidney disease (CKD) and stroke as a result of a rapid rise in shared common vascular risk factors such as hypertension and diabetes mellitus. However, no previous study has prospectively explored independent associations between CKD and incident stroke occurrence among indigenous Africans. This study sought to fill this knowledge gap. Methods A prospective cohort study involving Ghanaians adults with hypertension or type II diabetes mellitus from 5 public hospitals. Patients were followed every 2 months in clinic for 18 months and assessed clinically for first ever stroke by physicians. Serum creatinine derived estimated glomerular filtration rates (eGFR) were determined at baseline for 2631 (81.7%) out of 3296 participants. We assessed associations between eGFR and incident stroke using a multivariate Cox Proportional Hazards regression model. Results Stroke incidence rates (95% CI) increased with decreasing eGFR categories of 89, 60–88, 30–59 and <29 ml/min corresponding to incidence rates of 7.58 (3.58–13.51), 14.45 (9.07–21.92), 29.43 (15.95–50.04) and 66.23 (16.85–180.20)/1000 person-years respectively. Adjusted hazard ratios (95%CI) for stroke occurrence according to eGFR were 1.42 (0.63–3.21) for eGFR of 60-89 ml/min, 1.88 (1.17–3.02) for 30-59 ml/min and 1.52 (0.93–2.43) for <30 ml/min compared with eGFR of >89 ml/min. Adjusted HR for stroke occurrence among patients with hypertension with eGFR<60 ml/min was 3.69 (1.49–9.13), p = .0047 and among those with diabetes was 1.50 (0.56–3.98), p = .42. Conclusion CKD is dose-dependently associated with occurrence of incident strokes among Ghanaians with hypertension and diabetes mellitus. Further studies are warranted to explore interventions that could attenuate the risk of stroke attributable to renal disease among patients with hypertension in SSA. We assessed association between incident stroke and estimated glomerular filtration rate. 2631 participants stroke-free Ghanaian adults with hypertension or diabetes were followed for 14 months. There were 45 incident strokes. Incident stroke risk independently increased with declining eGFR.
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Affiliation(s)
- Fred Stephen Sarfo
- Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
| | - Linda Meta Mobula
- Johns Hopkins University School of Medicine, Baltimore, MD, USA; Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Osei Sarfo-Kantanka
- Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Sheila Adamu
- Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Daniel Ansong
- Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | | | | | - David Ofori-Adjei
- Department of Medicine & Therapeutics, University of Ghana, School of Medicine and Dentistry, Accra, Ghana
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Joshi R, Thrift AG, Smith C, Praveen D, Vedanthan R, Gyamfi J, Schwalm JD, Limbani F, Rubinstein A, Parker G, Ogedegbe O, Plange-Rhule J, Riddell MA, Thankappan KR, Thorogood M, Goudge J, Yeates KE. Task-shifting for cardiovascular risk factor management: lessons from the Global Alliance for Chronic Diseases. BMJ Glob Health 2018; 3:e001092. [PMID: 30483414 PMCID: PMC6231102 DOI: 10.1136/bmjgh-2018-001092] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/05/2018] [Accepted: 10/06/2018] [Indexed: 12/11/2022] Open
Abstract
Task-shifting to non-physician health workers (NPHWs) has been an effective model for managing infectious diseases and improving maternal and child health. There is inadequate evidence to show the effectiveness of NPHWs to manage cardiovascular diseases (CVDs). In 2012, the Global Alliance for Chronic Diseases funded eight studies which focused on task-shifting to NPHWs for the management of hypertension. We report the lessons learnt from the field. From each of the studies, we obtained information on the types of tasks shifted, the professional level from which the task was shifted, the training provided and the challenges faced. Additionally, we collected more granular data on ‘lessons learnt ’ throughout the implementation process and ‘design to implementation’ changes that emerged in each project. The tasks shifted to NPHWs included screening of individuals, referral to physicians for diagnosis and management, patient education for lifestyle improvement, follow-up and reminders for medication adherence and appointments. In four studies, tasks were shifted from physicians to NPHWs and in four studies tasks were shared between two different levels of NPHWs. Training programmes ranged between 3 and 7 days with regular refresher training. Two studies used clinical decision support tools and mobile health components. Challenges faced included system level barriers such as inability to prescribe medicines, varying skill sets of NPHWs, high workload and staff turnover. With the acute shortage of the health workforce in low-income and middle-income countries (LMICs), achieving better health outcomes for the prevention and control of CVD is a major challenge. Task-shifting or sharing provides a practical model for the management of CVD in LMICs.
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Affiliation(s)
- Rohina Joshi
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia
| | - Amanda G Thrift
- Stroke and Ageing Research Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Carter Smith
- Department of Medicine, Queen's University, Kingston, Ontario, Canada.,Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | | | - Rajesh Vedanthan
- Department of Population Health, New York University School of Medicine, New York City, New York, USA
| | - Joyce Gyamfi
- Department of Population Health, New York University School of Medicine, New York City, New York, USA
| | - Jon-David Schwalm
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Felix Limbani
- Centre for Health Policy, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | | | - Gary Parker
- Institute for Global Health, University College London, London, UK
| | - Olugbenga Ogedegbe
- Department of Population Health, New York University School of Medicine, New York City, New York, USA
| | | | | | - Kavumpurathu R Thankappan
- Achutha Menon Centre, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | | | | | - Karen E Yeates
- Department of Medicine, Queen's University, Kingston, Ontario, Canada.,Department of Global Health, College of Global Public Health, New York University, New York City, New York, USA
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Sarfo FS, Mobula LM, Plange-Rhule J, Ansong D, Ofori-Adjei D. Incident stroke among Ghanaians with hypertension and diabetes: A multicenter, prospective cohort study. J Neurol Sci 2018; 395:17-24. [PMID: 30268724 PMCID: PMC6227375 DOI: 10.1016/j.jns.2018.09.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/06/2018] [Accepted: 09/12/2018] [Indexed: 11/25/2022]
Abstract
Background The burden of stroke among hypertensive and diabetic population in sub-Saharan Africa remains high. We sought to identify the risk factors associated with stroke occurrence in these high-risk population groups. Methods A prospective cohort study involving adults with hypertension and or type II diabetes mellitus at 5 public hospitals in Ghana who were stroke-free at enrollment. Patients were followed every 2 months at clinic for 18 months and assessed clinically for first ever stroke by physicians. We calculated crude incidence rates for stroke and assessed the factors associated with stroke occurrence using a multivariate Cox Proportional Hazards regression models. Results Of 3220 eligible participants with 3805 person-years of follow-up, there were 54 clinically confirmed new strokes. Incidence rate of stroke was 14.19 events per 1000 person-years [95% CI: 10.77–18.38], with rates among diabetics with hypertension being 16.64 [10.58–25.00], hypertension of 13.77 [9.33–19.64] and diabetes was 9.81 [3.59–21.74]. Two factors independently associated with stroke occurrence were previous cigarette smoking with adjusted HR (95% CI) of 2.59 (1.18–5.67) and physical inactivity, 1.81 (1.06–3.10). In secondary analysis, stage II hypertension compared with optimal BP was associated with aHR of 3.04 (1.00–9.27), p = .05 for stroke occurrence. Conclusion Incident stroke among Ghanaians with hypertension and diabetes is quite high. Stricter control of blood pressure and engaging in regular physical activities are strongly recommended to reduce the risk of strokes. The first prospective cohort study to assess factors associated with incident strokes among Ghanaians 3220 participants stroke free adults with hypertension or diabetes were followed for an average of 14 months There were 54 strokes with incidence rate of 14.19 events per 1000 person-years Patients with both diabetes with hypertension had highest stroke rates Previous cigarette smoking and physical inactivity were independently associated with incident strokes
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Affiliation(s)
- Fred S Sarfo
- Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
| | - Linda M Mobula
- Johns Hopkins University School of Medicine, Baltimore, MD, USA; Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Daniel Ansong
- Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - David Ofori-Adjei
- Department of Medicine & Therapeutics, University of Ghana School of Medicine and Dentistry, Accra, Ghana
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Dugas LR, Lie L, Plange-Rhule J, Bedu-Addo K, Bovet P, Lambert EV, Forrester TE, Luke A, Gilbert JA, Layden BT. Gut microbiota, short chain fatty acids, and obesity across the epidemiologic transition: the METS-Microbiome study protocol. BMC Public Health 2018; 18:978. [PMID: 30081857 PMCID: PMC6090745 DOI: 10.1186/s12889-018-5879-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 07/24/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND While some of the variance observed in adiposity and weight change within populations can be accounted for by traditional risk factors, a new factor, the gut microbiota, has recently been associated with obesity. However, the causal mechanisms through which the gut microbiota and its metabolites, short chain fatty acids (SCFAs) influence obesity are unknown, as are the individual obesogenic effects of the individual SCFAs (butyrate, acetate and propionate). This study, METS-Microbiome, proposes to examine the influence of novel risk factors, the gut microbiota and SCFAs, on obesity, adiposity and weight change in an international established cohort spanning the epidemiologic transition. METHODS The parent study; Modeling the Epidemiologic Transition Study (METS) is a well-established and ongoing prospective cohort study designed to assess the association between body composition, physical activity, and relative weight, weight gain and cardiometabolic disease risk in five diverse population-based samples in 2500 people of African descent. The cohort has been prospectively followed since 2009. Annual measures of obesity risk factors, including body composition, objectively measured physical activity and dietary intake, components which vary across the spectrum of social and economic development. In our new study; METS-Microbiome, in addition to continuing yearly measures of obesity risk, we will also measure gut microbiota and stool SCFAs in all contactable participants, and follow participants for a further 3 years, thus providing one of the largest gut microbiota population-based studies to date. DISCUSSION This new study capitalizes upon an existing, extensively well described cohort of adults of African-origin, with significant variability as a result of the widespread geographic distributions, and therefore variation in the environmental covariate exposures. The METS-Microbiome study will substantially advance the understanding of the role gut microbiota and SCFAs play in the development of obesity and provide novel obesity therapeutic targets targeting SCFAs producing features of the gut microbiota. TRIAL REGISTRATION Registered NCT03378765 Date first posted: December 20, 2017.
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Affiliation(s)
- Lara R. Dugas
- Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, 2160 S. 1st Avenue, Maywood, IL 60153 USA
| | - Louise Lie
- Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, 2160 S. 1st Avenue, Maywood, IL 60153 USA
| | - Jacob Plange-Rhule
- Department of Physiology, SMS, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kweku Bedu-Addo
- Department of Physiology, SMS, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Pascal Bovet
- Institute of Social & Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
- Ministry of Health, Republic of Seychelles, Lausanne, Switzerland
| | - Estelle V. Lambert
- Research Unit for Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa
| | - Terrence E. Forrester
- Solutions for Developing Countries, University of the West Indies, Mona, Kingston Jamaica
| | - Amy Luke
- Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, 2160 S. 1st Avenue, Maywood, IL 60153 USA
| | - Jack A. Gilbert
- Microbiome Center, Department of Surgery, University of Chicago, Chicago, IL USA
| | - Brian T. Layden
- Division of Endocrinology, Diabetes, and Metabolism, University of Illinois at Chicago, Chicago, IL USA
- Jesse Brown Veterans Affairs Medical Center, Chicago, IL USA
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Lie L, Brown L, Forrester TE, Plange-Rhule J, Bovet P, Lambert EV, Layden BT, Luke A, Dugas LR. The Association of Dietary Fiber Intake with Cardiometabolic Risk in Four Countries across the Epidemiologic Transition. Nutrients 2018; 10:E628. [PMID: 29772682 PMCID: PMC5986507 DOI: 10.3390/nu10050628] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 05/08/2018] [Accepted: 05/14/2018] [Indexed: 01/01/2023] Open
Abstract
The greatest burden of cardiovascular disease is now carried by developing countries with cardiometabolic conditions such as metabolic syndrome, obesity and inflammation believed to be the driving force behind this epidemic. Dietary fiber is known to have protective effects against obesity, type 2 diabetes, cardiovascular disease and the metabolic syndrome. Considering the emerging prevalence of these cardiometabolic disease states across the epidemiologic transition, the objective of this study is to explore these associations of dietary fiber with cardiometabolic risk factors in four countries across the epidemiologic transition. We examined population-based samples of men and women, aged 25⁻45 of African origin from Ghana, Jamaica, the Seychelles and the USA. Ghanaians had the lowest prevalence of obesity (10%), while Jamaicans had the lowest prevalence of metabolic syndrome (5%) across all the sites. Participants from the US presented with the highest prevalence of obesity (52%), and metabolic syndrome (22%). Overall, the Ghanaians consumed the highest dietary fiber (24.9 ± 9.7 g), followed by Jamaica (16.0 ± 8.3 g), the Seychelles (13.6 ± 7.2 g) and the lowest in the USA (14.2 ± 7.1 g). Consequently, 43% of Ghanaians met the fiber dietary guidelines (14 g/1000 kcal/day), 9% of Jamaicans, 6% of Seychellois, and only 3% of US adults. Across all sites, cardiometabolic risk (metabolic syndrome, inflammation and obesity) was inversely associated with dietary fiber intake, such that the prevalence of metabolic syndrome was 13% for those in the lowest quartile of fiber intake, compared to 9% those in the highest quartile of fiber intake. Notably, twice as many of participants (38%) in the lowest quartile were obese compared to those in the highest quartile of fiber intake (18%). These findings further support the need to incorporate strategies and policies to promote increased dietary fiber intake as one component for the prevention of cardiometabolic risk in all countries spanning the epidemiologic transition.
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Affiliation(s)
- Louise Lie
- Public Health Sciences, Stritch School of Medicine, Maywood, IL 60153, USA.
| | - Laquita Brown
- Public Health Sciences, Stritch School of Medicine, Maywood, IL 60153, USA.
| | - Terrence E Forrester
- Solutions for Developing Countries, University of West Indies, Mona, Kingston, Jamaica.
| | - Jacob Plange-Rhule
- Department of Physiology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Pascal Bovet
- Unit for the Prevention and Control of Cardiovascular Disease, Ministry of Health, Victoria, Mahè Island, Republic of Seychelles.
- Institute of Social and Preventive Medicine, University of Lausanne, Lausanne 1010, Switzerland.
| | - Estelle V Lambert
- Division for Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Cape Town 7700, South Africa.
| | - Brian T Layden
- Division of Endocrinology, Diabetes and Metabolism, University of Illinois at Chicago, Chicago, IL 60612, USA.
- Section of Endocrinology, Department of Medicine, Jesse Brown VA Medical Center, Chicago, IL 60612, USA.
| | - Amy Luke
- Public Health Sciences, Stritch School of Medicine, Maywood, IL 60153, USA.
| | - Lara R Dugas
- Public Health Sciences, Stritch School of Medicine, Maywood, IL 60153, USA.
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Mobula LM, Sarfo S, Arthur L, Burnham G, Plange-Rhule J, Ansong D, Gavor E, Ofori-Adjei D. A multi-center prospective cohort study to evaluate the effect of differential pricing and health systems strengthening on access to medicines and management of hypertension and diabetes in Ghana: A study protocol. Gates Open Res 2018; 2:6. [PMID: 29757315 DOI: 10.12688/gatesopenres.12797.1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2018] [Indexed: 11/20/2022] Open
Abstract
Background: There is evidence to suggest that the prevalence of non-communicable diseases (NCDs), in particular cardiovascular diseases and diabetes, are being recognized as forming a substantial proportion of the burden of disease among populations in Low- and Middle-Income Countries (LMICs). Access to treatment is likely a key barrier to the control and prevention of NCD outcomes. Differential pricing, an approach used to price drugs based on the purchasing power of patients in different socioeconomic segments, has been shown to be beneficial and leads to improved access and affordability. Methods: This is a quasi-experimental study, with a pragmatic trial design, to be conducted over the course of three years. A mixed methods design will be used to evaluate the effects of health systems strengthening and differential pricing on the management of diabetes, hypertension and selected cancers in Ghana. A public private partnership was established between all sites that will receive multi-level interventions, including health systems strengthening and access to medicines interventions. Study populations and sites: Study participants will include individuals with new or previously diagnosed hypertension and diabetes (n=3,300), who present to two major referral hospitals, Komfo Anokye Teaching Hospital and Tamale Teaching Hospital, as well as three district hospitals, namely Kings Medical Centre, Agogo Presbyterian District Hospital, and Atua Government Hospital. Discussion: The objective of this study aims to test approaches intended to improve access to drugs for the treatment of hypertension and diabetes, and improve disease control. Patients with these conditions will benefit from health systems strengthening interventions (education, counseling, improved management of disease), and increased access to innovative medicines via differential pricing. Pilot programs also will facilitate health system strengthening at the participating institutions, which includes training of clinicians and updating of guidelines and production of protocols for the treatment of diabetes, hypertension and cancer.
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Affiliation(s)
- Linda Meta Mobula
- Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA.,Johns Hopkins School of Public Health, Baltimore, MD, 21205, USA
| | - Stephen Sarfo
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Lynda Arthur
- Ghana Access and Affordability Program, Accra, Ghana
| | - Gilbert Burnham
- Johns Hopkins School of Public Health, Baltimore, MD, 21205, USA
| | | | - Daniel Ansong
- Department of Child Health, School of Medical Sciences, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | | | - David Ofori-Adjei
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
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Mobula LM, Sarfo S, Arthur L, Burnham G, Plange-Rhule J, Ansong D, Gavor E, Ofori-Adjei D. A multi-center prospective cohort study to evaluate the effect of differential pricing and health systems strengthening on access to medicines and management of hypertension and diabetes in Ghana: A study protocol. Gates Open Res 2018; 2:6. [PMID: 29757315 PMCID: PMC5941285 DOI: 10.12688/gatesopenres.12797.2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2018] [Indexed: 11/20/2022] Open
Abstract
Background: There is evidence to suggest that the prevalence of non-communicable diseases (NCDs), in particular cardiovascular diseases and diabetes, are being recognized as forming a substantial proportion of the burden of disease among populations in Low- and Middle-Income Countries (LMICs). Access to treatment is likely a key barrier to the control and prevention of NCD outcomes. Differential pricing, an approach used to price drugs based on the purchasing power of patients in different socioeconomic segments, has been shown to be beneficial and leads to improved access and affordability. Methods: This is a quasi-experimental study, with a pragmatic trial design, to be conducted over the course of three years. A mixed methods design will be used to evaluate the effects of health systems strengthening and differential pricing on the management of diabetes, hypertension and selected cancers in Ghana. A public private partnership was established between all sites that will receive multi-level interventions, including health systems strengthening and access to medicines interventions. Study populations and sites: Study participants will include individuals with new or previously diagnosed hypertension and diabetes (n=3,300), who present to two major referral hospitals, Komfo Anokye Teaching Hospital and Tamale Teaching Hospital, as well as three district hospitals, namely Kings Medical Centre, Agogo Presbyterian District Hospital, and Atua Government Hospital. Discussion: The objective of this study aims to test approaches intended to improve access to drugs for the treatment of hypertension and diabetes, and improve disease control. Patients with these conditions will benefit from health systems strengthening interventions (education, counseling, improved management of disease), and increased access to innovative medicines via differential pricing. Pilot programs also will facilitate health system strengthening at the participating institutions, which includes training of clinicians and updating of guidelines and production of protocols for the treatment of diabetes, hypertension and cancer.
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Affiliation(s)
- Linda Meta Mobula
- Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA.,Johns Hopkins School of Public Health, Baltimore, MD, 21205, USA
| | - Stephen Sarfo
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Lynda Arthur
- Ghana Access and Affordability Program, Accra, Ghana
| | - Gilbert Burnham
- Johns Hopkins School of Public Health, Baltimore, MD, 21205, USA
| | | | - Daniel Ansong
- Department of Child Health, School of Medical Sciences, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | | | - David Ofori-Adjei
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
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Ogedegbe G, Plange-Rhule J, Gyamfi J, Chaplin W, Ntim M, Apusiga K, Iwelunmor J, Awudzi KY, Quakyi KN, Mogaverro J, Khurshid K, Tayo B, Cooper R. Health insurance coverage with or without a nurse-led task shifting strategy for hypertension control: A pragmatic cluster randomized trial in Ghana. PLoS Med 2018; 15:e1002561. [PMID: 29715303 PMCID: PMC5929500 DOI: 10.1371/journal.pmed.1002561] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 03/26/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Poor access to care and physician shortage are major barriers to hypertension control in sub-Saharan Africa. Implementation of evidence-based systems-level strategies targeted at these barriers are lacking. We conducted a study to evaluate the comparative effectiveness of provision of health insurance coverage (HIC) alone versus a nurse-led task shifting strategy for hypertension control (TASSH) plus HIC on systolic blood pressure (SBP) reduction among patients with uncontrolled hypertension in Ghana. METHODS AND FINDINGS Using a pragmatic cluster randomized trial, 32 community health centers within Ghana's public healthcare system were randomly assigned to either HIC alone or TASSH + HIC. A total of 757 patients with uncontrolled hypertension were recruited between November 28, 2012, and June 11, 2014, and followed up to October 7, 2016. Both intervention groups received health insurance coverage plus scheduled nurse visits, while TASSH + HIC comprised cardiovascular risk assessment, lifestyle counseling, and initiation/titration of antihypertensive medications for 12 months, delivered by trained nurses within the healthcare system. The primary outcome was change in SBP from baseline to 12 months. Secondary outcomes included lifestyle behaviors and blood pressure control at 12 months and sustainability of SBP reduction at 24 months. Of the 757 patients (389 in the HIC group and 368 in the TASSH + HIC group), 85% had 12-month data available (60% women, mean BP 155.9/89.6 mm Hg). In intention-to-treat analyses adjusted for clustering, the TASSH + HIC group had a greater SBP reduction (-20.4 mm Hg; 95% CI -25.2 to -15.6) than the HIC group (-16.8 mm Hg; 95% CI -19.2 to -15.6), with a statistically significant between-group difference of -3.6 mm Hg (95% CI -6.1 to -0.5; p = 0.021). Blood pressure control improved significantly in both groups (55.2%, 95% CI 50.0% to 60.3%, for the TASSH + HIC group versus 49.9%, 95% CI 44.9% to 54.9%, for the HIC group), with a non-significant between-group difference of 5.2% (95% CI -1.8% to 12.4%; p = 0.29). Lifestyle behaviors did not change appreciably in either group. Twenty-one adverse events were reported (9 and 12 in the TASSH + HIC and HIC groups, respectively). The main study limitation is the lack of cost-effectiveness analysis to determine the additional costs and benefits, if any, of the TASSH + HIC group. CONCLUSIONS Provision of health insurance coverage plus a nurse-led task shifting strategy was associated with a greater reduction in SBP than provision of health insurance coverage alone, among patients with uncontrolled hypertension in Ghana. Future scale-up of these systems-level strategies for hypertension control in sub-Saharan Africa requires a cost-benefit analysis. TRIAL REGISTRATION ClinicalTrials.gov NCT01802372.
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Affiliation(s)
- Gbenga Ogedegbe
- Department of Population Health, New York University School of Medicine, New York, New York, United States of America
- * E-mail:
| | - Jacob Plange-Rhule
- School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Joyce Gyamfi
- Department of Population Health, New York University School of Medicine, New York, New York, United States of America
| | - William Chaplin
- Department of Psychology, St. John’s University, Queens, New York, United States of America
| | - Michael Ntim
- School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kingsley Apusiga
- School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Juliet Iwelunmor
- College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri, United States of America
| | | | - Kofi Nana Quakyi
- College of Global Public Health, New York Unversity, New York, New York, United States of America
| | - Jazmin Mogaverro
- Department of Psychology, St. John’s University, Queens, New York, United States of America
| | - Kiran Khurshid
- Department of Psychology, St. John’s University, Queens, New York, United States of America
| | - Bamidele Tayo
- Department of Public Health Sciences, Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois, United States of America
| | - Richard Cooper
- Department of Public Health Sciences, Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois, United States of America
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Sarfo FS, Mobula LM, Burnham G, Ansong D, Plange-Rhule J, Sarfo-Kantanka O, Ofori-Adjei D. Factors associated with uncontrolled blood pressure among Ghanaians: Evidence from a multicenter hospital-based study. PLoS One 2018; 13:e0193494. [PMID: 29554106 PMCID: PMC5858765 DOI: 10.1371/journal.pone.0193494] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 02/12/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The burden of uncontrolled hypertension in Low-and-Middle Income Countries (LMICs) is high, with an increased risk of cardiovascular diseases and chronic renal failure in these settings. OBJECTIVE To assess the factors associated with uncontrolled blood pressure control in a cross-section of Ghanaian hypertensive subjects involved in an on-going multicenter epidemiological study aimed at improving access to hypertension treatment. METHODS A cross-sectional study involving 2,870 participants with hypertension with or without diabetes who were enrolled at 5 hospitals in Ghana (2 tertiary, 2 district and 1 rural hospital). Data on demographics, medical history, lifestyle factors, anti-hypertensive medications and treatment adherence were collected. The 14-item version of the Hill-Bone compliance to high blood pressure therapy scale was used to assess adherence to treatment in 3 domains namely adherence to medications, salt intake and clinic appointments. Questionnaires on knowledge, attitudes and practices on hypertension, sources of antihypertensive medications and challenges with accessing these medications were also administered. Blood pressure, weight and height were measured for each subject at enrollment. Factors associated with uncontrolled blood pressure (>140/90mmHg) were assessed using a multivariate logistic regression model. RESULTS The mean ± SD age of study participants was 58.9 ± 16.6 years, with a female preponderance (76.8%). Among study participants, 1,213 (42.3%) study participants had blood pressure measurements under control. Factors that remained significantly associated with uncontrolled blood pressure with adjusted OR (95% CI) included receiving therapy at a tertiary level of care: 2.47 (1.57-3.87), longer duration of hypertension diagnosis: 1.01 (1.00-1.03), poor adherence to therapy: 1.21 (1.09-1.35) for each 5 points higher score on the Hill-Bone scale, reported difficulties in obtaining antihypertensive medications: 1.24 (1.02-1.49) and number of antihypertensive medications prescribed: 1.32 (1.21-1.44). CONCLUSION We have found high rates of uncontrolled blood pressure among Ghanaian patients with hypertension accessing healthcare in public institutions. The system-level and individual-level factors associated with poor blood pressure control should be addressed to improve hypertension management among Ghanaians.
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Affiliation(s)
- Fred Stephen Sarfo
- Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- * E-mail:
| | - Linda M. Mobula
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Gilbert Burnham
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Daniel Ansong
- Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Osei Sarfo-Kantanka
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - David Ofori-Adjei
- Department of Medicine & Therapeutics, University of Ghana School of Medicine and Dentistry, Accra, Ghana
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40
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Mobula LM, Sarfo S, Arthur L, Burnham G, Ansong D, Plange-Rhule J, Ofori-Adjei D. A novel initiative to improve access to medicines for control of non-communicable diseases in low-and middle- income countries. Gates Open Res 2018. [DOI: 10.12688/gatesopenres.12798.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The global burden of non-communicable diseases (NCDs) is growing, and access to prevention and treatment strategies remain limited, especially for those in low- and middle-income countries (LMICs). Novel approaches are needed to improve access and affordability of medicines that can treat NCDs in LMICs. An integrated approach including differential pricing, health systems strengthening, improved supply chain management and greater affordability can improve access to innovative branded medicines for NCDs. While differential pricing has several advantages for improving the affordability of NCD medicines in LMICs, it can’t overcome all access barriers as a standalone approach. An integrated approach to health systems strengthening, supply chain management and affordability are needed to overcome key challenges in getting medicines for NCD to patients in LMICs. The Access and Affordability Initiative (AAI) is a public private partnership aiming to improve access to and availability of essential medicines for the treatment of NCDs and strengthening of health systems. Through this novel initiative a prospective cohort of patients with hypertension and diabetes were followed in Ghana and the Philippines to examine the effect of differential pricing on access to treatment of hypertension and diabetes.
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Osafo C, Raji YR, Olanrewaju T, Mamven M, Arogundade F, Ajayi S, Ulasi I, Salako B, Plange-Rhule J, Mengistu Y, Mc'Ligeyo SO, Moturi G, Winkler CA, Moxey-Mims MM, Rasooly RS, Kimmel P, Adu D, Ojo A, Parekh RS. Genomic approaches to the burden of kidney disease in Sub-Saharan Africa: the Human Heredity and Health in Africa (H3Africa) Kidney Disease Research Network. Kidney Int 2018; 90:2-5. [PMID: 27312436 DOI: 10.1016/j.kint.2015.12.059] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 12/09/2015] [Accepted: 12/11/2015] [Indexed: 12/21/2022]
Affiliation(s)
- Charlotte Osafo
- School of Medicine and Dentistry, University of Ghana, Accra, Ghana.
| | - Yemi R Raji
- Department of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Manmak Mamven
- Department of Medicine, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Fatiu Arogundade
- Department of Medicine, Obafemi Awolowo University, Ile Ife, Nigeria
| | - Samuel Ajayi
- Department of Medicine, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Ifeoma Ulasi
- Department of Medicine, University of Nigeria, Enugu, Nigeria
| | | | - Jacob Plange-Rhule
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - S O Mc'Ligeyo
- Department of Medicine, University of Nairobi, Nairobi, Kenya
| | - George Moturi
- Department of Medicine, University of Nairobi, Nairobi, Kenya
| | - Cheryl A Winkler
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Marva M Moxey-Mims
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Rebekah S Rasooly
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Paul Kimmel
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Dwomoa Adu
- School of Medicine and Dentistry, University of Ghana, Accra, Ghana
| | - Akinlolu Ojo
- Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Rulan S Parekh
- Departments of Pediatrics and Medicine, Hospital for Sick Children, University of Health Network, University of Toronto, Toronto, Ontario, Canada
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Creber C, Cooper RS, Plange-Rhule J, Bovet P, Lambert EV, Forrester TE, Schoeller D, Riesen W, Korte W, Cao G, Luke A, Dugas LR. Independent association of resting energy expenditure with blood pressure: confirmation in populations of the African diaspora. BMC Cardiovasc Disord 2018; 18:4. [PMID: 29320983 PMCID: PMC5763572 DOI: 10.1186/s12872-017-0737-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 12/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obesity is a major risk factor for hypertension, however, the physiologic mechanisms linking increased adiposity to elevations in blood pressure are not well described. An increase in resting energy expenditure (REE) is an obligatory consequence of obesity. Previous survey research has demonstrated that REE is an independent predictor of blood pressure, and eliminates the co-linear association of body mass index. This observation has received little attention and there have been no attempts to provide a causal explanation. METHODS At baseline in an international comparative study on obesity, 289 participants aged 25-44 were recruited from communities in the US, the Seychelles, Ghana and South Africa and had REE measured with indirect calorimetry. All participants were thought to be free of major illness. RESULTS In multivariate regression models, both systolic and diastolic blood pressure were positively associated with REE (p < 0.01), while body mass index and fat mass were negatively correlated with systolic blood pressure (p < 0.01, and p < 0.05 respectively), but not diastolic blood pressure. CONCLUSIONS These data confirm previous reports and suggest that a common physiologic abnormality links REE and blood pressure. Elevated catecholamines, a putative metabolic characteristic of obesity, is a possible candidate to explain this association. The direct role of excess adipose tissue is open to question.
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Affiliation(s)
- Chloe Creber
- Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Richard S Cooper
- Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | | | - Pascal Bovet
- Institute of Social & Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland.,Ministry of Health, Victoria, Mahè Island, Seychelles
| | - Estelle V Lambert
- Research Unit for Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa
| | - Terrence E Forrester
- Solutions for Developing Countries, University of the West Indies, Mona, Kingston, Jamaica
| | - Dale Schoeller
- Department of Nutritional Sciences, University of Wisconsin, Madison, WI, USA
| | - Walter Riesen
- Center for Laboratory Medicine, Canton Hospital, St. Gallen, Switzerland
| | - Wolfgang Korte
- Center for Laboratory Medicine, Canton Hospital, St. Gallen, Switzerland
| | - Guichan Cao
- Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Amy Luke
- Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Lara R Dugas
- Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA.
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Amoako YA, Laryea DO, Bedu-Addo G, Nkum BC, Plange-Rhule J. Left ventricular hypertrophy among chronic kidney disease patients in Ghana. Pan Afr Med J 2017; 28:79. [PMID: 29255549 PMCID: PMC5724957 DOI: 10.11604/pamj.2017.28.79.9183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 09/13/2017] [Indexed: 01/20/2023] Open
Abstract
Introduction The presence of left ventricular hypertrophy (LVH) in patients with Chronic Kidney Disease (CKD) is associated with worsening cardiovascular outcomes. There is a dearth of data on LVH in Ghanaian CKD patients. Methods This was a cross sectional study carried out at the Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana. A questionnaire was used to obtain information on clinical features of CKD. The MDRD-4 equation was used to calculate eGFR. Information on the prevalence and factors associated with electrocardiographic left ventricular hypertrophy were obtained during the initial assessment. Results About 64.5% of the 203 participants were male and the mean age was 43.9 ± 17.8 years. Most subjects (79.8%) had stage 5 disease. The mean systolic and diastolic blood pressures were 167.86 ± 39.87 and 101.8 ± 24.4 respectively. Approximately 43% of respondents had LVH. eGFR correlated negatively with LVH. High systolic pressure (OR 4.9, CI 2.4 – 10.4; p < 0.05), high diastolic pressure (OR 8.1, CI 4.0 – 16.1; p < 0.05) increased pulse pressure (OR 3.4 CI 2.6-9.3, p < 0.05), increased body mass index (OR 3.6 CI 1.7-11.2, p < 0.001) as well as male gender (OR 4.7, 95% CI 2.4 – 9.1; p <0.05) were associated with the presence of LVH. Conclusion LVH is common in our cohort. High pulse pressure, high DBP, increased BMI and male gender are significant associated factors. Adequate treatment of high blood pressure as well as early detection of LVH and interventions aimed at prevention and/or regression of LVH are to be encouraged.
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Affiliation(s)
- Yaw Ampem Amoako
- Renal Medicine and Dialysis Unit, Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - George Bedu-Addo
- Renal Medicine and Dialysis Unit, Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.,School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Bernard Cudjoe Nkum
- Renal Medicine and Dialysis Unit, Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.,School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Jacob Plange-Rhule
- Renal Medicine and Dialysis Unit, Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.,School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Gyamfi J, Plange-Rhule J, Iwelunmor J, Lee D, Blackstone SR, Mitchell A, Ntim M, Apusiga K, Tayo B, Yeboah-Awudzi K, Cooper R, Ogedegbe G. Erratum to: Training nurses in task-shifting strategies for the management and control of hypertension in Ghana: a mixed-methods study. BMC Health Serv Res 2017; 17:216. [PMID: 28314385 PMCID: PMC5356329 DOI: 10.1186/s12913-017-2161-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 03/13/2017] [Indexed: 11/29/2022] Open
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Dugas LR, Forrester TE, Plange-Rhule J, Bovet P, Lambert EV, Durazo-Arvizu RA, Cao G, Cooper RS, Khatib R, Tonino L, Riesen W, Korte W, Kliethermes S, Luke A. Cardiovascular risk status of Afro-origin populations across the spectrum of economic development: findings from the Modeling the Epidemiologic Transition Study. BMC Public Health 2017; 17:438. [PMID: 28499375 PMCID: PMC5429531 DOI: 10.1186/s12889-017-4318-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 04/26/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Cardiovascular risk factors are increasing in most developing countries. To date, however, very little standardized data has been collected on the primary risk factors across the spectrum of economic development. Data are particularly sparse from Africa. METHODS In the Modeling the Epidemiologic Transition Study (METS) we examined population-based samples of men and women, ages 25-45 of African ancestry in metropolitan Chicago, Kingston, Jamaica, rural Ghana, Cape Town, South Africa, and the Seychelles. Key measures of cardiovascular disease risk are described. RESULTS The risk factor profile varied widely in both total summary estimates of cardiovascular risk and in the magnitude of component factors. Hypertension ranged from 7% in women from Ghana to 35% in US men. Total cholesterol was well under 200 mg/dl for all groups, with a mean of 155 mg/dl among men in Ghana, South Africa and Jamaica. Among women total cholesterol values varied relatively little by country, following between 160 and 178 mg/dl for all 5 groups. Levels of HDL-C were virtually identical in men and women from all study sites. Obesity ranged from 64% among women in the US to 2% among Ghanaian men, with a roughly corresponding trend in diabetes. Based on the Framingham risk score a clear trend toward higher total risk in association with socioeconomic development was observed among men, while among women there was considerable overlap, with the US participants having only a modestly higher risk score. CONCLUSIONS These data provide a comprehensive estimate of cardiovascular risk across a range of countries at differing stages of social and economic development and demonstrate the heterogeneity in the character and degree of emerging cardiovascular risk. Severe hypercholesterolemia, as characteristic in the US and much of Western Europe at the onset of the coronary epidemic, is unlikely to be a feature of the cardiovascular risk profile in these countries in the foreseeable future, suggesting that stroke may remain the dominant cardiovascular event.
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Affiliation(s)
- Lara R. Dugas
- Public Health Sciences, Stritch School of Medicine, Maywood, IL USA
| | - Terrence E. Forrester
- Solutions for Developing Countries, University of the West Indies, Mona, Kingston, Jamaica
| | - Jacob Plange-Rhule
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Pascal Bovet
- Ministry of Health, Republic of Seychelles, Seychelles, Seychelles
- Institute of Social & Preventive Medicine, Laussanne University Hospital, Lausanne, Switzerland
| | - Estelle V. Lambert
- Research Unit for Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Guichan Cao
- Public Health Sciences, Stritch School of Medicine, Maywood, IL USA
| | | | - Rasha Khatib
- Public Health Sciences, Stritch School of Medicine, Maywood, IL USA
| | - Laura Tonino
- Public Health Sciences, Stritch School of Medicine, Maywood, IL USA
| | - Walter Riesen
- Center for Laboratory Medicine, Canton Hospital, St. Gallen, Switzerland
| | - Wolfgang Korte
- Center for Laboratory Medicine, Canton Hospital, St. Gallen, Switzerland
| | - Stephanie Kliethermes
- Department of Orthopaedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, WI USA
| | - Amy Luke
- Public Health Sciences, Stritch School of Medicine, Maywood, IL USA
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Blackstone S, Iwelunmor J, Plange-Rhule J, Gyamfi J, Quakyi NK, Ntim M, Ogedegbe G. Sustaining Nurse-Led Task-Shifting Strategies for Hypertension Control: A Concept Mapping Study to Inform Evidence-Based Practice. Worldviews Evid Based Nurs 2017; 14:350-357. [PMID: 28449387 DOI: 10.1111/wvn.12230] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND The use of task-shifting is an increasingly widespread delivery approach for health interventions targeting prevention, treatment, and control of hypertension in adults living in sub-Saharan Africa (SSA). Addressing a gap in the literature, this research examined the sustainability of an ongoing task-shifting strategy for hypertension (TASSH) from the perspectives of community health nurses (CHNs) implementing the program. METHODS We used concept-mapping, a mixed-methods participatory approach to understand CHNs' perceptions of barriers and enablers to sustaining a task-shifting program. Participants responded to focal prompts, eliciting statements regarding perceived barriers and enablers to sustaining TASSH, and then rated these ideas based on importance to the research questions and feasibility to address. Twenty-eight community health nurses (21 women, 7 men) from the Ashanti region of Ghana completed the concept-mapping process. RESULTS Factors influencing sustainability were grouped into five categories: Limited Drug Supply, Financial Support, Provision of Primary Health Care, Personnel Training, and Patient-Provider Communication. The limited supply of antihypertensive medication was considered by CHNs as the most important item to address, while providing training for intervention personnel was considered most feasible to address. LINKING EVIDENCE TO ACTION This study's findings highlight the importance of examining nurses' perceptions of factors likely to influence the sustainability of evidence-based, task-shifting interventions. Nurses' perceptions can guide the widespread uptake and dissemination of these interventions in resource-limited settings.
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Affiliation(s)
- Sarah Blackstone
- Doctoral Candidate, Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Champaign, IL
| | - Juliet Iwelunmor
- Assistant Professor, Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Champaign, IL
| | - Jacob Plange-Rhule
- Professor, Department of Physiology Kwame Nkrumah, University of Science and Technology, Kumasi, Ghana
| | - Joyce Gyamfi
- Research Coordinator, Department of Population Health, New York University School of Medicine, New York, NY
| | - Nana Kofi Quakyi
- Doctoral Student, Department of Population Health, New York University School of Medicine, New York, NY
| | - Micheal Ntim
- Research Coordinator, Department of Physiology Kwame Nkrumah, University of Science and Technology, Kumasi, Ghana
| | - Gbenga Ogedegbe
- Professor and Director, Department of Population Health, New York University School of Medicine, New York, NY
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Iwelunmor J, Gyamfi J, Plange-Rhule J, Blackstone S, Quakyi NK, Ntim M, Zizi F, Yeboah-Awudzi K, Nang-Belfubah A, Ogedegbe G. Exploring stakeholders' perceptions of a task-shifting strategy for hypertension control in Ghana: a qualitative study. BMC Public Health 2017; 17:216. [PMID: 28222754 PMCID: PMC5320716 DOI: 10.1186/s12889-017-4127-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 02/13/2017] [Indexed: 01/25/2023] Open
Abstract
Background The purpose of this study was to explore stakeholders' perception of an on-going evidence-based task-shifting strategy for hypertension (TASSH) in 32 community health centers and district hospitals in Ghana. Methods Using focus group discussions and in-depth interviews, qualitative data were obtained from 81 key stakeholders including patients, nurses, and site directors of participating community health centers involved in the TASSH trial. Qualitative data were analyzed using open and axial coding techniques. Results Analysis of the qualitative data revealed three themes that illustrate stakeholders' perceptions of the ongoing task-shifting strategy for blood pressure control in Ghana and they include: 1) awareness and understanding of the TASSH program; 2) reasons for participation and non-participation in TASSH; and 3) the benefit and drawbacks to the TASSH program. Conclusion The findings support evidence that successful implementation of any task-shifting strategy must focus not only on individual patient characteristics, but also consider the role contextual factors such as organizational and leadership factors play. The findings also demonstrate the importance of understanding stakeholder's perceptions of evidence-based task-shifting interventions for hypertension control as it may ultimately influence the sustainable uptake of these interventions into "real world" settings.
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Affiliation(s)
- Juliet Iwelunmor
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, College of Applied Health Sciences, Champaign, USA.
| | - Joyce Gyamfi
- Department of Population Health, New York University School of Medicine, New York, USA
| | | | - Sarah Blackstone
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, College of Applied Health Sciences, Champaign, USA
| | - Nana Kofi Quakyi
- Department of Population Health, New York University School of Medicine, New York, USA
| | - Michael Ntim
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ferdinand Zizi
- Department of Population Health, New York University School of Medicine, New York, USA
| | | | | | - Gbenga Ogedegbe
- Department of Population Health, New York University School of Medicine, New York, USA
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Gyamfi J, Plange-Rhule J, Iwelunmor J, Lee D, Blackstone SR, Mitchell A, Ntim M, Apusiga K, Tayo B, Yeboah-Awudzi K, Cooper R, Ogedegbe G. Training nurses in task-shifting strategies for the management and control of hypertension in Ghana: a mixed-methods study. BMC Health Serv Res 2017; 17:104. [PMID: 28148255 PMCID: PMC5288999 DOI: 10.1186/s12913-017-2026-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 01/17/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Nurses in Ghana play a vital role in the delivery of primary health care at both the household and community level. However, there is lack of information on task shifting the management and control of hypertension to community health nurses in low- and middle-income countries including Ghana. The purpose of this study was to assess nurses' knowledge and practice of hypertension management and control pre- and post-training utilizing task-shifting strategies for hypertension control in Ghana (TASSH). METHODS A pre- and post- test survey was administered to 64 community health nurses (CHNs) and enrolled nurses (ENs) employed in community health centers and district hospitals before and after the TASSH training, followed by semi-structured qualitative interviews that assessed nurses' satisfaction with the training, resultant changes in practice and barriers and facilitators to optimal hypertension management. RESULTS A total of 64 CHNs and ENs participated in the TASSH training. The findings of the pre- and post-training assessments showed a marked improvement in nurses' knowledge and practice related to hypertension detection and treatment. At pre-assessment 26.9% of the nurses scored 80% or more on the hypertension knowledge test, whereas this improved significantly to 95.7% post-training. Improvement of interpersonal skills and patient education were also mentioned by the nurses as positive outcomes of participation in the intervention. CONCLUSIONS Findings suggest that if all nurses receive even brief training in the management and control of hypertension, major public health benefits are likely to be achieved in low-income countries like Ghana. However, more research is needed to ascertain implementation fidelity and sustainability of interventions such as TASSH that highlight the potential role of nurses in mitigating barriers to optimal hypertension control in Ghana. TRIAL REGISTRATION Trial registration for parent TASSH study: NCT01802372 . Registered February 27, 2013.
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Affiliation(s)
- Joyce Gyamfi
- New York University School of Medicine, NYU Langone Medical Center, New York, NY 10016 USA
| | - Jacob Plange-Rhule
- School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Juliet Iwelunmor
- University of Illinois at Urbana-Champaign, Urbana, IL 61801 USA
| | - Debbie Lee
- Stony Brook University School of Medicine, Stony Brook, NY 11797 USA
| | | | - Alicia Mitchell
- New York University School of Medicine, NYU Langone Medical Center, New York, NY 10016 USA
| | - Michael Ntim
- School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kingsley Apusiga
- School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Bamidele Tayo
- Stritch School of Medicine, Loyola Chicago Medical Center, Maywood, IL 60153 USA
| | | | - Richard Cooper
- Stritch School of Medicine, Loyola Chicago Medical Center, Maywood, IL 60153 USA
| | - Gbenga Ogedegbe
- New York University School of Medicine, NYU Langone Medical Center, New York, NY 10016 USA
- NYU College of Global Public Health, New York University, New York, NY 10003 USA
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Dugas LR, Kliethermes S, Plange-Rhule J, Tong L, Bovet P, Forrester TE, Lambert EV, Schoeller DA, Durazo-Arvizu RA, Shoham DA, Cao G, Brage S, Ekelund U, Cooper RS, Luke A. Accelerometer-measured physical activity is not associated with two-year weight change in African-origin adults from five diverse populations. PeerJ 2017; 5:e2902. [PMID: 28133575 PMCID: PMC5251933 DOI: 10.7717/peerj.2902] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 12/12/2016] [Indexed: 12/20/2022] Open
Abstract
Background Increasing population-levels of physical activity (PA) is a controversial strategy for managing the obesity epidemic, given the conflicting evidence for weight loss from PA alone per se. We measured PA and weight change in a three-year prospective cohort study in young adults from five countries (Ghana, South Africa, Jamaica, Seychelles and USA). Methods A total of 1,944 men and women had baseline data, and at least 1 follow-up examination including measures of anthropometry (weight/BMI), and objective PA (accelerometer, 7-day) following the three-year study period. PA was explored as 1-minute bouts of moderate and vigorous PA (MVPA) as well as daily sedentary time. Results At baseline; Ghanaian and South African men had the lowest body weights (63.4 ± 9.5, 64.9 ± 11.8 kg, respectively) and men and women from the USA the highest (93.6 ± 25.9, 91.7 ± 23.4 kg, respectively). Prevalence of normal weight ranged from 85% in Ghanaian men to 29% in USA men and 52% in Ghanaian women to 15% in USA women. Over the two-year follow-up period, USA men and Jamaican women experienced the smallest yearly weight change rate (0.1 ± 3.3 kg/yr; −0.03 ± 3.0 kg/yr, respectively), compared to South African men and Ghanaian women greatest yearly change (0.6.0 ± 3.0 kg/yr; 1.22 ± 2.6 kg/yr, respectively). Mean yearly weight gain tended to be larger among normal weight participants at baseline than overweight/obese at baseline. Neither baseline MVPA nor sedentary time were associated with weight gain. Using multiple linear regression, only baseline weight, age and gender were significantly associated with weight gain. Discussion From our study it is not evident that higher volumes of PA alone are protective against future weight gain, and by deduction our data suggest that other environmental factors such as the food environment may have a more critical role.
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Affiliation(s)
- Lara R Dugas
- Public Health Sciences, Stritch School of Medicine, Loyola University Chicago , Maywood , IL , United States
| | - Stephanie Kliethermes
- Department of Orthopedics & Rehabilitation, University of Wisconsin, Madison , Madison , WI , United States
| | - Jacob Plange-Rhule
- Department of Physiology, Kwame Nkrumah University of Science and Technology , Kumasi , Ghana
| | - Liping Tong
- Public Health Sciences, Stritch School of Medicine, Loyola University Chicago , Maywood , IL , United States
| | - Pascal Bovet
- Institute of Social & Preventive Medicine, Lausanne University Hospital, Lausanne, VD, Switzerland; Ministry of Health, Victoria, Republic of Seychelles
| | - Terrence E Forrester
- Solutions for Developing Countries, University of West Indies, Mona , Kingston , Jamaica
| | - Estelle V Lambert
- Division of Exercise Science and Sports Medicine, Health Sciences, University of Cape Town , Cape Town , South Africa
| | - Dale A Schoeller
- Nutritional Sciences, University of Wisconsin, Madison , Madison , WI , United States
| | - Ramon A Durazo-Arvizu
- Public Health Sciences, Stritch School of Medicine, Loyola University Chicago , Maywood , IL , United States
| | - David A Shoham
- Public Health Sciences, Stritch School of Medicine, Loyola University Chicago , Maywood , IL , United States
| | - Guichan Cao
- Public Health Sciences, Stritch School of Medicine, Loyola University Chicago , Maywood , IL , United States
| | - Soren Brage
- MRC Epidemiology Unit, University of Cambridge , Cambridge , United Kingdom
| | - Ulf Ekelund
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom; Department of Sport Medicine, Norwegion School of Sport Sciences, Oslo, Norway
| | - Richard S Cooper
- Public Health Sciences, Stritch School of Medicine, Loyola University Chicago , Maywood , IL , United States
| | - Amy Luke
- Public Health Sciences, Stritch School of Medicine, Loyola University Chicago , Maywood , IL , United States
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Stringhini S, Forrester TE, Plange-Rhule J, Lambert EV, Viswanathan B, Riesen W, Korte W, Levitt N, Tong L, Dugas LR, Shoham D, Durazo-Arvizu RA, Luke A, Bovet P. The social patterning of risk factors for noncommunicable diseases in five countries: evidence from the modeling the epidemiologic transition study (METS). BMC Public Health 2016; 16:956. [PMID: 27612934 PMCID: PMC5017030 DOI: 10.1186/s12889-016-3589-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 08/25/2016] [Indexed: 12/04/2022] Open
Abstract
Background Associations between socioeconomic status (SES) and risk factors for noncommunicable diseases (NCD-RFs) may differ in populations at different stages of the epidemiological transition. We assessed the social patterning of NCD-RFs in a study including populations with different levels of socioeconomic development. Methods Data on SES, smoking, physical activity, body mass index, blood pressure, cholesterol and glucose were available from the Modeling the Epidemiologic Transition Study (METS), with about 500 participants aged 25–45 in each of five sites (Ghana, South Africa, Jamaica, Seychelles, United States). Results The prevalence of NCD-RFs differed between these populations from five countries (e.g., lower prevalence of smoking, obesity and hypertension in rural Ghana) and by sex (e.g., higher prevalence of smoking and physical activity in men and of obesity in women in most populations). Smoking and physical activity were associated with low SES in most populations. The associations of SES with obesity, hypertension, cholesterol and elevated blood glucose differed by population, sex, and SES indicator. For example, the prevalence of elevated blood glucose tended to be associated with low education, but not with wealth, in Seychelles and USA. The association of SES with obesity and cholesterol was direct in some populations but inverse in others. Conclusions In conclusion, the distribution of NCD-RFs was socially patterned in these populations at different stages of the epidemiological transition, but associations between SES and NCD-RFs differed substantially according to risk factor, population, sex, and SES indicator. These findings emphasize the need to assess and integrate the social patterning of NCD-RFs in NCD prevention and control programs in LMICs.
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Affiliation(s)
- Silvia Stringhini
- University Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Biopôle 2, Route de la Corniche 10, 1010, Lausanne, Switzerland.
| | - Terrence E Forrester
- Tropical Medicine Research Institute, University of the West Indies, Mona, Kingston, Jamaica
| | | | - Estelle V Lambert
- Research Unit for Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Walter Riesen
- Center for Laboratory Medicine, Canton Hospital, St. Gallen, Switzerland
| | - Wolfgang Korte
- Center for Laboratory Medicine, Canton Hospital, St. Gallen, Switzerland
| | - Naomi Levitt
- Chronic Disease Initiative in Africa, Department of Medicine, University of CapeTown, Cape Town, South Africa
| | - Liping Tong
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Lara R Dugas
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - David Shoham
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | | | - Amy Luke
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Pascal Bovet
- University Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Biopôle 2, Route de la Corniche 10, 1010, Lausanne, Switzerland.,Ministry of Health, Victoria, Republic of Seychelles
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