Diabetes in sub-Saharan Africa Mbanya, Jean Claude N, Prof; Motala, Ayesha A, Prof; Sobngwi, Eugene, MD ...
The Lancet (British edition),
2010-Jun-26, Letnik:
375, Številka:
9733
Journal Article
Recenzirano
Summary In Sub-Saharan Africa, prevalence and burden of type 2 diabetes are rising quickly. Rapid uncontrolled urbanisation and major changes in lifestyle could be driving this epidemic. The increase ...presents a substantial public health and socioeconomic burden in the face of scarce resources. Some types of diabetes arise at younger ages in African than in European populations. Ketosis-prone atypical diabetes is mostly recorded in people of African origin, but its epidemiology is not understood fully because data for pathogenesis and subtypes of diabetes in sub-Saharan African communities are scarce. The rate of undiagnosed diabetes is high in most countries of sub-Saharan Africa, and individuals who are unaware they have the disorder are at very high risk of chronic complications. Therefore, the rate of diabetes-related morbidity and mortality in this region could grow substantially. A multisectoral approach to diabetes control and care is vital for expansion of socioculturally appropriate diabetes programmes in sub-Saharan African countries.
The increasing burden of non-communicable diseases in sub-Saharan Africa (SSA) warrants rigorous studies of contributing lifestyle factors. Combined heart rate (HR) and movement monitoring make it ...possible to objectively measure physical activity in free-living individuals. We examined the validity of a combined HR and motion sensor in estimating physical activity energy expenditure (PAEE) in free-living adults in rural and urban Cameroon compared with doubly-labelled water (DLW) as criterion.
PAEE was measured in 33 free-living rural and urban dwellers by DLW over 7 consecutive days. Simultaneously, the combined sensor recorded HR and uni-axial acceleration. Individual HR vs PAEE calibration was done by a step test. Branched equation modelling was used to estimate PAEE from HR and acceleration. Validity and accuracy of prediction were expressed as mean bias and root mean square error (RMSE). Agreement was analysed using Bland and Altman limits of agreement (LOA).
There was no significant mean bias between PAEE estimated from the combined sensor or measured by DLW mean bias (standard error): -5.4 (5.1) kJ/kg/day; P = 0.3; RMSE = 29.3 kJ/kg/day. The bias doubled for group compared with individual calibration of HR -9.1 (5.0) kJ/kg/day, P = 0.08. PAEE prediction was more accurate in urban compared with rural volunteers. The 95% LOAs between predicted and measured PAEE were ∼50-60 kJ/kg/day above or below perfect agreement.
Combined HR and movement sensing is a valid method for estimating free-living PAEE on group level in adults in SSA.
We examined the independent associations between objectively measured free-living physical activity energy expenditure (PAEE) and the metabolic syndrome in adults in rural and urban Cameroon.
PAEE ...was measured in 552 rural and urban dwellers using combined heart rate and movement sensing over 7 continuous days. The metabolic syndrome was defined using the National Cholesterol Education Program-Adult Treatment Panel III criteria.
Urban dwellers had a significantly lower PAEE than rural dwellers (44.2 ± 21.0 vs. 59.6 ± 23.7 kJ/kg/day, P < 0.001) and a higher prevalence of the metabolic syndrome (17.7 vs. 3.5%, P < 0.001). In multivariate regression models adjusted for possible confounders, each kJ/kg/day of PAEE was associated with a 2.1% lower risk of prevalent metabolic syndrome (odds ratio 0.98, P = 0.03). This implies a 6.5 kJ/kg/day difference in PAEE, equivalent to 30 min/day of brisk walking, corresponds to a 13.7% lower risk of prevalent metabolic syndrome. The population attributable fraction of prevalent metabolic syndrome due to being in the lowest quartile of PAEE was 26.3% (25.3% in women and 35.7% in men).
Urban compared with rural residence is associated with lower PAEE and higher prevalence of metabolic syndrome. PAEE is strongly independently associated with prevalent metabolic syndrome in adult Cameroonians. Modest population-wide changes in PAEE may have significant benefits in terms of reducing the emerging burden of metabolic diseases in sub-Saharan Africa.
Background: There is an assumption that people in developing countries have a higher total energy expenditure (TEE) and physical activity level (PAL) than do people in developed nations, but few ...objective data for this assertion exist.
Objective: We conducted a meta-analysis of TEE and PAL by using data from countries that have a low or middle human development index (HDI) compared with those with a high HDI to better understand how energy-expenditure variables are associated with development status and population differences in body size.
Design: We performed a literature search for studies in which energy expenditure was measured by using doubly labeled water. Mean data on age, weight, body mass index (BMI; in kg/m2), TEE, and PAL were extracted, and HDI status was assessed. Pooled estimates of the mean effect by sex were obtained, and the extent to which age, weight, HDI status, and year of publication explained heterogeneity was assessed.
Results: A total of 98 studies (14 studies from low- or middle-HDI countries) that represented 183 cohorts and 4972 individuals were included. Mean (±SE) BMI was lower in countries with a low or middle HDI than in those with a high HDI for both men and women (22.7 ± 1.0 compared with 26.0 ± 0.7, respectively, in men and 24.3 ± 0.7 compared with 26.6 ± 0.4, respectively, in women). In meta-regression models, there was an inverse association of age (P < 0.001) and a positive association of weight (P < 0.001) with TEE for both sexes; there was an association of age only in men with PAL (P < 0.001). There was no association of HDI status with either TEE or PAL.
Conclusion: TEE adjusted for weight and age or PAL did not differ significantly between developing and industrialized countries, which calls into question the role of energy expenditure in the cause of obesity at the population level.
There is a mounting body of evidence regarding the challenge posed by diabetes and obesity on the health systems of many Sub-Sahara African countries. This trend has been linked to the changing ...demographic profile together with rapid urbanization and changing lifestyles in both rural and urban settings in Africa. Africa is expected to witness the greatest increase in the number of people with diabetes from 19.8 million in 2013 to 41.4 million in 2035 if current trends persist. Excess weight alone currently accounts for at least 2.8 million deaths globally each year through increased risk for type 2 diabetes and cardiovascular complications. This review highlights recent literature on the problem of obesity and type 2 diabetes in Sub-Sahara Africa. It exposes the need for concrete interventions based on the now available wealth of evidence.
Agricultural workers especially in sugarcane plantations have a high risk of chronic kidney disease (CKD). Little is known about CKD among sugarcane plantation workers in Cameroon. This study sought ...to evaluate the prevalence and identify factors associated with CKD in sugarcane plantation workers in Cameroon.
We conducted an analytic cross-sectional study including 204 adult workers at the sugarcane plantation complex in Mbandjock, Cameroon; over 500 m above sea level. Chronic kidney disease (proteinuria as estimated by urine dipstick analysis and/or estimated glomerular filtration rate < 60 ml/min/1.73 m
persistent after 3 months) was the outcome of interest. Those with abnormal results were seen again after 3 months to confirm the diagnosis. We evaluated the association between CKD and participant age, sex, contract-type, duration of employment, socio-economic status, workspace, exposure to agrochemicals, heavy metals and heat, selected risk factors and co-morbid conditions.
The overall prevalence of CKD was 3.4%. The factory workers were the most affected (7%), compared to the field (2.4%) and office workers (0%). 2.9% of the participants had persistent proteinuria, mild in every case, and 0.5% of them had an estimated glomerular filtration rate < 60 ml/min/1.73 m
. Age ≥ 40 years was an independent predictor of CKD.
The prevalence of CKD among employees of the Mbandjock sugarcane plantation is low, probably reflecting the preventive measures against heat stress and dehydration in place.
The World Health Organization's Framework Convention on Tobacco Control, enforced in 2005, was a watershed international treaty that stipulated requirements for signatories to govern the production, ...sale, distribution, advertisement, and taxation of tobacco to reduce its impact on health. This paper describes the timelines, context, key actors, and strategies in the development and implementation of the treaty and describes how six sub-Saharan countries responded to its call for action on tobacco control.
A multi-country policy review using case study design was conducted in Cameroon, Kenya, Nigeria, Malawi, South Africa, and Togo. All documents related to the WHO Framework Convention on Tobacco Control and individual country implementation of tobacco policies were reviewed, and key informant interviews related to the countries' development and implementation of tobacco policies were conducted.
Multiple stakeholders, including academics and activists, led a concerted effort for more than 10 years to push the WHO treaty forward despite counter-marketing from the tobacco industry. Once the treaty was enacted, Cameroon, Kenya, Nigeria, Malawi, South Africa, and Togo responded in unique ways to implement tobacco policies, with differences associated with the country's socio-economic context, priorities of country leaders, industry presence, and choice of strategies. All the study countries except Malawi have acceded to and ratified the WHO tobacco treaty and implemented tobacco control policy.
The WHO Framework Convention on Tobacco Control provided an unprecedented opportunity for global action against the public health effects of tobacco including non-communicable diseases. Reviewing how six sub-Saharan countries responded to the treaty to mobilize resources and implement tobacco control policies has provided insight for how to utilise international regulations and commitments to accelerate policy impact on the prevention of non-communicable diseases.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
GLOBAL MONITORING OF PHYSICAL ACTIVITY Physical activity has consistently been shown to be associated with several health benefits, but global surveillance data suggest that on average one in four ...adults are insufficiently active, with populations living in low- and middle-income countries being far more active than those living in high-income countries.1 The WHO Global Action Plan for Physical Activity aims to reduce the prevalence of insufficient activity by 10% in 2025 and by 15% in 2030.2 The key to monitoring progress towards these targets is a robust surveillance system. OBJECTIVELY MEASURED PHYSICAL ACTIVITY IN MALAWI Pratt and colleagues describe the levels of objectively measured physical activity in 414 working-age adults, sampled from agricultural (rural) households in Malawi, a low–middle-income country as assessed by the World Bank.3 Physical activity was measured during the farming season using a hip-mounted accelerometer, and participants were asked to wear the device for 2 weeks, except when sleeping and bathing. ...rural dwellers of Cameroon accumulated 50% (in men) to 100% (in women) more moderate-to-vigorous activity than urban dwellers, but the difference was only 20% higher for the two accelerometer-based measures.13 Rural populations of Kenyan Lou, Kamba and Masaai accumulated even higher levels of activity, with time spent above the highest accelerometry cutpoint being slightly higher than the equivalent in the Malawian men but slightly lower in the women.18 Estimates from Ghana and Seychelles using hip accelerometry were however much lower, suggesting substantial variation between African populations.15 A previous study from Malawi undertaken in 2017 as a feasibility study for incorporating objective measures of activity into the WHO STEPwise approach to Surveillance (STEPS) programme assessed activity in both rural and urban dwellers using a triaxial wrist accelerometer.14 Again this found higher activity in rural dwellers, about 60% for men and 80% for women, compared to Malawian urban dwellers, and both these populations were more active than UK populations assessed with the same method.19 20 Figure 1. Overview of objectively-measured moderate-to-vigorous intensity physical activity (MVPA) estimates of adult men (top panel) and women (bottom panel) residing in rural and urban areas of Africa, compared with a few measurement method-matched estimates from the USA and the UK. 3 12-16 18-20 SAMPLING THE DIURNAL PATTERN OF PHYSICAL BEHAVIOUR The daily 24-hour cycle of physical behaviour is one of the most recognisable patterns in objective monitoring records.
A low intake of fruit and vegetables and a high intake of meat are associated with higher cardiometabolic disease risk; however much prior research has relied on subjective methods for dietary ...assessment and focused on Western populations. We aimed to investigate the association of blood folate as an objective marker of fruit and vegetable intake and holotranscobalamin (holoTC) as a marker of animal-sourced food intake with cardiometabolic risk factors. We conducted a population-based cross-sectional study on 578 adults (mean ± SD age = 38.2 ± 8.6 years; 64% women). The primary outcome was a continuous metabolic syndrome score. The median serum folate was 12.9 (IQR: 8.6-20.5) nmol/L and the mean holoTC was 75 (SD: 34.3) pmol/L. Rural residents demonstrated higher serum folate concentrations (15.9 (9.8-25.9) nmol/L) than urban residents (11.3 (7.9-15.8) nmol/L), but lower holoTC concentrations (rural: 69.8 (32.9) pmol/L; urban: 79.8 (34.9)) pmol/L,
< 0.001 for both comparisons. There was an inverse association between serum folate and metabolic syndrome score by -0.20 in the z-score (95% CI, -0.38 to -0.02) per 10.8 (1 SD) of folate) in a model adjusted for socio-demographic factors, smoking status, alcohol intake, BMI, and physical activity. HoloTC was positively associated with the metabolic syndrome score in unadjusted analysis (0.33 (95% CI, 0.10 to 0.56)) but became non-significant (0.17 (-0.05 to 0.39)) after adjusting for socio-demographic and behavioural characteristics. In conclusion, serum folate and holoTC were associated with the metabolic syndrome score in opposite directions. The positive association between serum holoTC and the metabolic syndrome score was partly dependent on sociodemographic characteristics. These findings suggest that, based on these biomarkers reflecting dietary intakes, public health approaches promoting a higher intake of fruit and vegetables may lower cardiometabolic risk factors in this population.
Abstract
Background
An inverse association between vitamin D status and cardiometabolic risk has been reported but this relationship may have been affected by residual confounding from adiposity and ...physical activity due to imprecise measures of these variables. We aimed to investigate the relationship between serum 25-hydroxyvitamin D (25(OH)D) and cardiometabolic risk factors, with adjustment for objectively-measured physical activity and adiposity.
Methods
This was a population-based cross-sectional study in 586 adults in Cameroon (63.5% women). We assessed markers of glucose homoeostasis (fasting blood glucose (BG), 2 h post glucose load BG, HOMA-IR)) and computed a metabolic syndrome score by summing the sex‐specific z‐scores of five risk components measuring central adiposity, blood pressure, glucose, HDL cholesterol and triglycerides.
Results
Mean±SD age was 38.3 ± 8.6 years, and serum 25(OH)D was 51.7 ± 12.5 nmol/L. Mean 25(OH)D was higher in rural (53.4 ± 12.8 nmol/L) than urban residents (50.2 ± 12.1 nmol/L),
p
= 0.002. The prevalence of vitamin D insufficiency (<50 nmol/L) was 45.7%. There was an inverse association between 25(OH)D and the metabolic syndrome score in unadjusted analyses (β = −0.30, 95% CI −0.55 to −0.05), which became non-significant after adjusting for age, sex, smoking status, alcohol intake and education level. Serum 25(OH)D was inversely associated with fasting BG (−0.21, −0.34 to −0.08)), which remained significant after adjustment for age, sex, education, smoking, alcohol intake, the season of data collection, BMI and physical activity (−0.17, −0.29 to −0.06). There was an inverse association of 25(OH)D with 2-h BG (−0.20, −0.34 to −0.05) and HOMA-IR (−0.12, −0.19 to −0.04) in unadjusted analysis, but these associations became non-significant after adjustment for potential confounders.
Conclusion
Vitamin D insufficiency was common in this population. This study showed an inverse association between vitamin D status and fasting glucose that was independent of potential confounders, including objectively measured physical activity and adiposity, suggesting a possible mechanism through insulin secretion.
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