A comparison of the associations between adiposity and lipids in Malawi and the United Kingdom

Abstract

Background: The prevalence of excess adiposity, as measured by elevated body mass index (BMI) and waist-hip ratio (WHR), is increasing in sub-Saharan African (SSA) populations. This could add a considerable burden of cardiovascular and metabolic diseases for which these populations are currently ill-prepared. Evidence from white, European origin populations shows that higher adiposity leads to an adverse lipid profile; whether these associations are similar in all SSA populations requires further exploration. This study compared the association of BMI and WHR with lipid profile in urban Malawi with a contemporary cohort with contrasting socioeconomic, demographic, and ethnic characteristics in the United Kingdom (UK). Methods: We used data from 1248 adolescents (mean 18.7 years) and 2277 Malawian adults (mean 49.8 years), all urban-dwelling, and from 3201 adolescents (mean 17.8 years) and 6323 adults (mean 49.7 years) resident in the UK. Adiposity measures and fasting lipids were assessed in both settings, and the associations of BMI and WHR with total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG) were assessed by sex and age groups in both studies. Results: Malawian female adults were more adipose and had more adverse lipid profiles than their UK counterparts. In contrast, Malawian adolescent and adult males were leaner and had more favourable lipid profiles than in the UK. Higher BMI and WHR were associated with increased TC, LDL-C and TG and reduced HDL-C in both settings. The magnitude of the associations of BMI and WHR with lipids was mostly similar or slightly weaker in the Malawian compared with the UK cohort in both adolescents and adults. One exception was the stronger association between increasing adiposity and elevated TC and LDL-C in Malawian compared to UK men. Conclusions: Malawian adult women have greater adiposity and more adverse lipid profiles compared with their UK counterparts. Similar associations of adiposity with adverse lipid profiles were observed for Malawian and UK adults in most age and sex groups studied. Sustained efforts are urgently needed to address the excess adiposity and adverse lipid profiles in Malawi to mitigate a future epidemic of cardio-metabolic disease among the poorest populations.

Associations between low HDL, sex and cardiovascular risk markers are substantially different in sub-Saharan Africa and the UK: analysis of four population studies

“…Malawi compared with the UK, using the same Malawian cohort. 15 Our findings within people living in Africa are in contrast to studies of people of African origin living in high-income countries. Black African migrants to highincome countries have higher HDL levels than people of their ethnic origin in sub-Saharan African, although they have higher BMI.…”

“… 14 22 23 31 This is also constant with recent analysis comparing the relationship between lipids and both BMI and waist to hip ratio in Malawi compared with the UK, using the same Malawian cohort. 15 …”

“…8 A number of studies have shown that low HDL is common in sub-Saharan African populations. [9][10][11][12][13][14][15] Low HDL is by far the most common dyslipidaemia in sub-Saharan Africa. 11 This has been interpreted by many as an indicator of escalating CVD risk, driven by increasing urbanisation, westernisation of diets and increasingly sedentary lifestyles.…”

Modeling and Analysis of the Relationship between Aerobic Exercise and Obesity Reduction in Adolescents

“…Therefore, in order to meet the growth and development needs of teenagers, it is necessary to provide children with a lot of nutrition and increase energy intake. In recent years, the trend of adolescent obesity has become more and more serious, which has attracted close attention from parents, schools, society, and relevant experts [ 2 ]. According to an expert survey, the proportion of overweight and obese urban students is 12.03 percent, and it is increasing by 8 percent every year.…”

Associations of Body Shapes with Insulin Resistance and Cardiometabolic Risk in Middle-aged and Elderly Chinese

“…Anthropometric trait such as body mass index (BMI), waist circumference, and waist-to-hip ratio (WHR) is widely used to classify obesity and body shapes (apple or pear), which plays a pivotal role in evaluating cardiometabolic risk [5][6][7]. However, these traits cannot adequately discriminate regional fat distribution or evaluate individual cardiometabolic risk [8].…”