Contrasting impact of rural, versus urban, living on glucose metabolism and blood pressure in Uganda

Sanya, Richard E.; Andia-Biraro, Irene; Nampijja, Margaret; Zziwa, Christopher; Nanyunja, Carol; Nsubuga, Denis; Kiwanuka, Samuel; Tumusiime, Josephine; Nassuuna, Jacent; Walusimbi, Bridgious; Cose, Stephen; Ocama, Ponsiano; Grencis, Richard K.; Elliott, Alison M.; Webb, Emily L.

doi:10.12688/wellcomeopenres.15616.1

Cited by 4 publications

(6 citation statements)

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“…It was therefore surprising to find no differences in the Th1, Th2, Th17 cytokines except for lower levels of IL-5 in the rural population compared to the urban population. Despite the higher burden of helminth infections in this rural setting 15 , there was no difference in the regulatory cytokines IL-10 and TGF-beta between the settings. It is possible that there is substantial exposure of individuals in this particular urban setting to infectious agents (both current and previous) sufficient to achieve a similar regulatory profile to individuals in the rural setting.…”

Section: Discussionmentioning

confidence: 65%

“…We, therefore, exploited a unique opportunity to measure inflammatory markers from individuals living in a rural and urban setting. We investigated rural-urban differences in inflammatory cytokines and chemokines and examined correlations between the inflammatory markers and the metabolic parameters HOMA-IR, fasting blood glucose, blood pressure and body mass index (BMI), which we had found to be different between the urban and rural settings 15 .…”

Section: Introductionmentioning

confidence: 99%

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Profiles of inflammatory markers and their association with cardiometabolic parameters in rural and urban Uganda

et al. 2021

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Background: Inflammation may be one of the pathways explaining differences in cardiometabolic risk between urban and rural residents. We investigated associations of inflammatory markers with rural versus urban residence, and with selected cardiometabolic parameters previously observed to differ between rural and urban residents: homeostatic model assessment of insulin resistance (HOMA-IR), fasting blood glucose (FBG), blood pressure (BP) and body mass index (BMI). Methods: From two community surveys conducted in Uganda, 313 healthy individuals aged ≥ 10 years were selected by age- and sex-stratified random sampling (rural Lake Victoria island communities, 212; urban Entebbe municipality, 101). Fluorescence intensities of plasma cytokines and chemokines were measured using a bead-based multiplex immunoassay. We used linear regression to examine associations between the analytes and rural-urban residence and principal component analysis (PCA) to further investigate patterns in the relationships. Correlations between analytes and metabolic parameters were assessed using Pearson’s correlation coefficient. Results: The urban setting had higher mean levels of IL-5 (3.27 vs 3.14, adjusted mean difference [95% confidence interval] 0.12[0.01,0.23] p=0.04), IFN-⍺ (26.80 vs 20.52, 6.30[2.18,10.41] p=0.003), EGF (5.67 vs 5.07, 0.60[0.32,0.98] p<0.00001), VEGF (3.68 vs 3.28, 0.40[0.25,0.56] p<0.00001), CD40 Ligand (4.82 vs 4.51, 0.31[0.12, 0.50] p=0.001) and Serpin-E1 (9.57 vs 9.46, 0.11[0.05,0.17] p<0.00001), but lower levels of GMCSF (2.94 vs 3.05, -0.10[-0.19,-0.02] p=0.02), CCL2 (2.82 vs 3.10, -0.45[-0.70,-0.21] p<0.00001) and CXCL10 (5.48 vs 5.96, -0.49[-0.71,-0.27] p<0.00001), compared to the rural setting. In PCA, the urban setting had lower representation of some classical inflammatory mediators but higher representation of various chemoattractants and vasoactive peptides. HOMA-IR, FBG, BP and BMI were positively correlated with several principal components characterised by pro-inflammatory analytes. Conclusions: In developing countries, immunological profiles differ between rural and urban environments. Differential expression of certain pro-inflammatory mediators may have important health consequences including contributing to increased cardiometabolic risk observed in the urban environment.

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Section: Discussionmentioning

confidence: 65%

Section: Introductionmentioning

confidence: 99%

Profiles of inflammatory markers and their association with cardiometabolic parameters in rural and urban Uganda

et al. 2021

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“…In both surveys, the main reasons for non-participation were absenteeism (180/2167;8.3% in the rural setting and 165/1124;14.7% in the urban setting) and refusal (80/2167;3.7% in the rural setting and 18/1124;1.6% in the urban setting). Individual-level demographic data and survey responses are available as Underlying data 26 .…”

Section: Resultsmentioning

confidence: 99%

“…Households where all members refused to participate, or where all members were absent during the survey period, were excluded. All survey questions are described in the Codebook of the Underlying data 26 .…”

Section: Participantsmentioning

confidence: 99%

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Contrasting impact of rural, versus urban, living on glucose metabolism and blood pressure in Uganda

et al. 2020

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Background: The burden of cardiometabolic diseases, including cardiovascular diseases and diabetes, is increasing in sub-Saharan Africa and this has been linked to urbanisation. Helminths, through their immunomodulatory properties, may protect against these disorders. We hypothesised that the rural environment protects against cardiometabolic diseases and that helminths may influence rural-urban disparity of cardiometabolic disease risk. Methods: We compared metabolic parameters of individuals aged ≥10 years living in rural, high-helminth-transmission and urban, lower-helminth-transmission settings in Uganda. Cross-sectional surveys were conducted in rural Lake Victoria island fishing communities and in urban sub-wards in Entebbe municipality. Helminth infection and outcomes, including insulin resistance (computed using the homeostatic model assessment of insulin resistance [HOMA-IR]), fasting blood glucose, fasting blood lipids, blood pressure, body mass index (BMI), waist and hip circumference, were assessed. Results: We analysed 1,898 rural and 930 urban participants. Adjusting for BMI, exercise, smoking, alcohol intake, age and sex, urban residents had lower mean fasting glucose (adjusted mean difference [95%CI] 0.18 [-0.32, -0.05] p=0.01) and HOMA-IR (-0.26 [-0.40, -0.11] p=0.001) but higher blood pressure (systolic, 5.45 [3.75, 7.15] p<0.001; diastolic, 1.93 [0.57, 3.29] p=0.006). Current helminth infection did not explain the observed differences. Conclusions: In the Ugandan context, living in rural fishing communities may protect against hypertension but worsen glucose metabolism.

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Prevalence of Intestinal Helminth Coinfection in Drug-Resistant Tuberculosis in Uganda

Baluku

Nakazibwe

Wasswa

et al. 2022

Open Forum Infectious Diseases

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Background Although a third of people with tuberculosis (TB) are estimated to be co-infected with helminths, the prevalence is largely unknown among people with drug-resistant TB (DRTB). We determined the prevalence of helminth co-infection among people with DRTB in Uganda. Methods In a multi-centre, cross sectional study, eligible Ugandan adults with confirmed DRTB were consecutively enrolled between July to December 2021 at four treatment centres. Socio-demographic data were collected using a questionnaire. Participants underwent anthropometric and blood pressure (BP) measurements, and blood samples were evaluated for random blood glucose (RBG), glycated haemoglobin (HbA1c), non-fasting lipid profile, HIV infection, and a complete blood count. Fresh stool samples were evaluated for adult worms, eggs and larvae using direct microscopy after Kato-Katz concentration techniques. Results Of 212 participants, 156 (73.6%) were male, 118 (55.7%) had HIV and 3 (2.8%) had malaria co-infection. The prevalence of intestinal helminth co-infection was 4.7% (10/212) (95% confidence interval (CI) 2.6–8.6%). The frequency of helminth infections was: Ancylostoma duodenale (n = 4), Schistosoma mansoni (n = 2), Enterobius vermicularis (n = 2), Ascaris lumbricoides (n = 1), and Trichuris trichiuria (n = 1). Conclusion The prevalence of helminth co-infection was low among people with DRTB. More studies are needed to determine the clinical relevance of helminth/DRTB co-infection.

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Contrasting impact of rural, versus urban, living on glucose metabolism and blood pressure in Uganda

Cited by 4 publications

References 38 publications

Profiles of inflammatory markers and their association with cardiometabolic parameters in rural and urban Uganda

Profiles of inflammatory markers and their association with cardiometabolic parameters in rural and urban Uganda

Contrasting impact of rural, versus urban, living on glucose metabolism and blood pressure in Uganda

Prevalence of Intestinal Helminth Coinfection in Drug-Resistant Tuberculosis in Uganda

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