Differential associations of cardio-metabolic diseases by population group, gender and adiposity in South Africa

Abstract

AimsTo describe the distribution and examine the associations of diabetes, hypertension and hypercholesterolaemia across and within population groups, gender and body mass index (BMI) categories.MethodsThis national cross-sectional study was conducted in 2013 among ≥18-year-old black African, coloured, white and Indian adults self-selected for screening. Data collection included self-reported behavioural risk factors and clinical measurements comprising blood pressure, anthropometry and point-of-care random blood glucose and cholesterol assessments.ResultsAmong the 7711 participants, 2488 men and 5223 women, the prevalence of diabetes and hypertension increased by BMI category across population groups. Compared with white men and women, black African men (odds ratio: 2.66, 95% confidence interval: 1.70–4.16) and women (2.10, 1.49–2.96), coloured men (2.28, 1.44–3.60) and women (2.15, 1.52–3.05) and Indian men (4.38, 2.65–7.26) and women (3.64, 2.50–5.32) were significantly more likely to have diabetes. The odds for hypertension were significantly higher only in coloured men compared with white men (1.37, 1.02–1.83), while it was significantly higher in black African, coloured and Indian women compared with white women. The odds for hypercholesterolaemia were significantly lower in black African men (0.64, 0.49–0.84) and women (0.52, 0.43–0.62) compared with white men and women, and significantly higher in Indian men (1.47, 1.05–2.08) compared with white men. Black African women compared with their male counterparts were less likely to have diabetes (0.64, 0.46–0.89). Black African (0.66, 0.54-.082), coloured (0.65, 0.50–0.84) and white (0.69, 0.53–0.88) women were significantly less likely to have hypertension compared with their male counterparts. The odds for hypercholesterolaemia were higher in coloured (1.44, 1.16–1.80) and white (1.47, 1.18–1.84) women compared with their counterparts.ConclusionsThe cardio-metabolic diseases of diabetes, hypertension and hypercholesterolaemia were differentially associated with population groups and gender in South Africa. The insights obtained highlight the need for multi-disciplinary targeted management approaches in high-risk populations.

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

“…Some previous studies in SSA populations report stronger associations between BMI and lipids in men than women [8,11,14], whereas we observed similar associations in both sexes in this contemporary Malawian study. Our results of similar or weaker associations in Malawian than UK participants corroborate previous findings of weaker age-adjusted associations of WC with TC and TG in urban Cameroonian women and men than their French counterparts, observed approximately 25 years ago [14].…”

“…Evidence from HIC, from populations of white European origin, shows that higher BMI and measures of central adiposity, such as WHR and WC, are associated with adverse lipid profiles, including higher total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG), which are key modifiable risk factors for coronary heart disease (CHD) [4][5][6]. The body of evidence on this relationship in SSA countries is growing and also showing associations between higher generalised and central adiposity with adverse lipid profile in both men and women [7][8][9][10][11] and adults from urban and rural area [9]. However, very few studies have made direct comparisons between SSA and HIC populations, which have a much more advanced stage of economic development.…”

Prevalence of multimorbidity of cardiometabolic conditions and associated risk factors in a population-based sample of South Africans: A cross-sectional study

“…The prevalence of multiple cardiometabolic conditions in people of Indian descent was more than twice that of the black African and mixed-race ethnic groups. Several studies in SA have confirmed a high risk for cardiometabolic diseases, particularly diabetes, in South Africans of Indian descent [ 9 , 30 , 34 ]. Indian Asians have been shown to have a higher risk than White Caucasians for the development of cardiometabolic diseases for the same unit of increase in BMI [ 35 , 36 ] and they may also have genetic markers that increase their susceptibility to diabetes [ 35 ].…”

Bone Mineral Density, Body Composition, and Mineral Homeostasis Over 24 Months in Urban South African Women With HIV Exposed to Antiretroviral Therapy

“…Rapid and sustained increases in adiposity are likely to be contributory to future cardiometabolic disease risk in women regardless of HIV status. (38)(39)(40) Those living with HIV may be at higher risk of such outcomes, (41,42) though the precise mechanisms are unknown. There is some evidence suggesting that South Africans with HIV receive enhanced levels of care for their obesity-related conditions compared with those without HIV.…”