Overweight/obesity and associated cardiovascular risk factors in sub-Saharan African children and adolescents: a scoping review

Abstract

Introduction:Recently, childhood and adolescence overweight/obesity has increased disproportionately in developing countries, with estimates predicting a parallel increase in future cardiovascular disease (CVD) burden identifiable in childhood and adolescence. Identifying cardiovascular risk factors (CVRF) associated with childhood and adolescence overweight/obesity is pivotal in tailoring preventive interventions for CVD. Whilst this has been examined extensively in high-income countries, there is scant consistent or representative data from sub-Saharan Africa (SSA). Objective: This scoping review synthesises contemporary studies on CVRF associated with overweight and obesity in SSA children and adolescents to provide evidence on the current burden of overweight/obesity and CVD in this population. Methods: We searched MEDLINE and Google Scholar up to July 31, 2019 for observational and experimental studies and systematic reviews addressing childhood and adolescence overweight/obesity and CVRF in SSA without language restriction. Four investigators working in four pairs, independently selected and extracted the relevant data. The methodological quality of all included studies was assessed. Results: We included 88 studies with a total of 86,637children and adolescents from 20 SSA countries. The risk of bias was low in 62 (70.5%), moderate 18 (20.5%), and high in eight (9%) studies. Overweight/obesity in SSA children and adolescents is rising at an alarming rate. Its main associations include physical inactivity, unhealthy diets, high socio-economic status, gender and high maternal body mass index. Identified CVRF in overweight/obese SSA children and adolescents are mainly metabolic syndrome, hypertension, dyslipidaemia, diabetes and glucose intolerance. There is a dearth of guidelines or consensus on the management of either childhood overweight/ obesity or CVRF in overweight/obese SSA children and adolescents. Conclusion: The current findings suggest an urgent need to review current health policies in SSA countries. Health education and transforming the current obesogenic environment of the SSA child and adolescent into one which promotes physical activity and healthy dietary habits is required.

Anthropometric indices and cardiometabolic risk factors in a Ghanaian adolescent population

“…Almost one in three of the female participants were overweight/obese in our study compared with less than one in 10 for the males, which is a similar trend to previously reported studies in adolescent and adult populations in Ghana [31,33,34,[47][48][49]. The preponderance of females with overweight/obesity in our study is similar to what has been reported from most LMIC and developed economies [50]. Some reasons adduced to explain this phenomenon include the propensity for male adolescents to engage in more rigorous physical activities and social constraints of overweight and obese females appearing more desirable to the males [9,49].…”

“…In most developed economies, overweight/obesity tend to be associated with adolescents from low socioeconomic background, the converse is true in most LMICs. Adolescents from high socioeconomic backgrounds are more exposed to and can afford energydense fast foods, processed foods and beverages as opposed to those from low socioeconomic backgrounds who still depend on healthy traditional foods [1,33,50]. However, the results from our study revealed a higher prevalence of overweight/obesity in participants from lower socio-economic status albeit not statistically significant.…”

“…However, the test of association was statistically significant to the diastolic blood pressure category. A recent systematic review has reported a paucity of data on cardiometabolic risk factors among the adolescent overweight/obese population in sub-Sahara Africa [50]. Some studies in Ghana have reported pre-hypertension (elevated blood pressure) and hypertension prevalence of 28.3, 36.3 and 39.2% among some adolescent and youth populations [31,56,57], which were less than what we are reporting.…”

Dietary Practices and Adolescent Obesity in Secondary School Learners at Disadvantaged Schools in South Africa: Urban–Rural and Gender Differences

“…In the USA, currently about 17% of children are obese [2]. In sub-Saharan Africa (SSA) the prevalence of combined overweight and obesity ranges from 2% to as high as 54% across 20 countries and is increasing at an alarming rate [3].…”

Epidemiology of Non-communicable Diseases and Risk factors in South African Adolescents and Youth Living with HIV: Implications for Integrated Prevention

“…Although adolescents may lack autonomy in navigating their food environment, this life stage is characterised by increasing independence and as such they need to be informed about the importance of diet and how it can affect their current health status or future adult health [182]. Some practices like healthy cooking methods requiring steaming, roasting or baking can be adopted in their homes with cooperation of parents and caregivers [184]. With adequate knowledge, older adolescents in our study who ate more fast-food and more meals prepared outside the home, could be encouraged to make healthier food choices.…”