Modifiable risk factors associated with non-communicable diseases among adult outpatients in Manzini, Swaziland: a cross-sectional study

Abstract

Background: Four major non-communicable diseases (NCD), including T2DM, contributed to nearly three-quarters of all deaths worldwide in 2017. Dietary and lifestyle actors associated with NCDs are potentially modifiable. Therefore, this study was conducted to determine the dietary and lifestyle factors associated with T2DM, prediabetes, and hypertension among adult outpatients in Manzini, Swaziland. Methods: A random sample of 385 subjects aged 18 years and above was selected. The data regarding demographics, socioeconomic status, lifestyle behaviour, diet, and physical activities were collected. Additionally, participants' anthropometric measurements and vital signs were taken. A biochemical examination was done for fasting plasma glucose, and a 2-h oral glucose tolerance test, where necessary. The Statistical Package for Social Sciences (SPSS) version 26 was used for this data analysis, and the level of statistical significance was set at p < 0.05. Results: A total of 385 (197 men and 188 women) subjects aged 18 years and older participated in the study. The overall prevalence of hypertension was 48.3%, while the prevalence of hypertension stage 1 and 2 were 29.4 and 19%, respectively. Smoking, SES and consumption of sweet drinks, salty processed foods, fruits, and vegetables were significantly associated with T2DM. However, in the multivariate analysis, only consumption of vegetables (p < 0.0001), fruits (p =0.014), sweet drinks (p = 0.042), and salty processed foods (p = 0.005) remained significantly associated with T2DM. Smoking (p = 0.002) and consumption of fruits (p < 0.0001), vegetables (p < 0.0001), and sweet drinks (p = 0.043) were independently associated with pre-diabetes, while the consumption of vegetables (p = 0.002) and salty processed foods (p = 0.003) were the factors independently associated with hypertension. Conclusions: The factors associated with T2DM, pre-diabetes, and hypertension are potentially modifiable. Therefore, interventions which target lifestyle changes at primary health care and population levels are warranted to address the growing burden of these chronic conditions in Swaziland.

Behavioral Sciences in the Optimization of Pharmacological and Non-Pharmacological Therapy for Type 2 Diabetes

“…Briefly, the MBS model defends that an informed patient, motivated and available to act, has the skills and confidence to make more assertive decisions that will allow greater success in the desired results. Patient/disease characteristics can be classified as being generally non-modifiable or potentially modifiable [ 77 , 78 ]. Poor adherence to therapy is associated with factors that may not be directly related to the patient (such as lack of integrated care at the level of health systems and clinical inertia among health professionals), demographic factors (young age, low level of poor education and financial situation), the patient’s beliefs about the therapy (perceived treatment ineffectiveness) and the implications for the patient that are directly related to the therapeutic regimen (treatment complexity, direct costs and hypoglycemia) [ 77 , 78 , 79 ].…”

“…Patient/disease characteristics can be classified as being generally non-modifiable or potentially modifiable [ 77 , 78 ]. Poor adherence to therapy is associated with factors that may not be directly related to the patient (such as lack of integrated care at the level of health systems and clinical inertia among health professionals), demographic factors (young age, low level of poor education and financial situation), the patient’s beliefs about the therapy (perceived treatment ineffectiveness) and the implications for the patient that are directly related to the therapeutic regimen (treatment complexity, direct costs and hypoglycemia) [ 77 , 78 , 79 ]. Aspects such as the risks potentially associated with hypoglycemia and other adverse drug effects, the duration of diabetes (whether the diagnosis is recent or long-term), the life expectancy, concomitant pathologies and established vascular complications are generally not modifiable [ 78 ].…”

“…Poor adherence to therapy is associated with factors that may not be directly related to the patient (such as lack of integrated care at the level of health systems and clinical inertia among health professionals), demographic factors (young age, low level of poor education and financial situation), the patient’s beliefs about the therapy (perceived treatment ineffectiveness) and the implications for the patient that are directly related to the therapeutic regimen (treatment complexity, direct costs and hypoglycemia) [ 77 , 78 , 79 ]. Aspects such as the risks potentially associated with hypoglycemia and other adverse drug effects, the duration of diabetes (whether the diagnosis is recent or long-term), the life expectancy, concomitant pathologies and established vascular complications are generally not modifiable [ 78 ]. The patient’s attitude and motivation, as well as their capacity for self-care, together with the resources and support systems at their disposal, are potentially modifiable aspects that can decisively influence the disease’s evolutionary state [ 77 , 78 , 79 , 80 ].…”

“…Aspects such as the risks potentially associated with hypoglycemia and other adverse drug effects, the duration of diabetes (whether the diagnosis is recent or long-term), the life expectancy, concomitant pathologies and established vascular complications are generally not modifiable [ 78 ]. The patient’s attitude and motivation, as well as their capacity for self-care, together with the resources and support systems at their disposal, are potentially modifiable aspects that can decisively influence the disease’s evolutionary state [ 77 , 78 , 79 , 80 ].…”

Gender Differences in Healthy Lifestyle Practices and Well-Being in Preventing Noncommunicable Diseases

“…4 There are gaps in knowledge, lack of availability of prospective studies on mechanistic pathway in relation between positive well-being, and occurrence of cardiovascular diseases. 4,5 The article entitled "Gender-wise comparative assessment of lifestyle patterns and well-being status among health care employees at a tertiary care hospital" published in this issue of the journal is relevant and significant as very few studies have been done on the importance of gender wise assessment of lifestyle practices and well-being in India. The well-being assessment tool described in the article Ind J Car Dis Wom which included physical health, social health, mental health, intellectual health, and spiritual health components is comprehensive and acceptable.…”