Obesity and type 2 diabetes in sub-Saharan Africans – Is the burden in today’s Africa similar to African migrants in Europe? The RODAM study

Agyemang, Charles; Meeks, Karlijn; Beune, Erik; Owusu‐Dabo, Ellis; Mockenhaupt, Frank P.; Addo, Juliet; Aikins, Ama de Graft; Bahendeka, Silver; Danquah, Ina; Schulze, Matthias B.; Spranger, Joachim; Burr, Tom; Agyei‐Baffour, Peter; Amoah, Stephen; Galbete, Cecilia; Henneman, Peter; Klipstein‐Grobusch, Kerstin; Nicolaou, Mary; Adeyemo, Adebowale; Straalen, Jan van; Smeeth, Liam; Stronks, Karien

doi:10.1186/s12916-016-0709-0

Cited by 154 publications

(180 citation statements)

References 28 publications

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“…Some studies in Ghana have alluded to the fact that socioculturally, a large body size among females is perceived as a sign of affluence [27], and women with higher education are likely to be affluent and have more exposure to energy-dense foods. The observed association of sedentary lifestyle with higher BMI among men and women is largely consistent with other studies both outside [1] and within Africa [39,45] and Ghana [41,42]. …”

Section: Discussionsupporting

confidence: 90%

Socio-demographic and behavioural determinants of body mass index among an adult population in rural Northern Ghana: the AWI-Gen study

Nonterah

Debpuur

Agongo

et al. 2018

Global Health Action

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Background: Obesity and associated cardiometabolic diseases are increasing in urban sub-Saharan Africa due to a complex epidemiological and nutritional transition. Related data on rural communities is scarce. Objectives: The study characterized the socio-demographic and behavioural factors influencing body mass index (BMI) among adults in rural Northern Ghana Methods: A population-based cross-sectional study involving adults aged 40–60 years residing in the Kassena-Nankana districts was undertaken. Demographic, socio-economic and behavioural data were collected along with measures of anthropometry. We determined factors associated with BMI among women and men. Results: A total of 2014 adults were studied. The median age was 51 (IQR 45–57) years and 54% were women. The prevalence of overweight/obesity was higher among women than men (18.4% vs. 7.2%; p < 0.001), whilst underweight was more prevalent in men (18.3% vs. 13.1%; p = 0.001). Participants with the highest level of education and a high household socio-economic status had higher BMIs than those in the lowest strata in both men (β = 0.074, p = 0.028 and β = 0.072, p < 0.001, respectively) and women (β = 0.174, p = 0.001 and β = 0.109, p < 0.001, respectively). Men (β = −0.050; p < 0.001) and women (β = −0.073; p < 0.001) of the Nankana ethnic group had a lower BMI than the Kassena ethnic group. Among men, alcohol consumption (β = −0.021; p = 0.001) and smoking (β = −0.216; p < 0.001) were associated with lower BMI. Smokeless tobacco was associated with lower BMI among women. Pesticide exposure was associated with higher BMI (β = 0.022; p = 0.022) among men. Conclusion: Age, sex, ethno-linguistic group and prevailing socio-demographic and behavioural factors within this rural community in Northern Ghana influence BMI. The observed positive association between pesticide use and BMI warrants further investigation.

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Section: Discussionsupporting

confidence: 90%

Socio-demographic and behavioural determinants of body mass index among an adult population in rural Northern Ghana: the AWI-Gen study

Nonterah

Debpuur

Agongo

et al. 2018

Global Health Action

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“…Previous studies in this rural population have reported higher BMIs in females, with an age-adjusted prevalence of obesity of 26% in females aged 15 and older compared to 7% in similarly aged males [17] and a 24.6% higher prevalence of obesity in females in those over 50 years [18]. Similar differences were evident in rural Ghana where the prevalence of obesity in women was seven times that in men [24]. The sex disparity in obesity appears independent of urbanicity with females in rural and peri-urban Uganda being 4.3 times as likely to be obese as males [25] and the prevalence of obesity in females 20–75 years of age in urban Cameroon being 4 times that of their male counterparts [26].…”

Section: Discussionsupporting

confidence: 65%

Sociodemographic, socioeconomic, clinical and behavioural predictors of body mass index vary by sex in rural South African adults-findings from the AWI-Gen study

Wagner

Crowther

Gómez‐Olivé

et al. 2018

Global Health Action

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Background: Despite increasing obesity in South African adults, data on the prevalence and determinants of body mass index (BMI) from rural communities, home to a significant proportion of the population, are scarce. Objectives: To investigate overall and sex-specific determinants of BMI in a rural adult South African population undergoing rapid social and epidemiological transitions. Methods: Baseline cross-sectional demographic, socioeconomic, anthropometric, clinical and behavioural data were collected between 2015 and 2016 from 1388 individuals aged 40–60 years and resident in the Agincourt sub-district of Mpumalanga province, a setting typical of rural northeast South Africa. A Health and Socio-Demographic Surveillance System (HDSS) underpins the sub-district and contributes to the Africa Wits-INDEPTH partnership for Genomic Studies (AWI-Gen). Linear regression was used to investigate univariate associations between log-transformed BMI and individual variables and multiple linear regression was used to investigate independent predictors of BMI overall and in sex-stratified analyses. Results: Median BMI was significantly higher in females (28.7 kg/m2[95% CI 24.2–33.2] vs 23.0 kg/m2[95% CI 20.3–26.8];p < 0.001) with male sex associated with 17% lower BMI. In sex-stratified multiple linear regression models, compared to those never married, BMI was 7% higher in currently married males and 6% in currently married females. Current smoking in men and former smoking in women were associated with reductions in BMI of 13% and 26% respectively, compared with non-smokers. Higher educational attainment in women and higher socioeconomic status in men were both associated with higher BMI, while being HIV-positive and alcohol consumption in women were associated lower BMI. Conclusions: Female sex strongly predicts higher BMI in this rural African population. While some predictors of higher BMI differ by sex, married individuals in both sexes had a higher BMI, suggesting that, in addition to developing sex-specific interventions to combat overweight and obesity, targeting married couples may result in reduction in population BMI.

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“…We also observed marked differences in BMI, which could partly explain the differences in CVD risk among these populations because a recent study that explored BMI among Ghanaian migrants and their home counterparts found increasing prevalence of obesity, with a rising gradient from rural Ghana to urban Ghana to Europe. 23 Other lifestyle and behavioral changes after migration have been cited as possible explanation for increased CVD risk among migrant populations. In this study, we observed differences in physical activity and psychosocial stress between the migrants and their home counterparts.…”

Section: Discussion Of Key Findingsmentioning

confidence: 99%

“…21 The equations are derived using pooled data from ethnically and geographically diverse community-based cohorts, permitting the creation of sex-and ethnic-specific equations for non-Hispanic White American and Black women and men. 22 Because most studies on CVDs among African migrant populations have focused on individual risk factors, this study, as part of the RODAM study (Research on Obesity and Diabetes Among African Migrants), 23,24 sought to (1) assess the potential role of migration on CVD risk by assessing the differences in 10-year estimated CVD risk among nonmigrant Ghanaians living in rural and urban Ghana and Ghanaian migrants living in 3 different European countries using the PCE algorithms and (2) assess the modifiable risk factors that predispose them to poor CVD outcomes in their host countries.…”

Section: Boateng Et Al Cardiovascular Disease Risk Among Ghanaian Migmentioning

confidence: 99%

Migration and Cardiovascular Disease Risk Among Ghanaian Populations in Europe:

Boateng

Agyemang²,

Beune³

et al. 2017

Circ: Cardiovascular Quality and Outcomes

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M igrants' health is an important public health issue 1 with growing evidence supporting the role of migration in the development of noncommunicable diseases. [2][3][4] Migrant populations from sub-Saharan Africa (SSA) seem to be affected disproportionately by cardiovascular diseases (CVDs) and related risk factors, including hypertension, obesity, and diabetes mellitus. 5,6 For instance, the prevalence of hypertension in The Netherlands relative to Dutch people is higher in all ethnic minority groups, with the exception of Moroccan women. 7 Evidence from Canada, however, shows better CVD risk profile among migrants than the host population. 8 This shows the importance of diverse factors (including acculturative stress resulting from the feeling of isolation, discrimination, alienation and dislocation, Background-For migrant populations from sub-Saharan Africa, adverse cardiovascular disease (CVD) risk factors have been observed to be higher than found in their home country-based counterparts or among the host populations in high-income countries. Differences in absolute overall CVD risk, however, remain largely unexplained. We, therefore, predicted the differences in 10-year CVD risk among sub-Saharan African migrants (Ghanaians) living in 3 European cities and Ghana. Methods and Results-For 3864 subjects aged 40 to 70 years from the multicenter RODAM study (Research on Obesity and Diabetes Among African Migrants) conducted among Ghanaian adults residing in rural and urban Ghana and 3 European cities (Amsterdam, Berlin, and London), 10-year risk of CVD was estimated using the Pooled Cohort Equations with estimates ≥7.5% defining high CVD risk. Logistic regressions were used to determine the association of migration on CVD risk. Migrant populations carry along disease characteristics, inherited from their place of origin, 11 which affect future risk of CVD. The CVD risk profile among migrant populations, however, may change over time as they get exposed to the factors of their host environment. 12 This results in differences in CVD risk between similar populations residing in different industrialized countries. For instance, Agyemang et al 13 found that people of African descent residing in England had a lower prevalence of type 2 diabetes mellitus than those residing in The Netherlands, and these differences reflected the difference in prevalence of CVDs of their host countries. 14The reasons for these differences are unclear but could include cross-national differences in health behaviors and related factors, such as socioeconomic position, accessibility, and utilization of preventive services. 13,15 CVDs reflect the combined effect of several risk factors, 16 which tend to appear in clusters.17 Current guidelines for CVD risk reduction have, therefore, reiterated the need to assess all risk factors as a more effective basis to deliver CVD prevention interventions.16 Absolute CVD risk estimates, using established risk algorithms, help to determine the probability of a cardiovascular event occurring within a sp...

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Obesity and type 2 diabetes in sub-Saharan Africans – Is the burden in today’s Africa similar to African migrants in Europe? The RODAM study

Cited by 154 publications

References 28 publications

Socio-demographic and behavioural determinants of body mass index among an adult population in rural Northern Ghana: the AWI-Gen study

Socio-demographic and behavioural determinants of body mass index among an adult population in rural Northern Ghana: the AWI-Gen study

Sociodemographic, socioeconomic, clinical and behavioural predictors of body mass index vary by sex in rural South African adults-findings from the AWI-Gen study

Migration and Cardiovascular Disease Risk Among Ghanaian Populations in Europe:

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