Obesity in African women in the North West Province, South Africa is associated with an increased risk of non-communicable diseases: the THUSA study

Abstract

The objective of the present study was to assess the relationship between anthropometric measurements and risk factors for non-communicable diseases (NCD) in South African black women. A cross-sectional sample of 1040 apparently healthy black female volunteers, 15 -70 years old, was recruited from thirty-seven randomly selected sites in the North West Province, stratified according to level of urbanisation. We analysed the association between BMI, waist:hip (WHR), waist circumference (WC) and skinfold measurements and the following risk factors for NCD: blood pressure, serum lipids, fasting serum glucose and insulin and plasma fibrinogen, by using age-adjusted correlation analyses and stepwise regression analysis. Of the subjects, 28 : 6 % were obese (BMI.30). After adjustment for age and smoking status, BMI correlated significantly with diastolic blood pressure (r 0 : 21, P¼0 : 037), serum triacylglycerols (TG) (r 0 : 30, P¼0 : 003), fasting glucose (r 0 : 29, P¼0 : 005) and log fasting insulin (r 0 : 24, P¼0 : 02). There was a significant negative correlation between BMI and HDL-cholesterol (r 20 : 38, P,0 : 001). Similar but stronger correlations were found between both WC and WHR and these risk factors. Together with age, WC was a significant predictor of TG, HDL-cholesterol and fasting glucose in regression analysis, while subscapular skinfold was a significant predictor of diastolic blood pressure and fasting glucose concentration. Triceps skinfold was a significant predictor of total serum cholesterol, LDL-cholesterol, plasma fibrinogen and the insulin sensitivity index. Measures of obesity, particularly WC, are associated with the risk for NCD in black South African women, in which a high rate of obesity has been found. Obesity: Black women: Non-communicable disease risk factorsThere is controversy in the literature, and a lack of evidence regarding the detrimental effects of obesity on risk factors of non-communicable disease (NCD) in African women. 'Healthy obesity' was first described by Walker et al. (1989) in rural black women, when one or more of the adverse sequelae of obesity could be found in only 12 : 5 % of the obese women studied and 87 : 5 % were free of any sign of the metabolic syndrome.

Coping and metabolic syndrome indicators in urban black South African men

“…The proposed mechanism for established MS could be that visceral adiposity is associated with impaired glucose tolerance and atherogenic dyslipidaemia, which is a combination of increased triglyceride and reduced HDL levels as well as LDL particles 13,15. As intra-abdominal fat is highly lipolytic and increases fatty acid transport to the liver, a decrease in insulin clearance is inevitable, causing hyperinsulinaemia 17.…”

“…Furthermore, both visceral obesity and hyperinsulinaemia are associated with increased sympathetic activity, favouring re-absorption of Na + 17. Increased circulating Na+ causes vasoconstriction, and hypertension follows 15,17…”

Beliefs of South Africans regarding food and cardiovascular health

“…In the THUSA study, a cross-sectional study on the black population of the North West Province of South Africa, obesity was the most important factor associated with elevated total serum cholesterol and low-density lipoprotein cholesterol concentrations during urbanisation (28) . In addition, among the women in the THUSA study a high rate of obesity was reported that was associated with an increased risk for non-communicable disease (29) . The large number of South African metropolitan adults (21 %; 2Á2 million) who consider the influence of eating certain food types on weight loss as unimportant is of concern.…”

Assessment of the physical activity, body mass index and energy intake of HIV-uninfected and HIV-infected women in Mangaung, Free State province

“…2 Furthermore, the country is experiencing a nutrition transition 6,7 that features diet-related conversions and a reduction in physical activity patterns 8 that are exceptionally evident in black South African women who are in the midst of an urbanisation phase. 3,9,10 A previous countrywide survey, in which HIV status was unknown, revealed that 32% of black women were obese and 26.7% were overweight, 11 while 53.8% were overweight or obese in a study in North West province (that borders the Free State). 4 However, participating in some form of physical activity would have a favourable eff ect on cardiovascular health, while combating outcomes such as type 2 diabetes, 12 respiratory infections 13,14 and overweight or obesity.…”

“…[3][4][5] In 2010, the HIV prevalence rate in women attending antenatal clinics in the Free State province was established to be an alarming 30.6%. 2 Furthermore, the country is experiencing a nutrition transition 6,7 that features diet-related conversions and a reduction in physical activity patterns 8 that are exceptionally evident in black South African women who are in the midst of an urbanisation phase.…”