Cardiometabolic disease prevalence has been on the rise not only in the developed countries but also in the emerging economies of developing nations. Unhealthy diet and physical inactivity contribute to the increasing prevalence of cardiometabolic conditions, including obesity, and diabetes with perception of body image being suggested to be a predictor of overweight/obesity development. This study assessed the relationship between nutrition and physical activity level on cardiometabolic traits among 302 healthy Asante adults in Kumasi. A cross-sectional study was conducted in the urban Oforikrom Municipality. Trained field workers administered questionnaires. Demographic and anthropometric data were collected and venous blood samples were taken for biochemical tests. A 3-day repeated 24-hour dietary recall was used to assess dietary intakes. Physical activity was assessed with global physical activity questionnaire (GPAQ). Data was entered into Microsoft excel and analysed with SPSS version 25. There were 126 males (41.7%) and 176 females (58.3%) in the study with mean age of 38.17±9.6 years. About 2 in 5 participants were centrally obese while hyperglycaemia prevalence was low (FBG ≥ 7 mmol/l = 1.3%). Metabolic syndrome and high risk of coronary heart disease (coronary risk) were present in 5.3% and 36.1% of study population, respectively. High coronary risk was strongly associated with LDL (r= 0.921, p-value < 0.001), HDL (r = -0.758, p-value < 0.001), and TC (r= 0.892, p-value < 0.001). Binary logistic regression showed that high TG and high LDL had significant effects on increased coronary risk (OR=14.2, 95% CI= 1.3-153.5, p-value= 0.029 and OR= 121.4, 95% CI= 15.4-958.3, p-value< 0.001, respectively). Based on WHO’s physical activity recommendation of 600 MET- minutes/ week, 68.5% of participants were physically active. Mean energy intake for both males and females was below their RDA. Intake of antioxidant micronutrients (zinc, vitamin C and E) were generally low. Fewer participants (44%) were able to correctly perceive their body image. Among obese people, 26% thought they were normal weight and this could account for why 2 in 5 overweight/obese persons did not desire to lose weight. The difference in prevalence of both metabolic syndrome and high coronary risk between participants who correctly perceived their body image and those who did not was not statistically significant. In conclusion, cardiometabolic disease and other CVD risk factors were high among apparently healthy adults in Oforikrom Municipality.

Cardiometabolic disorders or diseases are multifactorial traits arising from the interaction of a number of different factors including genetic and epigenetic factors, diet, physical activity and changes in living environments (Malik et al., 2013: Vimaleswaran and Loos, 2010). The obesity, diabetes, dyslipidaemia and hypertension cluster are known factors which increase cardiovascular diseases (CVD) risk and these non- communicable diseases typically co-exist in the same individual (Pi- Sunyer, 2002).

Obesity, hypertension and type 2 diabetes mellitus (T2DM) are among the common cardiometabolic conditions whose prevalence have been on a dramatic rise in the past two decades not only in advanced countries but also in emerging economies of developing nations (Malik et al., 2013: Vimaleswaran and Loos, 2010). Though a global epidemic, there is considerable variation globally in the obesity and diabetes problem (Agyemang et al., 2016). About 415 million representing 9% and 650 million representing 13% of the global adult population have Type 2 Diabetes Mellitus and are obese respectively (IDF, 2015; WHO, 2017). In Sub- Saharan Africa, an estimated 8% of adults aged above 25 years suffer from diabetes (Alwan, 2010). The situation in Ghana is not much different as about 15%, and 3.2% of adult women and men aged 15- 49, respectively, are obese according to the Ghana Demographic and Health Survey (2014) findings. It has been shown, however, that the urban cities in Ghana have higher prevalence of obesity than rural Ghana mainly due to increasing westernization of diet and low physical activity level with urban obesity prevalence standing at 34% in women and 7% in men aged 25-70 (Agyemang et al., 2016). According to Agyemang et al. (2016), 9% of women and 10% in men living in urban Ghana had type 2 diabetes.

Hypertension is a significant public health concern globally and in Ghana as well with both urban and rural areas experiencing relatively high prevalence of high blood pressure. Hypertension burden stands at 16% in urban Ghana and 9% in rural Ghana (Awuah et al., 2014; GDHS, 2014; Agyemang et al., 2016). The increases in cardiometabolic disease prevalence have been linked to rising trends of overweight/ obesity. For instance, according to the Ghana Demographic and Health Survey (2014), hypertension was a more serious health concern in obese people with 27% of 995 obese women and 51% of 111 obese men being hypertensive.

Popkin et al. (2012), stated that the obesity epidemic with its attendant non- communicable diseases was being fuelled by changes in physical activity and diet patterns termed as the nutrition transition. Characterized by increased consumption of sugar-sweetened beverages, edible oils and highly processed or refined foods as well as reduced physical activity levels and increasing sedentary behavior, the nutrition transition which used to be a concern mainly in the higher income countries is now widespread even in rural areas of middle and low income countries in Asia and sub Saharan Africa.

Perception of body image has been suggested to be a predictor of overweight/ obesity development (Duda et al., 2007). According to Benkeser et al. (2012), having the right perception about their weight status made overweight/ obese women about ten times more likely to desire weight loss compared to normal weight women (OR: 10.12; CI: 8.04-12.72). Understanding individual preferences for various body sizes is of utmost necessity in designing approaches and interventions for preventing and halting the fast rise of obesity prevalence with its attendant metabolic consequences (Duda et al., 2007; Benkeser et al., 2012)

Unhealthy diet and physical inactivity have been shown to contribute to the increasing prevalence of cardiometabolic conditions such as obesity, T2DM, dyslipidaemia and hypertension (Popkin et al., 2012). There are a myriad of complications and consequences of these conditions including reduced productivity and economic growth as well as reduced life expectancy (Danquah et al., 2012). The International Diabetes Federation (2015), noted that type 2 diabetes mellitus led to the death of about 4,790 adults in Ghana. The Action to Control Cardiovascular Risk in Diabetes Study (2008), found that a percentage rise in plasma glucose level leads to a corresponding increase in cardiovascular risk by 18% and a 12-14% mortality risk.

High blood pressure has been shown to lead to many complications including cardiovascular diseases (Law et al., 2009). However, in spite of these fatal complications of hypertension, the Ghana Demographic and Health Survey (2014) revealed that about 63% and 86% of women and men, respectively aged 15-49 who had hypertension were unaware of their hypertensive status. This is quite alarming as awareness of their disease condition is the first course of action in managing hypertension and other chronic diseases in order to prevent premature disability and death (GDHS, 2014). Without proper awareness, the current trend of non-communicable disease is expected to keep rising.

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