ABSTRACT
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.
CHAPTER ONE
INTRODUCTION
1.1 BACKGROUND
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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