Exploring the association between body image, body fat, and total cardiovascular disease risk among adults in a rural and an urban community of South Africa

Philosophiae Doctor - PhDBackground: Obesity is increasing worldwide, and cultural perception of body image is considered an important contributor to the obesity epidemic among black Africans. Aim: To explore the association between body image perceptions and perceived obesity threat, change in adiposity, and total cardiovascular disease (CVD) mortality risk. Study Design: This is a mixed-methods study embedded in the PURE longitudinal cohort study involving adults aged 35-78 years in South Africa. Data Collection/Analysis: This included analysis of baseline cross-sectional data, the conduct of a qualitative study and a cross-sectional follow-up survey. Sex-specific logistic regression models of excessive adiposity were determined. Body image perception indexes were obtained based on 'Feel- Ideal' difference (FID) and 'Feel-Actual' discordance (FAD). Bivariate analyses and analysis of variance were used to determine the relationships between body image and adiposity, annual changes in weight and adiposity. The correlations between body image indexes (FID and FAD) and total 10- year CVD risk score were determined – controlling for possible confounders. Qualitative data was managed with ATLAS-ti software and analysed thematically. Results: The prevalence of excessive body fat at baseline and at 5-year follow-up based on body fat percent were 96.0% and 79.6% for women, and 44.3% and 62.2% for men respectively. The majority of the obese (85%) and overweight (79%) participants underestimated their weight, and weight discordance status was inversely associated with the willingness to lose weight. Mean total 10-year CVD risk score was 18.7%, and 61% of men and 26% of women with body mass index (BMI) ≥ 25 kg/m2 had CVD risk scores ≥ 20%. Bivariate analyses indicated that FID and FAD were significantly associated with annual changes in weight and adiposity. FAD index had a significant but weak correlation with total CVD risk score (r = 0.13, p-value = 0.001) when adjusted for covariates. Conclusion: Body image discordance was associated with an annual change in adiposity, total 10- year CVD risk scores, and there was poor obesity risk perception, and low motivation towards weight loss among predominantly obese black adults with negative body image. Interventions to reduce obesity need to address negative body image, poor obesity risk perception, self-efficacy and motivation towards weight loss.National Research Foundation; Chromnic Disease Initiative for Africa (CDIA); National Institute of Health (NIH

Perceptions of mothers and caregivers regarding the detection and treatment of severely malnourished children in Kanchele, Kalomo district, Zambia

Each year, malnutrition accounts for about 50 percent of the deaths of under-fives in developing countries. In Zambia, about 45 percent of children under the age of five exhibit stunted growth, mainly due to malnutrition. Early detection of cases by health workers and prompt health-seeking practices at household and community levels can improve the identification and management of malnutrition, and prevent unnecessary deaths. The study provides insights into the perceptions of mothers, caregivers, community members and community health workers regarding the detection, referral and health-seeking practices of malnourished children in Kalomo district of Zambia. This qualitative study explored perceptions and challenges of detection and prompt treatment of malnutrition (kwashiorkor and marasmus) in children under five years of age in the community. Focus group discussions using pictographs were conducted with purposely selected mothers and caregivers of children attending immunisation clinics in rural health centres in Zambia. In-depth interviews were also conducted with purposely selected grandparents, community health workers and nutrition advisors to validate the findings obtained from focus group discussions. Data were analysed using thematic analysis. Malnutrition, particularly marasmus, was linked to HIV infection. Barriers to seeking health care for severely malnourished children included beliefs about causes of malnutrition, failure to link malnutrition to poor feeding practices, distance to health care facilities and the lack of free feeding schemes for malnourished children. Mothers’ decisions to seek care for malnourished children were influenced largely by grandparents. Increasing awareness about causes, signs and symptoms of malnutrition in this community is needed to improve detection and treatment of malnourished children.Department of HE and Training approved lis

Factors associated with excessive body fat in men and women: cross-sectional data from Black South Africans living in a rural community and an urban township

Objective To determine the factors associated with excessive body fat among black African men and women living in rural and urban communities of South Africa. METHODS: This is a cross-sectional analysis of data from the Prospective Urban and Rural Epidemiology (PURE) study, Cape Town, South Africa conducted in 2009/2010. The study sample included 1220 participants (77.2% women) aged 35-70 years, for whom anthropometric measurements were obtained and risk factors documented through face-to-face interviews using validated international PURE study protocols. Sex-specific logistic regression models were used to evaluate socio-demographic, lifestyle and psychological factors associated with three excessive body fat indicators, namely body mass index (BMI), waist circumference (WC) and body fat percent (BF%). RESULTS: The prevalence of excessive body fat based on BF%, WC and BMI cut-offs were 96.0%, 86.1%, and 81.6% for women respectively, and 62.2%, 25.9%, and 36.0% for men respectively. The significant odds of excessive body fat among the currently married compared to unmarried were 4.1 (95% CI: 1.3-12.5) for BF% and 1.9 (95% CI: 1.3-2.9) for BMI among women; and 4.9 (95% CI: 2.6-9.6), 3.2 (95% CI: 1.6-6.4) and 3.6 (95% CI: 1.9-6.8) for BF%, WC and BMI respectively among men. Age ≤50 years (compared to age >50 years) was inversely associated with excessive BF% in men and women, and less-than-a-college education was inversely associated with excessive BMI and WC in men. Tobacco smoking was inversely associated with all three excessive adiposity indicators in women but not in men. Unemployment, depression, and stress did not predict excessive body fat in men or women. CONCLUSION: The sex-differences in the socio-demographic and lifestyle factors associated with the high levels of excessive body fat in urban and rural women and men should be considered in packaging interventions to reduce obesity in these communities

Low intake of commonly available fruits and vegetables in socio-economically disadvantaged communities of South Africa: influence of affordability and sugary drinks intake

Consumption of fruits and vegetables reduces the risk of obesity, diabetes, cancer, cardiovascular mortality and all-cause mortality. The study assessed the pattern of intake and the factors that influence daily intake of commonly available fruits and vegetables in economically disadvantaged South African communities. This is a cross-sectional study nested on an ongoing longitudinal study in South Africa. Two communities (a rural and urban) of low socio-economic status were purposely selected from two of the nine provinces. A sample of 535 participants aged 30–75 years was randomly selected from the longitudinal cohort of 1220; 411 (78%) women. Data were collected using validated food frequency and structured interviewer-administered questionnaires. Descriptive and multivariate regression analysis were undertaken

The Relationship between Physical Activity and the Objectively-Measured Built Environment in Low- and High-Income South African Communities

There is limited data concerning the built environment and physical activity (PA) in a country with a history of socio-politically motivated, spatial and economic disparities. We explored the extent to which objectively measured attributes of the built environment were associated with self-report or device-measured PA in low- and high-socioeconomic status (SES) communities. Methods: In a convenient sample of residents (n = 52, aged 18–65 years) from four urban suburbs in low- and high-income settings near Cape Town, South Africa, self-reported transport- and leisure-time PA, and device-measured moderate-to-vigorous PA (MVPA) data were collected. Built environment constructs derived from individual-level street network measures (1000 m buffer, ArcGIS, 10.51) were obtained. We assessed PA between four groups, based on income and GIS walkability (derived by a median split, low or high SES and low or high walkable). Results: No relationships between self-reported MVPA and GIS-measured walkability were found. Only intersection density was significantly, inversely associated with moderate and total MVPA (rho = −0.29 and rho = −0.31, respectively, p < 0.05). In the high SES group, vigorous PA was inversely associated with intersection density (rho = −0.39, p < 0.05). Self-report transport PA differed between groups (p < 0.013). Conclusions: Results suggest that the construct of walkability may relate to volitional (leisure) and utilitarian (transport) PA differently, in highly inequitable settings

A modified Delphi study towards developing a guideline to inform policy on fetal alcohol spectrum disorders in South Africa: a study protocol

INTRODUCTION Maternal alcohol consumption during pregnancy can result in mental and physical birth defects in individuals. These birth defects are usually described as fetal alcohol spectrum disorders (FASDs). With an estimated 183–259 per 1000 children born with FASDs, South Africa is identified to have the highest prevalence of FASDs in the world. Nevertheless, there is a lack of appropriate policies, guidelines and interventions addressing the issues around FASDs. This protocol outlines a proposed process for developing a guideline to inform policies on FASDs. METHODS AND ANALYSIS This process will have three phases. Phase I will be carried out in three steps; we plan to conduct a document review of available policies on the prevention and management of FASDs and update the existing systematic review on FASDs interventions. The aim of the two reviews is to explore the availability and content of existing policies and global interventions on FASDs. In addition, we will conduct two exploratory qualitative studies to obtain the perspectives of various stakeholders on the existing or possible guidelines and policies for the management of FASDs and available interventions and services. In phase II, we will aggregate the findings of the previous phase to develop a prototype guideline. In phase III, using the developed prototype, we will apply the Delphi approach with experts on FASDs, soliciting their opinions on the nature and content of the proposed guidelines for policies. The information gathered will be used to modify the prototype to formulate a policy guideline on FASDs. The data will be analysed using thematic analysis and narrative synthesis. ETHICS AND DISSEMINATION Ethical clearance has been obtained from the ethics committee of the university and governmental departments. The findings will be disseminated through publications and the guideline will be submitted to relevant departments

The Comparability of Lipid-based and Body Mass Index-based Cardiovascular Disease Risk Scores: Using the Rwanda 2012-2013 Non-communicable Diseases Risk Factors Survey Data

Background In Rwanda, cardiovascular diseases (CVDs) ranked second of the most common cause of death in 2016.&nbsp; CVD risk score tools have been recommended to identify people at high risk for management. Objective To assess the comparability of body mass index (BMI)-based and lipid-based CVD risk scores in Rwandan population. Methods Secondary analysis was conducted on 4185 study participants extracted from the dataset of Rwanda 2012-2013 non-communicable diseases risk factors survey. Individual CVD risk scores were calculated using both BMI-based and lipid-based algorithms, one at a time. Spearman rank’s coefficient and Cohen’s Kappa coefficient were used to compare the two tools. Results About 63.5% of participants were women. There was a significant positive correlation between BMI-based algorithm and lipid-based algorithm vis-à-vis a 10-year CVD risk prediction (Spearman rank correlation coefficients &gt; 0.90, p&lt;0.001) considering either men, women or overall study participants. There was a moderate agreement between BMI-based and lipid-based algorithms vis-à-vis CVD risk characterization, kappa = 0.52; p-value p&lt;0.001 considering either overall study participants or men and kappa = 0.48; p-value p&lt;0.001 considering women. Conclusion The findings from this study suggest the use of BMI-based algorithm, a cost effective tool compared to lipid-based tool, can be alternatively used in resource-limited settings.&nbsp; Rwanda J Med Health Sci 2021;4(1):166-18

Perceptions of body size, obesity threat and the willingness to lose weight among black South African adults: a qualitative study

BACKGROUND: The obesity epidemic is associated with rising rates of cardiovascular disease (CVD) among adults, particularly in countries undergoing rapid urbanisation and nutrition transition. This study explored the perceptions of body size, obesity risk awareness, and the willingness to lose weight among adults in a resource-limited urban community to inform appropriate community-based interventions for the prevention of obesity. METHOD: This is a descriptive qualitative study. Semi-structured focus group discussions were conducted with purposively selected black men and women aged 35–70 years living in an urban South African township. Weight and height measurements were taken, and the participants were classified into optimal weight, overweight and obese groups based on their body mass index (Kg/m2). Participants were asked to discuss on perceived obesity threat and risk of cardiovascular disease. Information on body image perceptions and the willingness to lose excess body weight were also discussed. Discussions were conducted in the local language (isiXhosa), transcribed and translated into English. Data was analysed using the thematic analysis approach. RESULTS: Participants generally believed that obesity could lead to health conditions such as heart attack, stroke, diabetes, and hypertension. However, severity of obesity was perceived differently in the groups. Men in all groups and women in the obese and optimal weight groups perceived obesity to be a serious threat to their health, whereas the overweight women did not. Obese participants who had experienced chronic disease conditions indicated strong perceptions of risk of obesity and cardiovascular disease. Obese participants, particularly men, expressed willingness to lose weight, compared to the men and women who were overweight. The belief that overweight is ‘normal’ and not a disease, subjective norms, and inaccessibility to physical activity facilities, negatively influenced participants’ readiness to lose weight. CONCLUSION: Low perception of threat of obesity to health particularly among overweight women in this community indicates a considerable challenge to obesity control. Community health education and promotion programmes that increase awareness about the risk associated with overweight, and improve the motivation for physical activity and maintenance of optimal body weight are needed.IS

Adjusted odd ratios (95% CI) for association of general, abdominal and percent body fat overweight/obesity with determinants by sex.

<p>^<b>*</b>Adjusted for all other variables in the model; ref = reference category (for respective variables)</p><p>^a p<0.0001</p><p>^<b>b</b> p<0.001</p><p>^<b>c</b> p<0.01</p><p>^p>0.05</p><p>¹Only 4% of the study sample had no education, and where added to any primary & high school education for analyses purpose</p><p>²Reported being depressed for 2 weeks or more in a row within last 12 months.</p><p>³Smoke tobacco products or alcohol at least once a week.</p><p>Adjusted odd ratios (95% CI) for association of general, abdominal and percent body fat overweight/obesity with determinants by sex.</p

Bivariate analysis, OR (95% CI) for the association of excess body fat with potential determinants by sex.

<p>ref = reference category (for respective variables).</p><p>^ap<0.0001</p><p>^bp<0.001</p><p>^cp<0.01</p><p>^p>0.05</p><p>¹reported stress at home, and</p><p>² any form of depression for at least 3 consecutive weeks in past 12 month</p><p>³reported staying sometimes without food at home within last 12 month</p><p>^<b>d</b>Smoke or consume tobacco products or alcohol at least once a week</p><p>*Physical activity based on metabolic equivalent (MET) score/mins: low = MET <600, moderate = MET 600–3000; high = MET >3000).</p><p>Bivariate analysis, OR (95% CI) for the association of excess body fat with potential determinants by sex.</p