Deriving an optimal threshold of waist circumference for detecting cardiometabolic risk in sub-Saharan Africa.

BACKGROUND: Waist circumference (WC) thresholds derived from western populations continue to be used in sub-Saharan Africa (SSA) despite increasing evidence of ethnic variation in the association between adiposity and cardiometabolic disease and availability of data from African populations. We aimed to derive a SSA-specific optimal WC cut-point for identifying individuals at increased cardiometabolic risk. METHODS: We used individual level cross-sectional data on 24 181 participants aged ⩾15 years from 17 studies conducted between 1990 and 2014 in eight countries in SSA. Receiver operating characteristic curves were used to derive optimal WC cut-points for detecting the presence of at least two components of metabolic syndrome (MS), excluding WC. RESULTS: The optimal WC cut-point was 81.2 cm (95% CI 78.5-83.8 cm) and 81.0 cm (95% CI 79.2-82.8 cm) for men and women, respectively, with comparable accuracy in men and women. Sensitivity was higher in women (64%, 95% CI 63-65) than in men (53%, 95% CI 51-55), and increased with the prevalence of obesity. Having WC above the derived cut-point was associated with a twofold probability of having at least two components of MS (age-adjusted odds ratio 2.6, 95% CI 2.4-2.9, for men and 2.2, 95% CI 2.0-2.3, for women). CONCLUSION: The optimal WC cut-point for identifying men at increased cardiometabolic risk is lower (⩾81.2 cm) than current guidelines (⩾94.0 cm) recommend, and similar to that in women in SSA. Prospective studies are needed to confirm these cut-points based on cardiometabolic outcomes.International Journal of Obesity advance online publication, 31 October 2017; doi:10.1038/ijo.2017.240

Deriving an optimal threshold of waist circumference for detecting cardiometabolic risk in sub-Saharan Africa

BACKGROUND: Waist circumference (WC) thresholds derived from western populations continue to be used in sub-Saharan Africa (SSA) despite increasing evidence of ethnic variation in the association between adiposity and cardiometabolic disease and availability of data from African populations. We aimed to derive a SSA-specific optimal WC cut-point for identifying individuals at increased cardiometabolic risk. METHODS: We used individual level cross-sectional data on 24 181 participants aged ⩾15 years from 17 studies conducted between 1990 and 2014 in eight countries in SSA. Receiver operating characteristic curves were used to derive optimal WC cutpoints for detecting the presence of at least two components of metabolic syndrome (MS), excluding WC. RESULTS: The optimal WC cut-point was 81.2 cm (95% CI 78.5–83.8 cm) and 81.0 cm (95% CI 79.2–82.8 cm) for men and women, respectively, with comparable accuracy in men and women. Sensitivity was higher in women (64%, 95% CI 63–65) than in men (53%, 95% CI 51–55), and increased with the prevalence of obesity. Having WC above the derived cut-point was associated with a twofold probability of having at least two components of MS (age-adjusted odds ratio 2.6, 95% CI 2.4–2.9, for men and 2.2, 95% CI 2.0–2.3, for women). CONCLUSION: The optimal WC cut-point for identifying men at increased cardiometabolic risk is lower (⩾81.2 cm) than current guidelines (⩾94.0 cm) recommend, and similar to that in women in SSA. Prospective studies are needed to confirm these cut-points based on cardiometabolic outcomes

Prevalence of risk factors for diabetes mellitus in a non-diabetic population in Jos, Nigeria

Background: Diabetes mellitus (DM) is assuming epidemic proportions worldwide, but probably more so in the developing world. Identification of risk factors for the development of type 2 diabetes mellitus is a necessary step in planning prevention programmes for diabetes mellitus. The objective of this study was to determine the frequency of risk factors for type 2 DM among inhabitants of Jos, a northern city on the Nigerian Plateau. Method: A district in central Jos was randomly picked. Census of the district was carried out to record the names of all eligible residents from 250 households selected systematically. A questionnaire was administered by trained interviewers. Socio-demographic data, family history of diabetes, and data on work related physical activity were recorded. Height, weight and waist and hip circumferences were also measured. BMI (kg/m2) and waist-hip ration were calculated Results: Of 902 subjects (≥ 15years of age), 825 (91.5%) responded. The mean (SD) age of 400 males and 422 females were respectively 36.4 (15.2) and 39.9 (17.3) years. About 50% of the respondents were inactive. 435 (52.7%) were currently taking alcohol. Twenty nine (3.5%) of the subjects admitted to parental history of DM. 177 (21.4%) were either overweight or obese. 32% of males and 86% of females had abnormal waist circumferences (WCE). 96 (23.8%) males and 316 (74.9%) females had abnormal WHR. BMI correlated strongly and significantly with WHR (r = 0.64,

Anti-diabetic Agents and the Potentials for Reducing Cardiovascular Risks in Type-2 Diabetes Mellitus

Recent reports from Cardiovascular Outcome Trials (CVOTs) revealed that some newer anti-diabetic drugs impact Major Adverse Cardiovascular Events (MACE). These medications include the Sodium-Glucose Co-Transporter (SGLT2) inhibitors and the Glucagon-like Peptide-1 (GLP-1) receptor agonists. There is a need for a review of the mechanisms of action of these drugs, in addition to their glucose-lowering effects and CV benefits. This review paper aims to explore the cardio-protective effects and CV risks of anti-diabetic medications, their mechanisms of action and the CV benefits evidenced by CVOTs. Using internet search, with search items such as Type 2 Diabetes mellitus, cardiovascular risk factors, cardiovascular outcome trials, major adverse cardiovascular events, sodium-glucose transporter-2 inhibitors, glucagon-like peptide-1 receptor agonist, the Google Scholar, EMBASE, PubMed, Medline, Web MD, and Scopus were checked for various relevant published articles. Analyses of the results of multiple CVOTs from various parts of the world were considered. These CVOTs were reviewed to assess the role of anti-diabetic agents in reducing cardiovascular risk in patients with T2DM. The SGLT2 inhibitors and GLP1 agonists were found to be beneficial in lowering MACE when compared with placebo. This is in addition to their anti-hyperglycaemic benefits. In conclusion, SGLT2 inhibitors and GLP-1 agonists confer dramatic beneficial CV risk reduction on patients with T2DM, as shown by the various CVOTs. This is in addition to their anti-hyperglycaemic effects. This remarkable benefit justifies the need by various guidelines to adopt them as second line agents to metformin in managing patients with T2DM

Exercise tolerance in type - 2 male diabetics

The objective of this study was to compare the exercisetolerance of a set of male diabetic Nigerians with non-diabetic male subjects. Ten male Type-2 diabetics between the ages of 35 and 50 years in good glycaemic control and ten male non-diabetic controls of similar age were exercised on the ergometer at uptake of 90% and 60% V02 max respectively for anaerobic and aerobic exercises. Cardiovascular and fatigue rates or times to fatigue were then determined in both groups.In both diabetics and controls, the time to fatigue was significantly longer during exercise at 60% VO2max than at 90% VO2max (P 0.1}. The diabetic men fatigued more easily than controls under anaerobic condition (p 0.1 > p > 0.05). Type 2 male diabetics with good glycaemic control appear to tolerate aerobic exercise as well as non-diabetic males, but less so during anaerobic exercise. This difference in aerobic and anaerobic exercise tolerance should be borne in mind in prescribing exercise regimes in patients with type 2 diabetes mellitus

Glycaemic control amongst persons with diabetes mellitus in Benin City

Objective: This study set out to find the level of glycaemic control amongst persons with diabetes mellitus in Benin City. Methods: Forty two persons with diabetes had their glycaemic control assessed by measuring the level of their glycated hae-moglobin. Other data collected included age, sex, duration of diabetes, type of diabetes, weight, height, body mass index and waist hip ratio. Results: There were twenty four males and eighteen females in the study population. Thirty one subjects had type 2 diabetes, while eleven had type 1 diabetes. Nineteen subjects (46%), had poor glycaemic control (HbAic > 7%) while twenty three (54%) had good control (HbAic ͳ 7%). Thirteen males (54%) had good control while ten females (53%) had good control and this was not statistically significant (p>0.05). Eighteen of the thirty-one type 2 DM subjects (58%) had good glycaemic control, while five persons out of eleven with type 1 DM (45%) had good glycaemic control and this was not statistically significant (p>0.05). Conclusion: This study has shown that poor glycaemic control is common amongst persons with diabetes mellitus in Benin City. Studies have shown that good glycaemic control prevents and delays the complications of diabetes mellitus. We therefore recommend that health education on the benefits of good glycaemic control should be given in diabetes clinics, and ef-forts intensified to achieve target glycated haemoglobin levels to prevent diabetes complications

CD4 count as a predictor of adrenocortical insufficiency in persons with human immunodeficiency virus infection: How useful?

Objective: To determine the usefulness of CD4 count in predicting adrenocortical insufficiency (AI) in persons with HIV infection. Design: Experimental study involving people with HIV infection and healthy people. Participants: The participants were recruited from the Lagos University Teaching Hospital. Forty-three newly diagnosed, treatment naive persons with HIV (23 males and 20 females) and 70 (35 males and 35 females) HIV negative subjects completed the study. Intervention: One microgram Synacthen® was given intravenously to stimulate the adrenal glands. Main Outcome Measures: Blood was collected for cortisol at 0 and 30 min after the injection of adrenocorticotropic hormone (ACTH) and CD4 count. Results: Mean basal cortisol was 154.9 ± 27.2 nmol/L and 239.9 ± 31.6 nmol/L (P < 0.001); the 30-min post ACTH test, cortisol level was 354.8 ± 19.9 nmol/L and 870.9 ± 163.5 nmol/L (P < 0.001); the increment was 100.0 ± 17.2 nmol/L and 588.8 ± 143.4 nmol/L (P < 0.001) in HIV and healthy subject group; respectively. Using the diagnostic criteria for diagnosis of AI in this study, fifteen (34.8%) persons with HIV had AI. There was no significant correlation between basal cortisol levels and CD4 count in patients with HIV infection (r = -0.2, P = 0.198). There was no significant correlation between stimulated cortisol level and CD4 count in patients with HIV infection (r = -0.09, P = 0.516). Conclusion: CD4 count does not predict the presence or absence of AI. ACTH stimulation of the adrenal gland remains the acceptable standard

Correlation Of Various Anthropometric Indices Among Nigerians With Type 2 Diabetes Mellitus

Background: Obesity has been described as the major driving force for the development of type 2 diabetes mellitus (DM). Various parameters have been measured to give some estimates about the levels of adiposity. It is therefore very pertinent to know the best index for the measurement of obesity among patients with type 2 DM who had MSX and those without it. Objective: To determine the correlations, if any, of the various anthropometric variables among Nigerians with type 2 DM who had metabolic syndrome X (MSX) and those who did not have MSX. Materials and Methods: One-hundred and ninety-two patients with type 2 DM attending Diabetic clinic of the Lagos University Teaching Hospital (LUTH), Lagos were randomly enrolled for the study. Ninety-six of the patients had metabolic syndrome X (presence of hypertension and obesity in addition to type 2 DM), while the rest had only type 2 DM. History was obtained through a questionnaire and patients were physically examined. Anthropometric indices were obtained using standards from the WHO Technical Report Series-854 on physical status 1995. Results: Body mass index (BMI) correlated well with waist circumference (WC) and subscapular skinfold thickness (SST) (r=0.63 and &#96

Fasting plasma glucose control among nigerians with metabolic syndrome.

Introduction: Metabolic Syndrome consists of many diseases that predispose to cardiovascular events including type 2 diabetes mellitus, systemic hypertension, central obesity, dyslipidaemia, endothelial dysfunction and inflammation. Hence, glycaemic management of these cluster of diseases might take a different pattern compared with only type 2 diabetes mellitus. Objective: To determine the levels of fasting plasma glucose (FPG) and the type of oral antidiabetic drugs patients with metabolic syndrome are receiving. To relate the FPG to the type of medications the patients were using. Materials and Methods: One-hundred and ninety-two patients with type 2 DM attending Diabetic clinic of the Lagos University Teaching Hospital (LUTH), Lagos were randomly enrolled for the study. Ninety-six of the patients had metabolic syndrome X (presence of hypertension and obesity in addition to type 2 DM), while the rest had only type 2 DM. History was obtained through a questionnaire and they were physically examined. Blood samples were obtained twice for plasma glucose estimation. Results: There were more metabolic syndrome subjects on combination of sulponylurea and metformin (80%) than the controls (28%), (&#61554