Interplay of adipokines in the pathogenesis of essential hypertension: A comparative cross-sectional in Ghana

Background: The renin-angiotensin-system (RAS), endothelial dysfunction and sympathetic nervous system are mechanistic risk factors of hypertension. The study sought to elucidate the interplay of adipokines in the pathogenesis of essential hypertension.Methodology: This comparative cross-sectional study recruited 200 confirmed hypertensive patients from the KATH and 50 age-matched normotensives. Participants’ blood pressures, anthropometric and socio-demographic information were voluntarily obtained. Serum levels of adiponectin, leptin and resistin of the participants were quantified using the ELISA. Renal function, lipid profile and glycemic status of all subjects were also analyzed.Results: Hypertensive patients showed a significantly higher anthropometric indices of adiposity compared to normotensives, CI (p < 0.0001), BAI (p < 0.0001) and AVI (p = 0.002). Adiponectin levels (p < 0.0001) were significantly lower in the hypertensive relative to the normotensives. Furthermore, significantly higher concentrations of serum leptin (p = 0.016) and the leptin-adiponectin ratio (p = 0.001) were observed among the hypertensive compared to the normotensives. The study further observed a direct association between serum leptin and weight (r = 0.111, p = 0.022), BMI (r = 0.129, p = 0.009) and WHtR (r = 0.098, p = 0.045) but inverse relationship with height (r = -0.134, p = 0.006) among the hypertensive. Serum leptin has a significant negative correlation with HDL-C among the hypertensive (r = -0.174, p = 0.013). The fully aOR for hypertension as predicted by resistin and adiponectin were 1.12 (95% Cl, 1.02–1.25); p = 0.019) and 0.93 (95% Cl, 0.91–0.95); p = 0.0001) respectively.Conclusion: We found that elevations in serum levels of leptin and resistin, and low levels of adiponectin may play a role in the pathogenesis of essential hypertension. Therefore, adipokines may offer themselves as potential indices for early and accurate detection of high blood pressure. At the same time our presentresults also confirm the conclusions with respect to correlation of leptin and obesity. Further longitudinal studies in a larger population are warranted to investigate the physiological and pathological functions of adipokines in hypertension.Keywords: Adipokines, Hypertension, Leptin, Adiponectin, Resisti

Vaccination timing of low-birth-weight infants in rural Ghana: a population-based, prospective cohort study

Objective: To investigate delays in first and third dose diphtheria–tetanus–pertussis (DTP1 and DTP3) vaccination in low-birth-weight infants in Ghana, and the associated determinants. Methods: We used data from a large, population-based vitamin A trial in 2010–2013, with 22 955 enrolled infants. We measured vaccination rate and maternal and infant characteristics and compared three categories of low-birth-weight infants (2.0–2.4 kg; 1.5–1.9 kg; and <1.5 kg) with infants weighing ≥2.5 kg. Poisson regression was used to calculate vaccination rate ratios for DTP1 at 10, 14 and 18 weeks after birth, and for DTP3 at 18, 22 and 24 weeks (equivalent to 1, 2 and 3 months after the respective vaccination due dates of 6 and 14 weeks). Findings: Compared with non-low-birth-weight infants (n=18 979), those with low birth weight (n=3382) had an almost 40% lower DTP1 vaccination rate at age 10 weeks (adjusted rate ratio, aRR: 0.58; 95% confidence interval, CI: 0.43–0.77) and at age 18 weeks (aRR: 0.63; 95% CI: 0.50–0.80). Infants weighing 1.5–1.9 kg (n=386) had vaccination rates approximately 25% lower than infants weighing ≥2.5 kg at these time points. Similar results were observed for DTP3. Lower maternal age, educational attainment and longer distance to the nearest health facility were associated with lower DTP1 and DTP3 vaccination rates. Conclusion: Low-birth-weight infants are a high-risk group for delayed vaccination in Ghana. Efforts to improve the vaccination of these infants are warranted, alongside further research to understand the reasons for the delays

Cumulative effects of heat exposure and storage conditions of Oxytocin-in-Uniject in rural Ghana: implications for scale up.

OBJECTIVE: Postpartum hemorrhage can be reduced substantially in home deliveries attended by community-based workers by using Oxytocin-in-Uniject (OIU) devices affixed with temperature-time indicators. We characterized the distribution of time to discard of these devices when stored under normal field conditions in Ghana. METHODS: Two drug storage simulation studies were conducted in rural Ghana in 2011 and 2012. Devices were transported under refrigeration from manufacture (Argentina) to storage at the study site. Twenty-three field workers each stored at home (unrefrigerated) 25 OIU devices and monitored them daily to record: (1) time to transition from usable to unusable, and (2) continuous digital ambient temperature to determine heat exposure over the simulation period. Time to discard was estimated and compared with mean kinetic temperature exposure of the devices during the shipment and storage phases and with characteristics of the storage locations using Weibull regression models. We used the time to discard distributions in a Monte Carlo simulation to estimate wastage rates in a hypothetical program setting. RESULTS: Time for shipment and transfer to long-term refrigerated storage and mean kinetic temperature during the shipment phase was 8.6 days/10.3°C and 13.4 days/12.1°C, for the first and second simulation studies, respectively. Median (range) time to discard when stored under field conditions (unrefrigerated) was 43 (6 to 59) days and 33 (14 to 50) days, respectively. Mean time to discard was 10.0 days shorter in the second simulation, during which mean kinetic temperature exposure was 3.9°C higher. Simulating a monthly distribution system and assuming typical usage, predicted wastage of product was less than 10%. CONCLUSION: The time to discard of devices was highly sensitive to small changes in temperature exposure. Under field conditions typical in rural Ghana, OIU packages will have a half-life of approximately 30 to 40 days based on the temperature monitor used during the study. Program managers will need to carefully consider variations in both ambient temperature and rate of use to allocate the appropriate supply level that will maximize coverage and minimize stock loss

Is social support associated with hypertension control among Ghanaian migrants in Europe and non-migrants in Ghana? The RODAM study

Hypertension (HTN) control is crucial in preventing HTN-related complications such as stroke and coronary heart disease. Yet, HTN control remains suboptimal particularly among sub-Saharan African (SSA) populations partly due to poor self-management. Self-management of HTN is influenced by social support, but the evidence on the role of social support on HTN control particularly among SSA populations is limited. This study assessed the association between multiple proxies for social support and HTN control among Ghanaians resident in Ghana and Europe. The Research on Obesity and Diabetes among African Migrants (RODAM) study participants with HTN and who self-reported HTN (n = 1327) were included in this analysis. Logistic regression was used to assess the association between proxies of social support and HTN control (SBP < 140 mmHg and DBP < 90 mmHg) with adjustments for age and socioeconomic status (SES). Among Ghanaian males in both Europe and Ghana, cohabiting with more than two persons was associated with increased odds of having HTN controlled. Male hypertensive patients cohabiting with ≥ 5 persons had the highest odds of having HTN controlled after adjustment for age and SES (OR 0.30; 95% CI 0.16–0.57; 0.60; 0.34–1.04, respectively). This association was not observed among females. Relationship status, frequency of religious activity attendance and satisfaction with social support did not show any significant association with HTN control. Our study shows that cohabitation is significantly associated with HTN control but in males only. The other proxies for social support appeared not to be associated with HTN control. Involving persons living with Ghanaian men with HTN in the treatment process may help to improve adherence to HTN treatment. Further research is needed to explore in-depth, how these social support proxies could contribute to improved HTN control among SSA populations

Dietary patterns and type 2 diabetes among Ghanaian migrants in Europe and their compatriots in Ghana: the RODAM study.

BACKGROUND/OBJECTIVES: We aimed to study the associations of dietary patterns (DPs) with type 2 diabetes (T2D) among Ghanaian adults. SUBJECTS/METHODS: In the multi-centre, cross-sectional RODAM (Research on Obesity and Diabetes among African Migrants) study (n = 4543), three overall DPs ("mixed", "rice, pasta, meat and fish," and "roots, tubers and plantain") and two site-specific DPs per study site (rural Ghana, urban Ghana and Europe) were identified by principal component analysis. The DPs-T2D associations were calculated by logistic regression models. RESULTS: Higher adherence to the "rice, pasta, meat and fish" DP (characterized by legumes, rice/pasta, meat, fish, cakes/sweets, condiments) was associated with decreased odds of T2D, adjusted for socio-demographic factors, total energy intake and adiposity measures (odds ratio (OR)per 1 SD = 0.80; 95% confidence interval (CI) = 0.70-0.92). Similar DPs and T2D associations were discernible in urban Ghana and Europe. In the total study population, neither the "mixed" DP (whole grain cereals, sweet spreads, dairy products, potatoes, vegetables, poultry, coffee/tea, sodas/juices, olive oil) nor the "roots, tubers and plantain" DP (refined cereals, fruits, nuts/seeds, roots/tubers/plantain, fermented maize products, legumes, palm oil, condiments) was associated with T2D. Yet, after the exclusion of individuals with self-reported T2D, the "roots, tubers and plantain" DP was inversely associated with T2D (ORper 1 SD = 0.88; 95% CI = 0.69-1.12). CONCLUSION: In this Ghanaian population, DPs characterized by the intake of legumes, fish, meat and confectionery were inversely associated with T2D. The effect of a traditional-oriented diet (typical staples, vegetables and legumes) remains unclear

Food consumption, nutrient intake, and dietary patterns in Ghanaian migrants in Europe and their compatriots in Ghana.

Background: West African immigrants in Europe are disproportionally affected by metabolic conditions compared to European host populations. Nutrition transition through urbanisation and migration may contribute to this observations, but remains to be characterised. Objective: We aimed to describe the dietary behaviour and its socio-demographic factors among Ghanaian migrants in Europe and their compatriots living different Ghanaian settings. Methods: The multi-centre, cross-sectional RODAM (Research on Obesity and Diabetes among African Migrants) study was conducted among Ghanaian adults in rural and urban Ghana, and Europe. Dietary patterns were identified by principal component analysis. Results: Contributions of macronutrient to the daily energy intake was different across the three study sites. Three dietary patterns were identified. Adherence to the 'mixed' pattern was associated with female sex, higher education, and European residency. The 'rice, pasta, meat, and fish' pattern was associated with male sex, younger age, higher education, and urban Ghanaian environment. Adherence to the 'roots, tubers, and plantain' pattern was mainly related to rural Ghanaian residency. Conclusion: We observed differences in food preferences across study sites: in rural Ghana, diet concentrated on starchy foods; in urban Ghana, nutrition was dominated by animal-based products; and in Europe, diet appeared to be highly diverse

Food variety, dietary diversity, and type 2 diabetes in a multi-center cross-sectional study among Ghanaian migrants in Europe and their compatriots in Ghana: the RODAM study.

PURPOSE: The importance of dietary diversification for type 2 diabetes (T2D) risk remains controversial. We investigated associations of between- and within-food group variety with T2D, and the role of dietary diversification for the relationships between previously identified dietary patterns (DPs) and T2D among Ghanaian adults. METHODS: In the multi-center cross-sectional Research on Obesity and Diabetes among African Migrants (RODAM) Study (n = 3810; Ghanaian residence, 56%; mean age, 46.2 years; women, 63%), we constructed the Food Variety Score (FVS; 0-20 points), the Dietary Diversity Score (DDS; 0-7 points), and the Diet Quality Index-International (DQI-I) variety component (0-20 points). The associations of these scores, of a "rice, pasta, meat and fish" DP, of a "mixed" DP, and of a "roots, tubers and plantain" DP with T2D were calculated by logistic regression. RESULTS: The FVS was inversely associated with T2D, adjusted for socio-demographic, lifestyle, and anthropometric factors [odds ratio (OR) for T2D per 1 standard deviation (SD) increase: 0.81; 95% confidence interval (CI) 0.71-0.93]. The DDS and the DQI-I variety component were not associated with T2D. There was no association of the "mixed" DP and the "roots, tubers and plantain" DP with T2D. Yet, the "rice, pasta, meat and fish" DP is inversely associated with T2D (OR for T2D per 1 SD increase: 0.82; 95% CI 0.71-0.95); this effect was slightly attenuated by the FVS. CONCLUSIONS: In this Ghanaian population, between-food group variety may exert beneficial effects on glucose metabolism and partially explains the inverse association of the "rice, pasta, meat and fish" DP with T2D

Cross-sectional study of association between socioeconomic indicators and chronic kidney disease in rural-urban Ghana: the RODAM study

OBJECTIVES: Studies from high-income countries suggest higher prevalence of chronic kidney disease (CKD) among individuals in low socioeconomic groups. However, some studies from low/middle-income countries show the reverse pattern among those in high socioeconomic groups. It is unknown which pattern applies to individuals living in rural and urban Ghana. We assessed the association between socioeconomic status (SES) indicators and CKD in rural and urban Ghana and to what extent the higher SES of people in urban areas of Ghana could account for differences in CKD between rural and urban populations. SETTING: The study was conducted in Ghana (Ashanti region). We used baseline data from a multicentre Research on Obesity and Diabetes among African Migrants (RODAM) study. PARTICIPANTS: The sample consisted of 2492 adults (Rural Ghana, 1043, Urban Ghana, 1449) aged 25-70 years living in Ghana. EXPOSURE: Educational level, occupational level and wealth index. OUTCOME: Three CKD outcomes were considered using the 2012 Kidney Disease: Improving Global Outcomes severity of CKD classification: albuminuria, reduced glomerular filtration rate and high to very high CKD risk based on the combination of these two. RESULTS: All three SES indicators were not associated with CKD in both rural and urban Ghana after age and sex adjustment except for rural Ghana where high wealth index was significantly associated with higher odds of reduced estimated glomerular filtration rate (eGFR) (adjusted OR, 2.38; 95% CI 1.03 to 5.47). The higher rate of CKD observed in urban Ghana was not explained by the higher SES of that population. CONCLUSION: SES indicators were not associated with prevalence of CKD except for wealth index and reduced eGFR in rural Ghana. Consequently, the higher SES of urban Ghana did not account for the increased rate of CKD among urban dwellers suggesting the need to identify other factors that may be driving this

Association between socioeconomic position and the prevalence of type 2 diabetes in Ghanaians in different geographic locations: the RODAM study

BACKGROUND: The prevalence of diabetes has been shown to be socially patterned but the direction of the association in low-income countries and among migrant populations in Europe has varied in the literature. This study examined the association between socioeconomic position (SEP) and diabetes in Ghanaians in Europe and in Ghana. METHODS: Data were derived from the multicentre Research on Obesity and Diabetes among African Migrants (RODAM) study of Ghanaian adults aged 25-70 years residing in Europe (Amsterdam, Berlin and London) and in urban and rural Ghana. Educational attainment (elementary, secondary or higher) and occupational class (low or high) were used as indicators of SEP. Age-standardised prevalence of diabetes and prevalence ratios were evaluated separately for men and women of different SEP in Ghana and Europe. RESULTS: A total of 5290 participants were included in the analyses. The prevalence of diabetes decreased with increasing level of education in Ghanaian men and women in Europe and in men in urban Ghana, whereas diabetes prevalence increased with increasing level of education in men and women in rural Ghana. The association between occupational class and the prevalence of diabetes followed a less consistent pattern in men and women in the different locations. CONCLUSIONS: The association of diabetes and SEP differed in rural Ghana compared with urban settings in Ghana and Europe and comparing men and women, highlighting the complex interaction of SEP and the development of diabetes. These findings have important implications for diabetes prevention strategies in Ghanaians in different locations