Economic growth and obesity in South African adults: an ecological analysis between 1994 and 2014

Abstract: To assess the trend associations between South Africa’s economic growth using various economic growth indicators (EGIs) with adult obesity prevalence over a specified period of time. Methods: Data for obesity levels reported was obtained from national surveys conducted in South African adults between the periods of 1994 to 2014. EGIs incorporated in the current analysis were obtained from the World Bank and IHS Global insight databases. Obesity prevalence is presented by gender, urbanisation level and ethnicity. EGIs congruent to the time points where obesity data are available are presented. Unadjusted time trend plots were applied to assess associations between obesity prevalence and EGIs by gender, urbanisation level and ethnicity. Results: Females present higher levels of obesity relative to males for all time points. For both males and females, an overall increase in prevalence was observed in both rural and urban settings over‐time, with urban dwellers presenting higher obesity levels. An overall increase in Gross Domestic Product (GDP) per capita and Household Final Consumption Expenditure (HFCE) per capita was observed. The Gini coefficient for all ethnicities except the white group increased between 1998 and 2003 but declined by 2012

Economic growth as an underlying probable systemic driver for childhood obesity in South Africa : a joinpoint regression and ecological analysis over 10 years

BACKGROUND. Childhood obesity has become a global public health problem and is a known risk factor for type 2 diabetes, cardiovascular disease, hypertension, stroke, myocardial infarction and various cancers in later adulthood. Associations between adult obesity and economic growth, technological changes, socioeconomic status and economic inequities have been reported, but limited data are available for children and adolescents in countries that are undergoing an epidemiological health transition exhibiting both under- and overnutrition. OBJECTIVES. To demonstrate childhood obesity trends and explore their associations with economic growth in South Africa (SA). METHODS. This was a retrospective review and analysis of obesity and economic growth trends in SA. Data for obesity levels were obtained from national surveys conducted in SA youths in 2002, 2008 and 2012. Economic growth indicators (EGIs), namely gross domestic product (GDP) per capita, household final consumption expenditure and Gini coefficient, were obtained from the World Bank and IHS Global Insight databases. Obesity trends for 2002 - 2012 are presented by gender and ethnicity. Annual percentage changes (APCs) in obesity prevalence were computed to assess obesity trends using the linear Joinpoint regression. RESULTS. An overall increase in obesity prevalence over time from 3.8% to 6.0% was observed. Females had higher levels across all time points. APCs in both males (7.8%; 95% confidence interval (CI) 0.3 - 15.9; p=0.01) and females (3.1%; 95% CI –14.7 - 24.7; p=0.30) were observed. Among black Africans, coloureds and whites, females had higher obesity levels than males for the three time points. For males, the prevalence of obesity was highest in whites and Asians/Indians, whereas coloureds and blacks had lower levels across all time points. However, the black male population had the highest APC increase (9.4%; 95% CI –23.0 - 55.3; p=0.20). The prevalence of obesity was positively and inversely associated with GDP per capita and the Gini coefficient, respectively. CONCLUSIONS. An increase in childhood and adolescent obesity over time was observed, while trend associations between obesity and EGIs exist.http://www.samj.org.zadm2022Human Nutritio

Validity of instruction leaflets for parents to measure their child's weight and height at home: results obtained from a randomised controlled trial

Objectives: To compare the validity of parent-reported height, weight and body mass index (BMI) values of children (aged 4-10years), when measured at home by means of newly developed instruction leaflets in comparison with simple estimated parental reports. Design: Randomised controlled trial with control and intervention group using simple randomisation. Setting: Belgian children and their parents recruited via schools (multistage cluster sampling design). Participants: 164 Belgian children (53% male; participation rate 62%). Intervention: Parents completed a questionnaire including questions about the height and weight of their child. Parents in the intervention group received instruction leaflets to measure their child's weight and height. Classes were randomly allocated to the intervention and control groups. Nurses measured height and weight following standardised procedures up to 2weeks after parental reports. Outcome measures: Weight, height and BMI category of the child were derived from the index measurements and the parental reports. Results: Mean parent-reported weight was slightly more underestimated in the intervention group than in the control group relative to the index weights. However, for all three parameters (weight, height and BMI), correlations between parental reports and nurse measurements were higher in the intervention group. Sensitivity for underweight and overweight/obesity was respectively, 75% and 60% in the intervention group, and 67% and 43% in the control group. Weighed for classifying children in the correct BMI category was 0.30 in the control group and was 0.51 in the intervention group. Conclusions: Although mean parent-reported weight was slightly more underestimated in the intervention than in the control group, correlations were higher and there was considerably less misclassification into valid BMIcategories for the intervention group. This pattern suggests that most of the parental deviations from the index measurements were probably due to random errors of measurement and that diagnostic measures could improve by encouraging parents to measure their children's weight and height at home by means of instruction leaflets

Oropharyngeal HPV infection: prevalence and sampling methods among HIV-infected men in South Africa.

Worldwide, 96,000 cases of oropharyngeal cancer (OPC) occurred in 2012. Human papillomavirus (HPV) is a risk factor for OPC. Data on oropharyngeal HPV infection are limited. There is no consensus on the best sampling method for detecting the infection. We describe the prevalence of oropharyngeal HPV infection among HIV-infected men and compare the performance of oral rinses and swabs in detecting oropharyngeal HPV infection. Paired oral rinses and swabs for 181 men were tested for HPV DNA using the Roche Linear Array. Performance was determined by the number of infections detected and the percentage of samples with adequate DNA extraction. Agreement between sampling methods was assessed by the kappa statistic. Prevalence of oropharyngeal HPV infection with rinse samples was 1.8% (three infections) and 0.6% (one infection) with swabs (p = 0.06). Adequate cellular DNA extraction was more likely with rinse (93.4%) than swab samples (89.0%, p = 0.05). There was moderate agreement between the methods (kappa = 0.49). The prevalence of oropharyngeal HPV DNA infection among this predominantly heterosexual sample of men living with HIV was low and consistent with the infrequent oral sex practices. Oral rinse performed better than oral swab in detecting oropharyngeal HPV DNA infection and might contribute to screening for OPCs

The relationship between dietary intake and adiposity in South African female adolescents : a systematic review

: The prevalence of obesity has increased significantly in developing nations over the past decade, particularly among adolescent girls. To assess the scale of this epidemic among female adolescents in South Africa, a systematic review was undertaken to investigate the connection between diet and obesity. Multiple databases (Google Scholar, Science Direct, Cochrane Library, PubMed, and Web of Science) were searched to identify studies investigating the associations between diet and various adiposity indices as outcomes. Of the 56 studies identified, 7 met the inclusion criteria. The age range of participants spanned from 11 to 21 years. Tabulation was used to report the data, study by study. The consumption of nutrients from animal sources exhibited a positive correlation with higher BMI-for-age Z scores (p = 0.02). Eating habits such as sporadic family meals (p ≤ 0.02), irregular breakfast consumption (p ≤ 0.05), and a high energy intake derived from fat were linked to an increased risk of adiposity. Additionally, factors such as socioeconomic status and residential location revealed associations with certain dietary intakes and adiposity. As more studies identify the causative role of diet in obesity, there is an urgent need for policy intervention and strategies to address the growing non-communicable disease burden in South Africa.The prevalence of obesity has increased significantly in developing nations over the past decade, particularly among adolescent girls. To assess the scale of this epidemic among female adolescents in South Africa, a systematic review was undertaken to investigate the connection between diet and obesity. Multiple databases (Google Scholar, Science Direct, Cochrane Library, PubMed, and Web of Science) were searched to identify studies investigating the associations between diet and various adiposity indices as outcomes. Of the 56 studies identified, 7 met the inclusion criteria. The age range of participants spanned from 11 to 21 years. Tabulation was used to report the data, study by study. The consumption of nutrients from animal sources exhibited a positive correlation with higher BMI-for-age Z scores (p = 0.02). Eating habits such as sporadic family meals (p ≤ 0.02), irregular breakfast consumption (p ≤ 0.05), and a high energy intake derived from fat were linked to an increased risk of adiposity. Additionally, factors such as socioeconomic status and residential location revealed associations with certain dietary intakes and adiposity. As more studies identify the causative role of diet in obesity, there is an urgent need for policy intervention and strategies to address the growing non-communicable disease burden in South Africa.https://www.mdpi.com/journal/applsciHuman Nutritio

Association of socioeconomic status change between infancy and adolescence, and blood pressure, in South African young adults: Birth to Twenty Cohort

ObjectiveSocial epidemiology models suggest that socioeconomic status (SES) mobility across the life course affects blood pressure. The aim of this study was to investigate the association between SES change between infancy and adolescence, and blood pressure, in young adults, and the impact of early growth on this relationship.SettingData for this study were obtained from a ‘Birth to Twenty’ cohort in Soweto, Johannesburg, in South Africa.ParticipantsThe study included 838 Black participants aged 18 years who had household SES measures in infancy and at adolescence, anthropometry at 0, 2, 4 and 18 years of age and blood pressure at the age of 18 years.MethodsWe computed SES change using asset-based household SES in infancy and during adolescence as an exposure variable, and blood pressure and hypertension status as outcomes. Multivariate linear and logistic regressions were used to investigate the associations between SES change from infancy to adolescence, and age, height and sex-specific blood pressure and hypertension prevalence after adjusting for confounders.ResultsCompared to a persistent low SES, an upward SES change from low to high SES tertile between infancy and adolescence was significantly associated with lower systolic blood pressure (SBP) at the age of 18 years (β=−4.85; 95% CI −8.22 to −1.48; p<0.01; r2=0.1804) after adjusting for SES in infancy, small-for-gestational-age (SGA) and weight gain. Associations between SES change and SBP were partly explained by weight gain between birth and the age of 18 years. There was no association between SES mobility and diastolic blood pressure, mean arterial pressure or hypertension status.ConclusionsOur study confirms that upward SES change has a protective effect on SBP by the time participants reach young adulthood. Socioeconomic policies and interventions that address inequality may have the potential to reduce cardiovascular disease burden related to BP in later life

Incidence, Persistence, Clearance, and Correlates of Genital Human Papillomavirus Infection and Anogenital Warts in a Cohort of Men Living With Human Immunodeficiency Virus in South Africa.

OBJECTIVE: To estimate the incidence; persistence and correlates of human papillomavirus (HPV) infection and anogenital warts (AGW) among men living with human immunodeficiency virus (MLHIV). METHODS: Overall, 304 MLHIV 18 years or older were enrolled and attended follow-up visits at 6, 12, and 18 months. Clinicians examined for AGW, collected blood, and penile swabs for HPV testing (Roche Linear Array) at each visit. Time to AGW incidence or clearance was estimated by Kaplan-Meier method. Factors associated with persistent HPV infection and AGW clearance were evaluated with generalized estimating equations and Cox regression, respectively. RESULTS: Mean age of participants was 38 years (standard deviation, 8 years); 25% reported more than 1 sexual partner in the past 3 months. Most (65%) participants were on antiretroviral treatment (ART) with a median CD4 count of 445 cells/?L (interquartile range, 328-567). Prevalence of HPV infection and AGW at enrolment were 79% (224 of 283) and 12% (36 of 304), respectively. Two hundred fifty-nine men were followed up for a median (interquartile range) 1.4 years (0.5-1.7 years). Incidence of any-genital HPV infection was 2.9 (95% confidence interval, 1.5-5.5) per 100 person-years. Persistence of any-genital HPV infection was 35% (68 of 192) and was higher among MLHIV with low CD4 count (adjusted odds ratio, 3.54; 95% confidence interval, 2.07-6.05). Incidence of AGW was 1.4 per 100 person-years. Men living with human immunodeficiency virus with high CD4 count were more likely to clear AGW than those with low CD4 count (adjusted hazard ratio, 3.69; 95% confidence interval, 1.44-9.47). No associations were observed between persistent genital HPV infection, AGW clearance with enrolment ART status or duration. CONCLUSIONS: Human immunodeficiency virus-positive men have a high burden of genital HPV infection and AGW. The ART and HPV vaccine could reduce this burden

Association of Alcohol Consumption with Specific Biomarkers: A Cross-sectional Study in South Africa

Alcohol consumption plays an important role in the health transition associated with urbanization in developing countries. Thus, reliable tools for assessing alcohol intake levels are necessary. We compared two biological markers of alcohol consumption and self-reported alcohol intakes in participants from urban and rural South African communities. This cross-sectional epidemiological survey was part of the North West Province, South African leg of the 12-year International Prospective Urban and Rural Epidemiology (PURE) study which investigates the health transition in urban and rural subjects. A total of 2,010 apparently healthy African volunteers (35 years and older) were recruited from a sample of 6,000 randomly-selected households. Alcohol consumption was assessed through self-reports (24-hour recalls and quantitative food frequency questionnaire) and by two biological markers: percentage carbohydrate-deficient transferrin (%CDT) and gamma-glutamyl transferase (GGT). Of the 716 men and 1,192 women volunteers, 64% and 33% respectively reported regular alcohol consumption. Reported mean habitual intakes of drinker men and women were 29.9 (\ub130.0) and 23.3 (\ub129.1) g of pure alcohol per day. Reported habitual intake of the whole group correlated positively and significantly with both %CDT (R=0.32; p 640.01) and GGT (R=0.43; p\u22640.01). The correlation between the two biomarkers was low (0.211; p 640.01). GGT and %CDT values should be interpreted with care in Africans as self-reported non-drinker men and women had elevated levels of GGT (19% and 26%) and %CDT (48% and 38%). A need exists for a more specific biological marker for alcohol consumption in black Africans

Prevalence of anogenital HPV infection, related disease and risk factors among HIV-infected men in inner-city Johannesburg, South Africa: baseline findings from a cohort study.

BACKGROUND: Persistent high-risk human papillomavirus (HR-HPV) infection is associated with the development of anogenital cancers, particularly in men living with HIV (MLWH). We describe the prevalence of anogenital HPV infection, abnormal anal cytology and anogenital warts (AGWs) in MLWH in Johannesburg, and explore whether HPV infection and receipt of antiretroviral treatment is associated with detection of abnormal anal cytology and AGWs. METHODS: We enrolled a cohort of 304 sexually-active MLWH ≥18 years, who completed a questionnaire and physical examination. Genital swabs were collected from all men and intra-anal swabs from 250 (82%). Swabs were tested for HPV DNA and genotypes, and anal smears graded using the Bethesda classification. Factors associated with anogenital disease were assessed by logistic regression models. RESULTS: Two thirds were receiving antiretroviral treatment, for a median 33 months (IQR = 15-58) and 54% were HIV-virologically suppressed. Only 5% reported ever having sex with men. Among 283 genital swabs with valid results, 79% had any HPV, 52% had HR-HPV and 27% had >1 HR-HPV infection. By comparison, 39% of the 227 valid intra-anal swabs had detectable HPV, 25% had any HR-HPV and 7% >1 HR infection. While most anal smears were normal (51%), 20% had ASCUS and 29% were LSIL. No cases had HSIL or cancer. Infection with >1 HR type (adjusted OR [aOR] = 2.39; 95%CI = 1.02-5.58) and alpha-9 types (aOR = 3.98; 95%CI = 1.42-11.16) were associated with having abnormal cytology. Prevalence of AGWs was 12%. Infection with any LR type (aOR = 41.28; 95%CI = 13.57-125.62), >1 LR type (aOR = 4.14; 95%CI = 1.60-10.69), being <6 months on antiretroviral treatment (aOR = 6.90; 95%CI = 1.63-29.20) and having a CD4+ count <200 cells/μL (aOR = 5.48; 95%CI: 1.60-18.78) were associated with having AGWs. CONCLUSIONS: In this population, anogenital HR-HPV infection and associated low-grade disease is common, but severe anal dysplasia was not detected. Findings reinforce the need for HPV vaccination in men for preventing both AGWs and HR-HPV infection. Given the absence of anal HSILs, however, the findings do not support the use of anal screening programmes in this population

Association of socioeconomic status change between infancy and adolescence and blood pressure in South African young adults: Birth to Twenty Cohort

OBJECTIVE. Social epidemiology models suggest that socioeconomic status (SES) mobility across the life course affects blood pressure. The aim of this study was to investigate the association between SES change between infancy and adolescence, and blood pressure, in young adults, and the impact of early growth on this relationship. SETTING. Data for this study were obtained from a ‘Birth to Twenty’ cohort in Soweto, Johannesburg, in South Africa. PARTICIPANTS. The study included 838 Black participants aged 18 years who had household SES measures in infancy and at adolescence, anthropometry at 0, 2, 4 and 18 years of age and blood pressure at the age of 18 years. METHODS. We computed SES change using asset-based household SES in infancy and during adolescence as an exposure variable, and blood pressure and hypertension status as outcomes. Multivariate linear and logistic regressions were used to investigate the associations between SES change from infancy to adolescence, and age, height and sex-specific blood pressure and hypertension prevalence after adjusting for confounders. RESULTS. Compared to a persistent low SES, an upward SES change from low to high SES tertile between infancy and adolescence was significantly associated with lower systolic blood pressure (SBP) at the age of 18 years (β=−4.85; 95% CI −8.22 to −1.48; p<0.01; r2=0.1804) after adjusting for SES in infancy, small-for-gestational-age (SGA) and weight gain. Associations between SES change and SBP were partly explained by weight gain between birth and the age of 18 years. There was no association between SES mobility and diastolic blood pressure, mean arterial pressure or hypertension status. CONCLUSIONS. Our study confirms that upward SES change has a protective effect on SBP by the time participants reach young adulthood. Socioeconomic policies and interventions that address inequality may have the potential to reduce cardiovascular disease burden related to BP in later life