Obesity and diabetes mellitus association in rural community of Katana, South Kivu, in Eastern Democratic Republic of Congo : Bukavu Observ Cohort study results

Background: Factual data exploring the relationship between obesity and diabetes mellitus prevalence from rural areas of sub-Saharan Africa remain scattered and are unreliable. To address this scarceness, this work reports population study data describing the relationship between the obesity and the diabetes mellitus in the general population of the rural area of Katana (South Kivu in the Democratic Republic of the Congo). Methods: A cohort of three thousand, nine hundred, and sixty-two (3962) adults (>15 years old) were followed between 2012 and 2015 (or 4105 person-years during the observation period), and data were collected using the locally adjusted World Health Organization's (WHO) STEPwise approach to Surveillance (STEPS) methodology. The hazard ratio for progression of obesity was calculated. The association between diabetes mellitus and obesity was analyzed with logistic regression. Results: The diabetes mellitus prevalence was 2.8 % versus 3.5 % for obese participants and 7.2 % for those with metabolic syndrome, respectively. Within the diabetes group, 26.9 % had above-normal waist circumference and only 9.8 % were obese. During the median follow-up period of 2 years, the incidence of obesity was 535/100,000 person-years. During the follow-up, the prevalence of abdominal obesity significantly increased by 23 % (p < 0.0001), whereas the increased prevalence of general obesity (7.8 %) was not significant (p = 0.53). Finally, diabetes mellitus was independently associated with age, waist circumference, and blood pressure but not body mass index. Conclusion: This study confirms an association between diabetes mellitus and abdominal obesity but not with general obesity. On the other hand, the rapid increase in abdominal obesity prevalence in this rural area population within the follow-up period calls for the urgent promoting of preventive lifestyle measures

Analyse de cinq bio-marqueurs cardiaques y compris la glycogène phosphorylase BB (GPBB) dans un groupe de diabétiques de type 2 asymptomatiques : résultats préliminaires

Nous avons analysé cinq bio-marqueurs cardiaques chez 32 diabétiques de type 2, tous asymptomatiques sur le plan cardiaque et 42 non diabétiques. La stratification du risque cardiovasculaire (RCV) a été faite chez les diabétiques par l’échelle de l’UKPDS. Dans les deux groupes, la myoglobine (MYO), la créatine kinase BB (CK-MB), la heart-type fatty acid binding protein (h-FABP), la glycogène phosphorylase BB (GPBB) et l’anhydrase carbonique 3 (CA III) ont été dosés. Les résultats de cette étude notent essentiellement une association entre les valeurs de GPBB et respectivement le diabète sucré de type 2 [valeur pathologique : diabète vs. témoins, 16 (50%) Vs 0 (0%), p<0,001] et l’HBA1c [coefficient de régression par %, 2,054 (0,150 à 3,958) ng/ml ; coefficient de corrélation, 37,2% ; p=0,03]. La GPBB n’était pas corrélée au débit de filtration glomérulaire. Les résultats préliminaires de cette étude montrent que la GPBB pourrait trouver une place dans le bilan cardiaque ou métabolique du patient diabétique de type 2 asymptomatique

Bioelectrical impedance outperforms waist circumference for predicting cardiometabolic risk in Congolese hypertensive subjects: a cross-sectional study.

BACKGROUND: Waist circumference threshold values used in sub-Saharan Africa correspond to those of European populations and are therefore inappropriate. Thus, they may over predict insulin resistance, especially in hypertensive Africans, in whom there is often no association between blood pressure and insulin resistance. Using bioelectrical impedance measurement in sub-Saharan Africa could possibly be advantageous to overcome the shortcomings of waist circumference measurement. The aim of this study was to evaluate the contribution of body composition estimation by bioelectrical impedance to predict cardiometabolic risk in Congolese hypertensive subjects. METHODS: Cardiovascular profiling and body composition analysis by bioelectrical impedance was measured in 400 patients (men = 40%; age = 51.1 ± 12.6 years). Patients were diagnosed with a metabolic syndrome (MS) according to the IDF Criteria with and without the "blood pressure" criterion to remove any confounding autocorrelation bias, a visceral fat-MS (with and without the "blood pressure" criterion) being defined by the presence of ≥ 2 criteria with the precondition of excess visceral fat defined by a bio impedance measurement score >10/30. Total cardiovascular risk was assessed using the criteria of Framingham-2008. RESULTS: The frequencies of enlarged waist circumference (71.9% vs 68.9%, p = 0.52) and IDF-MS without blood pressure criterion (24.9% vs 21.9%, p = 0.48) were similar among hypertensive vs. non hypertensive however excess visceral fat (57.6% vs 33.8%, p 0.05). CONCLUSIONS: Pending the determination of thresholds values for pathological waist circumference adapted to sub-Saharan populations, using bioelectrical impedance measurement may contribute to better characterize the cardiometabolic risk and the insulin resistant phenotype of hypertensive sub-Saharan Africans

Hypertension, insulin resistance and chronic kidney disease in type 2 diabetes patients from South Kivu, DR Congo

Objectif : Évaluer la fréquence et les déterminants de l’hypertension artérielle dans un groupe de diabétiques de race noire habitant l’Est de la République Démocratique du Congo. Méthodologie : Les dossiers de 98 patients diabétiques suivis à l’hôpital général de référence de Bukavu entre 2005 et 2007 ont été analysés. L’hypertension artérielle était définie par une pression artérielle supérieure ou égale à 140/90 mmHg et l’insulinosensibilité (HOMA S) déterminée à partir du modèle HOMA (insulinorésistance (IR), définine par HOMA S < 50 %). Les patients ont été phénotypés sur le plan cardiométabolique selon les critères non-tensionnels du syndrome métabolique. La probabilité de l’hypertension artérielle a été modélisée par régression logistique multiple. Résultats : La présente étude note une prévalence élevée de l’hypertension artérielle (59,6 %) et de la maladie rénale chronique (66 %) contrastant avec une fréquence faible de l’insulinorésistance (5,2 %) et de l’obésité (18,6 %). De plus, l’hypertension artérielle n’était pas corrélée à l’insulinorésistance [régression de PAS par %S : coefficient de régression (IC à 95 %) par %, 0,007 (−0,090–0,104) mmHg ; coefficient de corrélation, 0,00 ; p = 0,89], [régression de PAD par %S :−0,004 (−0,053–0,045) mmHg ; 0,00 ; 0,87], de même qu’il n’y avait pas de différence quant à la fréquence du syndrome métabolique modifié entre les hypertendus et les non hypertendus [38,6 % versus 33,3 % ; p = 0,60]. En analyse multivariée, l’excès pondéral [OR ajusté=3,20 (IC à 95 % :1,19–8,61) ; p = 0,02] et la MRC [2,49 (0,98–6,34 ; 0,05] étaient retrouvés comme déterminants majeurs de l’hypertension artérielle. Conclusion : Le syndrome métabolique est faiblement prédictif d’insulinorésistance absolue dans une population de diabétiques de type 2 au sein de laquelle la fréquence d’hypertension artérielle est élevée et celle de l’insulinorésistance basse. L’excès pondéral indépendamment de l‘insulinorésistance et la maladie rénale chronique fréquente chez les diabétiques du type 2 en Afrique sub-saharienne chez lesquels la maladie est mal contrôlée pourraient jouer un rôle majeur dans le déterminisme de l’hypertension artérielle.Objective: To assess the frequency and determinants of high blood pressure (HBP) in a group of type 2 black diabetics living in the east of Democratic Republic of Congo. Methodology: The medical records of 98 diabetic patients followed at the General Reference Hospital in Bukavu between 2005 and 2007 were collected and analyzed. Hypertension was defined as blood pressure ≥ 140/90 mmHg. Insulin sensitivity (HOMA S; %) was determined with the HOMA model, with insulin resistance (IR) representing HOMA S-1 and defined from HOMA S values < 50%). Patients were phenotyped regarding their cardiometabolic profile using metabolic syndrome criteria (minus that for HBP). The probability of hypertension was assessed by multiple logistic regression. Results: There was an overall high prevalence of HBP (59.6%) and of chronic kidney disease (66%) contrasting with a low frequency of insulin resistance (5.2%) and obesity (18.6%). In addition, hypertension was not associated with insulin resistance [regression of SBP by % S: regression coefficient, 0.007 (-0.090-0.104) mmHg; correlation coefficient, 0.00; p = 0.89], [regression of DBP by % S: -0.004 (-0.053-0.045) mmHg; 0.00; 0.87]. There was no significant difference in prevalence of metabolic syndrome changed between hypertensive and normotensive patients [38.6% versus 33.3%, p = 0.60]. In multivariate analysis, overweight [OR adjusted = 3.20 (95%: 1.19-8.61), p = 0.02] and CKD [2.49 (0,98-6.34; 0.05] were found as major determinants of hypertension. Conclusion: The metabolic syndrome is poorly predictive of an absolute decrease in insulin sensitivity in a type 2 diabetes population, in which the prevalence of hypertension was high, and that of insulin resistance low. Overweight independently of insulin resistance and chronic kidney disease common in type 2 diabetes in Sub-Saharan Africa in which the disease is poorly controlled may play a major role in the determinism of hypertensio

Relationship between waist circumference, visceral fat and metabolic syndrome in a Congolese community: Further research is still to be undertaken

Introduction: The criteria of positivity of waist circumference to define the metabolic syndrome as currently recommended for the population of sub-Saharan Africa do not take into account specific ethnic or regional variation. Methods: The predictive value of different values of waist circumference compared with visceral fat as determined by OMRON BF510 body composition in 360 indigenous patients from Bukavu city between June 1, 2010 and May 30, 2011 was studied. Results: The prevalence was higher in women for enlarged waist circumference according to the pathological IDF or NCEP/ATP III threshold (p < 0.0001) contrasting with lower rates for pathological accumulation of visceral fat in men (p = 0.0001). The highest values for sensitivity and specificity were obtained for a threshold value of 95 cm for men (sensitivity = 72.4%, specificity = 91.1%, area under the curve (99% CI) = 0.899 (0.833 to 0.965)) and 99 cm in women (sensitivity = 75.0%, specificity = 78.3%, AUC (99% CI) = 0.844 (0.777 to 0.911)). This test also showed an independent effect on the probability of accumulation of visceral fat (Odd adjusted OR = 5.0 (99% CI: 2.1 to 11.7), p <0.0001) after adjustment for other confounding factors. Conclusion: The threshold value for pathological waist circumference currently used for black African populations may overpredict abdominal fat excess in women. Further studies are needed to provide adequate cutoffs in sub-Saharan populations. © Philippe Bianga Katchunga et al

Ferroportin Q248H mutation, hyperferritinemia and atypical type 2 diabetes mellitus in South Kivu

Background: The ferroportin Q248H mutation is relatively common in sub-Saharan Africa. No previous study examined its relationship with atypical diabetes mellitus (DM) in this area. Objective: To determine the potential interactions between ferroportin Q248H mutation, hyperferritinemia and DM in South Kivu (RDC). Methodology: Presence of ferroportin Q248H mutation and iron status were investigated in diabetic patients (n = 179, age (mean) 57.7 years, CRP (median) 0.16 mg/L) and non-diabetic subjects (n = 86, age 44.5 years, CRP 0.07 mg/L) living in the city of Bukavu. Hyperferritinemia was considered for values greater than 200 and 300 μg/L in women and in men, respectively. Results: The prevalence of ferroportin Q248H mutation [12.1%] was non-significantly higher in diabetics than non-diabetics [14.0% vs. 8.1%, p = 0.17]. Similarly, hyperferritinemia frequency was higher in diabetic patients with Q248H mutation [44.0% vs. 14.3%, p = 0.16] and in mutation carriers [37.0% vs 16.5%, p = 0.001] than in the control groups, respectively. The association between Q248H mutation and DM was nevertheless not significant [adjusted OR 1.70 (95% CI: 0.52-5.58), p = 0.37], whereas hyperferritinemia [OR 2.72 (1.24-5.98), p = 0.01] showed an independent effect after adjustment for age and metabolic syndrome. Conclusions: The present work suggests a potential association between abnormal iron metabolism, ferroportin Q248H mutation and atypical DM in Africans, which may be modulated by environmental factors. © 2013 Diabetes India. Published by Elsevier Ltd. All rights reserved

The trend in blood pressure and hypertension prevalence in the general population of South Kivu between 2012 and 2016: Results from two representative cross-sectional surveys-The Bukavu observational study.

ObjectiveData on blood pressure trends are scarce or unavailable in Sub-Saharan Africa in general and especially in the Democratic Republic of the Congo. This work addresses this gap by analyzing the dynamics in the prevalence and control of hypertension in a cohort of Congolese adults in South Kivu.MethodsTwo phases of data collection were conducted including a baseline at the beginning in 2012 and a follow up in 2016. The subjects were ≥ 18 years old living in urban (n = 4413) or rural areas (n = 6453). Hypertension was defined as a blood pressure ≥ 140/90 mmHg and/or taking antihypertensive medications. The crude prevalence of hypertension was age-adjusted to the WHO population.ResultsBetween 2012 and 2016, there was a significant increase in blood pressure (+2.5/+1.4 mmHg; p = 0.001), age standardized prevalence of hypertension [19.0% vs. 18.0%; OR = 1.05 (1.02-1.08); p 60 years old (8.8% to 11.3%; pConclusionThere was an increase in the prevalence of hypertension as well as cardiovascular-associated risk factors in the population. However, this trend did not increase for treated subjects with no improvements in the level of AHT control. Therefore, improved strategies for the prevention and management of non-communicable diseases are very important in Sub-Saharan Africa

Age and living in an urban environment are major determinants of diabetes among South Kivu Congolese adults

OBJECTIVES: This study aimed to determine the risk factors for diabetes mellitus (DM) in the eastern part of the Democratic Republic of Congo. METHODOLOGY: Multilevel sampling identified 200 households (444 adults aged ≥ 20 years) from 20 neighbourhoods in the city of Bukavu, and 90 households (255 adults aged ≥ 20 years) from 10 villages in the Kaziba (South Kivu) chiefdom (the South Kivu VITARAA study). DM was defined as a personal history of the disorder or a casual glycaemia greater or equal to 200 mg/dL. Standardization according to age and sample readjustment based on the urban-rural distribution of the population was applied accordance with the typical Congolese population. The probability of DM was assessed by multiple logistic regressions. RESULTS: Total prevalence of DM was 3.5%. DM was significantly more prevalent in urban areas (age-standardized prevalence: 4.0%) than in rural areas (1.7%). City-dwelling DM patients were characterized by higher rates of indices of abdominal obesity (P < 0.05) whereas, in rural areas, no patients were obese. In the study group as a whole, only 25.0% of diabetic patients were obese. On multivariate analyses, only age [adjusted OR (95% CI): 4.79 (1.60-14.25); P = 0.004] was independently associated with the prevalence of DM, while the effect of obesity was not significant [2.64 (0.99-7.02); P = 0.051]. CONCLUSION: Age and living in an urban environment appeared to be major determinants of DM in South Kivu. Also, obesity prevalence was relatively low in these diabetic patients, confirming the peculiar, relatively lean, phenotype of type 2 DM in indigenous sub-Saharan African

Hypertension artérielle chez l'adulte Congolais du Sud Kivu: Résultats de l'étude Vitaraa

Objective: To assess the prevalence of cardiovascular risk factors in adult urban and rural Congolese subjects. Methods: We obtained anthropometric data and information on life habits and medical history in 699 people ≥ 20. years, 444 in an urban, 255 in a rural setting. We determined the body mass index and recorded two blood pressure measurements that were averaged for analysis. Hypertension was BP ≥ 140/90. mmHg, awareness and/or use of antihypertensive treatment. Diabetes mellitus was self-reported diagnosis or a casual glycemia ≥ 200. mg/dL. We assessed the probability of hypertension in stepwise multiple logistic analysis, and awareness, and control of hypertension. Results: We found higher (P 55. years: 2.35; P< 0.001), overweight/obesity (2.22; P< 0.001) and diabetes mellitus (2.67; P< 0.05). Conclusions: Our results indicate a heavy burden of uncontrolled risk factors in the Congolese population the potential complications of which run at a high mortality rate. They highlight the need for reasonable prevention measures at the population level. © 2011.SCOPUS: ar.jinfo:eu-repo/semantics/publishe