Évolution du risque cardiométabolique sur une période de quatre ans : étude chez des adultes béninois (Afrique de l’Ouest)

Les objectifs de l’étude de l’évolution du risque cardiométabolique (RCM) sur une période de quatre ans (2006-2010) chez des adultes béninois consistaient à: • Examiner les relations entre l’obésité abdominale selon les critères de la Fédération Internationale du Diabète (IFD) ou l’insulino-résistance mesurée par le Homeostasis Model Assessment (HOMA) et l’évolution des autres facteurs de RCM, • Examiner les liens entre les habitudes alimentaires, l’activité physique et les conditions socio-économiques et l’évolution du RCM évalué conjointement par le score de risque de maladies cardiovasculaires de Framingham (FRS) et le syndrome métabolique (SMet). Les hypothèses de recherche étaient: • L’obésité abdominale telle que définie par les critères de l’IDF est faiblement associée à une évolution défavorable des autres facteurs de RCM, alors que l’insulino-résistance mesurée par le HOMA lui est fortement associée; • Un niveau socioéconomique moyen, un cadre de vie peu urbanisé (rural ou semi-urbain), de meilleures habitudes alimentaires (score élevé de consommation d’aliments protecteurs contre le RCM) et l’activité physique contribuent à une évolution plus favorable du RCM. L’étude a inclus 541 sujets âgés de 25 à 60 ans, apparemment en bonne santé, aléatoirement sélectionnés dans la plus grande ville (n = 200), une petite ville (n = 171) et sa périphérie rurale (n = 170). Après les études de base, les sujets ont été suivis après deux et quatre ans. Les apports alimentaires et l’activité physique ont été cernés par deux ou trois rappels de 24 heures dans les études de base puis par des questionnaires de fréquence simplifiés lors des suivis. Les données sur les conditions socioéconomiques, la consommation d’alcool et le tabagisme ont été recueillies par questionnaire. Des mesures anthropométriques et la tension artérielle ont été prises. La glycémie à jeun, l’insulinémie et les lipides sanguins ont été mesurés. Un score de fréquence de consommation d’« aliments sentinelles » a été développé et utilisé. Un total de 416 sujets ont participé au dernier suivi. La prévalence initiale du SMet et du FRS≥10% était de 8,7% et 7,2%, respectivement. L’incidence du SMet et d’un FRS≥10% sur quatre ans était de 8,2% et 5%, respectivement. Le RCM s’était détérioré chez 21% des sujets. L’obésité abdominale définie par les valeurs seuils de tour de taille de l’IDF était associée à un risque plus élevé d’insulino-résistance: risque relatif (RR) = 5,7 (IC 95% : 2,8-11,5); d’un ratio cholestérol total/HDL-Cholestérol élevé: RR = 3,4 (IC 95% : 1,5-7,3); mais elle n’était pas associée à un risque significativement accru de tension artérielle élevée ou de triglycérides élevés. Les valeurs seuils de tour de taille optimales pour l’identification des sujets accusant au moins un facteur de risque du SMet étaient de 90 cm chez les femmes et de 80 cm chez les hommes. L’insulino-résistance mesurée par le HOMA était associée à un risque élevé d’hyperglycémie: RR = 5,7 (IC 95% : 2,8-11,5). En revanche, l’insulino-résistance n’était pas associée à un risque significatif de tension artérielle élevée et de triglycérides élevés. La combinaison de SMet et du FRS pour l’évaluation du RCM identifiait davantage de sujets à risque que l’utilisation de l’un ou l’autre outil isolément. Le risque de détérioration du profil de RCM était associé à un faible score de consommation des «aliments sentinelles» qui reflètent le caractère protecteur de l’alimentation (viande rouge, volaille, lait, œufs et légumes): RR = 5,6 (IC 95%: 1,9-16,1); et à l’inactivité physique: RR = 6,3 (IC 95%: 3,0-13,4). Les sujets de niveau socioéconomique faible et moyen, et ceux du milieu rural et semi-urbain avaient un moindre risque d’aggravation du RCM. L’étude a montré que les relations entre les facteurs de RCM présentaient des particularités chez les adultes béninois par rapport aux Caucasiens et a souligné le besoin de reconsidérer les composantes du SMet ainsi que leurs valeurs seuils pour les Africains sub-sahariens. La détérioration rapide du RCM nécessité des mesures préventives basées sur la promotion d’un mode de vie plus actif associé à de meilleures habitudes alimentaires.The objectives of this study on four-year trends (2006-2010) in cardiometabolic risk (CMR) in Benin adults were: • To examine whether abdominal obesity according to International Diabetes Federation (IDF) waist circumference cut-offs, or insulin resistance measured by the homeostasis model assessment (HOMA) was associated with more unfavourable changes in other CMR factors, • To examine the effects of diet, physical activity and socioeconomic status including place of residence on the evolution of CMR assessed by both the Framingham risk score for cardiovascular diseases (FRS) and the metabolic syndrome (MetS). We hypothesized that: • Abdominal obesity as currently defined by IDF anthropometric criteria is weakly associated with unfavourable changes in other CMR factors while IR exacerbates other CMR factors in sub-Saharan Africans, • Medium income status, less urbanized place of residence (rural or semi-urban), physical activity and healthy eating patterns (higher score of consumption of foods that may protect against CMR) contribute to more favourable evolution of CMR. The study included initially 541 apparently healthy adults aged 25-60 years and randomly selected in a large city (n = 200), a small town (n = 171) and its surrounding rural area (n = 170). After baseline survey, subjects were followed-up after two and four years. Dietary intake and physical activity were assessed by two or three 24-hour recalls in baseline studies and then by short frequency questionnaires at follow-ups. Data on alcohol intake and smoking patterns were collected in personal interviews. Anthropometric data, blood pressure, insulin resistance based on homeostasis model assessment (HOMA), blood glucose and blood lipids were measured. Education, income (proxy) and place of residence were the socioeconomic variables appraised in interviews. A food score based on consumption frequency of “sentinel foods” was developed and used. Complete data at last follow-up was available in 416 subjects. Baseline prevalence of MetS and FRS ≥ 10% was 8.7% and 7.2%, respectively. The incidence of MetS, and a FRS ≥ 10% over four years was 8.2% and 5%, respectively. The CMR deteriorated in 21% of subjects. Abdominal obesity as defined by IDF thresholds of the waist circumference was associated with a higher likelihood of insulin resistance: relative risk (RR) = 5.7 (CI 95%: 2.8-11.5), high total cholesterol/HDL-Cholesterol ratio: RR = 3.4 (CI 95%: 1.5-7.3). However, abdominal obesity was not associated with a significantly increased risk of high blood pressure or high triglycerides. In the study population, the optimal cut-offs of waist circumference that predicted at least one component of MetS were 90 cm in women and 80 cm in men. Insulin resistance measured by HOMA was associated with an increased risk of hyperglycemia: RR = 5.7 (CI 95%: 2.8-11.5). However, the insulin resistance was not associated with a significant risk of high blood pressure and high triglycerides. The combination of MetS and the FRS depicted more at-risk subjects than the use of either tool alone. Diet and lifestyle mediated location and income effects on CMR evolution. Low “sentinel food” scores (foods that may reflect the protective effect of the diet against CMR): meat, poultry, milk and milk products, eggs and vegetables; and inactivity increased the likelihood of CMR deterioration: RR = 5.6 (CI 95%: 1.9-16.4) and RR = 6.3 (CI 95%: 3.0-13.4), respectively. Subjects with medium or low socioeconomic levels, and those living in the rural and semi-urban areas had a lower risk of CMR deterioration. The study showed some differences in the relationship between abdominal obesity, insulin resistance and other CMR factors in Blacks compared to Caucasians and it also highlighted the need to reconsider MetS components and their cut-offs for sub-Saharan Africans. Combining MetS and FRS might be appropriate for surveillance purposes in order to better capture CMR. The results of the present study call for urgent measures to reduce CMR deterioration focusing on more active lifestyle and dietary inadequacies

Four-Year Trends in Cardiometabolic Risk Factors according to Baseline Abdominal Obesity Status in West-African Adults: The Benin Study

The study examined whether abdominal obesity (AO) according to waist circumference was associated with more unfavourable changes in other cardiometabolic risk (CMR) factors in sub-Saharan Africans. The study included 541 randomly selected and apparently healthy subjects (50% women) aged 25–60 years. Complete data at baseline, 24, and 48 months later was available in 366 subjects. AO was associated with higher CMR at baseline and over the follow-up period, except for high blood pressure. A significantly higher incidence of high ratio of total cholesterol : HDL-cholesterol (TC/HDL-C) was associated with AO. Controlling for WC changes, age, baseline diet, and lifestyles, the relative risk (RR) of low HDL-C and high TC/HDL-C was 3.2 (95% CI 1.06–9.61) and 7.4 (95% CI 2.01–25.79), respectively, in AO men; the RR was not significant in women. Over a four-year period, AO therefore appeared associated with an adverse evolution of cholesterolemia in the study population

Performances comparées du HDL-cholestérol et du ratio cholestérol total/HDL pour le dépistage du syndrome métabolique chez des adultes du Sud-Bénin (Afrique de l’Ouest)

Les critères de définition du Syndrome métabolique (SMet) n’identifient pas convenablement les sujets d’origine africaine à risque. L’objectif était de déterminer lequel du ratio cholestérol total/HDL-cholestérol (CT/HDL-C) et du HDL-Cholestérol est le meilleur prédicteur du SMet chez les adultes béninois. L’étude de type transversal, issue d’une enquête longitudinale sur le risque cardiométabolique a inclu 416 sujets âgés de 29 à 69 ans. Les composantes du SMet considérées sont : l’obésité abdominale, la tension artérielle élevée, la glycémie élevée, le HDL-C bas et les triglycérides élevés. La comparaison des aires sous les courbes (AUC) de la « fonction d’efficacité du récepteur » (ROC) de prédiction de l’existence deux composantes du SMet autre que l’obésité abdominale, a permis de déterminer le meilleur prédicteur. Les prévalences du SMet étaient de 13,9% selon la définition harmonisée, 12,3% lorsque le HDL-C bas est remplacée par CT/HDL-C élevé. Les prévalences du HDL-bas et du CT/HDL-C élevé sont de 37,7% et 22,6%, respectivement. Pour le dépistage du SMet, l’AUC du CT/HDL-C est de 0,69 (IC 95% 0,61-0,77) chez les femmes et 0,68 (IC 95% 0,59-0,77) chez les hommes. L’AUC du HDL-C est de 0,45 (IC 95% 0,37-0,53) chez les femmes et 0,40 (IC 95% 0,30-0,44) chez les hommes. Le HDL-C et le CT/HDL-C ont une faible capacité prédictive pour le SMet, mais la composante CT/HDL-C prédit mieux le SMet que le HDL-C isolé. Toutefois, l’utilisation de l’un ou l’autre des deux paramètres ne modifie pas substantiellement la prévalence du SMet dans la population d’étude.© 2016 International Formulae Group. All rights reserved.Mots clés: Syndrome métabolique, lipoprotéines, ratio CT/HDL-C, Sud-BéninEnglish Title: Comparative performance of HDL-cholesterol and total cholesterol / HDL ratio for screening of metabolic syndrome in Southern Benin adults (West Africa)English AbstractCurrent definition criteria of the metabolic syndrome (MetS) do not adequately identify at risk African origin subjects. The objective was to determine which of total cholesterol/HDL-cholesterol (TC/HDL-C) and HDL-cholesterol is the best predictor of metabolic syndrome (SMet) in Benin adults. This cross-sectional study was nested in a four-year follow-up study on cardiometabolic risk factors and included 416 adults aged 29-69 years. Components of MetS considered were abdominal obesity, high blood pressure (BP), high fasting glucose, low HDL-C and high triglycerides. Areas under the "Receiver operator characteristic" curves (AUC)for CT/HDL-C and HDL-C in predicting the presence of at least two other components of SMet were compared in order to determine the best predictor of SMet. The prevalence of SMet was 13.9%, when replacing low HDL-C by high TC/HDL-C and 15.3% when both dyslipidemia indicators are combined. The prevalence of low HDL-C and high TC/HDL-C was 37.7% and 22.6%, respectively (p<0.001). Screening for SMet, the AUC of TC/HDL-C were 0.69 (95% CI 0.61-0.77) for women and 0.68 (95% CI 0.59-0.77) in men. The AUC of HDL-C were 0.45 (95% CI 0.37-0.53) for women and 0.40 (95% CI 0.30-0.44) for men. Both TC/HDL-C and HDL-C showed some weak predictive values for SMet, but TC/HDL-C ratio predicted SMet better than HDL-C.© 2016 International Formulae Group. All rights reserved.Keywords: Metabolic syndrome, lipoprotein, ratio CT/HDL-C, Southern Beni

Factors associated with early sexual intercourse among teenagers and young adults in rural south of Benin

Early initiation to sexual intercourse increases the risk of sexually transmitted infections including HIV/AIDS and early or unwanted pregnancies. This study aimed identifying the factors associated with the early initiation to sexual intercourse among teenagers and young adults aged 10-24, in the south of Benin. A cross-sectional study was conducted in the south of Benin where 360 respondents were selected by random cluster sampling. Multiple logistic regressions was used to find related factors to early sexual intercourse. The significance level for the tests was of 5%. The average reported age of initiation to sexual intercourse was 14.75±2.18. Among the male teenagers and young adults, 41.11% had an early sexual intercourse against 20.24% for the female gender (P<10-3). The lack of communication between parents-teenagers (P=0.003), level of education of the father (P=0.021), exposure to pornographic movies (P=0.025), an adverse opinion on premarital sexual abstinence (P=0.026) were significantly associated with early sexual intercourse. Communication about health promotion for behavioural change may contribute to delay the age of sexual initiation

Towards adequate food environment in Benin public primary schools, the challenge of food supply and hygiene practices: a case study of three municipalities

Background and aim: School food environment is a component of food system which provides the opportunity to implement interventions that lead to better nutrition. This study aimed to describe two of the five components of food environment notably food supply and food safety through hygiene practices in schools inside Cotonou, Abomey-Calavi and Sèmè-Kpodji, in Benin country. Methods: Twelve schools were randomly selected from a sampling frame of all public primary schools with canteens and that have space for school gardens and closer to the market garden sites. In the selected schools, we assessed the diversity of the Food Supply using Food Group Score (FGS) and Hygiene practices using the Summary Hygiene Index (SHI). Data were mainly collected using semi-structured questionnaire administered to foods cookers/ vendors and by observation within schools. Fifteen food groups were considered to determine the FGS and 15 for SHI. Wilcoxon test was used to compare scores among urban and peri-urban areas. Results: Food supply appeared to be limited in 9 schools (FGS< 8) over the 12 with no significant difference between periurban and urban zone (p-value = 0.72). The most represented food group which was available in all schools are cereals, legumes, nuts, seeds, followed by sweet foods and drink while others groups (source of vitamin A and micronutrients) are poorly represented. It appears in all schools a low variability of food within each group. Basically, 8 schools out of 12 have a SHI lower than the median score (08) and the urban zone has a SHI (SHI = 9.5 ± 1.29) higher than peri-urban (SHI = 6.5 ± 1.18) with p-value = 0.015. Conclusions: The food supply is not very diversified in public primary schools and hygiene practices need to be improved for a healthy food environment around schools

Sociodemographic and Nutritional Factors Associated with Adherence to Antiretroviral Therapy in PLWHA in Benin

Abstract Adherence to antiretroviral treatment (ART) is critical for suppression of viral replication, repletion of CD

Determinants of Adherence to Recommendations of the Dietary Approach to Stop Hypertension in Adults with Hypertension Treated in a Hospital in Benin

Abstract The dietary approach to stop hypertension (DASH) is an effective nutritional strategy to prevent and treat cardiovascular disease. Optimal benefit from dietary recommendations in management of hypertension depends on the compliance. This analytic cross sectional study aimed at establishing determinants of DASH among adults with hypertension treated at hospital in Benin. The study included 150 hypertensive adults selected during medical visit for blood pressure monitoring at hospital Saint-Luc in Cotonou from June 3 rd to July 1 st , 2014. Data on consumption of sodium, fruits and vegetables, alcohol, saturated and trans fat rich products were collected by questionnaire. A score of adherence to DASH was built. Determinants of adherence to DASH were identified using logistic regression model. Only 20% of subjects showed adherence to DASH. Better knowledge on hypertension OR=5.18 (95%IC 1.98-13.22) and healthy dietary habits and lifestyle prior to diagnosis of hypertension OR=4.26 (95%IC 1.67-13.18) increased the likelihood of adherence to dietary recommendations for hypertension management. Nutrition education and information of patients on hypertension and its complications during medical consultations may increase their adherence to dietary recommendations for management of the disease

Trends in obesity and diabetes across Africa from 1980 to 2014: an analysis of pooled population-based studies

Background: The 2016 Dar Es Salaam Call to Action on Diabetes and Other non-communicable diseases (NCDs) advocates national multi-sectoral NCD strategies and action plans based on available data and information from countries of sub-Saharan Africa and beyond. We estimated trends from 1980 to 2014 in age-standardized mean body mass index (BMI) and diabetes prevalence in these countries, in order to assess the co-progression and assist policy formulation. Methods: We pooled data from African and worldwide population-based studies which measured height, weight and biomarkers to assess diabetes status in adults aged ≥ 18 years. A Bayesian hierarchical model was used to estimate trends by sex for 200 countries and territories including 53 countries across five African regions (central, eastern, northern, southern and western), in mean BMI and diabetes prevalence (defined as either fasting plasma glucose of ≥ 7.0 mmol/l, history of diabetes diagnosis, or use of insulin or oral glucose control agents). Results: African data came from 245 population-based surveys (1.2 million participants) for BMI and 76 surveys (182 000 participants) for diabetes prevalence estimates. Countries with the highest number of data sources for BMI were South Africa (n = 17), Nigeria (n = 15) and Egypt (n = 13); and for diabetes estimates, Tanzania (n = 8), Tunisia (n = 7), and Cameroon, Egypt and South Africa (all n = 6). The age-standardized mean BMI increased from 21.0 kg/m2 (95% credible interval: 20.3–21.7) to 23.0 kg/m2 (22.7–23.3) in men, and from 21.9 kg/m2 (21.3–22.5) to 24.9 kg/m2 (24.6–25.1) in women. The age-standardized prevalence of diabetes increased from 3.4% (1.5–6.3) to 8.5% (6.5–10.8) in men, and from 4.1% (2.0–7.5) to 8.9% (6.9–11.2) in women. Estimates in northern and southern regions were mostly higher than the global average; those in central, eastern and western regions were lower than global averages. A positive association (correlation coefficient ≃ 0.9) was observed between mean BMI and diabetes prevalence in both sexes in 1980 and 2014. Conclusions: These estimates, based on limited data sources, confirm the rapidly increasing burden of diabetes in Africa. This rise is being driven, at least in part, by increasing adiposity, with regional variations in observed trends. African countries’ efforts to prevent and control diabetes and obesity should integrate the setting up of reliable monitoring systems, consistent with the World Health Organization’s Global Monitoring System Framework