Evaluation of waist-to-height ratio to predict 5 year cardiometabolic risk in sub-Saharan African adults

Simple, low-cost central obesity measures may help identify individuals with increased cardiometabolic disease risk, although it is unclear which measures perform best in African adults. We aimed to: 1) cross-sectionally compare the accuracy of existing waist-to-height ratio (WHtR) and waist circumference (WC) thresholds to identify individuals with hypertension, pre-diabetes, or dyslipidaemia; 2) identify optimal WC and WHtR thresholds to detect CVD risk in this African population; and 3) assess which measure best predicts 5-year CVD riskPeer reviewedFinal Accepted Versio

Attenuated brain-derived neurotrophic factor and hypertrophic remodelling: the SABPA study

Brain-derived neurotrophic factor (BDNF) has been linked to neurological pathologies, but its role in cardiometabolic disturbances is limited. We aimed to assess the association between serum BDNF levels and structural endothelial dysfunction (ED) as determined by cross-sectional wall area (CSWA) and albumin/creatinine ratio (ACR) in black Africans. Ambulatory blood pressure (BP) and ultrasound CSWA values were obtained from 82 males and 90 females. Fasting blood and 8 h overnight urine samples were collected to determine serum BDNF and cardiometabolic risk markers, that is, glycated haemoglobin (HbA1c), lipids, inflammation and ACR. BDNF median split × gender interaction effects for structural ED justified stratification of BDNF into low and high ($\le$/$\gt$1.37 ng ml$^{−1}$) gender groups. BDNF values (0.86–1.98 ng ml−1) were substantially lower than reference ranges (6.97–42.6 ng ml−1) in the African gender cohort, independent of age and body mass index. No relationship was revealed between BDNF and renal function and was opposed by an inverse relationship between BDNF and CSWA (r=−0.17; P=0.03) in the African cohort. Linear regression analyses revealed a positive relationship between systolic BP and structural remodelling in the total cohort and low-BDNF gender groups. In the high-BDNF females, HbA1C was associated with structural remodelling. Attenuated or possible downregulated BDNF levels were associated with hypertrophic remodelling, and may be a compensatory mechanism for the higher BP in Africans. In addition, metabolic risk and hypertrophic remodelling in women with high BDNF underpin different underlying mechanisms for impaired neurotrophin homeostasis in men and women

Defensive coping facilitates higher blood pressure and early sub–clinical structural vascular disease via alterations in heart rate variability: the SABPA study

Objectives: Defensive coping (AC) responses in urban African males have been associated with vascular responsiveness, partly explaining autonomic nervous system dysfunction. We therefore aimed to assess whether AC responses facilitate higher blood pressure and early sub-clinical structural vascular disease via alterations in frequency- and time-domain heart rate variability (HRV) responses. Methods:We included 355 African and Caucasian men and women without pre-existing atrial fibrillation, aged 45 9 years. Significant interaction on main effects (coping ethnicity gender) for left carotid intima media thickness far wall (L-CIMTf) and cross sectional wall area values necessitated selection of AC responders above mean via the Coping Strategy Indicator. We collected B-mode ultrasound L-CIMTf, ambulatory BP andeHRV data. Overnight fasting blood was obtained. Results: Overall, Africans and AC Africans, mostly men, revealed a poorer lifestyle profile, higher prevalence of hypertensive status, disturbed sympathovagal balance and depressed HRV temporal and geometric patterns compared to the Caucasians (P 0.05). Moderately depressed non-linear and timedomain HRV (SDNN <100 ms) was prevalent in 28% of Africans compared to 11% of Caucasians. A similar trend was shown for the AC African participants (32%) compared to Caucasians (16%). Only depressed HRV time-domain (SDNN: adj. R2 ¼ 0.34; b ¼ 0.24; p ¼ 0.08) and vagal-impaired heart rate responses (RMSSD: adj. R2 ¼ 0.28; b ¼ 0.28; p < 0.05) were associated with higher blood pressure and early structural vascular changes in AC African men. Conclusion: Defensive coping facilitated autonomic nervous system dysfunction, which was associated with higher blood pressure and sub-clinical structural vascular disease in an African male cohort.http://www.journals.elsevier.com/atherosclerosis

Tuberculosis reinfection rate as a proportion of total infection rate correlates with the logarithm of the incidence rate: a mathematical model

In a significant number of instances, an episode of tuberculosis can be attributed to a reinfection event. Because reinfection is more likely in high incidence regions than in regions of low incidence, more tuberculosis (TB) cases due to reinfection could be expected in high-incidence regions than in low-incidence regions. Empirical data from regions with various incidence rates appear to confirm the conjecture that, in fact, the incidence rate due to reinfection only, as a proportion of all cases, correlates with the logarithm of the incidence rate, rather than with the incidence rate itself. A theoretical model that supports this conjecture is presented. A Markov model was used to obtain a relationship between incidence and reinfection rates. It was assumed in this model that the rate of reinfection is a multiple, ρ (the reinfection factor), of the rate of first-time infection, λ. The results obtained show a relationship between the proportion of cases due to reinfection and the rate of incidence that is approximately logarithmic for a range of values of the incidence rate typical of those observed in communities across the globe. A value of ρ is determined such that the relationship between the proportion of cases due to reinfection and the logarithm of the incidence rate closely correlates with empirical data. From a purely theoretical investigation, it is shown that a simple relationship can be expected between the logarithm of the incidence rates and the proportions of cases due to reinfection after a prior episode of TB. This relationship is sustained by a rate of reinfection that is higher than the rate of first-time infection and this latter consideration underscores the great importance of monitoring recovered TB cases for repeat disease episodes, especially in regions where TB incidence is high. Awareness of this may assist in attempts to control the epidemic

Conservation and monitoring of invertebrates in terrestrial protected areas

Invertebrates constitute a substantial proportion of terrestrial and freshwater biodiversity and are critical to ecosystem function. However, their inclusion in biodiversity monitoring and conservation planning and management has lagged behind better-known, more widely appreciated taxa. Significant progress in invertebrate surveys, systematics and bioindication, both globally and locally, means that their use in biodiversity monitoring and conservation is becoming increasingly feasible. Here we outline challenges and solutions to the integration of invertebrates into biodiversity management objectives and monitoring in protected areas in South Africa. We show that such integration is relevant and possible, and assess the relative suitability of seven key taxa in this context. Finally, we outline a series of recommendations for mainstreaming invertebrates in conservation planning, surveys and monitoring in and around protected areas. Conservation implications: Invertebrates constitute a substantial and functionally significant component of terrestrial biodiversity and are valuable indicators of environmental condition. Although consideration of invertebrates has historically been neglected in conservation planning and management, substantial progress with surveys, systematics and bioindication means that it is now both feasible and advisable to incorporate them into protected area monitoring activities.Centre of Excellence for Invasion Biolog