Adiposity Phenotypes and Subclinical Atherosclerosis in Adults from Sub–Saharan Africa: An H3Africa AWI–Gen Study
Engelbert A. Nonterah,
Michiel L. Bots,
Abraham Oduro,
Godfred Agongo,
Cassandra C. Soo,
Lisa K. Micklesfield,
Felistas Mashinya,
Palwendè R. Boua,
Shukri F. Mohamed,
Alisha N. Wade,
Catherine Kyobutungi,
Halidou Tinto,
Shane A. Norris,
Stephen M. Tollman,
Michèle Ramsay,
Diederick E. Grobbee,
Kerstin Klipstein-Grobusch,
Nigel J. Crowther,
on behalf of the AWI–Gen and the H3Africa Consortium
Affiliations
Engelbert A. Nonterah
Clinical Sciences Department, Navrongo Health Research Centre, Ghana Health Service, Navrongo, GH; Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht
Michiel L. Bots
Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht
Abraham Oduro
Clinical Sciences Department, Navrongo Health Research Centre, Ghana Health Service, Navrongo
Godfred Agongo
Clinical Sciences Department, Navrongo Health Research Centre, Ghana Health Service, Navrongo
Cassandra C. Soo
Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
Lisa K. Micklesfield
SAMRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
Felistas Mashinya
Dikgale Health Demographic Surveillance Site, Department of Pathology and Medical Sciences, School of Health Care Sciences, Faculty of health Sciences, University of Limpopo, Polokwane
Palwendè R. Boua
Institut de Research en Sciences de la Santé, Clinical Research Unit of Nanoro, Nanoro
Shukri F. Mohamed
African Population and Health Research Centre (APHRC), Nairobi
Alisha N. Wade
SAMRC Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
Catherine Kyobutungi
African Population and Health Research Centre (APHRC), Nairobi
Halidou Tinto
Institut de Research en Sciences de la Santé, Clinical Research Unit of Nanoro, Nanoro
Shane A. Norris
SAMRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
Stephen M. Tollman
SAMRC Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
Michèle Ramsay
Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
Diederick E. Grobbee
Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht
Kerstin Klipstein-Grobusch
Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, NL; Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
Nigel J. Crowther
Department of Chemical Pathology, National Health Laboratory Service, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
on behalf of the AWI–Gen and the H3Africa Consortium
Background: Obesity and adipose tissue distribution contribute to an increased risk of cardiovascular disease (CVD) by promoting atherosclerosis. This association has been poorly studied in sub–Saharan Africa (SSA) despite the rising prevalence of cardiovascular disease. Objectives: We determined the association between various adiposity phenotypes and carotid intima–media thickness (CIMT), a proxy of subclinical atherosclerosis, in a large SSA population. Methods: A population–based cross–sectional study was performed from 2013–2016 in Burkina Faso, Ghana, Kenya and South Africa. Body mass index (BMI), waist (WC), hip circumferences (HC), visceral (VAT) and subcutaneous adipose tissue (SCAT) using B-mode ultrasound were measured. Ultrasonography of left and right far wall CIMT of the common carotid artery was used as an indicator of subclinical atherosclerosis. Individual participant data meta–analyses were used to determine the associations between adiposity phenotypes and CIMT in the pooled sample while adjusted multivariable linear regression analyses were used for site specific analyses. Results: Data were obtained from 9,010 adults (50.3% women and a mean age of 50± 6years). Men had higher levels of visceral fat than women while women had higher BMI, waist and hip circumference and subcutaneous fat than men at all sites except Burkina Faso. In the pooled analyses, BMI (â–value [95% CIs]: 19.5 [16.8, 22.3] ìm) showed the strongest relationship with CIMT followed by VAT (5.86 [4.65, 7.07] ìm), SCAT (5.00 [2.85, 7.15] ìm), WC (1.27 [1.09, 1.44] ìm) and HC (1.23 [1.04, 1.42] ìm). Stronger associations were observed in men than in women. Conclusion: Obesity within SSA will likely result in higher levels of atherosclerosis and promote the occurrence of cardio- and cerebrovascular events, especially in males, unless addressed through primary prevention of obesity in both rural and urban communities across Africa. The inverse association of VAT with CIMT in Burkina Faso and Ghana requires further investigation. Highlights All adiposity phenotypes were positively associated with common carotid intima–media thickness (CIMT) in the entire cohort (pooled analyses). BMI had the strongest association with CIMT compared to other phenotypes. The magnitude of association between adiposity phenotypes and CIMT was higher in men than in women. Subcutaneous adipose tissue was inversely associated with CIMT only in women. An unexpected finding was the inverse association of visceral adipose tissue with CIMT in Burkina Faso and Ghana.
