Victoire Agueh

Obesity and cardio-metabolic risk factors in urban adults of Benin: Relationship with socio-economic status, urbanisation, and lifestyle patterns

BackgroundThere is a dearth of information on diet-related chronic diseases in West Africa. This cross-sectional study assessed the rate of obesity and other cardiovascular disease (CVD) risk factors in a random sample of 200 urban adults in Benin and explored the associations between these factors and socio-economic status (SES), urbanisation as well as lifestyle patterns.MethodsAnthropometric parameters (height, weight and waist circumference), blood pressure, fasting plasma glucose, and serum lipids (HDL-cholesterol and triglycerides) were measured. WHO cut-offs were used to define CVD risk factors. Food intake and physical activity were assessed with three non-consecutive 24-hour recalls. Information on tobacco use and alcohol consumption was collected using a questionnaire. An overall lifestyle score (OLS) was created based on diet quality, alcohol consumption, smoking, and physical activity. A SES score was computed based on education, main occupation and household amenities (as proxy for income).ResultsThe most prevalent CVD risk factors were overall obesity (18%), abdominal obesity (32%), hypertension (23%), and low HDL-cholesterol (13%). Diabetes and hypertriglyceridemia were uncommon. The prevalence of overall obesity was roughly four times higher in women than in men (28 vs. 8%). After controlling for age and sex, the odds of obesity increased significantly with SES, while a longer exposure to the urban environment was associated with higher odds of hypertension. Of the single lifestyle factors examined, physical activity was the most strongly associated with several CVD risk factors. Logistic regression analyses revealed that the likelihood of obesity and hypertension decreased significantly as the OLS improved, while controlling for potential confounding factors.ConclusionOur data show that obesity and cardio-metabolic risk factors are highly prevalent among urban adults in Benin, which calls for urgent measures to avert the rise of diet-related chronic diseases. People with higher SES and those with a longer exposure to the urban environment are priority target groups for interventions focusing on environmental risk factors that are amenable to change in this population. Lifestyle interventions would appear appropriate, with particular emphasis on physical activity.

Abdominal obesity explains the positive rural-urban gradient in the prevalence of the metabolic syndrome in Benin, West Africa

This cross-sectional study was designed to verify the hypothesis that there is a positive rural-urban gradient in the overall prevalence of the metabolic syndrome (MetS) and its components and that the differences are associated with socioeconomic status, a sedentary lifestyle, and poor diet quality. A sample of 541 Beninese adults apparently healthy was randomly selected from rural (n = 170), semi-urban (n = 171), and urban (n = 200) areas. The MetS was defined according to the International Diabetes Federation. Diet and physical activity were assessed with a 3-day recall. Socioeconomic and additional lifestyle information was obtained during personal interviews. A positive rural-urban gradient (rural to semi-urban to urban) was observed for the overall prevalence of the MetS (4.1%, 6.4%, and 11%, respectively; P = .035), which reflected that of abdominal obesity (28.2%, 41.5%, 52.5%; P < .001) but not for the other prominent features of the MetS, that is, high blood pressure (HBP; 24.1%, 21.6%, and 26.5%; P > .05) and reduced high-density lipoprotein cholesterol (HDL-C; 25.3%, 18.1%, 37.5%; P < .001). Diet quality and physical activity were higher in rural and semi-urban compared to urban subjects. Physical activity appeared protective for obesity, HBP, and low HDL-C. Micronutrient adequacy was an independent predictor of HDL-C and was associated with a lower likelihood of HBP. Socioeconomic status was positively associated with abdominal obesity only, which was more widespread in women than in men. This study shows that the nutrition transition is ongoing in Benin and suggests that cardiovascular disease risk could be reduced substantially by promoting physical activity and a more adequate diet.

Dietary patterns of urban adults in Benin: relationship with overall diet quality and socio-demographic characteristics

Objectives:To identify dietary patterns of urban Beninese adults and explore their links with overall diet quality and socio-demographics.Subjects and methods:A sample of 200 men and women aged 25–60 years was randomly selected in 10 neighbourhoods. Food intake was assessed through three non-consecutive 24 h food recalls. Dietary patterns were examined using cluster analysis. Diet quality was assessed based on diversity, a micronutrient adequacy score (MAS) and a healthfulness score (HS). Socio-demographics were documented using a questionnaire.Results:Two distinct dietary patterns emerged: a ‘traditional’ type (66% of the subjects) and a ‘transitional’ type (34%). Subjects with a ‘transitional diet’ were predominantly from the upper socioeconomic status or born in the city. Compared with the traditional type, the ‘transitional diet’ had a significantly higher percentage of energy from fat (17.6 vs 15.5%), saturated fat (5.9 vs 5.2%) and sugar (6.3 vs 5.0%). It was also significantly higher in cholesterol and lower in fibre. The ‘transitional diet’ was more diversified, but it also showed a lower HS than the ‘traditional diet’. Mean intake of fruit was low in both clusters (<16 g day−1). A higher intake of vegetables was associated with both a higher MAS (P<0.001) and a higher HS (P<0.001).Conclusions:The dietary transition is evidenced in this study, although both dietary patterns were still low in fat and sugar. Programmes focusing on the prevention of diet-related chronic diseases in this population should encourage the maintenance of the healthful elements of the diets, while emphasizing consumption of fruits and vegetables.

Physical Activity and Socioeconomic Status Explain Rural-Urban Differences in Obesity: a Cross-Sectional Study in Benin (West Africa)

To explore the relationships between obesity, socioeconomic status (SES), and physical activity (PA), we conducted a study with 341 subjects of a medium-size city of Benin and its semi-rural outskirts. PA was appraised with 24-hour recalls and SES, with a questionnaire. The overall prevalence of obesity (body mass index [BMI] ≥ 30), abdominal obesity (waist circumference) and elevated percent of body fat (%BF) were 10.6%, 23.8% and 20.2%, respectively. However, 14.6% were underweight (BMI < 18.5). Overweight (BMI ≥ 25) was significantly higher in urban than rural areas and in women than men. SES and PA were independently associated with obesity indicators, while urbanization variables were not.

Partnership research on nutrition transition and chronic diseases in West Africa - trends, outcomes and impacts.

BackgroundNutrition-related chronic diseases (NRCD) are rising quickly in developing countries, and the nutrition transition is a major contributor. Low-income countries have not been spared. Health issues related to nutritional deficiencies also persist, creating a double burden of malnutrition (DBM). There is still a major shortage of data on NRCD and DBM in Sub-Saharan Africa. A research program has been designed and conducted in partnership with West African institutions since 2003 to determine how the nutrition transition relates to NRCD and the DBM in order to support prevention efforts.MethodsIn Benin, cross-sectional studies among apparently healthy adults (n=540) from urban, semi-urban and rural areas have examined cardiometabolic risk (hypertension, obesity, dyslipidemia, insulin resistance) in relation to diet and lifestyle, also factoring in socio-economic status (SES). Those studies were followed by a longitudinal study on how risk evolves, opening the way for mutual aid groups to develop a prevention strategy within an action research framework. In Burkina Faso, a cross-sectional study on the nutritional status and dietary patterns of urban school-age children (n=650) represented the initial stages of an action research project to prevent DBM in schools. A cross-sectional study among adults (n=330) from the capital of Burkina Faso explored the coexistence, within these individuals, of cardiometabolic risk factors and nutritional deficiencies (anemia, vitamin A deficiency, chronic energy deficiency), as they relate to diet, lifestyle and SES.ResultsThe studies have shown that the prevalence of NRCD is high among the poor, thereby exacerbating social inequalities. The hypothesis of a positive socio-economic (and rural–urban) gradient was confirmed only for obesity, whereas the prevalence of hypertension, insulin resistance and dyslipidemia did not prove to be higher among affluent city dwellers. Women were particularly affected by abdominal obesity, at 48% compared to 6% of men. Protective factors against the risk of NRCD were physical activity and adequate micronutrient intake. The research also showed that nutritional deficiencies were not restricted to schoolchildren in rural areas because in the capital of Ouagadougou, for example, 40% of schoolchildren were anaemic and 40% were vitamin A deficient. Partnership research has expanded to include advocacy and human resources training.ConclusionThese initial studies on NRCD in West Africa indicate the relevance and urgency of prevention, even among low-income groups and countries. They show that the fight against NRCD as well as nutritional deficiencies should focus on women. Seeing how researchers from the African partner institutions have connections with decision-making authorities, the research findings could have an impact on prevention policies and programs in communities and schools alike. Greater support must nevertheless be provided to lobbying and advocacy work for an even greater impact. As well, the sustainability of the research program remains a challenge that requires resource mobilization and training for the purpose.

Lifestyle and Dietary Factors Associated with the Evolution of Cardiometabolic Risk over Four Years in West-African Adults: The Benin Study

Aim. To assess in adults from Benin changes in cardiometabolic risk (CMR) using both the Framingham risk score (FRS) and metabolic syndrome (MetS) and to examine the effects of diet, and lifestyles, controlling for location and socioeconomic status. Methods. Apparently healthy subjects (n = 541) aged 25–60 years and randomly selected in the largest city, a small town, and rural areas were included in the four-year longitudinal study. Along with CMR factors, socioeconomic, diet and lifestyle data were collected in individual interviews. A food score based on consumption frequency of four “sentinel” food groups (meat and poultry, dairy, eggs, and vegetables) was developed. Lifestyle included physical activity, alcohol and tobacco use. Education and income (proxy) were the socioeconomic variables. Results. Among the subjects with four-year follow-up data (n = 416), 13.5% were at risk at baseline, showing MetS or FRS ≥ 10%. The incidence of MetS and FRS ≥ 10% during follow-up was 8.2% and 5%, respectively. CMR deteriorated in 21% of subjects. Diet and lifestyle mediated location and income effects on CMR evolution. Low food scores and inactivity increased the likelihood of CMR deterioration. Conclusion. Combining MetS and FRS might be appropriate for surveillance purposes in order to better capture CMR and inform preventive measures.

Contribution to the development of a food guide in Benin: linear programming for the optimization of local diets

OBJECTIVE Food guides are important tools for nutrition education. While developing a food guide in Benin, the objective was to determine the daily number of servings per food group and the portion sizes of common foods to be recommended. DESIGN Linear programming (LP) was used to determine, for each predefined food group, the optimal number and size of servings of commonly consumed foods. Two types of constraints were introduced into the LP models: (i) WHO/FAO Recommended Nutrient Intakes and dietary guidelines for the prevention of chronic diseases; and (ii) dietary patterns based on local food consumption data recently collected in southern Benin in 541 adults. Dietary intakes of the upper tertile of participants for diet quality based on prevention and micronutrient adequacy scores were used in the LP algorithms. SETTING Southern area of the Republic of Benin. SUBJECTS Local key-players in nutrition (n 30) from the government, academic institutions, international organizations and civil society were partners in the development of the food guide directed at the population. RESULTS The number of servings per food group and the portion size for eight age-sex groups were determined. For four limiting micronutrients (Fe, Ca, folate and Zn), local diets could be optimized to meet only 70 % of the Recommended Nutrient Intakes, not 100 %. CONCLUSIONS It was possible to determine the daily number of servings and the portion sizes of common foods that can be recommended in Benin with the help of LP to optimize local diets, although Recommended Nutrient Intakes were not fully met for a few critical micronutrients.

Facteurs associés à la qualité de l’eau de puits et prévalence des maladies hydriques dans la commune d’Abomey-Calavi (Bénin)

The objective of this work is to assess the factors associated with the water quality of household wells, suggest solutions to improve it, and study the prevalence of water-borne diseases in this community. The quality of well water and the prevalence of waterborne diseases in the municipality were studied by analysis of the microbiological indicators currently used to assess drinking-water quality and the retrospective study of waterborne diseases treated in the local health centres. The wells surveyed were contaminated by Escherichia coli, Klebsiella pneumonia, Staphylococcus aureus, Salmonella spp, Clostridium perfringens and fecal streptococci, at prevalences of 12.5, 12.2, 12.2, 12.1, 12 and 11.1%, respectively. The high rates of diarrhea, urinary infections, typhoid fever and abdominal pain found in the retrospective study were consistent with the results of the well-water quality assessment. These results showed that human activity has strongly influenced water quality, especially the lack of sanitation in the different districts and neighbourhoods. Other factors affecting the vulnerability of well water include poor waste management by households, the low depth of the water table, the nature of the soil, and the permeability of the aquifer used. Improvement in water quality, sanitation, and personal hygiene will make it possible to reduce considerably the propagation of these diseases and several others. It is therefore important to provide these populations with the necessary equipment for an adequate drinking water supply, but also to promote health education to avoid water pollution. The search for solutions to these problems will lead to a plan for future action.

Pilot project of the Nutrition-Friendly School Initiative (NFSI) in Ouagadougou, Burkina Faso and Cotonou, Benin, in West Africa

This paper describes the first African experience with the Nutrition-Friendly School Initiative (NFSI) in two large West African cities: Ouagadougou, Burkina Faso and Cotonou, Benin. NFSI was launched by the World Health Organization (WHO) and its partners in 2006, as a means of preventing the double burden of malnutrition: the coexistence of undernutrition and overnutrition among school-children. NFSI pilot-testing is one component of the Partnership Project on the Double Burden of Malnutrition, funded by the Canadian International Development Agency for 6 years (2008–2014). The Project assisted the government in the selection of pilot schools, fostered the installation of health and nutrition committees in selected schools, and helped with the initial school self-assessments. In accordance with the empowering philosophy of health promotion, pilot schools did not follow a pre-defined schedule of interventions, except for the training of teachers in nutrition education and the nutritional (anthropometric) surveillance of schoolchildren. For the latter activities, technical assistance and seminal funds were provided. Yearly planning workshops were held for school committees, with WHO support. In both settings, training was given to street vendors in order to improve the hygiene and nutritional value of food sold to schoolchildren. Other activities included special nutrition events and sanitation measures. In both cities, NFSI showed promising results in terms of school and community mobilization towards improved nutrition and health; however, NFSI must be better understood as an endogenous and self-sustaining approach. Furthermore, household poverty and scarce school resources appear as major barriers to gaining full impact of NFSI in low-income populations.

Insulin resistance status and four-year changes in other cardiometabolic risk factors in West-African adults: the Benin study

Background: The association of insulin resistance (IR) with other cardiometabolic risk (CMR) factors in sub-Saharan Africans is poorly documented. This study examined the links between IR and the evolution of blood pressure (BP), glycaemia, serum lipids and abdominal obesity in the population of Benin. Design: Population-based longitudinal study. Methods: This study initially included 541 apparently healthy Beninese adults (50% women) aged 25–60 years who were randomly selected in a large city, a small town and a rural area. After a baseline survey, our subjects were followed up after 2 years, and again at 4 years. IR based on homeostasis model assessment (HOMA), blood glucose, BP, waist circumference (WC), triglycerides, total cholesterol and HDL-cholesterol were measured. Complete data at the end of the follow-up periods was available for 416 subjects. Results: IR was more prevalent in women than in men (33.2% versus 17.8%) and it was generally associated with more adverse values of CMR factors, excepting BP. In controlling for baseline age, sex, WC, diet, lifestyle variables and WC changes; the relative risk (RR) of hyperglycemia over 4 years was as least 3-fold in IR subjects, compared to normal subjects. The RR of abdominal obesity was 5.3 (1.04–26.93) in IR women, compared to non-IR. The association of IR with the evolution of dyslipidemia was inconsistent, but IR tended to exacerbate low HDL-cholesterol. Conclusion: Over 4 years, IR exacerbated hyperglycemia in both men and women, and abdominal obesity in women, but IR did not affect blood pressure. Further research on the link found between IR and dyslipidemia, particularly low HDL-C, is needed in sub-Saharan Africa.