Metabolic Syndrome Risk in Black South African Women Compared to Caucasian Women

Abstract

Rapid urbanisation has led African women to have an obesity prevalence double than that of Caucasian women, and this also holds true for the stroke prevalence in Africans. The study aimed to compare various metabolic syndrome (MS) criteria of the International Diabetes Federation (IDF) of body mass index and age-matched African (n=102) and Caucasian women (n=115). More Caucasian (30.4%) than African women (24.8%) had MS. Only 48% of African women had waist circumferences (WC) higher than the IDF cutoff, compared to 62.6% of Caucasians. Caucasian women were significantly taller and heavier and had higher triglycerides, plasminogen activator inhibitor-1 activity, and cortisol. African women had significantly higher blood pressure, leptin, fibrinogen and C-reactive protein, and higher odds ratios for having the MS for HDL-cholesterol, blood pressure, and fasting glucose than Caucasians. It is concluded that the IDF WC criterion needs a downward adjustment for African women due to a smaller body size. Lean African women seem to be at higher risk for MS than Caucasians. South Africa needs to stem the increasing rates of type 2 diabetes by decreasing obesity and by education (unschooled African women showed a 4.8 times higher likelihood of having MS than schooled women).

Key words

obesity - glucose - inflammation - cardiovascular disease - lipids - coagulation - T2D risk

References

• 1 Vorster HH. The emergence of cardiovascular disease during urbanisation of Africans.  Publ Health Nutr. 2002;  5 239-243
• 2 Vorster HH, Wissing MP, Venter CS, Kruger HS, Kruger A, Malan NT, de Ridder JH, Veldman FJ, Steyn HS, Margetts BM, MacIntyre U. The impact of urbanization on physical, physiological and mental health of Africans in the North West Province of South Africa: the THUSA study.  S Afr J Sci. 2000;  96 505-514
• 3 MacIntyre UE, Kruger HS, Venter CS, Vorster HH. Dietary intakes of an African population in different stages of transition in the North West Province, South Africa, the THUSA study.  Nutr Res. 2002;  239-256
• 4 Puoane T, Steyn K, Bradshaw D, Laubscher R, Fourie J, Lambert V, Mbananga N. Obesity in South Africa: The South African demographic and health survey.  Obes Res. 2002;  10 1038-1048
• 5 Walker AR, Adam F, Walker BF. World pandemic of obesity: the situation in Southern African populations.  Public Health. 2001;  115 368-372
• 6 Opie LH, Seedat YK. Hypertension in sub-Saharan African populations.  Circulation. 2005;  112 3562-3568
• 7 Seedat YK. Hypertension in black South Africans.  J Hum Hypertens. 1999;  13 96-103
• 8 Van Rooyen JM, Kruger HS, Huisman HW, Wissing MP, Margetts BM, Venter CS, Vorster HH. An epidemiological study of hypertension and its determinants in a population in transition: the THUSA study.  J Hum Hypertens. 2000;  14 779-787
• 9 Steyn K, Kazenellenbogen JM, Lombard CJ, Bourne LT. Urbanization and the risk for chronic diseases of lifestyle in the black population of the Cape Peninsula, South Africa.  J Cardiovasc Risk. 1997;  4 135-142
• 10 Schutte AE, van Rooyen JM, Huisman HW, Kruger HS, de Ridder JH. Factor analysis of possible risks for hypertension in a black South African population.  J Hum Hypertens. 2003;  17 339-348
• 11 World Health Organization .Obesity: Preventing and Managing the Global Epidemic. Report of a WHO Consultation on Obesity, June 3–5. Geneva: World Health Organization 1997
• 12 MacIntyre UE, Venter CS, Vorster HH. A culture-sensitive quantitative food frequency questionnaire used in an African population: 2.  Relative validation by 7-day weighed records and biomarkers Public Health Nutr. 2000;  4 63-71
• 13 Langenhoven ML, Kruger M, Gouws E, Faber M. MRC Food composition tables. 3rd ed. Parow: National Research Institute for Nutritional Diseases of the South African Medical Research Council 2001
• 14 Norton K, Olds T. Anthropometrica .A textbook of body measurement for sports and health courses. Sydney: University of New South Wales Press 1996
• 15 Imholz BPM, Wieling W, van Montfrans GA, Wesseling KH. Fifteen years experience with finger arterial pressure monitoring: assessment of the technology.  Cardiovasc Res. 1998;  38 605-616
• 16 Schutte AE, Huisman HW, van Rooyen JM, Malan NT, Schutte R. Validation of the Finometer device for measurement of blood pressure in black women.  J Hum Hypertens. 2004;  18 79-84
• 17 Clauss A. Rapid physiological coagulation method in determination of fibrinogen.  Acta Haematol. 1957;  17 237-246
• 18 The IDF consensus worldwide definition of the metabolic syndrome.  International Diabetes Federation. 2005; 
• 19 Schutte AE,  , van Vuuren D,  , van Rooyen JM, Huisman HW, Schutte R, Malan L, Malan NT. Inflammation, obesity and cardiovascular function in African and Caucasian women from South Africa: the POWIRS study.  J Hum Hypertens. 2006;  20 850-859
• 20 Greyling A, Pieters M, Hoekstra T, Oosthuizen W, Schutte AE. Differences in the association of PAI-1 activity with the metabolic syndrome between African and Caucasian women.  Nutr Metab Cardiovasc Dis. 2007;  17 499-507
• 21 Schutte R, Huisman HW, Schutte AE, Malan NT. Leptin is favourably associated with vascular function in obese Caucasians, but not in obese Africans.  J Hum Hypertens. 2005;  19 933-939
• 22 Kruger HS, Rautenbach PH, Venter CS, Wright HH, Schwarz PEH. An inverse association between calcium and adiposity in women with high fat and calcium intakes.  Ethn Dis. 2007;  17 6-13
• 23 Schutte R, Huisman HW, Schutte AE, Malan NT. Leptin is independently associated with systolic blood pressure, pulse pressure and arterial compliance in hypertensive African women with increased adiposity: the POWIRS study.  J Hum Hypertens. 2005;  19 535-541
• 24 Olckers A, Towers GW, Van der Merwe A, Schwarz PEH, Rheeder P, Schutte AE. Protective effect against type 2 diabetes identified within the ACDC gene, in a black South African diabetic cohort.  Metabolism. 2007;  56 587-592
• 25 Oelofse A, Jooste PL, Steyn K, Badenhorst CJ, Lombard C, Bourne L, Fourie J. The lipid and lipoprotein profile of the urban black South Africa population of the Cape Peninsula - the BRISK study.  S Afr Med J. 1996;  86 162-166
• 26 Oosthuizen W, Vorster HH, Kruger A, Venter CS, Kruger HS, de Ridder JH de. Impact of urbanisation on serum lipid profiles--the THUSA survey.  S Afr Med J. 2002;  92 723-728
• 27 Parrinello G, Scaglione R, Pinto A, Corrao S, Cecala M, Silvestre G Di, Amato P, Licata A, Licata G. Central obesity and hypertension. The role of plasma endothelin.  Am J Hypertens. 1996;  9 1186-1191
• 28 Schutte R, Huisman HW, Schutte AE, Malan NT. Plasma endothelin-1 is not increased in overweight/obese hypertensive African women: the POWIRS study.  Blood Press. 2005;  14 279-283
• 29 Brewster LM, van Montfrans GA, Kleijnen J. Systematic review: Antihypertensive drug therapy in black patients.  Ann Intern Med. 2004;  141 614-627
• 30 Reimann M, Schutte AE, Huisman HW, Schutte R, van Rooyen JM, Malan L, Malan NT, Schwarz PEH. Ethnical differences in C-peptide secretion but not in non-esterified fatty acid metabolism in pre-menopausal women with and without abdominal obesity.  Diab Res Clin Pract 2007; 77: 62 – 69 
• 31 Slabbert S, de Ridder JH, Kruger HS, Schutte AE, Underhay C, Van Lieshout M. The association between C-reactive protein concentrations and body composition in 19 to 56 year old black South African women.  Int J Body Comp Res. 2006;  4 129-135
• 32 Vorster HH, Jerling JC, Steyn K, Badenhorst CJ, Slazus W, Venter CS, Jooste PL, Bourne LT. Plasma fibrinogen of black South Africans: the BRISK study.  Public Health Nutr. 1998;  1 169-176
• 33 Vorster HH. Fibrinogen and women's health.  Thromb Res. 1999;  95 137-154
• 34 Schutte AE, Kruger HS, Wissing MP, Underhay C, Vorster HH. The emergence of the metabolic syndrome in urban obese African women: The POWIRS-Study.  S Afr J Sci. 2005;  101 61-67
• 35 Hsieh SD, Muto T. Metabolic syndrome in Japanese men and women with special reference to the anthropometric criteria for the assessment of obesity: Proposal to use the waist-to-height ratio.  Prev Med. 2006;  42 135-139
• 36 Kahn HS, Imperatore G, Cheng YJ. A population-based comparison of BMI percentiles and waist-to-height ratio for identifying cardiovascular risk in youth.  J Pediatr. 2005;  146 482-488
• 37 Stewart S, Wilkinson D, Becker A, Askew D, Ntyintyane L, MacMurray JJ, Sliwa K. Mapping the emergence of heart disease in a black, urban population in Africa: the Heart of Soweto Study.  Int J Cardiol. 2006;  108 101-108
• 38 Actuarial Society of South Africa . Summary of biennial report on the state of the South African HIV/AIDS epidemic.  2006; 
• 39 Lee YW, Eum SY, Nath A, Toborek M. Estrogen-mediated protection against HIV Tat protein-induced inflammatory pathways in human vascular endothelial cells.  Cardiovasc Res. 2004;  63 139-148
• 40 Fisher SD, Miller TL, Lipshultz SE. Impact of HIV and highly active antiretroviral therapy on leukocyte adhesion molecules, arterial inflammation, dyslipidemia, and atherosclerosis.  Atherosclerosis. 2006;  185 1-11
• 41 Grinspoon SK. Metabolic syndrome and cardiovascular disease in patients with human immunodeficiency virus.  Am J Med. 2005;  118 ((Suppl 2)) 23S-28S
• 42 van Wijk JP, de Koning EJ, Cabezas MC, Joven J, op’t Roodt J, Rabelink TJ, Hoepelman AM. Functional and structural markers of atherosclerosis in human immunodeficiency virus-infected patients.  J Am Coll Cardiol. 2006;  47 1117-1123

Correspondence