Soares Ana Luiza G, Banda Louis, Amberbir Alemayehu, Jaffar Shabbar, Musicha Crispin, Price Alison, Nyirenda Moffat J, Lawlor Debbie A, Crampin Amelia
Population Health Sciences, University of Bristol, Bristol, UK.
MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK, Bristol, UK.
BMJ Glob Health. 2019 Sep 11;4(5):e001542. doi: 10.1136/bmjgh-2019-001542. eCollection 2019.
Evidence from high-income countries shows that higher adiposity results in an adverse lipid profile, but it is unclear whether this association is similar in Sub-Saharan African (SSA) populations. This study aimed to assess the association between total and central adiposity measures and lipid profile in Malawi, exploring differences by sex and area of residence (rural/urban).
In this cross-sectional study, data from 12 096 rural and 12 847 urban Malawian residents were used. The associations of body mass index (BMI) and waist to hip ratio (WHR) with fasting lipids (total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C) and triglycerides (TG)) were assessed by area and sex.
After adjusting for potential confounders, higher BMI and WHR were linearly associated with increased TC, LDL-C and TG and reduced HDL-C. BMI was more strongly related to fasting lipids than was WHR. The associations of adiposity with adverse lipid profile were stronger in rural compared with urban residents. For instance, one SD increase in BMI was associated with 0.23 mmol/L (95% CI 0.19 to 0.26) increase in TC in rural women and 0.13 mmol/L (95% CI 0.11 to 0.15) in urban women. Sex differences in the associations between adiposity and lipids were less evident.
The consistent associations observed of higher adiposity with adverse lipid profiles in men and women living in rural and urban areas of Malawi highlight the emerging adverse cardio-metabolic epidemic in this poor population. Our findings underline the potential utility of BMI in estimating cardiovascular risk and highlight the need for greater investment to understand the long-term health outcomes of obesity and adverse lipid profiles and the extent to which lifestyle changes and treatments effectively prevent and modify adverse cardio-metabolic outcomes.
高收入国家的证据表明，较高的肥胖程度会导致不良的血脂谱，但尚不清楚这种关联在撒哈拉以南非洲（SSA）人群中是否相似。本研究旨在评估马拉维总体和中心性肥胖指标与血脂谱之间的关联，并探讨性别和居住地区（农村/城市）的差异。
在这项横断面研究中，使用了来自12096名马拉维农村居民和12847名城市居民的数据。通过地区和性别评估体重指数（BMI）和腰臀比（WHR）与空腹血脂（总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）和甘油三酯（TG））之间的关联。
在调整潜在混杂因素后，较高的BMI和WHR与TC、LDL-C和TG升高以及HDL-C降低呈线性相关。BMI与空腹血脂的相关性比WHR更强。与城市居民相比，农村居民中肥胖与不良血脂谱的关联更强。例如，BMI每增加一个标准差，农村女性的TC升高0.23 mmol/L（95%CI 0.19至0.26），城市女性升高0.13 mmol/L（95%CI 0.11至0.15）。肥胖与血脂之间关联的性别差异不太明显。
在马拉维农村和城市地区的男性和女性中，较高的肥胖程度与不良血脂谱之间存在一致的关联，这凸显了这个贫困人口中正在出现的不良心血管代谢流行趋势。我们的研究结果强调了BMI在估计心血管风险方面的潜在效用，并突出了需要加大投资，以了解肥胖和不良血脂谱的长期健康后果，以及生活方式改变和治疗有效预防和改善不良心血管代谢结局的程度。
