MRC Integrated Epidemiology Unit, University of Bristol, Bristol, UK.
Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.
BMC Med. 2020 Jul 16;18(1):181. doi: 10.1186/s12916-020-01648-0.
The prevalence of excess adiposity, as measured by elevated body mass index (BMI) and waist-hip ratio (WHR), is increasing in sub-Saharan African (SSA) populations. This could add a considerable burden of cardiovascular and metabolic diseases for which these populations are currently ill-prepared. Evidence from white, European origin populations shows that higher adiposity leads to an adverse lipid profile; whether these associations are similar in all SSA populations requires further exploration. This study compared the association of BMI and WHR with lipid profile in urban Malawi with a contemporary cohort with contrasting socioeconomic, demographic, and ethnic characteristics in the United Kingdom (UK).
We used data from 1248 adolescents (mean 18.7 years) and 2277 Malawian adults (mean 49.8 years), all urban-dwelling, and from 3201 adolescents (mean 17.8 years) and 6323 adults (mean 49.7 years) resident in the UK. Adiposity measures and fasting lipids were assessed in both settings, and the associations of BMI and WHR with total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG) were assessed by sex and age groups in both studies.
Malawian female adults were more adipose and had more adverse lipid profiles than their UK counterparts. In contrast, Malawian adolescent and adult males were leaner and had more favourable lipid profiles than in the UK. Higher BMI and WHR were associated with increased TC, LDL-C and TG and reduced HDL-C in both settings. The magnitude of the associations of BMI and WHR with lipids was mostly similar or slightly weaker in the Malawian compared with the UK cohort in both adolescents and adults. One exception was the stronger association between increasing adiposity and elevated TC and LDL-C in Malawian compared to UK men.
Malawian adult women have greater adiposity and more adverse lipid profiles compared with their UK counterparts. Similar associations of adiposity with adverse lipid profiles were observed for Malawian and UK adults in most age and sex groups studied. Sustained efforts are urgently needed to address the excess adiposity and adverse lipid profiles in Malawi to mitigate a future epidemic of cardio-metabolic disease among the poorest populations.
在撒哈拉以南非洲（SSA）人群中，体质量指数（BMI）和腰臀比（WHR）升高导致的超重患病率正在增加。这可能会给这些人群带来相当大的心血管疾病和代谢疾病负担，而他们目前对此准备不足。来自白种欧洲人群的证据表明，较高的肥胖程度会导致不良的血脂谱；这些关联在所有 SSA 人群中是否相似，还需要进一步探索。本研究比较了城市马拉维与英国（UK）具有对比性社会经济、人口和民族特征的当代队列中，BMI 和 WHR 与血脂谱的关联。
我们使用了来自马拉维的 1248 名青少年（平均年龄 18.7 岁）和 2277 名成年人（平均年龄 49.8 岁），以及来自英国的 3201 名青少年（平均年龄 17.8 岁）和 6323 名成年人（平均年龄 49.7 岁）的数据。在两个地区都评估了肥胖程度和空腹血脂，并根据性别和年龄组评估了 BMI 和 WHR 与总胆固醇（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）的关系。
马拉维成年女性比英国同龄人更肥胖，血脂谱更差。相比之下，马拉维青少年和成年男性比英国同龄人更瘦，血脂谱更好。在两个地区，较高的 BMI 和 WHR 与 TC、LDL-C 和 TG 的增加以及 HDL-C 的减少有关。在青少年和成年人中，BMI 和 WHR 与血脂的关联强度在马拉维和英国队列中大多相似或稍弱。一个例外是在马拉维和英国男性中，随着肥胖程度的增加，TC 和 LDL-C 的升高与肥胖的关联更强。
与英国同龄人相比，马拉维成年女性的肥胖程度更大，血脂谱更差。在大多数研究的年龄和性别组中，马拉维和英国成年人的肥胖与不良血脂谱之间存在相似的关联。迫切需要采取持续的努力来解决马拉维的超重和不良血脂谱问题，以减轻最贫困人群中心血管代谢疾病的未来流行。
