Research Initiative for Cities Health and Equity (RICHE), Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom.
PLoS One. 2023 Jan 24;18(1):e0266637. doi: 10.1371/journal.pone.0266637. eCollection 2023.
Chronic non-communicable disease comorbidities are a major problem faced by people living with HIV (PLHIV). Obesity is an important factor contributing to such comorbidities and PLHIV face an elevated risk of obesity. However, there is data paucity on the intersection of obesity and HIV in adolescents and youth living with HIV (AYLHIV) in sub-Saharan Africa. We therefore aimed to investigate the prevalence of abdominal obesity and associated multilevel factors in AYLHIV in peri-urban Cape Town, South Africa.
We conducted a cross-sectional study enrolling AYLHIV aged 15-24 years attending primary healthcare facilities in peri-urban Cape Town in 2019. All measures, except for physical examination measures, were obtained via self-report using a self-administered electronic form. Our outcome of interest was abdominal obesity (waist-to-height ratio ≥ 0.5). We collected individual-level data and data on community, built and food environment factors. Data was summarized using descriptive statistics, stratified by obesity status. Multilevel logistic regression was conducted to investigate factors associated with abdominal obesity, adjusted for sex and age.
A total of 87 participants were interviewed, 76% were female and the median age was 20.7 (IQR 18.9-23.0) years. More than two fifths had abdominal obesity (41%; 95% CI: 31.0-51.7%), compared to published rates for young people in the general population (13.7-22.1%). In multilevel models, skipping breakfast (aOR = 5.42; 95% CI: 1.32-22.25) was associated with higher odds of abdominal obesity, while daily wholegrain consumption (aOR = 0.20; 95% CI: 0.05-0.71) and weekly physical activity (aOR = 0.24; 95% CI: 0.06-0.92) were associated with lower odds of abdominal obesity. Higher anticipated stigma was associated with reduced odds of obesity (aOR = 0.58; 95% CI: 0.33-1.00). Land-use mix diversity (aOR = 0.52; 95% CI: 0.27-0.97), access to recreational places (aOR = 0.37; 95% CI: 0.18-0.74), higher perceived pedestrian and traffic safety (aOR = 0.20; 95% CI: 0.05-0.80) and having a non-fast-food restaurant within walking distance (aOR = 0.30; 95% CI: 0.10-0.93) were associated with reduced odds of abdominal obesity. The main limitations of the study were low statistical power and possible reporting bias from self-report measures.
Our findings demonstrate a high prevalence of abdominal obesity and highlight multilevel correlates of obesity in AYLHIV in South Africa. An intersectoral approach to obesity prevention, intervening at multiple levels is necessary to intervene at this critical life stage.
慢性非传染性疾病合并症是艾滋病毒感染者（PLHIV）面临的主要问题。肥胖是导致这些合并症的一个重要因素，PLHIV 面临肥胖的风险增加。然而，在撒哈拉以南非洲，青少年和青年艾滋病毒感染者（AYLHIV）中肥胖和艾滋病毒的交叉问题数据仍然匮乏。因此，我们旨在调查南非开普敦郊区 AYLHIV 中腹部肥胖的流行情况及其相关的多层次因素。
我们开展了一项横断面研究，纳入了 2019 年在开普敦郊区初级保健机构就诊的年龄在 15-24 岁的 AYLHIV。除体检措施外，所有措施均通过自我报告使用自我管理的电子表格获得。我们感兴趣的结局是腹部肥胖（腰高比≥0.5）。我们收集了个体层面的数据以及社区、建筑和食物环境因素的数据。采用描述性统计方法对数据进行总结，并按肥胖状况进行分层。采用多水平逻辑回归调查与腹部肥胖相关的因素，调整了性别和年龄。
共对 87 名参与者进行了访谈，其中 76%为女性，中位年龄为 20.7（IQR：18.9-23.0）岁。超过五分之二的人有腹部肥胖（41%；95%CI：31.0-51.7%），高于一般人群中年轻人的报告率（13.7-22.1%）。在多水平模型中，不吃早餐（aOR=5.42；95%CI：1.32-22.25）与腹部肥胖的几率增加相关，而每天食用全谷物（aOR=0.20；95%CI：0.05-0.71）和每周进行体育锻炼（aOR=0.24；95%CI：0.06-0.92）与腹部肥胖的几率降低相关。较高的预期耻辱感与肥胖几率降低相关（aOR=0.58；95%CI：0.33-1.00）。土地利用混合多样性（aOR=0.52；95%CI：0.27-0.97）、娱乐场所可达性（aOR=0.37；95%CI：0.18-0.74）、较高的行人与交通安全感（aOR=0.20；95%CI：0.05-0.80）和步行距离内有非快餐店（aOR=0.30；95%CI：0.10-0.93）与腹部肥胖几率降低相关。该研究的主要局限性是统计效力低，以及自我报告措施可能存在报告偏倚。
我们的研究结果表明，南非 AYLHIV 中腹部肥胖的患病率很高，并强调了肥胖的多层次相关因素。为了在这一关键生命阶段进行干预，需要采取多部门方法预防肥胖，在多个层面进行干预。
