Sex and area differences in the association between adiposity and lipid profile in Malawi

Soares, A. L. G., Banda, L., Amberbir, A., Jaffar, S., Musicha, C., Price, A., Nyrienda, M. J., Lawlor, D. A. and Crampin, A. (2019) Sex and area differences in the association between adiposity and lipid profile in Malawi. BMJ Global Health, 4(5), e001542. (doi: 10.1136/bmjgh-2019-001542) (PMID:31565403) (PMCID:PMC6747887)

Abstract

Background 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). Methods 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. Results 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. Conclusions 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.

• Item Type: Articles
• Additional Information: Funding Wellcome (Grant ref: 098610/Z/12/Z and 098610/B/12/A) supported MEIRU NCD survey. ALGS and DAL work in a Unit that is supported by the University of Bristol and UK Medical Research Council (MC_UU_00011/6) and DAL is a UK National Institute of Research Senior Investigator (NF-SI-0611 10196).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Crampin, Professor Mia
• Authors: Soares, A. L. G., Banda, L., Amberbir, A., Jaffar, S., Musicha, C., Price, A., Nyrienda, M. J., Lawlor, D. A., and Crampin, A.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
• Journal Name: BMJ Global Health
• Publisher: BMJ Publishing Group
• ISSN: 2059-7908
• ISSN (Online): 2059-7908
• Copyright Holders: Copyright © 2019 The Authors
• First Published: First published in BMJ Global Health 4:e001542
• Publisher Policy: Reproduced under a Creative Commons License