A comparison of the associations between adiposity and lipids in Malawi and the United Kingdom

Soares, A. L. G., Banda, L., Amberbir, A., Jaffar, S., Musicha, C., Price, A. J., Crampin, A. C. , Nyirenda, M. J. and Lawlor, D. A. (2020) A comparison of the associations between adiposity and lipids in Malawi and the United Kingdom. BMC Medicine, 18, 181. (doi: 10.1186/s12916-020-01648-0) (PMID:32669098) (PMCID:PMC7364601)

Abstract

Abstract: Background: 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). Methods: 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. Results: 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. Conclusions: 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.

• Item Type: Articles
• Additional Information: Wellcome (Grant ref.: 098610/Z/12/Z and 098610/B/12/A) supported MEIRU NCD survey. The UK Medical Research Council and Wellcome (Grant ref.: 102215/2/13/2) and the University of Bristol provide core support for ALSPAC. The ALSPAC data used in this paper were specifically funded by the British Heart Foundation (SP/07/008/24066), Wellcome Trust (WT092830M) and UK MRC (G1001357). 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’s contribution to this work was supported by a grant from the British Heart Foundation (AA/18/7/34219) and her UK National Institute of Research Senior Investigator (NF-0616-10102). No funders had any influence on the analysis plan, results presented or decision to publish. The views expressed in this paper are those of the authors and not necessarily any funding body. This publication is the work of the authors, and ALGS, DAL and ACC will serve as guarantors for the contents of this paper.
• Keywords: Research Article, Cardiovascular Issues in Underrepresented Populations, Obesity, Body mass index, Waist-hip ratio, Lipid profile, Dyslipidaemia, Sub-Saharan Africa, ALSPAC
• 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. J., Crampin, A. C., Nyirenda, M. J., and Lawlor, D. A.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
• Journal Name: BMC Medicine
• Publisher: BioMed Central
• ISSN: 1741-7015
• ISSN (Online): 1741-7015
• Copyright Holders: Copyright © 2020 The Author(s)
• First Published: First published in BMC Medicine 18: 181
• Publisher Policy: Reproduced under a Creative Commons License