scholarly journals Association Between Food Insecurity and Key Metabolic Risk Factors for Diet-Sensitive Non-Communicable Diseases in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Sphamandla Josias Nkambule ◽  
Indres Moodley ◽  
Desmond Kuupiel ◽  
Tivani P. Mashamba-Thomson

Abstract BackgroundIn previous studies, food insecurity has been hypothesised to promote the prevalence of metabolic risk factors on the causal pathway to diet-sensitive non-communicable diseases (NCDs). This prevalence has been shown to differ between gender and populations. However, evidence of this association in resources-limited settings with high levels of food insecurity such as sub-Saharan African countries remains elusive.PurposeWe aimed to identify the association between food insecurity and key metabolic risk factors on the causal pathway to diet-sensitive NCDs in sub-Saharan African population.MethodsWe did a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Relevant studies published between January 2015 and October 2019 were searched in PubMed, Web of Science (SCiELO Citation Index), and five other databases followed by explicit and reproducible hand-searches of included studies which were peer-reviewed epidemiological studies conducted in sub-Saharan Africa, directly measured food insecurity, and compared food insecurity to a metabolic risk factor outcome. Two reviewers extracted all the necessary data from individual studies independently and employed the Mixed Methods Appraisal Tool (MMAT) – Version 2018 to evaluate the risk of bias. Prevalence estimates from individual studies were pooled using the random-effect model.ResultsThe initial searches yielded 11 803 articles, 22 were eligible for inclusion, presenting data from 26 609 food-insecure participants and 11 545 incident of metabolic risk factor cases. Most studies confirmed an adverse association between food insecurity and key metabolic risk factors for diet-sensitive NCDs. The Meta-analysis showed a significantly high pooled prevalence estimate of key metabolic risk factors at 41.8 per cent (95% CI: 33.2% to 50.8%, I2 = 99.5% p-value < 0.00). The most prevalent type of metabolic risk factors was dyslipidaemia 27.6 per cent (95% CI: 6.5% to 54.9%), hypertension 24.7 per cent (95% CI: 15.6% to 35.1%), and overweight 15.8 per cent (95% CI: 10.6% to 21.7%). Notably, the prevalence estimates of these metabolic risk factors were considerably more frequent in females than males.ConclusionThis study is the first to systematically review or meta-analyse the association between food insecurity and key metabolic risk factors for diet-sensitive non-communicable diseases (NCDs) in sub-Saharan African countries, in order to generate an integrated, evidence-based, comprehensive summary of how key metabolic risk factors are patterned by food insecurity. Further high-quality longitudinal data and mediation analysis are warranted to understand the basis of this findings to support targeted prevention and control strategies for those confronted with food insecurity.PROSPERO registration number: PROSPERO 2019 CRD42019136638

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sphamandla Josias Nkambule ◽  
Indres Moodley ◽  
Desmond Kuupiel ◽  
Tivani P. Mashamba-Thompson

AbstractIn previous studies, food insecurity has been hypothesised to promote the prevalence of metabolic risk factors on the causal pathway to diet-sensitive non-communicable diseases (NCDs). This systematic review and meta-analysis aimed to determine the associations between food insecurity and key metabolic risk factors on the causal pathway to diet-sensitive NCDs and estimate the prevalence of key metabolic risk factors among the food-insecure patients in sub-Saharan Africa. This study was guided by the Centre for Reviews and Dissemination (CRD) guidelines for undertaking systematic reviews in healthcare. The following databases were searched for relevant literature: PubMed, EBSCOhost (CINAHL with full text, Health Source - Nursing, MedLine). Epidemiological studies published between January 2015 and June 2019, assessing the associations between food insecurity and metabolic risk outcomes in sub-Saharan African populations, were selected for inclusion. Meta-analysis was performed with DerSimonian-Laird’s random-effect model at 95% confidence intervals (CIs). The I2 statistics reported the degree of heterogeneity between studies. Publication bias was assessed by visual inspection of the funnel plots for asymmetry, and sensitivity analyses were performed to assess the meta-analysis results’ stability. The Mixed Methods Appraisal Tool (MMAT) – Version 2018 was used to appraise included studies critically. The initial searches yielded 11,803 articles, 22 cross-sectional studies were eligible for inclusion, presenting data from 26,609 (46.8% males) food-insecure participants, with 11,545 (42.1% males) reported prevalence of metabolic risk factors. Of the 22 included studies, we identified strong evidence of an adverse association between food insecurity and key metabolic risk factors for diet-sensitive NCDs, based on 20 studies. The meta-analysis showed a significantly high pooled prevalence estimate of key metabolic risk factors among food-insecure participants at 41.8% (95% CI: 33.2% to 50.8%, I2 = 99.5% p-value < 0.00) derived from 14 studies. The most prevalent type of metabolic risk factors was dyslipidaemia 27.6% (95% CI: 6.5% to 54.9%), hypertension 24.7% (95% CI: 15.6% to 35.1%), and overweight 15.8% (95% CI: 10.6% to 21.7%). Notably, the prevalence estimates of these metabolic risk factors were considerably more frequent in females than males. In this systematic review and meta-analysis, exposure to food insecurity was adversely associated with a wide spectrum of key metabolic risk factors, such as obesity, dyslipidaemia, hypertension, underweight, and overweight. These findings highlight the need to address food insecurity as an integral part of diet-sensitive NCDs prevention programmes. Further, these findings should guide recommendations on the initiation of food insecurity status screening and treatment in clinical settings as a basic, cost-effective tool in the practice of preventive medicine in sub-Saharan Africa.PROSPERO registration number: PROSPERO 2019 CRD42019136638.


BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e049565
Author(s):  
Tilahun Tewabe Alamnia ◽  
Wubshet Tesfaye ◽  
Solomon Abrha ◽  
Matthew Kelly

ObjectivesNon-communicable diseases (NCDs) are causing a new and yetsignificant health challenge in low-income countries. In Ethiopia, although 39% of deaths are NCD related, the health system remains underprepared, highlighting the clear need for evidence on risk factor distributions to inform resource planning and the health response. Therefore, this review investigates prevalence distributions and sex and age variations of metabolic risk factors among Ethiopian adults.Research design and methodsThis systematic review used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies published until 6 January 2021 were searched from PubMed, Scopus, ProQuest and Web of Science databases, reference lists of selected studies and grey literature. Studies reporting prevalence of metabolic risk factors: overweight/obesity, hypertension, impaired glucose homoeostasis and metabolic syndrome among Ethiopian adults were eligible for this systematic review and meta-analysis. Two authors independently extracted data and used the Joanna Briggs Institute tool for quality appraisal. The random effects model was used to conduct meta-analysis using Stata V.16. Subgroup analyses examined prevalence differences by region, study year, sample size and settings.ResultsFrom 6087 records, 74 studies including 104 382 participants were included. Most showed high prevalence of metabolic risk factors. Meta-analysis revealed pooled prevalence of metabolic risk factors from 12% to 24% with the highest prevalence observed for overweight/obesity (23.9%, 95% CI 19.9% to 28.0%) and hypertension (21.1%, 95% CI 18.7% to 23.5%), followed by metabolic syndrome (14.7%, 95% CI 9.8% to 19.6%) and impaired glucose tolerance (12.4%, 95% CI 8.7% to 16.1%). The prevalence of overweight/obesity was higher in women. All metabolic risk factors were higher among people aged above 45 years.ConclusionsA signficant proportion of Ethiopian adults have at least one metabolic risk factor for NCDs. Despite heterogeneity of studies limiting the certainty of evidence, the result suggests the need for coordinated effort among policymakers, healthcare providers, non-governmental stakeholders and the community to implement appropriate preventive measures to reduce these factors.


Author(s):  
Blaise Nguendo Yongsi

Background: In sub-Saharan Africa, communicable diseases have long been among the most prominent contributors to disease burden. However, like most low-income and middle-income countries across the globe, countries in sub-Saharan Africa are experiencing a shift from disease-burden profiles dominated by communicable diseases and childhood illnesses to profiles featuring an increasing predominance of chronic, non-communicable diseases (NCDs). Objective : The main objective of this study is to investigate the magnitude of non-communicable chronic diseases at the Chantal Biya Foundation in Yaoundé. Design and participants: This is an institution-based and cross-sectional study conducted from january to december 2018. Participants were in and out patients who visited the institution and whose a medical condition was clearly diagnosed. Results : Of the 643 medical records, leading causes of visit were infectious diseases (51.1%), followed by NCDs (48.9%). Diagnosed NCDs range from sickle cell disease (5.7%), injuries (9.8%), cardiovascular diseases (12.0%), to cancers (25.0%). Conclusion There is a significant burden of NCDs among adolescents in Yaoundé. Then, interventions for primordial prevention (ie, actions to inhibit the emergence of NCD risk factors) and primary prevention (ie, actions on existing NCD risk factors), as well as educational programmes on leading modifiable behavioural risk factors and metabolic risk factors are crucial.


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