Abstracting and Indexing

  • Google Scholar
  • CrossRef
  • WorldCat
  • ResearchGate
  • Academic Keys
  • DRJI
  • Microsoft Academic
  • Academia.edu
  • OpenAIRE

Double Burden of Obesity and Hypertension in the Elderly: Cross- Sectional Study of Prevalence and Risk Factors in Foumban, West Region, Cameroon

Article Information

William Dakam1,2, Pierre Mintom4, Chetou Mbete3, Christine Fernande Nyangono Biyegue1,3*

1University of Yaounde I, Laboratory of Nutrition and Nutritional Biochemistry. PO Box 812 Yaounde, Cameroon.

2University of Douala, Faculty of Medicine and Pharmaceutical Sciences. PO Box 2701 Douala, Cameroon.

3University of Douala, Higher Teacher’s Training School for Technical Education. PO Box 1872 Douala, Cameroon.

4University of Yaounde I, Faculty of Medicine of Biomedical Sciences. PO Box 1364 Yaounde, Cameroon.

*Corresponding Author: Christine Fernande Nyangono Biyegue, University of Yaounde I, Faculty of Medicine of Biomedical Sciences. PO Box 1364 Yaounde, Cameroon

Received: 13 June 2022; Accepted: 20 June 2022; Published: 18 July 2022

Citation: William Dakam, Pierre Mintom, Chetou Mbete, Christine Fernande Nyangono Biyegue. Double Burden of Obesity and Hypertension in the Elderly: Cross-Sectional Study of Prevalence and Risk Factors in Foumban, West Region, Cameroon. Journal of Food Science and Nutrition Research 5 (2022): 612-621.

View / Download Pdf Share at Facebook

Abstract

Objective: To identify the factors contributing to the double burden of obesity and hypertension in the elderly Cameroonians.

Methodology: A total of 172 participants aged over 60 were enrolled in a crosssectional study carried out in households in the city of Foumban. The sociodemographic and nutritional data of each participant were collected using a questionnaire adapted from the WHO STEP wise approach while anthropometric and hemodynamic measurements were recorded. Based on the WHO guidelines and ACC/AHA definitions, three patterns of the double burden of obesity and hypertension were investigated: i) generalized obesity/hypertension (GO/H), ii) abdominal obesity/hypertension (AO/H) and iii) combined generalized and abdominal obesity/hypertension (CO/H).

Results: Prevalence of the different patterns of the double burden of obesity and hypertension were: 29.7% (CO/H), 37.8% (GO/H), and 46.5% (AO/H). Type of marriage, source of income, consumption of fat and starchy recipes, consumption of refined sugars and family history were significantly linked to the AO/H pattern while consumption of refined sugars and irregular consumption of fruits were associated with the GO/H pattern.

Conclusion: Abdominal obesity appears to be the most frequent pattern of the double burden of obesity and hypertension in the elderly. Key risk factors are mainly diet-based, suggesting the importance of nutritional education of the elderly in Cameroon. Yet, large scale studies are needed to refine the nutritional education strategies for the elderly in Cameroon.

Keywords

Double burden, Elderly, Hypertension, Obesity, Risk factors

Double burden articles; Elderly articles; Hypertension articles; Obesity articles; Risk factors articles

Article Details

1. Introduction

Cardiovascular diseases (CVDs) are one of the leading causes of death today. CVDs incidence results partially from a significant increase in the prevalence of various pathological conditions such as obesity, insulin resistance, dyslipidemia, sympathetic overactivity, arterial hypertension, etc. in adults and adolescents [1]. Several studies around the world have shown that an increase in human body weight is the cause of several pathologies. Indeed, Framingham's studies have shown that body weight gain is a predictor of an increase in blood pressure due to the accumulation of LDL-cholesterol [2]. In addition, high blood pressure is three times more common in obese people than people of normal weight [3]. The concomitant occurrence of obesity and hypertension in the same person actually constitutes a double burden that is critical in terms of quality of life and budget. The risk factors of this double burden are as numerous as diverse and include eating habits, lifestyle, psychosocial stress, family history, alcohol consumption, tobacco consumption [4,5]. Such factors are present in the environment and all age groups are thus exposed. The vast majority of obese people-predominantly of android type-over 50 years old are hypertensive [3]. The elderly are the most vulnerable to the occurrence of the combination of obesity and arterial hypertension because of the weakening of their immune system caused by human aging, a normal inevitable phenomenon, causing several biological, psychological and sociological changes that can generate potentially harmful effects. With life expectancy increasing worldwide, the number of elderly people is expected to rise especially in the developing countries. Cameroon is no exception as from the country’s independence in 1960 to 2018 life expectancy has been increased by 18 years [6]. However, no published data are available to date regarding prevalence and risk factors of the concomitant occurrence of obesity and hypertension in the elderly in Cameroon. The main objective of the study was to assess the prevalence of the double burden of obesity and hypertension in the elderly in Cameroon and to identify its risk factors.

2. Methodology

The study population consisted of Cameroonians of both genders, aged 60 and above from various regions of the country and living in Foumban. The study included elderly people who had been residing in Foumban for at least 6 months and had freely consented to participate in the study. Elderly people with serious illness and those who were not fully mentally able were excluded from the study. The study was descriptive and cross-sectional. It took place during the period from July to August 2019 and was carried out in various neighbourhoods of the city of Foumban, Western Region of Cameroon. A total of 172 elderly apparently healthy aged 60 and over randomly recruited during household survey organized by Koukouet Medical Center.

Questionnaire

Under assistance of well-trained and qualified technicians, participants filled out a questionnaire conceived from “WHO steps instrument for chronic diseases” related to their socio-demographic, lifestyle, eating habits, food security, perceived stress scale. During the survey, participants spent 20 to 30 minutes in answering the questions and some of them were helped by investigators to complete the questionnaire. In this study, food security and perceived stress scale were not used. Marital status and the source of income help to determine the socio-economic conditions. In our study the marital status was collected. Three levels of marital status were thus coded: “0”: marriage, “1”: widowhood/divorce and “2”: bachelorhood/engagement.

Source of incomes has been used as a determinant of socioeconomic status. The main source of incomes for our participants has been collected. Four income levels were coded as follows: “0” permanent salary, “1” temporary salary, “2” trade and “3” help/assistance.

Three level of education were obtained: none education, primary level, secondary level and university level. The dietary habits of the participants were explored using a questionnaire. For each participant, we documented over a seven-day period: frequency of consumption of "local" foods, foods specific to "urban" areas, "western" foods [7].

Anthropometric measurements

The following parameters: age, gender, weight, height, Knee Height, blood pressure, waist circumference were measured on the first and only visit. The body weight of participants in light clothing and without shoes was measured with a precision of ± 100g using a portable electronic scale of 150kg capacity (TANITATM). Height was measured to the nearest 0.5 cm using a portable stadiometer specially design for the study, with the participants standing upright on a flat surface without shoes and with the back of their heels and the occiput against the stadiometer. To have the exact height of the elderly, knee height (KH) was measured and used in the [8] formula to calculate their height. Waist circumference (WC), strongly correlated to visceral adipose tissue and associated to several cardiometabolic risk factors, was measured [9]. It was measured to the nearest 0.1 cm with a flexible, non-stretchable and tension-regulated steel tape, at the midpoint between the lowest rib and the iliac crest, while participants were standing and breathing normally. Body mass index (BMI) was calculated as weight (in kilograms) divided by the square of height (in metres). Overweight and obesity profiles were categorised as follows [10,7]:

· Overweight was defined as BMI≥25.0 kg/m2 but >30.0kg/m2 for both genders with or without abdominal obesity;

  1. Generalized obesity (GO) was defined as BMI≥30.0 kg/m2 for both genders with or without abdominal obesity;
  2. Abdominal obesity (AO) was defined as WC≥94 cm for men and WC≥80 cm for women with or without generalized obesity;
  3. Combined obesity (CO): individuals with both GO and AO.

Blood pressure measurements

The measurement of systolic and diastolic blood pressures (SBP and DBP respectively) was performed using a blood pressure monitor (OMRON HEM 7124) based on oscillometric measurement method with Fuzzylogic technique [11]. Blood pressure records were made three times on the upper left arm. The first measurement was taken after a 5 min rest in a sitting position and was followed by two subsequent measurements in the middle and at the end of the interview. The average of the three measurements was used to assess the presence or absence of hypertension according to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines: SBP≥130 mmHg, or DBP≥80 mmHg [11]. A participant was considered to have isolated systolic hypertension (ISH) for a SBP≥130 mmHg and DBP>80 mmHg; isolated diastolic hypertension (IDH) for a SBP>130 mmHg and DBP≥80 mmHg and the systo-diastolic hypertension (SDH) with a SBP≥130 mmHg and DBP≥80 mmHg [11].

Definition of double burden

Three patterns of the double burden of obesity and hypertension (SDH only) were defined:

  1. Generalized obesity/hypertension (GO/H) was defined as BMI≥30.0 kg/m2 for both genders with or without abdominal obesity and SBP ≥ 130mm Hg and DBP ≥ 80 mm Hg;
  2. Abdominal obesity/hypertension (AO/H) was defined as WC≥94 cm for men and WC≥80 cm for women with or without generalized obesity and SBP ≥ 130mm Hg and DBP ≥ 80 mm Hg;
  3. Combined generalized and abdominal obesity/hypertension (CO/H): individuals with both GO and AO and SBP ≥ 130mm Hg and DBP ≥ 80 mm Hg.

Ethical approvals

The study was approved by the following institutions:- Cameroon National Ethics Committee through the ethical clearance N°2014/08/488/EC/CNERSH;- First Deputy Mayor of the city of Foumban by validation of our request N° 780/UD/ ENSET/D/DA/ESF; The names of the respondents were coded and anonymity of the information was respected. The data has been used for scientific purposes only and the results obtained are published with strict respect for the confidentiality and dignity of the respondents.Statistical analysisIBM Statistical Package for Social Sciences (IBM SPSS) for Windows version 22.0 software was used to perform the statistical analyzes. The descriptive statistics made it possible to assess the distributions of each variable under study to determine its characteristics (frequency, mean, standard deviation). Student's t-test was used to compare men and women based on age, BMI, WC, SBP and DBP. The results were expressed as the mean ± standard error of the mean. Pearson's chi-square test was used to examine relation between sociodemographic parameters and double burden. Binary logistic regression was done to assess the influence of food consumed on the incidence of double burden and the risk to develop double burden. The significance level was p >0.05.3.Results
Our sample consisted of 172 people aged 60 and above. Table 1 below presents the socio-demographic parameters and shows that approximately 2/3 or 61.6% of respondents were of male gender, 3/4 (73.3%) were married, the vast majority of them have been in school at one time in their life (69.21%), 94.3% were living as part of a couple, 39.5% had a permanent salary and 96.5% of our respondents had an history with cardiometabolic risk.

Sociodemographic parameters

Classification

Frequency (n=172)

Percentage (%)

Gender

Men

106

61.6

Women

66

38.4

Marital status

Marriage or concubinage

126

73.3

widowed/divorced

42

24.4

single

4

2.3

Education level

Illeteracy

53

30.8

Primary

34

19.8

Secondary

41

23.8

University

44

25.6

Regime of marriage

Monogamous

66

38.5

Polygamous

96

55.8

Single parent

10

5.8

Source of income

Permanent salary

68

39.5

Temporary salary

11

6.4

Trade

29

16.9

Help/assistance

64

37.2

Family history

No antécédent

6

3.5

Cardiovascular diseases (CVD)

12

7

CVD+ hypertension

4

2.3

CVD + hypertension+diabetes

7

4.1

CVD+diabetes

4

2.3

Hypertension

75

43.6

Hypertension+diabetes

20

11.6

Diabetes

44

25.6

Table 1: Characteristics of the study population

Anthropometric and hemodynamic parameters of the study population

The results of the distribution of the study population according to anthropometric and hemodynamic parameters are given in table 2 below. We see from table 2 below that: age, BMI and waist circumference are significantly higher in senior women compared to men, on the other hand the DBP is significantly high in older men compared to older women.

Variables

Total population (n=172)

Men (n=106)

Women (n=66)

Age (years)

72.5 ± 0.8

70.3 ± 1.0

76.1 ± 1.2*

BMI (kg/m2)

31.6 ± 0.4

30.0 ± 0.6

34.3 ± 0.6*

WC (cm)

101.2 ± 1.5

95.7 ± 1.7

109.9 ± 2.3*

SBP (mm Hg)

139.5 ± 2.6

139.5 ± 3.7

139.5 ± 3.5

DBP (mm Hg)

94.5 ± 1.4

97.2 ± 1.4*

90.0 ± 2.91

*Significant difference between men and women at P 0.05 with the t-test of Student.BMI=Body mass index; WC= waist circumference; SBP= systolic blood pressure; DBP= diastolic blood pressure.

Table 2: Distribution of study population based on mean of age, BMI, WC, SBP and DBP.

Prevalence of obesity, hypertension and double burden

The results of the distribution of the study population according to overweight and arterial hypertension are shown in table 3 below. From this study we find that almost all of our study population is overweight (26.7%). Abdominal obesity having the highest prevalence (715%). In addition, the results of the distribution of the study population according to the prevalence of arterial hypertension shows that in this study more than two thirds (2/3) (66.3%) of elderly people are in a situation of general hypertension. The results of the distribution of the study population according to the double burden of obesity and hypertension. In the present study, the prevalence of the AO/H pattern is highest (46.5%) followed by the GO/H pattern (37.8%) and finally the CO/H pattern (29.7%).

Frequency

Percentage (%)

Overweight and subtypes of obesity

Overweight

46

26.7

Generalized obesity (GO)

99

57.6

Abdominal obesity (AO)

123

71.5

Isolated generalized obesity (IGO)

15

8.7

Isolated abdominal obesity (IAO)

39

22.7

Combined obesity (CO= GO+AO)

84

48.8

Subtypes of arterial hypertension

Isolated systolic hypertension (ISH)

6

3.5

Isolated diastolic hypertension (IDH)

17

9.9

Generalized hypertension (GH)

114

66.3

Double burden of obesity and hypertension

GO/H

65

37.8

AO/H

80

46.5

CO/H

51

29.7

%= pourcentage. GO= Generalized obesity; H= Hypertension; AO= Abdominal obesity; CO= Combined obesity.

Table 3: Prevalence of overweight, obesity, hypertension and double burden

Overweight, obesity and hypertension based on gender

The study population was grouped according to the gender. Table 4 below shows us that our male seniors are generally obese (50.5%), while our female seniors have high prevalence of abdominal obesity (57.7%) and combined obesity (58.3%). In addition, older men are more exposed to the all subtypes of hypertension compared to older women. The results of the distribution of the study population according to the double burden of obesity- hypertension according to gender have shown that older women are more exposed to all three types of combinations compared to older men.

Total population n=172

Men n=106

Women n= 66

n (%)

n (%)

n (%)

Overweight and subtypes of obesity

Overweight

46 (26.7)

29 (63.0)**

17 (37.0)

Generalized obesity (GO)

99 (57.6)

50 (50.5)**

49 (49.5)

Abdominal obesity (AO)

123 (71.5)

57 (46.3)

66(53.7)**

Combined obesity (CO= GO + AO)

84 (48.8)

35 (42.0)

49 (58.3)

Subtypes of arterial hypertension

Isolated systolic hypertension (ISH)

120 (69.8)

76 (63.3)

44 (36.7)

Isolated diastolic hypertension (IDH)

131 (76.2)

90 (68.7)**

41 (31.3)

Systo – diastolo hypertension (SDH)

114 (66.3)

74 (64.9)

40 (35.1)

Double burden of obesity and hypertension

GO/H

65 (37.8)

31 (47.7)

34 (52.3)*

AO/H

80 (46.5)

40 (50)**

40 (50)**

CO/H

51 (29.7)

20 (39.2)

31 (60.8)**

GO= Generalized obesity; H= Hypertension; AO= Abdominal obesity; CO= Combined obesity; n= frequency; %= percentage. **=p>0.01; *=p>0.05

Table 4: Prevalence of overweight, obesity; hypertension and double burden based on gender

Overweight, obesity and hypertension based on age

The results of the distribution of the study population according to overweight, obesity, hypertension and age are shown in table 5 below. It appears that people aged 60-69 years are much more exposed to all types of obesity and hypertension compared to other age groups.

The results of the distribution of patterns of the double burden of obesity and hypertension based on age shows that the 60-69 years age group was the most exposed to all patterns of double burden (prevalence 50-60%) as compared to other age groups.

Total population n=172

60-69years n=100

70-79years n=25

80-89years n=31

90-99years n=16

n (%)

n (%)

n (%)

n (%)

n (%)

Overweight and subtypes of obesity

Overweight

46 (26.7)

24 (52.2)**

2 (4.3)

17 (37.0)

3 (6.5)

Generalized obesity (GO)

99 (57.6)

55 (55.6)**

17 (17.2)

14 (14.1)

13 (13.1)

Abdominal obesity (AO)

123 (71.5)

61 (49.6)**

18(14.6)

31 (25.2)

13 (10.6)

Combined obesity (CO= GO + AO)

84 (48.8)

41 (48.8)**

16 (19.1)

14 (17)

13 (15.5)

Subtypes of arterial hypertension

Isolated systolic hypertension (ISH)

120 (69.8)

77 (64.2)**

13 (10.8)

20 (16.7)

10 (8.3)

Isolated diastolic hypertension (IDH)

131 (76.2)

85 (64.9)**

10 (7.6)

10 (7.6)

6 (4.6)

Systo – diastolo hypertension (SDH)

114 (66.3)

71 (62.3)**

13 (11.4)

20 (17.5)

10 (8.8)

Double burden of obesity and hypertension

GO/H

65 (37.8)

40 (62.0)

7 (10.8)

11 (16.9)

7 (11.0)

AO/H

80 (46.5)

46 (57.5)

7 (8.8)

20 (25.0)

7 (8.8)

CO/H

51 (29.7)

26 (51.0)

7 (14.0)

11 (21.6)

7 (13.7)

GO= Generalized obesity; H= Hypertension; AO= Abdominal obesity; CO= Combined obesity; n= frequency; %= percentage. **=p>0.01.

Table 5: Prevalence of overweight, obesity, hypertension and double burden based on age

Relationship between double burden obesity - hypertension with some cardiometabolic risk factors

Table 6 below shows the relationship between socio-demographic factors and the double burden obesity- hypertension. It appears that our study population is mainly made up of elderly males (61.6%). Both genders are affected by the double burden obesity- hypertension, with the prevalence of all three combinations being high with the male gender. The majority of our study population is married (94.2%). Among these married couples, we find that those who are in the monogamous marriage are more exposed to the three types of combination. The prevalence of AO/H is higher among elderly married people (47.6%) compared to other marital status. In terms of education level, it is clear that, two thirds (2/3) of our respondents are educated, the prevalence of all three combinations of double burden obesity-hypertension is low among university-level seniors. The results of the relation between the source of incomes and the obesity-hypertension combination show that the prevalence of the three combinations of double burden obesity-hypertension is high among the elderly receiving assistance, followed by the elderly who trade and finally those who receive a permanent salary. Regarding family health history, the prevalence of the- double burden obesity-hypertension is high in older people with a family history of hypertension.

Sociodemographic factors

Variables

Total population

n (%)

GO/H

n (%)

AO/H

n (%)

CO/H

n (%)

Gender

Male

106 (61.6)

34 (32.1)

40 (37.7)

20 (18.9)

Female

66 (38.4)

31 (47.0)

40 (60.6)

31 (47.0)

Type of mariage

Monogamous

66(38.4)

31 (47.0)

39 (59.1)*

25 (37.9)

Polygamous

96(55.8)

30 (31.3)

35 (36.5)

22 (22.9)

Single parent

10 (5.8)

4 (40.0)

6 (60.0)

4 (40.0)

Marital status

Married

126 (73.3)

52 (41.3)

60 (47.6)

40 (31.7)

Widowed/ Divorced/ Separated

42 (24.4)

13 (31.0)

20 (47.6)

11 (26.2)

Single or fianced

4 (2.3)

0 (0.0)

0 (0.0)

0 (0.0)

Level of education

No education

53 (30.8)

11 (21.0)

27 (51.0)

11(20.8)

Primary

34 (19.8)

21 (61.8)

22 (64.7)

15(44.1)

Secondary

41 (23.8)

26 (63.4)

18 (43.9)

18 (43.9)*

University

44 (25.6)

7 (15.9)

13 (29.5)

7 (15.9)

Source of income

Permanent salary

68 (39.5)

25(36.8)

25 (36.7)

19 (27.9)

Temporary salary

11 (6.4)

4 (36.4)

0 (0.0)

0 (0.0)

Trade

29 (16.9)

9 (31.0)

13 (44.8)

7 (29.1)

Help/assistance

64 (37.2)

27 (42.3)

42 (65.6) **

25 (39.1)

Family history

None

6 (3.5)

0 (0.0)

0 (0.0)

0 (0.0)

Cardiovascular diseases (CVD)

12 (7.0)

2 (16.7)

2 (16.7)

2 (16.7)

CVD + hypertension

4 (2.3)

0 (0.0)

0 (0.0)

0 (0.0)

CVD + hypertension + diabetes

7 (4.1)

2 (28.6)

7 (100.0)

2 (28.6)

CVD + diabetes

4 (2.3)

1 (25.0)

4 (100.0)

1 (25.0)

Hypertension

75 (43.6)

40 (53.3)

39 (52.0) **

28 (37.3)

Hypertension + diabetes

20 (11.6)

8 (40.0)

8 (40.0)

8 (40.0)

Diabetes

44 (25.6)

12 (27.3)

20 (45.5)

10 (22.7)

GO= Generalized obesity; H= Hypertension; AO= Abdominal obesity; CO= Combined obesity. **=p>0.01; *=p>0.05

Table6: Relation between the double burden obesity - hypertension with sociodemographic factors

Contributing factors to double burden obesity-hypertension

Sociodemographic factors

In this part, it will be a question to establish the influence of some socio-demographic factors on the different combinations. Table 10 below shows that, type of marriage, source of income and family history influence the combination AO/H, and education level influences combination CO/H (Table 7).

Sociodemographic factors

Variables

GO/H

Chi square

P value

AO/H

Chi square

P value

CO/H

Chi square

P value

Age strata

60-69

1.5 a

P>0.05

7.5 a

P>0.05

2.7 a

P>0.05

70-79

80-89

90-99

Marital status

Marriage

3.9 a

P>0.05

3.6 a

P>0.05

2.2 a

P>0.05

widowed/divorced/ separated

Single or fianced

Level of education

No education

10.1 a

P>0.05

10.1 a

P>0.05

13.4 a

P=0.04 (P<0.05)

Primary

Secondary

University

Type of marriage

Monogamous

4.1 a

P>0.05

8.8 a

P=0.012 (P<0.05)

4.7 a

P>0.05

Polygamous

Single parent

Source of incomes

Permanent salary

1.1 a

P>0.05

21.6a

P=0.00 (P<0.01)

9.4 a

P>0.05

Temporary salary

Trade

Help/ assistance

Family history

None

18.7 a

P>0.05

26.9 a

P=0.00 (P<0.01)

9.4 a

P>0.05

Cardiovascular diseases (CVD)

CVD+Hypertension

CVD+ Hypertension+

Diabete

CVD +

Diabete

Hypertension

Hypertension +

Diabete

Diabete

GO= Generalized obesity; H= Hypertension; AO= Abdominal obesity; CO= Combined obesity

Table 7: Influence of sociodemographic factors with double burden obesity - hypertension

Dietary habits associated to double burden obesity -hypertension

The results of the influence of eating habits on the three obesity-hypertension patterns inform us that the consumption of lettuce-based dishes has a protective effect of the GO/H patterns ([0.33 (95% CI: 0.15-0.73)]) and CO/H ([0.38 (95% CI: 0.16-0.91)]) (Table 11). The consumption of fat and starchy recipes and refined sugars exposes 4.49 (95% CI: 1.30-15.48) times and 2.45 (95% CI: 1.04-5.77) times respectively to the AO/H pattern while the consumption of refined sugars and the irregular fruit consumption exposes 2.52 (95% CI: 1.03-6.17) times and 5.18 (95% CI: 1.36-19.69) times respectively to the combination of GO/H (Table 8). The consumption of local meals has a protective effect on the different combinations. Indeed our study tells us that the most consumed local meals are based on fufu corn and vegetable sauces such as oka soup, “kelekelen” soup, “folere” soup, cassava leaves and “Djapche” (Table 9).

Types of foods consumed

GO/H

Odds ratio (95% IC)

p value

AO/H

Odds ratio (95% IC)

p value

CO/H

Odds ratio (95% IC)

p value

Foods specific to urban environment

Pastas

(yes)

0.59 (0.19-1.79)

P>0.05

0.40 (0.14-1.17)

P>0.05

0.85 (0.26-2.81)

P>0.05

Canned fishes

(yes)

0.96 (0.19-1.79)

P>0.05

1.85 (0.47-2.99)

P>0.05

0.77 (0.27 -2.20)

P>0.05

Canned vegetables

(yes)

1.86 (0.62-5.62)

P>0.05

2.89 (0.96-8.71)

P>0.05

1.41 (0.39-5.06)

P>0.05

Lettuce dishes

(yes)

0.33 (0.15-0.73)

P<0.05

0.70 (0.32-1.51)

P>0.05

0.38 (0.16-0.91)

P<0.05

Rice-soup

(yes)

1.84 (0.58-5.88)

P>0.05

4.49 (1.30- 15.48)

P<0.05

2.76 (0.82-9.24)

P>0.05

Western foods

Soft drinks

(yes)

0.96 (0.42-2.22)

P>0.05

1.48 (0.65-3.37)

P>0.05

1.76 (0.67-4.65)

P>0.05

Candies

(yes)

2.52 (1.03-6.17)

P<0.05

2.45 (1.04-5.77)

P<0.05

1.57 (0.59-4.20)

P>0.05

Fried irish potatoes

(yes)

2.14 (0.78-5.84)

P>0.05

1.27 (0.48-3.39)

P>0.05

1.35 (0.44-4.17)

P>0.05

Pop corn

(yes)

0.36 (0.13-1.00) P>0.05

0.91 (0.36-2.27)

P>0.05

2.61 (0.90-7.56)

P>0.05

Pastries

(yes)

1.45 (0.58-3.64)

P>0.05

0.91 (0.36-2.27)

P>0.05

2.61 (0.90-7.56)

P>0.05

Milk and diary products

(no)

1.08 (0.47-2.51)

P>0.05

0.61 (0.27-1.42)

P>0.05

0.60 (0.24-1.52)

P>0.05

Local meals and fruits

Local meals

(regular)

0.42 (0.17-1.02)

P>0.05

0.66 (0.28-1.57)

P>0.05

0.42 (0.16-1.14)

P>0.05

Fruits

(irregular)

5.18 (1.36-19.69)

P<0.05

1.00 (0.26-3.84)

P>0.05

4.93 (0.88-27.60)

P>0.05

GO= Generalized obesity; H= Hypertension; AO= Abdominal obesity; CO= Combined obesity; OR= odds ratio; P= P value

Table 8: Binary logistic regression of double burden obesity - hypertension with food consumed

Local meals

Consumption

Total population n(%)

GO/ H n(%)

AO/H n(%)

CO/H n(%)

Fufu corn +okra soup

Regular

159 (92.4)

62 (39.0)

74 (46.5)

49 (31.0)

Irregular

13 (7.6)

3 (23.0)

6 (46.2)

2 (15.4)

Fufu corn + «kelenkelen» soup

Regular

115 (66.9)

46 (40.0)

54 (47.0)

37 (32.2)

Irregular

57 (33.1)

19 (40.4)

14 (24.6)

14 (24.6)

Fufu corn + melon leaves

Regular

71 (41.3)

22 (31.0)

32 (45.1)

16 (22.5)

Irregular

101 (58.7)

43 (42.6)

48 (47.5)

48 (47.5)

Fufu corn + folere leaves

Regular

145 (84.3)

58 (40.0)

66 (45.5)

45 (68.2)

Irregular

27 (15.7)

7 (26.0)

14 (51.9)

6 (22.2)

Fufu corn +«djapche»

Regular

162 (94.2)

61 (37.7)

73 (45.1)

48 (29.6)

Irregular

10 (5.8)

4 (40.0)

7 (70.0)

3 (30.0)

Fufu corn +cassava leaves

Regular

120 (69.8)

50 (41.7)

58 (48.3)

40 (33.3)

Irregular

50 (29.1)

14 (28.0)

20 (40.0)

10 (20.0)

GO= generalized obesity; GH= general hypertension; AO= abdominal obesity; CO= combined obesity.

Table 9: Prevalence of consumption local meals based on double burden obesity-hypertension

Discussion

Our study population consisted of 172 elderly aged 60 and above. The male gender was the most dominant. This could be explained by the fact that men are more available and more accessible than women. The prevalences of abdominal obesity, generalized hypertension, and the AO/H pattern were highest. [10] and [7] have shown that the prevalence of abdominal obesity is high in urban areas of Cameroon. This high prevalence could be due to socioeconomic changes and changes in lifestyle in Cameroon (less leisure-time physical activity, increase of educational level, weight gain during youth particularly in married couple...) [10]. Visceral obesity is also believed to be implicated in the etiology of arterial hypertension in the elderly by several mechanisms. Among other things, an increased vasoconstrictive response in response to angiotensin II has been observed in obese normotensive men [12]. This could be explained by the stimulation of the sympathetic nervous system, which inhibits vasorelaxation induced by nitrite oxide (NO) and promotes endothelial dysfunction [13]. Otherwise, a high weight could have beneficial effects in the elderly. Bone mass is increased in older obese people. There is less osteoporosis and less frequent hip fractures in obese men and women. This is due to a mechanical factor of course but also a hormonal one. Estrogen, insulin, and leptin can stimulate bone turnover and bone growth [14]. The prevalence of the three patterns of the double burden was high among women. This result could be explained by menopause. The transition to menopause is a period of life associated with a number of hormonal, morphological and metabolic changes. A redistribution of adipose tissue [15], and this preferentially at the level of abdominal adipose tissue [16], has been observed in postmenopausal women. The change in body composition in these women can lead to deterioration in the metabolic profile. Indeed, it has been shown that postmenopausal women have high plasma triglyceride concentrations [17], low plasma high density lipoprotein cholesterol (HDL) concentrations [18] as well as high prevalence of metabolic syndrome [19] compared to premenopausal women. The high prevalence of the three patterns of double burden among women could also explain by sedentary lifestyle. In fact in the West region - Cameroon and particularly in Foumban, the elderly female are sedentary. In sedentary people, energy expenditure is reduced or even close to that of rest and when intake is not reduced, there is energy storage leading to the phenomenon of obesity. This obesity in turn leads to increased vascular lipid peroxidation, the production of superoxide ion which promotes endothelial dysfunction and subsequently atherosclerosis [20]. In our study, the prevalence of all three types of combinations was high with people aged between 60 - 69 years. In a general population, the weight increases gradually until the age of 50-59 years in both men and women, from there the weight tends to decrease, knowing that there is a bias due to the high mortality rate in obese people [14]. After 20-30 years, the lean mass decreases. There is a decrease in muscle mass of 40% between 20 and 70 years while fat mass increases. The maximum lean mass is reached at age twenty and the maximum fat mass at 60-70 years. Beyond 70 years, the fat mass and the lean mass further decrease and there is also a redistribution of these masses in the body, the lean mass decreases in the periphery and the fat mass predominates at the intra-abdominal, intramuscular and intrahepatic level. These changes are often associated with insulin resistance [14]. Type of marriage, source of income and family history contribute to the AO/H pattern (p<0.05). In our study population, the prevalence of the AO/H pattern is high with the elderly married under a monogamous diet (59.1%), the elderly receiving aid or assistance as a source of income (65.6%) and people elderly with a history of hypertension (52.0%). Studies by Mata and Hertwig [21] have shown that married people unlike single people have a much higher body weight, due to a much healthier and more filling diet. In addition, married men settled into a more comfortable diet and exercised less. In addition, Meltzer et al [22] have shown that happy housewives tend to gain weight. This situation could have been the case for the elderly in our study population in both youth and senior years. Education level was associated with the CO/H pattern. In our study, people in primary and secondary levels had a high prevalence of the combination of CO/H. This result could be explained as the consequence of differences between social classes concerning: the type of diet, the practice of physical exercise and the knowledge of the risks associated with obesity. People from more popular social classes are less aware of the risks associated with weight, have a less balanced diet and exercise less than individuals from more affluent classes [23]. In addition, Macia et al [24] have shown that the lower classes consume, out of “necessity”, rich and inexpensive foods that necessarily make you fat. Thus, the shape of the body, which seems natural to us, would only be the product of lifestyle habits, mainly linked to social class. The differences between men and women are mentioned by the author: according to him, the richest foods are traditionally considered to be "men's foods". Many studies have looked at nutritional risk factors for obesity, including simple carbohydrates. In our study, the consumption of refined sugars, in particular candies, is associated with the AO/H pattern. In fact, these refined sugars have a high GI causing blood sugar levels to rise sharply upon ingestion. The consumption of these sugary foods is harmful because of their high sugar contents and their implication in the development of diabetes and obesity [25]. In our study, the irregularity of fruit consumption was associated with the AO/H pattern, while the consumption of lettuce salad had a protective effect against obesity-hypertension combinations. An inverse relationship between the consumption of fruits and vegetables and weight is reported by a few studies [26]. Different cross-sectional studies indicate a negative relationship between consumption and weight. Fiber consumption is the best predictor of body build with level of physical activity. It is the indigestible fraction of the diet. Fiber is essential for stimulating intestinal transit and facilitates the elimination of certain undesirable elements such as cholesterol [27]. Consumption of rice with sauces was associated with the AO/H pattern. This result is in agreement with studies by Nyangono et al. [7] which showed that fat and starchy recipes was associated with high obesity in urban areas.

Strengths and limitations of the study

The results of our study are difficult to generalize because the study was only carried out on a sample of the elderly of the Foumban. Very few studies are carried out on the elderly in Cameroon. This work makes it possible to challenge all the stakeholders involved in the health field that the double burden of obesity and hypertension should be carefully considered in elderly and general population. Moreover, it must be as an emerging disease influenced by several factors including unhealthy diet. This work also makes it possible to complete the policies for the control and prevention of non communicable diseases on elderly in Cameroon.

Conclusion

Our study showed that the double burden of obesity and hypertension is present in our study population, AO/H pattern being the most discriminating because it prevalence was the highest (46.5%). Regarding socio-demographic parameters, the level of education is associated with the CO/H pattern while the type of marriage, the source of income and the family history are associated with the AO/H pattern. Regarding eating habits, the consumption of lettuce salads has a protective effect of the combinations GO/H and CO/H. Consumption of fat and starchy recipes and refined sugars exposes to the AO/H pattern while consumption of refined sugars and irregular consumption of fruit exposes to the GO/H pattern.

Recommendations

It would be important for the elderly to favor the consumption of vegetables and fruits and also to reduce the consumption of dishes with a high content of refined sugars.

Ethical approvals

The study was approved by the following institutions:

Cameroon National Ethics Committee through the ethical clearance N°2014/08/488/EC/CNERSH;

First Deputy Mayor of the city of Foumban by validation of our request N° 780/UD/ ENSET/D/DA/ESF;

The names of the respondents were coded and anonymity of the information was respected. The data has been used for scientific purposes only and the results obtained are published with strict respect for the confidentiality and dignity of the respondents.

Availability of data and materials

SPSS data outputs are available for review from corresponding author, if requested. Official registration is required to access the database.

Author’s contributions

CFNB and designed the study protocol and wrote the first manuscript draft. NBCF and WD led the statistical analyses and contributed to the manuscript drafting. CM contributed to data collection. NBCF, WD and PM critically contributed to the analysis, discussion and interpretation of the data and contributed to data interpretation and the writing of the manuscript. All authors reviewed and approved the final manuscript draft.

Consent for publication

Sign written consent was taken from all study participants.

Competing interests

The authors have declared any competing interests.

Data funding

The study had no funding source to disclose.

Acknowledgements

The authors acknowledge the elderly of Foumban for their cooperation in this study.

References

  1. NCEP-ATP III. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 285 (2001): 2486-2497.
  2. Girerd X, Herpin D, Vaisse B et al. Prevalence of masked hypertension and white coat hypertension in a representative sample of the French population treated for hypertension. 15th European Meeting on Hypertension, Milan. J Hypertens 23 (2005): S289.
  3. Blacher J, Czernichow S, Iaria P. et al. Non pharmacological treatment of arterial hypertension. EMC-Cardiology Angeiology 2 (2005): 136-151.
  4. Popkin B. An overview on the nutrition transition and its health implications: the Bellagio meeting. Public Health Nutr 5 (2002): 93-103.
  5. Popkin B. The shift in stages of the nutrition transition in the developing world differs from past experiences. Mal J Nutr 8 (2002): 109-124.
  6. United Nations Population Division. World Population Prospects: Revision (2019).
  7. Nyangono BCF, Dakam W, Ntentie FR, et al. Profile of Obesity and Factors Associated Among Adults Cameroonian Living in Urban Area: A Cross Sectional Study. Central Afr J of Public Health 6 (2020): 256-267.
  8. Jesus P, Mizehou AC, Houinato D, et al. Validity of equations for using knee height to predict overall height among older people in Benin. Nutrition 42 (2017): 46-50.
  9. Van DI, Kromhout D, Geleijnse JM, et al. Body mass index and waist circumference predict both 10-year nonfatal and fatal cardiovascular disease risk: Study conducted in 20000 Dutch men and women aged 20-65 years. Eur J cardiovasc prevention and rehabilitation 16 (2009): 729-734
  10. Fezeu LK, Assah FK, Balkau B, et al. Ten-year Changes in Central Obesity and BMI in Rural and Urban Cameroon. Obesity 16 (2008) 21-26.
  11. Nyangono BCF, Mintom MP, William D, et al. Epidemiological profile of hypertension, and its determinants amongst adult patients in Cameroon: A hospital based study. Public Health Open J 4 (2019): 15-23.
  12. Nielsen S, Halliwill JR, Joyner MJ, et al. Vascular response to angiotensin II in upper body obesity. Hypertension 44 (2004): 435-441.
  13. Egan BM, Hennes MM, Stepniakowski KT et al. Obesity hypertension is related more to insulin's fatty acid than glucose action. Hypertension 27 (1996): 723-728.
  14. Thiebaud SB, Pataky Z and Golay A. Obésité chez la personne agée: quelle attitude. Rev Med Suisse 6 (2010): 666–669.
  15. Sowers M, Zheng H, Tomey K, et al. Changes in body composition in women over six years at midlife: ovarian and chronological aging. J Clin Endocrinol Metab 92 (2007): 895-901.
  16. Lovejoy JC, Champagne CM, De Jonge L, et al. Increased visceral fat and decreased energy expenditure during the menopausal transition. Int J Obes 32 (2008): 949-958.
  17. Tremollieres FA, Pouilles JM, Cauneille C, et al. Coronary heart disease risk factors and menopause: a study in 1684 French women. Atherosclerosis 142 (1999): 415-423.
  18. Carr M.The emergence of the metabolic syndrome with menopause. J Clin Endocrinol Metab 88 (2003): 2404-2411.
  19. Park YW, Zhu S, Palaniappan L, et al. The Metabolic syndrome: prevalence and associated risk factor findings in the US population from the Third National Health and Nutrition Examination Survey 1988-1994. Arch Intern Med. 163 (2003): 427-436.
  20. Laufs U, Wassmann S, Czech T, et al. Physical inactivity increases oxidative stress, endothelial dysfunction and artherosclerosis. Arterioscler Thromb Vasc Biol 25 (2005): 809-814.
  21. Mata J and Hertwig R. Higher body mass index, less exercise, but healthier eating in married adults: nine representative survey across ectope. Social Science and Medicine 138 (2015): 119-127.
  22. Meltzer AL, Novak SA, McNulty JK, et al (2013). Marital satisfaction predicts weight gain in early marriage. Health Psychol 32 (2013): 824-827.
  23. Kaplan RM, Huguet N, Newsom JT, et al. Prevalence and correlates of overweight and obesity among older adults: findings from the Canadian national population health survey, Journal of Gerontology: Medical Sciences 11(2003): M1018-1030.
  24. Macia E, Chapuis LN, Boëtsch G. Obesité, facteurs sociodmographiques et indicateurs de santé chez la personne âgées à Marseille. Bulletin et mémoire de a société d’anthropologie de Paris 19 (2007): 77 – 92.
  25. Vasanti SM, Popkin BM, Bray GA, et al. Sugar-Sweetened Beverages, Obesity, Type 2 Diabetes Mellitus, and Cardiovascular Disease Risk. Circulation 121 (2010): 1356-1364.
  26. Savini I, Catani MV, Evangelista D, et al. Obesity-associated oxidative stress: strategies finalized to improve redox state. Int J Mol Sci 14 (2013): 10497-10538.
  27. Kaczmarczyk MM, Miller MJ, Freund GG. The health benefits of dietary fiber: beyond the usual suspects of type 2 diabetes mellitus, cardiovascular disease and colon cancer. Metabolism 61 (2012): 1058-1066.

Grant Support Articles

© 2016-2022, Copyrights Fortune Journals. All Rights Reserved!