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Obesity and Type 2 Diabetes in Sub-Sahara Africa

  • Obesity (J McCaffery, Section Editor)
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Abstract

There is a mounting body of evidence regarding the challenge posed by diabetes and obesity on the health systems of many Sub-Sahara African countries. This trend has been linked to the changing demographic profile together with rapid urbanization and changing lifestyles in both rural and urban settings in Africa. Africa is expected to witness the greatest increase in the number of people with diabetes from 19.8 million in 2013 to 41.4 million in 2035 if current trends persist. Excess weight alone currently accounts for at least 2.8 million deaths globally each year through increased risk for type 2 diabetes and cardiovascular complications. This review highlights recent literature on the problem of obesity and type 2 diabetes in Sub-Sahara Africa. It exposes the need for concrete interventions based on the now available wealth of evidence.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. UNAIDS. Report on the global AIDS epidemic. Geneva: UNAIDS; 2010.

    Google Scholar 

  2. World Health Organisation. WHO global tuberculosis control report. Geneva: WHO; 2010.

    Google Scholar 

  3. Saydah SH, Eberhardt MS, Loria CM, Brancati FL. Age and the burden of death attributable to diabetes in the United States. Am J Epidemiol. 2002;156:714–9.

  4. International Diabetes Federation. IDF diabetes atlas. 6th ed. Brussels: International Diabetes Federation; 2013. Presents the most current global updates on diabetes. Published by the International Diabetes Federation.

  5. Gwatkin D, Guillot M, Heuveline P. The burden of disease among the global poor. Lancet. 1999;354:586–9.

    Article  CAS  PubMed  Google Scholar 

  6. World Health organization (WHO). Global health risks: mortality and burden of disease attributable to selected major risks. Geneva: World Health Organization; 2009.

    Google Scholar 

  7. WHO. Definition, diagnosis and classification of diabetes mellitus and its complications. Geneva: World Health Organization. Department of Noncommunicable Disease Surveillance Geneva; 1999. Report No.: WHO/NCD/NCS/99.2.

    Google Scholar 

  8. Sobngwi E, Mauvais-Jarvis F, Vexiau P, Mbanya JC, Gautier JF. Diabetes in Africans. Part 1: epidemiology and clinical specificities. Diabetes Metab. 2001;27:628–34.

    CAS  PubMed  Google Scholar 

  9. Evaristo-neto AD, Foss-Freitas MC, Foss MC. Prevalence of diabetes mellitus and impaired glucose tolerance in a rural community of Angola. Diabetol Metab Syndr. 2010;2:63.

    PubMed Central  PubMed  Google Scholar 

  10. World Health Organization. Prevention of diabetes mellitus. Report of a WHO Study Group. Geneva: World Health organization; 1994. Report No.: 844.

    Google Scholar 

  11. Adeleye JO, Abbiyesuku FM. Glucose and insulin responses in offspring of Nigerian type 2 diabetics. Afr J Med Med Sci. 2002;31:253–7.

    CAS  PubMed  Google Scholar 

  12. American Diabetes Association. Position statement: diagnosis and classification of diabetes mellitus. Diabetes Care. 2004;27:Suppl 1: S5–S10.

  13. World Health Organization. Use of glycated haemoglobin (HbA1c) in the diagnosis of diabetes mellitus. Geneva: World Health Organization; 2010.

    Google Scholar 

  14. Otaigbe BE, Imafidon EE. Type 2 diabetes mellitus in a Nigerian child: a case report. Afr Health Sci. 2011;11:454–6. Nigerian study which provides evidence of T2DM occurring in a child. This is of importance as the current tendency is to assume T1DM in children presenting with hyperglycemia.

    CAS  PubMed Central  PubMed  Google Scholar 

  15. International Diabetes Federation, World Health Organization, African Union. The diabetes strategy for Africa: an integrated strategic plan for diabetes and related health risks. IDF. 2006.

  16. Barruet R, Gbadoe AD. Type 2 diabetes mellitus in children in black Africa: description of first five cases in Togo. Med Trop (Mars). 2006;66:481–3.

    CAS  Google Scholar 

  17. Crowther NJ, Cameron N, Trusler J, Gray IP. Association between poor glucose tolerance and rapid post natal weight gain in seven-year-old children. Diabetologia. 1998;41:1163–7.

    Article  CAS  PubMed  Google Scholar 

  18. Yu C, Zinman B. Type2 diabetes and impaired glucose tolerance in aboriginal populations: a global perspective. Diabetes Res Clin Pract. 2007;78:159–70.

    Article  CAS  PubMed  Google Scholar 

  19. Nettleton C, et al. Symposium on the social determinants of Indigenous health. In: An overview of current knowledge of the social determinants of indigenous health. Ref Type: Pamphlet. Geneva: World Health Organization; 2007.

  20. Levitt NS, Steyn K, Lambert EV, et al. Modifiable risk factors for type 2 diabetes mellitus in a peri-urban community in South Africa. Diabetes Medicine. 1999;16:946–50.

  21. Cooper RS, Rotimi CN, Kaufman JS, Owoaje EE, Fraser H, Forrester T, et al. Prevalence of NIDDM among populations of the African diaspora. Diabetes Care. 1997;20:343–8.

    Article  CAS  PubMed  Google Scholar 

  22. Klimentidis YC, Abrams M, Wang J, Fernandez JR, Allison DB. Natural selection at genomic regions associated with obesity and type-2 diabetes: East Asians and sub-Saharan Africans exhibit high levels of differentiation at type-2 diabetes regions. Hum Genet. 2011;129:407–18.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Dowse GK, Zimmet PZ, Gareeboo H, George K, Alberti MM, Tuomilehto J, et al. Abdominal obesity and physical inactivity as risk factors for NIDDM and impaired glucose tolerance in Indian, Creole, and Chinese Mauritians. Diabetes Care. 1991;14:271–82.

    Article  CAS  PubMed  Google Scholar 

  24. Kasiam LO, Longo-Mbenza B, Nge OA, Kangola KN, Mbungu FS, Milongo DG. Classification and dramatic epidemic of diabetes mellitus in Kinshasa Hinterland: the prominent role of type 2 diabetes and lifestyle changes among Africans. Niger J Med. 2009;18:311–20.

    PubMed  Google Scholar 

  25. Bourne LT, Lambert EV, Steyn K. Where does the black population of South Africa stand on the nutrition transition? Public Health Nutr. 2002;5:157–62.

    Article  PubMed  Google Scholar 

  26. Levitt NS, Katzenellenbogen JM, Bradshaw D, Hoffman MN, Bonnici F. The prevalence and identification of risk factors for NIDDM in urban Africans in Cape Town. S Afr Diabetes Care. 1993;16:601–7.

    Article  CAS  Google Scholar 

  27. Rotimi CN, Cooper RS, Okosun IS, Olatunbosun ST, Bella AF, Wilks R, et al. Prevalence of diabetes and impaired glucose tolerance in Nigerians, Jamaicans and US blacks. Ethn Dis. 1999;9:190–200.

    CAS  PubMed  Google Scholar 

  28. Levitt NS, Katzenellenbogen JM, Bradshaw D, Hoffman MN, Bonnici F. The prevalence and identification of risk factors for NIDDM in urban Africans in Cape Town, South Africa. Diabetes Care. 1993;16:601–7.

    Article  CAS  PubMed  Google Scholar 

  29. Plantinga LC, Crews DC, Coresh J, et al. Prevalence of chronic kidney disease in US adults with undiagnosed diabetes or prediabetes. Clin J Am Soc Nephrol. 2010;5:673–82.

    Article  PubMed Central  PubMed  Google Scholar 

  30. Flores-Le Roux JA, Comin J, Pedro-Botet J, et al. Seven-year mortality in heart failure patients with undiagnosed diabetes: an observational study. Cardiovasc Diabetol. 2011;10:39.

    Article  PubMed Central  PubMed  Google Scholar 

  31. Spijkerman AMW, Dekker JM, Nijpels G, et al. Microvascular complications at time of diagnosis of type2 diabetes are similar among diabetic patients detected by targeted screening and patients newly diagnosed in general practice: the hoorn screening study. Diabetes Care. 2003;29:2604–8.

    Article  Google Scholar 

  32. Mbanya JC, Ramiaya K. Diabetes mellitus. In: Jamison DT, Feachem RG, Makgoba MW, et al., editors. Disease and mortality in Sub-Saharan Africa. 2nd ed. Washington: World Bank; 2006.

    Google Scholar 

  33. International Working Group on the Diabetic Foot. International consensus on the Diabetic Foot. International Working Group on the Diabetic Foot; 1999.

  34. Kengne AP, Djouogo CF, Dehayem MY, Fezeu L, Sobngwi E, Lekoubou A, et al. Admission trends over 8 years for diabetic foot ulceration in a specialized diabetes unit in Cameroon. Int J Low Extrem Wounds. 2009;8:180–6.

    Article  PubMed  Google Scholar 

  35. Odusan O, Ogunsemi O, Olatawura MO. Common mental disorders among subjects with T2DM in Sagamu, Nigeria. Afr J Med Med Sci. 2012;41:141–5. This reference pays attention to the prevalence of foot ulceration as a diabetes-related complication. Diabetic foot does not currently receive sufficient attention in SSA.

    CAS  PubMed  Google Scholar 

  36. Lester FT. Clinical status of Ethiopian diabetic patients after 20 years of diabetes. Diabetes Med. 1991;8:272–6.

    Article  CAS  Google Scholar 

  37. Sobngwi E, Mbanya JC, Moukouri EN, Ngu KB. Microalbuminuria and retinopathy in a diabetic population of Cameroon. Diabetes Res Clin Pract. 1999;44:191–6.

    Article  CAS  PubMed  Google Scholar 

  38. Popkin BM. The nutrition transition and its health implications in in lower-income countries. Public Health Nutr. 2011;1:5–21. Author clearly spells out the role the nutrition transition in the current rising problem of obesity and diabetes.

    Google Scholar 

  39. Ettarh R, Van de Vijver S, Oti S, Kyobutungi C. Overweight, obesity, and perception of body image among slum residents in Nairobi, Kenya, 2008–2009. Prev Chronic Dis. 2013;10:E212. Highlights the importance of considering overweight/obesity perception in our quest to promote healthy weight maintenance. If people don’t see obesity as a problem, interventions might meet with resistance.

    Article  PubMed Central  PubMed  Google Scholar 

  40. Delisle H, Agueh V, Fayomi B. Partnership research on nutrition transition and chronic diseases in West Africa - trends, outcomes and impacts. BMC Int Health Hum Rights. 2011;11 Suppl 2:S10.

    Article  PubMed Central  PubMed  Google Scholar 

  41. Popkin BM, Adair LS, Ng SW. Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev. 2012;70:3–21. Another publication which points out the role of the nutrition transition in the changing disease pattern.

    Article  PubMed Central  PubMed  Google Scholar 

  42. Micklesfield LK, Lambert EV, Hume DJ, Chantler S, Pienaar PR, Dickie K, et al. Socio-cultural, environmental and behavioural determinants of obesity in black South African women. Cardiovasc J Afr. 2013;24:369–75.

    Article  PubMed Central  PubMed  Google Scholar 

  43. Msyamboza KP, Kathyola D, Dzowela T. Anthropometric measurements and prevalence of underweight, overweight and obesity in adult Malawians: nationwide population based NCD STEPS survey. Pan Afr Med J. 2013;15:108.

    Article  PubMed Central  PubMed  Google Scholar 

  44. Okpechi IG, Chukwuonye II, Tiffin N, Madukwe OO, Onyeonoro UU, Umeizudike TI, et al. Blood pressure gradients and cardiovascular risk factors in urban and rural populations in Abia State South Eastern Nigeria using the WHO STEPwise approach. PLoS One. 2013;8:e73403.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  45. Lourdes DO, Plat D, Pochet P, Sahabana M. La diffusion des motos-taxi dans l'Afrique Urbaine au Sud du Sahara, XLIIIe Colloque de l'ASRDLF: Association de Science Regionale De Langue Francaise; 2007.

  46. Assah FK, Ekelund U, Brage S, Mbanya JC, Wareham NJ. Urbanization, physical activity, and metabolic health in sub-Saharan Africa. Diabetes Care. 2011;34:491–6.

    Article  PubMed Central  PubMed  Google Scholar 

  47. World Health Organization. Global status report on non-communicable diseases, 2010. Geneva: WHO; 2010.

    Google Scholar 

  48. Danquah I, Bedu-Addo G, Terpe KJ, Micah F, Amoako YA, Awuku YA, et al. Diabetes mellitus type 2 in urban Ghana: characteristics and associated factors. Biomedcentral Public Health. 2012;12:210.

    CAS  Google Scholar 

  49. Frank LK, Heraclides A, Danquah I, Bedu-Addo G, Mockenhaupt FP, Schulze MB. Measures of general and central obesity and risk of type 2 diabetes in a Ghanaian population. Trop Med Int Health. 2013;18:141–51.

    Article  PubMed  Google Scholar 

  50. Buresi D. Clinical study of diabetes mellitus in hospital practice in Northern Rwanda (apropos of 86 case reports). Med Trop (Mars). 1988;48:229–35.

    CAS  Google Scholar 

  51. Erasmus RT, Blanco BE, Okesina AB, Gqweta Z, Matsha T. Assessment of glycaemic control in stable type 2 black South African diabetics attending a peri-urban clinic. Postgrad Med J. 1999;75:603–6.

    CAS  PubMed Central  PubMed  Google Scholar 

  52. Oguntibeju OO, Odunaiya N, Oladipo B, Truter EJ. Health behaviour and quality of life of patients with type 2 diabetes attending selected hospitals in south western Nigeria. West Indian Med J. 2012;61:619–26.

    CAS  PubMed  Google Scholar 

  53. Evaristo-neto AD, Foss-Freitas MC, Foss MC. Prevalence of diabetes mellitus and impaired glucose tolerance in a rural community of Angola. Diabetol Metab Syndr. 2010;2:63.

  54. World Health Organization. The world health report 2002. Reducing risks, promoting healthy life. Geneva: World Health Organization; 2002.

    Google Scholar 

  55. Beaglehole R, Bonita R, Alleyne G, Horton R, Li L, Lincoln P, et al. UN high-level meeting on non communicable diseases: addressing 4 questions. Lancet. 2011;378:449–55. This publication spells out the global attention that has been given NCDs as a global health challenge.

    Article  PubMed  Google Scholar 

  56. Young F, Critchley JA, Johnstone LK, Unwin NC. A review of co-morbidity between infectious and chronic disease in Sub Saharan Africa: TB and diabetes mellitus, HIV and metabolic syndrome, and the impact of globalization. Global Health. 2009;5.

  57. Hall V, Thomsen RW, Henriksen O, Lohse N. Diabetes in Sub Saharan Africa 1999–2011: epidemiology and public health implications. A systematic review. BMC Public Health. 2011;11:564.

    Article  PubMed Central  PubMed  Google Scholar 

  58. Gill GV, Mbanya JC, Ramaiya KL, Tesfaye S. A sub-Saharan African perspective of diabetes. Diabetologia. 2009;52:8–16.

    Article  CAS  PubMed  Google Scholar 

  59. World Health Organization (WHO). Preventing chronic diseases: a vital investment. Geneva: World Health Organization; 2005.

    Google Scholar 

  60. Gross Domestic Product per capita, PPP (current international $). World Bank International Comparison Program database 2014 [cited 2014 Jan 20]; available from: URL: http://search.worldbank.org/data?qterm=international%20USD&language=EN.

  61. BeLue R, Diaw M, Ndao F, Okoror T, Degboe A, Abiero B. A cultural lens to understanding daily experiences with type 2 diabetes self-management among clinic patients in M'bour, Senegal. Int Q Community Health Educ. 2012;33:329–47.

    Article  PubMed  Google Scholar 

  62. Cameron A, Roubos I, Ewen M, Mantel-Teeuwisse AK, Leufkens HGM, Laing RO. Differences in the availability of medicines for chronic and acute conditions in the public and private sectors of developing countries. Bull World Health Organ. 2011;89:412–21.

    Article  PubMed Central  PubMed  Google Scholar 

  63. Pories WJ, Flickinger EG, Meelheim D, Van Rij AM, Thomas FT. The effectiveness of gastric bypass over gastric partition in morbid obesity. Ann Surg. 1982;196:398–9.

    Article  Google Scholar 

  64. Naslund I, Wickbom G, Christofferson E, Agren G. A prospective randomized comparison of gastric bypass and gastro-plasty: complications and early results. Acta Chir Scand. 1986;152:681–9.

    CAS  PubMed  Google Scholar 

  65. Hall JC, Watts JM, O'Brien PE, Dustan RE, Walsh JF, Slavotinek AH, et al. Gastric surgery for morbid obesity: the Adelaide study. Ann Surg. 2014;211:419–27.

    Article  Google Scholar 

  66. World Health Assembly. Follow-up to the political declaration of the high-level meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases. Geneva: WHO; 2013.

    Google Scholar 

  67. Pan XR, Li GW, Hu YH, Wang JX, Yang WY, An ZX, et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care. 1997;20:537–44.

    Article  CAS  PubMed  Google Scholar 

  68. Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-Parikka P, et al. Prevention of type 2 diabetes mellitus by change in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;344:1343–50.

    Article  CAS  PubMed  Google Scholar 

  69. Vijan S, Stevens D, Hermann W, Funnell M, Strandiford C. Screening, prevention, counselling, and treatment for the complications of type ii diabetes mellitus. Putting evidence into practice. J Gen Int Med. 1997;12:567–80.

    Article  CAS  Google Scholar 

  70. Wojtaszewski JF, Hansen BF, Gade J, Kiens B, Markuns JF, Goodyear LJ, et al. Insulin signaling and sensitivity after exercise in human skeletal muscle. Diabetes. 2000;49:325–31.

    Article  CAS  PubMed  Google Scholar 

  71. Gogo-Jack S. Primary prevention of type-2 diabetes in developing countries. J Natl Med Assoc. 2006;98:415–9.

    Google Scholar 

  72. Vorster HH, Kruger A, Margetts BM. The nutrition transition in Africa: can it be steered into a more positive direction? Nutrients. 2011;3:429–41. Provides an interesting idea involving the steering of the nutrition transition to a more favorable transition.

    Article  PubMed Central  PubMed  Google Scholar 

  73. Schwarz PH, Li J, Lindstrom J, Tuomilehto J. Tools for predicting the risk of type 2 diabetes in daily practice. Horm Metab Res. 2009;41:86–97.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

Jean Claude Mbanya reports grants from the World Diabetes Federation. Felix K. Assah reports grants from Wellcome Trust.

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Jean Claude Mbanya, Emmanuella N. Atanga, and Jude Saji declare that they have no conflict of interest. Felix K. Assah reports personal fees from the government of Cameroon.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Correspondence to Jean Claude Mbanya.

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Mbanya, J.C., Assah, F.K., Saji, J. et al. Obesity and Type 2 Diabetes in Sub-Sahara Africa. Curr Diab Rep 14, 501 (2014). https://doi.org/10.1007/s11892-014-0501-5

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