Non Communicable Diseases Research Unit

Cape Town, South Africa

Non Communicable Diseases Research Unit

Cape Town, South Africa

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Maarman G.J.,University of Cape Town | Mendham A.E.,University of Cape Town | Lamont K.,University of Witwatersrand | George C.,Non Communicable Diseases Research Unit
Nutrition Research | Year: 2017

In 2012, the World Health Organization Global Status Report on noncommunicable diseases showed that 7.4 million deaths were due to ischemic heart disease. Consequently, cardiovascular disease is a significant health burden, especially when partnered with comorbidities such as obesity, metabolic syndrome, and type 2 diabetes mellitus. Of note, these diseases can all be induced or exacerbated by diet. Carbohydrates, in particular, fructose and glucose, generally form the largest part of the human diet. Accumulating evidence from animal studies suggests that if large amounts of fructose are consumed either in isolation or in combination with glucose (fructose-containing sugars), myocardial susceptibility to ischemia/reperfusion (I/R) injury increases. However, the underlying mechanisms that predisposes the myocardium to I/R injury in the fructose model are not elucidated, and no single mechanistic pathway has been described. Based on all available data on this topic, this review describes previously investigated mechanisms and highlights 3 main mechanistic pathways whereby fructose has shown to increase myocardial susceptibility to I/R injury. These pathways include (1) increased reactive oxygen species, resulting in reduced nitric oxide synthase and coronary flow; (2) elevated plasma fatty acids and insulin, leading to increased cardiac triglyceride content and lipotoxicity; and (3) disrupted myocardial calcium handling/homeostasis. Moreover, we highlight various factors that should be taken into account when the fructose animal model is used, such as rat strain, treatment periods, and doses. We argue that failure to do so would result in erratic inferences drawn from the existing body of evidence on fructose animal models. © 2017 Elsevier Inc.


Ameh O.I.,Zenith Medical and Kidney Center | Okpechi I.G.,University of Cape Town | Dandara C.,University of Cape Town | Kengne A.-P.,Non Communicable Diseases Research Unit
OMICS A Journal of Integrative Biology | Year: 2017

Telomere length (TL) is an important biological variable that can influence a variety of disease-related complex traits as well as host-environment interactions such as drug and nutritional responses. Chronic kidney disease (CKD) is a common global health challenge especially with the currently aging world population. We conducted a PubMed database search according to the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines for systematic reviews. Studies in adults (18 years and above) in which TL was determined and correlated with CKD, renal traits, and function were included, while animal model studies were excluded. Nine studies comprising 7829 participants, published between 2005 and 2016, met the inclusion criteria. These included eight observational studies (six being prospective), and one clinical trial. Participants in two studies were diabetic patients with varying stages of CKD, and nondialysis chronic glomerulonephritis CKD patients in two other studies. TL measurements used polymerase chain reaction in five studies, terminal restriction fragmentation in three studies, and quantitative fluorescence in situ hybridization in one study. Short TL was independently associated with increased risk of prevalent microalbuminuria in diabetic men with CKD (p = 0.007). Among CKD patients with heterogeneous etiologies, however, there was an unadjusted lower risk (p < 0.001). Short TL was significantly associated with CKD progression among smokers (p = 0.001) and diabetic patients (p = 0.03). On the other hand, long TL was paradoxically associated with longer diagnosed duration of moderate CKD. We postulate that shortening TL might be associated with CKD prevalence/occurrence or declining kidney function, but this association is likely offset by the cellular telomere reparative process in those surviving longer with CKD. This systematic review underscores the need for future omics and human genetics research to delineate the contribution of TL to CKD, renal dysfunction, and related health outcomes. Telomeres and telomerase activity hold great promise for CKD risk stratification and personalized medicine. © 2017, Mary Ann Liebert, Inc.


Matsungo T.M.,North West University South Africa | Kruger H.S.,North West University South Africa | Smuts C.M.,North West University South Africa | Faber M.,Non Communicable Diseases Research Unit
Proceedings of the Nutrition Society | Year: 2017

The prevalence of stunting remains high in low- and middle-income countries despite adoption of comprehensive nutrition interventions, particularly in low-income countries. In the present paper, we review current evidence on the acceptability and efficacy of small-quantity lipid-based nutrient supplements (SQ-LNS) on preventing stunting in children under 2 years, discuss the factors that affect their efficacy, highlight the implications of the current findings at pragmatic level and identify research priorities. Although the present paper is not a generic systematic review, we used a systematic approach to select relevant literature. The review showed that there is growing interest in the potential benefits of using SQ-LNS to prevent growth faltering. Acceptability studies showed that SQ-LNS are generally well accepted. However, results on the efficacy of SQ-LNS on improving linear growth or preventing growth faltering in infants and young children are still inconclusive. Factors that may affect efficacy include the duration of the trial, composition and dosage of SQ-LNS given, and baseline demographics and nutritional status of research participants. Future research should focus on controlled and long-term follow-up trials to obtain more conclusive results. In the long term, there will be need for studies to investigate how provision of SQ-LNS can be integrated with existing strategies to prevent stunting in low- and middle-income settings. Copyright © The Authors 2017


Faber M.,Non Communicable Diseases Research Unit | Laubscher R.,Biostatistics Unit | Berti C.,North West University South Africa
Maternal and Child Nutrition | Year: 2016

Infants and toddlers have high nutritional requirements relative to body size but consume small amounts of food and therefore need nutrient-dense complementary foods. A cross-sectional study included children aged 6–24 months, stratified in three age categories (6–11 months, 12–17 months and 18–24 months) and randomly selected from an urban (n = 158) and a rural (n = 158) area, both of low socio-economic status, in the KwaZulu-Natal Province of South Africa. Dietary diversity and nutrient density of the complementary diet (excluding breast milk and formula milk) based on a repeated 24-h dietary recall was assessed. For breastfeeding children, nutrient density of the complementary diet was adequate for protein, vitamin A and vitamin C; and inadequate for 100% of children for zinc, for >80% of children for calcium, iron and niacin; and between 60% and 80% of children for vitamin B6 and riboflavin. Urban/rural differences in density for animal and plant protein, cholesterol and fibre occurred in 18–24-month-old children. Fewer than 25% of children consumed ≥4 food groups, with no urban/rural differences. Higher dietary diversity was associated with higher nutrient density for protein and several of the micronutrients including calcium, iron and zinc. The poor nutrient density for key micronutrients can probably be ascribed to lack of dietary variety, and little impact of mandatory fortification of maize meal/wheat flour on infants/toddlers' diet. Targeted strategies are needed to enable mothers to feed their children a more varied diet. © 2014 John Wiley & Sons Ltd


Nel E.,North West University South Africa | Kruger H.S.,North West University South Africa | Baumgartner J.,North West University South Africa | Faber M.,Non communicable Diseases Research Unit | Smuts C.M.,North West University South Africa
Maternal and Child Nutrition | Year: 2015

We reassessed the iron deficiency (ID) prevalence in a South African trial that formed part of the International Research on Infant Supplementation study by comparing four methods that account for the high prevalence of acute (28.6%) and chronic (41.8%) inflammation observed in the study. Serum ferritin (SF) was measured as marker of iron status in 192 apparently healthy, 4-13-month-old infants. Alpha-1 glycoprotein and C-reactive protein concentrations were determined to indicate chronic and acute inflammation, respectively. The ID prevalence was obtained by four methods that adjust for inflammation: (1) excluding infants with inflammation; (2) using a higher cut-off (SF<30μgL-1); (3) using different cut-offs for infants with vs. without inflammation (SF<30μgL-1 vs. SF<12μgL-1); and (4) adjusting SF concentrations with correction factors (CFs) were compared with a reference method (SF<12μgL-1) not accounting for inflammation. Using the higher SF cut-off method resulted in the highest ID prevalence (52.1%), followed by using two different cut-offs (31.8%), using CFs (21.9%) and excluding subjects with inflammation (17.6%). The CF method showed the best agreement with the reference method. Disregarding inflammation resulted in a significantly lower ID prevalence (17.2%). ID anaemia (IDA) prevalence ranged from 13.2% to 24.5%, with the lowest prevalence (12.0%) for the reference method. Our analysis highlights the challenge of assessing ID and IDA using only SF as marker of iron status in the presence of inflammation. We demonstrate the importance of measuring inflammation markers to account for their elevating effect on SF. © 2015 John Wiley & Sons, Ltd.


Balti E.V.,Free University of Brussels | Echouffo-Tcheugui J.B.,Emory University | Yako Y.Y.,Non Communicable Diseases Research Unit | Yako Y.Y.,Cape Peninsula University of Technology | And 3 more authors.
Diabetes Research and Clinical Practice | Year: 2014

Aim: Whether exposure to relatively high levels of air pollution is associated with diabetes occurrence remains unclear. We sought to assess and quantify the association between exposure to major air pollutants and risk of type 2 diabetes. Methods: PubMed and EMBASE databases (through September 2013) were searched using a combination of terms related to exposure to gaseous (NO2 and NOx) or particulate matter pollutants (PM2.5, PM10 and PM10-2.5) and type 2 diabetes. Descriptive and quantitative information were extracted from selected studies. We used random-effects models meta-analysis to derive overall risk estimates per type of pollutant. Results: We included ten studies (five cross-sectional and five prospective), assessing the effects of air pollutants on the occurrence of diabetes. In prospective investigations, the overall effect on diabetes occurrence was significant for both NO2 (adjusted hazard ratio [HR], 1.13; 95% confidence interval [95%CI], 1.01-1.22; p<0.001; I2=36.4%, pheterogeneity=0.208) and PM2.5 (HR, 1.11; 95%CI, 1.03-1.20; p<0.001; I2=0.0%, pheterogeneity=0.827). Odds ratios were reported by two cross-sectional studies which revealed similar associations between both NO2 and PM2.5 with type 2 diabetes. Across studies, risk estimates were generally adjusted for age, gender, body mass index and cigarette smoking. Conclusions: Available evidence supports a prospective association of main air pollutants with an increased risk for type 2 diabetes. This finding may have implications for population-based strategies to reduce diabetes risk. © 2014 Elsevier Ireland Ltd.


Lekoubou A.,Medical University of South Carolina | Echouffo-Tcheugui J.B.,Emory University | Echouffo-Tcheugui J.B.,MedStar Health | Kengne A.P.,University of Cape Town | And 3 more authors.
BMC Public Health | Year: 2014

Background: Sub-Saharan African (SSA) countries are experiencing rapid transitions with increased life expectancy. As a result the burden of age-related conditions such as neurodegenerative diseases might be increasing. We conducted a systematic review of published studies on common neurodegenerative diseases, and HIV-related neurocognitive impairment in SSA, in order to identify research gaps and inform prevention and control solutions. Methods. We searched MEDLINE via PubMed, 'Banque de Données de Santé Publique' and the database of the 'Institut d'Epidemiologie Neurologique et de Neurologie Tropicale' from inception to February 2013 for published original studies from SSA on neurodegenerative diseases and HIV-related neurocognitive impairment. Screening and data extraction were conducted by two investigators. Bibliographies and citations of eligible studies were investigated. Results: In all 144 publications reporting on dementia (n = 49 publications, mainly Alzheimer disease), Parkinsonism (PD, n = 20), HIV-related neurocognitive impairment (n = 47), Huntington disease (HD, n = 19), amyotrophic lateral sclerosis (ALS, n = 15), cerebellar degeneration (n = 4) and Lewy body dementia (n = 1). Of these studies, largely based on prevalent cases from retrospective data on urban populations, half originated from Nigeria and South Africa. The prevalence of dementia (Alzheimer disease) varied between <1% and 10.1% (0.7% and 5.6%) in population-based studies and from <1% to 47.8% in hospital-based studies. Incidence of dementia (Alzheimer disease) ranged from 8.7 to 21.8/1000/year (9.5 to 11.1), and major risk factors were advanced age and female sex. HIV-related neurocognitive impairment's prevalence (all from hospital-based studies) ranged from <1% to 80%. Population-based prevalence of PD and ALS varied from 10 to 235/100,000, and from 5 to 15/100,000 respectively while that for Huntington disease was 3.5/100,000. Equivalent figures for hospital based studies were the following: PD (0.41 to 7.2%), ALS (0.2 to 8.0/1000), and HD (0.2/100,000 to 46.0/100,000). Conclusions: The body of literature on neurodegenerative disorders in SSA is large with regard to dementia and HIV-related neurocognitive disorders but limited for other neurodegenerative disorders. Shortcomings include few population-based studies, heterogeneous diagnostic criteria and uneven representation of countries on the continent. There are important knowledge gaps that need urgent action, in order to prepare the sub-continent for the anticipated local surge in neurodegenerative diseases. © 2014 Lekoubou et al.; licensee BioMed Central Ltd.


Peer N.,Non communicable Diseases Research Unit | Lombard C.,Biostatistics Unit | Steyn K.,University of Cape Town | Gaziano T.,Harvard University | Levitt N.,University of Cape Town
South African Medical Journal | Year: 2014

Objectives. To establish the prevalence and determinants of the 10-year risk of a cardiovascular disease (CVD) event in 25 - 74-year-old black Africans in Cape Town, South Africa, using Framingham laboratory- and non-laboratory-based and National Health and Nutrition Examination Survey (NHANES) I non-laboratory-based equations.Methods. CVD risk factors were determined by questionnaires, clinical measurements and biochemical analyses. Survey logistic regression analyses assessed the sociodemographic determinants of CVD risk ≥20%.Results. There were 1 025 participants, 369 men and 656 women. Mean 10-year risk for a CVD event by Framingham laboratory- and non-laboratory-based and NHANES I non-laboratory-based equations for men was 9.0% (95% confidence interval 7.7 - 10.3), 11.1% (9.6 - 12.6) and 9.0% (7.6 - 10.3), and for women 5.4% (4.7 - 6.1), 6.8% (5.9 - 7.7) and 8.7% (7.6 - 9.8). Correlations between laboratory- and non-laboratory-based scores were high (0.915 - 0.963). The prevalence of laboratory-based CVD risk ≥20% was 13.0% in men and 6.1% in women. In the logistic model for men, ≤7 years of education (odds ratio 3.09; 95% CI 1.67 - 5.71) and being unemployed (3.44; 1.21 - 9.81) compared with employed were associated with laboratory-based high risk. In women, high risk was associated with ≤7 years of education (4.20; 1.96 - 9.01), living in formal v. informal housing (2.74; 1.24 - 6.06) and being poor (middle v. lowest tertile 0.29; 0.13 - 0.66). In the Framingham non-laboratory-based logistic models there were no changes in the direction or significance of the variables except for housing, which was no longer significant in women.Conclusions. Comparability of laboratory- and non-laboratory-based CVD risk estimates illustrates the utility of the latter in resource-constrained settings. © 2014, South African Medical Association. All rights reserved.


Peer N.,Non communicable Diseases Research Unit | Peer N.,University of Cape Town | Ganie Y.N.,Inkosi Albert Luthuli Central Hospital | Ganie Y.N.,University of KwaZulu - Natal
South African Medical Journal | Year: 2016

Overweight and obesity are common in South African boys (18.8%) and girls (26.3%). Considering the potential serious consequences of these conditions, clinicians need to identify overweight and obese adolescents to enable early diagnosis and treatment. The key contributor in adolescents is increased intake of unhealthy foods and lower levels of physical activity. The consequences of overweight and obesity in adolescence are multisystemic and include cardiometabolic (type 2 diabetes mellitus, high blood pressure, dyslipidaemia), respiratory (obstructive sleep apnoea), gastrointestinal (non-alcoholic fatty liver disease), musculoskeletal, psychological (depression) and social (stigmatisation) effects. Body mass index (BMI) is calculated to determine overweight and obesity in adolescents. Numerous expert committees, despite using different methods, classify overweight and obesity in children by age- and gender-specific cut points for BMI. After a diagnosis of overweight and obesity, secondary causes must be excluded, and a history of dietary intake, physical activity and sedentary behaviour obtained. This will identify modifiable behaviours that promote energy imbalance. All obese adolescents should undergo cardiometabolic assessments comprising fasting glucose, lipid and blood pressure measurements every 2 years. Interventions should focus on creating healthier home environments that provide easy access to healthy foods, encourage physical activity and discourage sedentary behaviour. Medication for weight loss or bariatric surgery may be considered for severely obese adolescents who do not respond to other strategies. © 2016, South African Medical Association. All rights reserved.


Peer N.,Non communicable Diseases Research Unit | Lombard C.,Biostatistics Unit | Steyn K.,University of Cape Town | Levitt N.,University of Cape Town
European Journal of Preventive Cardiology | Year: 2015

Aims: To determine the metabolic syndrome prevalence by the 2009 harmonised criteria in 25-74-year-old urban Africans in Cape Town. Methods: In 2008/2009, a representative cross-sectional sample, stratified by age and gender, was randomly selected. Cardiovascular risk factors were determined with questionnaires, clinical measurements and biochemical analyses, including fasting blood samples. Logistic regression analysis assessed the independent effects of socio-demographic variables on metabolic syndrome. Results: There were 1099 participants, 392 of whom were men and 707 women (response rate 86%). Crude and agestandardised (SEGI) prevalence of metabolic syndrome was 30.7% (95% confidence interval (CI): 27.4-34.1) and 31.7% (95% CI: 28.4-35.3), respectively, with higher rates among women (43.5%, 95% CI: 39.2-47.9 and 44.9%, 95% CI: 40.5-49.3) than men (16.5%, 95% CI: 12.7-21.2 and 17.3%, 95% CI: 13.4-21.9) (p<0.001). Overall, metabolic syndrome components that were higher in women compared with men were central obesity (86.0% vs. 20.1%) and low high-density lipoprotein cholesterol (75.0% vs. 33.4%) while in men, raised blood pressure (51.4%) was the most frequent. In the multiple logistic models, higher age (55-64 years (peak age) versus 25-34 years: odds ratio (OR): 7.35, 95% CI: 3.27-16.56, p<0.001) and wealth (highest versus lowest tertile: OR: 1.87, 95% CI: 1.14-3.08, p=0.014) in women, and higher age (p=0.002) and employment compared with unemployment (OR: 3.01, 95% CI: 1.18-7.67, p=0.021) in men were significantly associated with metabolic syndrome. Conclusions: The high metabolic syndrome prevalence underscores the frequent clustering of cardiovascular risk factors, the need to determine other risk factors, if a single risk factor is present, and the need for comprehensive integrated approaches to tackle cardiovascular disease. © The European Society of Cardiology 2014.

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