Abstract
BackgroundAlong with a nutritional transition in Sub-Saharan Africa, the prevalence of non-communicable diseases is increasing rapidly. We assess the association between food intake and cardiometabolic risk factors in a rural population in Uganda.MethodsThe present study was based on data from a household-based case-control study of diabetic and non-diabetic households in Southwestern Uganda, 2012–2013. We analysed food intake in 359 individuals age ≥ 13 years from 87 households, using a household food frequency questionnaire, and measures of glycated haemoglobin (HbA1c), height and weight. We used multinomial logistic regression to model abnormal HbA1c (≥5.7%) and weight status (underweight, normal weight and overweight) as an outcome of total food intake and by nine food groups. Results were reported as odds ratios (OR) with 95% confidence intervals (CI). Models were adjusted for three nested sets of covariates.ResultsThe diet primarily consisted of staple food (cassava and plantain). High-Glycaemic Index staple food was the most consumed food group (median = 14 servings/week, p25-p75: 11–17). Milk, meat, fish and vegetables were the least consumed food groups (medians: 0–3 servings/week). Median intake of sugary food was 6 servings/week (p25-p75: 2–9). The OR of having abnormal HbA1c or being overweight increased with every weekly serving of food (1.02, 95% CI: 1.00–1.04 and 1.01 95% CI: 1.00–1.03, respectively). Of specific food groups, each weekly serving of meat increased the OR of being overweight with 33% (95% CI: 1.08–1.64), and fruit intake decreased the OR of abnormal HbA1c (0.94, 95% CI: 0.88–1.00), though this latter association was attenuated after adjustment for weight status, aerobic capacity, and socioeconomic status.ConclusionDiet was monotonous, mainly consisting of cassava and plantain, and increasing food intake was associated with abnormal HbA1c and overweight. To prevent non-communicable diseases a diet with higher intake of fish and vegetables, and less sugary food is recommended.
Highlights
Along with a nutritional transition in Sub-Saharan Africa, the prevalence of non-communicable diseases is increasing rapidly
We found that the odds ratios (OR) of abnormal Glycated haemoglobin (HbA1c) decreased with increased number of fruit servings, which is in accordance with a meta-analysis by Wang et al showing that a higher intake of fruit and vegetables was associated with a decreased risk of type 2 diabetes (T2D) [24]
We found an association between high-Glycaemic Index (GI) staple food and abnormal HbA1c, which is in line with a previous meta-analysis of three large US cohorts showing an association between increased intake of high-GI staple food and risk of T2D [31]
Summary
Along with a nutritional transition in Sub-Saharan Africa, the prevalence of non-communicable diseases is increasing rapidly. We assess the association between food intake and cardiometabolic risk factors in a rural population in Uganda. In Sub-Sahara Africa (SSA), these dietary changes are occurring along with an Historically, the diet in SSA consisted of fruits, green leafy vegetables, legumes and whole grain [4]; food items associated with a lower risk of developing cardiometabolic conditions [5], and included in the healthy diet recommendations from the World Health Organization. The nutritional transition is exposing LMIC populations to food items such as red/ processed meat, refined grains, fat and sugary drinks, which have been associated with increased risk of cardiometabolic conditions [5]. A study from eastern Uganda found that in 2013 17.8% of the population was overweight and 7% were obese, though overweight was higher among women than men and higher among people living in urban than rural areas [12]
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