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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 3  |  Issue : 2  |  Page : 66-71

Predictors of hypertension, hypercholesterolemia, and dyslipidemia of men living in a periurban community in Ghana


Department of Nutrition and Food Science, School of Biological Sciences, College of Basic and Applied Sciences, University of Ghana, Legon, Accra, Ghana

Date of Web Publication17-Jun-2016

Correspondence Address:
Frederick Vuvor
Department of Nutrition and Food Science, School of Biological Sciences, College of Basic and Applied Sciences, University of Ghana, Legon, Accra
Ghana
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2394-2010.184232

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  Abstract 

Aims and Objective: Unhealthy lifestyles influence the incidence of diet-related noncommunicable diseases such as hypertension. This study examined the effects of some lifestyles and their effects on blood pressure (BP) and cholesterol of men. Materials and Methods: The WHO stepwise questionnaires were used to collect data on 207 men aged ≥18 years living in a periurban community in Ghana. Dietary, anthropometric, clinical, and biochemical data were collected. Results and Analyses: About 24.6% of the subjects were overweight with body mass index ≥25 kg/m 2 , 26.1% were hypertensive with systolic BP >140 mmHg, 8.7% were diagnosed with hypercholesterolemia with total cholesterol >5.18 mmol/L, and 34.8% of the participants had dyslipidemic with blood "low-density lipoprotein" >2.29 mmol/L. Binary logistic regression revealed that tobacco smokers and overweight men were about 4 times (odds ratio [OR]: 3.68, P < 0.01) and more than twice (OR: 2.46, P < 0.01) likely to suffer from hypertension, respectively. Men with fat intake ≥60% of nutrient adequacy ratio were about 3 times more likely to suffer from hypercholesterolemia (OR: 2.72, P < 0.05). Tobacco users and overweight men were both about 3 times (OR: 2.65, P = 0.02) more likely to be dyslipidemic. Conclusion: These results suggest that tobacco use, overweight, and high intake of dietary fat were associated with high risk of cardiovascular events among men in the study group.

Keywords: Dyslipidemic, hypercholesterolemic, hypertensive, overweight, smoking


How to cite this article:
Vuvor F, Steiner-Asiedu M, Saalia KF, Owusu WB. Predictors of hypertension, hypercholesterolemia, and dyslipidemia of men living in a periurban community in Ghana. J Health Res Rev 2016;3:66-71

How to cite this URL:
Vuvor F, Steiner-Asiedu M, Saalia KF, Owusu WB. Predictors of hypertension, hypercholesterolemia, and dyslipidemia of men living in a periurban community in Ghana. J Health Res Rev [serial online] 2016 [cited 2020 May 29];3:66-71. Available from: http://www.jhrr.org/text.asp?2016/3/2/66/184232


  Introduction Top


Hypertension is a chronic cardiovascular disorder, [1] characterized by persistent high blood pressure (BP) systolic BP (SBP) >140 mmHg. Many developing countries in Sub-Saharan Africa are experiencing a transition from diseases of poverty, undernutrition, infection, and parasitic diseases, toward diet-related noncommunicable diseases, such as hypertension, which increasingly contributing to premature mortality of men. [2] A healthy diet is important in the primary prevention of hypertension. [3] Elevated levels of low-density lipoprotein (LDL) >2.29 mmol/L and total blood cholesterol (TC) >5.18 mmol/L have been documented to be significant contributors to the high prevalence of hypertension. [4] A prospective study in Ghana of 708 subjects with cardiovascular disease at the National Cardiac Referral Center revealed that 66.3% were hypertensive and 8.8% had hyperlipidemia. [5]

Men's nutrition and health studies are not major concerns for many researchers. However, men are known to have higher mortality rate and shorter life span. [6],[7] In Ghana, life expectancy at birth is 63.38 years for men and 66.19 for women. [8] There is therefore the need to understand the critical nutrition and health-related issues about men. [8],[9]

Periurban communities have been noted to be nutritionally and socioeconomically worse off than either urban or rural areas. [10] There was obvious knowledge gap that needed to be bridged in these communities. The main objective was to study the influences of lifestyle variables on hypertension and high blood cholesterol of men in a periurban community.


  Materials and methods Top


Participants

The total population of men ≥18 years was about 1200 in the study community. The selection of the study site involved simple random selection of one of the periurban communities in the Greater Accra Region of Ghana. A total of 1023 men eligible based only on their ages ≥18 years, but 207 men were willing to participate and were recruited into the study. The study was a cross-sectional, community-based study involving adult men. It encompassed the assessments of dietary, lifestyles (alcohol, tobacco use, and physical activities), anthropometric, physical health, clinical and biochemical investigations. The data were collected using the WHO stepwise questionnaires which were pretested and modified to suit our situations. To ensure the consistency of the responses, the questionnaires were translated into local languages and back-translated into English.

Diet history was employed to assess dietary intake. The dietary data were broken down into nutrients, using ESHA Food Processor (ESHA Research, 2012w, 4747 Skyline Rd S, Suite 100, Salem. OR 97306 USA) and MS Excel 2013 (Microsoft Corp, Redmond, WA) softwares assisted by Ghanaian Food Composition Table. [11] Various nutrients consumed per person per day were divided by the recommended dietary allowance [12] from which nutrient adequacy ratio (NAR) and mean nutrient adequacy ratio (MAR) were determined for each participant and presented in percentages. NAR was employed to estimate the dietary intakes for individual nutrient, and MAR was the estimate of the overall adequacy of the 9 nutrients estimated. Recommended dietary allowances (RDAs) are often used to compare dietary quality among population subgroups. [13] The NAR was based on the percentage of the recommended intakes for the amount of nutrient from all the different foods consumed. The NAR for a given nutrient is the ratio of a subject's intake to the current recommended allowance for each age category. [14]

Since the sufficiency of the diet is a function of the extent to which contribution of particular nutrients meets the best estimate of the need for nutrients, it is helpful to calculate an NAR for each nutrient. If NAR falls below 1, it may still be sufficient since the RDA is set at the mean requirement of 77% RDAs. The farther the NAR falls below 1, the higher the probability that the diet will fail to meet the needs of the individual. Only by determining some biochemical markers of dietary adequacy, however, can a judgment be made as whether the intake of a particular nutrient is adequate. As an overall measure of the nutrient adequacy, the MAR was calculated as follows: [15]



The values of 9 NARs for calories, protein, fat, carbohydrates, iron, calcium, sodium, Vitamin B 1 and Vitamin B 12 consumed by each man were used to arrive at MAR. NAR was truncated at 1 so that a nutrient with a high NAR could not compensate for a nutrient with a low NAR.

In determining the anthropometry of the subject, height was measured using a Shorr Height Board. The weight of each participant was measured with a Seca Scale. The body mass index (BMI) was computed from the formula: Body weight (kg) divided by the square of height (m 2 ). All the anthropometric measurements were measured using standard procedures in triplicates.

The BPs of subjects were taken using the Omron Automatic BP Monitor (with Comfit Cuff Model HEM-780 made in China for Omron Healthcare Inc., 1200 Lakeside Drive Bannockburn, Illinois 60015 ͹ 2006). The BP was measured on the left arm of the subjects. The men were made to sit comfortably on a chair for 10 min with their feet flat on the floor and arm rested on a table so that the cuff was at the same level as their heart. [16]

In determining the blood lipid profiles, PTS PANELS Test Strip (manufactured by Polymer Technology Systems, In. 7736 Zionsville Road, Indianapolis, IN 46268 USA {317} 870-5610. www.cardiocheck.com) [16],[17] was used. It is capable of screening total lipids, TC, high-density lipoprotein (HDL), and triglycerides (TG). The TC expected values should be below ≤5.18 mmol/L, and any value >5.18 mmol/L is regarded as high values. Dyslipidemia defined as LDL cholesterol value ≤2.59 mmol/L. LDL was not measured directly but was calculated using the following formula: LDL (calculated value) = TC - HDL - (TG/5). A TC/HDL ratio was also determined, and the normal value should be ≤3.32 and any value >3.32 is considered high. Hypertension defined as SBP ≥140 mmHg. [18] Fasting blood "HDL" mmol/L normal value = ≥1.55; normal TG mmol/L: ≤1.7; BMI kg/m 2 : Normal value <25 kg/m 2 .

Analysis

Data management system was designed using SPSS version 16 (SPSS Inc., Chicago, IL, USA). Descriptive statistics were calculated for continuous variables. To assess the risk and association between outcome variables (hypertension, high blood cholesterol) and independent variables (sociodemographic status, physical activity, lifestyle variables, BMI, and dietary), binary logistic regression analysis was carried out. Dependent category variables: Hypertension: SBP ≥140 mmHg; hypercholesterolemia: TC >5.18 mmol/L; dyslipidemia: LDL >2.29 mmol/L. Independent category variables: Alcohol use, tobacco use, physical activity score; and body weight (≥25 kg/m 2 = overweight, <25 kg/m 2 = normal).


  Results and analysis Top


Characteristics of the subjects

The study participants were made up of 207 men, with an average age of 40 ± 14.3 years ranging from 19 to 95 years. The majority (75.3%) of the men were self-employed. Most of them (71.0%) were habitual alcoholic drinkers and a number of (22.2%) them also smoked tobacco [Table 1]. More than 51% of men were below their nutrients needs (60% NAR), except iron (55.1%) and protein (84.1%). Only 43.5% of them met their overall nutrients need (≥60% MAR).
Table 1: Background characteristics of the participants by age distribution (n=207)

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About 7.2% of the study participants were underweight while 24.6% were overweight. Approximately 26.1% of men were hypertensive. The fasting blood biochemistry examinations revealed that 8.7% of the study group were hypercholesterolemic and about 34.8% were dyslipidemic [Table 2].
Table 2: Anthropometric, clinical and biochemistry distribution

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Risk factors for hypertension

Binary logistic regression demonstrates that tobacco users were 3.7 times more likely to suffer from hypertension (3.68, P < 0.01) than nonusers and that overweight men were about twice more likely to be hypertensive (2.46, P < 0.01). The age distribution was positively (P < 0.01) associated with SBP. [Figure 1] shows the best-fit linear regression of SBP on the age of participants, indicating that the SBP increased with age. The model with the equation: y = 0.5954x + 106.88; R΂ = 0.1536, where y = age in years and x = SBP described linear relationship explaining about 15.4% of the observed variations of SBP on age with 95% confident interval. Education below senior high school (SHS) levels was associated positively with hypertension (P < 0.01) [Table 3].
Figure 1: Relationship of blood pressure and age. (y = 0.5954x + 106.88; R2 =0.1536)

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Table 3: Multivariate regression for hypertension

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{Figure 1}

Risk factors for total blood cholesterol

[Table 4] depicts the predictors of high blood cholesterol. Men whose intake of fat was ≥60% NAR were about 3 times more likely to have hypercholesterolemia (odds ratio: 2.72, P < 0.05). Formal education below SHS levels were about 5 times (5.31; P < 0.01) more likely to suffer hypercholesterolemia.
Table 4: Multivariate regression for blood total cholesterol

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Factors associated with the risk of high low-density lipoprotein

Men who used tobacco were likely to suffer from dyslipidemia (2.65, P = 0.02). Overweight men were about 3 times more likely to suffer from dyslipidemia (2.88, P < 0.01) [Table 5].
Table 5: Multivariate regression for low - density lipoprotein

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  Discussion Top


More than one-third of the participants consumed alcoholic beverages. A number of them smoked tobacco. Apart from iron and protein, the rest of nutrients intake were lower than required. About a quarter were overweight. A 26.1% prevalence of hypertension was recorded among the study participants.

The prevalence of hypertension could have been due to high prevalence of overweight, consumption of alcoholic beverages, and tobacco use. Overweight has been found to be an independent risk factor for hypertension. At a fixed BMI, body fat increases with age by 1.9 kg/decade after 40 years of age. [19] Increase in fat-to-lean mass gives a corresponding increase in the blood-free fatty acids (FFAs) that make blood more viscous and raise the BP. [20] As human grows older, the arteries become weaker and gradually fail to support the heart in propelling the blood in the blood vessels. This phenomenon over tasks the heart, leading to cardiogenic hypertension. [21],[22] The prevalence of hypertension in this study was much higher than both rural and many urban areas in Ghana. Studies in Ghana have indicated that 4.5% of rural and 8-13% of urban had prevalence of hypertension. [23]

Even though tobacco user were a few in this study, they were about 4 times more likely to be hypertensive. Tobacco has hazardous chemical compounds including a poisonous alkaloid called nicotine. Nicotine is a stimulant [24],[25] and a vasoconstrictor, [26] narrowing the blood vessels and causing hypertension when one is exposed to it. Nicotine acts as a sympathomimetic on cardiac tissues causing tachycardia. Nicotine is an adrenergic in its action stimulating the release of catecholamine (adrenaline, noradrenaline, and dopamine) from the adrenal glands. All these together act on the heart and the arteries to undergo abnormally rapid contractions raising the SBP. Nicotine catalyzes the reaction between cholesterol and calcium resulting in the formation of atheromatous plaque [27] which may deposit on the intima of the arteries forming atherosclerosis or/and arteriosclerosis hardening as well as narrowing of the arteries, leading to hypertension. [28] Nicotine initiates coagulation of the blood and the sedimentation of FFAs that increase the viscosity of the blood triggering hypertension. [29] Less than 10% of the participants were identified as having hypercholesterolemia. Although smokers and those who consumed alcohol were about 2 times more likely to have hypercholesterolemia, more than 30% of the participants had dyslipidemia (LDL >2.29). The regression analyses indicated that tobacco users as well as those who are overweight were both about 3 times more likely to suffer from dyslipidemia.


  Conclusion Top


These results confirm the fact that nutrition and health situations might be worse in periurban communities than both rural and urban neighborhoods. Some possible explanation is that periurban areas are unstable communities, and while some of the habits are getting urbanized, others are stuck in the rural past, bringing the ills of both rural and urban food habits into the periurban areas.

The finding from the study warrants further studies with larger sample sizes across many ecological zones. An investigation into the causes of high BP in periurban community higher than both rural and urban prevalence requires in-depth investigations. A longitudinal and population-based study in all developing nations will bring to a clearer focus the extent of the determinants of nutrition and health status of men.

Acknowledgments

Authors express their appreciation to the study participants, chief/elders, nurses, pharmacy assistants, laboratory technicians, teaching/research assistants from the Department of Nutrition and Food Science, University of Ghana, for their kind support of this work and also Prof. Emmanuel Ohene Afoakwa and Dr. Agartha Ohemeng all of the Department of Nutrition and Food Science, University of Ghana, for their kind support of this work.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


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