Cardio-Metabolic Health of Offspring Exposed in Utero to Human Immuno-Deficiency Virus and Anti-Retroviral Treatment: A Systematic Review.

BACKGROUND: Antiretroviral treatment (ART) use during pregnancy continues to rise as it is known to decrease the likelihood of HIV transmission from mother to child. However, it is still unknown whether foetal exposure to (ART) may affect the foetal environment, predisposing the offspring to cardiometabolic risk. Therefore, the aim of this study was to systematically review the cardio-metabolic effects of in utero exposure to HIV/ART on offspring. METHODS: We carried out a systematic review and obtained literature from the Google scholar, PubMed, ProQuest, Web of Science, and Scopus databases. Two independent reviewers evaluated the titles, abstracts, and full-length English contents. Data from the eligible studies were included. RESULTS: The search yielded 7596 records. After assessing all of these records, 35 of the full-length articles were included in this systematic review. Several studies showed that low birth weight, small head circumference, and altered mitochondrial content were more common among HIV-exposed uninfected (HEU) children compared to HIV-unexposed uninfected children (HUU). A few studies demonstrated elevated triglyceride levels, lower levels of insulin, and increased blood pressure, oxidative stress, vascular dysfunction, cardiac damage, and myocardial dysfunction among HEU children compared with HUU children. CONCLUSION: Most findings showed that there were cardio-metabolic health risk factors among HEU children, indicating that maternal exposure to HIV and ART may negatively affect foetal health, which may lead to cardio-metabolic morbidity later in life.

Oxidative stress is associated with markers of renal dysfunction in children aged 6-9 years old in a South African population.

Introduction: although studies have shown a relationship between albuminuria and oxidative stress in adults, limited information on the subject is available in children. The aim of this study was to assess the relationship between oxidative stress and albuminuria in South African children of African ancestry. Methods: a cross-sectional study involving 6-9 years old children in randomly selected rural and urban schools of the Eastern Cape Province of South Africa was conducted. Anthropometric measurements were done and urine samples were collected for the determination of titres of albumin, creatinine, 8-hydroxy-2-deoxy-guanosine (8-OHdG) and thiobarbituric acid reactive substances (TBARS). The urinary albumin to creatinine ratio (ACR) was calculated and used to determine albuminuria. Results: creatinine and 8-OHdG were significantly higher (p<0.05) in urban children than in rural children while albumin, ACR and TBARS were significantly higher (p<0.05) in rural compared to urban children. The prevalence of albuminuria was 14.05% of which microalbuminuria was 8.83% while macroalbuminuria was 5.22%. Albuminuria was higher in rural children than their urban counterparts and was more prevalent in females. TBARS was positively (p<0.05) associated with creatinine and albumin in the cohort as well as in females and urban children while 8-OHdG was positively associated with albumin in the cohort. Conclusion: findings of this study showed that oxidative stress was associated with markers of renal dysfunction with a 14% prevalence of albuminuria observed in South African children of African ancestry.

Assessment of Anthropometric Indices for Optimal Cut-Offs for Obesity Screening in a South African Adolescent Population.

The assessment of obesity in sub-Saharan Africa relies on cut-offs established from western populations. This study assessed anthropometric indices to determine optimal cut-off values for obesity screening in the South African adolescent population. A cross-sectional study involving 1144 (796 females and 348 males) adolescents aged 11-17 years from the Eastern Cape Province of South African was conducted. Anthropometric parameters were measured. Receiver operating characteristic (ROC) analysis was performed to assess the sensitivity and specificity of obesity screening tools and establish cut-offs. The optimal cut-offs for obesity in the cohort using waist-to-height ratio (WHtR) as reference were: neck circumference (NC) = 30.6 cm, mid-upper arm circumference (MUAC) = 25.9 cm, waist circumference (WC) = 75.1 cm, hip circumference (HC) = 92.15 cm and body mass index percentile (pBMI) = p85.2th. The new pBMI cut-off value at p85.2th improved the sensitivity of the test by approximately 30% compared to the CDC recommended BMI percentile (pBMIr) of p95.0th. When pBMI was used as reference, the optimal cut-offs in the cohort were: WHtR = 0.481, NC = 30.95 cm, MUAC = 27.95 cm, WC = 76.1 cm and HC = 95.75 cm. The WHtR optimal cut-off of 0.481 was close to the recommended cut-off value of 0.5. The predicted prevalence of obesity obtained using cut-offs from ROC analysis was higher than those from recommended references. All cut-off values for the various anthropometric measures generally increased with age for all percentile ranges. This study reveals a lower pBMI cut-off value, different from the CDC recommended cut-off, for screening obesity in a South African adolescent population. The study has established that the optimal pBMI cut-off for obesity screening may be ethnic-specific.

Effect of Seasonal Variation on the Relationship of Indoor Air Particulate Matter with Measures of Obesity and Blood Pressure in Children.

BACKGROUND: Particulate matter (PM) air pollution is an important environmental health risk factor. Although some studies have shown PM to be associated with obesity and hypertension, very few studies have assessed the association of indoor PM specifically with obesity and blood pressure measures in children with respect to seasonal variation. OBJECTIVES: The present study investigated the relationship of PM with obesity and blood pressure variables in children across the winter and summer seasons. METHODS: A comparative descriptive approach was adopted and school children from 10-14 years of age from selected rural and urban localities of the Eastern Cape Province of South Africa were assessed in winter and summer. Anthropometric measurements were taken, including height, weight, waist circumference, body mass index (BMI), and total fat mass (TFM), while blood pressure variables including systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were measured. Indoor air PM concentrations were measured in the classrooms in the presence of children. RESULTS: The prevalence of obesity and hypertension in children were 13.4% and 5.1% in winter and 12.9% and 1.0% in summer, respectively. High blood pressure was more prevalent in children in rural areas, while the prevalence of obesity in children was higher in urban areas. Particulate matter was significantly (p<0.05) higher in rural areas compared to urban areas. Obese children in summer had a greater than 3-fold association (AOR: 3.681, p=0.005) with 4th interquartile range (IQR) of PM5 and a greater than 3- and 4-fold association (AOR: 3.08; 4.407; p<0.05) with 2nd and 4th IQR of PM10, respectively, than their overweight, normal weight or underweight counterparts. High blood pressure was not associated (p< 0.05) with PM. CONCLUSIONS: High concentrations of indoor PM were positively associated with obesity in children in summer, particularly among rural children. This association could be accounted for by location and seasonal differences. PARTICIPANT CONSENT: Obtained. ETHICS APPROVAL: Ethics approval was obtained from the Health Sciences Ethics Committee of Walter Sisulu University, South Africa (Ref No: CHI011SCHU01). COMPETING INTERESTS: The authors declare no competing financial interests.

Senecio serratuloides extract prevents the development of hypertension, oxidative stress and dyslipidemia in nitric oxide-deficient rats.

Background Hypertension is a silent killer with no obvious signs and symptoms; thus, it is crucial to prevent its development. Oxidative stress and hyperlipidemia are associated risk factors for developing hypertension. This study aimed at investigating the role of a crude extract of Senecio serratuloides in preventing the development of hypertension, oxidative stress and hyperlipidemia in a rat model of nitric oxide deficiency. Methods Female Wistar rats were co-treated with Nω-Nitro L-arginine methyl ester (L-NAME) (40 mg/kg) and the hydroethanolic extract of S. Serratuloides (HESS150 or HESS300 mg/kg) for 4 weeks. Twenty-hour urine samples were collected weekly during the study. At the end of the study serum, heart and kidneys were harvested for biochemical and histopathological analysis. Results The higher dose (300 mg/kg) of the extract was more effective in preventing increase in systolic (p<0.001) and diastolic (p<0.05) blood pressure. At the end of the treatment period HESS300 treated rats had significantly (p<0.01) higher concentration of creatinine (91.24 ± 6 mg/dL) in urine and significantly (6.36 ± 0.4 mg/24 h; 0.001) lower proteinuria compared to L-NAME control rats (55.75 ± 8 mg/dL and 18.92 ± 2 mg/24 h, respectively). Creatinine clearance and glomerular filtration rate were lower in the L-NAME control group compared to all treatment groups. HESS300 prevented L-NAME-induced decrease in serum angiotensin II concentration, significantly decreased malondialdehyde concentration in serum (p<0.05) and kidneys (p<0.001). It also significantly (p<0.001) decreased low-density lipoprotein concentration while increasing the concentration of high-density lipoprotein cholesterol. It showed cardio- and reno-protective effects and significantly (p<0.01) prevented collagen deposition in these target organs. Conclusion These findings demonstrate the potential of S. Serratuloides in protecting rats from developing hypertension, hyperlipidemia and oxidative stress.

Antihypertensive effects of the hydro-ethanol extract of Senecio serratuloides DC in rats.

BACKGROUND: Senecio serratuloides DC is used in folk medicine for treating hypertension, skin disorders, internal and external sores, rashes, burns and wounds. This study aimed at investigating the antihypertensive effects of the hydroethanol extract of S. serratuloides (HESS) in N-Nitro-L-arginine methyl ester (L-NAME) induced hypertension in rats. METHODS: Acute toxicity of HESS was first determined to provide guidance on doses to be used in this study. Lorke's method was used to determine safety of the extract in mice. Female Wistar rats were treated orally once daily with L-NAME (40 mg/kg) for 4 weeks and then concomitantly with L-NAME (20 mg/kg) and plant extract (150 and 300 mg/kg), captopril (20 mg/kg) or saline as per assigned group for 2 weeks followed by a 2-week period of assigned treatments only. Blood pressure was monitored weekly. Lipid profile, nitric oxide, renin and angiotensin II concentrations were determined in serum while mineralocorticoid receptor concentration was quantified in the kidney homogenate. Nitric oxide (NO) concentration was determined in serum and cardiac histology performed. RESULTS: HESS was found to be non-toxic, having a LD50 greater than 5000 mg/kg. Blood pressure increased progressively in all animals from the second week of L-NAME treatment. HESS treatment significantly and dose-dependently lowered systolic blood pressure (p < 0.001), diastolic blood pressure (p < 0.01), low density lipoprotein cholesterol (p < 0.01) and triglycerides (p < 0.01). It significantly prevented L-NAME induced decrease in serum angiotensin II (p < 0.01), high density lipoprotein cholesterol (p < 0.001) and serum nitric oxide concentrations (p < 0.001). HESS also significantly (p < 0.01) prevented collagen deposition in cardiac tissue. CONCLUSION: The hydro-ethanol extract of Senecio serratuloides showed antihypertensive, antihyperlipidemic and cardioprotective effects in rats thus confirming its usefulness in traditional antihypertensive therapy and potential for antihypertensive drug development.

Prevalence of metabolic syndrome in adolescents living in Mthatha, South Africa.

OBJECTIVE: Metabolic syndrome (MetS), defined as the clustering of three of five risk factors (hypertension, obesity, triglyceridemia, dyslipidemia and hyperglycemia), is being increasingly mentioned among children and adolescents despite there being no consensus on how it should be defined in this set of population. Furthermore, very few studies have focused on MetS in children and adolescents in sub-Saharan populations. This study, therefore, aimed at determining the prevalence of the MetS and contributing risk in adolescents living in Mthatha, South Africa. RESEARCH DESIGN AND METHODS: Four hundred and ten adolescents (age range: 13-18 years, both sexes) were recruited into this cross-sectional study. In addition to a lifestyle questionnaire being administered, anthropometric measurements (weight, height and waist circumferences) were carried out for each participant. Fasting venous blood was collected for lipid profile and blood glucose assessments. Blood pressure was also measured. MetS was assessed using appropriate diagnostic criteria for children and adolescents. RESULTS: Complete data sets were collected from 371 participants. Females showed an elevation in the risk factors for MetS. Of the 371 participants, 40.2% were overweight/obese (47.5% females; 22.5% males). MetS was diagnosed in 3.1% female participants compared with 6.0% in male participants. CONCLUSIONS: More risk factors for the MetS are seen among the overweight/obese as compared to lean adolescents. Given the fact that childhood overweight/obesity often continues into adulthood, it is important to address the causes of increased risk for MetS earlier in life to prevent the development of disease in adult life.

Antifertility effects of Pouzolzia mixta in female Wistar rats.

The continued use of plants by women to prevent pregnancy suggests there are plants out there with potential use as contraceptives. In Zimbabwe, Pouzolzia mixta is used as a "morning after" contraceptive, thus it may possess postcoital antifertility activity. To test contraceptive activity, animals (n=8/group) were orally pretreated with aqueous (AqPM) or ethanolic (EtPM) extract of P. mixta at 300mg/kg b.wt for 7 days followed by mating with continued treatment for 10 days post-conception. To test for postcoital activity, treatment was initiated on day-1 of pregnancy and continued for 10 days. Laparotomy was performed and implantations counted. For estrogenic activity, immature ovariectomised rats were treated for 7 days after which vaginal opening and uterine weights were determined. In vitro oxytocic effects were performed using uterine tissue in an organ bath with De Jalon's solution. Acetylcholine (Ach) was the positive control. Results showed modest contraceptive activity with EtPM more effective in inhibiting fertility compared to AqPM (37.5% vs 25%) with a similar trend for antiimplantation effects (31% vs 19%). There was potent postcoital antifertility effects with AqPM more effective in inhibiting implantation (94.6% vs 86%) and fertility (87.5% vs 75%) compared to EtPM. Immature rat bioassay for estrogenic activity demonstrated pronounced estrogenic activity by both extracts. Oxytocic effects at 400ng/ml were more pronounced for the AqPM (92% of 100ng/ml Ach) than EtPM (25% of 100ng/ml Ach). Findings demonstrate the antifertility effects of aqueous and ethanolic extracts of P. mixta. The antifertility effects may be attributed to antiimplantation, estrogenic and oxytocic effects of the plant extracts.