A Risk Factor Profile for Chronic Lifestyle Diseases in Three Rural Free State Towns

Background: Chronic diseases of lifestyle account for millions of deaths each year globally. These diseases share similar modifiable risk factors; including hypertension; tobacco smoking; diabetes; obesity; hyperlipidaemia and physical inactivity. In South Africa the burden of noncommunicable disease risk factors is high. To reduce or control as many lifestyle risk factors as possible in a population; the distinct risk-factor profile for that specific community must be identified. Therefore; the aim of this study was to assess the health status in three rural Free State communities and to identify a distinct risk-factor profile for chronic lifestyle diseases in these communities. Methods: This study forms part of the baseline phase of the Assuring Health for All in the Free State project. This is a prospective and longitudinal epidemiological study aimed at determining how living in a rural area can either protect or predispose one to developing chronic lifestyle diseases. The communities of three black and coloured; rural Free State areas; namely Trompsburg; Philippolis and Springfontein; were evaluated. The study population consisted of 499 households; and 658 participants (including children) participated in the study. Only results of adult participants between 25 and 64 years will be reported in this article. The study group consisted of 29.4male and 70.6female participants; with a mean age of 49 years. During interviews with trained researchers; household socio-demographic questionnaires; as well as individual questionnaires evaluating diet; risk factors (history of hypertension and/or diabetes) and habits (tobacco smoking and physical activity levels); were completed. All participants underwent anthropometric evaluation; medical examination and blood sampling to determine fasting blood glucose levels.Results: Multiple risk factors for noncommunicable diseases were identified in this study population; including high blood pressure; tobacco smoking; high body mass index (BMI); diabetes and physical inactivity. The reported risk-factor profile was ranked. Increased waist circumference was ranked highest; high blood pressure second; tobacco smoking third; physical inactivity fourth and diabetes fifth. The cumulative risk-factor profile revealed that 35.6 and 21of this study population had two and three risk factors; respectively. Conclusions: The study demonstrated a high prevalence of risk factors for noncommunicable diseases; e.g. large waist circumference; high BMI; raised blood pressure; tobacco smoking and raised blood glucose levels. Serious consideration should be given to this escalating burden of lifestyle diseases in the study population. The development and implementation of relevant health promotion and intervention programmes that will improve the general health and reduce the risk for noncommunicable diseases in this population are advised

Prevalence of Diabetes Mellitus in Rural Southern Free State

Background: A worldwide increase in the prevalence of diabetes mellitus (DM) has been reported and an even further increase is expected as a result of lifestyle changes. The objectives of this study were to determine the prevalence of DM in the rural southern Free State and to investigate the contribution of risk factors such as age; physical activity; body mass index (BMI); waist-to-hip ratio and waist circumference to the development of impaired fasting glucose (IFG) or DM. Methods: Fasting venous plasma glucose (FVPG) levels were obtained from a total of 552 participants from Springfontein (n = 195); Trompsburg (n = 162) and Philippolis (n = 180). Participants were between 25 and 64 years of age; with 28.1male (mean age 47.3 years) and 71.9female (mean age 46 years). Anthropometric status was determined using standardised techniques. Levels of physical activity were determined using a 24-hour recall of physical activity as well as frequency of performing certain activities. Relative risks (RR) as well as 95confidence intervals (95CI) were used to distinguish significant risk factors for having IFG or DM. Results: In the study population the prevalence of DM was 7.6(5.2in men and 8.6in women) and that of IFG was 6.3(4.5in men and 7.1in women). The majority of nondiabetic (34); IFG (55) and DM (61) participants were between the ages of 51 and 60 years. Age was found to be a statistically significant risk factor for having IFG or DM in participants older than 40 years of age (RR 2.3; 95CI [1.22; 4.34]). Crude measurements (not age- and gender-adjusted) of waist circumference (RR 3.23; 95CI [1.82; 5.74]); BMI (RR 2.32; 95CI [1.43; 3.78]) and waist-to-hip ratio (RR 2.51; 95CI [1.55; 4.07]) were statistically significant risk factors for having IFG or DM. Physical inactivity in men . 40 years was also a statistically significant risk factor (RR 3.23; 95CI [1.15; 9.05]) for having IFG or DM. Conclusions: In this study; 37.5of diabetics were newly discovered. A high waist circumference; BMI and waist-to-hip-ratio were associated with an increased risk for developing IFG or DM; with a high waist circumference being the most significant general risk factor. Physically inactive men (. 40 years) were also at a higher risk of having IFG or DM. Follow-up FVPG and glucose tolerance tests should be performed on participants in the IFG group. A need for intervention regarding the identification and treatment of DM in these rural areas has been identified

Clinical use of a portable electronic device to measure haematocrit.

A small portable device called the blood electrometer (BEM) was developed to assist clinicians to distinguish patients with extreme blood loss from those with normal packed cell volumes. Blood was collected in 5 ml lithium heparin tubes from 80 normal controls and 24 patients in an intensive care unit. BEM and accurate microcentrifugal techniques were compared. Intraclass correlation coefficients between the techniques of r = 0.96 and r = 0.93 were found in the normal controls and patients respectively. Because the BEM operates on the principle of conductivity, changes in some of the biochemical variables which could influence conductivity were investigated in the patients. Mean plasma total protein and albumin concentrations were lower compared with normal reference ranges. Six of the 24 patients were acidotic and 4 alkalotic. Leucocyte counts obtained randomly from 13 patients were elevated. Changes in measurements which could influence conductivity did not affect the BEM reading. We conclude that the portable BEM could be of great value in circumstances where a fixed power source is not available and rapid haematocrit measurements in a large number of patients are required.

Effect of desferrioxamine on reperfusion damage of rat heart mitochondria.

Ischaemia of the myocardium leads to necrosis unless oxygen supply is restored but it has only recently been realised that reperfusion is not without danger. The greatest rate of myocardial damage, as measured by mitochondrial function, occurred during the first 5 minutes of reperfusion in rat hearts subjected to normothermic ischaemic cardiac arrest. Addition of desferrioxamine to the perfusate after 5 minutes of reperfusion did not reverse the mitochondrial damage. It is therefore concluded that desferrioxamine prevents mitochondrial damage caused by ischaemia-reperfusion but does not reverse the damage already present.

Vitamin B-6 nutrition status and cigarette smoking.

We investigated the vitamin B-6 status in smokers, nonsmokers, and exsmokers by measuring both B-6 aldehyde vitamers, pyridoxal-5'-phosphate (PLP) and pyridoxal (PL), in the plasma as well as in the erythrocyte compartment. Two hundred eighty-six healthy, sedentary male workers from a middle-income group were investigated. There were 159 smokers, 59 exsmokers, and 68 nonsmokers. Plasma PLP and PL concentrations were significantly lower in smokers than in the nonsmokers and exsmokers whereas erythrocyte PLP and PL did not differ significantly between groups. Because PLP mainly functions as an intracellular coenzyme, the clinical significance of a depressed plasma PLP concentration alone is uncertain. It is concluded that circulating plasma PLP is labile and not necessarily indicative of intracellular PLP concentrations. The measurement of erythrocyte PLP and/or PL may be more informative about vitamin B-6 status than is plasma PLP alone.

The effect of allopurinol and deferrioxamine on rat heart mitochondrial oxidative phosphorylation after normothermic ischemic cardiac arrest and of reperfusion.

The electron transport chain of the mitochondria is highly sensitive to myocardial ischemia. As free oxygen radicals take part in the damage that occurred during ischemia, this study was undertaken to determine if allopurinol and deferrioxamine had any beneficial effect on mitochondrial function. Our results showed that perfusion with allopurinol did not improve the mitochondrial function, but that reperfusion with allopurinol and deferrioxamine had a beneficial effect. We came to the conclusion that xanthine oxidase, as a generator of superoxide anions, is of minor importance in comparison with the hydroxyl radicals, which are probably formed in the presence of iron in the cell.

Effect of normothermic ischemic cardiac arrest and of reperfusion on the free oxygen radical scavenger enzymes and xanthine oxidase (a generator of superoxide anions).

Recent evidence suggests that free oxygen radicals are produced by ischaemic tissues, accounting for at least part of the damage that results. These free oxygen radicals are produced by xanthine oxidase, amongst others, and removed by scavenger enzymes (catalase, superoxide dismutase and glutathione peroxidase) and anti-oxidants. As mitochondria are oxygen-utilising organelles, they are capable of producing free oxygen radicals. Our results indicate that the removal of free oxygen radicals are not diminished during ischaemia, but the activity of the free oxygen radical generator, xanthine oxidase, is increased. This could lead to an increased superoxide anion concentration.