Chronic diseases of lifestyle: Do they exist in rural South African population?

• KD Monyeki PhD, MPHChronic Disease of Lifestyle Unit, Medical Research Council, Tygerberg, 7505, South Africa.

• Phuti Makgae JPTD, BED Jane Mashita UED, BED

Department of Kinesiology and Physical Education, University of Limpopo, Sovenga, South Africa.

• Prof dr Han KemperVU University Medical Center , Department of Public and Occupational Health, Amsterdam, Netherlands.

LEPHALALE (ELLISRAS) RURAL AREA

ELLISRAS LONGITUDINAL GROWTH AND HEALTH STUDY

� How do rural South African boys and girls grow and develop with respect to their physical and psycho-social well-being?

� How healthy are these children and how healthy is their lifestyle with respect to diet, physical activity, smoking behaviour and alcohol consumption?

� What are the development over time of biological and behavioural risk factors for cardiovascular diseases in a rural part of South Africa?

� What are the relationships over time between lifestyle changes and health outcomes?

ELS RESEARCH QUESTIONS

SAMPLE SIZE

� BASELINE- (1996) Cluster sampling method- 2200 children age 3 to 10 years or Born between 1993 to 1986

� CURRENT - Age- 12 to 19 years1768 subjects remained (2005

June/July)

� On average 1.05% of participants were permanently loss due to death and 11.47 % subjects lost due to teenage pregnancy, illness, migration to urban areas, school dropout were temporary as they rejoined the study thereafter.

Prof Han Kemper assist the team with data collection

Measurements data collected in the Ellisras Longitudinal Sample as from 1996 till 2005

*Smoking

****Fitness

*Physical Activity

*Questionnaire on menarche

**Tanner Scale

*Aptitudes tests (IQ test)

***Educational achievement (Maths and English)

**Learning environment

*Glucose tolerance

*Socio-economic status

**Diet

********Blood pressure

**************Anthropometric measurements

200520032002200120001999199819971996Survey

PURPOSE OF THIS PRESENTATION

� Major findings on the risk factors for chronic diseases of lifestyle (cardiovascular diseases) from the ongoing Ellisras Longitudinal growth and Health Study (ELS)

� Contributions of ELS to the development of the Lephalale(Ellisras) rural communities

Poor growth patterns

� The majority of Ellisras rural children demonstrated depressed growth velocities which culminate in adults heights and weight that can not be viewed as a true reflection of the genetic potential of black Africans (Monyeki, Makgae, Motlokoaet al. 2006, AJPHED, 12(2):171-181; Cameron, 1992; Am J Hum Biol, 4: 223-234) .

Under nutrition

� In South Africa, the prevalence of stunting and wasting = 22.9 to 30.2% (Steyn & Walker, 2000; AsPac J Clin Nutr , 9(1), 1-6)

� In Ellisras area the prevalence of stunting and wasting (ELS) ranged between 3.5 to 41.8% for children aged 3 to 10 years (Monyeki, Cameron, Getz. 2000; Am J Hum Biol 12:42–49)

Physical fitness and malnutrition

� Generally rural children from developing countries exhibited low physical fitness compare to other children studied in developed countries.

� Changes in Physical fitness performance that requires a high energy flux over a short period of time are affected by malnutrition –associated muscle wasting, where as having a low body weight appears to be the more crucial factor for good performance on other fitness items in this malnourished population of rural South African children (Monyeki, Koppes, Kemper et al., 2007, Am J Hum Biol).

Under nutrition and cardiovascular risk factor� In our cross-sectional analysis

we found a significant association between under nutrition parameters (stunting and wasting) with high BP, waist girth and waist to hip ratio.

� Under nutrition should be recognized as a risk factor associated with cardiovascular diseases (Monyeki et al., in press; Gaskin, Walker, Forrester, et al. 2000 European Journal of Clin Nutri,, 54:563-567).

Fat patterning and cardiovascular risk factor� Obesity does not exhist in Ellisras

rural children (Monyeki, Van Lenthe, Steyn Int J Epidemiol 1999; 28: 287-292).

� Waist girth, triceps and subscapular skinfold thickness are better predictors and facilitate the detection of cardiovascular diseases than Body mass index and waist to hip ratio in children (Monyeki, Makgae, Kemper, In press; Maffeis, Pietrobelli, Grezzani, et al. 2001 Obesity Research; 9: 179-187 )

ANTHROPOMETRIC MEASUREMENTS

Diabetes mellitus

� There was no clear evidence between indicators of nutritional status and impaired glucose tolerance. No case of diabetes mellitus has been found (Kars, Frankhuisen, Monyeki, et al. 2001, Technical report, Amsterdam).

ELS GLUCOSE TOLERANCE TEST

Overweight and hypertension� Hypertension and overweight are

evident in the present sample, although the number of affected children is very small. A significant association between high DBP and high BMI was found (Monyeki, Kemper, Makgae , 2006, Int J. Epidemol, 35(1):114-20).

� Weak tracking exist for BP and overweight to permit early detection for future hypertension and does not justify preventive measure other than advice on diet and way of life (Monyeki et al., In press; Marshall, Sark, Sallis. 1998 Med Sci Sports Exerc,; 30: 910-916 ).

ELS BLOOD PRESSURE MEASUREMENTS

Physique type and cardiovascular risk factor

� [Herrera Rebato, Hernandex et al. 2004, Gerontology 50:223–9] and [Valkov, Matev, Hristov 1996, Folia Medicine 38:17–21] Reported the development of high BP among adult subjects who experienced high endomorphy and mesomorphy components.

� In the ELS the correlation between systolic BP and somatotypecomponents occurred at age 11 years. Even after adjusting for age, gender and height a significant association was found between BP, BMI and ectomorphy.

(Makgae, Monyeki, Brits et al., 2007, Ann Hum Biol, 34(2):240-251)

“The presumption is made that the practice of medicine was previously based on a direct communication with God or by

tossing a coin”(Fowler, Lancent 1995; 246; 823)

RECOMMENDATIONS� The introduction of physical education in all the public schools in South Africa

will help to improve motor skills acquisition, physical, mental and social development of children.

� Longitudinal studies should verify whether changes in waist girth and skinfoldthickness will indicate changes in cardiovascular risk factors during growth.

� Large scale screening of BP is not recommended, rather community based programs aimed at modifying health behavior in order to prevent development of cardiovascular risk factors and associated morbidity and mortality should be introduced in rural South African population

� SCIENTIST/ECONOMIST BELIEVED THAT:KNOWLEDGE/MONEY IS STRONGLY ASSOCIATED WITH WISDOM, POWER AND

AUTHORITY OF AN INDIVIDUAL IRRESPECTIVE OF GEOGRAPHICAL LOCATION.

Community development- ELS report back seminar

� Birth certificate-

� Cleanliness of children – ELS calendar

� Vegetable garden

� Clinic Attendance-

� Community health workers ELS REPORT BACK SEMINAR

Community development- Northern Sotho Novel based on the findings of ELS and SA national surveys

Dr KD Monyeki

MAGADI A KAE?

FINALLY

When you are inspired by some great purpose, some extraordinary project, all your thoughts break their bonds; Your mind transcends limitations, yours consciousness expands in every direction, and you find yourself in a new, great and wonderful world. Dormant forces, faculties and talents become alive and you discover yourself. (PATANJALI, First to third century BC).

THANK YOU FOR LISTENING