Background Sub-Saharan Africa (SSA) has the highest burden of HIV in the world and a rising prevalence of cardiometabolic disease; however, the interrelationship between HIV, antiretroviral therapy (ART) and cardiometabolic traits is not well described in SSA populations. Methods We conducted a systematic review and meta-analysis through MEDLINE and EMBASE (up to January 2012), as well as direct author contact. Eligible studies provided summary or individual-level data on one or more of the following traits in HIV+ and HIV-, or ART+ and ART- subgroups in SSA: body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TGs) and fasting blood glucose (FBG) or glycated hemoglobin (HbA1c). Information was synthesized under a random-effects model and the primary outcomes were the standardized mean differences (SMD) of the specified traits between subgroups of participants. Results Data were obtained from 49 published and 3 unpublished studies which reported on 29 755 individuals. HIV infection was associated with higher TGs [SMD, 0.26; 95% confidence interval (CI), 0.08 to 0.44] and lower HDL (SMD, −0.59; 95% CI, −0.86 to −0.31), BMI (SMD, −0.32; 95% CI, −0.45 to −0.18), SBP (SMD, −0.40; 95% CI, −0.55 to −0.25) and DBP (SMD, −0.34; 95% CI, −0.51 to −0.17). Among HIV+ individuals, ART use was associated with higher LDL (SMD, 0.43; 95% CI, 0.14 to 0.72) and HDL (SMD, 0.39; 95% CI, 0.11 to 0.66), and lower HbA1c (SMD, −0.34; 95% CI, −0.62 to −0.06). Fully adjusted estimates from analyses of individual participant data were consistent with meta-analysis of summary estimates for most traits. Conclusions Broadly consistent with results from populations of European descent, these results suggest differences in cardiometabolic traits between HIV-infected and uninfected individuals in SSA, which might be modified by ART use. In a region with the highest burden of HIV, it will be important to clarify these findings to reliably assess the need for monitoring and managing cardiometabolic risk in HIV-infected populations in SSA.

Household food security impacts heavily on quality of life. We determined factors associated with food insecurity in 886 households in rural and urban Free State Province, South Africa. Significantly more urban than rural households reported current food shortage (81% and 47%, respectively). Predictors of food security included vegetable production in rural areas and keeping food for future use in urban households. Microwave oven ownership was negatively associated with food insecurity in urban households and using a primus or paraffin stove positively associated with food insecurity in rural households. Interventions to improve food availability and access should be emphasized.

Waist circumference (WC) thresholds derived from western populations continue to be used in sub-Saharan Africa (SSA) despite increasing evidence of ethnic variation in the association between adiposity and cardiometabolic disease and availability of data from African populations. We aimed to derive a SSA-specific optimal WC cut-point for identifying individuals at increased cardiometabolic risk. We used individual level cross-sectional data on 24 181 participants aged 15 years from 17 studies conducted between 1990 and 2014 in eight countries in SSA. Receiver operating characteristic curves were used to derive optimal WC cut-points for detecting the presence of at least two components of metabolic syndrome (MS), excluding WC. The optimal WC cut-point was 81.2 cm (95% CI 78.5–83.8 cm) and 81.0 cm (95% CI 79.2–82.8 cm) for men and women, respectively, with comparable accuracy in men and women. Sensitivity was higher in women (64%, 95% CI 63–65) than in men (53%, 95% CI 51–55), and increased with the prevalence of obesity. Having WC above the derived cut-point was associated with a twofold probability of having at least two components of MS (age-adjusted odds ratio 2.6, 95% CI 2.4–2.9, for men and 2.2, 95% CI 2.0–2.3, for women). The optimal WC cut-point for identifying men at increased cardiometabolic risk is lower (81.2 cm) than current guidelines (94.0 cm) recommend, and similar to that in women in SSA. Prospective studies are needed to confirm these cut-points based on cardiometabolic outcomes.

All rigorous primary cardiovascular disease (CVD) prevention guidelines recommend absolute CVD risk scores to identify high- and low-risk patients, but laboratory testing can be impractical in low- and middle-income countries. The purpose of this study was to compare the ranking performance of a simple, non-laboratory-based risk score to laboratory-based scores in various South African populations.

This study compared the diet and anthropometric status of adults (25-64 years) in rural and urban South Africa. Anthropometric status of adults and preschool children (<7 years old) from the same households were also determined. A descriptive cross-sectional design was applied. All adults from three towns in the rural southern Free State (n = 553) and a stratified proportional cluster sample from urban Mangaung (n = 419) participated. Anthropometric assessments included body mass index and waist circumference. Trained students administered a qualitative food frequency questionnaire in a structured interview with each participant to assess frequency of consumption of foods. The 35 foods that were included were chosen as a measure of protection or predisposition to obesity and non-communicable diseases. The height-for-age, weight-for-age and weight-for-height of 60 rural and 116 urban children were also assessed. Sugar was the most frequently consumed food item, eaten at least twice per day by all groups. Cooked porridge was the most frequently consumed starchy food (range 47.3-53.2 times a month), followed by bread, consumed at a mean frequency of 20 or more times per month in all groups. Tea was the most frequently consumed fluid (used at least once a day by all). Salt and/or stock was used more than once a day, while margarine, oil and other fats were consumed at least once per day. Fruit and vegetables were consumed at a mean frequency of less than once a day, while milk was consumed less than once daily in urban participants and once per day in rural participants. Chicken or eggs were the most frequently consumed protein-rich food (approximately 10 times per month). Overweight/obesity was identified in 65.6% rural and 66.2% urban women. Fewer men (23.3% rural and 16.0% urban) were overweight/obese. More than 66% of stunted, underweight and wasted children lived with an overweight/obese caregiver. Daily consumption of sugar, salt and fats and inadequate frequency of consumption of vegetables, fruits and milk was confirmed in both rural and urban participants. In addition, a double burden of malnutrition was evident.

Introduction: Type 2 diabetes mellitus (T2DM) is a global health problem with high morbidity and mortality in patients who are mostly still economically active. The growing incidence and health implications for those affected make T2DM a major public health issue. Objectives: To compile a demographic, anthropometric and knowledge, attitude and practices (KAP) profile of adult patients with T2DM in the public health sector of the Free State province, South Africa. Design: A descriptive observational study was conducted. Setting: A total of 255 participants attending public health facilities in the Free State were interviewed. Outcome Measures: Questionnaires were completed in an interview to determine demographics and KAP. Anthropometric measurements were obtained by standard techniques. Results: The majority of the participants (n = 222; 87.1%) were black women from urban areas, who were overweight and obese. The median age at diagnosis was 48 years (range 15–80 years), and 25 participants (9.8%) lacked formal schooling. In 212 participants (83.1%), a waist circumference above cut-off points was observed. Only half of the participants knew the normal range for blood glucose. Approximately 80% felt that they would be a different person if they did not have diabetes. Although 96.1% of participants were knowledgeable about the benefits of physical exercise, only 31.0% reported exercising on a daily basis. A statistically significant association was found between knowledge and attitudes, indicating that better knowledge about diabetes could be associated with a more positive attitude towards diabetes. Conclusion: Poor knowledge, a negative attitude and poor practices related to diabetes were observed in a very high percentage of participants, which may contribute to morbidity and mortality. The fact that knowledge was associated with attitude indicates that interventions aimed at improving knowledge could benefit patients in more than one way. Interventions to equip patients to successfully manage their condition are urgently required.