1. Obesity in relation to conventional and novel metabolic risk factors in urban Kenya
Lydia Kaduka (PhD)
Centre for Public Health Research
Kenya Medical Research Institute

2. Introduction
In Kenya, NCD accounts for >50% of total hospital admissions and over 55% of hospital deaths (MOH SP, 2014)
Overall, CVDs, diabetes, cancer and chronic lung disease contribute to over two thirds of morbidity & mortality from NCDs in Kenya (WHO 2010).
Leading CVDs RFs
Conventional - high blood pressure, dyslipideamia, tobacco and alcohol use, physical inactivity, obesity, unhealthy diets and raised blood glucose
Novel – homocysteine, CRP
Obesity - associated with CVDs, diabetes and cancers → ↑risk of premature death and disabilities → reduced quality of life.
It is true that the burden and threat of NCDs pose a major challenge to the social to the social economic fabric of many countries and Kenya is no exception.
1. Obesity increases the risk of morbidity from hypertension, dyslipidemia, diabetes, coronary heart disease, stroke, gall bladder disease, osteoarthritis, sleep apnea and respiratory problems, and some cancers.
2. Obesity is also associated with an increased risk of all-cause and CVD mortality.
It is a key risk factor of CVDs
3. Hcy independently predicts progression of coronary plaque burden irrespective of conventional risk factors
4. Hcy (aa) is a key branch-point intermediate in the ubiquitous methionine cycle and connects to the folate cycle, glycolysis pathway, and urea cycle.
5. Hcy activates platelet function, endothelial leukocyte interaction, and enhances inflammatory response responsible for atherosclerotic disease
6. CRP is an innate immune response protein produced mainly by hepatocytes
7. CRP downregulates endothelial NO synthase, upregulates adhesion molecules 8.

3. Potential mechanisms linking obesity to hypertension, diabetes and cancer
Excess intra-abdominal fat (visceral adiposity) is linked to excess morbidity and mortality, and positively correlates with the risks of insulin resistance, type 2 diabetes, cardiovascular diseases, certain cancers, and premature death.
(Narkiewicz, 2006)

4. Objective
To assess the relationship between obesity and conventional and novel metabolic risk markers in an urban population in Kenya

5. Methodology –Design
Study site – Kibra and Karen Constituency of Nairobi County – hosts all the five SEC (Upper, Lower Upper, Middle, Lower Middle and Lower class).
Study design: Cross sectional design based on a three-stage cluster sampling methodology – selection of clusters, households and respondents.

6. Sample size and sampling
Sample size – 536 (Fisher et al., 1983)
Sampling – 30 clusters sampled using the systematic Probability Proportional to Size (PPS) sampling method
Inclusion – adults aged >18yrs, absence of debilitating disease, residence>2years

7. Sampling Procedure
Kibra and Karen Constituencies
Upper Upper Middle Middle Upper Lower Lower
Quick Count of EA
Select one Segment
Identify Eligible Respondents
Select one Respondent from the Eligibles per Household
Interview and testing

8. Assessments Socio-economic and demographic assessments
Anthropometric assessments – weight, height (BMI), WC
Clinical examination- blood pressure
Biochemical assessments – fasting blood glucose, lipid profile, homocysteine and CRP
Permission – Ethical (KEMRI SERU) and informed consent

9. Findings
Total n = 539 (m: 50.5%; w: 49.5%); mean age years.
Prevalence of overweight (BMI )
m: 29.6%; w: 5.9%
Prevalence of obesity (BMI>30)
m: 30.3%; w: 27.3%

10. Association between BMI and CVD RF
Men
Women
Increased blood pressure
P=0.003
P=0.010
Fasting blood glucose
P<0.001
C-reactive protein
P>0.05
P=0.002
Homocysteine
Total cholesterol
LDLC
HDLC
TAG
SES
Increasing age

11. Association between WC and CVD RF
Men
(WC>95cm)
Women
WC (80cm)
Increased blood pressure
P<0.001
P=0.010
Fasting blood glucose
P=0.036
C-reactive protein
P>0.05
P=0.032
Homocysteine
P=0.021
P=0.025
Total cholesterol
p= 0.004
LDLC
HDLC
P=0.002
TAG
SES
Increasing age

12. Conclusions
Prevalence of CVD risk factors is high - consequence of components associated with urbanization
Components
More than an economic issue
Changes in lifestyle related factors, living conditions, social structures etc, associated with and induced by urbanization as probable contributing factors
Accelerated effects of cultural and behavioral shifts in transitional societies
Need to determine the right paths for tackling obesity, which requires a paradigm shift in thinking and combined approaches.
Incorporate new nutritional and physical strategies

13. Recommendations
Lifestyle management focusing on diet and physical activity.
Gender disparities → Patient-physician discussions of individual risks are paramount
Simple measures should be adapted as clinical components in the routine assessment and management of metabolic and cardiovascular risks
Risk factors operate in continuum - follow up longitudinal studies and prospective validation of the risk factors. 1. 2.
3. Measure waist circumference at least annually in overweight and obese adults. The greater the waist
circumference, the greater the risk of CVD, type 2 diabetes, and all-cause mortality 4.

14. Acknowledgements KEMRI Kenya National Bureau of Statistics
Administration-Karen and Kibra Constituencies
University of Southampton
Coca-Cola Company