Cardiovascular risk factors with special focus on diet in southern Ethiopia: a community-based cross-sectional study

Abstract

Background: Evidence from different studies indicates that Africa is experiencing a shift in dietary structure, and an increase in the burden of related non-communicable diseases, such as cardiovascular diseases The contributing factors for the change in dietary patterns are socioeconomic development, urbanization accompanied by advances in technology, and a sedentary lifestyle. Ethiopia has exhibited considerable economic growth during the last few decades. The rate of urbanization is relatively rapid, and the level of physical inactivity has also increased. Overweight and obesity are on the rise. However, in Ethiopia, there is minor knowledge about changes in dietary patterns, or the prevalence of cardiovascular risk factors like for instance hypertension. Therefore, the studies in this thesis attempted to answer the question of whether there is a transition to a new dietary pattern and if this has any relation to the prevalence of major modifiable cardiovascular (CVD) risk factors in Ethiopia.

Objectives: The general objective of this thesis was to obtain more information about dietary patterns, and other CVD risk factors in Wolaita, southern Ethiopia.

Methods: A community-based cross-sectional study was conducted among 2483 adult residents aged 25-64 years, selected using a three-stage random sampling technique in southern Ethiopia. Data, collected using structured questionnaires; anthropometric, dietary, blood pressure, and biochemical measurements, were analyzed in this study. We generated the weighted prevalence using finite population corrections for the clusters. Dietary patterns were identified using factor analysis by employing orthogonal transformation (varimax rotation) to identify uncorrelated factors. We used a logistic regression model to assess factors associated with hypertension, Poisson regression for the number of major modifiable cardiovascular disease risk factors, and multiple linear regressions for dietary patterns.

Results: We identified three dietary patterns in this study; the western, the traditional, and the healthy. These dietary patterns explained 51% of the variance in food consumption in the study area. There was a co-existence of western-style and healthy dietary patterns in the urban environment of the study area, while the traditional dietary pattern was found in the rural environment. The urban environment and major modifiable cardiovascular risk factors, consisting of obesity, hypertension, blood glucose, and total cholesterol levels, were significantly associated with the occurrence of the western dietary pattern. The prevalence of having one or more major modifiable cardiovascular risk factors was 75.8%, and hypertension was 31.3%. Socio-demographic and dietary factors comprising an urban residence, older age, male sex, being a farmer, and sugar-sweetened food consumption played an important role in the increased number of major modifiable cardiovascular risk factors, including hypertension. The combination of physical inactivity with low HDL-C was the largest co-occurrence of major modifiable cardiovascular risk factors, followed by physical inactivity with hypertension.

Conclusions: The co-existence of western, traditional, and healthy dietary patterns, indicates the transition to new diets, here called a nutrition transition in the study area. The magnitude of having one or more major modifiable cardiovascular risk factors, including hypertension in the study population, indicates a relationship between these factors and diet changes. In general, there seems to be a need to focus on nutrition-related non-communicable diseases, and strengthen the prevention of several modifiable cardiovascular risk factors.