Conference 2021 Pre-Recorded Video
Risk factors of type 2 diabetes in Nairobi, Kenya: A comparative cross-sectional study
Authors and Affiliations
Anthony Muchai Manyara1, Elizabeth Mwaniki2, Cindy M Gray1, Jason M.R. Gill3
1 School of Social and Political Sciences, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
2 Department of Health Systems Management and Public Health, Technical University of Kenya, Nairobi, Kenya.
3 British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
Type 2 diabetes (T2D) prevalence is increasing in sub-Saharan Africa and understanding its risk factors in this geographical context is important for development of appropriate prevention interventions. This study aimed to identify risk factors associated with T2D in Nairobi, Kenya.
We conducted a comparative cross-sectional of recently diagnosed T2D patients (cases: n=70, 53% women) and normoglycemic controls (n=81, 56% women). Self-reported data was collected on lifestyle factors and objectively measured data were obtained on body composition, anthropometrics, blood pressure, handgrip strength and physical activity.
Cases were shorter (women:157.2±5.9cm vs 159.7±5.8cm; men:169.1±5.8cm vs 171.3±7.3cm, p=0.019) and had higher waist-to-hip ratios (women:0.88±0.05 vs 0.85±0.08; men:0.93±0.06 vs 0.87±0.06, p<0.001) than controls. There was no difference in BMI between cases and controls (women:29.6±6.5kg.m-2 vs 30.8±6.7kg.m-2; men:24.2±5.5kg.m-2 vs 22.8±5.3kg.m-2, p=0.952) and, in men, 64% of cases had BMI <25kg.m-2. Handgrip strength was lower in cases (women: 23.9±4.4kg vs 26.7± 5.6kg; men:37.4±6.3kg vs 39.1±6.4kg, p=0.015) than controls. Diagnosed hypertension was more prevalent in cases (57% of women, 37% of men) than controls (20% of women, 3% of men, p<0.001). A higher proportion of cases (46% of women, 42% of men) had a first-degree relative with diabetes than controls (18% of women, 17% of men, p=0.0048). Cases reported better dietary practices such as higher intake of fruit and vegetable and reduced sugar intake than controls. However, objectively-measured physical activity was high in both groups and did not differ between cases and controls (women:44± 21min.day-1 of moderate-to-vigorous physical activity vs 43±24min.day-1; men:77±49min.day-1 vs 74±35min.day-1, p=0.908).
Family history was higher in cases highlighting its utility in risk stratification. In contrast to high-income countries, T2D patients did not have higher BMIs and lower physical activity levels. Rather they had a higher central obesity, shorter stature, and lower grip strength than normoglycemic controls. These findings suggest that central obesity should be used in risk stratification and a need to intervene and reduce weight for the centrally obese even if they have a normal weight. Also, more evidence is needed to determine if height and muscle strength play a causal role in T2D or are indicators of early life environment.