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Contrasting impact of rural, versus urban, living on glucose metabolism and blood pressure in Uganda.

ABSTRACT: Background: The burden of cardiometabolic diseases, including cardiovascular diseases and diabetes, is increasing in sub-Saharan Africa and this has been linked to urbanisation. Helminths, through their immunomodulatory properties, may protect against these disorders. We hypothesised that the rural environment protects against cardiometabolic diseases and that helminths may influence rural-urban disparity of cardiometabolic disease risk. Methods: We compared metabolic parameters of individuals aged ≥10 years living in rural, high-helminth-transmission and urban, lower-helminth-transmission settings in Uganda. Cross-sectional surveys were conducted in rural Lake Victoria island fishing communities and in urban sub-wards in Entebbe municipality. Helminth infection and outcomes, including insulin resistance (computed using the homeostatic model assessment of insulin resistance [HOMA-IR]), fasting blood glucose, fasting blood lipids, blood pressure, body mass index (BMI), waist and hip circumference, were assessed. Results: We analysed 1,898 rural and 930 urban participants. Adjusting for BMI, exercise, smoking, alcohol intake, age and sex, urban residents had lower mean fasting glucose (adjusted mean difference [95%CI] 0.18 [-0.32, -0.05] p=0.01) and HOMA-IR (-0.26 [-0.40, -0.11] p=0.001) but higher blood pressure (systolic, 5.45 [3.75, 7.15] p<0.001; diastolic, 1.93 [0.57, 3.29] p=0.006). Current helminth infection did not explain the observed differences. Conclusions: In the Ugandan context, living in rural fishing communities may protect against hypertension but worsen glucose metabolism.

SUBMITTER: Sanya RE

PROVIDER: S-EPMC7447960 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Contrasting impact of rural, versus urban, living on glucose metabolism and blood pressure in Uganda.

Sanya Richard E RE Andia Biraro Irene I Nampijja Margaret M Zziwa Christopher C Nanyunja Carol C Nsubuga Denis D Kiwanuka Samuel S Tumusiime Josephine J Nassuuna Jacent J Walusimbi Bridgious B Cose Stephen S Ocama Ponsiano P Grencis Richard K RK Elliott Alison M AM Webb Emily L EL

Wellcome open research 20200824

<b>Background:</b> The burden of cardiometabolic diseases, including cardiovascular diseases and diabetes, is increasing in sub-Saharan Africa and this has been linked to urbanisation. Helminths, through their immunomodulatory properties, may protect against these disorders. We hypothesised that the rural environment protects against cardiometabolic diseases and that helminths may influence rural-urban disparity of cardiometabolic disease risk. <b>Methods:</b> We compared metabolic parameters of ...[more]

PMID: 32875121

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Project description:BackgroundLongitudinal data on blood pressure changes in sub-Saharan African populations are limited despite a high hypertension burden. This study analysed systolic blood pressure (SBP) change and hypertension incidence among people from Ghana living in rural Ghana, urban Ghana, people from Ghana living in The Netherlands and a Dutch European population living in Amsterdam, The Netherlands.MethodsThe population-based Research on Obesity and Diabetes among African Migrants Prospective (RODAM-Pros) cohort study included adults aged ≥18 years at baseline (2012-2015) and follow-up (2019-2021) to study cardiovascular risk factors. At both timepoints, blood pressure (BP) was measured using a semiautomated device. Hypertension was defined as having a SBP ≥ 140 mmHg, diastolic BP ≥ 90 mmHg or the use of antihypertensive medication. We compared age-standardised SBP change and hypertension incidence between the geographical locations via linear and Poisson regression analyses, with adjustment for age, follow-up time, education, baseline BP, body mass index, renal function, and diabetes mellitus. The study protocol was approved by the respective ethics committees in Ghana and The Netherlands.FindingsData from 632 people living in rural Ghana, 602 in urban Ghana, 861 Ghanaian, and 2038 Dutch people living in Amsterdam, were analysed (58.3% women, mean age at baseline 46.5 years, follow-up time 6·5 years). SBP increased most in women in rural Ghana (+9.5 mmHg, 95% confidence interval 7·3-11·7 mmHg), compared to +5·7 mmHg (3·6-7·7 mmHg) in urban Ghana, +2·2 mmHg (0·7-3·7 mmHg) in Ghanaian women in Amsterdam and -0·4 mmHg (-1·2 to 0·4 mmHg) in Dutch women. In men, SBP increased +5·5 mmHg (2·6-8·4 mmHg) in rural Ghana, +6·1 mmHg (2·8-9·5 mmHg) in urban Ghana, +2·1 mmHg (0·4-3·8 mmHg) in Ghanaian men in Amsterdam, and +0·3 mmHg (-0·5 to 1·1 mmHg) in Dutch men. Hypertension incidence ranged from 20·7% (95% confidence interval 14·3-29·2%) in men in rural Ghana to 34·2% (23·3-49·1%) in urban Ghana, vs. 27·9% (19·8-38·5%) in Ghanaian men in Amsterdam and 14·5% (11·8-17·6%) in Dutch men. Among women, incidence was 29·0% (23·1-35·9%) in rural Ghana, 27·6% (21·4-35·3%) in urban Ghana, 34·4% (26·0-45·4%) in Ghanaian women in Amsterdam, and 7·2% (5·6-9·2%) in Dutch women. Hypertension incidence rate ratios did not differ across populations, regardless of adjustment for covariates.InterpretationSBP and hypertension increases were more pronounced in rural and urban Ghana than among migrants from Ghana in The Netherlands, suggesting that urbanisation of cardiovascular risk profile now extends to rural sub-Saharan Africa.FundingEuropean Research Council (grant number 772244).

Project description:Atmospheric particulate matter (PM) is a recognized risk factor for the global burden of disease in human populations. We are presenting here the application of toxicogenomics in the evaluation of the toxic effects of organic content of atmospheric particle matter (PM), from urban and rural environments (city of Barcelona and village of La Pobla, NE Spain), using the developing zebrafish embryo. The main goal is to identify the metabolic pathways involved in the adverse effects observed in zebrafish embryos exposed to PM organic content from urban and rural environments, also allowing the selection of genes of interest that are differentially expressed. The relevance of particle size to the PM toxicity is also addressed. Indeed, the zebrafish embryos were exposed to PM of aerodynamic diameter larger than 7.2 Î¼m and smaller than 0.5 Î¼m (PM10 and PM0.5, respectively). PM0.5 concentrated biological and toxic activities linked to organic substances. Transcriptomic analyses showed strong induction of the AhR signalling pathway (a.k.a. dioxin-like activity) for embryos exposed to both rural and urban extracts, correlating with the concentrations of PAHs. Urban extracts, with strong contribution of traffic emissions, specifically de-regulated oxidative stress-related genes, as well as pancreatic and eye-lens specific genes, two organs known to be affected by air pollution in humans. Exposure to rural extracts, with high contribution of wood burning emissions, affected genes implicated in basic cellular functions, in agreement with their strong embryotoxicity. Extracts from rural and urban samples elicited both common and specific transcriptome responses, suggesting different potentially adverse outcomes depending on PM source and composition. The authors thank the financial support of the Spanish Ministry (project TEA-PARTICLE, grant number CGL2011-29621) and the Portuguese Foundation for Science and Technology for the doctoral grant of Sofia R. Mesquita (SFRH/BD/80710/2011) funded by the Program POPH-QREN through the Portuguese Ministry of Education and Science and the European Social Fund, and support through project PEst-C/MAR/LA0015/2013. The PM filter samples used in the present study were PM10 and PM0.5 from the urban site - total of 4 samples from 2 sampling months; and PM0.5 from the rural site - total of 2 samples from 2 sampling months (PM10 samples from the rural site were not tested due to their very low concentration in organic compounds, and insignificant biological activity, previously measured). Sampling occurred during the cold periods of the year 2012/2013. The organic fraction of PM samples was extracted by sonication using a mixture of dichloromethane:methanol. Then, the extracts were filtered, evaporated and re-dissolved in Dimethyl sulfoxide (DMSO). Zebrafish fertilized eggs were exposed to PM organic extracts (0.2% DMSO) from the urban and rural sites from 24 to 120h post-fertilization. Total RNA was isolated from whole embryos (pools of 20 individuals), using Trizol reagent protocol (Invitrogen Life Technologies, Carlsberg, CA). The microarray study was performed using the Agilent Two-colour D. rerio Oligo Microarray v3 platform, following the Agilent Microarray â?? Based Gene Expression Analysis protocol. Three biological replicates were performed for each PM sample and controls. Biological replicates, a technical replicate and a self-to-self, were simultaneously amplified and labelled using Cyanine 3 (Cy3) and Cyanine 5 (Cy5) dye. After cRNA purification (RNeasy Kit, Quiagen GmbH, Hilden, Germany), the cRNA concentration and labelling were quantified in the NanoDrop spectrophotometer, obtaining incorporation rates in the range of 15-20pmol of cyanide dye/Âµl cRNA and yield values > 0.825ug, as recommended. cRNA was fragmented and hybridized in 4x44K arrays, for 17h at 65oC. After the hybridization the array slides were washed, and immediately scanned using Microarray Scanner Agilent G2505C system. Data was extracted using Agilent Feature Extraction Software v10.5.1.1, and the quality of microarray data was evaluated using the Quality Control report provided by Agilent Software. Based on the microarray data analysis, 22 primers were selected and designed using Primer Express 2.0 software (Applied Biosystems, Foster City, CA). Genes were quantified by real-time PCR to validate the microarray data, and a subset of 13 genes were further selected by their robust behaviour in the validation assays, allowing to differentiate the toxic potential of PM from urban and rural sources.

Project description:IntroductionStroke is one of the leading causes of death in Canada. While stroke care has improved dramatically over the last decade, outcomes following stroke among patients treated in rural hospitals have not yet been reported in Canada.ObjectivesTo describe variation in 30-day post-stroke in-hospital mortality rates between rural and urban academic hospitals in Canada. We also examined 24/7 in-hospital access to CT scanners and selected services in rural hospitals.Materials and methodsWe included Canadian Institute for Health Information (CIHI) data on adjusted 30-day in-hospital mortality following stroke from 2007 to 2011 for all acute care hospitals in Canada excluding Quebec and the Territories. We categorized rural hospitals as those located in rural small towns providing 24/7 emergency physician coverage with inpatient beds. Urban hospitals were academic centres designated as Level 1 or 2 trauma centres. We computed descriptive data on local access to a CT scanner and other services and compared mean 30-day adjusted post-stroke mortality rates for rural and urban hospitals to the overall Canadian rate.ResultsA total of 286 rural hospitals (3.4 million emergency department (ED) visits/year) and 24 urban hospitals (1.5 million ED visits/year) met inclusion criteria. From 2007 to 2011, 30-day in-hospital mortality rates following stroke were significantly higher in rural than in urban hospitals and higher than the Canadian average for every year except 2008 (rural average range = 18.26 to 21.04 and urban average range = 14.11 to 16.78). Only 11% of rural hospitals had a CT-scanner, 1% had MRI, 21% had in-hospital ICU, 94% had laboratory and 92% had basic x-ray facilities.ConclusionRural hospitals in Canada had higher 30-day in-hospital mortality rates following stroke than urban academic hospitals and the Canadian average. Rural hospitals also have very limited local access to CT scanners and ICUs. These rural/urban discrepancies are cause for concern in the context of Canada's universal health care system.

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Contrasting impact of rural, versus urban, living on glucose metabolism and blood pressure in Uganda.

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Contrasting impact of rural, versus urban, living on glucose metabolism and blood pressure in Uganda.

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