Abdominal obesity as a risk factor for stroke in Abuja, Nigeria

Gerald A. Onwuegbuzie; Peter Alabi; Fatima Abdulai

doi:10.18203/2320-6012.ijrms20213394

Authors

Gerald A. Onwuegbuzie Department of Medicine, University of Abuja Teaching Hospital, Abuja, Nigeria
Peter Alabi Department of Medicine, University of Abuja Teaching Hospital, Abuja, Nigeria
Fatima Abdulai Department of Medicine, University of Abuja Teaching Hospital, Abuja, Nigeria

DOI:

https://doi.org/10.18203/2320-6012.ijrms20213394

Keywords:

Obesity, Stroke, Risk factor

Abstract

Background: Obesity in Africa has remained a public health concern, which is been fueled by urbanization and its attendant lifestyle changes which includes less energy demanding jobs, sedentary lifestyle and adopting detrimental western eating habits. There are well established risk factors for stroke, however the association of obesity with that of stroke is less clear.

Methods: This study was designed to determine whether abdominal obesity is independently associated with an increased risk of ischaemic stroke. It is a case control study of 113 patients in which structured questionnaire was administered to consecutive patients admitted into the medical wards. The controls were matched for age and sex from a database with participants of the population-based cohort study. Statistical analysis of data was performed using SAS software (SAS Institute) 9.4.

Results: In the study 85% of the patients had hypertension, 50.5% had hypercholesterolemia and 33.6% had diabetes. The BMI was normal for most of the cases (23.3% vs. 76.7% p<0.0001) while the WHR was increased for most of the cases (70.9% vs. 29.1% p<0.0001). The statistical significance shows that WHR was more sensitive in assessing obesity than BMI. The logistic regression analysis, in model 1 unadjusted and model 2 adjusted for sex and age, BMI showed a positive association with risk of stroke (OR 1.10; 95% CI, 1.04-1.17; p=0.002) this association lost its significance in model 3 after adjusting for diabetes, hypertension and hypercholesterolemia (OR 1.04; 95% CI, 0.96-1.13; p=0.3751). The results of logistic regression analysis for WHR for model 1, model 2 and model 3 did not show any significance before and after adjustment.

Conclusions: Abdominal obesity may increase the risk of ischemic stroke through conventional vascular risk factors, but not as an independent risk factor.

Metrics

Metrics Loading ...

References

Heymsfield SB, Wadden TA. Mechanisms, pathophysiology, and management of obesity. N Engl J Med. 2017;376:1492.

Physical Status: The Use and Interpretation of Anthropometry. Available at: https://apps.who.int/ iris/handle/10665/37003. Accessed on 20 March 2021.

Chukwuonye II, Chuku A, John C. Prevalence of overweight and obesity in adult Nigerians – A systematic review. Diabetes Metab Syndr Obes. 2013;6:43-7.

Burton BT, Foster WR, Hirsch J, Van Itallie TB. Health implications of obesity: an NIH consensus development conference. Int J Obes. 1985;9:155-69.

Must A, Spadano J, Coakley EH, Field AE, Colditz G, Dietz WH. The disease burden associated with overweight and obesity. JAMA. 1999;282:1523-9.

The practical guide: identification, evaluation, and treatment of overweight and obesity in adults. Available at: http://www.nhlbi.nih.gov/guidelines/ obesity/practgde.htm. Accessed on 2 February, 2020.

Hubert HB, Feinleib M, McNamara PM, Castelli WP. Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study. Circulation. 1983;67:968-77.

Fraser GE, Strahan TM, Sabate J, Beeson WL, Kissinger D. Effects of traditional coronary risk factors on rates of incident coronary events in low-risk population. Circulation. 1992;86:406-13.

Prineas RJ, Folsom AR, Kaye SA. Central adiposity and increased risk of coronary disease mortality in older women. Ann Epidemiol. 1993;3:35-41.

Rimm EB, Stampfer MJ, Giovannucci E, Ascherio A, Spiegelman D, Colditz GA, Willett WC. Body size and fat distribution as predictors of coronary heart disease among middle-aged and older US men. Am J Epidemiol. 1995;141:1117-27.

Waist Circumference and Waist-Hip Ratio. Available at: https://www.who.int/publications-detail-redirect/ 9789241501491. Accessed on 20 March 2021.

Yusuf S, Hawken S, Ounpuu S. Obesity and the risk of myocardial infarction in 27,000 participants from 52 countries: a case-control study. Lancet. 2005; 366:1640-9.

Rimm EB, Stampfer MJ, Giovannucci E. Body size and fat distribution as predictors of coronary heart disease among middle-aged and older US men. Am J Epidemiol. 1995;141:1117-27.

Preventing and managing the global epidemic. Available at: https://apps.who.int/iris/handle/ 10665/42330. Accessed on 20 March 2021.

Lean ME, Han TS, Morrison CE. Waist circumference as a measure for indicating need for weight management. BMJ. 1995;311:158-61.

Sacco RL, Boden-Albala B, Gan R. Stroke incidence among white, black and Hispanic residents of an urban community: The Northern Manhattan Stroke Study. Am J Epidemiol. 1998;147:259-68.

Sacco RL, Elkind M, Boden-Albala B. The protective effect of moderate alcohol consumption on ischemic stroke. JAMA. 1999;281:53-60.

Folsom AR, Prineas RJ, Kaye SA, Munger RG. Incidence of hypertension and stroke in relation to body fat distribution and other risk factors in older women. Stroke. 1990;21:701-6.

Blair D, Habicht J-P, Sims EAH, Sylwester D, Abraham S. Evidence for an increased risk for hypertension with centrally located body fat and the effect of race and sex on this risk. Am J Epidemiol. 1984;19:526-40.

Folsom AR, Burke GL, Ballew C. Relation of body fatness and its distribution to cardiovascular risk factors in young blacks and whites: the role of insulin. Am J Epidemiol. 1989;130:911-24.

Gillum RF. The association of body fat distribution with hypertension, hypertensive heart disease, coronary heart disease, diabetes and cardiovascular risk factors in men and women aged 18-79 years. J Chronic Dis. 1987;40:421-8.

Daniels SR, Morrison JA, Sprecher DL, Khoury P, Kimball TR. Association of body fat distribution and cardiovascular risk factors in children and adolescents. Circulation. 1999; 99:541-5.

Zhong CK, Zhong ZY, XU TZYH. Measures of abdominal adiposity and risk of stroke : A. Biomed Environ Sci. 2016;29(1):12-23.

Zeng Y, He GP, Yi GH, Huang YJ, Zhang QH, and He LL. Knowledge of stroke warning signs and risk factors among patients with previous stroke or TIA in China. J Clin Nurs. 2012;21(20):2886-95.

Sundseth A, Faiz KW, Rønning OM, and Thommessen B. Factors related to knowledge of stroke symptoms and risk factors in a Norwegian stroke population. J Stroke Cerebrovascular Diseas. 2014;23:7:1849–55.

Shravani K, Parmar MY, Macharia R, Mateti UV, Martha S. Risk factor assessment of stroke and its awareness among stroke survivors: A prospective study. Adv Biomed Res. 2015;4:187.

Pancioli AM, Broderick J, Kothari R. Public perception of stroke warning signs and knowledge of potential risk factors. JAMA. 1998;279:1288-92.

Kim JS, Yoon SS. Perspectives of Stroke in persons living in Seoul, South Korea: a survey of 1000 subjects. Stroke. 1997;28:1165-9.

Onwuegbuzie GA, Reng RS. Serum Lipid Profile of Patients with Ischaemic Stroke in A Tertiary Centre in Nigeria. J Dent Med Sci. 2016;15(11):60-4.

Walker SP, Rimm EB, Ascherio A, Kawachi I, Stampfer MJ, Willett WC. Body size and fat distribution as predictors of stroke among US men. Am J Epidemiol. 1996;144:1143-50.

Flegal KM, Carroll MD, Kuczmarski RJ, Johnson CL. Overweight and obesity in the United States: prevalence and trends, 1960-1994. Int J Obes Relat Metab Disord. 1998;22:39-47.

Mitchell AB, Cole JW, Mcardle PF, Cheng Y, Ryan KA, Sparks MJ, et al. obesity in the United States: prevalence and trends. HHS. 2016;46(6):1690-2.

Lapidus L, Bengtsson C, Larsson B, Pennert K, Rybo E, Sjostrom L. Distribution of adipose tissue and risk of cardiovascular disease and death: a 12 year follow up of participants in the population study of women in Gothenburg, Sweden. Bio Med J. 1984;289:1257-61.

Larsson B, Svardsudd K, Welin L, Wilhelmsen L, Bjorntorp P, Tibblin G. Abdominal adipose tissue distribution, obesity, and risk of cardiovascular disease and death: 13 years follow up of participants in the study of men born in 1913. Bio Med J. 1984;288: 1401-4.

Siti Rohmatul Laily, Santi Martini, Atik Choirul H, Eva Flourentina K. Abdominal Obesity as a Risk Factor of Ischemic Stroke Incidence in Lamongan Distric, Indonesia. Mal J Med Health Sci. 2020;16(1): 88-93.

Suk SH, Sacco RL, Boden-Albala B. Abdominal obesity and risk of ischemic stroke: the Northern Manhattan Stroke Study. Stroke. 2003;34:1586-92.

Arcaro G, Zamboni M, Rossi L. Body fat distribution predicts the degree of endothelial dysfunction in uncomplicated obesity. Int J Obes. 1999;23:936-42.

Solerte SB, Fioravanti M, Pezza N. Hyperviscosity and microproteinuria in central obesity: relevance to cardiovascular risk. Int J Obes. 1997;21:417-23.

Davi G, Guagnano MT, Ciabattoni G. Platelet activation in obese women: role of inflammation and oxidant stress. J Am Med Assoc. 2002;288:2008-14.