1. Academic Wits Research Publications (Faculties submissions)

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    Genetic risk score for adult body mass index associations with childhood and adolescent weight gain in an African population
    (BioMed Central, 2018-08) Munthali, Richard J.; Sahibdeen, Venesa; Kagura, Juliana; Hendry, Liesl M.; Norris, Shane A.; Ong, Ken K.; Lombard, Zané; Day, Felix R.
    Background: Ninety-seven independent single nucleotide polymorphisms (SNPs) are robustly associated with adult body mass index (BMI kg/m2) in Caucasian populations. The relevance of such variants in African populations at different stages of the life course (such as childhood) is unclear. We tested whether a genetic risk score composed of the aforementioned SNPs was associated with BMI from infancy to early adulthood. We further tested whether this genetic effect was mediated by conditional weight gain at different growth periods. We used data from the Birth to Twenty Plus Cohort (Bt20+), for 971 urban South African black children from birth to 18 years. DNA was collected at 13 years old and was genotyped using the Metabochip (Illumina) array. The weighted genetic risk score (wGRS) for BMI was constructed based on 71 of the 97 previously reported SNPs. Results: The cross-sectional association between the wGRS and BMI strengthened with age from 5 to 18 years. The significant associations were observed from 11 to 18 years, and peak effect sizes were observed at 13 and 14 years of age. Results from the linear mixed effects models showed significant interactions between the wGRS and age on longitudinal BMI but no such interactions were observed in sex and the wGRS. A higher wGRS was associated with an increased relative risk of belonging to the early onset obese longitudinal BMI trajectory (relative risk = 1.88; 95%CI 1.28 to 2.76) compared to belonging to a normal longitudinal BMI trajectory. Adolescent conditional relative weight gain had a suggestive mediation effect of 56% on the association between wGRS and obesity risk at 18 years. Conclusions: The results suggest that genetic susceptibility to higher adult BMI can be tracked from childhood in this African population. This supports the notion that prevention of adult obesity should begin early in life. The genetic risk score combined with other non-genetic risk factors, such as BMI trajectory membership in our case, has the potential to be used to screen for early identification of individuals at increased risk of obesity and other related NCD risk factors in order to reduce the adverse health risk outcomes later.
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    Influence of socioeconomic status on changes in body size and physical activity in ageing black South African women
    (BioMed Central, 2018-04) Gradidge, Philippe Jean-Luc; Norris, Shane A.; Munthali, Richard; Crowther, Nigel J.
    Background: The increasing prevalence of obesity in sub-Saharan African women is not well understood, and black South African women in the region are particularly vulnerable. This study aimed to examine whether the relationship of socioeconomic status (SES) with changes in body mass index (BMI) and waist circumference (WC) is mediated by physical activity in ageing African women. Methods: In a longitudinal analysis of the 518 caregivers associated with the Birth to Twenty Plus study, the role of SES associated with 10-year changes in BMI and WC was tested using structural equation modelling (SEM). The degree of mediation of moderate-vigorous physical activity (MVPA) and sitting time in this association was also assessed. Results: The prevalence of obesity increased significantly from baseline to follow-up (p < 0.0001). In the SEM models, baseline SES had a direct positive effect on changes in BMI (β, 95% CI, 0.02 (0.005 to 0.04), and a direct negative effect on changes in MVPA (β, 95% CI, − 3.81 (− 6.92 to − 0.70). Baseline MVPA had a direct negative effect (β, 95% CI, − 0.002 (− 0.003 to − 0.0003) and indirect positive effect via change in MVPA (β, 95% CI, 0.01 (0.0001 to 0.001) on change in WC. Conclusions: Our study demonstrates the role and interaction of sociodemographic and behavioural predictors of obesity and suggests a multifaceted approach to management of the crisis in communities of ageing urban African women.
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    Bone mineral density in midlife long-term users of hormonal contraception in South Africa: relationship with obesity and menopausal status
    (BMC, 2018-04) Beksinska, Mags E.; Smit, Jenni A.; Kleinschmidt, Immo
    Background: In South Africa, hormonal contraception is widely used in women over the age of 40 years. One of these methods and the most commonly used is depot-medroxyprogesterone acetate (DMPA) which has been found to have a negative effect on bone mass. Limited information is available on the effect of norethisterone enanthate (NET-EN) on bone mass, and combined oral contraceptives (COCs) have not been found to be associated with loss of bone mass. The aim of this study was to investigate bone mineral density (BMD) in pre and perimenopausal women (40–49 years) in relation to use of DMPA, NET-EN and COCs for at least 12 months preceding recruitment into the study and review associations with body mass index (BMI) and menopausal status. Methods: One hundred and twenty seven users of DMPA, 102 NET-EN users and 106 COC users were compared to 161 nonuser controls. Menopausal status was assessed, BMI and forearm BMD was measured at the distal radius using dual X-ray absorptiometry. Comparison analysis was conducted at baseline and 2.5 years. Results: There was no significant difference in BMD between the four contraceptive user groups (p = 0.26) with and without adjustment for age at baseline or at 2.5 years (p = 0.52). The BMD was found to be significantly associated with BMI (p = < 0.0001) with an increase of one unit of BMI translating to an increase of 0.0044 g/cm2 in radius BMD. Follicle stimulating hormone (FSH) level ≥ 25.8 mIU/mL was associated with a decrease of 0.017 g/cm2 in radius BMD relative to women with FSH < 25.8 mIU/mL. Significant interaction between FSH and BMI in their effect on BMD was observed (p = .006). Conclusion: This study found no evidence that long-term use of DMPA, NET-EN and COCs affects forearm BMD in this population at baseline or after 2.5 years of follow-up. This study also reports the complex relationship and significant interaction between FSH and BMI in their effect on BMD. BMD research in older women needs to ensure that women are assessed for menopausal status and BMI.