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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 6, November/December 2016

AFRICA

367

Determinants of change in body weight and body fat

distribution over 5.5 years in a sample of free-living

black South African women

Sarah Chantler, Kasha Dickie, Lisa K Micklesfield, Julia H Goedecke

Abstract

Objective:

To identify socio-demographic and lifestyle deter-

minants of weight gain in a sample of premenopasual black

South African (SA) women.

Methods:

Changes in body composition (dual-energy X-ray

absorptiometry, computerised tomography), socio-economic

status (SES) and behavioural/lifestyle factors were measured

in 64 black SA women at baseline (27

±

8 years) and after 5.5

years.

Results:

A lower body mass index (BMI) and nulliparity,

together with access to sanitation, were significant determi-

nants of weight gain and change in body fat distribution over

5.5 years. In addition, younger women increased their body

weight more than their older counterparts, but this associa-

tion was not independent of other determinants.

Conclusion:

Further research is required to examine the effect

of changing SES, as well as the full impact of childbearing on

weight gain over time in younger women with lower BMIs.

This information will suggest areas for possible intervention

to prevent long-term weight gain in these women.

Keywords:

body fat distribution, weight gain, black women,

South Africa

Submitted 10/12/15, accepted 22/3/16

Published online 25/5/16

Cardiovasc J Afr

2016;

27

: 367–374

www.cvja.co.za

DOI: 10.5830/CVJA-2016-038

Obesity and its co-morbidities continue to increase worldwide,

with women from low- and middle-income countries (LMICs)

being most affected.

1

Within South Africa, the prevalence of

overweight/obesity has increased from 56.2 to 64.8% in the

most recent South African National Health and Nutrition

Examination survey (SANHANES),

1,2

confirming the problem

within South Africa.

Our study in a cohort of black South African (SA)

women reported a 9% increase in body weight over a 5.5-year

period.

3

The weight gain was attributed predominantly to an

increase in fat mass, which was greatest in central compared

to peripheral depots. The relative redistribution of body fat

was associated with increases in fasting plasma glucose and

triglyceride concentrations, with reduced insulin sensitivity and

a compensatory increased insulin secretion at follow up.

3

Other longitudinal studies measuring changes in body

composition over time reported weight gain that ranged from

0.5–0.9 kg/year.

4-7

However, these studies were undertaken in

high-income countries (HICs). These data are valuable since to

the authors’ knowledge, there are no known longitudinal studies

from populations living in LMICs.

Determinants of weight gain in these studies include

non-modifiable factors such as age, gender and race, and

modifiable factors such as baseline body mass index (BMI),

5

dietary intake,

4,7-9

physical activity,

10

socio-economic status

(SES)

11,12

and parity.

13-15

Associations between these factors are

often complex in nature, and it is difficult to draw conclusions

regarding the relative contribution of these factors to increasing

body weight in different populations. Furthermore, many of

these studies failed to assess the impact of these determinants

on changes in body composition or body fat distribution. Due

to the risk of cardiometabolic disease associated with increasing

total and central fat mass,

16-18

and the possible protective benefits

associated with peripheral fat mass,

19

a greater understanding of

the determinants of body composition changes are important to

inform future intervention studies.

In addition, within LMICs, other factors such as

urbanisation and the ‘transition’ from a traditional to a more

westernised lifestyle have been associated with obesity and other

non-communicable diseases.

20

The relationship between SES

and obesity in LMICs differs from that in HICs, with studies in

LMICs reporting a positive association between SES and BMI,

with the inverse association being reported in HICs.

21

To our

knowledge no longitudinal studies have assessed the impact of

change in SES on body composition and body fat distribution.

Therefore, the aim of this study was to assess lifestyle factors

and SES variables at baseline and the changes in these factors

over a 5.5-year follow-up period, and how these are associated

with changes in body weight and whole-body fat distribution in

a sample of peri-urban free-living black SA women.

Division of Exercise Science and Sports Medicine,

Department of Human Biology, University of Cape Town,

Cape Town, South Africa

Sarah Chantler, MSc

Kasha Dickie, MSc

Lisa K Micklesfield, PhD

Julia H Goedecke, PhD

Non-Communicable Disease Research Unit, South African

Medical Research Council, Cape Town, South Africa

Julia H Goedecke, PhD,

julia.goedecke@mrc.ac.za

MRC/Wits Developmental Pathways for Health Research

Unit, Department of Paediatrics, Faculty of Health

Sciences, University of Witwatersrand, Johannesburg,

South Africa

Lisa K Micklesfield, PhD