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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 6, November/December 2016
AFRICA
373
activity (GPAQ) may be limiting due to the misinterpretation of
light- and moderate-intensity activity, leading to falsely elevated
levels of reported daily physical activity.
40
While the change in parity independently influenced weight
gain, the use of hormonal contraceptives was not associated with
a change in body weight or body fat distribution in this study.
Previous studies have found significant increases in body weight
and central fat mass with the use of hormonal contraceptives,
41
but due to the lack of data regarding length of usage, it is difficult
to correctly estimate the effect of the hormonal contraceptive in
these women. In addition, SES and access to healthcare may
influence the choice, as well as the consistency of contraceptive
use in this group and dilute the possible impact on weight change.
A limitation of the study was that measurements were only
taken at two time points, which may limit our interpretation of
subtle changes within the time period. Therefore, acute or short-
term changes could not be measured. Even though the sample
size was limited, the longitudinal nature of this study contributes
to knowledge regarding the determinants of weight gain and
their impact over time in a population at high risk of obesity and
metabolic disease. Since only baseline dietary intake and physical
activity were measured, this would be vital to follow up in future
research studies.
Conclusion
This study showed that lower BMI and nulliparity in the younger
women were significant determinants of weight gain and
centralisation of body fat over 5.5 years. In addition, although
higher SES at baseline was associated with a smaller change in
body weight, improvements in SES over the follow-up period were
associated with greater weight gain. Many health programmes
are targeted at women of reproductive age (e.g. family planning
clinics). Accordingly, the introduction of weight-management
interventions in these clinics is recommended to prevent and
manage weight gain in these vulnerable young women, as well
as future generations due to the intergenerational transfer of
risk. Research to understand the relationship between alternative
measures of SES, including sanitation and housing, and weight
gain are required to guide future policy recommendations.
We thank the research volunteers for their participation in this study,
Nandipha Sinyanya for her fieldwork, Hendriena Victor for her technical
assistance, Linda Bewerunge for performing the DXA scans and Mark
Punyanitya for analysing the CT scans. This study was funded by the
Sugar Association of South Africa, the South African Medical Research
Council, the International Atomic Energy Agency and the National Research
Foundation of South Africa.
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