29 / 60
CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 1, January/February 2021
AFRICA
27
22. Majeed-Saidan MA, Atiyah M, Ammari AN, AlHashem AM, Rakaf
MS, Shoukri MM,
et al.
Patterns, prevalence, risk factors, and survival
of newborns with congenital heart defects in a Saudi population: a
three-year, cohort case-control study.
J Congenit Cardiol
2019;
3
: 2.1–6.
23. Hoffman JIE, Kaplan S. The incidence of congenital heart disease.
J Am
Coll Cardiol
2002;
39
(12): 1890–900.
24. Zhang B, Liang S, Zhao J, Qian Z, Bassig BA, Yang R,
et al.
Maternal
exposure to air pollutant PM2.5 and PM10 during pregnancy and risk
of congenital heart defects.
J Expo Sci Environ Epidemiol
2016;
26
(4):
422–427.
25. Hwang B-F, Lee YL, Jaakkola JJ. Air pollution and the risk of cardiac
defects: a population-based case-control study.
Medicine
(Baltimore)
2015;
94
(44): e1883.
26. Roberts D, Kitchiner D. Antenatal diagnosis of fetal heart disease.
Hosp
Med
2014;
65
(7): 396–399
27. Abdulkadir M, Abdulkadir Z. A systematic review of trends and
patterns of congenital heart disease in children in Nigeria from 1964–
2015.
Afr Health Sci
2016;
16
(2): 367–377.
28. Ekure EN, Bode-Thomas F, Sadoh WE, Orogade AA, Otaigbe BE,
Ujunwa F,
et al
. Congenital heart defects in Nigerian children: prelimi-
nary data from the National Pediatric Cardiac Registry.
World J Pediatr
Congenit Heart Surg
2017;
8
(6): 699–706.
No ‘fat but healthy’ paradox in cardiovascular risk: large Spanish analysis
A large Spanish study found that physical activity does not
entirely undo the negative effects of excess body weight when
cardiovascular health was determined according to three
major risk factors for heart attack and stroke: diabetes, high
cholesterol and high blood pressure.
‘One cannot be “fat but healthy”,’ said study author Dr
Alejandro Lucia of the European University, Madrid, Spain.
‘This was the first nationwide analysis to show that being
regularly active is not likely to eliminate the detrimental
health effects of excess body fat. Our findings refute the
notion that a physically active lifestyle can completely negate
the deleterious effects of overweight and obesity.’
There is some evidence that fitness might mitigate the
negative effects of excess body weight on heart health. It
has been suggested that in adults and children, being ‘fat
but fit’ might be associated with similar cardiovascular
health to being ‘thin but unfit’. Lucia said: ‘This has led
to controversial proposals for health policies to prioritise
physical activity and fitness above weight loss. Our study
sought to clarify the links between activity, body weight and
heart health.’
The study used data from 527 662 working adults insured
by a large occupational risk-prevention company in Spain.
The average age of participants was 42 years and 32% were
women.
Participants were categorised as normal weight [body mass
index (BMI) 20.0–24.9 kg/m
2
], overweight (BMI 25.0–29.9
kg/m
2
), or obese (BMI 30.0 kg/m
2
or above). Additionally,
they were grouped by activity level: (1) regularly active,
defined as doing the minimum recommended for adults by
the World Health Organisation (WHO); (2) insufficiently
active, defined as some moderate to vigorous physical activity
every week but less than the WHO minimum; (3) inactive (no
exercise). Cardiovascular health was determined according to
three major risk factors for heart attack and stroke, namely
diabetes, high cholesterol and high blood pressure.
Approximately 42% of participants were normal weight,
41% were overweight and 18% were obese. The majority were
inactive (63.5%), while 12.3% were insufficiently active, and
24.2% were regularly active. Some 30% had high cholesterol
levels, 15% had high blood pressure and 3% had diabetes.
The researchers investigated the associations between each
BMI and activity group and the three risk factors. At all
BMI levels, any activity (whether it met the WHO minimum
or not) was linked with a lower likelihood of diabetes, high
blood pressure or high cholesterol compared to no exercise
at all.
Lucia said: ‘This tells us that everyone, irrespective of their
body weight, should be physically active to safeguard their
health.’ At all weights, the odds of diabetes and hypertension
decreased as physical activity rose. ‘More activity is better, so
walking 30 minutes per day is better than walking 15 minutes
a day,’ he said.
However, overweight and obese participants were at greater
cardiovascular risk than their peers with normal weight,
irrespective of activity levels. As an example, compared to
inactive normal-weight individuals, active obese people were
approximately twice as likely to have high cholesterol levels,
four times more likely to have diabetes, and five times more
likely to have high blood pressure.
Lucia said: ‘Exercise does not seem to compensate for
the negative effects of excess weight. This finding was also
observed overall in both men and women when they were
analysed separately.’
He concluded: ‘Fighting obesity and inactivity is equally
important; it should be a joint battle. Weight loss should
remain a primary target for health policies, together with
promoting active lifestyles.’
Source:
Medical Brief 2020