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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 30, No 4, July/August 2019
228
AFRICA
Plasma phospholipid fatty acid patterns are associated
with adiposity and the metabolic syndrome in black
South Africans: a cross-sectional study
Alice Achieng Ojwang, Herculina Salome Kruger, Manja Zec, Cristian Ricci, Marlien Pieters, Iolanthé
Marike Kruger, Edelweiss Wentzel-Viljoen, Cornelius Mattheus Smuts
Abstract
Background:
Diets rich in n-6 polyunsaturated fatty acids
(PUFAs) and saturated fatty acids (SFA) have been associated
with increased risk of obesity and the metabolic syndrome
(MetS), but the evidence is inconsistent, whereas diets high
in n-3 long-chain (LC)-PUFAs are associated with lower risk.
There is limited information about the association of plasma
phospholipid fatty acids (FAs) with obesity and the MetS
among black South Africans.
Objective:
To investigate the association of dietary FAs and
plasma phospholipid FA patterns, respectively, with measures
of adiposity (body mass index, waist circumference, waist-to-
height ratio) and the MetS in black South Africans.
Methods:
Factor analysis was used to identify FA patterns
from 11 dietary FAs and 26 individual plasma phospholipid
FAs. Cross-sectional association of the identified patterns with
measures of adiposity and the MetS was investigated. A
random sample of 711 black South African adults aged 30 to 70
years (273 men, 438 women) from the North West Province was
selected from the South African leg of the Prospective Urban
and Rural Epidemiology (PURE) study. Sequential regression
models adjusted for confounders were applied to investigate the
association between dietary FAs and plasma phospholipid FA
patterns with measures of adiposity and the MetS.
Results:
Two patterns were derived from dietary FAs and six
patterns from plasma phospholipid FAs that explained the
cumulative variance of 89 and 73%, respectively. The associa-
tion of FA patterns with adiposity and the MetS was weaker for
dietary FA patterns than for plasma phospholipid FA patterns.
The plasma phospholipid FA pattern with high loadings of
saturated FAs (high-Satfat) and another with high loadings of
n-3 very-long-chain PUFAs (n-3 VLC-PUFAs) were positive-
ly associated with measures of adiposity and the MetS, while
patterns with positive loadings of LC mono-unsaturated fatty
acids (n-9 LC-MUFA) and a positive loading of n-3 essential
FAs (n-3 EFA) showed inverse associations with the MetS
and some measures of adiposity.
Conclusions:
The n-9 LC-MUFA and n-3 EFA patterns
seemed to provide possible protective associations with
adiposity and the MetS, whereas the high-Satfat and n-3
VLC-PUFA patterns were associated with adiposity and
the MetS in our study participants. The results are reflective
of the metabolic difference between overweight and obese
compared to lean individuals.
Keywords:
phospholipid fatty acid patterns, dietary fatty acid
patterns, adiposity, metabolic syndrome, waist:height ratio
Submitted 23/1/19, accepted 3/5/19
Published online 11/7/19
Cardiovasc J Afr
2019;
30
: 228–238
www.cvja.co.zaDOI: 10.5830/CVJA-2019-026
South Africa is currently experiencing rapid nutritional,
economic, demographic and epidemiological transitions with
likely consequences for lifestyle and health.
1
The prevalence of
overweight and obesity in South Africa in 2012 was 31% in men
and 64% for women.
2
This increased in 2016 to 68% in women
but remained the same for men.
3
Abdominal obesity among
black South African women is particularly associated with
elevated blood pressure (BP), lower high-density lipoprotein
cholesterol, higher serum triglycerides, and elevated fasting
plasma glucose, indicative of insulin resistance.
4
Unhealthy diet
is a major risk factor associated with the rising prevalence of
obesity and the metabolic syndrome (MetS).
5,6
Fat intake among the black urban population of South
Africa has increased from 16.4 to 26.2% of total energy over the
past 50 years.
7
The transition from more traditional to Western
diets, characterised by an increase in n-6 polyunsaturated fatty
acids (PUFA), saturated fatty acids (SFA), industrial trans fatty
acids (FAs),
8
as well as a decrease in n-3 PUFA intake, is also
prevalent in this population.
9
Diets high in percentage energy
from animal protein and total fat intake may increase the risk
of non-communicable diseases in rural and urban black South
Africans,
10
and this may be related to meat intake, which is a
major source of both MUFAs and SFAs in South Africans.
11
Centre of Excellence for Nutrition, North-West University,
Potchefstroom, South Africa
Alice Achieng Ojwang, M Nutr, RDN,
ojwangaa@gmail.comHerculina Salome Kruger, PhD, RD (SA)
Manja Zec, PhD
Cristian Ricci, PhD
Marlien Pieters, PhD, RD (SA)
Edelweiss Wentzel-Viljoen, PhD, RD (SA), RNT (SA)
Cornelius Mattheus Smuts, PhD, RNT (SA)
Medical Research Council Hypertension and Cardiovascular
Disease Research Unit, North-West University,
Potchefstroom, South Africa
Herculina Salome Kruger, PhD, RD (SA)
Excellence in Nutrition and Metabolism, Institute for
Medical Research, University of Belgrade, Serbia
Manja Zec, PhD
Africa Unit for Transdisciplinary Health Research, North-
West University, Potchefstroom, South Africa
Iolanthé Marike Kruger, PhD