CARDIOVASCULAR JOURNAL OF AFRICA • Volume 33, No 4, July/August 2022 202 AFRICA by one researcher (LM). Full texts of all eligible articles (a total of 73 for both 2019 and 2020) were then accessed and divided among reviewers who were identified as experts in their respective sections. It is worth noting that many of the articles were relevant to more than one risk factor, which is why details of how many of these were included are described in the different sections representing each of the eight risk factors below. Prevalence data for each of the four lifestyle and four physiological risk factors were extracted by reviewers as follows: AP, physical activity; MM, alcohol consumption; RSM, tobacco use; SW, diet; GM, obesity; AR, dyslipidaemia; LW, hypertension; LM, diabetes. Each reviewer was provided with a standardised data-extraction form with the following headings: reference, study population/sample/setting/design, intervention/ exposure or barriers/facilitators/correlates (brief description of the purpose of the study), outcomes of interest (which included how the risk factor was measured) and main findings (prevalence of the risk factor), and instructed to complete the form for all the studies allocated to their risk factor. The quality of the evidence and risk of bias was not assessed. Although PRISMA guidelines were closely followed when selecting the articles to be reviewed, the results are presented as a narrative review of the eight different risk factors. Each of the sections is presented separately and structured in such a way to include a brief introduction outlining the global prevalence of the risk factor, as well as the prevalence in LMICs, if available. Each reviewer then briefly described the global and national targets, as well as the contribution of the specific risk factor to the South African NCD burden, where applicable. This is followed by a description of how articles were included or excluded, and then national and regional prevalence data are described for the selected articles. If national data have not been published in any of the selected articles, the data were obtained from the respective reports, and include, where appropriate, the South African Demographic and Health Survey (SADHS) 2003 and 2016, as well as the South African National Health and Nutrition Examination survey (SANHANES), the report of which was published in 2013.8,9,13 Each of the sections ends with a brief description of whether there are national policies, and if available, whether these have Table 2. PubMed Search strategy, modified as needed for other electronic databases Population: middle-aged adult South Africans MeSH terms: #1 Middle aged [MeSH] All fields #2 #3 #4 #5 #6 #7 Middle age middle aged midlife middle adulthood #2 OR #3 OR #4 OR #5 #1 OR #6 MeSH term: #8 South Africa [MeSH] All fields #9 #10 #11 #12 ‘South Africa’ OR ‘South African’ #8 OR #9 #7 OR #10 Intervention: modifiable lifestyle risk factors MeSH terms: #13 Alcohol drinking [MeSH] All fields #14 #15 Alcohol consumption #13 OR #14 MeSH terms: #16 Exercise [MeSH] All fields #17 #18 #19 #20 #21 #22 #23 Physical activity Exercise Physical exertion Physical training Physical fitness #17 OR #18 OR #19 OR #20 OR #21 #16 OR #22 MeSH terms: #24 #25 #26 Feeding behavior [MeSH] Diet, food, and nutrition [MeSH] #24 OR #25 All fields: #27 #28 #29 #30 #31 #32 #33 #34 #35 #36 #37 #38 #39 Food habits Dietary habits Eating behavior Dietary behaviour Feeding patterns Food preferences Dietary fat Dietary fats Dietary protein Dietary carbohydrates Food consumption #27 OR #28 OR #29 OR #30 OR #31 OR #32 OR #33 OR #34 OR #35 OR #36 OR #37 #26 OR #38 MeSH terms: #40 Tobacco use [MeSH] All fields: #41 #42 #43 Smoking Tobacco #41 OR #42 #44 #40 OR #43 Outcome: metabolic risk factors MeSH terms: #45 #46 #47 Diabetes mellitus [MeSH] Insulin resistance [MeSH] #45 OR #46 All fields: #48 #49 #50 #51 #52 #53 #54 #55 #56 Diabetes Insulin resistance insulin sensitivity Metabolic syndrome Syndrome X Glucose intolerance Hyperglycemia #48 OR #49 OR #50 OR #51 OR #52 OR #53 OR #54 #47 OR #55 MeSH terms: #57 #58 #59 #60 Overnutrition [MeSH] Overweight [MeSH] Body mass index [MeSH] #57 OR #58 OR #59 All fields: #61 #62 #63 #64 #65 #66 #67 #68 Obesity Overnutrition Overweight Hypernutrition Body mass index BMI #61 OR #62 OR #63 OR #64 OR #65 OR #66 #60 OR #67 MeSH terms: #69 Hypertension [MeSH] All fields: #70 #71 #72 #73 Hypertension High blood pressure #70 OR #71 #69 OR #72 MeSH terms: #74 Dyslipidaemias [MeSH] All fields: #75 #76 #77 #78 #79 #80 #81 #82 #83 #84 #85 #86 Dyslipidaemia Dyslipidaemias Hypercholesterolemia Hypercholesteremia High cholesterol Elevated cholesterol Raised cholesterol Triglycerides Lipid profile #75 OR #76 OR #77 OR #78 OR #79 OR #80 OR #81 OR #82 OR #83 #74 OR #84 #15 OR #23 OR #39 OR #56 OR #68 #73 OR #85 AND #7 AND #12
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