CARDIOVASCULAR JOURNAL OF AFRICA • Volume 33, No 5, September/October 2022 236 AFRICA and recorded to the nearest 0.1 kg while height was measured using a stadiometer and recorded to the nearest 0.1 m. For both weight and height, two measurements were taken by two different and independent research assistants. The average was recorded as the weight of the participants. The absolute technical error of measurement was 0.017 kg for weight measurements and 0.005 m for height measurements. In the study, the authors could not measure the intra-equipment variance. Overweight was defined as body mass index of between 25 and 29.9 kg/m2 and obesity was defined as body mass index of ≥ 30 kg/m2. A non-stretchable plastic tape measure was used to measure the waist circumferences (WC) and values were recorded to the nearest 0.1 cm. Two WC measurements were taken by two independent research assistants. The absolute technical error of measurement for WC was 0.012 cm. Abdominal obesity was defined by a waist circumference ≥ 80 cm for women and ≥ 94 cm for men.41 Blood pressure was measured using OMRON M-5 (OMRON UK) according to the WHO procedure. Blood pressure measurements were taken with participants in a seated position with a flexed elbow at the level of the heart. An appropriately tight blood pressure cuff was placed around the upper arm with its lower edge just above the antecubital fossa. The cuff was inflated to measure systolic blood pressure and released for diastolic blood pressure. Three measurements were taken and the average of the last two readings was reported. Participants with a systolic blood pressure (SBP) of ≥ 140 mmHg, diastolic blood pressure (DBP) of ≥ 90 mmHg and/or history of hypertension were considered hypertensive.42 This study was conducted according to the guidelines laid down in the Declaration of Helsinki43 and all procedures involving human subjects were approved by the Medunsa Research and Ethics Committee (MREC) [MREC/HS/102/2014:PG]. The nature of the study was explained to the subjects and written informed consent was obtained from parents and verbal assent from learners. Statistical analysis Data were analysed using the statistical package for social sciences (SPSS) version 22.0. Normally distributed data (Gaussian distribution) are presented as mean ± standard deviation and the skewed data were normalised through a logarithm transformed for further analysis and are presented as median (interquartile range). The Student’s t-test was used to compare serum lipids and inflammatory markers between participants with and without MA. Analysis of variance (ANOVA) was used to control for age in the comparison of parameters between participants with and without MA. Multiple logistic regression analysis was used to determine the association of MA with serum lipids and inflammatory markers. A simple logistic regression was used to determine the bi-variate relationship between MA and predictors. Predictors with a p-value ≤ 0.250 were entered into the first adjusted model and those with the weakest prediction (with p > 0.250) were removed and the model was run again to get the last adjusted model. The model was used to control for known confounders measured in this study, such as age, gender, blood pressure, high glucose and creatinine levels, to mention a few. Adjusted odds ratios (AOR) with a 95% confidence interval (CI) were generated and used to determine the independent strength of the associations. Results are presented as AOR (95% CI). Significance was set at the probability level of p < 0.05. Results Table 1 presents demographic and biochemical data for males and females. In this population, women were found to be significantly older and had a significantly higher ACR compared to their male counterparts (p = 0.03 and 0.02, respectively). Women were also found to have a significantly higher hs-CRP and TC/HDL-C ratio when compared to men (p = 0.01, 0.00 and 0.04, respectively). Men had a significantly higher estimated glomerular filtration rate (eGFR) and serum creatinine compared to women (p = 0.00 and 0.00, respectively). The prevalence of a high hs-CRP and TC was significantly higher in women that in men (p = 0.00 and 0.0, respectively). More men were found to have a lower HDL-C compared to women (p = 0.00). The prevalence of a high TC/HDL-C ratio was significantly higher in women than in men (p = 0.00 and 0.03, respectively). Table 2 presents anthropometric and blood pressure data in men and women. Women were found to have a higher body mass Table 1. Demographic and biochemical data of males and females Variables All (n = 602) Female (n = 377) Male (n = 225) p-value Age (years) 48.63 ± 20.89 50.14 ± 19.82 46.22 ± 22.44 0.03 ACR (mg/mmol) 2.04 (1.05–4.71) 4.11 ± 5.39 3.18 ± 3.53 0.02 Glucose (mmol/l) 5.15 ± 0.84 5.16 ± 0.85 5.13 ± 0.83 0.71 Insulin (µIU/l) 6.23 (3.33–1.85) 6.42 (3.50–12.63) 5.60 (3.20–10.67) 0.33 HOMA 1.81 ± 1.33 1.85 ± 1.31 1.74 ± 1.36 0.31 IL-6 (pg/ml) 3.09 (1.96–4.94) 2.74 (1.96–3.81) 3.01 (1.81–4.84) 0.12 hs-CRP (mg/l) 1.50 (0.56–4.28) 1.83 (0.65–5.35) 1.26 (0.47–2.76) 0.01 TC (mmol/l) 4.45 ± 1.23 4.54 ± 1.29 4.33 ± 1.06 0.05 HDL-C (mmol/l) 1.34 ± 0.51 1.34 ± 0.59 1.33 ± 0.32 0.78 LDL-C (mmol/l) 2.54 ± 1.09 2.66 ± 1.04 2.41 ± 0.93 0.00 TG (mmol/l) 1.11 (0.73–1.68) 1.11 (0.72–1.70) 1.10 (0.74–1.58) 0.91 TC/HDL-C 3.52 ± 1.13 3.59 ± 1.16 3.39 ± 1.06 0.04 eGFR (ml/min/1.73 m2) 97.34 ± 24.07 93.65 ± 23.51 103.49 ± 23.8 0.00 Creatinine (µmol/l) 82.31 ± 19.81 79.28 ± 18.31 87.55 ± 21.17 0.00 MA, n (%) 215 (35.7) 128 (34.0) 87 (38.7) 0.24 Age (< 40 years), n (%) 221 (36.7) 119 (31.6) 102 (45.3) 0.00 Age (40–59 years), n (%) 173 (28.7) 127 (33.7) 42 (20.4) Age (> 60 years), n (%) 208 (34.6) 131 (34.7) 77 (34.2) High glucose (≥ 5.6 mmol/l), n (%) 197 (32.8) 128 (34.0) 69 (30.7) 0.39 High HOMA (> 2.5), n (%) 166 (27.6) 106 (28.2) 60 (26.7) 0.69 High IL-6 (≥ 5 pg/ml), n (%) 32 (17.8) 14 (13.9) 18 (22.8) 0.12 High hs-CRP (≥ 3 mg/l), n (%) 198 (32.9) 146 (38.7) 52 (23.2) 0.00 High TC (≥ 5.0 mmol/l), n (%) 187 (32.0) 130 (35.5) 57 (26.1) 0.02 Low HDL-C (1.1 and 1.3 mmol/l), n (%) 167 (29.1) 85 (23.6) 82 (38.5) 0.00 High LDL-C (≥ 3.0 mmol/l), n (%) 295 (52.2) 195 (55.2) 100 (47.2) 0.06 High TG (≥ 1.7 mmol/l), n (%) 151 (26.1) 103 (28.1) 48 (22.5) 0.14 ACR, albumin–creatinine ratio; HOMA, homeostatic model assessment; IL-6, hs-CRP, high-sensitivity C-reactive protein; TC, total cholesterol; HDL-C, highdensity lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; TG, triglycerides; eGFR, estimated glomerular filtration rate; MA, microalbuminaria.
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