Prevalence rates and cardiometabolic determinants of diabetes mellitus and pre-diabetes with projected coronary heart disease at bank site of Brazzaville
Author(s)
Gombet Thierry,
Longo-Mbenza Benjamin*,
Ellenga-Mbolla Bertrand,
Ikama M. Stephan,
Kimbally-Kaky Gisèle,
Nkoua Jean-Louis,
Nge Okwe Augustin
Affiliation(s)
Service des Urgences, CHU de Brazzaville, Brazzaville, Congo. Faculty of Health Sciences, Walter Sisulu University, Eastern Cape, South Africa. Service de cardiologie et Médecine Interne, CHU de Brazzaville, Brazzaville, Congo. Biostatistics Unit, Lomo Medical Center and Heart of Africa Center of Cardiology, Kinshasa, Congo.
Service des Urgences, CHU de Brazzaville, Brazzaville, Congo. Faculty of Health Sciences, Walter Sisulu University, Eastern Cape, South Africa. Service de cardiologie et Médecine Interne, CHU de Brazzaville, Brazzaville, Congo. Biostatistics Unit, Lomo Medical Center and Heart of Africa Center of Cardiology, Kinshasa, Congo.
ABSTRACT
Background: Aim: Congolese Bank employees are often inactive without valid information on the burden of dysglycemia and cardiometabolic risk. This study aims to assess the prevalence rates of diabetes mellitus (DM) and pre-diabetes and to identify the environmental, genetic and cardiometabolic risk factors associated with Type 2 diabetes mellitus (T2DM) and pre-diabetes among Congolese bank employees. Methods: In representative 126 bank employees from Brazzaville, Congo, Central Africa, Abdominal obesity, dyslipidemia and metabolic syndrome (MetS) were defined by IDF for Europe, NCEP-ATPIII and IDF criteria modified for Central Africa. Projected high 10-year total risk of coronary heart disease (CHD) ≥20% was calculated using Framingham scores. Results: Out of the employees, 16% and 21.4% had DM and pre-diabetes, respectively. The rate of T2DM among diabetics was estimated 90%. Aging, high total cholesterol, high LDL-cholesterol, high conicity index and longer urban residence after migration were significantly associated with pre-diabetes. Physical inactivity, smoking, excessive alcohol intake, abdominal obesity, female gender, low HDL-C, hypertension, CHD, projected high 10-year total CHD risk, age ≥ 55 years, urban residence, Southern area residence, high socioeconomic status, non married status, MetS/NCEP, MetS/IDF for Europe and MetS/IDF for Africa were significantly associated with T2DM.MetS/IDF for Africa was the only independent determinant of T2DM. Conclusion: Urgent prevention and intervention programme are needed to curb the alarming increase in DM, T2DM, pre-diabetes.
Background: Aim: Congolese Bank employees are often inactive without valid information on the burden of dysglycemia and cardiometabolic risk. This study aims to assess the prevalence rates of diabetes mellitus (DM) and pre-diabetes and to identify the environmental, genetic and cardiometabolic risk factors associated with Type 2 diabetes mellitus (T2DM) and pre-diabetes among Congolese bank employees. Methods: In representative 126 bank employees from Brazzaville, Congo, Central Africa, Abdominal obesity, dyslipidemia and metabolic syndrome (MetS) were defined by IDF for Europe, NCEP-ATPIII and IDF criteria modified for Central Africa. Projected high 10-year total risk of coronary heart disease (CHD) ≥20% was calculated using Framingham scores. Results: Out of the employees, 16% and 21.4% had DM and pre-diabetes, respectively. The rate of T2DM among diabetics was estimated 90%. Aging, high total cholesterol, high LDL-cholesterol, high conicity index and longer urban residence after migration were significantly associated with pre-diabetes. Physical inactivity, smoking, excessive alcohol intake, abdominal obesity, female gender, low HDL-C, hypertension, CHD, projected high 10-year total CHD risk, age ≥ 55 years, urban residence, Southern area residence, high socioeconomic status, non married status, MetS/NCEP, MetS/IDF for Europe and MetS/IDF for Africa were significantly associated with T2DM.MetS/IDF for Africa was the only independent determinant of T2DM. Conclusion: Urgent prevention and intervention programme are needed to curb the alarming increase in DM, T2DM, pre-diabetes.
Cite this paper
Thierry, G. , Benjamin, L. , Bertrand, E. , Stephan, I. , Gisèle, K. , Jean-Louis, N. and Augustin, N. (2014) Prevalence rates and cardiometabolic determinants of diabetes mellitus and pre-diabetes with projected coronary heart disease at bank site of Brazzaville. World Journal of Cardiovascular Diseases, 4, 77-86. doi: 10.4236/wjcd.2014.42012.
Thierry, G. , Benjamin, L. , Bertrand, E. , Stephan, I. , Gisèle, K. , Jean-Louis, N. and Augustin, N. (2014) Prevalence rates and cardiometabolic determinants of diabetes mellitus and pre-diabetes with projected coronary heart disease at bank site of Brazzaville. World Journal of Cardiovascular Diseases, 4, 77-86. doi: 10.4236/wjcd.2014.42012.
References
[1] WHO Consultation (1999) Definition, diagnosis and classification of diabetes mellitus. Report n 99.2. World Health Organization, Geneva. [2] Longo-Mbenza, B., Vangu Ngoma, D., Nahimana, D., Mayuku, D.M., Mbungu, F.S., Ekwanzala, F. and Beya, C. (2008) Screen detected and the WHO Stepwise approach to the prevalence and risk factors of arterial hypertension in Kinshasa. The European Journal of Cardiovascular Prevention & Rehabilitation, 5, 503-508.
http://dx.doi.org/10.1097/HJR.0b013e3282f21640 [3] On’Kin, J.B.K.L., Longo-Mbenza, B., Nge okwe, A., Ditu, M.S., Okitolonda, W. and He, J. (2008) Prevalence and risk factors of diabetes mellitus in Kinshasa Hinterland. International Journal of Diabetes and Metabolism, 16, 97-106. [4] On’Kin, J.B.K.L., Longo-Mbenza, B., Nge okwe, A., Kangola Kabangu, N., Mbungu Fuele, S. and Milongo Dipa, G. (2008) Classification and dramatic epidemic of diabetes mellitus in Kinshasa Hinterland: The prominent role of Type 2 diabetes and lifestyle changes among Africans. Nigerian Journal of Medicine, 18, 311-320. [5] Ramachandran, A., Mary, S., Yamuna, A., Murugesan, N. and Snehalatha, C. (2008) High prevalence of diabetes and cardiovascular risk factors associated with urbanization in India. Diabetes Care, 31, 893-898.
http://dx.doi.org/10.2337/dc07-1207 [6] Sicree, R., Shaw, J. and Zimmet, P. (2006) Prevalence and projections. In Diabetes Atlas. 3rd Edition. Brussels, Belgium. International Diabetes Federation, 16-104. [7] Zimmet, P., Alberti, K.G. and Shaw, J. (2001) Global and societal implications of the diabetes epidemic. Nature, 414, 782-787.
http://dx.doi.org/10.1038/414782a [8] Wild, S., Roglic, G., Green, A., Sicree, R. and King, H. (2004) Global prevalence of diabetes: Estimates for the year 2000 and projections for 2030. Diabetes care, 27, 1047-1053.
http://dx.doi.org/10.2337/diacare.27.5.1047 [9] Fach, D., William, J., Tappy, L., Ravussin, E. and Bovet, P. (2007) Prevalence, awareness and control of diabetes in the Seychelles and relationship with excess body weight. BMC Public Health, 7, e163.
http://dx.doi.org/10.1186/1471-2458-7-163 [10] Yach, D., Stickler, D. and Brownell, K.D. (2006) Epidemiologic and economic consequences of the global epidemics of obesity and diabetes. Nature Medicine, 12, 62-66.
http://dx.doi.org/10.1038/nm0106-62 [11] Soderberg, S., Zimmet, P., Tuomilehto, J., de Courten, M., Dowse, G.K., Chitson, P., Gareeboo, H., Alberti, K.G. and Shaw, J.E. (2005) Increasing prevalence of Type 2 diabetes mellitus in all ethic groups in Mauritius. Diabetic Medicine, 22, 61-68.
http://dx.doi.org/10.1111/j.1464-5491.2005.01366.x [12] Hamilton, M.T., Hamilton, D.G. and Zderic, T.W. (2005) Role of low energy expenditure and sitting in obesity, metabolic syndrome, Type 2 diabetes and cardiovascular disease. Diabetes, 56, 2655-2667.
http://dx.doi.org/10.2337/db07-0882 [13] Oberlinner, C., Neumann, S.M., OH, M.G. and Zober, A. (2008) Screening for pre-diabetes and diabetes in the workplace. Occupational Medicine, 58, 41-45.
http://dx.doi.org/10.1093/occmed/kqm129 [14] Esc/EASD guidelines on diabetes, pre-diabetes and cardiovascular diseases: Executive summary. (2007) European Heart Journal, 28, 88-136. [15] Longo-Mbenza, B., Ngimbi, R.M., Ngoma, D.V., Fuele, S.M. and Buassabu-Tsumbu, B. (2008) Risk factors of stroke among Congolese black hypertensive diabetics. Annales de Cardiologie et d’Angéiologie, 57, 37-43.
http://dx.doi.org/10.1016/j.ancard.2007.08.013 [16] Erasmus, R.T., Blanco Blanco, E., Okesina, A.B., Matsha, T., Gaweta, Z. and Mesa, J.A. (2001) Prevalence of diabetes mellitus and impaired glucose tolerance in factory workers from Transkei, South Africa. South African Medical Journal, 91,157-160. [17] Lohman, T.G., Roche, A.F. and Martorel, R. (1998) Anthropometric standardization reference manual champaign, IL. Human Kinetics, 3-8, 39-70. [18] Wang, J., Thornton, J.C., Bari, S., Williamson, B., Gallagher, D., Heymsfield, S.B., Horlick, M., Kotler, D., Laferrere, B., Mayer, L., Pi-Sunyer, F.X. and Pierson, R.N. Jr. (2003) Comparison of waist circumference measured at four sites. The American Journal of Clinical Nutrition, 77, 379-384. [19] World Health Organization (1998) Obesity, preventing and managing the global epidemic. Report of a WHO Consultation on obesity. WHO, Geneva. [20] Spijkerman, A.M.W., Fuyun, M.F., Griffin, S.J., Dekker, J.M., Nijpels, G. and Warehan, N.J. (2004) The performance of a risk score as a screening test for undiagnosed hyperglycemia in ethnic minority groups. Diabetes Care, 27, 116-122.
http://dx.doi.org/10.2337/diacare.27.1.116 [21] Longo-Mbenza, B., Nkoy Belila, J., Vangu Ngoma, D. and Mbungu, S. (2007) Prevalence and risk factors of arterial hypertension among urban Africans in workplace: The obsolete role of body mass index. Nigerian Journal of Medicine, 16, 42-49.
http://dx.doi.org/10.4314/njm.v16i1.37280 [22] The Expert Committee on the diagnosis and classification of diabetes mellitus. (2003) Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care, 26, SE-S20. [23] Alberti, K.G., Zimmet, P., Shaw, J. and IDF Epidemiologic Task Force Consensus Group. (2005) The metabolic syndrome: A new worldwide definition. Lancet, 366, 1059-1062.
http://dx.doi.org/10.4314/njm.v16i1.37280 [24] On’Kin, J.B.K.L., Longo-Mbenza, B., Nge Okwe, A. and Kangola Kabangu, N. (2007) Survey of abdominal obesities in an adult urban population of Kinshasa, Democratic Republic of Congo. Cardiovascular Journal of Africa, 18, 300-307. [25] Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation and treatment of high blood cholesterol in adults (Adult treatment Panel III 2001). JAMA, 285, 2486-2497. [26] Valdez, R., Seidl, J.C., Ahn, Y.I. and Weiss, K.M. (1992) A new index of abdominal adiposity as an indicator of risk for cardiovascular disease: A cross-population study. International Journal of Obesity, 16, 77-82. [27] Longo-Mbenza, B., Bieleli, E., Muls, E., Vangu, N. and Ditu, M.S. (2002) The role of early hemodynamic impairment and disease duration on diabetic cardiomyopathy and hypertension in Central Africans with atherosclerosis. Journal of Diabetes and Its Complications, 16, 146-152. http://dx.doi.org/10.1016/S1056-8727(00)00129-X [28] Ford, E.S. (2002) Does exercise reduce inflammation? Physical activity and C-reactive protein in US adults. Epidemiology, 13, 561-568.
http://dx.doi.org/10.1097/00001648-200209000-00012 [29] Chobanian, A.V., Bakris, G.L., Black, H.R., Cushman, W.C., Green, L.A., Izzo Jr., J.L. (2003) The Seventh report of Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure: The JNC7 Report. JAMA, 289, 2560-2572.
http://dx.doi.org/10.1001/jama.289.19.2560 [30] Anderson, K.M., Wilson, P.W., Odell, P.M., Kannel, W.B. (1991) An updated coronary risk profile. A statement for health professionals. Circulation, 83, 356-362.
http://dx.doi.org/10.1161/01.CIR.83.1.356 [31] Grundy, S.M., Pasternal, R., Greenland, P., Smith Jr., S. and Fuster, V. (1999) Assessment of cardiovascular risk by use of multiple-risk-factor assessment equations: A statement for healthcare professionals from the American Heart Association and the America College of cardiology. Circulation, 100, 1481-1492.
http://dx.doi.org/10.1161/01.CIR.100.13.1481 [32] Prevention of coronary heart disease in clinical practice. (1998) Recommendations of the Second Joint Tak Force of European and other societies on coronary prevention. European Heart Journal, 19, 1434-503. [33] Longo-Mbenza, B., Mambune, H.F., Kasiam, J.B., Vita, E.K., Fuele, S.M., Nsenga, J.N., Mabwa, L. and Nzuzi, V. (2007) Relationship between waist circumference and cholesterol in Central Africans with congestive heart failure. West African Journal of Medicine, 26, 183-190. [34] Sobngwi, E., Mauvais-Jarvis, E., Vexiau, P., Mbanya, J.C. and Gautier, J.F. (2001) Diabetes in Africans. Part 1: Epidemiology and clinical specificities. Diabetes and Metabolism, 27, 628-634. [35] Balde, N.M., Diallo, I., Balde, M.D., Barry, I.S., Kaba, L., Diallo, M.M., Kaké, A., Camara, A., Bah, D., Barry, M.M., Sangaré-Bah, M. and Maugendre, D. (2007) Diabetes and impaired fasting glucose in rural and populations in Futa Jallon (Guinea): Prevalence and associated risk factors. Diabetes Metabolism, 33, 114-120.
http://dx.doi.org/10.1016/j.diabet.2006.10.001 [36] Fisch, A., Pichard, E., Prazuck, T., Leblanc, H., Sidibe, Y. and Brucker, G. (1987) Prevalence and risk factors of diabetes mellitus in the rural region of Mali (West Africa): A practical approach. Diabetologia, 30, 859-862. [37] King, H., Rewers, M. and WHO AD HOC Diabetes Reporting group. (1993) Global estimates for prevalence of diabetes mellitus and impaired glucose tolerance in adults. Diabetes Care, 16, 157-177.
http://dx.doi.org/10.2337/diacare.16.1.157 [38] Mbanya, J.C., Ngogang, J., Salah, J.N., Minkoulou, E. and Balkau, B. (1997) Prevalence of NIDDM and impaired glucose tolerance in a rural and an urban population in Cameroon. Diabetologica, 40, 824-829.
http://dx.doi.org/10.1007/s001250050755 [39] Motala, A.A. (2002) Diabetes trends in Africa. Diabetes/ Metabolism Research and Reviews, 18, S14-S20.
http://dx.doi.org/10.1002/dmrr.284 [40] Bonora, E., Kiechl, S., Willeit, J., Oberhollenzer, F., Egger, G., Meigs, J.B., Bonadonna, R.C. and Muggeo, M. (2004) Population-based incidence rates and risk factors for Type 2 diabetes in white individuals. The Bruneck study. Diabetes, 53, 1782-1789.
http://dx.doi.org/10.2337/diabetes.53.7.1782 [41] Lester, F.T. (1984) The clinical pattern of diabetes in Ethiopians. Diabetes Care, 7, 6-11.
http://dx.doi.org/10.2337/diacare.7.1.6 [42] Fezeu, L., Balkau, B., Kengne, A.P., Sobngwi, E. and Mbanya, J.C. (2007) Metabolic syndrome in a sub-Saharan African setting: Central obesity may be the key determinant. Atherosclerosis, 193, 70-76.
http://dx.doi.org/10.1016/j.atherosclerosis.2006.08.037 [43] Longo-Mbenza, B., Nkondi Nsenga, J. and Vangu Ngoma, D. (2007) Prevention of the metabolic syndrome insulin resistance and the atherosclerotic diseases in Africans infected by Helicobacter pylori infection and treated by antibiotics. International Journal of Cardiology, 121, 229-238.
http://dx.doi.org/10.1016/j.ijcard.2006.12.003 [44] Zhong, S., Sharp, D.S., Grove, J.S., Bruce, C., Yano, K., Curb, J.D. and Tall, A.R. (1996) Increased coronary heart disease in Japanese-American men with mutation in the cholesterol ester transfer protein in the despite increased HDL levels. Journal of Clinical Investigation, 97, 2917-2923.
http://dx.doi.org/10.1172/JCI118751 [45] Dehout, F., Haumont, S., Gaham, N., Amoussou Genou, K.D. and Hermans, M. (2008) Metabolic syndrome in Bantu subjects with Type 2 diabetes from sub-Saharan extraction prevalence, gender differences and HOMA-hyperbolic product. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 2, 5-11.
http://dx.doi.org/10.1016/j.dsx.2007.11.008 [46] Hu, F.B., Stampfer, M.J., Haffner, S.M., Solomon, C.G., Willett, W.C. and Manson, J.E. (2002) Elevated risk of cardiovascular disease prior to clinical diagnosis of Type 2 diabetes. Diabetes Care, 25, 1129-1134.
http://dx.doi.org/10.2337/diacare.25.7.1129 [47] Evans, J.M.M., Wang, J. and Morris, A.D. (2002) Comparison of cardiovascular risk between patients with Type 2 diabetes and those who had a myocardial infarction: Cross sectional and cohort studies. British Medical Journal, 324, 939.
http://dx.doi.org/10.1136/bmj.324.7343.939 [48] Al-Lawati, J.A., Barakat, N.M., Al-Lawati, A.M. and Mohammed, A.J. (2008) Optimal cut-points for body mass index, waist circumference and waist-to-hip ratio using the Framingham coronary heart disease risk score in an Arab population of the Middle East. Diabetes and Vascular Disease Research, 5, 304-309.
http://dx.doi.org/10.3132/dvdr.2008.044 [49] Longo-Mbenza, B., Kasiam Lasi On’Kin, J.B., Nge Okwe, A., Vangu Ngoma, D. and Mbungu Fuele, S. (2010) Metabolic syndrome, aging, physical inactivity and incidence of Type 2 diabetes in general African population. Diabetes and Vascular Disease Research, 7, 28-39.
http://dx.doi.org/10.1177/1479164109346362
[1] WHO Consultation (1999) Definition, diagnosis and classification of diabetes mellitus. Report n 99.2. World Health Organization, Geneva. [2] Longo-Mbenza, B., Vangu Ngoma, D., Nahimana, D., Mayuku, D.M., Mbungu, F.S., Ekwanzala, F. and Beya, C. (2008) Screen detected and the WHO Stepwise approach to the prevalence and risk factors of arterial hypertension in Kinshasa. The European Journal of Cardiovascular Prevention & Rehabilitation, 5, 503-508.
http://dx.doi.org/10.1097/HJR.0b013e3282f21640 [3] On’Kin, J.B.K.L., Longo-Mbenza, B., Nge okwe, A., Ditu, M.S., Okitolonda, W. and He, J. (2008) Prevalence and risk factors of diabetes mellitus in Kinshasa Hinterland. International Journal of Diabetes and Metabolism, 16, 97-106. [4] On’Kin, J.B.K.L., Longo-Mbenza, B., Nge okwe, A., Kangola Kabangu, N., Mbungu Fuele, S. and Milongo Dipa, G. (2008) Classification and dramatic epidemic of diabetes mellitus in Kinshasa Hinterland: The prominent role of Type 2 diabetes and lifestyle changes among Africans. Nigerian Journal of Medicine, 18, 311-320. [5] Ramachandran, A., Mary, S., Yamuna, A., Murugesan, N. and Snehalatha, C. (2008) High prevalence of diabetes and cardiovascular risk factors associated with urbanization in India. Diabetes Care, 31, 893-898.
http://dx.doi.org/10.2337/dc07-1207 [6] Sicree, R., Shaw, J. and Zimmet, P. (2006) Prevalence and projections. In Diabetes Atlas. 3rd Edition. Brussels, Belgium. International Diabetes Federation, 16-104. [7] Zimmet, P., Alberti, K.G. and Shaw, J. (2001) Global and societal implications of the diabetes epidemic. Nature, 414, 782-787.
http://dx.doi.org/10.1038/414782a [8] Wild, S., Roglic, G., Green, A., Sicree, R. and King, H. (2004) Global prevalence of diabetes: Estimates for the year 2000 and projections for 2030. Diabetes care, 27, 1047-1053.
http://dx.doi.org/10.2337/diacare.27.5.1047 [9] Fach, D., William, J., Tappy, L., Ravussin, E. and Bovet, P. (2007) Prevalence, awareness and control of diabetes in the Seychelles and relationship with excess body weight. BMC Public Health, 7, e163.
http://dx.doi.org/10.1186/1471-2458-7-163 [10] Yach, D., Stickler, D. and Brownell, K.D. (2006) Epidemiologic and economic consequences of the global epidemics of obesity and diabetes. Nature Medicine, 12, 62-66.
http://dx.doi.org/10.1038/nm0106-62 [11] Soderberg, S., Zimmet, P., Tuomilehto, J., de Courten, M., Dowse, G.K., Chitson, P., Gareeboo, H., Alberti, K.G. and Shaw, J.E. (2005) Increasing prevalence of Type 2 diabetes mellitus in all ethic groups in Mauritius. Diabetic Medicine, 22, 61-68.
http://dx.doi.org/10.1111/j.1464-5491.2005.01366.x [12] Hamilton, M.T., Hamilton, D.G. and Zderic, T.W. (2005) Role of low energy expenditure and sitting in obesity, metabolic syndrome, Type 2 diabetes and cardiovascular disease. Diabetes, 56, 2655-2667.
http://dx.doi.org/10.2337/db07-0882 [13] Oberlinner, C., Neumann, S.M., OH, M.G. and Zober, A. (2008) Screening for pre-diabetes and diabetes in the workplace. Occupational Medicine, 58, 41-45.
http://dx.doi.org/10.1093/occmed/kqm129 [14] Esc/EASD guidelines on diabetes, pre-diabetes and cardiovascular diseases: Executive summary. (2007) European Heart Journal, 28, 88-136. [15] Longo-Mbenza, B., Ngimbi, R.M., Ngoma, D.V., Fuele, S.M. and Buassabu-Tsumbu, B. (2008) Risk factors of stroke among Congolese black hypertensive diabetics. Annales de Cardiologie et d’Angéiologie, 57, 37-43.
http://dx.doi.org/10.1016/j.ancard.2007.08.013 [16] Erasmus, R.T., Blanco Blanco, E., Okesina, A.B., Matsha, T., Gaweta, Z. and Mesa, J.A. (2001) Prevalence of diabetes mellitus and impaired glucose tolerance in factory workers from Transkei, South Africa. South African Medical Journal, 91,157-160. [17] Lohman, T.G., Roche, A.F. and Martorel, R. (1998) Anthropometric standardization reference manual champaign, IL. Human Kinetics, 3-8, 39-70. [18] Wang, J., Thornton, J.C., Bari, S., Williamson, B., Gallagher, D., Heymsfield, S.B., Horlick, M., Kotler, D., Laferrere, B., Mayer, L., Pi-Sunyer, F.X. and Pierson, R.N. Jr. (2003) Comparison of waist circumference measured at four sites. The American Journal of Clinical Nutrition, 77, 379-384. [19] World Health Organization (1998) Obesity, preventing and managing the global epidemic. Report of a WHO Consultation on obesity. WHO, Geneva. [20] Spijkerman, A.M.W., Fuyun, M.F., Griffin, S.J., Dekker, J.M., Nijpels, G. and Warehan, N.J. (2004) The performance of a risk score as a screening test for undiagnosed hyperglycemia in ethnic minority groups. Diabetes Care, 27, 116-122.
http://dx.doi.org/10.2337/diacare.27.1.116 [21] Longo-Mbenza, B., Nkoy Belila, J., Vangu Ngoma, D. and Mbungu, S. (2007) Prevalence and risk factors of arterial hypertension among urban Africans in workplace: The obsolete role of body mass index. Nigerian Journal of Medicine, 16, 42-49.
http://dx.doi.org/10.4314/njm.v16i1.37280 [22] The Expert Committee on the diagnosis and classification of diabetes mellitus. (2003) Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care, 26, SE-S20. [23] Alberti, K.G., Zimmet, P., Shaw, J. and IDF Epidemiologic Task Force Consensus Group. (2005) The metabolic syndrome: A new worldwide definition. Lancet, 366, 1059-1062.
http://dx.doi.org/10.4314/njm.v16i1.37280 [24] On’Kin, J.B.K.L., Longo-Mbenza, B., Nge Okwe, A. and Kangola Kabangu, N. (2007) Survey of abdominal obesities in an adult urban population of Kinshasa, Democratic Republic of Congo. Cardiovascular Journal of Africa, 18, 300-307. [25] Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation and treatment of high blood cholesterol in adults (Adult treatment Panel III 2001). JAMA, 285, 2486-2497. [26] Valdez, R., Seidl, J.C., Ahn, Y.I. and Weiss, K.M. (1992) A new index of abdominal adiposity as an indicator of risk for cardiovascular disease: A cross-population study. International Journal of Obesity, 16, 77-82. [27] Longo-Mbenza, B., Bieleli, E., Muls, E., Vangu, N. and Ditu, M.S. (2002) The role of early hemodynamic impairment and disease duration on diabetic cardiomyopathy and hypertension in Central Africans with atherosclerosis. Journal of Diabetes and Its Complications, 16, 146-152. http://dx.doi.org/10.1016/S1056-8727(00)00129-X [28] Ford, E.S. (2002) Does exercise reduce inflammation? Physical activity and C-reactive protein in US adults. Epidemiology, 13, 561-568.
http://dx.doi.org/10.1097/00001648-200209000-00012 [29] Chobanian, A.V., Bakris, G.L., Black, H.R., Cushman, W.C., Green, L.A., Izzo Jr., J.L. (2003) The Seventh report of Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure: The JNC7 Report. JAMA, 289, 2560-2572.
http://dx.doi.org/10.1001/jama.289.19.2560 [30] Anderson, K.M., Wilson, P.W., Odell, P.M., Kannel, W.B. (1991) An updated coronary risk profile. A statement for health professionals. Circulation, 83, 356-362.
http://dx.doi.org/10.1161/01.CIR.83.1.356 [31] Grundy, S.M., Pasternal, R., Greenland, P., Smith Jr., S. and Fuster, V. (1999) Assessment of cardiovascular risk by use of multiple-risk-factor assessment equations: A statement for healthcare professionals from the American Heart Association and the America College of cardiology. Circulation, 100, 1481-1492.
http://dx.doi.org/10.1161/01.CIR.100.13.1481 [32] Prevention of coronary heart disease in clinical practice. (1998) Recommendations of the Second Joint Tak Force of European and other societies on coronary prevention. European Heart Journal, 19, 1434-503. [33] Longo-Mbenza, B., Mambune, H.F., Kasiam, J.B., Vita, E.K., Fuele, S.M., Nsenga, J.N., Mabwa, L. and Nzuzi, V. (2007) Relationship between waist circumference and cholesterol in Central Africans with congestive heart failure. West African Journal of Medicine, 26, 183-190. [34] Sobngwi, E., Mauvais-Jarvis, E., Vexiau, P., Mbanya, J.C. and Gautier, J.F. (2001) Diabetes in Africans. Part 1: Epidemiology and clinical specificities. Diabetes and Metabolism, 27, 628-634. [35] Balde, N.M., Diallo, I., Balde, M.D., Barry, I.S., Kaba, L., Diallo, M.M., Kaké, A., Camara, A., Bah, D., Barry, M.M., Sangaré-Bah, M. and Maugendre, D. (2007) Diabetes and impaired fasting glucose in rural and populations in Futa Jallon (Guinea): Prevalence and associated risk factors. Diabetes Metabolism, 33, 114-120.
http://dx.doi.org/10.1016/j.diabet.2006.10.001 [36] Fisch, A., Pichard, E., Prazuck, T., Leblanc, H., Sidibe, Y. and Brucker, G. (1987) Prevalence and risk factors of diabetes mellitus in the rural region of Mali (West Africa): A practical approach. Diabetologia, 30, 859-862. [37] King, H., Rewers, M. and WHO AD HOC Diabetes Reporting group. (1993) Global estimates for prevalence of diabetes mellitus and impaired glucose tolerance in adults. Diabetes Care, 16, 157-177.
http://dx.doi.org/10.2337/diacare.16.1.157 [38] Mbanya, J.C., Ngogang, J., Salah, J.N., Minkoulou, E. and Balkau, B. (1997) Prevalence of NIDDM and impaired glucose tolerance in a rural and an urban population in Cameroon. Diabetologica, 40, 824-829.
http://dx.doi.org/10.1007/s001250050755 [39] Motala, A.A. (2002) Diabetes trends in Africa. Diabetes/ Metabolism Research and Reviews, 18, S14-S20.
http://dx.doi.org/10.1002/dmrr.284 [40] Bonora, E., Kiechl, S., Willeit, J., Oberhollenzer, F., Egger, G., Meigs, J.B., Bonadonna, R.C. and Muggeo, M. (2004) Population-based incidence rates and risk factors for Type 2 diabetes in white individuals. The Bruneck study. Diabetes, 53, 1782-1789.
http://dx.doi.org/10.2337/diabetes.53.7.1782 [41] Lester, F.T. (1984) The clinical pattern of diabetes in Ethiopians. Diabetes Care, 7, 6-11.
http://dx.doi.org/10.2337/diacare.7.1.6 [42] Fezeu, L., Balkau, B., Kengne, A.P., Sobngwi, E. and Mbanya, J.C. (2007) Metabolic syndrome in a sub-Saharan African setting: Central obesity may be the key determinant. Atherosclerosis, 193, 70-76.
http://dx.doi.org/10.1016/j.atherosclerosis.2006.08.037 [43] Longo-Mbenza, B., Nkondi Nsenga, J. and Vangu Ngoma, D. (2007) Prevention of the metabolic syndrome insulin resistance and the atherosclerotic diseases in Africans infected by Helicobacter pylori infection and treated by antibiotics. International Journal of Cardiology, 121, 229-238.
http://dx.doi.org/10.1016/j.ijcard.2006.12.003 [44] Zhong, S., Sharp, D.S., Grove, J.S., Bruce, C., Yano, K., Curb, J.D. and Tall, A.R. (1996) Increased coronary heart disease in Japanese-American men with mutation in the cholesterol ester transfer protein in the despite increased HDL levels. Journal of Clinical Investigation, 97, 2917-2923.
http://dx.doi.org/10.1172/JCI118751 [45] Dehout, F., Haumont, S., Gaham, N., Amoussou Genou, K.D. and Hermans, M. (2008) Metabolic syndrome in Bantu subjects with Type 2 diabetes from sub-Saharan extraction prevalence, gender differences and HOMA-hyperbolic product. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 2, 5-11.
http://dx.doi.org/10.1016/j.dsx.2007.11.008 [46] Hu, F.B., Stampfer, M.J., Haffner, S.M., Solomon, C.G., Willett, W.C. and Manson, J.E. (2002) Elevated risk of cardiovascular disease prior to clinical diagnosis of Type 2 diabetes. Diabetes Care, 25, 1129-1134.
http://dx.doi.org/10.2337/diacare.25.7.1129 [47] Evans, J.M.M., Wang, J. and Morris, A.D. (2002) Comparison of cardiovascular risk between patients with Type 2 diabetes and those who had a myocardial infarction: Cross sectional and cohort studies. British Medical Journal, 324, 939.
http://dx.doi.org/10.1136/bmj.324.7343.939 [48] Al-Lawati, J.A., Barakat, N.M., Al-Lawati, A.M. and Mohammed, A.J. (2008) Optimal cut-points for body mass index, waist circumference and waist-to-hip ratio using the Framingham coronary heart disease risk score in an Arab population of the Middle East. Diabetes and Vascular Disease Research, 5, 304-309.
http://dx.doi.org/10.3132/dvdr.2008.044 [49] Longo-Mbenza, B., Kasiam Lasi On’Kin, J.B., Nge Okwe, A., Vangu Ngoma, D. and Mbungu Fuele, S. (2010) Metabolic syndrome, aging, physical inactivity and incidence of Type 2 diabetes in general African population. Diabetes and Vascular Disease Research, 7, 28-39.
http://dx.doi.org/10.1177/1479164109346362