Prevalence of cardiovascular disease risk factors among a Nigerian adult population: relationship with income level and accessibility to CVD risks screening.

BACKGROUND: In Nigeria, reports on the prevalence of modifiable cardiovascular disease (CVD) risk factors are scarce. In addition, socio-economic status (SES), an important component of the socioeconomic gradient in CVD and its risk factors has not been clearly elucidated. This study sought to assess the prevalence of CVD risk factors and how the difference in prevalence and accessibility to CVD risk screening across income levels and educational backgrounds contributes to disease diagnosis in rural and urban Nigerian adults. METHODS: A cross sectional study was carried out on a sociocultural ethnic group of persons living in rural and urban settings. All participants were aged ≥ 18 years. The WHO STEPS questionnaire was used to document the demographics, history of previous medical check-up or screening, anthropometric and biochemical measurements of the participants. Average income level and educational status were indicators used to assess the impact of SES. Multivariate analyses were performed to assess any difference between the geographical locations and SES indicators, and prevalence of CVD risk factors and access to CVD risk screening. RESULTS: The 422 participants (273 females and 149 males) [corrected] had mean age (± standard deviation) of 38.3 ± 20.5 and 42.9 ± 20.7 years, respectively. Only total cholesterol (p = 0.001), triglyceride (p = 0.005), high density lipoprotein cholesterol (HDL) (p < 0.0001), body mass index (BMI) (p = 0.03) and average income rate (p = 0.01) showed significant difference between gender groups. Overall prevalence of prediabetes (4.9%), diabetes (5.4%), hypertension (35.7%), low HDL (17.8%), hypertriglyceridemia (23.2%), hypercholesterolemia (38.1%) and central obesity of 52.2% was recorded. Except between total cholesterol (p = 0.042) and HDL (p = 0.017), other CVD risk factors did not show a statistical significance across income levels. Participants with 'university and postgraduate education' had higher access to blood pressure and blood glucose screening compared to other educational groups; and this showed a statistical significance. CONCLUSION: This study has shown that a significant number of modifiable CVD risk factors exist in the rural and urban migrants of an adult Nigerian population. While income level did not affect the CVD risk factor prevalence, it did affect accessibility to CVD risk screening. There is a need for access to diagnosis of modifiable risk factors at all levels of society.

Cost-effectiveness of community diabetes screening: Application of Akaike information criterion in rural communities of Nigeria.

Background: The prevalence of diabetes mellitus (DM) is increasing globally, and this requires several approaches to screening. There are reports of alternative indices for prediction of DM, besides fasting blood glucose (FBG) level. This study, investigated the ability of combination of biochemical and anthropometric parameters and orodental disease indicators (ODIs) to generate models for DM prediction, using Akaike information criterion (AIC) to substantiate health economics of diabetes screening. Methods: Four hundred and thirty-three subjects were enrolled in the study in Ndokwa communities, Delta State, Nigeria, and their glycaemic status was determined, using the CardioChek analyser® and previous data from the Prediabetes and Cardiovascular Complications Study were also used. The cost of screening for diabetes (NGN 300 = $0.72) in a not-for-profit organization/hospital was used as basis to calculate the health economics of number of individuals with DM in 1,000 participants. Data on the subjects' anthropometric, biochemical and ODI parameters were used to generate different models, using R statistical software (version 4.0.0). The different models were evaluated for their AIC values. Lowest AIC was considered as best model. Microsoft Excel software (version 2020) was used in preliminary analysis. Result: The cost of identifying <2 new subjects with hyperglycemia, in 1,000 people was ≥NGN 300,000 ($ 716). A total of 4,125 models were generated. AIC modeling indicates FBG test as the best model (AIC = 4), and the least being combination of random blood sugar + waist circumference + hip circumference (AIC ≈ 34). Models containing ODI parameters had AIC values >34, hence considered as not recommendable. Conclusion: The cost of general screening for diabetes in rural communities may appear high and burdensome in terms of health economics. However, the use of prediction models involving AIC is of value in terms of cost-benefit and cost-effectiveness to the healthcare consumers, which favors health economics.

Prevalence and correlations of hepatorenal functions in diabetes and cardiovascular disease among stratified adults.

BACKGROUND: The vulnerability of older adults to diabetes and cardiovascular complications is a global concern. Hepatorenal pathophysiology is implicated in these complications, but has yet to be clearly established, especially from rural low-mid income countries. This study investigates differences in prevalence of diabetes in aging groups and correlations of age with hepatorenal variables. METHODS: 203 participants of both sexes above the age of 18 years underwent anthropometric measurements at Catholic Hospital, Abbi, Nigeria. Questionnaires collected demographic information and medical history. Urinalysis as well as routine liver and renal function tests were performed. Data analysis included determination of levels of hepatorenal abnormalities and prevalence of diseases in age groups. Percentage of disease subpopulations made up by each age-group was also determined as well as Pearson's correlation coefficient between age and hepatorenal variables, and comparison of average age and hepatorenal variables in disease subgroups. RESULTS: Percentage hepatorenal abnormalities are not significantly different between age-groups. There is no significant difference in percentage level of disease between groups, but in age-groups constituting disease sub-populations (p<0.00001). The apparently healthy subpopulation comprises of younger adults compared to older adults constituting diabetes and hypertension (p < 0…). Age shows moderate correlation with renal function parameters, especially urea and chloride (r = 0.42), but relatively insignificant with liver function variables. CONCLUSION: This report affirms that diabetes cardiovascular co-morbidity comes with aging.  It also indicates that renal pathophysiology may be more associated, than liver, functions in the vulnerability of adults.

Prediabetes and cardiovascular complications screening in Nigeria: A family case presentation.

Metabolic disorders are on the increase globally, and the need for screening remains imperative. This case report is of a 48-year-old man who was screened as dyslipidaemic and on metabolic syndrome prevention, precipitating screening of family relatives. The extended family members (N=11) were invited for screening, of which 4 were hyperglycaemic, 3 had hypercholesterolaemia; and the HDL levels of 6 participants were abnormal. All family members had normal plasma triglyceride levels, and 4 people had high blood pressure. There was an indication that 55% members of a family had up to two metabolic disorders or risk factors including dyslipidaemia that may predispose them to CVD; as well as family history of periodontitis in the family. This pilot study plans to follow-up its association with dyslipidaemia as well as with prediabetes. The feasibility of using simple and affordable screening test for diabetes in oral health clinics and vice versa, including review of observations of technical importance relevant to pathology logistics will be investigated.

Prevalence of hyperglycemia and risk factors for orodental disease in Nigeria: Implications of opportunistic screening.

BACKGROUND: Diabetes mellitus (DM) is associated with complications and orodental disease. Whether screening for DM during orodental health visits is a potential option is yet to be established in Nigeria. This study aims at assessing the prevalence of hyperglycemia in orodental disease as a clinical scenario to capitalize for opportunistic screening. MATERIALS AND METHODS: This study was undertaken in Catholic Hospital Abbi for Ndokwa communities and dental clinic of Eku Baptist Government Hospital, all in Nigeria. However, 474 individuals (433 community-based and 41 dental clinic-based) including 10 orodental cases were screened for hyperglycemia and waist-hip circumference indices. Blood lipid profiles were also performed. Based on fasting blood glucose levels, participants were grouped into non-diabetic (n = 172), prediabetic (n = 168), and diabetic (n = 78). A World Health Organization questionnaire on oral health was used to collect information on orodental disease risk factors. Data were analyzed with IBM SPSS 22 statistical package. RESULTS: In the community-based cohort, the prevalence of hyperglycemia was 56.8%, including 38.8% prediabetes and 18.0% undiagnosed DM (UDM). In the dental-based group, 63.4% were hyperglycemic including 53.7% prediabetes and 9.7% UDM. There was significant difference (P < 0.05) in the ages of the participants in relation to glycemic status, with 17-29 years having the highest prevalence of UDM. However, 42.5% of the community-based clients had indication(s) of orodental disease. CONCLUSION: This is probably the first study to highlight higher prevalence of hyperglycemia from screening at a dental setting compared to general clinic. Opportunistic screening of DM in dental settings may be an option to consider during clients' orodental health visits.

Co-morbidity of Diabetes Mellitus and Orodental Diseases in Nigeria.

BACKGROUND: Although several epidemiological studies have reported an association between diabetes mellitus (DM) and orodental health. However, the occurrence of the co-morbidity of both diseases has been more of suspicion than evidence-based. DM is a serious public health concern globally, and in Nigeria. Studies have separately documented the prevalence of DM and orodental diseases, but data lack to adequately rationalise co-morbidity of both diseases. OBJECTIVE: The study aimed to report evidence of co-morbidity of DM and orodental diseases in Nigeria. METHOD: Data published between December, 1970 and June, 2015 were used in writing the review. These data were collated from electronic literature archives and databases. RESULT: This review suggests evidence of the association of DM and orodental diseases. It revealed that both diseases are densely distributed in South-East, South-South and South-West geopolitical zones of Nigeria, and sparsely spread across other regions of the country. CONCLUSION: Co-morbidity of both diseases holds promise that will favour public health practice, especially in Nigeria. It is hoped that the association may lead to the establishment of a cost-effective DM screening protocol in Nigeria. Again, screening of DM in dentistries and vice versa may be possible through the relationship of both diseases. It is recommended that the driving force of the co-morbidity be investigated.

New guidelines for diagnosis of gestational diabetes: pathology-based impact assessment.

BACKGROUND: A recent study indicated an average of 19.5% abnormal oral glucose tolerance in antenatal clients per year. AIM: The purpose of this study was to determine the impact on gestational diabetes cases due to new guidelines for diagnosis and classification of hyperglycaemia in pregnancy. MATERIALS AND METHODS: This study reviewed the archived clinical pathology data on oral glucose tolerance tests performed between January 1999 and December 2008 on antenatal clients (N = 615). The cases were reviewed to determine changes if any in percentage of gestational diabetes due to new guidelines. RESULTS: Over the 10 years period, a yearly average of additional 10.8% antenatal cases suggestive of gestational diabetes was observed due to the new recommended thresholds. Further, the average yearly incidence would have increased from 8.8 cases to 16.2 cases, which translates to almost 46% increase in the prospective numbers of gestational diabetes. CONCLUSIONS: This report presents the extent of how the new recommended guidelines for diagnosis and classification of hyperglycaemia in pregnancy could increase the prevalence of gestational diabetes. It also provides pathology-based evidence for the epidemiology of gestational diabetes mellitus and allows for planning the costs that would be attendant to the full implementation of the new guidelines.

Cardiovascular risk assessment in prediabetes and undiagnosed diabetes mellitus study: international collaboration research overview.

The study aims to develop a screening protocol for the risk of future cardiovascular disease and diabetes mellitus in people with prediabetes and undiagnosed diabetes; and to establish a framework for early identification and intervention of prediabetes including strategies for holistic management and monitoring of progression. The first phase is to identify prediabetes and undiagnosed diabetes in volunteers who are ≥18-years-old for 5 years. Point-of-care testing and questionnaire will be used to screen for prediabetes and cardiovascular disease. We anticipate screening more than 2000 individuals of both genders by the end of first phase. The second and third phases which shall run for 5-10 years will be longitudinal study involving participants identified in the first phase as having prediabetes without dyslipidaemia, or clinically established cardiovascular disease. The second phase shall focus on preventive management of risk of progress to diabetes with explicit diagnosis of cardiovascular disease. Oxidative stress measurements will be performed cum evaluation of the use of antioxidants, exercise, and nutrition. The third phase will include probing the development of diabetes and cardiovascular disease. Binomial logistic regression would be performed to generate and propose a model chart for the assessment of cardiovascular disease risk in prediabetes.

Whole blood viscosity issue VIII: Comparison of extrapolation method with diagnostic digital viscometer.

BACKGROUND: The first issue of this series proposed extrapolation chart with conventional reference range and suggested comparison of results with other methods. AIM: This work sets out to compare interpretative results from the extrapolation method with those from a digital viscometer method. MATERIALS AND METHODS: Five cases in our archived clinical pathology database that were specifically tested for whole blood viscosity by the digital method, and had results for haematocrit and serum proteins were pooled. The values of haematocrit and serum proteins were used to derive extrapolated values. The interpretative results of the extrapolation method were compared with those of digital viscometer-based clinical reports. Non-Newtonian fluids such as whole blood have different viscosities at different shear rates. Comparative statement can only be based on interpreted outcome. RESULTS: Two-fifth absolute concordance and one-fifth discordance is observed between extrapolation and viscometer-based clinical reports. The discordance is a case of hyperviscosity in the presence of neither hyperproteinaemia nor polycythemia. CONCLUSION: The extrapolation method may underestimate whole blood viscosity in some patients when compared with digital viscometer, which in turn may suggest hyperviscosity that cannot be explained by hyperproteinaemia or polycythemia concepts. The impact of oxidative stress is highlighted.

Whole blood viscosity extrapolation formula: Note on appropriateness of units.

BACKGROUND: A series has recently been done on whole blood viscosity. The first on the series proposed extrapolation chart with conventional reference range. Since the publication, two concerns have been received in personal communications. The first expressed concern over the use of serum proteins values in 'g/L' instead of 'g/dL' that was contained in the referenced material. The second enquired on suitability of the formula for determination of blood viscosity at low shear rate. AIM: This work sets out to compare different units-converted-modifications of the extrapolation with a view to develop a statement of comparison and suitability of units. MATERIALS AND METHODS: The values of haematocrit and serum proteins were used in different unit-conversions on the mathematical formula to derive four modifications, which were compared. Five clinical cases that were specifically tested for whole blood viscosity, and had results for haematocrit and serum proteins were evaluated. The appropriateness of modifications for determination of viscosity at low shear rate was reviewed. RESULTS: Except as modified and used in the series, determination of whole blood viscosity at low shear rate using other unit conversions on the formula yields negative values for all five cases. CONCLUSION: Given that it is unexpected for blood viscosity level to be zero let alone less, it is logical that negative values are invalid. A formula that gives the least invalid results may be most appropriate. Therefore, extrapolation modification used in the series is most appropriate.

Whole blood viscosity issues VII: The correlation with leucocytosis and implication on leukapheresis.

BACKGROUND: Blood hyperviscosity has been acknowledged to be a complicating factor in polycythaemia and hyperproteinaemia. Hyperleucocytosis has also been implicated in hyperviscosity and may be a basis for therapeutic leukapheresis. AIMS: This issue in the series seeks to determine the association and correlation between whole blood viscosity and white blood cell count (WBCC), with a view to advance the cause of a neglected clinical pathology index. MATERIALS #ENTITYSTARTX00026; METHODS: Based on archived clinical pathology data, 10,857 cases that were concomitantly tested for full blood count and total proteins in the 2008 calendar year were audited for hyperleucocytosis. Whole blood viscosity level was determined and compared in the group with leucocytosis relative to the group with leucopenia and normal WBCC. The confounding effects of age, gender and red blood cell indices were evaluated. The correlation between whole blood viscosity and WBCC was also determined. RESULTS: As a generalization, hypoviscosity is observed among individuals who presented hyperleucocytosis. There is no correlation (r = 0.20) between leucocytosis and blood viscosity. CONCLUSION: It is known that anaemia and thromboembolism, which can be associated with leucocytosis, predispose to hypoviscosity. The finding from this study provides evidence of association between hypoviscosity and leucocytosis. The absence of association and insignificant correlation between leucocytosis and hyperviscosity may be one explanation for ineffectiveness of therapeutic leukapheresis. Further, the non-correlation lends credence to specificity of blood viscosity, for which critical leucocytosis is not a substitute.

Management of stress and stress-related diseases: Emerging computer-based technologies and the rationale for clinical laboratory assessment.

BACKGROUND: Over the years, the issue of stress management in mental health has been discussed without reference to the clinical laboratory perspectives. Translational research and the vast array of emerging diagnostic technologies in alternative medical practice are now bridging the gap. While it would be scientific arrogance for the clinical practitioner and scientist to ignore the trend, the new technologies seeking clinical acceptability necessarily require expatiation of the scientific aspects of their products. AIMS: This commentary builds on a comparative critical review to further our hypothesis that oxidative stress is the biochemical basis of the emerging computer-based diagnostic technologies. MATERIALS #ENTITYSTARTX00026; METHOD: The available information on Computer Meridian Diagnostics, Neuropattern and Virtual Scanning technologies were critically reviewed. The differences and similarities were articulated. RESULTS: The technologies seem different, but have similarities that have not been articulated before. The seemingly different theories are traceable to Russian scientists and are based upon stress-induced adrenal secretions and the associated effect on glucose metabolism. The therapeutic effects of antioxidant nutrition, exercise or relaxation that are inherent in the technologies are highlighted. CONCLUSION: This commentary furthers explanation of the alterations in antioxidant activities as a result of biofeedback, oxidative stress and/or physiological effects as the biochemical basis of the technologies. The place for antioxidant indices and whole blood viscosity are also highlighted. This provides a rationale for the evaluation of available clinical diagnostic tests both to validate the technologies and as clinical laboratory correlates in stress management.