Inflammation and cardiovascular risk assessment in Moroccan obese patients with and without metabolic syndrome: importance of lipoproteins ratios.

BACKGROUND: Obesity predisposes an individual to numerous risk factors for cardiovascular diseases. Inflammation, reported as a link between obesity and cardiovascular disease, contributes to the development of atherosclerosis. OBJECTIVES: The aim of our study was to assess the relationship between lipid parameters, low grade inflammation and metabolic syndrome in a sample of obese Moroccan adults with or without metabolic syndrome (MetS). PATIENTS & METHODS: Our study included 235 obese patients, mean aged 53.30 ± 9.73 years, with or without MetS. Our data included anthropometric measurements, lipoprotein and apolipoproteins profiles and several lipid ratios. RESULTS: In patients with MetS, lipoprotein profile alterations and low-grade inflammation were observed. Lipid ratios were better predictors of cardiovascular risk than lipids alone because of their relative associations with lipoproteins and apolipoproteins. CONCLUSION: Our study shows that Moroccan obese adults with MetS have altered lipoproteins profiles and suffer from low-grade inflammation. Indeed, we have detected a high level of small dense LDL particles and HDL particles defectiveness. Hence, we propose that risk management of cardiovascular events should be based on lipoprotein ratios rather than lipids alone. Treatments should also take into account inflammatory markers and LDL heterogeneity.

Developing national obesity policy in middle-income countries: a case study from North Africa.

BACKGROUND: The prevalence of overweight and obesity is a rapidly growing threat to public health in both Morocco and Tunisia, where it is reaching similar proportions to high-income countries. Despite this, a national strategy for obesity does not exist in either country. The aim of this study was to explore the views of key stakeholders towards a range of policies to prevent obesity, and thus guide policy makers in their decision making on a national level. METHODS: Using Multicriteria Mapping, data were gathered from 82 stakeholders (from 33 categories in Morocco and 36 in Tunisia) who appraised 12 obesity policy options by reference to criteria of their own choosing. RESULTS: The feasibility of policies in practical or political terms and their cost were perceived as more important than how effective they would be in reducing obesity. There was most consensus and preference for options targeting individuals through health education, compared with options that aimed at changing the environment, i.e. modifying food supply and demand (providing healthier menus/changing food composition/food sold in schools); controlling information (advertising controls/mandatory labelling) or improving access to physical activity. In Tunisia, there was almost universal consensus that at least some environmental-level options are required, but in Morocco, participants highlighted the need to raise awareness within the population and policy makers that obesity is a public health problem, accompanied by improving literacy before such measures would be accepted. CONCLUSION: Whilst there is broad interest in a range of policy options, those measures targeting behaviour change through education were most valued. The different socioeconomic, political and cultural contexts of countries need to be accounted for when prioritizing obesity policy. Obesity was not recognized as a major public health priority; therefore, convincing policy makers about the need to prioritize action to prevent obesity, particularly in Morocco, will be a crucial first step.