Frequency and determinants of thyroid autoimmunity in Ghanaian type 2 diabetes patients: a case-control study.

BACKGROUND: The link between type 1 diabetes and thyroid autoimmunity is well described. The same cannot be said for type 2 diabetes where results have been mixed so far. We investigated the prevalence and determinants of thyroid autoimmunity among Ghanaian type 2 diabetes patients. METHODS: This was a case-control study involving 302 type 2 diabetes patients and 310 non - diabetic controls aged 40-80 years. Anthropometric and blood pressure measurements were obtained. Fasting samples were analyzed for glucose, thyroid function, and antibodies to thyroglobulin and thyroid peroxidase. RESULTS: The prevalence of thyroid autoimmunity was significantly higher among T2DM subjects (12.2% vs. 3.9%, p = 0.0004). Among T2DM subjects, 44 (14.7%) tested positive for TPOAb, 5 (1.7%) tested positive for TGAb and 15 (5.0%) tested positive for both autoantibodies. Females T2DM subjects showed a 3-fold increased risk of thyroid autoimmunity compared to males (OR:3.16, p =0.004), T2DM subjects with hyperthyroidism had a 41% increased risk of thyroid autoimmunity (OR: 1.41, p < 0.001), sub-clinical hyperthyroidism increased the risk of thyroid autoimmunity by 2 fold, (OR:2.19, p < 0.001), subclinical hypothyroidism increased the risk of autoimmunity by 4-fold, (OR:3.57 95% p < 0.0001), and hypothyroidism was associated with a 61% increased risk of thyroid autoimmunity (OR: 1.61,1.35-2.23). Dyslipidaemia was associated with a 44% increased risk of thyroid autoimmunity (OR: 1.44, p = 0.01) and a percentage increase in HbA1c was associated with 46% increased risk of thyroid autoimmunity (OR:1.46, p < 0.0001). CONCLUSION: We observed a high prevalence of thyroid autoimmunity in Ghanaian T2DM subjects compared to the general population. Thyroid autoimmunity in T2DM subjects was significantly associated with female gender, thyroid dysfunction, dyslipidaemia and poor glycemic control.

C-reactive protein (CRP) promoter polymorphisms influence circulating CRP levels in a genome-wide association study of African Americans.

C-reactive protein (CRP) is an acute phase reactant protein produced primarily by the liver. Circulating CRP levels are influenced by genetic and non-genetic factors, including infection and obesity. Genome-wide association studies (GWAS) provide an unbiased approach towards identifying loci influencing CRP levels. None of the six GWAS for CRP levels has been conducted in an African ancestry population. The present study aims to: (i) identify genetic variants that influence serum CRP in African Americans (AA) using a genome-wide association approach and replicate these findings in West Africans (WA), (ii) assess transferability of major signals for CRP reported in European ancestry populations (EA) to AA and (iii) use the weak linkage disequilibrium (LD) structure characteristic of African ancestry populations to fine-map the previously reported CRP locus. The discovery cohort comprised 837 unrelated AA, with the replication of significant single-nucleotide polymorphisms (SNPs) assessed in 486 WA. The association analysis was conducted with 2 366 856 genotyped and imputed SNPs under an additive genetic model with adjustment for appropriate covariates. Genome-wide and replication significances were set at P < 5 × 10(-8) and P < 0.05, respectively. Ten SNPs in (CRP pseudogene-1) CRPP1 and CRP genes were associated with serum CRP (P = 2.4 × 10(-09) to 4.3 × 10(-11)). All but one of the top-scoring SNPs associated with CRP in AA were successfully replicated in WA. CRP signals previously identified in EA samples were transferable to AAs, and we were able to fine-map this signal, reducing the region of interest from the 25 kb of LD around the locus in the HapMap CEU sample to only 8 kb in our AA sample.

A systematic review of work-related health problems of factory workers in the textile and fashion industry.

OBJECTIVES: The purpose of this study was to present a systematic review of the health-related problems of factory workers in the textile and fashion industry. These workers endure long sitting postures, poor workspace conditions, and long working hours to complete their overload of tasks. This situation results in several health problems that affect the productivity, mental health, and well-being of the workers. METHODS: The relevant data (21 article publications) were obtained from the Scopus database. Analysis of the 21 articles was grouped under 3 research themes based on the critical reading of the content and abstracts: respiratory problems, musculoskeletal disorders, and psychological stressors and other health issues. RESULTS: The findings show that factory workers are exposed to dust particles of cotton and other raw materials, fumes, and chemicals from manufacturing processes. This prolonged exposure without the use of personal protective equipment (PPE) leads to respiratory diseases like byssinosis that affect the workers' health. Additionally, working in a particular posture due to the workstation design for prolonged hours causes musculoskeletal disorders or pains. Workers also suffer from anxiety, depression, and stress from workload and pressure, hence making them unstable with reduced productivity. CONCLUSIONS: The findings of the study reinforce the need for a safe workspace and spacious work environment, provision of PPE, training in occupational hazards, frequent health checks, and ergonomic assessment of workstations to reduce prolonged work postures. Stakeholders, employers, policymakers, and governments should collaborate to safeguard and protect the well-being and health of the workers at these factories.

Genome-wide associated loci influencing interleukin (IL)-10, IL-1Ra, and IL-6 levels in African Americans.

Interleukins (ILs) are key mediators of the immune response and inflammatory process. Plasma levels of IL-10, IL-1Ra, and IL-6 are associated with metabolic conditions, show large inter-individual variations, and are under strong genetic control. Therefore, elucidation of the genetic variants that influence levels of these ILs provides useful insights into mechanisms of immune response and pathogenesis of diseases. We conducted a genome-wide association study (GWAS) of IL-10, IL-1Ra, and IL-6 levels in 707 non-diabetic African Americans using 5,396,780 imputed and directly genotyped single nucleotide polymorphisms (SNPs) with adjustment for gender, age, and body mass index. IL-10 levels showed genome-wide significant associations (p < 5 × 10(-8)) with eight SNPs, the most significant of which was rs5743185 in the PMS1 gene (p = 2.30 × 10(-10)). We tested replication of SNPs that showed genome-wide significance in 425 non-diabetic individuals from West Africa, and successfully replicated rs17365948 in the YWHAZ gene (p = 0.02). IL-1Ra levels showed suggestive associations with two SNPs in the ASB3 gene (p = 2.55 × 10(-7)), ten SNPs in the IL-1 gene family (IL1F5, IL1F8, IL1F10, and IL1Ra, p = 1.04 × 10(-6) to 1.75 × 10(-6)), and 23 SNPs near the IL1A gene (p = 1.22 × 10(-6) to 1.63 × 10(-6)). We also successfully replicated rs4251961 (p = 0.009); this SNP was reported to be associated with IL-1Ra levels in a candidate gene study of Europeans. IL-6 levels showed genome-wide significant association with one SNP (RP11-314E23.1; chr6:133397598; p = 8.63 × 10(-9)). To our knowledge, this is the first GWAS on IL-10, IL-1Ra, and IL-6 levels. Follow-up of these findings may provide valuable insight into the pathobiology of IL actions and dysregulations in inflammation and human diseases.

Tissue inhibitor metalloproteinase 2 (TIMP-2) and insulin-like growth factor binding protein 7 (IGFBP7) best predicts the development of acute kidney injury.

BACKGROUND: Acute kidney injury (AKI) is routinely diagnosed by creatinine-based guidelines, which is sub-optimal marker after injury due to renal and non-renal factors. This has necessitated the need for more specific and sensitive biomarkers for early detection of AKI in at risk patients. This prospective cross-sectional study used the biomarkers of cell cycle arrest and Neutrophil Gelatinase Associated Lipocalin (NGAL) to assess AKI among hospitalized patients. METHODS: We conveniently enrolled 151 in-patients at the Trauma and Specialist Hospital, Winneba in Ghana. Socio-demographic and clinical information were collected using structured questionnaires. Blood samples were collected for the estimation of serum creatinine, and AKI diagnosed and staged using the KDIGO guideline. Fresh urine samples were collected and urinary NGAL, TIMP-2 (tissue inhibitor metalloproteinase 2) and IGFBP-7 (insulin-like growth factor binding protein 7) were estimated using ELISA kits. RESULTS: The cell cycle arrest biomarkers and NGAL were significantly (P < 0.001) higher among participants with AKI than those without AKI. [TIMP-2]∗[IGFBP-7] showed the best diagnostic performance (AUC = 0.94, CI = 0.90-0.98) followed by [IGFBP-7]∗NGAL] (AUC = 0.93, CI = 0.87-0.99), with NGAL having the least (AUC = 0.62, CI = 0.46-0.78). The cut-off for [TIMP-2]∗[IGFBP-7] showed the best predictive ability (95.8% sensitivity, 77.2% specificity, 44.2% PPV and 99% NPV). The cut-off for NGAL, on the other hand, showed the least predictive ability (62.5% sensitivity, 42.5% specificity, 17.0% PPV and 85.7% NPV). CONCLUSION: Tissue inhibitor metalloproteinase 2 (TIMP-2) and insulin-like growth factor binding protein 7 (IGFBP7) best predicts the development of AKI, and can be used in high risk patients for early diagnosis of AKI.

Prevalence and risk factors for diabetes mellitus among adults in Ghana: a systematic review and meta-analysis.

BACKGROUND: The prevalence and risk factors for diabetes in Ghana vary from location to location, yet no study has been conducted to quantitatively synthesize the available studies. METHODS: The authors conducted a comprehensive literature search in Medline (PubMed), Embase, Cinahl, Web of Science, Scopus, African journals and grey literature. Two reviewers screened the articles for relevance, identified and selected studies based on inclusion and exclusion criteria. Methodological quality was independently assessed, using two validated assessment-of-bias tools. We explored study heterogeneity and performed a publication bias check. RESULTS: This search yielded a total of 624 articles, of which 17 studies were finally selected for the qualitative review and 12 studies included in the meta-analysis. The overall prevalence of diabetes mellitus among adult Ghanaians was high at 6.46% (95% CI: 4.66-8.26%) based on the inverse-variance random-effects model. Significant risk factors associated with diabetes were a family history of diabetes (OR: 3.46, 95% CI: 2.50-4.78), physical inactivity (OR: 3.06, 95% CI: 1.66-5.64) and age ≥40 years (OR: 2.36, 95% CI: 1.77-3.16). CONCLUSION: Studies with high methodological quality provided sufficient evidence about diabetes prevalence among adults and the associated significant risk factors in Ghana.

Evaluation of Metabolic Syndrome and Its Associated Risk Factors in Type 2 Diabetes: A Descriptive Cross-Sectional Study at the Komfo Anokye Teaching Hospital, Kumasi, Ghana.

Background. Metabolic syndrome (MS) is a collection of cardiovascular risk factors comprising insulin resistance, dyslipidemia, obesity, and hypertension, which may cause further complications in diabetes. Although metabolic syndrome (MS) is increasing in incidence in diabetics and leading to significant cardiovascular diseases and mortality, there is dearth of data in Ghana. This study investigated metabolic syndrome, its prevalence, and its associated risk factors in type 2 diabetes at the Komfo Anokye Teaching Hospital, Kumasi, Ghana. Methods. The study involved 405 diabetic patients attending the Diabetic Clinic of the Komfo Anokye Teaching Hospital (KATH) Kumasi, in the Ashanti Region of Ghana. A well-structured questionnaire was used to obtain demographic background such as their age and gender. Anthropometric measurements were obtained using the Body Composition Monitor (Omron ® 500, Germany) which generated digital results on a screen and also by manual methods. Fasting venous blood was collected for the measurement of biochemical parameters comprising fasting plasma glucose (FPG), glycated haemoglobin (HbA1c), high density lipoprotein cholesterol (HDL-c), and triglyceride (TG). Metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III). Results. Out of the total of 405 participants, 81 were males and 324 were females, and the estimated mean age was 58.5 ± 9.9 years. The female patients exhibited higher mean waist circumference (WC) and mean hip circumference (HC) as well as an approximately higher body mass index than males (28.3 ± 5.1, 26.5 ± 4.2 for the female and male respectively). Overall, the prevalence of metabolic syndrome observed among the study population was 90.6%. Conclusions. The prevalence of metabolic syndrome observed among the study population was 90.6%, with a higher percentage in females than males. High triglyceride levels and high waist circumference were the main risk factors for MS in the diabetic population.

Type 2 diabetes complications and comorbidity in Sub-Saharan Africans.

BACKGROUND: Context-specific evidence of the spectrum of type 2 diabetes (T2D) burden is essential for setting priorities and designing interventions to reduce associated morbidity and mortality. However, there are currently limited data on the burden of T2D complications and comorbidity in sub-Saharan Africa (SSA). METHODS: T2D complications and comorbidities were assessed in 2,784 participants with diabetes enrolled from tertiary health centres and contextualised in 3,209 individuals without diabetes in Nigeria, Ghana and Kenya. T2D complications and comorbidities evaluated included cardiometabolic, ocular, neurological and renal characteristics. FINDINGS: The most common complications/comorbidities among the T2D participants were hypertension (71%; 95% CI 69-73), hyperlipidaemia (34%; 95% CI 32-36), and obesity (27%; 95% CI 25-29). Additionally, the prevalence of cataracts was 32% (95% CI 30-35), diabetic retinopathy 15% (95% CI 13-17), impaired renal function 13% (95% CI 12-15), and erectile dysfunction (in men) 35% (95% CI 32-38). T2D population-attributable fraction for these comorbidities ranged between 6 and 64%. INTERPRETATION: The burden of diabetes complications and comorbidity is substantial in SSA highlighting the urgent need for innovative public health strategies that prioritise promotion of healthy lifestyles for prevention and early detection of T2D. Also needed are strategies to strengthen health care system capacities to provide treatment and care for diabetes complications.

ZRANB3 is an African-specific type 2 diabetes locus associated with beta-cell mass and insulin response.

Genome analysis of diverse human populations has contributed to the identification of novel genomic loci for diseases of major clinical and public health impact. Here, we report a genome-wide analysis of type 2 diabetes (T2D) in sub-Saharan Africans, an understudied ancestral group. We analyze ~18 million autosomal SNPs in 5,231 individuals from Nigeria, Ghana and Kenya. We identify a previously-unreported genome-wide significant locus: ZRANB3 (Zinc Finger RANBP2-Type Containing 3, lead SNP p = 2.831 × 10-9). Knockdown or genomic knockout of the zebrafish ortholog results in reduction in pancreatic ß-cell number which we demonstrate to be due to increased apoptosis in islets. siRNA transfection of murine Zranb3 in MIN6 ß-cells results in impaired insulin secretion in response to high glucose, implicating Zranb3 in ß-cell functional response to high glucose conditions. We also show transferability in our study of 32 established T2D loci. Our findings advance understanding of the genetics of T2D in non-European ancestry populations.

A genome-wide search for linkage to renal function phenotypes in West Africans with type 2 diabetes.

BACKGROUND: Reduced renal function often is a major consequence of diabetes and hypertension. Although several indices of renal function (eg, creatinine clearance) are clearly heritable and show linkage to several genomic regions, the specific underlying genetic determinants are still being sought. The purpose of this study is to conduct a genome-wide search for regions linked to 3 renal function phenotypes, serum creatinine, creatinine clearance, and glomerular filtration rate (GFR), in persons with type 2 diabetes. METHODS: A genome-wide panel of 372 autosomal short tandem repeat markers at an average spacing of 9 centimorgan were typed in 691 patients with type 2 diabetes (321 sib pairs and 36 half-sib pairs) in an affected sib pair study in West Africa. Linkage analysis was conducted with the 3 phenotypes by using a multipoint variance components linkage method. RESULTS: Creatinine clearance showed higher logarithm of odds (LOD) score than the other 2 phenotypes. Linkage to creatinine clearance was observed on chromosomes 16 (marker D16S539, LOD score of 3.56, empirical P = 0.0001), 17 (D17S1298, LOD score of 2.08, empirical P = 0.0018), and 7 (D7S1818, LOD score of 1.84, nominal P = 0.00181, empirical P = 0.0022). Maximum LOD scores for serum creatinine were observed on chromosomes 10 (D10S1432, LOD score of 2.53, empirical P = 0.0001) and 3 (D3S2418, LOD score of 2.21, empirical P = 0.0003) and for GFR on chromosomes 6 (D6S1040, LOD score of 2.08, empirical P = 0.0001) and 8 (D8S256, LOD score of 1.80, empirical P = 0.0001). Several of these results are replications of significant findings from other genome scans. CONCLUSION: A genome-wide scan for serum creatinine, creatinine clearance, and GFR in a West African sample showed linkage regions that may harbor genes influencing variation in these phenotypes. Potential candidate genes in these regions that have been implicated in diabetic nephropathy and/or renal damage in models of hypertension include CYBA (or P22PHOX) (16q24), NOX1 (10q22), and NOX3 (6q25.1-q26).

Polymorphism of the endothelial nitric oxide synthase gene is associated with diabetic retinopathy in a cohort of West Africans.

PURPOSE: In addition to chronic hyperglycemia, there is increasing evidence that genetic factors may be important in the development of diabetes retinopathy (DR). Specifically, polymorphisms of the endothelial nitric oxide synthase gene (eNOS) have been reported to be associated with multiple health conditions including DR, hypertension, nephropathy, and cardiovascular diseases in several ethnic groups. However, there is a paucity of similar data in African Americans and other African populations. To address this issue, we investigated the potential association between polymorphisms of the eNOS gene and diabetes-related phenotypes in 384 persons with type 2 diabetes and 191 controls from two West African countries (Ghana and Nigeria). METHODS: We genotyped the deletion/insertion (4a/b) and the G894T polymorphisms of eNOS gene in a total of 575 persons. RESULTS: The b/b genotype of the polymorphism was associated with a 2.4 fold increased risk of DR (95% CI 1.39-4.09). In contrast, we did not observe any association between the genotypes or alleles of G894T polymorphism with DR, hypertension, or nephropathy. CONCLUSIONS: We observed a significant association between the 4a/b polymorphism of the eNOS and DR in our West African cohort.

Prevalence and predictors of microalbuminuria in patients with diabetes mellitus: a cross-sectional observational study in Kumasi, Ghana.

OBJECTIVE: To evaluate the prevalence and predictors of microalbuminuria in diabetics in Kumasi, Ghana. DESIGN: Prospective, cross-sectional study of diabetic patients. SUBJECTS: Patients with diabetes, 20 to 78 years of age. MAIN OUTCOME MEASURES: Microalbuminuria METHODS: All patients (109) attending an outpatient diabetic clinic at the Komfo Anokye Teaching Hospital Diabetes Centre in Kumasi, Ghana from January to July 2005 were enrolled in the study. RESULTS: The mean overall age of the cohort was 54.1 +/- 10.9 years, and 28% were male. The proportion of subjects who had microalbuminuria was 43.1% (n=47). The median duration of diabetes before development of microalbuminuria was 10 years. Duration of diabetes, blood urea nitrogen, serum concentration of creatinine, and triglyceride were significantly higher in patients with microalbuminuria (P<.05). Urinary potassium concentration and fractional excretion of potassium were also significantly higher in the patients with microalbuminuria. CONCLUSIONS: The prevalence of microalbuminuria in patients with diabetes in this study was 43%. Significant predictors of microalbuminuria included duration of diabetes and serum concentration of creatinine. To reduce renal failure among these patients, strategies to mitigate its occurrence are needed. This includes strict glycemic control, control of hypertension, and the early blockade of the renin-angiotensin system.

Fasting plasma glucose and lipid profiles of diabetic patients improve with aerobic exercise training.

OBJECTIVE: This study presents the effects of aerobic exercise training on fasting plasma glucose and lipid profiles (FPG/LP) of diabetic patients in Kumasi. DESIGN: A randomised experimental with control design. SETTING: The study was conducted at the diabetic unit of KATH in Kumasi, Ghana. PARTICIPANTS: Twelve diabetic patients [grouped into intervention (IG) and control (CG)] attending the diabetic unit of KATH with diabetes diagnosis durations less than fifty years, ambulant status/age of 20-68years, sedentary and free from complications. INTERVENTIONS: Eight weeks aerobic exercise training between August 2015 and March 2016. MAIN OUTCOME MEASURES: Body weight (BW), Body mass index (BMI), fasting plasma glucose (FPG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglycerides (T) and total cholesterol (TC). RESULTS: Body weight (4.85kg, 7.0%), body mass index (4.08kg/m2, 7.3%), FPG (5.28mmol/L, 43.5%), LDL-C (.33mmol/l, 11.9%), TC (.47 mmol/l, 5.3%) and T (.48mmol/l, 29.4%) profiles of the patients in IG declined while HDL-C (.11mmol/l, 7.1%) increased. IG patients improved significantly in FPG [6.27 ± 0.91 < 8.00 ± 0.96; t=-52.00, P = 0.000], BW [58.60 ± 15.34 < 75.35 ± 22.00; t= 3.29, P = 0.040] and BMI [23.45 ±5.03<27.04 ±4.78, t=4.24, P = .050] compared to CG. CONCLUSION: Patients in IG, in addition to conventional care, experienced non-significant decline in LDL-C, TC, T, increase in HDL-C and significant reduction in FPG, BW, and BMI over those receiving conventional care only. Exercise Scientists are recommended to handle exercise sessions for healthcare prevention and management routines of diabetic patients. FUNDING: Not declared.

Genome-wide analysis identifies an african-specific variant in SEMA4D associated with body mass index.

OBJECTIVE: The prevalence of obesity varies between ethnic groups. No genome-wide association study (GWAS) for body mass index (BMI) has been conducted in continental Africans. METHODS: We performed a GWAS for BMI in 1,570 West Africans (WA). Replication was conducted in independent samples of WA (n = 1,411) and African Americans (AA) (n = 9,020). RESULTS: We identified a novel genome-wide significant African-specific locus for BMI (SEMA4D, rs80068415; minor allele frequency = 0.008, P = 2.10 × 10-8 ). This finding was replicated in independent samples of WA (P = 0.013) and AA (P = 0.017). Individuals with obesity had higher serum SEMA4D levels compared to those without obesity (P < 0.0001), and elevated levels of serum SEMA4D were associated with increased obesity risk (OR = 4.2, P < 1 × 10-4 ). The prevalence of obesity was higher in individuals with the CT versus TT genotypes (55.6% vs. 22.9%). CONCLUSIONS: A novel variant in SEMA4D was significantly associated with BMI. Carriers of the C allele were 4.6 BMI units heavier than carriers of the T allele (P = 0.0007). This variant is monomorphic in Europeans and Asians, highlighting the importance of studying diverse populations. While there is evidence for the involvement of SEMA4D in inflammatory processes, this study is the first to implicate SEMA4D in obesity pathophysiology.

Genomewide scan and fine mapping of quantitative trait loci for intraocular pressure on 5q and 14q in West Africans.

PURPOSE: High intraocular pressure (IOP) is a major risk factor for glaucoma, one of the leading causes of blindness worldwide. Because it has been demonstrated that African populations are at increased risk for glaucoma, the authors investigated the genetic basis of IOP in a sample of West Africans with type 2 diabetes (T2D) from Ghana and Nigeria. METHODS: Genomewide linkage analysis was conducted for loci linked to IOP (measured by applanation tonometry) in 244 affected sibling pairs with T2D using 372 autosomal short-tandem repeat markers at an average spacing of 9 cM. RESULTS: Multipoint variance components linkage analyses revealed suggestive linkage on chromosome 5 (5q22) with a logarithm of odds (LOD) score of 2.50 (nominal P = 0.0003; empiric P = 0.0004) and on chromosome 14 (14q22) with an LOD score of 2.95 (nominal P = 0.0001; empiric P = 0.0003). Fine mapping at a marker density of 2 cM in the 5q region confirmed the linkage signal, with an increase in peak LOD score to 4.91. CONCLUSIONS: The strong signal on chromosome 5 lies in the region in which a novel gene, WDR36, in the GLC1G locus was recently identified as causative for adult-onset primary open-angle glaucoma and provides additional evidence that chromosome 5 contains susceptibility loci for glaucoma in multiple human populations. The evidence provided in this study is particularly important given the evolutionary history of these West African populations and the recent ancestral relationship to African Americans-a population with one of the highest rates of diabetes and associated complications (including glaucoma) in the world.

Elevated adiponectin but varied response in circulating leptin levels to falciparum malaria in type 2 diabetics and non-diabetic controls.

BACKGROUND: To investigate effects of falciparum malaria on circulating levels of leptin and adiponectin in type 2 diabetes mellitus (T2DM) and non-diabetic controls in relation to measures of adiposity. METHODS: Levels of leptin and adiponectin were measured in 100 type 2 diabetics and 100 age-matched controls before and during falciparum malaria in a 2-year prospective study. Also, waist circumference (WC), weight, height and hip circumference were measured. Body mass index (BMI) and waist-to-hip ratio (WHR) were computed. RESULTS: At baseline, diabetics had significantly (p < 0.05) higher WC and BMI but lower WHR, leptin and adiponectin levels. Baseline leptin correlated positively with WC (r = 0.633; p < 0.001) and BMI (r = 0.63; p < 0.001) in diabetics but only BMI (0.562; p < 0.001) in non-diabetic controls. Baseline leptin and adiponectin correlated positively (r = 0.249; p = 0.029) in non-diabetic respondents only. Adiponectin correlated negatively with WC (r = -0.58; p = 0.006) in diabetic males only. During malaria, mean levels of leptin and adiponectin were comparable (p > 0.05) between diabetics and controls. However, compared to baseline levels, significant (p < 0.001) elevation of adiponectin was found in both study groups. In respect of leptin, significant (p < 0.001) rise but decline was observed in diabetics and controls respectively. Malaria-induced leptin correlated negatively with adiponectin (r = -0.694; p < 0.001) in non-diabetic controls only. CONCLUSION: Diabetics and controls exhibited increased adiponectin levels due to falciparum malaria but differed in response in terms of leptin levels.

Secular Trends in Admissions and Mortality Rates from Diabetes Mellitus in the Central Belt of Ghana: A 31-Year Review.

INTRODUCTION: Diabetes Mellitus is currently a leading cause of morbidity and mortality throughout the world, particularly in sub-Saharan Africa where a significant proportion of diabetes cases are now found. Longitudinal profiling of in-patient admissions and mortality trends from diabetes provide useful insights into the magnitude of the burden of diabetes, serve as a sentinel on the state of out-patient diabetes care and provide effective tools for planning, delivering and evaluating the health care needs relating to the disease in sub-Saharan Africa. OBJECTIVE: To evaluate the 31-year trend in diabetic admissions and mortality rates in central Ghana. METHODS: This is a retrospective analysis of data on diabetes admissions and deaths at a tertiary referral hospital in central Ghana between 1983 and 2014. Rates of diabetes admissions or deaths were expressed as diabetes admissions or deaths divided by the total number of admissions or deaths respectively. Yearly crude fatality rates for diabetes were calculated. Trends were analysed for in patient diabetes admissions and mortality for the period. Predictors of diabetes mortality were determined using multiple logistic regression. RESULTS: A total of 11,414 diabetes patients were admitted over the period with a female predominance; female:male ratio of 1.3:1.0. Over the study period, diabetes admission rates increased significantly from 2.36 per 1000 admissions in 1983 to 14.94 per 1000 admissions in 2014 (p<0.0001for linear trend), representing a 633% rise over the 31-year period. In-patient diabetes fatality rates increased from 7.6 per 1000 deaths in 1983 to 30 per 1000 deaths in 2012. The average 28-day mortality rate was 18.5%. The median age of patients increased significantly over the period. So was the proportion of females admitted over the years. Predictors of in-patient mortality were increasing age- aOR of 1.23 (CI: 1.15-1.32) for age > 80 years compared with < 20 years, admissions in 2000s compared to 1980s-aOR of 1.56 (1.21-2.01), male gender-aOR of 1.45 (1.19-1.61), the presence of glycemic complications such as ketoacidosis- aOR-2.67(CI: 2.21-3.21), hyperosmolar hyperglycemic states- aOR 1.52 (1.33-1.73) symptomatic hypoglycemia- aOR 1.64 (1.24-2.17) and presence of end organ complications including peripheral neuropathic ulcers- aOR 1.31 (1.12-1.56), nephropathy- aOR -1.11 (1.03-1.23), cerebrovascular disease-aOR-1.52 (1.32-1.98), coronary artery disease- aOR-3.21 (1.91-5.15) and peripheral artery disease- aOR-1.15 (1.12-1.21) were associated with increased risk of death compared with normoglycemic diabetic admissions and admissions without end organ complications respectively. CONCLUSION: Diabetes admission and mortality rates have increased significantly over the past three decades in central Ghana. More intensive education on the risk factors for diabetes, acute diabetes care as well as instituting hospital guidelines for diabetes control and reduction of modifiable risk factors for diabetes are urgently needed to reduce the poor case fatality associated with diabetes in resource-limited settings.

Impact of Type 2 Diabetes on Impaired Kidney Function in Sub-Saharan African Populations.

BACKGROUND: Diabetes is a leading risk factor for impaired kidney function, an indicator of chronic kidney disease. The aim of this study was to examine the association between type 2 diabetes (T2D) and impaired kidney function among adults in sub-Saharan Africa (SSA). METHODS: Participants were enrolled from Ghana, Kenya, and Nigeria. Impaired kidney function was based on an estimated glomerular filtration rate <60 ml/min/1.73 m(2). Using logistic regression models, we conducted case-control analyses to estimate the multivariate-adjusted association of T2D and kidney function. RESULTS: We used data from 4815 participants for whom the mean (SD) age was 48 (15) years, 41% were male and 46% had T2D. Those with T2D were more likely to have impaired kidney function [13.4% (95% CI: 11.9-14.7)] compared to those without T2D [4.8% (95% CI: 4.0-5.6)], p-value <0.001. The multivariate odds ratio of impaired kidney function among those with type 2 diabetes was 1.50 (95% CI: 1.17-1.91) p-value = 0.001, compared to those without T2D. Also, individuals with T2D who were at least 60 years old, obese, hypertensive or dyslipidemic were more likely to have impaired kidney function compared to those without T2D. CONCLUSION: T2D was associated with 50% increased risk of impaired kidney function in this sample of adults from SSA. Interventions targeted at prevention, early diagnosis, and management of T2D are likely to reduce the burden of kidney disease in SSA.

A genome-wide search for type 2 diabetes susceptibility genes in West Africans: the Africa America Diabetes Mellitus (AADM) Study.

The incidence of type 2 diabetes is growing rapidly, not only in developed countries but also worldwide. We chose to study type 2 diabetes in West Africa, where diabetes is less common than in the U.S., reasoning that in an environment where calories are less abundant, incident cases of type 2 diabetes might carry a proportionately greater genetic component. Through the Africa America Diabetes Mellitus (AADM) study, we carried out a genome-wide linkage analysis of type 2 diabetes in a cohort of 343 affected sibling pairs (691 individuals) enrolled from five West African centers in two countries (Ghana: Accra and Kumasi; Nigeria: Enugu, Ibadan, and Lagos). A total of 390 polymorphic markers were genotyped, and multipoint linkage analysis was conducted using the GENEHUNTER-PLUS and ASM programs. Suggestive evidence of linkage was observed in four regions on three chromosomes (12, 19, and 20). The two largest logarithm of odds scores of 2.63 and 1.92 for chromosomes 20q13.3 and 12q24, respectively, are particularly interesting because these regions have been reported to harbor diabetes susceptibility genes in several other populations and ethnic groups. Given the history of forced migration of West African populations during the slave trade, these results should have considerable relevance to the study of type 2 diabetes in African Americans.

A genome wide quantitative trait linkage analysis for serum lipids in type 2 diabetes in an African population.

Lipid abnormalities are strongly linked with coronary heart disease and are common in type 2 diabetes. However, little is known about the genetic determinants of serum lipids in African populations. An autosomal genome scan was performed for linkage to five plasma lipid phenotypes (total cholesterol, triglycerides (TG), HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C) and VLDL-cholesterol (VLDL-C)) in the Africa-America Diabetes Mellitus (AADM) study. Two hundred and ninety-five affected sibling pairs with type 2 diabetes mellitus enrolled from Ghana and Nigeria were genotyped for 390 microsatellite markers with an average inter-marker distance of 9cM. Multipoint variance components linkage analysis showed that HDL-C had a LOD score of 4.34 near marker D7S3061 and 3.00 near marker D7S513. Some clustering of linkage evidence to several lipid phenotypes was observed on chromosomes 5 (LDL-C, total cholesterol, VLDL-C), chromosome 7 (HDL-C, TG) and chromosome 19 (total cholesterol, LDL-C, TG). Principal component analysis of the five phenotypes yielded two factors, one (TG, HDL-C and VLDL) of which was linked to QTLs on chromosomes 2, 5 and 7, while the other (total cholesterol and LDL-C) was linked to a different set of QTLs on chromosomes 2, 5 and 18. Several of these regions have been reported to be linked to lipids in other studies. Follow up investigations are warranted in view of the central role serum lipids play in the aetiopathogenesis of cardiovascular disease.