Tackling the Growing Burden of Cardiovascular Diseases in Sub-Saharan Africa
2018; Lippincott Williams & Wilkins; Volume: 138; Issue: 22 Linguagem: Inglês
10.1161/circulationaha.118.037367
ISSN1524-4539
Autores Tópico(s)Nutritional Studies and Diet
ResumoHomeCirculationVol. 138, No. 22Tackling the Growing Burden of Cardiovascular Diseases in Sub-Saharan Africa Free AccessArticle CommentaryPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessArticle CommentaryPDF/EPUBTackling the Growing Burden of Cardiovascular Diseases in Sub-Saharan AfricaNeed for Dietary Guidelines A. Kofi Amegah, PhD A. Kofi AmegahA. Kofi Amegah A. Kofi Amegah, PhD, Public Health Research Group, Department of Biomedical Sciences, University of Cape Coast, Cape Coast, Ghana. Email E-mail Address: [email protected] Public Health Research Group, Department of Biomedical Sciences, and Department of Clinical Nutrition and Dietetics, University of Cape Coast, Ghana. Originally published26 Nov 2018https://doi.org/10.1161/CIRCULATIONAHA.118.037367Circulation. 2018;138:2449–2451Sub-Saharan Africa (SSA) is experiencing an epidemic of cardiovascular diseases (CVDs) on an unimaginable scale. Disability and mortality attributable to CVDs and the traditional risk factors, including hypertension, obesity, diabetes mellitus, and dyslipidemia, continue to rise in several SSA countries. In 2013, an estimated 1 million deaths were attributable to CVD in SSA, constituting 5.5% of all global CVD-related deaths and 11.3% of all deaths in Africa.1 Between 1990 and 2013, SSA remained the only geographical region of the world where CVD-related deaths increased.1 The Figure is a global distribution of the CVD-attributable disability-adjusted life years with several SSA countries depicted to record some of the highest rates in the world.2 The CVD burden in SSA has been projected to double by 2030.Download figureDownload PowerPointFigure. Global distribution of the burden of age standardized DALYs attributable to CVDs in males (top) and females (bottom). CVD indicates cardiovascular disease; DALY, disability-adjusted life year; and WHO, World Health Organization. Reprinted from the WHO Global Atlas on Cardiovascular Disease Prevention and Control2 with permission. Copyright ©2011, WHO.The CVD epidemic in SSA is driven by changing lifestyles including physical inactivity, increased alcohol consumption and tobacco use, and increased consumption of foods high in saturated fat, salt, and sugar. This is as a result of increasing urbanization, modernization, and westernization; socioeconomic development; and the embrace of free market policies. The ongoing nutrition transition in SSA countries, characterized by a shift from the traditional African diet to processed and fast foods, is at the heart of the CVD epidemic. Western fast food chains such as KFC, McDonald's, Burger King, and Pizza Hut, among others, are rapidly growing on the continent and further deepening the nutrition transition.The CVD burden has major ramifications for SSA economies in terms of manpower loss and spiraling healthcare costs, and it also places additional pressure on an already constrained health system in many countries.Important Role of Food-Based Dietary GuidelinesGlobally, strategies to prevent CVDs have always focused on dietary and lifestyle modifications. In line with this, in many developed countries, measures such as nutrition communication and education, health education and promotion, and improving access to screening and detection of CVDs and the traditional risk markers have been deployed with success in curbing the incidence of CVDs.Food-based dietary guidelines (FBDGs), promoted globally as an important component of national food and nutrition policies, are important for effecting dietary and lifestyle modification in populations for public health gains. According to the Food and Agriculture Organization database, as of 2018, only 7 African countries, South Africa, Benin, Sierra Leone, Seychelles, Kenya, Namibia, and Nigeria, had FBDGs. The Namibia guidelines, published in 2000, were the first, with the Kenya guidelines published in 2017, the most recent. The South Africa guidelines were first published in 2003 and revised in 2012. The Nigeria guidelines have been published in 4 languages.There is lack of empirical data on how these African dietary guidelines have been implemented and their effectiveness in promoting healthy eating and good lifestyle habits for curtailing CVDs. However, there is overwhelming epidemiological evidence from developed countries. Randomized controlled trials have found adherence to United Kingdom3 and Health Canada4 dietary guidelines to lower CVD risk factors, including blood pressure, cholesterol levels, and body weight. A systematic review and meta-analysis of randomized controlled trials also found adherence to Nordic dietary guidelines to lower cholesterol levels and blood pressure.5 The Mediterranean and DASH (Dietary Approaches to Stop Hypertension) dietary regimens have also been proven to lower the risk of CVDs and contributing factors.The Way ForwardDevelopment and effective implementation of FBDGs are required for combating the growing CVD burden and associated social and economic costs in Africa. FBDGs will enable the promotion of healthy eating and physical activity among the populace, and also guide the production and supply of healthy foods. Ministries of health, in close consultation with the country/regional offices of the Food and Agriculture Organization and World Health Organization, should oversee the development and implementation of guidelines. The guidelines should be translated into all the dominant languages of the country and given wide publicity. Close collaboration between the country's health and education sectors is required for effective implementation. In line with this, the guidelines should be incorporated into the curricula for training health workers so they are abreast of guidelines content and application to enable better education of patients and the public. The guidelines should also be incorporated into the food and nutrition curricula of secondary/high schools and colleges. The guidelines should emphasize regular exercise among students and also guide the preparation of school meals. These measures will guarantee an early orientation of the populace on healthy eating habits, physical activity, and good lifestyle choices. Furthermore, departments of health in the regions/provinces/districts should regularly organize training workshops on the relevance of the guidelines for improved health for staff within their jurisdiction to enable better interpretation and communication to patients and the public.The main barrier to implementation is the limited and weak primary healthcare system in several SSA countries. FBDGs are best implemented in settings with strong primary healthcare systems. This challenge can be surmounted by engaging nongovernmental/community-based organizations devoted to health in education of the public on the application of the guidelines. It is important that the guidelines are revised every 5 years at most. Ministries of health should conduct social and epidemiological research nationwide on the guidelines' effectiveness to inform revisions. Effective FBDGs are anchored on sound empirical evidence. Political will, which is often lacking in many SSA countries, is required but can be realized by getting governments to understand that CVDs rival malaria, HIV/AIDS, and other communicable diseases, and should be given similar attention.Poverty and food insecurity, a concern in many SSA countries, are other major barriers to implementation. Poverty impedes access to healthy foods such as fruits, vegetables, legumes, low/nonfat dairy, whole grains, polyunsaturated fatty acid–rich cooking oils, and seafood. The most important factor that determines adherence to a healthy dietary regimen is access to affordable healthy foods. Food insecurity causes the poor to eat less or switch to cheaper, unhealthy foods. Investments in agriculture and removal of tariffs on healthy food imports should enable countries to overcome the food poverty barrier.A barrier to promotion of regular physical activity in many SSA countries is the absence of bicycle lanes, and either a lack of sidewalks or their takeover for vending. The solution lies in the promotion of nonmotorized transport (ie, walking and cycling) through the construction of sidewalks and bicycle lanes, and also through education and encouragement programs led by national civic education bodies and health authorities.DisclosuresNone.FootnotesThe opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.https://www.ahajournals.org/journal/circA. Kofi Amegah, PhD, Public Health Research Group, Department of Biomedical Sciences, University of Cape Coast, Cape Coast, Ghana. Email [email protected]edu.ghReferences1. Roth GA, Forouzanfar MH, Moran AE, Barber R, Nguyen G, Feigin VL, Naghavi M, Mensah GA, Murray CJ. Demographic and epidemiologic drivers of global cardiovascular mortality.N Engl J Med. 2015; 372:1333–1341. doi: 10.1056/NEJMoa1406656CrossrefMedlineGoogle Scholar2. Mendis S, Puska P, Norrving B, eds. Global Atlas on Cardiovascular Disease Prevention and Control. Geneva, Switzerland:World Health Organization; 2011:6.Google Scholar3. Reidlinger DP, Darzi J, Hall WL, Seed PT, Chowienczyk PJ, Sanders TA; Cardiovascular disease risk REduction Study (CRESSIDA) investigators. How effective are current dietary guidelines for cardiovascular disease prevention in healthy middle-aged and older men and women? A randomized controlled trial.Am J Clin Nutr. 2015; 101:922–930. doi: 10.3945/ajcn.114.097352CrossrefMedlineGoogle Scholar4. Jenkins DJA, Boucher BA, Ashbury FD, Sloan M, Brown P, El-Sohemy A, Hanley AJ, Willett W, Paquette M, de Souza RJ, Ireland C, Kwan N, Jenkins A, Pichika SC, Kreiger N. 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