Opportunity For Early Health Interventions - Brief Article

Nutrition Research Newsletter, August, 2001 by M. van der Sande, G. Walraven, P. Milligan, W. Banya, S. Ceesay, O. Nyan, K. McAdam

Noncommunicable diseases (NCD), particularly cardiovascular diseases, are an important determinant of morbidity and mortality of people all over the world. Because NCDs affect mainly adults who are usually responsible for the economic and social welfare of both children and elderly people, these diseases have major repercussions for all age groups. In industrialized countries, the risk of becoming hypertensive for an individual with a family history of hypertension has been estimated to be up to four times higher than average. The risk of becoming diabetic for an individual with a positive family history of diabetes varies with the age of when the diagnosis was made and the type of diabetes. Having a parent with non-insulin-dependent diabetes mellitus (NIDDM) increases by two- to fourfold an offspring's chance of developing this condition. The increase of NCDs in developing countries is seen as a consequence of a combination of demographic transitions--increase in life expectancy and increasing proportion of the population in older age groups--and an epidemiological transition; the availability of immunizations and treatment for infectious diseases is reducing the immediate impact of many such diseases. In contrast, changes in lifestyle related to urbanization, such as diet, smoking, physical inactivity, and increased levels of stress, lead to an increase in risk factors for NCDs. The combined effect of these transitions has been summarized as a "health transition." The present study assessed the risks related to a family history of hypertension, diabetes, or obesity in a sub-saharan African country in transition.

The Gambia is situated in West Africa in the arid Sahel belt along both sides of the river Gambia. Researchers conducted a community-based survey on the prevalence of several major NCDs in 1996-1997, in one urban area (Banjul) and one rural area (Farafenni). Many in the working population of Banjul are involved in small industries, trades, or crafts, while many in the villages surrounding Farafenni are farmers. Data was collected in 2166 adults in Banjul and from 3223 adults in the 20 study villages surrounding Farafenni. The subjects reported to a local community center, where they completed questionnaires and also had their blood pressure (BP), pulse rate, and anthropometric data taken. Overall, participation in the study areas was 78.1%. The mean age was 35.4 years and 58.5% of the participants were females. The prevalence of hypertension was 7.1%, of obesity 4.0%, and of diabetes 3.4%.

A total of 789 (14.6%) of the subjects reported a positive family history for hypertension, obesity and/or stroke. There were several significant differences in demographics, education, and occupation between subjects who did and who did not report a family history, and between those who did and did not know. A family history was reported significantly more often by younger subjects, women, persons with formal education, and non-manual workers, and among the participants from Banjul. Subjects who were not aware of their family history were significantly older; were more often from the rural study area, and had less formal education but more Islamic education compared with other subjects. Reported smoking was high in all groups, particularly among men.

Subjects with a family history of hypertension had a higher diastolic BP and BMI and higher concentrations of glucose, cholesterol, triglycerides and uric acid, and their risk of obesity and diabetes was increased. Subjects with a family history of stroke had a higher BMI, as well as higher cholesterol, triglyceride, and uric acid concentrations. A family history of hypertension, obesity, diabetes, or stroke was found to be a significant risk factor for obesity and hyperlipidemia. With increase of age, more pathological manifestations can develop in this high-risk group. Health professionals should therefore utilize every opportunity to include direct family members in health education. An intervention that includes individuals in high-risk families is therefore a rational strategy that will contribute to the control and prevention of cardiovascular diseases in transitional societies where family coherence is strong.

M. van der Sande, G. Walraven, P. Milligan, W. Banya, S. Ceesay, O. Nyan, K. McAdam. Family History: an opportunity for early interventions and improved control of hypertension, obesity and diabetes. Bulletin World Health Org 79:321-328 (2001) [Correspondence: Marianne A.B. van der Sande, Medical Research Council Laberatories, Fajara, PO Box 273, Banjul, The Gambia. E-mail: mvdsande@mrc.gm].