Background: Despite the evidence about the increasing prevalence of dyslipidemia among adult obese Cameroonians, little is known about the Low-Density Lipoprotein (LDL) particles which influence lipid metabolism and affect cardiovascular status. The present study aims to assess the relationship between adiposity, LDL particles size and cardiovascular risk (CVR) among adult obese Cameroonians. Methods: A cross-sectional study was conducted from September 2015 to March 2016 on apparently healthy adults (n = 1006), aged 20 - 70 years and living in the West and North-West regions of Cameroon. Anthropometric measurements, blood pressure (BP), fasting blood glucose (FBG) and lipid profile markers were analyzed and LDL particle phenotypes (LDL phenotype A; LDL phenotype I; LDL phenotype B) were characterized using small, dense LDL-cholesterol (sdLDL-c) levels. Abdominal fat accumulation (AFA) was defined as waist circumference (WC) ≥ 88 cm (men) and ≥90 cm (women) and the CVR was assessed using Framingham score method. Results: In the overall population, 36.6% were overweight, 33.1% were obese and 69.1% were overweight/obese with AFA. The prevalence of LDL phenotype B was 19.8%, 37.5% and 42.8% respectively in normal-weight, overweight and obese. Among the obese, sdLDL and triglycerides levels correlated significantly with WC (r = 0.768; p < 0.05 and r = 0.768; p < 0.05 respectively) and body mass index (BMI) (r = 0.895; p < 0.01 and r = 0.676; p < 0.01 respectively). The risk of having LDL phenotype B in overweight/obese patients with higher CVR was three times greater in overweight/obese patients with AFA (OR: 3.1; CI 95% (0.8 - 9.1); p = 0.007) as compared to those without AFA (OR: 1.6; CI 95% (0.8 - 2.9); p = 0.021). Conclusion: Among obese Cameroonians, anthropometric markers of adiposity (BMI and WC) were strongly correlated to LDL phenotype B which was associated with high CVR dependently of AFA. SdLDL particles could exacerbate the CVR in obese Cameroonians subjects.
References
[1]
World Health Organization (WHO) (2015) Obesity and Overweight: Fact Sheet.
http://www.who.int/mediacentre/factsheets/fs311/en/
[2]
Popkin, B.M., Adair, L.S. and Ng, S.W. (2012) Global Nutrition Transition and the Pandemic of Obesity in Developing Countries. Nutrition Reviews, 70, 3-21.
https://doi.org/10.1111/j.1753-4887.2011.00456.x
[3]
Food and Agricultural Organization of the United Nations (FAO) (2019) FAOSTAT.
http://www.fao.org/faostat/en/#country/32
[4]
Wong, M.C.S., Huang, J., Wang, J., Chan, P.S.F., Lok, V., Chen, X., et al. (2020) Global Regional and Time-Trend Prevalence of Central Obesity: A Systematic Review and Meta-Analysis of 13.2 Million Subjects. European Journal of Epidemiology, 35, 673-683. https://doi.org/10.1007/s10654-020-00650-3
[5]
Hanieh, M., Joel, O., Andrea, D., Johan, S., Kristina, H., Tomas, J. and Per, S. (2020) Abdominal Obesity and the Risk of Recurrent Atherosclerotic Cardiovascular Disease after Myocardial Infarction. European Journal of Preventive Cardiology, 27, 1944-1952. https://doi.org/10.1177/2047487319898019
[6]
National Cholesterol Education Program (NCEP) (2001) Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Final Report. Circulation, 106, 3143-3421.
https://doi.org/10.1161/circ.106.25.3143
[7]
Zazai, R., Wilms, B., Ernst, B., Thurnheer, M. and Schultes, B. (2014) Waist Circumference and Related Anthropometric Indices Are Associated with Metabolic Traits in Severely Obese Subjects. Obesity Surgery, 24, 107-78.
https://doi.org/10.1007/s11695-013-1141-6
[8]
Xi, Y., Niu, L., Cao, N., Bao, H., Xu, X., Zhu, H., Yan, T., Zhang, N., Qiao, L., Han, K., Hang, G., Wang, W. and Zhang, X. (2020) Prevalence of Dyslipidemia and Associated Risk Factors among Adults Aged ≥ 35 Years in Northern China: A Cross-Sectional Study. BMC Public Health, 20, Article No. 1068.
https://doi.org/10.1186/s12889-020-09172-9
[9]
Haile K., Haile A. and Timerga A. (2020) Predictors of Lipid Profile Abnormalities among Patients with Metabolic Syndrome in Southwest Ethiopia: A Cross-Sectional Study. Vascular Health and Risk Management Journal, 17, 461-469.
https://doi.org/10.2147/VHRM.S319161
[10]
Jellinger, P.S., Smith, D.A., Mehta, A.E., Ganda, O., Handelsman, Y., Rodbard, H.W., Shepherd, M.D. and Seibel, J.A. (2012) AACE Task Force for the Management of Dyslipidemia and Prevention of Atherosclerosis Writing Committee. Endocrine Practice, 18, 270-293. https://doi.org/10.4158/EP.18.S1.1
[11]
Wang, X., Wang, L., Cao, R., Yang, X., Xiao, W., Zhang, Y., et al. (2021) Correlation between Small and Dense Low-Density Lipoprotein Cholesterol and Cardiovascular Events in Beijing Community Population. The Journal of Clinical Hypertension, 23, 345-351. https://doi.org/10.1111/jch.14150
[12]
Diffenderfer, M.R. and Schaefer, E.J. (2014) The Composition and Metabolism of Large and Small LDL. Current Opinion in Lipidology, 25, 221-226.
https://doi.org/10.1097/MOL.0000000000000067
[13]
Liou, L. and Kaptoge, S. (2020) Association of Small, Dense LDL-Cholesterol Concentration and Lipoprotein Particle Characteristics with Coronary Heart Disease: A Systematic Review and Meta-Analysis. PLoS ONE, 15, Article ID: e0241993.
https://doi.org/10.1371/journal.pone.0241993
[14]
Jin, J.-L., Zhang, H.-W., Cao, Y.-X., Liu, H.-H., Hua, Q., et al. (2020) Association of Small Dense Low-Density Lipoprotein with Cardiovascular Outcome in Patients with Coronary Artery Disease and Diabetes: A Prospective, Observational Cohort Study. Cardiovascular Diabetology, 19, Article No. 45.
https://doi.org/10.1186/s12933-020-01015-6
[15]
Mphoweh, J.N. and Futonge, N.K. (2009) Regions of Cameroon.
https://globaledge.msu.edu/countries/cameroon/history
[16]
Magnani, R. (1997) Sampling Guide: IMPACT Food Security and Nutrition Monitoring Project. International Science and Technology Institute, Arlington.
https://www.alnap.org
[17]
United Nations Children’s Fund (UNICEF) (1995) Monitoring Progress toward the Goals of the World Food Summit for Children: A Practical Handbook for Multiple Indicator Surveys. United Nations Children’s Fund, New York, 100-117.
[18]
World Health Organization (WHO) (2014) Global Status Report on Noncommunicable Diseases 2014. World Health Organization, Geneva, 298 p.
http://apps.who.int/iris/bitstream/10665/148114/1/9789241564854_eng.pdf?ua=1
[19]
World Health Organization (WHO) (2009) WHO STEPS Instrument Question by Question. World Health Organization, Geneva, 498 p.
http://www.who.int/chp/steps/STEPS_QbyQ_Guide.pdf
[20]
Keys, A., Fidanza, F., Karvonen, M.J., Kimura, N. and Taylor, H.L. (1972) Indices of Relative Weight and Obesity. Journal of Chronic Diseases, 25, 329-343.
https://doi.org/10.1016/0021-9681(72)90027-6
[21]
World Health Organization Expert Consultation (1999) The Metabolic Syndrome. In: Definition, Diagnosis and Classification of Diabetes Mellitus and Its Complications. Part 1: Diagnosis and Classification of Diabetes Mellitus, World Health Organization, Department of Non Communicable Disease Surveillance, Geneva, 59. https://apps.who.int/iris/handle/10665/66040
[22]
World Health Organization (1995) Physical Status: The Use and Interpretation of Anthropometry, Report of a WHO Expert Committee. WHO Technical Report Series No. 854, World Health Organization, Geneva, 1-452.
[23]
Trinder, P. (1969) Determination of Glucose in Blood Using Glucose Oxidase with an Alternative Acceptor. Annals of Clinical Biochemistry, 6, 24-27.
https://doi.org/10.1177/000456326900600108
[24]
World Health Organization (WHO) (2006) Definition and Diagnosis of Diabetes Mellitus and Intermediate Hyperglycemia: Report of a WHO/IDF Consultation. World Health Organization, Geneva, 50 p.
[25]
McAuley, K.A., Williams, S.M., Mann, J.I., Walker, R.J., Ledwis-Barned, N.J., Temple, L.A. and Duncan, A.S. (2001) Diagnosing Insulin Resistance in the General Population. Diabetes Care, 24, 460-464. https://doi.org/10.2337/diacare.24.3.460
[26]
Richmond, W. (1973) Preparation and Properties of A Cholesterol Oxidase from Nocardia sp. and Its Application to the Enzymatic Assay of Total Cholesterol in Serum. Clinical Chemistry, 19, 476-482.
https://doi.org/10.1093/clinchem/19.12.1350
[27]
Ng, V. (2001) Effects of Disease on Clinical Laboratory Tests, 4th Edition, Vol. 1 and 2. D.S. Young and R.B. Friedman, Eds. Washington, DC: AACC Press, 2001, $199.00 ($159.00 AACC members), Softcover. ISBN 1-890883-45-X. Clinical Chemistry, 48, 682-683. https://doi.org/10.1093/clinchem/48.4.682a
[28]
Fossati, P. and Prencipe, L. (1982) Serum Triglycerides Determined Colorimetrically with an Enzyme That Produces Hydrogen Peroxide. Clinical Chemistry, 28, 2077-2080.
https://doi.org/10.1093/clinchem/28.10.2077
[29]
Alberti, K.G., Eckel, R.H., Grundy, S.M., Zimmet, P.Z., Cleeman, J.I., Donato, K.A., et al. (2009) Harmonizing the Metabolic Syndrome: A Joint Interim Statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation, 120, 1640-1645.
https://doi.org/10.1161/CIRCULATIONAHA.109.192644
[30]
Nauck, M., Warnick, G.R. and Rifai, N. (2002) Methods for Measurement of LDL-Cholesterol: A Critical Assessment of Direct Measurement by Homogeneous Assays versus Calculation. Clinical Chemistry, 48, 236-254.
https://doi.org/10.1093/clinchem/48.2.236
[31]
Hirano, T., Ito, Y., Saegusa, H. and Yoshino, G. (2003) A Novel and Simple Method for Quantification of Small, Dense LDL. Journal of Lipid Research, 44, 2193-2201.
https://doi.org/10.1194/jlr.D300007-JLR200
[32]
Srisawasdi, P., Chaloeysup, S., Teerajetgul, Y., Pocathikorn, A., Sukasem, C., et al. (2011) Estimation of Plasma Small Dense LDL Cholesterol from Classic Lipid Measures. American Journal of Clinical Pathology, 136, 20-29.
https://doi.org/10.1309/AJCPLHJBGG9L3ILS
[33]
D’Agostino, R.B., Vasan, R.S., Pencina, M.J., Wolf, P.A., Cobain, M., Massaro, J.M., et al. (2008) General Cardiovascular Risk Profile for Use in Primary Care: The Framingham Heart Study. Circulation, 117, 743-753.
https://doi.org/10.1161/CIRCULATIONAHA.107.699579
[34]
Kim, S., Popkin, B.M., Siega-Riz, A.M., Haines, P. and Arab, L. (2004) A Cross-National Comparison of Lifestyle between China and the United States, Using a Comprehensive Cross-National Measurement Tool of the Healthfulness of Lifestyles: The Lifestyle Index. Preventive Medicine, 38, 160-171.
https://doi.org/10.1016/j.ypmed.2003.09.028
[35]
Simo, L.P., Agbor, V.N., Temgoua, F.Z., Fozeu, L.C.F., Bonghaseh, D.T., Mbonda, A.G.N., et al. (2021) Prevalence and Factors Associated with Overweight and Obesity in Selected Health Areas in a Rural Health District in Cameroon: A Cross-Sectional Analysis. BMC Public Health, 21, Article No. 475.
https://doi.org/10.1186/s12889-021-10403-w
[36]
Aminde, L.N., Atem, J.A., Kengne, A.P., Dzudie, A. and Veerman, J.L. (2017) Body Mass Index-Measured Adiposity and Population Attributability of Associated Factors. A Population-Based Study from Buea, Cameroon. BMC Obesity, 4, Article No. 1. https://doi.org/10.1186/s40608-016-0139-8
[37]
Sobngwi, E., Mbanya, J.-C.N., Unwin, N.C., Kengne, A.P., Fezeu, L., Minkoulou, E.M., et al. (2002) Physichal Activity and Its Relationship with Obesity, Hypertension and Diabetes in Urban and Rural Cameroon. International Journal of Obesity, 26, 1009-1016. https://doi.org/10.1038/sj.ijo.0802008
[38]
Liu, P., Ji, Y., Yuen, T., Rendina-Ruedy, E., DeMambro, V.E., Dhawan, S., et al. (2017) Blocking FSH Induces Thermogenic Adipose Tissue and Reduces Body Fat. Nature, 546, 107-112. https://doi.org/10.1038/nature22342
[39]
Despres, J.P. (2012) Abdominal Obesity and Cardiovascular Disease: Is Inflammation the Missing Link? Canadian Journal of Cardiology, 28, 642-652.
https://doi.org/10.1016/j.cjca.2012.06.004
[40]
Berneis, K.K. and Krauss, R.M. (2002) Metabolic Origins and Clinical Significance of LDL Heterogeneity. Journal of Lipid Research, 43, 1363-1379.
https://doi.org/10.1194/jlr.R200004-JLR200
[41]
Kodama, S., Horikawa, C., Fujihara, K., Yoshizawa, S., Yachi, Y., Tanaka, S. and Sone, H. (2014) A Quantitative Relationship between Body Weight Gain in Adulthood and Incident Type 2 Diabetes: A Meta-Analysis. Obesity Reviews, 15, 202-214.
https://doi.org/10.1111/obr.12129
[42]
Yoon, Y.-W., Lee, H.-M. and Oh, H.-W. (2016) Correlation of Dyslipidemia with Waist Circumference and Waist-Height Ratio. Korean Journal of Family Practice, 6, 560-567. https://doi.org/10.21215/kjfp.2016.6.6.560
[43]
Mehdi, K., Mohsen, P., Shiva, E.N. and Sohrab, R. (2020) the Relationship between Anthropometric Indices and Lipid Profiles In-Office Employees. Journal of Sports Science, 8, 76-82. https://doi.org/10.17265/2332-7839/2020.02.006
[44]
Okada, T., Iwata, F. and Harada, K. (2004) Relationship of Post-heparin Hepatic and Lipoprotein Lipases to High Density Lipoprotein Modulation in Obese Children. Atherosclerosis, 172, 195-196.
https://doi.org/10.1016/j.atherosclerosis.2003.09.027
[45]
Svensson, J., Bengtsson, B.A., Taskinen, M.R., Wiklund, O. and Johannsson, G. (2000) A Nine-Month, Placebo-Controlled Study of the Effects of Growth Hormone Treatment on Lipoproteins and LDL Size in Abdominally Obese Men. Growth Hormone & IGF Research, 10, 118-126. https://doi.org/10.1054/ghir.2000.0148
[46]
McNamara, J.R., Jenner, J.L., Li, Z., Wilson, P.W. and Schaefer, E.J. (1992) Change in LDL Particle Size Is Associated with Change in Plasma Triglyceride Concentration. Arteriosclerosis and Thrombosis, 12, 1284-1290.
https://doi.org/10.1161/01.ATV.12.11.1284
[47]
Lahdenperä, S., Syvänne, M., Kahri, J. and Taskinen, M.R. (1996) Regulation of Low-Density Lipoprotein Particle Size Distribution in NIDDM and Coronary Disease: Importance of Serum Triglycerides. Diabetologia, 39, 453-461.
https://doi.org/10.1007/BF00400677
[48]
Rizzo, M. (2006) Low-Density Lipoprotein Size and Cardiovascular Risk Assessment. QJM, 99, 1-14. https://doi.org/10.1093/qjmed/hci154
[49]
Sam, S., Haffner, S., Davidson, M.H., D’Agostino Sr., R.B., Feinstein, S., Kondos, G., Perez, A. and Mazzone, T. (2008) Relationship of Abdominal Visceral and Subcutaneous Adipose Tissue with Lipoprotein Particle Number and Size in Type 2 Diabetes. Diabetes, 57, 2022-2027. https://doi.org/10.2337/db08-0157
[50]
Klop, B., Elte, J.W. and Cabezas, M.C. (2013) Dyslipidemia in Obesity: Mechanisms and Potential Targets. Nutrients, 5, 1218-1240. https://doi.org/10.3390/nu5041218
[51]
Ikezaki, H., Lim, E., Cupples, L.A., et al. (2021) Small Dense Low-Density Lipoprotein Cholesterol Is the Most Atherogenic Lipoprotein Parameter in the Prospective Framingham Offspring Study. Journal of the American Heart Associatio, 10, Article ID: e019140. https://doi.org/10.1161/JAHA.120.019140
[52]
Qi, Y., Liu, J., Wang, W., Wang, M., Zhao, F., Sun, J., Liu, J., Deng, Q. and Zhao, D. (2020) High SdLDL Cholesterol Can Be Used to Reclassify Individuals with Low Cardiovascular Risk for Early Intervention: Findings from the Chinese Multi-Provincial Cohort Study. Journal of Atherosclerosis and Thrombosis, 27, 695-710.
https://doi.org/10.5551/jat.49841
