RESEARCH ARTICLE SA JOURNAL OF DIABETES & VASCULAR DISEASE 14 VOLUME 19 NUMBER 1 • July 2022 analysis, gender (p = 0.026), age (p ≤ 0.0001), marital status (p = 0.001), alcohol use (p = 0.030) and tobacco use (p = 0.055) were associated with the MetS. After adjustment, multivariate analysis showed that the odds of having the MetS were 5.02 times higher for participants aged between 35 and 59 years (AOR = 5.02, 95% CI: 2.24–11.23) and 6.57 times higher for those aged ≥ 60 years (AOR = 6.57, 96% CI: 1.57–27.54), while males had a lower risk of having the MetS. Discussion The aim of the study was to screen for cardiometabolic risk factors and their association with selected demographic and lifestyle variables among South African adults living in informal settlements. Our results show the presence of cardiometabolic risk factors (abdominal obesity, overweight/obesity, hypertension, and elevated cholesterol and glucose levels) that contributed to the presence of the MetS among participants, associated with several demographic and lifestyle variables. These findings are consistent with other studies conducted in the urban, peri-urban and rural settings in South Africa.18,19,30-33,36 Metabolic health screening is imperative to identify public health challenges and therapeutic targets to improve population health.19,56 The presence of abdominal obesity in this study, indicated by WC (46%), was lower compared to a study conducted among farm workers (56.4%)18 and rural and semi-urban communities (65.2%)19 in South Africa. However, abdominal obesity by WHtR (72%), observed in this study, was similar to other reports among South African adults (72.5%).19 The differences in abdominal obesity (WC and WHtR) by gender and age, observed in this study, are consistent with other South African studies.19,33 The literature documents that abdominal obesity often precedes the development of other cardiometabolic risk factors for the MetS and should be regarded as a vital component of cardiovascular risk evaluation in routine clinical practice, particularly, among females.19,57 In addition, a high prevalence of overweight/obesity (45%) was also observed in this study, with females being significantly more affected than males, as well as older participants more affected than younger participants. Increased overweight/obesity and variation of its presence in terms of age and gender have been reported in South Africa.44,58,59 The prevalence of hypertension was high in the current study (66%), and females and older participants were more affected compared to their counterparts. Disparities in the presence of hypertension by gender, age and setting in South Africa have been reported.14 16,60 Elevated levels of cholesterol (14%) and glucose (7%) in this study were similar to those of other studies.29,61 The presence of any of the three cardiometabolic risk factors found in this study contributes to the MetS.54 Challenges exist with regard to comparison of the presence of the MetS across studies, due to the various definitions of the MetS in the literature.62 In South Africa, not much is known about the MetS among vulnerable communities.18 However, the prevalence of the MetS (17%) was low in this study compared to the 42% reported in Soweto (Gauteng province)36 and the 55.4 to 62% reported in the urban Western Cape province.29 Higher prevalence of the MetS was observed among middle-aged (28%) to older (40%) participants and females (30%), similar to other studies.19,30 The prevalence of the MetS in the current study setting may be driven by the presence of obesity, hypertension and dyslipidaemia, similar to previous studies,30,36 and explained by the urbanisation and epidemiological transition currently occurring in South Africa.19 Factors such as age and gender (multivariate analysis), marital status, and alcohol and tobacco use (bivariate analysis) were associated with individual cardiometabolic risk and the MetS in this study, similar to other studies.16,18-20,63-65 The literature documents that females are more prone to abdominal obesity and overweight/ obesity than males58 because of the hormonal regulation of body fat distribution in females.66 Furthermore, older age was associated with hypertension and the MetS in this study, similar to other studies.16,19 Owolabi et al.19 summarised that ageing is often associated with a higher tendency towards cardiometabolic risk factors such as obesity, hypertension and dyslipidaemia. It should be noted that this study has several limitations and strengths. This study serves as a baseline for pre-morbid cardiometabolic risks among adults living in informal settlements, in the absence of screening studies. The study adhered to standardised methods and sheds light on the presence of cardiometabolic risk factors and the MetS, as well as their associated factors among South Africans living in informal settlements. In terms of limitations, the study may not necessarily represent the entire informal settlement population, due to the low participation experienced during the screening campaign. The results of this study cannot be generalised to rural and other urban areas in South Africa, except for other informal settlements in the Gauteng province. Data on all variables were not obtained from all participants due to resistance to participation. Future research should endeavour to study cardiometabolic risks in detail and use venous blood and, if necessary, repeated tests to confirm dyslipidaemia and diabetes. Larger studies are needed to determine the associations of demographic and lifestyle factors with the MetS, mediated by the informal settlement environment. Conclusion Our study confirms that, similar to other communities in South Africa, informal settlements in South Africa have entered the epidemic of the MetS. This is confirmed by the evidence of prevalent cardiometabolic risk factors, such as hypertension, overweight/obesity, abdominal obesity and elevated cholesterol levels. Population-based strategies to reduce the impact of cardiometabolic risks need to include contextual and diversified public health and health-promotion programmes to benefit the community in informal settlements. It is also imperative to emphasise routine screening for all the components of the MetS at the primary healthcare level. Acknowledgements We thank the population of the selected informal settlements for participating in the study. This study was supported by the South African Medical Research Council (SAMRC) through the Research Capacity Development programme. References 1. Arndt C, Davies R, Thurlow J. Urbanization, structural transformation, and ruralurban linkages in South Africa. SATIED 2018. Available from: https://sa-tied. wider.unu.edu/sites/default/files/pdf/SATIED_WP41_Arndt_Davies_Thurlow_ March_2019.pdf. [Accessed: 19/02/2020]. 2. Jones P. Formalizing the informal: Understanding the position of informal settlements and slums in sustainable urbanization policies and strategies in Bandung, Indonesia. Sustain 2017; 9: 1436.
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