REPORTCARD2022
TheHealthyAgingAdultSouthAfricareportcardsystematicreview[1] showsthatduetotheincreasingnon-communicablediseaseburden inAfrica,severalstrategiesthattargetthemajorlifestyleand physiologicalriskfactorshavebeenimplementedtocombatsuch diseases.TheHealthyAgingAdultSouthAfricareportcard systematicallyreviewednationalandregionalprevalencedataof middle-agedSouthAfricanadults(45–65years)published between2013and2020ondiet,physicalactivity,tobaccouse andalcoholconsumption,obesity,hypertension,dyslipidaemia anddiabetesmellitus.Eachindicatorwasassignedtwogrades, (1)basedontheavailabilityofprevalencedata,and(2)basedon whetherpolicieshavebeenproposedandimplementedforthe respectiveindicators.Alcoholconsumption,obesity,hypertension anddiabetesreceivedanAgradefortheavailabilityof prevalencedata.TobaccouseanddietreceivedanAgradefor policyandimplementation.Gapshavebeenidentifiedthatneed tobefilledbyfutureresearchfocusingoncontinuedsurveillance ofallindicatorstoinformandimplementeffectivepolicies.
Acknowledgement:
AbstractadaptedfromTheHealthyAging AdultSouthAfricareportcard:a systematicreviewoftheevidence between2013and2020for middle-agedSouthAfrican menandwomenby Micklesfieldetal.,2022.
The2016SouthAfricanStrategicPlanforthePreventionandControl ofNon-CommunicableDiseases2020goalsandtargets[2]: Reduce relative premature mortality 25% 20% Reduce theprevalence ofpeoplewith raisedblood pressure Reduce tobaccouse 10% Increase theprevalenceof peoplemeeting physicalactivity recommendations 20% Reduce thepercapita consumptionof alcohol 20% Reduce theprevalenceof cervicalcancer Reduce themean population intakeofsalt 5g 30% Increase thepercentageof peoplecontrolled forhypertension, diabetesand asthma Increase thenumberof peoplescreened andtreatedfor mentaldisorders 30%10% Reduce thepercentage ofpeoplewho areobeseor overweight 2
Policyandimplementation C Availabilityofnationalprevalence datainSA B PrevalencelevelcomparedtotheUSA Lower: + Higher: ––0 20 40 60 80 100 USA 50-64years MenMenWomenWomenMen Women 45-54years 55-64years SouthAfrica PHYSICALINACTIVITY [3],[4] 24% 56% 67%27% 64% 67% Policyandimplementation C Availabilityofnationalprevalence datainSA A PrevalencelevelcomparedtotheUSA Lower: + Higher: ––0 20 40 60 80 100 USA 50-64years Men Men Men Women Women Women 45-54years 55-64years SouthAfrica ALCOHOLCONSUMPTION [5],[6] 28% 37% 45%17% 11% 11% AcomparisonbetweenSouthAfricanandUSdataonmiddle-agedadultsfortheeight physiologicalandlifestyleindicatorsincludedintheHealthyAgingAdultReportCard Criteriausedtogradeeachriskfactor[1]. 3 Grade Prevalencedata Policyandimplementation A Publishednationalandregionalprevalence dataavailableforthisagegroup. Nationalpolicy/ieshavebeenimplementedfor morethan10years. B Publishednationalandregionalprevalence dataavailable,notspecifictoagegroup. Nationalpolicy/ieshavebeenrecently(less than10years)implemented. C Onlyregionalprevalencedataforthisage group. Nationalpolicy/ieshavebeenproposedbut notimplemented. D Onlyregionalprevalencedatabutnotspecific tothisagegroup. Nonationalpolicy/ies. E Noprevalencedata.
4 Policyandimplementation A Availabilityofnationalprevalence datainSA C PrevalencelevelcomparedtotheUSA Lower: + Higher: + 0 20 40 60 80 100 USA 31-59years Men Men WomenWomenMen Women 45-54years 55-64years SouthAfrica DIET:SODIUMINTAKE [6],[7] 97% 42% 55%82% 39% 50% Policyandimplementation A Availabilityofnationalprevalence datainSA C PrevalencelevelcomparedtotheUSA Lower: + Higher: –+ 0 20 40 60 80 100 USA 31-59years Men Men WomenWomenMen Women 45-54years 55-64years SouthAfrica DIET:HIGH-FATFOODSCONSUMPTION [5],[6] 73% 47% 55%82% 38% 48% Policyandimplementation B Availabilityofnationalprevalence datainSA A PrevalencelevelcomparedtotheUSA Lower: + Higher: ––0 20 40 60 80 100 USA Men Men Men Men WomenWomen Women 45-64 years 45-54 years 55-64 years 40-59years 60+years SouthAfrica OBESITY [5],[6] 35% 43% 53%30% 82%36% 32%
5 Policyandimplementation B Availabilityofnationalprevalence datainSA C PrevalencelevelcomparedtotheUSA Lower: + Higher: ––0 20 40 60 80 100 USA Men WomenMenMenWomenWomen 40-59years 60+years18+years SouthAfrica DYSLIPIDAEMIA:ELEVATEDTOTALCHOLESTEROL 17% 19%7%18% 28%17% Policyandimplementation B Availabilityofnationalprevalence datainSA C PrevalencelevelcomparedtotheUSA Lower: + Higher: ––0 20 40 60 80 100 USA Men Men WomenMen Women Women 40-59years 60+years18+years SouthAfrica DYSLIPIDAEMIA:LIPOPROTEIN(HDL)CHOLESTEROL [8],[9] 32% 52%23%9% 44%7% Policyandimplementation A Availabilityofnationalprevalence datainSA B PrevalencelevelcomparedtotheUSA Lower: + Higher: –0 20 40 60 80 100 USA 50-64years Men Men Men WomenWomen Women 45-54years 55-64years SouthAfrica TOBACCOUSE [6],[7] 18% 45% 37%14% 9% 10%
Recommendationsformiddle-agedadults,researchers andpolicymakers 6 Policyandimplementation C Availabilityofnationalprevalence datainSA A PrevalencelevelcomparedtotheUSA Lower: + Higher: ––0 20 40 60 80 100 USA Men MenMen WomenMen WomenWomen Women 40-59years 55-64years40-54years 55-64years SouthAfrica 9% 12%18% 23%9% 21%14% 29% DIABETES [5],[6] Physicalactivity Nationalprevalencedataavailableonthisagegroupisfromtheyear2012and showsaworseninginadherencetophysicalactivityguidelinesovertime.Itis unclearwhetherSouthAfricahasreachedthenationaltargetofincreasing physicalactivityby10%in2020;thereisaneedformorerecentlyupdateddata. Forthisagegroup,thebestwaytogetstartedonPAistofocusonalight-to moderate-intensityactivity,suchaswalking5-15minutesatleast3timesa week. AlcoholConsumption Toreducetheriskofalcohol-relatedharm,werecommendthatadultsinthis agegroupcanchoosenottodrink,ortodrinkinmoderationbylimitingintake totwodrinksorlessinadayformenoronedrinkorlessinadayforwomen, orondayswhenalcoholisconsumed. Policyandimplementation B Availabilityofnationalprevalence datainSA A PrevalencelevelcomparedtotheUSA Lower: + Higher: ––0 20 40 60 80 100 USA Men MenMen WomenMen WomenWomen Women 40-59years 60+years40-54years 55-64years SouthAfrica 59% 55%75% 74%50% 63%74% 78% HYPERTENSION [6],[10]
Tobaccouse
Smokingleadstodiseasessuchaschronicobstructivepulmonarydisease (COPD),disability,harmsnearlyeveryorgansystemofthebodyandpremature death.Werecommendedsmokingcessationandthatcliniciansaskallmiddleagedadultsabouttobaccouse,advisethemtostopusingtobacco,and providebehaviouralinterventionsforcessation,particularlytomen.
Diet
Onlyregionaldataonsodiumandhigh-fatfoodintakeexistforthisagegroup, thereisaneedfornationallyrepresentativedata.Theremustbeagreater focusonimprovingoveralldietaryquality,routinemonitoringofsaltintakesat nationalandregionallevelsinthisagegroupisnecessarytotrackprogress towardsachievingthetargetofa30%reductioninpopulationsalt/sodium intakes.Dataexploringdietarypatterns,aswellastheirdeterminants(food insecurity),inthisagegroupareneededtoinforminterventionsandachieve progresstowardsotherNCDtargets,whicharereliantonpopulation-level dietarybehaviouralchange Obesity
Topreventandmanageobesity,adultsinthisagegroupneedtochoose healthierfoods(wholegrains,fruitsandvegetables,healthyfatsandprotein sources)andbeverages.Theymustlimitunhealthyfoods(refinedgrainsand sweets,potatoes,redmeat,processedmeat)andbeverages(sugarydrinks), screentimeandincreasephysicalactivity,andgetgoodqualitysleep.Fast foodnutritionallabellingneedstobemandatory.
Dyslipidaemia
Thereisaneedforcut-offpointsspecifictotheAfricanpopulationtoimprove ourmeasurementaccuracyandtheclinicalimpactcanbesignificant.National surveysthatreportsprevalenceandcurrenttreatmentdataspecifictothe45to65-yearagegrouparealsoneeded.
Hypertension
Aneedformorerecentnationalprevalencedataassessingtheimpactof legislationonmiddle-agedadults’sodiumintakesorbloodpressureandif SouthAfricaisontracktoreacheithertheSouthAfricannationalorglobal target.
Diabetes Aneedforoptimalmanagementfocusingonglycaemiccontrolandreducing riskfactorsformacro-andmicrovasculardisease.Physicalactivityshouldbe highlyencouragedforthisagegroupiftherearenocontra-indications.
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Conclusion
Inconclusion,althoughnationalandlocalprevalencedataisavailableitismoreextensiveforsome indicatorssuchasobesity,hypertension,anddiabetes,thanothers,suchasphysicalactivityanddiet. Whatisclearisthedisconnectbetweentheprevalenceandpolicygradesforallindicatorswithsome (physicalinactivity,alcoholconsumption,obesity,hypertension,anddiabetes)havinghigher gradesfortheavailabilityofprevalencedata,whileothershavehighergradesforpolicyand implementation(tobacco,diet,anddyslipidaemia).Futurestepsshouldincludeusingstandardized methodologiesinnationalandregionalprevalencestudies,andtousetheprevalencedatathatis alreadyavailableforindicatorssuchasalcoholconsumptiontoprioritizeandsupportthe implementationofpolicies.
References
1.Micklesfield,L.K.,etal., TheHealthyAgingAdultSouthAfricareportcard:asystematicreviewofthe evidencebetween2013and2020formiddle-agedSouthAfricanmenandwomen. CardiovascJAfr,2022. 33:p.1-20.
2.NationalDepartmentofHealth(NDoH), StrategicPlanforthePreventionandControlofNon-Communicable Diseases2013-2017[Internet].2013[Accessed2020Sep10]:Pretoria:NationalDepartmentofHealth (NDoH); https://www.iccp-portal.org/south-africa-strategic-plan-prevention-and-control-non-communicablediseases-2013-2017
3.CentersforDiseaseControlandPrevention, TheStateofAgingandHealthinAmerica:Databriefs. National AssociationofChronicDiseaseDirectors(NACDD)StateofAgingandHealthinAmerica; https://nccd.cdc.gov/aging_data/rdPage.aspx?rdReport=DPH_HAP.ExploreByTopic,2019.
4.NationalDepartmentofHealth(NDoH)andSouthAfricanMedicalResearchCouncil(SAMRC), SouthAfrica DemographicandHealthSurvey2003. Pretoria:DepartmentofHealth,SouthAfrica:MRCSouthAfrica,2003.
5.RobinA.Cohen,P.D.,EmilyP.Terlizzi,M.P.H.,andMichaelE.Martinez,M.P.H.,M.H.S.A., EarlyReleaseofSelectedEstimatesBasedonDataFromthe2018NationalHealthInterviewSurvey, in DivisionofHealthInterviewStatistics,NationalCenterforHealthStatistics https://www.cdc.gov/nchs/nhis/releases/released201905.htm#9.2019.
6.NationalDepartmentofHealth(NDoH),etal., SouthAfricaDemographicandHealthSurvey2016[Internet]., in PretoriaandRockville,Maryland,USA:NDoH,StatsSA,SAMRC,andICF[Accessed2020Aug31]. https://www.samrc.ac.za/reports/sadhs2016.2019.
7.U.S.DepartmentofAgricultureandU.S.DepartmentofHealthandHumanServices, DietaryGuidelinesfor Americans,2020-2025.9thEdition AvailableatDietaryGuidelines.gov.,2020.
8.Shisana,O.,etal., TheSouthAfricanNationalHealthandNutritionExaminationSurvey,2012:SANHANES-1: thehealthandnutritionalstatusofthenation. 2014.
9.Carroll,M.D.,C.D.Fryar,andD.T.Nguyen, TotalandHigh-densityLipoproteinCholesterolinAdults:United States,2015-2016.NCHSDataBrief,2017(290):p.1-8.
10.Ostchega,Y.,etal., HypertensionPrevalenceAmongAdultsAged18andOver:UnitedStates,2017-2018. NCHSDataBrief,2020(364):p.1-8
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