A Matter of Fat: Body Fat Distribution and Cardiometabolic Disease in Africa

Africa is a complex and diverse continent that faces numerous challenges. It is a region in epidemiological transition which is currently experiencing a dual burden of communicable and non-communicable diseases. The high prevalence of cardiometabolic disease (CMD) on the continent is driven largely by the increasing prevalence of obesity in the more affluent African nations. Although epidemiological studies demonstrate that a greater level of total body fat is associated with a higher risk for CMD, there is a complex association between body fat distribution and CMD risk. Thus, visceral adipose tissue (VAT) is considered a prime etiological agent for CMD, while subcutaneous adipose tissue (SAT) may act as a protective factor. The literature demonstrates positive correlations of VAT with type 2 diabetes, hypertension, and atherogenic dyslipidemia. However, the mechanisms via which VAT and SAT modulate CMD risk in African patients require further investigation. In addition, studies from high-income countries have shown that HIV and antiretroviral therapy (ART) are associated with changes in body fat distribution and higher risk for CMDs. The prevalence of HIV infection is at its highest in sub-Saharan Africa. However, cross-sectional studies from this region have produced contradictory results on the association of HIV and ART with CVD risk factors, and data is required from large prospective studies to clarify these relationships.