Air pollution is linked to Metabolic Syndrome (METSYN)

The more one reads about the health ef­fects of air pollution the more you begin to appreciate the barriers against optimal health which are to an extent out of one’s control. It is therefore important for one to get all the benefits from the factors within your control.

Metabolic syndrome (MetSyn) represents a group of symptoms including central obesity, hyperten­sion, atherogenic dyslipidaemias and insulin resistance. World Health Organisation (WHO) defines MetSyn as diagnosis of impaired fasting glycaemia (IFG; or treatment for type 2 diabetes) and of any two out of central obesity, hypertension, hypertriglyceridemia (HTG) and low high-density lipoproteins (HDL) (or treatment for specific dyslipidaemia), and urinary albumin excretion ratio ≥20μg/min.

MetS greatly contributes to global disease burden, occurring in about 25% of adults. It predisposes to cardiovascular events and type 2 dia­betes. Air pollution is ranked among top risk factors for hypertension, diabetes, dyslipidaemia (abnormal cholesterol levels) and obesity. These are also the main components of the metabolic syndrome (MetSyn). The American Heart Association (AHA) defines MetSyn as a group of five conditions that can lead to heart disease, diabetes, stroke and other health problems. MetSyn is diagnosed when someone has three or more of these risk factors: high blood glucose (sugar), low levels of HGL (“good”) cholesterol in the blood, high levels of triglycerides in the blood, large waist circumference or “apple-shaped” body and high blood pressure.

Although each of these is a risk factor for cardiovascular disease, when a person has three or more and is diagnosed with metabolic syndrome (MetSyn), the chance of developing a serious cardiovas­cular condition increases. MetSyn is a serious health condition that puts people at a higher risk of heart disease, diabetes, stroke and diseases related to fatty buildups in artery walls (atherosclerosis). The AHA list the underlying causes of MetSyn as overweight/obesity, insulin resistance, physical inactiv­ity, genetic factors and increasing age. The AHA recommendations to reduce the risks of MetSyn include losing weight, increasing one’s physical activity, eating a health diet that is rich in whole grains, fruits, vegetables and fish and working with your health care team to monitor and manage one’s blood glucose, blood cholesterol and blood pressure.

Air pollution triggers pulmo­nary and systemic inflammation. Systemic inflammation leads to the development of MetSyn and cardiopulmonary disease, such as chronic obstructive pulmonary disease (COPD) and cardiovascu­lar disease (CVD). Individuals with these preexisting conditions are more susceptible to the inflam­matory effects of air pollution, which can further exacerbate their conditions. Additionally, MetSyn predisposes individuals to air pollution-induced pathogenesis of COPD and CVD (Clementi et al. Metabolic Syndrome and Air Pollution: A Narrative Review of Their Cardiopulmonary Effects. Toxics 2019, 7, 6; doi:10.3390/ toxics 7010006

So one may not have risk factors for MetSyn yet, but air pollution can increase one’s risk. The presence of three or more of such factors indicates the presence of MetSyn (National Institutes of Health guidelines), high blood pressure (130/85mmHg or high­er), elevated fasting blood glucose (5.6mmol/L or higher), large waist circumference (102 centi­meters for men, 89 centimeters for women), high triglyceride level (1.7mmol/L or higher of this type of fat found in blood, reduced “good” or HDL cholesterol (less than 1.04mmol/L in men or less than 1.3mmol/L in women). The presence of the MetSyn makes one susceptible to the ill effects of air pollution. The air quality index of Accra is been reported to aver­age above the WHO recommend­ed safety levels. During periods of low air quality index the health recommendations include the wearing of mask outdoors, using an air purifier indoors, closing windows to avoid dirty outdoor air, and reducing outdoor exercise. One of the key steps to reduce the effects of cardiovascular disease and MetSyn is regular physical exercises. Meanwhile, air pollution limits outdoor exercises which is the favourite of many people..

The prevalence of hypertension in Ghana ranges from 19.3% in rural to 54.6% in urban areas (Addo J, Agyemang C, Smeeth L, et al. A review of popula­tion-based studies on hypertension in Ghana. Ghana Med J 2012;46:4- 11). There is a significant undiag­nosed hypertensive population in Ghana. In a related study in three urban communities, only 7.4% of persons with high blood pressure were aware (Awuah RB, Anarfi JK, Agyemang C, et al. Prevalence, awareness, treatment and control of hypertension in urban poor communities in Accra, Ghana. J Hypertens 2014;32:1203-10). Even among the hypertensive popu­lation in Ghana, blood pressure (BP) control remains terribly low at less than 5% (Lloyd-Sherlock P, Beard J, Minicuci N, et al, Hy­pertension among older adults in low- and middle income countries: prevalence, awareness and control. Int J Epidemiol 2014;43:116-28).

Diabetes is also on the rise in Ghana. Current estimate of the prevalence of diabetes in Ghana is around 6% with about 450,000 cases of the disease in the country in 2014 (Danquah I, Bedu-Addo G, Terpe K. et al. Diabetes melli­tus type 2 in urban Ghana: char­acteristics and associated factors. BMC Public Health 2012;12:210). It is estimated that undiagnosed diabetes accounts for about 70% of those with the disease in Ghana (International Diabetes Federa­tion. Ghana. (Accessed on 2015 May 18). Available online: http:// www.idf.org/membership/afr/ ghana).

The prevalence of overweight or obesity in Ghanaian women aged 15-49 years has increased from 13% in 1993 to 30% in 2008 (Bosu WK. A comprehensive review of the policy and pro­grammatic response to chronic non-communicable disease in Ghana. Ghana Med J 2012; 46:69- 78).

The fore-going information on prevalence of hypertension, diabetes and obesity in Ghana is worrying. These are all risk factors for MetSyn. To top these risk factors with the ill effects of air pollution makes the situation even more dire.

Cocoa consumption per cap­ita in Ghana is reported to have increased from about 600g in 2017 to 1kg 2023. In the USA it is about 5kg and Ireland it is about 12kg. Developed countries account for 64% of worldwide cocoa consumption. Consumption in Africa is generally low even though Africa accounts for over 70% of the world output of co­coa. Flavanol-rich cocoa has blood pressure lowering, blood glucose lowering, cholesterol lowering, blood thinning, anti-inflammatory and strong anti-oxidant properties. These properties are all beneficial against high blood pressure, dia­betes, obesity and other ill effects of air pollution. I see daily cocoa consumption as a unique defense against the ill effects of pollution and MetSyn. Consuming cocoa every day is not a dietary choice. It is a must if you want to reduce the ill effects of air pollution. It is an additional point to be stressed as we push Ghana’s premium quality cocoa into the African Continen­tal Free Trade Area (AfCFTA).

This year 2023 is the 50th Anni­versary of cocoa clinic. At Cocoa Clinic daily intake of flavanol-rich cocoa is considered as part of the safeguards for wellness.

[The writer is the Chief Pharmacist Cocoa Clinic]

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