TheHealthyAging AdultSouthAfrica
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]:
25%
20%
Reduce relative premature mortality
20%
Reduce tobaccouse 10%
Reduce theprevalence ofpeoplewith raisedblood pressure
20%
Reduce thepercapita consumptionof alcohol
5g
Reduce themean population intakeofsalt
30%
Increase theprevalenceof peoplemeeting physicalactivity recommendations
10%
Reduce thepercentage ofpeoplewho areobeseor overweight
30%
Reduce theprevalenceof cervicalcancer
Increase thepercentageof peoplecontrolled forhypertension, diabetesand asthma
Increase thenumberof peoplescreened andtreatedfor mentaldisorders
Grade Prevalencedata
A Publishednationalandregionalprevalence dataavailableforthisagegroup.
B Publishednationalandregionalprevalence dataavailable,notspecifictoagegroup.
C Onlyregionalprevalencedataforthisage group.
D Onlyregionalprevalencedatabutnotspecific tothisagegroup.
E Noprevalencedata.
Nationalpolicy/ieshavebeenimplementedfor morethan10years.
Nationalpolicy/ieshavebeenrecently(less than10years)implemented.
Nationalpolicy/ieshavebeenproposedbut notimplemented.
Nonationalpolicy/ies.
DIET:SODIUMINTAKE [6],[7]
HYPERTENSION [6],[10]
DIABETES [5],[6]
Recommendationsformiddle-agedadults,researchers andpolicymakers
Physicalactivity
Nationalprevalencedataavailableonthisagegroupisfromtheyear2012and showsaworseninginadherencetophysicalactivityguidelinesovertime.Itis unclearwhetherSouthAfricahasreachedthenationaltargetofincreasing physicalactivityby10%in2020;thereisaneedformorerecentlyupdateddata. Forthisagegroup,thebestwaytogetstartedonPAistofocusonalight-to moderate-intensityactivity,suchaswalking5-15minutesatleast3timesa week.
AlcoholConsumption
Toreducetheriskofalcohol-relatedharm,werecommendthatadultsinthis agegroupcanchoosenottodrink,ortodrinkinmoderationbylimitingintake totwodrinksorlessinadayformenoronedrinkorlessinadayforwomen, orondayswhenalcoholisconsumed.
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.
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
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