A comparison of the associations between adiposity and lipids in Malawi and the United Kingdom

Ana Luiza G Soares*, Louis Banda, Alemayehu Amberbir, Shabbar Jaffar, Crispin Musicha, Alison J Price, Amelia C Crampin, Moffat J Nyirenda, Deborah A Lawlor

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

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Background: The prevalence of excess adiposity, as measured by elevated body mass index (BMI) and waist-hip ratio (WHR), is increasing in sub-Saharan African (SSA) populations. This could add a considerable burden of cardiovascular and metabolic diseases for which these populations are currently ill-prepared. Evidence from white, European origin populations shows that higher adiposity leads to an adverse lipid profile; whether these associations are similar in SSA populations is unknown. This study compared the association of BMI and WHR with lipid profile in urban Malawi with a contemporary cohort with contrasting socioeconomic, demographic, and ethnic characteristics in the United Kingdom (UK).

Methods: We used data from 1,248 adolescents (mean 18.7 years) and 2,277 Malawian adults (mean 49.8 years), all urban-dwelling, and from 3,201 adolescents (mean 17.8 years) and 6,323 adults (mean 49.7 years) resident in the UK. Adiposity measures and fasting lipids were assessed in both settings, and the associations of BMI and WHR with total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C) and triglycerides (TG) were assessed by sex and age groups in both studies.

Results: Malawian female adults were more adipose and had more adverse lipid profiles than their UK counterparts. In contrast, Malawian adolescent and adult males were leaner and had more favourable lipid profiles than in the UK. Higher BMI and WHR were associated with increased TC, LDL-C and TG and reduced HDL-C in both settings. The magnitude of the associations of BMI and WHR with lipids was mostly similar or slightly weaker in the Malawian compared with the UK cohort in both adolescents and adults. One exception was the stronger association between increasing adiposity and elevated TC and LDL-C in Malawian compared to UK men.

Conclusions: Malawian adult women have greater adiposity and more adverse lipid profiles compared with UK counterparts. Similar associations of adiposity with adverse lipid profiles were observed for Malawian and UK adults in most age and sex groups studied. Sustained efforts are urgently needed to address the excess adiposity and adverse lipid profiles in Malawi to mitigate a future epidemic of cardio-metabolic disease among the poorest populations.
Original languageEnglish
Article number181 (2020)
Number of pages13
JournalBMC Medicine
Publication statusPublished - 16 Jul 2020


  • obesity
  • body mass index
  • waist-hip ratio
  • lipid profile
  • dyslipidaemia
  • sub-Saharan Africa

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