The association of diet and physical inactivity with obesity, diabetes, and hypertension among older adults living in Sierra Leone

Abstract Introduction Cardiovascular diseases (CVDs) are primarily driven by modifiable behavioural risk factors and are the leading cause of death globally. In low- and middle-income countries (LMICs), rapid urbanization and changes in behaviour are exacerbating the burden of CVDs but there is limited research into specific associations with CVDs in older adults in low-income countries, such as Sierra Leone. This study examines the association between behavioural risk factors and their physiological sequalae among adults aged 40 and above in Bo District, Sierra Leone. Methods A cross-sectional study design was used to collect data from 1,978 randomly sampled adults through a household survey. Survey questions were based on the validated WHO STEPs questionnaire. Multivariable logistic regression analysis was performed to determine the associations between behavioural risk factors (such as diet, physical activity, and salt intake) and the presence of hypertension, diabetes, and obesity, adjusting for socio-demographic variables. Results At least one physiological risk-factor for CVD was present in 43.5% of participants. Hypertension was associated with urban living (OR=1.46, 95% CI [1.41-1.51]), older age (OR for 80+=3.98, 95% CI [3.70-4.28]), insufficient fruit and vegetable intake (OR=1.52, 95% CI [1.46-1.60]), and low physical activity (OR=1.35, 95% CI [1.27-1.43]). Diabetes was associated with urban residence (OR=1.84, 95% CI [1.66-2.05]), older age (OR for 70-79 =3.82, 95% CI [3.28-4.45]), low fruit and vegetable consumption (OR=1.61, 95% CI [1.36-1.90]), high salt intake (OR=1.34, 95% CI [1.21-1.49]), and low physical activity (OR=1.47, 95% CI [1.26-1.71]). Obesity was less likely among males (OR=0.37, 95% CI [0.36-0.38]) and those aged 80+ (OR=0.39, 95% CI [0.35-0.43]). Conclusion This study highlights the need for evidence for targeted public health interventions in Bo District, Sierra Leone. Promoting healthier lifestyles to reduce poor diet, and physical inactivity, particularly in urban areas, could decrease CVD prevalence. Summary What is already known on this topic Cardiovascular diseases (CVDs) are the leading cause of global mortality, with a disproportionate burden in low- and middle-income countries. Modifiable risk factors, including diet and physical inactivity, significantly contribute to CVD prevalence. Limited research exists on the specific associations between these risk factors and CVDs in older adults in Sierra Leone. What this study adds This study provides evidence of significant associations between dietary habits, salt intake, physical activity levels, and physiological risk factors for CVD: hypertension, diabetes, and obesity among adults aged 40 and above in Bo District, Sierra Leone. It quantifies the increased odds of physiological CVD risk factors associated with inadequate fruit and vegetable intake, high salt consumption, and physical inactivity in this population. The study illuminates the links between behavioural and physiological risk factors in the context of rapid urbanisation in Sierra Leone. How this study might affect research, practice or policy These findings will directly inform the development of targeted public health interventions in Sierra Leone, prioritizing the promotion of fruit and vegetable consumption and increased physical activity among adults. The study results will drive policy changes to address urbanisation-related lifestyle factors, including initiatives to improve access to healthy foods and create environments conducive to physical activity. This research establishes a foundation for future studies on CVD risk factors in Sierra Leone, particularly focusing on age- and gender-specific interventions

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