Cardiovascular and Metabolic Risk

O R I G I N A L A R T I C L E

Prevalence of Metabolic Syndrome

Among an Urban Population in Kenya
LYDIA U. KADUKA, MSC1 JOHN K. BORE, MSC4 However, noncommunicable diseases
YERI KOMBE, MD, PHD1 ZIPPORAH N. BUKANIA, MSC
1
(NCDs) contribute over one-half of the
EUCHARIA KENYA, PHD2 MOSES MWANGI, MSC1 top 20 causes of morbidity and mortality
ELIZABETH KURIA, PHD3 (3). Total mortality attributed to NCDs
rose from 31.8% in 2002 to 33% in
2007. This has been attributed to urbani-
OBJECTIVEdDeveloping countries are undergoing an epidemiologic transition accompa- zation that brings with it changes in life-
nied by increasing burden of cardiovascular disease (CVD) linked to urbanization and lifestyle
modications. Metabolic syndrome is a cluster of CVD risk factors whose extent in Kenya
style that adversely affect metabolism.
remains unknown. The aim of this study was to determine the prevalence of metabolic syndrome In 1993, a hospital-based study in
and factors associated with its occurrence among an urban population in Kenya. Nairobi found high prevalence of obesity,
hypercholesterolemia, cigarette smoking,
RESEARCH DESIGN AND METHODSdThis was a household cross-sectional survey and electrocardiogram evidence of left
comprising 539 adults (aged $18 years) living in Nairobi, drawn from 30 clusters across ve ventricular hypertrophy, with hyperten-
socioeconomic classes. Measurements included waist circumference, HDL cholesterol, triacyl- sion as the most common discharge diag-
glycerides (TAGs), fasting glucose, and blood pressure. nosis (4). A study by Christensen et al. (5)
RESULTSdThe prevalence of metabolic syndrome was 34.6% and was higher in women than found the prevalence of overweight
in men (40.2 vs. 29%; P , 0.001). The most frequently observed features were raised blood (BMI $25 kg/m2) at 39.8 vs. 15.8% and
pressure, a higher waist circumference, and low HDL cholesterol (men: 96.2, 80.8, and 80%; obesity (BMI $30 kg/m2) at 15.5 vs. 5.1%
women: 89.8, 97.2, and 96.3%, respectively), whereas raised fasting glucose and TAGs were among urban versus rural Kenyan popula-
observed less frequently (men: 26.9 and 63.3%; women: 26.9 and 30.6%, respectively). The tions, respectively. The same study observed
main factors associated with the presence of metabolic syndrome were increasing age, socioeconomic an overall age-standardized prevalence of
status, and education. diabetes and impaired glucose tolerance of
CONCLUSIONSdMetabolic syndrome is prevalent in this urban population, especially 4.2 and 12.0%, respectively (6). These
among women, but the incidence of individual factors suggests that poor glycemic control is ndings, in addition to the prevailing
not the major contributor. Longitudinal studies are required to establish true causes of metabolic global understanding of CVDs, call for
syndrome in Kenya. The Kenyan government needs to create awareness, develop prevention screening and early detection of metabolic
strategies, and strengthen the health care system to accommodate screening and management of abnormalities to help identify people who
CVDs. are at risk and most likely to benet from
intervention efforts.
Diabetes Care 35:887893, 2012 The term metabolic syndrome refers
to the clustering of a number of cardio-

T
he global prevalence of leading Kenya is a rapidly developing country vascular risk factors (obesity, hyperten-
chronic diseases is increasing, with of sub-Saharan Africa, where the extent of sion, dyslipidemia, and hyperglycemia)
the majority occurring in low- and most cardiovascular diseases (CVDs) and believed to be related to insulin resis-
middle-income countries, and expected to the associated risk factors at population tance. It is estimated that ~2025% of the
rise substantially over the next two decades level remain largely unknown. Chronic worlds adult population have metabolic
(1). Chronic diseases are responsible for diseases have not received much attention syndrome, and they are twice as likely to
50% of the total disease burden, with esti- due to overemphasis on communicable die of and three times as likely to have a
mated age-standardized death rates being diseases, underreporting, missed diagnosis, heart attack or stroke compared with peo-
higher for men and women from low- misdiagnosis, and misclassication of dis- ple without the syndrome. In addition,
income compared to middle-income eases. According to the Ministry of Health people with metabolic syndrome have a
countries (2). Major causes are said to be Annual Status Report 2007, the leading vefold greater risk of developing type 2
increasing rates of hypertension, dyslipi- causes of deaths in Kenya are malaria, diabetes (7). The aim of this study was to
demia, diabetes, obesity, physical inactiv- pneumonia, HIV/AIDS, diarrhea, anemia, determine the prevalence and factors as-
ity, and tobacco use. tuberculosis, meningitis, and heart failure. sociated with the occurrence of metabolic
syndrome among an urban population in
c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c Kenya.
From the 1Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya; the 2De-
partment of Biochemistry and Biotechnology, Kenyatta University, Nairobi, Kenya; the 3Department of
RESEARCH DESIGN AND
Foods, Nutrition, and Dietetics, Kenyatta University, Nairobi, Kenya; and the 4Directorate of Population METHODSdThe study was carried
and Social Statistics, Kenya National Bureau of Statistics, Nairobi, Kenya. out in Langata constituency of Nairobi
Corresponding author: Lydia U. Kaduka, [email protected]. province, the capital city of Kenya. Langata
Received 17 March 2011 and accepted 3 January 2012. constituency covers an area of 223.4 km2
DOI: 10.2337/dc11-0537
2012 by the American Diabetes Association. Readers may use this article as long as the work is properly and has a density of 1,284 dwellings per
cited, the use is educational and not for prot, and the work is not altered. See http://creativecommons.org/ unit area, a population of 355,188, and a
licenses/by-nc-nd/3.0/ for details. total of 108,477 households. This is in

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Metabolic syndrome in urban Kenya

comparison with the entire Nairobi prov- Selection of households and the ribs and the iliac crest in a horizontal
ince, which covers an area of 696 km2 respondents plane. Measurements were recorded to the
and has a density of 4,509 dwellings per Following the quick household count, a nearest 0.1 cm.
unit area, with a total of 985,016 house- household list was generated for every Clinical assessment. Blood pressure was
holds, and a population of 3,138,369. cluster that included information on taken using the automated Omron M6
The countrys population has grown from household occupants. The total number Comfort (HEM-7000-E). Blood pressure
28,686,607 in 1999 to 38,610,097, of of households per cluster was selected was measured with subjects in a sitting
which ~32% live in urban areas (8). Langata using the systematic random-sampling position and the arm horizontally sup-
was chosen because of its cosmopolitan na- method, followed by the selection of ported. Family history of diabetes and
ture, and it hosts all the ve socioeconomic only one eligible respondent per house- CVDs were self-reported.
classes (upper, lower upper, middle, lower hold using the Kish Grid technique (9), Biochemical assessments. Fasting ve-
middle, and lower), as stratied by the which allows selection of one person to nous blood was collected between 7:00
Kenya National Bureau of Statistics. interview from all eligible household res- A.M. and 8.00 A.M., and blood glucose was
This was a cross-sectional study based idents. Sensitization, recruitment, and as- immediately determined using the Hemo-
on a three-stage, cluster-sampling meth- sessment of study subjects were done in cue B-Glucose 201+ analyzer (HemoCue,
odology. The rst stage involved the se- three phases. Sensitization at administra- Angelholm, Sweden). Blood lipid prole
lection of 30 clusters from the total tive and community levels was done dur- (triacylglycerides [TAGs], total choles-
enumeration areas in the constituency, ing the mapping and counting exercise, terol, and HDL cholesterol) was analyzed
followed by selection of the households, followed by visits to the selected house- on a Konelab autoanalyzer using the T
and nally selection of the respondents. holds and respondents to explain the na- Series Triglycerides Kit (cat no. 981301),
The study included urban dwellers of ture of the study, the requirement for the T Series Cholesterol Kit (cat no.
both sexes aged $18 years, with no fasting blood samples, and the intended 981812), and the T Series HDL Cholesterol
known medical history of a debilitating day and time of assessments. The third Kit (cat no. 981823) in accordance with the
disease and having resided in Nairobi phase involved a visit to the cluster by manufacturers instructions.
for at least 2 years before the study. the medical team for blood collection
and assessments. Denition of the metabolic
Sample size estimation and syndrome
sampling Assessments Metabolic syndrome was dened accord-
A comprehensive sampling frame was The following assessments were carried ing to the new 2009 International Di-
constructed to represent the target pop- out between August and October 2008. abetes Federation consensus statement
ulation in which the primary sampling Socioeconomic assessment. Interviews criteria, which is the presence of any three
unit was an enumeration area as dened were carried out and information on of the ve following risk factors. These are
during the 1999 Kenya Population and socioeconomic and demographics col- waist circumference $94 cm for men or
Housing Census. Enumeration areas are lected using a structured questionnaire. $80 cm for women, TAGs $1.7 mmol/L
small nonoverlapping units dened ac- Education level was categorized into ve or specic treatment for this abnormality,
cording to a specied measure of size and levels: none, primary (18 years), second- HDL cholesterol ,1.0 mmol/L for men or
have maps showing the boundaries and ary (914 years), university (.14 years), ,1.3 mmol/L for women or specic treat-
structures as well as total households and and adult education. Occupation was ment for this abnormality, elevated blood
population by sex. A measure of size is classied as formal, self-employed, and/ pressure $130/85 mmHg or treatment of
dened as having an average of 100 or petty trade. Information on monthly previously diagnosed hypertension, and el-
households with a lower and upper limit income also was obtained. Differences in evated fasting glucose $5.6 mmol/L or
of 50 and 149 households, respectively. A socioeconomic status were obtained us- treatment of previously diagnosed diabetes
total of 30 clusters from all the ve so- ing the wealth quintiles. The study used (10). The European cutoffs for waist circum-
cioeconomic divisions were selected using assets ownership and the principal com- ference were used because of the unavail-
the systematic probability-proportional-to- ponents analysis procedure in SPSS to ability of cutoffs for sub-Saharan Africans.
size sampling method. A quick household compute the index. The cut points in
count was carried out in each enumeration the wealth index at which to form the Ethical considerations
area to verify the number of the entire quintiles were calculated by obtaining a Permission to carry out this study was
households. Enumeration areas that sur- weighted frequency distribution of sought from the Kenya Medical Research
passed the maximum number of house- households and the sampling weight of Institute (KEMRI) National Ethical Re-
holds were segmented and only one the household. This resulted in the ve view Committee, and informed consent
segment randomly selected. The selected categories (i.e., lowest, second, middle, was obtained from each subject prior to
segments constituted clusters for the fourth, and highest wealth quintiles). participation in the study.
study. Anthropometric assessments. Waist
During the sampling process, three circumference was determined using Statistical methods
weights were generated from selection Roche circumference tapes. Subjects were Data were weighted and analyzed using
probabilities of clusters, households, and asked to stand upright in a relaxed manner, SPSS version 16, with P , 0.05 consid-
individuals. The nal individual weight with their feet comfortably apart, their ered statistically signicant. Results are
(taken as inverse of the three selection weight evenly balanced on both feet, and expressed as means 6 SD or as propor-
probabilities) was applied to the nal data with their arms hanging by their sides. tions (%). For categorical variables, the x2
in order to be representative of the target Waist circumference was measured at the test and Fisher exact probability were
population. point halfway between the lower border of used. Linear associations were calculated

888 DIABETES CARE, VOLUME 35, APRIL 2012 care.diabetesjournals.org

 Kaduka and Associates

using the Spearman correlation coef- fasting blood glucose (men: 77.8%; a signicant factor in men but not in
cient. Binary logistic regression using the women: 80.6%) were categorized as hav- women. In men, middle and high wealth
backward conditional method was per- ing metabolic syndrome. However, miss- quintiles were signicantly associated
formed on multiple factors to eliminate ing under the new criteria were 48% of with the occurrence of metabolic syn-
confounding and to examine the effect men with low HDL cholesterol and 61.4% drome (3.0 [1.18.0], P = 0.034, and
of the independent predictors of meta- with raised blood pressure and 43.9% 9.4 [3.524.9], P , 0.001, respectively).
bolic syndrome. of women with high waist circumfer- Level of education emerged as a signi-
ence and 46.1% with reduced HDL cant factor in women but not in men.
RESULTSdA total of 539 (men: 50.5%; cholesterol. Secondary education among women was
women: 49.5%) participants were as- The prevalence of metabolic syn- signicantly associated with protection
sessed for risk factors for metabolic drome among age-groups 1824, 25 from metabolic syndrome (0.3 [0.20.8];
syndrome. The mean age was 38 6 13 34, 3544, 4554, and .55 years was P = 0.012). Average monthly income
years. Up to 98% of the study partici- 9.9, 23.8, 39.6, 46.5, and 63.5%, respec- emerged as a signicant factor in men but
pants were black Africans from the fol- tively. Table 2 shows the proportions of not in women, with an income ranging
lowing ethnic groups: Luo (16.6%), men and women with risk factors for met- between $125 and $375 USD being sig-
Bohoran (3.7%), Luhya (22.3%), Kalenjin abolic syndrome by age categories. nicantly associated with the occurrence
(1.8%), Kikuyu (11.5%), Kamba (12.7%), of metabolic syndrome (7.0 [2.321.5];
Meru (2%), Kisii (7.4%), Mijikenda (2%), Bivariate analysis P = 0.001). No signicant association
Nubian (8.6%), Somali (2.6%), Indian Sex difference was observed in the asso- was observed between the main source
(1.2%), and others (Tanzania, Uganda, ciation with socioeconomic indicators of income and the occurrence of metabolic
Ethiopia, or Arab) 7.6%. The overall prev- and prevalence of metabolic syndrome, syndrome in both men and women.
alence of metabolic syndrome was 34.6% as shown in Table 3. A test for trend re-
and was higher in women than in men vealed age to be signicantly associated Multivariate analysis
(40.2 vs. 29%, respectively; P , 0.001). with occurrence of metabolic syndrome Binary logistic regression using the back-
Table 1 shows the prevalence of each com- in both men (x2 = 56.53, df = 4, P , ward conditional method was performed
ponent of the metabolic syndrome by sex 0.001) and women (x2 = 20.46, df = 4, on multiple factors to eliminate con-
in the study population. P , 0.001). Compared with the age- founding and to examine the effect of
Among those with metabolic syn- group 1824 years, the age-group 3544 independent predictors on the occur-
drome, the most frequently observed fea- years was signicantly associated with rence of metabolic syndrome. Four fac-
tures were raised blood pressure, a higher the occurrence of metabolic syndrome tors, namely age, socioeconomic status,
waist circumference, and low HDL choles- (odds ratio [OR] 27.2 [95% CI 3.7 level of education, and average monthly
terol (men: 96.2, 80.8, and 80%; women: 201.3]; P = 0.001) in men and also in income, found to be associated with the
89.8, 97.2, and 96.3%, respectively), women (2.9 [1.27.2]; P = 0.018). The occurrence of metabolic syndrome at P ,
whereas raised fasting glucose and TAGs association also was signicant in the age- 0.1 during bivariate analysis were consid-
were observed less frequently (men: 26.9 group 4554 years in men (25.9 [3.4 ered for multivariate analysis. Table 4
and 63.3%; women: 26.9 and 30.6%, re- 198.6]; P = 0.002) and women (5.8 shows factors found to predict occurrence
spectively). [2.215.3]; P , 0.001). The highest level of metabolic syndrome among men and
Under the new International Diabetes of signicance was observed in the age- women. Occurrence of metabolic syn-
Federation consensus statement criteria, group $55 years in both men (99.2 drome in men was signicantly associated
subjects with high waist circumference [12.6783.5]; P , 0.001) and women with age-groups 3544 years (adjusted
(men: 76.8%; women: 56.1%), raised (6.0 [2.216.5]; P , 0.001). Socioeco- OR 39.8 [95% CI 3.4263.0]; P =
TAGs (men: 90.9%; women: 94.3%), re- nomic status and occurrence of metabolic 0.002), 4554 years (46.0 [4.7446.6];
duced HDL cholesterol (men: 52%; syndrome among men and women re- P = 0.001), and $55 years (213.2
women: 53.9%), raised blood pressure vealed different measures of associa- [19.52326.9]; P , 0.001). In women,
(men: 38.6%; women: 63%), and raised tion. Socioeconomic status emerged as occurrence of metabolic syndrome was
signicantly associated with age-groups
4554 years (4.8 [1.415.8]; P = 0.011)
and $55 years (4.8 [1.317.8]; P = 0.018)
Table 1dPrevalence of risk factors for metabolic syndrome by sex
and not with age-group 3544 years (2.6
[0.88.3]; P = 0.097). Occurrence of met-
Risk factors for metabolic syndrome Men Women P abolic syndrome in men was signicantly
associated with the middle (OR 6.3 [95%
N 272 267
CI 1.625.1]; P = 0.009) and highest
High waist circumference* 30.1 70.3 ,0.001
quintiles (adjusted OR 14.9 [95% CI
Reduced HDL cholesterol 45.2 71.8 ,0.001
3.562.6]; P , 0.001), whereas in
Raised TAGs 20.2 13.1 0.155
women, the occurrence of metabolic syn-
Elevated blood pressurex 72.1 57.9 ,0.001
drome was signicantly associated with
Elevated fasting glucose|| 10.3 13.5 0.331
the fourth wealth quintile (3.7 [1.49.8];
Data are percentages, unless otherwise indicated. *Waist circumference $94 cm for men or $80 cm P = 0.009). Level of education was a sig-
for women. HDL cholesterol ,1.0 mmol/L for men or ,1.3 mmol/L for women or specic treatment for
this abnormality. TAG .1.7 mmol/L or specic treatment for this abnormality. xElevated blood pressure
nicant factor in men. Occurrence of meta-
.130/85 mmHg or treatment of previously diagnosed hypertension. ||Elevated fasting glucose .5.6 mmol/L bolic syndrome was signicantly associated
or treatment of previously diagnosed diabetes. with men who had attained a university

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Metabolic syndrome in urban Kenya

Table 2dProportions of risk factors for metabolic syndrome among men and women by age-group

1824 years 2534 years 3544 years 4554 years $55 years
Risk factors Male Female Male Female Male Female Male Female Male Female
High waist circumference* 2 (4.2) 15 (35.7) 15 (21.1) 45 (62.5) 22 (30.1) 57 (80.3) 17 (38.6) 38 (90.5) 27 (73.0) 32 (86.5)
Reduced HDL cholesterol 24 (50.0) 23 (53.5) 26 (37.1) 58 (80.6) 37 (50.7) 54 (76.1) 14 (31.8) 28 (66.7) 21 (58.3) 27 (73.0)
Raised TAGs 1 (2.1) 2 (4.7) 6 (8.6) 4 (5.6) 23 (31.5) 10 (14.1) 13 (28.9) 9 (21.4) 13 (35.1) 9 (24.3)
Elevated blood pressurex 35 (72.9) 16 (37.2) 37 (52.9) 35 (48.6) 51 (69.9) 38 (53.5) 40 (90.9) 34 (81.0) 33 (91.7) 30 (81.1)
Elevated fasting glucose|| 0 (0.0) 1 (2.4) 5 (7.1) 3 (4.2) 5 (6.8) 12 (16.9) 7 (15.9) 10 (23.8) 11 (29.7) 9 (24.3)
Data are n (%). *Waist circumference $94 cm for men or $80 cm for women. HDL cholesterol ,1.0 mmol/L for men or ,1.3 mmol/L for women or specic
treatment for this abnormality. TAG .1.7 mmol/L or specic treatment for this abnormality. xElevated blood pressure .130/85 mmHg or treatment of previously
diagnosed hypertension. ||Elevated fasting glucose .5.6 mmol/L or treatment of previously diagnosed diabetes.

level of education (9.8 [1.186.2]; P = addition to socioeconomic status and ed- In South Africa for instance, a study by
0.040). ucation contributing to the difference in Sliwa et al. (21) observed a high prevalence
the associations observed that need fur- of modiable risk factors for atherosclerotic
CONCLUSIONSdThe epidemiologi- ther investigation. disease and a combination of infectious
cal transition that often accompanies ur- Low HDL cholesterol and high waist and noncommunicable forms of heart
banization is characterized by increasing circumference were more prevalent in disease. They noted that epidemiological
prevalence of etiological risk factors for women as opposed to high blood pressure transition has broadened the complexity
metabolic syndrome, such as obesity, in men. Studies in Brazzaville, Cameroon, and spectrum of heart disease in the urban
diabetes, and high blood pressure. The and Ghana also have observed high car- African community. In Kenya, an autopsy
clustering of these risk factors confers a diometabolic risk in women than men, study by Ogengo et al. (22) found com-
greater risk of premature morbidity and with central obesity and high blood mon conditions associated with cardio-
mortality (11). Our study found the over- pressure as the most prevalent risk factors vascular deaths, such as myocardial
all prevalence of metabolic syndrome at (1618). Likewise, black populations in infarction, cardiomyopathy, subarach-
34.6% and was higher in women than the Caribbean, America, and Europe noid hemorrhage, pulmonary thrombo-
men (40.2 vs. 29%, respectively). Similar have been found to have low HDL choles- embolism, ruptured aortic aneurysm,
patterns have been observed elsewhere in terol levels and increased waist circumfer- hypertensive heart disease, infective peri-
Africa. The prevalence of metabolic syn- ence as the common risk factors for carditis, and rheumatic heart disease, sug-
drome among West African women and metabolic syndrome, and emphasis has gesting that NCDs do overlap with
men was found to be 42 vs.19%, respec- been on controlling central obesity and infectious conditions as causes of cardio-
tively; Great Tunis 31.2% (women 37.3 ethnic-specic reformulation of the meta- vascular mortality.
vs. men 23.9%, respectively); and bolic syndrome (12,19,20). Metabolic Various anthropometric and bio-
Seychelles between 25 and 30% (12 syndrome presents an increased risk for chemical factors differ with different eth-
14). The observed sex difference in the dis- type 2 diabetes and CVD. Thus, in addi- nic populations and with sex. In our
tribution of metabolic syndrome in this tion to pharmacologic treatment, lifestyle study, up to 48% of men with low HDL
study could be attributed to differences in interventions, such as atherogenic diets, cholesterol and 61.4% with raised blood
socioeconomic status, attainment of higher weight loss, and increased physical activ- pressure and 43.9% of women with high
education, and the interplay of the two. ity, should be encouraged to address the waist circumference and 46.1% with
Education attainment has a strong effect metabolic risk factors. There is need for reduced HDL cholesterol were missed
on health behaviors and attitudes and, more research to establish the true burden under the new International Diabetes
consequently, lifestyle. According to the and causes of CVDs and diabetes across Federation consensus statement criteria.
Kenya Demographic and Health Survey the country. Additional qualitative re- The new criteria may fall short in this
20082009 report, a sex difference exists search will help better understand the as- population and result in failure to
in educational attainment from the age of sociations observed. The inclusion of appropriately identify individuals for
14 years, with more male than female NCDs in national surveys such as the primary prevention and management
youths attending school (15). The same Kenya Demographic Health Surveys therapy (23). There is urgent need,
report shows a direct association between would serve as a start. therefore, for prospective research data
educational attainment and improvement In Kenya, chronic diseases have not from Africa that will guide the develop-
in wealth status for both men and women received much priority because of the ment of risk assessment tools that are pop-
in Kenya. In this study, the presence of overemphasis on communicable diseases ulation specic and sensitive to ethnic
metabolic syndrome was inversely associ- and donor-driven agenda that prioritize differences.
ated with attainment of higher education infectious diseases. Yet, ~53% of all hos- Identication of the social and eco-
in women but not in men. There was an pital admissions in Nairobi are attributed nomic characteristics associated with oc-
association between advancement in so- to NCDs, and diabetes contributes currence of metabolic syndrome is essential
cioeconomic status in both sexes, and at- ~27.3% of the total (3). It is important for the success of primary preventive mea-
tainment of university education in men for the policy makers and planners in sures. In women, the odds favoring meta-
with presence of metabolic syndrome. Kenya to be cognizant of the overlap be- bolic syndrome are said to signicantly
Thus, there could be other factors in tween infectious diseases and NCDs. increase with age and in unfavorable social

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891
Table 3dAssociation of selected risk factors with metabolic syndrome among men and women in an urban population in Kenya

DIABETES CARE, VOLUME 35, APRIL 2012

Men Women
With metabolic Without metabolic With metabolic Without metabolic
syndrome (n = 79) syndrome (n = 193) syndrome (n = 107) syndrome (n = 160)
OR OR
Factors n (%) n (%) (95% CI) P n (%) n (%) (95% CI) P
Age-group (years)
1824 1 (2.1) 47 (97.9) Reference 8 (18.6) 35 (81.4) Reference
2534 10 (14.1) 61 (85.9) 7.3 (0.956.9) 0.059 24 (33.3) 48 (66.7) 2.1 (0.85.2) 0.111
3544 27 (37.0) 46 (63.0) 27.2 (3.7201.3) 0.001 29 (40.8) 42 (59.2) 2.9 (1.27.2) 0.018
4554 16 (36.4) 28 (63.6) 25.9 (3.4198.6) 0.002 24 (57.1) 18 (42.9) 5.8 (2.215.3) ,0.001
.55 25 (69.4) 11 (30.6) 99.2 (12.6783.5) ,0.001 22 (59.5) 15 (40.5) 6.0 (2.216.5) ,0.001
NR/NA/DK 0 0 0 1
Socioeconomic status
Lowest quintile 6 (11.8) 45 (88.2) Reference 35 (40.2) 52 (59.8) Reference
Second quintile 9 (21.4) 33 (78.6) 2.1 (0.76.4) 0.197 16 (38.1) 26 (61.9) 0.9 (0.42) 0.882
Middle quintile 19 (28.4) 48 (71.6) 2.9 (1.18) 0.034 29 (38.2) 47 (61.8) 0.9 (0.51.7) 0.747
Fourth quintile 8 (17.4) 38 (82.6) 1.7 (0.55.1) 0.383 21 (56.8) 16 (43.2) 2.0 (0.94.4) 0.079
Highest quintile 36 (55.4) 29 (44.6) 9.3 (3.524.9) ,0.001 6 (24.0) 19 (76.0) 0.5 (0.21.3) 0.131
Level of education
None 7 (43.8) 9 (56.3) Reference 18 (50.0) 18 (50.0) Reference
Primary 21 (21.6) 76 (78.4) 0.4 (0.11.1) 0.066 61 (45.5) 73 (54.5) 0.8 (0.41.8) 0.647
Secondary 28 (23.9) 89 (76.1) 0.4 (0.11.2) 0.097 19 (25.0) 57 (75.0) 0.3 (0.10.8) 0.012
University 23 (54.8) 19 (45.2) 1.6 (0.54.9) 0.449 4 (28.6) 10 (71.4) 0.4 (0.11.4) 0.153
NR/NA/DK 0 0 5 1
Monthly income (USD)
,40 5 (12.8) 34 (87.2) Reference 39 (50.0) 39 (50.0) Reference
4075 11 (22.0) 39 (78.0) 2.1 (0.66.7) 0.216 22 (40.0) 33 (60.0) 0.7 (0.31.3) 0.262
75125 13 (19.7) 53 (80.3) 1.8 (0.65.7) 0.295 15 (35.7) 27 (64.3) 0.6 (0.31.2) 0.164
125375 22 (48.9) 23 (51.1) 7.0 (2.321.5) 0.001 11 (52.4) 10 (47.6) 1.2 (0.43.1) 0.759
.375 24 (63.2) 14 (36.8) 12.7 (4.040.7) ,0.001 4 (33.3) 8 (66.7) 0.5 (0.11.7) 0.249
NR/NA/DK 3 31 15 41
Main source of income
Formally employed 30 (29.4) 72 (70.6) Reference 20 (40.8) 29 (59.2) Reference
None 0 (0) 4 (100) UD 0.999 3 (30.0) 7 (70.0) 0.6 (0.12.5) 0.442

care.diabetesjournals.org
Farming 2 (33.3) 4 (66.7) 1.4 (0.37.7) 0.688 4 (66.7) 2 (33.3) 4.0 (0.626.4) 0.147
Self-employed 31 (32.3) 65 (67.7) 1.2 (0.62.1) 0.639 45 (45.0) 55 (55.0) 1.2 (0.62.5) 0.542
Petty trade 3 (14.3) 18 (85.7) 0.4 (0.11.6) 0.207 15 (41.7) 21 (58.3) 1.1 (0.42.6) 0.867
Other 9 (39.1) 14 (60.9) 1.5 (0.63.9) 0.388 13 (39.4) 20 (60.6) 1.0 (0.42.4) 0.924
NR/NA/DK 3 17 9 24
DK, do not know; NA, not applicable; NR, no response; UD, undened.
Metabolic syndrome in urban Kenya

Table 4dRisk factors for the occurrence of metabolic syndrome among men and women
in an urban population in Kenya AcknowledgmentsdThis study was sup-
ported in part by a scholarship from the Gregory
Taylor Memorial Fund (U.K.). The authors
Men Women thank Prof. Alan Jackson and Dr. Steven Wotton
of the Institute of Human Nutrition, University
Risk factors Adjusted OR (95% CI) P Adjusted OR (95% CI) P of Southampton, who awarded the scholarship
Age (years) for travel and biochemical analyses costs.
1824 Reference Reference No potential conicts of interest relevant to
this article were reported.
2534 9 (0.436.5) 0.230 2.4 (0.87.4) 0.139
L.U.K. researched data and wrote the man-
3544 29.8 (3.4263.0) 0.002 2.6 (0.88.3) 0.097 uscript. Y.K., J.K.B., and Z.N.B. researched
4554 46 (4.7446.6) 0.001 4.8 (1.415.8) 0.011 data, contributed to discussion, and reviewed
.55 213.2 (19.52,326.9) ,0.001 4.8 (1.317.8) 0.018 the manuscript. E.Ke. and E.Ku. contributed
Socioeconomic status to discussion and reviewed the manuscript.
Lowest wealth quintile Reference Reference M.M. contributed to discussion. L.U.K. is the
Second wealth quintile 3.1 (0.813.1) 0.115 1.2 (0.52.8) 0.751 guarantor of this work and, as such, had full
Middle wealth quintile 6.3 (1.625.1) 0.009 1.2 (0.62.6) 0.614 access to all the data in the study and takes
Fourth wealth quintile 1.9 (0.58.0) 0.372 3.7 (1.49.8) 0.009 responsibility for the integrity of the data and
Highest wealth quintile 14.9 (3.562.5) ,0.001 0.7 (0.22.1) 0.499 the accuracy of the data analysis.
Parts of this study were presented in abstract
Level of education
form at the 4th Africa Nutritional Epidemiol-
None Reference ogy Conference, Nairobi, Kenya, 48 October
Primary 1.7 (0.311.4) 0.581 2010.
Secondary 1.8 (0.312.3) 0.540 The authors acknowledge the editorial assis-
University 9.8 (1.186.2) 0.040 tance of Christine Bukania, formerly of the Aga
Khan Foundation, Kenya. The authors especially
thank Dr. John Jackson and Christian Gelauf of
class, as described by occupation and such as age, sex, income, and education the Institute of Human Nutrition, University of
decreased education level. In men, meta- level. Southampton (U.K.), for their assistance with
bolic syndrome increases signicantly This study helps to create awareness the biochemical analysis, as well as Ezekiel
with increasing age and socioeconomic among Kenyan policy makers and plan- Ogutu and Alex Muyera of the Kenya National
status (24). Our ndings were in support ners on the health status of the Kenyan Bureau of Statistics for their assistance in map-
of this observation. Metabolic syndrome urban population with respect to CVDs ping the study area. The authors also thank Ruth
Kayima and Linda Atieno of the University of
was prevalent among men of the highest and calls for attention to both behavioral Nairobi, Salma Abdi and Tobias Oliech of
socioeconomic status, those with second- and biological CVD risk factors. This study KEMRI for their assistance with nutritional
ary education, those who were self-employed, also contributes to the worldwide map- assessments, and Saidi Kisiwa and Ezekiel
and those of high-income earnings. ping of metabolic syndrome. This study Mukhaye of KEMRI for their laboratory support.
Women who presented with metabolic had a limitation. The cross-sectional de- The authors sincerely thank the administrative
syndrome were mostly those from the sign does not allow causal or directional ofcers and participants of Langata Constitu-
lowest socioeconomic status, those hav- inferences. Longitudinal studies are there- ency for their assistance and collaboration.
ing attained only primary education, fore encouraged.
those who were self-employed, and The prevalence of CVD risk factors
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