title: Obesity phenotypes in urban and rural Cameroonians: a cross-sectional study.
abstract: BACKGROUND
  Despite the increasing prevalence of diabetes and other health consequences of obesity, little is known on the metabolic profile across categories of body mass index (BMI) among African populations. We therefore assessed the prevalence and distribution of body size phenotypes among urban and rural Cameroonians.
  
  
  METHODS
  Adults (n = 1628; 41% rural dwellers) aged 24-74 years in 1994 provided data on BMI and metabolic health, defined on the basis of elevated levels of blood pressure (BP); triglycerides, fasting plasma glucose (FPG), and insulin resistance as assessed with homeostasis model assessment (HOMA). Cross-classification of BMI categories and metabolic status (healthy/unhealthy) created six groups. Metabolic measures include elevated blood pressure; elevated triglycerides (≥150 mg/dL or 1.69mmo/L), elevated fasting plasma glucose (≥100 mg/dl or 5.6 mmol/L or documented use of antidiabetic medications), and elevated homeostasis model assessment of insulin resistance value (HOMA-IR > 90(th) percentile).
  
  
  RESULTS
  A total of 25.2% of participants were overweight yet metabolically healthy (<1 abnormality) and 10.1% were obese yet metabolically healthy, whereas 1.4% were normal weight but metabolically abnormal (≥2 abnormalities). Proportion of rural dwellers with abnormal metabolic phenotype across normal-weight, overweight, obese categories were 2.9%, 0.8% and 0.3%, respectively; and 0 .3%, 2.2% and 2.6% among urban dwellers. Metabolically abnormal participants increased linearly across BMI categories (p < 0.001). BMI categories and metabolic status interacted to affect age, gender, BMI, FPG, triglycerides, and BP status distributions (all p < 0.04). Metabolic status and residence (rural vs. urban) interacted to influence the distribution across BMI categories of diastolic BP, BMI, waist circumference, fasting and 2-hour glucose, triglycerides, HOMA-IR, and prevalent diabetes (all p < 0.005), with differential occurrence of BMI categories and metabolic status among urban and rural participants.
  
  
  CONCLUSIONS
  Metabolic healthy obesity and obesity with a favorable cardiometabolic profile are not uncommon among Cameroonians, including among rural dwellers; but the latter group tended to have a better profile.
authors: Department of Community Medicine, Section of International Health, University of Oslo, Oslo, Norway.
authors: Vivian N
authors: VN
authors: Mbanya
authors: Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322 USA ; Department of Medicine, MedStar Health System, Baltimore, MD 21239 USA.
authors: Justin B
authors: JB
authors: Echouffo-Tcheugui
authors: Department of Community Medicine, Section of International Health, University of Oslo, Oslo, Norway.
authors: Hussain
authors: H
authors: Akhtar
authors: Health of Populations in Transition (HoPiT) Research Group, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé 1, Yaoundé, Cameroon.
authors: Jean-Claude
authors: JC
authors: Mbanya
authors: Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, Western Cape 7505 South Africa ; Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa ; The George Institute for Global Health, The University of Sydney, Sydney, NSW 2050 Australia.
authors: Andre P
authors: AP
authors: Kengne