2024-25 Project (Whincup & Donin & Doyle)

Nutrition and cardiovascular risk reduction for youth in Zimbabwe

SUPERVISORY TEAM

Supervisor

Professor Peter Whincup at SGUL
Email: pwhincup@sgul.ac.uk

Co-Supervisor

Dr Angela Donin at SGUL
Email: adonin@sgul.ac.uk

Co-Supervisor

Dr Aoife Doyle at LSHTM
Email: Aoife.Doyle@lshtm.ac.uk

PROJECT SUMMARY

Project Summary

This PhD project aims to quantify the main dietary risk factors for cardiovascular disease in a population of youth in Zimbabwe, in order to define the key targets for prevention.  Hypertension is the most common pre-disposing condition, followed by overweight/obesity and diabetes, and prevalence of all three conditions is rising rapidly in Sub Saharan Africa (SSA).  

A recently completed adolescent health programme (Y Check) examined the effectiveness of health check-ups for treatment and prevention of chronic diseases in Zimbabwean youth.  In addition, the SHEAR study has recently been funded to examine elevated blood pressure and its impact on cardiovascular health in young adults in Zimbabwe.   This project will involve secondary analysis of Y-check data and a 3-month primary data collection period in Zimbabwe, nested within the planned SHEAR study, hosted by The Health Research Unit Zimbabwe (THRU ZIM) at the Biomedical Research and Training Institute.   

Y-Check data analysis will examine risk factors associated with elevated BP in this younger cohort and help to inform the development of dietary data collection tools for the primary data collection within the SHEAR cohort.  Detailed dietary data will be collected using 24 hour recalls and Food Frequency Questionnaires. The project will involve development of data collection tools and protocols tailored for a sub-Saharan African context, followed by dietary data collection, nested within SHEAR study data collection.  Dietary associations with key health measures, including BP, HbA1c, and anthropometric measures will be investigated, analyses will provide several opportunities to publish in peer reviewed Journals and present at relevant scientific conferences.  Finally, nutritional prevention strategies will be proposed with a view to reducing future cardiovascular risk.

Project Key Words

Youth   Zimbabwe    Diet   Cardiovascular risk          Prevention

MRC LID Themes

  • Global Health = Yes
  • Health Data Science = No
  • Infectious Disease = No
  • Translational and Implementation Research = No

Skills

MRC Core Skills

  • Quantitative skills = Yes
  • Interdisciplinary skills = Yes
  • Whole organism physiology = No

Skills we expect a student to develop/acquire whilst pursuing this project

Epidemiological analysis skills 
Field epidemiology skills including population based dietary data collection in LMIC setting.  
Dietary data analysis using appropriate Food Composition Tables

Routes

Which route/s is this project available for?

  • 1+4 = Yes
  • +4 = Yes

Possible Master’s programme options identified by supervisory team for 1+4 applicants:

  • LSHTM – MSc Epidemiology
  • LSHTM – MSc Nutrition for Global Health
  • SGUL – MSc Global Health

Full-time/Part-time Study

Is this project available for full-time study? Yes
Is this project available for part-time study? No

Eligibility/Requirements

Particular prior educational requirements for a student undertaking this project

  • SGUL’s standard institutional eligibility criteria for doctoral study.
  • MSc in public health field (e.g., Public Health, Epidemiology, Nutrition)

Other useful information

  • Potential CASE conversion? = No
  • Following upgrading, the project supervisory team will change (pending approval from SGUL RD Committee). It is envisaged that at transfer, Dr Donin will become Primary Supervisor, with Dr Doyle and Dr Kalpana Sabapathhy as Co-Supervisors.

PROJECT IN MORE DETAIL

Scientific description of this research project

Cardiovascular disease (CVD) is a leading cause of death worldwide; with mortality from stroke and heart disease increasing significantly over the last few decades.  A large proportion of the burden is now occurring in low- and middle-income countries (LMICs) (WHO, 2019), recent population-based studies in Sub-Saharan Africa (SSA) suggest this could be driven by a high prevalence of hypertension and other key cardiovascular risk factors (e.g., diabetes, obesity).  Poor diet is an important determinant of CVD and is associated with increased risk markers such as elevated BP, HbA1c and overweight/obesity.  A recent analysis of approximately 17,000 Zimbabwean youth (18-24y), found prevalence of elevated blood pressure (BP) of 19.6%. (K. Sabapathy et al, under review Lancet Child and Adolescent Health), suggesting that prevention interventions early in the life-course are essential.   

Y-Check is an innovative strategy to provide health check-ups during adolescence; a novel approach to engaging adolescents in the healthcare system and involves the screening and treatment/referral for common conditions.  Initial data from Zimbabwe (2022) indicate that a high proportion of adolescents had elevated BP (24%), which demonstrates the urgent need to identify modifiable risk factors for cardiovascular risk in this young population.     

This PhD project aims to investigate the dietary determinants of elevated BP, and other cardiovascular risk markers in young people in Zimbabwe.   The project will be nested within a cross-sectional study of young people recently funded by the Wellcome trust (SHEAR study- Significance of Hypertension in Early Adulthood Research), which will collect a range of socio-demographic, behavioural, clinical, and biological markers associated with increased cardiovascular risk.  This PhD proposal will include the addition of detailed dietary data collection.  

Through secondary data analysis of adolescents in Y-Check to inform the primary data collection nested within the SHEAR study, the PhD project has the following objectives; 
1. To explore social, cultural and limited dietary risk factors for elevated BP in the Y-Check study cohort 
2. To develop an effective dietary measurement tool to assess key food item consumption relevant to the local context 
3. To examine associations between dietary intakes and cardiovascular risk markers in a population of young adults in Zimbabwe (nested within SHEAR study).  
4. To consider potential nutritional prevention strategies suitable for the Zimbabwean setting to reduce the risk of cardiovascular disease. 

Techniques 
1. Secondary quantitative analysis of Y-Check study data in Zimbabwe, using appropriate statistical techniques. 
2. Questionnaire development and dietary data collection tools. 
3. Dietary data collections (e.g., use of 24-hour dietary recall, food frequency questionnaires) and use of African Food Composition Tables to analyse dietary data.  

Availability of databases 
1. Review of openly available literature and literature available through LSHTM and SGUL licences 
2. Data on BP (up to 3 measurements), anthropometry, lifestyle factors (diet, alcohol, smoking, exercise etc.) will be available for a cohort of 1000 adolescents with measurements of BP and lifestyle measures at 2 timepoints (baseline and 4 months) using data from Y-Check 
3. Primary data collection which will be conducted during the PhD with funding from MRC DTP, nested within the SHEAR study. 

Potential risks  
The main potential risk is that the primary data collection (objective 3) cannot take place due to political unrest and/or other unforeseen circumstances. In such a situation, an additional secondary analysis component of the PhD would be introduced e.g. based on existing data from the Y-Check study, modelling of potential impact of screening and lifestyle interventions in adolescents in Zimbabwe to reduce cardiovascular risk in later life.

Further reading

(Relevant preprints and/or open access articles)

Additional information from the supervisory team

  • The supervisory team has provided a recording for prospective applicants who are interested in their project. This recording should be watched before any discussions begin with the supervisory team.
    Whincup-Donin-Doyle Recording

MRC LID LINKS