Musculoskeletal functional ability in three diverse Sub-Saharan Africa Populations; assessing muscle strength & function to understand healthy ageing

Lead Research Organisation: University of Southampton
Department Name: Human Development and Health

Abstract

Around the world people are living longer than ever before. There are now 1 billion people aged over 60 years. In Africa, rising life expectancy is most rapid. The United Nations declaration of the Decade of Health Ageing 2021-2030 states there has never been a timelier opportunity to act to ensure the health of ageing adults, their families and communities. But ageing brings risk of disease, with muscles, bones and joints commonly affected (musculoskeletal disease), which limits walking and daily life. Often diseases exist together, such as with HIV and/or diabetes, this is known as multimorbidity. Multimorbidity is a high priority for global health research. Importantly, one third of all multimorbidity cases across the world include musculoskeletal disease. Currently musculoskeletal diseases account for disability than cancer and heart disease combined.

Loss of muscle strength and function is a common manifestation of ageing (known as sarcopenia), which leads to falls and fragility fractures (broken bones from low impact injuries), disability, frailty, and sometimes death. Despite this, little is known about how muscle ages in people living in sub-Saharan Africa (SSA), nor the risk factors for muscle loss or the impact on quality of life. We will study three different populations in The Gambia, Zimbabwe and South Africa. Aiming to:
i. How commonly muscle strength is impaired, physical functional is limited and sarcopenia is experienced.
ii. Understand to what extent losses in muscle strength and ability reduce the ability to perform activities of daily life, increase the risk of frailty and disability and how these impact quality of life.
iii. Identify clinical, nutritional and metabolic risk factors for losses muscle function, to inform approaches to reduce future disability, and promote healthy ageing in SSA.

Work package 1: What is the epidemiology of muscle strength, mass and function in each country? We collaborate with a team currently planning extensive community surveys in The Gambia, Zimbabwe and South Africa, which will measure spine fractures in 5040 men and women aged 40 years and over. We have a unique and time-limited opportunity to add to these surveys, data collection and detailed measurements of muscle strength, mass and function, to answer our specific study questions. We will collect data from questionnaires (e.g. joint and back pain, ability to work around the house, quality of life), body composition scans (to quantify fat and muscle mass), X-rays (to quantify osteoarthritis), muscle strength, walking and balance tests (to measure frailty), and blood tests. We will quantify levels of all musculoskeletal multimorbidities including sarcopenia, and determine how these affect disability and quality of life.
Work package 2: What are the clinical, nutritional and metabolic risk factors for low muscle strength, mass and function? Identifying risk factors for muscle impairment will aid understanding of the mechanisms underlying muscle dysfunction and highlight biomarkers that can predict disease and disability, with potential use in clinical settings. We will examine clinical (e.g. HIV, diabetes, physical inactivity, osteoarthritis) and nutritional risk factors (e.g. malnutrition, food insecurity, obesity), and measure 184 markers of metabolism and inflammation using the latest proteomic analysis of blood samples, to see which predict age-related losses in muscle.

We will feedback our findings to local communities, national health leads and policy makers, and international researchers.

This project grant offers a unique and highly-cost effective opportunity, taking advantage of a funded research platform. This MRC investment would permit detailed and novel study of muscle in some of the most rapidly ageing populations in the world. This presents a time-limited opportunity to answer these important research questions focusing on muscle health and functional ability.

Technical Summary

In sub-Saharan Africa (SSA) shifting demographics, rapid urbanization and associated lifestyle changes are generating an exponential rise in non-communicable diseases of ageing, of which musculoskeletal diseases are a significant proportion. There is an urgent need to reduce the time people spend living with locomotor disabilities and dependence, and to maximize functional ability amongst the growing ageing populations in resource poor countries in SSA. This proposal focuses on three countries, The Gambia, South Africa and Zimbabwe. Hypothesis: In the diverse ageing populations, high levels of adiposity and chronic infection with low levels of dietary diversity and physical activity are, in differing combinations, responsible for growing levels of sarcopenia and poor functional ability.
WP1: What is the epidemiology of muscle strength, mass and function in each country? We collaborate with a team currently planning extensive community-based population prevalence surveys in The Gambia, Zimbabwe and South Africa. We have a unique and time-limited opportunity to add to these surveys. We will collect data from questionnaires, DXA scans, muscle strength and function, physical performance and blood tests. We will quantify musculoskeletal multimorbidities including sarcopenia and determine associations with disability and HRQoL.
WP2: What are the clinical, nutritional and metabolic risk factors for low muscle strength, mass and function? Identifying risk factors for muscle impairment will aid understanding of mechanisms underlying muscle dysfunction. We will examine clinical, nutritional and metabolomic markers, and determine predictors of sarcopenia.
Findings fed-back to local communities, national health leads and policy makers.
This project grant offers a highly-cost effective opportunity, taking advantage of a funded research platform. This MRC investment would permit detailed and novel study of muscle in some of the most rapidly ageing populations in the world.

Publications

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Madanhire T (2023) The Impact of Human Immunodeficiency Virus and Menopause on Bone Mineral Density: A Longitudinal Study of Urban-Dwelling South African Women. in Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research

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Mukwasi-Kahari C (2023) Impaired Bone Architecture in Peripubertal Children With HIV, Despite Treatment With Antiretroviral Therapy: A Cross-Sectional Study From Zimbabwe. in Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research

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Norris SA (2022) Nutrition in adolescent growth and development. in Lancet (London, England)

 
Description CZI Ancestry of Musculoskeletal Tissues 
Organisation University of Oxford
Department Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Diseases (NDORMS)
Country United Kingdom 
Sector Academic/University 
PI Contribution I am lead for MRC Gambia site.
Collaborator Contribution Leading the work and capacity building, community engagement
Impact Not yet
Start Year 2022
 
Description MRC Unit The Gambia Genomics collaboration 
Organisation Medical Research Council (MRC)
Department MRC Unit, The Gambia
Country Gambia 
Sector Public 
PI Contribution A new collaboration with Dr Abdul Sesay Head of Genomics, MRCG. He and team are collaborating on the DNA extraction methods for MUFASSA
Collaborator Contribution Leading and advising laboratory work
Impact TRaining of team for DNA extraction. Work still in progress
Start Year 2022
 
Description Associate Editor of the Journal of Bone and Mineral Research 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact Kate was Associate Editor of the Journal of Bone and Mineral Research 2018-2022 inclusive.
Year(s) Of Engagement Activity 2022
 
Description BoneUp podcast interview 
Form Of Engagement Activity A broadcast e.g. TV/radio/film/podcast (other than news/press)
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact Kate was interviewed for an hour-long podcast, talking about my research programme in global musculoskeletal health.
Year(s) Of Engagement Activity 2021
 
Description BoneUp podcast interview at Bone Research Society 
Form Of Engagement Activity A broadcast e.g. TV/radio/film/podcast (other than news/press)
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact I was interviewed as part of a podcast from the Bone Research Society Annual Conference in Manchester. I am President of the Society.
Year(s) Of Engagement Activity 2022
 
Description Conference presentation 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact - 13th South African Child Health Priorities Association Conference. 24-26 November 2022. School of Public Health, Johannesburg. Oral presentation title: Perceptions of community-based organizations of mothers' social needs around maternal and child nutrition in urban South Africa
Year(s) Of Engagement Activity 2022
 
Description Conference presentation 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Winfrida Tombe-Mdewa (NIHR Academy Member):
- Oral presentation at the Public Health association of South Africa 2022 Conference - A cost effectiveness analysis of maternal multiple micronutrient supplementation in South Africa
Year(s) Of Engagement Activity 2022
 
Description Invited Speaker - International Osteoporosis Foundation 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact I was an invited speaker to at the IOF meeting. Fracture Prevention Services in LMICs.
Year(s) Of Engagement Activity 2022
 
Description Invited Speaker for an online symposium 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact I was an invited speaker to an online International Federation of Musculoskeletal Sciences talk. The Sub-Saharan African Musculoskeletal Network and research in Africa.
Year(s) Of Engagement Activity 2022
 
Description Invited Talk at London School for Hygiene and Tropical Medicine Global Health Leaders Session 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact I was an invited speaker to an online symposium hosted by London School of Hygiene and Tropical Medicine.
Year(s) Of Engagement Activity 2022
 
Description Radio interview 
Form Of Engagement Activity A broadcast e.g. TV/radio/film/podcast (other than news/press)
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact - Radio Interview with Radio 786, on the 9th of January about the importance of investing in early child nutrition in South Africa
Year(s) Of Engagement Activity 2023