Background: Gastroduodenal ulcer disease (GUD) is a significant
health burden in urban West Africa, a region undergoing a rapid nutritional
transition. Conventional assessment using Body Mass Index (BMI) may fail to
detect complex malnutrition phenotypes like sarcopenic obesity that could
impair ulcer healing. While the infectious and pharmacological etiologies of
GUD are well-documented, a critical knowledge gap persists regarding the role
of nutritional status as a modulator of disease severity and healing capacity.
This gap is particularly concerning in the context of the rapid and profound
nutritional transition currently underway in urban African centres like Lomé.
Aim: This study aimed to characterise the detailed nutritional and
metabolic profiles of GUD patients in Lomé, Togo, to unmask these underlying
disorders.
Methods: This cross-sectional analytical study, conducted from July
to October 2024, recruited 127 patients with endoscopically confirmed GUD. Data
were collected on sociodemographic, clinical, and dietary characteristics, with
dietary quality assessed via a Dietary Diversity Score (SDA). A score of ≤ 4
was classified as low dietary diversity, while a score of ≥ 7 was considered
high diversity.
Body composition, including
visceral fat and skeletal muscle mass, was Evaluated using multi-frequency
bioelectrical impedance analysis (BIA). Fasting venous blood was analysed for
key biochemical markers, including albumin, folate, and homocysteine.
Results: The cohort (mean age 43.7; 35.4% Helicobacter pylori positive)
presented a paradoxical nutritional profile. While BMI classified only 31.5% as
overweight or obese, BIA revealed a high prevalence of sarcopenic obesity:
46.5% exhibited a low protein index, and 39.4% had visceral obesity. Poor
dietary quality (SDA ≤ 4) was significantly associated with lower
concentrations of prealbumin and albumin (p<0.05), reduced serum folate
(p<0.01), and consequently higher, detrimental levels of homocysteine
(p<0.01). The strong inverse correlation between a low Dietary Diversity
Score (SDA) and elevated homocysteine levels, mediated by folate deficiency,
unveils a critical metabolic pathway that further hinders recovery. Regular
fruit consumption was protective against H. pylori infection (OR = 0.42), while
a low education level was an independent risk factor (OR = 2.85).
Conclusion: Patients with GUD in Lomé are affected by a severe
"double burden of malnutrition." The high prevalence of sarcopenic
obesity, entirely masked by BMI, fosters a systemic metabolic environment of pro-inflammatory
visceral adiposity and depleted protein reserves that is fundamentally
antagonistic to mucosal healing. These findings highlight the inadequacy of BMI
and underscore the urgent need to integrate body composition analysis and key
biochemical markers into clinical assessment to guide effective nutritional
interventions. This study has some limitations, including its cross-sectional
design and its single-centre focus at a tertiary hospital. Future research
should explore longitudinal studies to better understand the causal
relationships between nutrition, body composition, and GUD progression.
Author(s)details:-
Kponou Mathieu
Bienvenu TOBOSSI
Department of Biochemistry and Cell Biology, Faculty of Sciences and
Technologies, University of Abomey – Calavi, 01 BP 526, Cotonou, Benin.
Mamatchi MELILA
Department of Biochemistry, Faculty of Sciences, University of Lomé, 01 BP
1515 Lomé 01, Togo.
Mlatovi DEGBE
Department of Biochemistry, Faculty of Sciences, University of Lomé, 01 BP
1515 Lomé 01, Togo.
Abdel Haziz SINA OROU
Department of Biochemistry and Cell Biology, Faculty of Sciences and
Technologies, University of Abomey – Calavi, 01 BP 526, Cotonou, Benin.
Please see the book
here:- https://doi.org/10.9734/bpi/rpbs/v9/6570
