Int
ern
at
i
onal
Journ
al of
P
u
bli
c Hea
lt
h S
c
ie
nce (IJPH
S)
Vo
l.
7
, No
.
4,
Decem
ber
201
8
, p
p.
274~
282
IS
S
N: 22
52
-
8806
,
DOI: 10
.11
591/ij
phs
.
v7
i4
.
14495
274
Journ
al h
om
e
page
:
https:
//
ww
w.i
aesco
re
.c
om
/j
our
nals/
ind
ex.
php/IJP
H
S
Ris
k
F
ac
tors fo
r Non
-
comm
un
icable Dis
eases am
ong A
du
lts of
25
-
65
Y
ears
at K
akam
ega Count
y Gen
eral Hospit
al, K
enya
Monic
ah N
j
am
bi Kibe,
Go
r
do
n
Ngu
ka, Si
lvenus K
onyo
l
e
Depa
rtment
o
f
N
utri
ti
on
al Sci
en
c
es,
Masinde
Mul
iro
Unive
rsi
t
y
of
Scie
n
ce a
nd
Tec
hnolog
y
,
Ken
y
a
Art
ic
le
In
f
o
ABSTR
A
CT
Art
ic
le
history:
Re
cei
ved
J
ul
1
9
, 2
01
8
Re
vised
Oct
2
0
, 2
01
8
Accepte
d
Oct
27
, 201
8
In
Ken
y
a
th
e
growing
num
ber
o
f
pre
m
at
ure
deat
hs
with
hal
f
of
al
l
hospital
admiss
ions
and
33%
of
al
l
de
aths
are
associate
d
with
Non
-
c
o
m
m
unic
abl
e
disea
ses.
The
stud
y
d
eterm
ine
d
th
e
ph
y
sic
a
l
m
ea
surem
ent
s
and
li
pid
par
amete
rs
of
a
dult
s
25
-
65
y
e
a
rs
at
Kak
amega
C
ount
y
Gen
eral
Hos
pit
a
l
.
Data
was
collecte
d
using
t
he
W
HO
STEPs
Instrum
en
t:
Ph
y
sic
al
m
ea
surem
ent
s
assess
ed
were
M
id
Upper
Arm
Circ
um
fer
ence,
W
ai
st
Hip
m
ea
surem
ent
s,
Bod
y
m
ass
Inde
x
and
blood
pre
ss
ure
.
The
stud
y
signifi
c
anc
e
le
ve
l
was
0.
05
.
Dat
a
was
anal
y
z
ed
using
SP
SS
ver
sion
20.
Descri
pti
v
e
stat
isti
cs
was
u
sed.
χ
2
te
st
of
inde
pende
n
ce
was
used
to
fi
nd
out
the
rel
a
ti
onship
betw
ee
n
ant
hropo
m
et
ric
m
ea
sure
m
ent
s
and
li
pid
par
amete
rs
.
Data
was
pre
sente
d
in
for
m
of
ta
ble
s,
figur
e
s
and
te
xts.
T
her
e
was
a
signifi
c
ant
re
la
t
i
onship
bet
wee
n
BMI
and
Tri
gl
yce
rid
eχ
2
(12
,
N=60)=
25.
752
P=0.
012,
BMI
and
LDLχ
2
(8
,
N=60)=
19.
312
p=0.
013,
BMI
and
Total
Chole
sterol
χ
2
(8
,
N=60)=
18
.
694
p=0.
017
,
MU
AC
and
HD
L
χ
2
(4,
N=60
)
=14.
446
p=0
.
00
6,
W
HR
and
Tot
al
Chole
st
ero
l
χ
2
(2,
N=60)=
17.
98
5
p
=0.
000
,
W
HR
and
LD
L
χ
2
(2,
N
=60)
=15.
246p=0
.
000
.
The
stud
y
ad
voca
t
e
d
for
poli
cies
to
red
u
c
e
th
e
in
ci
d
enc
es
of
risk
fa
ct
ors
fo
r
NCD
s
which
will
assist
i
n
ac
hi
eve
m
ent
of
Sus
ta
ina
ble
Dev
el
opm
ent
Goa
ls.
Ken
y
an
popu
lation
ar
e
in
nee
d
of
scre
eni
n
g
for
risks
associ
at
ed
with
NCD
s
.
Ke
yw
or
d:
Adults
An
t
hro
po
m
et
ri
cs
Ca
rd
io
vasc
ular
d
i
seases
Lipid
p
aram
et
ers
Non
-
com
m
un
ic
able d
ise
as
es
Copyright
©
201
8
Instit
ut
e
o
f Ad
vanc
ed
Engi
n
ee
r
ing
and
S
cienc
e
.
Al
l
rights re
serv
ed
.
Corres
pond
in
g
Aut
h
or
:
Mon
ic
a
h Nj
am
bi K
i
be
,
Dep
a
rtm
ent o
f Nu
t
riti
on
al
Sci
ences
,
Ma
sind
e M
ulir
o Un
i
ver
sit
y o
f
Scie
nce a
nd T
echnolo
gy
,
P.
O
. Box
190
-
50100 Ka
kam
e
ga
-
We
bu
ye
R
oa
d
, Ke
nya
.
Em
a
il
:
m
on
ic
a
k.kibe
@g
m
ai
l.
com
1.
INTROD
U
CTION
Global
ly
2.
8
m
illi
on
pe
ople
die
an
nual
ly
as
a
res
ult
of
be
ing
ov
e
r
weig
ht
or
obese
a
nd
35.8
m
il
li
on
disabili
ty
-
ad
j
ust
ed
li
fe
ye
ars
are
due
to
over
weig
ht
an
d
obesi
ty
[1]
.
STE
PS
20
15
i
nd
ic
a
te
s
that
pr
e
vale
nce
of
ov
e
r
weig
ht
an
d
obesi
ty
has
increase
d
dr
ast
i
cal
ly
especial
l
y
a
m
on
g
w
ome
n
ha
ving
38%
ov
e
rw
ei
gh
t
an
d
14%
ob
e
se
in
al
l
th
e
Ken
ya
n
c
ounties
[2
]
.
Wh
il
e
weigh
t
loss
al
on
e
can
im
pr
ove
on
m
ark
ers
of
Ca
r
diova
scular
diseases
(C
VDs),
m
anipu
la
ti
ng
dieta
ry
m
acr
onutrie
nts
co
ntents
co
ntribute
s
to
the
benefi
ci
al
eff
ect
s
of
weig
ht
loss and fur
the
rs
the im
pr
ov
e
m
ent o
f
li
pid
profil
e
even
without al
te
rati
on
of
total
caloric
intake
[
3]
.
CV
Ds
are
cause
d
by
at
he
ro
scl
e
ro
sis
w
hich
resu
lt
du
e
to
high
inta
ke
of
c
ho
le
ste
r
ol
w
hich
ca
use
s
narr
ow
i
ng
of
bloo
d
vessels
with
blo
od
li
pid
s
bein
g
car
diovascul
ar
healt
h
in
dicat
or
s
[
4]
.
The
con
ce
ntrati
on
of
plasm
a
li
po
prote
in
s
is
influe
nce
d
by
both
qu
a
ntit
y
and
qual
it
y
of
f
at
s
co
nsu
m
ed
an
d
it
s
ba
la
nce
is
m
or
e
i
m
po
rta
nt
tha
n
total
dieta
ry f
at
s c
onsu
m
ed
[
5]
.
NCDs
ar
e
the
sing
le
cause o
f
p
re
ve
ntable
il
l
nesses,
d
isa
bili
ty
and
m
or
ta
li
t
y
wo
rl
dw
i
de
w
hich
great
l
y
i
m
pact
on
pro
du
ct
ive
capaci
ty
[6]
.
Accele
r
at
ing
bu
rd
e
n
of
NC
Ds
in
de
velo
ping
co
unt
ries
is
now
a
public
healt
h
co
ncern
causing
a
ppr
ox
im
at
el
y
8.
4
m
i
ll
ion
death
s
annuall
y
distribu
te
d
world
wide
irres
pect
ive
of
so
ci
al
eco
nom
ic
sta
tus
with
increasin
g
t
rend
in
LMICs
[
7]
.
NC
Ds
a
cc
ount
for
27%
of
deat
hs
in
Ken
ya
,
total
ing
al
m
os
t
100,000
pe
ople
per
ye
ar
[8
]
.
Hype
rcholest
er
olem
ia
is
m
or
e
pr
e
valent
in
hi
gh
inc
om
e
gr
oups
Evaluation Warning : The document was created with Spire.PDF for Python.
IJPHS
IS
S
N: 22
52
-
8806
Risk
Fa
ct
or
s f
or N
on
-
c
omm
unic
ab
le
Disease
s amon
g
A
dult
s o
f
25
-
65 Ye
ars at
…
(
Mo
nica
h
Nj
am
bi Kibe
)
275
than
m
idd
le
an
d
lo
w
incom
e
gr
oups
[9]
.
I
n
a
stud
y
am
on
g
young
a
du
lt
s
of
18
-
25
ye
ars
sh
owe
d
that
pa
te
rn
al
edu
cat
io
n
was
associat
ed
wit
h
a
l
ow
e
r
BM
I
an
d
a
bette
r
li
pid
pro
file
[
10]
.
A
st
ud
y
by
Om
oto
ye
show
ed
that
edu
cat
io
n
an
d
incom
e
has
posit
ive
correla
ti
on
with
L
DL
-
C,
Tri
glyc
erid
es
an
d
T
otal
C
ho
le
ste
r
ol
bu
t
hav
e
a
neg
at
ive
a
sso
c
ia
ti
on
with
H
DL
-
C
[11]
.
Th
e
stud
y
ai
m
ed
to
show
t
he
re
la
ti
on
sh
i
p
bet
ween
a
nthro
po
m
et
rics
and li
pid
pa
ra
m
et
ers
of K
e
ny
ans
in
K
a
kam
ega C
ounty.
2.
RESEA
R
CH MET
HO
D
The
st
ud
y
was
locat
ed
at
Ka
kam
ega
Count
y
Gen
e
ral
H
ospit
al
a
m
on
g
60
ad
ults
of
25
-
65
ye
ars
as
a
cro
ss
-
sect
io
nal
analy
ti
cal
stud
y
desi
gn
w
he
re
qua
ntit
at
ive
m
e
tho
d
of
da
ta
colle
ct
ion
was
us
e
d.
T
he
stud
y
include
d
ad
ults
of
25
-
65
ye
ar
s
w
ho
a
gr
ee
d
t
o
par
ti
ci
pate
.
P
eop
le
excl
ud
e
d
from
the
stu
dy
wer
e
th
os
e
ha
ving
any
of
the
co
nd
it
io
ns
;
diabe
te
s,
hype
rten
sion
an
d
ca
rd
i
ovasc
ular
disea
ses.
Ra
nd
om
sa
m
pling
was
us
e
d
to
identify
the
ta
rg
et
popula
ti
on
an
d
pur
po
si
ve
sam
pling
w
as
us
e
d
to
determ
ine
tho
se
no
t
s
uffer
i
ng
f
ro
m
t
he
m
entioned
c
onditi
on
s
.
This
stud
y
was
a
ppr
oved
by
Ma
sinde
Muli
ro
U
nive
rsity
of
Scie
nc
e
and
Tec
hnol
og
y
In
sti
tuti
onal
R
eview
B
oard
(
MM
US
T
IRB)
an
d
per
m
it
was
giv
e
n
by
N
at
ion
al
Com
m
issi
on
for
Scie
nce,
Tech
no
l
og
y
a
nd
I
nnovat
ion
(NACO
STI/P
/17
/9
8745/1
90
74).
A
wr
it
te
n
co
ns
e
nt
wa
s
obta
ined
fro
m
the
par
ti
ci
pa
nts
up
on
thei
r
agr
e
e
m
ent.
Pr
incipl
es
of
et
hics
we
re
obser
ve
d
thr
oughout
the
stud
y;
be
nef
ic
e
nc
e
was
achieve
d
by
ai
m
ing
for
be
nefi
ts
fr
om
the
stu
dy
to
the
com
m
un
it
y,
j
us
ti
ce
was
achieve
d
by
rand
om
sa
m
pl
ing
,
and
non
-
m
al
fe
asance
was
obs
erv
e
d
by
m
inim
iz
ing
har
m
from
the
stud
y.
Au
t
onom
y
and
confide
ntial
it
y
of
th
e
data we
re m
ai
ntained by co
di
ng the
data a
nd
avoida
nce
of use o
f partic
ipa
nt’s nam
es.
Data
wa
s
c
ollec
te
d
us
in
g
WHO
S
TEPs
instr
um
ent
wh
ic
h
is
the
t
oo
l
us
e
d
t
o
c
ollec
t
data
a
nd
m
easure
NCD
s
.
T
he
W
or
l
d
Healt
h
O
r
gan
iz
at
io
n
S
T
EPs
I
ns
tr
um
ent
cov
e
red
2
dif
fer
e
nt
le
vels
or
ste
ps
of
ris
k
factor
assessm
ent:
St
ep
2:
P
hysic
al
Me
asur
em
ent
-
An
t
hro
po
m
et
ri
c
m
easur
em
ents
su
c
h
as
heig
ht
an
d
wei
gh
t
us
i
ng
Stadiom
et
er,
waist
-
hip
m
easur
em
ents
with
t
ape
m
easur
e,
Mi
d
Upper
Arm
ci
rcu
m
fer
en
ce
us
in
g
MUA
C
ta
pe
and
Bl
ood
P
r
essure
us
i
ng
s
ph
y
gm
o
m
ano
m
et
er,
Step
3:
Bi
och
em
ic
al
m
easur
em
ents;
li
pid
pa
nel.
Weig
ht
m
easur
em
ents
was
ta
ke
n
us
ing
a
porta
ble
sta
nd
a
rd
scal
e
with
sub
j
ect
s
wear
i
ng
only
li
gh
t
cl
oth
i
ng
a
nd
no
sh
oe
s.
Bo
dy
w
ei
gh
t
was
ta
ke
n
us
i
ng
a
scal
e
to
the
nea
res
t
0.
1k
g.
T
he
w
ei
gh
in
g
scal
e
was
cal
ibrate
d
ever
y
day
be
f
or
e
the
assessm
ent.
Bod
y
hei
gh
t
i
n
centim
et
ers
w
as
ta
ke
n
with
the
s
ubj
ect
s
st
and
wit
h
thei
r
heels
,
bu
tt
oc
ks,
a
nd
heads
a
gain
st
a
wall
.
A
flat
obj
ect
was
pla
ced
on
to
p
of
t
he
obj
ect
’
s
hea
d
a
nd
their
he
igh
t
was
m
ark
ed
on ta
pe
aff
i
xed to t
he
w
al
l.
Bod
y
Ma
ss
Index
was
cal
cul
at
ed
as
body
weig
ht
in
kilo
gr
am
s
div
ided
by
sq
ua
re
of
body
hei
gh
t
in
m
et
ers.
W
ai
st
ci
rcu
m
fer
ence
was
ta
ke
n
m
idp
oi
nt
bet
ween
the
lowe
r
m
arg
in
palpa
ble
ri
b
an
d
t
he
to
p
of
il
ia
c
crest
in
a
h
ori
zon
ta
l plane
. H
ip
ci
rc
um
fer
enc
e
was
m
easur
ed
a
rou
nd
the pel
vic
at
point o
f
m
axi
m
al
pr
ot
ru
si
on
of
the
butt
oc
ks.
For
both
Wai
st
Ci
rcu
m
fer
en
ce
and
Hip
Ci
r
cum
fer
ence
s
ubj
ect
s
wer
e
i
nst
ru
ct
ed
t
o
sta
nd
with
arm
s
at
the
sides,
feet
posit
ion
ed
cl
os
e
t
og
et
her,
an
d
weig
ht
even
ly
distri
bute
d
ac
ross
the
feet.
Ci
rc
um
fe
ren
c
e
was
m
easur
ed
at
the
end
of
a
qu
ie
t
ex
pirati
on
of
t
he
sub
je
ct
to
the
neare
st
0.
1cm
.
W
a
ist
Hip
Ra
ti
o
(
WH
R
)
was
cal
culat
ed
by
div
idin
g
Waist
Ci
rcu
m
fer
ence
by
Hip
Ci
rcu
m
fer
enc
e.
W
ai
st
and
hi
p
ci
rcu
m
fer
en
ce
was
done
usi
ng
a
ta
pe
m
easur
e
in
c
m
.
Lipid
par
a
m
et
ers
[Tr
igly
ceride
(T
G
),
L
ow
Densi
ty
Li
poprotei
n
-
Ch
ol
est
ero
l
(LDL
-
C)
,
Hi
gh
De
ns
it
y
Lipo
pr
otein
-
C
ho
le
ste
ro
l
(
HDL
-
C
)
an
d
Tot
al
Ch
oleste
ro
l
(
TC)]
wer
e
assesse
d
us
in
g
Ca
rd
io
-
Chec
k
Pr
ofessi
on
al
A
naly
zer
(PA)
Ma
chine.
Data
was
an
al
yz
ed
us
in
g
Stat
ist
ical
Packa
ge
f
or
So
ci
al
Scie
nces
(
SPS
S)
ve
rsion 2
0
s
of
t
war
e. D
esc
r
ipti
ve
sta
ti
sti
cs
and
i
nf
e
ren
ti
al
sta
ti
sti
cs
wer
e
us
ed
i
n
the
a
na
ly
si
s.
Descr
i
ptive
sta
ti
sti
cs
of
ce
ntr
al
te
nd
e
ncy
w
as
us
e
d
obta
in
fr
e
quencies
a
nd
pe
rce
ntages
of
ant
hro
po
m
et
rics
m
easur
es
a
nd
li
pid
pa
ram
et
e
rs.
Re
la
ti
on
s
hi
p
bet
ween
a
nt
hro
po
m
et
rics
and
li
pi
d
pa
ra
m
et
ers
was
ob
ta
ined
us
in
g
χ
2
sta
ti
sti
c of in
de
pende
nt.
Si
gn
i
fican
c
e level
s
was
te
ste
d
at
0.05
.
3.
RESU
LT
S
A
ND
DI
SCUS
S
ION
The
st
ud
y
was
done
t
o
deter
m
ine
the
ris
k
f
act
or
s
for
NC
Ds
am
on
g
ad
ul
ts
25
-
65
ye
a
rs
at
Kak
am
ega
County
Ge
neral
Hospita
l.
V
ariables
st
ud
ie
d
incl
ud
e
d
so
c
ia
l
dem
og
raph
ic
char
act
e
risti
cs
su
c
h
a
s
a
ge
,
se
x,
edu
cat
io
n
le
vel
,
incom
e
le
vel
and
ty
pe
of
oc
cup
at
io
n.
A
n
th
rop
om
et
rics
as
sessed
incl
ud
e
d,
MU
AC,
W
a
ist
and
Hip
Ci
rc
um
fe
ren
ce
(
WH
R)
,
W
ei
ght
an
d
Heig
ht
(BMI),
a
nd
total
body
fat
pe
rc
entage.
Bi
oche
m
ic
al
m
easur
em
ents assessed
w
as
li
pid
pro
file
incl
ud
i
ng Tr
i
glyc
erides,
HDL
-
C,
LDL
-
C an
d To
ta
l C
ho
le
ste
r
ol.
Re
su
lt
s on
s
oci
o
dem
ographic
ch
aracte
risti
cs ind
ic
at
ed
t
hat m
ajo
rity
of the
p
arti
ci
pa
nts were f
em
al
es
(67.3%
)
with
half
of
the
pa
r
ti
ci
pan
ts
bein
g
youth
s
26
-
35
ye
ars
(50.0%
).
A
good
num
ber
of
the
par
ti
c
ipants
had
form
al
edu
cat
ion
with
the
m
ajo
rity
hav
in
g
colle
ge/
unive
r
sit
y
edu
c
at
ion
(
73.3
%
).
In
te
rm
s
of
m
arit
al
sta
tus
ab
ou
t
ha
lf
of
the
par
ti
ci
pan
ts
wer
e
m
arr
ie
d
(
56.
7%
).
T
hirty
-
th
r
ee
po
i
nt
thr
ee
per
ce
nt
(
33.
3%
)
of
the
par
ti
ci
pa
nts
we
re
governm
ent e
m
plo
ye
es an
d 3
3.3%
of the
pa
rtic
ipants
ha
d no any
source
of inc
om
e
.
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S
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ol.
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,
No.
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,
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ber
2018
:
274
–
282
276
3.1.
Anthr
opome
trics me
as
ureme
nt
s
3.1.1.
B
ody
m
as
s in
dex
(B
M
I)
Fo
rty
-
t
hr
ee
point
fou
r
pe
rcen
t
(43.4%)
of
t
he
par
ti
ci
pa
nts
wer
e
ov
e
r
weig
ht
(25.0
-
29.
9k
g/m
2
),
33
.
3%
had
no
rm
al
BM
I
(
18.6
-
24.
9kg/m
2
),
16.7
%
we
re
obese
(≥3
0.0kg/m
2
),
3.
3%
were
un
derweig
ht
(17.1
-
18.
5kg/
m
2
)
and
3.3%
with
a
BM
I
of
(<
17
.
0kg/m
2
)
wer
e
m
od
eratel
y
un
de
rw
ei
ght.
Alm
os
t
half
of
the
par
ti
ci
pa
nts
w
ere
ov
e
rw
ei
gh
t
with
a
BM
I
of
25.
0
-
29.
9kg/m
2
sh
own
in
Figure
1
.
Re
gula
r
physi
cal
act
ivit
y
con
t
rib
ute the
avo
i
dan
ce
of
over
weig
ht a
nd
hen
ce
to
t
he
preven
ti
on
of
dysli
pid
em
ia
[12]
.
Figure
1. Bo
dy m
ass ind
ex
m
easur
em
ents
3.1.2.
Wais
t
hi
p ratio
mea
su
reme
nt
s
Seve
nty
-
three
po
i
nt
three
pe
rcen
t
(
73.3
%)
had
no
rm
al
waist
hip
rati
o
of
≤
0.88,
26.
7
%
of
th
e
par
ti
ci
pa
nts h
a
d
high w
ai
st hi
p
Ra
ti
o
m
easurem
ents (
> 0
.82
f
or
fe
m
al
es
an
d
> 0
.
94
fo
r
m
al
es).
Mor
e tha
n
half
at
7
3.3
%
of
t
he
p
a
rtic
ipants
ha
d norm
al
w
ai
st
h
ip
r
at
io
m
eas
ur
em
ents
sho
w
n
in
Fig
ure
2
.
Figure
2.
W
ai
s
t Hip
Ra
ti
o m
e
asur
em
ents
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IJPHS
IS
S
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52
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Risk
Fa
ct
or
s f
or N
on
-
c
omm
unic
ab
le
Disease
s amon
g
A
dult
s o
f
25
-
65 Ye
ars at
…
(
Mo
nica
h
Nj
am
bi Kibe
)
277
3.1.3.
T
otal b
ody
fat per
cen
t
ag
e
(TBF
%
)
measure
ment
s
Ninety
per
ce
nt
(90.0
%)
of
th
e
par
ti
ci
pan
ts
had
high
total
body
fat
pe
rce
ntage,
6.7%
ha
d
norm
al
and
3.3
%
had
low
total
body
fat
per
ce
ntage
.
Re
su
lt
s
sh
ows
m
ajo
rity
of
th
e
par
ti
ci
pan
ts
90%
ha
d
high
le
vels
of total
bo
dy f
a
t per
ce
ntage
s
how
n
i
n
Fi
gure
3.
Figure
3. Tot
al
bod
y
fat
per
ce
ntage (TB
F
%) m
easur
e
m
ents
3.1.4.
Mid
up
per a
r
m cir
cu
mference
mea
suremen
ts
Fo
rty
pe
rce
nt
(40.0
%
)
of
th
e
par
ti
ci
pa
nts
wer
e
over
weigh
t
(2
8.3
-
31.
6cm
),
30.
0
%
w
ere
norm
a
l
(24
-
28.
1cm
)
and
20.
0
%
w
ere
obese
(>31.
7cm
),
6.7
wer
e
unde
rw
e
igh
t
(
23
-
23.9c
m
)
and
3.3
%
wer
e
m
od
eratel
y
underweig
ht
(<22.
9cm
)
in
te
rm
s
of
Mi
d
U
ppe
r
Ar
m
Ci
rcu
m
fer
e
nce
m
easur
em
ents.
Alm
os
t
hal
f
of the
par
ti
ci
pa
nts
40.0
%
w
e
r
e ove
r
weig
ht s
how
n
in
Fig
ure
4
.
Figure
4. Mi
d
uppe
r
arm
circum
fer
ence m
easur
em
ents
3.2.
Bl
ood
pr
essure me
as
ur
ements
Ph
ysi
ol
og
ic
al
m
easur
em
ents
of
Bl
ood
pre
ssu
re
s
howe
d
40
.
0%
of
th
e
par
ti
ci
pan
ts
had
opti
m
al
syst
olic
blo
od
pr
ess
ure
of
<
120mm
Hg
and
about
23.
4%
ha
d
m
il
d
hyper
t
ensio
n
(
140
-
15
9mm
Hg
).
Dias
toli
c
blood
press
ur
e
m
easur
e
m
ents
show
ed
that
60.
0%
of
the
pa
rtic
ipants
ha
d
op
ti
m
al
diastoli
c
blood
press
ur
e
of
<80
m
m
Hg
wit
h
16.
7%
ha
vin
g
high
norm
al
le
vels
86
-
89m
m
Hg
.
Tabl
e
1.
T
he
st
udy
ob
se
rv
e
d
t
ha
t
the
popu
la
ti
on
un
der
st
ud
y
wa
s
at
risk
of
hype
rtensio
n.
Syst
olic
pr
ess
ur
e
s
howe
d
t
hat
23.
4%
ha
d
m
il
d
hype
rtensio
n
(
140
-
159
m
m
H
g)
an
d
3.3%
ha
d
m
od
erate
hy
per
te
ns
i
on
of
160
-
179mm
H
g.
Diast
olic
pressure
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IS
S
N
:
2252
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IJPHS
V
ol.
7
,
No.
4
,
Decem
ber
2018
:
274
–
282
278
m
easur
em
ents
sh
owe
d
t
hat
16.
7%
ha
d
high
norm
al
le
vels
86
-
89m
m
Hg
a
nd
10.
0%
ha
d
m
il
d
hyper
te
ns
i
on
Table
1.
The
r
esults
rev
e
al
ed
a
gr
eat
healt
h
risk
since
t
he
popula
ti
on
under
in
vestigat
i
on
has
nev
e
r
been
diag
nosed
of
hype
rtensio
n.
The
r
esult
c
orrelat
e
with
th
os
e
of
Nuge
nt
and
Br
ouwer
who
fou
nd
out
that
hype
rtensio
n
in
bo
t
h
m
al
e
and
fem
al
e
in
Ken
ya
ra
ng
e
s
from
7.
4%
to
21.4%
in
r
ural
areas
an
d
12.
3%
a
nd
22.8%
in
urb
an
ar
eas.
T
he
risk
of
hype
rtensio
n
ca
n
be
e
xp
la
ine
d
by
a
stu
dy
w
hich
f
ound
out
tha
t
tob
acc
o
pro
du
ces
su
bst
ances
that
narrow
or
dam
age
the
blood
vessels
w
hi
ch
caus
e
s
plag
ue
to
f
or
m
at
a
faster
rate
[13].
I
n
Ken
ya
aw
are
ne
ss
a
m
ong
those
who
ha
ve
hy
per
te
ns
i
on
is
low
an
d
s
ucce
ssfu
l
m
anag
e
m
ent
is
even
lo
we
r
[
14]
.
N
ug
e
nt
&
Brouwe
r
al
so
ob
s
er
ved
a
c
ha
ll
eng
e;
if
hype
rtensio
n
sta
ys
un
m
anag
e
d
it
would
cause
33,
600 d
eat
hs
by 2
030 [
14
]
.
Table
1.
Bl
ood
Pr
ess
ure Me
as
ur
em
ents
Variable
Measu
re
m
en
t valu
e
(%)
Sy
sto
lic Blo
o
d
pre
ss
u
re
Op
ti
m
al
-
<1
2
0
m
m
Hg
4
0
.0
No
r
m
al
-
121
-
1
3
0
m
m
Hg
2
3
.3
Hig
h
Nor
m
al
-
130
-
1
3
9
m
m
Hg
1
0
.0
Mild H
y
p
ertensi
o
n
(HT
N
)
-
140
-
1
5
9
m
m
H
g
2
3
.4
Mod
erate
H
TN
-
160
-
1
7
9
m
m
Hg
3
.3
Diasto
lic Blo
o
d
press
u
re
Op
ti
m
al
-
<8
0
m
m
H
g
6
0
.0
No
r
m
al
-
81
-
8
5
m
m
Hg
1
3
.3
Hig
h
Nor
m
al
-
86
-
8
9
m
m
Hg
1
6
.7
Mild HT
N
1
0
.0
3.
3
.
Li
pid
p
ar
amet
er
s me
asure
men
ts
3.3.1
.
T
otal
b
ody c
ho
le
s
tero
l
Eigh
ty
th
ree
po
i
nt
thre
e
pe
rcen
t
(83.3
%
)
of
the
pa
rtic
ipants
had
de
sirable
total
ch
oleste
rol
(<5.1
8mm
ol/L
),
10.0
%
(n
=
6)
ha
d
bor
der
l
ine
to
high
t
otal
cho
le
ste
r
ol
(5.19
-
6.2
0mmol/
L)
a
nd
6.7
%
of
t
he
par
ti
ci
pa
nts
ha
d
high
total
cho
le
ste
r
ol
le
ve
ls
of
>6
.21m
m
ol
/L.
Ma
j
or
i
ty
of
the
par
ti
ci
pan
ts
(
83.
3%
)
ha
d
desira
ble
total
cho
l
est
er
ol
le
ve
ls
sh
a
wn
in
F
igure
5
.
In
c
rea
sing
le
vels
of
cho
le
ste
r
ol
le
a
ds
t
o
car
diova
scular
diseases
a
nd
s
tro
ke
due
t
o
increase
d
L
DL
-
C
w
hich
unde
rgoes
ox
i
dative
m
od
ific
at
io
n
in
pr
e
sence
of
fr
e
e
rad
ic
al
s
[15]
.
Figure
5. Total
body c
hole
ste
r
ol
3.3.2.
High
de
nsity l
ipopr
ot
ei
n
Seve
nty
-
three
po
i
nt
three
pe
rcen
t
(73.3
%
)
of
t
he
par
ti
ci
pa
nts
ha
d
l
ow
High
D
ensity
Lipopr
otein
Cho
le
ste
r
ol
le
ve
ls
of
<1.0
4mm
ol
/L
and
26.
7
%
(n
=
16)
ha
d
optim
al
le
vels
of
H
DL
(
1.0
5
-
1.5
5mm
ol
/L).
A
big
nu
m
ber
of the
par
ti
ci
pa
nts
ha
d
lo
w
le
vels
of HDL
s
how
n
i
n
Fi
gure
6
.
Evaluation Warning : The document was created with Spire.PDF for Python.
IJPHS
IS
S
N: 22
52
-
8806
Risk
Fa
ct
or
s f
or N
on
-
c
omm
unic
ab
le
Disease
s amon
g
A
dult
s o
f
25
-
65 Ye
ars at
…
(
Mo
nica
h
Nj
am
bi Kibe
)
279
Figure
6. Hi
gh
Den
sit
y Li
po
protei
n
C
ho
le
ste
r
ol
3.3.3.
L
ow
de
nsity l
ipopr
ot
ei
n cho
le
s
tero
l
Eigh
ty
per
ce
nt
(80.0
%)
ha
d
op
ti
m
al
L
DL
(<2.5
9mm
ol
/L),
13.
3
%
ha
d
near
op
ti
m
al
le
vels
(2.60
-
3.3
5mmol/
L),
a
bout
6.7
%
of
the
pa
rt
ic
ipants
had
hi
gh
le
vels
of
(
4.14
-
4.90
m
m
ol/
L).
Alm
os
t
half
of
th
e
par
ti
ci
pa
nts
ha
d
opti
m
a
l
le
vels
of
LD
L
-
C
s
how
n
in
F
ig
ure
7
.
A
st
ud
y
by
Sh
ohai
m
i
found
out
that
L
DL
-
C
le
vel w
e
re
higher
am
on
g w
om
en
than
m
en
[16]
.
Figure
7. Lo
w Density
Lip
opr
otein
C
ho
le
ste
r
ol
3.3.4.
Tr
i
gly
ce
ri
de l
evels
Half
of
the
pa
rtic
ipants
(
50.
0
%)
had
norm
al
trigly
ceride
le
vels
(<1
.
70
m
m
ol/L).
Twen
ty
six
po
i
nt
seve
n
pe
rce
nt
(26.7
%
)
ha
d
hi
gh
le
vels
of
(
2.26
-
5.6
4m
m
ol/L),
20.0
%
ha
d
borderli
ne
to
high
le
vels
(1.71
-
2.2
5mmol/
L)
a
nd
3.3
%
had
ve
ry
hi
gh
trigly
ceride
le
vels
of
>
5.65
m
m
ol
/L.
Half
of
the
pa
rtic
ipant
s
ha
d
norm
al
levels of trigly
ceride
sh
ow
n
in
Fi
gur
e 8
.
Evaluation Warning : The document was created with Spire.PDF for Python.
IS
S
N
:
2252
-
8806
IJPHS
V
ol.
7
,
No.
4
,
Decem
ber
2018
:
274
–
282
280
Figure
8.
Tri
glyc
eride levels
3.
4
.
As
so
ci
at
i
on
between
anthr
op
om
etrics
a
n
d lipi
d par
amet
er
s
Sign
i
ficant
rel
at
ion
s
hip
was
obser
ve
d
be
tween
BM
I
a
nd
T
riglyc
eride
(p
=
0.0
12).
T
her
e
was
sign
ific
a
nt
rel
at
ion
s
hip
between
BM
I
an
d
L
ow
Densi
ty
Lipopr
otein
Cho
le
ste
r
ol
(
p=0.01
3).
The
re
wa
s
sign
ific
a
nt
rela
ti
on
s
hip
bet
we
en
BM
I
an
d
T
otal
Cho
le
ste
r
ol
(p
=
0.0
17)
a
nd
no
sig
nif
ic
ant
relat
ion
s
hi
p
was
ob
s
er
ved
bet
w
een
BM
I
an
d
H
DL
-
C
(
p=0.177).
MU
AC
was
ass
ociat
ed
with
HDL
(
p=0.00
6)
a
nd
no
associat
ion
wa
s
seen
bet
wee
n
MU
AC
an
d
LDL
(
p=0.10
5),
Total
Ch
oleste
ro
l
(
p=0.266)
an
d
Tri
glyc
eride
(p
=
0.1
03).
T
he
re
was
sig
nific
ant
ass
ociat
ion
be
twee
n
Wais
t
Hip
Ra
ti
o
a
nd
T
otal
Cho
le
s
te
ro
l
(
p=
0.000),
with
LDL
(
p=
0.000
)
an
d
no
sig
nif
ic
ant
relat
ion
s
hip
wa
s
obser
ved
betwee
n
Waist
Hip
Ra
ti
o
an
d
trigly
ceride
a
nd
HD
L
(
p=0.67
7
and
p=
0.263)
resp
ect
ively
.
T
otal
body
fat
pe
rcen
ta
ge
was
no
t
ass
ociat
ed
with
an
y
of
the
li
pi
d
par
am
et
ers
sho
wn in
Table
2.
Table
2.
Assoc
ia
ti
on
b
et
wee
n An
t
hro
po
m
et
ri
cs an
d
Li
pid
P
aram
et
ers
BMI
χ
2
df
p
Tr
ig
ly
c
eride
2
5
.75
2
12
0
.01
2
LDL
1
9
.31
2
8
0
.01
3
HDL
6
.31
7
4
0
.17
7
Total Ch
o
lestero
l
1
8
.69
4
8
0
.01
7
MUAC
LDL
1
3
.20
5
8
0
.10
5
Tr
ig
ly
c
eride
1
8
.42
9
12
0
.10
3
HDL
1
4
.44
6
4
0
.00
6
Total Ch
o
lestero
l
9
.99
3
8
0
.26
6
W
HR
Total Ch
o
lestero
l
1
7
.98
5
2
0
.00
0
HDL
1
.22
5
1
0
.26
3
Tr
ig
ly
c
eride
1
.52
4
3
0
.67
7
LDL
1
5
.24
6
2
0
.00
0
Total Bo
d
y
f
at per
cent
ag
e
LDL
3
.22
4
4
0
.52
1
Tr
ig
ly
c
eride
8
.83
7
4
0
.06
5
HDL
4
.52
6
2
0
.10
4
Total Ch
o
lestero
l
2
.62
3
4
0
.62
3
Mi
d
U
pp
e
r
Arm
Ci
rcu
m
fer
ence
wa
s
ass
ociat
ed
with
H
DL
(p
=
0.0
06)
a
nd
no
ass
ociat
ion
was
see
n
betwee
n
M
UAC
an
d
L
DL
-
C
(p
=
0.1
05),
Tot
al
Cho
le
ste
r
ol
(p
=
0.2
66)
a
nd
Triglyc
eride
(
p=
0.103
).
T
he
re
was
sign
ific
a
nt
associat
ion
bet
w
een
WH
R
an
d
Total
Cho
le
ste
ro
l
(p
=
0.0
00)
an
d
with
LDL
(
p=0.00
0).
The
sign
ific
a
nt
ass
ociat
ion
b
et
we
en
Waist
Hip
Ra
ti
o
and
LDL
and
Total
Ch
ol
est
ero
l
m
ay
be
exp
la
i
ned
b
y
the
fac
t
that
central o
be
sit
y
is
li
nk
ed
to v
isc
eral fats. N
o
a
ss
ociat
ion
was
obse
rv
e
d
betwee
n
WH
R
an
d
tri
glyc
erid
e
a
nd
HD
L
(p
=
0.6
77
and
p=
0.263
)
resp
ect
ively
.
T
his
diff
e
r
with
a
stud
y
wh
ic
h
ob
s
er
ved
that
Lo
w
HDL
-
C
s
howe
d
a
po
sit
ive
co
rrel
at
ion
with
a
hig
he
r
W
ai
st
Hip
Ra
ti
o
[17].
Total
body
fat
per
centa
ge
had
no
sig
ni
ficant
relat
ion
s
hip wi
th an
y
of the
li
pid
pa
ram
et
ers
shown i
n
Ta
bl
e 2
.
Evaluation Warning : The document was created with Spire.PDF for Python.
IJPHS
IS
S
N: 22
52
-
8806
Risk
Fa
ct
or
s f
or N
on
-
c
omm
unic
ab
le
Disease
s amon
g
A
dult
s o
f
25
-
65 Ye
ars at
…
(
Mo
nica
h
Nj
am
bi Kibe
)
281
In
the
pr
ese
nt
stud
y,
Mi
d
Upper
Ar
m
Ci
rcu
m
fer
ence
and
t
otal
body
fat
pe
rcen
ta
ge
sho
wed
poor
correla
ti
on
with li
pid pa
ram
eter
s.
T
his
dif
fers wit
h
a
stu
dy
done
i
n
East
e
r
n
I
ndia
which
s
how
e
d
that t
he
re w
a
s
a
wea
k
c
orrela
ti
on
betwee
n
BM
I
an
d
li
pi
d
par
am
et
ers
an
d
that
am
on
g
a
ll
the
ant
hro
pom
et
ric
var
ia
ble
s
use
d
in the st
udy
Waist
Ci
rcu
m
fer
ence
was
t
he b
est
co
r
relat
ed
t
o
li
pid pa
ram
eter
s
[9
]
.
BM
I
was
ass
ociat
ed
with
Triglyc
eride
(
p=0.01
2),
wi
th
LDL
(
p=0.01
3),
with
total
cho
le
ste
r
ol
(p
=
0.0
17)
an
d
no
ass
ociat
io
n
was
obse
rv
e
d
betwee
n
BM
I
and
HDL
-
C
(
p=
0.177
).
The
r
esults
correla
te
with
a
stud
y
am
on
g
m
al
e
s
tud
e
nts
at
Saud
i
Ar
a
bi
a
wh
ic
h
s
how
ed
a
po
sit
ive
correla
ti
on
bet
ween
BM
I
an
d
Total
Cho
le
ste
r
ol
an
d
L
DL
w
hile
a
neg
at
ive
co
rr
e
la
ti
on
coe
xisted
bet
ween
BM
I
an
d
HD
L
-
C.
[18].
A
nothe
r
study
fou
nd
out
a
BM
I
≥
25kg/
m
2
was
ne
gat
ively
correla
te
d
to
H
DL
-
C
[9
]
.
BM
I
inc
r
eases
plasm
a
Total
Cho
le
ste
r
ol, Tr
igly
cerides a
nd
LD
L
inc
reases
[12
]
.
The
st
udy
has
con
t
rib
uted
t
o
the
fiel
d
of
hea
lt
h
by
pro
vid
i
ng
in
f
or
m
at
ion
on
ris
k
facto
rs
for
NCDs
and
m
eet
ing
re
com
m
end
at
io
ns
that
we
re
pr
opose
d
by
ot
her
researc
he
rs;
S
ou
za
rec
omm
e
nd
e
d
t
hat
stu
dies
that
repor
t
on
hi
gh
pr
e
vale
nce
of
m
od
ifia
ble
risk
facto
rs
f
or
dysli
pi
dem
i
a
are
i
m
po
rtant
to
restru
ct
ure
the
pr
e
ve
ntion
m
od
el
for
the
dis
eases
associat
ed
with
dysli
pidem
ia
[1
7].
It
has
al
so
so
lve
d
a
chall
eng
e
tha
t
was
no
ti
ced
in
a
ddr
essing
NC
Ds
by
World
Healt
h
O
r
gan
iz
at
io
n
in
the
2015
N
CDs
Co
unty
Ca
pacit
y
Su
r
vey
;
la
ck
of po
pu
la
ti
on
b
ased su
rv
ei
ll
an
ce an
d poo
r
ta
r
geting o
f
sc
ree
ning
pro
ogram
m
es
[19].
The
st
ud
y
a
dvocates
f
or
t
he
s
creeni
ng
of
t
he
popula
ti
on
at
risk
a
nd
unawa
re
of
their
nu
t
r
it
ion
an
d
healt
h
sta
tus
.
This
will
be
of
hel
p
in
the
e
conom
y
dev
el
op
m
ent
of
t
he
Ken
ya
n
go
vernm
ent
becau
se
healt
h
exp
e
ndit
ur
e
in
Ken
ya
sta
nds
at
6.
2%
of
total
healt
h
e
xpen
ditu
re
w
hich
is
0.4%
of
total
gr
os
s
dom
est
ic
pro
du
ct
of
t
he
Country.
P
re
ve
nting
occ
urre
nc
e
of
NC
Ds
wi
ll
i
m
pr
ov
e
t
he
econom
y
and
f
igh
t
po
ver
ty
th
at
is
a
bur
den
to
m
any
Ken
ya
ns
.
H
ouse
ho
l
ds
a
ff
li
c
te
d
by
NC
Ds
ha
ve
high
c
ha
nc
e
of
bein
g
im
po
ve
rishe
d
an
d
dr
i
v
en
into
pove
rty
due
to
healt
hca
re
an
d
treat
m
ent
costs
[
20
]
.
The
stu
dy
ha
s
con
tri
bu
te
d
to
achievem
e
nt
of
reco
m
m
end
at
ion
s
m
ade
by
research
e
rs;
ob
esi
ty
can
be
us
ed
to
scree
n
f
or
dysli
pid
em
ia
with
oth
e
r
coe
xisti
ng
risk fact
ors
[12
]
4.
CONCL
US
I
O
N
It
is
app
r
opri
at
e
to
con
cl
ud
e
that
Kak
am
ega
residen
ts
a
re
at
risk
of
ca
rd
i
ov
a
scular
dise
ases
du
e
t
o
high
le
vels
of
card
i
ov
asc
ular
bio
m
ark
ers
ha
ving
73.
3%
of
the
pa
rt
ic
ipant
s
with
lo
w
le
ve
ls
of
H
DL
-
C
,
26.7%
of
them
hav
in
g
high
trigly
ce
ride
le
vels,
6.7
%
LDL
-
C
a
nd
6.7%
hi
g
h
le
ve
ls
of
Total
Ch
oleste
ro
l.
Am
on
g
the
par
ti
ci
pa
nts
43.4
%
we
re
ov
e
r
weig
ht,
16.7%
we
re
ob
ese
a
n
in
dicat
or
of
risk
of
poor
c
ard
i
ov
asc
ular
s
yst
e
m
and th
us
i
ncr
ea
sed risk
of ca
rdi
ov
asc
ular dise
ases an
d diabet
es.
Stud
ie
s
of
sim
il
ar
natur
e
li
ke
the
pr
e
sent
sh
ou
l
d
be
co
nducted
at
the
com
m
un
it
ie
s
in
orde
r
to
i
de
ntify
popula
ti
on
at
r
isk
of
NCDs
be
cause
the
stu
dy
has
sho
wn
m
ajo
ri
ty
cou
l
d
be
at
risk
bu
t
un
a
war
e
.
The
stud
y
reco
m
m
end
s
the
go
vernm
ent
to
pro
vid
e
fin
ancial
suppo
rt
to
nutrit
ion
pro
j
ect
s
that
are
ai
m
ing
a
t
reduci
ng
a
nd
pr
e
ve
nting
t
he
burd
e
n
of
N
CDs
beca
us
e
a
nu
m
ber
of
people
are
not
awar
e
of
t
he
se
risk
factors
.
More
researc
h
s
houl
d be
done o
n N
CDs es
pecial
ly
cli
nical
r
esear
ch
.
ACKN
OWLE
DGE
MENTS
The
aut
hors
ac
knowle
dge
al
l
that
play
ed
pa
r
t
to
see
the
su
c
cess
of
th
e
pre
sent
stu
dy.
The
Un
iv
ersit
y
of
Ma
si
nd
e
M
uliro
U
niv
e
rsity
of
Scie
nce
a
nd
Tech
nolo
gy
fo
r
pro
visio
n
of
r
eadi
ng
m
at
erial
s
and
researc
h
sk
il
ls
thr
ough
sem
inars
an
d
worksh
ops.
T
he
patie
nts
f
or
par
ti
ci
patin
g
a
nd
c
oope
rati
ng
thr
oughout
th
e
stud
y.
Re
search
assist
ance
for
thei
r
s
upport
.
REFERE
NCE
S
[1]
N.
P.
Ste
y
n
and
Z.
J.
Mchi
za,
“
Obesit
y
and
the
Nutrit
ion
Tr
ansition
i
n
Sub
-
Saha
ran
Afric
a
,
”
Ann
.
N.
Y
.
A
cad.
Sc
i
Annal
s of
the New
Y
ork
Ac
ad
emy
of
S
cienc
es
.
,
vol
.
1311
,
no
.
1
,
pp
.
88
–
101,
2014.
[2]
G.
of
K.
Ken
y
a
Mi
nistr
y
of
Hea
lt
h
,
“
Stat
isti
c
al
Revi
ew
of
P
r
o
gre
ss
towar
ds
the
Mid
-
te
rm
T
ar
get
s
of
the
Ken
y
a
Hea
lt
h
Sect
or
St
rat
eg
ic
Pl
an
201
4
-
2018,
”
20
16.
[3]
E.
Daoud,
C.
Sc
hee
de
-
b
erg
dah
l,
and
A.
Bergda
hl
,
“
Eff
ec
ts
of
Die
ta
r
y
M
ac
ronutr
ients
on
Plasm
a
L
ipi
d
Le
v
el
s
and
the
Consequ
ence
for
Ca
rdiova
scu
la
r
Dise
ase
,
”
no
.
Cvd,
pp
.
201
–
2
13,
2014
.
[4]
M.
Dashti,
W
.
K
uli
k,
F.
Hoek,
E
.
C.
Vee
rm
an,
M.
P.
Peppel
enbosc
h,
and
F.
Rez
a
ee,
“
A pho
spholipi
dom
ic
Anal
y
sis
of
All
De
fine
d
Hum
an
Plasm
a
L
i
poprote
ins,
”
S
cienti
f
ic R
eports
,
vol.
1
,
p
p
.
1
–
11
,
2011.
[5]
A
.
Hafi
an
e
and
J.
Gene
st,
“
Hi
gh
Densit
y
L
ip
op
rote
ins:
Me
asure
m
ent
Techni
ques
and
Potential
Biom
ark
ers
of
Cardi
ovasc
u
la
r
R
isk,”
BB
A
Cl
in
ic
al
.
,
vol. 3, pp.
175
–
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Evaluation Warning : The document was created with Spire.PDF for Python.