Lisa K. Micklesfield

Background: Elevated blood pressure (BP) during adolescence is an early marker of cardiovascular risk, particularly in settings experiencing under and overnutrition. However, the relationship between detailed body composition and BP across nutritional extremes remains poorly understood. We examined associations between dual-energy X-ray absorptiometry (DXA)-derived body composition and BP among underweight and overweight South African adolescent girls to assess multilevel correlates of BP. Methods: The Ntshembo trial included 1268 girls 13-19-years from rural Agincourt and urban Soweto. Participants were selected as underweight or overweight. BP was measured in triplicate at a single visit and classified into clinic BP category ranges. DXA provided measures of fat mass (FM), fat-free soft tissue mass (FFSTM), and related indices. Results: Mean SBP and DBP were 110.0±11.2mmHg and 68.7±8.2mmHg, respectively; 21.1% of participants had elevated or hypertensive-range BP. Overweight adolescents had higher SBP and BP categories compared with underweight adolescents. DXA-derived adiposity measures were positively associated with SBP and BP category. FFSTM showed strong association with SBP. Higher FM/FFSTM was associated with elevated (RRR=4.25, 95%CI:1.77-10.20) and hypertensive-range BP (RRR=19.04, 95%CI:6.43–56.40). Caregiver hypertensive-range BP was independently associated with adolescent hypertensive-range BP (RRR=1.72-1.82). Sedentary behaviour independently associated with elevated BP, highlighting a modifiable behavioural target alongside intergenerational risk. Associations were more consistent for SBP than DBP. Conclusions: both FM and FFSTM positively associated with BP, particularly SBP. Regional percentage analyses were consistent with higher BP when a greater proportion of total fat was distributed centrally rather than peripherally.

Plasma proteomic scores for body mass index have been derived primarily in European populations, and it is unclear whether these scores are generalizable and useful in other ancestries. Here, we show that plasma proteomic BMI scores developed in participants of European, East Asian, South Asian and African ancestries from the UK Biobank (UKBB; N=50,621) and the South African Middle-Aged Soweto Cohort (MASC; N=948) are portable across ancestries, explain up to 48.7% of trait variance and significantly predict incident obesity. We identified eight protein biomarkers common across all scores, six of which showed causal associations with BMI in Mendelian randomization analyses and were associated with BMI across the Olink (UKBB, MASC) and SomaScan platforms (Qatar Biobank; N= 2410). Discrepancy analysis between the high predicted proteomic BMI and low measured BMI revealed metabolically unhealthy normal weight (MUNW) individuals, with higher visceral fat, elevated triglycerides, and low insulin sensitivity. Thus, plasma proteomic BMI scores may enhance the precision of cardiometabolic risk stratification across diverse populations

Plasma proteomic scores for body mass index have been derived primarily in European populations, and it is unclear whether these scores are generalizable and useful in other ancestries. Here, we show that plasma proteomic BMI scores developed in participants of European, East Asian, South Asian and African ancestries from the UK Biobank (UKBB; N = 50,621) and the South African Middle-Aged Soweto Cohort (MASC; N = 948) are portable across ancestries, explain up to 48.7% of trait variance and significantly predict incident obesity. We identified eight protein biomarkers common across all scores, six of which showed causal associations with BMI in Mendelian randomization analyses and were associated with BMI across the Olink (UKBB, MASC) and SomaScan platforms (Qatar Biobank; N = 2410). Discrepancy analysis between the high predicted proteomic BMI and low measured BMI revealed metabolically unhealthy normal weight (MUNW) individuals, with higher visceral fat, elevated triglycerides, and low insulin sensitivity. Thus, plasma proteomic BMI scores may enhance the precision of cardiometabolic risk stratification across diverse populations.

Non-communicable diseases (NCDs), such as cardiovascular diseases, diabetes, chronic respiratory diseases, and cancers, account for about 75% of the global deaths, with the greatest burden falling ...

Creating healthy food environments is central to improving adolescent nutrition; a life-stage characterised by rapid growth, body composition changes and heightened nutrient requirements. In low- and middle-income countries (LMICs), cash transfer (CT) programmes are increasingly implemented as poverty-alleviation strategies to influence diet quality and related health behaviours by relaxing household budget constraints. While evidence demonstrates CT effects on nutrition and health in infancy and early childhood, few studies have evaluated their impact in adolescents in LMICs. We conducted a scoping review of randomised controlled trials and quasi-experimental studies (2012-2025) evaluating CT interventions reporting adolescent (10-19 years) outcomes in LMICs. Comprehensive searches of PubMed and Google Scholar yielded 164 publications, of which 19 were included. Studies were eligible regardless of whether the CT programme targeted adolescents, provided adolescent-related outcomes were reported. Outcomes were categorised by: mental health; school attendance/enrolment; HIV prevalence; sexual activity/behaviour; partner violence; economic and food security; tuberculosis treatment; nutritional status; and healthcare utilisation. Almost all trials were conducted in sub-Saharan Africa (SSA), eight studies examined the effect of conditional cash transfer (CCT), five studies unconditional cash transfers (UCT), five studies both CCT and UCT, while one study reported 'cash transfers' with no further information on the type of CT. Most studies reported beneficial effects in domains closely linked to the social determinants of adolescent health (schooling, economic security, sexual and reproductive health, and psychosocial wellbeing). In conclusion, CTs can contribute to improved adolescent wellbeing in LMICs, however direct evidence on adolescent nutrition outcomes is sparse.

Returning individualized microbiome results in ways that are ethical, comprehensible, and useful remains under-explored in African settings. We nested a multi-site, mixed-methods study within the AWI-Gen Wave 2 gut microbiome sub-study of 1,801 women aged 42 – 86 years to engage the participants and provide feedback. All (1,001) participants from Agincourt and Soweto (South Africa) and Nairobi (Kenya) were invited to feedback meetings: 496 from Agincourt, 87 from Soweto, and 195 from Nairobi responded. Engagement strategies were tailored by site (small-group and home-based sessions, visual metaphors, Foldscopes, and local-language delivery). Using semi-structured discussions and structured observations analysed thematically in MAXQDA under COREQ, five cross-cutting themes emerged: (1) understanding of microbiome reports, (2) emotional responses to feedback, (3) perceived health relevance, (4) trust in research institutions, and (5) suggestions for improving engagement. Culturally grounded explanations and local-language facilitation enhanced comprehension and perceived relevance; English-heavy sessions were associated with more confusion. Most participants expressed satisfaction and described planned or enacted dietary and lifestyle changes, while frustration centred on long delays between sampling and feedback. Trust increased with transparency and individualized return of results but was often conditional on minimizing burdensome procedures such as repeat blood sampling (phlebotomy) and ensuring timely feedback. Engagement was feasible and low-cost (approximately USD 29-59 per participant) with site-specific resource needs. Limitations included constrained generalizability beyond the three study sites. Returning individualized microbiome findings in community settings in Africa is acceptable, feasible, and can motivate health-promoting behaviours when delivered promptly and in culturally and linguistically appropriate ways. IMPORTANCE: Microbiome studies rarely return individualized results in low-resource settings due to concerns about appropriate feedback and associated costs. This gap risks eroding trust and diminishing research impact. In three African communities, tailored feedback on gut microbiome profiles was provided to 778 women. By documenting a costed, multi-site engagement model and the themes influencing acceptance and actionability, this work offers a practical framework for ethically returning complex -omics results at scale in underrepresented populations - advancing scientific equity and strengthening community trust in microbiome research.

Despite repeated calls from international governing bodies for benefit sharing in biomedical research as a means of promoting mutual trust and reciprocity, real-world examples of benefit sharing are lacking. Here, we discuss benefit-sharing initiatives instituted as part of human genomics research projects carried out in both semi-rural and urban settings in South Africa. We explore lessons learned from applying different approaches to benefit sharing, as well as recommendations for ways to enhance success for future initiatives. Ultimately, we advocate for the adoption of flexible benefit-sharing models that take into consideration community representation and engagement, benefit management mechanisms, and long-term sustainability.

To assess the diagnostic ability and cut-points of traditional and novel adiposity measures for cardiometabolic disease (CMD) risk, and to determine the associations between these adiposity measures and metabolic syndrome (MetS) among corporate employees.