Bone health, obesity, and multimorbidity risk among teachers in under-resourced South African public primary schools: Results from a cross-sectional dual-energy X-ray absorptiometry study
1
Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
2
Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
3
Department of Human Movement Science, Nelson Mandela University, Gqeberha, South Africa
4
Department of Internal Medicine, Livingstone Hospital, Gqeberha, South Africa
5
Department of Radiography, Nelson Mandela University, Gqueberha, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):A3022
ABSTRACT
BACKGROUND:
In low- and middle-income countries, rapid urbanisation, dietary transitions and reduced physical activity accelerate the risk for adverse body composition. Quantifying and interpreting bone, fat and lean mass risks requires appropriate measurement and context-sensitive thresholds to detect subclinical vulnerability in under-resourced settings. Few studies, particularly from Africa, have quantified how these risks intersect and cluster with cardiometabolic and socio-demographic determinants shaped by structural inequities. The purpose of this study was to characterise body composition profiles, estimate the prevalence and co-occurrence of risk phenotypes and examine their distribution across health determinants.
METHODS:
The study was carried out in under-resourced public schools in Gqeberha, Eastern Cape, South Africa. A school-based workplace health intervention was conducted, using repeated cross-sectional assessments. We employed dual-energy X-ray absorptiometry (DXA), assessed metabolic indicators, behavioural indicators (alcohol and tobacco use, device-measured physical activity, handgrip strength), and obtained demographic and medical data.
RESULTS:
Among 136 apparently healthy teachers (85% women; age 21-72 years; mean=47 years; standard deviation=11 years), body composition risk was highly prevalent: obesity 91.9% (n=125; 95%CI 86.0-95.9%), reduced lean mass/function 50.7% (n=69; 95%CI 42.0-59.4%) and impaired bone health 30.2% (n=41; 95%CI 22.6-38.6%). The most frequent combined phenotype was fat-lean risk (49.3%; n=67; 95%CI 40.6-58.0%), while 14.0% (n=19; 95%CI 8.6-21.0%) exhibited all three risks. Metabolic syndrome criteria were met in 55.3% (n=73; 95%CI 46.4-64.0%) of teachers, and adverse risk phenotypes were associated with elevated multimorbidity and poorer metabolic health.
CONCLUSIONS:
This is the first study from South Africa’s Eastern Cape to report DXA-derived body composition profiles. Body composition risks and multimorbidity were highly prevalent, with likely substantial impacts on quality of life. Protecting teachers’ health will require multi-level strategies from workplace monitoring and culturally responsive prevention to addressing structural inequities, to safeguard well-being and sustain their pivotal role in educating future generations.
In low- and middle-income countries, rapid urbanisation, dietary transitions and reduced physical activity accelerate the risk for adverse body composition. Quantifying and interpreting bone, fat and lean mass risks requires appropriate measurement and context-sensitive thresholds to detect subclinical vulnerability in under-resourced settings. Few studies, particularly from Africa, have quantified how these risks intersect and cluster with cardiometabolic and socio-demographic determinants shaped by structural inequities. The purpose of this study was to characterise body composition profiles, estimate the prevalence and co-occurrence of risk phenotypes and examine their distribution across health determinants.
METHODS:
The study was carried out in under-resourced public schools in Gqeberha, Eastern Cape, South Africa. A school-based workplace health intervention was conducted, using repeated cross-sectional assessments. We employed dual-energy X-ray absorptiometry (DXA), assessed metabolic indicators, behavioural indicators (alcohol and tobacco use, device-measured physical activity, handgrip strength), and obtained demographic and medical data.
RESULTS:
Among 136 apparently healthy teachers (85% women; age 21-72 years; mean=47 years; standard deviation=11 years), body composition risk was highly prevalent: obesity 91.9% (n=125; 95%CI 86.0-95.9%), reduced lean mass/function 50.7% (n=69; 95%CI 42.0-59.4%) and impaired bone health 30.2% (n=41; 95%CI 22.6-38.6%). The most frequent combined phenotype was fat-lean risk (49.3%; n=67; 95%CI 40.6-58.0%), while 14.0% (n=19; 95%CI 8.6-21.0%) exhibited all three risks. Metabolic syndrome criteria were met in 55.3% (n=73; 95%CI 46.4-64.0%) of teachers, and adverse risk phenotypes were associated with elevated multimorbidity and poorer metabolic health.
CONCLUSIONS:
This is the first study from South Africa’s Eastern Cape to report DXA-derived body composition profiles. Body composition risks and multimorbidity were highly prevalent, with likely substantial impacts on quality of life. Protecting teachers’ health will require multi-level strategies from workplace monitoring and culturally responsive prevention to addressing structural inequities, to safeguard well-being and sustain their pivotal role in educating future generations.
| eISSN: | 2654-1459 |
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