The objective of this study was to gain a deeper understanding of the relationship between lifestyle factors and dietary behaviors among participants of cancer prevention events in Moshi Urban, Moshi Rural, and Meru District.
Our results highlight variations between male and female participants at the three PrevACamps and disparities between rural and urban residents in (1) BMI, (2) physical activity and (3) nutrition behaviors such as intake of fruits and vegetables, processed meats, sugar and salt, skipping meals and alcohol consumption.
Variations between male and female participants
Results from PrevACamps in rural areas show that women participated in cancer prevention more than men. This discrepancy implies that women are interested in cancer prevention when these programs are in nearby settings. A previous study from Tanzania postulated that rural women's health status was significantly worse than men. Low education, socioeconomic status, and lower quality health care for rural women were highlighted as barriers [18]. Another study reported that over 80% of women living in rural areas do not have access to health facilities [19]. However, the results of PrevACamp in Moshi Urban show that men and women were equally represented. One explanation for participation could be that educational, occupational and income levels are better for both sexes in urban areas than in rural areas. Better educational status could at least partially explain the comparatively high participation of men in urban areas, assuming that educational status correlates with better health awareness [25] [26] [27].
The results indicated no profound differences in eating behavior between men and women. Findings were that men would choose healthier convenience foods when available and drink more during their workday than women. In addition, men reported regularly choosing convenience foods and processed meats.
Disparities between rural and urban participants
First, our data indicate that participants from urban regions have a higher BMI. More than two-thirds of participants from urban regions are overweight or have obesity compared to rural regions with about 50%. These findings are in line with previous observations of increased cases of obesity in urban regions of Tanzania [20] [28] [29]. Elevated BMI and less physical activity are associated with cardiovascular disease [30] [25], fatty liver disease [26], and some cancers [27] [31] [32]. There is also evidence of initial BMI and increased cancer mortality [33].
In tandem, our results show lower satisfaction with body weight and higher rates of health problems among participants from the urban region. In consideration that higher BMI are associated with the above-mentioned diseases, it might be possible that people from urban regions have a higher risk to develop health related problems, different metabolic diseases and cancer than people from rural regions. However, when interpreting these results, it is important to consider differences in body composition. Participants who have a high BMI in combination with a high percentage of lean body mass do not necessarily have to be considered overweight or obese. Differences in body composition are known from several ethnic groups and races [34]. So more profound investigations about the body composition of the participants may give a better understanding.
Second, our data confirm that living in urban areas is negatively associated with an active lifestyle. In 2019, McTiernan et al. summarised that physical activity leads to a reduction in the risk of developing carcinomas [27]. Amongst them are carcinoma of the bladder, breast, colon, endometrium and esophagus [27] [35]. In addition to physical inactivity, other risk factors include obesity, sex hormones, insulin resistance, insulin-related factors, adiponectin, systemic inflammation, low vitamin D, and immune disorders that can trigger cancers [35] [36] [37]. To what extent less physical activity in urban compared to rural regions leads to an elevation of cancer cases needs further evaluation.
Third, our results indicated a change towards a western lifestyle in the urban regions. This is observed by people replacing lunch with snacking, frequently using salt while cooking, increasing intake of processed meats, basing main meals around starchy foods, and drinking alcohol and sweetened sodas at elevated levels. This is in line with previous findings [20] [38]. Considering the behavior to snack frequently, snacks are high in energy but less rich in nutrients, leading to higher intakes of energy than needed [39]. Moreover, snacking does not guarantee to cover the daily need of nutrients. A good education about healthy nutrition may lead to healthy snacking pattern and seems to be a possible alternative if the main meal cannot be ensured. However, snacking while doing other activities might be associated with less satiety and higher food consumption [40].
The frequent use of salt reported by the participants is also observed in other countries from Sub-Saharan Africa [41]. However, a study about the salt consumption worldwide showed that the salt intake in Sub-Saharan Africa East was the lowest worldwide in 2013. The urbanization and change into a more western diet might lead to a rise of salt intake [42]. The high salt consumption levels in our findings reflect the extensive consumption of processed meat, also reported by the participants.
In addition, our results show that substantial amounts of sweetened and starchy foods and sweetened lemonade are crucial in urban and rural regions. A study showed that this high consumption, especially of sweetened sodas, is associated with many health-related problems [38].
The elevated intake of alcohol in Moshi Urban is consistent with previous findings by Temba et al. 2021 [20]. Also data from South Africa confirm this trend [43]. However, there appears to be wide variation between the regions in different countries [43] [37]. Religion, culture, and education seem to be important factors, which may influence alcohol intake.
Interestingly, our survey indicated that people from urban regions eat more fruits and vegetables, choose healthy food preparation alternatives instead of fried foods, and do not add sugar to meals too often. They also reported better drinking habits with plenty of fluids, including water, and fewer sweetened beverages compared to people from rural areas.
The elevated consumption of fruits was not expected but might be a result of the season in which the survey was implemented. An existing study showed that there might be seasonal changes in food patterns in Kilimanjaro-region, with a change towards a more healthy way of nutrition during dry season [20]. In addition, Temba et al. identified a number of food-derived metabolites which have an impact on immune response and inflammatory events [44]. Consequently, there is evidence that nutrition impacts immune status. The researchers reasoned that plant based traditional diets in Tanzania are beneficial for health. The frequent consumption of fruits and vegetables could also be due to a greater level of education in the urban area. Better education might be associated with an increased understanding for healthy nutrition and a healthier lifestyle.
Considering the rhythm of food intake, many participants skip breakfast and lunch. Dinner is not skipped that often. Having dinner more regularly than breakfast and lunch may be a traditional behavior maintaining the feeling of belonging within families, as it is common in African countries.
Limitation
Study findings cannot be generalized for the Tanzanian population as our sample represents voluntarily attending people from three region in Northern Tanzania.
However, this survey gives an overview about the differences in lifestyle between urban and rural areas of the Kilimanjaro region in Tanzania. These data are based on a questionnaire which was implemented retrospectively during a cancer screening event. To gain further information about nutritional changes, methods like 24h protocols of food intake and activity protocols in a greater variety of residents are suitable.