RESUMO
Background: Non-communicable diseases including metabolic health disorders are becoming area of concern for low/middle income countries with poor health-care resources. Present study was planned to assess the prevalence of metabolically unhealthy (MU) subjects in the community and proportion of the MU subjects having the risk of significant Non-alcoholic Fatty Liver Disease (NAFLD) using a step-wise evaluation strategy in a resource-poor setting. Methods: Study was performed in 19 community development blocks of Birbhum district, West Bengal, India. Every fifth member in the electoral list was included for the first step evaluation (n = 79,957/1,019,365, 7.8%) to detect any metabolic risk. Subjects with any metabolic risk in the first step (n = 9819/41,095, 24%) were taken for second step evaluation with Fasting blood glucose (FBG) and ALT. Subjects with elevated FBG and/or ALT in the second step (n = 1403/5283, 27%) were taken into third step evaluation. Finding: At least one risk factor was found in 51.4% (n = 41,095/79,957). 63% (n = 885/1403) of the subjects with metabolic abnormality (third step) had MU state making its overall prevalence of 1.1% (n = 885/79,957). 53% of MU subjects (n = 470/885) had 'persistently elevated ALT' suggesting the risk of having significant NAFLD. Interpretation: Step-wise evaluation strategy could detect the subjects at risk, actually having MU state and proportion of MU subjects at risk of having 'persistently elevated ALT' (surrogate of significant NAFLD) in the community with minimum utilization of scarce resources. Funding: This study was funded by Bristol Myers Squibb Foundation, USA, under the program 'Together on Diabetes Asia' (Project Number: 1205 - LFWB).
RESUMO
Background: Understanding the spirometry-based prevalence with concomitant assessment of the health status is important to appreciate the chronic obstructive pulmonary disease (COPD)-scenario in a geographic area. There is hardly any such rural data available from the developing world. Methods: We screened the adult population (>40 but <75 years) of seven villages in two different blocks of Birbhum district, West Bengal, for the presence respiratory symptoms (active or historical within 1 year). Those screened positive were tested with spirometry to diagnose COPD on having post bronchodilator FEV1/FVC <0.7. The COPD subjects were then applied with COPD assessment test (CAT). Results: Out of 6255 subjects residing in the villages, 1984 subjects belonged to the target age group and 51.56% (1013 of 1984) of them qualified for spirometry which was possible in 953 (88.81%) of them. COPD was identified in 166 (16.36%) of symptomatic individuals. The calculated prevalence of COPD was 2.65% in overall population and 8.367% in population above 40 years. The COPD patients (mean age 59.77 ± 9.47 years) had a male preponderance (120 [72.29%] of 166). They were mostly malnourished (body mass index = 17.15 ± 2.97), with poorhealth status (CAT = 15) and moderate degree (GOLD category-II) of airflow limitation showing FEV1/FVC as 0.60 ± 0.07 and the mean post bronchodilator FEV1 as 52% of predicted (1.26 ± 0.42 L). Most of the sufferers (74.09%) were either active (n = 88) or ex-smokers (n = 35) (>10 pack-years). The nonsmokers constituted 25, 90% (n = 43). Conclusion: The rural COPD prevalence in Bengal is far higher than the estimated national average with the health status of the sufferers been poor.