Prevalence of obesity in a rural Asian Indian (Bangladeshi) population and its determinants.

BACKGROUND: Obesity has reached epidemic proportions worldwide including Bangladesh. To assess the prevalence and associated factors of general and central obesity in a rural Bangladeshi population based on newly proposed cut off level for Asian population. METHODS: 2293 subjects aged ≥ 20 years from rural Bangladesh were randomly recruited to participate in a population-based, cross sectional survey, conducted in 2009. Both socio-demographic and anthropometric measurements were recorded. Age adjusted data for anthropometric indices were examined. RESULTS: The age standardized prevalence of overweight (BMI 23-24.9 kg/m(2)) and obesity (BMI ≥ 25 kg/m(2)) were 17.7 (95% confidence interval (CI): 16.1, 19.2%) and 26.2% (95% CI: 24.4, 27.9%), respectively. The age standardized prevalence of central obesity based on WC (M ≥ 90 & F ≥ 80 cm) and WHR (M ≥ 0.90 & F ≥ 0.80) were 39.8% (95% CI: 37.9, 41.7%) and 71.6% (95% CI: 69.8, 73.4%) respectively. The result shows that prevalence of central obesity was more in female than male. Study shows middle age, medium and high socioeconomic status (SES), low education levels, physical inactivity, high consumption of carbohydrate, protein and fat, were significant risk indicators for general and central obesity. Smoking was shown as protective factor for both general and central obesity. CONCLUSIONS: In rural Bangladeshi population, the prevalence of both general and central obesity was high among both sexes with the use of newly proposed cut off points for Asian population. Gender, diet, physical activity, education levels and SES were associated with the increase prevalence of obesity.

Cardiovascular Risk, Obesity, and Sociodemographic Indicators in a Brazilian Population.

Background and Aims: Cardiovascular diseases (CVDs) are the leading cause of death globally and in Brazil. Evidence suggests that the risk of CVDs differs by race/ethnicity. Scarce information exists about the association between CVD risk, obesity indicators and sociodemographic characteristics in the Brazilian population. Objectives: We aimed to assess the CVD risk following the Framingham risk score in relation to the population's sociodemographic profile. Further, we examined the association between anthropometric markers and risk of CVDs. Methods: A total of 701 subjects aged ≥20 years from North-eastern Brazil were recruited randomly to participate in a population-based, cross-sectional survey. Age-adjusted data for CVD risk, sociodemographic characteristics, and anthropometric indices were assessed, and their relationships examined. Results: High CVD risk (Framingham risk score ≥10%) was observed in 18.9% of the population. Males (31.9 vs. 12.5%) and older subjects (age ≥45 years: 68.9% vs. age <45 years: 4.2%) had significantly higher risk of CVDs, whereas those employed in manual labor showed lower risk (7.6 vs. 21.7%). Central obesity measures like waist-to-hip ratio and waist-to-height ratio were more strongly associated with predicted CVD risk than body mass index. Conclusions: Our population had a high risk of CVDs using the Framingham risk score. Cost-effective strategies for screening, prevention and treatment of CVDs may likely reduce disease burden and health expenditure in Brazil. Central obesity measures were strongly associated with predicted CVD risk and might be useful in the clinical assessment of patients. Follow-up studies are warranted to validate our findings.

Vitamin D3 and B12 supplementation in pregnancy.

AIM: To assess the efficacy of vitamin D3 or B12 supplementation during pregnancy. METHODS: Pregnant women at 6-14 weeks in the intervention arm received oral high dose intermittent vitamin D3 and/or low dose B12 supplementation if they had vitamin D or vitamin B12 deficiency. The control arm received prescribed dietary instruction only. An additional observational arm for those mothers at booking with normal vitamin D and vitamin B12 level was also recruited. All groups received standard care during pregnancy. RESULTS: The primary endpoint of either vitamin D or B12 at term was not met. At baseline 25% participants in both the interventional and control arms had severe D deficiency (<30 nmol/l), reducing to under 3.4% in both groups. No maternal differences in vitamin D or B12 levels were found at delivery between the intervention, control, or observational groups. No significant difference in any of the pregnancy or birth outcomes was observed between three groups. CONCLUSIONS: In this study, oral supplementation of high dose intermittent vitamin D or low dose vitamin B12 regime failed to correct the relevant nutritional deficiencies in Bangladeshi pregnant women as per protocol. Both dietary supplementation and high dose vitamin D corrected severe vitamin deficiency.

Prevalence of Metabolic Syndrome by different definitions, and its association with type 2 diabetes, pre-diabetes, and cardiovascular disease risk in Brazil.

BACKGROUND AND AIMS: Metabolic Syndrome (MS) is increasing in developing countries. Different definitions of MS lead to discrepancies in prevalence estimates and applicability. We assessed the prevalence of MS as defined by the International Diabetes Federation (IDF), modified National Cholesterol Education Program Adult Treatment Plan III (Modified NCEP) and Joint Interim Statement (JIS); compared the diagnostic performance and association of these definitions of MS with pre-diabetes, type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) risk. METHODS: A total of 714 randomly selected subjects from Northeastern Brazil were investigated in a cross-sectional study. Sociodemographic, anthropometric, and clinical data were recorded. Diagnostic test performance measures assessed the ability of the different MS definitions to identify those with pre-diabetes, T2DM and increased CVD risk. RESULTS: The adjusted prevalence of MS was 36.1% applying the JIS criteria, 35.1% the IDF and 29.5% Modified NCEP. Women were more affected by MS according to all definitions. MS was significantly associated with pre-diabetes, T2DM and CVD risk following the three definitions. However, the JIS and IDF definitions showed higher sensitivity than the Modified NCEP to identify pre-diabetes, T2DM and CVD risk. The odds ratios for those conditions were not significantly different when comparing the definitions. CONCLUSIONS: MS is highly prevalent in Brazil, particularly among those with pre-diabetes, T2DM, and high CVD risk. The IDF and JIS criteria may be better suited in the Brazilian population to identify pre-diabetes, T2DM and CVD risk. This may also signify the importance of the assessment of MS in clinical practice.

Glycated Hemoglobin in the Diagnosis of Diabetes Mellitus in a Semi-Urban Brazilian Population.

The study evaluated glycated hemoglobin (HbA1c) as a diagnostic tool for diabetes and pre-diabetes in the Brazilian population. Further, the homeostasis model assessment of insulin resistance (HOMA-IR) was also examined against HbA1c values to identify the most suitable cut-off points for HOMA-IR to predict the risk of diabetes. A cross-sectional study was conducted among 714 randomly selected subjects. HbA1c, fasting, and 2 h plasma glucose values were measured. Insulin resistance estimates were calculated with HOMA-IR. The receiver operating characteristic curve assessed HbA1c performance. The adjusted prevalence rate of diabetes mellitus was 14.7%, and pre-diabetes 14.2%. The optimal HbA1c cut-off value was ≥6.8% for the diagnosis of diabetes, and ≥6.0% for pre-diabetes. The area under the curve using HbA1c was 0.85 (95% CI: 0.80-0.90) for detecting diabetes and 0.61 (95% CI: 0.55-0.67) for pre-diabetes. The optimal HOMA-IR cut-off value was 2.06 for HbA1c at 6.8%. The HbA1c cut-off value of ≥6.8% may be suitable for diagnosing diabetes in the Brazilian population. Our results do not support the use of HbA1c to diagnose pre-diabetes. A HOMA-IR cut-off point of 2.06 was a sensitive marker to assess the risk of diabetes.

Serum Lipid Profile and Its Association with Diabetes and Prediabetes in a Rural Bangladeshi Population.

Dyslipidemia is commonly associated with diabetes (T2DM). This has been demonstrated for the Caucasian population, but few data are available for Asian Indians. The paper aims to investigate serum lipids (separately or in combination) and their association with glucose intolerance status (T2DM and prediabetes) in a rural Bangladeshi population. A sample of 2293 adults (≥20 years) were included in a community based cross-sectional survey in 2009. Anthropometric measures, blood pressure, blood glucose (fasting and 2-h oral glucose tolerance test) and fasting serum lipids (total cholesterol, T-Chol; triglycerides, Tg; low density lipoprotein cholesterol, LDL-C and high density lipoprotein cholesterol, HDL-C) were registered. Analysis of covariance (ANCOVA) and regression analysis were performed. High Tg levels were seen in 26% to 64% of the participants, depending on glucose tolerance status. Low HDL-C levels were seen in all groups (>90%). Significant linear trends were observed for high T-Chol, high Tg and low HDL-C with increasing glucose intolerance (p for trend <0.001). T2DM was significantly associated with high T-Chol (Odds ratio (OR): 2.43, p < 0.001), high Tg (OR: 3.91, p < 0.001) and low HDL-C (OR: 2.17, p = 0.044). Prediabetes showed a significant association with high Tg (OR: 1.96, p < 0.001) and low HDL-C (OR: 2.93, p = 0.011). Participants with combined high Tg and low HDL-C levels had a 12.75-fold higher OR for T2DM and 4.89 OR for prediabetes. In Asian Indian populations an assessment of serum lipids is warranted not only for T2DM patients, but also for those with prediabetes.

Association of general and central obesity with diabetes and prediabetes in rural Bangladeshi population.

BACKGROUND AND AIMS: Recent data shown that both general and central obesity indices are significantly associated with diabetes (T2DM) and prediabetes (impaired glucose tolerance [IGT] and impaired fasting glucose [IFG]). Data regarding association of obesity with T2DM and prediabetes in rural Bangladeshi population is scarce. This study aims to observe the association of general and central obesity with diabetes (T2DM) and prediabetes in rural Bangladeshi population. MATERIALS AND METHODS: A total of 2293 rural Bangladeshi adults aged ≥20 years were randomly selected in a population-based, cross-sectional survey which was conducted in 2009. The association of general (defined by body mass index [BMI]) and central obesity (defined by waist circumference [WC] and waist hip ratio [WHR]) with T2DM and prediabetes was assessed by using receiver operating characteristic curve analysis and logistic regression. RESULTS: Subjects with T2DM, IGT and IFG had a higher rate of general and central obesity than normal subjects. WHR was more closely associated with T2DM than WC and BMI. However, all three obesity indices were significantly associated with IGT and IFG. CONCLUSIONS: In rural Bangladeshi population, both general and central obesity showed good association with T2DM and prediabetes.

Comparison of the prevalence of metabolic syndrome and its association with diabetes and cardiovascular disease in the rural population of Bangladesh using the modified National Cholesterol Education Program Expert Panel Adult Treatment Panel III and International Diabetes Federation definitions.

AIMS/INTRODUCTION: To compare the prevalence of metabolic syndrome (MS) using the modified National Cholesterol Education Program Adult Treatment Plan III (NCEP) and the International Diabetes Federation (IDF) definitions and, using both definitions, determine and compare the association of MS, prediabetes, type 2 diabetes, hypertension (HTN) and cardiovascular disease risk (CVD). MATERIALS AND METHODS: A total of 2,293 randomly selected participants (aged ≥20 years) in a rural community in Bangladesh were investigated in a population-based cross-sectional study. Sociodemographic and anthropometric characteristics, blood pressure, blood glucose, and lipid profiles were studied. Age-adjusted data for MS and cardiometabolic risk factors were assessed, and their relationships were examined. RESULTS: The age-adjusted prevalence of MS was 30.7% (males 30.5%; females 30.5%) using the NCEP definition, and 24.5% (males 19.2%, females 27.5%) using the IDF definition. The prevalence of MS using the NCEP definition was also higher in study participants with prediabetes, type 2 diabetes, HTN and CVD risk. The agreement rate between both definitions was 92% (k = 0.80). The NCEP definition had a stronger association with type 2 diabetes and HTN (odds ratio 12.4 vs 5.2; odds ratio 7.0 vs 4.7, respectively) than the IDF definition. However, the odds ratios for prediabetes and CVD risk were not significantly different. CONCLUSIONS: The prevalence of MS was higher using the NCEP definition, and was more strongly associated with prediabetes, type 2 diabetes, HTN and CVD in this Bangladeshi population.

Anthropometric indices of obesity and type 2 diabetes in Bangladeshi population: Chandra Rural Diabetes Study (CRDS).

BACKGROUND: Obesity is a risk factor for type 2 diabetes (DM); however, no study has specially assessed the anthropometric indices as predictors of diabetes in rural Bangladeshi population. OBJECTIVE: To identify markers for diabetes through body mass index (BMI), waist circumference (WC), waist hip ratio (WHR) and waist height ratio (WHtR) and identify the optimal cut-off values suitable for Bangladeshi adult population. METHODS: A total of 2293 subjects aged ≥20 years from rural Bangladesh were randomly recruited to participate in a population-based, cross sectional survey. Age adjusted data for anthropometric indices and diabetes risk were assessed and their relationships were examined. RESULTS: Age adjusted prevalence of DM in men and women were 9.5% and 7.0%, respectively. Both men and women with DM had a higher rate of general obesity (defined by BMI) and central obesity (defined by WC, WHR and WHtR) than non-diabetic subjects. In both men and women the most sensitive indice was WHR for predicting DM. The appropriate cut-offs values for WHR to predict DM in men and women were 0.93 and 0.87, respectively. WC of 82 cm for both sexes was appropriate to predict DM. Those of BMI and WHtR were 21.2 kg/m2, 21.8 kg/m2 and 0.53, 0.54 in men and women, respectively. CONCLUSIONS: Compared with BMI, measures of central obesity, WHR, WC, WHtR showed a better association with the risk of DM for both sexes in rural Bangladeshi population. Follow-up studies are needed for validifying these cut-offs values.

Anthropometric indicators of obesity for identifying cardiometabolic risk factors in a rural Bangladeshi population.

AIMS/INTRODUCTION: The aim of the present study was to evaluate the predictive ability of body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and body fat percentages (BF%) for the presence of cardiometabolic risk factors, namely type 2 diabetes (DM), hypertension (HTN), dyslipidemia and metabolic syndrome (MS). MATERIALS AND METHODS: A total of 2293 subjects aged ≥20 years from rural Bangladesh were randomly selected in a population-based, cross-sectional survey. The association of anthropometric indicators with cardiometabolic risk conditions was assessed by using receiver operating characteristic curve analysis and adjusted odds ratios (ORs) for DM, HTN, dyslipidemia and MS. RESULTS: Area under the curve cut-off values showed that the association of WHR, BF% and WC was higher than that for other indices for DM, HTN and MS, respectively, for both sexes, and WHtR for men and WHR for women for dyslipidemia. The ORs were highest for WHR for DM and WC for MS for both sexes, and WHtR for men and WC for women for HTN and dyslipidemia, respectively. The optimal cut-off values for obesity for the present study in men and women showed BMIs of 22 and 22.8 kg/m(2), WHRs of 0.93 and 0.87, WHtRs of 0.52 and 0.54, BF% of 21.4 and 32.4%, and WCs of 82 and 81 cm, except for MS, which were 90 for men and 80 for women. CONCLUSIONS: Compared with BMI, measures of central obesity, particularly WHR, WC, WHtR and BF%, showed a better association with obesity-related cardiometabolic risk factors for both sexes.

Prevalence of type 2 diabetes and impaired glucose regulation with associated cardiometabolic risk factors and depression in an urbanizing rural community in bangladesh: a population-based cross-sectional study.

BACKGROUND: To determine the prevalence of type 2 diabetes (T2DM) and impaired glucose regulation (impaired fasting glucose [IFG] and impaired glucose tolerance [IGT]) in an urbanizing rural population of Bangladesh and associated cardiometabolic risk indicators and depression. METHODS: A total of 2,293 subjects aged ≥20 years in an urbanizing rural Bangladeshi community were investigated. Socio-demographic and anthropometric details, blood pressure, fasting plasma glucose (FPG), 2 hours after 75 g plasma glucose (2hPG), glycosylated hemoglobin, fasting serum insulin and lipid profiles were studied. Presence of depressive symptoms using Montogomery-Asberg Depression Rating Scale was also assessed. RESULTS: The prevalence of IFG, IGT, IFG+IGT, and T2DM were 3.4%, 4.0%, 1.2%, and 7.9%, respectively. The prevalence of T2DM and impaired glucose regulation differed between males and females, but, both increased with age in both sexes. FPG and 2hPG had positive correlation. Employing logistic regression, it was found that increased age, waist to hip ratio, systolic blood pressure, total cholesterol, triglycerides, and depression were independent risk indicators for diabetes. Both insulin resistance and ß-cell deficiency were significantly related for causation of diabetes. Among the study population, 26.2% had general obesity, 39.8% central obesity, 15.5% hypertension, 28.7% dyslipidemia, 17.6% family history of diabetes, and 15.3% had depression. Physical inactivity and smoking habits were significantly higher in male. CONCLUSION: Rising prevalence of diabetes and impaired glucose regulation in this urbanizing rural population exist as a significant but hidden public health problem. Depression and other cardiometabolic risk indicators including obesity, hypertension, and dyslipdemia were also prevalent in this population.