Undiagnosed diabetes, hypertension, and hypercholesterolaemia in an overweight or obese population: implications for cardiovascular disease risk screening programme.

INTRODUCTION: Establishing the burden of undiagnosed CVD risk factors is critical to monitoring public health efforts related to screening and diagnosis. OBJECTIVE: To assess the proportion and determinants of undiagnosed diabetes, hypertension, and hypercholesterolaemia, among overweight or obese adults. METHODS: A sample of 1200 participants aged 35-64 years with a BMI ≥25 kg/m2 was selected from the Colombo district. Data were collected through a questionnaire, anthropometry, blood pressure measurement, and blood sampling for fasting plasma glucose, HbA1c, and lipid profile. Undiagnosed diabetes, hypertension, and hypercholesterolaemia were defined as fasting plasma glucose ≥126 mg/dL or HbA1c ≥6.5%; systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg; total cholesterol ≥240 mg/dl respectively, in a person without a previous diagnosis. Multiple logistic regression analyses were carried out to identify determinants. RESULTS: The prevalence (95%CI) of diabetes was 28% (25.5, 30.5), hypertension, 33.4% (30.7, 36.1) and hypercholesterolaemia, 31.9% (29.2, 34.5). The proportion of undiagnosed diabetes was 13.8% (11.9, 15.8), undiagnosed hypertension 11.3% (9.5, 13.1), and undiagnosed hypercholesterolaemia 17.8% (15.6, 19.9). Undiagnosed cases accounted for almost half of all diabetes cases, one-third of all hypertension cases, and more than half (56%) of all high cholesterol cases. The key determinants for undiagnosed CVD risk were: male sex, low or middle income, rural residence, and relatively younger age. CONCLUSION: CVD screening programmes should be tailored to target populations based on these determinants and provide basic diagnostic facilities in all health centres. The 'proportion undiagnosed' in the population may be a useful indicator to evaluate their effectiveness.

mHealth nutrition and lifestyle intervention (mHENAL) to reduce cardiovascular disease risk in a middle-aged, overweight and obese population in Sri Lanka: Study protocol for a randomized controlled trial.

Mobile phone-based health interventions (mHealth) are viewed as an attractive approach to foster behaviour change, and found to be effective in promoting physical activity and healthy diets. The present study aims to investigate whether mHealth with advice for dietary and lifestyle modifications would reduce 10-year cardio vascular disease (CVD) risk among overweight or obese adults aged 35-64 years in Sri Lanka. A two-group parallel-arm randomized controlled trial (RCT) was conducted in Colombo district, recruiting 1200 individuals aged 35-64 years with a body mass index (BMI) of ≥25 kgm-2. Participants were randomly assigned either to mHealth package (intervention arm, n = 600) or usual care (control arm, n = 600). The intervention package contains a series of dietary and lifestyle improvement messages, a mobile application to register participants, and a web application to deliver these messages. Participants in the intervention arm receive 2 voice and 2 text messages per week to their mobile phones for a period of 12 months. The primary outcome (10-year CVD risk) will be assessed according to sex, age, smoking status, blood pressure, serum cholesterol and glycaemic status. Data are collected at enrollment and after 12 months of intervention on: dietary practices, physical activity, smoking, anthropometry, body composition, blood pressure, fasting plasma glucose, HbA1c and lipid profile. Analysis of effect will be performed by intention-to-treat principle, comparing the outcomes between intervention and control arms. The study resulted in a comprehensive mHealth nutrition and lifestyle package (mHENAL) and successfully completed recruitment and baseline assessment of participants. The message delivery is in progress.